Evaluation of the accuracy of ChatGPT's responses to and references for clinical questions in physical therapy.

[Purpose] This study evaluated the accuracy of ChatGPT's responses to and references for five clinical questions in physical therapy based on the Physical Therapy Guidelines and assessed this language model's potential as a tool for supporting clinical decision-making in the rehabilitation field. [Participants and Methods] Five clinical questions from the "Stroke", "Musculoskeletal disorders", and "Internal disorders" sections of the Physical Therapy Guidelines, released by the Japanese Society of Physical Therapy, were presented to ChatGPT. ChatGPT was instructed to provide responses in Japanese accompanied by references such as PubMed IDs or digital object identifiers. The accuracy of the generated content and references was evaluated by two assessors with expertise in their respective sections by using a 4-point scale, and comments were provided for point deductions. The inter-rater agreement was evaluated using weighted kappa coefficients. [Results] ChatGPT demonstrated adequate accuracy in generating content for clinical questions in physical therapy. However, the accuracy of the references was poor, with a significant number of references being non-existent or misinterpreted. [Conclusion] ChatGPT has limitations in reference selection and reliability. While ChatGPT can offer accurate responses to clinical questions in physical therapy, it should be used with caution because it is not a completely reliable model.

A retrospective study on return to living alone of stroke patients who were living alone before stroke.

[Purpose] To identify factors that affect the return to solitary living of patients with stroke who had lived alone prior to stroke onset. [Participants and Methods] From January 2017 to March 2020, we enrolled a total of 103 patients with stroke who had lived alone prior to stroke onset and retrospectively analyzed their age, gender, length of hospital stay, outcome (return to living alone or not), functional independence measure at discharge, and social score at discharge. We also analyzed the relationship between the above factors and the outcome. [Results] Functional independence measure and social score at discharge were significantly associated with the outcome. The cutoff value of the functional independence measure at discharge was 91 (area under the curve: 0.91; sensitivity: 0.96; specificity: 0.72), while the rate of return to living alone was 23.5% when the social score was ≥3. The sensitivity and specificity for return to living alone were 0.91 and 0.88, respectively, when cutoff values of the functional independence measure and social score at discharge were 91 and 3, respectively. [Conclusion] Social factors and ability to perform activities of daily living are important for return to solitary living for patients with stroke who lived alone prior to stroke onset.

Spastic muscle stiffness evaluated using ultrasound elastography and evoked electromyogram in patients following severe traumatic brain injury: an observational study.

OBJECTIVE: To determine the relationship between muscle stiffness assessed using ultrasound shear wave elastography, spinal motor neuron excitability assessed using the F wave, and clinical findings of spasticity in patients with spastic muscle overactivity following severe traumatic brain injury. METHODS: This study enrolled 17 inpatients with severe traumatic brain injury and 20 healthy volunteers. Biceps brachii muscle stiffness was then evaluated using ultrasound shear wave speed. Spinal motor neuron excitability was evaluated using the F/M ratio recorded from abductor pollicis brevis muscle. Clinical parameters, such as the modified Ashworth scale and modified Tardieu scale, were assessed in the patient with traumatic brain injury. RESULTS: The patients with traumatic brain injury group had a significantly higher shear wave speed and F/M ratio compared with the healthy group. A higher shear wave speed was correlated with higher clinical spastic severity in patients with traumatic brain injury. The F/M ratio was not significantly correlated with clinical spastic severity. CONCLUSION: Ultrasound shear wave elastography might be helpful for assessing muscle stiffness in patients with spastic muscle overactivity following severe traumatic brain injury. Further studies comprising larger cohorts are warranted.

Brainstem volume, diffusion, and metabolism are associated with chronic consciousness disorders after traumatic brain injury.

BACKGROUND AND PURPOSE: We aimed to identify reliable neuroradiological features of the brainstem reflecting the neurological symptoms of patients with chronic disorders of consciousness (DOCs) due to severe traumatic brain injury (TBI). METHODS: We retrospectively examined 86 patients with chronic DOCs due to severe TBI caused by automobile accidents. We studied the relationships among (1) neurological symptoms, including consciousness level, (2) integrated cognitive/physical condition, and (3) neuroradiological features of the brainstem (brainstem volume on MRI, fractional anisotropy [FA] value in the brainstem, and standardized uptake value [SUV] of 18F-fluorodeoxyglucose [FDG] on positron emission tomography in the brainstem). RESULTS: Brainstem volume was significantly larger and FA values were significantly higher in patients with a better level of consciousness. However, brainstem volumes were significantly decreased and the maximum SUV (SUVmax ) of FDG significantly increased at 2 years following admission regardless of the level of consciousness at admission. The brainstem volume was significantly larger and the FA value and SUVmax of FDG were significantly higher in patients with better National Agency for Automotive Safety and Victims' Aid (NASVA) scores at admission. The decrease in the brainstem volume was significantly minimized and the SUVmax of FDG significantly increased in patients with more improvement in the NASVA score 2 years after admission. CONCLUSIONS: The volume, FA value, and SUVmax of FDG of the brainstem are important neuroradiological features associated with the neurological conditions of patients with chronic DOCs due to severe TBI.

Effect of fascial Manipulation® on reaction time.

INTRODUCTION: This study aimed to investigate the effects of fascial manipulation (FM) on muscle force and electrical activity. METHODS: Sixty healthy adult participants were randomly assigned to the FM intervention group (FM group; n = 20), static stretching intervention group (SS group; n = 20), and control group (C group; n = 20). The FM group underwent FM for the right brachial fascia (antecubitus) for 210 s. The SS group underwent static stretching of the right biceps brachii for 210 s. The C group was supine for 210 s. Participants were asked to flex the right elbow joint as quickly as possible after a light signal appeared during three sessions (before, immediately after, and 1 week after the intervention). During each session, the muscle activity of the right biceps brachii and bending force of the right elbow joint were measured. We calculated the reaction time (RT), pre-motor time (PMT), motor time (MT), time to peak force (TPF), and time to peak activity (TPA) from these measurements. RESULTS: The RT, MT, TPA, and TPF of the FM group were significantly shorter immediately after or 1 week after the intervention compared with those before the intervention. The RT, MT, TPA, and TPF of the FM group were significantly shorter than those of the SS group or C group immediately after or 1 week after the intervention. CONCLUSION: FM improved RT, MT, TPA, and TPA, and the effects lasted for 1 week. Both mechanical and neurological factors may contribute to improvements in motor performance after FM.