Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 14 appraisals
Bioinspiration & biomimetics
Length control of pneumatic artificial muscles inspired by intrafusal-extrafusal muscle interactions
Pneumatic artificial muscles (PAMs) are widely used in pneumatic musculoskeletal robots due to their lightweight nature and high power output. On the other hand, their control typically relies on electro-pneumatic valves, electronic sensors, and peripheral circuits such as A/D converters. This increases the number of distributed electronic components and electrical interconnections, potentially leading to greater system mass as well as higher maintenance requirements, particularly in systems containing many PAMs. To overcome these challenges, inspired by the intrafusal-extrafusal muscle interactions in biological systems, this paper proposes a length control method for PAMs in which the pneumatic feedback loop is implemented mechanically, while the target length is commanded by a minimal electronic actuator. We first examined flow path conditions to suppress oscillations caused by pneumatic delays. Second, Experiments demonstrated a tracking error of2.01% for input frequencies0.20 Hz.
29 July 2026
Read appraisal →Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
Effects of transcranial direct current stimulation on motor function in patients with multiple sclerosis: a systematic review and meta-analysis
OBJECTIVE: To assess the effectiveness of transcranial direct current stimulation (tDCS) in enhancing motor function recovery in the upper and lower extremities of individuals with multiple sclerosis. DATA SOURCES: PubMed, Embase, Web of Science, Cochrane Library, and China Knowledge Network (CNKI) databases from inception until December 28, 2025. STUDY SELECTION: Randomized controlled trials that investigated transcranial direct current stimulation and tDCS combined with physical training on motor function in the upper and lower limbs of individuals with MS. DATA EXTRACTION: Two reviewers extracted the data and assessed the risk of bias. Standardized mean difference (SMD) and 95% confidence intervals (CI) were calculated using a random-effects model based on heterogeneity. The analysis included 10 articles with a total of 299 subjects. DATA SYNTHESIS: The Meta-analysis shows tDCS significantly improves lower limb motor function in MS patients (SMD = 0.31, 95% CI: 0.16 - 0.46, p < 0.0001). Subgroup analyses found significant increases in walking distance (p = 0.0005) and static balance (Berg Balance Score, p = 0.0002), but no significant improvements were observed in walking speed and dynamic balance. For upper limb motor function, no statistically significant difference was found in hand dexterity (9-HPT) (p = 0.11). Notably, subgroup analyses of stimulation parameters showed that high intensity (2.0-2.5 mA, p = 0.007) and a 20-minute duration (p = 0.03) yielded significant effects, whereas low intensity (1.0-1.5 mA) and 15-minute duration showed no significant benefits. CONCLUSIONS: Transcranial direct current stimulation is effective in enhancing lower limb motor function in patients with MS. However, the efficacy of tDCS in improving upper limb fine motor skills remains unclear. Evidence suggests that stimulation at 2.0-2.5 mA for 20 min may be the optimal protocol for clinical intervention.
13 July 2026
Read appraisal →Progress in biomedical engineering (Bristol, England)
Assessing the relevance of biosignal-controlled robotic rehabilitation technologies: a systematic review.
Technology is transforming rehabilitative medicine by enhancing accessibility and personalisation. Robot-assisted rehabilitation uses robotic systems for recovery from physical and neurological impairments, enabling intensive, repetitive training with real-time feedback. These systems aim to restore motor function and mobility and to increase independence in daily life, needs that are growing in light of population ageing. Rather than revisiting control algorithms or mechanical design, this review aims to investigate the combined use of bio-signals and robotic rehabilitation systems, and to discuss their potential in rehabilitation settings outside disease-specific clinical frameworks. We reviewed studies published from 2020 through early 2025 to capture recent advances in this rapidly evolving field. Our objective was to assess the relevance of these technologies to rehabilitation outcomes, such as improvements in motor function or other clinical metrics. We considered robot-assisted systems driven by biosignals such as electromyography (EMG), electroencephalography, or electrocardiography and included only studies reporting measurable rehabilitative outcomes. Following PRISMA guidelines, we searched Scopus, PubMed, and WoS databases. Of 207 records screened, 15 met the inclusion criteria. Overall, the included studies suggest that contemporary biosignal-controlled robotic rehabilitation, particularly EMG-driven approaches, may support more intensive, personalised, and engaging therapy than conventional care alone, although the current evidence remains preliminary. Preliminary findings indicate that, by closing the loop among patient, device, and therapist, these systems may reduce muscle activity and support improvements in motor performance; however, the evidence base remains heterogeneous and generally underpowered. To support future clinical adoption, the field needs adequately sized, head-to-head trials with standardised outcome measures, longer follow-up, and transparent reporting of adherence, adverse events, user experience, and implementation barriers, including training and cost. These steps will be important to further assess efficacy and evaluate usability in real-world settings.
20 June 2026
Read appraisal →Behavioural brain research
Function-specific repetitive transcranial magnetic stimulation enhances motor strategy adaptation when combined with motor practice.
Effective motor strategy adaptation is essential for both high-performance sports and neurorehabilitation. Repetitive transcranial magnetic stimulation (rTMS) can modulate brain function; however, its efficacy may depend on the specificity of the stimulation targets. This study investigated whether function-specific rTMS, guided by fMRI-defined activation during motor imagery, enhances motor strategy adaptation. Forty-six healthy adults were randomized into three groups: function-specific rTMS, hotspot rTMS, and a no-stimulation control. All participants received identical motor imagery and physical practice in the backward glide shot put. Kinematic and resting-state functional magnetic resonance imaging (rs-fMRI) data were collected before and after the 7-day intervention, and functional connectivity (FC) was analyzed. Results showed that function-specific rTMS led to significantly greater improvements in trunk angle during the glide phase, a critical biomechanical parameter. FC between the right inferior frontal gyrus (IFG) and primary sensorimotor cortex increased significantly in this group and was positively correlated with kinematic improvements. These findings demonstrate that rTMS targeting task-relevant brain regions enhances motor strategy adaptation via mechanisms involving FC associated with motor performance, highlighting its potential for optimizing motor learning in both athletic and clinical populations.
7 June 2026
Read appraisal →Behavioural brain research
Effects of anodal transcranial direct current stimulation on athletic performance among elite athletes: A systematic review and meta-analysis
BACKGROUND: Non-invasive brain stimulation techniques, such as transcranial direct current stimulation (tDCS), have been proposed as promising approaches for enhancing motor performance. However, evidence regarding their effects on different domains of athletic performance in elite athletes remains inconclusive. OBJECTIVE: This study aims to quantify the effects of anodal tDCS on athletic performance in elite athletes, compared with a sham condition. METHODS: A comprehensive search of six electronic databases (PubMed, Web of Science, SportDiscus, ECSCO, Embase, and the Cochrane Library) was conducted to identify randomized clinical trials (RCTs). Standardized mean differences (SMDs) based on post-intervention scores were pooled using random-effects models to estimate pooled effect sizes. Subgroup analyses were performed to examine potential moderating variables. Study quality and risk of bias were evaluated using the Cochrane Risk of Bias Tool. RESULTS: A total of 18 studies involving 259 elite athletes were included in the analysis. The results indicated that anodal tDCS had a moderate but significant overall effect on athletic performance in elite athletes (SMD = 0.57, 95% CI [0.39, 0.75], p < 0.01), although moderate heterogeneity was observed ( I²= 51.38%). Subgroup analyses revealed significant domain-specific variability: the effects were strongest in sport-specific performance (SMD = 0.79, 95% CI [0.51, 1.08], p < 0.01) and physical fitness (SMD = 0.58, p < 0.01), whereas the effects on recovery (SMD = 0.17, p = 0.65) and psychological variables (SMD = 0.38, p = 0.09) were negligible and non-significant. Additionally, the M1 area was found to be the most effective cortical target. CONCLUSIONS: Our findings provide evidence that anodal tDCS is a promising tool for enhancing performance in elite athletes, but its effectiveness is highly domain-dependent. It is particularly potent for improving sport-specific skills and physical fitness, while its role in accelerating recovery remains unsupported. Coaches and practitioners should consider these domain-specific variations and the ceiling effect of elite populations when designing tDCS interventions.
7 June 2026
Read appraisal →Behavioural brain research
Efficacy of repetitive transcranial magnetic stimulation at different frequencies for post-stroke cognitive impairment: A network meta-analysis
PURPOSE: Post-stroke cognitive impairment (PSCI) affects nearly half of stroke survivors, necessitating effective interventions. This Bayesian network meta-analysis evaluated the efficacy of various repetitive transcranial magnetic stimulation (rTMS) protocols for PSCI. METHODS: We systematically searched PubMed, Cochrane Library, and Chinese databases up to December, 2025, including 37 randomized controlled trials (2543 patients) comparing rTMS protocols with different frequencies (low/high) and sites (left/right). Outcomes were measured using the Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), and Modified Barthel Index (MBI). RESULTS: Results indicated that high-frequency left dorsolateral prefrontal cortex stimulation (HFL-rTMS) most effectively improved MoCA scores (MD=3.38, SUCRA=87.6%), high-frequency right-sided stimulation (HFR-rTMS) ranked highest for MMSE improvement (MD=2.93, SUCRA=79.7%), and high-frequency bilateral stimulation (HFB-rTMS) yielded the greatest MBI enhancement (MD=13.47, SUCRA=89.6%). CONCLUSIONS: High-frequency rTMS demonstrated superior efficacy in cognitive and functional recovery. HFL-rTMS, HFR-rTMS, and HFB-rTMS are recommended as optimal interventions for MoCA, MMSE, and MBI outcomes, respectively. Further studies are warranted to validate stimulation parameters and expand multicenter evidence for clinical application.
30 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 →Archives of orthopaedic and trauma surgery
Extracorporeal shockwave therapy in bone fractures: a systematic review
INTRODUCTION: The increasing incidence of fractures and cases of delayed union or nonunion has encouraged the search for non-invasive therapies. Extracorporeal shockwave therapy (ESWT) has been proposed as a strategy to stimulate bone regeneration and improve fracture healing. MATERIALS AND METHODS: A systematic review was conducted following PRISMA guidelines, with searches performed in PubMed, Scopus, Web of Science, and Embase (2005-2025). Clinical studies evaluating ESWT for fracture treatment with radiographic assessment of bone healing and the presence of a control group were included. RESULTS: A total of 834 studies were initially identified, of which 7 were included in the final analysis. Most studies demonstrated positive effects of ESWT, including improved bone healing, pain reduction, and functional recovery. However, there was considerable heterogeneity in treatment protocols and relatively small sample sizes. CONCLUSION: ESWT shows potential as a non-invasive therapy to stimulate fracture healing, particularly in cases of delayed union or nonunion. However, further controlled clinical trials and standardized protocols are needed to confirm its clinical effectiveness.
25 May 2026
Read appraisal →Journal of neurology
Effectiveness of telemedicine-based rehabilitation after stroke: a systematic review
BACKGROUND: Access to timely post-acute stroke rehabilitation remains inconsistent, contributing to persistent disability despite advances in acute stroke care. Telemedicine has been proposed as a strategy to improve continuity and access to rehabilitation services, but its effectiveness across functional domains remains incompletely defined. OBJECTIVE: To evaluate the effectiveness of telemedicine-delivered post-acute follow-up and rehabilitation on functional recovery and disability outcomes among adult stroke survivors. METHODS: A systematic review was conducted in accordance with PRISMA guidelines. PubMed, Embase, Scopus, and Web of Science were searched for studies published between January 2015 and December 2025. Eligible studies included adult stroke populations receiving telemedicine-based post-acute follow-up or rehabilitation and reporting functional, motor, balance, quality-of-life, or feasibility outcomes. Randomized controlled trials and observational studies were included. Risk of bias was assessed using validated tools, and findings were synthesized narratively without quantitative pooling due to heterogeneity. RESULTS: Twenty-eight studies comprising approximately 1237 participants were included. Telerehabilitation was associated with improvements in activities of daily living, although between-group differences varied across studies. Activities of daily living improved post-discharge (Barthel Index + 23.3 vs + 9.3; p < 0.001), and Functional Independence Measure scores increased in tele-CIMT and wearable-assisted interventions. Upper limb performance improved (WMFT time - 2.28 s; Box and Block Test + 5.57 vs 1.0; Nine-Hole Peg Test - 71.6 s; Jebsen-Taylor - 26.6 s). Spasticity decreased (MAS) with wrist improvements maintained at 6 months. Mobility and balance also improved, with intervention groups walking farther (6MWT 141.6 ± 8.7 m vs 129.5 ± 7.1 m; p < 0.001) and showing comparable improvements in BBS outcomes across groups. Technology-assisted telerehabilitation programs were more frequently associated with statistically significant improvements; however, these findings were not consistently superior to standard rehabilitation across all studies. Most randomized trials had some concerns for bias, and half of non-randomized studies were rated as serious risk, limiting overall certainty. CONCLUSIONS: Telemedicine-based post-acute stroke rehabilitation is feasible and associated with functional improvements comparable to in-person care. Reported adverse events were infrequent and generally minor, though safety outcomes were inconsistently measured across studies. High feasibility, adherence, and patient satisfaction support its role as a scalable component of post-stroke rehabilitation pathways.
23 May 2026
Read appraisal →Journal of medical Internet research
Effectiveness of Digital Health Interventions in Older Adults With Frailty and Sarcopenia: Systematic Review and Meta-Analysis of Randomized Controlled Trials
BACKGROUND: Frailty and sarcopenia represent substantial global health challenges, frequently diminishing patients' quality of life through impaired muscle function and physical performance. Digital health interventions (DHIs) have shown promise in mitigating these conditions among older adults. However, outcomes of such interventions in this demographic are inconsistent, and a thorough synthesis of existing evidence is lacking. OBJECTIVE: This study aimed to evaluate the effectiveness of DHIs in older adults with frailty and sarcopenia. METHODS: A comprehensive search of PubMed, Web of Science, MEDLINE, Embase, and Cochrane Library was conducted from their inception until January 2026 to identify randomized controlled trials. Meta-analyses were performed using R software (R Foundation for Statistical Computing). Study quality was evaluated using the revised Cochrane Risk of Bias Tool 2.0 (Cochrane Collaboration), and evidence certainty was assessed using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). RESULTS: From 3506 records, 16 studies were included. DHIs significantly improved total skeletal muscle mass (weighted mean difference [WMD] 1.01, 95% CI 0.08-1.94, 95% prediction interval [PI] -0.95 to 2.96), gait speed (WMD 0.09, 95% CI 0.03-0.15, 95% PI -0.1 to 0.26), Timed Up and Go Test (TUGT: WMD -0.52, 95% CI -1.02 to -0.03, 95% PI -1.93 to 0.85), 30-second Chair Stand Test (30CST: WMD 2.19, 95% CI 0.89-3.48, 95% PI -1.59 to 5.66), balance (standardized mean difference [SMD] 0.61, 95% CI 0-1.21, 95% PI -0.94 to 2.13), and quality of life (SMD 0.16, 95% CI 0.05-0.27, 95% PI 0.04-0.28). No significant improvements were observed in Appendicular Skeletal Muscle Mass Index (ASMI), grip strength, 6-minute walk test (6MWT), 2-minute walk test (2MWT), Short Physical Performance Battery (SPPB), or BMI. Although the pooled effect was favorable, the wide 95% PI suggests substantial between-study heterogeneity. Subgroup analysis stratified by intervention duration revealed significant intersubgroup differences in ASMI (χ²₁=9.93; P=.0016), indicating interventions lasting ≥12 weeks were more effective for improving ASMI (WMD 0.28, 95% CI 0.06-0.50, 95% PI -0.30 to 0.83). Subgroup analysis stratified by intervention type showed significant intersubgroup differences in balance (χ²₃=9.89; P=.0195), with exergame-based interventions showing significant effects (SMD 0.83, 95% CI 0.26-1.40). CONCLUSIONS: This systematic review is the first to quantify the disease-specific efficacy of DHIs in improving muscle function, physical performance, and quality of life among older adults with frailty and sarcopenia, demonstrating their unique value as a scalable complementary approach. By overcoming geographical and resource constraints, DHIs support underserved populations. However, low evidence quality and heterogeneity warrant cautious interpretation. The 95% PIs indicate that actual effects may vary with population characteristics and implementation contexts. Nonetheless, DHIs represent a promising and cost-effective strategy for service expansion. Future high-quality studies are needed to better understand their effectiveness and implementation across settings.
13 May 2026
Read appraisal →Proceedings of the National Academy of Sciences of the United States of America
Neural reservoir control of a bio-hybrid soft arm
A long-standing engineering problem, the control of soft robots is difficult because of their highly nonlinear, heterogeneous, anisotropic, and distributed nature. Here, bridging engineering and biology, neural reservoirs are employed for the dynamic control of a bio-hybrid model arm made of multiple muscle-tendon groups enveloping an elastic spine. We show how the use of reservoirs facilitates simultaneous control and self-modeling across challenging tasks, outperforming classic neural network approaches. Further, through the use of spiking reservoirs on neuromorphic hardware, energy efficiency gains of up to 75 and 45 times are obtained relative to standard and high-efficiency CPUs, with implications for the on-board control of untethered, small-scale systems.
28 Apr 2026
Read appraisal →PloS one
A secondary head-to-head comparison of low-intensity focused ultrasound and repetitive transcranial magnetic stimulation for motor recovery after stroke
BACKGROUND: Low-intensity focused ultrasound (LIFU) is a non-invasive neuromodulation technique with high spatial precision and the ability to reach deeper brain regions, offering potential advantages for post-stroke rehabilitation. Repetitive transcranial magnetic stimulation (rTMS) is a widely adopted non-invasive brain stimulation technique that modulates cortical excitability to promote neuroplasticity. However, direct head-to-head comparisons between these two modalities for post-stroke motor recovery remain limited. OBJECTIVE: To perform a secondary head-to-head comparison of LIFU and repetitive transcranial magnetic stimulation (rTMS) for motor recovery after stroke, based on a prospectively registered randomized controlled trial. METHODS: This secondary analysis included patients with subacute stroke who received two weeks of standard rehabilitation combined with either LIFU (n = 25) or rTMS (n = 25) targeting the ipsilesional primary motor cortex. LIFU parameters: 0.5 MHz, spatial-peak pulse-average intensity (ISPPA) 10.2 W/cm² (free-field), pulse duration 0.2 ms, duty cycle 20%, 20 minutes per session, five days per week for two weeks (10 sessions total). rTMS parameters: 10 Hz, 80% resting motor threshold, 1,000 pulses per session (20 trains of 5 seconds), 20 minutes per session, five days per week for two weeks (10 sessions total). Motor outcomes were assessed using the Fugl-Meyer Assessment (FMA; upper and lower extremities), Modified Barthel Index (MBI), and Brunnstrom stages. Resting-state functional near-infrared spectroscopy (fNIRS) was used to evaluate cortical activity and functional connectivity before and after the intervention. Primary analyses were conducted in the intention-to-treat (ITT) population (n = 50), with completer analyses (n = 43) performed as sensitivity analyses. RESULTS: Both groups showed significant within-group improvements in FMA and MBI after the intervention (all p < 0.001), and changes in Brunnstrom stages were also uniformly significant. No statistically significant between-group differences were observed in post-intervention FMA, MBI, or Brunnstrom stages (all p > 0.05), and completer analyses yielded consistent between-group conclusions. In contrast, change-from-baseline analyses demonstrated greater improvements in FMA scores in the LIFU group compared with the rTMS group (ΔFMA upper limb: median 7 [IQR 3-10.5] vs. 2 [1-3], p = 0.001; lower limb: 3 [1-4.5] vs. 1 [0-1.5], p < 0.001). Exploratory fNIRS analyses revealed modality-specific patterns: prefrontal fractional amplitude of low-frequency fluctuations (fALFF) increased significantly in the LIFU group (p = 0.002) but not in the rTMS group, while functional connectivity changes did not remain significant after correction for multiple comparisons. CONCLUSION: LIFU and rTMS were associated with comparable short-term motor outcomes in subacute stroke. Differences observed in change-from-baseline motor improvements and exploratory neuroimaging measures suggest potential divergence in recovery dynamics and cortical modulation, warranting further investigation in larger, longitudinal studies. TRIAL REGISTRATION: This study was derived from a prospectively registered, three-arm randomized controlled trial in the Chinese Clinical Trial Registry (ChiCTR2500114687). The present manuscript reports a secondary head-to-head comparison between the two neuromodulation intervention arms.
27 Apr 2026
Read appraisal →American journal of physical medicine & rehabilitation
Optimal Strategy of Resistance Training Combined With Other Rehabilitation Interventions for Lower-Limb Dysfunction in Stroke Patients: A Systematic Review and Network Meta-Analysis
OBJECTIVE: Stroke frequently results in lower-limb dysfunction, severely limiting independence. This study compared the effectiveness of resistance training alone and resistance training combined with other rehabilitation modalities in improving poststroke lower-limb function. DESIGN: A systematic review and Bayesian network meta-analysis were conducted following PRISMA guidelines. Randomized controlled trials involving resistance training alone or in combination with other therapies versus daily care or resistance training alone were included. The primary outcomes were balance, lower-limb motor function, and walking ability. RESULTS: Forty-seven trials with 2448 participants were analyzed. Resistance training combined with electrical stimulation therapy produced the greatest improvements in balance and lower-limb motor function, while resistance training combined with stretching training showed the best enhancement in walking ability. Surface Under the Cumulative Ranking Curve rankings indicated resistance training plus electrical stimulation therapy as most effective for balance (91.13%) and lower-limb motor function (79.70%), and resistance training plus stretching training for walking ability (96.34%). CONCLUSIONS: Resistance training remains fundamental in stroke rehabilitation. Integrating resistance training with targeted adjunctive training particularly electrical stimulation therapy or stretching training yields superior therapeutic outcomes and supports individualized, evidence-based strategies for optimizing lower-limb recovery after stroke.
25 Apr 2026
Read appraisal →Spinal cord series and cases
Early transanal irrigation in spinal cord injury-related neurogenic bowel dysfunction: preliminary insights.
STUDY DESIGN: Prospective, randomized, open-label, multicenter, parallel group study. OBJECTIVES: Neurogenic bowel dysfunction (NBD) is a common complication in spinal cord injury (SCI) patients, severely affecting quality of life. While transanal irrigation (TAI) has shown superior efficacy over conservative treatments (CT), its early adoption during the first hospitalization post-injury remains unexplored. This study aimed to compare early TAI initiation versus CT in managing NBD in SCI patients. SETTING: This study involved four spinal units across Italy. METHODS: SCI patients were randomized to receive TAI or CT during a four-week hospital stay, followed by continued treatment at home for 6 months. Bowel function, constipation, and continence were assessed using the Wexner scales, while quality of life was measured using the EQ-5D-5L and Spinal Cord Independence Measure (SCIM) questionnaires. Stool transit time and patient independence were also monitored. RESULTS: Twenty-two patients were enrolled, with the TAI group showing significant improvements in constipation (Wexner score reduction from 13.43 ± 4.24 at baseline to 7.55 ± 2.38 and 8.80 ± 4.16 at 4 weeks and 6 months, p = 0.02) and a trend toward continence improvement. A significant increase in the total SCIM score was observed in the TAI group (p = 0.02), particularly in respiratory and sphincter management. Quality of life improved in both groups, with a notable enhancement in self-care activities for the TAI group (p = 0.006). CONCLUSIONS: These preliminary results suggest early TAI adoption improves bowel management, especially constipation, and enhances patient independence. Larger studies are needed to validate these findings and assess long-term benefits.
22 Apr 2026
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