The latest medical research on Rehabilitation Medicine

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about rehabilitation medicine gathered by our medical AI research bot.

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Development and validity of an innovative test to assess guideline-consistent clinical reasoning by physical therapists in stroke rehabilitation.

Journal of Rehabilitation Medicine

To evaluate the validity of a script concordance test to assess guideline-consistent clinical reasoning by physical therapists in stroke rehabilitation, and to identify critical features of physical therapists specializing in stroke rehabilitation.

A script concordance test was developed according to current standards. Four subgroups of physical therapists (those specializing in neurology, those focusing on neurology or geriatrics, other, and non-specialized undergraduate students) were asked to complete the test. The construct validity of the script concordance test was evaluated with 1-way analysis of variance (ANOVA) to estimate differences between subgroups. Associations between physical therapist characteristics, and script concordance test scores were analysed with bivariate regression analysis followed by multivariate analyses.

The script concordance test, with 59 items, was completed by 211 physical therapists. ANOVA analysis showed statistically significant differences between the script concordance test scores of the 4 groups (p < 0.001), with higher scores by the physical therapists specializing in neurology compared with the other, non-specialized, subgroups. The multivariate analysis showed that better guideline knowledge (B = 1.07; CI = 0.48-1.65; p = <0.001), successful completion of the Dutch Neurorehabilitation course (B = 4.1; CI = 1.37-6.87; p = 0.003), and participation in professional development activities (B = 2.4; CI = 0.05-4.68; p = 0.046) were associated with higher script concordance test scores.

The script concordance test has good construct validity. Greater self-reported guideline knowledge, successful completion of the post-bachelor Dutch Neurorehabilitation course, as well as systematic participation in professional development activities facilitate important factors that enhance specialization. The script concordance test is a valid feedback tool for physical therapists to support professional development in the domain of stroke rehabilitation.

Association between metabolic syndrome and knee osteoarthritis: A cross-sectional Nationwide survey study.

Journal of Rehabilitation Medicine

To investigate the association of metabolic syndrome with the development of knee osteoarthritis.

Subjects aged 50 years or older were included. Knee osteoarthritis (≥grade 2 Kellgren-Lawrence) and severe knee osteoarthritis (≥grade 3 Kellgren-Lawrence) were evaluated based on radiological findings. Medical information and demographic data were obtained from survey records. Multivariate regression analysis was performed to investigate the relationship between knee osteoarthritis and metabolic syndrome, and the number of metabolic syndrome components for dose-response relationship evaluation. Analyses were adjusted by age group (model 1) or by age group, education, smoking, alcohol consumption, and physical activity (model 2).

A total of 8,491 subjects (3,684 men and 4,807 women) were included in the study. In women, metabolic syndrome increased the risk of knee osteoarthritis (odds ratio (OR) = 1.644, p < 0.001; and OR = 1.608, p < 0.001; respectively; for models 1 and 2) and severe knee osteoarthritis (OR = 1.593, p < 0.001; and OR = 1.559, p < 0.001; respectively; for models 1 and 2). However, in men, knee osteoarthritis and severe knee osteoarthritis were not associated with metabolic syndrome. As the number of metabolic syndrome components increased, knee osteoarthritis and severe knee osteoarthritis generally increased in women, but not in men.

Metabolic syndrome affects the development of knee osteoarthritis and severe knee osteoarthritis in women. In addition, dose-response relationships were observed between metabolic syndrome components and knee osteoarthritis in women, but not in men.

Effect of different levels of exercise on telomere length: A systematic review and meta-analysis.

Journal of Rehabilitation Medicine

To investigate the effect of different levels of exercise on telomere length.

CINAHL, SPORTDiscus (EBSCO), OVID (Medline) and EMBASE databases were searched for eligible studies. Methodological quality was evaluated using the Newcastle-Ottawa Scale, and heterogeneity among the studies was assessed using the I-squared test. When heterogeneity among studies was high (I2 > 50%), a random-effects model was used (Review Manager version 5, Cochrane Collaboration, Copenhagen, Denmark); otherwise, a fixed-effects model was used.

Eleven eligible studies involving 15,645 participants were included in this meta-analysis. Longer telomere length was associated with physically active individuals, with a mean difference (MD) of 0.15; 95% confidence interval; 95% CI 0.05, 0.24; I2 = 99%. Longer telomere length was significantly associated with robust exercise (MD 0.08; 95% CI 0.04, 0.12); I2 = 99%, as was moderate exercise (MD 0.07; 95% CI 0.03, 0.11); I2 = 100%. Subgroup analysis revealed that longer telomere length was positively associated with exercise, regardless of sex, but was not statistically significant in elderly populations.

Compared with inactive individuals, telomere lengths were longer in active subjects, regardless of the intensity of exercise.

Concurrent validity and reliability of a low-cost gait analysis system for assessment of spatiotemporal gait parameters.

Journal of Rehabilitation Medicine

To determine the concurrent validity and reliability of a low-cost spatiotemporal gait analysis system for clinical use in rehabilitation medicine.

The spatiotemporal gait analysis system consists of a video camera placed perpendicular to a 10-m walkway and calibrated for spatial reference. The conditions evaluated in this study were: barefoot walking at comfortable and slow speed; toe and shod walking using a stationary camera setup; and barefoot walking at comfortable speed using a moving camera setup. The GAITRite® was used as reference.

High intraclass correlation coefficients (IC≥ 0.97; 95% lower limit confidence intervals (CIs) ≥ 0.77) were found between systems for step and stride length, and step, stance and stride time, across setups and conditions. Standard error of measurement and Bland-Altman repeatability coefficients were ≤ 2.4% and ≤ 6.3%, respectively. A minimum of 4 footsteps was required to obtain ICC >0.90 and coefficient of variation < 10%. For double support and swing time, ICCs were generally low (ICC≥ 0.21). Inter-rater reliability was excellent for step length, step and stance time (ICC≥ 0.94; lower limit CIs ≥ 0.86).

The spatiotemporal gait analysis system is valid and reliable for assessing spatiotemporal parameters in different walking conditions. However, the validity of double support and swing time could not be confirmed.

Polytrauma Transitional Rehabilitation in the Veterans Administration: Implementing the Principles of Person-Centered, Participation-Oriented Rehabilitation.

Journal of Head Trauma Rehabilitation

To review principles of person-centered, participation-oriented (PCPO) rehabilitation and introduce their implementation in Veterans Administration (VA) Polytrauma Transitional Rehabilitation Programs (PTRPs).

In the civilian sector, PCPO programs are generally provided locally or regionally in outpatient or community settings to individuals with moderate-severe ABI associated with other traumatic injuries and comorbidities. Because of the geographical dispersion of veterans, the VA provides these services in residential centers serving larger geographical areas. The group of veterans served more often has sustained milder traumatic ABI associated with neuropsychiatric comorbidities, particularly posttraumatic stress disorder and depression. Measuring progress and outcome is important to establish a feedback loop for process improvement. VA PTRPs use state-of-the-science standardized outcome measures and methods for identifying successful cases, that is, the minimal clinically important difference. Vocational reintegration is an important element of PCPO rehabilitation. Articles in this special section detail the development and effectiveness of PTRPs.

Developing a Therapeutic Approach Toward Active Engagement for Veterans With Mild Traumatic Brain Injury.

Journal of Head Trauma Rehabilitation

Treatment of chronic mild traumatic brain injury (mTBI) or postdeployment syndrome can be challenging to frontline providers who care for our nation's war heroes. There is ample guidance available for symptom-based interventions, but relatively little information regarding the structure and language of the clinical encounter. Dynamic patient education centered upon relatable language, accessible analogies, and brain health can move the visit beyond historical diagnostics into a shared understanding of postdeployment barriers to reintegration.

We aim to describe a practical, education-based clinical approach for chronic mTBI or postdeployment syndrome (mTBI/PDS). The foundation of this method is gathering the veteran's narrative, validating and normalizing his or her experience, highlighting neurobehavioral changes from combat that may represent barriers to full community reintegration, and transitioning to an emphasis on overall brain health.

The chronic mTBI or PDS clinical encounter can be enhanced by empowering the patient with relatable terms and concepts to describe his or her reintegration challenges and emphasizing factors of brain health. This approach can provide the patient with a base of understanding regarding his or her current symptoms, promote focus on factors for cognitive health, and orient the clinical encounter toward improved community reintegration and long-term cognitive wellness.

Providing Care for Comorbid Mental Health Conditions in the Polytrauma System of Care.

Journal of Head Trauma Rehabilitation

To summarize challenges and best practices relevant to providing care for mental health comorbidities in veterans and service members (V/SM) treated in the Polytrauma System of Care (PSC) and to review themes that emerged during a May 2017 meeting of rehabilitation professionals on this topic. Management of comorbid mental health conditions remains a critical issue within the PSC, given the high rate of these comorbidities and the impact of mental health conditions on treatment planning and outcomes.

To identify the challenges of concomitantly treating TBI-related symptoms and mental health comorbidities in V/SM treated within the PSC, describe specialty programs within the Veterans Health Administration designed to treat these comorbid conditions, and report on the themes and recommendations identified by rehabilitation professionals at the 2017 meeting.

To further develop mental health treatment within the PSC, the following recommendations were made: (1) continued support for family members as critical members of the rehabilitation team; (2) adding measures and mechanisms to monitor mental health within the PSC; and (3) exploration of modern technologies to enhance care of existing polytrauma clients and to better prepare to serve clients with all types of acquired brain injury.

Vocational Rehabilitation in the Veterans Health Administration Polytrauma System of Care: Current Practices, Unique Challenges, and Future Directions.

Journal of Head Trauma Rehabilitation

Veterans and service members (V/SMs) with traumatic brain injury (TBI) and comorbid conditions are treated in the Veterans Health Administration (VHA) Polytrauma System of Care (PSC). These V/SMs comprise a unique population with distinct needs for restoring community reintegration, including participation in meaningful employment. Low employment rates after TBI vary and are influenced by many factors. Employment is a central aspect of the VHA priority of facilitating adjustment, and addressing vocational needs alongside healthcare is critical to community reintegration. The purpose of this article is to outline current practices of addressing vocational rehabilitation in the PSC, discuss the unique challenges in serving Veterans with polytrauma, and outline future directions to improve vocational services and outcomes.

Briefly review literature on V/SM with TBI and employment, describe the PSC and VHA vocational programs for V/SM with polytrauma, and synthesize proceedings on vocational rehabilitation from the 2017 VHA "Community Reintegration in the Polytrauma System of Care" meeting.

To advance and expand vocational services the following guidelines were recommended: (1) designing flexible services based on individualized needs, (2) increasing access to vocational services through communication and collaboration, (3) promoting cross-disciplinary education and engagement in vocational care, and (4) systematically tracking employment outcomes.

Postdeployment Polytrauma Diagnoses Among Soldiers and Veterans Using the Veterans Health Affairs Polytrauma System of Care and Receipt of Opioids, Nonpharmacologic, and Mental Health Treatments.

Journal of Head Trauma Rehabilitation

To determine the proportion of Army soldiers who utilized care in the Veterans Health Administration (VHA) Polytrauma System of Care (PSC) within the postdeployment year and to describe prevalence of polytrauma diagnoses, and receipt of opioids, nonpharmacologic treatments (NPTs), and mental health treatments in the VHA during the year following first PSC utilization.

Prevalence of polytrauma diagnoses (ie, traumatic brain injury [TBI], posttraumatic stress disorder [PTSD], and chronic pain [CP]), VHA utilization rates of opioid prescriptions, NPT, and specialty mental health treatment within 1 year of PSC utilization.

In total, 2.6% of the sample (n = 16 590) used the PSC during the postdeployment year. Among PSC users, CP (76.5%), PTSD (53.1%), and TBI (48.6%) were common and more frequently found together than in isolation; 26.6% filled an opioid prescription, 35.5% received at least 1 NPT, and 83.8% received specialty mental health treatment in the VHA within 1 year of PSC utilization.

CP was the most common polytrauma condition among PSC users, highlighting the importance of incorporating interdisciplinary pain management approaches within the PSC, with an effort to reduce reliance on long-term opioid therapy and improve rehabilitation.

Developing the Disorders of Consciousness Guideline and Challenges of Integrating Shared Decision-Making Into Clinical Practice.

Journal of Head Trauma Rehabilitation

To review methodology informing evidence-based guideline development and integration of guidelines into clinical care through shared decision-making (SDM) and highlight challenges to SDM in disorders of consciousness.

We describe guideline development strategies and implications for use, approaches to SDM generally and with surrogate decision makers, and considerations when implementing the prolonged disorders of consciousness guideline into clinical care.

Clinical practice guidelines aim to improve high-quality patient care and outcomes by assessing the best medical evidence and incorporating this into care recommendations. This is accomplished through transparent methodology and compliance with published standards. Guidelines support SDM with patients and surrogate decision makers. Effective SDM can be challenging in conditions such as prolonged disorders of consciousness where surrogates are required, but assessment of patient values and incorporation of these values into SDM is ethically critical.

Recently published disorders of consciousness guideline recommendations provide strategies for clinicians to enhance quality care for individuals with prolonged disorders of consciousness. They also provide details helping clinicians partner with individuals with disorders of consciousness and their surrogates. Further research is needed into many aspects of caring for individuals with disorders of consciousness and optimal strategies for partnering with surrogates in decision-making.

Chronic pian in intensive care unit surviviors: incidence, characteristics and side-effects up to one-year post-discharge.

Journal of Rehabilitation Medicine

Intensive care unit survivors experience significant physical and psychological problems, including chronic pain following discharge. The aim of this study was to observe the incidence, anatomical sites, intensity, and interference of chronic pain in intensive care unit survivors over a 1-year period. In addition, potential predictors of chronic pain were analysed.

Data were collected during an intensive care unit follow-up programme as part of a quality improvement initiative. Data from the Brief Pain Inventory and in person-musculoskeletal assessment were examined, alongside demographic data from the patient. Data were collected from patients at baseline and at a 1-year follow-up appointment.

Data from 47 intensive care unit survivors were included in this study. A "new" chronic pain was reported in 66% (n = 31) of patients. Pain intensity in this patient group was "moderate"' and did not improve significantly over the 1-year period. Although pain interference with life decreased over the study period, it was still the most common cause of reduced enjoyment of life and reduced employment at 1-year follow-up.

Chronic pain is associated with morbidity in intensive care unit survivors. Pain interference, but not pain intensity, improved significantly in the first year after discharge. Further multi-centre research is required to elucidate the chronic pain experience.

Preliminary Evidence of a Dose-Response for Continuing to Play on Recovery Time After Concussion.

Journal of Head Trauma Rehabilitation

To investigate a dose-response relationship between continuing to play following concussion and outcomes.

Recovery was the number of days from injury to clearance. Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) measured neurocognitive outcomes and the Post-Concussion Symptom Scale (PCSS) measured symptom severity.

Long-Play (44.09 ± 27.01 days) took longer to recover than Short-Play (28.42±12.74 days) and Removed (18.98 ± 13.76 days). Short-Play was 5.43 times more likely, and Long-Play 11.76 times more likely, to experience protracted recovery relative to Removed. Both Play groups had worse neurocognitive performance and higher symptom scores than Removed at days 1 to 7, with Long-Play demonstrating worse reaction time than Short-Play. At days 8 to 30, both Play groups performed worse than Removed on visual memory and visual motor speed, while only Long-Play performed worse on verbal memory and reaction time.

Results provide initial evidence of a dose-response effect for continuing to play on recovery from concussion, highlighting the importance of removal from play.