OBJECTIVE:Localized bioimpedance spectroscopy (BIS) is a non-invasive technique for assessing muscle tissue properties. This study examined the test-retest reliability of BIS measurements on the upper trapezius muscle and the effects of body positioning and electrode reapplication. APPROACH:Ten healthy adults (ages 18-30) with no history of neck or shoulder pain participated in the study. BIS measurements were collected over two days across three body positions (prone, seated, seated with neck bent) and with different electrode applications. Key impedance parameters were extracted from Cole-Cole plots. We evaluated measurement reliability, variability, and the minimum detectable change. MAIN RESULTS:BIS measures demonstrated high reliability for primary impedance parameters when body positioning was controlled, whereas model-derived parameters showed greater variability. Impedance parameters differed if the participants were seated or lying prone but were not sensitive to bending the neck to the side. Electrode reapplication did not significantly alter measures unless applied a third time, and sex-related differences were not significant. SIGNIFICANCE:BIS appears to be a reliable method for assessing upper trapezius muscle tissue properties when body position is standardized. Future research should explore BIS applications in larger and more diverse populations and evaluate its potential clinical utility.

INTRODUCTION:Individuals with lung cancer frequently experience functional limitations, yet best practice to achieve functional recovery has not been synthesized. This Clinical Practice Guideline generates evidence-based recommendations to improve functional outcomes in this population. METHODS:A multispecialty expert workgroup completed a systematic review of the literature from 2010 to 2021 examining interventions for improving patient function at any stage or phase of disease. National Institutes of Health Quality Assessment standards were employed for bias assessment. Recommendations were generated per GRADE methodology, for mobility, physical activity, general function, and social function outcomes, during phases of prehabilitation, surgical post-operative acute (hospitalization), during-or-immediate post-treatment (first year), and survivorship. RESULTS:Fifty-four studies were included. Combined exercise approaches should be used to improve mobility during the Prehabilitation and the During and Immediate Post-Treatment phases. For physical activity, combined interventions may be beneficial during the Surgical Post-Operative Acute phase, and multimodal interventions with exercise and education may improve function in the During and Immediate Post-Treatment phase. Combined exercise may improve general function in the During and Immediate Post-Treatment phase. CONCLUSION:Current evidence emphasizes mobility outcomes, in prehabilitation and early post-treatment phases, with moderate level benefits of combined aerobic with resistance and/or breathing exercise. Further study is needed into sustainability of performing the interventions and durability of outcomes; increased breadth of interventions and functional outcome domains examined; and exploration of specific contexts including advanced disease, survivorship, high medical complexity and frailty, and caregiver-related factors. These recommendations are applicable for clinicians including oncologists, rehabilitation specialists, surgeons, primary and pulmonary care providers, nurses, and other supportive care personnel.

Objective: To identify predictors of clinically meaningful declines in health-related quality of life (HRQoL) among COVID-19 patients over a 12-month period in a prospective, natural history investigation. Methods: We conducted a longitudinal study involving individuals who had tested positive for SARS-CoV-2, assessing various factors and their impact on HRQoL after 12 months. Key potential predictors examined included demographic information, medical history, and symptom reporting. HRQoL was measured using the validated EuroQoL Dimension 5 level scale at baseline and at the 12-month follow-up. Results: The analysis revealed that shortness of breath, a diagnosis of COPD, lower BMI, and a history of anxiety at the initial visit were all significantly associated with clinically meaningful worsening of HRQoL at 12 months. Specifically, individuals with these factors experienced more pronounced declines in HRQoL compared to those without. Notably, the small number of COPD cases within our sample (4 total) limited the reliability of this predictor. Conclusions: Shortness of breath, lower BMI, and a history of anxiety are important predictors of deteriorated HRQoL in COVID-19 patients over the long term. Although the association with COPD is less reliable due to sample size limitations, these findings highlight the need for targeted interventions and continued support for patients exhibiting these risk factors to improve long-term HRQoL outcomes. Future research with larger samples is needed to confirm these results and further investigate the role of these factors in post-COVID HRQoL declines.

There is great interest in characterizing the material properties of heterogeneous transversely anisotropic media such as muscle and associated connective tissue for a number of clinical conditions. For example, alterations in tissue mechanical properties are a hallmark of many chronic musculoskeletal pain disorders, such as neck and lower back pain, which are leading causes of disability worldwide. Current diagnostic criteria are based on subjective physical examination, and there is a pressing need to develop reliable and objective image-based biomarkers. Ultrasound shear wave elastography (SWE) is an attractive modality due to its suitability for use in community-based pain management clinics. However, the complex architecture and heterogeneous material properties of muscle make it challenging to develop ultrasound-based biomarkers. This talk will describe the use of 3-D rotational SWE as a method for quantifying the anisotropic material properties of muscle. In this method, the ultrasound transducer is mechanically rotated at different angles and SWE images are acquired at each angle to develop a 3-D representation of the anisotropic shear wave propagation speed. Results from a recent clinical study of 90 subjects with and without chronic musculoskeletal neck pain highlight the opportunities and challenges associated with 3-D rotational SWE in this clinical application and the need for future research in this area.

This study aims to analyze the changes in inflammatory cytokines and state fatigue after exposure to a mental or physical fatiguing activity in breast cancer survivors (BCS). A total of 46 BCS women (age: 58.9 ± 9.1) were recruited for this study and randomly assigned to one of three groups: exposure to physical fatigue (n = 16), mental fatigue (n = 15), or control (n = 15). Participants exposed to physical fatigue performed a 6-minute walk/run test. Participants exposed to mental fatigue performed a version of a dual 2-back task on a computer. Participants in the control group watched a video for 6 min. Clinically significant fatigue was defined by the FACIT-F. Analytes in serum were profiled using the Bio-Plex 200 Suspension Array System, specifically IL-1β, IL-4, IL-5, IL-6, IL-8, IL-10, eotaxin, TNF-α, TGF-β1, and VEGF. Changes in inflammatory factors in response to the assigned fatigue-inducing tasks were mainly not statistically significant. The presence of clinically significant fatigue reported at baseline was, however, related to reactions to fatigue-inducing stimuli. Levels of TGF-β and eotaxin were consistently altered in reactions to fatigue-inducing tasks, particularly in those with clinical fatigue. Clinically significant fatigue is related to increased inflammatory reactions to mentally or physically fatiguing tasks, highlighting the consistent impact that fatigue has across various challenges of daily activities. Acute fatigue challenges, the kind that BCS would be exposed to in everyday circumstances, does increase inflammatory responses, and those with clinically significant levels of fatigue at baseline are more likely to show these effects.

We appreciate the opportunity to respond to Moraska and Hickner's (MH) latest comments about our microanalytical studies. Response to Letter to the Editor on "Biochemicals Associated With Pain and Inflammation Are Elevated in Sites Near to and Remote From Active Myofascial Trigger Points"Archives of Physical Medicine and RehabilitationPreviewWe appreciate the reply by Shah et al to our initial letter and believe scientific debate to be healthy and necessary, especially given the historic significance the papers have on trigger point research.1,2 Nevertheless, we are unpersuaded by their response regarding our concerns with their methodology and results. Full-Text PDF

Background Measuring function with valid and responsive tools in patients with cancer is essential for driving clinical decision-making and for the end points of clinical trials. Current patient-reported outcome measurements of function fall short for many reasons. This study evaluates the responsiveness of the Patient-Reported Outcomes Measurement Information System (PROMIS) Cancer Function Brief 3D Profile, a novel measure of function across multiple domains. Methods Two hundred nine participants across five geographically distinct tertiary care centers completed the assessment and pain rating at two outpatient cancer rehabilitation clinic visits. Patients and providers completed a global rating of change measure at the second visit to indicate whether the patient was improving or worsening in function. Multiple response indices and linear models measured whether the measure was responsive to self-reported and clinician-rated changes over time. Correlations between changes in function and changes in anchors (pain rating and performance status) were also calculated. Results Function as measured by the PROMIS Cancer Function Brief 3D Profile changed appropriately as both patients and clinicians rated change. Small to moderate effect sizes supported the tool's responsiveness. Function was moderately correlated with pain and more strongly correlated with performance status, and changes in function corresponded with changes in anchor variables. No floor/ceiling effect was found. Conclusions The PROMIS Cancer Function Brief 3D Profile is sensitive to changes over time in patients with cancer. The measure may be useful in clinical practice and as an end point in clinical trials. Lay summary We gave patients a questionnaire by which they told their physicians how well they were functioning, including how fatigued they were. This study tested that questionnaire to see whether the scores would change if patients got better or worse.

BACKGROUND: Practice guidelines (CPGs) provide informed treatment recommendations from systematic reviews and assessment of the benefits and harms that are intended to optimize patient care. Review of CPGs addressing rehabilitation for people with moderate/severe traumatic brain injury (TBI), has not been fully investigated. OBJECTIVE: Identify published, vetted, clinical practice guidelines that address rehabilitation for people with moderate/severe TBI. METHODS: Six data bases were accessed using key word search terms: “Traumatic Brain Injury” and “Clinical Practice Guidelines” and “Rehabilitation”. Further inclusions included “adult” and “moderate or severe”. Exclusions included: “mild” and “concussive injury”. Three reviewers read abstracts and manuscripts for final inclusion. The AGREE II template was applied for additional appraisal. RESULTS: There were 767 articles retrieved using the search terms, 520 were eliminated because of content irrelevance; and 157 did not specify rehabilitation treatment or did not follow a process for CPGs. A total of 17 CPGs met all criteria and only 4 of these met all AGREE II criteria. CONCLUSION: There are few CPGs addressing rehabilitation for people with moderate/severe TBI. More interventional trials are needed to determine treatment effectiveness. Timely and methodologically sound vetting of studies are needed to ensure CPG reliability and facilitate access to quality, effective treatment for people with moderate/severe TBI.

INTRODUCTION:Understanding the impact of disease on function and improving functional outcomes is an important goal of rehabilitation. This scoping review analyzes 25 years of published traumatic brain injury (TBI) clinical rehabilitation research (CRR) to determine the frequency with which function is a research goal. METHODS:The review protocol was prepared by experienced clinical researchers in the field. We used these search terms: "moderate traumatic brain injury" and "severe traumatic brain injury" and "functional outcomes"; and "rehabilitation" and "educational outcomes" or "cognition" or "community roles" or "community integration" "behavior" or "neuropsychology" or "quality of life", or "vocational outcomes" or "work" or "return to work". Publications from January 1, 1990-December 31, 2016 were included. RESULTS:1,815 articles met initial criteria, of which 202 were intervention studies, 84 were randomized controlled trials and 353 prospective non-intervention studies. The combination of intervention and prospective non-intervention studies (n = 555) were analyzed for the kind of measurement tools used. Impairment measures (60%) and symptom measures (43%) either singly or in combination were most frequently used. Measures of function were employed in fewer than 30%. For single outcomes, 95 publications used impairment measures, 60 used symptoms and only18 used function. There were 117 studies that used neurocognitive measures. Participation/societal integration evaluation tools were used for community integration(n = 77) employment (n = 50) and independent living status (n = 37). DISCUSSION:This scoping review identifies a need for additional types of clinical research in the field of TBI CRR. Much of the research is aimed at mitigating impairment and controlling symptoms rather than promoting function. Future efforts by the CRR community studying TBI should address this need.

Study Design: Scoping review Objective: To study the design, clinical setting and outcome measures used in spinal cord injury rehabilitation publications. Methods: A literature search on PubMed and Medline was conducted focusing on articles published between 1990-2016 and using "traumatic SCI", "functional outcomes", "rehabilitation", "work" and "return to work" as outcomes. Studies were categorized based on design (intervention, including RCTs vs. non-intervention studies), settings (inpatient vs. outpatient vs. transition), and outcome measures used (impairment vs. function vs. participation/integration vs. quality of life vs. symptoms). Work-related studies were categorized independently. Results: Five hundred forty-four articles met the inclusion criteria. Of these, 234 were interventional studies, including 23 RCTs. Studies were evenly divided among inpatient, outpatient and transition settings. Of the 234 interventional studies, 143 used functional evaluations. Sixty-one different functional instruments were used, with a predominant use of the Functional Independence Measure (61 times) and an additional use of SCI-specific measures, i.e. Spinal Cord Independence Measure and Craig Handicap Assessment and Reporting Technique (13 times each). Fifty-one studies measured mobility, while only three measured hand functions. The work-related sub-analysis revealed 32 intervention studies (no RCTs), of which 15 used functional evaluations and only three focused on tetraplegia. Conclusion: Our study revealed a paucity of intervention trials and RCTs, indicating a dearth of knowledge that would be needed to establish evidence-based practice guidelines. This is particularly true for tetraplegia. While standard measures of function were frequently used, providing valuable data, there is no consensus about what exact outcome measure to use. Using newer measurement techniques, for instance based on the application of item response theory, should be considered to enhance uniformity.

There is a need for additional strategies for performing systematic reviews (SRs) to improve translation of findings into practice and to influence health policy. SRs critically appraise research methodology and determine level of evidence of research findings. The standard type of SR identifies randomized controlled trials (RCTs) as providing the most valid data and highest level of evidence. RCTs are not among the most frequently used research design in disability and health research. RCTs usually measure impairments for the primary research outcome rather than improved function, participation or societal integration. It forces a choice between "validity" and "utility/relevance." Other approaches have effectively been used to assess the validity of alternative research designs, whose outcomes focus on function and patient-reported outcomes. We propose that utilizing existing evaluation tools that measure knowledge, dissemination and utility of findings, may help improve the translation of findings into practice and health policy.

To compare symptoms, activities and participation between breast cancer survivors (BCS) and controls in a prospective surveillance model (PSM) prior to cancer treatment and 12-24 months post-operatively using the Upper Limb Disability Questionnaire (ULDQ). We hypothesize there are no differences between groups for symptoms, activities and participation secondary to PSM. The ULDQ is a patient reported outcome tool (PRO) developed to assess symptoms, body structure and function, activities and participation in BCS to prevent adverse effects of cancer treatment. We are unaware of a PRO that assesses these domains within the breast cancer population. CorrectionArchives of Physical Medicine and RehabilitationVol. 98Issue 5PreviewResearch Poster #4677 in the 2015 ACRM American Congress of Rehabilitation Medicine Annual Conference Late-Breaking Research Abstracts published in December 2015 contained an incomplete list of authors and a missing affiliation for the presenter (To view the full issue, please visit the Archives journal website at http://www.archives-pmr.org/issues .) The corrected author list and affiliation appears below. Full-Text PDF

Background: Objective measures of upper limb (UL) function specific to breast cancer survivors (BC) are limited. Motion, strength, and muscular endurance are measurable components of UL function. A clinical test that quantifies these components is needed.

SummaryThe interaction of lipoproteins with hepatitis C virus (HCV) has pathogenic and therapeutic implications. Our aim was to evaluate changes in the apolipoprotein profile of patients with chronic hepatitis C during and after successful cure with ledipasvir and sofosbuvir (LDV/SOF) with and without ribavirin (RBV). One hundred HCV genotype 1 patients who had achieved SVR‐12 after treatment with 12 weeks of LDV/SOF ± RBV were selected from the ION‐1 clinical trial. Frozen serum samples from baseline, end of treatment and week 4 of follow‐up were used to assay apolipoproteins (apoAI, apoAII, apoB, apoCII, apoCIII, apoE) using the Multiplex platform to assess for changes in the apolipoprotein levels. At the end of treatment compared to baseline, a significant reduction in apoAII levels (−14.97 ± 63.44 μg/mL, P = 0.0067) and apoE levels (−4.38 ± 12.19 μg/mL, P < 0.001) was noted. These declines from baseline in apoAII (−16.59 ±66.15 μg/mL, P = 0.0075) and apoE (−2.66 ± 12.64 μg/mL, P = 0.015) persisted at 4 weeks of post‐treatment follow‐up. In multivariate analysis, treatment with LDV/SOF + RBV was independently associated with reduction in apoE (beta = 5.31 μg/mL, P = 0.002) (compared to RBV‐free LDV/SOF) (P < 0.05). In contrast, apoCII levels overall increased from baseline to end of treatment (+2.74 ±11.76 μg/mL, P = 0.03) and persisted at 4 weeks of follow‐up (+4.46 ± 12.81 μg/mL from baseline, P = 0.0005). Subgroup analysis revealed an increase in apoCII during treatment only in patients receiving LDV/SOF without RBV (+5.52 ± 11.92 μg/mL, P = 0.0007) but not in patients receiving LDV/SOF + RBV (P = 0.638). Treatment with LDV/SOF ± RBV is associated with a persistent reduction in the apolipoprotein AII and E after achieving cure. These data suggest that treatment with LDV/SOF ± RBV may be associated with alterations in serum apolipoproteins which could potentially impact viral eradication.

Background and Aims: HCV causes chronic hepatitis C, while spontaneous recovery from infection is relatively infrequent. HCV expression after spontaneous resolution has rarely been investigated. We analyzed, using high sensitivity HCVRNA detection approaches, plasma and PBMC from individuals with a past episode of hepatitis C and repeatedly normal liver enzymes and undetectable HCVRNA by conventional testing. Methods: Parallel plasma and PBMC from 23 non-viraemic individuals by standard testing, followed for 0.3–14.3 (mean 6.3) years prior to initial collection, were examined. From 9 of them, additional samples were obtained 4.5–7.2 (mean 5.9) years later. RNA was extracted from 500ml plasma and, if HCV negative, from ~10ml after ultracentrifugation, and from PBMC cultured with PHA or PHA-PWM-IL2-IL4 (JGV2005;86:657). HCVRNA positive and negative strands were detected by RT-PCR/NAH with a sensitivity of <5 and <100 copies/mg RNA, respectively (JVI2004;78:5867; JVI2012;86,3723). Results: HCVRNA was detected in 13/23 (56.5%) plasma and 11/23 (47.8%) PBMC obtained during the first collection. 10/13 (76.9%) plasma were reactive when RNA from 500ml was tested. HCV replication was evident in 7/11 (63.6%) PBMC. In total, 15/23 (65.2%) individuals carried HCVRNA. Samples collected 4.5–7.2 years later revealed HCVRNA in 4/9 (44.4%) plasma and 5/9 (55.6%) PBMC. 3/5 (60%) PBMC demonstrated virus RNA replicative strand. Overall, 6/9 (66.7%) of individuals remained HCV viraemic. Conclusions: HCV persists after apparent complete spontaneous resolution of HCV infection at levels undetectable by current clinical testing. Long-term pathological consequences should be assessed, even in patients who achieve undetectable HCVRNA.

Cancer-related fatigue (CRF) has been documented as 1 of the most distressing symptoms reported by breast cancer survivors. CRF affects functioning and impacts quality of life. Possible causal factors include physical conditions, affective and cognitive states, proinflammatory cytokines, and metabolic factors. Several common problems are associated with CRF in women with breast cancer, including treatment side effects, obesity, arm/upper quadrant symptoms, sleep disturbances, psychological effects, and comorbid conditions. In this article, the authors review the state of the knowledge regarding these issues and nonpharmacologic and pharmacologic interventions for CRF. Physical activity and psychosocial interventions are recommended for practice. Numerous limitations of past studies need to be considered in the design of future studies. CRF is prevalent in preoperative, postoperative, and ongoing surveillance phases. Throughout the continuum of care for women with breast cancer, clinicians must screen, further assess as indicated, and treat CRF, because it is associated with emotional distress and limits function and willingness to exercise. Cancer 2012;118(8 suppl):. (c) 2012 American Cancer Society.