搜索结果：Archives of rehabilitation research and clinical translation

To determine the effectiveness of rehabilitation interventions on participation outcomes in daily living, leisure, social, and educational contexts for children and adolescents with unilateral cerebral palsy (UCP), and to identify whether specific intervention categories yield superior participation improvements. MEDLINE via PubMed, Physiotherapy Evidence Database, Cochrane Library, CINAHL, and Scopus were searched from inception to July 31, 2025, for randomized controlled trials (RCTs), non-RCTs, and single-arm pre-post studies involving participants aged 18 months to 18 years with UCP, rehabilitation interventions, and standardized participation measures. After screening 417 records, 23 studies (19 RCTs and 4 pre-post designs; total N=840) met inclusion criteria. Two independent reviewers extracted study characteristics and participation outcomes. Risk of bias was assessed via Risk of Bias 2.0 and Risk Of Bias In Nonrandomized Studies of Interventions-I; certainty of evidence was judged using Grading of Recommendations Assessment, Development and Evaluation. Pooled pre-post analyses using a random-effects model (Restricted Maximum Likelihood) showed a standardized mean difference of 1.44 (95% CI: 0.95-1.92), indicating strong within-group participation improvements; however, certainty of evidence was low because of methodological limitations and high heterogeneity (I2=95%). Secondary analyses showed no significant superiority for constraint-induced movement therapy (standardized mean difference=-0.09; I2=0%), technology-assisted interventions (standardized mean difference=0.15; I2=56%), or bimanual therapy (standardized mean difference=0.69; I2=88%). Rehabilitation interventions yield substantial pre-post participation gains in children and adolescents with UCP; no specific modality showed clear superiority. Intervention characteristics may be key drivers. Future RCTs with active comparators and standardized, participation-focused protocols are needed.

To assess the feasibility of providing dance groups to people with recent acquired brain injuries (ABIs) in a hospital rehabilitation outpatient setting. A mixed methods exploratory trial that included qualitative interviews and a single blind randomized controlled trial comparing 10 weeks (3 per wk: 30 sessions) of dance group to circuit group. A day rehabilitation outpatient setting in a tertiary hospital in South Australia. A total of 49 participants (N=49) with ABI consented and were randomly divided. Patients were randomly divided to a 10-week program of either dance group (n=25) or physiotherapy circuit group (n=24). The intervention was completed by 84% of dance participants and 87% of physiotherapy circuit group participants. Primary outcome measure was health-related quality of life measured with Short Form-36. Secondary outcomes included a battery of assessments of balance, function, mobility, mood, and cognition. Feasibility outcomes included information on enrolment rates, attendance, participant satisfaction, and adverse events. Physical outcomes were comparable between the 2 groups (with no adverse outcomes), but gains in the mental health component of quality of life measures were observed in the dance group only, including energy/fatigue and emotional well-being. Qualitative results indicated that participants found both dance and circuit groups enjoyable and acceptable. Participants offered that dance had complemented other aspects of their rehabilitation. Dance groups in rehabilitation outpatient settings appear a safe, feasible therapeutic option post ABI, with significant gains in health-related quality of life, mood, and fatigue measures. Findings support feasibility to progress to a larger cluster randomized controlled trial to assess cost effectiveness and implementation issues in rehabilitation services generally.

Cognitive-motor dual-task (CMDT) research has expanded rapidly over the past 2 decades, yet this growth has occurred almost exclusively within geriatric and neurologic rehabilitation. In contrast, musculoskeletal, sports, cardiopulmonary, pediatric, and pain rehabilitation fields demonstrate markedly limited engagement with CMDT despite its relevance to motor control and functional performance. This Special Communication synthesizes the current state-of-the-field and examines the structural mechanisms that have produced this persistent interdisciplinary imbalance. Drawing from existing literature, the analysis identifies a set of recurring patterns: (1) CMDT emerged historically within domains where gait, balance, and cognitive decline are central clinical outcomes, creating an early advantage for geriatric and neurologic research; (2) CMDT-sensitive outcomes are not equally prioritized across all rehabilitation fields, reducing its perceived relevance in others; (3) standardization of dual-task assessments has developed primarily within neurologic and aging research, limiting methodological accessibility elsewhere; (4) clinician-level barriers-including time, expertise, and tool availability-restrict CMDT implementation even within well established settings; and (5) evidence and expertise have accumulated most rapidly in the fields where CMDT was first adopted, reinforcing its continued concentration in those domains. Collectively, these patterns suggest that the uneven distribution of CMDT research is not a transient artifact but a reflection of deeper disciplinary structures within rehabilitation science. By clarifying these mechanisms, this work provides a conceptual foundation for understanding why CMDT has flourished in some fields but not others, without presuming uniform applicability or advocating for indiscriminate expansion.

To assess the feasibility and the tolerance of a high-intensity interval training (HIIT) program compared with conventional rehabilitation during a 3-week hospital stay in adults with cystic fibrosis (CF) and to analyze the effectiveness and impact on health indicators of HIIT. A prospective, 2-center, open-label, randomized, controlled study. Cystic Fibrosis Resource and Expert Centers, Roscoff and Giens (France). A total of 62 adults (aged: 36.1±11y; M/F ratio: 1.3) with CF were included. Intervention group performed 3 HIIT sessions, alternating 30 seconds of work and 30 seconds of rest repeated 6 times ≥80% of maximum heart rate, and 2 low-intensity sessions per week. Control group (conventional rehabilitation) performed 5, 20-to-30-minute sessions per week at the first aerobic ventilatory threshold. (1) Feasibility was evaluated by compliance; (2) tolerance by the degree of dyspnea and adverse effects; (3) effect on physical capacity using the 6-minute walk, body composition, the forced expiratory volume in 1 second (FEV1), and the multidimensional dyspnea profile; (4) impact on health indicators by the Fibrosis Quality of Life Questionnaire and the Hospital Anxiety and Depression; and (5) participant satisfaction by the STARFISH (perception of physical activity) and the Physical Activity Enjoyment Scale. Compliance with exercise sessions was marginally higher but statistically significant in the HIIT (93.3%) than the control (86.7%) group, P=.032. However, tolerance was lower in those with severe respiratory impairment and those without cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy. Effectiveness on physical capacity (6-minute walk test, muscle strength, and FEV1) and quality of life was similar between the training methods. HIIT is feasible, safe, and well tolerated and could be used as a timesaving alternative to conventional treatment, particularly in people under CFTR modulator therapy.

To systematically evaluate the application and utility of omics technologies, high-throughput methods measuring the complete or targeted set of molecules inside a biological system at a certain timepoint, in monitoring and optimizing rehabilitation interventions in traumatic spinal cord injury. Embase, Medline/Ovid, and Web of Science were searched from inception to November 27, 2024. Eligible studies included adults (≥18 years) with spinal cord injury undergoing rehabilitation interventions assessed using omics technologies (genomics, epigenomics, transcriptomics, proteomics, metabolomics, or metagenomics). Following PRISMA guidelines, independent screening, data extraction, and risk of bias (RoB) assessment (National Institutes of Health Quality Assessment Tools) were performed by 2 investigators. Based on RoB assessment, studies were classified from level 1 (most reliable) to level 4 (least reliable). Twenty-three trials were included: 8 randomized controlled trials, 5 non-randomized controlled trials, and 10 pre-post trials. Twenty-two studies (96%) exhibit a moderate RoB due to small sample size and heterogeneity. Omics technologies were primarily applied to exercise and electrical muscle stimulation interventions (65%), followed by hormonal and cellular therapies (22%), and diet (13%). Transcriptomic analyses revealed consistent molecular adaptations, including increased mitochondrial biogenesis (proliferator-activated receptor gamma coactivator 1-alpha) and reduced muscle atrophy gene expression (myostatin), correlating with enhanced insulin sensitivity and improved aerobic capacity. Metagenomics consistently identified microbiome shifts, such as decreased inflammatory taxa and increased beneficial taxa, associated with improved metabolic profiles and bowel function. Proteomics and metabolomics highlighted systemic changes related to neurorecovery, immune modulation, and sperm motility, linking molecular signatures directly to clinical outcomes. Omics technologies enable early identification of molecular alterations. However, given small sample sizes and heterogeneity of the current studies, these findings should be interpreted with caution. Gradual integration of omics, particularly epigenomics which may capture long-term, injury-related changes holds promise for developing personalized rehabilitation protocols and monitoring clinical progression in spinal cord injury.

To investigate the relationship between the occurrence of falls and the time taken to perform the Timed Up and Go (TUG) test in a population of patients with Charcot-Marie-Tooth disease type 1A (CMT1A). We conducted a longitudinal, single-center, exploratory study involving adult patients with CMT1A, followed for 1 year. Physical, functional, and analytical tests, including the TUG test, gait analysis, and muscle strength assessment, were performed at baseline, 6 months, and 12 months. Patients also completed questionnaires on physical capabilities, fatigue, falls, and the impact on quality of life and psychological health. The study was conducted between September 2020 and February 2025. This study was conducted at a university hospital. Patients (n=40) included in this study had to be adults, have a molecular biology-confirmed diagnosis of CMT1A, have quadriceps strength >2 of 5, and have a proficient oral and written understanding of French. Not applicable. The primary outcome was the time (in s) required to complete the TUG test, analyzed according to the frequency of self-reported falls. Secondary outcome measures included balance performance assessed with the Berg Balance Scale (BBS) and walking endurance evaluated by the distance covered during the 6-minute walk test (6MWT). Physical, functional, and analytical tests were conducted at baseline, 6 months, and 12 months. We included 40 patients with CMT1A, predominantly women (62.5%), with a median (interquartile range) age of 52 (42-67) years. Analysis of the TUG test results according to fall frequency revealed no significant difference between groups (no fall, 1-2 falls, and >2 falls) with respect to the median (interquartile range) time: 9.3 (6.9-10.8), 9.0 (7.5-10.4), and 9.5 (7.8-11.0) seconds, respectively (P=.710). Median BBS and 6MWT values at baseline were 52 (47-55) and 422 (335-480) m, respectively, showing no significant change after 1 year of follow-up. When used alone, the TUG test is not a suitable tool for fall risk screening in patients with CMT1A. Balance (BBS) and walking endurance (6MWT) also remained stable over 1 year. Global assessment is crucial for detecting physical impairments and preventing falls. A future study could include a larger sample and a more precise categorization of falls.

To critically analyze evidence on the effectiveness of telerehabilitation in the treatment of shoulder injuries through a systematic review of randomized controlled trials. A comprehensive literature search was conducted in PubMed, Cochrane Library, Embase, and LILACS databases, covering studies published from 2019 to 2024. Studies were included if they were randomized controlled trials, published in English or Spanish, and focused on telerehabilitation interventions targeting shoulder injuries with outcomes related to pain and/or function. Two reviewers independently selected and extracted data on study characteristics, participant demographics, intervention protocols, and reported outcomes. Disagreements were resolved by a third reviewer. Five studies involving 196 participants were included. Interventions varied in duration, frequency, and technological platforms. Most studies reported improvements in pain and function comparable to those achieved with in-person therapy, with high adherence and satisfaction rates. Telerehabilitation is a promising approach for managing shoulder injuries, providing effective, accessible, and personalized care. However, standardization of protocols and further research on complex pathologies are needed.

To determine the safety and efficacy of moderate to high intensity exercise for patients in the subacute phase of stroke recovery. Embase, PubMed, Cochrane Central Register of Controlled Trials, CINAHL, ClinicalTrials.gov, Google Scholar, and previous meta-analyses published between January 1994 and October 2024. Title and abstract screening required consensus by 2 reviewers. A total of 27 randomized controlled trials met inclusion criteria. Studies were included if they enrolled participants <6 months post stroke. Interventions were eligible if they were of moderate or high cardiovascular intensity as defined by the American College of Sports Medicine. Acceptable comparator groups included sham, low intensity interventions, no exercise, relaxation, or cognitive interventions. Three reviewers independently extracted data using the COVIDENCE platform, with each article reviewed by at least 2 individuals. Random effect meta-analyses were employed to generate pooled estimates of effects. Primary outcomes included severe cardiac and cerebral adverse events, measures of endurance, and gait speed. Secondary outcomes included death, blood pressure, balance, quality of life, and functional independence. Several measures of endurance and gait speed were significantly improved with moderate to high intensity interventions (change in 6-minute walk test, mean difference (MD): 33.11 m; 95% CI, 23.24-42.98; P<.001, k=15; change in peak work rate, MD: 9.28 watts; 95% CI, 5.20-13.37; P=.002; and change in fastest gait speed, MD: 0.12 m/s; 95% CI: 0.05-0.19; P=.003, k=10). Severe adverse cardiac/cerebral events (SAE), peak volume of oxygen, comfortable gait speed, and secondary outcomes did not significantly differ between groups (SAE incidence rate ratio: 1.45; 95% CI, 0.74-2.82; P=.245, k=11). Moderate to high intensity exercise should be considered within acute rehabilitation facilities, skilled nursing facilities, and outpatient settings for patients in the subacute phase of post stroke rehabilitation and screened as appropriate. Physician collaboration for patient selection and continued active monitoring for SAEs is recommended.

To evaluate the efficacy of a specific group of modified constraint-induced movement therapy (mCIMT) protocols, including &#x2264;39 hours of therapist-supervised training combined with &#x2265;10 h/d of restraint, on upper limb motor function in adults with chronic stroke. PubMed, Scopus, EBSCO, and the Cochrane Library were systematically searched up to March 20, 2025, using MeSH terms related to stroke, constraint-induced therapy, and upper limb function. Randomized controlled trials (RCTs) involving adults with chronic stroke who received mCIMT compared with conventional rehabilitation were included. Exclusion criteria included multimodal interventions or insufficient outcome data. Of 6486 records, 5 RCTs (n=239) met the inclusion criteria. Two reviewers independently extracted study and participant characteristics, intervention details, and upper limb outcomes. Risk of bias was assessed with the Cochrane Risk of Bias Tool for Randomized Trials-2, and certainty of evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Meta-analysis revealed significant larger improvements for the intervention group compared with controls posttreatment: Wolf Motor Function Test Functional Ability (mean difference [MD]=0.59; 95% CI, 0.23-0.94), Motor Activity Log Quality of Movement (MD=1.08; 95% CI, 0.61-1.55), and Amount of Use (MD=1.01; 95% CI, 0.24-1.79). Wolf Motor Function Test Performance Time improved modestly (standardized mean difference=-0.36; 95% CI: -0.68 to -0.04). At follow-up, only Motor Activity Log scores demonstrated sustained gains. Heterogeneity was moderate to high for some outcomes, and overall evidence strength was rated very low because of small sample sizes and high risk of bias. mCIMT protocols requiring fewer therapist hours but extended restraint time yield meaningful improvements in upper limb function among chronic stroke survivors, with real-world use gains persisting at follow-up. These findings suggest that optimizing, rather than maximizing, therapy intensity may improve feasibility and adherence, supporting broader clinical adoption. Further large-scale, high-quality RCTs with long-term follow-up are warranted to refine dosing guidelines and tailor interventions to patient subgroups.

To determine the feasibility of using behavior change techniques in people with acute stroke during hospitalization and to evaluate the preliminary effects of these interventions on the physical activity and mobility of the participants. Nonblinded, parallel-group pilot randomized controlled trial. The trial was conducted in a stroke unit of a university hospital in Germany. A random sample of 24 participants (N=24) was selected. Included were people with acute stroke (<48h after the incident), with National Institutes of Health Stroke Scale score 0-5, who were able to ambulate independently. Participants of the intervention group received 3 behavior change techniques alongside standard physiotherapy during their hospital stay: education, goal setting, and monitoring. In the control group, participants received standard physiotherapy. Feasibility was assessed based on previously established feasibility criteria. Physical activity levels were measured using accelerometry, while mobility was evaluated with the de Morton Mobility Index. Twenty-four participants were recruited in total (participation rate: 77.4%), and 12 of them received the intervention. There were no drop-outs and none lost to follow-up (drop-out rate 0%; retention rate: 100%). The recruitment rate, retention, acceptability, and safety of the intervention were assessed as feasible. The target adherence of 80% potential wear time of an accelerometer could not be confirmed. No adverse events were reported. A trend for higher physical activity of the intervention group was observed; however, the results were not statistically significant. Despite a small number of participants, the feasibility and safety of the use of behavior change techniques in people with acute stroke, as well as indications of a potential effect, were established. Therefore, after implementing adjustments regarding the recruitment and inclusion of participants, the recommendation can be made to conduct a definite trial.

Depressive symptoms are prevalent in physical therapy and rehabilitation populations and can act as a limiting factor for rehabilitation participation and outcomes across diagnoses. Even when not meeting criteria for major depressive disorder, elevated depressive symptoms can undermine rehabilitation participation through reduced motivation, impaired self-regulation, sleep disturbance, fatigue, low perceived control, and avoidance of effort or movement. Although referral pathways for mental health care remain essential, access barriers and stigma commonly delay help-seeking. This Special Communication argues that resistance exercise can be positioned in physical therapy as a dual-target intervention: supporting functional recovery while concurrently engaging mood-relevant mediators that influence rehabilitation participation and outcomes. Beyond physiological adaptations, resistance training provides rapid and measurable experiences of mastery and agency (eg, progressive increases in repetitions, time under tension, or load), which may strengthen self-efficacy and perceived control, reduce helplessness, and improve tolerance to discomfort through graded exposure to effort. These mediators are clinically relevant because they map directly onto modifiable drivers of adherence, persistence, and dropout risk in rehabilitation. Pragmatic, safety-oriented principles are outlined for prescribing resistance exercise across settings (clinic- or home-based; minimal equipment), including techniques to maximize early achievable success, simplify programs to reduce cognitive load, apply symptom- and fatigue-guided progression, and monitor engagement outcomes. Scope of practice boundaries and red flags requiring timely referral are also discussed. Future work should test implementation strategies and quantify whether targeting mood-related mediators through resistance exercise improves both depressive symptoms and rehabilitation endpoints, including adherence, functional outcomes, and return to valued activities.

To review the current literature on the feasibility as well as weaknesses and strengths of robot-assisted gait training (RAGT) in the rehabilitation of gait in adult patients with Guillain-Barr&#xe9; syndrome (GBS). This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis for Scoping Reviews guidelines. A systematic search between November 2024 and May 2025 of PubMed, Cochrane Library, Embase, Canadian Agency for Drugs and Technologies in Health (CADTH) Grey Matters, and citation mining was performed to evaluate for relevant studies. All studies involving the use of RAGT in adults (&#x2265;18y) diagnosed with acute inflammatory demyelinating polyneuropathy or GBS were included. Eligible study designs comprised case reports, case series, feasibility studies, and randomized controlled trials. The search yielded 11 potentially relevant articles. Study selection was conducted in 2 stages: title and abstract screening followed by full-text review. Discrepancies between the 2 independent reviewers were resolved through discussion until consensus was achieved. Four studies met the inclusion criteria, comprising 2 case reports, 1 mixed-methods feasibility study, and 1 cross-sectional study, with a total of 19 participants. Across studies, RAGT was generally reported to be feasible, well tolerated, and acceptable to patients, with no major safety concerns. Reported benefits included the ability to initiate overground ambulation, high-intensity repetitive gait practice, and reduced physical burden on therapists. Patient acceptance was supported by positive user experiences, adherence to training sessions, and completion of prescribed protocols, although outcome measures and reporting were inconsistent. The current evidence base for RAGT in adults with GBS is limited but suggests that it is a feasible and acceptable adjunct to conventional rehabilitation. Although functional improvements were reported, conclusions regarding effectiveness remain constrained by small sample sizes and study heterogeneity. Further prospective and methodologically robust studies are needed to better characterize feasibility, patient experience, and implementation considerations of RAGT in this population.

To investigate the clinical effects of olfactory training (OT) on olfactory function and related nonmotor symptoms in patients with Parkinson disease (PD). Randomized controlled trial with a duration of 6 months of follow-up. A tertiary hospital providing neurology rehabilitation services in China. Of 81 initially recruited PD patients, 70 completed the study (N=70, 35 per group after randomization: OT group n=35, control n=35). All participants met inclusion criteria and received standard medical care. No dropouts were because of adverse effects. The intervention group received OT using a standardized protocol. The training involved daily exposure to specific odorants for 6 months. The control group did not receive OT. Primary outcomes included changes in olfactory test scores, memory and cognition scores (assessed using neuropsychological tests), and depressive and anxiety scale scores. These were measured before and after the 6-month intervention. After 6 months, the intervention group exhibited significant improvements in olfactory test scores (threshold-discrimination-identification score: t=3.839, P<.01, Cohen's d=0.649), memory (memory quotient: t=2.597, P<.05, Cohen's d=0.439) and cognition scores (Mini-Mental State Examination: z=-2.791, P<.01, rank-biserial correlation (r)=-0.330 and Montreal Cognitive Assessment: t=2.626, P<.05, Cohen's d=0.444), depressive (Hamilton Depression Scale: z=-3.601, P<.001, r=-0.425 and Patient Health Questionnaire-9: z=-2.396, P<.05, r=-0.29) and anxiety (Hamilton Anxiety Scale: z=-3.049, P<.01, r=-0.36 and Generalized Anxiety Disorder-7: z=-2.849, P<.01, r=0.336) scale scores compared to the control group, showing moderate effects, respectively. The increase in memory scale scores was positively correlated with the increase in olfactory scores (Spearman r=0.415, P<.05). Statistical analysis was performed using SPSS 27.0 software, with P values indicating significance. The OT has beneficial effects on olfactory function and related nonmotor symptoms in patients with PD. The 6-month training led to significant improvements in memory, cognition, depression, and anxiety. Further studies are needed to determine the long-term effects and optimal duration of OT for patients with PD.

Quality of care is fundamental for achieving optimal patient outcomes, enhancing patient experiences, and engaging in improvement practices. Quality of care comprises 6 domains: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. Despite robust frameworks guiding quality measurement in other health care fields, orthotics and prosthetics (O&P) rehabilitation lags in adopting these practices. As quality-of-care measures become more prevalent, particularly as the Centers for Medicare and Medicaid Services plans to shift to value-based care by 2030, the urgency to establish measures in O&P increases. Establishing specific evidence-based quality measures in O&P empowers the profession to define appropriate standards, helping to ensure that care remains tailored to patients' needs and produces optimal outcomes-while minimizing the risk of inappropriate, externally imposed benchmarks. Several key groups across the care continuum are highlighted in this article, because they will be responsible for transitioning toward quality-of-care assessment in O&P care: leaders in O&P organizations, researchers, manufacturers, clinic owners, clinicians, patients, and educators. When each group fulfills its responsibilities, it strengthens overall quality and enhances the value of care provided. This special communication highlights the imperative of incorporating quality-of-care measurement into O&P practice across each key group and calls for research to define meaningful measures, establish standardized indicators, and implement systems for quality improvement. This article provides a comprehensive perspective to inform and educate each key group in quality-of-care concepts to foster improvement efforts in O&P.

To describe and explore factors related to unmet needs and differences in urban vs rural centrality of community-based rehabilitation in patients with moderate-to-severe traumatic injuries with TBI at 12 months postinjury. A 12-month follow-up study of rehabilitation needs in a longitudinal multicenter cohort study Rehabilitation Needs, Service Provision, and Costs in the First Year after Traumatic Injuries. Two reginal trauma centers and the patients' municipality of residence. Patients with moderate-to-severe trauma with a traumatic brain injury with age&#x2265;18 years, a New Injury Severity Score>9, an Abbreviated Injury - Head score&#x2265;2, admission to the trauma centers within 72 hours, and a hospital stay of at least 2 days. N=235 community dwelling patients (mean age 51.9y; 77.4% men) were included. Not applicable. Unmet rehabilitation needs at 12 months on the Needs and Provision Complexity Scale. We hypothesized that injury severity and urban vs rural centrality of residence would predict unmet rehabilitation needs at 12 months postinjury. 42.1% reported unmet rehabilitation needs on the Needs and Provision Complexity Scale Rehabilitation subscale at 12 months postinjury. Median unmet rehabilitation needs was 2.0 (interquartile range 1-3). Mean Glasgow Outcome Scale Extended (GOSE) was 6.2 (SD, 1.5).A logistic regression model that included demographic and injury-related variables, urban vs rural centrality of residence and global functioning on the GOSE found that significant predictors of unmet rehabilitation needs were living in less central municipalities (odds ratio [OR], 2.18), AIS-Head&#x2265;3 (OR, 3.35), and lower GOSE scores at 6 months (OR, 1.60). Unmet rehabilitation needs are common after moderate-to-severe trauma with TBI at 12 months postinjury. Particular attention is required for individuals with more severe TBI and those in less central municipalities, because they face higher risk of unmet rehabilitation needs.

To examine hand motor features in individuals diagnosed with disorder of consciousness (DoC) after severe brain injury, and to investigate the relationship between manual dexterity and levels of consciousness. Cross-sectional study. Rehabilitation hospital. Sixty patients with DoC (44 men and 16 women), with a mean age of 55.03&#xb1;15.28 years and a mean postinjury duration of 10.68&#xb1;7.98 months. Not applicable (no interventions were administered). Manual dexterity (Brunnstrom Recovery Stage [BRS]), spasticity (Modified Ashworth Scale), pain (Nociception Coma Scale-Revised), and consciousness (Coma Recovery Scale-Revised) were assessed. Descriptive, nonparametric, and multivariate analyses were performed. Evaluation of the best-functioning hands in the 60 patients with DoC showed that 60% (n=36) had low dexterity (BRS<4), and edema was revealed in 28.3% (17/60) of these hands. Compared with patients in minimally conscious state (MCS), those in unresponsive wakefulness syndrome (UWS) had significantly lower manual dexterity (96.2% vs 32.4%) and a higher prevalence of hand edema (42.3% vs 17.6%). BRS scores were significantly higher for hands than for arms (P<.001). Manual dexterity was strongly associated with consciousness diagnosis (adjusted odds ratios=16.03, 95% confidence interval, 2.16-119.11; P=.007). No significant difference was found between right and left hands. A considerable proportion of patients with DoC experience severe hand complications, which can negatively impact their clinical diagnosis and quality of life. The BRS is effective in detecting subtle hand motor responses that may reflect residual consciousness in DoC. The observed association between manual dexterity and consciousness suggests that hand motor control may engage neural circuits involved in consciousness processing.

To quantify the proportion of individuals who have underutilized rehabilitation for rheumatoid arthritis (RA) and examine the associations of demographic and clinical characteristics with rehabilitation underutilization. Cross-sectional. Online survey. Adults with RA (N=309) who received care at an academic medical center rheumatology clinic from January 1, 2020 to December 31, 2021. Of 1506 patients identified from electronic medical records who met inclusion criteria, 659 were contacted, 354 enrolled in the study, and 309 completed the survey (age 56.5&#xb1;14.1y, 82% women). Not applicable. The primary outcome was rehabilitation underutilization, which was defined as reporting moderate-severe functional limitation (Patient-Reported Outcome Measure Information System Physical Function -10a score <40) and never using rehabilitation services related to RA (self-reported use yes vs. no). The exposure variables were race and ethnicity, gender identity, health insurance, financial status, education status, work status, and body mass index. Of 309 adults with RA who participated, 47% reported moderate-severe functional limitation, 63% never used rehabilitation services related to RA, and 25% had underutilized rehabilitation. The following characteristics were strongly associated (adjusted OR range 2.8-15.8) with rehabilitation underutilization: Medicaid + Medicare, Medicaid, Medicare, no health insurance, lower financial status, lower education, disabled work status, obesity, and major comorbidity. One in 4 adults with RA underutilized rehabilitation. There is a clear unmet need for rehabilitation, particularly in adults with lower socioeconomic status and groups with greater functional needs. Future work should develop strategies to facilitate rehabilitation use for adults with RA who need it.

To investigate how participation changes over time among individuals with Parkinsondisease (PD) and identify factors influencing these changes, focusing on impairment level and social factors. Secondary analysis of a 3-year prospective cohort study of social self-management of PD. Data were collected during 4 in-person assessments conducted at baseline and then annually thereafter. Multilevel modeling was used to analyze data from the 4 time points. Department of Occupational Therapy Research Laboratory and Department of Neurology Movement Disorder Clinic. A total of 86 individuals (N = 86) with idiopathic PD (Hoehn & Yahr stages I-IV; mean age &#xb1; SD, 65.0 &#xb1; 9.6y). Not applicable. Participation was measured by the Activity Card Sort. Potential predictors contributing to changes in participation included motor impairment (Movement Disorder Society-Unified Parkinson Disease Rating Scale-III), depressive symptoms (Geriatric Depression Scale), cognitive function (Montreal Cognitive Assessment), social isolation (Nottingham Health Profile), and social support (Health Management Resources Survey). There were no significant changes in overall activity participation over the 3-year period among the participants with PD. More severe depressive symptoms were associated with reduced participation in instrumental (&#x3b2; = -0.42, P < .01), high-demand leisure (&#x3b2; = -0.22, P = .04), and social activities (&#x3b2; = -0.41, P < .01). Greater social support from family and friends (&#x3b2; = 0.77, P = .03) and organizations (&#x3b2; = 1.07, P < .01) was associated with greater participation in social activities. Depressive symptoms were a significant within-person driver of restricted participation in instrumental, high-demand leisure, and social activities, as well as in the global domain, whereas higher social support from organizations, family, and friends predicted greater participation, particularly in social and global activity participation. Early detection of depressive symptoms and strategies to enhance social support resources may help promote sustained activity participation in this population.

To evaluate the efficacy of clemastine in improving clinical and electrophysiological outcomes in patients with carpal tunnel syndrome (CTS) when combined with standard splint therapy. A double-blind, randomized, placebo-controlled trial with follow-up assessments at 1 and 3 months. A physical medicine and rehabilitation outpatient clinic. Adult patients (N=27) (mean age=46.4y; sex ratio, 29.2% men and 70.8% women), enrolled with electrodiagnostically confirmed mild to moderate CTS, were randomized into clemastine (n=14) and placebo (n=13) groups. The treatment group received 1 mg oral clemastine nightly plus a wrist splint, while the control group received a placebo plus an identical wrist splint, with both interventions maintained for 3 months. Primary endpoints included Boston Carpal Tunnel Questionnaire Symptom Severity (BQ-SS) and Functional Status (BQ-FS) scores, nerve conduction study parameters (median nerve sensory and motor distal latency), and ultrasonographic median nerve cross-sectional area. The case group showed a significant difference in follow-up mean BQ-FS and BQ-SS scores (ANOVA, p<.01) at 1 month and 3 months compared with the control. No significant differences were found in the nerve conduction study or ultrasonographic cross-sectional area between groups. Clemastine, combined with wrist splinting, may provide further clinical benefits in patients with CTS, particularly in improving BQ-SS and BQ-FS outcomes. Further research is necessary to confirm these findings and explore appropriate dosing options.