Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 26 appraisals
Indian journal of ophthalmology
Internet of things in assistive technology for people with visual impairment: A scoping review
Assistive technology (AT) can significantly enhance functional abilities among persons with disabilities. Recently, a rapid advance in computer and Internet of Things (IoT)-based AT has been observed with the integration of Artificial Intelligence. The present scoping review explores a range of IoT-based AT for vision impairments, focusing on their functioning, reliability, and identifying the existing gaps and opportunities for future enhancement. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search was conducted for the articles published between 2020 and March 2025. After the initial screening of both titles and abstracts of 705 articles, 18 full-text articles were selected for the review. It was found that the majority of the papers (38%) are related to smart canes/sticks. The findings indicate that several studies use Raspberry Pi and Arduino platform to make products cost-effective and flexible options for real-time processing. The accuracy of these devices ranges from 87.8% in navigation to 93% in voice control and 100% in object identification. Further, challenges such as usability testing, hardware limitations, dataset constraints, and environmental adaptability remain a matter of concern which need to be addressed in future innovation. Incorporating IoT technologies into vision-assistive devices has substantially improved accessibility. Future research should focus on enhancing real-time performance, AI-driven decision-making, and user-centric designs.
1 Aug 2026
Read appraisal →Biomedical physics & engineering express
EEG-EMG spatiotemporal cross-attention fusion network for functional upper-limb movement classification
Objective. Electroencephalography (EEG) and electromyography (EMG) are widely used for decoding motor intentions, yet unimodal approaches often suffer from low robustness and limited representational information. EEG-EMG hybrid brain-computer interfaces (BCIs) can bridge cortical intention and muscular execution, but challenges remain in signal alignment, fusion modeling, and clinical generalization.Approach. To address these issues, we propose spatio-temporal cross-attention fusion (STCAFusion), a spatiotemporal cross-attention (CA) framework that integrates EEG and EMG through multi-band based dual-branch convolutional encoders and parallel temporal and spatial CA modules. This design enables detailed modeling of inter-modal correlations across both time and space. We evaluate STCAFusion on a newly collected dataset of synchronous EEG-EMG recordings from 12 subjects, where the data were acquired under two paradigms (Reaching and Lifting) designed from daily functional upper-limb activities to emphasize directional and strength control.Main results. With leave-one-run-out cross-validation, STCAFusion achieves average accuracies of 84.15% and 95.22% in the two paradigms, outperforming the strongest competing EEG-EMG fusion baselines by 3.4% in the Reaching paradigm and 1.8% in the Lifting paradigm. Visualization of learned attention weights further reveals meaningful spatiotemporal EEG-EMG coupling patterns, offering insights into neural-muscular coordination patterns relevant to rehabilitation-oriented BCI design.Significance. These results highlight the potential of CA-based multimodal physiological signal fusion in building reliable hybrid BCI and wearable devices for upper-limb control and rehabilitation.
14 July 2026
Read appraisal →Science advances
Transforming static interfaces into tactile channels with steerable transdermal foci
Grasping objects such as handles, mice, and phones plays a central role in human-machine interaction, yet the contact surfaces of the hand, despite their exquisite tactile sensitivity, are rarely exploited as channels for information transfer. Here, we introduce transdermal all-directional targeting (TADT), a static-contact interface design strategy that converts passive grip surfaces into active tactile displays, allowing users to grasp stably while receiving spatially and temporally evolving information on the fingertips. TADT enhances sub-actuator-pitch energy delivery by integrating a microtextured skin-coupling interface with phase-controlled vibrotactile actuation, thereby generating steerable three-dimensional tactile foci beneath the skin, enabling >200-hertz vibration and sub-actuator-pitch spatial super-resolution. Psychophysical experiments show that TADT lowers detection thresholds by 30% and reduces power consumption by 80% compared with designs without TADT. Using static grip alone, users reliably identified six directional cues and completed nonvisual indoor navigation and virtual reality interaction tasks, demonstrating a compact, energy-efficient modality for expressive tactile communication.
12 July 2026
Read appraisal →Science advances
Motor-free hip exosuit via high-output fibrous dielectric elastomer actuators
Exosuits can assist gait and reduce fatigue for both healthy and pathological populations, yet their bulky, rigid actuators (usually motors or pneumatic actuators) hinder natural, comfortable movement. Dielectric elastomer actuators (DEAs) provide a lightweight, compliant alternative, but are constrained by insufficient force, energy output, and integration challenges. Herein, we propose a motor-free hip exosuit driven by high-output fibrous DEAs, offering a previously unexplored paradigm for lower-limb assistance. We develop high-aspect-ratio fibrous DEAs that deliver high blocked stress (381.6 mN·mm-2), energy density (260 J/kg), and power density (1,664 W/kg), enabled by a dual-polar molecular design of the elastomer to overcome the intrinsic trade-offs between dielectric and mechanical properties. A Lego-like integration strategy is established to efficiently bundle fibers for force amplification. The resulting exosuit reduces the walking metabolic cost by 13.9% compared to no assistance, surpassing most hip exoskeletons. These findings advance DEAs toward practical wearable robotics for real-world human assistance.
12 July 2026
Read appraisal →Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
Combined transcranial direct current stimulation and mirror therapy for upper limb rehabilitation in patients with stroke: a systematic review and meta-analysis
Upper limb impairment is among the common consequences of stroke. Combining transcranial direct current stimulation (tDCS) and mirror therapy (MT) have recently been used to improve neural plasticity and functional recovery. This review aims to evaluate the effects of combined tDCS and MT on upper limb function in patients with stroke. "PubMed, Scopus, Web of Science, CINAHL, PEDro, and EMBASE" were searched from their inception to March 2026. Randomized controlled trials investigating the combination of tDCS and MT in patients with stroke and assessing upper limb function were included. The quality and the certainty of evidence were evaluated. Seven studies (454 participants) met the eligibility criteria. Significant improvements were demonstrated in upper limb motor function (SMD = 0.73, 95% CI 0.34 to 1.12, p = 0.0002), activities of daily living (SMD = 0.84, 95% CI 0.46 to 1.22, p < 0.0001), and neurophysiological outcomes reflecting corticospinal conduction efficiency, assessed using central motor conduction time (CMCT) (SMD = -1.26, 95% CI -1.60 to -0.92, p < 0.0001). Subgroup analysis demonstrated greater effects in subacute stroke (SMD = 1.03, 95% CI 0.73 to 1.33). Other outcomes reported improvements in hand function and grip strength. Preliminary evidence suggests that combining tDCS and MT may improve upper limb motor and functional outcomes after stroke; however, these findings should be interpreted with caution due to heterogeneity and the limited data. Further studies are strongly needed.
11 July 2026
Read appraisal →PloS one
Effects of immersive virtual reality on limb motor function, balance, gait and quality of life after stroke: A systematic review and meta-analysis
Immersive virtual reality (IVR) has been increasingly integrated into stroke rehabilitation albeit the effectiveness across different outcome domains remains unclear. This study aimed to review evidence from randomized controlled trials evaluating the effects of IVR, used alone or in combination with conventional rehabilitation, on motor-, functional-, and participation-related outcomes after stroke. Ovid MEDLINE, Embase, Cochrane Library and CINAHL were screened up to April 2025 to identify eligible randomized controlled trials (RCTs). A systematic literature search was conducted. Randomized controlled trials including adults with stroke and evaluating immersive virtual reality interventions were eligible. Studies using non-immersive VR, non-randomized designs, or not reporting motor, functional, or participation outcomes were excluded. Meta-analyses were performed where data were sufficiently homogeneous; otherwise, outcomes were summarized descriptively. Risk of bias was assessed using standardized appraisal tools, and certainty of evidence was evaluated using the GRADE approach. Out of 3,574, we included 34 RCTs involving post-acute, subacute and chronic stroke survivors, with a total of1200 participants. Meta-analyses showed IVR, most commonly delivered in combination with conventional rehabilitation, to be associated with improvements in upper extremity motor impairment, particularly measured by the Fugl-Meyer Assessment Upper Extremity (FMA-UE). Small but significant effects were also found for selected gait parameters. In contrast, effects on functional performance, balance, and quality of life were inconsistent and could not be robustly quantified. The overall certainty of evidence ranged from low to very low, primarily due to heterogeneity, methodological limitations, and small sample sizes. In conclusion, IVR appears to be a promising and safe supplement to conventional stroke rehabilitation, particularly for improving motor impairment. However, evidence remains limited and inconsistent across functional outcomes. More well-designed, adequately powered trials with standardized interventions and clinically meaningful outcome measures are needed to clarify the role of IVR in stroke rehabilitation. PROSPERO (Registration number: CRD420250639792).
7 July 2026
Read appraisal →Brain impairment : a multidisciplinary journal of the Australian Society for the Study of Brain Impairment
Rehabilitation technologies perceived positively by patients and facilitated intensive therapy within sessions.
BACKGROUND: Australian inpatient rehabilitation facilities are increasingly integrating rehabilitation technologies to support patient recovery. However, little is known about patient perceptions of rehabilitation technologies and the intensity of therapy able to be facilitated. This study aimed to quantify the amount of practice being achieved by patients in an Australian inpatient rehabilitation setting and explore their perceptions of upper limb rehabilitation technologies. METHODS: A multimethod study design was used to investigate the perceptions and use of rehabilitation technologies (i.e. InMotion, Fourier ArmMotus, SaeboReJoyce and Touch Accessible Platform for Interactive Technology) by adult inpatients. Semi-structured interviews and the System Usability Scale were completed. Observations of routine therapy sessions were undertaken to quantify the amount and intensity of technology-based practice. RESULTS: Ten participants were recruited (50% male, mean age 62 years). A total of 15 sessions were observed across all participants using robot-assisted therapy and Touch Accessible Platform for Interactive Technology at an average duration of 35 min/session; of which 29 min was active therapy. Most participants described their experiences with rehabilitation technologies positively, highlighting benefits for recovery, enjoyability and easy usability. Participants rated the technologies highly on the System Usability Scale, with total scores ranging between 65 and 100 for usability, and a minimum rating of 'good' for user-friendliness. CONCLUSION: Rehabilitation technologies were well received by adults undergoing inpatient rehabilitation and with application for a range of impairments. The technologies facilitated enjoyment of daily therapy, and participants were comfortable with limited therapist input when using the devices. Additionally, participants were able to engage in highly intensive practice using the technologies.
27 June 2026
Read appraisal →ACS applied materials & interfaces
Biodegradable Electrohydraulic Actuators for Wearable Haptic Interfaces
Biodegradable soft actuators have gained significant attention due to their inherent conformability, adaptability, and ability to safely interact with humans, while substantially reducing long-term environmental waste. Although various biodegradable materials have been explored for fabricating soft devices and their electrical interfaces, many still suffer from limited durability and operational stability under ambient conditions. In particular, biodegradable electrohydraulic actuators often exhibit a performance degradation over time. In this work, we systematically evaluate the influence of various biodegradable materials, including compliant electrodes, dielectric films, and dielectric fluids, on actuator performance. The optimal material combination was identified and used to fabricate a biodegradable actuator that demonstrated stable operation over 10,000 cycles with no noticeable variation in actuation strain. Under industrial composting conditions, the device underwent degradation within 50 days, supporting its environmental sustainability. Furthermore, a wrist-worn biodegradable haptic device is demonstrated that is capable of generating diverse and salient tactile sensations, highlighting its potential applications in assistive technology and virtual/augmented reality.
25 June 2026
Read appraisal →Behavioural brain research
Sex differences in the use of spatial strategies in humans: An updated systematic review of the last decade.
Although sex differences in spatial cognition have been widely studied, the extent to which men and women differ in their use of egocentric and allocentric spatial strategies remains unclear. This systematic review summarizes findings from 21 studies published between 2014 and 2024 that examined sex differences in spatial strategy use throughout development, adulthood, and aging. Studies were identified through searches of Scopus, Web of Science, PubMed, and PsycINFO, in accordance with PRISMA guidelines. Eligible articles examined egocentric and allocentric spatial strategies in humans and reported results by sex. Results demonstrated male advantages in allocentric strategy, as observed in thirteen studies involving children, young adults, and older adults. Men also outperformed women in several navigation outcomes, including target retrieval, route efficiency, and directional accuracy. Evidence for a female advantage in egocentric strategies was limited and inconsistent. Seven studies reported no sex differences, particularly those using small-scale, familiar, or less immersive tasks. This suggests that methodological factors and task demands strongly influence the observed effects. Age also influenced outcomes. Male advantages in allocentric strategies emerged in early childhood. Older women showed relatively preserved egocentric abilities, but greater decline in allocentric tasks. Men showed stronger hippocampal-parietal connectivity supporting allocentric processing, while women exhibited enhanced fronto-temporal connectivity. Hormonal studies highlight the context-dependent effects of testosterone and estrogen. These findings indicate that sex differences in spatial strategies are highly sensitive to task complexity, environmental familiarity, cognitive load, and individual factors. These findings emphasize the necessity of integrative models that consider developmental, neurobiological, and sociocultural contributors.
25 June 2026
Read appraisal →Bioinspiration & biomimetics
A bioinspired hybrid robotic joint for safer physical human-robot interaction
In many robotic applications, such as humanoids, wearable robots or supernumerary limbs, there is a growing shift from rigid, traditional mechanisms toward softer, more compliant systems. This trend is driven by the need for safer physical human-robot interaction and the ability to operate in unstructured environments. In this work, we present a hybrid approach to controlling a single-degree-of-freedom robotic joint that combines a rigid frame with soft pneumatic actuators to enable both precise and versatile interaction. The joint is bioinspired, as it is powered by a couple of actuators mounted in an antagonist configuration, such as the human elbow. A key innovation is the design of pneumatic artificial muscles using thermoplastic polyurethane, which achieve high isometric force (400 N at 240 kPa), significant stretchability (80 mm), and low density(0.3gcm-3), making them competitive with state-of-the-art alternatives. Two model-free controllers were developed to independently regulate joint position and stiffness. Angle control achieved high precision (<2∘RMSE) with minimal overshoot (<1%) and fast response (rise time<1.3s). Stiffness control modulated joint compliance across a range of 0.054-0.076 Nm deg-1, with the expected trade-off of reduced workspace. A final proof-of-concept demonstrated the concurrent use of both controllers to modulate the joint's dynamic behavior in response to external disturbances. While future work will address multi-DOF coordination and wearable integration, this study represents a foundational step toward safe, adaptable robotic actuation through the combination of rigid structures and soft actuation.
21 June 2026
Read appraisal →ACS applied materials & interfaces
Breathable and Washable E-Textile with Readily Integrated Piezoelectric Perfluoroalkoxy Fiber for Wide Temperature Range Human Machine Interfaces
Flexible wearable sensors are widely explored for human-machine interaction and health monitoring. Electronic textiles (E-textiles) offer a promising pathway toward comfortable wearable devices by integrating sensing fibers directly into fabric structures. Among them, compared with piezoresistive and capacitive fiber sensors, piezoelectric fiber sensors require no external power supply. Compared with triboelectric fiber sensors, which are highly sensitive to humidity and temperature, piezoelectric fiber sensors provide more stable and reliable electrical signals. However, conventional piezoelectric fiber sensors still face challenges in achieving long-term wearing comfort and reliability under harsh environments. Herein, we develop a breathable, washable, and wide-temperature-tolerant based on piezoelectric perfluoroalkoxy (PFA) fibers, which can be readily integrated into E-textiles. The textile is produced via a weft knitting process that integrates coaxially structured PFA fibers with wool yarns, combining stable piezoelectric performance with wearing comfort. The fibers exhibited a charge sensitivity of (2.6 ± 0.2) pC/N at 0.2 MPa. The resulting E-textile exhibits a charge sensitivity of up to (316.6 ± 45.9) pC/N and a voltage sensitivity of (744.9 ± 73.9) mV/N. The textile maintains stable operation over a wide temperature range from -78 °C to 150 °C. Its weft-knitted structure provides breathability, while the textile also offers washability, UV resistance, and mechanical durability exceeding 10,000 stretching or bending cycles. Furthermore, the textile can effectively monitor various human motions. A smart glove constructed from five-channel PFA fibers achieved recognition accuracies above 95% for five hand gestures, demonstrating the potential offer self-powered E-textile as a wearable sensor for human-machine interaction.
30 May 2026
Read appraisal →ACS nano
All-Printed MXene-Based Springs for Concurrent Bidirectional Hand Motion Capture
Accurately capturing hand movements remains a challenge because the skin undergoes stretching, compression and bending at the same time, yet most flexible sensors respond only to tension. Achieving high sensitivity and a wide range often means making the sensor thick, which causes the sensing layer to shift under complex deformations and distorts the signal. Here, we address this by placing the strain-accommodating space within a plane parallel to the strain direction. Using a MXene/polyurethane ink with glycerol as a molecular bridge, we create a dense hydrogen-bonding network that enables high-resolution printing of a planar spring architecture. The resulting all-printed sensor achieves a gauge factor of 83.7 across a linear bidirectional range of ±60% strain. With just two sensors, we track and decode complex wrist motions with ±10° accuracy. When attached to finger joints, they enable real-time, dexterous control of a virtual hand. This work provides an alternative approach for skin strain capture through synergistic innovation in materials and architecture.
27 May 2026
Read appraisal →Journal of neural engineering
Non-invasive somatotopic proprioceptive feedback for closed-loop robotic hand aperture control
Objective.Current robotic prostheses developed for individuals with transradial amputation often lack physiological feedback, particularly proprioceptive information, which limits control precision and increases reliance on vision.Approach.This study investigates the effect of introducing non-invasive somatotopic feedback using transcutaneous electrical nerve stimulation (TENS) to convey hand aperture information, as an artificial form of proprioceptive feedback. Twenty healthy participants with intact limbs were divided into two groups: one receiving TENS-based feedback and one without feedback. Participants performed an aperture control task under visual and non-visual conditions, with some trials including a concurrent Stroop task to assess cognitive load. We hypothesized that providing non-invasive somatotopic proprioceptive feedback via TENS mitigates key control and integration challenges, leading to improved accuracy, faster learning, and reduced reliance on vision, without increasing cognitive demands.Main results.Under visual deprivation, participants receiving TENS feedback achieved significantly smaller aperture control errors than those without feedback, both under alternating visual conditions (p<0.001) and under prolonged visual deprivation conditions (p=0.017). From the very first trial, TENS-based feedback enabled control accuracy comparable to that with visual input. Although perceptual shifts affected control accuracy under dual-task conditions, the +TENS group maintained high cognitive performance and effective control toward perceived functional targets, suggesting that the artificial feedback nonetheless supported hand control in the presence of a secondary task.Significance.These findings highlight the potential of non-invasive somatotopic proprioceptive feedback delivered through TENS to provide physiologically meaningful information and support future strategies for restoring proprioceptive function in prosthetic hand users.
27 May 2026
Read appraisal →Journal of rehabilitation medicine
The effect of combined motor and cognitive rehabilitation on motor performance in Parkinson's disease: a systematic review and meta-analysis
OBJECTIVE: To evaluate the effectiveness of sequential and simultaneous motor and cognitive treatment on motor functions, activities of daily living, and quality of life in people with Parkinson's disease. DESIGN: Systematic review and meta-analysis. SUBJECTS/PATIENTS: Patients with Parkinson's disease. METHODS: A search was conducted in PubMed, Embase, Scopus, Web of Science, and Cochrane Library. Functional mobility was assessed as the main outcome, and balance, gait, activities of daily living, and quality of life as secondary outcomes. Meta-analyses were conducted using mean difference or standardized mean difference with 95% confidence intervals and fixed or random effect models. Heterogeneity was explored, setting a cut-off value of I2 = 50%. RESULTS: Sixteen studies were included, with 8 -eligible for meta-analysis. Results showed that sequential combined treatment offered no clear advantage over motor rehabilitation alone for functional mobility, although a significant benefit was found for activities of daily living. Results on simultaneous combined treatment suggested improvements in quality of life, but no significant differences between treatments for functional mobility. CONCLUSION: Motor-cognitive approaches may enhance prefrontal cortex efficiency, supporting complex motor tasks and reducing the risk of falls. Future research should elucidate neural mechanisms and compare simultaneous and sequential strategies to develop personalized, multidisciplinary rehabilitation protocols.
26 May 2026
Read appraisal →Lasers in medical science
Functional and ultrasonographic evaluation of high intensity laser therapy and Kinesio taping in stroke patients with hemiplegic shoulder pain: a randomized controlled trial
Hemiplegic shoulder pain (HSP) is a common post-stroke complication that limits functional recovery and rehabilitation participation. The objective of this study was to evaluate and compare the clinical, functional, and ultrasonographic superiority of High-Intensity Laser Therapy (HILT) and Kinesio Taping (KT) over each other, as well as in comparison to conventional therapy (COT). The study was designed as a prospective, double-blind, randomized controlled trial. Participants were allocated into three equal groups (n = 11 each group): Group 1 (Control Group) received COT with sham HILT and sham KT, Group 2 (HILT Group) received COT with active HILT and sham KT, and Group 3 (KT Group) received COT with sham HILT and active KT. COT was performed five days per week for three weeks, HILT was administered in 10 sessions, and KT was applied every other day for three weeks (nine sessions). The primary outcome measure of the study was the Shoulder Pain and Disability Index (SPADI) score. Secondary outcome measures included pain intensity assessed using the Visual Analog Scale (VAS), passive shoulder range of motion (pROM), ultrasonographic findings, Brunnstrom Recovery Stage (BRS), the Functional Independence Measure (FIM), and the Health Assessment Questionnaire (HAQ). All measures were evaluated at baseline (pre-treatment) and immediately following the intervention period (post-treatment). Data were analyzed using repeated measures ANOVA and McNemar tests. Groups were sociodemographically comparable (p > 0.05). Post-treatment, all groups exhibited significant improvements in shoulder flexion, extension, external rotation, and BRS, VAS, SPADI, FIM, and HAQ scores (p < 0.05). No significant changes occurred in ultrasonographic findings, shoulder abduction, or internal rotation. Notably, HILT demonstrated superior VAS and SPADI improvements compared to other groups (p < 0.05). HILT provides rapid, clinically significant pain relief and functional recovery in HSP without adverse effects, offering a safe and superior therapeutic option.
23 May 2026
Read appraisal →JMIR aging
Leveraging Multimodal Large Language Models for Fall Risk Reduction in Older Adults in the Home: Proposed Model Design
This research letter proposes a novel model design leveraging natively multimodal large language models to identify fall risks and generate visualizations of recommended home environmental modifications, aiming to improve the accessibility and impact of personalized fall prevention advice for older adults. Through a pilot rating study, this work demonstrates that multimodal large language models can generate safe and actionable advice to reduce fall risk in lived spaces of older adults, and also generate realistic edits based on original images. While this concept needs further testing and clinical comparison, it highlights a promising avenue for further innovation of fall prevention tactics.
15 May 2026
Read appraisal →Behavior research methods
A stroke-level large-scale database of Chinese character handwriting and the OpenHandWrite_Toolbox for handwriting research
Understanding what linguistic components (e.g., phonological, semantic, and orthographic systems) modulate Chinese handwriting at the character, radical, and stroke levels remains an important yet understudied topic. Additionally, there is a lack of comprehensive tools for capturing and batch-processing fine-grained handwriting data. To address these issues, we constructed a large-scale handwriting database in which 42 Chinese speakers each handwrote 1200 characters in a handwriting-to-dictation task. Additionally, we enhanced the existing handwriting package and provided comprehensive documentation for the upgraded OpenHandWrite_Toolbox. This toolbox allows users to easily modify the experimental design, capture the stroke-level handwriting trajectory, and batch-process handwriting measurements (e.g., latency and duration). Analysis of our large-scale database indicates that orthographic predictors affect handwriting preparation and execution at the character, radical, and stroke levels. Phonological factors influence handwriting at character and radical levels. Importantly, these lexical effects demonstrate hierarchical attenuation: they were most pronounced at the character level, followed by the radical, and weakest at the stroke level. These findings demonstrate that handwriting preparation and execution at the radical and stroke levels are closely intertwined with linguistic components. This database and toolbox offer valuable resources for future psycholinguistic and neurolinguistic research on the handwriting of characters and sub-characters across different languages.
14 May 2026
Read appraisal →Journal of medical systems
Artificial Intelligence in Physical, Occupational and Neuro-Rehabilitation: Clinical Effectiveness, Prognostic Performance, and Pre-Implementation Feasibility - A Systematic Review
BACKGROUND: Global rehabilitation needs far exceed capacity, and artificial intelligence (AI) is proposed to extend access, personalise therapy, and support adherence. We aimed to synthesise evidence on clinical effectiveness, prognostic performance, and implementation feasibility of AI-enabled rehabilitation across conditions and care settings. METHODS: We conducted a mixed-methods systematic review of AI-enabled rehabilitation and rehabilitation-led prevention relevant to physiotherapy practice. MEDLINE, Embase, Web of Science, CINAHL, Scopus, and IEEE Xplore were searched. Methodological quality was appraised with MMAT and PROBAST + AI (prediction/diagnostic models), with a priori AI-reporting minimums checklist. Given heterogeneity, evidence was integrated via prespecified thematic synthesis. FINDINGS: Thirty studies from diverse regions met inclusion, comprising randomised trials, non-randomised comparisons, cohorts, surveys, qualitative work, and prediction/diagnostic models. Clinical effects were modest and heterogeneous. Most AI-enabled interventions were comparable to conventional rehabilitation; signals of benefit appeared in selected musculoskeletal and telerehabilitation contexts but rarely persisted beyond short follow-up. Internal validity was frequently limited by asymmetric adherence measurement objective telemetry in AI arms versus self-report or attendance in controls alongside low uptake and declining engagement over time. Safety and usability were generally favourable within short horizons, although surveillance and explicit attribution to AI components were inconsistently reported. Prognostic and adaptive models showed encouraging discrimination in development settings but lacked multicentre external validation, calibration, subgroup-error profiling, and prospective impact evaluation, leaving them unready for clinical use. Stakeholders reported willingness to adopt AI while highlighting gaps in training, governance and information technology support, costs, and digital equity. Overall certainty for comparative clinical outcomes was low to moderate, for models, very low. CONCLUSION: AI in rehabilitation presently acts more as a behavioural amplifier structuring home programmes and supporting execution than as a replacement for dose-matched therapist-delivered care. Credible scale-up should position AI as an adjunct and hinge on arm-symmetric capture of adherence and execution, clinically meaningful outcomes paired with verified behaviour change over treatment and longer-term follow-up, and model deployment only after transparent development, external validation with calibration and subgroup-error characterisation, and demonstration of clinical impact. Embedding equity and economic evaluation, together with living oversight and version control, will be essential to convert promising prototypes into trustworthy, durable, and widely accessible services.
14 May 2026
Read appraisal →Science advances
Wearable thumb sleeves enabled by self-supervised learning with few stretchable sensors and few-shot data for switchable finger tasks
Human fingers exhibiting remarkable dexterity are ideal for natural human-machine interaction. Traditional methods require at least one device per finger and extensive labeled data, often limiting models to a single user and task. Here, we propose a wearable thumb sleeve integrated with self-supervised learning, which exhibits user independence and data efficiency, enabling recognition of various finger-related tasks. The thumb sleeve is equipped with only two stretchable sensors at the thumb joints and learns latent features from unlabeled random thumb movement data. By using fine-tuning with five-shot labeled data, it can rapidly adapt to new users and tasks, including eight directional commands and 10 knuckle key inputs. It allows free switching between tasks without the need to reconstruct or retrain the model. The proposed approach demonstrates strong potential for real-world applications, serving as a substitute for a mouse and keyboard to enable tasks such as online shopping.
25 Apr 2026
Read appraisal →JMIR aging
"Living Inside the Walls": Systematic Review and Qualitative Meta-Synthesis
BACKGROUND: Social isolation is a prevalent issue among older people in long-term care facilities (LTCFs), with profound negative impacts on their quality of life and mental health. However, the authentic experiences and underlying mechanisms of social isolation among older people in LTCFs remain understudied. A nuanced understanding of these experiences is essential for designing targeted nursing interventions. OBJECTIVE: This study aimed to systematically review and synthesize qualitative evidence to explore the experiences of social isolation among older adults in LTCFs and analyze them in terms of causes, mechanisms, outcomes, and strategies. METHODS: A systematic review and qualitative meta-synthesis were conducted. We searched PubMed, Web of Science, Embase, PsycInfo, Cochrane Library, CINAHL, Scopus, Chinese Biomedical Literature Database, CNKI, Wanfang Data, and Weipu (VIP) with no restriction on the start year, up to February 2025. Two reviewers (WL and ZM) independently screened studies, extracted data using a Microsoft Excel spreadsheet, and assessed study quality with the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. Qualitative data synthesis was performed following Thomas and Harden's thematic and content analysis method, including line-by-line coding of participant quotes, organizing codes into descriptive themes, and developing analytical themes. RESULTS: A total of 4856 papers were retrieved through systematic searches, and 14 qualitative studies met the inclusion criteria. Four overarching analytical themes were identified: (1) root cause: person-environment mismatch (encompassing 4 interrelated dimensions: imbalance between declining individual capacity and insufficient environmental support, negative self-perception paired with inadequate positive environmental feedback, personal biases conflicting with homogeneous institutional social ecology, and disrupted social roles due to rigid institutional management); (2) overt behavioral patterns: proactive isolation, defensive isolation, and adaptive isolation; (3) inner emotional experiences: feelings of confinement, sorrow, and weariness; and (4) strategies for restoring person-environment match: active engagement in interaction, rational acceptance of coexistence, and passive avoidance and withdrawal. Notably, person-environment mismatch was confirmed as the core mechanism driving the onset and persistence of social isolation in this population. CONCLUSIONS: Person-environment mismatch is the fundamental driver of social isolation among older adults in LTCFs. Interventions should prioritize restoring person-environment alignment-including optimizing physical environments, reconstructing supportive social environments, and enhancing psychological empowerment. Future studies should focus on developing tools to quantify person-environment matching degrees in LTCFs and conduct longitudinal evaluations of targeted interventions to further reduce social isolation and promote active social participation among older people.
18 Apr 2026
Read appraisal →Science advances
Drawn-on-skin electronic tattoo as a closed-loop sensing-stimulation system for the muscles
Simultaneous electromyography (EMG) sensing and closed-loop electrical stimulation (ES) could enable interactive muscle training, motor rehabilitation, and kinesthetic feedback. However, current systems often suffer from nonconformal device/skin interfaces, poor wearability, and anatomical variability among users, limiting signal fidelity and stimulation precision. Here, we present a fully wireless, skin-integrated electronic tattoo platform that records high-quality EMG and delivers closed-loop ES through custom drawn-on-skin, conformal electrodes with strong adhesion and high spatial accuracy. The system supports closed-loop muscle interactions across body regions and even between individuals. Machine learning models classify EMG patterns from different hand gestures with >90% accuracy and adapt ES parameters to stimulate specific muscle groups. In a heavy object holding task, users reached the required grip behavior substantially faster than unassisted controls, indicating improved neuromuscular efficiency. This closed-loop framework not only supports personalized muscle control but also supports coordinated activation across multiple sites or users, unlocking possibilities in interactive motor training, remote rehabilitation, and virtual reality environments.
16 Apr 2026
Read appraisal →Progress in biomedical engineering (Bristol, England)
Navigation paradigms for non-invasive BCI-controlled wheelchairs: a systematic review
Brain-controlled powered wheelchairs represent a promising advancement for individuals with neurological conditions that significantly impair motor function. Despite substantial progress, brain-controlled wheelchairs have not been adapted for real-world settings. This article systematically reviews recent trends in brain-computer interface (BCI) technology for wheelchair navigation and control, highlighting the contributions and limitations of various navigation paradigms. The review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, sourcing studies from four databases (PubMed, Scopus, IEEE Xplore, Google Scholar) published between 2000 and April 2025. It focused on non-invasive BCI paradigms and real-world navigation experiments. The results were narratively synthesized and classified into two primary categories: BCI-based navigation paradigms and wheelchair-based navigation paradigms, along with intersecting concepts such as single-variant BCI, hybrid BCI, control switches, and proportional control. Of the 149 full-text articles reviewed, 47 were included and categorized by navigation paradigm, comprising 20 BCI-based and 27 wheelchair-based studies, with 6 involving participants with motor disabilities. Quality assessment scores ranged from 40% to 95%, with approximately 40% of the studies demonstrating a low risk of bias. The findings indicate that low-level navigation control was predominant in BCI wheelchair studies, with 31 studies employing minimal or no obstacle avoidance. Most studies (57%) integrated sensors for obstacle avoidance, localization, mapping, and autonomous navigation. Twenty-two studies utilized control switches, and five incorporated proportional control for wheelchair navigation. Additionally, motor imagery and steady-state visually evoked potential paradigms have emerged as the most common approaches for generating control commands, highlighting their potential for effective navigation. Given the potential societal impact on a large number of individuals, future research should prioritize enhancing the reliability and adaptability of BCI wheelchair systems in real-world environments.
16 Apr 2026
Read appraisal →Journal of medical Internet research
Digital Health Technology Use Among Rehabilitation Professionals in China: Multi-Province Cross-Sectional Survey
BACKGROUND: The rapid expansion of rehabilitation needs in China has intensified pressure on a workforce that remains unevenly distributed. Digital health technologies (DHTs) offer potential to increase service reach and efficiency. However, little is known about how rehabilitation professionals currently gather and document clinical information, nor about their readiness to integrate digital tools into routine practice within China's rapidly digitalizing health system. OBJECTIVE: This study aimed to describe how rehabilitation professionals in China collect subjective and objective clinical information, document patient data in routine practice, and assess their willingness to use DHTs in clinical settings. METHODS: We conducted a multi-province observational cross-sectional survey using a culturally adapted questionnaire based on the World Health Organization Digital Health Interventions framework. The instrument assessed participant characteristics, information collection methods, documentation practices, and willingness to adopt digital functions across rehabilitation activities. Descriptive analyses and subgroup comparisons were performed on 324 complete responses from certified rehabilitation professionals. The multi-province cross-sectional online survey was conducted among licensed rehabilitation professionals in China with internet access. Participants were recruited through professional networks and social media platforms. RESULTS: Respondents were drawn from 20 provincial-level administrative regions across China, including Fujian (n=72), Guangdong (n=77), and Shanxi (n=45), among others, with 82.7% (268/324) employed in public sector rehabilitation services. Traditional methods dominated clinical work. Face-to-face communication was used frequently for subjective assessment by 96.3% (312/324) of respondents, whereas digital channels such as email (22/324, 6.8%) and telephone (47/324, 14.5%) saw limited use. For objective information, visual observation (271/324, 83.7%) and manual measurement tools (195/324, 60.2%) remained the primary approaches, while motion capture technology (45/324, 13.8%) and wearable sensors (13/324, 4%) were rarely used. Documentation practices also relied heavily on analogue formats, with 82.1% (266/324) using handwritten notes and 60.2% (195/324) using paper templates. In contrast, willingness to adopt DHTs was consistently high, with 80.6% (261/324) of respondents indicating readiness to use digital systems for identity verification, 79.0% (256/324) for progress tracking, and 78.1% (253/324) for outcome measurement. Subgroup analyses revealed that educational level significantly influenced the adoption of advanced technologies, with master's or doctoral degree holders reporting higher use of sensor-based assessment, motion capture, and wearable devices. In contrast, professional title and clinical specialty showed limited influence, with no significant differences observed for most digital health functions. CONCLUSIONS: Rehabilitation professionals in China demonstrate strong readiness to use DHTs, yet their routine practice remains largely paper-based and analogue. These findings provide evidence to inform implementation strategies, workforce training, and system-level planning aimed at accelerating digital transformation in rehabilitation services.
11 Apr 2026
Read appraisal →PloS one
Effects of virtual reality training on racket sports performance: A systematic review and meta-analysis of controlled trials
BACKGROUND: Virtual reality (VR) interventions are increasingly used in racket sports, and quantitative evidence is emerging. PURPOSE: To synthesise controlled trials examining the effects of VR-based training on racket sports performance outcomes. METHODS: A systematic search of five databases (PubMed, Web of Science, Scopus, SPORTDiscus, PsycINFO) up to 15 August 2025 was conducted following PRISMA 2020 guidelines. Eligible studies were controlled trials (randomised or non-randomised) comparing VR-based training (immersive or exergaming) with non-VR controls in tennis or table tennis players. Risk of bias was assessed using Cochrane RoB 2 (randomised) and ROBINS-I (non-randomised). Standardised mean differences (Hedges' g) were pooled using a random-effects model with Paule-Mandel τ² and Hartung-Knapp-Sidik-Jonkman (HKSJ) adjustment. The protocol was registered (PROSPERO CRD420251132325). RESULTS: Six controlled trials(total N = 426; analysed N = 401) were included. The pooled meta-analysis indicated a moderate overall effect favouring VR (Hedges' g = 0.78; HKSJ 95% CI [0.41, 1.15]), with moderate heterogeneity (I² = 52%). The 95% prediction interval was [-0.01, 1.57], which spans the null effect, indicating that in some future populations or settings VR training may not yield a meaningful performance advantage. One trial investigated perceptual-cognitive VR training (Anguera et al., 2025), showing a substantial but imprecise effect (g = 0.81, 95% CI [-0.05, 1.67]). As only a single study was available, this evidence is presented descriptively rather than meta-analytically. A subgroup examination of five physically engaging VR interventions found a similarly large effect (*g* = 0.78, 95% CI [0.31, 1.25]) despite considerable heterogeneity (I² = 62%). CONCLUSION: According to six controlled trials, VR training was associated with average performance enhancements in racket sports; however, the 95% prediction interval [-0.01, 1.57] encompasses the null effect, indicating that a future study could plausibly show no benefit. Due to the limited evidence base (k = 6), significant heterogeneity (I² = 52%), and considerable statistical uncertainty, the existing evidence does not allow for definitive conclusions regarding the efficacy of VR. The current findings should be regarded as a preliminary signal rather than confirmation of effectiveness. Larger, more methodologically robust RCTs with standardised outcomes are needed before definitive recommendations can be made.
7 Apr 2026
Read appraisal →PloS one
Appreciating the complexity of frailty and user context in digital health intervention design: A qualitative study with personas
Frailty is a complex and dynamic process that is becoming increasingly common as the population ages. Early intervention has been shown to reverse or slow progression, but requires support from increasingly limited healthcare resources. Digital health interventions could potentially assist, but first it is vital to understand older adults' experiences and perspectives. This study describes feedback from older adults with symptoms of pre or early frailty on the design concept of a digital device intended to function as an adjunct to physiotherapy and occupational therapy by increasing frequency and quality of safe movement at home. Objectives were to better understand experiences of frailty, and to identify potential influencing factors on adoption and adherence. In-person audio-recorded qualitative interviews were conducted with 17 older adults and 5 carers recruited from community settings. Reflexive thematic analysis generated two themes: 'autonomy and prompts: importance of personalisation'; and 'digital interfaces and accountability: importance of usability and purpose'. In addition, three personas were generated from the data, each describing different needs and preferences for such a device. Situating the results of analysis in the context of current literature, a set of Guiding Principles was created to support future design development in this area. These highlight important factors for consideration when designing for this population, and provide key design feature suggestions and implementation strategies to address these factors including: ensuring the device has clear purpose; is adaptable to the diversity of needs within this clinical population; any form of feedback is safe, relevant, useful and rewarding to multiple users; and technical support is accessible and ongoing. It is recommended that the target population, and clinical purpose be more clearly defined within the healthcare context to encourage personal rehabilitation through enhancing the therapeutic alliance rather than focussing on individual behaviour change of diverse older adults.
7 Apr 2026
Read appraisal →Rheumatology international
The effect of structured hand massage on hand function and grip strength in rheumatoid arthritis patients: a randomized controlled pilot study
INTRODUCTION: This study aimed to assess the impact of a 10-session hand massage protocol on hand function, grip strength, pinch strength, pain threshold, and tactile sensory threshold in patients with early-stage, seropositive rheumatoid arthritis (RA) without radiographic damage or hand deformity. METHODS: This study was a randomized controlled clinical trial. Thirty female RA patients with a diagnosis time of less than two years, seropositive, with low disease activity/remission, and without active arthritis in their hands were included in the study. Participants were randomized 1:1 to intervention and control groups. The intervention group underwent 10 hand massage sessions over a two-week period, in addition to regular medical care. The control group received only regular medical care. All assessments were performed at baseline (T1) and at week 2 (T2). Outcome measures included hand grip strength, pinch strength, pain threshold (dolorimetry), tactile sensory threshold (Semmes-Weinstein monofilament test), Duruöz Hand Index (DHI), and patient global assessment (PGA). RESULTS: A total of 30 RA patients were included in the study (intervention group, n = 15; control group, n = 15). At baseline, no significant differences were observed between the groups in demographic, laboratory, or clinical characteristics (p > 0.05). In the intervention group, significant improvements in hand grip strength and pinch force were observed at T2 compared with baseline (p = 0.008 and p = 0.023, respectively). Median hand grip strength increased from 55 (40-75) to 65 (45-80) kg, and median pinch strength increased from 15 (6-18) to 16 (11-21) kg. No significant alterations were noted in these parameters within the control group (p > 0.05). In the control group, median hand grip strength was 45 (25-80) kg at baseline and 45 (20-80) kg at week 2, while median pinch strength was 14 (6-18) kg at baseline and 14 (5-19) kg at week 2. In the intervention group, significant reductions in DHI and PGA scores were recorded at the end of therapy (p = 0.005 and p = 0.001, respectively). No significant differences were noted in DHI and PGA levels in the control group (p > 0.05). Moreover, median PGA scores were significantly lower in the intervention group than in the control group at T2 (4 [2-5] vs. 5 [3-6]; p < 0.001). No significant changes were found in dolorimeter and touch sensory thresholds in either group (p > 0.05). CONCLUSION: Hand massage interventions for patients with RA enhance grip strength, hand function, and overall patient evaluations. No effect on pain or tactile thresholds was observed. Further studies with larger sample sizes and longer follow-up periods are required to corroborate these findings.
6 Apr 2026
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