Journal of Rehabilitation Medicine

04/12/2025

Attitudes and practice patterns of Canadian physiatrists regarding medical cannabis

Authors: Karen Ethans, Harpal Chaudhary, Alan Casey, Colleen O'Connell, Mayur Nankar, Avni Khandelwal

Canadian physiatrists show expertise in conditions in which medical cannabis (MC) should be considered, showcasing the importance of capturing this demographics attitudes and practice patterns on MC. A 24-item, web-based survey was sent to physiatrists across Canada. The results show a large consensus for agreement in the medicinal value of MC and comfort discussing it with patients, but lack of confidence in authorization patterns. Respondents agreed that their medical school and residency training left them with considerable gaps in MC knowledge; and this coupled with the lack of institutional and governmental guidelines deter them from using MC. Though years of clinical experience did not impact doctor-patient discussions of MC, those with 21+ years of experience authorized MC more frequently, perhaps due to first-hand observations of MC benefits for patients.

https://doi.org/10.2340/jrm-cc.v8.43254

02/12/2025

Changes in tibialis anterior muscle activity following tibial nerve block in adults with spastic equinovarus foot: an observational pilot study

Authors: Alessandro Picelli, Mirko Filippetti, Angelo Pontillo, Eleonora Dimitrova, Nicola Valè, Rita Di Censo, Nicola Smania, Matteo Bertucco

People who have had a stroke or brain injury often develop a condition where their foot turns inward and points down, making walking difficult. This is called spastic equinovarus foot. In this study, we tested a simple and safe procedure that temporarily blocks a nerve in the leg to see how it affects walking. We looked at how 2 key leg muscles worked before and after the procedure using sensors placed on the skin. We found that the treatment helped reduce muscle tightness and improved ankle movement. Interestingly, it also changed how the muscles worked together during walking. These results suggest that this nerve block can help doctors better understand the cause of walking problems and choose the most effective treatment for each patient. This approach could lead to more personalized and successful rehabilitation strategies.

https://doi.org/10.2340/jrm.v57.44405

02/12/2025

A cost-utility analysis for return-to-work interventions comparing alternative methods for handling missing health-related quality of life data

Cindy Nguyen, Emily A. Burger, Lene Aasdahl, Niccolò Morgante, Marius Steiro Fimland, Gudrun Maria Waaler Bjørnelv

Prior to the implementation of a new health intervention, the costs and health effects of the intervention are compared, typically, with usual care using a cost-effectiveness analysis. The effects are often measured in quality-adjusted life years, where the health-related quality of life is a key input. However, surveys that measure health-related quality-of-life data often suffer from high non-response, especially in interventions tailored to those who are on sick leave. We evaluated the costs and effects of 2 return-to-work interventions, while describing and applying the most common methods used to handle missing health-related quality-of-life data. We found that different methods to handle missingness did not affect the conclusions of the study, but different methods do lead to different incremental effects, thus warranting the use of several methods in applied cost-effectiveness analyses.

https://doi.org/10.2340/jrm.v57.42359

26/11/2025

Pain catastrophizing, kinesiophobia, and exercise adherence in postoperative cardiovascular surgery patients: the mediating role of exercise self-efficacy

Authors: Jingfang Wang, Yufang Chen

After heart surgery, it is important for patients to follow an exercise programme to help them recover. However, many patients struggle to stick with these exercises. This study looks at how certain mental and emotional factors, such as fear of pain and worrying too much about discomfort, can make it harder for people to stay active after surgery. We found that if patients feel more confident about their ability to exercise, they are more likely to stick with their rehabilitation programme, even if they worry about pain or fear injury. This research helps us understand how to better support heart surgery patients by addressing their fears and boosting their confidence, making it easier for them to recover fully and improve their quality of life.

https://doi.org/10.2340/jrm.v57.43853

26/11/2025

Motor imagery enhances early rehabilitation in patients with high kinesiophobia after total knee arthroplasty: a randomized controlled trial

Authors: Jejeong Lee, Minjeong Kim, Yongwoo Lee

This study tested a mental training technique called motor imagery in people recovering from knee replacement surgery. Motor imagery helps patients imagine movements before they actually do them. Forty patients were divided into 2 groups: 1 followed standard rehabilitation, and the other used motor imagery along with the same rehabilitation. The goal was to reduce fear of movement, known as kinesiophobia, improve mental strength, reduce pain, and support physical recovery. After 2 weeks, both groups improved, but those who used motor imagery showed better results in pain relief, knee movement, leg strength, and motivation to stick with exercise. This shows that thinking about movement, even without doing it, can help the body heal faster and better. Motor imagery is easy to add to rehabilitation and does not require special equipment, making it useful for hospitals and clinics. It may also help people who are too afraid or in too much pain to move early after surgery.

https://doi.org/10.2340/jrm.v57.43688

18/11/2025

Effects of higher- and lower-intensity exercise on fitness, cognition, motor function, and quality of life in adults with traumatic brain injury

Authors: Monica E. Soliman, Cris Zampieri, Lisa M.K. Chin, Diane L. Damiano

The aim was to evaluate the effects of exercise on adults with a traumatic brain injury who could walk but were generally inactive. We randomly assigned nine participants to high-intensity training exercise or lower-intensity exercise focusing on increasing movement speed. Before and after a 12-week supervised training program and after a 12-week follow-up, we measured their ability to think quickly and recall things. We assessed physical abilities like fitness levels, how fast they walked, and how good their balance was, and we also collected ratings of how satisfied they were with their life and abilities. No differences were found between exercise types; however, when groups were combined, positive effects on thinking, moving, and satisfaction were observed. Those with greater fitness after training, which interestingly was not related to training intensity, had greater improvement. In conclusion, regular exercise at a safe level should be advocated for people with a brain injury.

https://doi.org/10.2340/jrm-cc.v8.44345

12/11/2025

The Borg scale is safe and efficacious for prescribing and monitoring self-administered balance and resistance exercise in patients with chronic kidney disease: a post-hoc analysis of RENEXC, a randomized controlled trial

Authors: Philippa Svensson, Matthias Hellberg, Anita Wisén, Naomi Clyne

Exercise is important to prevent loss of balance and strength in patients with chronic kidney disease. In this study patients exercised independently at home or at a gym and were prescribed either balance or strength exercises by a physiotherapist. Exercise intensity was prescribed and monitored using the Borg scale of rating of perceived exertion. We found that exercise was safe to perform, resulted in high participation, and patients followed the prescribed exercise intensity, although there was a wide range of reported weekly exercise duration. Both groups improved balance and strength regardless of baseline measurements, showing that the Borg scale was safe and efficacious both for balance and resistance exercise in patients with chronic kidney disease, and that even short exercise durations resulted in improved physical performance when the prescribed exercise intensity was maintained.

https://doi.org/10.2340/jrm.v57.44158

12/11/2025

Reliability of upper limb kinematic variables: adults with unilateral cerebral palsy performing a standardized drinking task

Authors: Camilla Aksdal, Viven Jørgensen, Arve Opheim, Linda Rennie

Adults with cerebral palsy (CP) experience problems with reaching, grasping, and releasing objects due to decreased motor control. Specialized camera systems, which are now clinically available, could be a step forward in objective assessment of upper limb function in neurological populations. The main aim of this study was therefore to evaluate the consistency of motion variables obtained during a drinking task using a motion-capture system. Twenty-five adults with CP were measured on 2 occasions while performing this task. The results showed a high level of consistency between the 2 measurements for all investigated motion variables. We therefore concluded that the method may be used as an outcome measure to evaluate the effect of treatments of upper limb function, as well as to follow the function over time.

https://doi.org/10.2340/jrm.v57.42583

11/11/2025

Clinical assessments and gait characteristics by subtype classification using temporal and kinematic symmetry indices during gait in patients with chronic stroke

Authors: Yuichiro Hosoi, Takayuki Kamimoto, Kohsuke Okada, Kohshiro Haruyama, Tetsuya Tsuji, Michiyuki Kawakami

Many people who have had a stroke have difficulty walking, often because one leg moves differently from the other. This study examined 59 people with chronic stroke to better understand these differences. We used a walking test to measure how similar the timing and movement of the legs were during walking. Based on these measurements, we identified 4 distinct types of walking patterns. Some individuals showed movements that were quite similar on both sides, but still walked slowly, whereas others walked faster, but had greater differences between the 2 legs. These differences were also associated with other issues, such as muscle stiffness and weakness. Understanding these walking patterns can help therapists select more appropriate exercises for each person. By tailoring rehabilitation to the specific type of walking problem, we hope to improve walking ability and increase independence in daily life.

https://doi.org/10.2340/jrm.v57.44623

11/11/2025

Shoulder problems after spinal cord injury. Part one: self-assessment by questionnaires

Authors: Ellen Andreasson, Jörgen Söverstad, Inka Löfvenmark

This study on shoulder pain after spinal cord injury took place in Stockholm. A questionnaire was distributed including type of and time since injury, shoulder loading, shoulder pain, and pain specifics. The results showed that shoulder pain remains a substantial problem within this group (self-reported shoulder pain in the last week = 34%), and was evenly distributed regardless of s*x, age, and time since injury. Among those with tetraplegia, complete or incomplete, the reports were 42–44%. Wheelchair users experienced pain in both shoulders more frequently compared with ambulatory participants. Pharmacological treatment was low; however, many took medication for other kinds of pain, such as neuropathic. Training, TENS, and massage were used for pain management. This study shows that individuals with all types of SCI, including ambulators, need to take preventive measures to maintain shoulder health and need follow-up by qualified staff. Clinical and ultrasound assessments were also done as part of a larger study and will be forthcoming shortly.

https://doi.org/10.2340/jrm.v57.43631

06/11/2025

Exploring exercise intolerance in adult patients with persistent post-concussion symptoms after mild traumatic brain injury

Authors: Lars-Johan V. Valaas, Helene L. Soberg, Mari S. Rasmussen, Sophie E. Steenstrup, Ingerid Kleffelgård

Many people experience persisting symptoms after mild traumatic brain injury (mTBI). These symptoms can worsen during exercise. In this study, we included 100 adult patients with persistent post-concussion symptoms, 3 to 24 months after injury, and tested them for exercise intolerance with a standardized treadmill test. Overall, 81% of the patients had exercise intolerance. Greater symptom burden was associated with higher likelihood of exercise intolerance. More research is needed for a better understanding of important factors that can explain exercise intolerance. Our study found that in patients with exercise intolerance, a higher pre-test heart rate was associated with higher symptom threshold, whereas more anxiety was associated with lower symptom threshold. These findings show that exercise intolerance is common in people with persisting post-concussion symptoms and is linked to both physical and psychological factors. Testing for exercise intolerance may help tailor treatment and improve recovery for these patients.

https://doi.org/10.2340/jrm.v57.43931

04/11/2025

JRM Newsletter November 2025

Optimizing the clinical functioning information tool (ClinFIT) in routine clinical practice: development of functional staging cutoff scores for rehabilitation provision and intensityBhasker Amatya, Adrian Martinez de la Torre , Masahiko Mukaino , Krystal Song, Melissa Selb, Gerold Stucki , Khan Far...