BACKGROUND AND PURPOSE:Little is known about how pain influences physical function in people with mild Parkinson disease (PwPD). The purpose of this study was to investigate the association between physical function and pain presence, location, and intensity in PwPD who were evaluated in an early physical therapy program. METHODS:Retrospective cross-sectional analysis of electronic medical records from patients with PD evaluated at a single center (2016-2023). Pain presence, location, and intensity (0-10 scale) were recorded at the initial physical therapy evaluation. Functional outcomes included 5-time sit-to-stand, 10-meter walk test, 6-minute walk test, timed up and go, mini-BESTest, and Functional Gait Assessment. Multivariable linear and proportional-odds regression models assessed associations between pain (presence and intensity by location) and function, adjusting for age and sex, with significance set at P < 0.05. RESULTS:Ninety-eight (28%) of the 355 patients with PD reported pain. The presence of pain was associated with worse performance on the 10-meter walk test, 6-minute walk test, and 5-time sit-to-stand test. Those with lower extremity pain had worse gait performance as pain intensity increased. There were no associations between pain intensity and functional performance for those with axial or upper extremity pain. DISCUSSION AND CONCLUSIONS:Even in individuals with early PD, pain was associated with worse gait, endurance, and sit-to-stand performance. Surprisingly, increasing axial pain intensity was not associated with poorer gait performance, but increasing lower extremity pain was. There are opportunities for future studies on integrated pain assessment and management within neurologic Parkinson's care.
Little is known about the delivery of physical therapy services to promote physical activity (PA) for adults with neurologic conditions. This systematic review aimed to: (1) identify the roles of physical therapists (PTs) in the delivery of PA interventions, (2) describe PA intervention types, and (3) explore the efficacy of physical therapy PA interventions. This systematic review included randomized controlled trials of interventions including physical therapy, PA or exercise, and PA health promotion in adults with neurologic conditions. Database searches included: PubMed MEDLINE, Embase, CINAHL, PsycINFO, and CENTRAL. Meta-analyses were performed for accelerometry-based and self-report measures of PA; meta-regressions explored moderators. Sixty articles met the inclusion criteria, representing 54 unique trials with 15,874 participants. Most articles had a moderate quality of reporting (85%) and a high risk of bias (RoB) (90%). PA interventions led to small, but significant effects on direct measures of PA (effect size [ES] = 0.18, CI 95% , 0.01, 0.35). Small-moderate effects were present when articles with high RoB were excluded (n = 6, ES = 0.36, CI 95% , 0.05, 0.67). Meta-regressions suggested that interventions including both PA and behavior change techniques were more positive than either intervention alone (β = 0.43, CI 95% , 0.23, 0.62). PTs used direct and supervisory roles to deliver effective PA interventions, particularly using interventions combining PA and behavior change techniques. However, heterogeneity of PA measures limits the interpretation of the meta-analyses. Further research should develop consensus on feasible direct measures of PA outcome measures to use in research and clinical practice for adult neurologic populations. for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A562).
BACKGROUND AND PURPOSE:Previous studies suggest targeting higher heart rates (HRs) during locomotor training improves locomotor outcomes (ie, walking speed and distances) in individuals poststroke. However, those who walk slower or are prescribed β-adrenergic antagonists (β-blockers) may not achieve targeted HRs. The purpose of this study was to evaluate the contributions of these patient-related variables on the ability to achieve targeted HRs during graded exercise testing (GXT) or locomotor training, and their effects on locomotor outcomes. METHODS:This secondary analysis of a randomized trial enrolled 90 individuals >6 months poststroke assigned to either high-intensity training targeting >70% HR reserve (HRR) or low-intensity training (<40% HRR). Associations between baseline walking speeds and distances or β-blocker use versus HRRs during GXTs and training were identified. Subsequent analysis focused on whether training HRs or ratings of perceived exertion (RPEs) were related to changes in walking speeds/distances. RESULTS:Achieving higher HRRs during GXTs was related to faster peak treadmill speeds (r = 0.60, P < 0.01) and β-blockers use (r = -0.23, P < 0.05). However, training HRRs were unrelated to initial locomotor outcomes, with depressed HRRs in those using β-blockers. Only 40% of participants averaged >70% HRRs during high-intensity training. Regression analysis suggested training HRRs were related to walking speeds/distances only in those without β-blockers, while RPEs were correlated regardless of β-blocker use. Analysis of changes in walking speeds/distances indicates no differences in those able or unable to achieve targeted HRRs. DISCUSSION AND CONCLUSION:Achieving targeted HRRs was not a primary determinant of locomotor outcomes, although attempts to achieve higher intensities and use of RPEs may be helpful.
Background and Purpose: Reduction in ambulation levels has been described as a clinical “red flag” that represents the emergence of disability in individuals with Parkinson disease (PD). Multiday ambulatory activity measures may capture disability not detected by standard clinical assessments. However, the influence of disease severity and nonmotor symptoms on ambulatory activity remains unclear. This study aimed to examine the association between daily ambulatory activity and motor disease severity, assessed in both medication states, and to identify which non-motor symptoms were associated with daily step accumulation in individuals with mild to moderate PD. Methods: Mean daily steps were calculated over 7 days in 198 participants with PD. Motor and nonmotor symptoms were characterized using Movement Disorders Society—Unified Parkinson Disease Rating Scale (MDS-UPDRS) Part I, III, and IV. Descriptive statistics were calculated at baseline to characterize participant demographics and clinical characteristics. Linear regressions modeled the association between motor/nonmotor signs/symptoms and ambulatory activity, adjusting for age, race, and body mass index. Results: Median daily step count was 5180 (interquartile range: 3521-7199). Standardized off-medication MDS-UPDRS III scores were significantly associated with fewer mean daily steps, while on-medication scores were not, though the magnitude of this association was modest. Among nonmotor symptoms, a self-reported complaint of lightheadedness upon standing was associated with approximately 2000 fewer mean daily steps. Conclusion: A self-report of lightheadedness upon standing showed a clinically meaningful association with reduced ambulatory activity, while motor severity, even assessed in the standardized off-medication state, showed only a modest association. These findings highlight the value of nonmotor symptom assessment, particularly cardiovascular autonomic screening, in understanding real-world disability in PD.
BACKGROUND AND PURPOSE:Nearly 50% of individuals with spinal cord injury (SCI) report no regular physical activity (PA). We developed a novel group tele-exercise program for individuals with SCI to address barriers to exercise and influence individual determinants of PA behavior. The purpose was to compare outcomes of exercisers versus non-exercisers based on self-reported PA at baseline following participation in an 8-week program, Tele-Exercise to promote Empowered Movement in individuals with SCI (TEEMS). METHODS:Individuals with chronic SCI (n = 51, 24 non-exercisers) participated. Primary outcomes (Exercise Self-Efficacy Scale for SCI, Multidimensional Outcome Expectations for Exercise, Leisure Time PA Questionnaire for SCI, Subjective Quality of Life) and secondary outcomes (sleep, pain interference, domains of SCI Quality of Life) were assessed pre-, post-, and 8 weeks following program completion (retention). RESULTS:Pre-program non-exercisers reported lower exercise expectations (P = 0.02), weekly minutes of moderate- to high-intensity PA (P < 0.001), total weekly PA (P < 0.001), and self-esteem (P = 0.01) compared with exercisers. Non-exercisers improved in exercise self-efficacy (P = 0.02) and increased moderate- to high-intensity PA (P = 0.01), eliminating the group difference. Non-exercisers demonstrated large effects for greater participation in social roles (d = 0.92), satisfaction with social roles (d = 1.0), and self-esteem (d = 0.92) post-program. Self-evaluative expectations of exercise improved in non-exercisers and exercisers (P < 0.001) with no difference between groups. Changes were maintained at retention. DISCUSSION AND CONCLUSIONS:For individuals with SCI, especially non-exercisers, participation in Tele-Exercise to promote Empowered Movement in individuals with SCI positively impacted personal determinants of PA behavior, along with improved self-esteem and social participation. Improved exercise self-efficacy, influenced by exercise knowledge gained during program participation and increased expectations of internal exercise outcomes, was found.
BACKGROUND AND PURPOSE:Mal de débarquement syndrome (MdDS) is a rare disorder characterized by persistent oscillatory sensations following exposure to prolonged passive motion. Inadequate readaptation of the sensory balance systems may contribute to MdDS symptoms. Sensory adaptation exercises modify sensory input to improve balance and reduce symptoms; however, research on this intervention in MdDS is limited. The purpose of this case series was to describe a sensory adaptation program for individuals with MdDS and report changes in perceived severity of oscillatory motion, balance, and patient-reported function. Feasibility was also examined retrospectively. CASE DESCRIPTION:Ten participants (mean age = 64.4 years [standard deviation: 11.7]; 8 women) with MdDS completed the study. Outcomes assessed at baseline and post-intervention included: perceived severity of oscillatory motion (Visual Analog Scale and Numeric Rating Scale [NRS]); balance (Modified Clinical Test for Sensory Interaction on Balance and Functional Gait Assessment); patient-reported function (Patient Specific Functional Scale 2.0 [PSFS 2.0]); and feasibility (retention, adherence, safety, and acceptability). The PSFS 2.0 and NRS were repeated at 3-month post-intervention. INTERVENTION:Participants completed 9 intervention sessions over 3 weeks. Interventions included education, sensory adaptation, and functional mobility. OUTCOMES:All participants completed the study, no adverse events were reported, and clinically meaningful improvements on the Visual Analog Scale, NRS, Functional Gait Assessment, and PSFS 2.0 were observed. Seven of 10 participants sustained improvement on the PSFS 2.0, and 6 of 10 sustained improvement on NRS at 3 months. DISCUSSION:The sensory adaptation program was feasible, and improvements in perceived oscillatory motion, dynamic gait, and patient-reported function were observed. Future efficacy studies are warranted.
BACKGROUND AND PURPOSE:To assess the efficacy of robot-assisted gait training (RAGT) in individuals with spinal cord injury, with a focus on motor function, quality of life (QoL), activities of daily living (ADL), cardiopulmonary function, psychological function, and bowel function. METHODS:Seven databases were searched from inception to March 26, 2025. The risk of bias and evidence certainty (The Grading of Recommendations Assessment, Development and Evaluation) were assessed. Effect sizes were reported as mean differences (MDs) or standardized mean differences (SMDs). Subgroup analyses were performed based on injury severity (The American Spinal Injury Association), exoskeleton type, intervention duration, and duration of injury (DOI). RESULTS:In total, 37 studies met eligibility criteria, with 30 included in the meta-analysis. The results demonstrated that RAGT significantly improved walking ability (SMD, 0.58; 95 % confidence interval [CI], 0.28-0.87; moderate certainty), muscle strength (MD, 1.81; 95% CI, 0.48-3.14; moderate certainty), QoL (SMD, 0.43; 95% CI, 0.02-0.85; low certainty), and ADL (SMD, 0.28; 95% CI, 0.11-0.45; moderate certainty) compared with control interventions. However, control interventions were superior in reducing muscle tone (MD, 0.23; 95% CI, 0.01-0.46; low certainty). No significant differences were observed in balance, psychological function, or cardiopulmonary function. Subgroup analysis revealed that both intervention duration and DOI moderated effects. DISCUSSION AND CONCLUSIONS:RAGT may effectively enhance walking ability, muscle strength, QoL, and ADL for spinal cord injury, while its benefits may be influenced by intervention duration and DOI. RAGT suggests potential superiority for muscle strength gains in protocols exceeding 8 weeks and balance recovery in subacute stages, whereas control interventions may be more effective for reducing muscle tone.
BACKGROUND AND PURPOSE:People with stroke have low levels of activity, are sedentary, and have poor sleep, which have a negative impact on outcomes. Compositional data analysis (CoDA) provides a method to analyze movement behaviors that preserves the relative nature of the different movement behaviors within a day. The purpose of this study was to use CoDA analysis to explore the association between the composition of movement behaviors and physical function and to compare it to traditional analyses that consider movement behaviors as independent variables. METHODS:Participants (n = 68) wore activity monitors that measured time in active, sedentary, and sleep behaviors at 60 days post stroke. CoDA using the isometric log-ratios of the composition of the movement behaviors in a linear regression was used to explore the association between movement behaviors and the Stroke Impact Scale 16. Traditional analysis considered individual movement behaviors separately. RESULTS:The compositional mean of the movement behaviors found that participants spent 7.3% of the day in active, 58.1% in sedentary, and 34.6% in sleep behaviors. The composition of the movement behaviors was significantly associated with Stroke Impact Scale 16 (adjusted R2 = 0.5007, P < 0.05). This was greater than when the individual movement behaviors were considered separately (adjusted R2 = 0.3926, P < 0.05). DISCUSSION AND CONCLUSIONS:The composition of movement behaviors (active, sedentary, and sleep) was associated with physical function. Using CoDA with movement behavior data in people with stroke may improve the interpretability of the data by accounting for the dependency between compositional components. Clinicians may want to consider a comprehensive intervention to support behavioral change that seeks to increase physical activity, enhance sleep, and reduce sedentary time.
BACKGROUND AND PURPOSE:Hemiplegic shoulder pain (HSP) represents a common and disabling complication following stroke, which has multiple causes and important functional consequences. Physical modalities are frequently used to manage HSP, but evidence on their effectiveness remains inconsistent. Our aim is to systematically review the evidence from randomized controlled trials (RCTs) on the efficacy and safety of physical modalities, compared with sham or standard care, for improving pain and function in adults with poststroke HSP. METHODS:This systematic review was conducted following the Cochrane Guidelines and Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. We included RCTs assessing physical modalities versus sham or standard therapy in adult stroke survivors with HSP. The primary outcome was pain reduction; secondary outcomes included functional mobility, quality of life, and adverse events. A comprehensive search was conducted in MEDLINE, EMBASE, CENTRAL, PEDro, CINAHL, Web of Science, ClinicalTrials.gov, and World Health Organisation International Clinical Trials Registry Platform (WHO ICTRP) up to July 30, 2025. Risk of bias was assessed using the Cochrane Risk of Bias tool 2. RESULTS:Twelve RCTs involving 567 participants were included. Interventions comprised electrotherapy (n = 6), shock wave therapy (n = 3), and laser therapy (n = 3). Most studies showed significant pain reduction compared with control. Electrotherapy provided sustained analgesia; extracorporeal shock wave therapy improved structural abnormalities and pain; laser therapy enhanced both pain and functional outcomes. Adverse events were mostly mild. However, safety conclusions are limited by incomplete and inconsistent adverse event reporting. Heterogeneity in interventions and outcomes precluded meta-analysis. DISCUSSION AND CONCLUSIONS:Based on low to very low certainty evidence, physical modalities may offer benefit for HSP, but uncertainty remains regarding both long-term effectiveness and safety. Integration into multimodal rehabilitation protocols may be considered.
BACKGROUND AND PURPOSE:Sedentary behavior (SB) is highly prevalent during stroke rehabilitation. Evaluating both the duration and pattern of SB may inform tailored interventions. This study aimed to classify patients with stroke undergoing inpatient rehabilitation into distinct subgroups based on multiple SB indicators at admission and examine their longitudinal changes in SB outcomes over a 1-month period. METHODS:This multicenter prospective longitudinal study was conducted across 14 rehabilitation hospitals in Japan. SB was objectively assessed using triaxial accelerometers at admission and at 1 month. K-means clustering was applied to the following 5 SB-related variables: short (<30 minutes), medium (30-59 minutes), and long (≥60 minutes) sedentary bout ratios; total SB time; and break frequency. Longitudinal changes were examined using generalized linear mixed models. RESULTS:A total of 420 participants (median age 71.0 years; 57.9% male) were enrolled. Clustering analysis identified 3 subgroups: low SB (n = 109), moderate SB (n = 196), and high SB (n = 115). Generalized linear mixed models showed significant main effects of time for most SB indicators, except the long SB bout ratio. Significant group × time interactions were observed for the short and medium SB bout ratios and break frequency in the low SB group and for the medium and long SB bout ratios in the high SB group (P < 0.05). DISCUSSION AND CONCLUSIONS:Three distinct SB phenotypes were identified among patients with stroke during inpatient rehabilitation. Early behavioral profiling using SB indicators may support the development of individualized strategies to reduce sedentary time.
BACKGROUND AND PURPOSE:Poststroke fall prevention is hindered by inaccurate prediction of imminent fallers. We compared the predictive validity of the Berg Balance Scale (BBS), Functional Gait Assessment (FGA), 10-m gait speed, and a novel, step test + obstacle test (STOB) in subacute stroke. METHODS:A total of 64 ambulatory stroke survivors discharging home from inpatient rehabilitation completed all tests before discharge. Falls were tracked prospectively for 3 months. Logistic regression estimated the odds of being a faller with a failed test. Sensitivity, specificity, likelihood ratios, area under the curve, accuracy, and posttest probabilities for classifying fall status for each test were calculated using existing and optimized cutoffs. RESULTS:Twenty participants (31.3%) were fallers at 3 months. STOB had the best overall model fit with odds ratio 8.0 (95% CI 2.4-26.8). FGA ≤13 had the highest sensitivity of all tests (0.85), and gait speed ≤0.47 m/s had the highest specificity (0.89). A combination of positive tests for 10-m gait speed (≤0.47 m/s), STOB (≥3), FGA (≤13), and BBS (≤43) generated a cumulative diagnostic posttest probability of future falls of 94.5%. DISCUSSION AND CONCLUSIONS:No single test emerged with strong discriminative power for predicting future falls at discharge from inpatient rehabilitation for stroke, but a combination of gait speed, STOB, and FGA may enhance prognostic decision-making accuracy.
BACKGROUND AND PURPOSE:Little is known about the delivery of physical therapy services to promote physical activity (PA) for adults with neurologic conditions. This systematic review aimed to: (1) identify the roles of physical therapists (PTs) in the delivery of PA interventions, (2) describe PA intervention types, and (3) explore the efficacy of physical therapy PA interventions. METHODS:This systematic review included randomized controlled trials of interventions including physical therapy, PA or exercise, and PA health promotion in adults with neurologic conditions. Database searches included: PubMed MEDLINE, Embase, CINAHL, PsycINFO, and CENTRAL. Meta-analyses were performed for accelerometry-based and self-report measures of PA; meta-regressions explored moderators. RESULTS:Sixty articles met the inclusion criteria, representing 54 unique trials with 15,874 participants. Most articles had a moderate quality of reporting (85%) and a high risk of bias (RoB) (90%). PA interventions led to small, but significant effects on direct measures of PA (effect size [ES] = 0.18, CI 95% , 0.01, 0.35). Small-moderate effects were present when articles with high RoB were excluded (n = 6, ES = 0.36, CI 95% , 0.05, 0.67). Meta-regressions suggested that interventions including both PA and behavior change techniques were more positive than either intervention alone (β = 0.43, CI 95% , 0.23, 0.62). DISCUSSION AND CONCLUSIONS:PTs used direct and supervisory roles to deliver effective PA interventions, particularly using interventions combining PA and behavior change techniques. However, heterogeneity of PA measures limits the interpretation of the meta-analyses. Further research should develop consensus on feasible direct measures of PA outcome measures to use in research and clinical practice for adult neurologic populations.
BACKGROUND AND PURPOSE:To evaluate the effect of intensity and frequency of vestibular rehabilitation exercises over time on dizziness handicap and secondary outcomes in adults with vestibular impairments following mild traumatic brain injuries (mTBI). METHODS:The Targeted Rehabilitation Exercises for Vestibular (T-REV) impaiments randomized clinical trial was conducted from February 2020 to May 2024. Adult (18-50 years) civilian and military service members within 8 days to 1 year of mTBI with vestibular impairments participated. The sample size target was 252 participants. Exercises prescribed by a physical therapist were performed at home for 4 weeks at an intensity of 30% or 70%, and a frequency of once or twice daily. The Dizziness Handicap Inventory (DHI) and secondary outcomes were assessed at baseline, 2 and 4 weeks, and DHI at 12 weeks. Least square mean differences and 95% confidence intervals were calculated from a linear mixed model to examine the effects of intensity, frequency, time, and their interactions. RESULTS:A total of 120 participants completed baseline assessment (69 F, 51 M; 73 civilians, 47 military service members; mean (SD) age: 29 (9) years). Group differences in DHI and secondary outcomes over time due to intensity or frequency were equivocal. For all participants, mean improvement in DHI from baseline to 4 weeks was 16 points (95% CI: 13-19 points, P < .0001), and most secondary outcomes significantly improved across 4 weeks. Adverse events occurred in 20% of the participants. DISCUSSION AND CONCLUSIONS:The dose of vestibular rehabilitation for individuals with mTBI-related vestibular impairments can be individualized based on patient goals and symptom burden.
BACKGROUND AND PURPOSE:In 2013, the American Physical Therapy Association put forth a vision statement that declared that the movement system be central to physical therapy practice. Since then, the Academy of Neurologic Physical Therapy has supported this vision by creating task forces that have worked to advance the utility of movement analysis and movement diagnoses. In 2021, the Movement Analysis of Tasks (MAT) Subgroup created and defined a series of observable movement constructs and developed a systematic method for movement analysis of specific high-priority tasks. Since then, we have sought feedback across the physical therapy community through informal methods, including national stakeholder discussions, and a formal qualitative survey of 30 physical therapists in a single health system. The purpose of this project is to provide an update to the Framework for MAT based on this feedback. SUMMARY OF KEY POINTS:The updates to the 2021 Framework for MAT include (1) presentation of a revised set of observable movement constructs that reduces redundancy, (2) proposal of a generalized method for standardized MAT that more comprehensively considers environmental and sociocultural factors during any movement-centered examination, and (3) provide guidance on how the MAT fits within the physical therapy examination and facilitates clinical reasoning. RECOMMENDATIONS FOR CLINICAL PRACTICE:Through the use of case presentations, we demonstrate the use of these tools across a wide variety of patient scenarios, thereby advocating for continued professional conversation about their clinical utility. VIDEO ABSTRACT AVAILABLE:for more insights from the authors (see the Video, Supplemental Digital Content available at: http://links.lww.com/JNPT/A556 ; http://links.lww.com/JNPT/A557 ; http://links.lww.com/JNPT/A558 .
BACKGROUND AND PURPOSE:Few studies have examined the long-term effects of lung volume recruitment (LVR) in amyotrophic lateral sclerosis (ALS). This study aimed to clarify the impact of LVR on respiratory function (Aim 1) and survival (Aim 2). METHODS:This retrospective cohort included hospitalized patients with ALS who underwent LVR from 2015 to 2020. For Aim 1, longitudinal changes in forced vital capacity (%FVC) were assessed every 3 months before and after LVR. For Aim 2, the survival study, data on sex, onset age, delay in diagnosis, duration of LVR, and subtype were also collected. RESULTS:A total of 79 patients underwent LVR (Aim 2), 48 patients had %FVC data before and after LVR (Aim 1). Regarding long-term effects on respiratory function (Aim 1), %FVC declined at approximately 2% per month before LVR, with significant decreases observed at 12, 9, and 6 months relative to baseline ( P < .001). After LVR, the decline slowed to less than 1% per month, and no significant decreases were observed at 3, 6, 9, or 12 months. In Aim 2, patients continuing LVR ≥6 months had longer survival than those with shorter use. Multivariate Cox regression identified LVR ≥6 months as a prognostic factor (hazard ratio [95% CI] = 0.42 [0.19-0.96], P = .04). DISCUSSION AND CONCLUSIONS:These findings suggest a potential association between continued LVR and both a slower decline in %FVC and longer survival in patients with ALS. Further prospective studies are warranted to confirm these findings. VIDEO ABSTRACT AVAILABLE:For more insights from the author (see the Video, Supplemental Digital Content Video, available at http://links.lww.com/JNPT/A552.
BACKGROUND AND PURPOSE:The American Physical Therapy Association's (APTA) vision of transforming society by optimizing movement to improve the human experience must include a reduction in the unwarranted variation in physical therapist practice. The APTA proposed that the profession adopt the movement system as a basis for developing diagnoses to classify movement dysfunction so that treatment is more consistent and specific. In 2021, the Academy of Neurologic Physical Therapy Movement System Diagnosis Task Force developed 10 movement system diagnoses for balance dysfunction, a diagnostic process, and recommended intervention strategies. The purpose of this special interest paper is to report on the ongoing refinement of the balance diagnoses and the diagnostic process based on a pilot survey of practicing clinicians and colleagues' informal feedback. SUMMARY OF KEY POINTS:Pilot survey participants largely agreed on the clarity of the definitions, the accuracy of the key movement observations, and appropriateness of the key findings from tests and measures, but not the mutual exclusivity of the balance diagnoses. Using an iterative process, the authors considered the feedback to arrive at a consensus to address these concerns. The result is an updated set of 12 balance diagnoses, revision of some key definitions, a refined diagnostic process, and an updated summary of the evidence for task-specific balance-related interventions. These updated diagnoses and diagnostic processes must be examined for mutual exclusivity, validity, and reliability prior to clinical adoption. RECOMMENDATIONS FOR CLINICAL PRACTICE:Until the balance diagnoses are shown to be mutually exclusive, valid, and reliable, we recommend that clinicians conceptualize balance control dysfunction using the well-established postural control strategies and apply well-supported principles of task-specific interventions when managing individuals with balance dysfunction.
BACKGROUND AND PURPOSE:Stroke clinicians need access to cost-effective, accurate, and time-efficient tools that can assist with cardiorespiratory fitness (V̇O 2 peak) screening. The associations and diagnostic metrics between physical activity as measured by the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) and V̇O 2 peak among individuals ≥6 months post-stroke were evaluated. METHODS:This is a secondary analysis of an randomized controlled trial (RCT). Participants' baseline age, sex, gait speed, V̇O 2 peak, and PASIPD were included in adjusted logistic regression analyses. The association between the PASIPD (MET-hours/day) and V̇O 2 peak at 15, 12, and 18 mL/kg/min was evaluated to reflect the average, lower, and upper limits of V̇O 2 peak post-stroke, respectively. Predicted classifications and the Youden index identified cut points of the PASIPD. RESULTS:Eighty-five participants (n =53 males, aged 65.1 ± 9.5 years, 1.8 ± 1.2 years post-stroke) were included. A 1-unit increase in the PASIPD (MET-hours/day) was significantly associated with 21% increased odds of identifying an individual with a V̇O 2 peak ≥ 15 mL/kg/min (adjusted OR [aOR] = 1.21; 95% CI 1.07, 1.36; P = .002) with excellent area under the curve (AUC = 0.91; 95% CI 0.85, 0.97). Consistent associations were found for a V̇O 2 peak ≥ 12 mL/kg/min (aOR = 1.15; 95% CI 1.01, 1.14; P = .046) but not for V̇O 2 peak ≥ 18 mL/kg/min (aOR = 1.04; 95% CI 0.99, 1.10; P = .15). Unadjusted Youden PASIPD cut point of 8.9 MET-hours/day may identify individuals with a V̇O 2 peak ≥ 15 mL/kg/min post-stroke (AUC = 0.69; 95% CI 0.59, 0.79). DISCUSSION AND CONCLUSIONS:Clinicians may use the PASIPD to screen V̇O 2 peak impairments post-stroke.
BACKGROUND AND PURPOSE:The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a well-established tool for assessing disability. However, diverse factor structures complicate its interpretation, necessitating further validation. This study examined the factorial validity of the 32-item WHODAS 2.0 in persons with stroke using 1-factor, 6-factor, and 2-level hierarchical structures. METHODS:A cross-sectional design was used with data from 1343 persons with stroke in the Taiwan Databank of Persons with Disabilities. Confirmatory factor analysis (CFA) was used to determine the valid structure of the 32-item WHODAS 2.0. RESULTS:The 1-factor structure exhibited poor model fits, while the 6-factor and the overall 2-level hierarchical structure had acceptable model fits. However, the relationships between domains and overall score of the 2-level structure yielded poor fits. Excellent internal consistencies (Cronbach's α ≥ 0.90) were obtained for the 6 domain scores and the overall score. DISCUSSION AND CONCLUSIONS:Our results revealed poor model fit for the 1-factor model, whereas the 6-factor structure and the overall 2-level hierarchical structure were both acceptable. However, the relationships between domains and the overall score within the 2-level structure were poor. The 6-factor model is preferable due to its better fit and alignment with WHODAS 2.0's design to assess multiple life perspectives. The 6-domain structure appears the most robust for persons with stroke. Thus, the 6 domain scores of the 32-item WHODAS 2.0 are recommended.
