Evidence-based Rehabilitation Research Articles

Applying the Risk–Need–Responsivity (RNR) Model to Transgender Women in the Criminal Justice System

Transgender women are at least twice as likely as cisgender people to be incarcerated in their lifetimes, and, in custody, they experience harassment, abuse, and denial of affirming healthcare. Despite several legal and policy changes intended to improve these conditions, there has been little discussion about the need for evidence-based rehabilitation with the population. This article examines the use of the risk–need–responsivity (RNR) model with transgender women in the criminal justice system and discusses how it can be beneficial for tailoring rehabilitation services to address the unique needs of the population, thereby improving opportunities for successful community reintegration.

The effect of unaffected side resistance training on upper limb function reconstruction and prevention of sarcopenia in stroke patients: a randomized controlled trial

Aging has made stroke a top killer and disabler, with post-stroke sarcopenia worsening disability and quality of life. While resistance training benefits the elderly, its impact on stroke patients is understudied. This study evaluates the potential of a 4-week unilateral resistance training (URT) program to prevent sarcopenia in stroke patients. It assesses the impact of URT on hand grip strength (HG), muscle thickness (MT), upper limb functionality, and the psychological status of the patients. The study aims to quantitatively analyze these indicators to inform evidence-based post-stroke rehabilitation practices. This study employed a randomized controlled trial (RCT) involving 77 eligible stroke survivors, equally allocated into a control group (n = 39) and an intervention group (n = 38). The control group received standard rehabilitation, while the intervention group additionally underwent a 4-week URT program. The primary outcomes were unaffected side HG and MT, measuring muscle mass and function. Secondary outcomes included the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) for upper limb functionality and the Hamilton Depression Rating Scale (HAMD) for psychological well-being changes. Statistical analysis showed significant differences (p < 0. 05) in all measured parameters between the intervention and control groups after the 4-week period. Intra-group comparisons also indicated substantial improvements (p < 0. 05). Unilateral resistance training significantly mitigates muscle atrophy in stroke patients, preventing sarcopenia and enhancing upper limb function. It also ameliorates depressive symptoms, improving rehabilitation outcomes and overall quality of life.

Guideline for rehabilitation assessment and treatment of adolescent idiopathic scoliosis (2024 edition)

Scoliosis is a complex three-dimensional deformity of the spine that affects the growth of the spine in adolescent, leading to a heavy burden on families and society. According to the guidelines for the treatment of scoliosis, most adolescent idiopathic scoliosis (AIS) requires rehabilitative intervention. So far there has been a lack of scientific, evidence-based, and standardized rehabilitation assessment and treatment for AIS in China. Therefore, in order to promote the standardization of rehabilitation assessment and treatment for AIS, Chinese Society of Physical Medicine and Rehabilitation organized the domestic experts in multiple disciplines such as rehabilitation medicine, orthopedics, pediatric surgery, radiology, evidence-based medicine, etc., who has conformed to the principles of scientificity, safety, efficacy and advancement to propose the 19 recommendations of 8 categories using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and Reporting Items for Practice Guidelines in Healthcare (RIGHT). Through the steps of literature search, evaluation, and establishment of direction and intensity of recommendation opinions, 19 recommendations were formed, involving AIS screening, assessment and treatment.

Rehabilitation Outcomes in Diabetic Peripheral Neuropathy: An Evidence-Based Physiotherapy Approach for Functional Improvement – Case

Background: Diabetic Peripheral Neuropathy (DPN) is a prevalent and debilitating complication of diabetes mellitus (DM), affecting up to 70% of individuals with diabetes. DPN impairs motor and sensory functions, leading to pain, muscle weakness, and functional limitations that severely affect the quality of life. Effective rehabilitation strategies, including physiotherapy, are essential for improving these functional outcomes. Methods: This study assessed the effectiveness of a 12-week evidence-based physiotherapy rehabilitation program designed to improve the functional status of a 48-year-old female patient with DPN. The intervention included Transcutaneous Electrical Nerve Stimulation (TENS), range of motion (ROM) exercises, strengthening exercises, balance training, and gait improvement, administered over 45 physiotherapy sessions. Progress was measured using the Visual Analog Scale (VAS), Berg Balance Scale (BBS), and the Timed Up and Go (TUG) test. Results: Following the 12-week intervention, the patient reported significant improvements in pain reduction, with VAS scores decreasing from 9/10 to 4/10. Sensory function improved from impaired to intact, as assessed through light and deep touch sensation tests. Balance scores on the BBS increased from 22 to 48, indicating substantial gains in stability. Gait speed, measured using the TUG test, improved from 35 seconds to 13 seconds. Additionally, there were marked improvements in ROM, muscle strength, and overall functional abilities. Conclusion: The study demonstrates the effectiveness of a structured physiotherapy rehabilitation program in reducing neuropathic pain and improving functional outcomes in patients with DPN. TENS, combined with exercise-based interventions, significantly enhanced pain management, balance, and gait. Long-term monitoring and continued physiotherapy may further optimize the patient’s functional status and quality of life.

Pamela Serón: bridging evidence-based rehabilitation and community-driven research

Pamela Serón: bridging evidence-based rehabilitation and community-driven research

Evidence-Based Medical Management and Physiotherapy Rehabilitation in Pediatric Traumatic Brain Injury: A Narrative Review.

Children between the ages of one and 18 are at a heightened risk of death and impairment due to traumatic brain injury (TBI). TBI can be deadly and is usually categorized as mild, moderate, or severe according to the Glasgow Coma Scale (GCS). For individuals with a TBI and an abnormal GCS, the preferred modality is non-contrast CT of the head. This review focuses on the medical treatment and rehabilitation of children with TBI and their outcomes. This was searched in databases such as PubMed, Google Scholar, and EMBASE. The literature search criteria included "traumatic brain injury AND physiotherapy rehabilitation OR medical treatment," with additional filters applied, including full text, both male and female, ages below 18 years, and publications from 2012 to 2024. This study conducted research on the treatment and rehabilitation of children with TBI. Ten randomized clinical trials, non-randomized trials, and longitudinal cohort study randomized trials met the inclusion criteria, which include hyperbaric oxygen therapy, melatonin, nabiximols, psycho-educational intervention, online therapy, the virtual reality rehabilitation program, and conventional occupational therapy. The results show significant improvement in forearm supination, performance in daily living, quality of life, reduced anger, improved school functioning, improvement in TBI conditions, reduced hospital stay, activity facilitating recovery, and reduced prolonged symptoms. This review has addressed the effectiveness of various medical management and rehabilitation strategies, which are important in TBI and aim to mitigate post-traumatic/concussion impact and improve quality of life. Articles regarding children's TBI rehabilitation are comparatively few. One possible solution to this issue would be to encourage further rehabilitation intervention trials.

SMART-goal domains and goal attainment in an individualized, goal-oriented intervention for children with acquired brain injury and their families

ABSTRACT Pediatric acquired brain injury (pABI) may lead to long-lasting challenges in need of rehabilitation-efforts years after the insult. The Child in Context Intervention (CICI) is an individualized, goal-oriented intervention targeting children with pABI, their families and schools in the chronic phase. This paper describes the goals that patients and families in the CICI intervention group identified to work on. The 29 participating families worked on 90 goals that were predominantly coded to the domains of Body functioning (46.6%) and Activities and participation (40.5%), according to the International Classification of functioning, Disability and Health (ICF). The most frequently used codes focused on fatigue and emotional symptoms, in addition to codes in the AP domain describing the need for increased independence in everyday life at school, at home, and socially. Goal attainment in the intervention group was high, with positive progress on 94.4% of the goals and positive goal achievement for all included families. The high level of goal attainment provides promising evidence of the CICI programme’s efficacy, and highlights the need to further develop evidence-based rehabilitation programs for children with pABI in the chronic stage of recovery. Trial registration ClinicalTrials.gov identifier: NCT04798859.

Evidence-Based Infant Assessment for Cerebral Palsy: Diagnosis Timelines and Intervention Access in a Newborn Follow-up Setting.

Evidence-based assessment pathways inform early detection of cerebral palsy and access to intervention. This study investigated the relationships between early evidence-based assessments, diagnosis timeline, and rehabilitation intervention access in a population of children with cerebral palsy who were seen between 2010 and 2022 at the University of Wisconsin Waisman Center Newborn Follow Up Clinic. Cerebral palsy-specific assessments were increasingly integrated after the publication of early detection guidelines by Novak et al. in 2017. Age at cerebral palsy first mention (high risk for cerebral palsy) decreased over time, although age at diagnosis remained similar. Infants who received multiple evidence-based assessments were diagnosed at a younger age. Ninety-nine percent of children were referred to rehabilitation therapies before diagnosis. Infant age at referral to outpatient therapies decreased over time. This study provides novel clinical data on diagnosis timelines and identifies remaining gaps related to implementation feasibility toward improved early diagnosis and intervention access.

158 Evaluation of a multi-modal rehabilitation programme for people affected by cancer: the Active Together service

Abstract Purpose Rehabilitation (including prehabilitation) can help cancer patients prepare for and recover well from treatment, improve physical and psychological outcomes, and reduce demand on healthcare resources. Project description Active Together is a novel evidence-based multi-modal rehabilitation service for patients with cancer before, during and after their treatment. It was developed collaboratively by Sheffield Hallam University’s Advanced Wellbeing Research Centre (AWRC) and Sheffield Teaching Hospitals NHS Trust and funded by Yorkshire Cancer Research charity. The service is personalised to individual needs and includes exercise, nutrition, and psychological support. The service is delivered by a clinical team combining physiotherapists, exercise specialists, dietitians, and clinical psychologists at the AWRC and two community health and exercise facilities, with plans to extend to more sites as the service expands. Since launching in 2022, over 600 patients with either lung, colorectal, or upper gastrointestinal cancer have received support from the Active Together service. The evaluation of the service examines physical and psychological outcomes, alongside healthcare resource use. Service uptake and attrition rates will be examined by demographics such as age, gender, and ethnicity. The evaluation is due be completed in August 2024; therefore, the results will be available for this presentation. Conclusions The evaluation of this service will assess the feasibility and effectiveness of the Active Together Service in improving the lives of cancer patients, and addressing the health inequalities and barriers which may prevent someone from accessing the Active Together service. If the evaluation produces positive outcomes, it will support the case for embedding multimodal rehabilitation services within routine cancer care. Funding The Active Together service is funded by Yorkshire Cancer Research.

Evidence-based early rehabilitation for children with cerebral palsy: co-development of a multifaceted knowledge translation strategy for rehabilitation professionals.

Cerebral palsy (CP) is the most common childhood physical disability. Early and evidence-based rehabilitation is essential for improving functional outcomes in children with CP. However, rehabilitation professionals face barriers to adopting evidence-based practices (EBP)s. The objective of this project is to develop a knowledge translation (KT) strategy to support CP-EBP among pediatric rehabilitation professionals. We follow an integrated KT approach by collaborating with clinician- and patient-partners. Partners engaged in co-design through team meetings and content review via email. The KT strategy comprises two components: (1) An electronic (e)-KT toolkit was created from summarized evidence extracted from randomized clinical trials on early rehabilitation for children with CP, and (2) a multifaceted online KT training program developed with guidance from a scoping review exploring effective KT strategies. The e-KT toolkit summarizes twenty-two early interventions for children with or at risk for CP aged 0-5 years. Each module features an introduction, resources, parent/family section, and clinician information, including outcomes, intervention effectiveness, and evidence level. The KT training program includes three 10-15 min video-based training modules, text summaries, quizzes, and case studies. Site champions, identified as qualified rehabilitation professionals, were onboarded to support the site implementation of the training program. A champion-training booklet and 1-hour session were designed to equip them with the necessary knowledge/resources. The tailored, multifaceted, and co-designed KT strategy aims to be implemented in pediatric rehabilitation sites to support professional's uptake of CP-EBPs. Lessons learned from its development, including the co-development process and multifaceted nature, hold potential for broader applications in rehabilitation.

Acute Achilles tendon ruptures between 2002–2021: sustained increased incidence, surgical decline and prolonged delay to surgery—a nationwide study of 53 688 ruptures in Sweden

IntroductionGiven the lack of consensus on optimal treatment strategies for acute Achilles tendon rupture (ATR), understanding temporal trends, treatment choice and demographic characteristics is important. Previous research suggests increasing incidence...

“What I thought was the dream job was a little different than I had expected”: A qualitative study exploring the turnover of IPS employment specialists

BACKGROUND: Individual Placement and Support (IPS) is an evidence-based vocational rehabilitation program that helps people with severe mental problems to obtain and maintain paid jobs. Turnover of IPS employment specialists is a scarcely studied subject that can undermine the effectiveness and implementation of the intervention. OBJECTIVE: This study aimed to explore and describe the experiential factors and processes that shape IPS employment specialists’ decisions to quit. METHODS: Braun and Clarke thematic analysis was used to analyze interviews of former IPS employment specialists, who worked during the early implementation phase in Northern Norway. RESULTS: A number of negative and positive experiential factors and processes were found to shape IPS employment specialists’ decisions to quit their jobs. A single theme captured our findings ‘The decision to quit for IPS employment specialists is a gradual process consisting of draining factors outweighing nourishing factors’. CONCLUSION: To retain IPS employment specialists in the early implementation phase, it is not enough to rely on hiring well-fitting individuals. Instead, prospectively developing interorganizational contexts, timely identifying and addressing work environment problems, while nurturing the strengths of individual workers can be helpful in decreasing turnover rates of IPS employment specialists.

Rehabilitation of brachial plexus injury in contact sport: Where are the data that underpin clinical management? A scoping review.

Although a common injury there is a lack of published primary data to inform clinical management of sports related brachial plexus injuries. A systematic search was completed in Medline, CINAHL, PubMed, SPORTDiscus and Web of Science databases and Google Scholar from inception to August 2023 according to the PRISMA-ScR guidelines. Methodological quality assessment of included articles was with the Joanna Briggs Institute tool. Studies providing primary data as to the rehabilitative management of diagnosed or suspected brachial plexus injuries sustained when playing contact sports were included. Sixty-five studies were identified and screened, of which, 8 case reports were included, incorporating 10 participants with a mean age of 19.8 (±4.09) years. There was wide heterogeneity in injury severity, injury reporting, physical examination and imaging approaches documented. 9 of 10 participants returned to competitive sports, though follow-up periods also varied widely. Whilst return to play criteria varied between studies, the most consistent indicator was pain-free shoulder range of motion and strength. There is a distinct lack of data available to inform evidence-based rehabilitation management of sports related brachial plexus injury. Only 8 individual case reports contain published data reporting on 10 athletes. Further reporting is critical to inform clinical management.

Evaluating the Effectiveness of Geriatric-Specific Cancer Rehabilitation Programs on Patient Health Outcomes.

This study evaluated a specialized rehabilitation program's impact on senior cancer patients' quality of life. one hundred and thirty patients aged ≥65 years with various cancer types undergoing/recovering from treatment were enrolled in oncology clinics in Al-Ahsa, Saudi Arabia. The intervention arm (n=65) participated in a tailored geriatric cancer rehabilitation program. The control group (n=65) received standard oncology care. The Functional Assessment of Cancer Therapy-General (FACT-G) tool assessed the quality of life across physical, social, emotional, and functional domains. T-tests and multivariate regression analyses compared outcomes. Total FACT-G scores showed a significantly higher quality of life for the geriatric cancer rehabilitation group versus standard care. Rehabilitation patients also demonstrated meaningful improvements across physical, social, and functional subscales. Rehabilitation involvement was the most predictive factor for optimized outcomes. Specialized geriatric cancer rehabilitation meaningfully improved several quality of life domains in older patients over standard care. Despite persistent barriers, rehabilitation programming optimized older cancer patients' physical and psychosocial health. Oncology and geriatrics must collaborate to ensure evidence-based rehabilitation access meets older cohorts' unique needs.

“Behind bars: Understanding prisoner perception of penitentiary rehabilitation in Kazakhstan”

This study focuses on identifying factors that, from the perspective of prisoners, contribute to positive perceptions of rehabilitation (correction) in prison. A survey was conducted of 645 soon-to-be-released inmates (530 males and 115 females) in five institutions, with questions covering demographics, incarceration details, access to social services, and personal values. The research revealed that male inmates tended to hold more positive views on penitentiary rehabilitation than female inmates. However, it was observed that the rigidity of the prison regime and the existence of chronic illnesses among inmates negatively influenced these positive perceptions towards rehabilitation. Furthermore, the implementation of diverse rehabilitation-focused initiatives by non-governmental organisations (NGOs), coupled with an awareness of rights and responsibilities and the presence of strong family values, has been linked to fostering positive perceptions of rehabilitation. These findings highlight the critical need for enhanced cooperation between non-governmental organisations and prison facilities, as well as the introduction of social work practices within Kazakhstan's prison system. Policymakers should consider these factors when designing evidence-based rehabilitation strategies, emphasising the utilization of social work technologies.

Injury Rehabilitation in Badminton: An Evidence-based Approach to Player Well-being- A Systematic Review

Badminton, as a sport that demands speed, accuracy, and agility, often causes injuries to players. These injuries can reduce their quality of life and athletic careers. Therefore, effective and evidence-based injury rehabilitation is crucial for recovery and prevention of re-injury. This study aims to systematise the current evidence regarding injury rehabilitation methods in badminton and evaluate their effectiveness in supporting player well-being. This systematic review was conducted in accordance with PRISMA guidelines; this study screened and analysed studies from PubMed, Scopus, and Web of Science databases. Inclusion criteria included studies that evaluated injury rehabilitation programmes specifically for badminton players, with outcome measures of functional recovery, pain reduction, and prevention of re-injury. Quality assessment was conducted using the CASP (Critical Appraisal Skills Programme) tool, and data were extracted for thematic analysis. The results showed that a combination of physical therapy, strengthening exercises, and manual intervention techniques such as joint mobilisation and manipulation provided the most effective outcomes in injury rehabilitation. There is strong evidence supporting the use of proprioceptive training to prevent re-injury. Factors such as player age, initial injury severity, and adherence to the rehabilitation programme were shown to influence recovery success. This study concludes that the approach to injury rehabilitation in badminton should be multidisciplinary, integrating various physiotherapy techniques for optimal outcomes. The findings emphasise the importance of a tailored and evidence-based rehabilitation programme in supporting athletes' recovery and preventing possible future injuries. This study also suggests the need for further research to develop specific and standardised rehabilitation guidelines for badminton players.

The impact of reminiscent music therapy and robot-assisted rehabilitation on older stroke patients: a protocol for a randomized controlled trial.

Stroke is the main disease that causes the burden of neurological disease, leading to upper limb dysfunction and affecting their self-care abilities. Robot-assisted rehabilitation therapy has been gradually used in the rehabilitation of upper limb function after stroke. However, it would be beneficial to explore auxiliary interventions such as reminiscent music therapy, a combination of music and reminiscent, to relieve negative emotions and post-stroke fatigue and improve rehabilitation outcomes. This protocol aims to evaluate the effectiveness of reminiscent music therapy combined with robot-assisted rehabilitation in older stroke patients. This trial is a single-blind, three-arm randomized controlled trial. Older stroke patients with upper limb dysfunction will be recruited. Participants will be randomly assigned to receive usual rehabilitation treatment and care, usual rehabilitation treatment and care plus robot-assisted rehabilitation and reminiscent music therapy, or usual rehabilitation treatment and care plus robot-assisted rehabilitation. Robot-assisted rehabilitation will be conducted by rehabilitation doctors five times per week for 3 weeks. In experimental group 1, a reminiscent song list will be played for patients. The primary outcome is activities of daily living. All outcomes will be evaluated at baseline and in the week immediately post-intervention. We are conducting the first randomized controlled trial on the effects of reminiscent music therapy combined with robot-assisted rehabilitation in older stroke patients. It is expected that this study, if proven effective in improving the activities of daily living in older stroke patients with upper limb dysfunction, will provide evidence-based rehabilitation strategies for medical staff.Clinical Trial Registration: ChiCTR2200063738.

Current and Future Challenges for Rehabilitation for Inflammatory Arthritis.

This narrative review discusses the importance of rehabilitation in rheumatic and musculoskeletal diseases (RMDs), ultimately aiming to reduce their impact on individuals and society. It specifically emphasizes the need for rehabilitation in inflammatory arthritis (IA), particularly in cases where medical management is insufficient. It acknowledges that the complexity of rehabilitation demands a flexible approach. Thereby, it touches on the various models of rehabilitation, which may include multidisciplinary team care, extended practice models, shared care, remote care, and work rehabilitation. It discusses the challenges in research, practice, and policy implementation. In research, the need for innovative research designs is highlighted, whereas regarding clinical practice the importance of early detection of disability and patient engagement is underlined, as well as the role of telehealth and AI in reshaping the rehabilitation landscape. Financial barriers and work force shortages are identified as challenges that hinder the effective delivery of rehabilitative care. On the policy level, this paper suggests that the allocation of healthcare resources often prioritizes acute conditions over chronic diseases, leading to disparities in care. This paper concludes by emphasizing the critical role of evidence-based rehabilitation in improving the quality of life for people with RMDs, in particular for those with IA, and promoting their healthy aging. It also calls for tailored rehabilitation models and the early identification of persons with rehabilitation needs as future challenges in this field.

Coherent activity within and between hemispheres: cortico-cortical connectivity revealed by rTMS of the right posterior parietal cortex.

Low frequency (1 Hz) repetitive transcranial stimulation (rTMS) applied over right posterior parietal cortex (rPPC) has been shown to reduce cortical excitability both of the stimulated area and of the interconnected contralateral homologous areas. In the present study, we investigated the whole pattern of intra- and inter-hemispheric cortico-cortical connectivity changes induced by rTMS over rPPC. To do so, 14 healthy participants underwent resting state EEG recording before and after 30 min of rTMS at 1 Hz or sham stimulation over the rPPC (electrode position P6). Real stimulation was applied at 90% of motor threshold. Coherence values were computed on the electrodes nearby the stimulated site (i.e., P4, P8, and CP6) considering all possible inter- and intra-hemispheric combinations for the following frequency bands: delta (0.5-4 Hz), theta (4-8 Hz), alpha (8-12Hz), low beta (12-20 Hz), high beta (20-30 Hz), and gamma (30-50 Hz). Results revealed a significant increase in coherence in delta, theta, alpha and beta frequency bands between rPPC and the contralateral homologous sites. Moreover, an increase in coherence in theta, alpha, beta and gamma frequency bands was found between rPPC and right frontal sites, reflecting the activation of the fronto-parietal network within the right hemisphere. Summarizing, subthreshold rTMS over rPPC revealed cortico-cortical inter- and intra-hemispheric connectivity as measured by the increase in coherence among these areas. Moreover, the present results further confirm previous evidence indicating that the increase of coherence values is related to intra- and inter-hemispheric inhibitory effects of rTMS. These results can have implications for devising evidence-based rehabilitation protocols after stroke.

Effect of Sit-To-Stand Training versus Manual Strengthening Exercises on Mobility and Function in Children with Cerebral Palsy: A Randomized Controlled Trial

Background: Cerebral palsy poses significant challenges to mobility and function in affected children. This study addresses the need for evidence-based rehabilitation interventions by comparing the impact of sit-to-stand training and manual strengthening exercises. Objective: To evaluate and compare the effectiveness of sit-to-stand training and manual strengthening exercises in improving mobility and function in children with cerebral palsy. Method: A randomized controlled trial involving 44 participants (22 in each group) was conducted. Baseline characteristics were assessed, and interventions were implemented over a 12-week period. Regular assessments tracked changes, employing statistical analyses to compare outcomes between the two groups. Results: Both interventions led to positive changes, with a statistically significant superiority favoring the Sit-to-Stand Group at the 12-week mark. Baseline comparability was established, reinforcing the credibility of the findings. Conclusion: Sit-to-stand training, emphasizing weight-bearing activities, demonstrated notable efficacy in enhancing mobility and function. The study provides valuable insights for clinicians, guiding evidence-based practices in pediatric rehabilitation.