[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 187-195

Titre :	Randomized Controlled Trial of the Lateral Push-Off Skater Exercise for High-Intensity Interval Training vs Conventional Treadmill Training
Type de document :	Article
Auteurs :	Soo-Hyun Soh ; Min Cheol Joo ; Na Ri Yun
Année de publication :	2020
Article en page(s) :	p. 187-195
Note générale :	https://doi.org/10.1016/j.apmr.2019.08.480
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Accident vasculaire cérébral (AVC) ; Capacité cardiorespiratoire ; Équilibre postural ; Patinage ; Qualité de vie ; Réadaptation
Résumé :	Objective To examine the therapeutic effects of the lateral push-off skater exercise vs conventional treadmill training on health-related quality of life, cardiorespiratory fitness (CRF), and balance. Design Single-blinded, randomized controlled trial. Setting Outpatient clinic at a tertiary hospital. Participants Patients after minor stroke (N=36) with National Institutes of Health Stroke Scale scores≤3 between 20 and 65 years of age were randomly assigned to the intervention group (n=18) or the control group (n=18). Interventions Thirty-minute sessions of the skater exercise were performed 3 times weekly for 12 weeks in the intervention group. Conventional treadmill aerobic exercise was conducted in the control group at the same frequency and duration as the experimental group exercise. Main Outcome Measures The primary outcome was measured using the European Quality of Life–5 Dimension (EQ-5D). Secondary outcomes included CRF and balance indicators. Assessments were performed at baseline (T0), 12 weeks from T0 (T1), and 16 weeks from T0 (T2). Results Significant improvements in EQ-5D, peak oxygen uptake (VO2peak), peak oxygen pulse, peak minute ventilation (VE), Dynamic Gait Index (DGI), and Berg Balance Scale (BBS) were found in the intervention group after performing the skater exercise (P<.05 all and these improvements were sustained at t2 between-group comparisons demonstrated greater in eq-5d vo2peak peak oxygen pulse ve dgi bbs the intervention group than those control both t1 correlation analysis showed significant relationships between> Conclusions The skater exercise improved health-related quality of life, CRF, and balance in patients after minor stroke more effectively than conventional treadmill-based aerobic exercise. We recommend the skater exercise as a high-intensity interval training program for patients after minor stroke.
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[article] Randomized Controlled Trial of the Lateral Push-Off Skater Exercise for High-Intensity Interval Training vs Conventional Treadmill Training [Article] / Soo-Hyun Soh ; Min Cheol Joo ; Na Ri Yun . - 2020 . - p. 187-195.
https://doi.org/10.1016/j.apmr.2019.08.480
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 187-195

Descripteurs :	HE Vinci Accident vasculaire cérébral (AVC) ; Capacité cardiorespiratoire ; Équilibre postural ; Patinage ; Qualité de vie ; Réadaptation
Résumé :	Objective To examine the therapeutic effects of the lateral push-off skater exercise vs conventional treadmill training on health-related quality of life, cardiorespiratory fitness (CRF), and balance. Design Single-blinded, randomized controlled trial. Setting Outpatient clinic at a tertiary hospital. Participants Patients after minor stroke (N=36) with National Institutes of Health Stroke Scale scores≤3 between 20 and 65 years of age were randomly assigned to the intervention group (n=18) or the control group (n=18). Interventions Thirty-minute sessions of the skater exercise were performed 3 times weekly for 12 weeks in the intervention group. Conventional treadmill aerobic exercise was conducted in the control group at the same frequency and duration as the experimental group exercise. Main Outcome Measures The primary outcome was measured using the European Quality of Life–5 Dimension (EQ-5D). Secondary outcomes included CRF and balance indicators. Assessments were performed at baseline (T0), 12 weeks from T0 (T1), and 16 weeks from T0 (T2). Results Significant improvements in EQ-5D, peak oxygen uptake (VO2peak), peak oxygen pulse, peak minute ventilation (VE), Dynamic Gait Index (DGI), and Berg Balance Scale (BBS) were found in the intervention group after performing the skater exercise (P<.05 all and these improvements were sustained at t2 between-group comparisons demonstrated greater in eq-5d vo2peak peak oxygen pulse ve dgi bbs the intervention group than those control both t1 correlation analysis showed significant relationships between> Conclusions The skater exercise improved health-related quality of life, CRF, and balance in patients after minor stroke more effectively than conventional treadmill-based aerobic exercise. We recommend the skater exercise as a high-intensity interval training program for patients after minor stroke.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 196-203

Titre :	Home-based Upper Extremity Stroke Therapy Using a Multiuser Virtual Reality Environment: A Randomized Trial
Type de document :	Article
Auteurs :	Kelly O. Thielbar ; Kristen M. Triandafilou ; Alexander J. Barry
Année de publication :	2020
Article en page(s) :	p. 196-203
Note générale :	https://doi.org/10.1016/j.apmr.2019.10.182
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Accident vasculaire cérébral (AVC) ; Membre supérieur ; Réadaptation ; Réalité de synthèse ; Téléréadaptation
Résumé :	Objective To compare participation and subjective experience of participants in both home-based multiuser virtual reality (VR) therapy and home-based single-user (SU) VR therapy. Design Crossover, randomized trial. Setting Initial training and evaluations occurred in a rehabilitation hospital; the interventions took place in participants’ homes. Participants Survivors of stroke with chronic upper extremity impairment (N=20). Interventions Four weeks of in-home treatment using a custom, multiuser virtual reality system (VERGE): 2 weeks of both multiuser (MU) and SU versions of VERGE. The order of presentation of SU and MU versions was randomized such that participants were divided into 2 groups, First MU and First SU. Main Outcome Measures We measured arm displacement during each session (m) as the primary outcome measure. Secondary outcome measures include time participants spent using each MU and SU VERGE and Intrinsic Motivation Inventory scores. Fugl-Meyer Assessment of Motor Recovery After Stroke Upper Extremity (FMA-UE) score and compliance with prescribed training were also evaluated. Measures were recorded before, midway, and after the treatment. Activity and movement were measured during each training session. Results Arm displacement during a session was significantly affected the mode of therapy (MU: 414.6m, SU: 327.0m, P=.019). Compliance was very high (99% compliance for MU mode and 89% for SU mode). Within a given session, participants spent significantly more time training in the MU mode than in the SU mode (P=.04). FMA-UE score improved significantly across all participants (Δ3.2, P=.001). Conclusions Multiuser VR exercises may provide an effective means of extending clinical therapy into the home. Previous article in issue
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[article] Home-based Upper Extremity Stroke Therapy Using a Multiuser Virtual Reality Environment: A Randomized Trial [Article] / Kelly O. Thielbar ; Kristen M. Triandafilou ; Alexander J. Barry . - 2020 . - p. 196-203.
https://doi.org/10.1016/j.apmr.2019.10.182
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 196-203

Descripteurs :	HE Vinci Accident vasculaire cérébral (AVC) ; Membre supérieur ; Réadaptation ; Réalité de synthèse ; Téléréadaptation
Résumé :	Objective To compare participation and subjective experience of participants in both home-based multiuser virtual reality (VR) therapy and home-based single-user (SU) VR therapy. Design Crossover, randomized trial. Setting Initial training and evaluations occurred in a rehabilitation hospital; the interventions took place in participants’ homes. Participants Survivors of stroke with chronic upper extremity impairment (N=20). Interventions Four weeks of in-home treatment using a custom, multiuser virtual reality system (VERGE): 2 weeks of both multiuser (MU) and SU versions of VERGE. The order of presentation of SU and MU versions was randomized such that participants were divided into 2 groups, First MU and First SU. Main Outcome Measures We measured arm displacement during each session (m) as the primary outcome measure. Secondary outcome measures include time participants spent using each MU and SU VERGE and Intrinsic Motivation Inventory scores. Fugl-Meyer Assessment of Motor Recovery After Stroke Upper Extremity (FMA-UE) score and compliance with prescribed training were also evaluated. Measures were recorded before, midway, and after the treatment. Activity and movement were measured during each training session. Results Arm displacement during a session was significantly affected the mode of therapy (MU: 414.6m, SU: 327.0m, P=.019). Compliance was very high (99% compliance for MU mode and 89% for SU mode). Within a given session, participants spent significantly more time training in the MU mode than in the SU mode (P=.04). FMA-UE score improved significantly across all participants (Δ3.2, P=.001). Conclusions Multiuser VR exercises may provide an effective means of extending clinical therapy into the home. Previous article in issue
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 204-212

Titre :	Low-Intensity vs High-Intensity Home-Based Treadmill Training and Walking Attainment in Young Children With Spastic Diplegic Cerebral Palsy
Type de document :	Article
Auteurs :	Katrin Mattern-Baxter ; Julia Looper ; Chuan Zhou
Année de publication :	2020
Article en page(s) :	p. 204-212
Note générale :	https://doi.org/10.1016/j.apmr.2019.09.015
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Développement de l'enfant ; Marche à pied ; Paralysie cérébrale ; Réadaptation
Résumé :	To compare the effect of low-intensity (LI) vs high-intensity (HI) treadmill training (TT) on walking attainment and overall walking activity in children with cerebral palsy (CP). Design Prospective, multisite, randomized controlled trial. Setting Homes of the participants. Participants Children with spastic diplegic CP, Gross Motor Function Classification System Level I and II, ages 14-32 months (N=19; male, n=8). Interventions The children were randomized to LI TT (2×/wk for 6wk) (n=10) and HI TT (10×/wk for 6wk) (n=9). The TT was carried out by the families with weekly instruction by the researchers. Main Outcome Measures Children were assessed at study onset, post intervention, and 1 and 4 months post intervention with the Gross Motor Function Measure Dimension D/E (GMFM D/E), average strides per day and percentage of time spent walking with accelerometers, the Peabody Developmental Motor Scales-2 (PDMS-2), Pediatric Evaluation of Disability Index Mobility Scale, timed 10-m and 1-minute walk test, and Functional Mobility Scale. Blinding was conducted for GMFM D/E and PDMS-2. Linear mixed effects regression models were applied to all outcomes. Results No significant between-group differences were found in any outcome measure at any of the time points. Children in the HI group did not show significant improvement immediately following the intervention in GMFM E (P=.061), while children in the LI group did (P=.003), but no statistically significant differences were detected over time (P=.71). Children in the HI group showed better walking independence on the Functional Mobility Scale at all postintervention assessments. Conclusions A twice-weekly dosage was equally effective in improving skills related to walking compared with a 10×/wk program and can be more readily implemented into clinical practice.
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[article] Low-Intensity vs High-Intensity Home-Based Treadmill Training and Walking Attainment in Young Children With Spastic Diplegic Cerebral Palsy [Article] / Katrin Mattern-Baxter ; Julia Looper ; Chuan Zhou . - 2020 . - p. 204-212.
https://doi.org/10.1016/j.apmr.2019.09.015
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 204-212

Descripteurs :	HE Vinci Développement de l'enfant ; Marche à pied ; Paralysie cérébrale ; Réadaptation
Résumé :	To compare the effect of low-intensity (LI) vs high-intensity (HI) treadmill training (TT) on walking attainment and overall walking activity in children with cerebral palsy (CP). Design Prospective, multisite, randomized controlled trial. Setting Homes of the participants. Participants Children with spastic diplegic CP, Gross Motor Function Classification System Level I and II, ages 14-32 months (N=19; male, n=8). Interventions The children were randomized to LI TT (2×/wk for 6wk) (n=10) and HI TT (10×/wk for 6wk) (n=9). The TT was carried out by the families with weekly instruction by the researchers. Main Outcome Measures Children were assessed at study onset, post intervention, and 1 and 4 months post intervention with the Gross Motor Function Measure Dimension D/E (GMFM D/E), average strides per day and percentage of time spent walking with accelerometers, the Peabody Developmental Motor Scales-2 (PDMS-2), Pediatric Evaluation of Disability Index Mobility Scale, timed 10-m and 1-minute walk test, and Functional Mobility Scale. Blinding was conducted for GMFM D/E and PDMS-2. Linear mixed effects regression models were applied to all outcomes. Results No significant between-group differences were found in any outcome measure at any of the time points. Children in the HI group did not show significant improvement immediately following the intervention in GMFM E (P=.061), while children in the LI group did (P=.003), but no statistically significant differences were detected over time (P=.71). Children in the HI group showed better walking independence on the Functional Mobility Scale at all postintervention assessments. Conclusions A twice-weekly dosage was equally effective in improving skills related to walking compared with a 10×/wk program and can be more readily implemented into clinical practice.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 213-219

Titre :	Acute and Chronic Pain in Children and Adolescents With Cerebral Palsy: Prevalence, Interference, and Management
Type de document :	Article
Auteurs :	Katarina Ostojic ; Simon Paget ; Maria Kyriagis
Année de publication :	2020
Article en page(s) :	p. 213-219
Note générale :	https://doi.org/10.1016/j.apmr.2019.08.475
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Douleur ; Paralysie cérébrale ; Pédiatrie ; Réadaptation
Résumé :	Objective To determine the prevalence, interference, and management of acute and chronic pain among youth with cerebral palsy (CP) aged 5-18 years attending outpatient rehabilitation services. Design A cross-sectional study using the Faces Pain Scale-Revised, Patient Reporting Outcomes Measurement Information System Pediatric Pain Interference Scale, and the Cerebral Palsy Quality of Life questionnaire. Where children were unable to self-report, parent or caregiver proxy was obtained. Setting Outpatient rehabilitation. Participants Participants (N=280) with CP aged 5-18 years and their parent or caregiver. Self-report was obtained by 45.7% (n=128) and proxy-report was obtained by 54.3% (n=152) of the cohort. Interventions Not applicable. Main Outcome Measures Presence or absence of acute pain and chronic pain. Secondary measures were pain intensity, pain interference, pain management, and quality of life. Results Acute pain and chronic pain were reported by 67.1% and 31.4% of participants, respectively. Of those reporting acute pain, 42% also experienced chronic pain. Factors that increased the odds of chronic pain were: predominately dyskinesia (odds ratio [OR]=3.52; 95% confidence interval [CI], 1.64-7.55); mixed spasticity-dyskinesia (OR=1.93; 95% CI, 1.07-3.47); bilateral involvement (OR=3.22; 95% CI, 1.844-5.61) and Gross Motor Function Classification System level IV (OR=2.32; 95% CI, 1.02-5.25), and V (OR=3.73; 95% CI, 1.70-8.20). Pain frequently interferes with sleep, attention, ability to have fun, and quality of life. Short-acting pharmacologic analgesics, thermotherapy, hydrotherapy, and massage were commonly used for pain management. Conclusions Routine screening for pain is critical for early identification and intervention. Multimodal interventions are needed to address the biopsychosocial model of pain, and should be tailored for all abilities across the CP spectrum.
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[article] Acute and Chronic Pain in Children and Adolescents With Cerebral Palsy: Prevalence, Interference, and Management [Article] / Katarina Ostojic ; Simon Paget ; Maria Kyriagis . - 2020 . - p. 213-219.
https://doi.org/10.1016/j.apmr.2019.08.475
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 213-219

Descripteurs :	HE Vinci Douleur ; Paralysie cérébrale ; Pédiatrie ; Réadaptation
Résumé :	Objective To determine the prevalence, interference, and management of acute and chronic pain among youth with cerebral palsy (CP) aged 5-18 years attending outpatient rehabilitation services. Design A cross-sectional study using the Faces Pain Scale-Revised, Patient Reporting Outcomes Measurement Information System Pediatric Pain Interference Scale, and the Cerebral Palsy Quality of Life questionnaire. Where children were unable to self-report, parent or caregiver proxy was obtained. Setting Outpatient rehabilitation. Participants Participants (N=280) with CP aged 5-18 years and their parent or caregiver. Self-report was obtained by 45.7% (n=128) and proxy-report was obtained by 54.3% (n=152) of the cohort. Interventions Not applicable. Main Outcome Measures Presence or absence of acute pain and chronic pain. Secondary measures were pain intensity, pain interference, pain management, and quality of life. Results Acute pain and chronic pain were reported by 67.1% and 31.4% of participants, respectively. Of those reporting acute pain, 42% also experienced chronic pain. Factors that increased the odds of chronic pain were: predominately dyskinesia (odds ratio [OR]=3.52; 95% confidence interval [CI], 1.64-7.55); mixed spasticity-dyskinesia (OR=1.93; 95% CI, 1.07-3.47); bilateral involvement (OR=3.22; 95% CI, 1.844-5.61) and Gross Motor Function Classification System level IV (OR=2.32; 95% CI, 1.02-5.25), and V (OR=3.73; 95% CI, 1.70-8.20). Pain frequently interferes with sleep, attention, ability to have fun, and quality of life. Short-acting pharmacologic analgesics, thermotherapy, hydrotherapy, and massage were commonly used for pain management. Conclusions Routine screening for pain is critical for early identification and intervention. Multimodal interventions are needed to address the biopsychosocial model of pain, and should be tailored for all abilities across the CP spectrum.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 220-226

Titre :	Subgroups Defined by the Montreal Cognitive Assessment Differ in Functional Gain During Acute Inpatient Stroke Rehabilitation
Type de document :	Article
Auteurs :	Abhishek Jaywant ; Joan Toglia ; Faith M. Gunning
Année de publication :	2020
Article en page(s) :	p. 220-226
Note générale :	https://doi.org/10.1016/j.apmr.2019.08.474
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Angiopathies intracrâniennes ; Cognition ; Infarctus encéphalique ; Neuropsychologie ; Réadaptation ; Rééducation neurologique
Résumé :	Objective To validate subgroups of cognitive impairment on the Montreal Cognitive Assessment (MoCA)—defined as normal (score of 25-30), mildly impaired (score of 20-24), and moderately impaired (score less than 19)—by determining whether they differ in rehabilitation gain during inpatient stroke rehabilitation. Design Observational study. Linear regression models were conducted and predictors included MoCA subgroups and relevant baseline demographic and clinical covariates. Separate models included the cognitive subscale of the FIM instrument as a predictor. Setting Inpatient rehabilitation facility of an urban, academic medical center. Participants Inpatients (N=334) with mild-moderate strokes who were administered the MoCA on admission. Interventions Not applicable. Main Outcome Measures The mean relative functional gain (mRFG) and mean relative functional efficiency (mRFE, which adjusts for length of stay) on the FIM total. Results MoCA subgroups significantly predicted mRFG and mRFE after accounting for age, sex, education, stroke severity, and recurrent vs first stroke. The normal group exhibited greater mRFG and mRFE than the mildly impaired group, while the moderately impaired group had significantly worse mRFG and mRFE than the mildly impaired group. The moderately impaired group had a significantly smaller proportion of individuals who made a clinically meaningful change on the total-FIM than the mildly impaired and normal groups. MoCA subgroups better accounted for mRFG and mRFE than a standard-of-care cognitive assessment (cognitive-FIM). Conclusions Use of MoCA-defined subgroups can assist providers in predicting functional gain in survivors of stroke being treated in inpatient rehabilitation.
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[article] Subgroups Defined by the Montreal Cognitive Assessment Differ in Functional Gain During Acute Inpatient Stroke Rehabilitation [Article] / Abhishek Jaywant ; Joan Toglia ; Faith M. Gunning . - 2020 . - p. 220-226.
https://doi.org/10.1016/j.apmr.2019.08.474
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 220-226

Descripteurs :	HE Vinci Angiopathies intracrâniennes ; Cognition ; Infarctus encéphalique ; Neuropsychologie ; Réadaptation ; Rééducation neurologique
Résumé :	Objective To validate subgroups of cognitive impairment on the Montreal Cognitive Assessment (MoCA)—defined as normal (score of 25-30), mildly impaired (score of 20-24), and moderately impaired (score less than 19)—by determining whether they differ in rehabilitation gain during inpatient stroke rehabilitation. Design Observational study. Linear regression models were conducted and predictors included MoCA subgroups and relevant baseline demographic and clinical covariates. Separate models included the cognitive subscale of the FIM instrument as a predictor. Setting Inpatient rehabilitation facility of an urban, academic medical center. Participants Inpatients (N=334) with mild-moderate strokes who were administered the MoCA on admission. Interventions Not applicable. Main Outcome Measures The mean relative functional gain (mRFG) and mean relative functional efficiency (mRFE, which adjusts for length of stay) on the FIM total. Results MoCA subgroups significantly predicted mRFG and mRFE after accounting for age, sex, education, stroke severity, and recurrent vs first stroke. The normal group exhibited greater mRFG and mRFE than the mildly impaired group, while the moderately impaired group had significantly worse mRFG and mRFE than the mildly impaired group. The moderately impaired group had a significantly smaller proportion of individuals who made a clinically meaningful change on the total-FIM than the mildly impaired and normal groups. MoCA subgroups better accounted for mRFG and mRFE than a standard-of-care cognitive assessment (cognitive-FIM). Conclusions Use of MoCA-defined subgroups can assist providers in predicting functional gain in survivors of stroke being treated in inpatient rehabilitation.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 227-233

Titre :	Importance of Early Inpatient Geriatric Rehabilitation on Outcomes in Individuals on Dialysis
Type de document :	Article
Auteurs :	Janine Farragher ; Yael Einbinder ; Matthew J. Oliver
Année de publication :	2020
Article en page(s) :	p. 227-233
Note générale :	https://doi.org/10.1016/j.apmr.2019.08.472
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Dialyse ; Réadaptation ; Vieillissement
Résumé :	Objective To report short-term functional outcomes of patients incident to dialysis undergoing inpatient rehabilitation within 3 months of dialysis initiation. Design Retrospective observation study using prospectively collected data. Setting Single-center, hospital-based geriatric dialysis rehabilitation unit. All patients incident to hemodialysis admitted to the geriatric dialysis rehabilitation unit between May 2002 and April 2016 were identified using a retrospective observational design. Clinical and demographic data were collected prospectively and linked, using the unique hospital number and dates of admission and discharge, to FIM scores (used to assess functional recovery) at admission and discharge. Participants Patients (N=449; mean age ± SD, 74±9y) newly started on hemodialysis (within 3mo). Interventions Inpatient rehabilitation care, short daily dialysis therapy with nephrologist support, and geriatrician assessment. Main Outcomes Change in FIM score; discharge location. Results Patients were admitted within 3 months of hemodialysis initiation. The median length of stay in the rehabilitation program was 43 days (25th and 75th quartile, 33-55 days). Of those with complete data (n=370), 95% had improvement in FIM scores (median changes in total FIM score 25 [quartiles, 16, 33]; in motor FIM 23 [quartiles, 15, 32]; and in cognitive FIM 1 [quartiles, 0, 3], respectively). Most improvement was seen in transfer abilities, grooming, and mobility. A total of 324 patients (72%; 95% CI, 68%-76%) were discharged to a private home. An additional 11 were discharged to a seniors’ residence. Conclusion The data suggest that older patients incident to dialysis with functional decline respond well to specialized rehabilitation care and suggest this may be a novel approach to dialysis initiation.
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[article] Importance of Early Inpatient Geriatric Rehabilitation on Outcomes in Individuals on Dialysis [Article] / Janine Farragher ; Yael Einbinder ; Matthew J. Oliver . - 2020 . - p. 227-233.
https://doi.org/10.1016/j.apmr.2019.08.472
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 227-233

Descripteurs :	HE Vinci Dialyse ; Réadaptation ; Vieillissement
Résumé :	Objective To report short-term functional outcomes of patients incident to dialysis undergoing inpatient rehabilitation within 3 months of dialysis initiation. Design Retrospective observation study using prospectively collected data. Setting Single-center, hospital-based geriatric dialysis rehabilitation unit. All patients incident to hemodialysis admitted to the geriatric dialysis rehabilitation unit between May 2002 and April 2016 were identified using a retrospective observational design. Clinical and demographic data were collected prospectively and linked, using the unique hospital number and dates of admission and discharge, to FIM scores (used to assess functional recovery) at admission and discharge. Participants Patients (N=449; mean age ± SD, 74±9y) newly started on hemodialysis (within 3mo). Interventions Inpatient rehabilitation care, short daily dialysis therapy with nephrologist support, and geriatrician assessment. Main Outcomes Change in FIM score; discharge location. Results Patients were admitted within 3 months of hemodialysis initiation. The median length of stay in the rehabilitation program was 43 days (25th and 75th quartile, 33-55 days). Of those with complete data (n=370), 95% had improvement in FIM scores (median changes in total FIM score 25 [quartiles, 16, 33]; in motor FIM 23 [quartiles, 15, 32]; and in cognitive FIM 1 [quartiles, 0, 3], respectively). Most improvement was seen in transfer abilities, grooming, and mobility. A total of 324 patients (72%; 95% CI, 68%-76%) were discharged to a private home. An additional 11 were discharged to a seniors’ residence. Conclusion The data suggest that older patients incident to dialysis with functional decline respond well to specialized rehabilitation care and suggest this may be a novel approach to dialysis initiation.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 234-241

Titre :	Video-Based Pairwise Comparison: Enabling the Development of Automated Rating of Motor Dysfunction in Multiple Sclerosis
Type de document :	Article
Auteurs :	Jessica Burggraaff ; Jonas Dorn ; Marcus D'Souza
Année de publication :	2020
Article en page(s) :	p. 234-241
Note générale :	https://doi.org/10.1016/j.apmr.2019.07.016
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Analyse appariée ; Évaluation de résultat (soins) ; Évaluation des résultats des patients ; Réadaptation ; Sclerose en plaques ; Troubles moteurs
Résumé :	Objectives To examine the feasibility, reliability, granularity, and convergent validity of a video-based pairwise comparison technique that uses algorithmic support to enable automated rating of motor dysfunction in patients with multiple sclerosis (MS). Design Feasibility and larger cross-sectional cohort study. Setting The outpatient clinic of 2 specialist university medical centers. Participants Selected sample from a cohort of patients with MS participating in the Assess MS study (N=42). Videos were randomly drawn from each strata of the ataxia severity-degrees as defined in the Expanded Disability Status Scale (EDSS). In Basel: 19 videos of 17 patients (mean age, 43.4±11.6y; 10 women). In Amsterdam: 50 videos of 25 patients (mean age, 50.0±10.0y; 15 women). Interventions Not applicable. Main Outcome Measures In each center, neurologists (n=13; n=10) viewed pairs of videos of patients performing standardized movements (eg, finger-to-nose test) to assess relative performance. A comparative assessment score was calculated for each video using the TrueSkill algorithm and analyzed for intrarater (test-retest; ratio of agreement) and interrater reliability (intraclass correlation coefficient [ICC] for absolute agreement) and convergent validity (Spearman ρ). Granularity was estimated from the average difference in comparative assessment scores at which 80% of neurologists considered performance to be different. Results Intrarater reliability was excellent (median ratio of agreement≥0.87). The comparative assessment scores calculated from individual neurologists demonstrated good-excellent ICCs for interrater reliability (0.89; 0.71). The comparative assessment scores correlated (very) highly with their Neurostatus-EDSS equivalent (ρ=0.78, P<.001 p suggesting a more fine-grained rating.> Conclusions Video-based pairwise comparison of motor dysfunction allows for reliable and fine-grained capturing of clinical judgment about neurologic performance, which can contribute to the development of a consistent quantified metric of motor ability in MS. Previous article in issue
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[article] Video-Based Pairwise Comparison: Enabling the Development of Automated Rating of Motor Dysfunction in Multiple Sclerosis [Article] / Jessica Burggraaff ; Jonas Dorn ; Marcus D'Souza . - 2020 . - p. 234-241.
https://doi.org/10.1016/j.apmr.2019.07.016
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 234-241

Descripteurs :	HE Vinci Analyse appariée ; Évaluation de résultat (soins) ; Évaluation des résultats des patients ; Réadaptation ; Sclerose en plaques ; Troubles moteurs
Résumé :	Objectives To examine the feasibility, reliability, granularity, and convergent validity of a video-based pairwise comparison technique that uses algorithmic support to enable automated rating of motor dysfunction in patients with multiple sclerosis (MS). Design Feasibility and larger cross-sectional cohort study. Setting The outpatient clinic of 2 specialist university medical centers. Participants Selected sample from a cohort of patients with MS participating in the Assess MS study (N=42). Videos were randomly drawn from each strata of the ataxia severity-degrees as defined in the Expanded Disability Status Scale (EDSS). In Basel: 19 videos of 17 patients (mean age, 43.4±11.6y; 10 women). In Amsterdam: 50 videos of 25 patients (mean age, 50.0±10.0y; 15 women). Interventions Not applicable. Main Outcome Measures In each center, neurologists (n=13; n=10) viewed pairs of videos of patients performing standardized movements (eg, finger-to-nose test) to assess relative performance. A comparative assessment score was calculated for each video using the TrueSkill algorithm and analyzed for intrarater (test-retest; ratio of agreement) and interrater reliability (intraclass correlation coefficient [ICC] for absolute agreement) and convergent validity (Spearman ρ). Granularity was estimated from the average difference in comparative assessment scores at which 80% of neurologists considered performance to be different. Results Intrarater reliability was excellent (median ratio of agreement≥0.87). The comparative assessment scores calculated from individual neurologists demonstrated good-excellent ICCs for interrater reliability (0.89; 0.71). The comparative assessment scores correlated (very) highly with their Neurostatus-EDSS equivalent (ρ=0.78, P<.001 p suggesting a more fine-grained rating.> Conclusions Video-based pairwise comparison of motor dysfunction allows for reliable and fine-grained capturing of clinical judgment about neurologic performance, which can contribute to the development of a consistent quantified metric of motor ability in MS. Previous article in issue
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 242-248

Titre :	Poststroke Postural Sway Improved by Botulinum Toxin: A Multicenter Randomized Double-blind Controlled Trial
Type de document :	Article
Auteurs :	Marjorie Kerzoncuf ; Jean-Michel Viton ; Frédéric Pellas
Année de publication :	2020
Article en page(s) :	p. 242-248
Note générale :	https://doi.org/10.1016/j.apmr.2019.04.024
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Accident vasculaire cérébral (AVC) ; Équilibre postural ; Réadaptation ; Toxines botuliniques
Résumé :	Objective To assess the effects of injecting botulinum toxin into the lower limb muscles of people with hemiparesis post stroke in terms of their sway areas. Design A multicenter randomized double-blind trial on the effects of active botulinum toxin treatment vs placebo. Setting Clinical examinations and postural sway assessments were performed before botulinum toxin injection and again 4-6 weeks after the injection. Participants People with hemiparesis with chronic post stroke lower limb spasticity (N=40). Interventions Intramuscular injection of a placebo (physiological serum) was performed on the control group, and botulinum toxin injections were performed on the treatment group. Participants and physical and rehabilitation medicine specialists were given no information as to which of the 2 treatments was applied. Main Outcome Measures The sway area of the center of pressure was recorded for 30 seconds in 3 conditions: eyes open, eyes open in a dual task (a postural control task combined with an arithmetic task), and eyes closed. Spasticity was measured using the Modified Ashworth Scale. Results Forty people post stroke were enrolled and randomized into 2 groups, one of which was treated with botulinum toxin (n=19) and the other with placebo (n=21). Spasticity decreased significantly in the treatment group (−0.7, P=.049 in the soleus muscles; −0.8, P=.035 in the gastrocnemii muscles). The sway area did not differ significantly between the 2 groups before treatment. The most conspicuous effect was observed in the case of the dual task, where a significant decrease (P=.005) in the sway area occurred in the treatment group (−3.11±6.92) in comparison with the placebo group (+0.27±3.57). Conclusion Treating spasticity by injecting botulinum toxin into people’s lower limb muscles post stroke seems to improve their postural sway. The dual task used here to assess sway seems to be a useful, sensitive test for this purpose.
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[article] Poststroke Postural Sway Improved by Botulinum Toxin: A Multicenter Randomized Double-blind Controlled Trial [Article] / Marjorie Kerzoncuf ; Jean-Michel Viton ; Frédéric Pellas . - 2020 . - p. 242-248.
https://doi.org/10.1016/j.apmr.2019.04.024
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 242-248

Descripteurs :	HE Vinci Accident vasculaire cérébral (AVC) ; Équilibre postural ; Réadaptation ; Toxines botuliniques
Résumé :	Objective To assess the effects of injecting botulinum toxin into the lower limb muscles of people with hemiparesis post stroke in terms of their sway areas. Design A multicenter randomized double-blind trial on the effects of active botulinum toxin treatment vs placebo. Setting Clinical examinations and postural sway assessments were performed before botulinum toxin injection and again 4-6 weeks after the injection. Participants People with hemiparesis with chronic post stroke lower limb spasticity (N=40). Interventions Intramuscular injection of a placebo (physiological serum) was performed on the control group, and botulinum toxin injections were performed on the treatment group. Participants and physical and rehabilitation medicine specialists were given no information as to which of the 2 treatments was applied. Main Outcome Measures The sway area of the center of pressure was recorded for 30 seconds in 3 conditions: eyes open, eyes open in a dual task (a postural control task combined with an arithmetic task), and eyes closed. Spasticity was measured using the Modified Ashworth Scale. Results Forty people post stroke were enrolled and randomized into 2 groups, one of which was treated with botulinum toxin (n=19) and the other with placebo (n=21). Spasticity decreased significantly in the treatment group (−0.7, P=.049 in the soleus muscles; −0.8, P=.035 in the gastrocnemii muscles). The sway area did not differ significantly between the 2 groups before treatment. The most conspicuous effect was observed in the case of the dual task, where a significant decrease (P=.005) in the sway area occurred in the treatment group (−3.11±6.92) in comparison with the placebo group (+0.27±3.57). Conclusion Treating spasticity by injecting botulinum toxin into people’s lower limb muscles post stroke seems to improve their postural sway. The dual task used here to assess sway seems to be a useful, sensitive test for this purpose.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 249-257

Titre :	Effects of the Use of Anchor Systems in the Rehabilitation of Dynamic Balance and Gait in Individuals With Chronic Dizziness of Peripheral Vestibular Origin: A Single-Blinded, Randomized, Controlled Clinical Trial
Type de document :	Article
Auteurs :	Almir R. Coelho ; Rafaela C. Fontes ; Renato Moraes
Année de publication :	2020
Article en page(s) :	p. 249-257
Note générale :	https://doi.org/10.1016/j.apmr.2019.07.012
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Maladies vestibulaires ; Réadaptation ; Sensation vertigineuse
Résumé :	Objective To assess the effectiveness of the anchors in the balance rehabilitation of participants with chronic peripheral vestibulopathy who failed to respond positively to conventional rehabilitation for dynamic balance and gait. Design Assessor-blind, randomized controlled trial. Setting Department of Otoneurology and Laboratory of Assessment and Rehabilitation of Equilibrium. Participants Women with chronic dizziness of peripheral vestibular origin (N=42), who continued to show otoneurologic symptoms for more than 6 months after starting classic vestibular rehabilitation, with no clinical improvement observed. Interventions Participants were randomly assigned to receive a clinical intervention with the anchor system, a clinical intervention without the anchor system, or no intervention or anchor system. The intervention was based on multi-sensory exercises for 6 weeks, twice a week, totaling 12 sessions, in groups of up to 4 participants, with an average time of 40 minutes per session. Main Outcome Measures The primary outcome was functional balance as assessed by the short version of the Balance Evaluation Systems Test. The secondary outcomes were gait parameters of step width in meters, step length in meters, and gait speed in meters per second. The measures were assessed preintervention and postintervention, and after a 3-month follow-up period. Results The proposed intervention was beneficial for dizziness, balance, and gait for both groups studied. At the 3-month follow-up, only the group that used anchors retained the benefits related to the physical aspects of dizziness, balance, and gait. Conclusions The present study found that the proposed intervention protocol, with or without the use of anchors, was beneficial for improving the dizziness, balance, and gait. However, retention of the benefits achieved through the exercise protocol was observed only for those using the anchor system, which promotes the use of haptic information. The use of anchors was effective, in short protocols (12wk), with maintenance of results after 3 months.
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[article] Effects of the Use of Anchor Systems in the Rehabilitation of Dynamic Balance and Gait in Individuals With Chronic Dizziness of Peripheral Vestibular Origin: A Single-Blinded, Randomized, Controlled Clinical Trial [Article] / Almir R. Coelho ; Rafaela C. Fontes ; Renato Moraes . - 2020 . - p. 249-257.
https://doi.org/10.1016/j.apmr.2019.07.012
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 249-257

Descripteurs :	HE Vinci Maladies vestibulaires ; Réadaptation ; Sensation vertigineuse
Résumé :	Objective To assess the effectiveness of the anchors in the balance rehabilitation of participants with chronic peripheral vestibulopathy who failed to respond positively to conventional rehabilitation for dynamic balance and gait. Design Assessor-blind, randomized controlled trial. Setting Department of Otoneurology and Laboratory of Assessment and Rehabilitation of Equilibrium. Participants Women with chronic dizziness of peripheral vestibular origin (N=42), who continued to show otoneurologic symptoms for more than 6 months after starting classic vestibular rehabilitation, with no clinical improvement observed. Interventions Participants were randomly assigned to receive a clinical intervention with the anchor system, a clinical intervention without the anchor system, or no intervention or anchor system. The intervention was based on multi-sensory exercises for 6 weeks, twice a week, totaling 12 sessions, in groups of up to 4 participants, with an average time of 40 minutes per session. Main Outcome Measures The primary outcome was functional balance as assessed by the short version of the Balance Evaluation Systems Test. The secondary outcomes were gait parameters of step width in meters, step length in meters, and gait speed in meters per second. The measures were assessed preintervention and postintervention, and after a 3-month follow-up period. Results The proposed intervention was beneficial for dizziness, balance, and gait for both groups studied. At the 3-month follow-up, only the group that used anchors retained the benefits related to the physical aspects of dizziness, balance, and gait. Conclusions The present study found that the proposed intervention protocol, with or without the use of anchors, was beneficial for improving the dizziness, balance, and gait. However, retention of the benefits achieved through the exercise protocol was observed only for those using the anchor system, which promotes the use of haptic information. The use of anchors was effective, in short protocols (12wk), with maintenance of results after 3 months.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 258-264

Titre :	Cerebellar White Matter Damage Is Associated With Postural Sway Deficits in People With Multiple Sclerosis
Type de document :	Article
Auteurs :	Geetanjali Gera ; Brett W. Fling ; Fay B. Horak
Année de publication :	2020
Article en page(s) :	p. 258-264
Note générale :	https://doi.org/10.1016/j.apmr.2019.07.011
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Cervelet ; Équilibre postural ; Imagerie par tenseur de diffusion ; Neuroimagerie ; Réadaptation ; Sclerose en plaques
Résumé :	Objective To assess how postural sway deficits during eyes open and closed relate to the integrity of cerebellar peduncles in individuals with multiple sclerosis (MS). Design Cross-sectional study. Setting Laboratory based setting. Participants Twenty-nine adults with MS (Expanded Disability Status Scale: 2-4) and 15 adults without MS were recruited (N=44). Inclusion criteria for all participants were ability to maintain balance independently by standing on toes for 3 seconds, and no known biomechanical conditions affecting balance. Interventions Not applicable. Main Outcome Measures Postural sway using body-worn, inertial sensors during quiet standing, integrity of cerebellar peduncles quantified using diffusion-tensor imaging and clinical assessment scales for ataxia and balance. Results Radial diffusivity of the inferior cerebellar peduncle was related to postural sway measures during both eyes open and closed. In contrast, radial diffusivity of the superior cerebellar peduncle was related to postural sway only in stance with eyes open. Conclusions The inferior cerebellar peduncle, which carries somatosensory information to the cerebellum, contributes to control of standing balance with or without visual inputs, consistent with the high dependence on somatosensory information for posture. The superior cerebellar peduncle, which carries cortical information to the cerebellum, contributes to control of standing posture only when vision is available. Radial diffusivity of the inferior cerebellar peduncle was related to reactive balance control, whereas radial diffusivity of the superior cerebellar peduncle was related to the kinetic component of the ataxia rating scale.
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[article] Cerebellar White Matter Damage Is Associated With Postural Sway Deficits in People With Multiple Sclerosis [Article] / Geetanjali Gera ; Brett W. Fling ; Fay B. Horak . - 2020 . - p. 258-264.
https://doi.org/10.1016/j.apmr.2019.07.011
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 258-264

Descripteurs :	HE Vinci Cervelet ; Équilibre postural ; Imagerie par tenseur de diffusion ; Neuroimagerie ; Réadaptation ; Sclerose en plaques
Résumé :	Objective To assess how postural sway deficits during eyes open and closed relate to the integrity of cerebellar peduncles in individuals with multiple sclerosis (MS). Design Cross-sectional study. Setting Laboratory based setting. Participants Twenty-nine adults with MS (Expanded Disability Status Scale: 2-4) and 15 adults without MS were recruited (N=44). Inclusion criteria for all participants were ability to maintain balance independently by standing on toes for 3 seconds, and no known biomechanical conditions affecting balance. Interventions Not applicable. Main Outcome Measures Postural sway using body-worn, inertial sensors during quiet standing, integrity of cerebellar peduncles quantified using diffusion-tensor imaging and clinical assessment scales for ataxia and balance. Results Radial diffusivity of the inferior cerebellar peduncle was related to postural sway measures during both eyes open and closed. In contrast, radial diffusivity of the superior cerebellar peduncle was related to postural sway only in stance with eyes open. Conclusions The inferior cerebellar peduncle, which carries somatosensory information to the cerebellum, contributes to control of standing balance with or without visual inputs, consistent with the high dependence on somatosensory information for posture. The superior cerebellar peduncle, which carries cortical information to the cerebellum, contributes to control of standing posture only when vision is available. Radial diffusivity of the inferior cerebellar peduncle was related to reactive balance control, whereas radial diffusivity of the superior cerebellar peduncle was related to the kinetic component of the ataxia rating scale.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 265-274

Titre :	Added Value of Gluteus Medius and Quadratus Lumborum Dry Needling in Improving Knee Pain and Function in Female Athletes With Patellofemoral Pain Syndrome: A Randomized Clinical Trial
Type de document :	Article
Auteurs :	Hanieh Zarei ; Soha Bervis ; Soraya Piroozi
Année de publication :	2020
Article en page(s) :	p. 265-274
Note générale :	https://doi.org/10.1016/j.apmr.2019.07.009
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Équilibre postural ; Points de déclenchement ; Réadaptation ; Syndrome fémoro­patellaire ; Traitement par les exercices physiques
Résumé :	Objective To compare the effects of exercise therapy alone and exercise therapy plus gluteus medius (GM) and quadratus lumbarum (QL) dry needling on pain and function in female athletes with patellofemoral pain (PFP). Design Single-blind randomized controlled trial with follow-up. Setting Physiotherapy clinic. Participants Convenience sample of female athletes with PFP (N=40), who were randomly assigned to the exercise therapy (Ex group) or exercise-therapy+dry needling (Ex+DN group) group. Interventions The Ex group received exercise therapy for 4 weeks, and the Ex+DN group received exercise therapy in combination with dry needling directed at GM and QL trigger points for 4 weeks. Main Outcome Measures In all participants, pain intensity, function (Kujala score, modified star excursion balance test, step-down test), and QL and GM pressure pain threshold (PPT) were recorded at baseline and at 4 and 6 weeks after the start of treatment. Analysis of variance (2 groups×3 times) was used to compare within- and between-group differences. Results The group versus time interaction effect was significant for all variables (P<.05 both groups showed significant improvements in pain function and ppt at weeks compared to baseline between-groups comparisons significantly greater the ex group> Conclusions Targeting intervention to treat trigger points in the GM and QL muscles combined with exercise therapy had superior beneficial effects compared to exercise alone in managing PFP. Therefore, adding GM and QL muscle dry needling to exercise therapy may be advisable to enhance the effects of PFP rehabilitation.
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[article] Added Value of Gluteus Medius and Quadratus Lumborum Dry Needling in Improving Knee Pain and Function in Female Athletes With Patellofemoral Pain Syndrome: A Randomized Clinical Trial [Article] / Hanieh Zarei ; Soha Bervis ; Soraya Piroozi . - 2020 . - p. 265-274.
https://doi.org/10.1016/j.apmr.2019.07.009
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 265-274

Descripteurs :	HE Vinci Équilibre postural ; Points de déclenchement ; Réadaptation ; Syndrome fémoro­patellaire ; Traitement par les exercices physiques
Résumé :	Objective To compare the effects of exercise therapy alone and exercise therapy plus gluteus medius (GM) and quadratus lumbarum (QL) dry needling on pain and function in female athletes with patellofemoral pain (PFP). Design Single-blind randomized controlled trial with follow-up. Setting Physiotherapy clinic. Participants Convenience sample of female athletes with PFP (N=40), who were randomly assigned to the exercise therapy (Ex group) or exercise-therapy+dry needling (Ex+DN group) group. Interventions The Ex group received exercise therapy for 4 weeks, and the Ex+DN group received exercise therapy in combination with dry needling directed at GM and QL trigger points for 4 weeks. Main Outcome Measures In all participants, pain intensity, function (Kujala score, modified star excursion balance test, step-down test), and QL and GM pressure pain threshold (PPT) were recorded at baseline and at 4 and 6 weeks after the start of treatment. Analysis of variance (2 groups×3 times) was used to compare within- and between-group differences. Results The group versus time interaction effect was significant for all variables (P<.05 both groups showed significant improvements in pain function and ppt at weeks compared to baseline between-groups comparisons significantly greater the ex group> Conclusions Targeting intervention to treat trigger points in the GM and QL muscles combined with exercise therapy had superior beneficial effects compared to exercise alone in managing PFP. Therefore, adding GM and QL muscle dry needling to exercise therapy may be advisable to enhance the effects of PFP rehabilitation.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 275-282

Titre :	Assessing the Validity and Reliability of a New Video Goniometer App for Measuring Joint Angles in Adults and Children
Type de document :	Article
Auteurs :	Andrea Baraldi Cunha ; Iryna Babik ; Regina Harbourne
Année de publication :	2020
Article en page(s) :	p. 275-282
Note générale :	https://doi.org/10.1016/j.apmr.2019.07.008
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Amplitude articulaire ; Réadaptation
Résumé :	Objective To assess the convergent validity and reliability of joint angle measurements from a new video goniometer iPhone/iPad application separately in adults, older and young children. Design Cross-sectional. Setting Child care and university environments. Participants Fifty-four adults (mean ± SD=22.5±4.5y), 20 older children (mean ± SD=10.9±2.2y), 20 younger children (mean ± SD=1.6±0.8y) (N=94). Interventions Adults and older children performed both standardized static positions and functional activities. Younger children performed only a functional activity protocol. Main Outcome Measures Joint angle measurements using the app were validated against a commercially validated two-dimensional goniometric software program. In addition, validity of the app was compared to a standard mechanical goniometer for the measurement of angles drawn on a white board. Intra- and interrater reliability were assessed through independent rescoring of videos. Results Correlations between joint angle estimates obtained from the app and goniometer software or a mechanical goniometer were positive and very strong (r>.900; P<.0001 the intraclass correlation coefficient for repeated scoring from app indicated excellent intra- and interrater reliability>.900). Conclusions High correlations for repeated measures and comparison to gold standard angle measurement instruments suggest that the new app is a valid and reliable tool for assessing joint angles during functional activity. This tool may provide clinicians an inexpensive yet accurate method for quantification of movements and immediate feedback on range of motion during tasks in a natural environment.
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[article] Assessing the Validity and Reliability of a New Video Goniometer App for Measuring Joint Angles in Adults and Children [Article] / Andrea Baraldi Cunha ; Iryna Babik ; Regina Harbourne . - 2020 . - p. 275-282.
https://doi.org/10.1016/j.apmr.2019.07.008
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 275-282

Descripteurs :	HE Vinci Amplitude articulaire ; Réadaptation
Résumé :	Objective To assess the convergent validity and reliability of joint angle measurements from a new video goniometer iPhone/iPad application separately in adults, older and young children. Design Cross-sectional. Setting Child care and university environments. Participants Fifty-four adults (mean ± SD=22.5±4.5y), 20 older children (mean ± SD=10.9±2.2y), 20 younger children (mean ± SD=1.6±0.8y) (N=94). Interventions Adults and older children performed both standardized static positions and functional activities. Younger children performed only a functional activity protocol. Main Outcome Measures Joint angle measurements using the app were validated against a commercially validated two-dimensional goniometric software program. In addition, validity of the app was compared to a standard mechanical goniometer for the measurement of angles drawn on a white board. Intra- and interrater reliability were assessed through independent rescoring of videos. Results Correlations between joint angle estimates obtained from the app and goniometer software or a mechanical goniometer were positive and very strong (r>.900; P<.0001 the intraclass correlation coefficient for repeated scoring from app indicated excellent intra- and interrater reliability>.900). Conclusions High correlations for repeated measures and comparison to gold standard angle measurement instruments suggest that the new app is a valid and reliable tool for assessing joint angles during functional activity. This tool may provide clinicians an inexpensive yet accurate method for quantification of movements and immediate feedback on range of motion during tasks in a natural environment.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 283-296

Titre :	Comparative Effectiveness of Sleep Apnea Screening Instruments During Inpatient Rehabilitation Following Moderate to Severe TBI
Type de document :	Article
Auteurs :	Risa Nakase-Richardson ; Daniel J. Schwartz ; Leah Drasher-Phillips
Année de publication :	2020
Article en page(s) :	p. 283-296
Note générale :	https://doi.org/10.1016/j.apmr.2019.09.019
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Dépistage de masse ; Lésions encéphaliques ; Lésions traumatiques de l'encéphale ; Réadaptation ; Recherche comparative sur l'efficacité ; Sensibilité et spécificité ; Syndromes d'apnées du sommeil
Résumé :	Objective To determine the diagnostic sensitivity and specificity and comparative effectiveness of traditional sleep apnea screening tools in traumatic brain injury (TBI) neurorehabilitation admissions. Design Prospective diagnostic comparative effectiveness trial of sleep apnea screening tools relative to the criterion standard, attended level 1 polysomnography including encephalography. Setting Six TBI Model System Inpatient Rehabilitation Centers. Participants Between May 2017 and February 2019, 449 of 896 screened were eligible for the trial with 345 consented (77% consented). Additional screening left 263 eligible for and completing polysomnography with final analyses completed on 248. Intervention Not applicable. Main Outcome Measures Area under the curve (AUC) of screening tools relative to total apnea hypopnea index≥15 (AHI, moderate to severe apnea) measured at a median of 47 days post-TBI (interquartile range, 29-47). Results The Berlin high-risk score (receiving operating curve [ROC] AUC=0.634) was inferior to the Multivariable Apnea Prediction Index (MAPI) (ROC AUC=0.780) (P=.0211; CI, 0.018-0.223) and Snoring, Tired, Observed, Blood Pressure, Body Mass Index, Age, Neck Circumference, and Gender (STOPBANG) score (ROC AUC=0.785) (P=.001; CI, 0.063-0.230), both of which had comparable AUC (P=.7245; CI, −0.047 to 0.068). Findings were similar for AHI≥30 (severe apnea); however, no differences across scales was observed at AHI≥5. The pattern was similar across TBI severity subgroups except for posttraumatic amnesia (PTA) status wherein the MAPI outperformed the Berlin. Youden’s index to determine risk yielded lower sensitivities but higher specificities relative to non-TBI samples. Conclusion This study is the first to provide clinicians with data to support a choice for which sleep apnea screening tools are more effective during inpatient rehabilitation for TBI (STOPBANG, MAPI vs Berlin) to help reduce comorbidity and possibly improve neurologic outcome.
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[article] Comparative Effectiveness of Sleep Apnea Screening Instruments During Inpatient Rehabilitation Following Moderate to Severe TBI [Article] / Risa Nakase-Richardson ; Daniel J. Schwartz ; Leah Drasher-Phillips . - 2020 . - p. 283-296.
https://doi.org/10.1016/j.apmr.2019.09.019
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 283-296

Descripteurs :	HE Vinci Dépistage de masse ; Lésions encéphaliques ; Lésions traumatiques de l'encéphale ; Réadaptation ; Recherche comparative sur l'efficacité ; Sensibilité et spécificité ; Syndromes d'apnées du sommeil
Résumé :	Objective To determine the diagnostic sensitivity and specificity and comparative effectiveness of traditional sleep apnea screening tools in traumatic brain injury (TBI) neurorehabilitation admissions. Design Prospective diagnostic comparative effectiveness trial of sleep apnea screening tools relative to the criterion standard, attended level 1 polysomnography including encephalography. Setting Six TBI Model System Inpatient Rehabilitation Centers. Participants Between May 2017 and February 2019, 449 of 896 screened were eligible for the trial with 345 consented (77% consented). Additional screening left 263 eligible for and completing polysomnography with final analyses completed on 248. Intervention Not applicable. Main Outcome Measures Area under the curve (AUC) of screening tools relative to total apnea hypopnea index≥15 (AHI, moderate to severe apnea) measured at a median of 47 days post-TBI (interquartile range, 29-47). Results The Berlin high-risk score (receiving operating curve [ROC] AUC=0.634) was inferior to the Multivariable Apnea Prediction Index (MAPI) (ROC AUC=0.780) (P=.0211; CI, 0.018-0.223) and Snoring, Tired, Observed, Blood Pressure, Body Mass Index, Age, Neck Circumference, and Gender (STOPBANG) score (ROC AUC=0.785) (P=.001; CI, 0.063-0.230), both of which had comparable AUC (P=.7245; CI, −0.047 to 0.068). Findings were similar for AHI≥30 (severe apnea); however, no differences across scales was observed at AHI≥5. The pattern was similar across TBI severity subgroups except for posttraumatic amnesia (PTA) status wherein the MAPI outperformed the Berlin. Youden’s index to determine risk yielded lower sensitivities but higher specificities relative to non-TBI samples. Conclusion This study is the first to provide clinicians with data to support a choice for which sleep apnea screening tools are more effective during inpatient rehabilitation for TBI (STOPBANG, MAPI vs Berlin) to help reduce comorbidity and possibly improve neurologic outcome.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 297-308

Titre :	PROMIS Physical Function Short Forms Display Item- and Scale-Level Characteristics at Least as Good as the Roland Morris Disability Questionnaire in Patients With Chronic Low Back Pain
Type de document :	Article
Auteurs :	Alessandro Chiarotto ; Leo D. Roorda ; Martine H. Crins
Année de publication :	2020
Article en page(s) :	p. 297-308
Note générale :	https://doi.org/10.1016/j.apmr.2019.09.018
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Lombalgie ; Réadaptation
Résumé :	To compare dimensionality, item-level characteristics, scale-level reliability, and construct validity of PROMIS Physical Function short forms (PROMIS-PF) and 24-item Roland Morris Disability Questionnaire (RMDQ-24) in patients with chronic low back pain (LBP). Design Cross-sectional study. Setting Secondary care center for rehabilitation and rheumatology. Participants Patients with nonspecific LBP ≥3 months (N=768). Mean age was 49±13 years, 77% were female, and 54% displayed pain for more than 5 years. Interventions Not applicable. Main Outcome Measures Dutch versions of the 4-, 6-, 8-, 10-, and 20-item PROMIS-PF and of the RMDQ-24. Results PROMIS-PF-6, PROMIS-PF-8, and RMDQ-24 exhibited sufficient unidimensionality (confirmatory factor analysis: comparative fit index>0.950, Tucker-Lewis index>0.950, root means square error of approximation.001). Two-parameter item response theory models found 2 items with low discrimination for RMDQ-24. All other instruments had adequate fit statistics and item parameters. PROMIS-PF-20 displayed the best scale-level reliability. Construct validity was sufficient for all instruments as all hypotheses on expected correlations with other instruments and differences between relevant subgroups were met. Conclusions PROMIS-PF-6, PROMIS-PF-8, and RMDQ-24 exhibited better unidimensionality, whereas PROMIS-PF-4, PROMIS-PF-6, PROMIS-PF-8, and PROMIS-PF-10 showed superior item-level characteristics. PROMIS-PF-20 was the instrument with the best scale-level reliability. This study warrants assessment of other measurement properties of PROMIS-PF short forms in comparison with disease-specific physical functioning instruments in LBP.
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[article] PROMIS Physical Function Short Forms Display Item- and Scale-Level Characteristics at Least as Good as the Roland Morris Disability Questionnaire in Patients With Chronic Low Back Pain [Article] / Alessandro Chiarotto ; Leo D. Roorda ; Martine H. Crins . - 2020 . - p. 297-308.
https://doi.org/10.1016/j.apmr.2019.09.018
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 297-308

Descripteurs :	HE Vinci Lombalgie ; Réadaptation
Résumé :	To compare dimensionality, item-level characteristics, scale-level reliability, and construct validity of PROMIS Physical Function short forms (PROMIS-PF) and 24-item Roland Morris Disability Questionnaire (RMDQ-24) in patients with chronic low back pain (LBP). Design Cross-sectional study. Setting Secondary care center for rehabilitation and rheumatology. Participants Patients with nonspecific LBP ≥3 months (N=768). Mean age was 49±13 years, 77% were female, and 54% displayed pain for more than 5 years. Interventions Not applicable. Main Outcome Measures Dutch versions of the 4-, 6-, 8-, 10-, and 20-item PROMIS-PF and of the RMDQ-24. Results PROMIS-PF-6, PROMIS-PF-8, and RMDQ-24 exhibited sufficient unidimensionality (confirmatory factor analysis: comparative fit index>0.950, Tucker-Lewis index>0.950, root means square error of approximation.001). Two-parameter item response theory models found 2 items with low discrimination for RMDQ-24. All other instruments had adequate fit statistics and item parameters. PROMIS-PF-20 displayed the best scale-level reliability. Construct validity was sufficient for all instruments as all hypotheses on expected correlations with other instruments and differences between relevant subgroups were met. Conclusions PROMIS-PF-6, PROMIS-PF-8, and RMDQ-24 exhibited better unidimensionality, whereas PROMIS-PF-4, PROMIS-PF-6, PROMIS-PF-8, and PROMIS-PF-10 showed superior item-level characteristics. PROMIS-PF-20 was the instrument with the best scale-level reliability. This study warrants assessment of other measurement properties of PROMIS-PF short forms in comparison with disease-specific physical functioning instruments in LBP.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 309-316

Titre :	Effects of a Robot-Assisted Arm Training Plus Hand Functional Electrical Stimulation on Recovery After Stroke: A Randomized Clinical Trial
Type de document :	Article
Auteurs :	Sofia Straudi ; Andrea Baroni ; Sonia Mele
Année de publication :	2020
Article en page(s) :	p. 309-316
Note générale :	https://doi.org/10.1016/j.apmr.2019.09.016
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Accident vasculaire cérébral (AVC) ; Membre supérieur ; Réadaptation ; Robotique ; Stimulation magnétique transcranienne
Résumé :	Objective To compare the effects of unilateral, proximal arm robot-assisted therapy combined with hand functional electrical stimulation with intensive conventional therapy for restoring arm function in survivors of subacute stroke. Design This was a single-blinded, randomized controlled trial. Setting Inpatient rehabilitation university hospital. Participants Patients (N=40) diagnosed as having ischemic stroke (time since stroke Interventions Participants randomized to the experimental group received 30 sessions (5 sessions/wk) of robot-assisted arm therapy and hand functional electrical stimulation (RAT+FES). Participants randomized to the control group received a time-matched intensive conventional therapy. Main Outcome Measures The primary outcome was arm motor recovery measured with the Fugl-Meyer Motor Assessment. Secondary outcomes included motor function, arm spasticity, and activities of daily living. Measurements were performed at baseline, after 3 weeks, at the end of treatment, and at 6-month follow-up. Presence of motor evoked potentials (MEPs) was also measured at baseline. Results Both groups significantly improved all outcome measures except for spasticity without differences between groups. Patients with moderate impairment and presence of MEPs who underwent early rehabilitation ( Conclusions RAT+FES was no more effective than intensive conventional arm training. However, at the same level of arm impairment and corticospinal tract integrity, it induced a higher level of arm recovery.
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[article] Effects of a Robot-Assisted Arm Training Plus Hand Functional Electrical Stimulation on Recovery After Stroke: A Randomized Clinical Trial [Article] / Sofia Straudi ; Andrea Baroni ; Sonia Mele . - 2020 . - p. 309-316.
https://doi.org/10.1016/j.apmr.2019.09.016
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 309-316

Descripteurs :	HE Vinci Accident vasculaire cérébral (AVC) ; Membre supérieur ; Réadaptation ; Robotique ; Stimulation magnétique transcranienne
Résumé :	Objective To compare the effects of unilateral, proximal arm robot-assisted therapy combined with hand functional electrical stimulation with intensive conventional therapy for restoring arm function in survivors of subacute stroke. Design This was a single-blinded, randomized controlled trial. Setting Inpatient rehabilitation university hospital. Participants Patients (N=40) diagnosed as having ischemic stroke (time since stroke Interventions Participants randomized to the experimental group received 30 sessions (5 sessions/wk) of robot-assisted arm therapy and hand functional electrical stimulation (RAT+FES). Participants randomized to the control group received a time-matched intensive conventional therapy. Main Outcome Measures The primary outcome was arm motor recovery measured with the Fugl-Meyer Motor Assessment. Secondary outcomes included motor function, arm spasticity, and activities of daily living. Measurements were performed at baseline, after 3 weeks, at the end of treatment, and at 6-month follow-up. Presence of motor evoked potentials (MEPs) was also measured at baseline. Results Both groups significantly improved all outcome measures except for spasticity without differences between groups. Patients with moderate impairment and presence of MEPs who underwent early rehabilitation ( Conclusions RAT+FES was no more effective than intensive conventional arm training. However, at the same level of arm impairment and corticospinal tract integrity, it induced a higher level of arm recovery.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 317-328

Titre :	Effect of Pilates Intervention on Physical Function of Children and Youth: A Systematic Review
Type de document :	Article
Auteurs :	Elizabeth Hornsby ; Leanne M. Johnston
Année de publication :	2020
Article en page(s) :	p. 317-328
Note générale :	https://doi.org/10.1016/j.apmr.2019.05.023
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Douleur ; Enfant ; Réadaptation
Résumé :	Objective To conduct a systematic review to evaluate the effectiveness of Pilates intervention on physical function in children and youth. Data Sources Six electronic databases were searched from inception to June 2018 using the term Pilates. Study Selection Articles were included if they (1) reported original data for a Pilates-only intervention; (2) involved children or youth aged up to 22 years; (3) reported a musculoskeletal, pain, or function study outcome. Searches identified 2565 papers and 11 studies fulfilled the inclusion criteria. Data Extraction The 2 authors independently screened and assessed all studies and any discrepancies were resolved by consensus. Data Synthesis Level of evidence was classified using the Oxford Centre for Evidence Based Medicine. Study quality was assessed using the Physiotherapy Evidence Database for randomized controlled trials and Risk of Bias in N-of-1 Trials scale for single case experimental design studies. Four studies were high quality, 3 were fair quality, and 4 were of low quality. Findings showed that Pilates does appear to improve flexibility (n=6); muscle strength, power and movement speed (n=3); postural control, orientation and balance (n=3); metabolic cost (n=1); functional ability (n=1) and health related quality of life (n=1) and reduce pain (n=2) in children with musculoskeletal pathology, the majority with a large effect size. Pilates content varied from group-based mat classes to individualized programs using specialized equipment. Intervention dose and frequency varied widely. Conclusions This is the first systematic review of the effect of Pilates intervention for children and youth. Research is in the preliminary stages; however, Pilates does appear to improve flexibility, strength and postural control, and reduce pain in children with musculoskeletal pathology. Further research is warranted to determine the potential effectiveness of Pilates for children and youth for various population groups and to develop comprehensive treatment guidelines.
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[article] Effect of Pilates Intervention on Physical Function of Children and Youth: A Systematic Review [Article] / Elizabeth Hornsby ; Leanne M. Johnston . - 2020 . - p. 317-328.
https://doi.org/10.1016/j.apmr.2019.05.023
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 317-328

Descripteurs :	HE Vinci Douleur ; Enfant ; Réadaptation
Résumé :	Objective To conduct a systematic review to evaluate the effectiveness of Pilates intervention on physical function in children and youth. Data Sources Six electronic databases were searched from inception to June 2018 using the term Pilates. Study Selection Articles were included if they (1) reported original data for a Pilates-only intervention; (2) involved children or youth aged up to 22 years; (3) reported a musculoskeletal, pain, or function study outcome. Searches identified 2565 papers and 11 studies fulfilled the inclusion criteria. Data Extraction The 2 authors independently screened and assessed all studies and any discrepancies were resolved by consensus. Data Synthesis Level of evidence was classified using the Oxford Centre for Evidence Based Medicine. Study quality was assessed using the Physiotherapy Evidence Database for randomized controlled trials and Risk of Bias in N-of-1 Trials scale for single case experimental design studies. Four studies were high quality, 3 were fair quality, and 4 were of low quality. Findings showed that Pilates does appear to improve flexibility (n=6); muscle strength, power and movement speed (n=3); postural control, orientation and balance (n=3); metabolic cost (n=1); functional ability (n=1) and health related quality of life (n=1) and reduce pain (n=2) in children with musculoskeletal pathology, the majority with a large effect size. Pilates content varied from group-based mat classes to individualized programs using specialized equipment. Intervention dose and frequency varied widely. Conclusions This is the first systematic review of the effect of Pilates intervention for children and youth. Research is in the preliminary stages; however, Pilates does appear to improve flexibility, strength and postural control, and reduce pain in children with musculoskeletal pathology. Further research is warranted to determine the potential effectiveness of Pilates for children and youth for various population groups and to develop comprehensive treatment guidelines.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 329-358

Titre :	Conservative Interventions Reduce Fear in Individuals With Chronic Low Back Pain: A Systematic Review
Type de document :	Article
Auteurs :	Javier Martinez-Calderon ; Mar Flores-Cortes ; Jose Miguel Morales-Asencio
Année de publication :	2020
Article en page(s) :	p. 329-358
Note générale :	https://doi.org/10.1016/j.apmr.2019.08.470
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Douleur chronique ; Exercice physique ; Lombalgie ; Peur ; Réadaptation ; Revue systématique
Résumé :	Objective To systematically review and critically appraise the effectiveness of conservative and surgical interventions to reduce fear in studies of people with chronic low back pain, based on the analysis of randomized controlled trials for which fear was a primary or secondary outcome. Data Sources Electronic databases PubMed, CINAHL, PsycINFO, PEDro, and CENTRAL, as well as manual searches and grey literature were searched from inception until May 2019. Study Selection Randomized controlled trials analyzing the effectiveness of conservative and surgical interventions to reduce fear were included. Data Extraction Two reviewers independently conducted the search strategy, study selection, data extraction, risk of bias assessment, and quality of the evidence judgment. Data Synthesis Sixty-one studies (n=7201) were included. A large number of fear-related search terms were used but only 3 fear constructs (kinesiophobia, fear-avoidance beliefs, fear of falling) were measured in the included studies. Multidisciplinary and psychological interventions as well as exercise reduced kinesiophobia. Fear-avoidance beliefs were reduced by the aforementioned interventions, manual therapy, and electrotherapy. A multidisciplinary intervention reduced the fear of falling. There was moderate evidence of multidisciplinary interventions and exercise to reduce kinesiophobia. There was moderate evidence of manual therapy and electrotherapy to reduce fear-avoidance beliefs. Conclusions The present systematic review highlights the potential effectiveness of conservative interventions to reduce kinesiophobia and fear-avoidance beliefs in individuals with chronic low back pain. This information can help health professionals to reduce fear when treating patients with this condition.
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[article] Conservative Interventions Reduce Fear in Individuals With Chronic Low Back Pain: A Systematic Review [Article] / Javier Martinez-Calderon ; Mar Flores-Cortes ; Jose Miguel Morales-Asencio . - 2020 . - p. 329-358.
https://doi.org/10.1016/j.apmr.2019.08.470
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 329-358

Descripteurs :	HE Vinci Douleur chronique ; Exercice physique ; Lombalgie ; Peur ; Réadaptation ; Revue systématique
Résumé :	Objective To systematically review and critically appraise the effectiveness of conservative and surgical interventions to reduce fear in studies of people with chronic low back pain, based on the analysis of randomized controlled trials for which fear was a primary or secondary outcome. Data Sources Electronic databases PubMed, CINAHL, PsycINFO, PEDro, and CENTRAL, as well as manual searches and grey literature were searched from inception until May 2019. Study Selection Randomized controlled trials analyzing the effectiveness of conservative and surgical interventions to reduce fear were included. Data Extraction Two reviewers independently conducted the search strategy, study selection, data extraction, risk of bias assessment, and quality of the evidence judgment. Data Synthesis Sixty-one studies (n=7201) were included. A large number of fear-related search terms were used but only 3 fear constructs (kinesiophobia, fear-avoidance beliefs, fear of falling) were measured in the included studies. Multidisciplinary and psychological interventions as well as exercise reduced kinesiophobia. Fear-avoidance beliefs were reduced by the aforementioned interventions, manual therapy, and electrotherapy. A multidisciplinary intervention reduced the fear of falling. There was moderate evidence of multidisciplinary interventions and exercise to reduce kinesiophobia. There was moderate evidence of manual therapy and electrotherapy to reduce fear-avoidance beliefs. Conclusions The present systematic review highlights the potential effectiveness of conservative interventions to reduce kinesiophobia and fear-avoidance beliefs in individuals with chronic low back pain. This information can help health professionals to reduce fear when treating patients with this condition.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 359-373

Titre :	Systematic Review and Meta-Analysis of Home-Based Rehabilitation on Improving Physical Function Among Home-Dwelling Patients With a Stroke
Type de document :	Article
Auteurs :	Nai-Fang Chi ; Yi-Chieh Huang ; Hsiao-Yean Chiu
Année de publication :	2020
Article en page(s) :	p. 359-373
Note générale :	https://doi.org/10.1016/j.apmr.2019.10.181
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Accident vasculaire cérébral (AVC) ; Méta-analyse ; Réadaptation ; Services de soins à domicile
Résumé :	Objective To evaluate the effects of home-based rehabilitation on improving physical function in home-dwelling patients after a stroke. Data Sources Various electronic databases, including PubMed, Cumulative Index to Nursing and Allied Health, Embase, the Cochrane Central Register of Controlled Trials, and 2 Chinese data sets (ie, Chinese Electronic Periodical Services and China Knowledge Resource Integrated) were searched for studies published before March 20, 2019. Study Selection Randomized controlled trials conducted to examine the effect of home-based rehabilitation on improving physical function in home-dwelling patients with a stroke and published in English or Chinese were included. In total, 49 articles in English (n=23) and Chinese (n=26) met the inclusion criteria. Data Extraction Data related to patient characteristics, study characteristics, intervention details, and outcomes were extracted by 2 independent reviewers. Data Synthesis A random-effects model with a sensitivity analysis showed that home-based rehabilitation exerted moderate improvements on physical function in home-dwelling patients with a stroke (g=0.58; 95% CI, 0.45∼0.70). Moderator analyses revealed that those patients with stroke of a younger age, of male sex, with a first-ever stroke episode, in the acute stage, and receiving rehabilitation training from their caregiver showed greater improvements in physical function. Conclusions Home rehabilitation can improve functional outcome in survivors of stroke and should be considered appropriate during discharge planning if continuation care is required.
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[article] Systematic Review and Meta-Analysis of Home-Based Rehabilitation on Improving Physical Function Among Home-Dwelling Patients With a Stroke [Article] / Nai-Fang Chi ; Yi-Chieh Huang ; Hsiao-Yean Chiu . - 2020 . - p. 359-373.
https://doi.org/10.1016/j.apmr.2019.10.181
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 2 (2020) . - p. 359-373

Descripteurs :	HE Vinci Accident vasculaire cérébral (AVC) ; Méta-analyse ; Réadaptation ; Services de soins à domicile
Résumé :	Objective To evaluate the effects of home-based rehabilitation on improving physical function in home-dwelling patients after a stroke. Data Sources Various electronic databases, including PubMed, Cumulative Index to Nursing and Allied Health, Embase, the Cochrane Central Register of Controlled Trials, and 2 Chinese data sets (ie, Chinese Electronic Periodical Services and China Knowledge Resource Integrated) were searched for studies published before March 20, 2019. Study Selection Randomized controlled trials conducted to examine the effect of home-based rehabilitation on improving physical function in home-dwelling patients with a stroke and published in English or Chinese were included. In total, 49 articles in English (n=23) and Chinese (n=26) met the inclusion criteria. Data Extraction Data related to patient characteristics, study characteristics, intervention details, and outcomes were extracted by 2 independent reviewers. Data Synthesis A random-effects model with a sensitivity analysis showed that home-based rehabilitation exerted moderate improvements on physical function in home-dwelling patients with a stroke (g=0.58; 95% CI, 0.45∼0.70). Moderator analyses revealed that those patients with stroke of a younger age, of male sex, with a first-ever stroke episode, in the acute stage, and receiving rehabilitation training from their caregiver showed greater improvements in physical function. Conclusions Home rehabilitation can improve functional outcome in survivors of stroke and should be considered appropriate during discharge planning if continuation care is required.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 1 (2020) . - p. 1-10

Titre :	Effects of Motor Skill-Based Training on Wheelchair Propulsion Biomechanics in Older Adults: A Randomized Controlled Trial
Type de document :	Article
Auteurs :	Megan K. MacGillivray ; Janice J. Eng ; Elizabeth Dean
Année de publication :	2020
Article en page(s) :	p. 1-10
Note générale :	https://doi.org/10.1016/j.apmr.2019.07.017
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Fauteuils roulants ; Réadaptation ; Rétroaction
Résumé :	Objective To identify whether motor skill-based training improves wheeling biomechanics in older adults and whether transfer or retention occurs. Design Randomized controlled trial. Setting Human mobility laboratory. Participants Able-bodied older adults 50 years and older deemed ready to participate in physical activity (N=34). Intervention Participants were randomized to 1 of 3 groups: experimental group with 6 motor skill-based training sessions, active control group with dose-matched uninstructed practice, and the inactive control group (no training or practice). The experimental group's training sessions consisted of two 5-minute blocks of wheelchair propulsion training, separated by a 5-minute break, for a total of 60 minutes of wheeling. Breaks included education and discussion related to wheelchair propulsion. Training focused on increasing push angle, decreasing push frequency, decreasing negative braking forces, and using a circular wheeling pattern with smooth pushes. Main Outcome Measures Temporal spatial and kinetic variables (ie, push angle, push frequency, total and tangential forces, negative force) were evaluated during steady-state wheeling and biomechanical variables were assessed with the SmartWheel Clinical Protocol to identify transfer. Results The training group significantly increased push angle and decreased push frequency compared with the practice (P<.05 and control groups which were retained over time transferred to overground wheeling on tile the dose-matched practice group did not differ from inactive for any variables>.05). Conclusions Older adults improve select biomechanical variables following motor skill-based training, which are retained over time and transfer to overground wheeling. Participants in the active control group did not improve with uninstructed practice compared with the inactive control group.
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[article] Effects of Motor Skill-Based Training on Wheelchair Propulsion Biomechanics in Older Adults: A Randomized Controlled Trial [Article] / Megan K. MacGillivray ; Janice J. Eng ; Elizabeth Dean . - 2020 . - p. 1-10.
https://doi.org/10.1016/j.apmr.2019.07.017
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 1 (2020) . - p. 1-10

Descripteurs :	HE Vinci Fauteuils roulants ; Réadaptation ; Rétroaction
Résumé :	Objective To identify whether motor skill-based training improves wheeling biomechanics in older adults and whether transfer or retention occurs. Design Randomized controlled trial. Setting Human mobility laboratory. Participants Able-bodied older adults 50 years and older deemed ready to participate in physical activity (N=34). Intervention Participants were randomized to 1 of 3 groups: experimental group with 6 motor skill-based training sessions, active control group with dose-matched uninstructed practice, and the inactive control group (no training or practice). The experimental group's training sessions consisted of two 5-minute blocks of wheelchair propulsion training, separated by a 5-minute break, for a total of 60 minutes of wheeling. Breaks included education and discussion related to wheelchair propulsion. Training focused on increasing push angle, decreasing push frequency, decreasing negative braking forces, and using a circular wheeling pattern with smooth pushes. Main Outcome Measures Temporal spatial and kinetic variables (ie, push angle, push frequency, total and tangential forces, negative force) were evaluated during steady-state wheeling and biomechanical variables were assessed with the SmartWheel Clinical Protocol to identify transfer. Results The training group significantly increased push angle and decreased push frequency compared with the practice (P<.05 and control groups which were retained over time transferred to overground wheeling on tile the dose-matched practice group did not differ from inactive for any variables>.05). Conclusions Older adults improve select biomechanical variables following motor skill-based training, which are retained over time and transfer to overground wheeling. Participants in the active control group did not improve with uninstructed practice compared with the inactive control group.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 1 (2020) . - p. 11-19

Titre :	Measuring Pain in TBI: Development of the TBI-QOL Pain Interference Item Bank and Short Form
Type de document :	Article
Auteurs :	Noelle E. Carlozzi ; Pamela A. Kisala ; Aaron J. Boulton
Année de publication :	2020
Article en page(s) :	p. 11-19
Note générale :	https://doi.org/10.1016/j.apmr.2019.07.019
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Douleur ; Enquêtes et questionnaires ; Évaluation de résultat (soins) ; Lésions encéphaliques ; Lésions traumatiques de l'encéphale ; Qualité de vie ; Réadaptation
Résumé :	Objective To develop a pain interference item bank, computer adaptive test (CAT), and short form for use by individuals with traumatic brain injury (TBI). Design Cross-sectional survey study. Setting Five TBI Model Systems rehabilitation hospitals. Participants Individuals with TBI (N=590). Interventions Not applicable. Outcome Measures Traumatic Brain Injury–Quality of Life (TBI-QOL) Pain Interference item bank. Results Confirmatory factor analysis provided evidence of a single underlying trait (χ2 [740]=3254.030; P<.001 comparative fix index="0.988;" tucker-lewis root mean square error of approximation="0.076)" and a graded response model supported item fit pain interference items. items did not exhibit differential functioning or local dependence. grm calibration data were used to inform the selection static short form program tbi-qol cat. analyses indicated excellent comparability reliability across test administration formats.> Conclusion The 40-item TBI-QOL Pain Interference item bank demonstrated strong psychometric properties. End users can administer this measure as either a 10-item short form or CAT.
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[article] Measuring Pain in TBI: Development of the TBI-QOL Pain Interference Item Bank and Short Form [Article] / Noelle E. Carlozzi ; Pamela A. Kisala ; Aaron J. Boulton . - 2020 . - p. 11-19.
https://doi.org/10.1016/j.apmr.2019.07.019
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 1 (2020) . - p. 11-19

Descripteurs :	HE Vinci Douleur ; Enquêtes et questionnaires ; Évaluation de résultat (soins) ; Lésions encéphaliques ; Lésions traumatiques de l'encéphale ; Qualité de vie ; Réadaptation
Résumé :	Objective To develop a pain interference item bank, computer adaptive test (CAT), and short form for use by individuals with traumatic brain injury (TBI). Design Cross-sectional survey study. Setting Five TBI Model Systems rehabilitation hospitals. Participants Individuals with TBI (N=590). Interventions Not applicable. Outcome Measures Traumatic Brain Injury–Quality of Life (TBI-QOL) Pain Interference item bank. Results Confirmatory factor analysis provided evidence of a single underlying trait (χ2 [740]=3254.030; P<.001 comparative fix index="0.988;" tucker-lewis root mean square error of approximation="0.076)" and a graded response model supported item fit pain interference items. items did not exhibit differential functioning or local dependence. grm calibration data were used to inform the selection static short form program tbi-qol cat. analyses indicated excellent comparability reliability across test administration formats.> Conclusion The 40-item TBI-QOL Pain Interference item bank demonstrated strong psychometric properties. End users can administer this measure as either a 10-item short form or CAT.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 1 (2020) . - p. 20-32

Titre :	Development and Calibration of the TBI-QOL Ability to Participate in Social Roles and Activities and TBI-QOL Satisfaction With Social Roles and Activities Item Banks and Short Forms
Type de document :	Article
Auteurs :	Allen W. Heinemann ; Pamela A. Kisala ; Aaron J. Boulton
Année de publication :	2020
Article en page(s) :	p. 20-32
Note générale :	https://doi.org/10.1016/j.apmr.2019.07.015
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Lésions traumatiques de l'encéphale ; Mesures des résultats rapportés par les patients ; Participation sociale ; Psychométrie ; Qualité de vie ; Réadaptation
Résumé :	Objective To develop traumatic brain injury (TBI)-optimized versions of the Quality of Life in Neurological Disorders (Neuro-QoL) Ability to Participate in Social Roles and Activities and Satisfaction with Social Roles and Activities item banks, evaluate the psychometric properties of the item banks developed for adults with TBI, develop short form and computer adaptive test (CAT) versions, and report information to facilitate research and clinical applications. Design We used a mixed methods design to develop and evaluate Ability to Participate in Social Roles and Activities and Satisfaction with Social Roles and Activities items. Focus groups defined the constructs, cognitive interviews guided item revisions, and confirmatory factor analysis and item response theory methods helped calibrate item banks and evaluate differential item functioning related to demographic and injury characteristics. Setting Five TBI Model Systems centers in the United States. Participants Community-dwelling adults with TBI (N=556). Interventions None. Outcome Measures Traumatic Brain Injury–Quality of Life (TBI-QOL) Ability to Participate in Social Roles and Activities and TBI-QOL Satisfaction with Social Roles and Activities item banks. Results Forty-five Ability to Participate in Social Roles and Activities and 41 Satisfaction with Social Roles and Activities items demonstrated good psychometric properties. Although some of the items are new, most were drawn from analogous banks in the Neuro-QoL measurement system. Consequently, the 2 TBI-QOL item banks were linked to the Neuro-QoL metric, and scores are comparable with the general population. All CAT and short forms correlated highly (>0.90) with the full item banks and demonstrate comparable construct coverage and measurement error. Conclusion The TBI-QOL Ability to Participate in Social Roles and Activities and TBI-QOL Satisfaction with Social Roles and Activities item banks are TBI-optimized versions of the Neuro-QoL Ability to Participate in Social Roles and Activities and Satisfaction with Social Roles and Activities item banks and demonstrate excellent measurement properties in individuals with TBI. These measures, particularly in CAT or short form format, are suitable for efficient and precise measurement of social outcomes in clinical and research applications.
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[article] Development and Calibration of the TBI-QOL Ability to Participate in Social Roles and Activities and TBI-QOL Satisfaction With Social Roles and Activities Item Banks and Short Forms [Article] / Allen W. Heinemann ; Pamela A. Kisala ; Aaron J. Boulton . - 2020 . - p. 20-32.
https://doi.org/10.1016/j.apmr.2019.07.015
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 1 (2020) . - p. 20-32

Descripteurs :	HE Vinci Lésions traumatiques de l'encéphale ; Mesures des résultats rapportés par les patients ; Participation sociale ; Psychométrie ; Qualité de vie ; Réadaptation
Résumé :	Objective To develop traumatic brain injury (TBI)-optimized versions of the Quality of Life in Neurological Disorders (Neuro-QoL) Ability to Participate in Social Roles and Activities and Satisfaction with Social Roles and Activities item banks, evaluate the psychometric properties of the item banks developed for adults with TBI, develop short form and computer adaptive test (CAT) versions, and report information to facilitate research and clinical applications. Design We used a mixed methods design to develop and evaluate Ability to Participate in Social Roles and Activities and Satisfaction with Social Roles and Activities items. Focus groups defined the constructs, cognitive interviews guided item revisions, and confirmatory factor analysis and item response theory methods helped calibrate item banks and evaluate differential item functioning related to demographic and injury characteristics. Setting Five TBI Model Systems centers in the United States. Participants Community-dwelling adults with TBI (N=556). Interventions None. Outcome Measures Traumatic Brain Injury–Quality of Life (TBI-QOL) Ability to Participate in Social Roles and Activities and TBI-QOL Satisfaction with Social Roles and Activities item banks. Results Forty-five Ability to Participate in Social Roles and Activities and 41 Satisfaction with Social Roles and Activities items demonstrated good psychometric properties. Although some of the items are new, most were drawn from analogous banks in the Neuro-QoL measurement system. Consequently, the 2 TBI-QOL item banks were linked to the Neuro-QoL metric, and scores are comparable with the general population. All CAT and short forms correlated highly (>0.90) with the full item banks and demonstrate comparable construct coverage and measurement error. Conclusion The TBI-QOL Ability to Participate in Social Roles and Activities and TBI-QOL Satisfaction with Social Roles and Activities item banks are TBI-optimized versions of the Neuro-QoL Ability to Participate in Social Roles and Activities and Satisfaction with Social Roles and Activities item banks and demonstrate excellent measurement properties in individuals with TBI. These measures, particularly in CAT or short form format, are suitable for efficient and precise measurement of social outcomes in clinical and research applications.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 1 (2020) . - p. 33-42

Titre :	Development and Psychometric Characteristics of the TBI-QOL Independence Item Bank and Short Form and the TBI-QOL Asking for Help Scale
Type de document :	Article
Auteurs :	Pamela A. Kisala ; David S. Tulsky ; Aaron J. Boulton
Année de publication :	2020
Article en page(s) :	p. 33-42
Note générale :	https://doi.org/10.1016/j.apmr.2019.08.469
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Autonomie personnelle ; Comportement de recherche d'aide ; Évaluation des résultats des patients ; Lésions encéphaliques ; Réadaptation ; Vie autonome
Résumé :	Objective To develop an item response theory (IRT)-calibrated, patient-reported outcome measure of subjective independence for individuals with traumatic brain injury (TBI). Design Large-scale item calibration field testing; confirmatory factor analysis (CFA) and graded response model IRT analyses. Setting Five TBI Model System centers across the United States. Participants Adults with complicated mild, moderate, or severe TBI (N=556). Outcome Measures Traumatic Brain Injury–Quality of Life (TBI-QOL) Independence item bank and the TBI-QOL Asking for Help scale. Results A total of 556 individuals completed 44 items in the Independence item pool. Initial factor analyses indicated that items related to the idea of “asking for help” were measuring a different construct from other items in the pool. These 9 items were set aside. Twenty-two other items were removed because of bimodal distributions and/or low item-total correlations. CFA supported unidimensionality of the remaining Independence items. Graded response model IRT analysis was used to estimate slopes and thresholds for the final 13 Independence items. An 8-item fixed-length short form was also developed. The 9 Asking for Help items were analyzed separately. One misfitting item was deleted, and the final 8 items became a fixed-length IRT-calibrated scale. Reliability was high for both measures. Conclusions The IRT-calibrated TBI-QOL Independence item bank and short form and TBI-QOL Asking for Help scale may be used to measure important issues for individuals with TBI in research and clinical applications.
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[article] Development and Psychometric Characteristics of the TBI-QOL Independence Item Bank and Short Form and the TBI-QOL Asking for Help Scale [Article] / Pamela A. Kisala ; David S. Tulsky ; Aaron J. Boulton . - 2020 . - p. 33-42.
https://doi.org/10.1016/j.apmr.2019.08.469
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 1 (2020) . - p. 33-42

Descripteurs :	HE Vinci Autonomie personnelle ; Comportement de recherche d'aide ; Évaluation des résultats des patients ; Lésions encéphaliques ; Réadaptation ; Vie autonome
Résumé :	Objective To develop an item response theory (IRT)-calibrated, patient-reported outcome measure of subjective independence for individuals with traumatic brain injury (TBI). Design Large-scale item calibration field testing; confirmatory factor analysis (CFA) and graded response model IRT analyses. Setting Five TBI Model System centers across the United States. Participants Adults with complicated mild, moderate, or severe TBI (N=556). Outcome Measures Traumatic Brain Injury–Quality of Life (TBI-QOL) Independence item bank and the TBI-QOL Asking for Help scale. Results A total of 556 individuals completed 44 items in the Independence item pool. Initial factor analyses indicated that items related to the idea of “asking for help” were measuring a different construct from other items in the pool. These 9 items were set aside. Twenty-two other items were removed because of bimodal distributions and/or low item-total correlations. CFA supported unidimensionality of the remaining Independence items. Graded response model IRT analysis was used to estimate slopes and thresholds for the final 13 Independence items. An 8-item fixed-length short form was also developed. The 9 Asking for Help items were analyzed separately. One misfitting item was deleted, and the final 8 items became a fixed-length IRT-calibrated scale. Reliability was high for both measures. Conclusions The IRT-calibrated TBI-QOL Independence item bank and short form and TBI-QOL Asking for Help scale may be used to measure important issues for individuals with TBI in research and clinical applications.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 1 (2020) . - p. 43-53

Titre :	Development of Composite Scores for the TBI-QOL
Type de document :	Article
Auteurs :	Callie E. Tyner ; Aaron J. Boulton ; Mark Sherer
Année de publication :	2020
Article en page(s) :	p. 43-53
Note générale :	https://doi.org/10.1016/j.apmr.2018.05.036
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Lésions traumatiques de l'encéphale ; Mesures des résultats rapportés par les patients ; Psychométrie ; Qualité de vie ; Réadaptation
Résumé :	Objective To develop a set of composite scores that can be used for interpreting quality of life (QOL) after traumatic brain injury (TBI) using 9 of the patient-reported outcomes measures from the Traumatic Brain Injury Quality of Life (TBI-QOL) measurement system. Design Participants completed 20 item banks from the TBI-QOL as part of a larger assessment. Composite index scores were created with normalized transformation with nonlinear area conversion using scores from 9 of the banks, and are expressed in index score units, with higher composite scores indicating better functioning. For descriptive purposes, associations among composites and individual banks were evaluated using regression, along with patterns of composite scores by injury severity groups using analysis of variance. Setting Three medical centers in the United States. Participants Community-dwelling adults (n=504) with a history of TBI. Interventions Not applicable. Main Outcomes Measure TBI-QOL. Results Five composite indices were generated: global QOL, physical health, emotional health, cognitive health, and social health. Lookup tables are provided herein. Composite scores were highly intercorrelated (all r>.60, P<.0001 and individual tbi-qol banks all correlate strongly with the global qol composite in expected direction r>.50, P<.0001> Conclusion Researchers and clinicians can use the TBI-QOL global QOL, physical health, emotional health, cognitive health, and social health composite scores to aggregate results from multiple TBI-QOL banks, which is anticipated to ease interpretation and reliability. This work additionally highlights the importance of considering nonphysical symptoms as outcomes variables for TBI research, as cognitive, social, and emotional domains were some of the most strongly correlated banks with the global QOL composite.
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[article] Development of Composite Scores for the TBI-QOL [Article] / Callie E. Tyner ; Aaron J. Boulton ; Mark Sherer . - 2020 . - p. 43-53.
https://doi.org/10.1016/j.apmr.2018.05.036
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 1 (2020) . - p. 43-53

Descripteurs :	HE Vinci Lésions traumatiques de l'encéphale ; Mesures des résultats rapportés par les patients ; Psychométrie ; Qualité de vie ; Réadaptation
Résumé :	Objective To develop a set of composite scores that can be used for interpreting quality of life (QOL) after traumatic brain injury (TBI) using 9 of the patient-reported outcomes measures from the Traumatic Brain Injury Quality of Life (TBI-QOL) measurement system. Design Participants completed 20 item banks from the TBI-QOL as part of a larger assessment. Composite index scores were created with normalized transformation with nonlinear area conversion using scores from 9 of the banks, and are expressed in index score units, with higher composite scores indicating better functioning. For descriptive purposes, associations among composites and individual banks were evaluated using regression, along with patterns of composite scores by injury severity groups using analysis of variance. Setting Three medical centers in the United States. Participants Community-dwelling adults (n=504) with a history of TBI. Interventions Not applicable. Main Outcomes Measure TBI-QOL. Results Five composite indices were generated: global QOL, physical health, emotional health, cognitive health, and social health. Lookup tables are provided herein. Composite scores were highly intercorrelated (all r>.60, P<.0001 and individual tbi-qol banks all correlate strongly with the global qol composite in expected direction r>.50, P<.0001> Conclusion Researchers and clinicians can use the TBI-QOL global QOL, physical health, emotional health, cognitive health, and social health composite scores to aggregate results from multiple TBI-QOL banks, which is anticipated to ease interpretation and reliability. This work additionally highlights the importance of considering nonphysical symptoms as outcomes variables for TBI research, as cognitive, social, and emotional domains were some of the most strongly correlated banks with the global QOL composite.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 1 (2020) . - p. 54-61

Titre :	Responsiveness of the Traumatic Brain Injury–Quality of Life (TBI-QOL) Measurement System
Type de document :	Article
Auteurs :	Julia M.P. Poritz ; Mark Sherer ; Pamela A. Kisala
Année de publication :	2020
Article en page(s) :	p. 54-61
Note générale :	https://doi.org/10.1016/j.apmr.2017.11.018
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Lésions traumatiques de l'encéphale ; Mesures des résultats rapportés par les patients ; Qualité de vie
Résumé :	Objective To assess the responsiveness of the Traumatic Brain Injury–Quality of Life (TBI-QOL) measurement system. Design Participants completed the 20 TBI-QOL item banks and the Participation Assessment with Recombined Tools–Objective (PART-O) Productivity Subscale at baseline and 6-month follow-up assessments. Participants were categorized into 4 groups (increased productivity, unchanged productivity, and decreased productivity) based on PART-O Productivity scores. Paired sample t tests were used to compare TBI-QOL scores at baseline and 6 months, and standardized response means and Cohen's d were computed to estimate effect sizes. Setting Three traumatic brain injury (TBI) Model Systems rehabilitation centers in the United States. Participants Two hundred one community-dwelling adults with TBI. Interventions Not applicable. Main Outcome Measures 20 TBI-QOL item banks. Results As expected, given that there was no intervention, group mean TBI-QOL subdomain scores for the entire sample showed no change or small improvement over the 6-month study period. At the follow-up assessment, 72 participants reported increased productivity, 71 reported decreased productivity, and 58 reported the same level of productivity as they had 6 months prior. When compared with participants who reported unchanged or decreased productivity, participants who reported increased productivity on the PART-O subscale had clinically meaningful (d≥0.30) improvements on 7 TBI-QOL measures. The largest improvement was in the Independence subdomain (mean change, 7.06; df=0.84), with differences also observed in the Mobility, Positive Affect and Well-Being, Resilience, Grief/Loss, Ability to Participate, and Satisfaction with Participation subdomains. Conclusions The 20 TBI-QOL item banks demonstrate responsiveness to change and measurement stability in a community-dwelling sample. Researchers may use the TBI-QOL to detect changes in HRQOL after a clinical intervention and clinicians may use it in their daily practices to monitor patient recovery.
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[article] Responsiveness of the Traumatic Brain Injury–Quality of Life (TBI-QOL) Measurement System [Article] / Julia M.P. Poritz ; Mark Sherer ; Pamela A. Kisala . - 2020 . - p. 54-61.
https://doi.org/10.1016/j.apmr.2017.11.018
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 1 (2020) . - p. 54-61

Descripteurs :	HE Vinci Lésions traumatiques de l'encéphale ; Mesures des résultats rapportés par les patients ; Qualité de vie
Résumé :	Objective To assess the responsiveness of the Traumatic Brain Injury–Quality of Life (TBI-QOL) measurement system. Design Participants completed the 20 TBI-QOL item banks and the Participation Assessment with Recombined Tools–Objective (PART-O) Productivity Subscale at baseline and 6-month follow-up assessments. Participants were categorized into 4 groups (increased productivity, unchanged productivity, and decreased productivity) based on PART-O Productivity scores. Paired sample t tests were used to compare TBI-QOL scores at baseline and 6 months, and standardized response means and Cohen's d were computed to estimate effect sizes. Setting Three traumatic brain injury (TBI) Model Systems rehabilitation centers in the United States. Participants Two hundred one community-dwelling adults with TBI. Interventions Not applicable. Main Outcome Measures 20 TBI-QOL item banks. Results As expected, given that there was no intervention, group mean TBI-QOL subdomain scores for the entire sample showed no change or small improvement over the 6-month study period. At the follow-up assessment, 72 participants reported increased productivity, 71 reported decreased productivity, and 58 reported the same level of productivity as they had 6 months prior. When compared with participants who reported unchanged or decreased productivity, participants who reported increased productivity on the PART-O subscale had clinically meaningful (d≥0.30) improvements on 7 TBI-QOL measures. The largest improvement was in the Independence subdomain (mean change, 7.06; df=0.84), with differences also observed in the Mobility, Positive Affect and Well-Being, Resilience, Grief/Loss, Ability to Participate, and Satisfaction with Participation subdomains. Conclusions The 20 TBI-QOL item banks demonstrate responsiveness to change and measurement stability in a community-dwelling sample. Researchers may use the TBI-QOL to detect changes in HRQOL after a clinical intervention and clinicians may use it in their daily practices to monitor patient recovery.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 1 (2020) . - p. 62-71

Titre :	Conceptual Structure of Health-Related Quality of Life for Persons With Traumatic Brain Injury: Confirmatory Factor Analysis of the TBI-QOL
Type de document :	Article
Auteurs :	Mark Sherer ; Julia M.P. Poritz ; David Tulsky
Année de publication :	2020
Article en page(s) :	p. 62-71
Note générale :	https://doi.org/10.1016/j.apmr.2017.04.016
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Analyse statistique factorielle ; Lésions traumatiques de l'encéphale ; Mesures des résultats rapportés par les patients ; Qualité de vie ; Réadaptation
Résumé :	Objective To determine the factor structure of the Traumatic Brain Injury–Quality of Life (TBI-QOL) measurement system. Design Observational. Setting 3 TBI Model Systems rehabilitation centers. Participants Twenty TBI-QOL item banks were administered to a sample of community-dwelling adults with TBI (N=504) as part of a study of TBI classification. A subsample of participants (n=200) was randomly selected for exploratory factor analyses, while data from the remaining participants (n=304) were used for the confirmatory factor analysis. To examine a wide range of conceptual models, confirmatory factor analyses were conducted on a total of 16 models, ranging from 1 to 7 factors. Interventions Not applicable. Main Outcome Measures Not applicable. Results Initial exploratory factor analysis yielded support for a 5-factor model (negative emotion, cognitive impairment, functioning and participation, positive emotion, pain). Confirmatory factor analysis results, however, indicated a 7-factor model including physical function, physical symptoms, cognition, negative emotion, positive emotion, sense of self, and social participation (model 16; robust fit statistics root mean square error of approximation =.063, standardized root mean square residual =.035, comparative fit index =.955, Tucker-Lewis Index =.943, Bayes Information Criterion =40059.44). Conclusions The complex 7-factor model of the TBI-QOL provides a more nuanced framework for understanding health-related quality of life for persons with TBI than the commonly used 3-factor model including physical health, mental health, and social health.
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[article] Conceptual Structure of Health-Related Quality of Life for Persons With Traumatic Brain Injury: Confirmatory Factor Analysis of the TBI-QOL [Article] / Mark Sherer ; Julia M.P. Poritz ; David Tulsky . - 2020 . - p. 62-71.
https://doi.org/10.1016/j.apmr.2017.04.016
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 1 (2020) . - p. 62-71

Descripteurs :	HE Vinci Analyse statistique factorielle ; Lésions traumatiques de l'encéphale ; Mesures des résultats rapportés par les patients ; Qualité de vie ; Réadaptation
Résumé :	Objective To determine the factor structure of the Traumatic Brain Injury–Quality of Life (TBI-QOL) measurement system. Design Observational. Setting 3 TBI Model Systems rehabilitation centers. Participants Twenty TBI-QOL item banks were administered to a sample of community-dwelling adults with TBI (N=504) as part of a study of TBI classification. A subsample of participants (n=200) was randomly selected for exploratory factor analyses, while data from the remaining participants (n=304) were used for the confirmatory factor analysis. To examine a wide range of conceptual models, confirmatory factor analyses were conducted on a total of 16 models, ranging from 1 to 7 factors. Interventions Not applicable. Main Outcome Measures Not applicable. Results Initial exploratory factor analysis yielded support for a 5-factor model (negative emotion, cognitive impairment, functioning and participation, positive emotion, pain). Confirmatory factor analysis results, however, indicated a 7-factor model including physical function, physical symptoms, cognition, negative emotion, positive emotion, sense of self, and social participation (model 16; robust fit statistics root mean square error of approximation =.063, standardized root mean square residual =.035, comparative fit index =.955, Tucker-Lewis Index =.943, Bayes Information Criterion =40059.44). Conclusions The complex 7-factor model of the TBI-QOL provides a more nuanced framework for understanding health-related quality of life for persons with TBI than the commonly used 3-factor model including physical health, mental health, and social health.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 1 (2020) . - p. 72-80

Titre :	Cognitive Reserve Moderates Cognitive Outcome After Mild Traumatic Brain Injury
Type de document :	Article
Auteurs :	Jonas Stenberg ; Asta K. Håberg ; Turid Follestad
Année de publication :	2020
Article en page(s) :	p. 72-80
Note générale :	https://doi.org/10.1016/j.apmr.2019.08.477
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Etudes longitudinales ; Lésions encéphaliques ; Neuropsychologie ; Réadaptation ; Réserve cognitive ; Syndrome post-commotionnel
Résumé :	Objective To investigate whether cognitive reserve moderates differences in cognitive functioning between patients with mild traumatic brain injury (MTBI) and controls without MTBI and to examine whether patients with postconcussion syndrome have lower cognitive functioning than patients without postconcussion syndrome at 2 weeks and 3 months after injury. Design Trondheim MTBI follow-up study is a longitudinal controlled cohort study with cognitive assessments 2 weeks and 3 months after injury. Setting Recruitment at a level 1 trauma center and at a general practitioner-run, outpatient clinic. Participants Patients with MTBI (n=160) according to the World Health Organization criteria, trauma controls (n=71), and community controls (n=79) (N=310). Main Outcome Measures A cognitive composite score was used as outcome measure. The Vocabulary subtest was used as a proxy of cognitive reserve. Postconcussion syndrome diagnosis was assessed at 3 months with the British Columbia Postconcussion Symptom Inventory. Results Linear mixed models demonstrated that the effect of vocabulary scores on the cognitive composite scores was larger in patients with MTBI than in community controls at 2 weeks and at 3 months after injury (P=.001). Thus, group differences in the cognitive composite score varied as a function of vocabulary scores, with the biggest differences seen among participants with lower vocabulary scores. There were no significant differences in the cognitive composite score between patients with (n=29) and without (n=131) postconcussion syndrome at 2 weeks or 3 months after injury. Conclusion Cognitive reserve, but not postconcussion syndrome, was associated with cognitive outcome after MTBI. This supports the cognitive reserve hypothesis in the MTBI context and suggests that persons with low cognitive reserve are more vulnerable to reduced cognitive functioning if they sustain an MTBI.
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[article] Cognitive Reserve Moderates Cognitive Outcome After Mild Traumatic Brain Injury [Article] / Jonas Stenberg ; Asta K. Håberg ; Turid Follestad . - 2020 . - p. 72-80.
https://doi.org/10.1016/j.apmr.2019.08.477
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 1 (2020) . - p. 72-80

Descripteurs :	HE Vinci Etudes longitudinales ; Lésions encéphaliques ; Neuropsychologie ; Réadaptation ; Réserve cognitive ; Syndrome post-commotionnel
Résumé :	Objective To investigate whether cognitive reserve moderates differences in cognitive functioning between patients with mild traumatic brain injury (MTBI) and controls without MTBI and to examine whether patients with postconcussion syndrome have lower cognitive functioning than patients without postconcussion syndrome at 2 weeks and 3 months after injury. Design Trondheim MTBI follow-up study is a longitudinal controlled cohort study with cognitive assessments 2 weeks and 3 months after injury. Setting Recruitment at a level 1 trauma center and at a general practitioner-run, outpatient clinic. Participants Patients with MTBI (n=160) according to the World Health Organization criteria, trauma controls (n=71), and community controls (n=79) (N=310). Main Outcome Measures A cognitive composite score was used as outcome measure. The Vocabulary subtest was used as a proxy of cognitive reserve. Postconcussion syndrome diagnosis was assessed at 3 months with the British Columbia Postconcussion Symptom Inventory. Results Linear mixed models demonstrated that the effect of vocabulary scores on the cognitive composite scores was larger in patients with MTBI than in community controls at 2 weeks and at 3 months after injury (P=.001). Thus, group differences in the cognitive composite score varied as a function of vocabulary scores, with the biggest differences seen among participants with lower vocabulary scores. There were no significant differences in the cognitive composite score between patients with (n=29) and without (n=131) postconcussion syndrome at 2 weeks or 3 months after injury. Conclusion Cognitive reserve, but not postconcussion syndrome, was associated with cognitive outcome after MTBI. This supports the cognitive reserve hypothesis in the MTBI context and suggests that persons with low cognitive reserve are more vulnerable to reduced cognitive functioning if they sustain an MTBI.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 1 (2020) . - p. 81-88

Titre :	Posttraumatic Stress Disorder Symptoms Contribute to Staff Perceived Irritability, Anger, and Aggression After TBI in a Longitudinal Veteran Cohort: A VA TBI Model Systems Study
Type de document :	Article
Auteurs :	Shannon R. Miles ; Lisa A. Brenner ; Dawn Neumann
Année de publication :	2020
Article en page(s) :	p. 81-88
Note générale :	https://doi.org/10.1016/j.apmr.2019.07.018
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Agressivité ; Anciens combattants ; Colère ; Lésions traumatiques de l'encéphale ; Réadaptation ; Troubles de stress post-traumatique
Résumé :	Objective To examine the relationship between staff perceived irritability, anger, and aggression and posttraumatic stress disorder (PTSD) in veterans with traumatic brain injury (TBI) of all severity levels. Design Longitudinal cohort design. Setting Veterans Affairs Polytrauma Transitional Rehabilitation Programs. Participants Veterans and service members with TBI of all severity levels enrolled in the Veterans Affairs Polytrauma Rehabilitation Centers’ Traumatic Brain Injury Model System national database (N=240). Interventions Not applicable. Main Outcome Measure Univariable and multivariable logistic regression modeling was used to examine the association between irritability, anger, and aggression and potential risk factors, including PTSD symptoms. Irritability, anger, and aggression was measured as a single construct using an item from the Mayo-Portland Adaptability Inventory-4 that was rated by program staff at admission and discharge from the inpatient rehabilitation program. PTSD symptoms were assessed using the PTSD Checklist–Civilian Version. Results PTSD symptoms uniquely predicted program staff-rated irritability, anger, and aggression at discharge even after controlling for severity of TBI, age, male sex, education, and annual earnings. The model explained 19% of the variance in irritability, anger, and aggression. Conclusions When TBI severity and PTSD symptoms were considered simultaneously in a sample of veterans, only PTSD symptoms predicted staff-rated irritability, anger, and aggression. Given the negative outcomes linked with irritability, anger, and aggression, veterans may benefit from assessment and treatment of PTSD symptoms within rehabilitation settings.
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[article] Posttraumatic Stress Disorder Symptoms Contribute to Staff Perceived Irritability, Anger, and Aggression After TBI in a Longitudinal Veteran Cohort: A VA TBI Model Systems Study [Article] / Shannon R. Miles ; Lisa A. Brenner ; Dawn Neumann . - 2020 . - p. 81-88.
https://doi.org/10.1016/j.apmr.2019.07.018
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 1 (2020) . - p. 81-88

Descripteurs :	HE Vinci Agressivité ; Anciens combattants ; Colère ; Lésions traumatiques de l'encéphale ; Réadaptation ; Troubles de stress post-traumatique
Résumé :	Objective To examine the relationship between staff perceived irritability, anger, and aggression and posttraumatic stress disorder (PTSD) in veterans with traumatic brain injury (TBI) of all severity levels. Design Longitudinal cohort design. Setting Veterans Affairs Polytrauma Transitional Rehabilitation Programs. Participants Veterans and service members with TBI of all severity levels enrolled in the Veterans Affairs Polytrauma Rehabilitation Centers’ Traumatic Brain Injury Model System national database (N=240). Interventions Not applicable. Main Outcome Measure Univariable and multivariable logistic regression modeling was used to examine the association between irritability, anger, and aggression and potential risk factors, including PTSD symptoms. Irritability, anger, and aggression was measured as a single construct using an item from the Mayo-Portland Adaptability Inventory-4 that was rated by program staff at admission and discharge from the inpatient rehabilitation program. PTSD symptoms were assessed using the PTSD Checklist–Civilian Version. Results PTSD symptoms uniquely predicted program staff-rated irritability, anger, and aggression at discharge even after controlling for severity of TBI, age, male sex, education, and annual earnings. The model explained 19% of the variance in irritability, anger, and aggression. Conclusions When TBI severity and PTSD symptoms were considered simultaneously in a sample of veterans, only PTSD symptoms predicted staff-rated irritability, anger, and aggression. Given the negative outcomes linked with irritability, anger, and aggression, veterans may benefit from assessment and treatment of PTSD symptoms within rehabilitation settings.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 1 (2020) . - p. 89-94

Titre :	Frequency of Primary Neck Pain in Mild Traumatic Brain Injury/Concussion Patients
Type de document :	Article
Auteurs :	Jeffrey A. King ; Michael A. McCrea ; Lindsay D. Nelson
Année de publication :	2020
Article en page(s) :	p. 89-94
Note générale :	https://doi.org/10.1016/j.apmr.2019.08.471
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Cervicalgie ; Commotion de l'encéphale ; Réadaptation ; Service hospitalier d'urgences
Résumé :	Objectives To determine (1) the frequency of neck pain overall and relative to other symptoms in patients presenting to a level I trauma center emergency department (ED) with mild traumatic brain injury (mTBI) and (2) the predictors of primary neck pain in this population. Design Cohort study. Setting Level I trauma center ED. Participants Patients presenting to the ED with symptoms of mTBI having been exposed to an event that could have caused mTBI (N=95). Interventions Not applicable. Main Outcome Measures Frequency of self-reported neck pain as measured by Sport Concussion Assessment Tool 3 (SCAT3) symptom questionnaire at Results The frequency of any reported neck pain was 68.4%, 50.6%, 49%, and 41.9% within 72 hours and at 8, 15, and 45 days, respectively. Frequency of primary neck pain (equal or worse/worse definitions) was 35.8%/17.9%, 34.9%/14.5%, 37%/14.8%, and 39.2%/10.8% across the 4 follow-up assessments. Participants who sustained their injuries in motor vehicle collisions had a higher rate of primary neck pain than those with other mechanisms of injury. Conclusions A sizable percentage of patients who present to level I trauma center EDs with mTBI report neck pain, which is commonly rated as similar to or worse than other mTBI-related symptoms. Primary neck pain is more common after motor vehicle collisions than with other mechanisms of injury. These findings support consensus statements identifying cervical injury as an important potential concurrent diagnosis in patients with mTBI.
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[article] Frequency of Primary Neck Pain in Mild Traumatic Brain Injury/Concussion Patients [Article] / Jeffrey A. King ; Michael A. McCrea ; Lindsay D. Nelson . - 2020 . - p. 89-94.
https://doi.org/10.1016/j.apmr.2019.08.471
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 1 (2020) . - p. 89-94

Descripteurs :	HE Vinci Cervicalgie ; Commotion de l'encéphale ; Réadaptation ; Service hospitalier d'urgences
Résumé :	Objectives To determine (1) the frequency of neck pain overall and relative to other symptoms in patients presenting to a level I trauma center emergency department (ED) with mild traumatic brain injury (mTBI) and (2) the predictors of primary neck pain in this population. Design Cohort study. Setting Level I trauma center ED. Participants Patients presenting to the ED with symptoms of mTBI having been exposed to an event that could have caused mTBI (N=95). Interventions Not applicable. Main Outcome Measures Frequency of self-reported neck pain as measured by Sport Concussion Assessment Tool 3 (SCAT3) symptom questionnaire at Results The frequency of any reported neck pain was 68.4%, 50.6%, 49%, and 41.9% within 72 hours and at 8, 15, and 45 days, respectively. Frequency of primary neck pain (equal or worse/worse definitions) was 35.8%/17.9%, 34.9%/14.5%, 37%/14.8%, and 39.2%/10.8% across the 4 follow-up assessments. Participants who sustained their injuries in motor vehicle collisions had a higher rate of primary neck pain than those with other mechanisms of injury. Conclusions A sizable percentage of patients who present to level I trauma center EDs with mTBI report neck pain, which is commonly rated as similar to or worse than other mTBI-related symptoms. Primary neck pain is more common after motor vehicle collisions than with other mechanisms of injury. These findings support consensus statements identifying cervical injury as an important potential concurrent diagnosis in patients with mTBI.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 1 (2020) . - p. 95-105

Titre :	Effect of Rehabilitation Treatments on Disability in Persons With Disorders of Consciousness: A Propensity Score Study
Type de document :	Article
Auteurs :	Davide Sattin ; Matilde Leonardi ; Barbara Nelli
Année de publication :	2020
Article en page(s) :	p. 95-105
Note générale :	https://doi.org/10.1016/j.apmr.2019.07.010
Langues :	Anglais (eng)
Descripteurs :	HE Vinci État végétatif persistant ; Réadaptation ; Score de propension
Résumé :	Objective To evaluate the effects of rehabilitation (physical and cognitive) treatments on the diagnosis severity and Disability Rating Scale (DRS) scores, adjusted for a number of potential confounders measured at baseline, in a large cohort of patients with disorders of consciousness across time. Design and Setting An observational, longitudinal (2 evaluations), multicenter project was made in 90 Italian centers. Participants Patients (N=364) with a diagnosis of disorders of consciousness. Main Outcome Measures Primary outcome was the severity of diagnosis, expressed on an ordinal scale (Other Results A total of 364 subjects having a complete set of demographic, clinical, and pharmacologic data were included in the propensity score (PS) analysis. Results showed that the rehabilitation treatments (physical and cognitive) reduced the clinical worsening over time in both severity diagnosis and DRS (around 6.5 points) in patients with disorders of consciousness across different propensity score strategies (ie, PS matching, PS adjustment, and PS-weighted procedures). In addition, cognitive protocols seem to be limited to patients with a median value of DRS=23. Conclusions Our propensity score analysis suggests that rehabilitation treatment protocols seem effective and should be applied to a broader spectrum of patients with disorders of consciousness.
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[article] Effect of Rehabilitation Treatments on Disability in Persons With Disorders of Consciousness: A Propensity Score Study [Article] / Davide Sattin ; Matilde Leonardi ; Barbara Nelli . - 2020 . - p. 95-105.
https://doi.org/10.1016/j.apmr.2019.07.010
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 1 (2020) . - p. 95-105

Descripteurs :	HE Vinci État végétatif persistant ; Réadaptation ; Score de propension
Résumé :	Objective To evaluate the effects of rehabilitation (physical and cognitive) treatments on the diagnosis severity and Disability Rating Scale (DRS) scores, adjusted for a number of potential confounders measured at baseline, in a large cohort of patients with disorders of consciousness across time. Design and Setting An observational, longitudinal (2 evaluations), multicenter project was made in 90 Italian centers. Participants Patients (N=364) with a diagnosis of disorders of consciousness. Main Outcome Measures Primary outcome was the severity of diagnosis, expressed on an ordinal scale (Other Results A total of 364 subjects having a complete set of demographic, clinical, and pharmacologic data were included in the propensity score (PS) analysis. Results showed that the rehabilitation treatments (physical and cognitive) reduced the clinical worsening over time in both severity diagnosis and DRS (around 6.5 points) in patients with disorders of consciousness across different propensity score strategies (ie, PS matching, PS adjustment, and PS-weighted procedures). In addition, cognitive protocols seem to be limited to patients with a median value of DRS=23. Conclusions Our propensity score analysis suggests that rehabilitation treatment protocols seem effective and should be applied to a broader spectrum of patients with disorders of consciousness.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 1 (2020) . - p. 106-112

Titre :	Effect of Robot-Assisted Gait Training in a Large Population of Children With Motor Impairment Due to Cerebral Palsy or Acquired Brain Injury
Type de document :	Article
Auteurs :	Elena Beretta ; Fabio Alexander Storm ; Sandra Strazzer
Année de publication :	2020
Article en page(s) :	p. 106-112
Note générale :	https://doi.org/10.1016/j.apmr.2019.08.479
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Lésions encéphaliques ; Paralysie cérébrale ; Réadaptation ; Rééducation neurologique
Résumé :	Objective To evaluate retrospectively the effect of robotic rehabilitation in a large group of children with motor impairment; an additional goal was to identify the effects in children with cerebral palsy (CP) and acquired brain injury (ABI) and with different levels of motor impairment according to the Gross Motor Function Classification System. Finally, we examined the effect of time elapsed from injury on children’s functions. Design A cohort, pretest-posttest retrospective study was conducted. Setting Hospitalized care. Participants A total of 182 children, 110 with ABI and 72 with CP and with Gross Motor Function Classification System (GMFCS) levels I-IV, were evaluated retrospectively. Interventions Patients underwent a combined treatment of robot-assisted gait training and physical therapy. Main Outcome Measures All the patients were evaluated before and after the training using the 6-minute walk test and the Gross Motor Function Measure. A linear mixed model with 3 fixed factors and 1 random factor was used to evaluate improvements. Results The 6-minute walk test showed improvement in the whole group and in both ABI and CP. The Gross Motor Function Measure showed improvement in the whole group and in the patients with ABI but not in children with CP. The GMFCS analysis showed that all outcomes improved significantly in all classes within the ABI subgroup, whereas improvements were significant only for GMFCS III in children with CP. Conclusions Children with motor impairment can benefit from a combination of robotic rehabilitation and physical therapy. Our data suggest positive results for the whole group and substantial differences between ABI and CP subgroups, with better results for children with ABI, that seem to be consistently related to time elapsed from injury.
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[article] Effect of Robot-Assisted Gait Training in a Large Population of Children With Motor Impairment Due to Cerebral Palsy or Acquired Brain Injury [Article] / Elena Beretta ; Fabio Alexander Storm ; Sandra Strazzer . - 2020 . - p. 106-112.
https://doi.org/10.1016/j.apmr.2019.08.479
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 1 (2020) . - p. 106-112

Descripteurs :	HE Vinci Lésions encéphaliques ; Paralysie cérébrale ; Réadaptation ; Rééducation neurologique
Résumé :	Objective To evaluate retrospectively the effect of robotic rehabilitation in a large group of children with motor impairment; an additional goal was to identify the effects in children with cerebral palsy (CP) and acquired brain injury (ABI) and with different levels of motor impairment according to the Gross Motor Function Classification System. Finally, we examined the effect of time elapsed from injury on children’s functions. Design A cohort, pretest-posttest retrospective study was conducted. Setting Hospitalized care. Participants A total of 182 children, 110 with ABI and 72 with CP and with Gross Motor Function Classification System (GMFCS) levels I-IV, were evaluated retrospectively. Interventions Patients underwent a combined treatment of robot-assisted gait training and physical therapy. Main Outcome Measures All the patients were evaluated before and after the training using the 6-minute walk test and the Gross Motor Function Measure. A linear mixed model with 3 fixed factors and 1 random factor was used to evaluate improvements. Results The 6-minute walk test showed improvement in the whole group and in both ABI and CP. The Gross Motor Function Measure showed improvement in the whole group and in the patients with ABI but not in children with CP. The GMFCS analysis showed that all outcomes improved significantly in all classes within the ABI subgroup, whereas improvements were significant only for GMFCS III in children with CP. Conclusions Children with motor impairment can benefit from a combination of robotic rehabilitation and physical therapy. Our data suggest positive results for the whole group and substantial differences between ABI and CP subgroups, with better results for children with ABI, that seem to be consistently related to time elapsed from injury.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 1 (2020) . - p. 13-120

Titre :	The Safety and Feasibility of Exoskeletal-Assisted Walking in Acute Rehabilitation After Spinal Cord Injury
Type de document :	Article
Auteurs :	Kyle McIntosh ; Rebecca Charbonneau ; Yassine Bensaada
Année de publication :	2020
Article en page(s) :	p. 13-120
Note générale :	https://doi.org/10.1016/j.apmr.2019.09.005
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Réadaptation ; Securité
Résumé :	Objective To assess safety and feasibility for persons with acute spinal cord injury (SCI) using the robotic exoskeleton. Design Case series observational study. Setting A level-1 trauma center in Canada with both acute and tertiary inpatient SCI rehabilitation units. Participants Eight male and 3 female (N=11) participants were recruited with a mean age of 41 years and with neurologic level of injury (C6-L2) and severity (American Spinal Injury Association Impairment Scale [AIS] A-D). The time since injury is a range of 3-15 weeks at the onset of training. Interventions Up to 25 one-hour sessions of exoskeletal-assisted walking gait training, with participants less than 6 months from initial SCI. Main Outcome Measures Cardiopulmonary outcomes including blood pressure, heart rate, and peripheral oxygen saturation; and perceived physical exertion using the Borg CR10 Scale were recorded. Gait parameters were measured by 6-minute walk test (6MWT) and 10-meter walk test (10MWT). Up Time, walk time, and number of steps were detailed longitudinally. Safety was assessed with regard to pain, falls, and skin integrity. Results No serious adverse events occurred. Blood pressure decreased following initial sit to stand and increased during walking. Symptoms of hypotension were rare and improved with increased number of sessions. Perceived exertion was reported on average to be moderate (mean of 3.1). There was no significant increase in pain scores by Visual Analog Scale. On 6MWT, participants covered more distance (mean [m] ± SD, 117.1±11.7) in session 25 compared to session 2 (mean [m] ± SD, 47.6±6.6). On the 10MWT, all participants showed consistently improved gait speed; with participants traveling an average of 3.2 times faster during their last training session (mean [m/s] ± SD, 0.40±0.04) in comparison to session 2 (mean [m/s] ± SD, 0.12±0.01). Conclusions Exoskeletal-assisted walking in acute rehabilitation (
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[article] The Safety and Feasibility of Exoskeletal-Assisted Walking in Acute Rehabilitation After Spinal Cord Injury [Article] / Kyle McIntosh ; Rebecca Charbonneau ; Yassine Bensaada . - 2020 . - p. 13-120.
https://doi.org/10.1016/j.apmr.2019.09.005
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 1 (2020) . - p. 13-120

Descripteurs :	HE Vinci Réadaptation ; Securité
Résumé :	Objective To assess safety and feasibility for persons with acute spinal cord injury (SCI) using the robotic exoskeleton. Design Case series observational study. Setting A level-1 trauma center in Canada with both acute and tertiary inpatient SCI rehabilitation units. Participants Eight male and 3 female (N=11) participants were recruited with a mean age of 41 years and with neurologic level of injury (C6-L2) and severity (American Spinal Injury Association Impairment Scale [AIS] A-D). The time since injury is a range of 3-15 weeks at the onset of training. Interventions Up to 25 one-hour sessions of exoskeletal-assisted walking gait training, with participants less than 6 months from initial SCI. Main Outcome Measures Cardiopulmonary outcomes including blood pressure, heart rate, and peripheral oxygen saturation; and perceived physical exertion using the Borg CR10 Scale were recorded. Gait parameters were measured by 6-minute walk test (6MWT) and 10-meter walk test (10MWT). Up Time, walk time, and number of steps were detailed longitudinally. Safety was assessed with regard to pain, falls, and skin integrity. Results No serious adverse events occurred. Blood pressure decreased following initial sit to stand and increased during walking. Symptoms of hypotension were rare and improved with increased number of sessions. Perceived exertion was reported on average to be moderate (mean of 3.1). There was no significant increase in pain scores by Visual Analog Scale. On 6MWT, participants covered more distance (mean [m] ± SD, 117.1±11.7) in session 25 compared to session 2 (mean [m] ± SD, 47.6±6.6). On the 10MWT, all participants showed consistently improved gait speed; with participants traveling an average of 3.2 times faster during their last training session (mean [m/s] ± SD, 0.40±0.04) in comparison to session 2 (mean [m/s] ± SD, 0.12±0.01). Conclusions Exoskeletal-assisted walking in acute rehabilitation (
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 1 (2020) . - p. 121-129

Titre :	Differences in Acute Metabolic Responses to Bionic and Nonbionic Ambulation in Spinal Cord Injured Humans and Controls
Type de document :	Article
Auteurs :	Jennifer L. Maher ; Carsten Bach Baunsgaard ; Jan van Gerven
Année de publication :	2020
Article en page(s) :	p. 121-129
Note générale :	https://doi.org/10.1016/j.apmr.2019.07.014
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Dispositif d'exosquelette ; Exercice physique ; Metabolisme ; Réadaptation ; Traumatismes de la moelle épinière
Résumé :	Objectives To (1) compare energy expenditure during seated rest, standing, and prolonged bionic ambulation or bipedal ambulation in participants with spinal cord injury (SCI) and noninjured controls, respectively, and (2) test effects on postbionic ambulation glycemia in SCI. Design Two independent group comparison of SCI and controls. Setting Academic Medical Center. Participants Ten participants with chronic SCI (C7-T1, American Spinal Injury Association Impairment Scale A-C) and 10 controls (N=20). Interventions A commercial bionic exoskeleton. Main Outcome Measures Absolute and relative (to peak) oxygen consumption, perceived exertion, carbohydrate/fat oxidation, energy expenditure, and postbionic ambulation plasma glucose/insulin. Results Average work intensity accompanying 45 minutes of outdoor bionic ambulation was Conclusion Work intensity during prolonged bionic ambulation for this bionic exoskeleton is below a threshold for cardiorespiratory conditioning but above seated rest and passive standing. Bionic ambulation metabolism is consistent with low RPE and unchanged fuel partitioning from seated rest. Bionic ambulation did not promote beneficial effects on glycemia in well-conditioned, euglycemic participants. These findings may differ in less fit individuals with SCI or those with impaired glucose tolerance. Observed trends favoring this benefit suggest they are worthy of testing.
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[article] Differences in Acute Metabolic Responses to Bionic and Nonbionic Ambulation in Spinal Cord Injured Humans and Controls [Article] / Jennifer L. Maher ; Carsten Bach Baunsgaard ; Jan van Gerven . - 2020 . - p. 121-129.
https://doi.org/10.1016/j.apmr.2019.07.014
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 1 (2020) . - p. 121-129

Descripteurs :	HE Vinci Dispositif d'exosquelette ; Exercice physique ; Metabolisme ; Réadaptation ; Traumatismes de la moelle épinière
Résumé :	Objectives To (1) compare energy expenditure during seated rest, standing, and prolonged bionic ambulation or bipedal ambulation in participants with spinal cord injury (SCI) and noninjured controls, respectively, and (2) test effects on postbionic ambulation glycemia in SCI. Design Two independent group comparison of SCI and controls. Setting Academic Medical Center. Participants Ten participants with chronic SCI (C7-T1, American Spinal Injury Association Impairment Scale A-C) and 10 controls (N=20). Interventions A commercial bionic exoskeleton. Main Outcome Measures Absolute and relative (to peak) oxygen consumption, perceived exertion, carbohydrate/fat oxidation, energy expenditure, and postbionic ambulation plasma glucose/insulin. Results Average work intensity accompanying 45 minutes of outdoor bionic ambulation was Conclusion Work intensity during prolonged bionic ambulation for this bionic exoskeleton is below a threshold for cardiorespiratory conditioning but above seated rest and passive standing. Bionic ambulation metabolism is consistent with low RPE and unchanged fuel partitioning from seated rest. Bionic ambulation did not promote beneficial effects on glycemia in well-conditioned, euglycemic participants. These findings may differ in less fit individuals with SCI or those with impaired glucose tolerance. Observed trends favoring this benefit suggest they are worthy of testing.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 1 (2020) . - p. 130-140

Titre :	Effect of Repetitive Transcranial Magnetic Stimulation on Gait and Freezing of Gait in Parkinson Disease: A Systematic Review and Meta-analysis
Type de document :	Article
Auteurs :	Yun-Juan Xie ; Qiang Gao ; Cheng-Qi He
Année de publication :	2020
Article en page(s) :	p. 130-140
Note générale :	https://doi.org/10.1016/j.apmr.2019.07.013
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Démarche ; Maladie de Parkinson ; Méta-analyse ; Réadaptation ; Stimulation magnétique transcranienne
Résumé :	Objective The purpose of this review was to systematically assess the effectiveness of repetitive transcranial magnetic stimulation (rTMS) intervention on gait in individuals with Parkinson disease (PD). Data Sources We searched online electronic databases up to March 28, 2019, including MEDLINE, Embase, the Cochrane Library, and so on. Study Selection The inclusion criteria for this review were randomized controlled trials (RCTs), exploring the effect of rTMS in patients diagnosed with idiopathic PD. Data Extraction Data extraction was performed independently by 2 reviewers based on predefined criteria and the methodologic quality of included studies was quantified by the Physiotherapy Evidence Database scale. The outcome measure was walking performance, including walking time (short term and long term), Timed Up and Go (TUG) test, and so on. Data Synthesis Among 14 eligible studies, including 298 participants (mean age ± SD [y], 63.24±9.71; 191 [64%] men) were analyzed in this meta-analysis. Walking time was improved with rTMS compared with sham rTMS (standardized mean difference [SMD] -0.30; 95% confidence interval [CI], -0.57 to -0.03; P=.03). The score for the freezing of gait questionnaire did not differ significantly between rTMS and no intervention. Four studies compared TUG between the 2 treatment groups and no significant differences were found between the rTMS and control group (SMD -0.45; 95% CI, -1.32 to 0.41; P=.30). During the off-state, there were no significant differences in estimated effect sizes (SMD=-0.29; 95% CI, -0.79 to 0.21; P=.25), which is significantly different in on-state (SMD -0.98; 95% CI, -1.78 to -0.18; P=.02) evaluation. Conclusions The results of the meta-analysis propose the favorable effect of rTMS on walking performance in the short term but not over the long term in individuals with PD.
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[article] Effect of Repetitive Transcranial Magnetic Stimulation on Gait and Freezing of Gait in Parkinson Disease: A Systematic Review and Meta-analysis [Article] / Yun-Juan Xie ; Qiang Gao ; Cheng-Qi He . - 2020 . - p. 130-140.
https://doi.org/10.1016/j.apmr.2019.07.013
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 1 (2020) . - p. 130-140

Descripteurs :	HE Vinci Démarche ; Maladie de Parkinson ; Méta-analyse ; Réadaptation ; Stimulation magnétique transcranienne
Résumé :	Objective The purpose of this review was to systematically assess the effectiveness of repetitive transcranial magnetic stimulation (rTMS) intervention on gait in individuals with Parkinson disease (PD). Data Sources We searched online electronic databases up to March 28, 2019, including MEDLINE, Embase, the Cochrane Library, and so on. Study Selection The inclusion criteria for this review were randomized controlled trials (RCTs), exploring the effect of rTMS in patients diagnosed with idiopathic PD. Data Extraction Data extraction was performed independently by 2 reviewers based on predefined criteria and the methodologic quality of included studies was quantified by the Physiotherapy Evidence Database scale. The outcome measure was walking performance, including walking time (short term and long term), Timed Up and Go (TUG) test, and so on. Data Synthesis Among 14 eligible studies, including 298 participants (mean age ± SD [y], 63.24±9.71; 191 [64%] men) were analyzed in this meta-analysis. Walking time was improved with rTMS compared with sham rTMS (standardized mean difference [SMD] -0.30; 95% confidence interval [CI], -0.57 to -0.03; P=.03). The score for the freezing of gait questionnaire did not differ significantly between rTMS and no intervention. Four studies compared TUG between the 2 treatment groups and no significant differences were found between the rTMS and control group (SMD -0.45; 95% CI, -1.32 to 0.41; P=.30). During the off-state, there were no significant differences in estimated effect sizes (SMD=-0.29; 95% CI, -0.79 to 0.21; P=.25), which is significantly different in on-state (SMD -0.98; 95% CI, -1.78 to -0.18; P=.02) evaluation. Conclusions The results of the meta-analysis propose the favorable effect of rTMS on walking performance in the short term but not over the long term in individuals with PD.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 1 (2020) . - p. 141-153

Titre :	Functional Balance and Postural Control Improvements in Patients With Stroke After Noninvasive Brain Stimulation: A Meta-analysis
Type de document :	Article
Auteurs :	Nyeonju Kang ; Ru Da Lee ; Joon Ho Lee
Année de publication :	2020
Article en page(s) :	p. 141-153
Note générale :	https://doi.org/10.1016/j.apmr.2019.09.003
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Accident vasculaire cérébral (AVC) ; Équilibre postural ; Méta-analyse ; Réadaptation ; Revue systématique ; Stimulation magnétique transcranienne ; Stimulation transcrânienne par courant continu
Résumé :	Objectives The postural imbalance poststroke limits individuals’ walking abilities as well as increase the risk of falling. We investigated the short-term treatment effects of noninvasive brain stimulation (NIBS) on functional balance and postural control in patients with stroke. Data Sources We started the search via PubMed and the Institute for Scientific Information’s Web of Science on March 1, 2019 and concluded the search on April 30, 2019. Study Selection The meta-analysis included studies that used either repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) for the recovery of functional balance and postural control poststroke. All included studies used either randomized controlled trial or crossover designs with a sham control group. Data Extraction Three researchers independently performed data extraction and assessing methodological quality and publication bias. We calculated overall and individual effect sizes using random effects meta-analysis models. Data Synthesis The random effects meta-analysis model on the 18 qualified studies identified the significant positive effects relating to NIBS in terms of functional balance and postural control poststroke. The moderator-variable analyses revealed that these treatment effects were only significant in rTMS across patients with acute, subacute, and chronic stroke whereas tDCS did not show any significant therapeutic effects. The meta-regression analysis showed that a higher number of rTMS sessions was significantly associated with more improvements in functional balance and postural control poststroke. Conclusions Our systematic review and meta-analysis confirmed that NIBS may be an effective option for restoring functional balance and postural control for patients with stroke.
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[article] Functional Balance and Postural Control Improvements in Patients With Stroke After Noninvasive Brain Stimulation: A Meta-analysis [Article] / Nyeonju Kang ; Ru Da Lee ; Joon Ho Lee . - 2020 . - p. 141-153.
https://doi.org/10.1016/j.apmr.2019.09.003
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 1 (2020) . - p. 141-153

Descripteurs :	HE Vinci Accident vasculaire cérébral (AVC) ; Équilibre postural ; Méta-analyse ; Réadaptation ; Revue systématique ; Stimulation magnétique transcranienne ; Stimulation transcrânienne par courant continu
Résumé :	Objectives The postural imbalance poststroke limits individuals’ walking abilities as well as increase the risk of falling. We investigated the short-term treatment effects of noninvasive brain stimulation (NIBS) on functional balance and postural control in patients with stroke. Data Sources We started the search via PubMed and the Institute for Scientific Information’s Web of Science on March 1, 2019 and concluded the search on April 30, 2019. Study Selection The meta-analysis included studies that used either repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) for the recovery of functional balance and postural control poststroke. All included studies used either randomized controlled trial or crossover designs with a sham control group. Data Extraction Three researchers independently performed data extraction and assessing methodological quality and publication bias. We calculated overall and individual effect sizes using random effects meta-analysis models. Data Synthesis The random effects meta-analysis model on the 18 qualified studies identified the significant positive effects relating to NIBS in terms of functional balance and postural control poststroke. The moderator-variable analyses revealed that these treatment effects were only significant in rTMS across patients with acute, subacute, and chronic stroke whereas tDCS did not show any significant therapeutic effects. The meta-regression analysis showed that a higher number of rTMS sessions was significantly associated with more improvements in functional balance and postural control poststroke. Conclusions Our systematic review and meta-analysis confirmed that NIBS may be an effective option for restoring functional balance and postural control for patients with stroke.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 1 (2020) . - p. 154-165

Titre :	Exercise Programs Delivered According to Guidelines Improve Mobility in People With Stroke: A Systematic Review and Meta-analysis
Type de document :	Article
Auteurs :	Dina Pogrebnoy ; Amy M. Dennett
Année de publication :	2020
Article en page(s) :	p. 154-165
Note générale :	https://doi.org/10.1016/j.apmr.2019.06.015
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Accident vasculaire cérébral (AVC) ; Exercice physique ; Réadaptation
Résumé :	Objective To determine if prescribing a combined aerobic and resistance training exercise program in accordance with American Stroke Association physical activity guidelines improves mobility and physical activity levels of people after stroke. Data Sources Online database search from earliest available date to August 27, 2018. Study Selection Randomized controlled trials evaluating the effectiveness of exercise programs prescribed in accordance with guidelines for improving mobility and physical activity levels in adults with subacute or chronic stroke. Data Extraction Two independent reviewers completed data extraction. Risk of bias was assessed using the Physiotherapy Evidence Database Scale, and overall quality of evidence was assessed using the Grades of Research, Assessment, Development, and Evaluation approach. Data Synthesis Data was pooled from a total of 499 participants for meta-analysis. There was high-level evidence that exercise programs adhering to guidelines improve habitual walking speed (mean difference, 0.07m/s; 95% CI, −0.01 to 0.16) and walking endurance (mean difference, 39.2m, 95% CI, 17.2-61.2). A sensitivity analysis demonstrated high-level evidence of improvements in walking endurance (mean difference, 51.1m; 95% CI, 19.96-82.24) and moderate-level evidence of improvements on the Timed Up and Go test (standardized mean difference, 0.57; 95% CI, 0.16-0.99). No differences were detected for other mobility outcome measures or physical activity levels. Adherence was high and few adverse events were reported. Conclusion A combined exercise program comprising aerobic and resistance training that adheres to the American Stroke Association guidelines is safe and should be prescribed in addition to usual care to improve mobility. Further research is needed to understand the relationship between exercise programs and behavior change requirements to improve long-term physical activity levels.
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[article] Exercise Programs Delivered According to Guidelines Improve Mobility in People With Stroke: A Systematic Review and Meta-analysis [Article] / Dina Pogrebnoy ; Amy M. Dennett . - 2020 . - p. 154-165.
https://doi.org/10.1016/j.apmr.2019.06.015
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 1 (2020) . - p. 154-165

Descripteurs :	HE Vinci Accident vasculaire cérébral (AVC) ; Exercice physique ; Réadaptation
Résumé :	Objective To determine if prescribing a combined aerobic and resistance training exercise program in accordance with American Stroke Association physical activity guidelines improves mobility and physical activity levels of people after stroke. Data Sources Online database search from earliest available date to August 27, 2018. Study Selection Randomized controlled trials evaluating the effectiveness of exercise programs prescribed in accordance with guidelines for improving mobility and physical activity levels in adults with subacute or chronic stroke. Data Extraction Two independent reviewers completed data extraction. Risk of bias was assessed using the Physiotherapy Evidence Database Scale, and overall quality of evidence was assessed using the Grades of Research, Assessment, Development, and Evaluation approach. Data Synthesis Data was pooled from a total of 499 participants for meta-analysis. There was high-level evidence that exercise programs adhering to guidelines improve habitual walking speed (mean difference, 0.07m/s; 95% CI, −0.01 to 0.16) and walking endurance (mean difference, 39.2m, 95% CI, 17.2-61.2). A sensitivity analysis demonstrated high-level evidence of improvements in walking endurance (mean difference, 51.1m; 95% CI, 19.96-82.24) and moderate-level evidence of improvements on the Timed Up and Go test (standardized mean difference, 0.57; 95% CI, 0.16-0.99). No differences were detected for other mobility outcome measures or physical activity levels. Adherence was high and few adverse events were reported. Conclusion A combined exercise program comprising aerobic and resistance training that adheres to the American Stroke Association guidelines is safe and should be prescribed in addition to usual care to improve mobility. Further research is needed to understand the relationship between exercise programs and behavior change requirements to improve long-term physical activity levels.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 100, n° 12 (2019) . - p. 2225-2232

Titre :	Unilateral vs Bilateral Hybrid Approaches for Upper Limb Rehabilitation in Chronic Stroke: A Randomized Controlled Trial
Type de document :	Article
Auteurs :	Chung-shan Hung ; Keh-Chung Lin ; Wan-ying Chang
Année de publication :	2019
Article en page(s) :	p. 2225-2232
Note générale :	https://doi.org/10.1016/j.apmr.2019.06.021
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Accident vasculaire cérébral (AVC) ; Essai contrôlé randomisé ; Réadaptation ; Robotique
Résumé :	Objective To investigate the effects of unilateral hybrid therapy (UHT) and bilateral hybrid therapy (BHT) compared with robot-assisted therapy (RT) alone in patients with chronic stroke. Design A single-blind, randomized controlled trial. Setting Four hospitals. Participants Outpatients with chronic stroke and mild to moderate motor impairment (N=44). Intervention UHT combined unilateral RT (URT) and modified constraint-induced therapy. BHT combined bilateral RT (BRT) and bilateral arm training. The RT group received URT and BRT. The intervention frequency for the 3 groups was 90 min/d 3 d/wk for 6 weeks. Main Outcome Measures Fugl-Meyer Assessment (FMA, divided into the proximal and distal subscale) and Stroke Impact Scale (SIS) version 3.0 scores before, immediately after, and 3 months after treatment and Wolf Motor Function Test (WMFT) and Nottingham Extended Activities of Daily Living (NEADL) scale scores before and immediately after treatment. Results The results favored BHT over UHT on the FMA total score and distal score at the posttest (P=.03 and .04) and follow-up (P=.01 and .047) assessment and BHT over RT on the follow-up FMA distal scores (P=.03). At the posttest assessment, the WMFT and SIS scores of the 3 groups improved significantly without between-group differences, and the RT group showed significantly greater improvement in the mobility domain of NEADL compared with the BHT group (P<.01> Conclusions BHT was more effective for improving upper extremity motor function, particularly distal motor function at follow-up, and individuals in the RT group demonstrated improved functional ambulation post intervention.
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[article] Unilateral vs Bilateral Hybrid Approaches for Upper Limb Rehabilitation in Chronic Stroke: A Randomized Controlled Trial [Article] / Chung-shan Hung ; Keh-Chung Lin ; Wan-ying Chang . - 2019 . - p. 2225-2232.
https://doi.org/10.1016/j.apmr.2019.06.021
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 100, n° 12 (2019) . - p. 2225-2232

Descripteurs :	HE Vinci Accident vasculaire cérébral (AVC) ; Essai contrôlé randomisé ; Réadaptation ; Robotique
Résumé :	Objective To investigate the effects of unilateral hybrid therapy (UHT) and bilateral hybrid therapy (BHT) compared with robot-assisted therapy (RT) alone in patients with chronic stroke. Design A single-blind, randomized controlled trial. Setting Four hospitals. Participants Outpatients with chronic stroke and mild to moderate motor impairment (N=44). Intervention UHT combined unilateral RT (URT) and modified constraint-induced therapy. BHT combined bilateral RT (BRT) and bilateral arm training. The RT group received URT and BRT. The intervention frequency for the 3 groups was 90 min/d 3 d/wk for 6 weeks. Main Outcome Measures Fugl-Meyer Assessment (FMA, divided into the proximal and distal subscale) and Stroke Impact Scale (SIS) version 3.0 scores before, immediately after, and 3 months after treatment and Wolf Motor Function Test (WMFT) and Nottingham Extended Activities of Daily Living (NEADL) scale scores before and immediately after treatment. Results The results favored BHT over UHT on the FMA total score and distal score at the posttest (P=.03 and .04) and follow-up (P=.01 and .047) assessment and BHT over RT on the follow-up FMA distal scores (P=.03). At the posttest assessment, the WMFT and SIS scores of the 3 groups improved significantly without between-group differences, and the RT group showed significantly greater improvement in the mobility domain of NEADL compared with the BHT group (P<.01> Conclusions BHT was more effective for improving upper extremity motor function, particularly distal motor function at follow-up, and individuals in the RT group demonstrated improved functional ambulation post intervention.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 100, n° 12 (2019) . - p. 2233-2243

Titre :	A Cross-Sectional Study to Investigate the Effects of Perceived Discrimination in the Health Care Setting on Pain and Depressive Symptoms in Wheelchair Users With Spinal Cord Injury
Type de document :	Article
Auteurs :	Nathan Hogaboom ; Denise C. Fyffe ; Amanda L. Botticello
Année de publication :	2019
Article en page(s) :	p. 2233-2243
Note générale :	https://doi.org/10.1016/j.apmr.2019.06.016
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Dépression ; Discrimination sociale ; Douleur ; Fauteuils roulants ; Réadaptation ; Traumatismes de la moelle épinière
Résumé :	Objectives In a sample of wheelchair users with spinal cord injury (SCI), the objectives were to investigate which participant characteristics are associated with greater perceived discrimination in the health care setting, and how such discrimination relates to health outcomes of pain and depressive symptoms. Design Survey, cross-sectional. Setting Spinal Cord Injury Model Systems (SCIMS) Center. Participants Full-time wheelchair users with SCI from 9 SCIMS centers (N=410), with data collected between 2011 and 2016. Interventions N/A. Main Outcomes A 7-item questionnaire inquiring about perceived discrimination by hospital staff, self-reported pain severity over the past month using a 0-10 Numeric Rating Scale, and depressive symptoms using the 2-question Patient Health Questionnaire screener. Results Participants who were black or from the lowest income group were more likely to report experiencing more discrimination than those who were white or from the highest income group, respectively (incidence rate ratio=2.2-2.6, P<.01 those who reported more perceived discrimination had greater risk of severe pain compared to no confidence interval ci p mild depressive symptoms and symptoms.> Conclusions Wheelchair users with SCI who were from more disadvantaged groups (black, lower income levels) reported experiencing more discrimination in their health care setting. Furthermore, those who reported more discrimination were more likely to report worse mental and physical health outcomes. Attempts to reduce discrimination in health care settings may lead to better outcomes for people with SCI. These observations were correlational and not causal; a prospective analysis is necessary to prove causation. Future investigations should further explore the effect of discrimination on the many facets of living with an SCI.
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[article] A Cross-Sectional Study to Investigate the Effects of Perceived Discrimination in the Health Care Setting on Pain and Depressive Symptoms in Wheelchair Users With Spinal Cord Injury [Article] / Nathan Hogaboom ; Denise C. Fyffe ; Amanda L. Botticello . - 2019 . - p. 2233-2243.
https://doi.org/10.1016/j.apmr.2019.06.016
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 100, n° 12 (2019) . - p. 2233-2243

Descripteurs :	HE Vinci Dépression ; Discrimination sociale ; Douleur ; Fauteuils roulants ; Réadaptation ; Traumatismes de la moelle épinière
Résumé :	Objectives In a sample of wheelchair users with spinal cord injury (SCI), the objectives were to investigate which participant characteristics are associated with greater perceived discrimination in the health care setting, and how such discrimination relates to health outcomes of pain and depressive symptoms. Design Survey, cross-sectional. Setting Spinal Cord Injury Model Systems (SCIMS) Center. Participants Full-time wheelchair users with SCI from 9 SCIMS centers (N=410), with data collected between 2011 and 2016. Interventions N/A. Main Outcomes A 7-item questionnaire inquiring about perceived discrimination by hospital staff, self-reported pain severity over the past month using a 0-10 Numeric Rating Scale, and depressive symptoms using the 2-question Patient Health Questionnaire screener. Results Participants who were black or from the lowest income group were more likely to report experiencing more discrimination than those who were white or from the highest income group, respectively (incidence rate ratio=2.2-2.6, P<.01 those who reported more perceived discrimination had greater risk of severe pain compared to no confidence interval ci p mild depressive symptoms and symptoms.> Conclusions Wheelchair users with SCI who were from more disadvantaged groups (black, lower income levels) reported experiencing more discrimination in their health care setting. Furthermore, those who reported more discrimination were more likely to report worse mental and physical health outcomes. Attempts to reduce discrimination in health care settings may lead to better outcomes for people with SCI. These observations were correlational and not causal; a prospective analysis is necessary to prove causation. Future investigations should further explore the effect of discrimination on the many facets of living with an SCI.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 100, n° 12 (2019) . - p. 2244-2250

Titre :	Utilization of Rehabilitation Services in Stroke: A Study Utilizing the Health and Retirement Study With Linked Medicare Claims Data
Type de document :	Article
Auteurs :	Karen M. Keptner ; Kathleen Smyth ; Siran Koroukian
Année de publication :	2019
Article en page(s) :	p. 2244-2250
Note générale :	https://doi.org/10.1016/j.apmr.2019.06.017
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Accident vasculaire cérébral (AVC) ; Ergothérapeutes ; Kinésithérapeutes ; Réadaptation ; Services de santé
Résumé :	Objectives To describe Medicare fee-for-service beneficiaries who used poststroke rehabilitation services and identified the strongest predictors of utilization after the initial stroke care episode. Design Pooled, cross-sectional design using data from 1998 to 2010 from the Health and Retirement Study (HRS) with linked Medicare claims data. Setting NA. Participants Stroke survivors who were Medicare fee-for-service beneficiaries and participated in the HRS were included (N=515). Main Outcome Measure Utilization of rehabilitation services up to 10 years poststroke was the primary outcome with logistic regression used to predict utilization. Covariates included demographic factors, baseline functional status, health conditions, personal lifestyle factors, and social support. Results Rehabilitation service utilization was 21.6%, 6.8%, 15.8%, 16.5%, and Conclusion A small number of Medicare fee-for-service beneficiaries who are stroke survivors utilize rehabilitation services in the first 10 years poststroke. Of those who do, age is the primary driver of utilization. We analyzed a multitude of factors that might influence utilization, but other factors not available in these data also need to be explored.
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[article] Utilization of Rehabilitation Services in Stroke: A Study Utilizing the Health and Retirement Study With Linked Medicare Claims Data [Article] / Karen M. Keptner ; Kathleen Smyth ; Siran Koroukian . - 2019 . - p. 2244-2250.
https://doi.org/10.1016/j.apmr.2019.06.017
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 100, n° 12 (2019) . - p. 2244-2250

Descripteurs :	HE Vinci Accident vasculaire cérébral (AVC) ; Ergothérapeutes ; Kinésithérapeutes ; Réadaptation ; Services de santé
Résumé :	Objectives To describe Medicare fee-for-service beneficiaries who used poststroke rehabilitation services and identified the strongest predictors of utilization after the initial stroke care episode. Design Pooled, cross-sectional design using data from 1998 to 2010 from the Health and Retirement Study (HRS) with linked Medicare claims data. Setting NA. Participants Stroke survivors who were Medicare fee-for-service beneficiaries and participated in the HRS were included (N=515). Main Outcome Measure Utilization of rehabilitation services up to 10 years poststroke was the primary outcome with logistic regression used to predict utilization. Covariates included demographic factors, baseline functional status, health conditions, personal lifestyle factors, and social support. Results Rehabilitation service utilization was 21.6%, 6.8%, 15.8%, 16.5%, and Conclusion A small number of Medicare fee-for-service beneficiaries who are stroke survivors utilize rehabilitation services in the first 10 years poststroke. Of those who do, age is the primary driver of utilization. We analyzed a multitude of factors that might influence utilization, but other factors not available in these data also need to be explored.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 100, n° 12 (2019) . - p. 2251-2259

Titre :	Associations Between Adherence to the Physical Activity and Exercise Program Applied in the LAST Study and Functional Recovery After Stroke
Type de document :	Article
Auteurs :	Mari Gunnes ; Bent Indredavik ; Birgitta Langhammer
Année de publication :	2019
Article en page(s) :	p. 2251-2259
Note générale :	https://doi.org/10.1016/j.apmr.2019.04.023
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Accident vasculaire cérébral (AVC) ; Exercice physique ; Observance par le patient ; Réadaptation
Résumé :	Objective To investigate the associations between participants’ adherence to a physical activity and exercise program after stroke and functional recovery 18 months after inclusion. Design Secondary analyses of the intervention arm in the multisite randomized controlled trial Life After Stroke (LAST). Setting Primary health care services in 3 Norwegian municipalities. Participants Of the participants enrolled (N=380), 186 (48.9%) were randomized to the intervention. The study sample comprised community dwelling individuals included 3 months after stroke, with mean age of 71.7 ± 11.9 years and 82 (44.1%) women. According to the National Institutes of Health Stroke Scale, 97.3% were diagnosed as having mild (National Institutes of Health Stroke Scale Intervention Monthly coaching by physiotherapists encouraging participants to adhere to 30 minutes of daily physical activity and 45-60 minutes of weekly exercise. Main Outcome Measures The primary outcome was Motor Assessment Scale (MAS). Secondary outcome measures were 6-minute walk test, Timed Up and Go (TUG), Berg Balance Scale (BBS), and the physical domains of the Stroke Impact Scale (SIS). Adherence was assessed by combining participants’ training diaries and physiotherapists’ reports. Results The relationship between adherence and functional recovery was analyzed with simple and multiple linear regression models. Adjusted for age, sex, dependency, and cognition, results showed statistically significant associations between adherence and functional outcomes after 18 months, as measured by MAS, TUG, BBS, and SIS (P≤.026). Conclusions Increased adherence to physical activity and exercise was associated with improved functional recovery after mild to moderate stroke. This emphasizes the importance of developing adherence-enhancing interventions. Dose-response studies are recommended for future research.
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[article] Associations Between Adherence to the Physical Activity and Exercise Program Applied in the LAST Study and Functional Recovery After Stroke [Article] / Mari Gunnes ; Bent Indredavik ; Birgitta Langhammer . - 2019 . - p. 2251-2259.
https://doi.org/10.1016/j.apmr.2019.04.023
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 100, n° 12 (2019) . - p. 2251-2259

Descripteurs :	HE Vinci Accident vasculaire cérébral (AVC) ; Exercice physique ; Observance par le patient ; Réadaptation
Résumé :	Objective To investigate the associations between participants’ adherence to a physical activity and exercise program after stroke and functional recovery 18 months after inclusion. Design Secondary analyses of the intervention arm in the multisite randomized controlled trial Life After Stroke (LAST). Setting Primary health care services in 3 Norwegian municipalities. Participants Of the participants enrolled (N=380), 186 (48.9%) were randomized to the intervention. The study sample comprised community dwelling individuals included 3 months after stroke, with mean age of 71.7 ± 11.9 years and 82 (44.1%) women. According to the National Institutes of Health Stroke Scale, 97.3% were diagnosed as having mild (National Institutes of Health Stroke Scale Intervention Monthly coaching by physiotherapists encouraging participants to adhere to 30 minutes of daily physical activity and 45-60 minutes of weekly exercise. Main Outcome Measures The primary outcome was Motor Assessment Scale (MAS). Secondary outcome measures were 6-minute walk test, Timed Up and Go (TUG), Berg Balance Scale (BBS), and the physical domains of the Stroke Impact Scale (SIS). Adherence was assessed by combining participants’ training diaries and physiotherapists’ reports. Results The relationship between adherence and functional recovery was analyzed with simple and multiple linear regression models. Adjusted for age, sex, dependency, and cognition, results showed statistically significant associations between adherence and functional outcomes after 18 months, as measured by MAS, TUG, BBS, and SIS (P≤.026). Conclusions Increased adherence to physical activity and exercise was associated with improved functional recovery after mild to moderate stroke. This emphasizes the importance of developing adherence-enhancing interventions. Dose-response studies are recommended for future research.
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