搜索结果：Occupational Therapy

This study aimed to analyze recent trends in occupational therapy, derive updated job competencies for Korean occupational therapists that reflect recent clinical changes, and confirm their validity. This 5-month expert consensus study, conducted from April to August 2024, used a 3-round online Delphi survey with 20 occupational therapy experts, followed by a focus group meeting with 10 experts, to refine and validate updated job competencies. Considering recent trends in occupational therapy, we adapted the U.S. National Board for Certification in Occupational Therapy practice analysis framework to the Korean context and collected expert feedback. The Delphi panel identified several competency items that required contextualization within the Korean legal scope of practice, particularly items related to physical agent modalities. After the concluding focus group discussion, the superficial thermal agents item (D3-T1-K4) was excluded, and the electrotherapeutic modality item for swallowing disorders (D3-T1-K5) was revised; the remaining competencies were finalized. Updated job competencies for new occupational therapists were derived across 4 domains, 16 tasks, and 62 knowledge items. These competencies may support greater flexibility in international research and strengthen responses to the expansion of occupational therapists' scope of practice in community settings. Therefore, the findings of this study are expected to be actively used in research, education, and practice.

Assistive technology (AT) supports participation and functional independence in children with disabilities; however, its integration within paediatric occupational therapy practice remains inconsistent. This scoping review aimed to map occupational therapists' perspectives on the recommendation, selection, and implementation of AT for children with disabilities and identify barriers and enablers influencing AT use. This scoping review followed Arksey and O'Malley's framework and was reported according to PRISMA-ScR guidelines. Searches were conducted in PubMed, Scopus, Web of Science, and CINAHL. Peer-reviewed qualitative, quantitative, and mixed-methods studies exploring occupational therapists' perspectives on AT use for children (<18&#x2009;years) published up to 31 March 2025 were included. Data were synthesised using inductive thematic analysis. Eighteen studies met the inclusion criteria across high- and low-resource settings. Three overarching themes emerged: (i) systemic and policy influences on AT utilisation, (ii) professional and contextual determinants of occupational therapy decision-making, and (iii) family and child factors shaping AT adoption. Major barriers included funding limitations, restricted access to devices, inadequate professional training, fragmented services, and sociocultural stigma. Key enablers included therapist expertise, interdisciplinary collaboration, opportunities to trial AT, contextual adaptation, and family-centred practice. Occupational therapists' use of AT is shaped by interconnected systemic, professional, contextual, and family-related factors. Strengthening training, interdisciplinary collaboration, culturally responsive practice, and equitable access to AT services may support more effective participation-oriented paediatric occupational therapy practice. Occupational therapists are key decision-makers in paediatric assistive technology provision and require structured training, ongoing professional support, and clear role delineation to optimise AT outcomes.Access to funding, opportunities for device trials, and coordinated interdisciplinary services are critical to reduce delayed provision and abandonment of assistive technology.Family-centred, culturally responsive rehabilitation approaches enhance acceptance, sustained use, and functional participation of children using assistive technology across home, school, and community settings.Strengthening policy frameworks and service delivery systems is essential to promote equitable access to assistive technology, particularly in low-resource and underserved rehabilitation contexts.

Hyperbaric oxygen therapy (HBOT) is effective in managing ischemic encephalopathy of various etiologies, particularly following acute intoxication with specific gases. Considering the limited clinical evidence regarding HBOT for hypoxic encephalopathy induced by occupational exposure to toxic gases, investigating this therapeutic approach is clinically important. We report two cases of occupational poisoning due to inhalation of high-concentration toxic gases, both presenting with loss of consciousness and significant neurological deficits. Case 1 involved biogas inhalation, and case 2 involved hydrogen sulfide exposure. Following HBOT, both patients demonstrated significant neurological recovery compared to their pre-treatment status. These findings indicate that HBOT reduces neurological impairment and is associated with favorable clinical outcomes. Therefore, HBOT should be considered for ischemic encephalopathy secondary to high-risk occupational gas exposure. This approach holds potential clinical significance for preventing severe neurological sequelae in workers at risk and provides clinicians with evidence-based guidance for managing toxic gas-induced neurological injury.

The concept of "dark side occupations" remains ethically and culturally sensitive within occupational therapy practice. While the topic has been explored conceptually, less is known about how therapists across European regions address such occupations in clinical dialogue. This study examined regional differences in the perception of ethically sensitive or socially contested occupations and explored how professionals see the term itself. A cross-sectional survey was conducted among occupational therapy professionals across four European regions: Central and Eastern, Southern, Western, and Northern Europe. The questionnaire combined closed-ended items assessing the frequency with which specific topics (e.g., sexuality, addictions, politically or socially sensitive activities) are addressed in practice, with open-ended questions exploring avoided topics and perceptions of the term "dark side occupations." Quantitative data are presented descriptively with comparison across regions. Qualitative responses were subjected to thematic content analysis. Marked regional differences were identified. Topics such as sexuality, addictions, and other socially sensitive activities were addressed significantly less frequently in Central and Eastern Europe and, to a lesser extent, Southern Europe compared to Western/Northern Europe. In several regions, a pattern of pre-emptive topic avoidance was evident rather than explicit therapeutic refusal. Open-text responses suggested that contextual factors, including cultural norms, institutional climate, and perceived professional boundaries, shape clinical decision-making. Perceptions of the term "dark side occupations" were varied, with some respondents considering it a useful analytical framework and others viewing it as potentially normatively loaded or stigmatizing. The perception of ethically sensitive or socially contested occupations and topics in occupational therapy practice appears to be context-dependent and regionally patterned. Avoidance of certain topics may have implications for client autonomy and therapeutic dialogue. These findings highlight the need for culturally informed ethical reflection and clearer professional guidance in addressing complex socially sensitive or socially contested occupations within European occupational therapy practice.

Arthroscopic shoulder surgery is associated with postoperative pain and loss of function. Percutaneous electrical nerve stimulation (PENS) may serve as an effective adjunct to postoperative rehabilitation. This randomized clinical trial examined whether adding ultrasound-guided PENS to a multimodal rehabilitation program improves pain, disability, pressure pain sensitivity, shoulder range of motion, and muscle strength in individuals with postoperative pain following shoulder arthroscopy. A randomized, parallel-group clinical trial (registry: NCT06331871) was conducted. Seventy patients who had undergone shoulder arthroscopy were randomized to receive manual therapy/exercise alone (n = 35) or manual therapy/exercise/PENS (n = 35). All participants received the multimodal program including manual therapy and exercises four weeks after surgery for a duration of 12 weeks (five sessions/week). Those allocated to the PENS group also received two sessions (once per week) of ultrasound-guided PENS targeting the suprascapular and axillary nerves. Pain intensity (Numeric Pain Rating Scale (NPRS)) and disability (Disabilities of the Arm, Shoulder and Hand (DASH)) were the primary outcomes, whereas function (Shoulder Pain and Disability Index (SPADI)), pressure pain threshold (PPT), isometric strength, and shoulder range of motion (ROM) were secondary outcomes. Pain, PPT, strength, and ROM were assessed before and after treatment, and at 1 and 3 months. Disability and function were assessed at baseline and 3 months after treatment. Patients receiving PENS showed greater improvements in shoulder pain (F2.72, 182.32 = 7.76, p = 0.007, &#x3b7;2p = 0.10), disability (F1, 68 = 5.63, p = 0.020, &#x3b7;2p = 0.08), function (F1, 68 = 4.15, p = 0.046, &#x3b7;2p = 0.02) and PPT over the infraspinatus muscle (F3.20, 217.28 = 2.93, p = 0.032, &#x3b7;2p = 0.04) than those receiving manual therapy/exercise alone. No between-group differences were observed for PPT at the deltoid or tibialis anterior muscles. The PENS group also showed greater improvements in some, but not all, measures of shoulder strength and range of motion; however, the effect sizes were small and the clinical relevance of these differences remains uncertain. Adding ultrasound-guided PENS targeting the suprascapular and axillary nerves to a multimodal physical therapy program resulted in greater improvements in pain, disability, and shoulder-specific function, with limited additional benefits for some measures of strength and range of motion, compared with physical therapy alone, in individuals with postoperative shoulder pain. However, many of the lower-bound estimates of the 95% confidence interval did not surpass the minimal clinically important difference. Therefore, the clinical relevance of the results should be considered with caution.

This study outlines the revision and content validity process for the Domestic and Community Skills Assessment, Third Edition (DACSA-3). The DACSA-3 is an occupational therapy instrumental activities of daily living (IADL) assessment, which can be used to assess a person with a mental health condition. The DACSA-3 was developed by considering past development and research, technology changes, and current occupational therapy theories. Nine content experts (occupational therapists with mental health experience) were involved in a qualitative and quantitative review of the DACSA-3 to establish content validity using the content validity ratio (CVR) and content validity index (CVI), with recommended minimum thresholds of 0.78. The DACSA-3 was reviewed by two content reviewers (professionals with lived mental health experience) to ensure that recovery oriented language was included. The Initial Interview was retained and updated. The Supporting Interview was removed, because it lacked construct validity. The Observation Checklist was renamed to Context List and updated to include environmental and personal factors that may influence task performance. The Objective Assessment subtests were updated and reduced from 17 to 14 subtests. The money handling, personal presentation, and postage handling subtests were removed, because they were no longer relevant or did not fit the occupational category of IADL. The scoring criteria for each subtest were improved by aligning with the rating scale definitions to prevent discrepancies between ratings and clinical judgement. The CVR of DACSA-3 items ranged from 0.78 to 1.00, and the CVI of the DACSA-3 was 0.98. The DACSA-3 is a revised, contemporary occupational therapy assessment of IADL, which has content validity. The CVR and CVI exceeded the minimum recommended thresholds, and thus, the content validity of the DACSA-3 was established. Modifications were made to the DACSA-3 to reduce the administration time and it no longer contains a screening tool. This study describes how the Domestic and Community Skills Assessment, Third Edition (DACSA&#x2010;3) was updated. The DACSA&#x2010;3 is an occupational therapy test. It can be used to measure the living skills of people with a mental health condition. The update considered earlier research, changes in tasks over time, and current occupational therapy theories. Two content reviewers checked the test to ensure current mental health language was used. Nine occupational therapists then reviewed it step by step to confirm that it was a good measurement of living skills. The Initial Interview was kept and updated. The Supporting Interview was removed because it was not considered a good measurement. The Observation Checklist was renamed the Context List and updated. The subtests were reduced from 17 to 14. The money handling, personal presentation, and postage handling subtests were removed. They were no longer relevant or did not fit with other living skills. The scoring was also improved to reduce differences between ratings and therapist judgement. Overall, the DACSA&#x2010;3 is a current test of living skills. It takes less time to complete and no longer includes a screening tool.

Through the teaching of the Canadian Model of Occupational Performance and Engagement (CMOP-E), a number of repeated challenges were witnessed. The purpose was to critically reflect, through dialogue, on potential additions to align with societal evolution. The application of the CMOP-E was discussed with occupational therapy students for over more than 20 years of teaching at both the undergraduate level and the professional master's level in occupational therapy. Three key issues repeatedly emerged and triggered an in-depth reflection. The content of this reflection was discussed with a variety of senior academics holding expertise in the CMOP-E. Arguments supporting the idea that it would be of value to make explicit the concept of "identity" within the spirituality dimension are proposed. The environment should be considered at three levels: micro, meso, and macro levels, and a reflection is presented on the space that should be allowed for "virtual" as another category of environment. Lastly, "relationships" should be explicitly considered as a domain of occupation and not as an affective state or the social environment. Making these three "additions" to the description of the model will help to clarify how the CMOP-E can be used in contemporary practice.

Gender bias remains an issue in sports physiotherapy, influencing women's career progression and participation in scientific settings. To investigate the experiences, perceptions, and trajectories of Brazilian female sports physiotherapists and identify gender-related barriers and facilitators across education, professional practice, and research. A cross-sectional online survey assessed demographics, career paths, and perceptions of gender bias among women sports physiotherapists in Brazil. Quantitative data were analysed using descriptive statistics and logistic regression, and qualitative responses underwent thematic and lexical analyses. A total of 157 women sports physiotherapists (32.4&#xa0;&#xb1;&#xa0;7.5 years) participated. Two-thirds reported hearing during undergraduate studies that sports physiotherapy was not for women. Seventy percent identified being a woman as a barrier, and over 90% perceived unequal opportunities. Sexism was frequent, with 60% reporting harassment, 74% misogyny, and over 60% mansplaining or manterrupting. Although 80% expressed interest in lecturing at conferences, only 60% had done so. Early-career professionals had higher odds of entering the field and receiving faculty encouragement, whereas mid- to late-career professionals were more likely to hold postgraduate degrees and lecture at conferences. Gender-related barriers persist across career stages, while sports experience and mentorship act as facilitators, reinforcing the need for equity-promoting policies.

Epidermal growth factor receptor (EGFR) blockade combined with cytotoxic chemotherapy has substantially improved outcomes in unresectable metastatic colorectal cancer (mCRC), particularly in patients with left-sided RAS wild-type disease [...].

To describe and compare the characteristics of people living with multimorbidity randomized to personalized exercise therapy and self-management support (the MOBILIZE intervention) stratified by low-medium, and high-attendance. Cross-sectional study from the MOBILIZE randomized controlled trial, following a pre-specified statistical analysis plan (https://osf.io/tsmjf/). The intervention was delivered by physiotherapists across five municipalities. 114 Patients with multimorbidity (&#x2265;2 chronic conditions). 24 sessions of exercise therapy and self-management support. We compared the characteristics of the low-medium (<75% of 24 sessions) and high (&#x2265;75%) attendance group using t-test, chi2- or the Mann-Whitney U test, and reasons for non-attendance were identified through participant diary entries. Among 114 randomized patients (mean age: 70.0 years; 39% female; mean chronic conditions: 7, range 2-19), 76% had high attendance. The low-medium attendance group was younger (-6 years, 95% CI -9.44; -1.67, p=0.006), had lower self-efficacy (SEMCD6 -1.5 points, z=-2.5, p=0.01), and reported more depressive symptoms (PHQ-8 +2 points, z=3.1, p<0.001) and higher treatment burden (MTBQ +7.5, z=2.7, p=0.01). In 61% of missed sessions, the reason for non&#x2011;attendance was unknown. Common reasons for non-attendance included illness (18%), vacation (5%), and planned healthcare visits (5%). Patients with a low-medium attendance were younger, had lower self-efficacy, higher depressive symptoms, and higher treatment burden compared to people with a high attendance. Reasons for non-attendance varied widely and should be addressed when prescribing exercise therapy and self-management support for patients with multimorbidity.

Burn wounds are prone to infection, and traditional antibiotics cannot be used locally due to bacterial resistance. As a clinical first-line use of silver ion dressings, their use is often limited due to potential toxic side effects and high costs. To overcome these limitations, a bimetallic nanozyme with multiple antibacterial properties was proposed. CuO nanoflowers were first synthesized via a simple liquid-phase method, and then, Ag ions were doped to synthesize Ag-CuO nanozymes. In&#xa0;vitro/in vivo experiments/RNA sequencing revealed that it not only has a variety of enzyme activities, which can accumulate reactive oxygen species (ROS) for sterilization, but can also cooperate with the starvation-cuproptosis-like death cascade for sterilization. The genes regulating the phosphotransferase system were down-regulated by Ag-CuO nanozymes, which reduced the uptake of carbohydrates needed for energy synthesis by bacteria. The tricarboxylic acid cycle signaling pathway was inhibited, and adenosine triphosphate synthesis was reduced, thus inhibiting its own protection against external stimuli. Moreover, the down-regulation of the lpdA gene, coupled with bacterial starvation, synergistically led to an increase in Cu2+ influx and an increase in Cu+ accumulation, thereby amplifying bacterial cuproptosis-like death and biofilm inhibition. The unique ROS-starvation-cuproptosis-like death sterilization method overcomes the limitation that traditional antibiotics are easily tolerated by bacteria. Importantly, its efficacy was verified in a mouse New Zealand rabbit model, which strongly demonstrated its potential for clinical use in the treatment of drug-resistant bacterial infections, as it has excellent antibacterial activity and the ability to promote angiogenesis compared with those of commercial silver-based dressings with the same silver ion content.

Spinal cord injury (SCI) impacts physical, emotional, and social well-being, contributing to decreased quality of life and increased healthcare burden. Surface electromyography (sEMG), a non-invasive tool for measuring muscle activity, has demonstrated potential as a biomarker for recovery in SCI research, yet remains underutilized in clinical practice. Understanding how physical therapists (PTs) and occupational therapists (OTs) perceive the use of sEMG is necessary for integrating sEMG into post-SCI treatment and advancing personalized rehabilitation. A cross-sectional, qualitative descriptive design was employed. Ten participants (9 PTs and 1 OT) were recruited through convenience sampling. Semi-structured interviews were conducted and analyzed inductively using a thematic analysis approach. Two major themes were identified: 1) Perceived value of the use of electrophysiology and sEMG data in clinical practice. Participants valued sEMG as an adjunct assessment tool for providing objective feedback after incomplete SCI and setting goals during treatment. 2) Barriers and facilitators to implementing sEMG. Key barriers highlighted include the lack of training and standardized protocols. Continued training, resources, and educational support were key facilitators. PTs and OTs perceive sEMG as a valuable tool in SCI rehabilitation, but desire education and standardized protocols to support its clinical integration.

48,XXYY syndrome is a rare sex chromosome aneuploidy (SCA) characterized by neurodevelopmental deficits and medical comorbidities. The limited information available in the literature is almost exclusively limited to postnatally diagnosed cases. This study aims to describe the early medical and developmental features of prenatally identified 48,XXYY infants, with comparisons to 47,XYY, 47,XXY cohorts, and typical populations, as well as previously reported postnatally diagnosed 48,XXYY cases. The eXtraordinarY Babies Study prospectively follows children prenatally identified to be at high risk for SCA with annual medical and neurodevelopmental evaluations. Data presented herein include the prevalence of medical conditions, developmental milestones, developmental and adaptive functioning assessment scores, and therapy utilization in participants confirmed to have 48,XXYY. Comparisons were made between this cohort and the typical population, infants with 47,XYY and 47,XXY also enrolled in the eXtraordinarY Babies Study, and a 2008 cohort of individuals postnatally identified 48,XXYY. Infants with 48,XXYY exhibited a range of early medical features, including high rates of feeding and GI disorders (breastfeeding difficulties, gastroesophageal reflux, and eosinophilic esophagitis), allergic disorders (food allergies and environmental allergies), and hypotonia. Developmental and adaptive functioning scores indicated delays in motor, communication, and social domains, with nearly all infants receiving speech therapy, physical and/or occupational therapy. Comparisons with the 47,XYY and 47,XXY cohorts revealed more medical and developmental challenges in the 48,XXYY group, however there was variability and some overlap with both the general population and sex chromosome trisomy conditions. Additionally, comparison to the 2008 postnatally identified 48,XXYY cohort indicated that while prenatal diagnosis allowed for earlier intervention, developmental outcomes in the first years of life were similar between the two groups. 48,XXYY diagnosed prenatally facilitates early monitoring, anticipatory guidance, and proactive referrals for medical evaluations and intervention, given developmental delays and medical challenges are more common in infancy and early childhood compared to the general population and trisomy SCAs. These findings provide valuable insights for genetic counselors and healthcare providers, emphasizing the spectrum of medical and developmental findings and importance of early and proactive care to support individual outcomes. Prospective study of this prenatally identified cohort will provide important natural history and phenotypic variability in XXYY, as well as identification of predictors of health and developmental outcomes.

Low back pain is defined as pain localized below the costal margin and above the inferior gluteal fold, with or without leg pain. Low back pain affects approximately 619 million people worldwide and is the leading cause of years lived with disability worldwide. Approximately 90% of patients presenting for care with low back pain have nonspecific low back pain, which is defined as low back pain that is not associated with specific spinal disorders (such as lumbar radiculopathy, lumbar spinal stenosis, vertebral fracture, axial spondyloarthritis, infection, or malignancy). Low back pain is classified as acute if the duration is shorter than 6 weeks, subacute if the duration is 6 to 12 weeks, and chronic when the duration is longer than 12 weeks. The age-standardized prevalence of low back pain is higher in females (9330 per 100&#x202f;000) than in males (5520 per 100&#x202f;000). The prevalence of low back pain increases with age, peaking at approximately 85 years. Risk factors for low back pain include obesity, depressive symptoms, occupational exposures (eg, heavy lifting), tobacco use, chronic disease (eg, diabetes), and previous low back pain. Acute nonspecific low back pain is usually self-limited, and approximately 72% of individuals recover by 12 months. Prognosis is less favorable for chronic nonspecific low back pain, but 42% of patients recover within 12 months. Initial management of patients with low back pain of any duration includes reassurance that serious underlying disease is unlikely, discussion about the expected time course of recovery, and the recommendation to remain physically active. Patients should be encouraged to continue their usual activities (including work), avoid prolonged rest, and be advised to self-manage their condition, which consists of symptom-relief strategies (such as heat application) and activity pacing (maintaining or gradually increasing usual activities and work). For patients with acute nonspecific low back pain, first-line therapies include heat application, spinal manipulation, massage, and acupuncture (typically provided by physical therapists, chiropractors, acupuncturists, and massage therapists) as well as nonsteroidal anti-inflammatory drugs (NSAIDs; such as ibuprofen) and skeletal muscle relaxants (such as cyclobenzaprine). For chronic nonspecific low back pain, first-line therapies include exercise of any type, psychological therapies (eg, cognitive behavioral therapy), or combined multidisciplinary approaches (such as pain management programs and integrated exercise and psychological care) along with spinal manipulation, massage, and acupuncture. NSAIDs should be considered as second-line therapy for chronic nonspecific low back pain. Low back pain is a leading cause of disability worldwide. Acute nonspecific low back pain is often self-limited, whereas chronic nonspecific low back pain has a less favorable prognosis. For patients with acute nonspecific low back pain, first-line treatments include selected nonpharmacological therapies and medications (such as NSAIDs and skeletal muscle relaxants). For patients with chronic nonspecific low back pain, first-line treatment consists of exercise, psychological therapies (such as cognitive behavioral therapy), and combined multidisciplinary care.

The prefrontal cortex (PFC) has been extensively investigated in relation to higher-order cognition, emotional regulation, and behavioural control, particularly within clinically oriented studies addressing psychiatric symptoms, self-regulation, and intervention outcomes. Although a growing body of literature has examined prefrontal function assessment and intervention, the thematic organization and structural interconnections within this clinically focused literature have not been sufficiently clarified. Mapping these conceptual relationships may help identify dominant research concentrations and underrepresented areas within the retrieved literature. A total of 1,301 peer-reviewed articles published between January 2014 and December 2024 were retrieved from Web of Science, PubMed, and Embase. After keyword extraction and standardization, the top 52 high-frequency terms were analyzed using NetMiner 4.0. Network indices including density, inclusiveness, and average path length were calculated, together with degree and betweenness centrality. Cohesive subgroup analysis was additionally performed to identify thematic clusters within the keyword network. The keyword network demonstrated a density of 0.408, inclusiveness of 1.0, and an average distance of 1.621, indicating a highly connected structure without isolated nodes. Central hubs included Cognition, Depressive disorders, Randomized controlled trial, Cognitive behavioural therapy, and Psychotherapy, which emerged as the principal structural hubs, suggesting that the retrieved literature was strongly concentrated on standardized cognitive assessment and clinically applied intervention frameworks. Mobile health, E-health intervention, and Chronic illness group also showed substantial structural influence. Cohesive subgroup analysis identified seven differentiated thematic clusters spanning cognitive rehabilitation, emotional regulation, psychotherapy, digital self-management, mindfulness-based executive support, stress resilience, and neurocognitive motivation. The retrieved literature analyzed in this study exhibited a strongly interconnected thematic structure centered on clinically oriented assessment and intervention domains. Because direct neuroimaging and neurophysiological modalities were comparatively less represented in the retrieved dataset, the present findings should be interpreted as a structural mapping of clinically weighted prefrontal function research rather than a comprehensive representation of the entire methodological landscape. Nevertheless, this network-based analysis provides a systematic overview of current thematic concentrations and offers a useful foundation for future comparative and longitudinal investigations. Not applicable.

Community health is affected by transportation access, an underexplored factor in burn outcomes. Therefore, this study aimed to examine the associations of transportation mode with health service utilization and social community integration after burn injury. A multicenter burn longitudinal dataset was analyzed from 2018 to 2024. Self-reported transportation modality was examined primarily six months post-injury. The population was categorized into two groups: driving their own vehicle (DOV) and other modes of transportation (OMT). Outcomes included community integration and four health services (physical/occupational therapy, peer support, psychological services, and burn-related surgeries). Regression analyses examined the association between transportation mode and health services, and community integration, controlling for demographic and clinical factors. Of the 563 participants, 373 (66.3%) reported DOV, 151 (26.8%) riding with someone else, and 31 (5.5%) using public transit. The regression model demonstrated that the DOV group had higher community integration than the OMT group (b = 1.23; 95% CI = 0.74, 1.71; p&#x202f;<&#x202f;0.001). Logistic regression analyses revealed no significant associations between DOV and service utilization, controlling for demographic and clinical variables. DOV was associated with better social integration. Addressing transportation barriers may contribute to improved social integration outcomes after burn injury.

Despite the high prevalence of fatigue after acquired brain injury and the major impact of fatigue on people's lives, evidence-based interventions are scarce. We developed a new personalized blended care intervention, Tied by Tiredness, which was found to be feasible in a pilot study. In this paper, we present the design of a study of patient-related outcomes and the societal costs of the intervention. This study is a multicentre prospective nonrandomized patient preference trial with baseline (T0), posttreatment (T1), 3-month (T2) and 6-month (T3) follow-up data. The participants will be 45 adults who have experienced brain injury (stroke or traumatic brain injury) and are seeking treatment for fatigue symptoms. The participants will choose whether to receive Tied by Tiredness or treatment as usual. The Tied by Tiredness intervention consists of a 6-week blended care treatment, which combines experience sampling methodology (participants answer momentary questions about fatigue and their daily lives sent via a phone application) with personalized face-to-face feedback by a health care professional. Treatment as usual entails occupational therapy sessions once a week for 6-8 weeks. Measures of fatigue and secondary outcomes (mood, cognitive complaints, participation, and quality of life) will be collected via questionnaires at each time point. To investigate the changes in fatigue severity from pre- to postintervention and follow-up, a linear mixed-effects model with fatigue severity score (FSS) as the dependent variable and time point (T0, T1, T2, T3) as a within-subject factor will be used. In addition, a cost analysis will be performed from a societal perspective, including both direct medical costs (e.g., intervention costs) and societal costs (e.g., informal care, productivity losses). Fatigue after brain injury is multifactorial with high individual variability. We hypothesize that the personalized blended care intervention Tied by Tiredness may be an efficient and effective intervention to reduce fatigue and related problems TRIAL REGISTRATION: Clinical trial number: ID: NL-OMON21265; Overview of Medical Research in the Netherlands (OMON). The trial was first registered in the Overview of Medical Research in the Netherlands (ID: NL-OMON21265) on May 31st, 2021, before recruitment started.

Purpose The primary objective of this review was to report the results of trigger finger release (TFR) under real-time ultrasound (US) guidance in a real-world population, including patients with concomitant hand issues and other comorbidities. Method A retrospective review of the corresponding author's case log for 2023 was conducted to identify all patients who underwent an index, middle, ring, or little finger micro-incision TFR from February through September of that year under real-time US guidance (ultrasound TFR (uTFR)). The preoperative demographics collected included triggering severity, comorbidities, age, and sex. The postoperative course included the number and type of postoperative visits required and notation of intraoperative or postoperative complications. Results Overall, 209 TFRs were performed on 116 consecutive patients using uTFR. There were no revision surgeries, nerve injuries, or infections. One digit required an intraoperative conversion to an open TFR (oTFR) with flexor digitorum superficialis (FDS) slip resection for persistent locking. Notably, 114 of the patients (98%) had at least one medical comorbidity or concomitant hand procedure at the time of uTFR. Furthermore, 113 patients (97%) were eligible for a streamlined follow-up process, and 104 (92%) elected to have only a telephone or registered nurse (RN) visit for follow-up after surgery. Seven patients (6%) had a post-procedure steroid injection on the operative digit, and 18 (16%) attended at least one occupational therapy (OT) visit. Conclusion Microincision uTFR appears to be safe for the index, middle, ring, and little fingers regardless of comorbidities. Multiple digits can be released at the same time, even under local anesthesia. The technique allows for a streamlined process for most patients and for the practice.