Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 36 appraisals
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 →PloS one
Feasibility of mechanomyography-based fatigue classification for passive lower-limb exoskeleton evaluation: A pilot study
Mechanomyography (MMG) enables non-invasive monitoring of muscle mechanical activity, while its utility in time-resolved fatigue detection during dynamic human-exoskeleton interaction remains underexplored. This pilot study explored the feasibility of combining MMG with machine learning to characterize neuromuscular fatigue and evaluate passive lower-limb exoskeleton assistance during repetitive 10 kg squat-lifting tasks. MMG signals from five lower-limb muscles were extracted for time-domain, frequency-domain and nonlinear features, and fatigue identification was implemented via a spectral-based criterion and multi-muscle voting optimization. A radial basis function-enhanced random forest (RBF-RF) model integrated with data augmentation was validated through leave-one-subject-out cross-validation. The results demonstrated that the 1/5 voting rule achieved optimal performance, with mean accuracy of 0.913 ± 0.057, AUC of 0.792 ± 0.073, and a low fatigue detection error of 1.4 ± 0.8 s. Data augmentation steadily improved model robustness, and predicted fatigue levels were significantly correlated with subjective perceived exertion (ρ = 0.756, p < 0.001). This pilot study demonstrates the feasibility of MMG-based fatigue monitoring for wearable assistive systems. The proposed framework supports objective, high-temporal-resolution fatigue monitoring, and may serve as a viable tool for assessing wearable assistive systems. Further large-cohort studies are required to validate its generalizability for practical applications.
13 June 2026
Read appraisal →Scientific reports
Influence of a passive shoulder exoskeleton on drilling performance in women- a cross-sectional study
Work-related musculoskeletal disorders are common, especially among women performing repetitive overhead tasks. In a randomized 2 × 2 crossover study with 14 female participants, we investigated the effects of a passive upper-body exoskeleton during an overhead precision task, involving the tightening of 20 bolts into a sensor-based workstation, while muscle activation, task performance, and usability were assessed. The results showed significant reduced M. Trapezius muscle activations during arm lowering (p = .041, 73%), and lower target accuracy (p < .001, 100%) when using the exoskeleton. Subjective strain in the shoulders was significantly lower when using the exoskeleton (p = .035, 15%). The usability was rated as "unacceptable", with users criticizing the complexity and learning effort. While the exoskeleton reduced muscle load, its mechanical limitations impaired precision and usability, especially for women. These results highlight the importance of sex-specific, ergonomic, and adaptive designs to improve exoskeleton effectiveness and acceptance.
11 June 2026
Read appraisal →Medicine
Machine learning identifies traffic-related pollutant mixtures as potential factors suggestive of association with osteoporosis in a cross-sectional analysis of NHANES
The combined effect of traffic-related pollutant mixtures on osteoporosis (OP) remains unclear. This study aimed to evaluate such associations using machine learning and mixture modeling approaches. A cross-sectional analysis was conducted among 3053 participants from the National Health and Nutrition Examination Survey 2015 to 2018. Eighteen exposures were assessed, including heavy metals, polycyclic aromatic hydrocarbons, phthalates, per- and polyfluoroalkyl substances, volatile organic compounds, diesel exhaust, and behavioral factors. OP was defined by femoral neck bone mineral density T-score ≤-2.5. Weighted quantile sum regression and 5 machine learning models were applied, accounting for complex survey design. OP prevalence was 12.97%. Weighted quantile sum regression showed a positive but nonsignificant mixture odds ratio (odds ratio = 1.21; 95% confidence interval: 0.77-2.63; P = .412). The largest positive weights were daily outdoor work duration (0.240) and occupational diesel exhaust (0.136). Random forest identified female sex, age, vitamin D, blood lead, and body mass index as top predictors. Least Absolute Shrinkage and Selection Operator achieved the highest test area under the receiver operating characteristic curve (0.81) with the lowest cross-validation standard deviation (0.0167). Its coefficients highlighted occupational diesel exhaust (β = 0.40) as a notable environmental factor alongside female sex (β = 0.95) and age (β = 0.70). Traffic-related pollutant mixtures showed a cross-sectional association with OP in a nationally representative US population, with occupational diesel exhaust and prolonged outdoor work emerging as key contributors in mixture models. However, the nonsignificant overall mixture effect and potential for reverse causation warrant caution in interpretation. These findings support considering environmental and occupational factors in OP prevention, although the overall mixture effect did not reach statistical significance.
31 May 2026
Read appraisal →Medicine
Effect of aerobic exercise of different intensity on articular cartilage metabolism in patients with knee osteoarthritis: A randomized controlled trial
BACKGROUND: Osteoarthritis (OA) of the knee is a leading cause of disability worldwide, yet optimal exercise intensity for cartilage protection remains unclear. This randomized controlled trial investigated dose-response effects of aerobic exercise intensity on cartilage metabolism, clinical symptoms, and structural outcomes in knee OA patients. METHODS: One hundred twenty participants with knee OA (Kellgren-Lawrence grade 2-3) were randomly assigned to low-intensity (50-60% heart rate reserve [HRR]), moderate-intensity (60-70% HRR), high-intensity (70-80% HRR) treadmill walking or stationary cycling, or a control group for 12 weeks (3 sessions/week). Heart rate was continuously monitored using Polar H10 chest-strap monitors. Primary outcomes were serum C-terminal telopeptide of type II collagen and cartilage oligomeric matrix protein levels. Secondary outcomes included Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, Visual Analog Scale (VAS) pain, 6-minute walk test, and magnetic resonance imaging-assessed cartilage morphology. Data were analyzed using mixed-model repeated measures analysis of variance with IBM SPSS Statistics version 26.0 (IBM Corp.). RESULTS: The high-intensity group demonstrated the greatest reductions in C-terminal telopeptide of type II collagen (-28.5%, P < .001) and cartilage oligomeric matrix protein (-22.3%, P < .001), the largest improvements in WOMAC scores (-45.3%, P < .001) and VAS pain (-52.5%, P < .001), and the greatest increases in cartilage thickness (+4.2%) and volume (+3.8%). A significant dose-response relationship was confirmed (group × time interaction: F (3108) = 4.82, P = .003). Among participants in the high-intensity group, 73% achieved the minimal clinically important differences (MCID) for WOMAC total score and 80% achieved the MCID for VAS pain. The 6-minute walk test improvement in the high-intensity group (71 m) exceeded the established MCID of 26 m. No serious adverse events were reported; minor events (transient knee pain exacerbation and delayed-onset muscle soreness) resolved spontaneously within 48 to 72 hours. CONCLUSIONS: Appropriately prescribed high-intensity aerobic exercise safely and effectively improved cartilage metabolism, alleviated symptoms, and enhanced functional capacity in knee OA patients. These findings support revising current conservative exercise recommendations upward when tolerable.
31 May 2026
Read appraisal →BMC musculoskeletal disorders
The effectiveness of telerehabilitation in upper limb musculoskeletal disorders: a systematic review.
BACKGROUND: Telerehabilitative services have been increasingly used in recent years, raising questions about their effectiveness. In musculoskeletal disorders, evidence supports telerehabilitation but methodological quality of evidence is limited and focused on lower limb disorders. Hence, this systematic review aimed to assess the effectiveness of telerehabilitation in upper limb musculoskeletal disorders. METHODS: We conducted electronic searches in MEDLINE, Embase, and AMED (up until 11/27/2024), complemented by hand searches. Randomized (RCTs) and non-randomized studies of interventions (NRSIs) assessing upper limb musculoskeletal disorders reporting on pain, activities of daily living (ADL), or health-related quality of life (HrQol) were included. We focused on studies from high-income countries in English or German. Risk of bias was assessed using RoB 2 and ROBINS-I. Standardized mean differences (SMDs) and 95% confidence intervals were derived from meta-analysis, where negative values favor telerehabilitation. Certainty of evidence was rated using GRADE. We grouped studies comparing telerehabilitation to standard care (subgrouped into in-person or minimal intervention) and separately examined studies with a tele-adjunct. Compared to in-person rehabilitation we assessed whether outcomes were similarly improved with telerehabilitation. For tele-interventions as adjunct or compared to minimal care we assessed whether telerehabilitation improved outcomes. RESULTS: We included twenty RCTs representing 1,285 participants. All NRSIs were excluded due to critically high risk of bias. Compared to in-person rehabilitation, telerehabilitation showed similar improvements with very low certainty of evidence in pain (SMD: -0.33 [-1.16 to 0.5] VAS/NRS), moderate in ADL (SMD: -0.07 [-0.31 to 0.17] QuickDASH/DASH), and low in HrQol (SMD: -0.26 [-0.82 to 0.31]). Compared to brochure-based exercising, certainty of evidence was low for improved pain (SMD: -0.28 [-0.58 to 0.03]), moderate in ADL (SMD: -0.56 [-0.88 to -0.24]), and low in HrQol (SMD: -0.31 [-0.65 to 0.02]). Tele-adjunct yielded low certainty of evidence for improvements in pain (SMD: -0.38 [-0.71 to -0.05]) and moderate in ADL (SMD: -0.51 [-0.88 to -0.14). CONCLUSIONS: Our results tend to support the effectiveness of telerehabilitation across different comparisons although certainty of evidence is inconclusive. Future studies should particularly investigate the non-inferiority of telerehabilitation compared to in-person rehabilitation and the added benefit of tele-adjunct. TRIAL REGISTRATION: Prospero registration ID: CRD42024622465.
31 May 2026
Read appraisal →Rheumatology international
Cost-effectiveness of artificial intelligence interventions for musculoskeletal disorders of the spine: a systematic review
Musculoskeletal disorders (MSDs) represent a substantial global health burden, and artificial intelligence (AI)-based technologies are emerging as potential approaches for their management. However, evidence regarding the cost-effectiveness of these interventions remains limited. This systematic review synthesised the available evidence on the cost-effectiveness of AI-based technologies for managing MSDs of the spine. This systematic review was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. PubMed, Medline, CINAHL, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and Directory of Open Access Journals (DOAJ) databases were searched. After title and abstract screening, the remaining articles underwent full-text review by two independent reviewers, who extracted economic outcome data comparing AI-based interventions versus control. A total of 347 studies were identified, with 59 duplicates removed and 251 excluded based on title and abstract. After full-text review, seven eligible studies were included in the review. These studies represented five countries (United States (n = 2), Germany (n = 2), Denmark (n = 1), Australia (n = 1) and South Korea (n = 1)). The studies adopted a healthcare perspective (n = 4), a societal perspective (n = 2) and a healthcare and societal perspective (n = 1). Time durations varied widely, from four weeks to twelve months in trials to three years or lifetime in models, with one study using a 20-month post-implementation period. The AI components of the interventions encompassed a range of technologies, including a deep learning-based diagnostic and exercise prescription platform, AI-driven chest radiograph screening, the self-BACK application, standardised Magnetic Resonance Imaging (MRI) protocols, the Back Pain Choices online decision support tool, and the Kaia back pain application. In three studies, AI-based interventions for MSDs of the spine showed consistent positive QALY gains. Across the seven studies, five interventions (71%) were found to be cost-effective or cost-saving, four (57%) were dominant, while two (29%) were not cost-effective, indicating that most AI-based and digital interventions for MSDs of the spine provide favourable economic value compared with standard care. This is the first systematic review to synthesise evidence on the cost-effectiveness of AI-based technologies for the management of MSDs of the spine. The results suggest that AI-based interventions have the potential to contribute to more efficient healthcare resource use and may support policy and decision-making. However, their impact on reducing the economic burden of MSDs of the spine and improving health outcomes is not yet conclusive, and further standardised economic evaluations are needed to strengthen the evidence base. PROSPERO registration number: https://www.crd.york.ac.uk/PROSPERO/view/CRD42025642775 .
25 May 2026
Read appraisal →Archives of osteoporosis
Management of osteoporosis in older men: a systematic review of randomized trials of pharmacological and non-pharmacological strategies
INTRODUCTION: Osteoporosis in older men is often underdiagnosed and undertreated, increasing the risk of fractures and functional decline. Despite its clinical relevance, evidence specific to this population remains limited. This systematic review evaluated the effectiveness of pharmacological and non-pharmacological interventions in reducing fracture risk and improving bone mineral density (BMD) in older men with primary or secondary osteoporosis. METHODS: Searches were conducted in PubMed, EMBASE, Scopus, Cochrane Library, Web of Science, SciELO, PEDro, and LILACS, in addition to gray literature sources. Randomized controlled trials (RCTs) evaluating pharmacological and non-pharmacological interventions were included. Analyses were performed using RStudio (v. 4.3.3), and risk of bias was assessed using the RoB 2 tool. Results Twelve RCTs were included (10 pharmacological, one nutritional, and one exercise-based). The mean age was 60.9 ± 5.2 years, with baseline T-scores of - 2.9 ± 0.3 at the lumbar spine and - 2.7 ± 0.4 at the femoral neck. Bisphosphonates and teriparatide showed modest improvements in BMD, while effects on fracture risk were inconsistent. Resistance exercise (60-90 min/day) and L-carnitine supplementation were associated with BMD benefits, although evidence was limited by methodological constraints. Risk of bias varied across studies. CONCLUSION: Pharmacological therapies improve BMD in older men; however, evidence remains insufficient to demonstrate consistent fracture risk reduction. Non-pharmacological interventions show potential benefits but are supported by limited evidence. Larger randomized trials with clinically relevant outcomes are needed.
24 May 2026
Read appraisal →Medwave
Effects of manual therapy on pain and function in patients with plantar fasciitis: A systematic review of the literature
OBJECTIVE: Plantar fasciitis is common and impairs people's ability to move. Manual therapy is frequently used to treat plantar fasciitis. However, its effects are inconclusive. For this reason, the purpose of this systematic review is to determine the effect of manual therapy on plantar fasciitis. METHODS: A systematic review of the literature was conducted, following the PRISMA checklist. Five databases (CINAHL, Scopus, PubMed, Web of Science, and OVID) were searched, along with a review of the gray literature and a manual search. Randomized clinical trials from 2014 to 2024 were selected that examined the efficacy of manual therapy in reducing pain intensity and improving function in patients aged 18 to 60 years with a clinical diagnosis of plantar fasciitis. Methodological quality (PEDro scale) and risk of bias (risk of bias scale) were assessed. RESULTS: Four randomized clinical trials (n = 224) were included, reporting controversial statistical differences in pain and function. In addition, two studies reported clinically relevant changes favoring manual therapy. PEDro scale scores ranged from 4 to 6, and three studies presented a high risk of bias. CONCLUSIONS: The effects of manual therapy on pain and function in patients with plantar fasciitis are uncertain. The evidence is limited, heterogeneous, and lacking in methodological rigor. A larger number of randomized clinical trials with more consistent, replicable protocols are needed to determine the contributions of manual therapy to improving pain and function in patients with plantar fasciitis. Similarly, the inconsistency and limited evidence on indicators of clinical significance in the selected studies preclude an assessment of the clinical impact of this intervention. PROSPERO REGISTRATION: CRD42024501550. OBJETIVO: La fascitis plantar es común y genera alteraciones en la capacidad de moverse de las personas. La terapia manual se aplica frecuentemente en la fascitis plantar. Sin embargo, sus efectos no son concluyentes. Por esta razón, el propósito de esta revisión sistemática es determinar del efecto de la terapia manual sobre la fascitis plantar. MÉTODOS: Se realizó una revisión sistemática de la literatura, considerando la lista de verificación de PRISMA. Se consultaron cinco bases de datos (CINAHL, Scopus, PubMed, y OVID) junto con consulta de la literatura gris y búsqueda manual. Se seleccionaron ensayos clínicos aleatorios de 2014 a 2024 que consideraron la eficacia de la terapia manual en el cambio de la intensidad del dolor y funcionalidad en pacientes con diagnóstico clínico de fascitis plantar entre 18 y 60 años. Se determinó la calidad metodológica (escala PEDro) y riesgo de sesgo (escala riesgo de sesgo). RESULTADOS: Se incluyeron cuatro ensayos clínicos aleatorizados (n = 224), que reportaron diferencias estadísticas controversiales para dolor y la funcionalidad. Además, dos estudios reportaron cambios clínicamente relevantes a favor de la terapia manual. Los puntajes de la escala PEDro variaron de 4 a 6, y tres estudios presentaron alto riesgo de sesgo. CONCLUSIONES: Los efectos de la terapia manual sobre el dolor y la funcionalidad en pacientes con fascitis plantar son inciertos. La evidencia es limitada, heterogénea y con bajo rigor metodológico. Es necesario un mayor número de ensayos clínicos aleatorizados, con protocolos más consistentes y replicables para concluir definitivamente sobre los aportes de la terapia manual en los efectos clínicos en el dolor y funcionalidad de pacientes con fascitis plantar. De igual forma, la inconsistencia y limitada evidencia de indicadores de significancia clínica en los estudios seleccionados, no permite evaluar el impacto clínico de esta intervención. REGISTRO DEL PROTOCOLO: PROSPERO CRD42024501550.
23 May 2026
Read appraisal →BMJ (Clinical research ed.)
Calcium, vitamin D, or combined supplementation to prevent fractures and falls: systematic review and meta-analysis
OBJECTIVE: To assess the effect of calcium, vitamin D, or combined supplementation on fractures and falls in adults. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Trials included in systematic reviews from 2014, three databases (Medline, Embase, CENTRAL) to 19 February 2025, clinical trial registries, abstracts from scientific meetings, and references from included studies. ELIGIBILITY CRITERIA: Randomised controlled trials comparing calcium, vitamin D, or combined supplementation with placebo or no treatment in adults (≥18 years) not receiving drug treatment for osteoporosis. DATA EXTRACTION AND SYNTHESIS: The primary outcome was the risk of any fracture. Secondary outcomes included the risk of hip fracture, non-vertebral fracture, vertebral fracture, and falling, as well as the total number of falls. Pairs of reviewers independently screened trials, extracted data, and assessed risk of bias using the second version of Cochrane's risk of bias tool. Findings were synthesised using random effects meta-analyses and appraised using Grading of Recommendations Assessment, Development and Evaluation, with application of thresholds for absolute effects considered important. RESULTS: This review included 69 trials involving 153 902 participants. Participants in most of the trials were community dwelling (87%) and not at high risk of fractures or falls (73%). For the primary outcome of any fracture, little to no effect was found from use of calcium supplements (11 trials, 9067 participants; risk ratio 0.91, 95% confidence interval 0.81 to 1.01; moderate certainty), vitamin D supplements (36 trials, 92 045 participants; 1.00, 0.95 to 1.06; high certainty), or combined supplementation (15 trials, 51 126 participants; 0.91, 0.84 to 0.99; high certainty). Calcium, vitamin D, or combined supplementation appeared to have little to no effect on other fracture and fall outcomes, based largely on moderate to high certainty of evidence. The findings remained robust after an extensive exploration of heterogeneity across multiple subgroup analyses. Evidence for high risk patients or those requiring residential care was limited for many outcomes for calcium monotherapy and for combined supplementation. CONCLUSION: Based on absolute risk reductions and thresholds considered clinically meaningful, this review found little to no benefits from use of calcium, vitamin D, or combined supplementation on the prevention of fractures and falls. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42023483915.
22 May 2026
Read appraisal →Journal of rehabilitation medicine
Efficacy of ultrasound-guided intra-articular hyaluronic acid injection in the management of adhesive capsulitis: a randomized controlled trial
OBJECTIVE: To compare the efficacy and safety of ultrasound-guided intra-articular hyaluronic acid injection versus supervised rehabilitation in patients with frozen-phase adhesive capsulitis. DESIGN: Single-center, parallel-group, randomized controlled trial with 26-week follow-up. SUBJECTS/PATIENTS: Forty-six adults aged 40-70 years with clinically and radiologically confirmed frozen-phase adhesive capsulitis. METHODS: Participants were randomly assigned to receive either three weekly ultrasound-guided intra-articular hyaluronic acid injections or supervised physical therapy twice weekly for six weeks. Outcomes assessed at baseline and at weeks 4, 6, 8, and 26 included the Shoulder Pain and Disability Index (SPADI) and shoulder range of motion. RESULTS: Both groups achieved significant within-group improvements in SPADI and range of motion over 26 weeks (all p < 0.01 vs. baseline). No statistically significant between-group differences were observed in total SPADI or its pain and disability subscales at any follow-up time point (all p > 0.05). At week 26, the hyaluronic acid group's mean total SPADI decreased from 43.0 ± 17.7 to 16.1 ± 12.8 (p < 0.01), while the rehabilitation group improved from 52.0 ± 18.4 to 23.2 ± 21.8 (p < 0.01). Pain subscores were reduced by 64.3% (hyaluronic acid) and 56.1% (rehabilitation); function subscores decreased by 60.9% and 54.8%, respectively (all p < 0.01). Both groups showed significant gains in active and passive flexion, abduction, and external rotation, without significant between-group differences (all p > 0.05). No treatment-related adverse events were observed. CONCLUSION: Ultrasound-guided hyaluronic acid injection and supervised rehabilitation produced comparable and clinically meaningful improvements in pain, function, and shoulder mobility in frozen-phase adhesive capsulitis.
17 May 2026
Read appraisal →Annals of work exposures and health
Occupational mechanical exposures and upper-body musculoskeletal disorders: an overview of systematic reviews
OBJECTIVES: The aim was to provide a comprehensive overview of systematic reviews with meta-analyses of the association between occupational mechanical exposures and upper-body musculoskeletal disorders. METHODS: A systematic literature search was conducted in PubMed, Web of Science, Embase, and CINAHL. Systematic reviews were considered eligible if they included occupational mechanical exposures and provided weighted measures of association in relation to specific musculoskeletal disorders. From each systematic review, data on eg databases searched, exposure, outcome, effect estimates, and quality of evidence of the association were extracted. The methodological quality of each systematic review was assessed using AMSTAR 2. RESULTS: The screening of 1,756 articles resulted in the inclusion of 17 systematic reviews with meta-analysis covering 6 musculoskeletal disorders: subacromial pain syndrome (n = 3), lateral epicondylitis (n = 2), carpal tunnel syndrome (n = 7), Dupuytren's disease (n = 4), hand-arm vibration syndrome (n = 1), and hand osteoarthritis (n = 1). The weighted odds ratios from the meta-analyses generally ranged between 1.5 and 3.0. Approximately 35% of the included systematic reviews assessed the quality of evidence of the association, and among these, 48% graded the evidence as being low to very low. CONCLUSIONS: In general, this overview found an increased risk associated with most mechanical exposures in relation to specific upper-body musculoskeletal disorders. However, grading of evidence quality was rarely applied, and when present, showed substantial variability. Future research related to primary studies should prioritise high-quality prospective studies and objective exposure assessments, and systematic reviews would benefit from standardised methodologies and improved reporting transparency to further strengthen the evidence quality.
14 May 2026
Read appraisal →Journal of medical systems
Use of Generative Artificial Intelligence in the Management of Low Back Pain: a Scoping Review
BACKGROUND CONTEXT: Low back pain (LBP) is common and a major cause of disability globally. Generative artificial intelligence (GenAI) such as ChatGPT may have the potential to improve LBP, but it is unknown how GenAI is being used in clinical care settings. PURPOSE: This scoping review aimed to map and synthesise the existing literature on the use of GenAI in the management of LBP across all settings. STUDY DESIGN: This review followed the scoping review methodology of the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. METHODS: We searched the Cochrane Library, Medline, Scopus, Embase, Web of Science, CINAHL, and preprint platforms for studies published between January 2012 and July 2025, on the use of GenAI in the management of LBP across all healthcare settings. The included studies were categorised according to the primary purpose of GenAI implementation. RESULTS: A total of 31 studies were included. Seventeen studies evaluated GenAI as a potential support tool for diagnosis and treatment, including answering specific questions about LBP (n = 8), generating advice from clinical cases (n = 4), and generating advice from diagnostic imaging (n = 5). Eight studies examined the use of GenAI to provide educational advice for patients. Other uses included research support (n = 5) and clinical documentation support (n = 1). GenAI advice for the management of LBP demonstrated higher agreement when using simpler tasks, more detailed prompts, or newer generation models. Reported errors in GenAI advice included inconsistency with guidelines or clinicians' advice, hallucination, low accuracy for complex questions, sensitivity to prompt design, and challenges with interpretability. CONCLUSION: Thirty-one studies reported the use of GenAI in LBP management, mainly supporting diagnosis and treatment planning, patient education, research, and clinical documentation. Despite authors' claims about promising uses of GenAI, it typically requires further refinement or review by human end-users. Critically, no studies addressed end-user experience, or clinical effectiveness, underscoring the need for robust clinical evaluation beyond the lab-based environment.
12 May 2026
Read appraisal →Journal of diabetes science and technology
Adherence Monitor for Measurement of Removable Cast Walker Wear-Time: Multiple Sensors and Predictive Analytics Improve Accuracy
BACKGROUND: Treatment of diabetes and its complications is a primary health care expense. Up to 25% of people with diabetes will develop diabetic foot ulcers (DFUs). Removable cast walker (RCW) boots commonly prescribed for DFU treatment, promote healing, and provide offloading and wound protection. Patient RCW removal for hygiene and wound care can lead to decreased adherence and treatment effectiveness. This study evaluated a new system for wear-time adherence measurement using multiple sensor types. METHODS: An electronic wear-time monitor was developed, which included internal and external temperature sensors, an accelerometer, and capacitive proximity foot and ankle sensors. Time-stamped and date-stamped data were saved once per minute for up to 22 days. Ten healthy volunteer subjects were recruited to wear an RCW for two weeks while keeping a diary of don/doff times. Sensor data were then compared with volunteers' wear diaries using confusion matrix predictive analytics. RESULTS: Algorithms were developed for data processing. Correlation coefficients between algorithms and diaries were calculated for individual and multiple sensor combinations. Differential temperature and accelerometer algorithms were significantly better at predicting subject wear-time than individual temperature sensor algorithms (P = .009, P = .001, respectively). Foot proximity had significantly better correlation with subject diaries than temperature (P = .024), and acceleration algorithms (P = .005). Multi-sensor analysis showed high correlation (.96) with wear-time from subject diaries. CONCLUSIONS: Removable cast walker wear-time can be accurately determined using an electronic data recorder and multiple sensors. Wear-time measurement accuracy can be improved using algorithms that operate on data from multiple sensors that use a variety of sensor technologies.
9 May 2026
Read appraisal →Abdominal radiology (New York)
Advancing osteoporosis opportunistic screening: multicenter validation of a deep learning algorithm using abdominal CT scans
OBJECTIVES: To develop and do multicenter validation on an algorithm that screens for osteoporosis from abdominal CTs. METHODS: This is a diagnostic accuracy study with retrospective data from January 2022 to July 2022 consisting of two steps: a segmentation step of the lumbar vertebral bodies, involving outpatient non-contrast abdominal CTs from Diagnósticos da América S/A (Dasa), and a multicenter validation step incorporating data from four additional institutions. The segmentation employed a 2D UNet with a ResNet34 backbone. We determined the Pearson correlation coefficient (r) between the mean of the slices' mean attenuations (MSMA) on CT scans against the bone mineral density (BMD) on recent DEXA scans, calculated AUCs and performance metrics for osteoporosis prediction, including 95% confidence intervals, and evaluated calibration plots. RESULTS: The multicenter validation included 504 participants (median age, 66 years, interquartile range 56-72; 388 women). A linear regression analysis showed an r of 0.62 (95% CI, 0.56-0.67) between MSMA (HU) and BMD (g/cm2). The AUCs (95% CI) for distinguishing between normal and osteoporosis were 0.96 (0.89, 1.0) for the internal dataset and 0.82 (0.74, 0.89) for the external dataset, and the performance metrics (95% CI), for a globally optimized threshold of 202.6 HU, were 100% sensitivity (44, 100) and 91% specificity (84, 95) for internal data and 79% sensitivity (61, 90) and 81% specificity (76, 84) for external sites. MSMA was independently associated with osteoporosis on a mixed-effects logistic regression analysis. The model showed good calibration, with Brier score of 0.054. CONCLUSION: We developed and performed a multicenter validation of a DL model for osteoporosis prediction on CT.
6 May 2026
Read appraisal →European radiology
Enhancing vertebral fracture prediction using multitask deep learning computed tomography imaging of bone and muscle
OBJECTIVES: To develop and externally validate a computed tomography (CT)-based multitask learning model to predict fracture risk. MATERIALS AND METHODS: This study was conducted in two parts, using a multitasking learning approach. We developed a cross-sectional vertebral fracture (VF) detection model using abdominal CT scans of 2553 patients aged 50-80 years. Then, we leveraged this detection model within a multitask learning framework to develop a longitudinal VF prediction model over a 5-year follow-up period. External testing was performed on 1506 patients from two independent hospitals. The performance was compared between the single-task and multitask models, bone-only and bone+muscle images, and image-only and clinical models. RESULTS: For the cross-sectional fracture detection model, the mean age of the patients was 76.2 years, and 66.7% were female. In the classification task for detection of VF, the model using both bone and muscle showed an area under the receiver operating characteristic curve (AUROC) of 0.82 in the development set and 0.80 in the external test sets. Using multitask learning, the bone + muscle image model showed a c-index of 0.68 and had superior performance than the bone-only model in the external test set for 2-year, 3-year, and 5-year AUROCs (0.79 vs. 0.75, 0.71 vs. 0.68, and 0.71 vs. 0.68, respectively, all p < 0.01). Also, the multitask model significantly outperformed the Fracture Risk Assessment Tool (FRAX) (c-index: 0.68 vs. 0.66, p < 0.01). CONCLUSION: The CT-based multitask learning model integrating both bone and muscle data showed superior predictive performance for VFs compared with models using bone images only and traditional clinical models. KEY POINTS: Question Vertebral fracture risk remains underestimated in many individuals undergoing CT scans for other reasons, highlighting the need for improved opportunistic prediction tools. Findings A multitask deep learning model integrating both bone and muscle features from CT scans demonstrated superior performance compared to bone-only and traditional clinical models, including FRAX. Clinical relevance The proposed model enables accurate vertebral fracture risk prediction using routinely acquired CT scans, facilitating early identification and intervention without the need for additional tests.
6 May 2026
Read appraisal →ChemistryOpen
Ionic Hydrogel Triboelectric Sensor for Real-Time Swimming Kinematics Monitoring and Stroke Recognition
Recently, wearable sports electronics have attracted increasing attention for their potential to enable continuous motion tracking and energy-autonomous operation in complex athletic environments. In this work, we present a flexible triboelectric nanogenerator (PAC-TENG) constructed from a PVA/Ala/CaCl2 ionic hydrogel electrode and a compliant silicone triboelectric layer. The PAC hydrogel provides high stretchability, stable ionic conductivity, and strong deformation tolerance, while the silicone surface ensures efficient and repeatable charge generation. Benefiting from this synergistic design, the PAC-TENG achieves excellent electrical outputs, including a peak voltage of 472.9 V, a short-circuit current of 37.1 µA, and a transferred charge of 104.1 nC, along with high power density under matched load. The device exhibits strong sensitivity to bending angle, applied force, and motion frequency, enabling accurate perception of human biomechanics. When mounted on swimming-related joints, the PAC-TENG can reliably monitor stroke patterns and detect abnormal motion signals, highlighting its promise for self-powered aquatic sports analytics and intelligent safety monitoring.
6 May 2026
Read appraisal →Journal of medical imaging and radiation sciences
Automatic field-of-view planning for magnetic resonance shoulder imaging using Deep Learning
INTRODUCTION: Accurate prescription of oblique coronal and oblique sagittal field of views (FOV) is essential for diagnostic shoulder MRI. Manual planning is radiographer-dependent, time-consuming, and subject to inter- and intra-operator variability, leading to inconsistent image quality and incomplete coverage. Although deep learning (DL) has advanced automated scan planning in non-oblique planes, oblique shoulder prescriptions remain underexplored; an automated DL approach could standardize FOV prescription, reduce operator dependence, and improve reproducibility and workflow without compromising diagnostic quality. METHODS: In this retrospective multicenter study, 575 shoulder MRI examinations (2019-2025) from four sites were included. Sites A (n=151) and B (n=220) were used for training; testing was performed on sites C (n=61), and D (n=143). A two-stage pipeline was implemented using five oriented bounding box (OBB) variants of YOLOv11 (n, s, m, l, x): Stage 1 performed slice selection; Stage 2 performed FOV prescription. Performance was evaluated against radiographers' prescriptions using mean absolute slice difference (MASD, slices), intersection over union (IoU), and mean absolute angle difference (MAAD, degrees). Clinical utility was assessed by three raters. RESULTS: The YOLOv11-OBB-l model achieved the lowest MASD for Stage 1 (1.016±0.153 slices). For Stage 2, YOLOv11-OBB-x performed best (coronal IoU, 0.847±0.003; sagittal IoU, 0.852±0.007; MAAD, 3.259±0.190°). During testing across each site, MASD ranged from 0.700±0.837 to 1.192±2.550 slices; MAAD from 2.811±2.348 to 4.396±7.158°; coronal IoU from 0.800±0.092 to 0.872±0.065; and sagittal IoU from 0.824±0.111 to 0.887±0.047. Mean clinical utility was 97.2%. Performance was noninferior to interrater variability across all sites and metrics. CONCLUSION: DL-based automated FOV prescription for shoulder MRI achieves performance comparable to radiographers, generalizes across institutions, and demonstrates high clinical utility.
4 May 2026
Read appraisal →NMR in biomedicine
Deep Learning Reconstruction Enables Diagnostic-Quality 0.4T Knee and Spine MRI in One-Third of the Time
There has been a growing interest in low-field MRI due to its lower costs, enabling an increase in accessibility of MRI worldwide. Long scan times are currently needed to obtain high-quality images. The aim of our study was to accelerate low-field 0.4T musculoskeletal MRI using deep learning and evaluate maximum acceleration via assessment by two expert radiologists. A cascades of independently recurrent inference machines (CIRIM) model was trained using knee and spine 2D multislice scans, retrospectively undersampled in k-space. The heterogeneous dataset included varied contrasts, orientations, and matrix sizes. To determine the maximum possible acceleration factor, the undersampling pattern and loss function of the CIRIM were optimized using the knee dataset. Models were trained for acceleration factors 1.5-4. The different acceleration factors were evaluated quantitatively and clinically, with radiologist scores compared using Kendall's Tau and Cohen's Kappa. To assess the model's generalizability, two prospectively undersampled scans were evaluated, and the knee-trained models were tested on spine data. CIRIM accurately reconstructed all data, with slight metric degradation at higher accelerations. Combining L1, structural similarity index measure (SSIM), and perceptual loss improved sharpness, while undersampling pattern differences were minimal. Clinical scores from both radiologists declined with acceleration, reflected in Kendall's Tau values of 0.64, 0.64, 0.54, and 0.55 for image quality, sharpness, anatomical conspicuity, and artifacts. Inter-observer agreement was low (Cohen's kappa: 0.227-0.299). The model generalized well, reconstructing spine data with a knee-trained model at comparable quality and successfully handling prospectively undersampled scans. CIRIM consistently delivered high-quality reconstructions, demonstrating excellent robustness to variations in contrast, orientation, matrix size, and anatomy. Its ability to generalize across anatomies and handle prospectively undersampled scans highlights its practical utility. The differences in reading for higher accelerations between radiologists suggest that the optimal acceleration factor is context-dependent and should be tailored to the specific diagnostic task.
4 May 2026
Read appraisal →Physics in medicine and biology
Few shots transfer learning for universal SPECT denoising across diverse acquisition protocols
Objective.Accelerated single photon emission computed tomography (SPECT) imaging, achieved by reducing either the number of projection angles or the acquisition time per angle, enhances clinical workflow efficiency but introduces elevated noise. This study aims to develop and validate a universal DL-based reconstruction framework that effectively generalizes across diverse, clinically-realistic SPECT acceleration protocols by overcoming the data scarcity challenge.Approach.SPECT bone scans from 103 patients were acquired under a standard scan (60 views, 12 s/view, 60v12s) followed by a fast scan using one of five acceleration protocols (60v6s, 60v3s, 30v12s, 30v6s, 16v12s). AU-Net-based reconstruction framework was implemented using three strategies: (1) single model, trained on individual acceleration protocol), (2) base model, trained on aggregated datasets from five acceleration protocols, and (3) transfer model, fine-tuned from the base model for protocol-specific optimization. Pixel-level accuracy and structural similarity were assessed using peak signal-to-noise ratio (PSNR), structural similarity index (SSIM) metrics, and maximum pixel value of lesions. Clinical evaluation of image quality, radionuclide detail, artifacts, and diagnostic confidence was conducted using a 5-point system.Main results.Quantitative evaluation showed the transfer model achieved better PSNR and SSIM across all protocols (highest 48.02 PSNR and 0.9918 SSIM in 30v6 s protocol). Qualitative analysis confirmed enhanced structural fidelity. Clinical evaluations rated the transfer model highest across metrics, with scores of 4.667 ± 0.508 (image quality, 30v12 s), 4.800 ± 0.250 (radionuclide detail, 60v6 s), 1.150 ± 0.173 (artifact reduction, 60v6 s), and 4.800 ± 0.250 (diagnostic confidence, 60v6 s), surpassing full-scan results in most cases.Significance. The proposed transfer learning (TL) framework effectively addressed data scarcity and improved reconstruction performance across diverse SPECT acceleration scenarios. The adoption of a TL strategy mitigates data scarcity by utilizing shared features and fine-tuning for specific protocols. The framework demonstrates potential for integration into fast SPECT workflows, facilitating reliable use across diverse imaging scenarios.
2 May 2026
Read appraisal →Bone research
A phase 2 trial of burosumab for treatment of fibroblast growth factor-23-mediated hypophosphatemia in children and adults with fibrous dysplasia
Fibrous dysplasia (FD) is a rare disorder associated with fractures and deformities. FD lesions produce excess phosphaturic hormone fibroblast growth factor 23 (FGF23), leading to hyperphosphaturia in most patients, and hypophosphatemia in those with high FD burden. Skeletal complications are associated with both low-normophosphatemia and frank hypophosphatemia. Burosumab is approved for other forms of FGF23 excess, but there is little evidence to inform use in FD. A phase 2 study investigated the safety and efficacy of burosumab in patients with FD. The primary endpoint was the proportion of participants achieving phosphate levels within the mid to upper part of the normal range (age and sex-adjusted Z-score -1 to +2). 12 participants (7 children, 5 adults) received burosumab for 48 weeks. Median phosphate Z-score increased from -2.88 (1.65) to 0.22 (1.37), meeting the target in 100% of participants. Alkaline phosphatase levels were elevated at baseline in 8 participants [median 846 U/L (464)] and declined by 49% at week 48, representing a median decline of -364 (244.5) U/L. PROMIS questionnaires showed trends toward improvements in all domains in children; adult scores showed no identifiable trends. Two children experienced transformational mobility gains, including advancement from full-time wheelchair use to independent ambulation. Lesion biopsies showed no changes in cellularity or composition, and 18F-NaF PET/CT scans showed no changes in tracer uptake, suggesting burosumab did not adversely impact lesional activity. Adverse events were mild, and none resulted in treatment withdrawal. Burosumab treatment in patients with FD was well-tolerated, restored phosphate homeostasis, and reduced alkaline phosphatase levels. Burosumab has the potential to lead to functional improvements and ambulation gains in severely affected patients and is a valuable tool to reduce the impact of FD-related disability.
2 May 2026
Read appraisal →European journal of pediatrics
Efficacy and safety of vosoritide in children with achondroplasia: a systematic review and meta-analysis
UNLABELLED: Achondroplasia is caused by a gain-of-function mutation in the FGFR3 gene. Vosoritide activates the NPR-B receptor to inhibit the overactive FGFR3 signaling pathway. We aim to pool the efficacy and safety outcomes of vosoritide in children with genetically confirmed achondroplasia who are receiving the approved dose of 15 μg/kg/day. We searched five databases up to February 10, 2026. A systematic review and single-arm meta-analysis were conducted in accordance with the PRISMA guidelines. The primary outcomes were annualized growth velocity (AGV), height gain, and change in height Z-score. Three quality assessment tools were used to assess different study designs of the included studies. All analyses were conducted using OnlineMeta V1.1. Thirteen studies on vosoritide treatment in children with achondroplasia were included, comprising randomized controlled trials, cohort studies, case reports, and case series. A meta-analysis showed that vosoritide was associated with an AGV of 5.72 cm/year (95% CI: 5.51-5.94) at 12 months. The mean height Z-score improvement at 12 months after sensitivity analysis was 0.28 (95% CI: 0.16-0.4), with no significant difference between sexes. Overall, the most common adverse events were injection site reactions (51%) and gastrointestinal symptoms (50%). CONCLUSION: One-year treatment with vosoritide is associated with increased growth velocity, height gain, and a modest improvement in height Z-score, accompanied by a high incidence of mild to moderate adverse events. Larger, longer-term studies are necessary to confirm the treatment's safety and efficacy. WHAT IS KNOWN: • Achondroplasia is a skeletal dysplasia caused by a mutation in the FGFR3 gene, which leads to inhibit endochondral ossification and bone growth. • Vosoritide is a recombinant C-type natriuretic peptide analogue designed to counteract overactive FGFR3 signaling and was approved by the FDA and EMA. WHAT IS NEW: • One-year treatment with vosoritide in achondroplasia children is associated with increased growth velocity and improvement in height Z-score with reported minor adverse events.
26 Apr 2026
Read appraisal →The Journal of clinical endocrinology and metabolism
Health and adverse events associated with extended oral bisphosphonates among postmenopausal women: a systematic review
BACKGROUND: International guidelines recommend the use of oral bisphosphonates (oBP) for up to 5 years in the treatment of postmenopausal osteoporosis. However, benefits and risks of extending oBP therapy beyond this duration remain uncertain. AIM: To determine the health outcomes (bone mineral density [BMD], fracture risk) and adverse effects (atypical fracture, osteonecrosis of the jaw [ONJ]) of extended oBP therapy beyond 5 years among postmenopausal women. METHODOLOGY: A systematic search of Medline©, EMBASE©, and CINAHL© was conducted from inception to 15 March 2024. Interventional and observational studies published in English were included. Two authors independently performed screening, quality appraisal using the NIH Quality Appraisal tool, and data extraction. The review followed PRISMA guidelines and was registered on PROSPERO (CRD42024475332). High heterogeneity precluded meta-analysis. RESULTS: Eleven studies (4 controlled trials, 7 observational) were included: 3 rated as good quality, 7 as fair, and 1 as poor. Extended oBP therapy beyond 5 years increased BMD at the hip (3/3 studies), femoral neck (3/3 studies) and lumbar spine (5/5 studies). Prolonged oBP use reduced clinical vertebral fracture risk (1/6 studies) but increased the risk of atypical fractures (3/3 studies) and incomplete atypical femoral fractures (1/1 study). None of the included studies assessed or reported ONJ. CONCLUSION: Substantial heterogeneity and limited high-quality evidence preclude definitive conclusions regarding extended oBP use in postmenopausal women. While extended treatment may improve bone density and reduce vertebral fractures, it could also increase atypical fractures. Future high-quality studies are required to inform decisions regarding optimal treatment duration.
25 Apr 2026
Read appraisal →Annals of medicine
Artificial intelligence and wearable sensors in sports injury risk prediction: current status and future perspectives.
BACKGROUND: Artificial intelligence (AI) and wearable sensors are increasingly reshaping sports injury risk prediction by enabling continuous, individualized, and data-driven assessment. DISCUSSION: This review summarizes recent advances in wearable technologies - including inertial measurement units (IMUs), electromyography (EMG), physiological monitors, and flexible electronics - and their use in capturing biomechanical, physiological, and psycho-physiological indicators relevant to injury risk. Deep learning (DL) models, particularly those capable of temporal and multimodal fusion, have shown promise in predicting injuries such as anterior cruciate ligament (ACL) tears, muscle fatigue, and stress fractures. Through representative applications and mechanism-informed analysis, we highlight the growing role of interpretable AI, real-time feedback, and behavior-integrated predictive systems. CONCLUSIONS: Key challenges remain, including data heterogeneity, limited generalizability, compliance issues, and privacy concerns. Future directions point toward personalized modeling, explainable systems, federated learning, and digital twin frameworks. Together, these advancements mark a shift toward proactive, intelligent injury prevention across athletic and clinical settings.
24 Apr 2026
Read appraisal →Medical science monitor : international medical journal of experimental and clinical research
Effects of Abdominal Bracing Versus Abdominal Hollowing on Abdominal Muscle Thickness and Activation During Static and Dynamic Trunk Stabilization Tasks in Healthy Adults
BACKGROUND Abdominal hollowing selectively targets deep abdominal muscles, whereas abdominal bracing emphasizes global activation of the superficial musculature. This study aimed to compare the effects of abdominal bracing and abdominal hollowing on abdominal muscle thickness and activation during trunk stabilization tasks in healthy adults. MATERIAL AND METHODS Eighteen healthy adults (9 males, 9 females) participated in a randomized crossover study. Abdominal bracing and hollowing were performed in random order with a 1-week wash-out period. Muscle thickness of the rectus abdominis (RA), external oblique (EO), internal oblique (IO), and transversus abdominis (TrA) were measured using ultrasound imaging. Surface electromyography assessed activation of the RA, EO, and IO during a static hook-lying position and a dynamic supine toe-tap task. RESULTS RA thickness was greater during bracing than hollowing (10.07±1.55 mm vs 9.22±1.46 mm, p=0.032), whereas IO and TrA thicknesses were greater during hollowing (IO: 8.65±3.18 mm vs 6.63±2.14 mm; TrA: 4.08±1.23 mm vs 2.41±0.80 mm, both p<0.05), representing an approximately 31% increase in TrA thickness. During the static task, activation of the RA, EO, and IO was higher during hollowing (p<0.05), whereas no significant differences were observed during the dynamic task. CONCLUSIONS Abdominal hollowing preferentially enhances deep muscle activation during low-load static conditions, whereas abdominal bracing promotes global muscular engagement. With increasing task demands, stabilization strategies converge, indicating task-dependent neuromuscular coordination.
18 Apr 2026
Read appraisal →Spine
An Unsupervised Learning Approach for Multimodal Low Back Pain Stratification
STUDY DESIGN: Cross-sectional study. OBJECTIVE: This study proposes a novel stratification framework for individuals with low back pain (LBP). The method integrates Northern Finland Birth Cohort data comprising imaging biomarkers from deep learning (DL)-based analysis of lumbar spine MRI with the data on smoking status, demographics (sex and BMI), self-reported data from Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) short and the STarT Back Tool (SBT). Furthermore, the utility of this stratified approach was validated by demonstrating a superior net benefit compared with "treat-all" strategy. BACKGROUND: Current risk stratification for individuals with LBP relies on ÖMPSQ short and SBT among others. While these tools are invaluable for capturing psychosocial characteristics predictive of future disability and functional outcomes, LBP's multifactorial nature necessitates a more comprehensive framework for effective risk stratification. MATERIALS AND METHODS: A method for multimodal unsupervised patient stratification has been developed that allows for the integration of imaging biomarkers of disc degeneration (DD) and facet tropism (FT), extracted using DL models, with nonimaging data. The framework utilized robust K-Means clustering to stratify individuals. Clusters were characterized using LBP frequency and bothersomeness, and their robustness was validated with a multi-class logistic regression model. Net benefit was assessed through decision curve analysis. RESULTS: Three distinct subgroups were characterized by LBP frequency and bothersomeness. One subgroup was dominated by psychosocial characteristics (psychosocial risk P < 0.05), the second by physical degenerative changes (DD P < 0.05), and the third by a mix of both. Predictive models for cluster assignment were robust, achieving high mean accuracies (SBT-based: 0.89; ÖMPSQ-short-based: 0.87). The net benefit is superior throughout a range of threshold probabilities compared with a "treat-all" strategy. CONCLUSION: A novel framework was developed that integrates multimodal data to identify distinct subgroups differentiated by their physical and psychosocial characteristics in a population-based cohort, demonstrating potential for advancing personalized care.
17 Apr 2026
Read appraisal →Medicine
Bibliometric and visual analysis of artificial intelligence-related research in osteoarthritis: Trends and frontiers (2008-2025)
Osteoarthritis (OA) causes joint pain, functional impairment, and significantly impacts patients' quality of life. Recent advancements in artificial intelligence (AI) technology have provided new opportunities for OA diagnosis, treatment, and management. This study aims to understand the knowledge structure and research frontiers of "AI and OA" using bibliometric methods. Literature on "AI and OA" from January 1, 2008, to March 31, 2025, was retrieved from the Web of Science Core Collection database. VOSviewer, CiteSpace, and the R package "bibliometrix" were used for analysis. The study included 659 articles from 59 countries. Since 2019, the number of scientific outputs related to OA and AI has increased annually. The United States, China, and the United Kingdom are the main contributing countries, with Harvard University, Seoul National University, and the University of California system as leading institutions. The "JOURNAL OF ARTHROPLASTY" and "OSTEOARTHRITIS AND CARTILAGE" are the most contributing journals. Among the 2404 authors, GUERMAZI A and ROEMER FW are the most influential. Thematic trend analysis shows that AI and machine learning are driving new trends in OA research, especially in diagnosis, treatment planning, and patient monitoring. This paper summarizes the bibliometric trends and development in "AI and OA" studies over 18 years, identifying the latest research frontiers and hot topics. It provides valuable references for related research and highlights the importance of interdisciplinary collaboration as research topics diversify.
12 Apr 2026
Read appraisal →PloS one
Effects of complex training on jump performance and neuromuscular activation in volleyball athletes: A controlled study
This study examined the integrated effects of complex training combining barbell back squats (BBS) and drop jumps (DJ) on jump performance and concentric-phase neuromuscular activation in volleyball athletes. In a randomized controlled design, twenty male volleyball athletes were allocated to an intervention group (IG, n = 10) or a control group (CG, n = 10). The IG completed an 8-week, twice-weekly complex training protocol (BBS followed by DJ), with loads progressively adjusted according to individual 1RM values, whereas the CG performed an intensity-matched BBS protocol. Primary outcomes were countermovement jump (CMJ) and approach jump (AJ) height and propulsion impulse (expressed in BW·s), while concentric-phase integrated electromyography (iEMG) and root mean square (RMS) amplitude were secondary outcomes. The results showed that, compared with the CG, the IG exhibited greater improvements in both CMJ and AJ height (CMJ: Δ = 6.13 vs 2.65 cm; AJ: Δ = 7.28 vs 2.78 cm; both p < 0.05). In addition, gains in propulsion impulse were larger in the IG (CMJ: Δ = 0.06 vs 0.02 BW·s; AJ: Δ = 0.08 vs 0.03 BW·s; both p < 0.05). Furthermore, electromyography revealed task-specific recruitment patterns: under BBS, the quadriceps and tibialis anterior showed higher iEMG and RMS values, whereas under DJ the lateral and medial heads of the gastrocnemius were more strongly activated, indicating complementary effects across key lower-limb muscle groups. Taken together, these findings indicate that an 8-week BBS-DJ complex program, compared with resistance training alone, is more effective in improving jump performance and propulsion impulse and in optimizing task-specific concentric activation patterns of the lower-limb musculature in volleyball athletes, and may serve as a feasible and evidence-based prescription for volleyball-specific conditioning.
12 Apr 2026
Read appraisal →PloS one
The effectiveness of dry needling at myofascial trigger points for knee disorders: A quantitative synthesis of randomized controlled trials
PURPOSE: Dry needling (DN) targeting myofascial trigger points (MTrPs) has been proposed as a treatment for knee disorders, including knee osteoarthritis (KOA) and patellofemoral pain syndrome (PFPS). This meta-analysis evaluated the effectiveness of DN in improving pain and function in patients with knee disorders. METHODS: This meta-analysis was conducted in accordance with PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD420261294603). Systematic searches were performed in PubMed, Embase, Web of Science, Cochrane CENTRAL, CNKI, Wanfang, and VIP databases from inception to December 2025 for randomized controlled trials (RCTs) comparing DN targeting MTrPs with sham DN, no intervention, or other active treatments for knee disorders. Primary outcomes were pain intensity measured by the Visual Analog Scale (VAS) and Numeric Pain Rating Scale (NPRS). Secondary outcomes included functional status assessed by the WOMAC functional subscale and the Kujala Patellofemoral Score. Weighted mean differences (WMDs) were calculated using random-effects models. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool, and certainty of evidence was evaluated using the GRADE framework. RESULTS: Twenty RCTs (n = 1,234; mean age range: 22-69 years) met the inclusion criteria. Compared with controls, DN significantly reduced knee pain across all pain measures: NPRS (WMD = -1.00, 95% CI: -1.25 to -0.76; I² = 0.0%), VAS (WMD = -1.19, 95% CI: -1.73 to -0.66; I² = 80.4%), and WOMAC Pain subscale (WMD = -1.76, 95% CI: -2.57 to -0.95; I² = 67.6%), with an overall pooled pain reduction of WMD = -1.25 (95% CI: -1.58 to -0.92; I² = 74.7%). DN also significantly improved knee function as measured by the WOMAC functional subscale (WMD = -6.59, 95% CI: -8.88 to -4.29; I² = 61.6%) and the Kujala Patellofemoral Score (WMD = 6.39, 95% CI: 4.64 to 8.14; I² = 30.1%). Pre-specified sensitivity analyses using standardized mean differences confirmed the robustness of these findings. The overall risk of bias was moderate, with concerns primarily related to inadequate blinding of participants and outcome assessors. The GRADE certainty of evidence was rated as moderate for all primary outcomes. CONCLUSION: DN targeting MTrPs provides significant short-term pain relief and functional improvement in KOA and PFPS, with pain reductions approaching clinically important thresholds. However, substantial heterogeneity, blinding limitations, and short follow-up necessitate cautious interpretation, and high-quality long-term RCTs are needed.
12 Apr 2026
Read appraisal →Medicine
Influence of alteration of foot progression angle on three-dimensional pelvic kinematics in individuals with knee osteoarthritis during walking: A randomized crossover study
BACKGROUND: Foot progression angle (FPA) modification trials during walking have been used to reduce knee adduction moments in medial compartment knee osteoarthritis. However, few studies have confirmed the impact of FPA modification as a clinical intervention on pelvic segment kinematics. METHODS: Kinematic pelvic data were obtained from 37 participants with medial knee osteoarthritis using a three-dimensional motion capture system under varying FPA walking conditions. A repeated-measures analysis of variance was conducted to assess the influence of each FPA condition on kinematic values. RESULTS: During maximal internal foot rotation gait trials, participants exhibited decreased depression, reduced external rotation, and increased internal rotation of the pelvis compared to the free walking condition (P < .05). In contrast, under the maximal external foot rotation condition, significantly less internal rotation and increased external rotation of the pelvis were observed compared to the free walking condition (P < .05). CONCLUSION: The findings of this study suggest that additional musculoskeletal dysfunctions and clinical implications, including back pain and pelvic instability, should be considered when implementing FPA modification gait in individuals with medial compartment knee osteoarthritis.
11 Apr 2026
Read appraisal →PloS one
Effects of scapular-focused movement-based exercises on sports performance of athletes with scapular dyskinesis: A systematic review
BACKGROUND: Scapular dyskinesis is a common dysfunction among athletes, particularly in overhead sports, leading to pain, reduced range of motion (ROM), and impaired performance. Movement-based exercises are increasingly used to address these issues, but their overall impact on sports performance remains unclear. OBJECTIVE: This systematic review aims to evaluate the effects of movement-based exercises on sports performance in athletes with scapular dyskinesis. METHOD: A comprehensive search was conducted in Web of Science, Scopus, and PubMed up to July 30, 2025, following PRISMA guidelines. Data were extracted and assessed for risk of bias using RoB-2 and ROBINS-I tools. A narrative synthesis was performed due to study heterogeneity. RESULTS: Fourteen studies (8 RCTs and 6 non-RCTs) involving 412 participants with a mean age of 23.8 years assessed movement-based interventions lasting from a single session to 24 weeks, primarily focusing on scapular stabilization, kinetic chain control, and proprioception over 6-8 weeks with around three sessions per week. Moderate-certainty evidence suggests that exercise likely improves shoulder function, disability, and glenohumeral range of motion over 6-12 weeks. However, the evidence for pain reduction and improvement in rotator cuff/scapular strength is of low certainty, showing mixed effects depending on the specific program. Evidence for improvement in scapular kinematics is also of low certainty. Sport-specific performance outcomes, such as throwing velocity, remain highly uncertain due to small sample sizes and conflicting results from RCTs. CONCLUSION: Movement-based exercises may be considered by athletes with scapular dyskinesis to potentially improve shoulder function and glenohumeral range of motion; however, the certainty of evidence for effects on pain relief, strength, and sports performance is very low. Therefore, strong recommendations cannot be made at this stage. More tailored programs and well-structured RCTs are needed to clarify these effects.
11 Apr 2026
Read appraisal →BMJ paediatrics open
Does osteogenesis imperfecta predispose infants to metaphyseal fractures? A systematic review.
OBJECTIVE: The notion that osteogenesis imperfecta (OI) predisposes children to metaphyseal fractures is controversial. This review aimed to ascertain the prevalence of metaphyseal fractures in children with OI less than 2 years of age. MATERIALS AND METHODS: Medline, CINAHL and Web of Science were searched for studies reporting metaphyseal fractures in children with OI less than 2 years of age. Articles not retrievable, not published in English, or where 'metaphyseal' fracture was not defined/illustrated, were excluded. Article quality was independently assessed using the Critical Appraisal Skills Programme and Case Reports tools. RESULTS: Of 298 retrieved abstracts, 82 were duplicates: 216 articles were screened by title and abstract, excluding 186. Hand search of the remaining 30 articles identified two further articles. Only four articles were included: (1) 4/41 children with OI aged between 1 day and 3 years with 'metaphyseal' fractures; (2) a case series including a 16-month-old boy with three 'metaphyseal' fractures. Abuse concerns remained despite a type IV OI diagnosis (not genetically confirmed); (3) a 7-month-old girl with two 'corner' fractures suspected to have OI and to have been abused; and (4) a pair of siblings with 'metaphyseal' fractures and type XI OI (FKBP10 mutation). CONCLUSIONS: There is limited evidence that OI predisposes infants and young children to metaphyseal fractures. The two diagnoses are not mutually exclusive and until further large studies are conducted, physical abuse should always be considered in infants and young children with metaphyseal fractures, even in those with confirmed OI.
9 Apr 2026
Read appraisal →Annals of medicine
Intervention components, training dose, and adherence in exercise-based prevention of hamstring strain injury in football: a systematic review and meta-analysis
OBJECTIVE: To quantify associations between exercise-based prevention programmes and hamstring strain injury (HSI) risk in football participants, and whether training dose and adherence modify effects. METHODS: Six databases were searched to 1 October 2025. Randomised and cluster-randomised trials comparing HSI prevention programmes with usual practice or warm-up in football participants were included. Random-effects meta-analysis pooled risk ratios (RRs); subgroup analyses and meta-regression assessed effect modification. RESULTS: Fifteen trials (n = 7,465) were analysed. Programmes reduced HSI risk (RR = 0.51, 95% CI 0.36-0.71), with I²=57% and a prediction interval crossing the null (0.18-1.40). Based on a control event rate of 7.8%, absolute risk reduction was 3.8% (38 fewer HSIs per 1000 participants; 95% CI 23-50 fewer). Effects were stronger for shorter interventions (1-6 months; RR = 0.43) than longer interventions (7-10 months; RR = 0.77; P for interaction=0.04), and for elite/semi-professional players (RR = 0.38) than amateur players (RR = 0.77; P for interaction = 0.02). Training frequency and weekly volume did not modify effects, whereas adherence did. High adherence (≥75%) was associated with lower HSI risk (RR = 0.36, 95% CI 0.28-0.48), whereas low adherence (<75%) showed no clear benefit (RR = 0.92, 95% CI 0.68-1.23; P for interaction <0.00001). Each 10% increase in adherence corresponded to an RR multiplier of 0.83 (approximately 17% lower RR). Certainty of evidence was low. CONCLUSION: Exercise-based programmes reduce HSI risk in football when implementation supports sustained adherence. Effects may be stronger in shorter interventions and elite populations, but evidence remains insufficient to differentiate programme types or components.
8 Apr 2026
Read appraisal →The Cochrane database of systematic reviews
Antibiotic treatment for low back pain, radicular pain, or both.
RATIONALE: Low back pain is the leading cause of disability worldwide. Research has associated Modic changes (signal changes in the vertebral endplate on magnetic resonance imaging (MRI)) with low back pain. Some hypothesise that Modic type 1 changes (oedema) may have an infective cause, and that antibiotics could serve as targeted treatment. OBJECTIVES: To assess the benefits and harms of antibiotic therapy, compared with placebo or another treatment, in people with low back pain, radicular pain, or both. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, and two trials registries up to 26 August 2025, with no restrictions related to language or date of publication. ELIGIBILITY CRITERIA: We included randomised controlled trials (RCTs) that assessed antibiotics versus placebo (primary comparison) or other treatments. We assessed the evidence separately for four populations of adults with low back pain, radicular pain, or both: those with 1) Modic type 1 changes and evidence of disc herniation, 2) other Modic changes and evidence of disc herniation, 3) any Modic changes but no evidence of disc herniation, and 4) evidence of disc herniation without any Modic changes. OUTCOMES: Critical outcomes were pain intensity and disability or function up to 12 to 14 weeks, and the number of participants with any adverse events and serious adverse events at the end of the trial period. RISK OF BIAS: Two review authors independently evaluated the risk of bias using the Cochrane risk of bias tool RoB 1. SYNTHESIS METHODS: Two review authors independently screened studies and extracted data. We synthesised results for each outcome using random-effects meta-analysis. Where this was not possible due to the nature of the data, we reported the results descriptively. We used GRADE to assess the certainty of evidence. The primary comparison was antibiotics versus placebo in people with low back pain, radicular pain, or both, and Modic type 1 changes with evidence of disc herniation (population 1) up to 12 to 14 weeks. INCLUDED STUDIES: We included three trials, conducted in Denmark, Belgium, and Norway, with a total of 402 participants (mean ages ranged from 44.7 years to 51.0 years). Two trials recruited people with chronic (> 6 months) moderate-to-severe low back pain (with or without radicular pain), Modic changes, and disc herniation. One trial included people with Modic type 1 changes only (population 1) and compared oral amoxicillin-clavulanate 500 mg/125 mg to placebo (for both treatments, 1 or 2 tablets 3 times daily for 100 days). The second trial included people with either Modic type 1 changes (population 1) or Modic type 2 changes (population 2) and compared oral amoxicillin 750 mg to placebo (for both treatments, 3 times daily for 100 days). Follow-up was 12 months in both trials. The third trial recruited people with lumbar radicular pain (with or without low back pain) and disc herniation. Modic changes was not an inclusion criterion (population 4). This trial evaluated minocycline 100 mg versus amitriptyline 25 mg versus placebo and followed participants for 14 days (treatment duration). There were no trials with population 3. SYNTHESIS OF RESULTS: All three trials were at low risk of selection, performance, and detection bias. We rated one trial at high risk of attrition bias and unclear risk of reporting and other bias. The overall certainty of evidence is low to very low, primarily due to imprecision and indirectness. In people with low back pain, Modic type 1 changes, and disc herniation, the antibiotic oral amoxicillin (with or without clavulanate) may improve pain slightly and may result in a small to moderate improvement in disability at 12 to 14 weeks compared with placebo (low-certainty evidence, downgraded for imprecision and indirectness). At this time point, the mean back pain score was 50.6/100 (where a lower score indicates less pain) in the amoxicillin group versus 59/100 in the placebo group (mean difference (MD) -8.42 points, 95% CI -16.18 to -0.67; I² = 35%; 2 trials, 255 participants), and the mean disability score was 45.2/100 (where a lower score indicates less disability) in the amoxicillin group versus 55.7/100 in the placebo group (MD -10.52 points, 95% CI -15.94 to -5.09; I² = 0%; 2 trials, 255 participants). We are unsure if amoxicillin (with or without clavulanate) results in more people reporting adverse events (very low-certainty evidence, downgraded for imprecision, inconsistency, and indirectness). Adverse events were reported in 76 of every 100 people taking amoxicillin compared with 49 of every 100 people taking placebo (risk ratio (RR) 1.79, 95% CI 0.54 to 5.94; I² = 96%; 2 trials, 262 participants). We are unsure if amoxicillin (with or without clavulanate) results in more people reporting serious adverse events (very low-certainty evidence, downgraded for imprecision and indirectness). Serious adverse events were reported in three of every 100 people taking amoxicillin (with or without clavulanate) compared with two of every 100 people taking placebo (RR 1.43, 95% CI 0.11 to 18.35; I² = 45%; 2 trials, 262 participants). We are unsure of the effects of amoxicillin compared to placebo in people with low back pain, Modic type 2 change, and disc herniation. Similarly, we are unsure of the effects of minocycline compared to placebo or amitriptyline in people with low back pain, disc herniation, and no Modic changes. AUTHORS' CONCLUSIONS: In people with low back pain, Modic type 1 changes, and evidence of disc herniation, the antibiotic amoxicillin (with or without clavulanate) may provide slight to small benefits in reducing back pain and small to moderate benefits in improving disability compared to placebo at 12 to 14 weeks. The evidence on the risk of adverse events, including serious adverse events, with amoxicillin (with or without clavulanate) is very uncertain. Further research is likely to change our confidence in the estimates. FUNDING: This review had no dedicated funding. REGISTRATION: Protocol (2021): DOI 10.1002/14651858.CD014221.
8 Apr 2026
Read appraisal →European radiology
Large language model-based uncertainty-adjusted label extraction for artificial intelligence model development in upper extremity radiography
OBJECTIVES: To evaluate GPT-4o's zero-shot ability to extract structured diagnostic labels (with uncertainty) from free-text radiology reports and to test how these labels affect multi-label image classification of musculoskeletal radiographs. MATERIALS AND METHODS: This retrospective study included radiography series of the clavicle (n = 1170), elbow (n = 3755), and thumb (n = 1978). After anonymization, GPT-4o filled out structured templates by indicating imaging findings as present ("true"), absent ("false"), or "uncertain." To assess the impact of label uncertainty, "uncertain" labels of the training and validation sets were automatically reassigned to "true" (inclusive) or "false" (exclusive). Label-image pairs were used for multi-label classification using the ResNet50 architecture. Label extraction accuracy was manually verified on internal (clavicle: n = 233, elbow: n = 745, thumb: n = 393) and external test sets (n = 300 for each). Performance was assessed using macro-averaged receiver operating characteristic (ROC) area under the curve (AUC), precision, recall curves, sensitivity, specificity, and accuracy. AUCs were compared with the DeLong test. RESULTS: Automatic extraction was correct in 98.6% (60,618 of 61,488) of labels in the test sets. Across anatomic regions, label-based model training yielded competitive performance measured by macro-averaged AUC values for inclusive (e.g., elbow: AUC = 0.80 (range, 0.62-0.87)) and exclusive models (elbow: AUC = 0.80 (range, 0.61-0.88)). Models generalized well on external datasets (elbow (inclusive): AUC = 0.79 (range, 0.61-0.87); elbow (exclusive): AUC = 0.79 (range, 0.63-0.89)). No significant differences were observed across labeling strategies or datasets (p ≥ 0.15). CONCLUSION: GPT-4o extracted labels from radiologic reports to train competitive multi-label classification models with high accuracy. Detected uncertainty in the radiologic reports did not influence the performance of these models. KEY POINTS: Question Can GPT-4o automatically extract high-accuracy, uncertainty-aware diagnostic labels from routine radiologic reports of the clavicle, elbow, and thumb for use in training multi-label image classifiers? Findings GPT-4o extracted labels with > 98% accuracy, and multi-label classifiers for clavicle, elbow, and thumb radiographs performed consistently regardless of how uncertainty was handled. Clinical relevance Automated GPT-4o-based labeling of routine clavicle, elbow, and thumb radiologic reports enables the rapid conversion of radiologic reports into structured multi-label training datasets, supporting scalable development of dedicated image classification models.
4 Apr 2026
Read appraisal →Artif Cells Nanomed Biotechnol
Unveiling the ageing-related genes in diagnosing osteoarthritis with metabolic syndrome by integrated bioinformatics analysis and machine learning
Ageing significantly contributes to osteoarthritis (OA) and metabolic syndrome (MetS) pathogenesis, yet the underlying mechanisms remain unknown. This study aimed to identify ageing-related biomarkers in OA patients with MetS. OA and MetS datasets and ageing-related genes (ARGs) were retrieved from public databases. The limma package was used to identify differentially expressed genes (DEGs), and weighted gene coexpression network analysis (WGCNA) screened gene modules, and machine learning algorithms, such as random forest (RF), support vector machine (SVM), generalised linear model (GLM), and extreme gradient boosting (XGB), were employed. The nomogram and receiver operating characteristic (ROC) curve assess the diagnostic value, and CIBERSORT analysed immune cell infiltration. We identified 20 intersecting genes among DEGs of OA, key module genes of MetS, and ARGs. By comparing the accuracy of the four machine learning models for disease prediction, the SVM model, which includes CEBPB, PTEN, ARPC1B, PIK3R1, and CDC42, was selected. These hub ARGs not only demonstrated strong diagnostic values based on nomogram data but also exhibited a significant correlation with immune cell infiltration. Building on these findings, we have identified five hub ARGs that are associated with immune cell infiltration and have constructed a nomogram aimed at early diagnosing OA patients with MetS.
1 Dec 2025
Read appraisal →