[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 741-749

Titre :	Gender-Based Salary Inequities Among Pediatric Rehabilitation Medicine Physicians in the United States
Type de document :	Article
Auteurs :	Amy J. Houtrow ; David W. Pruitt ; Christina K. Zigler
Année de publication :	2020
Article en page(s) :	p. 741-749
Note générale :	https://doi.org/10.1016/j.apmr.2019.11.007
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Identité de genre ; Réadaptation ; Salaires et prestations accessoires
Résumé :	Objective To assess whether gender inequities exist for pediatric physiatrists and, if affirmative, what factors account for this difference. Design Cohort study. Setting Online REDCap survey administered via e-mail. Participants Pediatric physiatrists practicing in the United States in 2017. Interventions Not applicable. Main Outcome Measures Respondents reported on their gender, training, practice type and location, leadership positions, years in practice and years at their current location, salary, research, and clinical productivity. Results Of the 307 surveys sent, 235 individuals responded, yielding a response rate of 76.5%. Pediatric physiatrists who identified as women were more likely to work part-time but were demographically similar to their colleagues who identified as men. The odds of having no leadership role were higher for women (odds ratio=2.17; P=.02) than men. Pediatric physiatrists who identified as men made on average (in US dollars ± SD) 244,798±52,906 annually compared with those who identified as women 224,497±60,756. The average annual difference in full-time salary was $20,311 in favor of those who identified as men (95% confidence interval, $3135-$37,486). The set of predictors in the multivariable model explained about 40% of the total variability in annual full-time salary (R2=0.389; adjusted R2=0.339; F15,197=7.734; P<.001 gender was not a significant predictor in the model but prediction of salaries pediatric physiatrists who identified as men better than those women.> Conclusions Despite representing a majority of the field, pediatric physiatrists who identified as women were paid less than their counterparts who identified as men. The traditional predictors associated with the salaries of men were not enough to explain salary variation among those who identified as women, thereby providing evidence of the importance of intangible and unmeasured aspects of a women’s career, such as bias and institutional culture.
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[article] Gender-Based Salary Inequities Among Pediatric Rehabilitation Medicine Physicians in the United States [Article] / Amy J. Houtrow ; David W. Pruitt ; Christina K. Zigler . - 2020 . - p. 741-749.
https://doi.org/10.1016/j.apmr.2019.11.007
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 741-749

Descripteurs :	HE Vinci Identité de genre ; Réadaptation ; Salaires et prestations accessoires
Résumé :	Objective To assess whether gender inequities exist for pediatric physiatrists and, if affirmative, what factors account for this difference. Design Cohort study. Setting Online REDCap survey administered via e-mail. Participants Pediatric physiatrists practicing in the United States in 2017. Interventions Not applicable. Main Outcome Measures Respondents reported on their gender, training, practice type and location, leadership positions, years in practice and years at their current location, salary, research, and clinical productivity. Results Of the 307 surveys sent, 235 individuals responded, yielding a response rate of 76.5%. Pediatric physiatrists who identified as women were more likely to work part-time but were demographically similar to their colleagues who identified as men. The odds of having no leadership role were higher for women (odds ratio=2.17; P=.02) than men. Pediatric physiatrists who identified as men made on average (in US dollars ± SD) 244,798±52,906 annually compared with those who identified as women 224,497±60,756. The average annual difference in full-time salary was $20,311 in favor of those who identified as men (95% confidence interval, $3135-$37,486). The set of predictors in the multivariable model explained about 40% of the total variability in annual full-time salary (R2=0.389; adjusted R2=0.339; F15,197=7.734; P<.001 gender was not a significant predictor in the model but prediction of salaries pediatric physiatrists who identified as men better than those women.> Conclusions Despite representing a majority of the field, pediatric physiatrists who identified as women were paid less than their counterparts who identified as men. The traditional predictors associated with the salaries of men were not enough to explain salary variation among those who identified as women, thereby providing evidence of the importance of intangible and unmeasured aspects of a women’s career, such as bias and institutional culture.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 750-761

Titre :	Chronic Pain Self-Management Support With Pain Science Education and Exercise (COMMENCE) for People With Chronic Pain and Multiple Comorbidities: A Randomized Controlled Trial
Type de document :	Article
Auteurs :	Jordan Miller ; Joy C. MacDermid ; David M. Walton
Année de publication :	2020
Article en page(s) :	p. 750-761
Note générale :	https://doi.org/10.1016/j.apmr.2019.12.016
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Douleur chronique ; Éducation du patient comme sujet ; Exercice physique ; Gestion de soi ; Réadaptation
Résumé :	Objective To investigate the effectiveness of chronic pain self-management support with pain science education and exercise (COMMENCE) on improving function, pain interference, work status, pain intensity, fatigue, psychological factors associated with pain, health care visits, satisfaction, and perceived change compared with usual care. Design Parallel group randomized controlled trial with 1- and 12-week follow-ups. Setting Community health center. Participants Adults (N=102) with chronic noncancer pain referred for self-management support. Eighty of 102 participants completed 12-week follow-up assessments. No participants withdrew with adverse events. Interventions Participants were randomized to COMMENCE or usual care. Main Outcome Measures Primary: Function measured using the Short Musculoskeletal Function Assessment–Dysfunction Index. Secondary: Short Musculoskeletal Function Assessment–Bother Index, Patient Reported Outcomes Measurement Information System pain interference, work status, numeric pain, and fatigue rating scales, Tampa Scale of Kinesiophobia, Pain Catastrophizing Scale, Pain Self-Efficacy Scale, Neurophysiology of Pain Questionnaire, number of health care visits, satisfaction, and global rating of change. Results COMMENCE resulted in greater improvements in function (mean difference [MD] at 12-wk follow-up=−8.0; 95% CI, −14.7 to −1.3), bother with functional difficulties (MD, −12.0; 95% CI, −20.8 to −3.2), pain intensity (MD, −1.0; 95% CI, −2.1 to −0.1), catastrophizing (MD , −8.2; 95% CI, −14.5 to −2.0), self-efficacy (MD, 7.0; 95% CI, 0.8-13.2), knowledge (MD, 2.8; 95% CI, 1.6-3.9), satisfaction (MD, 1.2; 95% CI, 0.7-1.8), and perceived change (MD, 1.4; 95% CI, 0.8-2.1). There were no significant between-group differences in pain interference, work, fatigue, depressive symptoms, or health care visits. Conclusion COMMENCE is more effective than usual care at improving function, pain, catastrophic thinking, self-efficacy, pain knowledge, satisfaction, and perceived change but not pain interference, work status, fatigue, depressive symptoms, or health care visits.
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[article] Chronic Pain Self-Management Support With Pain Science Education and Exercise (COMMENCE) for People With Chronic Pain and Multiple Comorbidities: A Randomized Controlled Trial [Article] / Jordan Miller ; Joy C. MacDermid ; David M. Walton . - 2020 . - p. 750-761.
https://doi.org/10.1016/j.apmr.2019.12.016
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 750-761

Descripteurs :	HE Vinci Douleur chronique ; Éducation du patient comme sujet ; Exercice physique ; Gestion de soi ; Réadaptation
Résumé :	Objective To investigate the effectiveness of chronic pain self-management support with pain science education and exercise (COMMENCE) on improving function, pain interference, work status, pain intensity, fatigue, psychological factors associated with pain, health care visits, satisfaction, and perceived change compared with usual care. Design Parallel group randomized controlled trial with 1- and 12-week follow-ups. Setting Community health center. Participants Adults (N=102) with chronic noncancer pain referred for self-management support. Eighty of 102 participants completed 12-week follow-up assessments. No participants withdrew with adverse events. Interventions Participants were randomized to COMMENCE or usual care. Main Outcome Measures Primary: Function measured using the Short Musculoskeletal Function Assessment–Dysfunction Index. Secondary: Short Musculoskeletal Function Assessment–Bother Index, Patient Reported Outcomes Measurement Information System pain interference, work status, numeric pain, and fatigue rating scales, Tampa Scale of Kinesiophobia, Pain Catastrophizing Scale, Pain Self-Efficacy Scale, Neurophysiology of Pain Questionnaire, number of health care visits, satisfaction, and global rating of change. Results COMMENCE resulted in greater improvements in function (mean difference [MD] at 12-wk follow-up=−8.0; 95% CI, −14.7 to −1.3), bother with functional difficulties (MD, −12.0; 95% CI, −20.8 to −3.2), pain intensity (MD, −1.0; 95% CI, −2.1 to −0.1), catastrophizing (MD , −8.2; 95% CI, −14.5 to −2.0), self-efficacy (MD, 7.0; 95% CI, 0.8-13.2), knowledge (MD, 2.8; 95% CI, 1.6-3.9), satisfaction (MD, 1.2; 95% CI, 0.7-1.8), and perceived change (MD, 1.4; 95% CI, 0.8-2.1). There were no significant between-group differences in pain interference, work, fatigue, depressive symptoms, or health care visits. Conclusion COMMENCE is more effective than usual care at improving function, pain, catastrophic thinking, self-efficacy, pain knowledge, satisfaction, and perceived change but not pain interference, work status, fatigue, depressive symptoms, or health care visits.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 762-769

Titre :	Therapeutic Effects of Exercise Training on Elderly Patients With Dementia: A Randomized Controlled Trial
Type de document :	Article
Auteurs :	I-Ting Liu ; Wei-Ju Lee ; Shih-Yi Lin
Année de publication :	2020
Article en page(s) :	p. 762-769
Note générale :	https://doi.org/10.1016/j.apmr.2020.01.012
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Démence ; Entraînement en résistance ; Exercice physique ; Réadaptation ; Sujet âgé
Résumé :	Objective To investigate whether strength or aerobic training can offer significantly more benefits with regarding the activities of daily living of elderly patients with dementia as well as to determine the effects of exercise on cognition, depression, and biochemical markers. Design Single-blind randomized controlled trial. Setting A nursing home for veterans. Participants A volunteer sample of participants (N=80) whose scores on the Mini-Mental State Examination were between 15 and 26 were included. Because of cardiopulmonary or orthopedic conditions that prohibit exercise training, along with any cognitive problems that may impede answering the contents of our questionnaires, 11 participants were excluded. During the exercise training period, 8 participants voluntarily dropped out of the study. Interventions The participants were randomly assigned to perform either strength or aerobic training for a total of 4 weeks. Main Outcome Measures The main outcome measure was the Barthel Index. Other outcome measures included the Mini-Mental State Examination, Montreal Cognitive Assessment, Geriatric Depression Scale, plasma monocyte chemotactic protein-1 levels, insulin-like growth factor-1 levels, and serum brain-derived neurotrophic factor levels. Results After completion of the program, we discovered a significant improvement in the patients’ Barthel Index, Mini-Mental State Examination, Montreal Cognitive Assessment, and plasma monocyte chemotactic protein-1 levels in the strength-training group. For the patients who had received aerobic training, their serum brain-derived neurotrophic factor also improved significantly. However, the degree of improvement regarding these outcome measures did not achieve significant statistical difference between the 2 groups. Conclusions Through our study, an intensive 4-week exercise program, whether it be strength or aerobic training, is evidenced to bring significant benefits to elderly patients with dementia, while the serum brain-derived neurotrophic factor was additionally improved through aerobic training.
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[article] Therapeutic Effects of Exercise Training on Elderly Patients With Dementia: A Randomized Controlled Trial [Article] / I-Ting Liu ; Wei-Ju Lee ; Shih-Yi Lin . - 2020 . - p. 762-769.
https://doi.org/10.1016/j.apmr.2020.01.012
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 762-769

Descripteurs :	HE Vinci Démence ; Entraînement en résistance ; Exercice physique ; Réadaptation ; Sujet âgé
Résumé :	Objective To investigate whether strength or aerobic training can offer significantly more benefits with regarding the activities of daily living of elderly patients with dementia as well as to determine the effects of exercise on cognition, depression, and biochemical markers. Design Single-blind randomized controlled trial. Setting A nursing home for veterans. Participants A volunteer sample of participants (N=80) whose scores on the Mini-Mental State Examination were between 15 and 26 were included. Because of cardiopulmonary or orthopedic conditions that prohibit exercise training, along with any cognitive problems that may impede answering the contents of our questionnaires, 11 participants were excluded. During the exercise training period, 8 participants voluntarily dropped out of the study. Interventions The participants were randomly assigned to perform either strength or aerobic training for a total of 4 weeks. Main Outcome Measures The main outcome measure was the Barthel Index. Other outcome measures included the Mini-Mental State Examination, Montreal Cognitive Assessment, Geriatric Depression Scale, plasma monocyte chemotactic protein-1 levels, insulin-like growth factor-1 levels, and serum brain-derived neurotrophic factor levels. Results After completion of the program, we discovered a significant improvement in the patients’ Barthel Index, Mini-Mental State Examination, Montreal Cognitive Assessment, and plasma monocyte chemotactic protein-1 levels in the strength-training group. For the patients who had received aerobic training, their serum brain-derived neurotrophic factor also improved significantly. However, the degree of improvement regarding these outcome measures did not achieve significant statistical difference between the 2 groups. Conclusions Through our study, an intensive 4-week exercise program, whether it be strength or aerobic training, is evidenced to bring significant benefits to elderly patients with dementia, while the serum brain-derived neurotrophic factor was additionally improved through aerobic training.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 770-780

Titre :	Relative Effectiveness of Electroacupuncture and Biofeedback in the Treatment of Neck and Upper Back Myofascial Pain: A Randomized Clinical Trial
Type de document :	Article
Auteurs :	Fariba Eslamian ; Fatemeh Jahanjoo ; Neda Dolatkhah
Année de publication :	2020
Article en page(s) :	p. 770-780
Note générale :	https://doi.org/10.1016/j.apmr.2019.12.009
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Électroacupuncture ; Points de déclenchement ; Réadaptation ; Rétroaction biologique (psychologie) ; Syndromes de la douleur myofasciale
Résumé :	Objective To determine the differences between clinical effects of electroacupuncture and biofeedback therapy in addition to conventional treatment in patients with cervical myofascial pain syndrome (MPS). Design Randomized clinical trial. Setting Physical medicine and rehabilitation clinic of a university hospital. Participants Fifty patients (N=50) aged 25-55 years of both sexes with chronic neck pain diagnosed with MPS (characterized by trigger points within taut bands) were randomly assigned to 2 equal groups of 25 individuals. Interventions The patients in electroacupuncture group were treated with standard acupuncture and concomitant electrical stimulation; those in biofeedback group received visual electromyography biofeedback therapy for muscle activity and relaxation. Both groups received the intervention 2 times a week for a total of 6 sessions. Basic exercise training and medicines were administered for all the patients. Main Outcome Measures Pain severity based on the visual analog scale (VAS), functional status using Neck Disability Index (NDI), cervical range of motion (ROM) using and inclinometer, and pressure pain threshold (PPT) using an algometer were evaluated before and at 3 and 12 weeks after the treatment. Primary outcome was defined as 20% reduction in the 3-month neck pain and dysfunction compared to baseline, assessed through the NDI. Results Fifty patients (39 women, 11 men) with a mean age (years) ± SD of 39.0±5.5 and neck pain duration (weeks) of 6.0±2.2 were analyzed. All parameters, except for PPT of the lower trapezius and paravertebral muscles were improved significantly in both groups, while baseline values were controlled. The primary outcome was achieved more significantly in the acupuncture group than in the biofeedback group: 20 (80.0%) vs 10 (40.0%); rate ratio=2 with 95% confidence interval (CI), 1.19-3.36; number needed to treat (NNT)=2.5 with 95% CI, 1.54-6.58. Advantages of acupuncture over biofeedback were observed according to values obtained from the NDI, VAS, extension and left lateral-bending ROM, and PPT on the left upper trapezius after the last session of intervention until 3 months (P<.05> Conclusions Both electroacupuncture and biofeedback therapies were found to be effective in management of MPS when integrated with conventional treatment. However, intergroup differences showed priority of acupuncture in some parameters vs biofeedback. Thus, electroacupuncture seems to be a better complementary modality for treatment of MPS in the neck and upper back area.
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[article] Relative Effectiveness of Electroacupuncture and Biofeedback in the Treatment of Neck and Upper Back Myofascial Pain: A Randomized Clinical Trial [Article] / Fariba Eslamian ; Fatemeh Jahanjoo ; Neda Dolatkhah . - 2020 . - p. 770-780.
https://doi.org/10.1016/j.apmr.2019.12.009
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 770-780

Descripteurs :	HE Vinci Électroacupuncture ; Points de déclenchement ; Réadaptation ; Rétroaction biologique (psychologie) ; Syndromes de la douleur myofasciale
Résumé :	Objective To determine the differences between clinical effects of electroacupuncture and biofeedback therapy in addition to conventional treatment in patients with cervical myofascial pain syndrome (MPS). Design Randomized clinical trial. Setting Physical medicine and rehabilitation clinic of a university hospital. Participants Fifty patients (N=50) aged 25-55 years of both sexes with chronic neck pain diagnosed with MPS (characterized by trigger points within taut bands) were randomly assigned to 2 equal groups of 25 individuals. Interventions The patients in electroacupuncture group were treated with standard acupuncture and concomitant electrical stimulation; those in biofeedback group received visual electromyography biofeedback therapy for muscle activity and relaxation. Both groups received the intervention 2 times a week for a total of 6 sessions. Basic exercise training and medicines were administered for all the patients. Main Outcome Measures Pain severity based on the visual analog scale (VAS), functional status using Neck Disability Index (NDI), cervical range of motion (ROM) using and inclinometer, and pressure pain threshold (PPT) using an algometer were evaluated before and at 3 and 12 weeks after the treatment. Primary outcome was defined as 20% reduction in the 3-month neck pain and dysfunction compared to baseline, assessed through the NDI. Results Fifty patients (39 women, 11 men) with a mean age (years) ± SD of 39.0±5.5 and neck pain duration (weeks) of 6.0±2.2 were analyzed. All parameters, except for PPT of the lower trapezius and paravertebral muscles were improved significantly in both groups, while baseline values were controlled. The primary outcome was achieved more significantly in the acupuncture group than in the biofeedback group: 20 (80.0%) vs 10 (40.0%); rate ratio=2 with 95% confidence interval (CI), 1.19-3.36; number needed to treat (NNT)=2.5 with 95% CI, 1.54-6.58. Advantages of acupuncture over biofeedback were observed according to values obtained from the NDI, VAS, extension and left lateral-bending ROM, and PPT on the left upper trapezius after the last session of intervention until 3 months (P<.05> Conclusions Both electroacupuncture and biofeedback therapies were found to be effective in management of MPS when integrated with conventional treatment. However, intergroup differences showed priority of acupuncture in some parameters vs biofeedback. Thus, electroacupuncture seems to be a better complementary modality for treatment of MPS in the neck and upper back area.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 781-788

Titre :	Pressure Pain Threshold in Subjects With Piriformis Syndrome: Test-Retest, Intrarater, and Interrater Reliability, and Minimal Detectible Changes
Type de document :	Article
Auteurs :	Abbas Tabatabaiee ; Ismail Ebrahimi Takamjani ; Javad Sarrafzadeh
Année de publication :	2020
Article en page(s) :	p. 781-788
Note générale :	https://doi.org/10.1016/j.apmr.2019.10.194
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Douleur ; Fesses ; Lombalgie ; Réadaptation ; Syndrome du muscle piriforme
Résumé :	Objective This study aimed to assess the test-retest, intrarater, and interrater reliability of using the pressure pain threshold (PPT) in healthy and affected piriformis muscles and to estimate its absolute reliability. As a secondary objective, the degree of tenderness of the affected piriformis muscles was compared with healthy piriformis muscles. Study Design This study used a comparative and reliability-based design. Setting Rehabilitation clinic. Participants Patients (N=30) with unilateral piriformis muscle syndrome (30 affected and 30 healthy piriformis muscles) were recruited, and the PPT of both the healthy and affected piriformis muscles was recorded using digital algometry. Measurements of PPT were done by 2 raters (rater 1 and 2), which were selected at random order. Rater 1 repeated the PPT measurements 24-72 hours after initial assessment. Interventions Not applicable. Main Outcome Measure PPT. Results Excellent intrarater intraclass correlation coefficient (ICC) values were observed for the PPT of the affected piriformis (ICC: 0.86-0.96) and the healthy piriformis (ICC: 0.88-0.96) in the same session. The PPT measurements using digital algometry showed good-to-excellent interrater reliability (ICC: 0.64-0.92) and test-retest reliability (ICC: 0.72-0.95) in both the healthy and affected piriformis muscles. The findings revealed a significant decrease in the PPT of the affected piriformis muscle in comparison to the healthy piriformis muscle (mean difference 12.76; 95% confidence interval, 15.69-9.82; P<.001> Conclusions Digital algometry is a reliable tool for measuring piriformis PPT, regardless of the testing session and the rater. Patients with unilateral piriformis muscle syndrome have increased tenderness and decreased PPT in the affected piriformis muscle in comparison to the healthy piriformis muscle.
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[article] Pressure Pain Threshold in Subjects With Piriformis Syndrome: Test-Retest, Intrarater, and Interrater Reliability, and Minimal Detectible Changes [Article] / Abbas Tabatabaiee ; Ismail Ebrahimi Takamjani ; Javad Sarrafzadeh . - 2020 . - p. 781-788.
https://doi.org/10.1016/j.apmr.2019.10.194
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 781-788

Descripteurs :	HE Vinci Douleur ; Fesses ; Lombalgie ; Réadaptation ; Syndrome du muscle piriforme
Résumé :	Objective This study aimed to assess the test-retest, intrarater, and interrater reliability of using the pressure pain threshold (PPT) in healthy and affected piriformis muscles and to estimate its absolute reliability. As a secondary objective, the degree of tenderness of the affected piriformis muscles was compared with healthy piriformis muscles. Study Design This study used a comparative and reliability-based design. Setting Rehabilitation clinic. Participants Patients (N=30) with unilateral piriformis muscle syndrome (30 affected and 30 healthy piriformis muscles) were recruited, and the PPT of both the healthy and affected piriformis muscles was recorded using digital algometry. Measurements of PPT were done by 2 raters (rater 1 and 2), which were selected at random order. Rater 1 repeated the PPT measurements 24-72 hours after initial assessment. Interventions Not applicable. Main Outcome Measure PPT. Results Excellent intrarater intraclass correlation coefficient (ICC) values were observed for the PPT of the affected piriformis (ICC: 0.86-0.96) and the healthy piriformis (ICC: 0.88-0.96) in the same session. The PPT measurements using digital algometry showed good-to-excellent interrater reliability (ICC: 0.64-0.92) and test-retest reliability (ICC: 0.72-0.95) in both the healthy and affected piriformis muscles. The findings revealed a significant decrease in the PPT of the affected piriformis muscle in comparison to the healthy piriformis muscle (mean difference 12.76; 95% confidence interval, 15.69-9.82; P<.001> Conclusions Digital algometry is a reliable tool for measuring piriformis PPT, regardless of the testing session and the rater. Patients with unilateral piriformis muscle syndrome have increased tenderness and decreased PPT in the affected piriformis muscle in comparison to the healthy piriformis muscle.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 789-796

Titre :	Measurement Properties of the MPAI-4 in Veterans With mTBI
Type de document :	Article
Auteurs :	Kay J. Waid-Ebbs ; Pey-Shan Wen ; David P. Graham
Année de publication :	2020
Article en page(s) :	p. 789-796
Note générale :	https://doi.org/10.1016/j.apmr.2019.10.191
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Anciens combattants ; Lésions encéphaliques ; Psychométrie ; Réadaptation
Résumé :	Objectives To determine whether the measurement properties of the Mayo-Portland Adaptability Inventory Version 4 (MPAI-4) and its participation index (M2PI), which have been adopted as 2 outcome measures in the Veterans Health Administration (VHA) National Polytrauma Rehabilitation Systems of Care, are adequate in veterans with mild traumatic brain injury (mTBI). Design Cross-sectional. Setting Outpatient rehabilitation. Participants Postdeployment veterans with blast-related mTBI (N=177). Intervention Not applicable. Main Outcome Measures Mayo-Portland Adaptability Inventory Version 4 (MPAI-4) and Community Integration Questionnaire (CIQ). Results The unidimensional factor structure of the MPAI-4 total and 3 index scores (abilities, adjustment, participation) were confirmed. Eight of the 30 items were removed for violating monotonicity (6 items) and exceeding Rasch infit (2 items). The rating scale was collapsed from 5 to 3 ratings because of structure issues. The remaining 22 MPAI-4 items demonstrated excellent item/person reliability (0.98/0.91) and separated person ability into 4 strata. Two of the MPAI-4 index scores (abilities and adjustment) had good measurement properties. The third index, M2PI, retained only 3 items that had adequate person reliability (0.75) but separated person ability into only 2 strata. A significant but fair association with the CIQ was demonstrated with the modified MPAI-4. Conclusions The MPAI-4 has been validated in moderate to severe traumatic brain injury but required modification when used in active military personnel with mTBI. We also identified the need for modification of the MPAI-4 to support adequate psychometrics when measuring outcomes in veterans with mTBI. Additional validation of the M2PI is needed in veterans and active military personnel with mTBI, to determine whether the M2PI should continue to be used as an outcome measure in the VHA polytrauma rehabilitation systems.
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[article] Measurement Properties of the MPAI-4 in Veterans With mTBI [Article] / Kay J. Waid-Ebbs ; Pey-Shan Wen ; David P. Graham . - 2020 . - p. 789-796.
https://doi.org/10.1016/j.apmr.2019.10.191
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 789-796

Descripteurs :	HE Vinci Anciens combattants ; Lésions encéphaliques ; Psychométrie ; Réadaptation
Résumé :	Objectives To determine whether the measurement properties of the Mayo-Portland Adaptability Inventory Version 4 (MPAI-4) and its participation index (M2PI), which have been adopted as 2 outcome measures in the Veterans Health Administration (VHA) National Polytrauma Rehabilitation Systems of Care, are adequate in veterans with mild traumatic brain injury (mTBI). Design Cross-sectional. Setting Outpatient rehabilitation. Participants Postdeployment veterans with blast-related mTBI (N=177). Intervention Not applicable. Main Outcome Measures Mayo-Portland Adaptability Inventory Version 4 (MPAI-4) and Community Integration Questionnaire (CIQ). Results The unidimensional factor structure of the MPAI-4 total and 3 index scores (abilities, adjustment, participation) were confirmed. Eight of the 30 items were removed for violating monotonicity (6 items) and exceeding Rasch infit (2 items). The rating scale was collapsed from 5 to 3 ratings because of structure issues. The remaining 22 MPAI-4 items demonstrated excellent item/person reliability (0.98/0.91) and separated person ability into 4 strata. Two of the MPAI-4 index scores (abilities and adjustment) had good measurement properties. The third index, M2PI, retained only 3 items that had adequate person reliability (0.75) but separated person ability into only 2 strata. A significant but fair association with the CIQ was demonstrated with the modified MPAI-4. Conclusions The MPAI-4 has been validated in moderate to severe traumatic brain injury but required modification when used in active military personnel with mTBI. We also identified the need for modification of the MPAI-4 to support adequate psychometrics when measuring outcomes in veterans with mTBI. Additional validation of the M2PI is needed in veterans and active military personnel with mTBI, to determine whether the M2PI should continue to be used as an outcome measure in the VHA polytrauma rehabilitation systems.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 797-806

Titre :	Interrelationships Between Post-TBI Employment and Substance Abuse: A Cross-lagged Structural Equation Modeling Analysis
Type de document :	Article
Auteurs :	Nabil Awan ; Dominic DiSanto ; Shannon B. Juengst
Année de publication :	2020
Article en page(s) :	p. 797-806
Note générale :	https://doi.org/10.1016/j.apmr.2019.10.189
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Emploi ; Lésions traumatiques de l'encéphale ; Réadaptation ; Troubles liés à une substance
Résumé :	Objective To describe the interrelationship of postinjury employment and substance abuse (SA) among individuals with traumatic brain injury. Design Structural equation model (SEM) and logistic regression analytic approach using a merged database of the National Trauma Data Bank (NTDB) and Traumatic Brain Injury Model Systems (TBIMS) National Database, with acute care and rehabilitation hospitalization data and 1, 2, and 5 year follow-up data. Setting United States Level I/II trauma centers and inpatient rehabilitation centers with telephone follow-up. Participants Individuals in the TBIMS National Database successfully matched to their NTDB data, aged 18-59 years, with trauma severity, age, sex, employment, and SA data at 1, 2, and/or 5 years postinjury (N=2890). Interventions Not applicable. Main Outcome Measure Employment status (employed/unemployed) and SA (present/absent) at year 1, year 2, and year 5 postinjury. Results SEM analysis showed older age at injury predicted lower likelihood of employment at all time points postinjury (βYR1=−0.016; βYR2=−0.006; βYR5=−0.016; all P<.001 while higher injury severity score predicted lower likelihood of employment p=".027)" and sa at year male sex each follow-up all despite associations preinjury unemployment with postinjury during the previous period subsequent respectively.> Conclusions Employment and SA have unique longitudinal interrelationships and are additionally influenced by age, sex, and ISS. The present work suggests the need for more research on causal, confounding, and mediating factors and appropriate screening and intervention tools that minimize SA and facilitate successful employment-related outcomes.
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[article] Interrelationships Between Post-TBI Employment and Substance Abuse: A Cross-lagged Structural Equation Modeling Analysis [Article] / Nabil Awan ; Dominic DiSanto ; Shannon B. Juengst . - 2020 . - p. 797-806.
https://doi.org/10.1016/j.apmr.2019.10.189
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 797-806

Descripteurs :	HE Vinci Emploi ; Lésions traumatiques de l'encéphale ; Réadaptation ; Troubles liés à une substance
Résumé :	Objective To describe the interrelationship of postinjury employment and substance abuse (SA) among individuals with traumatic brain injury. Design Structural equation model (SEM) and logistic regression analytic approach using a merged database of the National Trauma Data Bank (NTDB) and Traumatic Brain Injury Model Systems (TBIMS) National Database, with acute care and rehabilitation hospitalization data and 1, 2, and 5 year follow-up data. Setting United States Level I/II trauma centers and inpatient rehabilitation centers with telephone follow-up. Participants Individuals in the TBIMS National Database successfully matched to their NTDB data, aged 18-59 years, with trauma severity, age, sex, employment, and SA data at 1, 2, and/or 5 years postinjury (N=2890). Interventions Not applicable. Main Outcome Measure Employment status (employed/unemployed) and SA (present/absent) at year 1, year 2, and year 5 postinjury. Results SEM analysis showed older age at injury predicted lower likelihood of employment at all time points postinjury (βYR1=−0.016; βYR2=−0.006; βYR5=−0.016; all P<.001 while higher injury severity score predicted lower likelihood of employment p=".027)" and sa at year male sex each follow-up all despite associations preinjury unemployment with postinjury during the previous period subsequent respectively.> Conclusions Employment and SA have unique longitudinal interrelationships and are additionally influenced by age, sex, and ISS. The present work suggests the need for more research on causal, confounding, and mediating factors and appropriate screening and intervention tools that minimize SA and facilitate successful employment-related outcomes.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 807-814

Titre :	Risk Factors for Suboptimal Medication Adherence in Persons With Multiple Sclerosis: Development of an Electronic Health Record-Based Explanatory Model for Disease-Modifying Therapy Use
Type de document :	Article
Auteurs :	Elizabeth S. Gromisch ; Aaron P. Turner ; Steven L. Leipertz
Année de publication :	2020
Article en page(s) :	p. 807-814
Note générale :	https://doi.org/10.1016/j.apmr.2019.11.005
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Adhésion au traitement médicamenteux ; Dossiers médicaux électroniques ; Facteurs de risque ; Réadaptation ; Rendez-vous et plannings ; Sclérose en plaques
Résumé :	Objective To determine which factors are associated with suboptimal disease-modifying therapy (DMT) adherence and to develop an explanatory model that could be used to identify individuals at risk and potentially inform interventions. Design Cross-sectional cohort study using electronic health records. Setting Veterans Health Administration (VA). Participants Veterans with multiple sclerosis (MS) (N=2939; 79.69% men) who received care through the VA and were included in the VA MS Center of Excellence Data Repository. Interventions Not applicable. Main Outcome Measures Suboptimal DMT adherence ( Results Nearly 31% of participants had suboptimal adherence. Flags for suboptimal adherence included >20% missed appointments (odds ratio [OR], 3.78; 95% CI, 2.45-2.82), traumatic brain injuries (OR, 1.55; 95% CI, 1.12-2.14), age younger than 59 years (OR, 1.47; 95% CI, 1.23-1.74), ≥1 emergency department visits (OR, 1.40; 95% CI, 1.18-1.67), mood disorders (ie, depressive and bipolar disorders) (OR, 1.40; 95% CI, 1.18-1.66), and service connection (OR, 1.22; 95% CI, 1.01-1.47). Hyperlipidemia (OR, 0.77; 95% CI, 0.65-0.92) and being issued a wheelchair (OR, 0.83; 95% CI, 0.70-1.00) were associated with lower risk. Conclusions Suboptimal adherence to DMTs continues to be an issue. Interventions that focus on person-level barriers should be urgently explored to increase adherence and improve self-management abilities.
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[article] Risk Factors for Suboptimal Medication Adherence in Persons With Multiple Sclerosis: Development of an Electronic Health Record-Based Explanatory Model for Disease-Modifying Therapy Use [Article] / Elizabeth S. Gromisch ; Aaron P. Turner ; Steven L. Leipertz . - 2020 . - p. 807-814.
https://doi.org/10.1016/j.apmr.2019.11.005
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 807-814

Descripteurs :	HE Vinci Adhésion au traitement médicamenteux ; Dossiers médicaux électroniques ; Facteurs de risque ; Réadaptation ; Rendez-vous et plannings ; Sclérose en plaques
Résumé :	Objective To determine which factors are associated with suboptimal disease-modifying therapy (DMT) adherence and to develop an explanatory model that could be used to identify individuals at risk and potentially inform interventions. Design Cross-sectional cohort study using electronic health records. Setting Veterans Health Administration (VA). Participants Veterans with multiple sclerosis (MS) (N=2939; 79.69% men) who received care through the VA and were included in the VA MS Center of Excellence Data Repository. Interventions Not applicable. Main Outcome Measures Suboptimal DMT adherence ( Results Nearly 31% of participants had suboptimal adherence. Flags for suboptimal adherence included >20% missed appointments (odds ratio [OR], 3.78; 95% CI, 2.45-2.82), traumatic brain injuries (OR, 1.55; 95% CI, 1.12-2.14), age younger than 59 years (OR, 1.47; 95% CI, 1.23-1.74), ≥1 emergency department visits (OR, 1.40; 95% CI, 1.18-1.67), mood disorders (ie, depressive and bipolar disorders) (OR, 1.40; 95% CI, 1.18-1.66), and service connection (OR, 1.22; 95% CI, 1.01-1.47). Hyperlipidemia (OR, 0.77; 95% CI, 0.65-0.92) and being issued a wheelchair (OR, 0.83; 95% CI, 0.70-1.00) were associated with lower risk. Conclusions Suboptimal adherence to DMTs continues to be an issue. Interventions that focus on person-level barriers should be urgently explored to increase adherence and improve self-management abilities.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 815-821

Titre :	Early Intervention Service Intensity and Change in Children’s Functional Capabilities
Type de document :	Article
Auteurs :	Zachary S. Richardson ; Elizabeth A. Scully ; Jodi K. Dooling-Litfin
Année de publication :	2020
Article en page(s) :	p. 815-821
Note générale :	https://doi.org/10.1016/j.apmr.2019.10.188
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Activités de la vie quotidienne ; Cognition ; Compétences sociales ; Réadaptation
Résumé :	Objective To estimate correlates of early intervention (EI) service dosage and gains in children’s functional capabilities from EI entry and discharge. Design Retrospective cohort study. Setting Secondary analyses of a subset of data (N=1005) collected from an EI administrative database on children discharged from a large, urban EI program between October 1, 2014 and September 30, 2016. Participants Children who were EI eligible due to developmental delay, had received an EI care plan and at least 1 billable EI service, and had outcomes data at EI entry and exit (N=1005). Measured child characteristics included age (49.0% 12-24mo; n=492), sex (36.0% female; n=362), number of developmental delays (76.1% had 1 developmental delay; n=765), and number of EI services received (78.5% received multiple; n=789). Intervention Not applicable. Main Outcome Measures Outcomes were EI service intensity (hours per month) and change in functional capabilities as measured via the state-mandated Child Outcomes Summary (COS). Adjusted quantile median regression estimated EI intensity. Adjusted linear regression estimated change in function for social-emotional, cognitive, and adaptive domains of the COS. Measures of children’s developmental delay severity, age at EI entry, race and ethnicity, sex, and language. Results Children older than 24 months old experienced significantly higher EI service intensity (b=0.40; 95% confidence interval, 0.18-0.63). Child age and EI service intensity were significantly linked to gains in social and cognitive COS score changes from EI entry to exit. Conclusions Older children receive a higher intensity of EI services. EI service intensity and age were linked with positive changes in functional gains.
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[article] Early Intervention Service Intensity and Change in Children’s Functional Capabilities [Article] / Zachary S. Richardson ; Elizabeth A. Scully ; Jodi K. Dooling-Litfin . - 2020 . - p. 815-821.
https://doi.org/10.1016/j.apmr.2019.10.188
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 815-821

Descripteurs :	HE Vinci Activités de la vie quotidienne ; Cognition ; Compétences sociales ; Réadaptation
Résumé :	Objective To estimate correlates of early intervention (EI) service dosage and gains in children’s functional capabilities from EI entry and discharge. Design Retrospective cohort study. Setting Secondary analyses of a subset of data (N=1005) collected from an EI administrative database on children discharged from a large, urban EI program between October 1, 2014 and September 30, 2016. Participants Children who were EI eligible due to developmental delay, had received an EI care plan and at least 1 billable EI service, and had outcomes data at EI entry and exit (N=1005). Measured child characteristics included age (49.0% 12-24mo; n=492), sex (36.0% female; n=362), number of developmental delays (76.1% had 1 developmental delay; n=765), and number of EI services received (78.5% received multiple; n=789). Intervention Not applicable. Main Outcome Measures Outcomes were EI service intensity (hours per month) and change in functional capabilities as measured via the state-mandated Child Outcomes Summary (COS). Adjusted quantile median regression estimated EI intensity. Adjusted linear regression estimated change in function for social-emotional, cognitive, and adaptive domains of the COS. Measures of children’s developmental delay severity, age at EI entry, race and ethnicity, sex, and language. Results Children older than 24 months old experienced significantly higher EI service intensity (b=0.40; 95% confidence interval, 0.18-0.63). Child age and EI service intensity were significantly linked to gains in social and cognitive COS score changes from EI entry to exit. Conclusions Older children receive a higher intensity of EI services. EI service intensity and age were linked with positive changes in functional gains.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 822-831

Titre :	Psychiatric Disorders After Traumatic Brain Injury: A Nationwide Population-Based Cohort Study and the Effects of Rehabilitation Therapies
Type de document :	Article
Auteurs :	Wu-Chien Chien ; Chi-Hsiang Chung
Année de publication :	2020
Article en page(s) :	p. 822-831
Note générale :	https://doi.org/10.1016/j.apmr.2019.12.005
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Lésions traumatiques de l'encéphale ; Réadaptation ; Troubles mentaux
Résumé :	Objective To investigate the risk of psychiatric disorders after traumatic brain injury (TBI), and to clarify whether the post-TBI rehabilitation was associated with a lower risk of developing psychiatric disorders. Design A register-based, retrospective cohort design. Setting Using data from the National Health Insurance Research Database of Taiwan, we established an exposed cohort with TBI and a nonexposed group without TBI matched by age and year of diagnosis between 2000 and 2015. Participants This study included 231,894 patients with TBI and 695,682 patients without TBI (N=927,576). Interventions Rehabilitation therapies in TBI patients. Main Outcome Measures A multivariable Cox proportional hazards regression model was used to compare the risk of developing psychiatric disorders. Results The incidence rate of psychiatric disorders was higher in the TBI group than the control group. Compared with the control group, the risk of psychiatric disorders in the TBI group was twofold (hazard ratio [HR]=2.072; 95% confidence interval [95% CI], 1.955-2.189; P<.001 among the participants with tbi had received rehabilitation therapy and a lower risk of psychiatric disorders ci p in subgroup analysis medium- to high-level intensity was associated risks disorder respectively but there no significant finding low-intensity group.> Conclusions We found that TBI was associated with a high risk for developing psychiatric disorders, and that the post-TBI rehabilitation significantly reduced the risk of psychiatric disorders in a dose-dependent manner.
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[article] Psychiatric Disorders After Traumatic Brain Injury: A Nationwide Population-Based Cohort Study and the Effects of Rehabilitation Therapies [Article] / Wu-Chien Chien ; Chi-Hsiang Chung . - 2020 . - p. 822-831.
https://doi.org/10.1016/j.apmr.2019.12.005
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 822-831

Descripteurs :	HE Vinci Lésions traumatiques de l'encéphale ; Réadaptation ; Troubles mentaux
Résumé :	Objective To investigate the risk of psychiatric disorders after traumatic brain injury (TBI), and to clarify whether the post-TBI rehabilitation was associated with a lower risk of developing psychiatric disorders. Design A register-based, retrospective cohort design. Setting Using data from the National Health Insurance Research Database of Taiwan, we established an exposed cohort with TBI and a nonexposed group without TBI matched by age and year of diagnosis between 2000 and 2015. Participants This study included 231,894 patients with TBI and 695,682 patients without TBI (N=927,576). Interventions Rehabilitation therapies in TBI patients. Main Outcome Measures A multivariable Cox proportional hazards regression model was used to compare the risk of developing psychiatric disorders. Results The incidence rate of psychiatric disorders was higher in the TBI group than the control group. Compared with the control group, the risk of psychiatric disorders in the TBI group was twofold (hazard ratio [HR]=2.072; 95% confidence interval [95% CI], 1.955-2.189; P<.001 among the participants with tbi had received rehabilitation therapy and a lower risk of psychiatric disorders ci p in subgroup analysis medium- to high-level intensity was associated risks disorder respectively but there no significant finding low-intensity group.> Conclusions We found that TBI was associated with a high risk for developing psychiatric disorders, and that the post-TBI rehabilitation significantly reduced the risk of psychiatric disorders in a dose-dependent manner.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 832-840

Titre :	Associations of Hospital Discharge Services With Potentially Avoidable Readmissions Within 30 Days Among Older Adults After Rehabilitation in Acute Care Hospitals in Tokyo, Japan
Type de document :	Article
Auteurs :	Seigo Mitsutake ; Tatsuro Ishizaki ; Rumiko Tsuchiya-Ito
Année de publication :	2020
Article en page(s) :	p. 832-840
Note générale :	https://doi.org/10.1016/j.apmr.2019.11.019
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Mégadonnées ; Réadaptation ; Réadmission du patient ; Services de santé pour personnes âgées
Résumé :	Objective To examine the associations of 3 major hospital discharge services covered under health insurance (discharge planning, rehabilitation discharge instruction, and coordination with community care) with potentially avoidable readmissions (PARs) within 30 days in older adults after rehabilitation in acute care hospitals in Tokyo, Japan. Design Retrospective cohort study using a large-scale medical claims database of all Tokyo residents aged ≥75 years. Setting Acute care hospitals. Participants Patients who underwent rehabilitation and were discharged to home (N=31,247; mean age in years ± SD, 84.1±5.7) between October 2013 and July 2014. Interventions None. Main Outcome Measure 30-day PAR. Results Among the patients, 883 (2.9%) experienced 30-day PAR. A multivariable logistic generalized estimating equation model (with a logit link function and binominal sampling distribution) that adjusted for patient characteristics and clustering within hospitals showed that the discharge services were not significantly associated with 30-day PAR. The odds ratios were 0.962 (95% confidence interval [CI], 0.805-1.151) for discharge planning, 1.060 (95% CI, 0.916-1.227) for rehabilitation discharge instruction, and 1.118 (95% CI, 0.817-1.529) for coordination with community care. In contrast, the odds of 30-day PAR among patients with home medical care services were 1.431 times higher than those of patients without these services (P<.001 and the odds of par among patients with a higher number or rehabilitation units were times than those lower median also hospital frailty risk score> Conclusions The insurance-covered discharge services were not associated with 30-day PAR, and the development of comprehensive transitional care programs through the integration of existing discharge services may help to reduce such readmissions.
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[article] Associations of Hospital Discharge Services With Potentially Avoidable Readmissions Within 30 Days Among Older Adults After Rehabilitation in Acute Care Hospitals in Tokyo, Japan [Article] / Seigo Mitsutake ; Tatsuro Ishizaki ; Rumiko Tsuchiya-Ito . - 2020 . - p. 832-840.
https://doi.org/10.1016/j.apmr.2019.11.019
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 832-840

Descripteurs :	HE Vinci Mégadonnées ; Réadaptation ; Réadmission du patient ; Services de santé pour personnes âgées
Résumé :	Objective To examine the associations of 3 major hospital discharge services covered under health insurance (discharge planning, rehabilitation discharge instruction, and coordination with community care) with potentially avoidable readmissions (PARs) within 30 days in older adults after rehabilitation in acute care hospitals in Tokyo, Japan. Design Retrospective cohort study using a large-scale medical claims database of all Tokyo residents aged ≥75 years. Setting Acute care hospitals. Participants Patients who underwent rehabilitation and were discharged to home (N=31,247; mean age in years ± SD, 84.1±5.7) between October 2013 and July 2014. Interventions None. Main Outcome Measure 30-day PAR. Results Among the patients, 883 (2.9%) experienced 30-day PAR. A multivariable logistic generalized estimating equation model (with a logit link function and binominal sampling distribution) that adjusted for patient characteristics and clustering within hospitals showed that the discharge services were not significantly associated with 30-day PAR. The odds ratios were 0.962 (95% confidence interval [CI], 0.805-1.151) for discharge planning, 1.060 (95% CI, 0.916-1.227) for rehabilitation discharge instruction, and 1.118 (95% CI, 0.817-1.529) for coordination with community care. In contrast, the odds of 30-day PAR among patients with home medical care services were 1.431 times higher than those of patients without these services (P<.001 and the odds of par among patients with a higher number or rehabilitation units were times than those lower median also hospital frailty risk score> Conclusions The insurance-covered discharge services were not associated with 30-day PAR, and the development of comprehensive transitional care programs through the integration of existing discharge services may help to reduce such readmissions.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 841-851

Titre :	Risk Adjustment, Mode Adjustment, and Nonresponse Bias Analysis on Quality Measures From a Long-Term Care Hospital Experience of Care Survey
Type de document :	Article
Auteurs :	Sara M. Zuckerbraun ; Anne Deutsch ; Celia Eicheldinge
Année de publication :	2020
Article en page(s) :	p. 841-851
Note générale :	https://doi.org/10.1016/j.apmr.2019.11.016
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Ajustement du risque ; Enquêtes et questionnaires ; Réadaptation
Résumé :	Objectives To develop a patient risk adjustment model for experience of care (EOC) quality measures for long-term care hospitals (LTCHs) that includes mode of survey administration. To assess presence of nonresponse bias in the adjusted facility-level scores. Design We tested 3 modes of collecting the EOC data: mail-only, mixed (ie, mail with telephone follow-up), and in-facility. This study used sequential modeling and impact analysis, specified a risk and mode adjustment model, and evaluated presence of nonresponse after adjustment. Setting LTCHs. Participants Patients (N=1364) and 69 LTCHs. Intervention Not applicable. Main Outcome Measures Risk and mode adjusted responses to 28 survey questions and 6 facility-level scores derived from survey responses. Results Mode of data collection and patient risk variables (age, sex, overall health, overall mental health, marital status, education, race, and whether a proxy responded) were included in the model. Clinical variables were not significant. The in-facility mode was associated with significantly higher performance scores than the other modes. When the recommended risk and mode adjustment model was applied, nonresponse bias was not observed in any mode. Conclusions LTCH EOC data should be adjusted for patient risk variables including mode of data collection.
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[article] Risk Adjustment, Mode Adjustment, and Nonresponse Bias Analysis on Quality Measures From a Long-Term Care Hospital Experience of Care Survey [Article] / Sara M. Zuckerbraun ; Anne Deutsch ; Celia Eicheldinge . - 2020 . - p. 841-851.
https://doi.org/10.1016/j.apmr.2019.11.016
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 841-851

Descripteurs :	HE Vinci Ajustement du risque ; Enquêtes et questionnaires ; Réadaptation
Résumé :	Objectives To develop a patient risk adjustment model for experience of care (EOC) quality measures for long-term care hospitals (LTCHs) that includes mode of survey administration. To assess presence of nonresponse bias in the adjusted facility-level scores. Design We tested 3 modes of collecting the EOC data: mail-only, mixed (ie, mail with telephone follow-up), and in-facility. This study used sequential modeling and impact analysis, specified a risk and mode adjustment model, and evaluated presence of nonresponse after adjustment. Setting LTCHs. Participants Patients (N=1364) and 69 LTCHs. Intervention Not applicable. Main Outcome Measures Risk and mode adjusted responses to 28 survey questions and 6 facility-level scores derived from survey responses. Results Mode of data collection and patient risk variables (age, sex, overall health, overall mental health, marital status, education, race, and whether a proxy responded) were included in the model. Clinical variables were not significant. The in-facility mode was associated with significantly higher performance scores than the other modes. When the recommended risk and mode adjustment model was applied, nonresponse bias was not observed in any mode. Conclusions LTCH EOC data should be adjusted for patient risk variables including mode of data collection.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 852-860

Titre :	Association Between Malnutrition and Outcomes in Patients With Severe Ischemic Stroke Undergoing Rehabilitation
Type de document :	Article
Auteurs :	Domenico Scrutinio ; Bernardo Lanzillo ; Pietro Guida
Année de publication :	2020
Article en page(s) :	p. 852-860
Note générale :	https://doi.org/10.1016/j.apmr.2019.11.012
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Accident vasculaire cérébral (AVC) ; Réadaptation
Résumé :	Objective To investigate the incremental prognostic significance of malnutrition in patients with severe poststroke disability. Design Retrospective cohort study. The patients were recruited from 3 specialized inpatient rehabilitation facilities. Nutritional status was assessed using the Prognostic Nutritional Index (PNI), which is calculated from serum albumin and total lymphocyte count. Scores >38 points reflect normal nutrition status, scores of 35-38 indicate moderate malnutrition, and scores Setting Inpatient rehabilitation facility. Participants Patients (N=668) with ischemic stroke admitted to inpatient rehabilitation within 90 days from stroke occurrence and classified as Case-Mix Groups 0108, 0109, and 0110 of the current Medicare case-mix classification system. Interventions Not applicable. Main Outcome Measures Three outcomes were examined: (1) the combined outcome of transfer to acute care and death within 90 days from admission to rehabilitation; (2) 2-year mortality; and (3) FIM motor effectiveness, calculated as (FIM motor change/maximum FIM motor−admission FIM motor score)×100. Results Overall, the median time to rehabilitation admission was 18 days (range, 12-26 days). The prevalence of moderate and severe malnutrition was 12.7% and 11.5%, respectively. Ninety-one patients (13.6%) experienced the combined outcome. After adjusting for independent predictors including sex, atrial fibrillation, dysphagia, FIM cognitive score, and hemoglobin levels, neither moderate (P=.280) nor severe malnutrition (P=.482) were associated with the combined outcome. Similar results were observed when looking at 2-year mortality. Overall, FIM motor effectiveness was 30%±24%. After adjusting for independent predictors, severe malnutrition (β coefficient −0.458±0.216; P=.034) was associated with FIM motor effectiveness. Conclusions Approximately 1 in every 9 patients presented severe malnutrition. On top of the independent predictors, severe malnutrition did not provide additional prognostic information concerning risk of the combined outcome or 2-year mortality. Conversely, severe malnutrition was associated with poorer functional outcome as expressed by FIM motor effectiveness.
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[article] Association Between Malnutrition and Outcomes in Patients With Severe Ischemic Stroke Undergoing Rehabilitation [Article] / Domenico Scrutinio ; Bernardo Lanzillo ; Pietro Guida . - 2020 . - p. 852-860.
https://doi.org/10.1016/j.apmr.2019.11.012
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 852-860

Descripteurs :	HE Vinci Accident vasculaire cérébral (AVC) ; Réadaptation
Résumé :	Objective To investigate the incremental prognostic significance of malnutrition in patients with severe poststroke disability. Design Retrospective cohort study. The patients were recruited from 3 specialized inpatient rehabilitation facilities. Nutritional status was assessed using the Prognostic Nutritional Index (PNI), which is calculated from serum albumin and total lymphocyte count. Scores >38 points reflect normal nutrition status, scores of 35-38 indicate moderate malnutrition, and scores Setting Inpatient rehabilitation facility. Participants Patients (N=668) with ischemic stroke admitted to inpatient rehabilitation within 90 days from stroke occurrence and classified as Case-Mix Groups 0108, 0109, and 0110 of the current Medicare case-mix classification system. Interventions Not applicable. Main Outcome Measures Three outcomes were examined: (1) the combined outcome of transfer to acute care and death within 90 days from admission to rehabilitation; (2) 2-year mortality; and (3) FIM motor effectiveness, calculated as (FIM motor change/maximum FIM motor−admission FIM motor score)×100. Results Overall, the median time to rehabilitation admission was 18 days (range, 12-26 days). The prevalence of moderate and severe malnutrition was 12.7% and 11.5%, respectively. Ninety-one patients (13.6%) experienced the combined outcome. After adjusting for independent predictors including sex, atrial fibrillation, dysphagia, FIM cognitive score, and hemoglobin levels, neither moderate (P=.280) nor severe malnutrition (P=.482) were associated with the combined outcome. Similar results were observed when looking at 2-year mortality. Overall, FIM motor effectiveness was 30%±24%. After adjusting for independent predictors, severe malnutrition (β coefficient −0.458±0.216; P=.034) was associated with FIM motor effectiveness. Conclusions Approximately 1 in every 9 patients presented severe malnutrition. On top of the independent predictors, severe malnutrition did not provide additional prognostic information concerning risk of the combined outcome or 2-year mortality. Conversely, severe malnutrition was associated with poorer functional outcome as expressed by FIM motor effectiveness.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 861-869

Titre :	Effect of Low Back Pain Chronicity on Patient Outcomes Treated in Outpatient Physical Therapy: A Retrospective Observational Study
Type de document :	Article
Auteurs :	Zachary Walston ; Cherilyn McLester ; John McLester
Année de publication :	2020
Article en page(s) :	p. 861-869
Note générale :	https://doi.org/10.1016/j.apmr.2019.11.009
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Douleur chronique ; Évaluation des résultats des patients ; Lombalgie ; Planification des soins du patient ; Réadaptation ; Techniques de physiothérapie
Résumé :	Objective To examine the potential relationship between physical therapy (PT) treatment outcomes and chronicity of low back pain (LBP) in the outpatient setting. Design Retrospective observational study. Setting Outpatient PT clinics across 11 states. Participants A total of 11,941 patients with LBP provided with PT services and discharged from care between January 1, 2017, and December 31, 2018. Main Outcome Measures Focus on Therapeutic Outcome Low Back Functional Status (FS) Patient-Reported Outcome Measure (PROM) was the primary outcomes measure used. It assesses the patients’ perceived physical abilities for patients experiencing LBP impairments. It determined a functional score on a linear metric ranging from 0 (low functioning) to 100 (high functioning). The difference in score between the intake FS and final FS score produced the FS change, which represented the overall improvement of the episode of care. Results The mean FS change was 16.997 (n=11,945). Patients with chronic symptoms (>90-d duration) had an FS change of 15.920 (n=7264) across 14.63 visits. Patients with subacute symptoms (15-90d) had an FS change of 21.66 (n=3631) across 14.05. Patients with acute symptoms (0-14d) had an FS change of 29.32 (n=1050) across 13.66 visits. Stepwise regression analysis revealed a significant â for chronicity (−4.155) with all models. Conclusions Overall, this study shows patients experiencing shorter duration of LBP symptoms before starting a PT episode of care experience significantly better outcomes than patients who waited. Furthermore, the number of treatment session and duration of care was similar between groups, indicating potential ineffective or insufficient care was provided for patients with chronic pain.
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[article] Effect of Low Back Pain Chronicity on Patient Outcomes Treated in Outpatient Physical Therapy: A Retrospective Observational Study [Article] / Zachary Walston ; Cherilyn McLester ; John McLester . - 2020 . - p. 861-869.
https://doi.org/10.1016/j.apmr.2019.11.009
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 861-869

Descripteurs :	HE Vinci Douleur chronique ; Évaluation des résultats des patients ; Lombalgie ; Planification des soins du patient ; Réadaptation ; Techniques de physiothérapie
Résumé :	Objective To examine the potential relationship between physical therapy (PT) treatment outcomes and chronicity of low back pain (LBP) in the outpatient setting. Design Retrospective observational study. Setting Outpatient PT clinics across 11 states. Participants A total of 11,941 patients with LBP provided with PT services and discharged from care between January 1, 2017, and December 31, 2018. Main Outcome Measures Focus on Therapeutic Outcome Low Back Functional Status (FS) Patient-Reported Outcome Measure (PROM) was the primary outcomes measure used. It assesses the patients’ perceived physical abilities for patients experiencing LBP impairments. It determined a functional score on a linear metric ranging from 0 (low functioning) to 100 (high functioning). The difference in score between the intake FS and final FS score produced the FS change, which represented the overall improvement of the episode of care. Results The mean FS change was 16.997 (n=11,945). Patients with chronic symptoms (>90-d duration) had an FS change of 15.920 (n=7264) across 14.63 visits. Patients with subacute symptoms (15-90d) had an FS change of 21.66 (n=3631) across 14.05. Patients with acute symptoms (0-14d) had an FS change of 29.32 (n=1050) across 13.66 visits. Stepwise regression analysis revealed a significant â for chronicity (−4.155) with all models. Conclusions Overall, this study shows patients experiencing shorter duration of LBP symptoms before starting a PT episode of care experience significantly better outcomes than patients who waited. Furthermore, the number of treatment session and duration of care was similar between groups, indicating potential ineffective or insufficient care was provided for patients with chronic pain.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 870-876

Titre :	Longer Time Before Acute Rehabilitation Therapy Worsens Disability After Intracerebral Hemorrhage
Type de document :	Article
Auteurs :	Carmen E. Capo-Lugo ; Robert L. Askew ; Kathryn Muldoon
Année de publication :	2020
Article en page(s) :	p. 870-876
Note générale :	https://doi.org/10.1016/j.apmr.2019.11.006
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Hemorragie cerebrale ; Réadaptation ; Recherche sur les services de santé
Résumé :	Objective Assess the association of time to initiation of acute rehabilitation therapy with disability after intracerebral hemorrhage (ICH) and identify predictors of time to initiation of rehabilitation therapy. Design Retrospective data analysis of prospectively collected data from an ongoing observational cohort study. Setting Large comprehensive stroke center in a metropolitan area. Participants Adults with ICH consecutively admitted (n=203). Interventions Not applicable. Main Outcome Measures Disability was assessed with the modified Rankin Scale (mRS), with poor outcome defined as mRS 4-6 (dependence or worse). Time to initiation of acute rehabilitation therapy was defined as the number of days between hospital admission and the first consult by any rehabilitation therapy specialist (eg, physical therapy, occupational therapy, speech therapy). Results The median number of days from hospital admission to initiation of acute rehabilitation therapy was 3 (range=2-7). Multivariable logistic regression models indicated that each additional day between admission and initiation of acute rehabilitation therapy was associated with increased odds of poor outcome at 30 days (adjusted odds ratio [OR]=1.151; 95% confidence interval [CI]=1.044-1.268; P=.005) and at 90 days (adjusted OR=1.107; 95% CI=1.003-1.222; P=.044) for patients with ICH. A multivariable linear regression model used to identify the predictors of time to initiation of rehabilitation therapy identified heavy drinking (>5 drinks per day), premorbid mRS Conclusions Longer time to initiation of acute rehabilitation therapy after ICH may have persistent effects on poststroke disability. Delays in acute rehabilitation therapy consults should be minimized and may improve outcomes after ICH.
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[article] Longer Time Before Acute Rehabilitation Therapy Worsens Disability After Intracerebral Hemorrhage [Article] / Carmen E. Capo-Lugo ; Robert L. Askew ; Kathryn Muldoon . - 2020 . - p. 870-876.
https://doi.org/10.1016/j.apmr.2019.11.006
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 870-876

Descripteurs :	HE Vinci Hemorragie cerebrale ; Réadaptation ; Recherche sur les services de santé
Résumé :	Objective Assess the association of time to initiation of acute rehabilitation therapy with disability after intracerebral hemorrhage (ICH) and identify predictors of time to initiation of rehabilitation therapy. Design Retrospective data analysis of prospectively collected data from an ongoing observational cohort study. Setting Large comprehensive stroke center in a metropolitan area. Participants Adults with ICH consecutively admitted (n=203). Interventions Not applicable. Main Outcome Measures Disability was assessed with the modified Rankin Scale (mRS), with poor outcome defined as mRS 4-6 (dependence or worse). Time to initiation of acute rehabilitation therapy was defined as the number of days between hospital admission and the first consult by any rehabilitation therapy specialist (eg, physical therapy, occupational therapy, speech therapy). Results The median number of days from hospital admission to initiation of acute rehabilitation therapy was 3 (range=2-7). Multivariable logistic regression models indicated that each additional day between admission and initiation of acute rehabilitation therapy was associated with increased odds of poor outcome at 30 days (adjusted odds ratio [OR]=1.151; 95% confidence interval [CI]=1.044-1.268; P=.005) and at 90 days (adjusted OR=1.107; 95% CI=1.003-1.222; P=.044) for patients with ICH. A multivariable linear regression model used to identify the predictors of time to initiation of rehabilitation therapy identified heavy drinking (>5 drinks per day), premorbid mRS Conclusions Longer time to initiation of acute rehabilitation therapy after ICH may have persistent effects on poststroke disability. Delays in acute rehabilitation therapy consults should be minimized and may improve outcomes after ICH.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 877-884

Titre :	Prevalence and Prognostic Factors for Psychological Distress After Trauma
Type de document :	Article
Auteurs :	Leonie de Munter ; Suzanne Polinder ; Juanita A. Haagsma
Année de publication :	2020
Article en page(s) :	p. 877-884
Note générale :	https://doi.org/10.1016/j.apmr.2019.10.196
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Anxiété ; Dépression ; Etudes prospectives ; Plaies et blessures ; Prévalence ; Pronostic ; Réadaptation ; Troubles de stress post-traumatique
Résumé :	Abstract Objective To describe the prevalence and prognostic factors of symptoms of anxiety and depression and posttraumatic stress symptoms (PTSS) after injury in the clinical trauma population. Design Multicenter, prospective, observational cohort study. Setting Ten hospitals in Noord-Brabant, The Netherlands. Participants Four thousand two hundred thirty-nine adult patients (N=4239) admitted due to injury between August 2015 and December 2016. Interventions Patients were asked to complete a questionnaire at 1 week and at 1, 3, 6, and 12 months after injury. Main Outcome Measures The Hospital Anxiety and Depression Scale was used to assess anxiety and depressive symptoms and the Impact of Event Scale was used to assess PTSS. Results The prevalence of symptoms of anxiety and depression decreased from 10% and 12%, respectively, at 1 week after injury to 7% and 7% at 12 months after injury. Acute traumatic stress symptoms were present in 13% at 1 week and PTSS was prevalent in 10% of the participants at 12 months after injury. Strong prognostic factors for poor psychological outcome in multivariable logistic mixed models were preinjury frailty, psychological complaints and nonworking status preinjury, female sex, low educational level, and accident category (ie, traffic accident, work-related accident, or accidents at home compared to sport injuries). Conclusions Psychological distress is a common health problem during the first year after injury. Important prognostic factors for psychological distress include psychological complaints before injury and frailty. Early recognition of psychological problems after injury could facilitate discussion between caregivers and patients and improve recovery.
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[article] Prevalence and Prognostic Factors for Psychological Distress After Trauma [Article] / Leonie de Munter ; Suzanne Polinder ; Juanita A. Haagsma . - 2020 . - p. 877-884.
https://doi.org/10.1016/j.apmr.2019.10.196
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 877-884

Descripteurs :	HE Vinci Anxiété ; Dépression ; Etudes prospectives ; Plaies et blessures ; Prévalence ; Pronostic ; Réadaptation ; Troubles de stress post-traumatique
Résumé :	Abstract Objective To describe the prevalence and prognostic factors of symptoms of anxiety and depression and posttraumatic stress symptoms (PTSS) after injury in the clinical trauma population. Design Multicenter, prospective, observational cohort study. Setting Ten hospitals in Noord-Brabant, The Netherlands. Participants Four thousand two hundred thirty-nine adult patients (N=4239) admitted due to injury between August 2015 and December 2016. Interventions Patients were asked to complete a questionnaire at 1 week and at 1, 3, 6, and 12 months after injury. Main Outcome Measures The Hospital Anxiety and Depression Scale was used to assess anxiety and depressive symptoms and the Impact of Event Scale was used to assess PTSS. Results The prevalence of symptoms of anxiety and depression decreased from 10% and 12%, respectively, at 1 week after injury to 7% and 7% at 12 months after injury. Acute traumatic stress symptoms were present in 13% at 1 week and PTSS was prevalent in 10% of the participants at 12 months after injury. Strong prognostic factors for poor psychological outcome in multivariable logistic mixed models were preinjury frailty, psychological complaints and nonworking status preinjury, female sex, low educational level, and accident category (ie, traffic accident, work-related accident, or accidents at home compared to sport injuries). Conclusions Psychological distress is a common health problem during the first year after injury. Important prognostic factors for psychological distress include psychological complaints before injury and frailty. Early recognition of psychological problems after injury could facilitate discussion between caregivers and patients and improve recovery.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 885-896

Titre :	Effectiveness of Virtual Reality- and Gaming-Based Interventions for Upper Extremity Rehabilitation Poststroke: A Meta-analysis
Type de document :	Article
Auteurs :	Reneh Karamians ; Rachel Proffitt ; David Kline
Année de publication :	2020
Article en page(s) :	p. 885-896
Note générale :	https://doi.org/10.1016/j.apmr.2019.10.195
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Accident vasculaire cérébral (AVC) ; Jeux vidéo ; Membre supérieur ; Parésie ; Réadaptation ; Réalité de synthèse
Résumé :	Objective To investigate the efficacy of virtual reality (VR)- and gaming-based interventions for improving upper extremity function poststroke, and to examine demographic and treatment-related factors that may moderate treatment response. Data Sources A comprehensive search was conducted within the PubMed, CINAHL/EBSCO, SCOPUS, Ovid MEDLINE, and EMBASE databases for articles published between 2005 and 2019. Study Selection Articles investigating gaming and VR methods of treatment for upper extremity weakness were collected with the following study inclusion criteria: (1) participants aged 18 years or older with upper extremity deficits; (2) randomized controlled trials or prospective study design; (3) Downs-Black rating score of ≥18; and (4) outcome measure was the Wolf Motor Functioning Test, the Fugl-Meyer, or the Action Research Arm Test. Data Extraction Thirty-eight articles met inclusion criteria. The primary outcome was proportional improvement on the Wolf Motor Functioning Test, Fugl-Meyer, or Action Research Arm Test. The following individual or treatment factors were extracted: VR or gaming dose, total treatment dose, chronicity (> or Data Analysis Random effects meta-analysis models were utilized to quantify (1) the proportional recovery that occurs after VR or gaming; (2) the comparative treatment effect of VR or gaming vs conventional physiotherapy; and (3) whether the benefit of virtual reality differed based on participant characteristics or elements of the treatment. Results On average, VR or gaming interventions produced an improvement of 28.5% of the maximal possible improvement. Dose and severity of motor impairment did not significantly influence rehabilitation outcomes. Treatment gains were significantly larger overall (10.8%) when the computerized training involved a gaming component vs just visual feedback. VR or gaming interventions showed a significant treatment advantage (10.4%) over active control treatments. Conclusions Overall, VR- or gaming-based upper extremity rehabilitation poststroke appears to be more effective than conventional methods. Further in-depth study of variables affecting improvement, such as individual motor presentation, treatment dose, and the relationship between them, are needed.
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[article] Effectiveness of Virtual Reality- and Gaming-Based Interventions for Upper Extremity Rehabilitation Poststroke: A Meta-analysis [Article] / Reneh Karamians ; Rachel Proffitt ; David Kline . - 2020 . - p. 885-896.
https://doi.org/10.1016/j.apmr.2019.10.195
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 885-896

Descripteurs :	HE Vinci Accident vasculaire cérébral (AVC) ; Jeux vidéo ; Membre supérieur ; Parésie ; Réadaptation ; Réalité de synthèse
Résumé :	Objective To investigate the efficacy of virtual reality (VR)- and gaming-based interventions for improving upper extremity function poststroke, and to examine demographic and treatment-related factors that may moderate treatment response. Data Sources A comprehensive search was conducted within the PubMed, CINAHL/EBSCO, SCOPUS, Ovid MEDLINE, and EMBASE databases for articles published between 2005 and 2019. Study Selection Articles investigating gaming and VR methods of treatment for upper extremity weakness were collected with the following study inclusion criteria: (1) participants aged 18 years or older with upper extremity deficits; (2) randomized controlled trials or prospective study design; (3) Downs-Black rating score of ≥18; and (4) outcome measure was the Wolf Motor Functioning Test, the Fugl-Meyer, or the Action Research Arm Test. Data Extraction Thirty-eight articles met inclusion criteria. The primary outcome was proportional improvement on the Wolf Motor Functioning Test, Fugl-Meyer, or Action Research Arm Test. The following individual or treatment factors were extracted: VR or gaming dose, total treatment dose, chronicity (> or Data Analysis Random effects meta-analysis models were utilized to quantify (1) the proportional recovery that occurs after VR or gaming; (2) the comparative treatment effect of VR or gaming vs conventional physiotherapy; and (3) whether the benefit of virtual reality differed based on participant characteristics or elements of the treatment. Results On average, VR or gaming interventions produced an improvement of 28.5% of the maximal possible improvement. Dose and severity of motor impairment did not significantly influence rehabilitation outcomes. Treatment gains were significantly larger overall (10.8%) when the computerized training involved a gaming component vs just visual feedback. VR or gaming interventions showed a significant treatment advantage (10.4%) over active control treatments. Conclusions Overall, VR- or gaming-based upper extremity rehabilitation poststroke appears to be more effective than conventional methods. Further in-depth study of variables affecting improvement, such as individual motor presentation, treatment dose, and the relationship between them, are needed.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 897-906

Titre :	Effectiveness of Platelet-Rich Plasma Injections for Nonsurgical Management of Carpal Tunnel Syndrome: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Type de document :	Article
Auteurs :	Michael Catapano ; Joseph Catapano ; Gregory Borschel
Année de publication :	2020
Article en page(s) :	p. 897-906
Note générale :	https://doi.org/10.1016/j.apmr.2019.10.193
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Plasma riche en plaquettes ; Réadaptation ; Syndrome du canal carpien
Résumé :	Objective To systematically review and evaluate the efficacy and complication profile of platelet-rich plasma (PRP) injection into the carpal tunnel for management of carpal tunnel syndrome (CTS). Data Sources PubMed, MEDLINE, SCOPUS, EMBASE, Google Scholar, Cochrane Central Register of Controlled Trials, and Web of Sciences (from inception to January 1, 2019). Study Selection Controlled trials addressing PRP for CTS. Data Extraction Two reviewers independently screened the titles, abstracts, and full texts, extracting data from eligible studies. The outcomes of interest were the visual analog score (VAS) for pain and the Boston Carpal Tunnel Questionnaire (BCTQ), including the subscales of the symptom severity scale (SSS) and the Functional Status Scale (FSS). Other reported outcome measures and complications were analyzed descriptively. Data Synthesis Four randomized controlled studies satisfied the inclusion criteria and analyzed a total of 191 cases with a final follow-up of either 3 or 6 months. Control groups included splinting in 2 studies, corticosteroid injection in 1 study, and saline injection in 1 study. There was a statistically and clinically significant improvement in the BCTQ (standardized mean difference=-2.06; 95% confidence interval [CI], -3.41 to -0.70; P=.003) between groups. Subgroup analysis showed significant improvement in SSS (standardized mean difference=-1.95; 95% CI, -3.65 to -0.25; P=.02) but not for FSS (standardized mean difference=-2.19; 95% CI, -4.77 to 0.40; P=.10). There was a similar improvement in VAS and nerve conduction studies in those receiving PRP compared to controls. Complication rate in the included studies was low with 4 of 97 participants receiving PRP injections experiencing transient pruritis, burning, or tingling. Conclusions PRP represents a promising therapy for patients with mild to moderate CTS; however, included studies were limited as follow-up was short, the studies included patients that were heterogeneous, and the number of included studies was low. Further investigation is necessary to determine the true efficacy and effect of PRP and to better delineate the long-term results in patients with CTS.
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[article] Effectiveness of Platelet-Rich Plasma Injections for Nonsurgical Management of Carpal Tunnel Syndrome: A Systematic Review and Meta-analysis of Randomized Controlled Trials [Article] / Michael Catapano ; Joseph Catapano ; Gregory Borschel . - 2020 . - p. 897-906.
https://doi.org/10.1016/j.apmr.2019.10.193
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 897-906

Descripteurs :	HE Vinci Plasma riche en plaquettes ; Réadaptation ; Syndrome du canal carpien
Résumé :	Objective To systematically review and evaluate the efficacy and complication profile of platelet-rich plasma (PRP) injection into the carpal tunnel for management of carpal tunnel syndrome (CTS). Data Sources PubMed, MEDLINE, SCOPUS, EMBASE, Google Scholar, Cochrane Central Register of Controlled Trials, and Web of Sciences (from inception to January 1, 2019). Study Selection Controlled trials addressing PRP for CTS. Data Extraction Two reviewers independently screened the titles, abstracts, and full texts, extracting data from eligible studies. The outcomes of interest were the visual analog score (VAS) for pain and the Boston Carpal Tunnel Questionnaire (BCTQ), including the subscales of the symptom severity scale (SSS) and the Functional Status Scale (FSS). Other reported outcome measures and complications were analyzed descriptively. Data Synthesis Four randomized controlled studies satisfied the inclusion criteria and analyzed a total of 191 cases with a final follow-up of either 3 or 6 months. Control groups included splinting in 2 studies, corticosteroid injection in 1 study, and saline injection in 1 study. There was a statistically and clinically significant improvement in the BCTQ (standardized mean difference=-2.06; 95% confidence interval [CI], -3.41 to -0.70; P=.003) between groups. Subgroup analysis showed significant improvement in SSS (standardized mean difference=-1.95; 95% CI, -3.65 to -0.25; P=.02) but not for FSS (standardized mean difference=-2.19; 95% CI, -4.77 to 0.40; P=.10). There was a similar improvement in VAS and nerve conduction studies in those receiving PRP compared to controls. Complication rate in the included studies was low with 4 of 97 participants receiving PRP injections experiencing transient pruritis, burning, or tingling. Conclusions PRP represents a promising therapy for patients with mild to moderate CTS; however, included studies were limited as follow-up was short, the studies included patients that were heterogeneous, and the number of included studies was low. Further investigation is necessary to determine the true efficacy and effect of PRP and to better delineate the long-term results in patients with CTS.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 907-916

Titre :	Measuring Motor Fatigability in the Upper Limbs in Individuals With Neurologic Disorders: A Systematic Review
Type de document :	Article
Auteurs :	Lieke Brauers ; Eugene Rameckers ; Deborah Severijns
Année de publication :	2020
Article en page(s) :	p. 907-916
Note générale :	https://doi.org/10.1016/j.apmr.2019.11.015
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Membre supérieur ; Réadaptation ; Rééducation neurologique
Résumé :	Objective To summarize the literature on definitions, assessment protocols, and outcome measures for motor fatigability in patients with neurologic problems and investigates the known clinimetric properties according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria. Data Sources Two databases were consulted for studies published between January 2003 and November 2018 using the terms “motor fatigability,” “nervous system disease,” and “upper limb.” Study Selection Studies were included if they were (1) not older than 15 years; (2) written in English, German, or Dutch; (3) involved upper limbs of patients with neurologic disease; and (4) adequately described protocols using maximum voluntary contractions. Data Extraction Thirty-three studies were included, describing 14 definitions, 37 assessment protocols, and 9 outcome measures. The following data were obtained: (1) author and publication year; (2) aim; (3) fatigability definition; (4) sample characteristics; (5) fatigability protocol; (8) measurement system; and (9) outcome measure. Data Synthesis Protocols relating to body function level of the International Classification of Functioning (ICF) were most often performed in patients with multiple sclerosis (MS) including maximal or submaximal, isometric or concentric, and eccentric contractions of variable duration. For ICF activities level, most protocols included wheelchair-related tasks. Clinimetric properties were known in 2 included protocols. Test-retest reliability in patients with MS were moderate to excellent for the static fatigue index and moderate for the dynamic fatigue index. Conclusions Based on physiology, recommendations are made for protocols and outcome measures for motor fatigability at the ICF body function level. For the ICF activities level, too little is known to make sound statements on the use of protocols in populations with neurologic disease. Clinimetric properties should be further investigated for populations with neurologic problems.
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[article] Measuring Motor Fatigability in the Upper Limbs in Individuals With Neurologic Disorders: A Systematic Review [Article] / Lieke Brauers ; Eugene Rameckers ; Deborah Severijns . - 2020 . - p. 907-916.
https://doi.org/10.1016/j.apmr.2019.11.015
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 5 (2020) . - p. 907-916

Descripteurs :	HE Vinci Membre supérieur ; Réadaptation ; Rééducation neurologique
Résumé :	Objective To summarize the literature on definitions, assessment protocols, and outcome measures for motor fatigability in patients with neurologic problems and investigates the known clinimetric properties according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria. Data Sources Two databases were consulted for studies published between January 2003 and November 2018 using the terms “motor fatigability,” “nervous system disease,” and “upper limb.” Study Selection Studies were included if they were (1) not older than 15 years; (2) written in English, German, or Dutch; (3) involved upper limbs of patients with neurologic disease; and (4) adequately described protocols using maximum voluntary contractions. Data Extraction Thirty-three studies were included, describing 14 definitions, 37 assessment protocols, and 9 outcome measures. The following data were obtained: (1) author and publication year; (2) aim; (3) fatigability definition; (4) sample characteristics; (5) fatigability protocol; (8) measurement system; and (9) outcome measure. Data Synthesis Protocols relating to body function level of the International Classification of Functioning (ICF) were most often performed in patients with multiple sclerosis (MS) including maximal or submaximal, isometric or concentric, and eccentric contractions of variable duration. For ICF activities level, most protocols included wheelchair-related tasks. Clinimetric properties were known in 2 included protocols. Test-retest reliability in patients with MS were moderate to excellent for the static fatigue index and moderate for the dynamic fatigue index. Conclusions Based on physiology, recommendations are made for protocols and outcome measures for motor fatigability at the ICF body function level. For the ICF activities level, too little is known to make sound statements on the use of protocols in populations with neurologic disease. Clinimetric properties should be further investigated for populations with neurologic problems.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 4 (2020) . - p. 571-578

Titre :	Effects of Geriatric Interdisciplinary Home Rehabilitation on Independence in Activities of Daily Living in Older People With Hip Fracture: A Randomized Controlled Trial
Type de document :	Article
Auteurs :	Asa Karlsson ; Nina Lindelöf ; Birgitta Olofsson
Année de publication :	2020
Article en page(s) :	p. 571-578
Note générale :	https://doi.org/10.1016/j.apmr.2019.12.007
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Activités de la vie quotidienne ; Equipe soignante ; Fractures de la hanche ; Gériatrie ; Réadaptation
Résumé :	Objective To evaluate the effects of early discharge followed by geriatric interdisciplinary home rehabilitation for older people with hip fracture on independence in activities of daily living (ADL) compared with inhospital geriatric care according to a multifactorial rehabilitation program. Design Planned analysis of a randomized controlled trial with 3- and 12-month follow-ups. Setting Geriatric ward, ordinary housing, and residential care facilities. Participants Of 466 people screened for eligibility, participants (N=205) with acute hip fracture, aged 70 years or older, including those with cognitive impairment and those living in residential care facilities, were randomized to intervention or control groups. Intervention Individually designed interdisciplinary home rehabilitation for a maximum of 10 weeks. The intervention aimed at early hospital discharge and focused on prevention of falls, independence in daily activities, and walking ability indoors and outdoors. Main Outcome Measures Independence in ADL was measured using the Barthel ADL Index, and the ADL Staircase including the Katz ADL Index during hospital stay (prefracture performance) and at the follow-up visits in the participants’ homes. Results There were no significant differences in ADL performance between the groups, and they recovered their prefracture level of independence in personal and instrumental ADL comparably. At 12 months, 33 (41.3%) in the intervention group vs 33 (41.8%) in the control group (P=.99) had regained or improved their prefracture ADL performance according to the Barthel ADL Index, and 27 (37.0%) vs 36 (48.6%) according to the ADL Staircase (P=.207). Conclusions In older people with hip fracture, early discharge followed by geriatric interdisciplinary home rehabilitation resulted in a comparable recovery of independence in ADL at 3 and 12 months as inhospital geriatric care and rehabilitation.
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[article] Effects of Geriatric Interdisciplinary Home Rehabilitation on Independence in Activities of Daily Living in Older People With Hip Fracture: A Randomized Controlled Trial [Article] / Asa Karlsson ; Nina Lindelöf ; Birgitta Olofsson . - 2020 . - p. 571-578.
https://doi.org/10.1016/j.apmr.2019.12.007

Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 4 (2020) . - p. 571-578

Descripteurs :	HE Vinci Activités de la vie quotidienne ; Equipe soignante ; Fractures de la hanche ; Gériatrie ; Réadaptation
Résumé :	Objective To evaluate the effects of early discharge followed by geriatric interdisciplinary home rehabilitation for older people with hip fracture on independence in activities of daily living (ADL) compared with inhospital geriatric care according to a multifactorial rehabilitation program. Design Planned analysis of a randomized controlled trial with 3- and 12-month follow-ups. Setting Geriatric ward, ordinary housing, and residential care facilities. Participants Of 466 people screened for eligibility, participants (N=205) with acute hip fracture, aged 70 years or older, including those with cognitive impairment and those living in residential care facilities, were randomized to intervention or control groups. Intervention Individually designed interdisciplinary home rehabilitation for a maximum of 10 weeks. The intervention aimed at early hospital discharge and focused on prevention of falls, independence in daily activities, and walking ability indoors and outdoors. Main Outcome Measures Independence in ADL was measured using the Barthel ADL Index, and the ADL Staircase including the Katz ADL Index during hospital stay (prefracture performance) and at the follow-up visits in the participants’ homes. Results There were no significant differences in ADL performance between the groups, and they recovered their prefracture level of independence in personal and instrumental ADL comparably. At 12 months, 33 (41.3%) in the intervention group vs 33 (41.8%) in the control group (P=.99) had regained or improved their prefracture ADL performance according to the Barthel ADL Index, and 27 (37.0%) vs 36 (48.6%) according to the ADL Staircase (P=.207). Conclusions In older people with hip fracture, early discharge followed by geriatric interdisciplinary home rehabilitation resulted in a comparable recovery of independence in ADL at 3 and 12 months as inhospital geriatric care and rehabilitation.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 4 (2020) . - p. 579-586

Titre :	The Importance of Cognitive Executive Functions in Gait Recovery After Total Hip Arthroplasty
Type de document :	Article
Auteurs :	Francesco Negrini ; Matteo Preti ; Eleonora Zirone
Année de publication :	2020
Article en page(s) :	p. 579-586
Note générale :	https://doi.org/10.1016/j.apmr.2019.12.004
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Cognition ; Fonction exécutive ; Réadaptation
Résumé :	Objective To determine the influence of cognitive functioning on gait recovery after total hip arthroplasty. Design Prospective cohort study. Setting Rehabilitation hospital. Participants Patients (N=40) who underwent a total hip arthroplasty, with normal cognitive functioning and without any other relevant medical condition, were recruited and studied before surgery and at the beginning and the end of the rehabilitation program. Main Outcome Measures Gait speed (10-Meter Walk Test [10MWT]) and gait functional mobility (Timed Up and Go [TUG] test), measured at the time of discharge from the rehabilitation unit, were the primary outcomes. The candidate predictors were the cognitive and psychological variables collected in the presurgery phase, together with other potentially informative measures such as age, education, perceived pain, body mass index, presurgical gait speed and functional mobility. Results Our results suggest the existence of a direct relationship between cognitive functioning, with specific reference to high-level frontal executive functions, and the postoperative gait progress: the better the cognitive functioning in the preoperative phase, the better the course of recovery in terms of gait speed and functional mobility. In particular, the performance of the Frontal Assessment Battery test, together with age, perceived pain. Presurgical gait speed and functional mobility, was the best predictor of recovery of walking measured by 10MWT and TUG. Conclusions The present study highlights the importance of cognitive functioning, together with clinical and demographic features, in the postsurgical recovery of walking, even in the absence of cognitive decline. In particular, these data show the crucial role of higher-order cognitive processes, such as executive functions, involved in the formulation of motor plans and their integration with proprioceptive and visual cues.
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[article] The Importance of Cognitive Executive Functions in Gait Recovery After Total Hip Arthroplasty [Article] / Francesco Negrini ; Matteo Preti ; Eleonora Zirone . - 2020 . - p. 579-586.
https://doi.org/10.1016/j.apmr.2019.12.004

Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 4 (2020) . - p. 579-586

Descripteurs :	HE Vinci Cognition ; Fonction exécutive ; Réadaptation
Résumé :	Objective To determine the influence of cognitive functioning on gait recovery after total hip arthroplasty. Design Prospective cohort study. Setting Rehabilitation hospital. Participants Patients (N=40) who underwent a total hip arthroplasty, with normal cognitive functioning and without any other relevant medical condition, were recruited and studied before surgery and at the beginning and the end of the rehabilitation program. Main Outcome Measures Gait speed (10-Meter Walk Test [10MWT]) and gait functional mobility (Timed Up and Go [TUG] test), measured at the time of discharge from the rehabilitation unit, were the primary outcomes. The candidate predictors were the cognitive and psychological variables collected in the presurgery phase, together with other potentially informative measures such as age, education, perceived pain, body mass index, presurgical gait speed and functional mobility. Results Our results suggest the existence of a direct relationship between cognitive functioning, with specific reference to high-level frontal executive functions, and the postoperative gait progress: the better the cognitive functioning in the preoperative phase, the better the course of recovery in terms of gait speed and functional mobility. In particular, the performance of the Frontal Assessment Battery test, together with age, perceived pain. Presurgical gait speed and functional mobility, was the best predictor of recovery of walking measured by 10MWT and TUG. Conclusions The present study highlights the importance of cognitive functioning, together with clinical and demographic features, in the postsurgical recovery of walking, even in the absence of cognitive decline. In particular, these data show the crucial role of higher-order cognitive processes, such as executive functions, involved in the formulation of motor plans and their integration with proprioceptive and visual cues.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 4 (2020) . - p. 587-591

Titre :	Minimal Clinically Important Differences in Functional Independence After a Knowledge Translation Intervention in Stroke Rehabilitation
Type de document :	Article
Auteurs :	Elizabeth Linkewich ; Lisa Avery ; Jorge Rios
Année de publication :	2020
Article en page(s) :	p. 587-591
Note générale :	https://doi.org/10.1016/j.apmr.2019.10.185
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Dysfonctionnement cognitif ; Réadaptation ; Recherche médicale translationnelle
Résumé :	Objective To examine the odds of persons with stroke achieving minimal clinically important difference (MCID) in functional independence during inpatient rehabilitation relative to cognitive impairment (CI) severity, site, and rehabilitation teams’ exposure to a Cognitive Orientation to daily Occupational Performance (CO-OP) knowledge translation (KT) intervention. Design A pre-post observational study was conducted using data from a centralized referral system. Our research team implemented a CO-OP KT intervention as part of a larger study aimed at training teams to use the CO-OP approach. Setting Five inpatient rehabilitation units. Participants Cases extracted from a centralized referral system from the 5 participating units. Interventions Not applicable. Main Outcome Measures The FIM instrument data from 12 months preintervention and 6 months postintervention were analyzed. A logistic regression was performed to determine the odds ratios (ORs) for achieving MCID based on sample cohort (historical control not exposed to CO-OP KT vs post-CO-OP KT intervention), controlling for site and severity of CI. Results A model that considered the intervention, admission score, CI severity, and site was the best fit for the cases analyzed. Those with severe CI were less likely to achieve FIM total MCID compared to those with no CI (P=<.001 or=".18;" confidence interval .09-.39 taking site and ci into account cases post co-op kt intervention were significantly more likely to achieve mcid on fim motor than historical controls.> Conclusion The CO-OP KT intervention is associated with increased odds of achieving MCID in the FIM motor subscale in inpatient stroke rehabilitation.
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[article] Minimal Clinically Important Differences in Functional Independence After a Knowledge Translation Intervention in Stroke Rehabilitation [Article] / Elizabeth Linkewich ; Lisa Avery ; Jorge Rios . - 2020 . - p. 587-591.
https://doi.org/10.1016/j.apmr.2019.10.185

Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 4 (2020) . - p. 587-591

Descripteurs :	HE Vinci Dysfonctionnement cognitif ; Réadaptation ; Recherche médicale translationnelle
Résumé :	Objective To examine the odds of persons with stroke achieving minimal clinically important difference (MCID) in functional independence during inpatient rehabilitation relative to cognitive impairment (CI) severity, site, and rehabilitation teams’ exposure to a Cognitive Orientation to daily Occupational Performance (CO-OP) knowledge translation (KT) intervention. Design A pre-post observational study was conducted using data from a centralized referral system. Our research team implemented a CO-OP KT intervention as part of a larger study aimed at training teams to use the CO-OP approach. Setting Five inpatient rehabilitation units. Participants Cases extracted from a centralized referral system from the 5 participating units. Interventions Not applicable. Main Outcome Measures The FIM instrument data from 12 months preintervention and 6 months postintervention were analyzed. A logistic regression was performed to determine the odds ratios (ORs) for achieving MCID based on sample cohort (historical control not exposed to CO-OP KT vs post-CO-OP KT intervention), controlling for site and severity of CI. Results A model that considered the intervention, admission score, CI severity, and site was the best fit for the cases analyzed. Those with severe CI were less likely to achieve FIM total MCID compared to those with no CI (P=<.001 or=".18;" confidence interval .09-.39 taking site and ci into account cases post co-op kt intervention were significantly more likely to achieve mcid on fim motor than historical controls.> Conclusion The CO-OP KT intervention is associated with increased odds of achieving MCID in the FIM motor subscale in inpatient stroke rehabilitation.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 4 (2020) . - p. 592-598

Titre :	Physical Function and Frailty for Predicting Adverse Outcomes in Older Primary Care Patients
Type de document :	Article
Auteurs :	Sachi O'Hoski ; Jonathan F. Bean ; Jinhui Ma
Année de publication :	2020
Article en page(s) :	p. 592-598
Note générale :	https://doi.org/10.1016/j.apmr.2019.11.013
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Chutes accidentelles ; Fragilité ; Hospitalisation ; Réadaptation ; Soins de santé primaires ; Sujet âgé
Résumé :	Objective To explore the predictive ability of the Short Physical Performance Battery (SPPB), Late Life Function and Disability Instrument-Function component (LLFDI-function) and frailty phenotype, for falls, hospitalizations, emergency department (ED) visits, and low self-rated health (SRH) over 1 and 2 years in older adults. Design Secondary analysis of data from a longitudinal study, the Boston Rehabilitative Impairment Study of the Elderly. Setting Primary care. Participants Adults 65 years and older at risk for disability who completed ≥1 follow-up call (N=391). Interventions None. Main Outcome Measures We computed separate logistic regression models using the SPPB, LLFDI-function, and frailty phenotype as independent variables and falls, hospitalizations, ED visits, and SRH over 1 and 2 years as dependent variables. Receiver operating characteristic curves were constructed and the areas under the curves calculated. Results Participants had a mean age of 76.5±7.1 years. The SPPB, LLFDI-function, and frailty phenotype all predicted hospitalizations and low SRH over a 1- and 2-year timeframe (odds ratio [OR] min-max, 1.35-1.51 and 1.67-3.07, respectively). Over 2 years, the SPPB predicted ED visits (OR, 1.28), and the LLFDI-function predicted falls (OR, 1.31). The LLFDI-function predicted low SRH better than the frailty phenotype over 1 year. There were no differences between the measures for any of the other outcomes. Conclusions The SPPB, LLFDI-function, and frailty phenotype had similar accuracy for predicting falls, hospitalizations, ED visits, and low SRH over 1 and 2 years among older primary care patients at risk for disability. As a result, when considering the optimal screening tool for older adults, the choice between a measure of function and frailty may ultimately depend on clinical preference and context.
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[article] Physical Function and Frailty for Predicting Adverse Outcomes in Older Primary Care Patients [Article] / Sachi O'Hoski ; Jonathan F. Bean ; Jinhui Ma . - 2020 . - p. 592-598.
https://doi.org/10.1016/j.apmr.2019.11.013

Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 4 (2020) . - p. 592-598

Descripteurs :	HE Vinci Chutes accidentelles ; Fragilité ; Hospitalisation ; Réadaptation ; Soins de santé primaires ; Sujet âgé
Résumé :	Objective To explore the predictive ability of the Short Physical Performance Battery (SPPB), Late Life Function and Disability Instrument-Function component (LLFDI-function) and frailty phenotype, for falls, hospitalizations, emergency department (ED) visits, and low self-rated health (SRH) over 1 and 2 years in older adults. Design Secondary analysis of data from a longitudinal study, the Boston Rehabilitative Impairment Study of the Elderly. Setting Primary care. Participants Adults 65 years and older at risk for disability who completed ≥1 follow-up call (N=391). Interventions None. Main Outcome Measures We computed separate logistic regression models using the SPPB, LLFDI-function, and frailty phenotype as independent variables and falls, hospitalizations, ED visits, and SRH over 1 and 2 years as dependent variables. Receiver operating characteristic curves were constructed and the areas under the curves calculated. Results Participants had a mean age of 76.5±7.1 years. The SPPB, LLFDI-function, and frailty phenotype all predicted hospitalizations and low SRH over a 1- and 2-year timeframe (odds ratio [OR] min-max, 1.35-1.51 and 1.67-3.07, respectively). Over 2 years, the SPPB predicted ED visits (OR, 1.28), and the LLFDI-function predicted falls (OR, 1.31). The LLFDI-function predicted low SRH better than the frailty phenotype over 1 year. There were no differences between the measures for any of the other outcomes. Conclusions The SPPB, LLFDI-function, and frailty phenotype had similar accuracy for predicting falls, hospitalizations, ED visits, and low SRH over 1 and 2 years among older primary care patients at risk for disability. As a result, when considering the optimal screening tool for older adults, the choice between a measure of function and frailty may ultimately depend on clinical preference and context.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 4 (2020) . - p. 599-606

Titre :	Exoskeleton-assisted Gait Training in Persons With Multiple Sclerosis: A Single-Group Pilot Study
Type de document :	Article
Auteurs :	Taimoor Afzal ; Shih-Chiao Tseng ; John A. Lincoln
Année de publication :	2020
Article en page(s) :	p. 599-606
Note générale :	https://doi.org/10.1016/j.apmr.2019.10.192
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Démarche ; Dispositif d'exosquelette ; Metabolisme ; Réadaptation ; Sclérose en plaques
Résumé :	Objective To investigate the feasibility of conducting exoskeleton-assisted gait training (EGT) and the effects of EGT on gait, metabolic expenditure, and physical function in persons with multiple sclerosis (MS). Design Single-group pilot study. Setting Research laboratory in a rehabilitation hospital. Participants Individuals with MS (N=10; mean age, 54.3±12.4y) and Expanded Disability Status Scale 6.0-7.5. Interventions All participants completed up to 15 sessions of EGT. Main Outcome Measures Timed 25-foot walk test at self-selected and fast speed, 6-minute walk test, metabolic expenditure of walking and timed Up and Go test were assessed during walking without the exoskeleton at baseline and immediate post training. Results All participants tolerated the training intensity and completed training without adverse events. After training, gait speed was improved and metabolic expenditure was reduced significantly during the timed 25-foot walk test at self-selected speed. Conclusions EGT is not only feasible but may also improve gait efficiency for persons with MS. Our observed improvement in gait speed was associated with reduced metabolic expenditure, which was likely because of improved neuromotor coordination. Further studies are required to investigate the effectiveness and integration of EGT in the continuum of MS rehabilitation.
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[article] Exoskeleton-assisted Gait Training in Persons With Multiple Sclerosis: A Single-Group Pilot Study [Article] / Taimoor Afzal ; Shih-Chiao Tseng ; John A. Lincoln . - 2020 . - p. 599-606.
https://doi.org/10.1016/j.apmr.2019.10.192

Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 4 (2020) . - p. 599-606

Descripteurs :	HE Vinci Démarche ; Dispositif d'exosquelette ; Metabolisme ; Réadaptation ; Sclérose en plaques
Résumé :	Objective To investigate the feasibility of conducting exoskeleton-assisted gait training (EGT) and the effects of EGT on gait, metabolic expenditure, and physical function in persons with multiple sclerosis (MS). Design Single-group pilot study. Setting Research laboratory in a rehabilitation hospital. Participants Individuals with MS (N=10; mean age, 54.3±12.4y) and Expanded Disability Status Scale 6.0-7.5. Interventions All participants completed up to 15 sessions of EGT. Main Outcome Measures Timed 25-foot walk test at self-selected and fast speed, 6-minute walk test, metabolic expenditure of walking and timed Up and Go test were assessed during walking without the exoskeleton at baseline and immediate post training. Results All participants tolerated the training intensity and completed training without adverse events. After training, gait speed was improved and metabolic expenditure was reduced significantly during the timed 25-foot walk test at self-selected speed. Conclusions EGT is not only feasible but may also improve gait efficiency for persons with MS. Our observed improvement in gait speed was associated with reduced metabolic expenditure, which was likely because of improved neuromotor coordination. Further studies are required to investigate the effectiveness and integration of EGT in the continuum of MS rehabilitation.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 4 (2020) . - p. 607-612

Titre :	Exoskeletal-Assisted Walking During Acute Inpatient Rehabilitation Leads to Motor and Functional Improvement in Persons With Spinal Cord Injury: A Pilot Study
Type de document :	Article
Auteurs :	Chung-Ying Tsai ; Andrew D. Delgado ; William J. Weinrauch
Année de publication :	2020
Article en page(s) :	p. 607-612
Note générale :	https://doi.org/10.1016/j.apmr.2019.11.010
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Marche à pied ; Patients hospitalisés ; Réadaptation ; Traumatismes de la moelle épinière
Résumé :	Objective To explore the potential effects of incorporating exoskeletal-assisted walking (EAW) into spinal cord injury (SCI) acute inpatient rehabilitation (AIR) on facilitating functional and motor recovery when compared with standard of care AIR. Design A quasi-experimental design with a prospective intervention group (AIR with EAW) and a retrospective control group (AIR only). Setting SCI AIR facility. Participants Ten acute inpatient participants with SCI who were eligible for locomotor training were recruited in the intervention group. Twenty inpatients with SCI were identified as matched controls by reviewing an AIR database, Uniform Data System for Medical Rehabilitation, by an individual blinded to the study. Both groups (N=30) were matched based on etiology, paraplegia/tetraplegia, completeness of injury, age, and sex. Intervention EAW incorporated into SCI AIR. Main Outcome Measures FIM score, International Standards for Neurological Classification of Spinal Cord Injury Upper Extremity Motor Score and Lower Extremity Motor Scores (LEMS), and EAW session results, including adverse events, walking time, and steps. Results Changes from admission to discharge LEMS and FIM scores were significantly greater in the intervention group (LEMS change: 14.3±10.1; FIM change: 37.8±10.8) compared with the control group (LEMS change: 4.6±6.1; FIM change: 26.5±14.3; Mann-Whitney U tests: LEMS, P<.01 and fim p one adverse event skin abrasion occurred during walking sessions. participants on average achieved minutes of up time walk with steps in eaw session.> Conclusions Incorporation of EAW into standard of care AIR is possible. AIR with incorporated EAW has the potential to facilitate functional and motor recovery compared with AIR without EAW.
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[article] Exoskeletal-Assisted Walking During Acute Inpatient Rehabilitation Leads to Motor and Functional Improvement in Persons With Spinal Cord Injury: A Pilot Study [Article] / Chung-Ying Tsai ; Andrew D. Delgado ; William J. Weinrauch . - 2020 . - p. 607-612.
https://doi.org/10.1016/j.apmr.2019.11.010

Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 4 (2020) . - p. 607-612

Descripteurs :	HE Vinci Marche à pied ; Patients hospitalisés ; Réadaptation ; Traumatismes de la moelle épinière
Résumé :	Objective To explore the potential effects of incorporating exoskeletal-assisted walking (EAW) into spinal cord injury (SCI) acute inpatient rehabilitation (AIR) on facilitating functional and motor recovery when compared with standard of care AIR. Design A quasi-experimental design with a prospective intervention group (AIR with EAW) and a retrospective control group (AIR only). Setting SCI AIR facility. Participants Ten acute inpatient participants with SCI who were eligible for locomotor training were recruited in the intervention group. Twenty inpatients with SCI were identified as matched controls by reviewing an AIR database, Uniform Data System for Medical Rehabilitation, by an individual blinded to the study. Both groups (N=30) were matched based on etiology, paraplegia/tetraplegia, completeness of injury, age, and sex. Intervention EAW incorporated into SCI AIR. Main Outcome Measures FIM score, International Standards for Neurological Classification of Spinal Cord Injury Upper Extremity Motor Score and Lower Extremity Motor Scores (LEMS), and EAW session results, including adverse events, walking time, and steps. Results Changes from admission to discharge LEMS and FIM scores were significantly greater in the intervention group (LEMS change: 14.3±10.1; FIM change: 37.8±10.8) compared with the control group (LEMS change: 4.6±6.1; FIM change: 26.5±14.3; Mann-Whitney U tests: LEMS, P<.01 and fim p one adverse event skin abrasion occurred during walking sessions. participants on average achieved minutes of up time walk with steps in eaw session.> Conclusions Incorporation of EAW into standard of care AIR is possible. AIR with incorporated EAW has the potential to facilitate functional and motor recovery compared with AIR without EAW.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 4 (2020) . - p. 613-623

Titre :	Two Weeks of Wearing a Knee Brace Compared With Minimal Intervention on Kinesiophobia at 2 and 6 Weeks in People With Patellofemoral Pain: A Randomized Controlled Trial
Type de document :	Article
Auteurs :	Liliam B. Priore ; Simon Lack ; Carmen Garcia
Année de publication :	2020
Article en page(s) :	p. 613-623
Note générale :	https://doi.org/10.1016/j.apmr.2019.10.190
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Genou ; Orthèses ; Peur ; Réadaptation
Résumé :	Objective To investigate the effect of a knee brace compared with minimal intervention on self-reported kinesiophobia and function, objective function, and physical activity level in people with patellofemoral pain (PFP). Design Single-blind randomized controlled trial (1:1), parallel. Participants Individuals with PFP (N=50). Main Outcome Measures Primary: kinesiophobia (Tampa Scale for Kinesiophobia). Secondary: self-reported function (Anterior Knee Pain Scale), physical activity level (International Physical Activity Questionnaire), and objective function (forward step-down test). Outcomes were assessed at baseline (T0), at the end of the intervention (2wk) (T1), and at 6 weeks after baseline (T2). Intervention Participants were randomly assigned to 1 of 2 interventions groups: (1) use of knee brace for 2 weeks during daily living, sports, or painful tasks (brace group) and (2) educational leaflet with information about PFP (leaflet group). Results The knee brace reduced kinesiophobia in people with PFP compared with minimal intervention with moderate effect size at T1=mean difference (95% CI) −5.56 (−9.18 to −1.93) and T2=−5.24 (−8.58 to −1.89). There was no significant difference in self-reported and objective function and physical activity level. Conclusions The knee brace improved kinesiophobia immediately after intervention (at 2wk) and at 6-week follow-up in people with PFP compared with minimal intervention. A knee brace may be considered within clinically reasoned paradigms to facilitate exercise therapy interventions for people with PFP.
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[article] Two Weeks of Wearing a Knee Brace Compared With Minimal Intervention on Kinesiophobia at 2 and 6 Weeks in People With Patellofemoral Pain: A Randomized Controlled Trial [Article] / Liliam B. Priore ; Simon Lack ; Carmen Garcia . - 2020 . - p. 613-623.
https://doi.org/10.1016/j.apmr.2019.10.190

Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 4 (2020) . - p. 613-623

Descripteurs :	HE Vinci Genou ; Orthèses ; Peur ; Réadaptation
Résumé :	Objective To investigate the effect of a knee brace compared with minimal intervention on self-reported kinesiophobia and function, objective function, and physical activity level in people with patellofemoral pain (PFP). Design Single-blind randomized controlled trial (1:1), parallel. Participants Individuals with PFP (N=50). Main Outcome Measures Primary: kinesiophobia (Tampa Scale for Kinesiophobia). Secondary: self-reported function (Anterior Knee Pain Scale), physical activity level (International Physical Activity Questionnaire), and objective function (forward step-down test). Outcomes were assessed at baseline (T0), at the end of the intervention (2wk) (T1), and at 6 weeks after baseline (T2). Intervention Participants were randomly assigned to 1 of 2 interventions groups: (1) use of knee brace for 2 weeks during daily living, sports, or painful tasks (brace group) and (2) educational leaflet with information about PFP (leaflet group). Results The knee brace reduced kinesiophobia in people with PFP compared with minimal intervention with moderate effect size at T1=mean difference (95% CI) −5.56 (−9.18 to −1.93) and T2=−5.24 (−8.58 to −1.89). There was no significant difference in self-reported and objective function and physical activity level. Conclusions The knee brace improved kinesiophobia immediately after intervention (at 2wk) and at 6-week follow-up in people with PFP compared with minimal intervention. A knee brace may be considered within clinically reasoned paradigms to facilitate exercise therapy interventions for people with PFP.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 4 (2020) . - p. 624-632

Titre :	Knee Flexion Contracture Associated With a Contracture and Worse Function of the Contralateral Knee: Data From the Osteoarthritis Initiative
Type de document :	Article
Auteurs :	Mark T. Campbell ; Guy Trudel
Année de publication :	2020
Article en page(s) :	p. 624-632
Note générale :	https://doi.org/10.1016/j.apmr.2019.11.018
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Amplitude articulaire ; Gonarthrose ; Réadaptation ; Traumatismes du genou
Résumé :	Objective Patients at risk of developing knee osteoarthritis (OA) or those already diagnosed with knee OA may present with a knee flexion contracture (FC). A knee FC can cause pain and can decrease function. By altering lower extremity biomechanics, the effect of a knee FC goes beyond the affected joint. Compensatory movements during gait can chronically affect other joints in both lower limbs. Few studies describe the effect of a knee FC on, or direct assessment toward, the contralateral knee. We investigated the associations between knee FC with range of extension, function, pain, and stiffness of the contralateral knee. Design Cross-sectional, using the Osteoarthritis Initiative Database. Participants Outpatient cohort study, recruiting from 4 United States academic health care centers (N=4796). Two groups were included: those at risk of developing OA (n=3284 knees), and those already with radiographic OA (n=1390 knees). Main Outcomes Measures Maximum contralateral knee extension and Western Ontario and McMaster Osteoarthritis Index (WOMAC) scores. Statistical analysis included a mixed linear model evaluating for independent associations between the index knee FC and contralateral knee outcome measures. Results A knee FC was associated with a contralateral knee FC (P<.001 with contralateral fc severity dependent on of the index knee participants at risk developing oa moderate showed worse function in than those mild functional subscale sd: vs p=".036)." mixed linear analysis confirmed an independent association between and womac function.> Conclusions Having an FC in 1 knee was associated with an FC in the contralateral knee for participants who were at risk of developing OA and for those with a current diagnosis of OA. For those at risk of developing OA, the severity of knee FC was an independent predictor for loss of contralateral knee function. Rehabilitation of patients with or at risk of developing OA should consider the restoration of extension and function for both knees.
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[article] Knee Flexion Contracture Associated With a Contracture and Worse Function of the Contralateral Knee: Data From the Osteoarthritis Initiative [Article] / Mark T. Campbell ; Guy Trudel . - 2020 . - p. 624-632.
https://doi.org/10.1016/j.apmr.2019.11.018

Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 4 (2020) . - p. 624-632

Descripteurs :	HE Vinci Amplitude articulaire ; Gonarthrose ; Réadaptation ; Traumatismes du genou
Résumé :	Objective Patients at risk of developing knee osteoarthritis (OA) or those already diagnosed with knee OA may present with a knee flexion contracture (FC). A knee FC can cause pain and can decrease function. By altering lower extremity biomechanics, the effect of a knee FC goes beyond the affected joint. Compensatory movements during gait can chronically affect other joints in both lower limbs. Few studies describe the effect of a knee FC on, or direct assessment toward, the contralateral knee. We investigated the associations between knee FC with range of extension, function, pain, and stiffness of the contralateral knee. Design Cross-sectional, using the Osteoarthritis Initiative Database. Participants Outpatient cohort study, recruiting from 4 United States academic health care centers (N=4796). Two groups were included: those at risk of developing OA (n=3284 knees), and those already with radiographic OA (n=1390 knees). Main Outcomes Measures Maximum contralateral knee extension and Western Ontario and McMaster Osteoarthritis Index (WOMAC) scores. Statistical analysis included a mixed linear model evaluating for independent associations between the index knee FC and contralateral knee outcome measures. Results A knee FC was associated with a contralateral knee FC (P<.001 with contralateral fc severity dependent on of the index knee participants at risk developing oa moderate showed worse function in than those mild functional subscale sd: vs p=".036)." mixed linear analysis confirmed an independent association between and womac function.> Conclusions Having an FC in 1 knee was associated with an FC in the contralateral knee for participants who were at risk of developing OA and for those with a current diagnosis of OA. For those at risk of developing OA, the severity of knee FC was an independent predictor for loss of contralateral knee function. Rehabilitation of patients with or at risk of developing OA should consider the restoration of extension and function for both knees.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 4 (2020) . - p. 633-641

Titre :	Association of Bisphosphonate Therapy With Incident of Lower Extremity Fractures in Persons With Spinal Cord Injuries or Disorders
Type de document :	Article
Auteurs :	Laura D. Carbone ; Beverly Gonzalez ; Scott Miskevics
Année de publication :	2020
Article en page(s) :	p. 633-641
Note générale :	https://doi.org/10.1016/j.apmr.2019.12.010
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Diphosphonates ; Réadaptation ; Traumatismes de la moelle épinière
Résumé :	Objective To investigate the association between prescriptions for bisphosphonates; calcium and vitamin D supplements; and receipt of dual-energy x-ray absorptiometry (DXA) screening, and incident fracture risk in men and women with a spinal cord injury (SCI) or disorder (SCID). Design Propensity-matched case-control analyses. Setting United States Veterans Affairs (VA) facilities. Participants A total of 7989 men and 849 women with an SCID included in VA administrative databases between October 1, 2005 and October 1, 2015 were identified (N=8838). Cases included 267 men and 59 women with a bisphosphonate prescription propensity matched with up to 4 controls. Interventions Not applicable. Main Outcome Measures Incident lower extremity fractures. Results There was no significant association between prescriptions for bisphosphonates and incident lower extremity fractures in men (odds ratio [OR], 1.04; 95% confidence interval [CI], 0.62-1.77) or women (OR, 1.02; 95% CI, 0.28-3.75). In men, similar null associations were seen among those who were adherent to bisphosphonate therapy (OR, 1.25; 95% CI, 0.73-2.16), were concomitant users of vitamin D and calcium and a bisphosphonate (OR, 1.05; 95% CI, 0.57-1.96), had more than 1 fracture on different dates during the study period (OR, 0.13; 95% CI, 0.02-1.16) and in those who had undergone DXA testing prior to the date of the bisphosphonate prescription and incident fracture (OR, 1.26; 95% CI, 0.69-2.32). Conclusions In men with a traumatic SCI and women with a traumatic SCID, bisphosphonate therapies for osteoporosis do not appear to significantly affect fracture risk. Adequately powered randomized controlled trials are needed to definitively demonstrate efficacy of bisphosphonates for fracture prevention in this population. There is a compelling need to identify new medications to prevent fractures in this high-risk population.
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[article] Association of Bisphosphonate Therapy With Incident of Lower Extremity Fractures in Persons With Spinal Cord Injuries or Disorders [Article] / Laura D. Carbone ; Beverly Gonzalez ; Scott Miskevics . - 2020 . - p. 633-641.
https://doi.org/10.1016/j.apmr.2019.12.010

Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 4 (2020) . - p. 633-641

Descripteurs :	HE Vinci Diphosphonates ; Réadaptation ; Traumatismes de la moelle épinière
Résumé :	Objective To investigate the association between prescriptions for bisphosphonates; calcium and vitamin D supplements; and receipt of dual-energy x-ray absorptiometry (DXA) screening, and incident fracture risk in men and women with a spinal cord injury (SCI) or disorder (SCID). Design Propensity-matched case-control analyses. Setting United States Veterans Affairs (VA) facilities. Participants A total of 7989 men and 849 women with an SCID included in VA administrative databases between October 1, 2005 and October 1, 2015 were identified (N=8838). Cases included 267 men and 59 women with a bisphosphonate prescription propensity matched with up to 4 controls. Interventions Not applicable. Main Outcome Measures Incident lower extremity fractures. Results There was no significant association between prescriptions for bisphosphonates and incident lower extremity fractures in men (odds ratio [OR], 1.04; 95% confidence interval [CI], 0.62-1.77) or women (OR, 1.02; 95% CI, 0.28-3.75). In men, similar null associations were seen among those who were adherent to bisphosphonate therapy (OR, 1.25; 95% CI, 0.73-2.16), were concomitant users of vitamin D and calcium and a bisphosphonate (OR, 1.05; 95% CI, 0.57-1.96), had more than 1 fracture on different dates during the study period (OR, 0.13; 95% CI, 0.02-1.16) and in those who had undergone DXA testing prior to the date of the bisphosphonate prescription and incident fracture (OR, 1.26; 95% CI, 0.69-2.32). Conclusions In men with a traumatic SCI and women with a traumatic SCID, bisphosphonate therapies for osteoporosis do not appear to significantly affect fracture risk. Adequately powered randomized controlled trials are needed to definitively demonstrate efficacy of bisphosphonates for fracture prevention in this population. There is a compelling need to identify new medications to prevent fractures in this high-risk population.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 4 (2020) . - p. 642-649

Titre :	Acute Hemodynamic Effects of Virtual Reality–Based Therapy in Patients of Cardiovascular Rehabilitation: A Cluster Randomized Crossover Trial
Type de document :	Article
Auteurs :	Mayara Moura Alves da Cruz ; Ana Laura Ricci-Vitor ; Giovanna Lombardi Bonini Borges
Année de publication :	2020
Article en page(s) :	p. 642-649
Note générale :	https://doi.org/10.1016/j.apmr.2019.12.006
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Exercice physique ; Maladies cardiovasculaires ; Pression sanguine ; Réadaptation ; Réadaptation cardiaque ; Réalité de synthèse ; Rythme cardiaque ; Thérapie par réalité virtuelle
Résumé :	Objective To analyze the acute hemodynamic effects of adding virtual reality–based therapy (VRBT) using exergames for patients undergoing cardiac rehabilitation (CR). Design Crossover trial. Setting Outpatient rehabilitation center. Participants Patients (N=27) with a diagnosis of cardiovascular disease or cardiovascular risk factors. Mean age (years) ± SD was 63.4±12.7 and mean body mass index (kg/m2) ± SD was 29.0±4.0. Interventions Patients performed 1 VRBT session and 1 CR session on 2 nonconsecutive days. Each session comprised an initial rest, warm-up, conditioning, and recovery. During warm-up, in the VRBT session, games were performed with sensors to reproduce the movements of avatars and, in the CR session, patients were required to reproduce the movements of the physiotherapists. In the conditioning phase for VRBT, games were also played with motion sensors, dumbbells, and shin guards. The CR session consisted of exercises performed on a treadmill. The intensity of training was prescribed by heart rate reserve (HRR; 40%-70%). Main Outcome Measures The primary outcomes were heart rate, blood pressure, respiratory rate (RR), rating of perceived exertion (RPE), and peripheral oxygen saturation, evaluated before, during, and after the VRBT or CR session on 2 nonconsecutive days. The secondary outcome was to evaluate whether the patients achieved the prescribed HRR and the percentage of time they maintained this level during the VRBT session. Results VRBT produces a physiological similar pattern of acute hemodynamic effects in CR. However, there was greater magnitude of heart rate, RR, and RPE (P<.01 during the execution of vrbt and until minutes recovery observed at moments rest recovery.> Conclusions Although the VRBT session produces similar physiological acute hemodynamic effects in CR, greater magnitudes of heart rate, RR, and RPE were observed during its execution and up to 5 minutes after the session.
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[article] Acute Hemodynamic Effects of Virtual Reality–Based Therapy in Patients of Cardiovascular Rehabilitation: A Cluster Randomized Crossover Trial [Article] / Mayara Moura Alves da Cruz ; Ana Laura Ricci-Vitor ; Giovanna Lombardi Bonini Borges . - 2020 . - p. 642-649.
https://doi.org/10.1016/j.apmr.2019.12.006

Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 4 (2020) . - p. 642-649

Descripteurs :	HE Vinci Exercice physique ; Maladies cardiovasculaires ; Pression sanguine ; Réadaptation ; Réadaptation cardiaque ; Réalité de synthèse ; Rythme cardiaque ; Thérapie par réalité virtuelle
Résumé :	Objective To analyze the acute hemodynamic effects of adding virtual reality–based therapy (VRBT) using exergames for patients undergoing cardiac rehabilitation (CR). Design Crossover trial. Setting Outpatient rehabilitation center. Participants Patients (N=27) with a diagnosis of cardiovascular disease or cardiovascular risk factors. Mean age (years) ± SD was 63.4±12.7 and mean body mass index (kg/m2) ± SD was 29.0±4.0. Interventions Patients performed 1 VRBT session and 1 CR session on 2 nonconsecutive days. Each session comprised an initial rest, warm-up, conditioning, and recovery. During warm-up, in the VRBT session, games were performed with sensors to reproduce the movements of avatars and, in the CR session, patients were required to reproduce the movements of the physiotherapists. In the conditioning phase for VRBT, games were also played with motion sensors, dumbbells, and shin guards. The CR session consisted of exercises performed on a treadmill. The intensity of training was prescribed by heart rate reserve (HRR; 40%-70%). Main Outcome Measures The primary outcomes were heart rate, blood pressure, respiratory rate (RR), rating of perceived exertion (RPE), and peripheral oxygen saturation, evaluated before, during, and after the VRBT or CR session on 2 nonconsecutive days. The secondary outcome was to evaluate whether the patients achieved the prescribed HRR and the percentage of time they maintained this level during the VRBT session. Results VRBT produces a physiological similar pattern of acute hemodynamic effects in CR. However, there was greater magnitude of heart rate, RR, and RPE (P<.01 during the execution of vrbt and until minutes recovery observed at moments rest recovery.> Conclusions Although the VRBT session produces similar physiological acute hemodynamic effects in CR, greater magnitudes of heart rate, RR, and RPE were observed during its execution and up to 5 minutes after the session.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 4 (2020) . - p. 650-657

Titre :	Association Between Exercise Capacity and Health-Related Quality of Life During and After Cardiac Rehabilitation in Acute Coronary Syndrome Patients: A Substudy of the OPTICARE Randomized Controlled Trial
Type de document :	Article
Auteurs :	Marie de Bakker ; Iris den Uijl ; Nienke ter Hoeve
Année de publication :	2020
Article en page(s) :	p. 650-657
Note générale :	https://doi.org/10.1016/j.apmr.2019.11.017
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Qualité de vie ; Réadaptation ; Réadaptation cardiaque ; Syndrome coronarien aigu ; Test de marche
Résumé :	Objective To examine the strength of the association between exercise capacity and health-related quality of life (HRQOL) during and after cardiac rehabilitation (CR) in patients with acute coronary syndrome (ACS) who completed CR. Design Prospective cohort study. Setting Outpatient CR center. Participants Patients (N=607) with ACS who completed CR. Interventions Multidisciplinary 12-week exercise-based CR program. Main Outcome Measures At baseline (pre-CR), the 6-Minute Walk Test (6MWT) was performed to determine exercise capacity, and the MacNew Heart Disease Health-related Quality of Life questionnaire was used to assess HRQOL. Measurements were repeated immediately after completion of CR (post-CR): at 12 months and 18 months follow-up. Multivariable linear regression, including an interaction term for time and exercise capacity, was applied to study the association between exercise capacity and HRQOL at different time points relative to CR, whereas model parameters were estimated by methods that accounted for dependency of repeated observations within individuals. Results Mean age in years ± SD was 58±8.9 and 82% of participants were male. Baseline mean 6MWT distance in meters ± SD was 563±77 and median (25th-75th percentile) global HRQOL was 5.5 (4.6-6.1) points. Mean 6MWT distance (P<.001 and the global physical emotional social domains of hrqol improved significantly during cr continued to improve follow-up post-cr. independent timing relative pre-cr post-cr or a difference m distance was associated with mean in domain confidence interval points ci> Conclusions Better exercise capacity was significantly associated with higher scores on the global and physical domains of HRQOL, irrespective of the timing relative to CR, albeit these associations were weak. Hence, CR programs in secondary prevention should continue to aim at enhancing both HRQOL and exercise capacity.
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[article] Association Between Exercise Capacity and Health-Related Quality of Life During and After Cardiac Rehabilitation in Acute Coronary Syndrome Patients: A Substudy of the OPTICARE Randomized Controlled Trial [Article] / Marie de Bakker ; Iris den Uijl ; Nienke ter Hoeve . - 2020 . - p. 650-657.
https://doi.org/10.1016/j.apmr.2019.11.017

Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 4 (2020) . - p. 650-657

Descripteurs :	HE Vinci Qualité de vie ; Réadaptation ; Réadaptation cardiaque ; Syndrome coronarien aigu ; Test de marche
Résumé :	Objective To examine the strength of the association between exercise capacity and health-related quality of life (HRQOL) during and after cardiac rehabilitation (CR) in patients with acute coronary syndrome (ACS) who completed CR. Design Prospective cohort study. Setting Outpatient CR center. Participants Patients (N=607) with ACS who completed CR. Interventions Multidisciplinary 12-week exercise-based CR program. Main Outcome Measures At baseline (pre-CR), the 6-Minute Walk Test (6MWT) was performed to determine exercise capacity, and the MacNew Heart Disease Health-related Quality of Life questionnaire was used to assess HRQOL. Measurements were repeated immediately after completion of CR (post-CR): at 12 months and 18 months follow-up. Multivariable linear regression, including an interaction term for time and exercise capacity, was applied to study the association between exercise capacity and HRQOL at different time points relative to CR, whereas model parameters were estimated by methods that accounted for dependency of repeated observations within individuals. Results Mean age in years ± SD was 58±8.9 and 82% of participants were male. Baseline mean 6MWT distance in meters ± SD was 563±77 and median (25th-75th percentile) global HRQOL was 5.5 (4.6-6.1) points. Mean 6MWT distance (P<.001 and the global physical emotional social domains of hrqol improved significantly during cr continued to improve follow-up post-cr. independent timing relative pre-cr post-cr or a difference m distance was associated with mean in domain confidence interval points ci> Conclusions Better exercise capacity was significantly associated with higher scores on the global and physical domains of HRQOL, irrespective of the timing relative to CR, albeit these associations were weak. Hence, CR programs in secondary prevention should continue to aim at enhancing both HRQOL and exercise capacity.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 4 (2020) . - p. 658-666

Titre :	Using Inferred Mobility Status to Estimate the Time to Major Depressive Disorder Diagnosis Post–Spinal Cord Injury
Type de document :	Article
Auteurs :	Catherine J. VanDerwerker ; Chris M. Gregory ; Kit N. Simpson
Année de publication :	2020
Article en page(s) :	p. 658-666
Note générale :	https://doi.org/10.1016/j.apmr.2019.11.014
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Analyse de regroupements ; Analyse de survie ; Dépression ; Matériel médical durable ; Réadaptation ; Traumatismes de la moelle épinière
Résumé :	Objective Estimate (1) prevalence of major depressive disorder (MDD) diagnosis; (2) risk factors associated with MDD diagnosis; (3) time at which MDD is diagnosed post–spinal cord injury (SCI); and (4) interaction of inferred mobility status (IMS) in a commercially insured population over 3 years. Design Retrospective longitudinal cohort design. Setting A commercial insurance claims database from January 1, 2010 to December 31, 2013. Participants Individuals with an index cervical or thoracic SCI in 2011 or 2012, without history of MDD ≤30 days pre-SCI (N=1409). Intervention Not applicable. Main Outcome Measures Prevalence of, risk factors associated with, and time to MDD diagnosis post-SCI. A stratified survival analysis using IMS, based upon durable medical equipment (DME) claims, was also completed. Results Post-SCI, 294 out of 1409 (20.87%) were diagnosed with new-onset MDD. Significant (P<.05 risk factors included: employment length of index hospitalization discharge from with healthcare services rehabilitation post-sci and ims comparisons. median time to mdd was days. survival analysis demonstrated a significant difference between regarding new-onset or recurring out were diagnosed post-sci. female>30 days pre-SCI, catheter claims, and 2 of 5 IMS comparisons. Median time to MDD was 74 days. Survival analysis demonstrated a significant difference between 4 of 10 IMS comparisons. Conclusions Prevalence of MDD post-SCI is greater than the general population. Stratification by IMS illustrated that individuals with greater inferred reliance on DME are at a greater risk for MDD and have shorter time to MDD diagnosis post-SCI.
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[article] Using Inferred Mobility Status to Estimate the Time to Major Depressive Disorder Diagnosis Post–Spinal Cord Injury [Article] / Catherine J. VanDerwerker ; Chris M. Gregory ; Kit N. Simpson . - 2020 . - p. 658-666.
https://doi.org/10.1016/j.apmr.2019.11.014

Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 4 (2020) . - p. 658-666

Descripteurs :	HE Vinci Analyse de regroupements ; Analyse de survie ; Dépression ; Matériel médical durable ; Réadaptation ; Traumatismes de la moelle épinière
Résumé :	Objective Estimate (1) prevalence of major depressive disorder (MDD) diagnosis; (2) risk factors associated with MDD diagnosis; (3) time at which MDD is diagnosed post–spinal cord injury (SCI); and (4) interaction of inferred mobility status (IMS) in a commercially insured population over 3 years. Design Retrospective longitudinal cohort design. Setting A commercial insurance claims database from January 1, 2010 to December 31, 2013. Participants Individuals with an index cervical or thoracic SCI in 2011 or 2012, without history of MDD ≤30 days pre-SCI (N=1409). Intervention Not applicable. Main Outcome Measures Prevalence of, risk factors associated with, and time to MDD diagnosis post-SCI. A stratified survival analysis using IMS, based upon durable medical equipment (DME) claims, was also completed. Results Post-SCI, 294 out of 1409 (20.87%) were diagnosed with new-onset MDD. Significant (P<.05 risk factors included: employment length of index hospitalization discharge from with healthcare services rehabilitation post-sci and ims comparisons. median time to mdd was days. survival analysis demonstrated a significant difference between regarding new-onset or recurring out were diagnosed post-sci. female>30 days pre-SCI, catheter claims, and 2 of 5 IMS comparisons. Median time to MDD was 74 days. Survival analysis demonstrated a significant difference between 4 of 10 IMS comparisons. Conclusions Prevalence of MDD post-SCI is greater than the general population. Stratification by IMS illustrated that individuals with greater inferred reliance on DME are at a greater risk for MDD and have shorter time to MDD diagnosis post-SCI.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 4 (2020) . - p. 667-673

Titre :	Effect of Telenursing and Face-to-Face Training Techniques on Quality of Life in Burn Patients: A Clinical Trial
Type de document :	Article
Auteurs :	Mohsen Rezaei ; Rostam Jalali ; Nastaran Heydarikhayat
Année de publication :	2020
Article en page(s) :	p. 667-673
Note générale :	https://doi.org/10.1016/j.apmr.2019.10.197
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Brûlures ; Qualité de vie ; Réadaptation ; Télénursing
Résumé :	Objective To compare the effect of telenursing and face-to-face training on the quality of life (QOL) of patients with a burn injury. Design This clinical trial with pretest–posttest design on 3 groups was conducted in Kermanshah, Iran, from 2017 to 2018. Convenience sampling was used. Setting A tertiary hospital in Kermanshah, west of Iran. Participants A total of 90 patients with burns of grade 2 and 3 after discharge from the hospital were randomly assigned to 3 groups including telenursing (30), face-to-face training (30), and control (30). Interventions Each intervention group received 1-on-1 telephone training and face-to-face training in 8 sessions (2 sessions of 15 to 20min/wk). The control group received regular care. Main Outcome Measures QOL was evaluated by the Burn Specific Health Scale–Brief (BSHS-B). Results The mean BSHS-B scores before and after intervention for telenursing, face-to-face, and the control group were 71.43±21.92 and 133.06±11.97; 64.83±26.16 and 124.83±23.05; and 58.63±20.89 and 73.13±33.04, respectively. There was a statistically significant difference among the 3 groups with respect to the training methods after intervention (P<.001 in addition post hoc test did not show a significant difference between the telenursing and face-to-face groups> Conclusions Educational methods in the form of telenursing and face-to-face training were effective and promoted QOL in survivors of burn injuries. Both telenursing and face-to-face training can be used to improve the QOL of survivors of burn injuries during the rehabilitation phase.
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[article] Effect of Telenursing and Face-to-Face Training Techniques on Quality of Life in Burn Patients: A Clinical Trial [Article] / Mohsen Rezaei ; Rostam Jalali ; Nastaran Heydarikhayat . - 2020 . - p. 667-673.
https://doi.org/10.1016/j.apmr.2019.10.197

Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 4 (2020) . - p. 667-673

Descripteurs :	HE Vinci Brûlures ; Qualité de vie ; Réadaptation ; Télénursing
Résumé :	Objective To compare the effect of telenursing and face-to-face training on the quality of life (QOL) of patients with a burn injury. Design This clinical trial with pretest–posttest design on 3 groups was conducted in Kermanshah, Iran, from 2017 to 2018. Convenience sampling was used. Setting A tertiary hospital in Kermanshah, west of Iran. Participants A total of 90 patients with burns of grade 2 and 3 after discharge from the hospital were randomly assigned to 3 groups including telenursing (30), face-to-face training (30), and control (30). Interventions Each intervention group received 1-on-1 telephone training and face-to-face training in 8 sessions (2 sessions of 15 to 20min/wk). The control group received regular care. Main Outcome Measures QOL was evaluated by the Burn Specific Health Scale–Brief (BSHS-B). Results The mean BSHS-B scores before and after intervention for telenursing, face-to-face, and the control group were 71.43±21.92 and 133.06±11.97; 64.83±26.16 and 124.83±23.05; and 58.63±20.89 and 73.13±33.04, respectively. There was a statistically significant difference among the 3 groups with respect to the training methods after intervention (P<.001 in addition post hoc test did not show a significant difference between the telenursing and face-to-face groups> Conclusions Educational methods in the form of telenursing and face-to-face training were effective and promoted QOL in survivors of burn injuries. Both telenursing and face-to-face training can be used to improve the QOL of survivors of burn injuries during the rehabilitation phase.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 4 (2020) . - p. 674-689

Titre :	Ergometer Training in Stroke Rehabilitation: Systematic Review and Meta-analysis
Type de document :	Article
Auteurs :	Jitka Veldema ; Petra Jansen
Année de publication :	2020
Article en page(s) :	p. 674-689
Note générale :	https://doi.org/10.1016/j.apmr.2019.09.017
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Accident vasculaire cérébral (AVC) ; Réadaptation ; Rééducation neurologique
Résumé :	Objective Ergometer training is routinely used in stroke rehabilitation. Through this meta-analysis, we sought to discover the strength of evidence of its effects. Data Source The PubMed database and PEDro database were reviewed prior to January 22, 2019. Study Selection Randomized controlled trials investigating the effects of ergometer training on stroke recovery were selected. Data Extraction Two reviewers independently selected the studies, performed independent data extraction, and assessed the risk of bias. Data Synthesis A total of 28 studies (including 1115 subjects with stroke) were included. The data indicates that (1) ergometer training leads to a significant improvement in walking ability, cardiorespiratory fitness, motor function, muscular force of the lower limbs, balance and postural control, spasticity, cognitive abilities, and the brain’s resistance to damage and degeneration; (2) neuromuscular functional electrical stimulation–assisted ergometer training is more efficient than ergometer training alone; (3) high-intensity ergometer training is more efficient that low-intensity ergometer training; and (4) ergometer training is more efficient than other therapies in supporting cardiorespiratory fitness, independence in activities of daily living, and balance and postural control, but less efficient in improving walking ability. Conclusions Ergometer training can support motor recovery after stroke. However, current data is insufficient for evidence-based rehabilitation. More data is required about the effects of ergometer training on cognitive abilities, emotional status, and quality of life in subjects with a history of stroke.
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[article] Ergometer Training in Stroke Rehabilitation: Systematic Review and Meta-analysis [Article] / Jitka Veldema ; Petra Jansen . - 2020 . - p. 674-689.
https://doi.org/10.1016/j.apmr.2019.09.017

Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 4 (2020) . - p. 674-689

Descripteurs :	HE Vinci Accident vasculaire cérébral (AVC) ; Réadaptation ; Rééducation neurologique
Résumé :	Objective Ergometer training is routinely used in stroke rehabilitation. Through this meta-analysis, we sought to discover the strength of evidence of its effects. Data Source The PubMed database and PEDro database were reviewed prior to January 22, 2019. Study Selection Randomized controlled trials investigating the effects of ergometer training on stroke recovery were selected. Data Extraction Two reviewers independently selected the studies, performed independent data extraction, and assessed the risk of bias. Data Synthesis A total of 28 studies (including 1115 subjects with stroke) were included. The data indicates that (1) ergometer training leads to a significant improvement in walking ability, cardiorespiratory fitness, motor function, muscular force of the lower limbs, balance and postural control, spasticity, cognitive abilities, and the brain’s resistance to damage and degeneration; (2) neuromuscular functional electrical stimulation–assisted ergometer training is more efficient than ergometer training alone; (3) high-intensity ergometer training is more efficient that low-intensity ergometer training; and (4) ergometer training is more efficient than other therapies in supporting cardiorespiratory fitness, independence in activities of daily living, and balance and postural control, but less efficient in improving walking ability. Conclusions Ergometer training can support motor recovery after stroke. However, current data is insufficient for evidence-based rehabilitation. More data is required about the effects of ergometer training on cognitive abilities, emotional status, and quality of life in subjects with a history of stroke.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 4 (2020) . - p. 690-699

Titre :	Comparison of Treadmill and Cycle Ergometer Exercise During Cardiac Rehabilitation: A Meta-analysis
Type de document :	Article
Auteurs :	Stéphanie Gerlach ; Christine Mermier ; Len Kravitz
Année de publication :	2020
Article en page(s) :	p. 690-699
Note générale :	https://doi.org/10.1016/j.apmr.2019.10.184
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Exercice physique ; Réadaptation ; Réadaptation cardiaque
Résumé :	Objective To compare treadmill versus cycling-based exercise in cardiac rehabilitation (CR) on functional capacity (FC) outcomes. Data Source Databases were searched for randomized studies using single modality continuous exercise. Study Selection Studies implemented a continuous cycling or treadmill protocol for patients with either coronary artery disease (CAD) or chronic heart failure (CHF). The effect of single modality exercise on FC (VO2peak) was analyzed. Differences in the effect of CR on FC was assessed between the mode subgroup (cycling vs treadmill) and disease state subgroup (CAD vs CHF) within both the cycling and treadmill groups. Data Extraction Data were extracted from 23 studies including 600 patients (mean age 60y, 86% men). Data Synthesis There was a significant difference in effect size between studies that used cycling, Hedges’ g=0.85 (95% confidence interval [95% CI], 0.52-1.17; k=13) and studies that used treadmill exercise, Hedges’ g=0.46 (95% CI, 0.22-0.70; k=8). Within cycling studies (n=14), FC was higher among CAD patients, Hedges’ g=1.03 (95% CI, 0.65-1.42; k=9) compared to those with CHF, Hedges’ g=0.40 (95% CI, 0.09-0.71; k=4, P<.001 conversely among treadmill studies fc was higher chf patients hedges g="0.94" ci k="2)" compared to cad p> Conclusions According to identified studies, when cycling was the primary mode of exercise in CR, there was larger change in FC compared to treadmill exercise. In addition, CAD patients experienced greater gains in FC when cycling was the primary mode of exercise in CR, while CHF patients benefited more from treadmill-based exercise programs.
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[article] Comparison of Treadmill and Cycle Ergometer Exercise During Cardiac Rehabilitation: A Meta-analysis [Article] / Stéphanie Gerlach ; Christine Mermier ; Len Kravitz . - 2020 . - p. 690-699.
https://doi.org/10.1016/j.apmr.2019.10.184

Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 4 (2020) . - p. 690-699

Descripteurs :	HE Vinci Exercice physique ; Réadaptation ; Réadaptation cardiaque
Résumé :	Objective To compare treadmill versus cycling-based exercise in cardiac rehabilitation (CR) on functional capacity (FC) outcomes. Data Source Databases were searched for randomized studies using single modality continuous exercise. Study Selection Studies implemented a continuous cycling or treadmill protocol for patients with either coronary artery disease (CAD) or chronic heart failure (CHF). The effect of single modality exercise on FC (VO2peak) was analyzed. Differences in the effect of CR on FC was assessed between the mode subgroup (cycling vs treadmill) and disease state subgroup (CAD vs CHF) within both the cycling and treadmill groups. Data Extraction Data were extracted from 23 studies including 600 patients (mean age 60y, 86% men). Data Synthesis There was a significant difference in effect size between studies that used cycling, Hedges’ g=0.85 (95% confidence interval [95% CI], 0.52-1.17; k=13) and studies that used treadmill exercise, Hedges’ g=0.46 (95% CI, 0.22-0.70; k=8). Within cycling studies (n=14), FC was higher among CAD patients, Hedges’ g=1.03 (95% CI, 0.65-1.42; k=9) compared to those with CHF, Hedges’ g=0.40 (95% CI, 0.09-0.71; k=4, P<.001 conversely among treadmill studies fc was higher chf patients hedges g="0.94" ci k="2)" compared to cad p> Conclusions According to identified studies, when cycling was the primary mode of exercise in CR, there was larger change in FC compared to treadmill exercise. In addition, CAD patients experienced greater gains in FC when cycling was the primary mode of exercise in CR, while CHF patients benefited more from treadmill-based exercise programs.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 4 (2020) . - p. 700-711

Titre :	Neuromuscular Electrical Stimulation in Chronic Kidney Failure: A Systematic Review and Meta-analysis
Type de document :	Article
Auteurs :	Jociane Schardong ; Cinara Stein ; Rodrigo Della Méa Plentz
Année de publication :	2020
Article en page(s) :	p. 700-711
Note générale :	https://doi.org/10.1016/j.apmr.2019.11.008
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Défaillance rénale chronique ; Dialyse rénale ; Réadaptation ; Stimulation électrique
Résumé :	Objective To systematically review the effects of neuromuscular electrical stimulation (NMES) in patients with chronic kidney failure (CKF) on hemodialysis (HD) on lower and upper limb muscle strength, functional capacity, and quality of life. Data Sources Data were obtained from MEDLINE (via PubMed), Embase, Scielo, Cochrane Central Register of Controlled Trials, and Physiotherapy Evidence Database. There were no mandatory language or publication date restrictions. Study Selection Clinical trials that assessed the chronic effect of NMES (alone or associated with other physical therapy) on lower limb muscle strength or functional capacity of CKF patients on HD compared with control, placebo, or another intervention were selected. Data Extraction Two independent reviewers extracted data using a predesigned data extraction form. Risk of bias was assessed with RoB 2.0 and ROBINS-I, and quality of evidence was assessed with Grading of Recommendations Assessment, Development, and Evaluation. Data Synthesis Ten studies were included, totaling 242 patients. Randomized clinical trials showed some concerns or high risk of bias, and the nonrandomized ones showed moderate or critical risk of bias. Random-effects meta-analysis showed that NMES increases quadriceps muscle strength (standardized mean difference=1.46; 95% confidence interval [CI], 0.86-2.07; P<.0001 moderate quality of evidence upper limb strength difference ci p=".03" low and functional capacity it was impossible to quantitatively analyze life data however nmes associated or not with exercise appears have positive effects on them.> Conclusions NMES improves quadriceps muscle strength and the functional capacity of patients with CFK on HD. The effects on upper limb muscle strength and quality of life seem to be positive; however, the quality of evidence is very limited for these outcomes.
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[article] Neuromuscular Electrical Stimulation in Chronic Kidney Failure: A Systematic Review and Meta-analysis [Article] / Jociane Schardong ; Cinara Stein ; Rodrigo Della Méa Plentz . - 2020 . - p. 700-711.
https://doi.org/10.1016/j.apmr.2019.11.008

Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 4 (2020) . - p. 700-711

Descripteurs :	HE Vinci Défaillance rénale chronique ; Dialyse rénale ; Réadaptation ; Stimulation électrique
Résumé :	Objective To systematically review the effects of neuromuscular electrical stimulation (NMES) in patients with chronic kidney failure (CKF) on hemodialysis (HD) on lower and upper limb muscle strength, functional capacity, and quality of life. Data Sources Data were obtained from MEDLINE (via PubMed), Embase, Scielo, Cochrane Central Register of Controlled Trials, and Physiotherapy Evidence Database. There were no mandatory language or publication date restrictions. Study Selection Clinical trials that assessed the chronic effect of NMES (alone or associated with other physical therapy) on lower limb muscle strength or functional capacity of CKF patients on HD compared with control, placebo, or another intervention were selected. Data Extraction Two independent reviewers extracted data using a predesigned data extraction form. Risk of bias was assessed with RoB 2.0 and ROBINS-I, and quality of evidence was assessed with Grading of Recommendations Assessment, Development, and Evaluation. Data Synthesis Ten studies were included, totaling 242 patients. Randomized clinical trials showed some concerns or high risk of bias, and the nonrandomized ones showed moderate or critical risk of bias. Random-effects meta-analysis showed that NMES increases quadriceps muscle strength (standardized mean difference=1.46; 95% confidence interval [CI], 0.86-2.07; P<.0001 moderate quality of evidence upper limb strength difference ci p=".03" low and functional capacity it was impossible to quantitatively analyze life data however nmes associated or not with exercise appears have positive effects on them.> Conclusions NMES improves quadriceps muscle strength and the functional capacity of patients with CFK on HD. The effects on upper limb muscle strength and quality of life seem to be positive; however, the quality of evidence is very limited for these outcomes.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 3 (2020) . - p. 401-411

Titre :	Profiles of Psychological Adaptation Outcomes at Discharge From Spinal Cord Injury Inpatient Rehabilitation
Type de document :	Article
Auteurs :	Mayra Galvis Aparicio ; Valerie Carrard ; Davide Morselli
Année de publication :	2020
Article en page(s) :	p. 401-411
Note générale :	https://doi.org/10.1016/j.apmr.2019.08.481
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Ajustement émotionnel ; Optimisme ; Réadaptation ; Traumatismes de la moelle épinière
Résumé :	Objective To evaluate the effect of a newly acquired spinal cord injury (SCI) by identifying profiles of psychological adaptation outcomes at discharge from inpatient rehabilitation, using several outcome measures in parallel and to examine biopsychosocial factors associated with profile membership. Design Cross-sectional analysis of data from the Swiss Spinal Cord Injury inception cohort study. Setting Inpatient rehabilitation. Participants Individuals 16 years old or older with recently diagnosed SCI who finished clinical rehabilitation in 1 of the 4 major national rehabilitation centers (N=370). Interventions Not applicable. Main Outcome Measures Life satisfaction, general distress, and symptoms of depression and anxiety were assessed using a single item from the International SCI Quality of Life Basic Data Set, the Distress Thermometer, and the Hospital Anxiety and Depression Scale respectively. Results Using latent profile analysis, 4 profiles of psychological adaptation outcomes were identified displaying different levels of impact, ranging from Minimal to Severe. Regarding covariates associated with profile membership, higher optimism, purpose in life, and self-efficacy indicated a higher probability of having a Minimal impact profile. Additionally, males, individuals with better functional independence, and those with an absence of pain were more likely to show a Minimal impact profile. Conclusions Among the participants, 70% showed Minimal or Low impact profiles. Our findings support that individuals can show positive responses across several outcome measures even at an early time after the injury onset (eg, at discharge from inpatient rehabilitation). Moreover, our results indicate that beyond functional independence, improvement, and pain management, a rehabilitation process that strengthens psychological resources might contribute to better adaptation outcomes.
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[article] Profiles of Psychological Adaptation Outcomes at Discharge From Spinal Cord Injury Inpatient Rehabilitation [Article] / Mayra Galvis Aparicio ; Valerie Carrard ; Davide Morselli . - 2020 . - p. 401-411.
https://doi.org/10.1016/j.apmr.2019.08.481
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 3 (2020) . - p. 401-411

Descripteurs :	HE Vinci Ajustement émotionnel ; Optimisme ; Réadaptation ; Traumatismes de la moelle épinière
Résumé :	Objective To evaluate the effect of a newly acquired spinal cord injury (SCI) by identifying profiles of psychological adaptation outcomes at discharge from inpatient rehabilitation, using several outcome measures in parallel and to examine biopsychosocial factors associated with profile membership. Design Cross-sectional analysis of data from the Swiss Spinal Cord Injury inception cohort study. Setting Inpatient rehabilitation. Participants Individuals 16 years old or older with recently diagnosed SCI who finished clinical rehabilitation in 1 of the 4 major national rehabilitation centers (N=370). Interventions Not applicable. Main Outcome Measures Life satisfaction, general distress, and symptoms of depression and anxiety were assessed using a single item from the International SCI Quality of Life Basic Data Set, the Distress Thermometer, and the Hospital Anxiety and Depression Scale respectively. Results Using latent profile analysis, 4 profiles of psychological adaptation outcomes were identified displaying different levels of impact, ranging from Minimal to Severe. Regarding covariates associated with profile membership, higher optimism, purpose in life, and self-efficacy indicated a higher probability of having a Minimal impact profile. Additionally, males, individuals with better functional independence, and those with an absence of pain were more likely to show a Minimal impact profile. Conclusions Among the participants, 70% showed Minimal or Low impact profiles. Our findings support that individuals can show positive responses across several outcome measures even at an early time after the injury onset (eg, at discharge from inpatient rehabilitation). Moreover, our results indicate that beyond functional independence, improvement, and pain management, a rehabilitation process that strengthens psychological resources might contribute to better adaptation outcomes.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 3 (2020) . - p. 412-417

Titre :	Behavioral Factors and Unintentional Injuries After Spinal Cord Injury
Type de document :	Article
Auteurs :	Yue Cao ; Nicole DiPiro ; Chao Li
Année de publication :	2020
Article en page(s) :	p. 412-417
Note générale :	https://doi.org/10.1016/j.apmr.2019.09.008
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Comportement ; Plaies et blessures ; Réadaptation ; Traumatismes de la moelle épinière
Résumé :	Objective To identify the relationships of behavioral factors with unintentional injuries among participants with traumatic spinal cord injury (SCI). Design Cross-sectional. Setting Medical university in the Southeastern United States. Participants Participants (N=4670) met the following inclusion criteria: traumatic SCI of at least 1-year duration, minimum of 18 years of age, and residual impairment from SCI (noncomplete recovery). Of these, 2516 were identified from a specialty hospital and 2154 were identified from population-based state surveillance systems. Interventions Not applicable. Main Outcome Measures Participants completed self-report assessments including multiple behavioral variables, SCI variables, and demographic characteristics. Primary outcome was unintentional injuries during the past 12 months. Results Twenty-three percent (n=969) reported at least 1 unintentional injury in the past year serious enough to receive medical care in a clinic, emergency department, or hospital, and the average number of times injured was 1.82 among those with at least 1 injury. Prescription medication use for pain and depression, nonmedical medication use, use of prescription medication for purposes other than prescribed, and binge drinking were associated with a greater odds of unintentional injury. There were some differences between fall-related and non–fall-related unintentional injuries, with ambulation associated with greater odds of fall-related injuries but lower odds of non–fall-related injuries. Participants identified through population-based systems were at greater risk of falls compared with those identified through a traditional specialty hospital. Conclusions Unintentional injuries were prevalent among people with SCI. After controlling for injury and demographic characteristics, multiple risk behaviors were related to the odds of unintentional injuries. Intervention studies are needed to address modifiable behaviors that may reduce the risk of injury.
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[article] Behavioral Factors and Unintentional Injuries After Spinal Cord Injury [Article] / Yue Cao ; Nicole DiPiro ; Chao Li . - 2020 . - p. 412-417.
https://doi.org/10.1016/j.apmr.2019.09.008
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 3 (2020) . - p. 412-417

Descripteurs :	HE Vinci Comportement ; Plaies et blessures ; Réadaptation ; Traumatismes de la moelle épinière
Résumé :	Objective To identify the relationships of behavioral factors with unintentional injuries among participants with traumatic spinal cord injury (SCI). Design Cross-sectional. Setting Medical university in the Southeastern United States. Participants Participants (N=4670) met the following inclusion criteria: traumatic SCI of at least 1-year duration, minimum of 18 years of age, and residual impairment from SCI (noncomplete recovery). Of these, 2516 were identified from a specialty hospital and 2154 were identified from population-based state surveillance systems. Interventions Not applicable. Main Outcome Measures Participants completed self-report assessments including multiple behavioral variables, SCI variables, and demographic characteristics. Primary outcome was unintentional injuries during the past 12 months. Results Twenty-three percent (n=969) reported at least 1 unintentional injury in the past year serious enough to receive medical care in a clinic, emergency department, or hospital, and the average number of times injured was 1.82 among those with at least 1 injury. Prescription medication use for pain and depression, nonmedical medication use, use of prescription medication for purposes other than prescribed, and binge drinking were associated with a greater odds of unintentional injury. There were some differences between fall-related and non–fall-related unintentional injuries, with ambulation associated with greater odds of fall-related injuries but lower odds of non–fall-related injuries. Participants identified through population-based systems were at greater risk of falls compared with those identified through a traditional specialty hospital. Conclusions Unintentional injuries were prevalent among people with SCI. After controlling for injury and demographic characteristics, multiple risk behaviors were related to the odds of unintentional injuries. Intervention studies are needed to address modifiable behaviors that may reduce the risk of injury.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 3 (2020) . - p. 418-425

Titre :	Chronic Pain Characteristics and Gait in Older Adults: The MOBILIZE Boston Study II
Type de document :	Article
Auteurs :	Elisa F. Ogawa ; Ling Shi ; Jonathan F. Bean
Année de publication :	2020
Article en page(s) :	p. 418-425
Note générale :	https://doi.org/10.1016/j.apmr.2019.09.010
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Cognition ; Démarche ; Douleur chronique ; Mobilité réduite ; Réadaptation ; Vieillissement
Résumé :	Objective To investigate a proposed cognitively-mediated pathway whereby pain contributes to gait impairments by acting as a distractor in community-living older adults. Design A cross-sectional study of a population-based cohort of older adults. Setting Urban and suburban communities in a large metropolitan area. Participants Community-living participants (N=302) 70 years and older recruited from a previous population-based cohort. Interventions Not applicable. Main Outcome Measures Gait parameters including gait speed, stride length, double support and swing characteristics, and variability were assessed under single- and dual-task conditions involving cognitive challenges (eg, counting backward). A joint pain questionnaire assessed pain distribution in the back and major joints. We examined pain-gait relationships using multivariable linear regression and bootstrapping mediation procedures. Results Forty-three percent of participants had pain in 2 or more musculoskeletal sites. Pain distribution was related to slower gait speed and other gait characteristics for all gait conditions. Associations persisted after adjustment for age, sex, education, body mass index, medication, and vision. Decrements in gait measures related to pain were comparable with decrements in gait related to dual-task conditions. There were no differences in dual-task cost among the pain distribution groups. Adjusted for confounders, pain-gait relationships appear mediated by selective attention. Conclusions These findings suggest that chronic pain contributes to decrements in gait, including slower gait speed, and that it operates through a cognitively-mediated pathway. Further research is needed to understand the mechanisms via pain alters mobility and to develop interventions to improve mobility among older adults with chronic pain.
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[article] Chronic Pain Characteristics and Gait in Older Adults: The MOBILIZE Boston Study II [Article] / Elisa F. Ogawa ; Ling Shi ; Jonathan F. Bean . - 2020 . - p. 418-425.
https://doi.org/10.1016/j.apmr.2019.09.010
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 3 (2020) . - p. 418-425

Descripteurs :	HE Vinci Cognition ; Démarche ; Douleur chronique ; Mobilité réduite ; Réadaptation ; Vieillissement
Résumé :	Objective To investigate a proposed cognitively-mediated pathway whereby pain contributes to gait impairments by acting as a distractor in community-living older adults. Design A cross-sectional study of a population-based cohort of older adults. Setting Urban and suburban communities in a large metropolitan area. Participants Community-living participants (N=302) 70 years and older recruited from a previous population-based cohort. Interventions Not applicable. Main Outcome Measures Gait parameters including gait speed, stride length, double support and swing characteristics, and variability were assessed under single- and dual-task conditions involving cognitive challenges (eg, counting backward). A joint pain questionnaire assessed pain distribution in the back and major joints. We examined pain-gait relationships using multivariable linear regression and bootstrapping mediation procedures. Results Forty-three percent of participants had pain in 2 or more musculoskeletal sites. Pain distribution was related to slower gait speed and other gait characteristics for all gait conditions. Associations persisted after adjustment for age, sex, education, body mass index, medication, and vision. Decrements in gait measures related to pain were comparable with decrements in gait related to dual-task conditions. There were no differences in dual-task cost among the pain distribution groups. Adjusted for confounders, pain-gait relationships appear mediated by selective attention. Conclusions These findings suggest that chronic pain contributes to decrements in gait, including slower gait speed, and that it operates through a cognitively-mediated pathway. Further research is needed to understand the mechanisms via pain alters mobility and to develop interventions to improve mobility among older adults with chronic pain.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 3 (2020) . - p. 426-433

Titre :	Changes in Trunk and Pelvis Motion Among Persons With Unilateral Lower Limb Loss During the First Year of Ambulation
Type de document :	Article
Auteurs :	Caitlin E. Mahon ; Courtney M. Butowicz ; Christopher L. Dearth
Année de publication :	2020
Article en page(s) :	p. 426-433
Note générale :	https://doi.org/10.1016/j.apmr.2019.08.476
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Locomotion ; Lombalgie ; Membres ; Plaies et blessures ; Réadaptation ; Tronc
Résumé :	Objective To retrospectively investigate trunk-pelvis kinematic outcomes among persons with unilateral transtibial and transfemoral limb loss with time from initial independent ambulation with a prosthesis, while secondarily describing self-reported presence and intensity of low back pain. Over time, increasing trunk-pelvis range of motion and decreasing trunk-pelvis coordination with increasing presence and/or intensity of low back pain were hypothesized. Additionally, less trunk-pelvis range of motion and more trunk-pelvis coordination for persons with more distal limb loss was hypothesized. Design Inception cohort with up to 5 repeated evaluations, including both biomechanical and subjective outcomes, during a 1-year period (0, 2, 4, 6, 12 months) after initial ambulation with a prosthesis. Setting Biomechanics laboratory within military treatment facility. Participants Twenty-two men with unilateral transtibial limb loss and 10 men with unilateral transfemoral limb loss (N=32). Interventions Not applicable. Main Outcome Measures Triplanar trunk-pelvis range of motion and intersegmental coordination (continuous relative phase) obtained at self-selected (∼1.30m/s) and controlled (∼1.20m/s) walking velocities. Self-reported presence and intensity of low back pain. Results An interaction effect between time and group existed for sagittal (P=.039) and transverse (P=.009) continuous relative phase at self-selected walking velocity and transverse trunk range of motion (P=.013) and sagittal continuous relative phase (P=.005) at controlled walking velocity. Trunk range of motion generally decreased, and trunk-pelvis coordination generally increased with increasing time after initial ambulation. Sagittal trunk and pelvis range of motion were always less and frontal trunk-pelvis coordination was always greater for persons with more distal limb loss. Low back pain increased for persons with transtibial limb loss and decreased for persons with transfemoral limb loss following the 4-month time point. Conclusions Temporal changes (or lack thereof) in features of trunk-pelvis motions within the first year of ambulation help elucidate relationships between (biomechanical) risk factors for low back pain after limb loss.
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[article] Changes in Trunk and Pelvis Motion Among Persons With Unilateral Lower Limb Loss During the First Year of Ambulation [Article] / Caitlin E. Mahon ; Courtney M. Butowicz ; Christopher L. Dearth . - 2020 . - p. 426-433.
https://doi.org/10.1016/j.apmr.2019.08.476
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 3 (2020) . - p. 426-433

Descripteurs :	HE Vinci Locomotion ; Lombalgie ; Membres ; Plaies et blessures ; Réadaptation ; Tronc
Résumé :	Objective To retrospectively investigate trunk-pelvis kinematic outcomes among persons with unilateral transtibial and transfemoral limb loss with time from initial independent ambulation with a prosthesis, while secondarily describing self-reported presence and intensity of low back pain. Over time, increasing trunk-pelvis range of motion and decreasing trunk-pelvis coordination with increasing presence and/or intensity of low back pain were hypothesized. Additionally, less trunk-pelvis range of motion and more trunk-pelvis coordination for persons with more distal limb loss was hypothesized. Design Inception cohort with up to 5 repeated evaluations, including both biomechanical and subjective outcomes, during a 1-year period (0, 2, 4, 6, 12 months) after initial ambulation with a prosthesis. Setting Biomechanics laboratory within military treatment facility. Participants Twenty-two men with unilateral transtibial limb loss and 10 men with unilateral transfemoral limb loss (N=32). Interventions Not applicable. Main Outcome Measures Triplanar trunk-pelvis range of motion and intersegmental coordination (continuous relative phase) obtained at self-selected (∼1.30m/s) and controlled (∼1.20m/s) walking velocities. Self-reported presence and intensity of low back pain. Results An interaction effect between time and group existed for sagittal (P=.039) and transverse (P=.009) continuous relative phase at self-selected walking velocity and transverse trunk range of motion (P=.013) and sagittal continuous relative phase (P=.005) at controlled walking velocity. Trunk range of motion generally decreased, and trunk-pelvis coordination generally increased with increasing time after initial ambulation. Sagittal trunk and pelvis range of motion were always less and frontal trunk-pelvis coordination was always greater for persons with more distal limb loss. Low back pain increased for persons with transtibial limb loss and decreased for persons with transfemoral limb loss following the 4-month time point. Conclusions Temporal changes (or lack thereof) in features of trunk-pelvis motions within the first year of ambulation help elucidate relationships between (biomechanical) risk factors for low back pain after limb loss.
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[article] 
inArchives of Physical Medicine and Rehabilitation > Vol. 101, n° 3 (2020) . - p. 434-441

Titre :	Beneficial Effects of Nonsurgical Treatment for Symptomatic Thumb Carpometacarpal Instability in Clinical Practice: A Cohort Study
Type de document :	Article
Auteurs :	Robbert M. Wouters ; Harm P. Slijper ; Lisa Esteban Lopez
Année de publication :	2020
Article en page(s) :	p. 434-441
Note générale :	https://doi.org/10.1016/j.apmr.2019.08.485
Langues :	Anglais (eng)
Descripteurs :	HE Vinci Articulations carpométacarpiennes ; Instabilité articulaire ; Orthèses ; Pouce ; Réadaptation ; Syndrome d'Ehlers-Danlos ; Techniques de physiothérapie ; Traitement par les exercices physiques
Résumé :	Objective To describe outcomes of nonsurgical treatment for symptomatic thumb carpometacarpal joint (CMC-1) instability. Secondary, to evaluate the conversion rate to surgical treatment. Design Prospective cohort study. Setting A total of 20 outpatient clinics for hand surgery and hand therapy in the Netherlands. Participants A consecutive sample of patients with symptomatic CMC-1 instability (N=431). Intervention Nonsurgical treatment including exercise therapy and an orthosis. Main Outcome Measures Pain (visual analog scale [VAS], 0-100) and hand function (Michigan Hand Outcomes Questionnaire [MHQ], 0-100) at baseline, 6 weeks, and 3 months. Conversion to surgery was recorded for all patients with a median follow-up of 2.8 years (range, 0.8-6.7y). Results VAS scores for pain during the last week, at rest, and during physical load improved with a mean difference at 3 months of 17 (97.5% CI, 9-25), 13 (97.5% CI, 9-18), and 19 (97.5% CI, 12-27), respectively (P<.001 no difference was present at months for mhq total score but the subscales activities of daily living work pain and satisfaction improved by ci points respectively after median follow-up years only participants were surgically treated. both in subgroups that did not convert to surgery vas scores decreased compared with baseline whereas improve subgroups. however remained worse patients who eventually converted> Conclusions In this large sample of patients with symptomatic CMC-1 instability, nonsurgical treatment demonstrated clinically relevant improvements in pain and aspects of hand function. Furthermore, after 2.8 years, only 14% of all patients were surgically treated, indicating that nonsurgical treatment is a successful treatment of choice.
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[article] Beneficial Effects of Nonsurgical Treatment for Symptomatic Thumb Carpometacarpal Instability in Clinical Practice: A Cohort Study [Article] / Robbert M. Wouters ; Harm P. Slijper ; Lisa Esteban Lopez . - 2020 . - p. 434-441.
https://doi.org/10.1016/j.apmr.2019.08.485
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 101, n° 3 (2020) . - p. 434-441

Descripteurs :	HE Vinci Articulations carpométacarpiennes ; Instabilité articulaire ; Orthèses ; Pouce ; Réadaptation ; Syndrome d'Ehlers-Danlos ; Techniques de physiothérapie ; Traitement par les exercices physiques
Résumé :	Objective To describe outcomes of nonsurgical treatment for symptomatic thumb carpometacarpal joint (CMC-1) instability. Secondary, to evaluate the conversion rate to surgical treatment. Design Prospective cohort study. Setting A total of 20 outpatient clinics for hand surgery and hand therapy in the Netherlands. Participants A consecutive sample of patients with symptomatic CMC-1 instability (N=431). Intervention Nonsurgical treatment including exercise therapy and an orthosis. Main Outcome Measures Pain (visual analog scale [VAS], 0-100) and hand function (Michigan Hand Outcomes Questionnaire [MHQ], 0-100) at baseline, 6 weeks, and 3 months. Conversion to surgery was recorded for all patients with a median follow-up of 2.8 years (range, 0.8-6.7y). Results VAS scores for pain during the last week, at rest, and during physical load improved with a mean difference at 3 months of 17 (97.5% CI, 9-25), 13 (97.5% CI, 9-18), and 19 (97.5% CI, 12-27), respectively (P<.001 no difference was present at months for mhq total score but the subscales activities of daily living work pain and satisfaction improved by ci points respectively after median follow-up years only participants were surgically treated. both in subgroups that did not convert to surgery vas scores decreased compared with baseline whereas improve subgroups. however remained worse patients who eventually converted> Conclusions In this large sample of patients with symptomatic CMC-1 instability, nonsurgical treatment demonstrated clinically relevant improvements in pain and aspects of hand function. Furthermore, after 2.8 years, only 14% of all patients were surgically treated, indicating that nonsurgical treatment is a successful treatment of choice.
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