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Most Cited Archives of Physical Medicine and Rehabilitation Articles
The most cited articles published since 2011, extracted from Scopus.
Volume 92, Issue 4, April 2011, Pages 519-530
Keith D. Cicerone | Donna M. Langenbahn | Cynthia Braden | James F. Malec | Kathleen Kalmar | Michael Fraas | Thomas Felicetti | Linda Laatsch | J. Preston Harley | Thomas Bergquist | Joanne Azulay | Joshua Cantor | Teresa Ashman
Objective: To update our clinical recommendations for cognitive rehabilitation of people with traumatic brain injury (TBI) and stroke, based on a systematic review of the literature from 2003 through 2008. Data Sources: PubMed and Infotrieve literature searches were conducted using the terms attention, awareness, cognitive, communication, executive, language, memory, perception, problem solving, and/or reasoning combined with each of the following terms: rehabilitation, remediation, and training for articles published between 2003 and 2008. The task force initially identified citations for 198 published articles. Study Selection: One hundred forty-one articles were selected for inclusion after our initial screening. Twenty-nine studies were excluded after further detailed review. Excluded articles included 4 descriptive studies without data, 6 nontreatment studies, 7 experimental manipulations, 6 reviews, 1 single case study not related to TBI or stroke, 2 articles where the intervention was provided to caretakers, 1 article redacted by the journal, and 2 reanalyses of prior publications. We fully reviewed and evaluated 112 studies. Data Extraction: Articles were assigned to 1 of 6 categories reflecting the primary area of intervention: attention; vision and visuospatial functioning; language and communication skills; memory; executive functioning, problem solving and awareness; and comprehensive-holistic cognitive rehabilitation. Articles were abstracted and levels of evidence determined using specific criteria. Data Synthesis: Of the 112 studies, 14 were rated as class I, 5 as class Ia, 11 as class II, and 82 as class III. Evidence within each area of intervention was synthesized and recommendations for Practice Standards, Practice Guidelines, and Practice Options were made. Conclusions: There is substantial evidence to support interventions for attention, memory, social communication skills, executive function, and for comprehensive-holistic neuropsychologic rehabilitation after TBI. Evidence supports visuospatial rehabilitation after right hemisphere stroke, and interventions for aphasia and apraxia after left hemisphere stroke. Together with our prior reviews, we have evaluated a total of 370 interventions, including 65 class I or Ia studies. There is now sufficient information to support evidence-based protocols and implement empirically-supported treatments for cognitive disability after TBI and stroke. © 2011 American Congress of Rehabilitation Medicine.
Effect of exercise on physical function, daily living activities, and quality of life in the frail older adults: A meta-analysis
Volume 93, Issue 2, February 2012, Pages 237-244
Chih Hsuan Chou | Chueh Lung Hwang | Ying Tai Wu
Objectives: To determine the effect of exercise on the physical function, activities of daily living (ADLs), and quality of life (QOL) of the frail older adults. Data Sources: Relevant articles published between 2001 and June 2010 were searched in PubMed, MEDLINE, EMBASE, the Chinese Electronic Periodical Service, CINAHL, and the Cochrane Library databases. Study Selection: The participants were selected based on the predetermined frailty criteria and randomly assigned to either an exercise or control group. The intervention for the exercise group was a single or comprehensive exercise training program, whereas usual care was provided to the control group. Data Extraction: The characteristics and outcome measures of the included studies were identified independently by 2 investigators. Data Synthesis: The effect sizes of physical function assessed by the timed up and go test, gait speed, the Berg Balance Scale (BBS), the ADL questionnaires, and QOL measured by the Medical Outcomes Study 36-Item Short-Form Health Survey were calculated, using a weighted mean difference (WMD) and a 95% confidence interval (CI) to represent the results. Compared with the control group, the exercise group increased their gait speed by.07m/s (95% CI.02.11), increased their BBS score (WMD=1.69; 95% CI.562.82), and improved their performance in ADLs (WMD=5.33; 95% CI 1.01-9.64). The exercise intervention had no significant effects on the Timed Up & Go test performance and the QOL between the groups. Conclusions: Exercise is beneficial to increase gait speed, improve balance, and improve performance in ADLs in the frail older adults. © 2012 American Congress of Rehabilitation Medicine.
Volume 92, Issue 3, March 2011, Pages 411-418
Jeanne M. Hoffman | Charles H. Bombardier | Daniel E. Graves | Claire Z. Kalpakjian | James S. Krause
Objective To describe rates of probable major depression and the development and improvement of depression and to test predictors of depression in a cohort of participants with spinal cord injury (SCI) assessed at 1 and 5 years after injury. Design Longitudinal cohort study. Setting SCI Model System. Participants Participants (N=1035) who completed 1- and 5-year postinjury follow-up interviews from 2000 to 2009. Interventions Not applicable. Main Outcome Measure Probable major depression, defined as Physician Health Questionnaire-9 score of 10 or higher. Results Probable major depression was found in 21% of participants at year 1 and 18% at year 5. Similar numbers of participants had improvement (25%) or worsening (20%) of symptoms over time, with 8.7% depressed at both 1 and 5 years. Increased pain (odds ratio [OR], 1.10), worsening health status (OR, 1.39), and decreasing unsafe use of alcohol (vs no unsafe use of alcohol; OR, 2.95) are risk factors for the development of depression at 5 years. No predictors of improvement in depression were found. Conclusion In this sample, probable major depression was found in 18% to 21% of participants 1 to 5 years after injury. To address this high prevalence, clinicians should use these risk factors and ongoing systematic screening to identify those at risk for depression. Worsening health problems and lack of effective depression treatment in participants with SCI may contribute to high rates of chronic or recurrent depression in this population. © 2011 American Congress of Rehabilitation Medicine.
The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain
Volume 92, Issue 12, December 2011, Pages 2041-2056
Adriaan Louw | Ina Diener | David S. Butler | Emilio J. Puentedura
Objective: To evaluate the evidence for the effectiveness of neuroscience education (NE) for pain, disability, anxiety, and stress in chronic musculoskeletal (MSK) pain. Data Sources: Systematic searches were conducted on Biomed Central, BMJ.com, CINAHL, the Cochrane Library, NLM Central Gateway, OVID, ProQuest (Digital Dissertations), PsycInfo, PubMed/Medline, ScienceDirect, and Web of Science. Secondary searching (PEARLing) was undertaken, whereby reference lists of the selected articles were reviewed for additional references not identified in the primary search. Study Selection: All experimental studies including randomized controlled trials (RCTs), nonrandomized clinical trials, and case series evaluating the effect of NE on pain, disability, anxiety, and stress for chronic MSK pain were considered for inclusion. Additional limitations: studies published in English, published within the last 10 years, and patients older than 18 years. No limitations were set on specific outcome measures of pain, disability, anxiety, and stress. Data Extraction: Data were extracted using the participants, interventions, comparison, and outcomes (PICO) approach. Data Synthesis: Methodological quality was assessed by 2 reviewers using the Critical Review FormQuantitative Studies. This review includes 8 studies comprising 6 high-quality RCTs, 1 pseudo-RCT, and 1 comparative study involving 401 subjects. Most articles were of good quality, with no studies rated as poor or fair. Heterogeneity across the studies with respect to participants, interventions evaluated, and outcome measures used prevented meta-analyses. Narrative synthesis of results, based on effect size, established compelling evidence that NE may be effective in reducing pain ratings, increasing function, addressing catastrophization, and improving movement in chronic MSK pain. Conclusions: For chronic MSK pain disorders, there is compelling evidence that an educational strategy addressing neurophysiology and neurobiology of pain can have a positive effect on pain, disability, catastrophization, and physical performance. © 2011 American Congress of Rehabilitation Medicine.
Volume 92, Issue 3, March 2011, Pages 332-338
Michael J. Devivo | Yuying Chen
Objective To determine the characteristics of the newly injured and prevalent population with spinal cord injury (SCI) and assess trends over time. Design Prospective cohort study. Setting SCI Model Systems and Shriners Hospital SCI units. Participants The study population included people whose injuries occurred from 1935 to 2008 (N=45,442). The prevalent population was estimated based on those who were still alive in 2008. Losses to follow-up (approximately 10%) were excluded from the prevalent population. Interventions Not applicable. Main Outcome Measures Demographic and injury characteristics, mortality, self-reported health, rehospitalization, FIM, Craig Handicap Assessment and Reporting Technique, and the Diener Satisfaction with Life Scale. Results Mean age at injury increased 9 years since the 1970s. Injuries caused by falls and injuries resulting in high-level tetraplegia and ventilator dependency are increasing, while neurologically complete injuries are decreasing. Discharge to a nursing home is increasing. The mean age of the prevalent population is slightly higher than that of newly injured individuals, and the percentage of incident and prevalent cases older than 60 years is the same (13%). Prevalent cases tend to be less severely injured than incident cases, and less than 5% of prevalent cases reside in nursing homes. Within the prevalent population, life satisfaction and community participation are greater among persons who are at least 30 years postinjury. These findings are a result of very high mortality rates observed after 60 years of age. Conclusions Within the prevalent population, the percentage of elderly persons will not increase meaningfully. Those who reach older ages will typically have incomplete and/or lower-level injuries and will have relatively high degrees of independence and overall good health. © 2011 American Congress of Rehabilitation Medicine.
Depression after spinal cord injury: Comorbidities, mental health service use, and adequacy of treatment
Volume 92, Issue 3, March 2011, Pages 352-360
Jesse R. Fann | Charles H. Bombardier | J. Scott Richards | Denise G. Tate | Catherine S. Wilson | Nancy Temkin
Objective To provide data for depression rates and psychiatric comorbid conditions, mental health service use, and adequacy of depression treatment in depressed and nondepressed adults with spinal cord injury (SCI). Design Cross-sectional survey as part of the Project to Improve Symptoms and Mood after SCI (PRISMS). Setting Community setting. Participants Community-residing people with traumatic SCI (N=947). Interventions Not applicable. Main Outcome Measures Patient Health Questionnaire-9 (PHQ-9) Depression Scale, psychiatric history questionnaire, Cornell Service Index (mental health service use), and current medication use. Results The prevalence of probable major depression (PHQ-9 score <10) was 23%. There was a high lifetime prevalence of other psychiatric conditions, particularly anxiety disorders. In depressed participants, 29% currently were receiving any antidepressant and 11% were receiving guideline-level antidepressant dose and duration, whereas 11% had been receiving any psychotherapy in the past 3 months and 6% had been receiving guideline-level psychotherapy in the past 3 months. Serotonergic antidepressants and individual psychotherapy were the most common types of treatment received, and there was a wide range of provider types and treatment settings. Demographic and clinical variables were not associated with receipt of mental health service or guideline-level care. Conclusions Findings from this study document the low rate of mental health treatment for persons with SCI and probable major depression. These findings have implications for improving the effectiveness of depression treatment in people with SCI. © 2011 American Congress of Rehabilitation Medicine.
Volume 92, Issue 10 SUPPL., October 2011, Pages S28-S36
David Cella | Cindy Nowinski | Amy Peterman | David Victorson | Deborah Miller | Jin Shei Lai | Claudia Moy
Objective: To describe the development and calibration of the banks and scales of the Quality of Life in Neurological Disorders (Neuro-QOL) project, commissioned by the National Institute of Neurological Disorders and Stroke to develop a bilingual (English/Spanish), clinically relevant, and psychometrically robust health-related quality-of-life (HRQOL) assessment tool. Design: Classic and modern test construction methods were used, including input from essential stakeholder groups. Setting: An online patient panel testing service and 11 academic medical centers and clinics from across the United States and Puerto Rico that treat major neurologic disorders. Participants: Adult and pediatric patients representing different neurologic disorders specified in this study, proxy respondents for select conditions (stroke, pediatric conditions), and English- and Spanish-speaking participants from the general population. Interventions: Not applicable. Main Outcome Measures: Multiple generic and condition-specific measures used to provide construct validity evidence for the new Neuro-QOL tool. Results: Neuro-QOL has developed 14 generic item banks and 8 targeted scales to assess HRQOL in 5 adult (stroke, multiple sclerosis, Parkinson's disease, epilepsy, amyotrophic lateral sclerosis) and 2 pediatric conditions (epilepsy, muscular dystrophies). Conclusions: The Neuro-QOL system will continue to evolve, with validation efforts in clinical populations and new bank development in health domains not presently included. The potential for Neuro-QOL measures in rehabilitation research and clinical settings is discussed. © 2011 American Congress of Rehabilitation Medicine.
Balance and ambulation improvements in individuals with chronic incomplete spinal cord injury using locomotor trainingbased rehabilitation
Volume 93, Issue 9, September 2012, Pages 1508-1517
Susan J. Harkema | Mary Schmidt-Read | Douglas J. Lorenz | V. Reggie Edgerton | Andrea L. Behrman
To evaluate the effects of intensive locomotor training on balance and ambulatory function at enrollment and discharge during outpatient rehabilitation after incomplete SCI. Prospective observational cohort. Seven outpatient rehabilitation centers from the Christopher and Dana Reeve Foundation NeuroRecovery Network (NRN). Patients (N=196) with American Spinal Injury Association Impairment Scale (AIS) grade C or D SCI who received at least 20 locomotor training treatment sessions in the NRN. Intensive locomotor training, including step training using body-weight support and manual facilitation on a treadmill followed by overground assessment and community integration. Berg Balance Scale; Six-Minute Walk Test; 10-Meter Walk Test. Outcome measures at enrollment showed high variability between patients with AIS grades C and D. Significant improvement from enrollment to final evaluation was observed in balance and walking measures for patients with AIS grades C and D. The magnitude of improvement significantly differed between AIS groups for all measures. Time since SCI was not associated significantly with outcome measures at enrollment, but was related inversely to levels of improvement. Significant variability in baseline values of functional outcome measures is evident after SCI in individuals with AIS grades C and D and significant functional recovery can continue to occur even years after injury when provided with locomotor training. These results indicate that rehabilitation, which provides intensive activity-based therapy, can result in functional improvements in individuals with chronic incomplete SCI. © 2012 by the American Congress of Rehabilitation Medicine.
Health outcomes associated with military deployment: Mild traumatic brain injury, blast, trauma, and combat associations in the Florida national guard
Volume 93, Issue 11, November 2012, Pages 1887-1895
Rodney D. Vanderploeg | Heather G. Belanger | Ronnie D. Horner | Andrea M. Spehar | Gail Powell-Cope | Stephen L. Luther | Steven G. Scott
Objectives: To determine the association between specific military deployment experiences and immediate and longer-term physical and mental health effects, as well as examine the effects of multiple deployment-related traumatic brain injuries (TBIs) on health outcomes. Design: Online survey of cross-sectional cohort. Odds ratios were calculated to assess the association between deployment-related factors (ie, physical injuries, exposure to potentially traumatic deployment experiences, combat, blast exposure, and mild TBI) and current health status, controlling for potential confounders, demographics, and predeployment experiences. Setting: Nonclinical. Participants: Members (N=3098) of the Florida National Guard (1443 deployed, 1655 not deployed). Interventions: Not applicable. Main Outcome Measures: Presence of current psychiatric diagnoses and health outcomes, including postconcussive and non-postconcussive symptoms. Results: Surveys were completed an average of 31.8 months (SD=24.4, range=0-95) after deployment. Strong, statistically significant associations were found between self-reported military deployment-related factors and current adverse health status. Deployment-related mild TBI was associated with depression, anxiety, posttraumatic stress disorder (PTSD), and postconcussive symptoms collectively and individually. Statistically significant increases in the frequency of depression, anxiety, PTSD, and a postconcussive symptom complex were seen comparing single to multiple TBIs. However, a predeployment TBI did not increase the likelihood of sustaining another TBI in a blast exposure. Associations between blast exposure and abdominal pain, pain on deep breathing, shortness of breath, hearing loss, and tinnitus suggested residual barotrauma. Combat exposures with and without physical injury were each associated not only with PTSD but also with numerous postconcussive and non-postconcussive symptoms. The experience of seeing others wounded or killed or experiencing the death of a buddy or leader was associated with indigestion and headaches but not with depression, anxiety, or PTSD. Conclusions: Complex relationships exist between multiple deployment-related factors and numerous overlapping and co-occurring current adverse physical and psychological health outcomes. Various deployment-related experiences increased the risk for postdeployment adverse mental and physical health outcomes, individually and in combination. These findings suggest that an integrated physical and mental health care approach would be beneficial to postdeployment care. © 2012 American Congress of Rehabilitation Medicine.
Effects of exercise training on fitness, mobility, fatigue, and health-related quality of life among adults with multiple sclerosis: A systematic review to inform guideline development
Volume 94, Issue 9, September 2013, Pages 1800-1828
Amy E. Latimer-Cheung | Lara A. Pilutti | Audrey L. Hicks | Kathleen A. Martin Ginis | Alyssa M. Fenuta | K. Ann MacKibbon | Robert W. Motl
Objective: To conduct a systematic review of evidence surrounding the effects of exercise training on physical fitness, mobility, fatigue, and health-related quality of life in adults with multiple sclerosis (MS). Data Sources: The databases included EMBASE, 1980 to 2011 (wk 12); Ovid MEDLINE and Ovid OLDMEDLINE, 1947 to March (wk 3) 2011; PsycINFO, 1967 to March (wk 4) 2011; CINAHL all-inclusive; SPORTDiscus all-inclusive; Cochrane Library all-inclusive; and Physiotherapy Evidence Database all-inclusive. Study Selection: The review was limited to English-language studies (published before December 2011) of people with MS that evaluated the effects of exercise training on outcomes of physical fitness, mobility, fatigue, and/or health-related quality of life. Data Extraction: One research assistant extracted data and rated study quality. A second research assistant verified the extraction and quality assessment. Data Synthesis: From the 4362 studies identified, 54 studies were included in the review. The extracted data were analyzed using a descriptive approach. There was strong evidence that exercise performed 2 times per week at a moderate intensity increases aerobic capacity and muscular strength. The evidence was not consistent regarding the effects of exercise training on other outcomes. Conclusions: Among those with mild to moderate disability from MS, there is sufficient evidence that exercise training is effective for improving both aerobic capacity and muscular strength. Exercise may improve mobility, fatigue, and health-related quality of life. © 2013 by the American Congress of Rehabilitation Medicine.
A prospective evaluation of balance, gait, and strength to predict falling in women with multiple sclerosis
Volume 92, Issue 11, November 2011, Pages 1840-1846
Susan L. Kasser | Jesse V. Jacobs | John T. Foley | Bradley J. Cardinal | Gianni F. Maddalozzo
Objective: To identify measures of balance, gait, and strength that predict falls in women with multiple sclerosis (MS). Design: This prospective study followed participants for 1 year. Setting: University research laboratories. Participants: A convenience sample of women with MS (N=99). Interventions: Not applicable. Main Outcome Measures: Balance was assessed with the limits of stability (LOS) test and the Sensory Organization Test. Peak force, torque, and power of knee flexors and extensors as well as hip abductors and adductors were also measured. Temporal-spatial parameters of gait were measured by an instrumented walkway system. For 1 year after baseline assessments, the participants reported their falls. Participants were then classified based on the number of reported falls for use in logistic regression models to predict either people with at least 1 fall or people with at least 2 falls (recurrent fallers). Results: A total of 159 falls were reported by 48% of the participants. Expanded Disability Status Scale scores, leaning forward to the LOS, and standing sway within a visually referenced surround significantly predicted people with at least 1 fall as well as recurrent fallers. Stance-phase asymmetries and base-of-support width during gait, as well as the force and power produced during leg extension or flexion additionally predicted recurrent fallers. The models' overall predictive accuracy ranged from 69% to 85%. Conclusions: This prospective study confirmed the prevalence and multifactorial nature of falls in this MS sample. In addition to advancing disease status, impaired forward LOS and visually dependent sway (as well as gait asymmetries and leg flexor-extensor weakness for recurrent fallers) predict future falls in women with MS. © 2011 American Congress of Rehabilitation Medicine.
How item banks and their application can influence measurement practice in rehabilitation medicine: A PROMIS fatigue item bank example
Volume 92, Issue 10 SUPPL., October 2011, Pages S20-S27
Jin Shei Lai | David Cella | Seung Choi | Doerte U. Junghaenel | Christopher Christodoulou | Richard Gershon | Arthur Stone
Objective: To illustrate how measurement practices can be advanced by using as an example the fatigue item bank (FIB) and its applications (short forms and computerized adaptive testing [CAT]) that were developed through the National Institutes of Health Patient Reported Outcomes Measurement Information System (PROMIS) Cooperative Group. Design: Psychometric analysis of data collected by an Internet survey company using item response theoryrelated techniques. Setting: A U.S. general population representative sample collected through the Internet. Participants: Respondents used for dimensionality evaluation of the PROMIS FIB (N=603) and item calibrations (N=14,931). Interventions: Not applicable. Main Outcome Measures: Fatigue items (112) developed by the PROMIS fatigue domain working group, 13-item Functional Assessment of Chronic Illness Therapy-Fatigue, and 4-item Medical Outcomes Study 36-Item Short Form Health Survey Vitality scale. Results: The PROMIS FIB version 1, which consists of 95 items, showed acceptable psychometric properties. CAT showed consistently better precision than short forms. However, all 3 short forms showed good precision for most participants in that more than 95% of the sample could be measured precisely with reliability greater than 0.9. Conclusions: Measurement practice can be advanced by using a psychometrically sound measurement tool and its applications. This example shows that CAT and short forms derived from the PROMIS FIB can reliably estimate fatigue reported by the U.S. general population. Evaluation in clinical populations is warranted before the item bank can be used for clinical trials. © 2011 American Congress of Rehabilitation Medicine.
Dual-task complexity affects gait in people with mild cognitive impairment: The interplay between gait variability, dual tasking, and risk of falls
Volume 93, Issue 2, February 2012, Pages 293-299
Manuel Montero-Odasso | Susan W. Muir | Mark Speechley
Objective: To determine the effect of 2 different dual tasks on gait variability in people with mild cognitive impairment (MCI) compared with control subjects. Design: Cross-sectional study. Setting: Memory clinic at a university hospital. Participants: Older adults with MCI (n=43) and cognitively normal control subjects (n=25) from the community. Gait was assessed under single (usual walking) and dual tasking (naming animals and subtracting serial 7s), using an electronic walkway. Interventions: Not applicable. Main Outcome Measures: The dependent variable was the coefficient of variation of gait variability, a marker of gait stability and an established risk factor for falls. Two-way repeated-measures analysis of variance was used to examine main effects (group, task) and their interaction. Results: A significant difference was found within and between groups (P=.016) of increasing gait variability as dual-task complexity increased. Gait velocity decreased within groups as dual-task complexity increased. The magnitude of increased gait variability across tasks was greater for the MCI group (2.68% 9.84%) than for the control group (1.86%3.74%), showing a significant between-group difference (P=.041). Conclusions: Dual-task load significantly increased gait variability in the MCI group compared with the control group, an effect that was larger than the changes in gait velocity. The magnitude of this impairment on gait stability was related to the complexity of the dual task applied. Our findings help to explain the high risk of falls recently described in older adults with MCI, and may help in the identification of fall risk in cognitively impaired persons. © 2012 American Congress of Rehabilitation Medicine.
Assessment of lymphatic contractile function after manual lymphatic drainage using near-infrared fluorescence imaging
Volume 92, Issue 5, May 2011, Pages 756-764.e1
I. Chih Tan | Erik A. Maus | John C. Rasmussen | Milton V. Marshall | Kristen E. Adams | Caroline E. Fife | Latisha A. Smith | Wenyaw Chan | Eva M. Sevick-Muraca
Objective To investigate the feasibility of assessing the efficacy of manual lymphatic drainage (MLD), a method for lymphedema (LE) management, by using near-infrared (NIR) fluorescence imaging. Design Exploratory pilot study. Setting Primary care unit. Participants Subjects (N=10; age, 1868y) with a diagnosis of grade I or II LE and 12 healthy control subjects (age, 2259y). Intervention Indocyanine green (25 μg in 0.1 mL each) was injected intradermally in bilateral arms or legs of subjects. Diffused excitation light illuminated the limbs, and NIR fluorescence images were collected by using custom-built imaging systems. Subjects received MLD therapy, and imaging was performed pre- and posttherapy. Main Outcome Measures Apparent lymph velocities and periods between lymphatic propulsion events were computed from fluorescence images. Data collected pre- and post-MLD were compared and evaluated for differences. Results By comparing pre-MLD lymphatic contractile function against post-MLD lymphatic function, results showed that average apparent lymph velocity increased in both the symptomatic (+23%) and asymptomatic (+25%) limbs of subjects with LE and control limbs (+28%) of healthy subjects. The average lymphatic propulsion period decreased in symptomatic (-9%) and asymptomatic (-20%) limbs of subjects with LE, as well as in control limbs (-23%). Conclusions We showed that NIR fluorescence imaging could be used to quantify immediate improvement of lymphatic contractile function after MLD. © 2011 American Congress of Rehabilitation Medicine.
Psychosocial factors and adjustment to chronic pain in persons with physical disabilities: A systematic review
Volume 92, Issue 1, January 2011, Pages 146-160
Mark P. Jensen | Michael R. Moore | Tamara B. Bockow | Dawn M. Ehde | Joyce M. Engel
Jensen MP, Moore MR, Bockow TB, Ehde DM, Engel JM. Psychosocial factors and adjustment to chronic pain in persons with physical disabilities: a systematic review. Objective To systematically review the research findings regarding the associations between psychosocial factors and adjustment to chronic pain in persons with physical disabilities. Data Sources A key word literature search was conducted using articles listed in PubMed, PsychInfo, and CINAHL up to March 2010, and manual searches were made of all retrieved articles to identify published articles that met the review inclusion criteria. Study Selection To be included in the review, articles needed to (1) be written in English, (2) include adults with a physical disability who report having pain, (3) include at least 1 measure of a psychosocial predictor domain, (4) include at least 1 criterion measure of pain or patient functioning, and (5) report the results of associations between the psychosocial factors and criterion measures used in the study. Twenty-nine studies met the inclusion criteria. Data Extraction Three reviewers tabulated study details and findings. Data Synthesis The disability groups studied included spinal cord injury (SCI), acquired amputation, cerebral palsy (CP), multiple sclerosis (MS), and muscular dystrophy (MD). Psychosocial factors were shown to be significantly associated with pain and dysfunction in all disability groups. The psychosocial factors most closely associated with pain and dysfunction across the samples included (1) catastrophizing cognitions; (2) task persistence, guarding, and resting coping responses; and (3) perceived social support and solicitous responding social factors. Pain-related beliefs were more strongly associated with pain and dysfunction in the SCI, CP, MS, and MD groups than in the acquired amputation group. Conclusions The findings support the importance of psychosocial factors as significant predictors of pain and functioning in persons with physical disabilities. Clinical trials to test the efficacy of psychosocial treatments for pain and dysfunction are warranted, as are studies to determine whether psychosocial factors have a causal influence on pain and adjustment in these populations. © 2011 American Congress of Rehabilitation Medicine.
Motivational enhancement therapy in addition to physical therapy improves motivational factors and treatment outcomes in people with low back pain: A randomized controlled trial
Volume 92, Issue 2, February 2011, Pages 176-183
Sinfia K. Vong | Gladys L. Cheing | Fong Chan | Eric M. So | Chetwyn C. Chan
Objectives To examine whether the addition of motivational enhancement treatment (MET) to conventional physical therapy (PT) produces better outcomes than PT alone in people with chronic low back pain (LBP). Design A double-blinded, prospective, randomized, controlled trial. Setting PT outpatient department. Participants Participants (N=76) with chronic LBP were randomly assigned to receive 10 sessions of either MET plus PT or PT alone. Intervention MET included motivational interviewing strategies and motivation-enhancing factors. The PT program consisted of interferential therapy and back exercises. Main Outcome Measures Motivational-enhancing factors, pain intensity, physical functions, and exercise compliance. Results The MET-plus-PT group produced significantly greater improvements than the PT group in 3 motivation-enhancing factors; proxy efficacy (P<.001), working alliance (P<.001), and treatment expectancy (P=.011). Furthermore, they performed significantly better in lifting capacity (P=.015), 36-Item Short Form Health Survey General Health subscale (P=.015), and exercise compliance (P=.002) than the PT group. A trend of a greater decrease in visual analog scale and Roland-Morris Disability Questionnaire scores also was found in the MET-plus-PT group than the PT group. Conclusion The addition of MET to PT treatment can effectively enhance motivation and exercise compliance and show better improvement in physical function in patients with chronic LBP compared with PT alone. © 2011 American Congress of Rehabilitation Medicine.
Volume 93, Issue 1 SUPPL., January 2012, Pages S15-S25
Dorothee Saur | Gesa Hartwigsen
Neurobiology of language recovery after stroke: lessons from neuroimaging studies. Language is organized in large-scale, predominantly left-lateralized, temporo-parieto-frontal networks in the human brain. After focal brain damage (eg, ischemic stroke), this network organization enables the brain to adaptively reorganize language functions in order to compensate lesion effects. Here, we summarize how structural and functional neuroimaging methods contribute to the current understanding of loss and recovery of language functions after stroke. This includes voxelwise lesion-behavior mapping, functional imaging for mapping reorganizational mechanisms from acute to chronic stroke, as well as imaging based outcome prediction. The review is complemented by an introductory section on language organization in the healthy brain. © 2012 American Congress of Rehabilitation Medicine.
Extra physical therapy reduces patient length of stay and improves functional outcomes and quality of life in people with acute or subacute conditions: A systematic review
Volume 92, Issue 9, September 2011, Pages 1490-1500
Casey L. Peiris | Nicholas F. Taylor | Nora Shields
Objectives: To investigate whether extra physical therapy intervention reduces length of stay and improves patient outcomes in people with acute or subacute conditions. Data Sources: Electronic databases CINAHL, MEDLINE, AMED, PEDro, PubMed, and EMBASE were searched from the earliest date possible through May 2010. Additional trials were identified by scanning reference lists and citation tracking. Study Selection: Randomized controlled trials evaluating the effect of extra physical therapy on patient outcomes were included for review. Two reviewers independently applied the inclusion and exclusion criteria, and any disagreements were discussed until consensus could be reached. Searching identified 2826 potentially relevant articles, of which 16 randomized controlled trials with 1699 participants met inclusion criteria. Data Extraction: Data were extracted using a predefined data extraction form by 1 reviewer and checked for accuracy by another. Methodological quality of trials was assessed independently by 2 reviewers using the PEDro scale. Data Synthesis: Pooled analyses with random effects model to calculate standardized mean differences (SMDs) and 95% confidence intervals (CIs) were used in meta-analyses. When compared with standard physical therapy, extra physical therapy reduced length of stay (SMD=-.22; 95% CI, -.39 to -.05) (mean difference of 1d [95% CI, 01] in acute settings and mean difference of 4d [95% CI, 07] in rehabilitation settings) and improved mobility (SMD=.37; 95% CI,.05.69), activity (SMD=.22; 95% CI,.07.37), and quality of life (SMD=.48; 95% CI,.29.68). There were no significant changes in self-care (SMD=.35; 95% CI, -.06.77). Conclusions: Extra physical therapy decreases length of stay and significantly improves mobility, activity, and quality of life. Future research could address the possible benefits of providing extra services from other allied health disciplines in addition to physical therapy. © 2011 American Congress of Rehabilitation Medicine.
The mini-mental state examination and montreal cognitive assessment in persons with mild subacute stroke: Relationship to functional outcome
Volume 92, Issue 5, May 2011, Pages 792-798
Joan Toglia | Kerri A. Fitzgerald | Michael W. O'Dell | Andrea R. Mastrogiovanni | C. David Lin
Objectives: To compare Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) global and subscores in classifying cognitive impairment in persons with mild stroke and to explore the relationship between admission and discharge functional status and improvement. Design: Retrospective analysis of data. Setting: Acute rehabilitation unit of a large urban university-affiliated hospital. Participants: Inpatients with stroke (N=72; mean age, 70y; median time poststroke, 8.5d) and mild neurologic (median National Institutes of Health Stroke Scale score, 4) and cognitive deficits (median MMSE score, 25). Intervention: Not applicable. Main Outcome Measure: Admission cognitive status was assessed by using the MMSE and MoCA. The motor subscale of the FIM instrument (mFIM) and motor relative functional efficiency was used to assess discharge functional status and improvement. Results: The MoCA classified more persons as cognitively impaired than the MMSE (89% vs 63%, respectively; using a cutoff score of 27 on the MMSE and 26 on the MoCA). The MoCA also showed less of a ceiling effect than the MMSE, higher internal reliability (Cronbach α=.78 compared with α=.60), and marginally stronger associations with discharge functional status (r=.40; P<.001) than the MMSE (r=0.30; P<.05). The MoCA visuoexecutive subscore was the strongest predictor of functional status (P=.01) and improvement (P=.02) in global and subscores for both tests. Conclusions: The MoCA may be an important cognitive screening tool for persons with stroke and mild cognitive dysfunction on an acute rehabilitation unit. Lower visuoexecutive subscores may assist in identifying persons at risk for decreased functional gains in self-care and mobility (mFIM) during inpatient rehabilitation. The findings justify further validation studies of the MoCA in persons with subacute stroke. © 2011 American Congress of Rehabilitation Medicine.
Volume 92, Issue 6, June 2011, Pages 983-997
Isaline C. Eyssen | Martijn P. Steultjens | Joost Dekker | Caroline B. Terwee
Objectives: To evaluate: (1) whether instruments which intend to measure participation actually do and (2) how frequently specific aspects and domains of participation are addressed. Data Sources: A systematic search was performed in PubMed. Study Selection: Included were patient-reported instruments that primarily aim to measure participation. Data Extraction: The full-text instruments were extracted from the articles or obtained from the authors. Two reviewers independently rated each item of the included instruments as measuring participation (yes, no, or undetermined). For each item, the specific aspect and domain of participation were categorized. Data Synthesis: Included were 103 instruments (2445 items). Of the included items, 619 items concerned participation and 217 concerned undetermined items. In total, 68 instruments contained at least 1 (sub)scale with 50% or more participation or undetermined items. The participation items referred to the participation aspects: participation problems (53%), participation accomplishment (31%), and satisfaction with participation (9%). The domains of the participation items concerned: work/study (27%), social life (27%), general participation (19%), and home (11%). The undetermined items mainly referred to domains about leisure (43%), transport (26%), and shopping (12%). Conclusions: According to our working definition of participation, most instruments that aim to measure participation do so only to a limited extent. These instruments mainly assess aspects of participation problems and participation accomplishment. The domains of participation covered by these instruments primarily include work/study, social life, general participation, home, leisure, transport, and shopping. © 2011 by the American Congress of Rehabilitation Medicine.
Modified constraint-induced movement therapy versus traditional rehabilitation in patients with upper-extremity dysfunction after stroke: A systematic review and meta-analysis
Volume 92, Issue 6, June 2011, Pages 972-982
Yue X. Shi | Jin H. Tian | Ke H. Yang | Yue Zhao
Objective: To compare the effectiveness of modified constraint-induced movement therapy (CIMT) with traditional rehabilitation (TR) therapy in patients with upper-extremity dysfunction after stroke. Date Sources: Computerized database searches and hand-searches, as 2 main search strategies, were used to collect studies. A comprehensive search of PubMed, EMBASE, the Cochrane Library, the Chinese academic journals full-text database, the Chinese biomedical literature database, the Chinese scientific journals database, and Chinese medical association journals was conducted. Relevant journals and article reference lists were hand-searched. Meanwhile, we searched unpublished trials by using the System for Information on Gray Literature database. Study Selection: Randomized controlled trials (RCTs) only about modified CIMT versus TR for treatment of patients with upper-extremity dysfunction after stroke were identified in this systematic review. Participants included adults age over 18 years with a clinical diagnosis of stroke and met the inclusion criteria of modified CIMT. Date Extraction: Two reviewers extracted relevant information from included studies according to a date extraction form. The methodologic quality of the included studies was assessed using a quality-scoring instrument, which was a 5-point scale that included a description of randomization, double-blind structure, and withdrawals/dropouts. Data Synthesis: Thirteen RCTs involving 278 patients (modified CIMT/TR=143/135) were included. Meta-analysis showed that patients receiving modified CIMT showed higher scores for the Fugl Meyer Assessment (mean difference [MD]=7.8; 95% confidence interval [CI], 4.21-11.38), the Action Research Arm Test (MD=14.15; 95% CI, 10.71-17.59), the FIM (MD=7.00; 95% CI, .75-13.26), and the Motor Activity Log: Amount of Use (MD=.78; 95% CI, .37-1.19) and Quality of Use (MD=.84; 95% CI, .42-1.25) than patients in the TR group. In kinematic variables, patients receiving modified CIMT had a shorter reaction time and a higher percentage of movement time where peak velocity occurred than patients receiving TR (P<.05), while meta-analysis showed that there was no significant difference in normalized movement time (P=.99), normalized total displacement (P=.44), and normalized movement unit (P=.68). Conclusions: This systematic review provided fairly strong evidence that modified CIMT could reduce the level of disability, improve the ability to use the paretic upper extremity, and enhance spontaneity during movement time, but evidence is still limited about the effectiveness of modified CIMT in kinematic analysis. © 2011 by the American Congress of Rehabilitation Medicine.
Volume 92, Issue 8, August 2011, Pages 1211-1219
Tessa Hart | Lisa Brenner | Allison N. Clark | Jennifer A. Bogner | Thomas A. Novack | Inna Chervoneva | Risa Nakase-Richardson | Juan Carlos Arango-Lasprilla
Objective: To examine minor as well as major depression at 1 year posttraumatic brain injury (TBI), with particular attention to the contribution of depression severity to levels of societal participation. Design: Observational prospective study with a 2-wave longitudinal component. Setting: Inpatient rehabilitation centers, with 1-year follow up conducted primarily by telephone. Participants: Persons with TBI (N=1570) enrolled in the TBI Model System database and followed up at 1-year postinjury. Interventions: Not applicable. Main Outcome Measures: FIM, Patient Health Questionnaire-9, Participation Assessment with Recombined Tools-Objective, Glasgow Outcome Scale-Extended, and the Satisfaction With Life Scale. Results: Twenty-two percent of the sample reported minor depression, and 26% reported major depression at 1-year post-TBI. Both levels of depression were associated with sex (women), age (younger), preinjury mental health treatment and substance abuse, and cause of injury (intentional). There was a monotonic dose-response relationship between severity of depression and all 1-year outcomes studied, including level of cognitive and physical disability, global outcome, and satisfaction with life. With other predictors controlled, depression severity remained significantly associated with the level of societal participation at 1-year post-TBI. Conclusions: Minor depression may be as common as major depression after TBI and should be taken seriously for its association to negative outcomes related to participation and quality of life. Findings suggest that, as in other populations, minor and major depression are not separate entities, but exist on a continuum. Further research should determine whether people with TBI traverse between the 2 diagnoses as in other patient groups. © 2011 American Congress of Rehabilitation Medicine.
Minimal detectable changes of the berg balance scale, fugl-meyer assessment scale, timed "up & go" test, gait speeds, and 2-minute walk test in individuals with chronic stroke with different degrees of ankle plantarflexor tone
Volume 93, Issue 7, July 2012, Pages 1201-1208
Vimonwan Hiengkaew | Khanitha Jitaree | Pakaratee Chaiyawat
Objective: To determine test-retest reliability and absolute and relative minimal detectable changes at the 95% confidence level (MDC 95) of measures to detect postural balance and lower limb movements in individuals with chronic stroke who were able to walk and had differences in ankle plantarflexor tone. Design: Test-retest study. Data were collected on 2 occasions, about 6 days apart. Setting: Outpatient physical therapy clinics. Participants: Volunteers (N=61) with chronic stroke who were able to walk and had differences in ankle plantarflexor tone: no increase in ankle plantarflexor tone (n=12), a slight increase in ankle plantarflexor tone (n=32), and a marked increase in ankle plantarflexor tone (n=17). Intervention: Not applicable. Main Outcome Measures: Reliability and absolute and relative MDC 95 of the Berg Balance Scale (BBS), the lower limb subscale of Fugl-Meyer Assessment (FMA-LE), the Timed "Up & Go" test (TUG), the comfortable gait speed (CGS), the fast gait speed (FGS), and the 2-minute walk test (2MWT). Results: Excellent reliability of the BBS, FMA-LE, TUG, CGS, FGS, and 2MWT for all the participants combined and for the subgroups was shown. All the participants combined showed the absolute and relative MDC 95 in the BBS of 5 points and 10%, FMA-LE of 4 points and 16%, TUG of 8 seconds and 28%, CGS of 0.2m/s and 34%, FGS of 0.1m/s and 21%, and 2MWT of 13m and 23%. The absolute and relative MDC 95 of the subgroups were varied based on ankle plantarflexor tone. Conclusions: The BBS, FMA-LE, TUG, CGS, FGS, and 2MWT are reliable measures to detect postural balance and lower limb movements in individuals with chronic stroke who have differences in ankle plantarflexor tone. The absolute and relative MDC 95 of each measure are dissimilar in those with differences in ankle plantarflexor tone. The relative MDC 95 seems more useful than the absolute MDC 95 because the relative value can be used for a single individual. © 2012 American Congress of Rehabilitation Medicine.
Community-based argentine tango dance program is associated with increased activity participation among individuals with parkinson's disease
Volume 94, Issue 2, February 2013, Pages 240-249
Erin R. Foster | Laura Golden | Ryan P. Duncan | Gammon M. Earhart
Objective: To determine the effects of a 12-month community-based tango dance program on activity participation among individuals with Parkinson's disease (PD). Design: Randomized controlled trial with assessment at baseline, 3, 6, and 12 months. Setting: Intervention was administered in the community; assessments were completed in a university laboratory. Participants: Volunteers with PD (n=62) enrolled in the study and were randomized to a treatment group; 10 participants did not receive the allocated intervention, and therefore the final analyzed sample included 52 participants. Interventions: Participants were randomly assigned to the tango group, which involved 12 months of twice-weekly Argentine tango dance classes, or to the no intervention control group (n=26 per group). Main Outcome Measure: Current, new, and retained participation in instrumental, leisure, and social activities, as measured by the Activity Card Sort (with the dance activity removed). Results: Total current participation in the tango group was higher at 3, 6, and 12 months compared with baseline (Ps≤.008), while the control group did not change (Ps≥.11). Total activity retention (since onset of PD) in the tango group increased from 77% to 90% (P=.006) over the course of the study, whereas the control group remained around 80% (P=.60). These patterns were similar in the separate activity domains. The tango group gained a significant number of new social activities (P=.003), but the control group did not (P=.71). Conclusions: Individuals with PD who participated in a community-based Argentine tango class reported increased participation in complex daily activities, recovery of activities lost since the onset of PD, and engagement in new activities. Incorporating dance into the clinical management of PD may benefit participation and subsequently quality of life for this population. © 2013 American Congress of Rehabilitation Medicine.
A training program to improve gait while dual tasking in patients with Parkinson's disease: A pilot study
Volume 93, Issue 1, January 2012, Pages 176-181
Galit Yogev-Seligmann | Nir Giladi | Marina Brozgol | Jeffrey M. Hausdorff
Impairments in the ability to perform another task while walking (ie, dual tasking [DT]) are associated with an increased risk of falling. Here we describe a program we developed specifically to improve DT performance while walking based on motor learning principles and task-specific training. We examined feasibility, potential efficacy, retention, and transfer to the performance of untrained tasks in a pilot study among 7 patients with Parkinson's disease (PD). Seven patients (Hoehn and Yahr stage, 2.1±0.2) were evaluated before, after, and 1 month after 4 weeks of DT training. Gait speed and gait variability were measured during usual walking and during 4 DT conditions. The 4-week program of one-on-one training included walking while performing several distinct cognitive tasks. Gait speed and gait variability during DT significantly improved. Improvements were also seen in the DT conditions that were not specifically trained and were retained 1 month after training. These initial findings support the feasibility of applying a task-specific DT gait training program for patients with PD and suggest that it positively affects DT gait, even in untrained tasks. The present results are also consistent with the possibility that DT gait training enhances divided attention abilities during walking. © 2012 by the American Congress of Rehabilitation Medicine.