Archives of Physical Medicine and Rehabilitation (ARCH PHYS MED REHAB )

Publisher: American Congress of Rehabilitation Medicine; American Congress of Physical Medicine and Rehabilitation; American Academy of Physical Medicine and Rehabilitation; American Society of Physical Medicine and Rehabilitation, Elsevier


Archives of Physical Medicine and Rehabilitation has distinguished itself through its coverage of the specialty of physical medicine and rehabilitation and of the more interdisciplinary field of rehabilitation. The journal publishes original articles that report on important trends and developments in these fields. Archives of Physical Medicine and Rehabilitation brings readers authoritative information on the therapeutic utilization of physical and pharmaceutical agents in providing comprehensive care for persons with disabilities and chronically ill individuals.

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    Archives of physical medicine and rehabilitation
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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective To verify that iterative proportional fitting (IPF) or raking has the desired effect of aligning estimates and parameters so that researches have confidence in population projections when weighting the Traumatic Brian Injury (TBI) Model Systems National Database. Design Secondary data analysis using IPF. Setting Inpatient rehabilitation. Participants People age 16 and over with a primary diagnosis of TBI receiving initial inpatient rehabilitation. Intervention N/A Main Outcome Measures Age at injury, race, gender, marital status, rehabilitation length of stay, payer source, and motor and cognitive FIMTM scores. Conclusion In general, IPF aligns population estimates based on weighted TBI Model Systems data and known population parameters. It is reasonable to assume IPF has the same effect on unknown variables. This provides confidence to researchers wishing to use IPF for making population projections in analyses.
    Archives of Physical Medicine and Rehabilitation 10/2014;
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    ABSTRACT: To examine the impact of frequent knee pain (KP) and obesity on gait speed (GS) among older men and women.
    Archives of Physical Medicine and Rehabilitation 10/2014; 95(10):41.
  • Archives of Physical Medicine and Rehabilitation 10/2014; 95(10):e94-e95.
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    ABSTRACT: Objective To identify the effective predictors for therapeutic outcomes based on intermittent theta-burst stimulation (iTBS). Design A sham-controlled, double-blind parallel study design. Setting A tertiary hospital. Participants Seventy-two people with stroke who presented with unilateral hemiplegia. Interventions Ten consecutive sessions of real or sham iTBS were implemented with the aim of enhancing hand function. Patients were categorized into 4 groups according to the presence (MEP+) or absence (MEP-) of motor-evoked potentials (MEP) and grip strength according to the Medical Research Council (MRC) scale. Outcome Measures Cortical excitability, Wolf Motor Function test (WFMT), finger tapping task (FT), and simple reaction time (RT), were performed before and after the sessions. Results MEP and the MRC were predictive of iTBS therapeutic outcomes. Group A (MEP+, MRC > 1) exhibited the greatest WMFT change (7.6 ± 2.3, P < .001), followed by Group B (MEP -, MRC > 1; 5.2 ± 2.2 score change), and Group C (MEP -, MRC = 0; 2.3 ± 1.5 score change). These improvements were correlated significantly with baseline motor function and ipsilesional MEPmax amplitude. Conclusions The effectiveness of iTBS modulation for poststroke motor enhancement depends on baseline hand grip strength and the presence of MEP. Our findings indicate that establishing neurostimulation strategies based on the proposed electrophysiological and clinical criteria can allow iTBS to be executed with substantial precision. Effective neuromodulatory strategies can be formulated by using electrophysiological features and clinical presentation information as guidelines.
    Archives of Physical Medicine and Rehabilitation 09/2014;
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    ABSTRACT: Objective: To analyze mediolateral joint powers at the low back during gait among persons with and without unilateral transfemoral amputation, to better understand the functional contributions of tissues in/surrounding the low back to altered lateral trunk movements in this population. Design: Retrospective analysis of biomechanical gait data. Setting: Gait laboratory. Participants: Twenty persons with unilateral transfemoral amputation and 20 uninjured controls. Interventions: Not applicable. Main Outcome Measure(s): Net joint powers, and total generation (+) and absorption (-) energies, at the low back (L5/S1 spinal level) were analyzed in the frontal plane using inverse dynamics analyses on overground gait data collected at self-selected walking speeds (∼1.3 m/s). Results: Compared to uninjured controls, four distinctly larger positive phases of mediolateral joint power at L5/S1 were evident in persons with transfemoral amputation, occurring prior to and following each heel strike. Total generation energies throughout the gait cycle were also larger (P < 0.001) among persons with transfemoral amputation [4.8 (1.4) J] compared to uninjured controls [1.3 (0.7) J]. Conclusions: Larger positive phases of joint power at L5/S1 in the frontal plane support prior suggestions that persons with transfemoral amputation use a more active mediolateral trunk movement strategy. Although, such an active trunk movement strategy with transfemoral amputation may contribute to higher metabolic energy expenditures and low back pain risk.
    Archives of Physical Medicine and Rehabilitation 08/2014;
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    ABSTRACT: Objective To identify measures of adherence to non-pharmacological self-management treatments for chronic musculoskeletal (MSK) populations, and report on the measurement properties of identified measures. Data sources Five databases were searched for all study types that included a chronic MSK population, an unsupervised intervention and a measure of adherence. Study selection Two independent researchers reviewed all titles for inclusion using criteria: adult (>18yrs) participants with a chronic MSK condition; the intervention included an unsupervised self-management component; and it contained a measure of adherence to the unsupervised self-management component. Data extraction Descriptive data regarding populations, unsupervised components, measures of unsupervised adherence (items and response options) were collected from each study by one researcher and checked by a second for accuracy. Data synthesis No named or referenced adherence measurement tools were found, but a total of 47 ‘self-invented measures’ were identified. No ‘measure’ was used in more than a single study. In terms of methods they could be grouped into: home diaries (n=31); multi-item questionnaires (n=11) and single-item questionnaires (n=7). All measures varied in type of information requested and scoring method. The lack of established tools precluded quality assessment of the measurement properties using COSMIN methodology. Conclusions Despite the importance of adherence to self-management interventions, measurement appears to be conducted on an ad hoc basis. It is clear that there is no consistency among adherence measurement tools and that the construct is ill-defined. This study alerts the research community to the gap in measuring adherence to self-care in a rigorous and reproducible manner. Thus, we need to address this gap by using credible methods (e.g. the COSMIN guidelines) to develop and evaluate an appropriate measure of adherence for self-management.
    Archives of Physical Medicine and Rehabilitation 08/2014;
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    ABSTRACT: Objective To investigate the effectiveness of MT combined with bilateral arm training and graded activities to improve motor performance in the paretic upper limb following stroke. Design Randomized, controlled, assessor – blinded study. Setting Inpatient stroke rehabilitation center of a tertiary care teaching hospital. Participants Twenty patients with first time ischemic or hemorrhagic stroke, confined to the territory of the middle cerebral artery, onset less than 6 months prior to commencement of the study. Intervention MT and control group participants underwent a patient specific multi-disciplinary rehabilitation program including conventional occupational therapy, physical therapy and speech therapy for 5 days per week, 6 hours a day, over three weeks The participants in the MT group received one hour of MT in addition to the conventional stroke rehabilitation. Main Outcome Measures The Upper Extremity Fugl-Meyer Assessment (FMA) for motor recovery, Brunnstrom stages of motor recovery for the arm and hand, Box and Block test (BBT) for gross manual hand dexterity and Modified Ashworth Scale to assess the spasticity (MAS). Results After three weeks of MT, the mean change scores were significantly greater in the MT group than in the control group for the FMA (P = 0.008), Brunnstrom stages for arm (P = 0.003) and hand (P = 0.003) and BBT (P = 0.022). No significant difference was found between the groups for MAS (P = 0.647). Conclusions MT when combined with bilateral arm training and graded activities was effective in improving motor performance of the paretic upper limb following stroke than conventional therapy without the MT.
    Archives of Physical Medicine and Rehabilitation 07/2014;
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    ABSTRACT: Objective To explore patterns of change in positive affect, general adjustment to lower limb amputation, and self-reported disability from rehabilitation admission to 15 months post-discharge; to examine whether goal pursuit and goal adjustment tendencies predict either initial status or rates of change in these outcomes, controlling for sociodemographic and clinical covariates. Design Prospective cohort study with four time points (T1 = on admission; T2 = 6 weeks post-discharge; T3 = 6 months post-discharge; T4 = 15 months post-discharge). Setting: Inpatient rehabilitation. Participants Consecutive sample of 98 persons aged 18 years and over with major lower limb amputation. Interventions Not applicable. Main Outcome Measures Positive affect subscale of the Positive and Negative Affect Scales (PANAS); general adjustment subscale of Trinity Amputation and Prosthesis Experience Scales-Revised (TAPES-R); World Health Organisation Disability Assessment Schedule Version 2.0 (WHODAS 2.0). Results Positive affect decreased from T1 to T4 for the overall sample, while general adjustment increased; self-reported disability scores remained stable over this period. Stronger goal pursuit tendencies were associated with greater positive affect at T1, stronger goal adjustment tendencies were associated with more favourable initial scores on each outcome examined. With regard to rates of change, stronger goal pursuit tendencies buffered against decreases in positive affect and promoted decreases in self-reported disability over time, while stronger goal adjustment tendencies enhanced increases in general adjustment to lower limb amputation. Conclusions Greater use of goal pursuit and goal adjustment strategies appears to promote more favourable adjustment to lower limb amputation over time across a range of important rehabilitation outcomes.
    Archives of Physical Medicine and Rehabilitation 06/2014;
  • Archives of Physical Medicine and Rehabilitation 05/2014; 95(5):1011–1012.
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    ABSTRACT: Objective: To explore gender differences in experiences of transitioning to adult health care among youth with acquired brain injury (ABI) who are part of a co-ordinated model of transitional care. Design: A descriptive design using in-depth qualitative interviews. Setting: Interviews with youth and parents were conducted over the phone, in person, in the home and at a rehabilitation hospital. Participants: Eighteen participants, including ten youth (6 males and 4 females, including 1 by parent proxy) and nine parents (8 female, 1 male) from the Greater Toronto Area, Ontario Canada. Youth were aged between 19 and 21 years and had a diagnosis of ABI. Interventions: Not applicable. Main outcome measure: Semi-structured interviews with participants. Results: Our findings highlight several commonalities and differences relative to sex / gender for youth with ABI who are transitioning from pediatric to adult care. Both males and females experienced a similar transition process, organization, continuity and availability of care. Gender differences were found in relational factors such as communication, family involvement and social support. Conclusions: Our findings show that male and female youth with ABI who have taken part in a transition preparation program experience similarities in continuity, organization and availability of care but differences in relational factors such as communication and family involvement. Our study addresses an important gap in the literature on transition from pediatric to adult care by teasing out youth’s experiences by gender.
    Archives of Physical Medicine and Rehabilitation 04/2014; in press.
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    ABSTRACT: Objective To report the prevalence of cardiometabolic risk factors in a cohort of adults with cerebral palsy (CP) and to investigate the ability of anthropometric measures to predict these factors. Design Cross-sectional study Setting Testing took place in a laboratory setting Participants Fifty-five adults with CP (mean±SD age 37.5±13.3 yr; Gross Motor Function Classification System levels I-V) participated in this study. Interventions Not applicable Main Outcome Measures Total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, glucose, insulin and C-reactive protein were measured from a fasting venous blood sample. Insulin resistance was calculated using the Homeostasis Model Assessment Index (HOMA-IR). The metabolic syndrome was defined according to the 2009 Joint Interim Statement. Blood pressure, body mass index (BMI), waist circumference (WC), waist-hip ratio and waist-height ratio were also measured. Results The prevalence of the metabolic syndrome was 20.5% in ambulatory adults and 28.6% in non-ambulatory adults. BMI was associated with HOMA-IR only (β=0.451, p<0.01). WC was associated with HOMA-IR (β=0.480, p<0.01), triglycerides (β=0.450, p<0.01) and systolic blood pressure (β=0.352, p<0.05). Receiver operating characteristic curve analysis revealed that WC provided the best indication of hypertensive blood pressure, dyslipidaemia, HOMA-IR, and the presence of multiple risk factors (area under the curve values of 0.713-0.763). Conclusion A high prevalence of the metabolic syndrome was observed in this relatively young sample of adults. WC was a better indicator of a number of risk factors compared to BMI and presents as a clinically useful method of screening for cardiometabolic risk among adults with CP.
    Archives of Physical Medicine and Rehabilitation 01/2014;
  • Archives of Physical Medicine and Rehabilitation 01/2014;
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    ABSTRACT: Objective Quadriceps arthrogenic muscle inhibition (AMI) is a common complication following knee pathology that produces quadriceps dysfunction and increases the risk of post-traumatic osteoarthritis. Direct (local muscle vibration-LMV) and indirect (whole body vibration-WBV) vibratory stimuli facilitate quadriceps activity and may minimize quadriceps AMI. The purpose of this investigation was to evaluate the effects of WBV and LMV on quadriceps function following experimental knee effusion (i.e. simulated pathology). Design Randomized controlled trial. Setting Research laboratory. Participants Forty-three healthy volunteers were randomized to WBV (n=14), LMV (n=16), and Control (n=13) groups. Interventions Saline was injected into the knee to induce quadriceps AMI. All groups then performed isometric squats while being exposed to WBV, LMV, or no vibration (Control). Main Outcome Measures Quadriceps function was assessed at baseline, immediately following effusion, and immediately and 5min following each intervention (WBV, LMV, or Control) via voluntary peak torque (VPT) and Central Activation Ratio (CAR) during maximal isometric knee extension on a multi-function dynamometer. Results CAR improved in the WBV (+11.4%, p=0.021) and LMV (+7.3%, p<0.001) groups immediately post-intervention, but not in the Control group. Similarly, VPT increased 16.5% (p=0.021) in the WBV group and 23.0% (p=0.078) in the LMV group immediately post-intervention, but not in the Control group. The magnitudes of improvements in CAR and VPT did not differ between the WBV and LMV groups. Conclusion Quadriceps strengthening following knee pathology is often ineffective due to AMI. WBV and LMV improve quadriceps function equivocally following simulated knee pathology, effectively minimizing quadriceps AMI. Therefore, these stimuli may be used to enhance quadriceps strengthening, thus improving the efficacy of rehabilitation and reducing the risk of osteoarthritis.
    Archives of Physical Medicine and Rehabilitation 01/2014;
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    ABSTRACT: Karpal tünel sendromunda (KTS) en sık karşılaşılan elektrodiagnostik bulgular: avuçiçi-bilek ve parmak- bilek segmentlerinde duyu iletim hızlarında yavaşlama ve amplitüt küçülmesi ve abdüktör pollisis brevis kasından kayıtla bakılan distal motor latansta gecikmedir. Bazı hastalarda abdüktör pollisis brevis kasından kayıtla elde edilen bilek-dirsek motor iletim hızında yavaşlama da izlenebilmektedir. Bu yavaşlama iki muhtemel mekanizma ile açıklanmaktadır: Birincisi hızlı ileten miyelinli liflerin karpal tünelden geçerken iletim bloğuna uğraması sonucu daha yavaş ileten aksonların hızın belirlenmesinde ön plana çıkması; ikincisi retrograd aksonal atrofi veya retrograd ileti yavaşlamasıdır. Ön kolda median karışık sinir iletim hızının ölçümü bize hangi mekanizmanın doğru olduğu konusunda fikir verebilmektedir. Bu çalışmada ön kol median motor iletim hızı normal sınırlarda olan 90 KTS’li ile 100 kontrol olgu karşılaştırılarak hızlar ve amplitütler arası fark olup olmadığı araştırıldı. KTS olanlarda kontrollere göre ön kol median motor hızlarında ve amplitütlerinde anlamlı bir azalma tespit edildi. Çalışmanın ikinci aşamasında bulunan bu ön kol median motor iletim hızındaki yavaşlamanın mekanizmasını açıklayabilmek için KTS’liler ile kontrol grubunun ön kol median karışık sinir amplitütleri (B-D BSAP amp) ile direk ve hesaplanan ön kol median karışık sinir iletim hızları karşılaştırıldı. KTS’li olgular ile kontroller arasında direk ön kol median karışık sinir iletim hızları arasında anlamlı bir fark tespit edilmedi. Ancak hesaplanan ön kol median karışık sinir hızında ve ön kol median karışık sinir aksiyon potansiyeli amplitütünde KTS’li olgular ve kontroller arasında anlamlı bir farklılık mevcuttu. Bu çalışmada elde edilen bulgular; KTS’de iletim yavaşlamasının karpal tünelin distalinde gibi görünse de aslında proksimalinde de birtakım olaylar olduğunu düşündürmektedir. Ön kol median motor ve ön kol karışık sinir aksiyon potansiyellerinin amplitütlerinin KTS’liler ile kontroller arası anlamlı derecede farklı bulunması da retrograd bir aksonal atrofinin varlığını düşündürmektedir.
    Archives of Physical Medicine and Rehabilitation 01/2014;
  • Archives of Physical Medicine and Rehabilitation 01/2014;
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    ABSTRACT: Abstract Objective To provide self-scoring templates for the Functional Independence Measure (FIM®) instrument’s motor and cognitive scales that enable clinicians to monitor progress during rehabilitation using equal-interval Rasch-calibrated measures instead of ordinal raw scores. Design Secondary analysis of a prospective, observational cohort study. Setting Six geographically dispersed hospital-based rehabilitation centers in the U.S. Participants Subset of consecutively enrolled individuals with new traumatic spinal cord injuries discharged from participating rehabilitation centers (N=1146). Intervention Not applicable. Main Outcome Measures Subscores of the Functional Independence Measure, including a 13- item motor scale, a 5-item Cognitive scale, an 11-item (without sphincter control items) motor scale, a 3-item transfer scale, a 6-item self-care scale, 3-item self-care upper extremity scale, and a 3-item self-care lower extremity scale. Results KeyForms for the FIM® scales allow clinicians and investigators to estimate patients’ functional status and monitor progress. In cases with no missing data, the look-up tables provide more accurate estimates of patients’ functional status. Conclusion Clinicians can use the KeyForms and look-up tables for FIM® subscales to monitor patients’ progress and communicate improvement in units that are equal-interval.
    Archives of Physical Medicine and Rehabilitation 12/2013;
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    ABSTRACT: OBJECTIVE: To examine intra-individual variability of kinetic and temporal-spatial parameters of wheelchair propulsion as a function of shoulder pain in manual wheelchair users (MWU). DESIGN: Cohort SETTING: University Research Laboratory PARTICIPANTS: 26 adults with physical disabilities who use a manual wheelchair for mobility full time (>80% ambulation) INTERVENTIONS: Participants propelled their own wheelchairs with force sensing wheels at a steady state pace on a dynamometer at 3 speeds (self-selected, 0.7m/s, 1.1m/s) for 3 minutes. Temporal-spatial and kinetic data were recorded unilaterally at the hand rim. MAIN OUTCOME MEASURES: Shoulder pain was quantified with the wheelchair users shoulder pain index (WUSPI). Intra-individual mean, standard deviation (SD), and coefficient of variation of (CV = mean/SD) with kinetic and temporal spatial metrics were determined at the handrim. RESULTS: There were no differences in mean kinetic and temporal spatial metrics as a function of pain group (p's > 0.016). However, individuals with pain displayed less relative variability (CV) in peak resultant force and push time then pain free individuals (p<0.016). CONCLUSIONS: Shoulder pain had no influence on mean kinetic and temporal-spatial propulsion variables at the handrim however group differences were found in relative variability. These results suggest that intra-individual variability analysis is sensitive to pain. It is proposed that variability analysis may offer an approach of earlier identification of manual wheelchair users at risk for developing shoulder pain.
    Archives of Physical Medicine and Rehabilitation 11/2013;