Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 8 appraisals
Journal of bodywork and movement therapies
Wearable technologies in neurorehabilitation and cardiac rehabilitation: A narrative review
BACKGROUND/OBJECTIVE: Wearable devices are sensor-based technologies capable of continuous physiological and movement monitoring, improving health tracking and clinical care. They can play a crucial role in clinical practice including cardiac and neurological rehabilitation, aiding in conditions as stroke, Parkinson and heart failure. These tools enhance treatment adherence and outcomes through remote, continuous, and personalized monitoring. By overcoming barriers of traditional rehabilitation, wearable devices offer cost-effective, accessible, and patient-centered solutions for chronic care. The purpose of this study is to evaluate the state of the art of the use of wearable devices in cardiology and neurology clinical rehabilitation practice. METHODS: A structured literature search was performed in PubMed, Embase, Web of Science, Scopus and Cochrane Library databases, for original studies published between 2014 and 2024 involving adult patients and clinical data. Only original studies with patient intervention or observation were included. RESULTS: Of the 25 studies included, 19 focused on neurology and 6 on cardiology, all exploring wearable devices in adult rehabilitation from 2014 to 2024. Neurological studies targeted conditions like stroke and Parkinson's disease, using robotic aids and virtual reality, while cardiac studies focused on activity monitoring and recovery support. Devices ranged from IMUs and sensor-equipped gloves to wrist-worn ECG monitors, with outcomes assessing motor function, heart rate, and rehabilitation adherence. Patient acceptance was generally positive, particularly in tele-rehabilitation contexts, although usability and long-term adherence were inconsistently reported. CONCLUSIONS: Wearable devices effectively improve neurological and cardiac rehabilitation by supporting personalized, data-driven therapies and remote monitoring, helping to monitor activity and therapeutic adherence. Overall, they promote better outcomes, patient autonomy, and access to care, although there is less evidence. Future studies should further investigate the utility of these devices in different rehabilitation settings.
1 July 2026
Read appraisal →Journal of special operations medicine : a peer reviewed journal for SOF medical professionals
Prediction Factors Associated with Success in Military Special Operations Courses: A Systematic Review
BACKGROUND: We investigated factors associated with military personnel success in Special Operations courses (course pass or fail). METHODS: A systematic search was conducted across eight databases using the keywords "Special Operations" and "attrition." Sample size and profile data, course characteristics, predictive factors, follow-up, and results were extracted from the studies. We compared the means of the variables associated with success between the groups that completed and did not complete the courses. A meta-analysis was conducted for factors assessed by two or more studies, pooling standardized or weighted mean differences using fixedor random-effects models. RESULTS: A total of 23 studies were included. They were published between 1990 and 2022, included samples from 10 nations, lasted between 5 days and 12 months, and ranged from 11 to 1,138 individuals. VO2max, pull-ups, push-ups, and marching performance showed consistent positive associations with course success, while body fat percentage and sit-up performance did not. Certainty of evidence was rated as low to very low using the Grading of Recommendations Assessment, Development, and Evaluation. CONCLUSION: The factors that increased the probability of success in Special Operations courses were character strengths, recidivism in the course, anthropometric data, performance on physical assessment tests, psychological dissociation, psychosocial resources, blood markers, smoking/alcohol consumption, personality, and psychological strength. These findings support the inclusion of aerobic capacity, muscular endurance, and psychological resilience in early screening and preparatory selection processes.
29 June 2026
Read appraisal →Journal of robotic surgery
Progress and perspectives in soft robotics for surgery and rehabilitation
Soft robotic systems have become a promising technology in the biomedical field due to their higher safety, dexterity and adaptability compared to traditional rigid robotic systems. This review focuses on recent advances in soft robotic systems applied to surgical assistance and rehabilitation. In surgery, soft grippers and flexible endoscopes show better adaptability, dexterity, and miniaturization, enabling safer and more precise manipulation of delicate tissues. In rehabilitation, wearable soft devices show great potential to help patients with neurological injuries to regain movement. Key innovations in actuation technology are examined, along with recent advances in multifunctional, self-healing, and environmentally responsive materials. Meanwhile, sensing systems are evolving from unimodal sensing to multimodal fusion, self-perception, and sense-drive integration, enabling robots to sense the body state and external environment with higher accuracy and realize closed-loop control. Finally, this paper points out that soft robots still face key challenges such as material durability, biosafety, and stability during clinical translation. In the future, the focus should be on the construction of systems with self-diagnosis, self-adaptive adjustment and closed-loop control, and promote the efficient landing and personalized application of soft robots from experimental research to real medical scenarios.
21 June 2026
Read appraisal →Lasers in medical science
Functional and ultrasonographic evaluation of high intensity laser therapy and Kinesio taping in stroke patients with hemiplegic shoulder pain: a randomized controlled trial
Hemiplegic shoulder pain (HSP) is a common post-stroke complication that limits functional recovery and rehabilitation participation. The objective of this study was to evaluate and compare the clinical, functional, and ultrasonographic superiority of High-Intensity Laser Therapy (HILT) and Kinesio Taping (KT) over each other, as well as in comparison to conventional therapy (COT). The study was designed as a prospective, double-blind, randomized controlled trial. Participants were allocated into three equal groups (n = 11 each group): Group 1 (Control Group) received COT with sham HILT and sham KT, Group 2 (HILT Group) received COT with active HILT and sham KT, and Group 3 (KT Group) received COT with sham HILT and active KT. COT was performed five days per week for three weeks, HILT was administered in 10 sessions, and KT was applied every other day for three weeks (nine sessions). The primary outcome measure of the study was the Shoulder Pain and Disability Index (SPADI) score. Secondary outcome measures included pain intensity assessed using the Visual Analog Scale (VAS), passive shoulder range of motion (pROM), ultrasonographic findings, Brunnstrom Recovery Stage (BRS), the Functional Independence Measure (FIM), and the Health Assessment Questionnaire (HAQ). All measures were evaluated at baseline (pre-treatment) and immediately following the intervention period (post-treatment). Data were analyzed using repeated measures ANOVA and McNemar tests. Groups were sociodemographically comparable (p > 0.05). Post-treatment, all groups exhibited significant improvements in shoulder flexion, extension, external rotation, and BRS, VAS, SPADI, FIM, and HAQ scores (p < 0.05). No significant changes occurred in ultrasonographic findings, shoulder abduction, or internal rotation. Notably, HILT demonstrated superior VAS and SPADI improvements compared to other groups (p < 0.05). HILT provides rapid, clinically significant pain relief and functional recovery in HSP without adverse effects, offering a safe and superior therapeutic option.
23 May 2026
Read appraisal →Oral and maxillofacial surgery
Does adjunctive low-level laser therapy provide additional benefit following temporomandibular joint arthrocentesis with hyaluronic acid? A randomized clinical trial.
PURPOSE: This study aimed to evaluate whether adjunctive low-level laser therapy (LLLT) provides additional clinical benefit over an optimized arthrocentesis protocol with hyaluronic acid in patients with ADDwoR. MATERIALS AND METHODS: From December 2022 to December 2023, a single-blinded prospective randomized clinical trial was conducted at The British University in Egypt's Department of Oral and Maxillofacial Surgery. The study involved 40 female participants diagnosed with Anterior Disc Displacement without Reduction (ADDwoR). Following TMJ arthrocentesis, subjects were assigned to one of two parallel cohorts: Group A received ten subsequent sessions of low-level laser therapy (LLLT), while Group B served as the control, receiving arthrocentesis alone. Treatment efficacy was evaluated based on pain intensity measured via a Visual Analogue Scale (VAS) and maximum mouth opening (MMO). Clinical assessments were performed at 2-week intervals over a 12-week follow-up period. RESULTS: No significant age-related differences were detected when comparing the intervention group to the control group (p = 0.087). No significant intergroup differences were observed in maximum mouth opening (MMO) or pain scores (VAS) at any follow-up time point (p > 0.05). Over the 12-week period, both study arms demonstrated significant clinical enhancement in terms of MMO and pain intensity (p < 0.001). Improvements in MMO were large in both groups, with postoperative values significantly higher than preoperative measurements. Pain scores decreased markedly following treatment, with preoperative scores significantly higher than all postoperative values. Overall, both interventions resulted in significant functional improvement and pain reduction, with no added benefit of the intervention over the control. CONCLUSION: While both TMJ arthrocentesis alone and arthrocentesis supplemented with LLLT significantly improved maximum mouth opening and reduced pain, LLLT did not provide a significant incremental benefit over arthrocentesis with hyaluronic acid. These findings suggest that clinical improvements are primarily driven by the main intervention and may reflect a possible therapeutic ceiling effect, beyond which adjunctive LLLT does not confer measurable short-term benefit. CLINICAL TRIAL NUMBER: Not applicable.
18 May 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Night-time compression with a Mobiderm® auto-adjustable arm-sleeve in addition to daytime compression was superior to daytime compression alone for maintenance therapy of upper limb lymphedema in breast cancer patients in a randomized controlled trial: LYMphoNIGHT study.
PURPOSE: To assess the benefit of night-time compression in addition to daytime compression on arm excess volume after 3 months of maintenance treatment in patients with secondary upper limb breast cancer-related lymphedema (BCRL). METHODS: This multicenter, controlled, randomized study was carried out in six centers in France and Turkey. Women with upper limb BCRL who had undergone the intensive phase of decongestive lymphedema therapy (DLT) were randomized into two groups: the Control group wore a daytime compression sleeve without any night compression for 3 months and the MOBIDERM Autofit (MobA) group used a night-time compression sleeve in addition to the daytime compression. The primary outcome was the change in arm excess volume between day 0 (D0) and D90. The main secondary endpoints were: quality of life (QoL), sleep quality, skin thickness and suppleness, satisfaction, compliance, and safety. RESULTS: Fifty-six patients were recruited (mean (± SD) age: 61.4 ± 12.3 years). Between D0 and D90, the mean excess volume decreased by 29.2% in the MobA group and increased by 10.7% in the Control group (p = 0.001). Only 3.6% of patients in the MobA group presented with treatment failure vs. 23.1% in the Control group. At D90, patients in the MobA group had a significantly greater improvement in QoL (p < 0.05), sleep quality (p = 0.018), skin suppleness (p = 0.01) reduced skin thickness (p = 0.025) compared with the Control group. CONCLUSION: MOBIDERM Autofit used in addition to daytime compression for 3 months during the maintenance phase after DLT was superior to daytime compression alone for the reduction of arm excess volume. Registered on ClinicalTrials.gov (NCT04203069; 17/12/2019).
11 May 2026
Read appraisal →International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group
Effects of locally applied water-filtered infrared a irradiation adjunctive to iloprost and carbon dioxide hand baths in patients with systemic sclerosis and severe Raynaud's phenomenon - a randomized controlled trial
BACKGROUND: Almost all patients with systemic sclerosis (SSc) experience Raynaud's phenomenon (RP) with risk of digital ulcers (DU). In severe RP, intravenous iloprost is standard, yet additive hyperthermic therapy may enhance vasodilation and microcirculation. However, whether more intensive or alternative hyperthermic modalities offer benefits beyond commonly used CO2 hand baths remains unclear. METHODS: In this randomized, controlled trial, all patients received a baseline therapy of iloprost plus CO2 hand baths. The intervention group (IG) received additional water-filtered infrared-A (wIRA; 2 × 30 min/day, 8 days), while the control group (CG) received baseline therapy alone. The primary endpoint was the difference in RP-associated pain (VAS 0-100 mm) after treatment. Secondary outcomes included changes in RP duration, frequency, and intensity, Health Assessment Questionnaire (HAQ), serum interleukin-6 (IL-6) and vascular endothelial growth factor (VEGF). RESULTS: Of 46 randomized patients, 38 (IG = 19, CG = 19) completed the study. Pain decreased from 70.4 ± 27.8 to 56.7 ± 21.4 mm with wIRA and from 73.9 ± 27.5 to 65.3 ± 26.8 mm in controls. Multivariable ANCOVA showed a mean difference of -14.7, 95% CI [-28.8;-0.7], p = 0.041 in favor of wIRA. RP duration improved more in the wIRA group (day 23: β = -3.8, 95% CI [-7.4;-0.2], p = 0.041), while RP frequency, intensity, HAQ, IL-6, and VEGF showed no significant differences (all p > 0.05). No adverse events occurred. CONCLUSIONS: Adjunctive wIRA during iloprost therapy was safe and yielded modest, short-term improvements in pain and RP duration. These exploratory effects warrant confirmation in larger controlled trials.
15 Apr 2026
Read appraisal →Rheumatology international
The effect of structured hand massage on hand function and grip strength in rheumatoid arthritis patients: a randomized controlled pilot study
INTRODUCTION: This study aimed to assess the impact of a 10-session hand massage protocol on hand function, grip strength, pinch strength, pain threshold, and tactile sensory threshold in patients with early-stage, seropositive rheumatoid arthritis (RA) without radiographic damage or hand deformity. METHODS: This study was a randomized controlled clinical trial. Thirty female RA patients with a diagnosis time of less than two years, seropositive, with low disease activity/remission, and without active arthritis in their hands were included in the study. Participants were randomized 1:1 to intervention and control groups. The intervention group underwent 10 hand massage sessions over a two-week period, in addition to regular medical care. The control group received only regular medical care. All assessments were performed at baseline (T1) and at week 2 (T2). Outcome measures included hand grip strength, pinch strength, pain threshold (dolorimetry), tactile sensory threshold (Semmes-Weinstein monofilament test), Duruöz Hand Index (DHI), and patient global assessment (PGA). RESULTS: A total of 30 RA patients were included in the study (intervention group, n = 15; control group, n = 15). At baseline, no significant differences were observed between the groups in demographic, laboratory, or clinical characteristics (p > 0.05). In the intervention group, significant improvements in hand grip strength and pinch force were observed at T2 compared with baseline (p = 0.008 and p = 0.023, respectively). Median hand grip strength increased from 55 (40-75) to 65 (45-80) kg, and median pinch strength increased from 15 (6-18) to 16 (11-21) kg. No significant alterations were noted in these parameters within the control group (p > 0.05). In the control group, median hand grip strength was 45 (25-80) kg at baseline and 45 (20-80) kg at week 2, while median pinch strength was 14 (6-18) kg at baseline and 14 (5-19) kg at week 2. In the intervention group, significant reductions in DHI and PGA scores were recorded at the end of therapy (p = 0.005 and p = 0.001, respectively). No significant differences were noted in DHI and PGA levels in the control group (p > 0.05). Moreover, median PGA scores were significantly lower in the intervention group than in the control group at T2 (4 [2-5] vs. 5 [3-6]; p < 0.001). No significant changes were found in dolorimeter and touch sensory thresholds in either group (p > 0.05). CONCLUSION: Hand massage interventions for patients with RA enhance grip strength, hand function, and overall patient evaluations. No effect on pain or tactile thresholds was observed. Further studies with larger sample sizes and longer follow-up periods are required to corroborate these findings.
6 Apr 2026
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