Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 73 appraisals
BMJ open
Potential benefits of music-based therapies on rehabilitation outcomes in people with multiple sclerosis: a systematic review
OBJECTIVES: To assess the evidence for a benefit of music-based therapies (MBTs) on rehabilitation outcomes in adults with multiple sclerosis (MS). SETTING: Scholarly literature (published in English) from any country. This systematic review received no specific funding and was registered on PROSPERO as CRD420251083656. DATA SOURCES: Six bibliographic databases: AMED (Ebsco), APA PsycINFO (Ovid), CINAHL (Ebsco), Cochrane CENTRAL, EMBASE (Ovid) and MEDLINE (Ovid), plus supplementary searches and citation chasing (search date July 2025). PRIMARY AND SECONDARY OUTCOME MEASURES: Eligible studies used a clinical trial or controlled quantitative observational study design to assess the benefit of MBTs on rehabilitation outcomes in adults with MS. Risk of bias was assessed using Critical Appraisal Skills Programme checklists. Data were synthesised using narrative synthesis. RESULTS: 23 studies were included (955 participants, of whom 880 people had MS and 691 received MBTs). The most frequently assessed outcome was motor function (16 studies), followed by quality of life (12 studies). Evidence suggests potential benefits for MBTs, particularly rhythmic auditory stimulation and music-cued motor imagery, on gait and mobility outcomes, including walking speed, walking distance, cadence, stride length and gait symmetry. Findings for other outcomes were less clear. CONCLUSIONS: MBTs may benefit people with MS, with the most consistent evidence observed for gait and mobility outcomes. However, heterogeneity in intervention type, study design and outcome measurement limits the strength of conclusions. Higher-quality, adequately powered trials with standardised outcomes and direct comparisons between MBTs are needed to clarify effectiveness and inform clinical implementation. PROSPERO REGISTRATION NUMBER: CRD420251083656.
24 July 2026
Read appraisal →Nature communications
Enhancing sit-to-stand transitions and walking efficiency in older adults with a soft robotic suit
Age-related declines in muscle strength and neuromuscular control make sit-to-stand transitions and walking progressively more difficult, compromising mobility and independence. Although wearable assistive technologies have been proposed to alleviate these challenges, few have demonstrated clear benefits in facilitating sit-to-stand movements for older adults who retain a degree of independent mobility. Here, we introduce a soft hip exosuit designed to assist both sit-to-stand transitions and walking activities. In a feasibility study involving ten older adults, the exosuit increased 1-minute sit-to-stand repetitions by an average of 1.8 and reduced the metabolic cost of walking by 13.6% compared with the unassisted condition. These improvements were achieved while preserving natural kinematics, lower-limb stability, and maintaining a strong sense of agency. Our findings demonstrate that soft exosuits can enhance sit-to-stand and walking performance in older adults while preserving biomechanical naturalness and user autonomy, highlighting their potential for practical home-integrated mobility assistance.
20 July 2026
Read appraisal →Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
Combined transcranial direct current stimulation and mirror therapy for upper limb rehabilitation in patients with stroke: a systematic review and meta-analysis
Upper limb impairment is among the common consequences of stroke. Combining transcranial direct current stimulation (tDCS) and mirror therapy (MT) have recently been used to improve neural plasticity and functional recovery. This review aims to evaluate the effects of combined tDCS and MT on upper limb function in patients with stroke. "PubMed, Scopus, Web of Science, CINAHL, PEDro, and EMBASE" were searched from their inception to March 2026. Randomized controlled trials investigating the combination of tDCS and MT in patients with stroke and assessing upper limb function were included. The quality and the certainty of evidence were evaluated. Seven studies (454 participants) met the eligibility criteria. Significant improvements were demonstrated in upper limb motor function (SMD = 0.73, 95% CI 0.34 to 1.12, p = 0.0002), activities of daily living (SMD = 0.84, 95% CI 0.46 to 1.22, p < 0.0001), and neurophysiological outcomes reflecting corticospinal conduction efficiency, assessed using central motor conduction time (CMCT) (SMD = -1.26, 95% CI -1.60 to -0.92, p < 0.0001). Subgroup analysis demonstrated greater effects in subacute stroke (SMD = 1.03, 95% CI 0.73 to 1.33). Other outcomes reported improvements in hand function and grip strength. Preliminary evidence suggests that combining tDCS and MT may improve upper limb motor and functional outcomes after stroke; however, these findings should be interpreted with caution due to heterogeneity and the limited data. Further studies are strongly needed.
11 July 2026
Read appraisal →PloS one
Effects of immersive virtual reality on limb motor function, balance, gait and quality of life after stroke: A systematic review and meta-analysis
Immersive virtual reality (IVR) has been increasingly integrated into stroke rehabilitation albeit the effectiveness across different outcome domains remains unclear. This study aimed to review evidence from randomized controlled trials evaluating the effects of IVR, used alone or in combination with conventional rehabilitation, on motor-, functional-, and participation-related outcomes after stroke. Ovid MEDLINE, Embase, Cochrane Library and CINAHL were screened up to April 2025 to identify eligible randomized controlled trials (RCTs). A systematic literature search was conducted. Randomized controlled trials including adults with stroke and evaluating immersive virtual reality interventions were eligible. Studies using non-immersive VR, non-randomized designs, or not reporting motor, functional, or participation outcomes were excluded. Meta-analyses were performed where data were sufficiently homogeneous; otherwise, outcomes were summarized descriptively. Risk of bias was assessed using standardized appraisal tools, and certainty of evidence was evaluated using the GRADE approach. Out of 3,574, we included 34 RCTs involving post-acute, subacute and chronic stroke survivors, with a total of1200 participants. Meta-analyses showed IVR, most commonly delivered in combination with conventional rehabilitation, to be associated with improvements in upper extremity motor impairment, particularly measured by the Fugl-Meyer Assessment Upper Extremity (FMA-UE). Small but significant effects were also found for selected gait parameters. In contrast, effects on functional performance, balance, and quality of life were inconsistent and could not be robustly quantified. The overall certainty of evidence ranged from low to very low, primarily due to heterogeneity, methodological limitations, and small sample sizes. In conclusion, IVR appears to be a promising and safe supplement to conventional stroke rehabilitation, particularly for improving motor impairment. However, evidence remains limited and inconsistent across functional outcomes. More well-designed, adequately powered trials with standardized interventions and clinically meaningful outcome measures are needed to clarify the role of IVR in stroke rehabilitation. PROSPERO (Registration number: CRD420250639792).
7 July 2026
Read appraisal →Journal of medical Internet research
Effectiveness of a Home-Based and Group-Based Tele-Exercise Program for Breast Cancer Survivors: Pilot Randomized Controlled Trial
BACKGROUND: Breast cancer remains the most prevalent cancer among women globally. Adjuvant therapies can cause adverse effects that compromise physical and mental health. Exercise may mitigate these effects; however, many breast cancer survivors remain insufficiently active. OBJECTIVE: This pilot study aimed to test the effectiveness of a 7-week theory-informed tele-exercise intervention for breast cancer survivors in Hong Kong. METHODS: We developed a 12-week theory-informed tele-exercise intervention for breast cancer survivors in Hong Kong; this pilot tested a 7-week abbreviated version. In this 2-group randomized controlled pilot trial, 34 individuals were assessed for eligibility, and 27 were randomized; 24 completed baseline and were included in the modified intention-to-treat analyses (12 per group). The intervention comprised a progressively supervised group-based tele-exercise intervention transitioning to unsupervised sessions, combined with psychological counseling. Outcomes were guided by the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework, with emphasis on feasibility, acceptability, and preliminary effects. RESULTS: Recruitment was 79.4% (27/34) and baseline-to-post retention was 100% (24/24), with satisfactory attendance (87.7%) and compliance (85.3%) in the intervention group. Acceptability was high. Preliminary signals of improvement were observed in cardiorespiratory fitness (primary outcome), lower-extremity strength, balance, affected-side shoulder range of motion, and health-related quality of life. CONCLUSIONS: This pilot supports the feasibility and acceptability of tele-exercise for breast cancer rehabilitation and provides preliminary evidence to justify a larger trial with longer follow-up to assess sustained effects and broader applicability.
29 June 2026
Read appraisal →Brain impairment : a multidisciplinary journal of the Australian Society for the Study of Brain Impairment
Rehabilitation technologies perceived positively by patients and facilitated intensive therapy within sessions.
BACKGROUND: Australian inpatient rehabilitation facilities are increasingly integrating rehabilitation technologies to support patient recovery. However, little is known about patient perceptions of rehabilitation technologies and the intensity of therapy able to be facilitated. This study aimed to quantify the amount of practice being achieved by patients in an Australian inpatient rehabilitation setting and explore their perceptions of upper limb rehabilitation technologies. METHODS: A multimethod study design was used to investigate the perceptions and use of rehabilitation technologies (i.e. InMotion, Fourier ArmMotus, SaeboReJoyce and Touch Accessible Platform for Interactive Technology) by adult inpatients. Semi-structured interviews and the System Usability Scale were completed. Observations of routine therapy sessions were undertaken to quantify the amount and intensity of technology-based practice. RESULTS: Ten participants were recruited (50% male, mean age 62 years). A total of 15 sessions were observed across all participants using robot-assisted therapy and Touch Accessible Platform for Interactive Technology at an average duration of 35 min/session; of which 29 min was active therapy. Most participants described their experiences with rehabilitation technologies positively, highlighting benefits for recovery, enjoyability and easy usability. Participants rated the technologies highly on the System Usability Scale, with total scores ranging between 65 and 100 for usability, and a minimum rating of 'good' for user-friendliness. CONCLUSION: Rehabilitation technologies were well received by adults undergoing inpatient rehabilitation and with application for a range of impairments. The technologies facilitated enjoyment of daily therapy, and participants were comfortable with limited therapist input when using the devices. Additionally, participants were able to engage in highly intensive practice using the technologies.
27 June 2026
Read appraisal →Brain impairment : a multidisciplinary journal of the Australian Society for the Study of Brain Impairment
Validating telehealth assessment of physical concussion symptoms
BACKGROUND: Telehealth could expand access to specialised concussion care; however, physiotherapists report low confidence in assessing physical symptoms remotely. This study adapted measures of vestibular, oculomotor, cervical and autonomic function for telehealth delivery, and evaluated their feasibility and comparability with in-person assessment. METHODS: Using a repeated-measures design, 16 participants with concussion and 20 controls completed assessment modalities in random order (3 × 4 block randomisation). Feasibility was evaluated through completion rates, technical issues, adverse events and clinician feedback. Concurrent validity was examined using percentage agreement, Cohen's kappa, and sensitivity and specificity analyses. RESULTS: Telehealth assessment was feasible; most concussion participants and all controls completed the protocols, there were minimal technical issues, no adverse events and shorter administration times. Clinicians reported high usability and efficiency. High agreement and sensitivity were observed across vestibular, ocular convergence, autonomic and cervical range of motion measures. Nuanced assessment of ocular smooth pursuits showed lower agreement, and a potential ceiling effect on autonomic assessment was identified. CONCLUSION: This study preliminarily supports the feasibility and comparability of telehealth compared with in-person physical concussion assessments. Assessment of smooth pursuits and autonomic function require protocol refinement to enhance accuracy. Replication in larger samples is required to establish comparability.
27 June 2026
Read appraisal →Biomedizinische Technik. Biomedical engineering
Arm support as hidden assistance during Sit-To-Stand movement: a systematic review
Sit-To-Stand (SitTS) training is often performed by patients who may require arm assistance to perform it successfully. This study examines the role of arms in performing the SitTS maneuver to better understand their contribution and clinical significance. This review synthesizes the reported outcome measures of arm-assisted SitTS exercise programs in people with physical impairments. Web of Science (WoS) and Scopus™ databases were searched for relevant studies up to May 2025. Inclusion and exclusion criteria were used to screen the titles and abstracts of articles identified using key search terms related to SitTS activity and arm support. Only articles that met the key terms were extracted and analyzed in this study. A total of 47 studies reported arm support measures during SitTS, either in clinical or biomechanical contexts. These studies highlighted various methods and tools used to assess the body's state during the rising movement. Joint angle and SitTS duration are clinically applicable and more easily measured compared to seat, foot, and arm forces which require specialized instrumentation. Balancing clinical measures with detailed biomechanical assessments is important in enabling practitioners and researchers to evaluate and enhance SitTS interventions that involve arm assistance, ultimately improving rehabilitation outcomes.
25 June 2026
Read appraisal →PloS one
Internet-based vestibular rehabilitation versus written instructions after acute vertigo: A randomised controlled trial
BACKGROUND: Acute vestibular syndrome (AVS) causes sudden and continuous vertigo, dizziness, and postural instability and is a common reason for emergency department visits, most commonly due to vestibular neuritis and, in rare cases, stroke. Vestibular rehabilitation (VR) is an evidence-based exercise therapy that facilitates vestibular compensation and is effective in chronic vestibular disorders. However, evidence for VR in acute vertigo remains limited and, despite guideline support, it remains underused in practice. Internet-based VR has demonstrated benefit in chronic dizziness but has not been evaluated in acute vertigo. This study aimed to evaluate the efficacy of an internet-based VR tool compared with standard care (written instructions) in reducing vestibular symptoms after acute onset vertigo. METHODS AND FINDINGS: A multicentre, randomised, evaluator-blinded superiority trial was conducted across nine hospitals in Sweden. Adults with ongoing AVS were recruited within 1-7 days after symptom onset and randomised (1:1) to six weeks of internet-based VR with personalised, progressively adjusted home exercises or to written instructions for home-based VR exercises. The primary outcome was the between-group difference in vestibular symptoms at six weeks measured using the Vertigo Symptom Scale Short Form (VSS-SF; range 0-60), with a difference of ≥3 points prespecified as clinically significant. Secondary outcomes included dizziness-related disability, walking speed, and balance. Of 184 randomised participants, 183 were included in the analyses (94 online VR; 89 written instructions; median age 56 years). In the intention-to-treat analysis, both groups improved at six weeks, with no significant between-group difference (adjusted mean difference -2.0 points, 95% CI -4.9 to 0.9; p = 0.18). Per-protocol analyses were consistent (-1.7 points, 95% CI -4.7 to 1.3; p = 0.27). Over 12 weeks, both groups showed reduced vestibular symptoms and improved disability, balance, and walking speed, without significant between-group differences. No serious adverse events were attributed to the interventions, and compliance was high in both groups. CONCLUSIONS: Internet-based VR was not superior to written instructions in reducing vestibular symptoms six weeks after acute onset vertigo. Both groups demonstrated improvement from baseline, with no statistically significant between-group differences. These findings suggest that ensuring access to vestibular rehabilitation exercises may be more important than the specific mode of delivery after acute onset vertigo, and internet-based tools represent viable alternatives for patients who prefer or may benefit from a digital format. TRIAL REGISTRATION: Clinicaltrials.gov NCT05056324. https://clinicaltrials.gov/study/NCT05056324. Registered on September 24, 2021.
14 June 2026
Read appraisal →Medical science monitor : international medical journal of experimental and clinical research
Impact of Gross Motor Coordination Exercises on Perceptual Processes and Praxis in Early School Children With Symptoms of Developmental Coordination Disorder: Preliminary Report of Randomized Controlled Study
BACKGROUND Physical activity has a general impact on cognitive processes, but evidence on the effects of specific exercises on particular cognitive or executive functions remains limited. Previous studies suggest that movements crossing the body's midline stimulate excitability and plasticity in the dorsolateral prefrontal cortex and superior parietal cortex. This study aimed to investigate whether such exercises produce long-term functional changes in these areas. MATERIAL AND METHODS The study involved 22 children aged 6 to 8 years with symptoms of developmental coordination disorder (DCD), divided into 2 equal groups. Both groups completed approximately 9 weeks of coordination training based on Bilateral Integration by Sheila Dobie OBE (the total diagnostic and therapeutic cycle lasted approximately 16 weeks, including a break). The intervention group performed exercises involving midline crossing, while the control group performed exercises without this element. Assessments (sensory integration and praxis tests and the bilateral motor coordination test) were conducted 3 times: before intervention, after 9-week program, and at follow-up. RESULTS Significant improvements were observed in both groups in sequencing praxis (P=0.041 in the control group; P<0.001 in the intervention group) and bilateral motor coordination (P=0.013; P=0.020), but at different rates. In the intervention group, improvements appeared after the intervention, while in the control group only at follow-up. Large effect sizes were found (η² ϵ [0.293, 0.670]), with high statistical power. No significant changes were observed in other functions. CONCLUSIONS The Bilateral Integration method improves sequencing praxis and interhemispheric integration in children with DCD symptoms. Midline-crossing exercises may yield relatively fast improvements in short-term programs.
11 June 2026
Read appraisal →African journal of reproductive health
Effects of kegel training combined with acupoint application in preventing postpartum pelvic floor dysfunction: A randomized controlled trial
This study investigated the early preventive benefits of combining Kegel exercises with acupoint application at Qi Hai and Guan Yuan points for addressing postpartum pelvic floor dysfunction (PFD). A total of 110 first-time mothers were randomized into two groups: the prevention group, which received the combined intervention, and the control group, which practiced only Kegel exercises. The interventions followed a structured schedule during the postpartum period. At 42 days postpartum, the prevention group showed a notably lower rate of urinary leakage and improved outcomes in Type II pelvic floor muscle strength, ICI-Q-SF scores, and Hamilton Anxiety Scale results (all P<0.05). However, there were no significant differences between the groups in Type I muscle strength, vaginal dynamic pressure, PFDI-20 scores, or anatomical positioning of the bladder and cervix (P>0.05). The treatments were well-tolerated, with only two minor cases of redness and itching at application sites. We conclude that combining Kegel exercises with acupoint application at Qi Hai and Guan Yuan points may effectively reduce postpartum urinary incontinence, strengthen specific pelvic floor muscles, and improve emotional well-being. Cette étude a examiné les bénéfices préventifs précoces de la combinaison d'exercices de Kegel avec l'application d'acupression sur les points Qi Hai et Guan Yuan pour traiter la dysfonction du plancher pelvien (DPP) post-partum. Au total, 110 primipares ont été randomisées en deux groupes : le groupe prévention, recevant l'intervention combinée, et le groupe témoin, pratiquant uniquement les exercices de Kegel. Les interventions ont suivi un calendrier structuré pendant la période post-partum. À 42 jours post-partum, le groupe prévention a montré un taux de fuites urinaires nettement inférieur et de meilleurs résultats pour la force musculaire de type II du plancher pelvien, les scores ICI-Q-SF et les résultats à l'échelle d'anxiété de Hamilton (tous p<0,05). Cependant, aucune différence significative n'a été observée entre les groupes pour la force musculaire de type I, la pression dynamique vaginale, les scores PFDI-20 ou la position anatomique de la vessie et du col de l'utérus (p>0,05). Les traitements ont été bien tolérés, avec seulement deux cas mineurs de rougeurs et de démangeaisons aux sites d'application. En résumé, combiner les exercices de Kegel avec l'acupression sur les points Qi Hai et Guan Yuan pourrait réduire efficacement l'incontinence urinaire post-partum, renforcer des muscles spécifiques du plancher pelvien et améliorer le bien-être émotionnel.
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 →BMJ open
Multicentre randomised controlled trial of the Norwegian health in work service for patients with common mental disorders or musculoskeletal disorders: the Norwegian Sickness Absence Clinic (NSAC) Efficacy Study
INTRODUCTION: In many countries, a high or increasing rate of sickness absence is challenging the sustainability of present sickness absence benefit schemes. Most sickness absence is certified on the grounds of common mental disorders or musculoskeletal disorders, and substantial effort has been invested in developing interventions promoting return to work for these patients. In Norway, the Health in Work ((HelseIArbeid), HIA) clinics were established as outpatients' services within the specialised healthcare system, with the aim of improving health and supporting return to work. The HIA service admits patients with low-to-moderate anxiety/depression and/or musculoskeletal disorders. In this protocol, we describe the naturalistic multicentre randomised controlled trial Norwegian Sickness Absence Clinic Efficacy study, which aims to determine the effect of HIA on work participation and health. METHODS AND ANALYSES: The HIA outpatient service is staffed by clinical psychologists, physiotherapists, medical specialists in physical medicine and rehabilitation and employment support supervisors from the Norwegian Labour and Welfare Administration. Patients admitted to HIA have access to multidisciplinary assessment and treatment. The trial recruits' patients from five HIA outpatient clinics in Northern Norway. Patients are randomised in equal proportions to either (1) rapid HIA (assessment within 4 weeks), (2) delayed HIA (assessment within 10-14 weeks) or (3) active control, which consists of a monodisciplinary examination at HIA close to diagnosis-specific deadline for examination as suggested by guidelines (8-26 weeks). The trial commenced recruitment on 16 January 2023 and will recruit 2500 patients. The aim is to assess the effect of the HIA service, with the hypothesis that the HIA concept is superior to what resembles treatment as usual, in improving employment and preventing long-term welfare dependency. Secondary outcomes include self-reported symptoms of health problems. We also examine the effect the service has on other healthcare utilisation. To date, no research has been conducted to assess the efficacy of the HIA service. If proven efficacious, and if there is an economic case for this investment in tailored healthcare delivery, the policy implication may be implementation of the service at scale. If not, adaptations or investments into other viable paths of treatment may be considered. ETHICS AND DISSEMINATION: The study is approved by the Regional Committee for Medical Research Ethics (REC North, #122770). Results from the study will be disseminated at national and international scientific conferences, to funders and participating outpatient clinics in seminars and in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER: NCT05310695.
31 May 2026
Read appraisal →Journal of neurology
Artificial intelligence for gait and balance in neurological disorders: a scoping review of clinical applications and technologies
BACKGROUND: Artificial intelligence (AI) has rapidly emerged within healthcare systems and neurological rehabilitation with the potential to revolutionize clinical decision-making and therapeutic strategies. However, a comprehensive understanding of how AI is currently applied to gait and balance rehabilitation in stroke, Parkinson's disease (PD), and multiple sclerosis (MS) is still lacking. OBJECTIVE: To map the current use of AI in neurological rehabilitation, focusing on clinical purposes, geographical distribution, and applied technologies for gait and balance rehabilitation. METHODS: Following the PRISMA-ScR statement, we conducted a literature search through MEDLINE, Cochrane CENTRAL, EMBASE, and Google Scholar up to July 2025 to identify studies applying AI-based methods to gait and balance outcomes in adults with stroke, PD, or MS. Study characteristics, AI methods, validation strategies, clinical purpose, and motor outcomes were extracted and synthesized narratively. RESULTS: Eighteen studies published from 2009 to 2025 were included. Most studies were conducted in Asia (50%) and involved people with stroke (77.8%). AI was predominantly used for prognostic purposes (72.22%), such as predicting falls, gait recovery, or treatment response and diagnostic applications (33.3%). Machine learning was the most common approach (88.9%) with Random Forest, Support Vector Machine, logistic regression, and eXtreme Gradient Boosting being the most frequently applied algorithms. None of the included studies performed prospective or external validation on independent datasets. CONCLUSIONS: This scoping review provides a comprehensive overview of current AI applications, highlighting promising but still immature approaches in the neurological rehabilitation of gait and balance. However, substantial methodological limitations remain major barriers to clinical translation.
30 May 2026
Read appraisal →JMIR cardio
Barriers and Facilitators to Maintaining Physical Activity After an mHealth Intervention for People Poststroke or Transient Ischemic Attack: Reflexive Thematic Analysis
BACKGROUND: Regular physical activity is critical for preventing secondary stroke following a stroke or transient ischemic attack (TIA). Although mobile health (mHealth) interventions have shown promise for promoting short-term increases in physical activity, evidence on their long-term effects and the mechanisms that support sustained behavior change remains limited. In particular, little is known about how people poststroke or TIA integrate the skills, knowledge, and habits gained through mHealth interventions into their daily lives once structured intervention support ends. OBJECTIVE: This study aimed to explore the perceived barriers and facilitators of maintaining physical activity among individuals poststroke or TIA after completing an mHealth intervention. METHODS: A qualitative approach was used, involving a strategic sample of 12 participants recruited after they had completed a 6-month mHealth intervention for people poststroke or TIA. The intervention included supervised physical therapy with mHealth support for physical exercises and behavior change (eg, counseling, goal-setting, and self-monitoring), followed by a 6-month postintervention period with access to self-managed mHealth support. To enable richness and depth in participants' accounts, the dataset consisted of 2 semistructured interviews conducted 3 months and 6 months after completing the intervention, along with participant-generated photographs. Between the interviews, participants took photos to reflect their experiences of maintaining physical activity after the intervention. These images served as prompts for dialog and reflection during the second interview. Data were analyzed using reflexive thematic analysis. RESULTS: We generated 3 themes: building experience and knowledge to maintain physical activity, staying physically active in a complex life situation, and the meaning of context for maintaining physical activity after the intervention. Barriers and facilitators were conceptually integrated into a comprehensive understanding of maintaining physical activity, symbolized by the metaphor of a soap bubble, which requires persistence and a supportive environment to stay afloat. The complexity of participants' health and life situations created barriers to maintaining physical activity. To overcome these barriers, developing personal strategies within a supportive social and physical context was crucial. This development was facilitated by the mHealth intervention, which enabled knowledge acquisition of the principles of physical activity after stroke or TIA, along with increased awareness of its health benefits. CONCLUSIONS: mHealth interventions for people poststroke and TIA can serve as a catalyst for physical activity engagement and an enhancer of the knowledge and experience necessary to maintain physical activity after the intervention. Despite health-related and contextual barriers, participants may use personalized strategies, supported by their social and environmental context, to navigate these challenges. These insights highlight opportunities for future mHealth interventions to strengthen the interaction between individuals and their environment and empower tailored strategies for behavior change and long-term physical activity maintenance.
30 May 2026
Read appraisal →JMIR mHealth and uHealth
Reducing Sedentary Time After Knee Replacement Using a Multicomponent mHealth Intervention: Randomized Controlled Trial
BACKGROUND: Total knee replacement (TKR) is a common surgery for end-stage knee osteoarthritis. Although reductions in pain and improvements in mobility occur after surgery, physical activity levels often do not change. Given the challenges of increasing physical activity in this population, targeting reductions in sedentary behavior may be a first step; however, no prior studies have examined the feasibility and effects of a sedentary reduction intervention after TKR. OBJECTIVE: This study examined the effects of a 2-month multicomponent mobile health sedentary reduction intervention (NEAT!2) on sedentary time in adults with TKR. METHODS: Adults (N=83; mean age 65.3, SD 9.4 years; mean BMI 32.7, SD 6.9 kg/m2; 62/83, 74.7% female; 64/83, 77.1% White) with a TKR ≤1 year ago were randomized to the NEAT!2 group (n=42, 50.6%) or the attention-matched control group (n=41, 49.4%). The NEAT!2 intervention focused on reducing sedentary time via a smartphone app designed to interrupt prolonged bouts (≥30 minutes) of sedentary behavior and through 5 coaching calls emphasizing goal setting and problem solving. The control group focused on surgery recovery via an app or website and 5 educational calls. Sedentary time, total physical activity, physical function, and pain were measured at 2 and 5 months. Linear mixed-effects models examined intervention effects and differences between groups at each time point. RESULTS: Retention was 96% and 95% at 2 and 5 months, respectively, with no differences between groups. Participants in the NEAT!2 group completed an average of 4.95 (SD 0.2) calls, used the app on an average of 40.3 (SD 13.8) days (out of 56 days), and received an average of 9.6 (SD 6.0) notifications per day. At 5 months, there was a significant increase in sit-to-stand transitions in the NEAT!2 group and a substantial decrease in the control group, resulting in a significant difference between groups (mean difference 4.06, 95% CI 0.13-7.99; P=.04); however, the NEAT!2 intervention did not result in significant effects on any of the other study outcomes at 2 or 5 months. Additionally, more days of app use were associated with greater increases in moderate-to-vigorous intensity physical activity (r=0.335; 95% CI 0.017-0.585; P=.04). CONCLUSIONS: This study highlights the challenges of reducing sitting time in adults with TKR. Future studies should explore alternative behavior change techniques across different levels of influence (eg, environmental and social) to support interventions implemented within the first year after TKR. TRIAL REGISTRATION: ClinicalTrials.gov NCT04482400; https://clinicaltrials.gov/ct2/show/NCT04482400.
28 May 2026
Read appraisal →JMIR research protocols
Development of a Digital Multimodal Pain Intervention (CHRONIC): Protocol for a Randomized Controlled Trial Study
BACKGROUND: Chronic pain affects approximately 12 million individuals in Germany and significantly impairs quality of life. Although multimodal treatment approaches-combining physical, psychological, and behavioral strategies-are considered the gold standard, access to specialized multidisciplinary pain treatment, including physiotherapy and psychological interventions, is often hampered by long waiting times, which highlights the need for scalable, low-threshold treatment options. Digital health interventions, particularly those grounded in established therapeutic models, offer a promising solution to bridge this treatment gap. The German Digital Health Care Act has opened pathways for reimbursable digital applications, such as CHRONIC, which is grounded in acceptance and commitment therapy as a third-wave cognitive behavioral therapy framework and integrates selected cognitive behavioral techniques, mindfulness-based strategies, and physiotherapy into a structured web-based program. OBJECTIVE: This study protocol outlines a randomized controlled trial (RCT) aimed at evaluating the effectiveness of CHRONIC, a 12-week web-based, multimodal self-help program for individuals with chronic pain, with a focus on reducing pain intensity, reducing pain-related interference, and improving quality of life. METHODS: This is a monocentric, 3-arm RCT with assessments up to 6 months after baseline. A total of 200 participants with chronic nonmalignant pain will be randomized into one of three groups: (1) intervention with individualized psychological feedback, (2) intervention with standardized computer-generated feedback, and (3) treatment-as-usual waitlist control. Weekly modules in the intervention arms include psychotherapeutic video sessions, interactive acceptance and commitment therapy-based and cognitive behavioral therapy-based exercises, mindfulness practices, and physiotherapeutic training. Outcomes will be assessed via validated self-report instruments: West Haven-Yale Multidimensional Pain Inventory for pain intensity and interference, Assessment of Quality of Life-8 Dimensions for quality of life, German version of Chronic Pain Acceptance Questionnaire for pain acceptance, Patient Health Questionnaire-9, German version for depression, and Generalized Anxiety Disorder 7-item Scale for anxiety. Data will be analyzed using mixed models for repeated measures based on the matched ~6-month assessment. Missing data will be addressed using multiple imputation. RESULTS: Recruitment started in January 2026 and is projected to end in July 2026. As of January 22, 2026, 18 participants had been enrolled. Primary end point data collection is expected to be completed in January 2027, with primary analyses and dissemination planned for 2027. CONCLUSIONS: This study protocol describes an RCT designed to evaluate the clinical utility of CHRONIC as a scalable, low-threshold intervention for chronic pain. CHRONIC aims to address the multifactorial nature of chronic pain by integrating psychotherapeutic, physiotherapeutic, and mindfulness-based strategies into a single digital program. Future studies will be required to determine how this multimodal format compares to unimodal interventions. The findings aim to inform future digital health developments and contribute to the implementation of biopsychosocial care models in routine practice.
28 May 2026
Read appraisal →Journal of rehabilitation medicine
The effect of combined motor and cognitive rehabilitation on motor performance in Parkinson's disease: a systematic review and meta-analysis
OBJECTIVE: To evaluate the effectiveness of sequential and simultaneous motor and cognitive treatment on motor functions, activities of daily living, and quality of life in people with Parkinson's disease. DESIGN: Systematic review and meta-analysis. SUBJECTS/PATIENTS: Patients with Parkinson's disease. METHODS: A search was conducted in PubMed, Embase, Scopus, Web of Science, and Cochrane Library. Functional mobility was assessed as the main outcome, and balance, gait, activities of daily living, and quality of life as secondary outcomes. Meta-analyses were conducted using mean difference or standardized mean difference with 95% confidence intervals and fixed or random effect models. Heterogeneity was explored, setting a cut-off value of I2 = 50%. RESULTS: Sixteen studies were included, with 8 -eligible for meta-analysis. Results showed that sequential combined treatment offered no clear advantage over motor rehabilitation alone for functional mobility, although a significant benefit was found for activities of daily living. Results on simultaneous combined treatment suggested improvements in quality of life, but no significant differences between treatments for functional mobility. CONCLUSION: Motor-cognitive approaches may enhance prefrontal cortex efficiency, supporting complex motor tasks and reducing the risk of falls. Future research should elucidate neural mechanisms and compare simultaneous and sequential strategies to develop personalized, multidisciplinary rehabilitation protocols.
26 May 2026
Read appraisal →Rheumatology international
Home-based postural exercise as an adjunct to duloxetine improves sleep quality, physical quality of life, and trunk mobility in fibromyalgia: a randomized controlled trial
In fibromyalgia syndrome (FMS), current guidelines recommend combining pharmacological treatments such as duloxetine with exercise interventions. This randomized controlled trial aimed to evaluate the effectiveness of a home-based postural exercise program as an adjunct to pharmacological treatment in individuals with FMS. Fifty-one patients diagnosed with FMS according to the 2016 American College of Rheumatology criteria were randomly assigned to an exercise group (EG, n = 26) or a control group (CG, n = 25). Both groups received duloxetine therapy, while the EG additionally performed a home-based postural exercise program three times per week for four weeks. Outcomes included pain intensity, pressure pain threshold (PPT), sleep quality, anxiety and depression, quality of life, and trunk range of motion (ROM). Significant improvements over time were observed in pain intensity, psychological symptoms, sleep quality, quality of life, and PPT in both groups (p < 0.05). Significant group × time interactions favored the EG for sleep quality assessed using the Pittsburgh Sleep Quality Index (F = 11.07, p = 0.002, η²=0.184), the physical component of the Short Form-12 (F = 4.31, p = 0.043, η²=0.081), trunk flexion (F = 20.85, p < 0.001, η²=0.299), trunk extension (F = 8.34, p = 0.006, η²=0.146), and global trunk ROM (F = 35.10, p < 0.001, η²=0.417). No significant group × time interactions were observed for pain intensity, anxiety, depression, mental quality of life, or PPT (p > 0.05). Adding a home-based postural exercise program to pharmacological treatment may provide short-term additional benefits in sleep quality, physical quality of life, and spinal mobility in individuals with FMS; however, these findings should be interpreted cautiously due to the short intervention duration and absence of follow-up assessment.
25 May 2026
Read appraisal →Medicine
The effects of electroacupuncture and the Otago Exercise Program in older adults with sarcopenia: A randomized controlled study
BACKGROUND: The aim of this study was to investigate the effects of a combination of electroacupuncture (EA) and the Otago Exercise Program (OEP) for sarcopenia in older individuals and provide treatment recommendations for this patient population. METHODS: In this assessor-blinded randomized controlled trial, 120 older patients with sarcopenia were randomly divided into an OEP group (n = 58) and an EA + OEP group (n = 62). The OEP group received OEP 5 times/week, with each session lasting 30 minutes, for a duration of 12 weeks. In addition to OEP treatment, the EA + OEP group was treated with EA at ST31, ST32, GB34 and ST36 for 30 minutes 3 times/week for 12 weeks. The appendicular skeletal muscle mass-height index (ASM/H2) was the primary outcome. The secondary outcomes included grip strength, 4-m gait speed and 6-min walk distance. Outcomes were measured before initiation and at 6 and 12 weeks after initiation. RESULTS: Significant differences in ASM/H2, grip strength, 4-m gait speed and 6-min walk distance were detected between the 2 groups at week 12, whereas no differences were detected at weeks 0 and 6. In the EA + OEP group, as the treatment time increased, ASM/H2, grip strength, 4-m gait speed and 6-min walk distance increased significantly. In the OEP group, as the treatment time increased, no significant difference was found in ASM/H2, whereas grip strength, 4-m gait speed and 6-min walk distance increased significantly (P < .05). CONCLUSION: In older patients with sarcopenia, EA + OEP was associated with increased skeletal muscle mass, but no such effect was found for OEP alone. Moreover, EA + OEP was superior to OEP alone in terms of improving muscle strength and walking ability. EA + OEP may be considered an effective treatment for sarcopenia in older adults.
25 May 2026
Read appraisal →PloS one
Effectiveness of tele-rehabilitation using AI-guided exercise and pain neuroscience education for fibromyalgia (FIBROIA): Protocol for a randomized controlled trial
INTRODUCTION: Fibromyalgia (FM) is a chronic condition characterized by widespread pain and cognitive dysfunction, with pharmacological treatments offering limited efficacy. Although Pain Neuroscience Education (PNE) and therapeutic exercise are evidence-based interventions, accessibility and adherence remain major challenges particularly in underserved regions such as Latin America. This trial investigates the effectiveness of a 12-week tele-rehabilitation program (FIBROIA) that integrates Artificial Intelligence (AI)-guided exercise with PNE to enhance access to comprehensive multimodal care. METHODS AND ANALYSIS: This multicentre, randomized, assessor-blinded, parallel-group controlled trial will enroll fifty adults meeting the 2016 ACR criteria for FM. Participants will be randomly assigned (1:1) to either the intervention group or enhanced usual care. The intervention consists of three personalized exercise sessions per week delivered through the Rehbody AI platform, which provides real-time biomechanical feedback, along with a weekly PNE module designed to reconceptualize pain. The primary outcome is the change in pain intensity, measured using the Visual Analogue Scale (VAS), at week 13 (±7 days), immediately following completion of the 12-week program. Secondary outcomes include the Fibromyalgia Impact Questionnaire-Revised (FIQ-R), lower-limb strength assessed by the 30-Second Sit-to-Stand test, and health-related quality of life measured with the EQ-5D-3L. Statistical analyses will follow an intention-to-treat (ITT) framework. DISCUSSION: The FIBROIA protocol addresses the urgent need for scalable, evidence-based interventions in resource-limited settings. By combining AI-driven biomechanical feedback with cognitive reappraisal through PNE, this study seeks to reduce fear-avoidance behaviors and improve exercise adherence. This integrative approach aims to overcome the limitations of passive tele-rehabilitation by simulating asynchronous professional supervision, thereby ensuring both safety and technical precision in movement execution. CONCLUSIONS: If effective, this protocol will offer a robust, technology-enabled framework for remote FM management. The results could help establish a new clinical standard for accessible, patient-centered rehabilitation, bridging the gap between high-level evidence and real-world practice across diverse socioeconomic contexts. TRIAL REGISTRATION: ClinicalTrials.gov NCT06672419.
24 May 2026
Read appraisal →Lasers in medical science
Acute effect of photobiomodulation therapy in quadriceps strength, fatigue and pain of patients with chronic kidney failure: a randomized, double-blind, placebo controlled crossover clinical trial
Patients with chronic kidney failure (CKF) present changes in physical capacity and low exercise tolerance. Photobiomodulation therapy (PBMT) has shown an ergogenic effect on exercise in studies with different populations and may be an adjuvant treatment in rehabilitation programs for CKF patients. This study aimed to evaluate the acute effects of different doses of PBMT on quadriceps strength, fatigue and muscle pain in CKF patients. This study is a randomized, placebo-controlled, double-blind, crossover clinical trial. Adult patients with CKF received four PBMT applications with different energy doses (30J, 60J, 90J, or placebo), administered in a random order. A one-week interval was maintained between each dose, and an 830nm laser was applied to six points of the quadriceps muscle. Immediately after PBMT, maximal isometric quadriceps muscle strength was assessed by dynamometry. Before the intervention and after the assessment of muscle strength, muscle fatigue (Borg rating of perceived exertion scale and blood lactate) and pain perception in the lower limbs (visual analogue scale) were measured. Fifteen patients were randomized and fourteen completed the study. There was no significant difference between the doses tested for maximal isometric muscle strength in the right (p=0.053) and left (p=0.509) quadriceps. The perception of fatigue assessed by the modified Borg scale was not altered (p=0.703) nor were blood lactate levels, regardless of the PBMT dose and measurement time (t0: p=0.126; t3: p=0.667; t6: p=0.700). There was no change in pain perception after quadriceps irradiation for any of the PBMT doses tested (p=0.566). A single application of PBMT with a dose of 30J, 60J, or 90J did not alter maximal isometric quadriceps muscle strength, fatigue, or muscle pain perception in the lower limbs of CKF patients on HD.
24 May 2026
Read appraisal →Journal of neurology
External sensory cueing on gait in Parkinson's disease: a systematic review and network meta-analysis
OBJECTIVE: This systematic review and network meta-analysis compares the individual and synergistic efficacy of external sensory cueing modalities to establish a treatment hierarchy for optimizing spatiotemporal gait parameters in individuals with Parkinson's disease (PD). METHODS: A systematic literature search was conducted across Scopus, PubMed, Cochrane CENTRAL, and ClinicalTrials.gov. Randomized controlled trials (RCTs) evaluating visual, auditory, somatosensory, or combined cueing modalities in individuals with PD were eligible. Trials were required to compare at least two active cueing modalities or an active modality against a control condition and report gait velocity and/or stride length. RESULTS: Thirty-three RCTs (n = 1118 participants) were included. For gait velocity, somatosensory (MD = 0.12 m/s; 95% CI 0.04-0.19) and visual cues (MD = 0.11 m/s; 95% CI 0.02-0.20) demonstrated significant improvements over control. For stride length, visual (MD = 11.46 cm; 95% CI 6.40-16.51), somatosensory (MD = 10.74 cm; 95% CI 7.04-14.44), and auditory cues (MD = 5.25 cm; 95% CI 0.43-10.06) all yielded statistically significant benefits. P-score rankings identified somatosensory cues as the top-ranked modality for gait velocity (P-score = 0.71) and visual cues for stride length (P-score = 0.83). Global heterogeneity was substantial (I2 = 64-90%), and no significant publication bias was detected. CONCLUSIONS: External sensory cueing improves spatiotemporal gait parameters in PD, with somatosensory and visual cues emerging as the most effective modalities for enhancing gait velocity and stride length. Both modalities outperformed standalone auditory stimulation, providing a data-driven hierarchy to guide evidence-based cueing selection in clinical practice.
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 →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 →BMJ evidence-based medicine
Comparative effects of early physical interventions on preventing intensive care unit-acquired weakness: a systematic review and component network meta-analysis
OBJECTIVE: To compare the effects of early physical interventions on the prevention of intensive care unit-acquired weakness (ICUAW) and the improvement of relevant clinical outcomes in patients with critical illness. METHODS: We systematically searched the Web of Science, PubMed, Embase and the Cochrane Central Register of Controlled Trials from their inception until 20 August 2024, to identify randomised controlled trials (RCTs) enrolling patients ≥18 years old and implementing early physical intervention that commenced at any time point during mechanical ventilation (MV) use or within 7 days after intensive care unit (ICU) admission for review. We synthesised data using a random-effects model and analysed through network meta-analysis (NMA) and component network meta-analysis (CNMA). MAIN OUTCOME MEASURES: Primary outcome is the incidence of ICUAW. Secondary outcomes included Medical Research Council sum score, length of stay in the ICU or hospital, duration of MV and mortality rates in the ICU or hospital. RESULTS: Our analyses included 63 RCTs involving 24 treatments and eight components. The NMA results revealed systematic early mobilisation (SEM) combined with neuromuscular electrical stimulation (NMES), SEM alone and NMES alone may lead to a moderate to large reduction in the incidence of ICUAW (odds ratios [ORs]=0.03, 0.09 and 0.12, 95% confidence intervals [CIs]=0.00 to 0.42, 0.01 to 0.97 and 0.03 to 0.44, respectively) and improved relevant clinical outcomes compared with routine care. The CNMA results further indicated that SEM (OR=0.14, 95% CI=0.02 to 0.83) and NMES (OR=0.22, 95% CI=0.09 to 0.52) effectively mitigated the ICUAW incidence. CONCLUSIONS: SEM and NMES are optimal interventions for preventing ICUAW. Healthcare providers in ICUs should implement early mobilisation with structured protocols and patient assessments or apply NMES to specific muscle groups to prevent ICUAW in critically ill patients and improve relevant clinical outcomes. PROSPERO REGISTRATION NUMBER: CRD42024581173.
23 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 →Thorax
Measurement properties of the sit-to-stand test in community-dwelling people with chronic obstructive pulmonary disease: a COSMIN systematic review
BACKGROUND: The sit-to-stand (STS) test can assess physical function in people with chronic obstructive pulmonary disease (COPD); however, there are multiple versions. No study has used current guidelines to assess the measurement properties of the STS tests in people with COPD. METHODS: We conducted a systematic review using current COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. Full text peer-reviewed publications were included if they assessed the measurement properties (validity, reliability and/or responsiveness) of at least one STS test among community-dwelling people with COPD. We searched six databases and imported results into Covidence where title/abstract screening and full text selection was completed independently and in duplicate. Extraction was conducted independently and in duplicate using the COSMIN extraction file. We assessed study risk of bias (very good, adequate, doubtful or inadequate), measurement property quality (sufficient, indeterminate or insufficient) and overall certainty of evidence (high, moderate, low or very low) using the COSMIN recommended tools. RESULTS: We assessed 2577 titles/abstracts and 102 full texts for inclusion; 30 publications met eligibility. Seven unique STS tests were located with the most common being the 1 min STS test (n=14, 39%), 5-repetition STS test (n=10, 28%) and the 30 s STS test (n=8, 22%). Where assessed, reliability was sufficient for the 1 min, the 5-repetition and the 30 s STS tests. Only the 1 min STS test had high-quality evidence of sufficient construct validity, while the 30 s STS test was the sole test with at least moderate quality evidence of sufficient responsiveness. CONCLUSIONS: The 1 min STS test has the most robust measurement properties for cross-sectional assessments while the 30 s STS test is more robust to assess change.
16 May 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Effectiveness of comprehensive interventions including exercise and exercise-only interventions on postoperative ileus and recovery of intestinal function in patients with colorectal cancer: a systematic review and meta-analysis
PURPOSE: This systematic review and meta-analysis aimed to evaluate the effectiveness of postoperative or preoperative comprehensive interventions including exercise and exercise-only interventions on postoperative ileus (POI) incidence and the recovery of intestinal function in patients with colorectal cancer (CRC). METHODS: Electronic searches were conducted in 6 databases. Cohort and randomized-controlled trial (RCT) studies investigating the effects of postoperative or preoperative comprehensive interventions including exercise or exercise-only interventions on POI and the recovery of intestinal function in patients with CRC were included. RESULTS: Thirty-eight studies involving 13,124 patients were included. Postoperative comprehensive interventions including exercise significantly shortened the time to first flatus (standardized mean difference [SMD] = -1.38, 95% confidence interval [CI]: -1.87 to -0.89) and time to first defecation (SMD = -1.56, 95% CI: -2.20 to -0.92), but did not reduce POI incidence (odds ratio [OR] = 1.38, 95% CI: 0.43 to 4.47). While, postoperative exercise-only interventions showed no significant effect on intestinal recovery (SMD = -0.31, 95% CI: -1.21 to 0.58). Preoperative comprehensive interventions including exercise shortened the time to first flatus (SMD = -0.41, 95% CI: -0.66 to -0.17). Also, preoperative exercise-only interventions significantly reduced the incidence of POI (OR = 0.56, 95% CI: 0.46 to 0.67). CONCLUSIONS: Postoperative comprehensive interventions effectively promote intestinal recovery; however, postoperative exercise-only interventions may not promote the recovery of intestinal function. On the other hand, preoperative comprehensive interventions or exercise-only interventions may promote the recovery of intestinal function and prevent POI onset; however, the limited number of included studies prevented definitive conclusions.
15 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
Artificial Intelligence in Physical, Occupational and Neuro-Rehabilitation: Clinical Effectiveness, Prognostic Performance, and Pre-Implementation Feasibility - A Systematic Review
BACKGROUND: Global rehabilitation needs far exceed capacity, and artificial intelligence (AI) is proposed to extend access, personalise therapy, and support adherence. We aimed to synthesise evidence on clinical effectiveness, prognostic performance, and implementation feasibility of AI-enabled rehabilitation across conditions and care settings. METHODS: We conducted a mixed-methods systematic review of AI-enabled rehabilitation and rehabilitation-led prevention relevant to physiotherapy practice. MEDLINE, Embase, Web of Science, CINAHL, Scopus, and IEEE Xplore were searched. Methodological quality was appraised with MMAT and PROBAST + AI (prediction/diagnostic models), with a priori AI-reporting minimums checklist. Given heterogeneity, evidence was integrated via prespecified thematic synthesis. FINDINGS: Thirty studies from diverse regions met inclusion, comprising randomised trials, non-randomised comparisons, cohorts, surveys, qualitative work, and prediction/diagnostic models. Clinical effects were modest and heterogeneous. Most AI-enabled interventions were comparable to conventional rehabilitation; signals of benefit appeared in selected musculoskeletal and telerehabilitation contexts but rarely persisted beyond short follow-up. Internal validity was frequently limited by asymmetric adherence measurement objective telemetry in AI arms versus self-report or attendance in controls alongside low uptake and declining engagement over time. Safety and usability were generally favourable within short horizons, although surveillance and explicit attribution to AI components were inconsistently reported. Prognostic and adaptive models showed encouraging discrimination in development settings but lacked multicentre external validation, calibration, subgroup-error profiling, and prospective impact evaluation, leaving them unready for clinical use. Stakeholders reported willingness to adopt AI while highlighting gaps in training, governance and information technology support, costs, and digital equity. Overall certainty for comparative clinical outcomes was low to moderate, for models, very low. CONCLUSION: AI in rehabilitation presently acts more as a behavioural amplifier structuring home programmes and supporting execution than as a replacement for dose-matched therapist-delivered care. Credible scale-up should position AI as an adjunct and hinge on arm-symmetric capture of adherence and execution, clinically meaningful outcomes paired with verified behaviour change over treatment and longer-term follow-up, and model deployment only after transparent development, external validation with calibration and subgroup-error characterisation, and demonstration of clinical impact. Embedding equity and economic evaluation, together with living oversight and version control, will be essential to convert promising prototypes into trustworthy, durable, and widely accessible services.
14 May 2026
Read appraisal →BMJ open
Pilates during pregnancy for maternal musculoskeletal pain and discomfort: a systematic review and meta-analysis
OBJECTIVES: The predominant concern during pregnancy is musculoskeletal pain, often accompanied by additional discomforts such as anxiety and insomnia. Pilates, as a low-impact mind-body exercise, may be beneficial in managing musculoskeletal pain and associated symptoms in adults. This systematic review and meta-analysis aimed to synthesise the evidence on the effectiveness of Pilates for alleviating musculoskeletal pain and other discomforts during pregnancy. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, Scopus, TRIP Medical Database, Web of Science and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to 14 January 2026. ELIGIBILITY CRITERIA: Randomised controlled trials and prospective non-randomised controlled studies that compared Pilates with other prenatal care modalities for improving musculoskeletal pain and discomfort were eligible. DATA EXTRACTION AND SYNTHESIS: Two researchers independently extracted data using standardised forms with subsequent cross-verification. Risk of bias was assessed using the Cochrane Risk of Bias V.2.0 tool. Meta-analyses were performed using random-effects models. The certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: 13 studies were included in the systematic review, of which 10 contributed data to the meta-analysis. Primary outcomes were pain intensity and disability level. Pain intensity was assessed using Visual Analogue Scale (range 0-10). Moderate-certainty evidence demonstrated that Pilates significantly reduced musculoskeletal pain during pregnancy (mean differences (MD)=-2.59, 95% CI -4.19 to -1.00; I²=91%, p=0.001). Low-certainty evidence suggested that Pilates reduced pregnancy-related disability (standardised mean differences (SMD)=-1.82, 95% CI -2.99 to -0.66; I² = 93%, p=0.002). Secondary outcomes comprised sleep quality and psychological status. Multivariate meta-analysis showed significant improvements in psychological status (SMD=-0.86, 95% CI -1.31 to -0.42; τ²=0.4, I²=86%, p=0.0005) but did not yield statistically significant improvements in sleep quality (MD=-1.93, 95% CI -4.70 to 0.84; I²=93%, p=0.17). Both secondary outcomes were supported by very low-certainty evidence. Risk of bias assessment rated three studies as high risk, three as unclear risk and seven as low risk. Formal assessment of publication bias was not feasible owing to the limited number of studies (fewer than 10 per outcome). CONCLUSION: This meta-analysis demonstrates that, compared with standard care, structured prenatal Pilates significantly alleviates musculoskeletal pain and disability while also enhancing psychological status. PROSPERO REGISTRATION NUMBER: CRD42024628027.
14 May 2026
Read appraisal →BMC health services research
Barriers and facilitators to telerehabilitation implementation: a mixed-methods study of German physiotherapists
BACKGROUND: The COVID-19 pandemic accelerated telehealth service adoption in physiotherapy, including telerehabilitation (TR). However, the extent of TR use and factors influencing its implementation in Germany remain unclear. This study aimed to evaluate TR use in physiotherapy (during COVID-19 lockdowns, current use, future intentions, conditions treated, content, setting, and session type) and identify barriers and facilitators from physiotherapists' (PTs) perspectives. METHODS: A mixed-methods sequential explanatory design was employed, combining a cross-sectional online survey (n = 152) with two focus group interviews (n = 9). The survey collected data on demographics, TR use, barriers, and facilitators. Focus groups explored themes emerging from the survey in greater depth. Data were analyzed using descriptive statistics and content analysis, integrating quantitative and qualitative findings. Quantitative and qualitative findings were integrated through explanatory linking and joint display in a comparative analysis table. RESULTS: TR use peaked during COVID-19 lockdown (32.26%) but decreased to 18.06% by October 2022, with 26.45% intending future use and 43.87% considering it. Among TR users, musculoskeletal conditions were most commonly treated (75%), followed by sports (38%), pulmonology (33%), and neurology (27%). The primary barrier was lack of physical examination (74% agreement). While technical challenges were not reported as a major barrier in the survey, interviews revealed significant concerns about insufficient internet bandwidth and technical infrastructure. Common reasons for using TR included promoting patient self-management (78% agreement) and broadening therapy options (69% agreement). Qualitative data identified additional implementation facilitators, including structured implementation processes, appropriate technical infrastructure, and patient involvement in decision-making. CONCLUSION: While TR implementation in German physiotherapy shows growth potential, several barriers currently limit its adoption. Successful implementation requires addressing PTs capabilities, knowledge gaps, professional identity concerns, and environmental factors. Addressing these issues could enhance patient care quality, increase service accessibility, and advance healthcare delivery models.
13 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 →PloS one
Effects of galvanic vestibular stimulation on bodily ownership and postural control: An experimental examination with counterbalanced randomization of stimulus conditions
Vestibular stimulation influences both bodily ownership and postural control. Although previous studies in the literature have examined the effects of galvanic vestibular stimulation (GVS) on body ownership and balance separately, their combined and time-dependent effects remain insufficiently explored. This study investigated how GVS modulates multisensory integration over time by assessing bodily ownership and postural control within the same participants. A within-participant design was used with four conditions: Baseline (pre-GVS), Sham (60-min post-GVS placebo), 30-min post-GVS, and 60-min post-GVS. Forty-eight healthy adults completed all conditions. Balance performance was assessed via the Single-Leg Stance (SLS) and Fukuda Stepping Test (FST), while bodily ownership was measured using the Rubber Hand Illusion (RHI) questionnaire. Balance performance on the SLS showed a significant reduction at 30 minutes post-GVS, with values returning toward baseline by 60 minutes. In contrast, angular deviation on the FST decreased significantly at both 30 and 60 minutes post-GVS. RHI ownership scores increased at both post-stimulation time points, with the most pronounced increase observed at 60 minutes. The sham condition also elicited increases in RHI scores, indicating possible expectancy-related effects. Overall, these findings indicate time-dependent and task-specific effects of GVS on bodily ownership and postural control. The results are consistent with adaptive sensory reweighting processes that differentially affect static and dynamic balance measures. Further research in clinical populations and using longer stimulation protocols is required to determine the extent to which these short-term effects translate into sustained functional benefits.
12 May 2026
Read appraisal →PloS one
Effects of deconstructed Tai Chi step training combined with conventional rehabilitation on lower limb function in brunnstrom stage III stroke patients: A randomized controlled trial
OBJECTIVE: To evaluate whether a deconstructed Tai Chi stepping protocol adapted for patients with Brunnstrom Stage III stroke, when combined with conventional rehabilitation, improves lower limb motor function, walking ability, and joint mobility compared with conventional rehabilitation plus limb synergy training. METHODS: In this assessor-blinded randomized controlled trial, 52 patients with subacute stroke (Brunnstrom Stage III, ≤ 6 months post-stroke) were randomized in a 1:1 ratio to an experimental group (conventional rehabilitation plus adapted Tai Chi stepping training) or a control group (conventional rehabilitation plus limb synergy training). Both interventions were delivered 5 days per week for 8 weeks. Fifty participants completed the study and were included in the final per-protocol analysis (25 per group). Outcomes were assessed at baseline and after intervention. The primary outcomes were the Fugl-Meyer Assessment for Lower Extremity (FMA-LE) and Holden Walking Function Classification. Secondary outcomes were hip, knee, and ankle range of motion (ROM). RESULTS: Both groups improved after treatment, with greater improvement observed in the experimental group. FMA-LE scores increased by 5.6 ± 1.5 points in the experimental group and 1.8 ± 0.8 points in the control group (p < 0.001, Cohen's d = 1.32). In addition, 92% (23/25) of participants in the experimental group achieved Holden Grades II-III compared with 60% (15/25) in the control group (p < 0.001). The experimental group also showed larger gains in joint ROM, including hip flexion (+19.9° vs. + 4.2°), knee external rotation (+9.9° vs. + 3.7°), and ankle dorsiflexion (+7.6° vs. + 1.3°) (all p < 0.001). CONCLUSION: Deconstructed Tai Chi stepping training combined with conventional rehabilitation was associated with greater improvement in lower limb motor function, walking ability, and joint mobility than conventional rehabilitation plus limb synergy training in patients with Brunnstrom Stage III stroke. This stage-specific protocol may represent a practical adjunct to stroke rehabilitation, although confirmation in larger trials is still needed. CLINICAL TRIAL REGISTRATION: International Traditional Medicine Clinical Trial Registry (ITMCTR; a WHO ICTRP Primary Registry), registration number ITMCTR2025000972.
12 May 2026
Read appraisal →Scandinavian journal of pain
Breathing therapy as a supplement to opioid management for complex chronic non-cancer pain conditions - a systematic review
OBJECTIVES: The purpose of this systematic review was to analyze whether breathing therapy is effective in reducing pain, improving health-related quality of life, improving physical functioning/activity, and improving sleep quality in patients suffering from complex chronic non-cancer pain conditions (CNCP). CONTENT: An electronic literature search was conducted in MEDLINE, CINAHL, EMBASE, Cochrane Library, PEDro, and PsycINFO from inception to October 2024. The inclusion criteria were randomized clinical trials (RCT) examining breathing therapy as a sole or central intervention component in adult patients with CNCP. From 2,369 abstracts, a total of 10 RCTs (n=638) met the inclusion criteria. The population in the selected studies were patients with chronic neck pain, chronic low back pain, fibromyalgia, or tension-typed headache. Breathing therapy significantly improved pain and/or health-related quality of life in six studies. However, the quality of the included RCTs ranged from high to critically low, and substantial heterogeneity in participants, intervention, and methods prevented synthesis of results across studies. SUMMARY: This systematic review highlights breathing therapy as a promising pain management strategy in patients suffering from CNCP. We evaluated two RCTs examining similar daily slow diaphragmatic breathing for 15 min to have a low risk of bias; both demonstrating statistically significant relevant pain reduction up to 37 %. However, the strength of recommendations for clinical practice depends on the level of evidence as indicated by a risk of bias assessment (internal validity), consistency of results between studies, and generalizability (external validity). Based on the findings of this systematic review evidence of breathing therapy invention in patients suffering from CNCP conditions remains sparse. OUTLOOK: Striving to eliminate or minimize opioid management for complex CNCP, high-quality research is needed to reinforce the evidence base for non-pharmacological interventions such as breathing therapy to support modern pain management rather than former traditional pharmacological treatment. Trial registry number: PROSPERO #CRD42023460181.
12 May 2026
Read appraisal →Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace
Prevalence of urinary incontinence in patients with chronic cough: a systematic review
Chronic cough-related diseases increase the risk of urinary incontinence (UI) due to repeated intra-abdominal pressure affecting the pelvic floor. Existing studies focus on specific diseases rather than UI as a broader consequence. To determine the prevalence of UI in patients with chronic cough-related diseases and compare it with the prevalence in healthy populations. A systematic review was conducted using Medline, Embase, Cochrane, OVID, Scopus, ProQuest, PEDro, and EBSCO. Two independent reviewers screened studies using predefined criteria in a Microsoft Excel spreadsheet. Only prevalence studies were included. Data were extracted, synthesized, and assessed using the GRADE approach for evidence quality and the STROBE checklist for reporting quality. Prevalence estimates varied widely based on demographic characteristics. UI prevalence ranged from 2.2% to 45% in pediatric patients, 30.4% to 74% in adult women, and 2.4% to 39% in adult men. The quality of evidence was low, while reporting quality was acceptable. UI is a common complication in patients with chronic cough, with a higher prevalence than in healthy populations. Due to the stigma surrounding urogenital disorders, clinicians should actively inquire about UI during patient history-taking and refer affected individuals for appropriate treatment.
11 May 2026
Read appraisal →International journal of medical informatics
BackTracker: Machine learning to identify kinematic phenotypes for personalised exercise management in non-specific low back pain.
BACKGROUND: Low back pain (LBP) is a leading cause of global disability. Most cases are non-specific (NSLBP) and lack identifiable causes. Early active management is endorsed by clinical guidelines; however, exercises are rarely customised despite substantial variability in impairments. Existing classification systems can support targeted rehabilitation but require extensive clinical training and lengthy assessment procedures, limiting timely personalised care. OBJECTIVE: This study used AI methods to identify the two most common motor control impairments (MCIs)-flexion and extension patterns (FP/EP)-in NSLBP. The approach used spinal silhouettes extracted from movement videos to enable self-phenotyping and guide personalised exercise selection. METHODS: Data were collected from a research fellowship involving ninety NSLBP participants classified by an expert physiotherapist (LS) into FP or EP MCIs. Participants performed standard forward- and backward-bend tasks recorded in the sagittal plane. Pose estimation and instance segmentation techniques were applied to extract motion features and spine silhouettes. From each participant, a curated set of 80 black-and-white back images captured at specific bending angles was produced. These features were used to train a feedforward neural network. Model performance was assessed using five-fold cross-validation with accuracy, sensitivity, specificity, F1 score and AUC. RESULTS: The model achieved a diagnostic accuracy of 91.91% (95% CI 84.8-99.1) for backward-bend videos, exceeding reported inter-examiner agreement rates for trained physiotherapists. Robustness was supported by a mean AUC of 0.9422. Accuracy was lower for forward-bend images (86.69%), combined tasks (86.29%), or PROMs alone (63.82%). Adding PROMs to forward- or backward-bend tasks provided only modest improvements (66.32% and 71.62%, respectively). CONCLUSION: The model reliably distinguished between FP and EP NSLBP subgroups, demonstrating the potential of AI to support timely personalised rehabilitation. The integration of PROMs with motion features reduced classification accuracy, suggesting that self-reported outcomes may provide limited benefit when tailoring exercises to specific physical impairments.
5 May 2026
Read appraisal →Journal of medical Internet research
Effects of a Soft Robotic Exoskeleton for Gait Training on Clinical Outcomes in Patients With Parkinson Disease: Randomized Controlled Pilot Study
BACKGROUND: Balance and gait disorders in Parkinson disease (PD) impair motor function and quality of life. OBJECTIVE: Evidence on soft exoskeleton robots (SERs) for PD rehabilitation is limited. This study evaluated the impact of SERs on motor dysfunction in PD. METHODS: A total of 56 people with PD (July 2023 to May 2024) were randomized to 2 groups: the control group (n=25, 44.6%) received conventional rehabilitation, and the experimental group (n=31, 55.4%) received conventional rehabilitation combined with SER training (ChiCTR2500111990). Training occurred 5 times per week for 20 minutes each session over 4 weeks. Primary outcomes included gait speed and stride length, while secondary outcomes assessed the percentage of swing phase, ankle joint range of motion, Unified Parkinson Disease Rating Scale total and motor scores, and Montreal Cognitive Assessment. Paired sample t tests (2-tailed) were used for within-group pre- and postintervention comparisons, and independent sample t tests (2-tailed) were used for between-group comparisons. Correlation analyses were conducted between gait parameters and improvements in ankle mobility. RESULTS: After 4 weeks, the experimental group showed significant improvements in gait and balance. Specifically, left stride length increased by a mean of 0.15 (SD 0.16; 95% CI 0.09-0.21) m (P<.001), right stride length by a mean of 0.15 (SD 0.15; 95% CI 0.10-0.21) m (P<.001), left ankle dorsiflexion by a mean of 2.84 (SD 1.46; 95% CI 2.32-3.36) degrees (P<.001), left swing phase percentage by a mean of 1.56% (SD 3.05%; 95% CI 0.44-2.68; P=.01), and right swing phase percentage by a mean of 1.6% (SD 2.72%; 95% CI 0.62-2.62; P=.002). The Unified Parkinson Disease Rating Scale Part III total score decreased by a mean of 2.80 (SD 3.98) points, and balance subscale scores decreased by a mean of 0.40 (0.58) points (P<.001). Montreal Cognitive Assessment scores increased by a mean of 1.23 (1.23; 95% CI 0.77-1.68) points (P<.01), and Barthel Index scores increased by a mean of 6.84 (7.14; 95% CI 4.22-9.46) points (P<.001). Other measures such as balance reaction time, reaction speed, maximum movement distance, and movement direction control showed significant improvement (P<.01). Compared to the control group, the experimental group demonstrated greater improvements in gait speed (P=.04), balance reaction time (P=.04), and maximum movement distance (P=.048). Correlation analysis revealed that improvements in left ankle dorsiflexion were positively correlated with improvements in gait speed, stride length, and swing phase duration (P<.05). CONCLUSIONS: SER-assisted training significantly improves gait, balance, and PD symptoms. Our work integrates multidimensional assessments (gait analysis, balance metrics, and clinical scales) and reveals that gains in ankle mobility directly correlate with gait improvements, suggesting a key mechanism. This study contributes by establishing SER as an effective adjunct to conventional therapy, supported by comprehensive quantitative data.
3 May 2026
Read appraisal →European journal of pediatrics
Evaluation of the quality, reliability, and readability of ChatGPT-4 responses related to the treatment and rehabilitation of children with cerebral palsy
UNLABELLED: This study aims to evaluate the reliability, quality, and readability of ChatGPT-4's responses to questions about cerebral palsy (CP) and rehabilitation strategies. The 56 most frequently asked questions by families about CP, its treatment, and rehabilitation strategies were divided into five categories (A1-5) and asked in ChatGPT-4. The reliability, quality, and readability of the responses were assessed by two researchers, respectively, using the modified DISCERN (mDISCERN) tool, the Global Quality Scale (GQS), and the Flesch Reading Ease Scale (FRE). Median (IQR) values for mDISCERN ranged from 3 (3-3) in A5 to 4 (3-4) in A1, while GQS values ranged from 3 (3-3.5) in A2 to 3.5 (3-4) in A1. The mean readability values assessed with FRE ranged from 31.47 ± 12.92 to 44.84 ± 17.39. No statistically significant differences were observed between the categories. The ICC values suggested very good agreement for both scales, with 0.851 for the mDISCERN total score and 0.824 for the GQS total score. CONCLUSION: This study suggests that ChatGPT-4 provides moderate reliability and generally acceptable quality of responses regarding CP treatment and rehabilitation. FRE scores indicated that many responses were difficult for families to understand. While ChatGPT-4 may serve as a supportive source of general information, its outputs should be interpreted with caution, particularly in clinical contexts, and supervision and oversight by healthcare professionals remain essential for safe and effective use. WHAT'S KNOWN: • Children with cerebral palsy (CP) receive lifelong rehabilitation. Exercise plays a fundamental role in maintaining functional independence and quality of life, as well as physical development. The use of AI-based tools such as ChatGPT-4 for health information is increasingly widespread; however, uncertainties regarding the reliability, quality,and readability of these tools remain. WHAT IS NEW: • Our study shows that ChatGPT-4''s responses to questions about treatment and rehabilitation strategies for children with CP have moderate to good reliability and quality, but low readability.
27 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 →PloS one
Short-duration phase-change material cryotherapy selectively enhances early neuromuscular and perceptual recovery.
The purpose of this study was to examine whether short-duration phase-change material cooling (PCM) applied at different temperatures influences acute recovery following fatigue induced by stretch-shortening cycle exercise (SSC). Sixty-four physically active participants were randomly assigned to 5°C, 10°C, or 15°C PCM cryotherapy group or a passive recovery control group. After completing a SSC fatigue protocol, participants underwent a 15-minute PCM intervention, and peak torque (PT), mean power, rate of force development (RFD), countermovement jump (CMJ) performance, Rating of perceived exertion (RPE), modified endurance ratio (MER), vastus lateralis (VL) and Rectus Femoris (RF) stiffness were assessed immediately after fatigue (Imm-fatigue), immediately after PCM cryotherapy (Imm-PCM), and 60 minutes post PCM cryotherapy (Post60-PCM). Mean power and RFD were significantly greater in PCM groups compared with the control group at Imm-PCM (P ≤ 0.01), with mean power remaining elevated in the 15°C PCM group at post-60-PCM (P ≤ 0.05). RPE was significantly lower in all PCM groups at Imm-PCM and post60-PCM compared with control (P ≤ 0.01). No between-group differences were observed for PT, CMJ, MER, or muscle stiffness, and no temperature-dependent effects were detected within the 5-15 °C. These findings indicate that 15-minute PCM cryotherapy selectively accelerates early-phase neuromuscular and perceptual recovery without affecting maximal strength, endurance capacity, or passive muscle mechanical properties. From an applied perspective, PCM cryotherapy may be an effective strategy to enhance explosive performance and perceived readiness during short recovery intervals in training or competition settings.
27 Apr 2026
Read appraisal →JMIR human factors
Dynamic Balance Control and Postural Adaptation in Human-Robot Collaborative Manipulation: Within-Subject Experimental Study
BACKGROUND: The integration of robots into industrial settings has rapidly advanced, aiming to reduce human involvement in demanding tasks while improving overall efficiency. As collaborative robots (cobots) become more prevalent, assessing the physical strain during joint tasks is essential to promote long-term well-being in the workplace. OBJECTIVE: This study aimed to investigate how human-robot collaboration influences workers' postural control and musculoskeletal load during manipulation tasks performed in parallel. METHODS: Fourteen healthy male participants performed manipulation tasks under 3 conditions: without robotic assistance, with a cobot providing load support (Robot Free [RF]) and a cobot constrained to horizontal movement (Robot Plane [RP]). Center of pressure trajectories were computed, and nonlinear recurrence quantification analysis indicators (recurrence rate [REC], determinism [DET], and their ratio) were calculated in the anteroposterior, mediolateral, and anteroposterior-mediolateral planes. RESULTS: Statistical analysis showed greater postural sway in robot-assisted conditions compared to Free. Mean distance increased from 1.7 (SD 0.6) cm in Free to 2.4 (SD 0.6) cm in RF (P<.001) and 2.3 (SD 0.6) cm in RP (P<.001). Mean velocity increased from 2.9 (SD 0.9) cm/s in Free to 4.3 (SD 1.4) cm/s in RF and RP. Confidence ellipse area increased from 7.6 (SD 4.1) cm2 in Free to 24.9 (SD 14.2) cm2 in RF and 23.1 (SD 13.4) cm2 in RP. Sway area increased from 1.5 (SD 0.7) cm2/s in Free to 2.9 (SD 1.2) cm2/s in RF and RP. Nonlinear metrics revealed lower recurrence rates in robot-assisted conditions, decreasing from 0.31 (SD 0.08) in Free to 0.2 (SD 0.08) in RF and 0.2 (SD 0.04) in RP in the anteroposterior-mediolateral plane (P<.001), from 0.33 (SD 0.08) in Free to 0.28 (SD 0.07) in RF (P=.02) and 0.16 (SD 0.03) in RP (P=.007) in the mediolateral direction, and from 0.36 (SD 0.07) in Free to 0.3 (SD 0.06) in RF (P=.009) and 0.26 (SD 0.03) in RP (P<.001) in the anteroposterior direction. Determinism remained stable (values close to 1), leading to higher determinism-to-recurrence ratios for robot-assisted conditions, increasing from 3.41 (SD 0.87) in Free to 5.41 (SD 1.69) in RF and 5.51 (SD 1.11) in RP in the anteroposterior-mediolateral plane (P<.001), from 3.11 (SD 0.63) in Free to 3.64 (SD 0.72) in RF (P=.02) and 3.92 (SD 0.48) in RP (P=.007) in the mediolateral direction, and from 2.82 (SD 0.48) in Free to 3.47 (SD 0.57) in RF (P=.009) and 3.46 (SD 0.45) in RP (P<.001) in the anteroposterior direction. No significant differences were found between the robot-assisted conditions. CONCLUSIONS: Interaction increases postural sway, indicating reduced stability and higher physical demand. This could reflect impaired balance or adaptation. Nonlinear analysis reveals that postural control remains structured. Results also suggest that the mere presence of the cobot is the primary driver of these postural changes.
26 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 →The Cochrane database of systematic reviews
Delivery arrangements for rehabilitation services in health systems: an overview of systematic reviews
BACKGROUND: Cochrane Rehabilitation and the World Health Organization (WHO) Rehabilitation Programme have collaborated to produce four Cochrane overviews of systematic reviews synthesizing evidence from health policy and systems research (HPSR) in rehabilitation. Each overview focuses on one of the four HPSR pillars identified by the Cochrane Effective Practice and Organisation of Care (EPOC) taxonomy: delivery, financial, and governance arrangements; and implementation strategies. This overview addresses delivery arrangements, which Cochrane EPOC defines as how health services are organized and delivered, including who provides care, how care is coordinated and managed, and where services are provided. OBJECTIVES: This overview aimed to synthesize current evidence on delivery arrangements in rehabilitation from an HPSR perspective. Our series of four overviews has the following overarching objectives. • To offer a broad synthesis of existing evidence on health policy and systems interventions' effects. • To direct end-users, including policymakers, towards systematic reviews that may address their health policy questions. • To identify current research gaps and set priorities for future primary HPSR. • To pinpoint needs and priorities for new evidence syntheses where no reliable, up-to-date systematic reviews currently exist. METHODS: We searched Epistemonikos Health Systems Evidence databases and EPOC Group systematic reviews with no language limitations to identify reviews published between 2015 and 17 November 2024. We included Cochrane systematic reviews (CSRs) and non-CSRs of randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs) evaluating the effectiveness of health policy and systems interventions for rehabilitation in health systems, specifically related to delivery arrangements as defined in the EPOC taxonomy. All four overview teams screened reviews and extracted data. We used AMSTAR 2 to critically appraise the reviews, and we analyzed the results descriptively. MAIN RESULTS: We included 25 systematic reviews. Three overlapped, and for 17 the AMSTAR 2 rating was low or critically low confidence. Five systematic reviews (2 CSRs and 3 non-CSRs) contributed to our synthesis. Most outcomes focused on patients, caregivers, or service use (e.g. access to rehabilitation). Equity-related outcomes were absent, and quality of care, adverse events, and our important outcomes were rarely reported. Below, we report the results of three of the five reviews judged to have moderate to high confidence for our outcomes of interest, in which authors conducted meta-analysis and assessed the certainty of the evidence. Who provides care One review analyzed advanced practice physiotherapy (APP) models, which may result in little to no difference in health-related outcomes measured by the Pain Disability Index and EuroQol 5-Dimension questionnaire after the intervention, compared with usual care in adults with spinal pain (standardized mean difference [SMD] 0.05, 95% confidence interval [CI] -0.32 to 0.42; 2 studies, 225 participants; low certainty). Information and communication technology We included two reviews in this category. One compared telerehabilitation with usual care in older adults, finding that telerehabilitation may have little or no effect on quality of life after seven to 20 weeks (SMD -0.09, 95% CI -0.23 to 0.40; 3 studies, 179 participants; low certainty). There was very low-certainty evidence on mobility after seven to 26 weeks (SMD 0.63, 95% CI -0.25 to 1.51; 5 studies, 302 participants), strength after 12 and 26 weeks (SMD 0.73, 95% CI -0.10 to 1.56; 4 studies, 226 participants), and balance after seven to 26 weeks (SMD 0.40, 95% CI -0.35 to 1.15; 3 studies, 199 participants). Another review on stroke survivors living in the community found that telerehabilitation compared with usual care probably has little or no effect on independence in activities of daily living (ADL) after 24 weeks (SMD 0.00, 95% CI -0.15 to 0.15; 2 studies, 661 participants; moderate certainty), self-reported quality of life after six to 24 weeks (SMD 0.03, 95% CI -0.14 to 0.20; 3 studies, 569 participants; moderate certainty), and depression after six to 24 weeks (SMD -0.04, 95% CI -0.19 to 0.11; 6 studies, 1145 participants; moderate certainty); and may have little or no effect on upper limb function after 12 weeks (SMD 0.33, 95% CI -0.21 to 0.87; 2 studies, 54 participants; low certainty) and mobility after six weeks (mean difference 0.01, 95% CI -0.12 to 0.14; 1 study; 144 participants; low certainty). This review also compared telerehabilitation with in-person rehabilitation and found that there may be little to no difference in independence in ADL, measured with the Modified Barthel Index at four to 12 weeks (MD 0.59, 95% CI -5.50 to 6.68; 2 studies, 75 participants; low certainty); balance, measured with the Berg Balance Scale at four to 12 weeks (MD 0.48, 95% CI -1.36 to 2.32; 3 studies, 106 participants; low certainty); and upper limb function, evaluated with the Fugl-Meyer Assessment (Upper Extremity) four weeks after intervention (MD 1.23, 95% CI -2.17 to 4.64; 3 studies, 170 participants; low certainty). AUTHORS' CONCLUSIONS: Current evidence on delivery arrangements in rehabilitation is limited, mostly of low certainty, and derived from high-income countries. Reviews covered five EPOC categories, but reliable evidence for our outcomes of interest was available for only two categories. Most evidence was on telerehabilitation. Compared with usual care, APP models may have little to no effect on health outcomes in adults with spinal pain. In people with stroke, telerehabilitation compared with usual care probably has little or no effect on independence in daily living, quality of life, and depression, and may have little to no effect on upper limb function and mobility. Compared with in-person care, telerehabilitation may have little to no effect on ADL, balance, and upper limb function. Further high-quality research using well-defined frameworks is needed, especially in low- and middle-income countries, to identify effective strategies and evaluate organizational, implementation, and equity outcomes. Future Cochrane overviews in HPSR should consider a broader range of study designs, such as observational, qualitative, and mixed-design evidence, to better capture evidence on delivery arrangements in rehabilitation. FUNDING: PC, CK, and SN were supported and funded by the Italian Ministry of Health (Ricerca Corrente). The funder played no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. REGISTRATION: Protocol (2025): DOI 10.23736/S1973-9087.24.08833-6.
25 Apr 2026
Read appraisal →Journal of rehabilitation medicine
Effect of inspiratory muscle training on inspiratory muscle strength in adults with post-COVID-19 condition and inspiratory muscle weakness: a randomized controlled trial
OBJECTIVE: Evaluate the effect of inspiratory muscle training in adults with post-COVID-19 condition (PCC) and inspiratory muscle weakness. DESIGN: Randomized controlled trial. SUBJECTS/PATIENTS: Adults with PCC and inspiratory muscle weakness. METHODS: Participants were randomized to inspiratory muscle training twice daily plus individualized exercise twice weekly or exercise alone, with weekly follow-ups over 8 weeks. PRIMARY OUTCOME: inspiratory muscle strength (Maximal Inspiratory Pressure). SECONDARY OUTCOMES: expiratory muscle strength (Maximal Expiratory Pressure); functional capacity (Six‑Minute Walk Test; One‑Minute Sit‑to‑Stand); lung function (spirometry); dyspnoea (mMRC); respiratory symptoms (chest tightness, impaired deep breathing, breathing‑related pain); cough frequency (CAAT cough item); fatigue (Fatigue Severity Scale); physical activity (Frändin-Grimby Activity Scale); activity limitations (Patient‑Specific Functional Scale); and health-related quality of life (EQ‑5D‑5L). Intention-to-treat analyses used imputed missing data. Estimated sample size: 90. RESULTS: Forty-four participants were included (median age 47; 82% women; n = 22/group). Between‑group differences favoured the intervention for inspiratory muscle strength (mean difference: 18%; 95% CI: 5-30; OR for clinically meaningful improvement: 7.08, 95% CI: 1.31-38.32) and cough frequency. No other between-group differences were observed. CONCLUSION: Inspiratory muscle training may improve inspiratory muscle strength and reduce cough frequency, but limited sample size and underrepresentation of the most severely affected warrant cautious interpretation.
23 Apr 2026
Read appraisal →Medicine
Clinical study on the efficacy of electroacupuncture combined with pelvic floor muscle training for female stress urinary incontinence
BACKGROUND: To evaluate the clinical efficacy and synergistic effects of electroacupuncture (EA) combined with pelvic floor muscle training (PFMT) in the treatment of mild-to-moderate stress urinary incontinence (SUI) in women. METHODS: A single-blind (assessor-blinded), 2 × 2 factorial, randomized controlled trial was conducted. A total of 128 SUI patients were allocated to 4 groups: the EA group (sessions every other day, targeting acupoints including Guanyuan [RN4] and Shenshu [BL23]), PFMT group (3 daily sessions), combination group (EA + PFMT), and waitlist group. The intervention lasted for 4 weeks. The primary outcome was the change in 1-hour pad test leakage volume. Secondary outcomes included 72-hour urinary incontinence episodes and International Consultation on Incontinence Questionnaire-Short Form scores. Data were analyzed using intention-to-treat and factorial analysis of variance. RESULTS: The combination group showed the greatest reduction in leakage volume (6.17 g, 95% confidence interval [CI] = 5.89-6.44), significantly outperforming the EA group (4.53 g, 95% CI = 4.26-4.81), PFMT group (2.13 g, 95% CI = 1.85-2.41), and waitlist group (0.38 g, 95% CI = 0.11-0.66; all P < .001). Factorial analysis confirmed significant main effects for EA (mean difference = 5.35 g, 95% CI = 5.15-5.54) and PFMT (mean difference = 4.15 g, 95% CI = 3.95-4.34; both P < .001), but no interaction effect (P = .686). Secondary outcomes showed consistent improvements in incontinence episodes and International Consultation on Incontinence Questionnaire-Short Form scores. CONCLUSION: Combined EA and PFMT significantly alleviated SUI symptoms. Although no synergy was observed, the additive therapeutic effect provided clinical benefits, offering a promising nonsurgical alternative for SUI management.
20 Apr 2026
Read appraisal →BMJ open
Early mobilisation after abdominal surgery: a concept analysis
OBJECTIVE: To clarify and define the clinical practice concept of early mobilisation after abdominal surgery. DESIGN: A concept analysis guided by Walker and Avant's method. DATA SOURCES: MEDLINE (Ovid), AMED-(Ovid), Embase (Elsevier) and CINAHL (EBSCO) were searched through 5 December 2024. ELIGIBILITY CRITERIA: Relevant studies that included combinations of the terms 'early mobilisation', 'early ambulation', 'early acceleration', 'abdominal surgery' and 'surgical procedures' were selected. We restricted the search to English full-text publications involving adult patients, limited to the year 2000 and onward. Inclusion criteria were original research articles describing the timing and/or type of mobilisation. DATA EXTRACTION AND SYNTHESIS: The study derives its defining attributes, antecedents and consequences through data analysis. To enhance understanding of the model, we constructed related and contrary cases of the concept and outlined relevant empirical referents. RESULTS: In total, 140 studies were included in the analysis. Early mobilisation is characterised by the key defining attributes of initiating active physical movement, including standing, sitting in a chair or walking, within the first 24 hours of surgery. Antecedents include haemodynamic and respiratory stability, adequate pain management, and the patient's cognitive and physical readiness. Contextual antecedents include competent and adequately staffed healthcare teams. Consequences include improved physiological recovery and enhanced postoperative outcomes. CONCLUSIONS: This analysis provides a clarified, practice-focused definition of early mobilisation after abdominal surgery. By delineating its key attributes and contextual prerequisites, the study offers a conceptual foundation that can support clinical guidelines, promote consistent implementation and inform future research aimed at optimising postoperative recovery.
20 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 →Medicine
Efficacy of floating needles in the treatment of postpartum urinary incontinence and pain: A systematic review and meta-analysis
BACKGROUND: Postpartum pain and urinary incontinence (UI) are the most common postpartum sequelae, which can lead to postpartum anxiety and depression when severe, and seriously affect the quality of life of postpartum mothers. Floating needle (FN) is one of the Chinese medical treatments of the latest in recent years, and studies have shown that FN for postpartum pain and stress urinary incontinence has a positive effect; this study aimed to comprehensively and critically evaluate the available evidence on the effectiveness of FN in managing postpartum pain and UI, and provide the first evidence-based medical evidence for FN intervention for postpartum sequela. METHODS: Computerized retrieval of Chinese databases (CNKI, Wanfang, VIP, and CBM) and English databases (PubMed, Embase, Web of Science, and Cochrane Library) for randomized controlled trials on FN therapy for postpartum pain and UI was conducted up to December 20, 2023. Search terms included "floating needle," "urinary incontinence," and "labor pain." Data extraction and quality assessment were performed on eligible studies. Meta-analysis was conducted using RevMan 5.4, with mean differences (MDs) for continuous outcomes and risk ratios for dichotomous endpoints. RESULTS: A total of 1194 women were included in 8 articles in both Chinese and English, all of which were conducted in China; 6 of the articles were included in the meta-analysis. The FN is more effective in treating postpartum incontinence and pain than the control group (risk ratio = 1.33, 95% confidence interval [CI] = 1.18-1.5, P < .001), and significantly reduced the International Consultation on Incontinence Questionnaire-Short Form score (MD = 1.56, 95% CI = 0.78-2.35, P < .001); FN therapy can significantly reduce the amount of urine leakage in postpartum patients (MD = 1.79, 95% CI = 1.09-2.49, P < .001). CONCLUSION: Our results suggest that FN therapy could be encouraged as one of the routine treatments for postpartum sequelae.
18 Apr 2026
Read appraisal →Thorax
Multidisciplinary, non-pharmacological breathlessness intervention service for patients with moderately severe to severe COPD: a randomised controlled trial
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is an often-progressive respiratory disease associated with disabling breathlessness. Breathlessness intervention services (BIS), which coach patients to self-manage breathlessness using non-pharmacological strategies, are effective in a variety of populations, including those with cancer and serious respiratory disease. This study aimed to compare the impact of the Westmead Breathlessness Service in people with moderate to severe COPD. METHODS: We analysed 113 participants randomised (1:1) with moderate/severe COPD (forced expiratory volume in 1 s (FEV1)/forced vital capacity <0.70 and FEV1 ≤60% predicted) and disabling breathlessness (modified Medical Research Council (mMRC) Breathlessness Score ≥2) to either an 8-week intervention involving breathing techniques, handheld fan use, exercise, energy conservation, dietetic advice (n=54) or 8-week wait-list control group (n=59). The primary outcome was change in Chronic Respiratory Questionnaire (CRQ) Mastery of breathlessness subscale. Secondary outcomes included change in other CRQ subscales (Fatigue, Emotion and Dyspnoea), exertional breathlessness intensity/unpleasantness (0-10 Numerical Rating Scale Score), anxiety and depression. Difference in change over 8 weeks between groups was compared using ANCOVA; p<0.05 statistically significant. FINDINGS: Participants were aged 70.9 (±8.5) years, 50% female, mean FEV1 =0.8 L (±0.3 L; 34% predicted), mMRC Breathlessness Score 3 (IQR 3-4). CRQ-Mastery improved following intervention compared with control (between-group difference 0.5 units; 95% CI 0.2 to 0.8; p=0.0262) using modified intention-to-treat analysis. Better CRQ-Dyspnoea and CRQ-Fatigue were seen in the intervention group (between-group difference-CRQ-Dyspnoea 0.4 units; CI 0.1 to 0.7; p=0.005, and CRQ-Fatigue 0.4 units; CI 0.1 to 0.7; p=0.014). Exertional breathlessness intensity (difference -0.8 units; CI -1.4 to -0.2; p=0.013) and breathlessness unpleasantness (difference -1.2 units; CI -1.7 to -0.6; p=0.001) also improved. INTERPRETATION: An 8-week BIS improved CRQ-Mastery, Dyspnoea and Fatigue, exertional breathlessness intensity and unpleasantness in people with severe COPD.
17 Apr 2026
Read appraisal →Carbohydrate polymers
Multifunctional conductive hydrogel based on carboxymethyl cellulose/oxidized sodium alginate for machine learning-guided sports training
Multifunctional hydrogels have shown great promise in advanced wearable sensing technologies; however, their performance under real-world sweaty and dynamic conditions remains a significant challenge. In this study, a highly conductive and adhesive hydrogel was developed using poly(AM-co-AA), carboxymethyl cellulose (CMC), oxidized sodium alginate (OSA), and polydopamine-modified carbon nanotubes (PDA-CNT). Featuring a dual dynamic cross-linking system based on reversible Schiff base bonds and strong hydrogen bonding, the hydrogel demonstrates high mechanical toughness (2416 kJ/m3), excellent stretchability (1829%), and stable electrical conductivity (1.5 S/m). It exhibits outstanding sweat resistance, maintaining strong adhesion and reliable sensing performance even during intense physical activities, along with high fatigue resistance over 10,000 deformation cycles, enabling long-term reliable monitoring. As a highly sensitive strain sensor, it offers multi-range gauge factors (up to 2.53) and accurately captures human motion and physiological signals without interference from sweat or motion artifacts. When integrated with machine learning algorithms, the sensor achieves a validation accuracy of 98.75%, providing real-time feedback on movement techniques and supporting personalized training optimization. Furthermore, the hydrogel demonstrates significant antibacterial properties and good biocompatibility, making it an ideal candidate for next-generation wearable electronic devices suited for long-term athletic training and high-sweat environments.
17 Apr 2026
Read appraisal →PloS one
A pilot randomized controlled trial of neuromodulation-augmented balance training in people with multiple sclerosis: STIM-Balance Protocol
BACKGROUND: Impairments in balance control and falls are common problems for people with multiple sclerosis (PwMS), resulting in mobility limitations and reduced participation. Non-invasive neuromodulation techniques such as functional electrical stimulation (FES) and transcutaneous spinal stimulation (TSS) have revealed promising results in improving motor functions in other neurological populations; however, their effects during task-specific balance training have not been investigated in PwMS. OBJECTIVE: To evaluate the feasibility, acceptability, safety, and preliminary clinical efficacy of neuromodulation-augmented balance training programs on balance, mobility, and neuroplasticity in PwMS (ClinicalTrials.gov Identifier: NCT07174973). METHODS: Twenty-four ambulatory PwMS will be randomly assigned into three groups: (1) visual feedback balance training (VFBT) with sham stimulation, (2) VFBT with active (closed-loop) FES for the ankle muscles and sham TSS, and (3) VFBT with active FES and active (open-loop sub-motor-threshold) TSS at the lumbosacral enlargement. Participants in each group will complete 12 training sessions over six weeks. Feasibility, safety, and acceptability will be assessed through recruitment and adherence metrics, adverse-event monitoring, and semi-structured interviews guided by the Technology Acceptance Model questionnaire-2. Performance-based measures of balance, mobility, and walking speed, as well as patient-reported outcomes of balance confidence, walking ability, and fear of falling will be recorded to assess the preliminary efficacy. Modulation in neural pathways excitability will be quantified by recording motor evoked potentials and spinal motor evoked potentials. CONCLUSION: Findings will help to determine whether neuromodulation-augmented balance training is feasible, safe, and acceptable for PwMS and will guide the design of a future fully powered RCT.
17 Apr 2026
Read appraisal →Science advances
Drawn-on-skin electronic tattoo as a closed-loop sensing-stimulation system for the muscles
Simultaneous electromyography (EMG) sensing and closed-loop electrical stimulation (ES) could enable interactive muscle training, motor rehabilitation, and kinesthetic feedback. However, current systems often suffer from nonconformal device/skin interfaces, poor wearability, and anatomical variability among users, limiting signal fidelity and stimulation precision. Here, we present a fully wireless, skin-integrated electronic tattoo platform that records high-quality EMG and delivers closed-loop ES through custom drawn-on-skin, conformal electrodes with strong adhesion and high spatial accuracy. The system supports closed-loop muscle interactions across body regions and even between individuals. Machine learning models classify EMG patterns from different hand gestures with >90% accuracy and adapt ES parameters to stimulate specific muscle groups. In a heavy object holding task, users reached the required grip behavior substantially faster than unassisted controls, indicating improved neuromuscular efficiency. This closed-loop framework not only supports personalized muscle control but also supports coordinated activation across multiple sites or users, unlocking possibilities in interactive motor training, remote rehabilitation, and virtual reality environments.
16 Apr 2026
Read appraisal →Journal of medical Internet research
Digital Technologies and Biomarkers for Locomotor Capacity Assessment in Older Adults: Systematic Review
BACKGROUND: Locomotor capacity, encompassing endurance, balance, muscle strength, muscle function, muscle power, and joint function of the body, is a key determinant of functional ability in older adults. Assessment tools based on digital technologies for objectively assessing locomotor capacity are increasingly being developed, but their reliability, validity, and clinical potential remain underexplored. OBJECTIVE: This systematic review aims to evaluate the current state of digital technologies, assess their validity and reliability for assessing locomotor capacity, and facilitate their effective implementation in clinical settings. METHODS: Systematic literature searches were performed in 6 electronic databases from inception to March 7, 2025. Citation lists from the included studies and gray literature from Google Scholar were additionally searched. Studies focusing on the reliability and validity of digital technologies for assessing locomotor capacity in general older adults were included. Standardized forms were used to extract information on study characteristics, participant demographics, digital technology details, and validity and reliability results. Methodological quality assessment and rating of measurement properties were conducted in accordance with the COSMIN (Consensus-Based Standards for the Selection of Health Measurement Instruments) guidelines. RESULTS: A total of 14 studies were included, of which 13 assessed balance using inertial measurement units, smartphones, balance boards, and force plates, and 1 assessed muscle power using smartphones. Fifty-one digital biomarkers were identified, including 47 for balance and 4 for muscle power assessment. Test-retest reliability coefficients ranged from 0.016 to 0.97, and validity was context specific. Overall, 13 studies demonstrated sufficient test-retest reliability and validity, whereas 1 study was rated as insufficient for convergent validity. Methodological quality was rated as "doubtful" or "inadequate" in 11 studies. CONCLUSIONS: This review provides a comprehensive summary of digital technologies for assessing locomotor capacity in older adults and identifies 51 digital biomarkers with generally acceptable reliability and validity. Unlike previous studies that focused on specific sensor types or disease-specific populations, this review integrates evidence across technologies within general older populations, providing insights into the clinical application potential of digital biomarkers as well as the key translational barriers limiting their real-world implementation. Specifically, existing digital technologies show considerable promise for early detection of functional decline, longitudinal monitoring, and informing personalized interventions. However, their clinical applicability remains constrained by limited assessment of certain locomotor components and by methodological shortcomings across current studies. Future research should prioritize rigorous, high-quality investigations that expand evaluation to a broader range of locomotor components in real-world settings while developing age-friendly tools with enhanced clinical interpretability.
16 Apr 2026
Read appraisal →JMIR mHealth and uHealth
Effect of a Comprehensive Mobile-Based Respiratory Training Program on Respiratory Function in Survivors of Acute Stroke: Randomized Controlled Trial
BACKGROUND: Respiratory dysfunction frequently occurs during the acute phase of stroke and is associated with reduced ventilatory capacity, respiratory muscle weakness, and increased pulmonary complications. However, delivering standardized respiratory training during hospitalization is often constrained by staffing and service continuity. OBJECTIVE: This study aimed to evaluate the efficacy, safety, and feasibility of a hospital-based comprehensive mobile-based respiratory training program (CMRTP) added to conventional rehabilitation in people with acute stroke who are inpatients. METHODS: This single-center, assessor-blinded randomized controlled trial enrolled 40 patients within 2 weeks after stroke onset with respiratory dysfunction (forced vital capacity <80% predicted). Participants were randomized (1:1) to CMRTP plus conventional rehabilitation or conventional rehabilitation alone. The CMRTP was delivered via the WeChat-based AIRHUB platform and performed 20 minutes twice daily, 5 days per week for 2 weeks, either independently or with caregiver assistance as needed. The primary outcome was change in forced vital capacity from baseline to week 2. Secondary outcomes included forced expiratory volume in 1 second (FEV₁), peak expiratory flow, maximal inspiratory pressure, maximal expiratory pressure, and modified Barthel index. All outcomes were assessed face-to-face by a blinded senior physician, and all analyses followed an intention-to-treat principle. RESULTS: Of 56 screened patients, 40 were randomized, and 39 completed the study. Adherence to the CMRTP reached 96%, and no serious adverse events occurred; mild, transient events (fatigue, dizziness, and hyperventilation) were recorded. Compared with the control group, the CMRTP group demonstrated greater improvement in forced vital capacity at week 2 (mean difference 0.77 L; 95% CI 0.39-1.16; P<.001; η²=0.32), with additional between-group differences in maximal inspiratory pressure (P=.001; η²=.25), maximal expiratory pressure (P<.001; η²=.08), and modified Barthel index (P=.001; η²=.26). No significant group differences were found for forced expiratory volume in 1 second or peak expiratory flow. CONCLUSIONS: A 2-week hospital-based mobile respiratory training program is feasible and safe in people with acute stroke who are inpatients and yields clinically meaningful improvements in respiratory function and daily functional performance when added to conventional rehabilitation.
15 Apr 2026
Read appraisal →European journal of pediatrics
Efficacy of physiotherapeutic interventions in the management of functional constipation in pediatric and adolescent populations: a systematic review and meta-analysis
UNLABELLED: To evaluate the efficacy of physiotherapeutic interventions in the management of functional constipation (FC) in pediatric and adolescent populations, and to analyze the methodological quality of the available evidence. A systematic review of randomized controlled trials (RCTs) published in PubMed, Cochrane Library, Embase, and Web of Science was conducted (February-March 2025). Studies including participants aged 18 years diagnosed with FC, treated with pelvic floor physiotherapy versus conventional medical treatment, were included. Methodological quality was assessed using the PEDro scale (Physiotherapy Evidence Database). Seven clinical trials were included in the meta-analysis with sample sizes ranging from 45 to 400 participants (total n = 775). The interventions covered pelvic floor exercises, biofeedback, telerehabilitation, visceral mobilization, and electrostimulation. The majority showed improvements in painful defecation, fecal consistency, and quality of life, with less consistent results in defecatory frequency (MD = 1.00; 95% CI: 0.35 to 1.65). However, the marked heterogeneity in protocols (type, intensity, duration), variability in assessment instruments, and frequent co-intervention with polyethylene glycol (PEG) hinder comparison between studies and limit external validity. Follow-ups shorter than 12 months and the absence of blinding of participants and therapists constitute additional risks of bias. CONCLUSIONS: Pelvic floor physiotherapy appears to be a promising adjuvant intervention in the treatment of pediatric FC, with positive effects on symptoms and quality of life. Nevertheless, multicenter trials with standardized protocols, large samples, and prolonged follow-up are required to confirm its efficacy and long-term sustainability. WHAT IS KNOWN: •Despite the clinical use of physiotherapy, there was no quantitative synthesis integrating its efficacy against standard medical treatment, nor had its specific effect size on defecatory pain and quality of life been established in the pediatric population. WHAT IS NEW: •This meta-analysis confi rms that pelvic fl oor physiotherapy is an eff ective adjuvant with a large effect size, demonstrating consistent improvements in reducing painful defecation and enhancing the biopsychosocial dimensions of quality of life.
12 Apr 2026
Read appraisal →Journal of neurology
Effect of exercise training on clinical and physiological variables in adults with myotonic dystrophy type 1: a systematic review and meta-analysis
Myotonic dystrophy type 1 (DM1) is a progressive neuromuscular disorder characterized by muscle weakness, fatigue, reduced endurance, and impaired quality of life. This systematic review and meta-analysis aimed to evaluate the effects of exercise training on clinical and physiological outcomes in adults with DM1. Six databases were searched for studies published between 2003 and 2023. Randomized controlled trials, quasi-experimental studies, and longitudinal cohort studies involving adults with DM1 undergoing aerobic or resistance training were included, and risk of bias was assessed. Meta-analyses used standardized mean differences with fixed- or random-effects models based on heterogeneity. Fourteen studies were included. Most studies demonstrated low risk of bias. Only one study reported any adverse events, and the incidence of these events was similar in occurrence between the intervention and standard care only groups. Meta-analysis demonstrated a moderate improvement in strength (p = 0.022). Endurance showed a large but non-significant pooled effect (p = 0.14). Meta-analyses for fatigue (p = 0.49) and sleep (p > 0.05) were inconclusive. Narrative synthesis indicated improvements in most clinical and physiological outcomes, while sleep outcomes showed minimal or inconsistent changes across studies. Exercise training appears safe and provides moderate benefits for strength and selected clinical and physiological outcomes in adults with DM1. Future well-powered trials with standardized protocols are needed to optimize exercise prescription.
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 →Journal of medical Internet research
Digital Health Technology Use Among Rehabilitation Professionals in China: Multi-Province Cross-Sectional Survey
BACKGROUND: The rapid expansion of rehabilitation needs in China has intensified pressure on a workforce that remains unevenly distributed. Digital health technologies (DHTs) offer potential to increase service reach and efficiency. However, little is known about how rehabilitation professionals currently gather and document clinical information, nor about their readiness to integrate digital tools into routine practice within China's rapidly digitalizing health system. OBJECTIVE: This study aimed to describe how rehabilitation professionals in China collect subjective and objective clinical information, document patient data in routine practice, and assess their willingness to use DHTs in clinical settings. METHODS: We conducted a multi-province observational cross-sectional survey using a culturally adapted questionnaire based on the World Health Organization Digital Health Interventions framework. The instrument assessed participant characteristics, information collection methods, documentation practices, and willingness to adopt digital functions across rehabilitation activities. Descriptive analyses and subgroup comparisons were performed on 324 complete responses from certified rehabilitation professionals. The multi-province cross-sectional online survey was conducted among licensed rehabilitation professionals in China with internet access. Participants were recruited through professional networks and social media platforms. RESULTS: Respondents were drawn from 20 provincial-level administrative regions across China, including Fujian (n=72), Guangdong (n=77), and Shanxi (n=45), among others, with 82.7% (268/324) employed in public sector rehabilitation services. Traditional methods dominated clinical work. Face-to-face communication was used frequently for subjective assessment by 96.3% (312/324) of respondents, whereas digital channels such as email (22/324, 6.8%) and telephone (47/324, 14.5%) saw limited use. For objective information, visual observation (271/324, 83.7%) and manual measurement tools (195/324, 60.2%) remained the primary approaches, while motion capture technology (45/324, 13.8%) and wearable sensors (13/324, 4%) were rarely used. Documentation practices also relied heavily on analogue formats, with 82.1% (266/324) using handwritten notes and 60.2% (195/324) using paper templates. In contrast, willingness to adopt DHTs was consistently high, with 80.6% (261/324) of respondents indicating readiness to use digital systems for identity verification, 79.0% (256/324) for progress tracking, and 78.1% (253/324) for outcome measurement. Subgroup analyses revealed that educational level significantly influenced the adoption of advanced technologies, with master's or doctoral degree holders reporting higher use of sensor-based assessment, motion capture, and wearable devices. In contrast, professional title and clinical specialty showed limited influence, with no significant differences observed for most digital health functions. CONCLUSIONS: Rehabilitation professionals in China demonstrate strong readiness to use DHTs, yet their routine practice remains largely paper-based and analogue. These findings provide evidence to inform implementation strategies, workforce training, and system-level planning aimed at accelerating digital transformation in rehabilitation services.
11 Apr 2026
Read appraisal →BMJ (Clinical research ed.)
Non-drug perioperative interventions to reduce postoperative pulmonary complications after abdominal surgery: systematic review and meta-analysis
OBJECTIVE: To evaluate the effectiveness of perioperative non-drug interventions in reducing postoperative pulmonary complications (PPCs) in adults undergoing abdominal surgery. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Ovid MEDLINE, Embase, and Web of Science from database inception to January 2025 and updated in January 2026, with no language restrictions. STUDY SELECTION: Randomised controlled trials assessing the effectiveness of perioperative non-drug interventions for the prevention of PPCs in adults undergoing elective abdominal surgery under general anaesthesia, with clearly defined PPCs. MAIN OUTCOME MEASURES: The primary outcome was the proportion of patients developing PPCs. Secondary outcomes included the proportion of patients with PPC subtypes according to European Perioperative Clinical Outcome definitions (respiratory infection, respiratory failure, pleural effusion, atelectasis, or pneumothorax) and hospital length of stay. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently screened studies, extracted data, and assessed risk of bias with the Cochrane RoB 2.0 tool. Data were synthesised using meta-analyses and trial sequential analyses, with the evidence certainty assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS: 255 trials including 55 260 participants were included, evaluating 10 types of interventions with 39 subtypes for PPC prevention. PPCs occurred in 6467 (11.7%) participants across all included trials. High certainty evidence showed that low fraction of inspired oxygen (FiO2) significantly reduced PPCs (risk ratio 0.81, 95% confidence interval 0.71 to 0.92). Moderate certainty evidence showed benefit for four intervention types: lung protective ventilation (risk ratio 0.66, 0.57 to 0.76), physiotherapy (0.55, 0.46 to 0.65), analgesia (0.73, 0.64 to 0.84), and nutrition (0.74, 0.63 to 0.87), with individualised positive end expiratory pressure, composite lung protective ventilation, early mobilisation, and epidural analgesia also showing benefit at the subtype level. Trial sequential analysis confirmed sufficient cumulative evidence for all the above interventions except early mobilisation. By contrast, goal directed haemodynamic therapy, targeted blood pressure management, restrictive fluid therapy, and postoperative bi-level positive airway pressure showed no evidence of benefit, with moderate certainty. CONCLUSIONS: This synthesis establishes an evidence hierarchy for PPC prevention in abdominal surgery. Low FiO2 is the only intervention supported by high certainty evidence and should be prioritised in clinical practice. Other beneficial strategies include lung protective ventilation, physiotherapy, analgesic techniques, and nutrition interventions. Conversely, the role of goal directed haemodynamic therapy-despite its widespread use-warrants reconsideration for PPC prevention. These findings facilitate prioritisation of effective interventions and development of evidence based guidelines. STUDY REGISTRATION: PROSPERO CRD42025637449.
11 Apr 2026
Read appraisal →Science advances
Filament sensing tension: A bionic artificial tendon for self-force-regulated artificial muscle-driven wearable robotics
Artificial muscles have been in development for decades and play a crucial role in the field of wearable robotics. However, a universal device for both sensing and regulating forces in artificial muscles is still absent, rendering scenario-required force control unfeasible. Inspired by Golgi tendon organs, this work proposes bionic ExoTendon for force sensing and regulating in artificial muscles as a general solution. Leveraging the principles of triboelectrification and electrostatic induction, the ExoTendon offers high linearity, minimal hysteresis, and adjustable sensitivity and range, making it suitable as the tendon of artificial muscles. Specifically, the ExoTendon effectively enable adjustment to the pretension of the artificial muscles, yielding various assistive forces under the same input. With the optimized pretension level and closed-loop force control, the artificial muscle-based exosuit achieves self-force regulation, substantially improving walking balance and speed in stroke subjects under low input, demonstrating its promise in wearable robotics and rehabilitation medicine.
9 Apr 2026
Read appraisal →JMIR medical informatics
Exploring the Role of AI in Managing Treatment Recommendations for Lymphedema: International, Multidisciplinary, Multiprofessional Survey Study of Trust, Reliability, and Impact on Decision-Making
BACKGROUND: Upper and lower extremity lymphedema is a chronic, progressive condition that significantly impairs the quality of life of affected patients. Despite the recently established effectiveness of physical therapy and supermicrosurgical interventions, current guidelines frequently lag behind emerging evidence and commonly do not offer stage-specific treatment algorithms. This gap in evidence-based guidance may prompt clinicians with limited experience to seek support from large language models such as ChatGPT. OBJECTIVE: Given the potential of artificial intelligence to rapidly integrate emerging research, this study evaluated how clinicians from different professional backgrounds rate the quality and reliability of personalized lymphedema management recommendations generated by ChatGPT. METHODS: In this exploratory cross-sectional study, ChatGPT generated treatment recommendations for 6 standardized lymphedema case scenarios. An international panel of 67 participants (resident doctors, board-certified specialists, physiotherapists, and advanced practice nurses) from 34 institutions across 11 countries assessed the recommendations using a modified DISCERN questionnaire with a 9-point agreement scale ranging from 1 (completely disagree) to 9 (completely agree). Ratings were summarized as pooled means with variability measures and compared across clinician groups (residents vs board-certified physicians vs physiotherapists or advanced practice nurses) using group comparison testing. RESULTS: ChatGPT was rated most favorably for diagnostic accuracy and treatment relevance, with higher ratings among residents than board-certified physicians. Residents assigned significantly lower scores for source indication, source currency, and communication of uncertainty. Between-group differences were observed across multiple DISCERN items, consistent with systematically more critical appraisal by experienced specialists. Participants reported moderate to high trust and willingness to consider ChatGPT as a supplementary resource, with more favorable perceptions among younger respondents. CONCLUSIONS: Clinicians perceived ChatGPT as potentially useful for preliminary orientation and educational support in lymphedema management, especially for less experienced users. Despite not being blinded, lower ratings in evidence transparency and uncertainty communication, particularly among experienced specialists, suggest that current artificial intelligence outputs should not be used as stand-alone guidance. Future work should test clinically integrated, citation-grounded workflows in prospective settings and evaluate whether they improve decision quality and efficiency.
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 →PloS one
Appreciating the complexity of frailty and user context in digital health intervention design: A qualitative study with personas
Frailty is a complex and dynamic process that is becoming increasingly common as the population ages. Early intervention has been shown to reverse or slow progression, but requires support from increasingly limited healthcare resources. Digital health interventions could potentially assist, but first it is vital to understand older adults' experiences and perspectives. This study describes feedback from older adults with symptoms of pre or early frailty on the design concept of a digital device intended to function as an adjunct to physiotherapy and occupational therapy by increasing frequency and quality of safe movement at home. Objectives were to better understand experiences of frailty, and to identify potential influencing factors on adoption and adherence. In-person audio-recorded qualitative interviews were conducted with 17 older adults and 5 carers recruited from community settings. Reflexive thematic analysis generated two themes: 'autonomy and prompts: importance of personalisation'; and 'digital interfaces and accountability: importance of usability and purpose'. In addition, three personas were generated from the data, each describing different needs and preferences for such a device. Situating the results of analysis in the context of current literature, a set of Guiding Principles was created to support future design development in this area. These highlight important factors for consideration when designing for this population, and provide key design feature suggestions and implementation strategies to address these factors including: ensuring the device has clear purpose; is adaptable to the diversity of needs within this clinical population; any form of feedback is safe, relevant, useful and rewarding to multiple users; and technical support is accessible and ongoing. It is recommended that the target population, and clinical purpose be more clearly defined within the healthcare context to encourage personal rehabilitation through enhancing the therapeutic alliance rather than focussing on individual behaviour change of diverse older adults.
7 Apr 2026
Read appraisal →PloS one
Randomized trial of transcutaneous tibial nerve stimulation to treat overactive bladder in older women
OBJECTIVES: To evaluate the effects of transcutaneous tibial nerve stimulation (TTNS) associated with behavior therapy (BT) compared to BT alone in the treatment of Overactive Bladder Syndrome (OAB) in older women. STUDY DESIGN: Randomized controlled clinical trial in two groups, G1 that received BT (n = 19) and G2 with the addition of TTNS (n = 19). MAIN OUTCOME MEASURES: The variables analyzed were impact on quality of live (QOL) and degree of discomfort of the symptoms of OAB by International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) and voiding habit by a 3-day voiding diary (VD). The assessments were conducted at the beginning and the end of the treatment. RESULTS: Both groups showed a significant reduction in the impact of QOL by ICIQ-OAB. The G1 (BT) reduced the discomfort of nocturia symptoms and urgency urinary incontinence, while in G2 (BT+TTNS), it just did not present a reduction in the discomfort of urinary frequency by ICIQ-OAB. In the VD, despite G1 presenting an episode reduction of urgency urinary incontinence and nocturia, it showed no significant difference. In the G2, the same variables had significant reduction. CONCLUSION: Behavioral therapy reduced OAB symptoms and discomfort in older women, but its combination with TTNS led to greater improvements, particularly in urgency and nocturia. TTNS was safe, well tolerated, and enhanced quality of life, although further studies with larger samples and longer follow-up are warranted. No adverse events or complications were observed, supporting the safety and tolerability of TTNS in older women with OAB.
7 Apr 2026
Read appraisal →Rheumatology international
The effect of structured hand massage on hand function and grip strength in rheumatoid arthritis patients: a randomized controlled pilot study
INTRODUCTION: This study aimed to assess the impact of a 10-session hand massage protocol on hand function, grip strength, pinch strength, pain threshold, and tactile sensory threshold in patients with early-stage, seropositive rheumatoid arthritis (RA) without radiographic damage or hand deformity. METHODS: This study was a randomized controlled clinical trial. Thirty female RA patients with a diagnosis time of less than two years, seropositive, with low disease activity/remission, and without active arthritis in their hands were included in the study. Participants were randomized 1:1 to intervention and control groups. The intervention group underwent 10 hand massage sessions over a two-week period, in addition to regular medical care. The control group received only regular medical care. All assessments were performed at baseline (T1) and at week 2 (T2). Outcome measures included hand grip strength, pinch strength, pain threshold (dolorimetry), tactile sensory threshold (Semmes-Weinstein monofilament test), Duruöz Hand Index (DHI), and patient global assessment (PGA). RESULTS: A total of 30 RA patients were included in the study (intervention group, n = 15; control group, n = 15). At baseline, no significant differences were observed between the groups in demographic, laboratory, or clinical characteristics (p > 0.05). In the intervention group, significant improvements in hand grip strength and pinch force were observed at T2 compared with baseline (p = 0.008 and p = 0.023, respectively). Median hand grip strength increased from 55 (40-75) to 65 (45-80) kg, and median pinch strength increased from 15 (6-18) to 16 (11-21) kg. No significant alterations were noted in these parameters within the control group (p > 0.05). In the control group, median hand grip strength was 45 (25-80) kg at baseline and 45 (20-80) kg at week 2, while median pinch strength was 14 (6-18) kg at baseline and 14 (5-19) kg at week 2. In the intervention group, significant reductions in DHI and PGA scores were recorded at the end of therapy (p = 0.005 and p = 0.001, respectively). No significant differences were noted in DHI and PGA levels in the control group (p > 0.05). Moreover, median PGA scores were significantly lower in the intervention group than in the control group at T2 (4 [2-5] vs. 5 [3-6]; p < 0.001). No significant changes were found in dolorimeter and touch sensory thresholds in either group (p > 0.05). CONCLUSION: Hand massage interventions for patients with RA enhance grip strength, hand function, and overall patient evaluations. No effect on pain or tactile thresholds was observed. Further studies with larger sample sizes and longer follow-up periods are required to corroborate these findings.
6 Apr 2026
Read appraisal →PloS one
Baseline associations between thoracic expansion, respiratory function, and pain in nonspecific low back pain: A cross-sectional analysis from the DIAFRAGMA trial
OBJECTIVE: To examine the associations of respiratory variables (chest and abdominal expansion, spirometry) with pain, lumbar mobility, and quality of life in nonspecific low back pain (NSLBP) using baseline data from the DIAFRAGMA trial. DESIGN: Cross-sectional study using baseline data from a randomized controlled trial. PARTICIPANTS: Fifty subjects (22 females [44%], 28 males [56%]; mean age 45.96 years; BMI 26.97 kg/m²) with NSLBP recruited between January and July 2024. Main measures: Axillary, sternal, and abdominal inspiratory expansion; spirometric parameters (FVC, FEV1); pain via pressure pain thresholds (PPT), Schober test, FFT; and quality of life via SF-12. METHODS: Pearson correlations assessed relationships between respiratory and clinical variables. Multiple linear regression adjusted for age, sex, and BMI. Significance was set at p < 0.05 with Bonferroni correction. RESULTS: Abdominal expansion correlated with FVC (r = 0.45; p < 0.001), FEV1 (r = 0.39; p = 0.003), PEF (r = 0.28; p = 0.03), axillary (r = 0.47; p < 0.001) and sternal expansion (r = 0.58; p < 0.001), PPT at L4 (r = 0.26; p = 0.04) and L5 (r = 0.29; p = 0.02), and SF-12 (r = 0.25; p = 0.04). BMI correlated negatively (r = -0.31; p = 0.02). In regression, abdominal expansion independently predicted pain after adjustment. CONCLUSIONS: Reduced thoracoabdominal expansion and spirometric performance are associated with greater pain and poorer quality of life in NSLBP, supporting the diaphragm's role in low back pain.
5 Apr 2026
Read appraisal →Curr Opin Neurol
Neuro-vestibular rehab: new developments.
PURPOSE OF REVIEW: This review highlights recent advances in neuro-vestibular rehabilitation, with emphasis on vestibular adaptation and emerging mobile technologies. It summarizes developments in promoting vestibular plasticity and discusses novel tools such as virtual reality, wearable sensors, and telehealth platforms that enhance access, engagement, and outcomes. The scope is broad, focusing on general principles rather than specific populations. RECENT FINDINGS: New methods to enhance vestibulo-ocular reflex (VOR) adaptation include incremental adaptation devices and gamified exercises. Inducing VOR gain-down adaptation temporarily increases postural sway, which normalizes via sensory reweighting, demonstrating central compensation. Portable tools like StableEyes show promise in boosting VOR gain with brief sessions. Concurrently, technology-driven approaches are gaining traction. Gamified mobile applications and wearable sensors allow home-based rehabilitation with remote supervision and monitoring, showing promising results in conditions like multiple sclerosis. Virtual reality interventions and telehealth models accelerated during the COVID-19 era, expanding therapy delivery to underserved populations. Adjunctive methods such as vibrotactile feedback and galvanic vestibular stimulation are emerging as complementary therapies. SUMMARY: Recent developments are advancing vestibular rehabilitation by refining adaptive training techniques and leveraging digital tools to overcome barriers in access and adherence. These innovations point to a more personalized, technology-enabled approach to optimizing neuro-vestibular recovery.
1 Feb 2026
Read appraisal →Am Surg
Neurogenic Thoracic Outlet Syndrome: A Current Literature Review
Neurogenic Thoracic Outlet Syndrome (nTOS), the most prevalent type of thoracic outlet syndrome, results from compression of the compression of the brachial plexus as it traverses the scalene triangle and rectopectoralis minor space. It typically presents with upper extremity pain, hand weakness, paresthesia, and muscle atrophy that is often exacerbated by arm elevation or overhead activity. Etiology commonly includes congenital anatomical variants, trauma, and repetitive overhead activity. Diagnosis remains challenging as a result of significant symptom overlap with cervical radiculopathy, brachial plexopathies, and entrapment neuropathies. Work up involves a combination of thorough history and physical with electrophysiologic testing, diagnostic injections and imaging such as MRI or duplex ultrasonography. Initial therapy indicates physical therapy with a focus on decompression and postural correction. In patients with persistent symptoms, motor deficits or failed conservative management, surgical decompression using transaxillary, supraclavicular or minimally invasive techniques is indicated. Rib-sparing surgical decompression is increasingly favored given lower complication rates. Postoperative rehabilitation focuses on restoring range of motion and shoulder girdle strength. This review serves to outline clinical presentation, diagnostic strategies and operative options for nTOS while emphasizing an individualized, stepwise approach to optimize outcomes and minimize risk.
1 Dec 2025
Read appraisal →