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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Associations of Lifetime Traumatic Brain Injury Characteristics With Prospective Suicide Attempt Among Deployed US Army Soldiers.Journal of Head Trauma Rehabilitation
To estimate associations of lifetime traumatic brain injury (TBI) characteristics with prospective suicide attempt among US Army soldiers.
The Army STARRS (Study to Assess Risk and Resilience in Servicemembers) Pre/Post Deployment Study surveyed 3 Brigade Combat Teams that were deployed to Afghanistan in 2012. Lifetime TBI and past-month postconcussive/post-TBI symptoms were evaluated at predeployment baseline. Recency and number of TBIs were quantified, and TBI severity was classified on the basis of reports of alteration/loss of consciousness and memory lapse. Suicide attempt data came from administrative records and surveys administered after return from deployment. Logistic regression models estimated associations of TBI characteristics with prospective suicide attempt among baseline respondents who were deployed (n = 7677), adjusting for other risk factors including lifetime mental disorder.
One hundred three soldiers made a suicide attempt over a median follow-up period of 30 months (weighted prevalence = 1.31% [0.14%]). In the final model estimating joint associations of TBI severity/recency and past-month postconcussive/post-TBI symptoms, only postconcussive/post-TBI symptoms were associated with a higher risk of suicide attempt (per standard score increase: AOR [adjusted odds ratio] = 1.31; 95% CI, 1.05-1.63; P = .012).
Among the lifetime TBI characteristics evaluated at predeployment baseline, only past-month postconcussive/post-TBI symptoms were prospectively associated with an increased risk of suicide attempt following deployment. Detection of postconcussive/post-TBI symptoms could facilitate targeting of Army suicide prevention programs.
Increased prevalence of osteoarthritis in adults with cerebral palsy.Journal of Rehabilitation Medicine
Adults with cerebral palsy have an increased risk of developing osteoarthritis. However, little is known about the epidemiology of osteoarthritis among this vulnerable population. The objectives of this study were to compare the prevalence of osteoarthritis between adults with and without cerebral palsy, and to determine how the prevalence of osteoarthritis changes throughout adulthood for each group.
ICD-10 codes were used to identify osteoarthritis. Prevalence of osteoarthritis was compared between adults with and without cerebral palsy before and after adjusting for age and sex. The prevalence of any type of osteoarthritis was compared between men and women with and without cerebral palsy, stratified by the following age groups: 18-30, 31-40, 41-50, 51-60, 61-70, and > 70 years.
Adults with cerebral palsy had higher prevalence and adjusted odds of any, poly, hip, knee, and other/unspecified osteoarthritis (odds ratio (OR): 1.3-2.1; p < 0.001), but not hand osteoarthritis (OR: 0.86; p = 0.46). Men and women with cerebral palsy had a higher prevalence of any osteoarthritis compared with adults without cerebral palsy across all age groups (all p < 0.05).
Privately-insured adults with cerebral palsy had a higher prevalence of osteoarthritis compared with adults without cerebral palsy across the adult lifespan.
Accuracy of examination of the long head of the biceps tendon in the clinical setting: A systematic review.Journal of Rehabilitation Medicine
To determine the diagnostic validity of high-resolution ultrasound and orthopaedic special tests in diagnosing long head of the biceps tendon pathologies in patients with shoulder pain.
Included studies had to report on the diagnostic validity of orthopaedic special tests or high-resolution ultrasound (HRUS) compared with a reference standard for diagnosing long head of the biceps tendon target conditions (superior labrum anterior and posterior lesions, long head of the biceps tendon tendinopathy, dislocation, effusion or rupture). Risk of bias was assessed using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2) tool.
Of the 30 included studies, 8 focused on high-resolution ultrasound and 22 on orthopaedic special tests. High-resolution ultrasound proved highly specific for the diagnosis of long head of the biceps tendon pathologies. Pooled positive (LR+) and negative (LR-) likelihood ratios were 38.00 and 0.24 for dislocation, respectively, and 35.50 and 0.30 for complete rupture, respectively. The accuracy of orthopaedic special tests varied greatly across studies. The only test of value was Yergason's ma-noeuvre in confirming proximal long head of the biceps tendon pathologies except superior labrum anterior and posterior lesion (high specificity): the summary LR+ and LR- were 2.56 and 0.70, respectively.
High-resolution ultrasound is reliable to confirm suspected long head of the biceps tendon pathologies. There is insufficient evidence to recommend individual orthopaedic special tests.
Rasch analysis of the UK Functional Assessment Measure in a sample of patients with traumatic brain injury from the UK national clinical database.Journal of Rehabilitation Medicine
To determine whether the UK Functional Assessment Measure (UK FIM+FAM) fits the Rasch model in patients with complex disability following traumatic brain injury.
A multicentre UK national cohort of 1,956 patients admitted for specialist rehabilitation following traumatic brain injury.
The suitability of the Partial Credit Model was confirmed by the likelihood-ratio test (χ2 (df86) =7,325.0, p < 0.001). Exploratory and confirmatory factor analyses supported 3 factors (Motor, Communication, Psychosocial). Rasch analysis of the full scale incorporating the 3 factors as super-items resulted in an acceptable overall model fit (χ2 (df24)=36.72, p = 0.05) and strict uni-dimensionality when tested on a sub-sample of n = 320. These results were replicated in a full sample (n = 1,956) showing uni-dimensionality and good reliability with Person Separation Index = 0.81, but item trait interaction was significant due to the large sample size. No significant differential item functioning was observed for any personal factors. Neither uniform re-scoring of items nor exclusion of participants with extreme scores improved the model fit.
The UK FIM+FAM scale satisfies the Rasch model reasonably in traumatic brain injury. A conversion table was produced, but its usefulness in clinical practice requires further exploration and clinical translation.
Secondary medical complications after traumatic spinal cord injury in Stockholm, Sweden: Towards developing prevention strategies.Journal of Rehabilitation Medicine
(i) To determine the prevalence of secondary complications after traumatic spinal cord injury during acute care and rehabilitation; (ii) to investigate whether associations exist between level and completeness of injury and the development of common complications; and (iii) to assess whether associations exist between secondary complications and return-to-work 1 year after injury.
The International Spinal Cord Injury Core Data Set was used to capture injury characteristics, as well as associated injuries and neurological severity. All secondary medical complications (e.g. pressure injuries, pulmonary embolism, pneumonia, urinary tract infection) were screened for during acute care and rehabilitation. Inferential statistics were carried out.
Out of the 45 persons undergoing acute care, the 3 most common complications were urinary tract infections (47%), pneumonia (22%) and neuropathic pain (18%). Of the 31 persons who received rehabilitation, the most common complications were urinary tract infections (42%), neuropathic pain (42%), and spasticity (35%). A significant association was found between injury level and development of neuropathic pain during rehabilitation.
Although a specialized system for spinal cord injury management is available in Sweden, secondary complications are still common. These findings could be used to inform the development of strategies for prevention of secondary complications.
Aerobic exercise in neuromuscular rehabilitation: A survey of healthcare professionals.Journal of Rehabilitation Medicine
To evaluate the current application of aerobic exercise in adult neuromuscular rehabilitation.
Participants received a self-designed, web-based, questionnaire, including 27 close-ended questions covering 4 categories: respondent profile, application of aerobic exercise, barriers to prescribing aerobic exercise, and need for support to improve the application of aerobic exercise.
All respondents (n = 52) prescribed aerobic exercise and in a wide variety of neuromuscular diseases, mostly applying sessions of more than 20 min, 2 days per week, over a period of 9-16 weeks, using different exercise modes and methods to target intensity. The majority (81%) agreed that aerobic exercise should be incorporated into neuromuscular rehabilitation. However, all respondents perceived barriers to the application of aerobic exercise in 1 or more domains, and 77% of the respondents indicated needing support to improve application of this type of training, mostly with respect to screening procedures (54%) and dosing of exercise programmes (48%).
These results support the necessity for more evidence-based knowledge, in order to develop and implement guidelines on aerobic exercise in adult neuromuscular rehabilitation.
Common content between quality of life questionnaires for children with cystic fibrosis and the International Classification of Functionality, Disability and Health.Journal of Rehabilitation Medicine
To identify the most common quality of life instruments for children with cystic fibrosis and link the content with the International Classification of Functioning, Disability and Health (ICF).
The study was conducted in 2 stages. The first stage involved a review of the literature to select quality of life questionnaires. In the second stage 2 independent reviewers identified questionnaire items and categories corresponding to the ICF, according to approved methodology. The degree of agreement was calculated using the kappa coefficient.
Two questionnaires were selected: the Cystic Fibrosis Questionnaire and DISABKIDS®. A total of 130 concepts were identified from the 112 items. Forty-seven different ICF categories were linked (k<0.62 for all questionnaires), 21 (44.7%) were related to the "body function" domain, 20 (42.6%) to "activity and participation" and 6 (12.8%) to "environmental factors". Thirteen items (10%) could not be linked because they represent personal factors or are not covered by the ICF.
Body functions were the category most linked to the ICF. Environmental factors were poorly described, and no items were related to body structures in any of the instruments.
Clinical effectiveness of non-surgical interventions for primary frozen shoulder: A systematic review.Journal of Rehabilitation Medicine
To update an existing systematic review of randomized clinical trials evaluating the clinical effectiveness of non-surgical management interventions for people with primary frozen shoulder in terms of pain, movement, self-reported function and disability, quality of life, recovery time, return to work and recreation, and adverse events.
Two reviewers evaluated eligibility. Data were extracted by 1 reviewer and checked by another. Two reviewers evaluated risk of bias. Meta-analyses were not appropriate. Narrative analyses were performed for trials evaluated as low risk of bias.
Thirty trials were included, with the majority of studies evaluated as being at high risk of potential bias. Only 4 trials were evaluated as being at low risk of bias and this, plus the variety of participants included/excluded in trials and the variety of methods, interventions and outcomes used across the trials provided limited new evidence to inform the non-surgical management and treatment of people with frozen shoulder.
Substantial evidence gaps remain for the non-surgical treatment of people with frozen shoulder.
Relationships among measures of physical fitness in adult patients with heart failure.Journal of Rehabilitation Medicine
To describe the relationships among 3 measures of physical fitness (exercise capacity, muscle function and functional capacity) in patients with heart failure, and to determine whether these measures are influenced by impairment of movement.
Secondary analysis of baseline data from the Italian subsample (n = 96) of patients with heart failure enrolled in a randomized controlled trial, the HF-Wii study. Exercise capacity was measured with the 6-min walk test, muscle function was measured with the unilateral isotonic heel-lift, bilateral isometric shoulder abduction and unilateral isotonic shoulder flexion, and functional capacity was measured with the Duke Activity Status Index. Principal component analysis was used to detect covariance of the data.
Exercise capacity correlated with all of the tests related to muscle function (r = 0.691-0.423, p < 0.001) and functional capacity (r = 0.531). Moreover, functional capacity correlated with muscle function (r = 0.482-0.393). Principal component analysis revealed the bidimensional structure of these 3 measures, thus accounting for 58% of the total variance in the variables measured.
Despite the correlations among exercise capacity, muscle function and functional capacity, these measures loaded on 2 different factors. The use of a wider range of tests will help clinicians to perform a more tailored assessment of physical fitness, especially in those patients with heart failure who have impairment of movement.
Peripheral Vestibular and Balance Function in Athletes With and Without Concussion.Journal of Neurologic Physical Therapy
According to the most recent consensus statement on management of sport-related concussion (SRC), athletes with suspected SRC should receive a comprehensive neurological examination. However, which measures to include in such an examination are not defined. Our objectives were to (1) evaluate test-retest reliability and normative data on vestibular and balance tests in athletes without SRC; (2) compare athletes with and without SRC on the subtests; and (3) identify subtests for concussion testing protocols.
Healthy athletes (n = 87, mean age 20.6 years; standard deviation = 1.8 years; 39 female and 48 male) and athletes with SRC (n = 28, mean age 20.7 years; standard deviation = 1.9 years; 11 female and 17 male) were tested using rotary chair, cervical vestibular-evoked myogenic potential (c-VEMP), and the Sensory Organization Test (SOT). A subset (n = 43) were tested twice. We analyzed reliability of the tests, and compared results between athletes with and without SRC.
Reliability ranged from poor to strong. There was no significant difference between athletes with and without SRC for tests of peripheral vestibular function (ie, rotary chair and c-VEMP). Athletes with SRC had significantly worse scores (P < 0.05) on vestibular-ocular reflex (VOR) cancellation gain, subjective visual vertical and horizontal variance, and all conditions of the SOT.
SRC did not affect medium frequency VOR or saccular function. SRC did affect the ability to use vestibular inputs for perception of vertical and postural control, as well as ability to cancel the VOR.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A274).
Stroke Survivors' Perspectives on Post-Acute Rehabilitation Options, Goals, Satisfaction, and Transition to Home.Journal of Neurologic Physical Therapy
Patients and caregivers have not typically been involved in the selection of a post-acute care (PAC) provider. In 2015, the Centers for Medicare & Medicaid Services proposed the need to involve patients and their families during discharge planning. Engaging patients in rehabilitation decisions encourages shared decision making among patients and their clinicians. The purpose of this study was to examine stroke survivors' perspectives on their involvement in selecting a PAC provider and their goal setting and their satisfaction with the rehabilitation stay and their discharge advice for stroke survivors, prior to 2015.
This qualitative study utilized semistructured interviews. Thematic content analysis was performed on interviews involving 18 stroke survivors (mean age = 68 years) related to their involvement in planning for their inpatient rehabilitation facility or skilled nursing facility stay, goal setting, and discharge needs.
More than half the participants were not involved in the selection of their PAC setting and believed that doctors made these decisions. Around two-fifths of stroke survivors reported that they were not involved in rehabilitation goal setting. Most patients were satisfied with their rehabilitation stay. When asked to recommend discharge topics for other stroke survivors, participants recommended additional information on health care services, interventions, and insurance coverage.
Despite recommendations to include stroke patients in PAC selection and goal setting, many former inpatient rehabilitation facility and skilled nursing facility patients report not being involved in either aspect of care.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A273).
Measuring Community Mobility in Survivors of Stroke Using Global Positioning System Technology: A Prospective Observational Study.Journal of Neurologic Physical Therapy
Returning to community mobility is important for people recovering from a stroke, yet few studies have directly measured this construct following inpatient rehabilitation. Using global positioning system (GPS) technology, we examined community mobility of survivors of stroke (SS) over the first year after discharge and compared them to an age-matched comparison group without neurological impairment.
We conducted a prospective observational study that included SS (n = 14) and age- and location-matched comparison subjects (CS; n = 6). All participants identified target locations important to their community mobility goals and wore a GPS unit during the first, fifth and ninth weeks after discharge, or from baseline for CS, and at 26 and 52 weeks' follow up. The 6-minute walk test (SMWT), Berg balance test (BBT), Reintegration to Normal Living (RNLI), and Short Form-36 Quality of Life Survey Physical Functioning domain (SF-36-PF) were collected. Number of trips and percentage of targets visited were extracted from GPS data.
Twelve of 14 SS completed 9 weeks, 7 completed the full year, and no CS withdrew. The SS took fewer trips and attained fewer targets compared with CS at weeks 1 and 9, but not at weeks 5, 26, and 52. All 4 clinical outcome measures were significantly correlated to trips (Spearman r for SMWT = 0.5067, BBT = 0.3841, RNLI = 0.4119, and SF-36-PF = 0.4192).
Directly measured community mobility in SS was decreased through 9 weeks following discharge from inpatient rehabilitation. The limited strength of bivariate correlations between clinical measures and number of trips supported the uniqueness of the community mobility construct.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A277).