Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 305 appraisals
IEEE transactions on cybernetics
Knowledge Distillation and Reinforcement Learning in a Human–Machine Collaboration Delivery System With a Robotic Arm
Robotic arms are widely used in various aspects of human-robot collaboration. The primary goal of this study is to explore the usability of robotic arms for delivering objects to humans in dynamic environments. Traditional robotic arms often face limitations in path planning, such as difficulties adapting to dynamic environments and complex developmental processes. To overcome these challenges, this study employs reinforcement learning (RL) to train four models-the Approach RL Model, Delivery RL Model, Decision RL Model, and Merged Model-as alternatives to conventional path planning control. Typically, there exists a significant discrepancy between simulated data and real-world features. Although image segmentation can substantially reduce the gap between virtual and real environments, notable differences remain in hand features. Therefore, to further bridge the simulation-to-reality gap, this study applies CycleGAN to transform real hand features into virtual hand features, thereby enhancing the model's transferability. Experimental results show that the Decision RL Model achieved an accuracy of 99.17%, while the Merged Model achieved 99.92%. The proposed method effectively improves the stability and accuracy of human-robot collaboration in complex scenarios. Overall, this study validates the feasibility of integrating RL, image segmentation, and image translation techniques, offering a scalable and efficient task-solving solution for robotic arms in highly dynamic application domains.
3 Aug 2026
Read appraisal →The Journal of rheumatology
Examining the Role of Wearables in Inflammatory Arthritis Care: A Narrative Literature Review
Rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis are types of inflammatory arthritis (IA) characterized by joint pain and stiffness that, despite therapeutic advances, remain difficult to treat. Changes in physical activity (PA) and sleep patterns may provide insights into IA disease course and activity. Wearable accelerometers have been validated as reliable, objective measures of PA and have provided insight into IA disease activity and progression through both PA and sleep metrics. Further, the granular nature of accelerometry data may provide the opportunity to identify early signals of treatment response or disease flares, leading to more effective and personalized therapeutic regimens in patients with IA. In this review, we summarize the current state of wearable technology in IA and explore the potential of wearables to bridge gaps in care.
3 Aug 2026
Read appraisal →Science advances
Human-inspired time-series health evaluation with an adaptive multimodal electronic skin
Electronic skin powered with artificial intelligence could enable next-generation robotic and medical devices, yet integrating multimodal sensors and analyzing heterogeneous, multifrequency time series remain challenging. Most wearable machine learning architectures are time-invariant and trained for a specific task, limiting transfer across modalities and users. We present a multimodal electronic skin that captures diverse physiological signs with an adaptive learning framework that rapidly generalizes to unseen tasks with minimal labeled data. Our streamlined end-to-end framework uses a spectral variational autoencoder to denoise and compress multifrequency biosignals into a shared, unified second-wise latent space that preserves the spectral-temporal structure, followed by a transformer to capture temporal dependencies to support diverse downstream tasks with data-efficient learning. We demonstrate robust adaptation with 94.7% accuracy in activity recognition and 90.2% precision in fatigue assessment across various users and daily activities regardless of device and user variations, highlighting a scalable route to generalized physiological time-series analytics and human performance assessments.
3 Aug 2026
Read appraisal →Cognitive, affective & behavioral neuroscience
A review of current capabilities and future directions in machine-based emotion recognition
The ability of machines to recognize emotions automatically is becoming increasingly significant across many domains where emotional understanding is essential. Such technology is applied in customer interaction, marketing, healthcare, education, the automotive industry, entertainment, and security. Providing real-time insights into human affective states improves user engagement and enables systems to respond more intelligently. Nevertheless, progress in this field is hindered by the inherent complexity of emotions, cultural differences in expression, and technical limitations that make accurate detection challenging. This paper delivers a broad review of contemporary approaches to emotion recognition. It highlights techniques based on facial expression analysis (FER), oculometrics (OM), microexpressions identification (MER), and speech analysis (SER). Further attention is given to methods involving body posture, gesture, and gait, as well as tactile interaction, text-based emotion recognition, and methods based on self-reporting. In addition, physiological signal-driven methods are discussed in depth, including respiration signals (RS), galvanic skin response (GSR), electroencephalography (EEG), electromyography (EMG), skin temperature (SKT), cardiac signals (ECG, PPG, HRV), and touch dynamics (TD) analysis. This comprehensive overview lays the foundation for advancing research on machine-based emotion recognition.
2 Aug 2026
Read appraisal →International journal of medical informatics
Machine learning models for predicting readmission after stroke: A systematic review and meta-analysis
BACKGROUND: Hospital readmission following stroke poses a significant challenge for healthcare systems. Machine learning (ML) offers the potential to improve prediction models for readmission risk, surpassing traditional statistical methods. However, the performance of ML models in such context has not been systematically evaluated. We aim to evaluate the performance of ML models in predicting post-stroke hospital readmission, as well as identifying the most important readmission predictors. METHODS: A comprehensive systematic literature review and meta-analysis was conducted.Studies included were those utilizing ML models for stroke readmission prediction. The primary outcome was the predictive performance of ML models for all time stroke readmission as reported by the Area Under the Receiver Operating Characteristic Curve (AUROC). Pooled AUROC values were calculated using a random-effects model. RESULTS: A total of eleven studies involving 380,254 patients were analyzed. Mean age of the patients ranged between 64.5 and 79.7 years. In total, 49 ML models were reported with Logistic regression (LR) and Random Forest being the most used. The number of input predictive variables used for model training ranged from 6 to 10,047. The overall pooled AUROC for predicting hospital readmission was 0.74 (95% CI: 0.69 to 0.78). For 30-day readmission, the pooled AUROC was 0.73 (95% CI: 0.67 to 0.79) while for 90-day readmission, it was 0.75 (95% CI: 0.69 to 0.80). The most frequently reported variables as being top predictors of readmission were Length of stay (LOS) (3 studies), Age (2 studies), National Institutes of Health Stroke Score (NIHSS) (2 studies), HbA1c (2 studies), Homocysteine blood level (2 studies). CONCLUSION: Machine learning models demonstrate moderate predictive performance in stroke readmission risk prediction. Future research should focus on validating and refining existing models and adopting unified methodological approaches to aid in drawing more accurate conclusions.
1 Aug 2026
Read appraisal →Science advances
Multispectral infrared-to-full-color upconversion expanding human vision
The human visual system is inherently blind to infrared radiation due to the insufficient energy of infrared photons to trigger the photoisomerization of the retinal chromophore, resulting in the loss of over half of the solar spectrum. Here, we report a colloidal quantum dot (CQD)-based infrared-to-visible upconverter that enables ultrasensitive upconversion of multispectral infrared light radiation as full-color visible vision. The photon-energy-selective excitonic transitions in quantum-confined states and the photon flux, respectively, enable infrared wavelength- and intensity-dependent number of photogenerated carriers. A dual-emissive-layer organic architecture with the strategically engineered hole-injection barrier could route these carriers into distinct color emission channels, resulting in correlated wavelength/intensity-to-color/luminance mapping. This paradigm shift yields a discrimination sensitivity for subtle infrared variations exceeding more than two orders of magnitude higher than conventional single-color modes, capitalizing on the human eye's intrinsic superiority in chromatic differentiation over only brightness contrast. The resulting upconverter exhibits broadband detection extending beyond 2 μm, luminance exceeding 700 cd m-2, and a photon-to-photon conversion efficiency of 3.85%. The upconverter could be applied as a lightweight, semi-transparent wearable eyeglass that projects multispectral infrared as full-color vision directly onto the retina. Besides, upconverters bound to light-sensitive proteins, potentially as an implantable retinal photoreceptor, confer innate infrared vision. By surpassing the evolutionary constraints of natural vision, this work establishes a versatile foundation for next-generation visual prosthetics and human-integrated sensory expansion.
1 Aug 2026
Read appraisal →PloS one
Does delayed exercise-based priming improve subsequent athletic performance? A systematic review and multilevel meta-analysis.
This systematic review and multilevel meta-analysis examined whether delayed exercise-based priming improves subsequent athletic performance. Following PRISMA 2020 principles, 3,095 records were identified; after removing 1,107 duplicates, 1,988 unique records were screened, 212 full-text reports were assessed, 186 reports were excluded at eligibility, and 26 studies were included. Eighteen studies contributed 46 effect sizes to the quantitative synthesis. Risk of bias was assessed with RoB 2 principles calibrated for crossover exercise trials, and certainty was evaluated using GRADE. A three-level random-effects model showed a small positive average effect of delayed priming on subsequent performance (g = 0.232, 95% CI [0.092, 0.372], p = .002), with cluster-robust inference supporting the same conclusion (p = .004). The prediction interval crossed zero (-0.265 to 0.730), and the overall certainty of evidence was low. Delayed exercise-based priming can be used as a practical competition-day strategy when embedded in planned preparation windows, although protocol selection and athlete response should be checked in training before competition use.
31 July 2026
Read appraisal →Scientific reports
Adaptive level modification via player skill classification and large language models
Maintaining player engagement in video games requires a careful balance between challenge and player competence. Static difficulty settings fail to account for individual skill variation, while existing dynamic difficulty adjustment systems are limited to tuning low-level game parameters rather than restructuring level content. This paper presents an adaptive level modification framework that personalizes gameplay by continuously inferring player skill and applying targeted structural modifications to level content in real-time. A hybrid behavioral dataset is constructed by combining agent-generated trajectories, produced by Proximal Policy Optimization (PPO) agents, a reinforcement learning approach, trained at three distinct skill levels, with manually collected human gameplay data labeled through clustering. A classifier trained on this dataset categorizes players into expert, normal, and beginner skill levels, achieving an overall accuracy of 97.82%. The classifier output drives a two-stage large language model (LLM) pipeline guided by prompt engineering, which expands a skill-conditioned prompt into a structured modification instruction applied to the current level chunk. A physics-constrained verifier based on a graph-based shortest path method ensures all modified levels remain traversable. Evaluated on Super Mario Bros. levels, the framework achieves a post-modification playability rate of 74.1% at the full-level granularity and 83.5% at the isolated-chunk granularity, closely matching the 80.0% baseline of the original levels.
30 July 2026
Read appraisal →Bioinspiration & biomimetics
Length control of pneumatic artificial muscles inspired by intrafusal-extrafusal muscle interactions
Pneumatic artificial muscles (PAMs) are widely used in pneumatic musculoskeletal robots due to their lightweight nature and high power output. On the other hand, their control typically relies on electro-pneumatic valves, electronic sensors, and peripheral circuits such as A/D converters. This increases the number of distributed electronic components and electrical interconnections, potentially leading to greater system mass as well as higher maintenance requirements, particularly in systems containing many PAMs. To overcome these challenges, inspired by the intrafusal-extrafusal muscle interactions in biological systems, this paper proposes a length control method for PAMs in which the pneumatic feedback loop is implemented mechanically, while the target length is commanded by a minimal electronic actuator. We first examined flow path conditions to suppress oscillations caused by pneumatic delays. Second, Experiments demonstrated a tracking error of2.01% for input frequencies0.20 Hz.
29 July 2026
Read appraisal →Journal of neural engineering
A roadmap to navigate the future of neural engineering
A group of leaders in neural engineering collaborated to develop a roadmap to navigate the future of neural engineering. We covered a range of themes, including brain machine interfaces, neural modeling, artificial intelligence and machine learning, neural interfaces, neural imaging, augmented rehabilitation, and neuromaterials. For each topic we reviewed the current status, identified current and future challenges, and speculated on the emerging and necessary advances in science and technology to meet these challenges. Neural engineering will continue to yield the approaches and insights that advance the diagnosis and treatment of nervous system disorders, as well as provide new understanding of neural function.
28 July 2026
Read appraisal →Cerebellum (London, England)
Advancing Cerebro-cerebellar Network Imaging with Ultra-high Field (7T) MRI: Progress and Future Challenges
Ultra-high field (UHF) MRI (≥ 7T) is increasingly used to study the cerebro-cerebellar networks, offering substantial gains in signal-to-noise ratio and blood oxygen level dependent (BOLD) sensitivity that enable submillimeter functional and structural imaging. These advantages are particularly relevant for the cerebellum, whose tightly folded cortex and small deep nuclei have historically been difficult to resolve in vivo. In this targeted review, we synthesize recent progress in UHF-MRI applied to cerebro-cerebellar network mapping and critically examine the methodological challenges that accompany these developments. We highlight how UHF-MRI has enabled more precise delineation of cerebellar functional territories, improved visualization of the dentate nucleus and its connectivity, and facilitated integration of cerebellar nodes into whole-brain network models. We also discuss the technical challenges, including RF-field inhomogeneity, susceptibility-induced distortions, and the trade-off between spatial resolution and signal strength. These issues are compounded in the cerebellum due to its anatomical location and fine-scale organization, increasing the risk of spatial biases and misinterpretation if not carefully addressed. Beyond acquisition, we identify key gaps in analysis methodologies, including the need for cerebellum-specific preprocessing pipelines, segmentation tools that preserve mesoscale anatomy, and frameworks that treat the cerebellum and cerebrum as a unified system. We also discuss emerging opportunities, such as neurostimulation, integration with postmortem imaging and deep learning-based methods that may help bridge microstructural and in vivo findings. Overall, we argue that while UHF-MRI holds transformative potential for cerebellar systems neuroscience, translational progress will depend on rigorous methodological standardization and awareness of its limitations.
27 July 2026
Read appraisal →Journal of neural engineering
Cortical-SSM: a deep state space model for motor imagery decoding from EEG signals
Objective.Classification of electroencephalogram (EEG) signals obtained during motor imagery (MI) has substantial application potential, including for communication assistance and rehabilitation support for patients with motor impairments. These signals remain inherently susceptible to physiological artifacts (e.g. eye blinking, swallowing), which pose persistent challenges. Although Transformer-based approaches for classifying EEG signals have been widely adopted, they often struggle to capture fine-grained dependencies within them.Approach.To overcome these limitations, we propose Cortical-SSM, a novel architecture that extends deep state space models to capture integrated dependencies of EEG signals across temporal, spatial, and frequency domains. We validated our method across two large-scale public MI EEG datasets containing more than 50 subjects.Main results.Our method outperformed baseline methods on the two benchmarks. Furthermore, visual explanations derived from our model indicate that it effectively captures neurophysiologically relevant regions of EEG signals.Significance.These results indicate that Cortical-SSM provides a robust and interpretable alternative to attention-based architectures for MI EEG decoding. By enabling physiologically grounded feature learning, our method advances the reliability of subject-independent EEG classification and supports the development of practical and clinically deployable brain-computer interface systems.
26 July 2026
Read appraisal →Scientific reports
Recognition of everyday activities using experiment data from wearable sensors: a deep learning-based framework
Tracking everyday activities is vital for detecting changes in older adults' health, allowing timely support to promote well-being. Wearable sensors and deep learning provide continuous monitoring, making them a supportive tool in detecting such changes. However, a more refined method is needed to recognise precise activities with a minimal set of sensors. This study aimed to develop a method to recognise everyday activities among older adults by utilising wearable sensors and a deep learning model. This is a small-scale home lab experiment to develop a method to recognise 14 everyday activities. We compared five models that recognised everyday activities with different sensor signal counts and accuracy. Our results showed that sensor placement is important. Based on the results, we proposed a two-sensor method (pelvis and right hand) to collect and correctly recognise everyday activities among older adults. This model, which utilises two sensors, classified 12 activities with an accuracy of 89.3%. Another model recognised all 14 activities with a lower accuracy of 88.2% using five sensors. We also explored a one-sensor approach, which showed low recognition performance and struggled to distinguish activity variability. The two-sensor-based system will allow for large-scale data collection on everyday activities of older adults.
26 July 2026
Read appraisal →PloS one
Systematic review and meta-analysis of the acute effects of self-selected rest intervals on exercise performance maintenance, lactate levels, and heart rate.
BACKGROUND: Rest interval duration is a key variable in exercise prescription, influencing both performance and physiological responses. Traditional training typically employs fixed rest intervals; however, this approach may not adequately reflect individual variability in recovery needs. Recently, self-selected rest intervals-based on individual perception-have gained attention as a potential strategy for more precise load regulation. Nevertheless, current evidence regarding their effects on exercise performance, heart rate, and blood lactate remains inconsistent. METHODS: This study followed PRISMA guidelines and conducted a systematic search of Web of Science, PubMed, Cochrane Library, and Embase from database inception to March 20, 2026. Acute experimental studies comparing self-selected and fixed rest intervals were included. A three-level random-effects meta-analysis was performed to account for dependency among multiple effect sizes. Subgroup analyses, meta-regression, and sensitivity analyses were conducted to explore potential moderators and assess robustness. RESULTS: Sixteen studies (k = 16) involving 281 participants were included. No significant overall difference was observed between self-selected and fixed rest intervals for exercise performance (g = 0.27, 95% CI [-0.14, 0.69], p = 0.29), with substantial between-study heterogeneity. After removing outliers, a small but significant effect favoring self-selected rest intervals was identified (g = 0.20, 95% CI [0.08, 0.33], p < 0.01). No significant differences were observed for heart rate (g = 0.002, p = 0.98) or blood lactate (g = -0.20, p = 0.36). CONCLUSION: Self-selected and fixed rest intervals produce comparable effects on exercise performance and physiological responses. However, self-selected rest intervals may confer a small advantage in maintaining performance under specific conditions. These findings should be interpreted with caution due to sensitivity to outliers and study heterogeneity.
25 July 2026
Read appraisal →Nanoscale
Advances in printable flexible and stretchable thin-film electrodes: materials, interfaces, technologies and bioelectronic applications
The mechanical mismatch between rigid clinical electrodes and soft biological tissues remains a primary bottleneck restricting the stability of long-term electrophysiological monitoring. Printable flexible thin-film electrodes offer a compelling solution by enabling additive, high-throughput patterning on flexible and stretchable substrates, thereby circumventing the reliance on vacuum environments and high-temperature processing typical of conventional microfabrication. This review synthesizes recent advances in functional inks, ranging from metals and carbon nanomaterials to conductive polymers and ionogels, together with high-resolution printing techniques. Addressing the critical challenge of interfacial failure in flexible devices, we explore engineering strategies to enhance adhesion at both electrode-substrate and electrode-tissue interfaces. Specifically, we analyze the pivotal roles of physical interlocking and chemical anchoring mechanisms in suppressing dynamic delamination and maintaining device integrity. Finally, the review highlights representative applications in wearable electronics, implantable systems, and emerging organoid interfaces, and outlines key translational challenges, including long-term stability and manufacturing reproducibility.
25 July 2026
Read appraisal →ACS applied materials & interfaces
Bioinspired Ionic Biogels for Conformal On-Skin Wearable Bioelectronics
Conductive gels are promising materials for on-skin wearable bioelectronics owing to their softness, ionic conductivity, and tissue-like interfacial characteristics. However, conventional preformed conductive gels often cannot fully accommodate complex and dynamically deforming skin surfaces, thereby limiting their interfacial adhesion and signal-transmission performance. Inspired by the reversible mechanical switching behavior of sea cucumbers, we developed a thermoresponsive ionic biogel (IBG) composed of gelatin, water, and 1-ethyl-3-methylimidazolium ethyl sulfate. In this system, gelatin forms a physical network with reversible sol-gel transition behavior, while the ionic liquid modulates the network through hydrogen bonding and electrostatic interactions and provides mobile ions for charge transport. This design integrates mechanical compliance, skin adhesion, water retention, and electrical functionality. The IBG can be directly coated onto skin in a flowable state and subsequently undergo mild in situ gelation, forming a soft, adaptive, and ion-conductive bioelectronic interface. The optimized IBG43 exhibits a low modulus, high stretchability, strong adhesion, and good environmental stability, together with stable strain sensing, reliable electrophysiological signal acquisition, and potential for self-powered sensing. This work presents a simple and effective strategy for constructing in situ formable skin-interfaced bioelectronic materials.
25 July 2026
Read appraisal →Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation
Quality of life with anophthalmia: a systematic review.
PURPOSE: Anophthalmia due to enucleation, evisceration, or exenteration, results in permanent vision loss that may have profound functional, psychological, and social consequences. The purpose of this study is to evaluate health-related quality of life, vision-related quality of life, and psychosocial outcomes among adults with anophthalmia. METHODS: This systematic review was conducted in accordance with PRISMA 2020 guidelines and prospectively registered on PROSPERO (ID: CRD420251274476). MEDLINE, Embase, and CENTRAL were searched from inception to September 9, 2025. Eligible studies included participants with congenital or acquired anophthalmia and reported outcomes related to quality of life or psychosocial health. Risk of bias was assessed using the Cochrane RoB-2 tool for randomized trials and Joanna Briggs Institute critical appraisal tools for observational studies and results were synthesized narratively. RESULTS: Forty-two studies (1999-2025) including 4544 patients (56.0% male; mean age 49.9 years) were included. Enucleation was the most common procedure (55.1%), and most cases were unilateral (59.6%). Health-related quality of life was commonly assessed using the SF-36 and vision-related quality of life using the NEI VFQ-25. Early postoperative reductions in health-related quality of life were frequently observed, with partial recovery over time. Vision-related quality of life remained persistently impaired, particularly for depth perception, peripheral vision, and driving. While mean anxiety and depression scores were often within normal ranges, a substantial subset of patients experienced ongoing psychological distress and appearance-related concerns. CONCLUSIONS: Acquired anophthalmia is associated with enduring vision-specific and psychosocial challenges, supporting the need for anticipatory counseling and integrated multidisciplinary rehabilitation in clinical practice.
25 July 2026
Read appraisal →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 →Journal of neural engineering
Multimodal quantification of cognitive load using a printed wearable facial bio-potential system
Objective.Cognitive load refers to the amount of mental effort required to process information and perform tasks. It has a strong impact on both learning and task performance and, therefore, plays a central role in cognitive neuroscience, psychology, neurology, human-machine interaction, and education research. Despite its significance, measuring cognitive load is challenging due to its complex and dynamic nature, influenced by task complexity, individual differences, and emotional states. While standard methods are based on subjective self-reports, numerous objective methods have been explored to assess cognitive load, such as electroencephalography (EEG), heart rate variability, and performance-based metrics. Despite these efforts, it remains challenging to objectively measure cognitive load in stationary and even more so in freely moving individuals.Approach.In this study, a wireless wearable system was employed to collect facial bio-potential markers and systematically compare their sensitivity to cognitive load. A dedicated task paradigm was developed and validated to induce graded cognitive load, allowing precise synchronization of physiological signals with task events. Facial muscle activity, eye movements, and brain activity were acquired simultaneously using a single facial electrode array.Main results.Across nine participants, entropy-based features tracked cognitive load more closely than conventional band-power measures. Facial EMG was the most informative modality: a cross-subject (leave-one-subject-out) model predicted the NASA-TLX weighted workload score with a mean Spearman correlation= 0.792 (95% CI [0.747, 0.836]; mean absolute error4.3, on a NASA-TLX 0-100 scale), and a single forehead-EMG entropy feature (the EMG-band entropy of forehead channel Ch14, above the right eyebrow) was selected in every cross-subject fold, generalizing across all participants without subject-specific calibration. An EEG-only model carried weaker but genuine cross-subject information (= 0.739), whereas EOG features did not pass the feature-selection threshold in this seated paradigm.Significance.Facial bio-potentials offer a practical, wearable system for objective cognitive load assessment. An outdoor pilot experiment further demonstrated electrophysiological measures under non-laboratory conditions. These findings offer insights into the suitability of different physiological indicators for assessing cognitive load, particularly the informativeness of facial EMG for seated assessment and the robustness of blink-based measures under ambulatory motion, contributing to the future development of practical measurement techniques in dynamic everyday settings.
23 July 2026
Read appraisal →Journal of neural engineering
Dynamic functional graph-Laplacian priors integrated with optimization for EEG source localization
Objective. Electroencephalography (EEG) source localization is an ill-posed inverse problem in which conventional methods often rely on static anatomical or smoothness assumptions and may neglect task-related dynamic functional interactions. This study aims to develop a dynamic graph-regularized EEG source localization framework that incorporates time-varying functional connectivity directly into inverse reconstruction and improves source-space motor imagery (MI) decoding.Approach. We propose DynaGraph-alternating direction method of multipliers (DG-ADMM), a source localization framework that combines linearly constrained minimum variance (LCMV) beamforming, region-of-interest-level dimensionality reduction, dynamic phase synchronization analysis, graph-Laplacian regularization, and efficient optimization. Initial source estimates are obtained using a LCMV beamformer. Region-level source signals are then extracted using principal component analysis and sliding-window phase-locking values with surrogate-based statistical testing are used to construct reliable dynamic functional graphs. The resulting graph Laplacian is mapped back to source space and embedded as a structured prior in an ADMMs optimization problem.Main results. Experiments on the MNE sample dataset showed that DG-ADMM produced spatially concentrated and physiologically plausible source patterns. On the PhysioNet MI dataset, the proposed framework achieved a binary left-versus-right MI classification accuracy of 93.52%, outperforming representative deep learning baselines. In a 320-dataset synthetic benchmark covering single-source, double-source, correlated-source, and dynamic-source conditions at two signal-to-noise ratios, DG-ADMM achieved the lowest mean center-of-mass localization error in five of eight conditions and showed its clearest advantage for dynamic sources.Significance. The results demonstrate that dynamic functional connectivity can serve as an informative graph-structured prior for EEG inverse reconstruction. DG-ADMM provides an interpretable and computationally feasible strategy for improving spatial focus, temporal consistency, and source-space decoding performance in EEG-based brain-computer interfaces.
21 July 2026
Read appraisal →Food & function
Efficacy of different dietary fibers for chronic idiopathic constipation: a systematic review and network meta-analysis
This study aims to compare the efficacy and safety of different dietary fiber subtypes in treating patients with chronic idiopathic constipation (CIC) through network meta-analysis (NMA). PubMed, Embase, Cochrane Library, and Web of Science were searched from inception to October 23, 2025. The risk of bias was evaluated using the Cochrane RoB 2.0 tool, and treatment rankings were calculated using the surface under the cumulative ranking curve (SUCRA). 17 randomized controlled trials (RCTs) involving 1423 adults with CIC were included. NMA suggested that viscous soluble fibers were associated with greater efficacy compared with placebo in relieving defecation difficulty (high certainty, class 1), and were also associated with improvements in stool consistency and stool frequency relative to placebo (moderate certainty, class 1). According to SUCRA rankings, viscous soluble fibers tended to have a higher probability of favorable performance compared with other dietary fiber subtypes in improving straining during defecation (moderate certainty), stool frequency (low certainty), and stool consistency (low certainty), and was associated with a relatively favorable tolerability profile (moderate certainty). Insoluble dietary fibers showed the highest ranking probability for improvement in overall constipation symptom scores; however, this finding was supported by very low certainty evidence. Overall, the findings suggest that viscous soluble fibers have a higher probability of improving stool consistency, stool frequency, and straining during defecation. In contrast, insoluble fibers showed a relatively higher ranking for improvement in overall constipation symptom scores. These results support a symptom-oriented and individualized approach to dietary fiber selection in the management of CIC.
21 July 2026
Read appraisal →Neuroinformatics
NeuroFusion: A Unified Framework for Generalized Visual Stimulus Decoding from fMRI Across Datasets and Subjects
Recent advancements in neural decoding have shown promising results in reconstructing visual experiences from brain activity. However, existing approaches focus primarily on decoding within a single dataset or subject, which limits generalization across various sources of neuroimaging. In this work, we propose a novel framework for the decoding of visual stimuli between subjects and between data sets, integrating neural recordings from multiple publicly available fMRI datasets. To address inherent intersubject and interdataset variability, we introduce a contrastive learning-based alignment strategy using image embeddings from a pre-trained IP-Adapter model. Our approach learns a shared latent space by aligning subject-specific neural representations with image features, enabling generalized decoding across both subjects and datasets. In addition, we propose a simple yet effective data augmentation method using ridge regression. This method synthesizes realistic fMRI-like signals from novel images by predicting voxel activity and injecting learned noise distributions, thus enhancing training diversity and model robustness. To the best of our knowledge, while several recent studies have explored cross-subject decoding, we extend recent cross-subject decoding efforts by training a single unified framework jointly across multiple public fMRI datasets and subjects, enabling cross-dataset transfer in addition to cross-subject generalization. We distinguish this multi-dataset unified training setting, where each dataset contributes training data, from a stricter leave-one-dataset-out transfer setting in which the target dataset is excluded from source pretraining and used only for lightweight alignment-layer adaptation. Empirically, our unified model achieves strong semantic reconstruction across datasets (e.g., up to 94.8% CLIP similarity on NSD (AUG) and 0.403 SSIM on BOLD5000 after lightweight finetuning), demonstrating robust cross-subject and cross-dataset transfer.
20 July 2026
Read appraisal →Biomedical physics & engineering express
Benchtop validation of a low-cost wearable triaxial accelerometer
Wearable inertial sensors have become a cornerstone technology for detecting fall-related events, such as tripping while walking, in older adults. However, low-cost devices must undergo rigorous validation to ensure fidelity and stability in measurement. This study aimed to evaluate the concurrent validity of a newly developed, low-cost triaxial accelerometer by comparing its linear acceleration measurements with those obtained from a widely used commercial reference sensor (RS). A methodological validation study was conducted to assess the accuracy and precision of the proposed accelerometer. Triaxial linear acceleration data were simultaneously collected from the new device (sensor under test, SUT) and a commercial RS (Physilog®5, GaitUp, Lausanne, Switzerland). Measurements were obtained across three independent axes from 49 SUT units, with three repeated trials performed for each axis. The RS exhibited a more negative mean bias on the mediolateral (x) axis and a slightly larger mean bias on the vertical (y) axis. The SUT showed a greater mean bias (offset) on the anteroposterior (z) axis. Root mean squared error values were highly similar between thexandyaxes (<3.2% difference), while thez-axis presented moderately larger errors (∼9%). Mean absolute error was similar in thexandyaxes, whereas thez-axis was slightly higher. Visual waveform comparisons demonstrated strong overlap in mean time-series profiles, and near-unity correlations indicated high correspondence in signal variation. Bland-Altman analysis confirmed minimal bias and narrow limits of agreement for thexandyaxes, with greater variability observed along thezaxis, but no evidence of substantial systematic deviation. Overall, the low-cost accelerometer (∼60 USD) showed strong agreement with the commercial reference device (>1 000 USD), supporting its validity for three-dimensional linear acceleration measurement under controlled laboratory conditions. This low-cost device represents a promising solution for scalable motion monitoring and fall-related event detection.
20 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 →Science advances
A wearable biomechanical system for medical evaluation of soft tissue disorders
Evaluating soft tissue elasticity provides critical biomechanical insights essential for the precise characterization of various physiological and pathological conditions. Here, we present the clinical validation of a wireless, compact wearable system designed for direct, location-specific monitoring of the elastic modulus of the skin and underlying tissues via vibro-rotational biomechanical dynamics. Validated by computational models and experiments, the device uses a tunable skin interface to enable depth-controlled measurements across diverse anatomical sites. Two human subject studies, one involving patients with cancer-related lymphedema and the other involving patients with systemic scleroderma, yield data that correlate with standard clinical metrics. This technology offers the potential for longitudinal assessments in these and other contexts, in both clinical and home settings.
20 July 2026
Read appraisal →Journal of global health
Animal-assisted therapy on psychological and physical outcomes: a meta-analysis of randomised controlled trials
BACKGROUND: Adults are at heightened risk of anxiety, stress, and depression; animal-assisted therapy (AAT) may serve as an effective approach to promote psychological well-being. In this study, we compared the effectiveness of AAT in improving depression, anxiety, stress, pain, and gait among adults with or without illness. METHODS: We systematically searched six electronic databases (PubMed, CINAHL, Embase, Web of Science, the Cochrane Library, and Scopus) and included all studies published up to August 2024. We used comprehensive meta-analysis software to complete the quantitative synthesis. We reported pooled effect sizes as Hedges' g with corresponding 95% confidence intervals (CIs), after applying a random-effects model. Furthermore, we assessed heterogeneity using Cochran's Q test and the I2 statistic. We applied the Cochrane Risk of Bias 2.0 tool to appraise the methodological quality of the included studies. The synthesis process followed PRISMA guidelines. RESULTS: From the 13,345 studies identified, 35 randomised controlled trials involving 2391 adults were included. Across diverse populations, AAT was associated with reductions in depression (Hedges' g = -0.403; 95% CI = -0.536, -0.271), anxiety (Hedges' g = -0.661; 95% CI = -1.069, -0.253), and stress (Hedges' g = -1.062; 95% CI = -1.849, -0.275) at post-intervention, although substantial between-study variability was observed. CONCLUSIONS: We demonstrated that AAT significantly improves anxiety, depression and stress in adults, but has no meaningful effect on pain or gait. Subgroup and meta-regression analyses indicate that psychological benefits depend on population and intervention characteristics, and are not moderated by age or gender. REGISTRATION: PROSPERO: CRD42024570108.
19 July 2026
Read appraisal →Scientific reports
Walking stability prediction for pedestrians using gait energy images and hybrid deep and few-shot learning models
The prediction and recognition of unstable human walking patterns are of high importance for active video surveillance, smart environments, and assistive healthcare, particularly for fall detection in the elderly. This research investigates the utility of Gait Energy Images (GEIs) combined with deep learning, vision transformers, and few-shot learning architectures to enhance the classification of stable and unstable pedestrian walking patterns. We evaluate and compare twelve methodologies: six classical or feature-based machine learning models (Linear SVM, HOG + SVM, LBP + RBF-SVM, Random Forest, XGBoost, and an adapted GaitSet baseline), three deep learning models (MobileNet, Vision Transformer (ViT), and YOLOv8-cls), and three episodic few-shot learning techniques (Prototypical, Matching, and Relation Networks) under data-scarcity regimes. To facilitate this evaluation, we introduce the Unstable and Stable Walking Pedestrian (USWP) dataset, constructed by fusing and harmonizing sequences from seven public action recognition databases, containing 3250 unique GEIs with a subject-independent evaluation protocol to prevent identity-based domain leakage. Our experiments demonstrate that the YOLOv8-cls model achieves an overall accuracy of 96.92% (97.14% on Loss-of-Balance anomalies and 94.67% on Active Motion anomalies), significantly outperforming the conventional Linear SVM baseline (75.38%) and MobileNet (91.08%). Conversely, Relation Networks exhibit lower few-shot performance (71.08%) due to optimization complexities in learning similarity metrics from sparse data. Leave-One-Dataset-Out (LODO) cross-validation reveals an average generalization accuracy of 83.28%, indicating significant domain bias across source databases and underscoring that within-dataset evaluations overestimate real-world generalization. Computational complexity analysis shows that MobileNet provides an optimal trade-off for real-time edge deployment (4.2 ms latency), while preprocessing ablation studies demonstrate that integrating the Segment Anything Model (SAM) with MediaPipe-derived Regions of Interest (ROIs) yields a 12.50% absolute improvement in accuracy by eliminating background noise.
19 July 2026
Read appraisal →Science advances
Reduction of appearance artifacts in wearable on-skin electronics
Facial electrophysiological signals are crucial to human-machine interfaces and health care monitoring. Soft and skin-conformable electrodes enabled long-term and comfortable signal monitoring. However, the appearance of the electrodes affects the wearer's social interactions and self-identity, making daily usage difficult and leaving appearance artifacts. Here, we developed fully invisible and unperceivable on-skin electrodes free from appearance artifacts. Neither the wearer nor observers can detect the visual and tactile presence of the electrodes on the skin. The unperceivable property was confirmed with sensory experiments and physical characterizations of the film on skin. Furthermore, our invisible electrodes did not affect the psychological conditions of the wearers, which confirms the feasibility of artifact-free monitoring in daily lives. Last, we demonstrated the functionality of our electrode with successful monitoring of various facial electrophysiological signals, including electrooculogram (EOG), electromyogram (EMG), and electroencephalogram (EEG). Our fully invisible electrodes provide a promising direction in developing on-skin bioelectronics, seamlessly integrating health monitoring and human-computer interaction technologies into people's daily lives.
19 July 2026
Read appraisal →Medicine
Effect of physical exercise on executive function in individuals with substance use disorder: A systematic review and meta-analysis
BACKGROUND: The increasing number of individuals with substance use disorder (SUD) has a serious impact on individuals, families, and society. As a complementary therapy, physical exercise has been used in the rehabilitation of individuals with SUD. This study systematically aimed to evaluate the effect of physical exercise interventions on enhancing executive function in individuals with SUD. METHODS: Electronic databases were searched, covering the period from their inception to December 26, 2024. The Cochrane Risk of Bias Assessment Tool was utilized to assess the methodological quality of the included literature. Data were extracted from study graphs using GetData Graph Digitizer 2.26, and Stata 17.0 was also employed to conduct analysis. Grading of recommendations assessment, development and evaluation pro was utilized to evaluate the quality of evidence of outcome indicators. RESULTS: Nine studies, encompassing 752 participants, were included in the analysis. Compared with the control group, physical exercise improved inhibition (Hedges's g = 0.47, 95% CI: 0.29 to 0.65, P < .001) and working memory (Hedges's g = 0.42, 95% CI: 0.16 to 0.69, P = .002), but did not significantly affect cognitive flexibility (Hedges's g = 0.51, 95% CI: -0.22 to 1.24, P = .170). Subgroup analysis revealed that physical exercise with single time of 46 to 60 minutes (Hedges's g = 0.39, 95% CI: 0.05 to 0.73, P = .024), 5 times per week (Hedges's g = 0.45, 95% CI: 0.07 to 0.83, P = .020), duration of 8 weeks (Hedges's g = 0.46, 95% CI: 0.14 to 0.77, P = .004) may improve working memory in individuals with SUD (these subgroup findings are exploratory and should be interpreted as hypothesis-generating). CONCLUSION: Evidence from this study suggests physical exercise may enhance inhibition and working memory in individuals with SUD. However, the improvement in cognitive flexibility requires further investigation in future studies.
19 July 2026
Read appraisal →BMJ open
Current evidence on radiofrequency denervation for chronic low back pain: a systematic review and meta-analysis
OBJECTIVE: To assess the effects of radiofrequency (RF) denervation for chronic low back pain (LBP) from facet joint, sacroiliac joint, discogenic and non-specific pain. DESIGN: Systematic review and meta-analysis. DATA SOURCES: We searched Medline, Embase, Cochrane Library, CINAHL, PsycINFO, ClinicalTrials.gov and WHO ICTRP up to 18 February 2025 for randomised controlled trials (RCTs). STUDY SELECTION, DATA EXTRACTION AND SYNTHESIS: Pairs of reviewers independently selected studies, extracted data and assessed risk of bias (Cochrane RoB 2). Meta-analyses with clinically homogeneous studies were performed and certainty of evidence was assessed using Grades of Recommendation, Assessment, Development and Evaluation. RESULTS: 55 RCTs (n=4394) were included; many outcomes were at some risk of bias. Low to moderate certainty evidence suggested small improvements in pain and function with RF denervation versus sham for facet joint pain, sacroiliac, discogenic and non-specific chronic LBP. None exceeded predefined minimally clinically important between-group differences, suggesting limited clinical relevance. CONCLUSIONS: RF denervation showed small improvements in pain and function compared with sham, steroid injection or standard care, but the effects did not reach clinically meaningful thresholds and the certainty of evidence was very low to moderate. Additional research is needed to clarify the effects of RF denervation and guide clinical decision-making. PROSPERO REGISTRATION NUMBER: CRD42023460743.
18 July 2026
Read appraisal →Nature communications
Sensory-guided human-machine joint learning accelerates the acquisition of motor imagery brain computer interface control
Brain-computer interfaces (BCIs) offer the potential to restore function and augment human capabilities. However, non-invasive electroencephalography (EEG)-based BCIs still face challenges in learning efficiency and control precision, particularly for naïve users performing complex tasks. Here, we present a sensory-guided joint learning framework that integrates human motor learning with adaptive machine learning to improve BCI training and performance. In 31 BCI-naïve participants, the framework enabled rapid skill acquisition, achieving average online discrete accuracies of 86.0% for one-dimensional (1D) and 77.5% for two-dimensional (2D) motor imagery tasks, along with continuous control accuracies of 77.5% (1D) and 66.9% (2D). Mechanistically, tactile guidance reduced user exploration and accelerated neural adaptation, while sample reweighting aligned decoder updates with human learning trajectories. By coupling reinforcement-driven neural plasticity with adaptive algorithmic optimization, this framework advances BCI training from passive calibration to active human-machine joint learning, enabling practical and scalable neural interfaces for communication and rehabilitation.
17 July 2026
Read appraisal →Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
Creative thinking in Parkinson's disease: A systematic review and meta-analysis
INTRODUCTION: Creativity in Parkinson's disease (PD) has aroused research interest due to its neurological underpinnings, which involve brain regions crucial for creative and divergent thinking (a core-process of creative thinking), and because of some patients who displayed an increased artistic drive following dopaminergic treatment. From a cognitive point of view, creative thinking underlies several cognitive abilities, such as executive functions and memory. Therefore, a better understanding of whether it is increased (or, at least, preserved) in PD patients can provide useful insights for sustaining cognitive functioning. The aim of the present study was to investigate whether PD patients regularly assuming dopaminergic medications present higher divergent thinking skills than healthy controls. METHODS: A meta-analysis was conducted according to the PRISMA guidelines to provide a statistical synthesis of the studies. Study quality was assessed using the QUADAS -2 tool. RESULTS: Ten studies were included in the meta-analysis, which indicated the absence of significant differences between PD patients and healthy controls in tasks assessing divergent thinking (Cohen's d = -0,095 (95% CI: -0,308, 0,118)). CONCLUSIONS: Such findings support the notion that divergent thinking can be spared by the disease, maybe constituting a possible resource for patients' cognitive functioning, as it involves those cognitive abilities that can compensate impairments in PD. Clinical implications and guidance to further studies and interventions to support PD patients' cognition were discussed.
17 July 2026
Read appraisal →European journal of cardiovascular nursing
The psychological effects of interventions targeting informal caregivers of patients with cardiovascular disease-a systematic review.
AIMS: To explore the psychological effects of interventions aimed at supporting informal caregivers involved in the care and treatment of patients with cardiovascular disease. METHODS AND RESULTS: Databases (PubMed, CINAHL, Embase, Cochrane Library, and PsycInfo) were searched for studies in accordance with the Cochrane Handbook guidelines. Inclusion criteria were: caregivers of patients with one or more cardiovascular diseases, patient and caregiver >18 years, caregivers included in the intervention, and, reporting of psychological outcomes specific to caregivers. Study designs were randomized controlled trials with a follow-up periods of >2 months. The RoB 2.0 bias assessment tool was used to assess risk of bias. Fifteen studies from nine countries were identified. Most interventions consisted of multiple components including educational face-to-face sessions, telephone support, and/or written resources. The analysis showed inconsistent results on caregiver outcomes, but significant improvements were reported in eight studies in at least one caregiver outcome. Analysis indicated that the studies providing more frequent contact with caregivers and patients were more likely to report significant improvements in caregiver outcomes. Risk of bias was judged as low in three studies, some concerns in nine studies, and as high in three studies. CONCLUSION: Due to inconsistency in results, this review yield uncertainty about whether interventions targeting caregivers of patients with cardiovascular disease improve caregivers' psychological outcomes. Therefore, further research is needed to develop effective interventions for caregivers, as they play a vital role in the daily care and treatment of patients with cardiovascular disease. REGISTRATION: PROSPERO: CRD420250654618.
17 July 2026
Read appraisal →Journal of neurology
Effects of respiratory muscle training on respiratory function in patients with amyotrophic lateral sclerosis: a systematic review and meta-analysis
BACKGROUND: Respiratory decline is prognostically important in amyotrophic lateral sclerosis (ALS), but the efficacy of respiratory muscle training (RMT) remains uncertain. We synthesized randomized evidence on respiratory and related outcomes. METHODS: We searched databases, specialized registers, and trial registries through June 19, 2025, for randomized RMT trials in ALS. Risk of bias was assessed with the Cochrane tool. Random-effects meta-analyses reported standardized mean differences (SMDs) with 95% confidence intervals (CIs), and certainty was rated with GRADE. RESULTS: Six studies were included; five concurrently randomized trials contributed quantitative data, whereas Pinto 2013 was retained for qualitative context. RMT improved maximal expiratory pressure (MEP; SMD 0.387, 95% CI 0.192-0.581; P = 0.008) and showed small favorable effects on maximal inspiratory pressure (MIP; SMD 0.156, 95% CI 0.089-0.224; P = 0.005), sniff nasal inspiratory pressure (SNIP; SMD 0.216, 95% CI 0.039-0.392; P = 0.034), peak expiratory flow (PEF; SMD 0.205, 95% CI 0.088-0.323; P = 0.017), and ALSFRS-R (SMD 0.214, 95% CI 0.039-0.388; P = 0.030). Forced vital capacity showed a borderline favorable trend (SMD 0.129, 95% CI - 0.003 to 0.262; P = 0.053). Low heterogeneity estimates were imprecise because most endpoints included only three to four small studies. Certainty was moderate for MIP, low for MEP, FVC, and PEF, and very low for SNIP and ALSFRS-R. Exploratory analyses identified no reliable effect modifiers. CONCLUSIONS: RMT was associated with small, directionally consistent improvements mainly in pressure- and flow-based outcomes, whereas effects on FVC and longer-term clinical outcomes remain uncertain. RMT may be considered an individualized adjunct to ALS respiratory care, not a disease-modifying therapy. Larger, longer, standardized trials with patient-important endpoints are needed.
16 July 2026
Read appraisal →Journal of affective disorders
Ecological momentary interventions for depression: A systematic review and meta-analysis
INTRODUCTION: Depression remains a prevalent condition with many individuals experiencing residual symptoms despite standard treatments. Ecological momentary interventions (EMIs) offer real-time, ecologically-valid microinterventions, yet their clinical utility and implementation challenges in depression remain underexplored. METHOD: A systematic search of six databases (inception to 25 July 2025) identified randomised controlled trials (RCTs) evaluating EMIs for depression. Pooled effect sizes assessed differences relative to comparator conditions. RESULTS: Sixteen RCTs involving 1258 participants were included. EMIs significantly reduced depressive symptoms at posttest (Hedges' g = 0.57; 95% CI = 0.33-0.80; p < 0.001) and at follow-up ranging from 10 to 32 weeks (Hedges' g = 0.43). High heterogeneity reflected variability in EMI formats. EMIs also showed a statistically significant improvement in quality of life (Hedges' g = 0.44; 95% CI = 0.17-0.71; p < 0.01), supporting their broader impact beyond symptom reduction. Engagement averaged 64.91% (SD = 17.18), ranging 37.5%- 88.0%, with variation across reporting methods. Acceptability and usability ratings were consistently high. Intervention dosage and risk of bias were significant moderators of treatment efficacy. Subgroup analyses revealed greater benefits from EMIs incorporating psychoeducation and active practice, and fully-automated formats. CONCLUSION: The review highlights EMI efficacy in reducing depressive symptoms and improving quality of life, with intervention dosage and methodological rigor emerging as key moderating factors. Reporting engagement remains a challenge, and substantial heterogeneity underscores the need for refined trial designs to isolate the active EMI components to best optimise treatment outcomes in depression. Future studies should prioritise strategies strengthen methodological rigor and optimising user engagement. PROSPERO No. CRD420251105663.
16 July 2026
Read appraisal →Analytical chemistry
Biodegradable Self-Powered Electrotherapy Patch for Integrated Smart Wound Management
Smart patches based on multimodal wearable devices enable real-time physiologic monitoring and proactive interventions to promote wound healing. Herein, we describe a biodegradable wearable electrotherapy patch (E-patch) that integrates noninvasive self-powered electrical stimulation (ES) therapy for tissue regeneration and a multiplexed electrochemical biosensor array for continuous monitoring of wound status. Custom-developed supercapacitor arrays (SCs) supply stable energy for ES, and constructed wearable biosensors enable sensitive monitoring of biomarkers in the wound exudate. As-fabricated wearable E-patches degrade harmlessly after operation, significantly reducing the environmental pollution pressure associated with flexible electronics. In vitro studies demonstrated that an applied electric field (EF) significantly promotes cell-directed alignment, which is crucial for tissue regeneration and remodeling. In vivo investigations in the Sprague-Dawley (SD) rat model illustrate that combination therapy dramatically accelerates wound healing. Overall, this work provides a promising strategy toward integrated smart wound management and future feedback-assisted wearable therapeutic systems.
15 July 2026
Read appraisal →Biomedical physics & engineering express
EEG-EMG spatiotemporal cross-attention fusion network for functional upper-limb movement classification
Objective. Electroencephalography (EEG) and electromyography (EMG) are widely used for decoding motor intentions, yet unimodal approaches often suffer from low robustness and limited representational information. EEG-EMG hybrid brain-computer interfaces (BCIs) can bridge cortical intention and muscular execution, but challenges remain in signal alignment, fusion modeling, and clinical generalization.Approach. To address these issues, we propose spatio-temporal cross-attention fusion (STCAFusion), a spatiotemporal cross-attention (CA) framework that integrates EEG and EMG through multi-band based dual-branch convolutional encoders and parallel temporal and spatial CA modules. This design enables detailed modeling of inter-modal correlations across both time and space. We evaluate STCAFusion on a newly collected dataset of synchronous EEG-EMG recordings from 12 subjects, where the data were acquired under two paradigms (Reaching and Lifting) designed from daily functional upper-limb activities to emphasize directional and strength control.Main results. With leave-one-run-out cross-validation, STCAFusion achieves average accuracies of 84.15% and 95.22% in the two paradigms, outperforming the strongest competing EEG-EMG fusion baselines by 3.4% in the Reaching paradigm and 1.8% in the Lifting paradigm. Visualization of learned attention weights further reveals meaningful spatiotemporal EEG-EMG coupling patterns, offering insights into neural-muscular coordination patterns relevant to rehabilitation-oriented BCI design.Significance. These results highlight the potential of CA-based multimodal physiological signal fusion in building reliable hybrid BCI and wearable devices for upper-limb control and rehabilitation.
14 July 2026
Read appraisal →Journal of molecular neuroscience : MN
Scalp Acupuncture Combined with Mouse Nerve Growth Factor Acupoint Injection for Post-stroke Cognitive Impairment
Post-stroke cognitive impairment (PSCI) markedly impairs rehabilitation efficacy and quality of life. Safe and effective interventions are urgently needed. Eighty-four patients with PSCI were randomly allocated into three groups (n = 28 per group). Group A received conventional cognitive training. Group B received conventional training plus scalp acupuncture. Group C received the treatment of Group B combined with mouse nerve growth factor (mNGF) acupoint injection. All interventions lasted 4 weeks. All groups exhibited significant within-group improvements in MoCA, ADL, MBI, and FMA scores after intervention. Group C achieved the optimal cognitive efficacy: the post-treatment MoCA score was 26.7 ± 2.9 (95% CI, 25.53-27.87), significantly higher than that in Group A (21.5 ± 3.5 (95% CI, 20.22-22.78), P < 0.001) and Group B (23.8 ± 3.2)(95% CI, 22.48-25.12), P = 0.003). The ADL score in Group C was the lowest among the three groups (F = 28.963, P < 0.001), suggesting better independence. Moreover, motor function (FMA) and basic self-care ability (MBI) were also significantly improved in all groups after intervention. There were significant inter-group differences in post-treatment FMA and MBI scores (F-FMA = 29.745, P < 0.001; F-MBI = 35.872, P < 0.001). The scores increased gradually from Group A to Group C, with Group C achieving the best improvement. Conventional cognitive training improves cognitive function and daily living ability in patients with PSCI. Scalp acupuncture combined with conventional training is more effective than training alone. The triple therapy of conventional training, scalp acupuncture, and mNGF acupoint injection further enhances rehabilitation outcomes, with prominent clinical application value.
13 July 2026
Read appraisal →Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
Effects of transcranial direct current stimulation on motor function in patients with multiple sclerosis: a systematic review and meta-analysis
OBJECTIVE: To assess the effectiveness of transcranial direct current stimulation (tDCS) in enhancing motor function recovery in the upper and lower extremities of individuals with multiple sclerosis. DATA SOURCES: PubMed, Embase, Web of Science, Cochrane Library, and China Knowledge Network (CNKI) databases from inception until December 28, 2025. STUDY SELECTION: Randomized controlled trials that investigated transcranial direct current stimulation and tDCS combined with physical training on motor function in the upper and lower limbs of individuals with MS. DATA EXTRACTION: Two reviewers extracted the data and assessed the risk of bias. Standardized mean difference (SMD) and 95% confidence intervals (CI) were calculated using a random-effects model based on heterogeneity. The analysis included 10 articles with a total of 299 subjects. DATA SYNTHESIS: The Meta-analysis shows tDCS significantly improves lower limb motor function in MS patients (SMD = 0.31, 95% CI: 0.16 - 0.46, p < 0.0001). Subgroup analyses found significant increases in walking distance (p = 0.0005) and static balance (Berg Balance Score, p = 0.0002), but no significant improvements were observed in walking speed and dynamic balance. For upper limb motor function, no statistically significant difference was found in hand dexterity (9-HPT) (p = 0.11). Notably, subgroup analyses of stimulation parameters showed that high intensity (2.0-2.5 mA, p = 0.007) and a 20-minute duration (p = 0.03) yielded significant effects, whereas low intensity (1.0-1.5 mA) and 15-minute duration showed no significant benefits. CONCLUSIONS: Transcranial direct current stimulation is effective in enhancing lower limb motor function in patients with MS. However, the efficacy of tDCS in improving upper limb fine motor skills remains unclear. Evidence suggests that stimulation at 2.0-2.5 mA for 20 min may be the optimal protocol for clinical intervention.
13 July 2026
Read appraisal →Science advances
Transforming static interfaces into tactile channels with steerable transdermal foci
Grasping objects such as handles, mice, and phones plays a central role in human-machine interaction, yet the contact surfaces of the hand, despite their exquisite tactile sensitivity, are rarely exploited as channels for information transfer. Here, we introduce transdermal all-directional targeting (TADT), a static-contact interface design strategy that converts passive grip surfaces into active tactile displays, allowing users to grasp stably while receiving spatially and temporally evolving information on the fingertips. TADT enhances sub-actuator-pitch energy delivery by integrating a microtextured skin-coupling interface with phase-controlled vibrotactile actuation, thereby generating steerable three-dimensional tactile foci beneath the skin, enabling >200-hertz vibration and sub-actuator-pitch spatial super-resolution. Psychophysical experiments show that TADT lowers detection thresholds by 30% and reduces power consumption by 80% compared with designs without TADT. Using static grip alone, users reliably identified six directional cues and completed nonvisual indoor navigation and virtual reality interaction tasks, demonstrating a compact, energy-efficient modality for expressive tactile communication.
12 July 2026
Read appraisal →Science advances
Motor-free hip exosuit via high-output fibrous dielectric elastomer actuators
Exosuits can assist gait and reduce fatigue for both healthy and pathological populations, yet their bulky, rigid actuators (usually motors or pneumatic actuators) hinder natural, comfortable movement. Dielectric elastomer actuators (DEAs) provide a lightweight, compliant alternative, but are constrained by insufficient force, energy output, and integration challenges. Herein, we propose a motor-free hip exosuit driven by high-output fibrous DEAs, offering a previously unexplored paradigm for lower-limb assistance. We develop high-aspect-ratio fibrous DEAs that deliver high blocked stress (381.6 mN·mm-2), energy density (260 J/kg), and power density (1,664 W/kg), enabled by a dual-polar molecular design of the elastomer to overcome the intrinsic trade-offs between dielectric and mechanical properties. A Lego-like integration strategy is established to efficiently bundle fibers for force amplification. The resulting exosuit reduces the walking metabolic cost by 13.9% compared to no assistance, surpassing most hip exoskeletons. These findings advance DEAs toward practical wearable robotics for real-world human assistance.
12 July 2026
Read appraisal →PloS one
Edge-intelligent safelink-V2X: A low-latency cooperative framework for real-time vulnerable road user protection.
The protection of Vulnerable Road Users (VRUs) remains a major challenge in modern transportation safety, as onboard line-of-sight and adverse weather conditions limit conventional onboard sensors. Existing systems that rely solely on vehicle-based sensing or on isolated communication struggle to provide timely, accurate alerts in dynamic urban environments. To address these shortcomings, this paper introduces SafeLink-V2X, a comprehensive Vehicle-to-Everything Cooperative Warning Framework designed to enhance safety for pedestrians, cyclists, and scooter riders. SafeLink-V2X employs Cellular Vehicle-to-Everything (C-V2X) and Dedicated Short-Range Communications (DSRC) protocols to enable direct data exchange of location, velocity, and heading between connected vehicles, smart infrastructure, and VRUs via smartphones or wearable tags. By applying sensor fusion and machine learning-based conflict prediction, the system identifies potential collision points and issues real-time, context-aware warnings through vehicle HMIs and VRU devices, promoting immediate evasive action. Evaluation on urban intersection simulations (detailed in Section 5) demonstrates that SafeLink-V2X reduces simulated collision probability by up to 91.4%, increases situational awareness measures by 44%, and lowers end-to-end alert latency by 30% compared to baseline onboard-only and communication-only systems under the same conditions.
12 July 2026
Read appraisal →Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
Combined transcranial direct current stimulation and mirror therapy for upper limb rehabilitation in patients with stroke: a systematic review and meta-analysis
Upper limb impairment is among the common consequences of stroke. Combining transcranial direct current stimulation (tDCS) and mirror therapy (MT) have recently been used to improve neural plasticity and functional recovery. This review aims to evaluate the effects of combined tDCS and MT on upper limb function in patients with stroke. "PubMed, Scopus, Web of Science, CINAHL, PEDro, and EMBASE" were searched from their inception to March 2026. Randomized controlled trials investigating the combination of tDCS and MT in patients with stroke and assessing upper limb function were included. The quality and the certainty of evidence were evaluated. Seven studies (454 participants) met the eligibility criteria. Significant improvements were demonstrated in upper limb motor function (SMD = 0.73, 95% CI 0.34 to 1.12, p = 0.0002), activities of daily living (SMD = 0.84, 95% CI 0.46 to 1.22, p < 0.0001), and neurophysiological outcomes reflecting corticospinal conduction efficiency, assessed using central motor conduction time (CMCT) (SMD = -1.26, 95% CI -1.60 to -0.92, p < 0.0001). Subgroup analysis demonstrated greater effects in subacute stroke (SMD = 1.03, 95% CI 0.73 to 1.33). Other outcomes reported improvements in hand function and grip strength. Preliminary evidence suggests that combining tDCS and MT may improve upper limb motor and functional outcomes after stroke; however, these findings should be interpreted with caution due to heterogeneity and the limited data. Further studies are strongly needed.
11 July 2026
Read appraisal →Journal of speech, language, and hearing research : JSLHR
Language-Common and Language-Specific Error Patterns in Children With Speech Sound Disorders: A Systematic Review
OBJECTIVES: This systematic review synthesized cross-linguistic evidence on speech error patterns in children with speech sound disorders (SSDs), focusing on percent consonants correct (PCC), SODA (substitution, omission, distortion, and addition) error profiles, and phonological processes, as well as factors contributing to variations in error patterns. METHOD: Comprehensive searches were conducted in PubMed, CINAHL Ultimate, Scopus, Web of Science, and Linguistics and Language Behavior Abstracts in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible studies included empirical research on children with phonological, articulation, or functional SSDs that reported quantitative error analyses. Twenty-eight studies met the inclusion criteria. Methodological quality, evaluated using a 16-item framework, ranged from 50.0% to 100.0% (M = 82.7%). RESULTS: The 28 studies spanned nine languages (English, German, Spanish, Portuguese, Italian, French, Turkish, Korean, and Chinese), including three dialects each of Spanish and Chinese and two dialects of Portuguese. Reported PCC values (typically 65.0%-85.0%) indicated predominantly mild-moderate to moderate impairment. Substitution errors were the most prevalent across languages, followed by omissions and distortions. Both language-common and language-specific phonological processes were documented. DISCUSSION: The findings indicate that PCC is generally comparable across languages, whereas SODA error profiles and phonological processes reflect both cross-linguistic similarities and language-specific characteristics. Phonological processes, in particular, exhibit greater cross-linguistic variation. Collectively, these results emphasize the need for culturally responsive diagnostic practices and highlight the importance of developing cross-linguistic frameworks to guide the assessment of SSDs. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.32649549.
10 July 2026
Read appraisal →British journal of sports medicine
Comparative effectiveness of physical therapy interventions in adults with rotator cuff tendinopathy: a systematic review and network meta-analysis
OBJECTIVE: To compare the effects of different physical therapy interventions and identify the most effective intervention on pain, function, quality of life (QoL) and adverse events (AEs) in adults with rotator cuff (RC) tendinopathy. DESIGN: Systematic review and network meta-analysis (NMA) of randomised clinical trials (RCTs). DATA SOURCES: Seven databases and two trial registries were searched up to March 2024. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: RCTs comparing physical therapy interventions to any other physical therapy intervention, sham, placebo, waiting list or no treatment on pain, function, QoL and AEs in adults with RC tendinopathy. DATA SYNTHESIS: A frequentist NMA using a random-effects model was performed. Risk of bias and certainty of the evidence were assessed using the revised Cochrane risk-of-bias tool and the Grading of Recommendations, Assessment, Development and Evaluation approach, respectively. RESULTS: 89 RCTs (5532 participants) were included. Exercises targeting the shoulder muscles may reduce pain (standardised mean difference (SMD) -0.79, 95% CI -1.33 to -0.26) and improve function (SMD 0.74, 95% CI 0.34 to 1.14) compared with no treatment but the evidence is very uncertain. Exercises targeting shoulder and scapular muscles in addition to percutaneous electrolysis (SMD -1.58, 95% CI -2.68 to -0.48) and to trigger point dry needling (SMD 3.10, 95% CI 1.99 to 4.22) seem to be the most effective interventions on pain and function at the end of treatment, respectively. CONCLUSION: Most of the interventions identified may not be superior to isolated shoulder exercises alone, which might be considered a reasonable first-line approach, but the evidence is very uncertain and most interventions are informed by limited data. High-quality research is needed to improve evidence of physical therapy interventions in adults with RC tendinopathy. PROSPERO REGISTRATION NUMBER: CRD42024527176.
8 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 →Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
Topography and functional connectivity analysis of heart surgery-associated brain lesions: a literature review
BACKGROUND: Cardiac surgery is a major therapeutic advancement but remains associated with neurological complications, including ischemic stroke and postoperative cognitive decline. Compared with stroke of other etiologies, ischemic brain injury following cardiac surgery may involve distinct vascular territories and functional networks, potentially influencing its characteristic cognitive profile. METHODS: We performed a systematic review of case reports describing ischemic brain lesions occurring after cardiac surgery in adults with available neuroimaging data. Lesions were manually traced onto a standard brain atlas and compared with ischemic stroke lesions from the ATLAS database, matched for hemispheric involvement. Lesion topography was analyzed at the arterial territory and voxel levels. Lesion network mapping was conducted using normative resting-state functional connectivity data to identify patterns of functional disconnection. Permutation-based statistical analyses were applied, with correction for multiple comparisons and lesion volume included as a covariate. RESULTS: Nineteen articles met the inclusion criteria, yielding 20 cases of post-cardiac surgery ischemic lesions. Compared with stroke controls, these lesions more frequently involved posterior arterial territories, particularly the occipital branches of the posterior cerebral arteries and posterior thalamic regions. Lesion network mapping revealed a distinct pattern of functional disconnection in the occipital lobes, posterior thalamus (including the pulvinar), and medial frontal cortex. CONCLUSIONS: Our results suggest that ischemia associated with cardiac surgery may preferentially involve posterior arterial territories and be associated with distinct patterns of functional disconnection involving the occipital lobe, the pulvinar, and the medial frontal cortex.
6 July 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Interventions to improve the psychosocial outcomes of individuals with lymphedema: a systematic review
PURPOSE: Lymphedema is a common and enduring consequence of cancer treatment with substantial physical and psychosocial morbidity, yet research predominantly focuses on physical outcomes. This systematic review examines psychosocial interventions for individuals with lymphedema, describing the intervention characteristics, methodological quality, and strength of the evidence. METHODS: A systematic literature search was conducted of studies published through November 2025. Empirical interventions with psychosocial components and outcomes for individuals with lymphedema were eligible. Methodological quality was assessed. Strength of the evidence was determined by combining quality with intervention effectiveness. RESULTS: Ten studies met inclusion criteria, including mind-body (n = 3), education and support (n = 3), and physical activity (n = 4) intervention models, and most delivered following completion of decongestive therapy. Psychosocial outcomes included mental health (n = 8) and quality of life (n = 6). Methodological rigor was mixed, with MQRS scores ranging from 5-13 (of 14). Interventions delivered in combined in-clinic and remote settings demonstrated stronger evidence for improving mental health outcomes than either setting alone. CONCLUSION: Few empirical evaluations exist targeting the psychosocial needs of individuals with lymphedema, particularly during intensive phases of decongestive therapy. Heterogeneity in intervention models, outcome measures, and treatment timing limits cross-study comparisons; however, hybrid delivery approaches show promise for improving psychosocial outcomes. Greater integration of psychosocial care across the lymphatic care continuum, supported by standardized outcome measures, may strengthen supportive care for individuals living with lymphedema.
5 July 2026
Read appraisal →Journal of medical Internet research
Sensor-Based Monitoring of Knee Osteoarthritis Symptoms in Free-Living Settings: Scoping Review
BACKGROUND: Knee osteoarthritis is a heterogeneous condition characterized by chronic pain, stiffness, and fatigue that fluctuate rapidly over time. Traditional clinical assessments provide only static diagnoses of disease severity, failing to capture the dynamic, day-to-day symptom variability that impacts patient quality of life. While wearable technologies offer the potential for continuous, high-frequency monitoring, previous reviews have examined general technological interventions for knee osteoarthritis management, yet they lack a specific synthesis of technologies for symptom monitoring. OBJECTIVE: This study aims to synthesize current research on sensor technologies used for the continuous monitoring of knee osteoarthritis symptoms in free-living or simulated daily environments. Specifically, the review seeks to (1) map sensor modalities to specific symptom domains (biomechanical, physiological, and behavioral); (2) evaluate the alignment between objective sensor metrics and patient-reported outcome measures; and (3) identify gaps in current monitoring paradigms. METHODS: A systematic literature search was conducted across PubMed, Embase, Web of Science, and IEEE Xplore. The review followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Eligibility criteria included studies involving participants with knee osteoarthritis using wearable or portable sensors capable of continuous monitoring (eg, inertial measurement units and electrocardiography) and assessing clinical symptoms (eg, pain, fatigue, and stiffness). Studies relying solely on stationary laboratory equipment (eg, force plates) without a portable component were excluded to ensure relevance to real-world applicability. Data regarding sensor types, sampling frequencies, monitored symptoms, and the statistical association between objective features and subjective symptom severity (key findings) were extracted. RESULTS: A total of 16 studies met the inclusion criteria. The summary constructed from the results revealed a distinct technological saturation: the majority of studies (n=6) used inertial measurement units to quantify biomechanical deficits (eg, gait asymmetry and range of motion), which showed robust correlations with functional limitations. In contrast, there was a notable scarcity of research using physiological sensors (eg, electrocardiography and bioimpedance) to monitor systemic symptoms. Crucially, findings highlighted a significant discrepancy between subjective and objective data, particularly in sleep monitoring, where poor self-reported sleep quality predicted pain exacerbations despite stable objective actigraphy metrics. Furthermore, most systems operated as passive data loggers, with a lack of integration into active feedback loops. CONCLUSIONS: Unlike previous reviews focused solely on biomechanics, this study innovatively maps the use of sensors across a multidimensional symptom spectrum, revealing a critical gap in the monitoring of fatigue and physiological stress. The findings suggest that current sensor applications are limited by a lack of integration with subjective patient experiences. Real-world implementation requires a hybrid monitoring paradigm that combines the ecological validity of wearable sensors with the clinical relevance of patient-reported outcomes. This approach paves the way for digital phenotyping and active feedback systems, offering a personalized strategy for managing the complex symptom burden of knee osteoarthritis.
3 July 2026
Read appraisal →The Orthopedic clinics of North America
Wearable Devices and Artificial Intelligence to Enhance Perioperative Care in Total Knee Arthroplasty
Rapidly evolving wearable devices have the potential to transform health care delivery and enhance outcomes. Applications of wearable smart devices range from activity and motion tracking to real-time monitoring of vital signs and biochemical markers. Recent evidence provides support for the use of wearable devices in chronic disease management, rehabilitation, and perioperative care of patients with total knee arthroplasty. Data derived from these devices may enhance treatment personalization and early identification of complications. Challenges remain regarding accuracy, standardization, privacy, and patient adherence. Future advances must overcome these limitations.
2 July 2026
Read appraisal →Langmuir : the ACS journal of surfaces and colloids
An Ultrasoft Initiator-Free Eutectogel for Strain Sensing and Gesture Recognition Assisted by Machine Learning
With the rapid development of Internet of Things and artificial intelligence technologies, flexible wearable sensors have shown great potential in human-machine interaction and health monitoring fields. However, traditional hydrogel sensors face challenges such as water loss, freezing, and the use of toxic initiators during the preparation process, which lead to biological safety issues. To address these challenges, this paper proposes a green, initiator-free polymerization strategy based on the deep eutectic solvent system composed of choline chloride (ChCl) and D-sorbitol. By utilizing the property that the nitrogen-containing quaternary ammonium group in the ChCl molecule can generate free radicals upon ultraviolet irradiation, this study achieves the rapid polymerization of acrylamide in an initiator-free manner. The prepared eutectogel exhibits high transparency (≈96%), skin-fitting elastic modulus, good antifreezing performance, suitable breathability, and broad-spectrum adhesion. The flexible strain sensor constructed based on the eutectogel has high sensitivity, wide detection range, and good fatigue resistance. Combined with machine learning algorithms, this sensor system achieves a high accuracy (98.5%) of recognizing Curwen gestures. This research provides an innovative approach for developing safe, reliable, and environmentally adaptable intelligent wearable devices and has broad application prospects in intelligent music education and modern human-machine interaction.
1 July 2026
Read appraisal →JMIR aging
Use of Wearable Technology for Measuring and Characterizing Sedentary Behavior in People With Mild Cognitive Impairment and Dementia: Systematic Review
BACKGROUND: Sedentary behavior (SB) is a critical, modifiable risk factor for adverse health outcomes. Evidence suggests that SB is higher among individuals with cognitive impairment relative to their cognitively healthy peers. However, the nature and extent of SB across cognitive impairments remains unclear, largely due to the reliance on self-report data and the lack of synthesized evidence from more accurate methodology, such as wearable devices. Wearable device-based methodologies offer a reliable means of capturing SB in real-world settings, circumventing the recall bias inherent to self-report methods. Continuous remote monitoring of SB, via wearable devices, may provide nuanced insights important for understanding SB's contribution to cognitive impairment and health consequences. OBJECTIVE: This review aims to synthesize evidence on the volume, patterns, and variability of SB across cognitive impairment and critically appraise the wearable device-based methodology used to capture SB in this population. METHODS: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched 5 databases (Embase, MEDLINE, PsycInfo, Scopus, and Web of Science) up to January 2025 for peer-reviewed English-language studies using wearable devices to measure SB in community-dwelling or aged residential care residents aged 50 years or older with cognitive impairment (PROSPERO: CRD42024616523). Study quality was assessed using an adapted version of the National Institute of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Data were extracted on SB outcomes (eg, volume, pattern, and variability) and methodological characteristics (eg, device type, placement, SB classification/processing, and its corresponding validation). RESULTS: From 2824 screened records, 17 studies (2016-2025) were included. Most studies (n=11, 65%) were of "good" quality (scoring ≥5 on bias assessment). Synthesis revealed inconsistent evidence for differences in SB volume across cognitive impairment. However, individuals with dementia consistently exhibited a unique SB pattern, engaging in significantly fewer but longer sedentary bouts than other forms of cognitive impairment and cognitively intact controls. All (n=17, 100%) studies used volume metrics to describe SB, followed by pattern metrics (n=7, 41%); only 1 study reported on SB variability. Methodological appraisal found significant heterogeneity: 13 different device models across 6 body placements were used. Most studies quantified SB using count-based thresholds (counts per minute), which were largely unvalidated in cognitively impaired or older adult populations. CONCLUSIONS: This review found that participants with dementia consistently exhibited a unique pattern of SB compared to other forms of cognitive impairment and healthy controls, while evidence for differences in SB volume was inconsistent. This may indicate that differences in SB volume are not inherent to dementia pathology but may be mediated by other factors, such as neuropsychiatric symptoms or environmental influences. Furthermore, methodological heterogeneity and unvalidated thresholds were observed throughout the review, highlighting a need for standardized protocols to enhance the validity and clinical applicability of future research. TRIAL REGISTRATION: PROSPERO CRD42024616523; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024616523.
28 June 2026
Read appraisal →Journal of global health
Habitual physical activity and sarcopenia: a systematic review and meta-analysis of prospective cohort studies
BACKGROUND: Habitual physical activity (HPA) has been associated with a lower risk of sarcopenia by enhancing skeletal muscle protein synthesis and suppressing systemic inflammation. However, the evidence for a long-term protective association remains inconclusive. Therefore, we conducted a systematic review and meta-analysis to quantify the association between HPA and sarcopenia. METHODS: We searched PubMed, the Cochrane Library, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and the China National Knowledge Infrastructure for prospective cohort studies on the relationship between physical activity (PA) and sarcopenia. We selected English and Chinese-language literature published before 6 October 2025, and assessed study quality using the Newcastle-Ottawa Scale. Data were statistically synthesised by calculating pooled relative risks (RRs) and 95% confidence intervals (CIs) using a random-effects model with the generic inverse-variance method. RESULTS: This meta-analysis included nine prospective cohort studies involving 21 265 participants. High levels of HPA were associated with a significantly lower risk of sarcopenia compared to the low levels (RR = 0.55; 95% CI = 0.44-0.67). This protective association remained consistent in subgroup analyses stratified by gender and by compliance with international PA guidelines. Furthermore, moderate HPA was also associated with a reduced risk compared to low HPA levels (RR = 0.73; 95% CI = 0.50-0.96). CONCLUSIONS: Our analysis indicates that moderate to high levels of HPA are independently associated with a lower risk of sarcopenia, serving as a significant protective factor. However, given the methodological heterogeneity in PA measurement, further high-quality prospective studies are needed to clarify the optimal PA dose while accounting for potential reverse causality. REGISTRATION: PROSPERO: CRD420251162529.
28 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 →Biomedical physics & engineering express
Intelligent integrated system for dysphagia rehabilitation and assessment
Current dysphagia assessment suffers from subjectivity and reliance on complex clinical tools, while rehabilitation lacks objective feedback. The critical mechanism of respiration-swallowing coordination (RSC) for preventing aspiration is often overlooked in existing monitoring systems. This study aimed to develop and validate an intelligent integrated system for dysphagia rehabilitation and that provides a closed-loop solution for quantitative assessment and personalized rehabilitation. The system's core innovation is the tight integration of a wireless wearable hardware subsystem for synchronous swallowing sound and respiratory waveform acquisition with an intelligent software subsystem. The software incorporates novel algorithms for automated swallowing identification, respiratory cycle analysis, and real-time classification of RSC patterns into aspiration risk levels. This enables an interactive platform that closes the loop between assessment, visual feedback, and personalized audiovisual guidance for rehabilitation training. Validation included hardware performance tests and a clinical trial with 16 participants (8 healthy participants and 8 participants with dysphagia). The hardware demonstrated reliable performance, achieving a robust swallowing sound SNR (14.07 dB in a noisy environment) and showing acceptable temporal consistency in the respiratory waveform. On a 0-100 scale, the system significantly differentiated swallowing function between healthy (82.72) and dysphagic (57.25) subjects (p< 0.01). We also conducted an exploratory experiment in two dysphagic participants using audiovisual guided training. A preliminary upward trend in swallowing-coordination scores was observed after training, suggesting a potential short-term training effect of the audiovisual guidance module. The integrated system represents an innovation by seamlessly merging wearable sensing with intelligent, coordination-focused algorithms into a unified closed-loop platform. It offers a practical and effective solution for transforming dysphagia management towards objective, personalized, and intelligent rehabilitation.
27 June 2026
Read appraisal →Scientific reports
Multimodal emotion recognition using hybrid deep feature fusion under speaker-independent evaluation
Emotion recognition is one of the most important and complex challenges for machines to understand, as most robots and AI agents struggle with human-centric perception and interpretation. Therefore, this paper introduces a novel multimodal emotion recognition system that analyzes emotions through two complementary channels: voice and facial expressions. The proposed approach is evaluated on the RAVDESS and CREMA-D datasets, which consist of acted emotional expressions across multiple discrete emotion categories. Utilizing an advanced multimodal deep feature fusion technique, the system combines handcrafted audio features (e.g., Mel-Frequency Cepstral Coefficients (MFCCs)) with deep visual features extracted from an attention-based VGGFace model. These features are integrated into a unified representation through a hybrid fusion strategy that jointly employs concatenation, cross-attention, gated fusion, and multiplicative fusion mechanisms to capture complementary cross-modal interactions. To ensure a comprehensive and realistic assessment, the model is evaluated under both random-split and strict speaker-independent protocols. On the RAVDESS dataset, the proposed system achieves an accuracy of 95.83% under random-split evaluation and 48.06% ± 9.76% accuracy under speaker-independent Leave-One-Speaker-Out (LOSO) testing, while on the CREMA-D dataset it attains 73.54% accuracy using random splits and 53.12% ± 2.65% accuracy under subject-exclusive speaker-independent 5-fold cross-validation.
27 June 2026
Read appraisal →BMJ open
Understanding self-management and digital health needs in musicians with playing-related musculoskeletal disorders: an explanatory sequential mixed-methods study
OBJECTIVES: To explore the characteristics of musicians with current or previous troubling musculoskeletal symptoms associated with musician self-limitation of activity (often referred to as playing-related musculoskeletal disorders (PRMSDs)), barriers and facilitators to PRMSD self-management, health needs and perspectives on digital health interventions (DHIs). The purpose of the study was to understand the unique needs of this population to effectively inform future DHIs to support this community. DESIGN: A mixed-methods study comprising an online survey and four online focus groups (2-3 participants per group). Survey data were analysed statistically, and focus group discussions were analysed thematically. SETTING: Online survey and focus groups conducted via Zoom. PARTICIPANTS: UK-based musicians with current or previous PRMSDs. RESULTS: A total of 100 musicians participated in the survey study, and 10 musicians participated in the focus group study. Over a third (38%, n=38) of participants had experienced musculoskeletal symptoms that interfered with their ability to play at their usual level 0-2 times in the last 5 years, 24% (n=24) reported 3-5 episodes, and 38% (n=38) had experienced them more than five times. The majority of participants (67%, n=67) continued playing music while experiencing these symptoms. Several barriers to self-management were identified, including limited music-specific health education during training, financial and time constraints and insufficient accessible resources. Key facilitators and health needs included healthcare professionals who understood musicians' professional demands and performance pressures, personalised instrument-specific health support, peer support from fellow musicians and accessible digital resources including self-assessment tools, automated reminders, health tracking, motivational features, peer support forums and multimedia resources organised by condition or symptom stage. Addressing these needs could enable musicians to better manage their symptoms, maintain playing activity and make informed decisions about when and how to seek help. CONCLUSION: This study reveals unmet health needs in musicians and offers recommendations for designing DHIs that promote musicians' health and well-being. Key design recommendations include personalisation by instrument type, health tracking, peer support and consolidated multimedia resources. These findings can inform both intervention design and policy development to better support this population.
26 June 2026
Read appraisal →Journal of medical Internet research
Explainable and Interpretable AI for Voice and Speech Analysis in Clinical Care: Systematic Review
BACKGROUND: Driven by recent advances in artificial intelligence (AI), particularly in medicine, audio-based voice and speech biomarkers are increasingly investigated for various medical applications as a complementary or even alternative modality to traditional medical devices. The adoption of deep learning techniques in recent literature is motivated by their superior performance compared to classical machine learning methods. However, ethical and regulatory concerns regarding the black-box nature of these models have limited their integration into clinical workflows. Consequently, explainable artificial intelligence (XAI) has recently been used to address this issue by generating explanations for opaque model outputs. Ideally, medical XAI systems aim to provide human-understandable, clinically grounded explanations essential for enhanced AI trustworthiness and, thereby, facilitate adoption into real-world clinical settings. OBJECTIVE: We conduct a systematic literature review of XAI methods applied for explaining deep learning techniques in audio-based voice and speech clinical applications. We aim to identify what XAI methods have been used to explain the decisions of deep learning voice and speech AI systems in health care, as well as XAI-informed insights. Additionally, we aim to contextualize these findings with respect to clinical applicability and stakeholder relevance. Lastly, we identify opportunities and recommendations for future clinical audio XAI design. METHODS: We used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Six electronic databases (IEEE Xplore, ACM Digital Library, Scopus, PubMed, Web of Science, and Nature) were searched for papers published between January 2015 and February 2025. Eligible studies applied explainability or interpretability methods to deep learning models for voice or speech audio in health care contexts. Risk of bias was assessed using PROBAST+AI (Prediction Model Risk of Bias Assessment Tool). The results were thematically synthesized across explainability categories, input representations, clinical domains, validation strategies, and stakeholder considerations. RESULTS: A total of 30 studies met the inclusion criteria. These studies used a range of explainability approaches, including gradient-based methods, perturbation-based techniques, surrogate model-based methods, model-internal representation analyses, concept-based detectors, and attention-based explanations. Applications spanned diverse clinical domains, including voice disorders, neurodegenerative diseases, psychiatric conditions, and traumatic brain injury. Overall, results indicate that most studies relied primarily on qualitative interpretation of explainability outputs, with limited quantitative validation of explanation consistency across external datasets. Furthermore, none of the included studies explicitly conducted human-in-the-loop evaluations with relevant stakeholders, highlighting a substantial gap in stakeholder alignment. CONCLUSIONS: Current XAI practices in clinical voice and speech analysis are limited by insufficient validation, lack of domain-specific design, and misalignment with clinical stakeholder needs. This review highlights opportunities for developing validated, audio-aware, and stakeholder-centered XAI approaches to support trustworthy clinical deployment. Interpretation of these findings should consider limitations related to single-reviewer study selection, potential high-risk of bias, and the repeated use of benchmark datasets.
25 June 2026
Read appraisal →ACS applied materials & interfaces
Biodegradable Electrohydraulic Actuators for Wearable Haptic Interfaces
Biodegradable soft actuators have gained significant attention due to their inherent conformability, adaptability, and ability to safely interact with humans, while substantially reducing long-term environmental waste. Although various biodegradable materials have been explored for fabricating soft devices and their electrical interfaces, many still suffer from limited durability and operational stability under ambient conditions. In particular, biodegradable electrohydraulic actuators often exhibit a performance degradation over time. In this work, we systematically evaluate the influence of various biodegradable materials, including compliant electrodes, dielectric films, and dielectric fluids, on actuator performance. The optimal material combination was identified and used to fabricate a biodegradable actuator that demonstrated stable operation over 10,000 cycles with no noticeable variation in actuation strain. Under industrial composting conditions, the device underwent degradation within 50 days, supporting its environmental sustainability. Furthermore, a wrist-worn biodegradable haptic device is demonstrated that is capable of generating diverse and salient tactile sensations, highlighting its potential applications in assistive technology and virtual/augmented reality.
25 June 2026
Read appraisal →Journal of medical economics
From options to decisions: an innovative model for treatment sequencing in relapsing-remitting multiple sclerosis
AIMS: With the expanding range of disease-modifying therapies (DMTs) for relapsing-remitting multiple sclerosis (RRMS), clinicians face increasing complexity in defining optimal treatment sequences and timing of therapy switches. In this study, we adapted an earlier computer-assisted model to optimize therapeutic decisions and identify preferred treatment pathways, based on expert opinion and observations from clinical practice in Spain. MATERIALS AND METHODS: The original model was updated to integrate magnetic resonance imaging (MRI) activity data and define reaching an Expanded Disability Status Scale (EDSS) score of 3 - indicating moderate disability without ambulation impairment - as a criterion for switching treatment. Matrices were designed to model options when switching DMTs, triggered by either a lack of effectiveness or safety concerns. Change in DMT was based on a set of composite criteria (encompassing contributions from relapses, disability worsening, MRI activity, costs, and quality of life) according to the disease activity level. A maximum of three DMTs could be administered within the 8-year time horizon evaluated. RESULTS: The revised model identified high efficacy treatment, in particular cladribine tablets as the preferred initial DMT for patients with RRMS with mild or moderate disease activity. Of these patients with mild and moderate disease activity, most were switched to ofatumumab (79.4%) and ocrelizumab (75.9%), respectively, when disease progression occurred. Patients with high disease activity mostly received natalizumab if they were John Cunningham virus (JCV)-negative, or ocrelizumab if they were JCV-positive. LIMITATIONS: The model is informed by a Spain-based healthcare expert panel and has been evaluated using a simulated cohort of 10,000 patients with RRMS. CONCLUSION: This computational model helps to inform clinicians towards making optimal treatment decisions for RRMS, and identified high-efficacy DMTs as the preferred model-based option for all levels of disease activity, supporting early and effective control of disease activity in real-world clinical practice.
25 June 2026
Read appraisal →Psychological medicine
Sorting the mind: cognitive enhancement through transcutaneous auricular vagus nerve stimulation: a systematic review and meta-analysis
Transcutaneous auricular vagus nerve stimulation (taVNS) is a noninvasive technique engaging vagal afferents that may enhance cognition, but results vary across domains and samples. Following PRISMA, seven databases (inception-October 2025) plus registries and gray literature were searched. Random-effects meta-analyses (REML; Hedges' g) were complemented by Bayesian hierarchical models and sensitivity analyses. Fifty-three studies were included; 30 contributed quantitative data (>1,500 participants). taVNS was associated with improved cognitive performance overall (g = 0.41, 95% CI: 0.30-0.53; I2 = 51.4%). Effects were moderate for executive functions (g = 0.46, 95% CI: 0.27-0.65; I2 = 9.5%) and cognitive flexibility/learning (g = 0.53, 95% CI: 0.32-0.75; I2 = 52.9%), and small for working memory/attention (g = 0.19, 95% CI: 0.04-0.33; I2 = 14.9%). Social cognition/emotion regulation showed larger but imprecise effects (k = 3; g = 0.80, 95% CI: 0.07-1.52; I2 = 82.1%). Clinical samples benefited similarly (k = 7; g = 0.55, 95% CI: 0.31-0.79; I2 = 29.5%), with no difference from healthy cohorts (β = -0.001, p = .994). High-intensity protocols (>1.0 mA) yielded larger effects; mode, duration, and site were not moderators. Bayesian models supported effects (P [μ > 0] ≥ 0.93). taVNS is associated with statistically significant improvements in cognitive performance, strongest for executive control and adaptive learning. We propose a Vagal Neurocognitive Integration Model linking LC-NE arousal modulation to prefrontal control. Future diagnosis-specific, adequately powered trials with multimodal neuroimaging should refine mechanisms and dose-response.
25 June 2026
Read appraisal →Behavioural brain research
Sex differences in the use of spatial strategies in humans: An updated systematic review of the last decade.
Although sex differences in spatial cognition have been widely studied, the extent to which men and women differ in their use of egocentric and allocentric spatial strategies remains unclear. This systematic review summarizes findings from 21 studies published between 2014 and 2024 that examined sex differences in spatial strategy use throughout development, adulthood, and aging. Studies were identified through searches of Scopus, Web of Science, PubMed, and PsycINFO, in accordance with PRISMA guidelines. Eligible articles examined egocentric and allocentric spatial strategies in humans and reported results by sex. Results demonstrated male advantages in allocentric strategy, as observed in thirteen studies involving children, young adults, and older adults. Men also outperformed women in several navigation outcomes, including target retrieval, route efficiency, and directional accuracy. Evidence for a female advantage in egocentric strategies was limited and inconsistent. Seven studies reported no sex differences, particularly those using small-scale, familiar, or less immersive tasks. This suggests that methodological factors and task demands strongly influence the observed effects. Age also influenced outcomes. Male advantages in allocentric strategies emerged in early childhood. Older women showed relatively preserved egocentric abilities, but greater decline in allocentric tasks. Men showed stronger hippocampal-parietal connectivity supporting allocentric processing, while women exhibited enhanced fronto-temporal connectivity. Hormonal studies highlight the context-dependent effects of testosterone and estrogen. These findings indicate that sex differences in spatial strategies are highly sensitive to task complexity, environmental familiarity, cognitive load, and individual factors. These findings emphasize the necessity of integrative models that consider developmental, neurobiological, and sociocultural contributors.
25 June 2026
Read appraisal →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 →JMIR medical informatics
Computational Insights Into Smart Bioelectronics in Digital Health Care (2020-2024): Topic Modeling Study
BACKGROUND: Smart bioelectronics are electronic medical devices that combine hardware and artificial intelligence (AI)-based software. These convergent medical devices analyze bio-signals measured through hardware using AI algorithms and deliver physical stimulation to enhance therapeutic effects. OBJECTIVE: This study aimed to systematically analyze recent research trends in smart bioelectronics to understand their evolving role in digital health care and to provide evidence-based insights for shaping future research and development strategies. METHODS: A total of 92 publications indexed in PubMed between 2020 and 2024 were analyzed. Latent Dirichlet allocation-based topic modeling, optimized using coherence scores, was applied to identify latent research themes. RESULTS: The results indicate a steady increase in related research over the past 5 years, along with a clear shift in research focus from bio-signal sensing and bioelectronic device materials toward AI-driven analysis and disease-oriented applications, ultimately evolving into intelligent and adaptive bioelectronic therapeutic systems. Three major research topics were identified: bio-signal-based neuromodulation (n=23, 25%), AI-driven neurological disease analysis (n=32, 34.7%), and implantable bioelectronics and biomaterials (n=37, 40.2%). CONCLUSIONS: By mapping the evolving landscape of smart bioelectronics, this study provides valuable insights into their multidisciplinary development and highlights their potential applications in clinical decision support, personalized rehabilitation, and next-generation medical device innovation.
24 June 2026
Read appraisal →Journal of neural engineering
Recalibration of implantable brain-computer interfaces to enable long-term independent use - a systematic review
Background.Implantable brain-computer interfaces (iBCIs) decode neural signals to generate command signals for effector devices to restore lost functions, such as movement or speech. However, maintaining device performance over time requires recalibration of decoding algorithms due to inherent instability in neural signals.Objective.To systematically review recalibration procedures in iBCIs for patients with motor impairments, focusing on the clinical implications of recalibration requirements and strategies which can enable long-term, independent use.Approach.A systematic search was conducted across EMBASE, MEDLINE, and CINAHL databases to identify studies involving recalibration of iBCIs. Data on recalibration frequency, duration, staff requirements, and location were extracted and analyzed.Main results.Recalibration practices varied widely amongst studies and were typically performed according to predetermined study protocols, rather than practical need following deteriorating device performance. Common practices include manual recalibration requiring a specialist research team, semi-automatic recalibration which could be performed by a non-specialist caregiver, and automatic recalibration methods whereby patients did not require assistance. Devices utilizing electrocorticography (ECoG) recording arrays generally required less frequent recalibration compared to those using microelectrode arrays (MEAs). Extended independent use was more frequently reported with ECoG-based iBCIs.Significance.Reducing recalibration frequency or complexity can improve patient autonomy, which is crucial for enhancing long-term independent iBCI use in home and clinical settings. ECoG iBCIs typically have a low recalibration burden due to inherent signal stability. Conversely, MEA iBCIs typically involve a higher recalibration burden, though recent studies have reduced this by incorporating spectral data and continuously updating models. Despite this progress, recalibration procedures are often not fully defined in iBCI studies, and where they are, they usually relate to the study protocol rather than the clinically meaningful recalibration requirement due to worsening device performance. Future studies should continue to develop user-friendly recalibration procedures and outline the clinically relevant recalibration requirements where possible.
24 June 2026
Read appraisal →Journal of medical Internet research
Potential of Digital Tools for Chronic Pain Management
Chronic pain is notoriously complex to manage and treat. In this News and Perspectives article, JMIR Correspondent Vanessa Nirode reports on several digital innovations that may help to bridge existing care gaps.
24 June 2026
Read appraisal →PloS one
Applications of electromyography in Amyotrophic Lateral Sclerosis: A systematic review
This systematic review examined the use of surface electromyography (sEMG) for the neuromuscular assessment of individuals with Amyotrophic Lateral Sclerosis (ALS), focusing on clinical parameters, the muscle groups evaluated, acquisition protocols, technical properties of the recording systems, integration with other technologies, and signal processing strategies. We included observational studies that applied sEMG to individuals diagnosed with ALS, with or without comparison to healthy controls, and without restrictions on publication year. The analyses included signals recorded at rest and during voluntary contractions, with or without the use of biofeedback. Most studies employed conventional or high-density surface electrodes, with sampling frequencies ranging from 500 Hz to 3000 Hz. The results showed that the primary parameters assessed were muscle fatigue, fasciculation patterns, the number of motor units (MUNE/MUNIX), motor unit firing rates, and signal complexity. These parameters demonstrated sensitivity to disease progression and may contribute to early diagnosis, phenotypic stratification, and functional monitoring of ALS. Additionally, the studies highlighted the increasing use of advanced computational approaches, such as machine learning, for feature extraction and automated classification. In conclusion, sEMG is a promising tool for functional assessment in ALS, with the potential to improve diagnostic accuracy and support new therapeutic strategies based on electrophysiological biomarkers. However, despite technological advances, the included studies displayed substantial methodological heterogeneity and limited protocol standardization. Integration with other neurophysiological modalities also remains underexplored, despite its significant clinical potential.
23 June 2026
Read appraisal →PloS one
Inhaled nitric oxide in fibrotic and advanced interstitial lung disease: A systematic review and meta-analysis of randomized controlled trials.
PURPOSE: Interstitial lung disease (ILD) can lead to pulmonary hypertension (PH), contributing to reduced exercise capacity in patients with ILD. Inhaled nitric oxide (iNO) reduces pulmonary artery pressure and pulmonary vascular resistance and may improve exercise capacity in this population; however, the available evidence remains limited. Therefore, we conducted a systematic review and meta-analysis to compare the efficacy and safety of iNO versus placebo in patients with ILD. METHODS: We systematically searched PubMed, Embase, Cochrane databases, and ClinicalTrials.gov for randomized controlled trials (RCTs) comparing iNO with placebo in patients with ILD. The primary endpoint was 6-minute walk distance (6MWD). Secondary endpoint was moderate-to-vigorous physical activity (MVPA). Safety endpoint was any adverse events. Continuous endpoints were reported using mean differences (MDs) or standardized mean differences (SMDs), and binary endpoints were reported using risk ratios (RRs), all with 95% confidence intervals (CIs). RESULTS: Four RCTs, including one crossover trial, enrolling 274 patients were analyzed. Of these, 172 received iNO. The median follow-up period was 12 weeks. In the pooled analyses, iNO likely results in little to no difference in 6MWD compared with placebo (MD 1.83m; 95% CI -12.98 to 16.64; p = 0.81), and may result in little to no difference in any adverse events (RR 1.12; 95% CI 0.97 to 1.30; p = 0.12) and MVPA (SMD 0.32; 95% CI -0.93 to 1.56; p = 0.39). CONCLUSION: INO did not demonstrate improvements in 6MWD or MVPA. These findings do not support routine use of iNO in this population.
23 June 2026
Read appraisal →European journal of pediatrics
Subtypes in developmental coordination disorder: what do we know so far? A systematic review.
UNLABELLED: Developmental coordination disorder (DCD) is a highly heterogeneous disorder. This systematic review examined whether statistically derived clusters can effectively distinguish subgroups of children with DCD. Web of Science, Scopus, PubMed, Embase, and PsycInfo were systematically searched (CRD420251237685) using controlled terminology and free-text terms. Studies were eligible if they included children (aged 0-18 years) with DCD with(out) comorbidities and employed statistical clustering to identify subtypes. Methodological quality was assessed using an adapted version of the Critical Appraisal Skills Programme and certainty of the evidence with the Grading of Recommendations Assessment, Development and Evaluation. Ten of the 1719 search results were included, three of which included both children with DCD and typical development. Two studies explored clusters unidimensionally (motor-only and mental health-only). Eight studies included multiple domains of functioning: motor (n = 8), sensory functions (n = 5), fitness (n = 3), cognitive functions (n = 3), executive functions (n = 2), mental health (n = 1), and participation (n = 1). Studies identified between four (n = 4) and six (n = 1) subtypes, which primarily reflected gradients of severity rather than distinct domain-specific profiles. The overall certainty of evidence for distinct subtypes in DCD was rated low to very low. CONCLUSION: Evidence suggests that DCD is better conceptualized as a spectrum of pervasiveness rather than discrete subtypes. Existing findings lack consistency across studies due to methodological shortcomings and variable measurement domains. Although evidence-based clinical subtypes cannot yet be recommended, future research should prioritize subtyping studies focused on primary symptoms to better identify potential phenotypes within the DCD population. WHAT IS KNOWN: • DCD is a heterogeneous condition, and identifying discrete subtypes is a long-standing research goal to improve clinical support. • Researchers have proposed various motor and non-motor profiles, but no consensus exists on a definitive subtyping model. WHAT IS NEW: • This review found no consistent discrete subtypes, suggesting DCD is better viewed as a spectrum of pervasiveness rather than categories. • Future research should focus on subtyping primary motor symptoms to determine whether distinct, stable subgroups exist within the broader DCD population.
22 June 2026
Read appraisal →Bioinspiration & biomimetics
A bioinspired hybrid robotic joint for safer physical human-robot interaction
In many robotic applications, such as humanoids, wearable robots or supernumerary limbs, there is a growing shift from rigid, traditional mechanisms toward softer, more compliant systems. This trend is driven by the need for safer physical human-robot interaction and the ability to operate in unstructured environments. In this work, we present a hybrid approach to controlling a single-degree-of-freedom robotic joint that combines a rigid frame with soft pneumatic actuators to enable both precise and versatile interaction. The joint is bioinspired, as it is powered by a couple of actuators mounted in an antagonist configuration, such as the human elbow. A key innovation is the design of pneumatic artificial muscles using thermoplastic polyurethane, which achieve high isometric force (400 N at 240 kPa), significant stretchability (80 mm), and low density(0.3gcm-3), making them competitive with state-of-the-art alternatives. Two model-free controllers were developed to independently regulate joint position and stiffness. Angle control achieved high precision (<2∘RMSE) with minimal overshoot (<1%) and fast response (rise time<1.3s). Stiffness control modulated joint compliance across a range of 0.054-0.076 Nm deg-1, with the expected trade-off of reduced workspace. A final proof-of-concept demonstrated the concurrent use of both controllers to modulate the joint's dynamic behavior in response to external disturbances. While future work will address multi-DOF coordination and wearable integration, this study represents a foundational step toward safe, adaptable robotic actuation through the combination of rigid structures and soft actuation.
21 June 2026
Read appraisal →Science advances
Bioinspired heliconical auxetic biofibers for intelligent biomechanical surveillance
Wearable bio-based fibers are emerging as platforms for biomechanical sensing and physiological interaction. However, achieving high sensitivity to subtle mechanical cues while maintaining flexibility, self-powered output, and distributed perception remains challenging. Inspired by the helical twining mechanics of climbing plant stems, we design a mechano-adaptive auxetic electronic bio-based fiber as an embodied intelligence sensing unit. The dual-modulus helical confinement, achieved by wrapping rigid aramid fiber/polydimethylsiloxane helices around a flexible collagen aggregate/waterborne polyurethane core, enables programmable deformation and a stable negative Poisson's ratio (ν = -0.47). Nonlinear intercomponent coupling facilitates synergistic axial-radial dynamics, amplifying interfacial contact variation under strain. The optimized fiber exhibits ultrahigh sensitivity (strain factor: 11.75), strong electrical output (8.1 volts), and remarkable power density (8.48 milliwatts per square meter) with excellent cyclic stability. Integrated into fiber-sensing arrays, it decodes microstrain patterns linked to lower-limb function, offering a scalable strategy for self-powered, adaptive, and durable biomechanical monitoring.
21 June 2026
Read appraisal →Progress in biomedical engineering (Bristol, England)
Assessing the relevance of biosignal-controlled robotic rehabilitation technologies: a systematic review.
Technology is transforming rehabilitative medicine by enhancing accessibility and personalisation. Robot-assisted rehabilitation uses robotic systems for recovery from physical and neurological impairments, enabling intensive, repetitive training with real-time feedback. These systems aim to restore motor function and mobility and to increase independence in daily life, needs that are growing in light of population ageing. Rather than revisiting control algorithms or mechanical design, this review aims to investigate the combined use of bio-signals and robotic rehabilitation systems, and to discuss their potential in rehabilitation settings outside disease-specific clinical frameworks. We reviewed studies published from 2020 through early 2025 to capture recent advances in this rapidly evolving field. Our objective was to assess the relevance of these technologies to rehabilitation outcomes, such as improvements in motor function or other clinical metrics. We considered robot-assisted systems driven by biosignals such as electromyography (EMG), electroencephalography, or electrocardiography and included only studies reporting measurable rehabilitative outcomes. Following PRISMA guidelines, we searched Scopus, PubMed, and WoS databases. Of 207 records screened, 15 met the inclusion criteria. Overall, the included studies suggest that contemporary biosignal-controlled robotic rehabilitation, particularly EMG-driven approaches, may support more intensive, personalised, and engaging therapy than conventional care alone, although the current evidence remains preliminary. Preliminary findings indicate that, by closing the loop among patient, device, and therapist, these systems may reduce muscle activity and support improvements in motor performance; however, the evidence base remains heterogeneous and generally underpowered. To support future clinical adoption, the field needs adequately sized, head-to-head trials with standardised outcome measures, longer follow-up, and transparent reporting of adherence, adverse events, user experience, and implementation barriers, including training and cost. These steps will be important to further assess efficacy and evaluate usability in real-world settings.
20 June 2026
Read appraisal →ACS nano
Learning Human-Environment Interactions via Wearable AI Interfaces
Wearable artificial intelligence (AI) interfaces are reshaping the boundaries between humans and the environment. While prior works often focus on narrow human-machine interactions, this review proposes an intact interaction information flow. It introduces a comprehensive interaction blueprint spanning local interaction and global interaction to the interaction entity, showing how humans interact with the environment. This review first examines advances in wearable form factors, sensing performance improvement strategies, and data analysis. Special emphasis is onspot on how AI interprets heterogeneous data from tactile signatures for local interaction, wearable vision for global interaction with human motion, and electrophysiological signals for the interaction entity. We then discuss the essential applications of this interaction framework, such as human-machine interaction and smart healthcare. By discussing potential barriers in device reliability, algorithm generalization, and scalable applications of wearable AI interfaces, this review provides an outlook on data-driven inverse sensor design, general intelligence strategies, and building a standard ecosystem for scalable applications. The wearable AI interfaces are toward on-body intelligence, actively perceiving, understanding, and assisting in the complex dynamic human-environment interactions.
19 June 2026
Read appraisal →British journal of sports medicine
Randomised three-armed trial investigation of the Copenhagen Achilles tendon Rupture Treatment Algorithm (CARTA) for individualised treatment of acute Achilles tendon rupture
OBJECTIVE: To evaluate whether individualised treatment using the Copenhagen Achilles Rupture Treatment Algorithm (CARTA) is superior to default operative or non-operative strategies. METHODS: We conducted a multicentre, three-arm, randomised controlled trial. Adults with acute Achilles tendon rupture were randomised (1:1:1) to individualised CARTA, non-operative or operative treatment. In the CARTA arm, surgery was indicated if ultrasound showed<25% tendon overlap or ≥7% elongation. The primary outcome was the Heel-Rise Work Test (HRWT) at 12 months. Secondary outcomes included HRWT at 6 months, and at both 6 and 12 months, the Heel-Rise Height, Achilles tendon Total Rupture Score (ATRS), Tegner activity scale, Copenhagen Achilles tendon Length Measure, Achilles Tendon Resting Angle (ATRA) and complication recordings. RESULTS: Between May 2018 and June 2023, 970 patients were screened; 300 were randomised (male/female 76%/24%, mean age 41 (SD 1)). At 12 months, data were available for 98 CARTA (64% operated), 100 non-operative and 97 operative patients. There were no significant between-group differences in HRWT at 12 months. However, CARTA significantly reduced rerupture rates by 73% compared with non-operative treatment (3% (95% CI) (1 to 8) vs 11% (6 to 19), p=0.03), improved ATRS by 8 points (1 to 15, p=0.02) and improved ATRA by -2° (-4 to -1), p=0.01). No difference between CARTA and operative treatment was found except 36% less underwent surgery. CONCLUSION: Individualised CARTA did not improve functional outcomes based on the HRWT at 12 months, but among secondary outcomes, it reduced rerupture rates and improved patient-reported outcomes compared with non-operative treatment and with fewer surgeries than routine operative care. TRIAL REGISTRATION NUMBER: NCT03525964.
14 June 2026
Read appraisal →British journal of sports medicine
Multimodal symptom-targeted treatment for young people with persisting post-concussion symptoms: a randomised clinical trial
OBJECTIVE: To evaluate the effectiveness of Concussion Essentials (CE), a symptom-targeted, multidisciplinary treatment for persisting post-concussion symptoms (PPCS). METHODS: This single-site, open-label, assessor-blinded, parallel-group randomised clinical trial recruited 8-18-year-olds within 17 days of concussion from the emergency department of a tertiary paediatric hospital and from community referrals. Participants who endorsed ongoing PPCS on review at 14 (±3) days post-injury were invited to a baseline assessment at 3 weeks post-injury, where symptoms were re-assessed. Symptomatic participants were randomised to CE or usual care (UC). CE participants received individualised, multidisciplinary treatment modules (education, psychological, physiotherapy) for up to 8 weeks, while UC participants received weekly monitoring. Primary outcome was full recovery at intervention completion, defined as <1 symptom of increased severity compared with pre-injury on the Post-Concussion Symptom Inventory, parent version (PCSI-P). RESULTS: Participants were recruited between August 2019 and July 2024. Outcomes were analysed for 158 participants (CE=78; UC=80, mean age 13±2.5 years, 57.6% male). Pre-treatment PCSI-P total mean scores were: CE 36.7 (95% CI 31.0 to 42.4) and UC 33.5 (95% CI 28.4 to 38.7). Proportions with full resolution were CE 62.5% and UC 37.0% (adjusted risk difference=25.5%, 95% CI -10.0 to 41.0%). Post-treatment mean scores were CE 8.5 (5.9-11.2), UC 21.8 (95% CI 15.6 to 27.9) (p<0.0001). Seven adverse events, unrelated to trial factors, were recorded. CONCLUSION: Individualised, multidisciplinary treatment is associated with accelerated recovery in young people with PPCS. Implementation of such approaches should be considered in routine clinical care of concussion. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (number: ACTRN12617000418370).
14 June 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Feasibility and acceptability of ExerciseGuideUK for those living with and beyond lung cancer: a mixed methods study
PURPOSE: Digital health interventions offer promise for addressing unmet needs in individuals living with and beyond lung cancer (LWBLC). ExerciseGuideUK, a personalised, web-based exercise platform, was developed for those LWBLC. This study aimed to evaluate ExerciseGuideUK. METHODS: Participants were recruited from Hull University Teaching Hospital and used ExerciseGuideUK over eight weeks. Feasibility and acceptability were assessed using quantitative measures, including the System Usability Scale, structured questionnaires, and qualitative interviews (guided by the Theoretical Framework of Acceptability). A novel mixed-methods integration approach called the Pillar Integration process (PIP) was used to integrate quantitative and qualitative findings on feasibility, engagement, barriers, and adaptation potential. RESULTS: Eighteen participants (mean age 65 ± 14.42y) enrolled. Recruitment and retention rates were 30.5% and 77%, respectively. Notably, 25.4% of those screened were excluded due to digital access issues, including some participants who owned smartphones, suggesting limited digital literacy. Among those who participated, acceptability, usability, and engagement were high. Valued features included goal-setting tools, breathlessness management strategies, and personalised exercise prescriptions. Barriers included treatment side effects, work responsibilities, and low confidence with technology. CONCLUSION: ExerciseGuideUK showed moderate feasibility and high acceptability among users. This is the first known application of PIP in the context of lung cancer, exercise, and digital health. The PIP facilitated a comprehensive understanding of feasibility and acceptability, guiding informed adaptations by users. The PIP warrants further testing and refinement in relation to optimising digital intervention design that promotes equitable, patient-centred care. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05121259.
14 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 →Current pain and headache reports
Artificial Intelligence in Neuropathic Pain: From Mechanisms to Neuromodulation and Regenerative Strategies
PURPOSE OF REVIEW: Neuropathic pain remains challenging due to its heterogeneous mechanisms and variable treatment response. This narrative review evaluates recent advances in artificial intelligence (AI) and machine learning (ML) for patient phenotyping, treatment selection, outcome prediction, neuromodulation, and regenerative therapies. RECENT FINDINGS: ML-based phenotyping integrates genomic, neuroimaging, sensory, and behavioral data. Multimodal automatic pain assessment is approaching clinical deployment, supported by recent expert consensus. Large language models have been benchmarked against multidisciplinary teams for spinal cord stimulation (SCS) candidate selection. Real-world cohort data confirm sustained 24-month SCS benefit. AI is increasingly applied to regenerative interventions, including pulsed radiofrequency, which is now linked to epigenetic remodeling of dorsal root ganglion pathways. Most studies remain single-center and retrospective. AI may enable mechanism-based stratification, individualized neuromodulation programming, and rational integration of regenerative therapies in the treatment of neuropathic pain. Robust prospective validation, transparent reporting, and ethical safeguards are required before approaching translational maturity in selected settings.
13 June 2026
Read appraisal →PloS one
Feasibility of mechanomyography-based fatigue classification for passive lower-limb exoskeleton evaluation: A pilot study
Mechanomyography (MMG) enables non-invasive monitoring of muscle mechanical activity, while its utility in time-resolved fatigue detection during dynamic human-exoskeleton interaction remains underexplored. This pilot study explored the feasibility of combining MMG with machine learning to characterize neuromuscular fatigue and evaluate passive lower-limb exoskeleton assistance during repetitive 10 kg squat-lifting tasks. MMG signals from five lower-limb muscles were extracted for time-domain, frequency-domain and nonlinear features, and fatigue identification was implemented via a spectral-based criterion and multi-muscle voting optimization. A radial basis function-enhanced random forest (RBF-RF) model integrated with data augmentation was validated through leave-one-subject-out cross-validation. The results demonstrated that the 1/5 voting rule achieved optimal performance, with mean accuracy of 0.913 ± 0.057, AUC of 0.792 ± 0.073, and a low fatigue detection error of 1.4 ± 0.8 s. Data augmentation steadily improved model robustness, and predicted fatigue levels were significantly correlated with subjective perceived exertion (ρ = 0.756, p < 0.001). This pilot study demonstrates the feasibility of MMG-based fatigue monitoring for wearable assistive systems. The proposed framework supports objective, high-temporal-resolution fatigue monitoring, and may serve as a viable tool for assessing wearable assistive systems. Further large-cohort studies are required to validate its generalizability for practical applications.
13 June 2026
Read appraisal →Annals of medicine
Analgesic effect of premixed nitrous oxide in postoperative rehabilitation for ankle fractures: a randomized controlled trial
INTRODUCTION: The global incidence of ankle fractures is on the rise, effective postoperative rehabilitation is a crucial aspect of surgical management. However, the occurrence of severe pain during the rehabilitation continues to pose a substantial clinical challenge. METHODS: The study utilizes a dual-arm, single-center, double-blind, randomized controlled trial design. A total of 100 participants were enrolled. Participants included patients experiencing acute pain (self-reported pain score ≥4) who underwent postoperative rehabilitation for ankle fractures. Participants undergoing rehabilitation training were randomized to receive either 65% nitrous oxide or 100% oxygen. The primary outcome measured was the pain score, while secondary outcomes encompassed anxiety scores, physiological indices, side effects, patient and therapist satisfaction, acceptance, and residual pain. RESULTS: Pain scores were found to be significantly lower in the nitrous oxide group than in the oxygen group (T1: median difference -3.0, [95% CI -3.4 to -2.6]; p < 0.001; T2: median difference -2.0, [95% CI -2.8 to -1.2]; p < 0.001). Compared with the oxygen group, both therapists (p < 0.001) and participants (p < 0.001) in the nitrous oxide group reported significantly higher satisfaction levels. Acceptance rate showed significant intergroup differences (p < 0.001). No severe adverse effects were observed in either group. Anxiety scores between the two groups did not show a significant difference (p = 0.31, η2 = 0.027). CONCLUSION: The safety and analgesic profile of nitrous oxide renders it a suitable option for pain management in postoperative ankle fractures rehabilitation, thus providing a safe and easily manageable alternative to the current available strategies. CLINICAL TRIAL REGISTRATION: We have registered at https://www.chictr.org.cn and the registration number is: ChiCTR2400089379. In comparison with oxygen gas, nitrous oxide has been demonstrated to reduce pain during rehabilitation training following ankle fracture surgery, offering a practical and effective alternative to oral analgesics.The use of nitrous oxide in postoperative rehabilitation training for ankle fractures is relatively safe, with few and mild adverse reactions.Patients and rehabilitation therapists reported high satisfaction with nitrous oxide intervention, and residual pain was significantly reduced.
12 June 2026
Read appraisal →Scientific reports
Influence of a passive shoulder exoskeleton on drilling performance in women- a cross-sectional study
Work-related musculoskeletal disorders are common, especially among women performing repetitive overhead tasks. In a randomized 2 × 2 crossover study with 14 female participants, we investigated the effects of a passive upper-body exoskeleton during an overhead precision task, involving the tightening of 20 bolts into a sensor-based workstation, while muscle activation, task performance, and usability were assessed. The results showed significant reduced M. Trapezius muscle activations during arm lowering (p = .041, 73%), and lower target accuracy (p < .001, 100%) when using the exoskeleton. Subjective strain in the shoulders was significantly lower when using the exoskeleton (p = .035, 15%). The usability was rated as "unacceptable", with users criticizing the complexity and learning effort. While the exoskeleton reduced muscle load, its mechanical limitations impaired precision and usability, especially for women. These results highlight the importance of sex-specific, ergonomic, and adaptive designs to improve exoskeleton effectiveness and acceptance.
11 June 2026
Read appraisal →International journal of biometeorology
Impact of balneotherapy on drug consumption: a systematic review and an economic evaluation of drug deprescribing
Some previous studies have suggested that balneotherapy could be associated with a decrease in drug consumption. No study has investigated pharmacoeconomic consequences in terms of monetary savings. The present study was performed to evaluate potential savings (according to societal perspective) associated with decreased drug consumption resulting from spa treatments using randomized clinical trials (RCT) identified after a systematic review. Among 48 RCT, 8 trials investigating rheumatological diseases (low back or shoulder pain, osteoarthritis, ankylosing spondylitis, fibromyalgia), were included in the economic evaluation of direct costs (€) using 2024 data of drug reimbursements according to French health insurance data. Savings calculated related to non-steroidal anti-inflammatory drugs (NSAIDs') decrease were between €0.05 million and €1.03 million at 6 months (mean value: €504.900) for the 441,776 patients who underwent rheumatology-oriented spa treatment in France in 2024 versus controls. For analgesics, values ranged from €0.73 million to around €2.31 million (mean value: €1,547.400). Despite several limitations that could not be overlooked (heterogeneity of studied populations, interventions, duration, outcome measures), the study showsfor the first timethat decreased drug consumption resulting from balneotherapy is associated with important savings regarding NSAIDs and, to a greater extent, analgesics. Balneotherapy is a unique opportunity for deprescribing, enabling both significant monetary savings for national health insurance, complementary health insurances and patients, while preventing adverse drug reactions or decreasing physiotherapy sessions or hospitalizations.
11 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 →JMIR formative research
User Perspectives on a Clinical Decision Tool to Support Individualized Exercise Prescriptions for Breast Cancer Survivors Not Meeting Exercise Guidelines: Cross-Sectional Survey
BACKGROUND: More than 80% of breast cancer survivors do not meet the recommended levels of exercise, and <50% of health care providers promote exercise as part of survivorship care. Patient-provider communication may enhance exercise engagement by increasing patients' understanding of exercise benefits and linking patients to resources, such as rehabilitation and exercise programs. OBJECTIVE: This study aimed to explore perspectives on a novel clinical decision tool designed to support individualized exercise discussions and prescriptions among breast cancer survivors who do not meet exercise guidelines and health care providers who primarily treat such survivors. METHODS: We conducted a cross-sectional online survey among US breast cancer survivors and health care providers. Participants were (1) female breast cancer survivors aged ≥35 years engaging in ≤150 minutes/week of moderate-intensity aerobic exercise or ≤2 days/week of muscle-strengthening exercise and (2) health care providers who had cared for breast cancer survivors within the past 12 months and reported below-average guideline adherence among their patients. Respondents reviewed a paper draft of a web-based clinical decision prototype tool for supporting individualized exercise discussions and prescriptions based on patients' demographic, clinical, and contextual characteristics. We assessed perceived usefulness, potential uses (eg, counseling), preferred timing of access within clinical encounters, and preferences for tool characteristics (inputs/outputs). RESULTS: The analytic sample comprised 26 breast cancer survivors and 69 health care providers. The survivors' median age was 48 (IQR 37-65) years. Providers included patient navigators/social workers/nurses (29/69, 42.0%), breast oncologists (13/69, 18.8%), and occupational/physical therapists (12/69, 17.4%). The majority of providers (62/69, 89.9%, 95% CI 80.2%-95.8%) and survivors (23/26, 88.5%, 95% CI 69.8%-97.6%) reported that they would find the tool useful. Similarly, 85.5% of providers (59/69, 95% CI 75.0%-92.8%) and 84.6% of survivors (22/26, 95% CI 65.1%-95.6%) reported that the tool would increase their confidence to discuss exercise in a clinical setting. Both groups preferred that survivors access the tool with staff after a medical appointment (survivors: 20/26, 76.9%, 95% CI 56.4%-91.0%; providers: 58/67, 86.6%, 95% CI 76.0%-93.7%). Both groups also endorsed treatment history and readiness to exercise to consider as key inputs and improved quality of life and reduced treatment-related side effects as exercise benefits to communicate as tool outputs. CONCLUSIONS: The prototype tool concept was well received, with high endorsement of individual characteristics to consider and clinical benefits of exercise to communicate. Findings will inform refinement of the tool and future implementation testing in an understudied population of breast cancer survivors.
11 June 2026
Read appraisal →Neurology
Vamorolone Safety, Pharmacokinetics, and Exploratory Efficacy in Duchenne Muscular Dystrophy: A Phase II, Nonrandomized, Multiple-Dose Study in 2-<4-Year-Old Boys
BACKGROUND AND OBJECTIVES: Vamorolone is a dissociative corticosteroid (CS) approved by the US Food and Drug Administration in 2023 for treating Duchenne muscular dystrophy (DMD). This study evaluated the safety, tolerability, and pharmacokinetics (PK) of vamorolone in young boys with DMD; exploratory objectives included efficacy and patient-reported outcomes. METHODS: A 12-week, phase II, open-label, multiple-dose study (VBP15-006) enrolled CS-naive boys with DMD aged 2-<4 years in Canada. Participants received 2 or 6 mg/kg/d oral vamorolone. An ongoing expanded access protocol (EAP) provided longer-term data. Primary end points were the occurrence of treatment-emergent adverse events (TEAEs) and changes from baseline to week 12 in height, weight, and body mass index (BMI); other end points included PK and effects of vamorolone on muscle function. RESULTS: Twenty boys (mean age [SD] 3.4 [0.39] years) with similar baseline characteristics were enrolled; all completed VBP15-006 and 19 continued to receive vamorolone through EAP Canada. TEAEs were mostly mild, with no deaths, serious TEAEs, or TEAEs leading to drug discontinuation during VBP15-006. TEAEs were more frequent with 6 mg/kg/d vamorolone than with 2 mg/kg/d, with gastrointestinal disorders and infections/infestations, respectively, most reported. Vamorolone use was associated with morning serum cortisol reductions in all patients, more pronounced with 6 mg/kg/d. Stable growth trajectories were observed at both doses throughout VBP15-006 and the EAP Canada follow-up period, with a total median (Q1; Q3) exposure to vamorolone of 2 years (1.7; 2.3). By EAP Canada last visit, 8/19 patients had weight and BMI z-scores changes >0.5, suggestive of excessive weight gain over time. Vamorolone displayed a dose-dependent PK profile with rapid absorption and no accumulation. Dose-dependent improvements in motor function (measured by Bayley-III gross motor scaled score) were observed. Glucose metabolism and bone turnover biomarkers remained stable. Ease of administration was rated favorably. DISCUSSION: Vamorolone was well tolerated in 2-<4-year-old boys with DMD, with no new safety concerns identified. A dose-dependent PK profile was observed, consistent with previous studies. Exploratory evidence suggested dose-dependent improvements in gross motor function. These findings are consistent with potential therapeutic benefit of vamorolone for young boys with DMD. TRIAL REGISTRATION INFORMATION: ClinicalTrials.gov: NCT05185622 (VBP15-006; clinicaltrials.gov/study/NCT05185622), NCT03863119 (EAP; clinicaltrials.gov/study/NCT03863119). First submitted November 9, 2021. First patient enrolled: March 21, 2022. CLASSIFICATION OF EVIDENCE: The VBP15-006 study provides Class IV evidence that in boys with DMD aged 2-<4 years, 12-week treatment with vamorolone was not associated with serious adverse events or changes in weight, height, or BMI. Gastrointestinal events and infections were the most reported TEAEs.
9 June 2026
Read appraisal →Behavioural brain research
Function-specific repetitive transcranial magnetic stimulation enhances motor strategy adaptation when combined with motor practice.
Effective motor strategy adaptation is essential for both high-performance sports and neurorehabilitation. Repetitive transcranial magnetic stimulation (rTMS) can modulate brain function; however, its efficacy may depend on the specificity of the stimulation targets. This study investigated whether function-specific rTMS, guided by fMRI-defined activation during motor imagery, enhances motor strategy adaptation. Forty-six healthy adults were randomized into three groups: function-specific rTMS, hotspot rTMS, and a no-stimulation control. All participants received identical motor imagery and physical practice in the backward glide shot put. Kinematic and resting-state functional magnetic resonance imaging (rs-fMRI) data were collected before and after the 7-day intervention, and functional connectivity (FC) was analyzed. Results showed that function-specific rTMS led to significantly greater improvements in trunk angle during the glide phase, a critical biomechanical parameter. FC between the right inferior frontal gyrus (IFG) and primary sensorimotor cortex increased significantly in this group and was positively correlated with kinematic improvements. These findings demonstrate that rTMS targeting task-relevant brain regions enhances motor strategy adaptation via mechanisms involving FC associated with motor performance, highlighting its potential for optimizing motor learning in both athletic and clinical populations.
7 June 2026
Read appraisal →Behavioural brain research
Effects of anodal transcranial direct current stimulation on athletic performance among elite athletes: A systematic review and meta-analysis
BACKGROUND: Non-invasive brain stimulation techniques, such as transcranial direct current stimulation (tDCS), have been proposed as promising approaches for enhancing motor performance. However, evidence regarding their effects on different domains of athletic performance in elite athletes remains inconclusive. OBJECTIVE: This study aims to quantify the effects of anodal tDCS on athletic performance in elite athletes, compared with a sham condition. METHODS: A comprehensive search of six electronic databases (PubMed, Web of Science, SportDiscus, ECSCO, Embase, and the Cochrane Library) was conducted to identify randomized clinical trials (RCTs). Standardized mean differences (SMDs) based on post-intervention scores were pooled using random-effects models to estimate pooled effect sizes. Subgroup analyses were performed to examine potential moderating variables. Study quality and risk of bias were evaluated using the Cochrane Risk of Bias Tool. RESULTS: A total of 18 studies involving 259 elite athletes were included in the analysis. The results indicated that anodal tDCS had a moderate but significant overall effect on athletic performance in elite athletes (SMD = 0.57, 95% CI [0.39, 0.75], p < 0.01), although moderate heterogeneity was observed ( I²= 51.38%). Subgroup analyses revealed significant domain-specific variability: the effects were strongest in sport-specific performance (SMD = 0.79, 95% CI [0.51, 1.08], p < 0.01) and physical fitness (SMD = 0.58, p < 0.01), whereas the effects on recovery (SMD = 0.17, p = 0.65) and psychological variables (SMD = 0.38, p = 0.09) were negligible and non-significant. Additionally, the M1 area was found to be the most effective cortical target. CONCLUSIONS: Our findings provide evidence that anodal tDCS is a promising tool for enhancing performance in elite athletes, but its effectiveness is highly domain-dependent. It is particularly potent for improving sport-specific skills and physical fitness, while its role in accelerating recovery remains unsupported. Coaches and practitioners should consider these domain-specific variations and the ceiling effect of elite populations when designing tDCS interventions.
7 June 2026
Read appraisal →Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation
Association of intensive blood pressure lowering with health-related quality of life after endovascular thrombectomy: a post-hoc analysis of the ENCHANTED2/MT trial
BACKGROUND AND PURPOSE: Intensive blood pressure (BP) targets of less than 120 mm Hg have been shown to worsen functional outcomes after endovascular thrombectomy (EVT) for acute ischemic stroke. However, their effects on self-reported health-related quality of life (HRQoL) remain uncertain. METHODS: This post-hoc exploratory analysis used data from ENCHANTED2/MT, an open-label, blinded-endpoint randomized trial conducted in 44 Chinese hospitals. Adults with elevated BP within 3 h after successful reperfusion were randomized to intensive (< 120 mmHg) or less intensive (140-180 mmHg) systolic BP targets. HRQoL at 90 days was assessed using the EQ-5D-3 L and EQ visual analogue scale (EQ VAS). Functional outcome was measured by the modified Rankin Scale (mRS). Treatment effects were estimated using adjusted regression models, and causal mediation analysis was performed to explore indirect and direct pathways. RESULTS: Of 816 randomized patients, EQ-5D data were available in 685. At 90 days, both EQ-5D index (0.66 vs. 0.72) and EQ VAS (73.01 vs. 76.84) were lower in the more intensive BP group. Adjusted mean differences favored the less intensive treatment group: 0.06 (95% CI, 0.01 ~ 0.11; P = 0.017) for EQ-5D index and 3.49 (95% CI, 0.38 ~ 6.60; P = 0.028) for EQ VAS. Mediation analysis showed that the association of intensive BP lowering with worse HRQoL was mainly indirect via worse mRS outcomes. CONCLUSIONS: Intensive BP lowering after EVT was associated with modestly worse HRQoL at 90 days. The observed differences were small in magnitude, particularly for EQ VAS relative to commonly reported thresholds for clinical importance. These findings are consistent with less intensive BP targets after EVT and highlight the importance of incorporating patient-reported outcomes in acute stroke trials. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov number, NCT04140110 the Registration Date, 22/10/2019.
7 June 2026
Read appraisal →Lancet (London, England)
Efficacy and safety of a bodyweight-adjusted higher dose of ocrelizumab in relapsing (MUSETTE) and primary progressive (GAVOTTE) multiple sclerosis: two multicentre, randomised, double-blind, parallel-group phase 3b trials.
BACKGROUND: Ocrelizumab is a humanised anti-CD20 monoclonal antibody approved for people with relapsing (RMS) or primary progressive multiple sclerosis (PPMS). In a post-hoc analysis of phase 3 trials in RMS and PPMS using a 600 mg dose, higher exposure to ocrelizumab was associated with greater B-cell depletion and lower risk of confirmed disability progression. Here, we prospectively assessed the efficacy and safety of a high dose of ocrelizumab in patients with RMS or PPMS. METHODS: Two multicentre, double-blind, phase 3 controlled trials were conducted to compare high-dose ocrelizumab with the approved 600 mg dose of the drug in patients with RMS (MUSETTE) and PPMS (GAVOTTE) aged 18-56 years. MUSETTE involved 122 centres in 21 countries and GAVOTTE involved 149 centres in 22 countries. Participants were randomly assigned 2:1, with a permuted-block randomisation method, to high-dose ocrelizumab (1200 mg or 1800 mg for baseline body weight <75 kg or ≥75 kg, respectively) or 600 mg ocrelizumab. Patients, investigators, and the sponsor were blinded to treatment allocation. Patients received ocrelizumab infusions every 24 weeks for a minimum 120 weeks and until a prespecified minimum number of confirmed disability events (MUSETTE, 205; GAVOTTE, 357) had occurred. In both trials, the primary endpoint was time to onset of 12-week composite confirmed disability progression (cCDP), assessed by prespecified increases in Expanded Disability Status Scale, Timed 25-Foot Walk Test, or 9-Hole Peg Test scores. Efficacy endpoints were evaluated in all randomised participants and safety endpoints were evaluated in participants who received at least one ocrelizumab infusion. These studies are registered with ClinicalTrials.gov: MUSETTE, NCT04544436; GAVOTTE, NCT04548999. FINDINGS: Participants in MUSETTE were enrolled between Nov 26, 2020, and Aug 30, 2022; participants in GAVOTTE were enrolled between Dec 3, 2020, and May 15, 2023. In MUSETTE, 860 patients were randomly assigned (high-dose ocrelizumab, n=577; 600 mg ocrelizumab, n=283) and had median overall treatment duration of 184·4 weeks. In GAVOTTE, 753 patients were randomly assigned (high-dose ocrelizumab, n=500; 600 mg ocrelizumab, n=253) and had median overall treatment duration of 174·1 weeks. In MUSETTE, the percentage of patients with 12-week cCDP was 34% (198 of 577) with high-dose ocrelizumab versus 37% (104 of 283) with 600 mg ocrelizumab (hazard ratio [HR] 0·93 [95% CI 0·73-1·18]; p=0·53). In GAVOTTE, the percentage of patients with 12-week cCDP was 47% (235 of 500) with high-dose ocrelizumab versus 49% (124 of 253) with 600 mg ocrelizumab (HR 0·95 [95% CI 0·76-1·18]; p=0·64). Safety profiles were similar for the high-dose ocrelizumab and 600 mg ocrelizumab; in MUSETTE, rates of adverse events (552 [96%] of 577 and 267 [94%] of 283), serious adverse events (77 [13%] of 577 and 34 [12%] of 283), and fatalities (four [1%] of 577 and one [<1%] of 283) were comparable, as were rates of adverse events (447 [90%] of 499 and 230 [91%] of 254), serious adverse events (61 [12%] of 499 and 29 [11%] of 254), and fatalities (two [<1%] of 499 and three [1%] of 254) in GAVOTTE. INTERPRETATION: In both studies, high-dose ocrelizumab did not further improve control of disability progression in either RMS or PPMS, and no new safety concerns were identified. FUNDING: F Hoffmann-La Roche.
1 June 2026
Read appraisal →Journal of neural engineering
An online brain-computer interface for detecting incongruity in augmented reality applications
Objective.Augmented reality can provide digital information about physical entities presented within its real-world context. However, this information might disagree with the user's expectations due to factual errors in the data or cognitive biases. Such incongruity can impair user experience and undermine trust in the AR system. To address this issue, we propose detecting inconsistencies between physical objects and digital information through hybrid brain-computer interfaces.Approach.We conducted two complementary experiments. First, we implemented a strategy that integrates eye-tracking and brain signals for incongruity detection in an offline study. Subsequently, we assessed our approach in an online study in which participants received immediate feedback on the classification.Main results.The grand average event-related potentials revealed consistent electroencephalographic responses to incongruent augmentations, specifically a centroparietal N400 effect, across both experiments. We could further distinguish between congruent and incongruent information with an average balanced accuracy of 70% in the online study.Significance.These findings demonstrate the feasibility of detecting incongruity online, allowing for autonomous system adaptation, like presenting information in a more accessible format or providing contextual support.
31 May 2026
Read appraisal →Lancet (London, England)
Efficacy and safety of ocrelizumab in primary progressive multiple sclerosis, including older patients and those with more advanced disease (ORATORIO-HAND): a multicentre, double-blind, randomised, placebo-controlled, phase 3b study
BACKGROUND: The ORATORIO trial showed that ocrelizumab reduced the risk of disability progression versus placebo in patients with primary progressive multiple sclerosis (PPMS). We aimed to elucidate the effect of ocrelizumab in older and more disabled patients with PPMS, particularly regarding hand function preservation. METHODS: ORATORIO-HAND was a multicentre, double-blind, randomised, placebo-controlled, phase 3b study with 138 sites across 22 countries. Patients with PPMS aged 18-65 years and Expanded Disability Status Scale (EDSS) score of 3·0-8·0 were randomly assigned 1:1 to intravenous ocrelizumab 600 mg or placebo every 6 months for 144 weeks or until a prespecified number of progression events occurred. Masking was achieved by use of a placebo solution administered in the same manner as ocrelizumab. Double-blinding across all periods was maintained through separation of investigators responsible for efficacy and safety assessments. MRI scans were evaluated by a masked central reader, and laboratory parameters that could reveal treatment allocation were masked to site personnel until the primary analysis. Two coprimary estimands were defined, with the endpoint of time to onset of 12-week composite confirmed disability progression (12W-cCDP) in 9-Hole Peg Test or EDSS evaluated in all randomly assigned patients, and the same endpoint evaluated in a subset of patients with MRI activity at baseline. This study is registered with ClinicalTrials.gov, NCT04035005 and is ongoing and not recruiting. FINDINGS: Between Aug 12, 2019, and Dec 10, 2024, of 1360 patients assessed for eligibility, 1013 were randomly assigned (ocrelizumab [n=505]; placebo [n=508]). The proportion of patients with 12W-cCDP was 165 (33%) of 505 with ocrelizumab and 205 (40%) of 508 with placebo (hazard ratio, 95% CI 0·70 0·57-0·86; relative risk reduction=30%; p=0·0007). In the MRI-active subgroup, a significant risk reduction was also observed in 12W-cCDP (risk reduction=55%; p<0·0001). The overall safety profile was similar in both groups. More infections (245 [48%] of 506 vs 226 [45%] of 506) were observed with ocrelizumab, but not after COVID-19 was excluded (38% vs 37%). Rates of serious adverse events and serious infections were similar between groups. INTERPRETATION: Ocrelizumab was superior to placebo in delaying disability progression, with stronger effect on hand function, in a broad PPMS population including older patients and those with more advanced disease, while maintaining a manageable safety profile. FUNDING: F Hoffmann-La Roche.
31 May 2026
Read appraisal →European journal of nutrition
Microencapsulated docosahexaenoic acid increases the Omega-3 Index and attenuates the physiological impact of eccentric exercise in physically trained adults: a 12-week double-blind placebo-controlled trial
PURPOSE: This study investigated the effects of docosahexaenoic acid (DHA) supplementation on delayed onset muscle soreness (DOMS), physical function, and inflammation following eccentric exercise-induced muscle damage in physically trained male and female adults (training ≥ 5d/wk). METHODS: Thirty-eight participants (12 Control, 26 DHA) completed a 12-week double-blind, placebo-controlled matched-pair trial. The Control group received high-oleic acid tablets. The DHA group received 715 mg/d of microencapsulated DHA tablets. Participants performed eccentric cycling at weeks 0 and 12, with assessments conducted pre-exercise, 0-h, 24-h, and 48-h post-exercise. The primary outcomes were DOMS (visual analogue scale) and the Omega-3 Index (O3I) (estimated by finger-stick dry blood spot). Secondary outcomes included neuromuscular function and inflammatory cytokines. RESULTS: O3I was not different between groups at week 0 but was elevated in the DHA group (∆2.43%, [95% CI; 2.10, 2.77], P < 0.001) and between Control at week 12 (P < 0.001). DOMS was lower at 24-h and 48-h post-exercise in the DHA group and between Control at week 12 (P < 0.01). At week 12, jump height and peak vertical force improved at 48-h post-exercise in the DHA group (P < 0.05), resulting in moderate (d = 0.60) and small (d = 0.32) effect sizes for 48-h post-exercise area under the curve (AUC) between groups, respectively. There were interaction effects for 48-h post-exercise AUC of IL-6 (P = 0.049), TNF-α (P = 0.010), and IL-10 (P = 0.026). CONCLUSION: A dietary achievable dose of DHA elevated the O3I and reduced DOMS in physically trained adults. These outcomes support protracted intake of DHA to attenuate the physiological impact of eccentric exercise and promote recovery.
31 May 2026
Read appraisal →Medicine
Machine learning-based identification of multidimensional predictors of quality of life in individuals with multiple sclerosis
This study aimed to identify independent predictors of quality of life in patients with multiple sclerosis (MS) using machine learning approaches. One hundred and one individuals diagnosed with MS were included in this cross-sectional study. Quality of life was assessed using the MS Quality of Life-54 (MSQoL-54). Demographic variables, clinical characteristics, disability level (Expanded Disability Status Scale [EDSS]), fatigue severity, sleep quality (Pittsburgh Sleep Quality Index), depression level (Beck Depression Inventory), and functional mobility (Timed Up and Go test) were evaluated. Multiple machine learning regression models, including Linear Regression, Lasso, Elastic Net, Support Vector Machines, Random Forest, and XGBoost, were developed and compared. Five-times repeated five-fold cross-validation was applied for internal validation. Model performance was evaluated using root mean squared error (RMSE), mean absolute error (MAE), and coefficient of determination (R2). Among all models, Lasso regression demonstrated the best predictive performance (RMSE = 5.02, MAE = 4.04, R2 = 0.86). Disability level (EDSS) emerged as the strongest negative predictor of quality of life, followed by fatigue severity, sleep quality, and impaired functional mobility. Although disease duration was not significantly correlated with quality of life in univariate analyses, it showed a positive contribution in the multivariable model. Depression showed a strong bivariate association but had a relatively lower weight in the final predictive model. Quality of life in individuals with MS is strongly influenced by disability, fatigue, sleep quality, and functional mobility. Machine learning approaches provide an effective and interpretable framework for identifying key determinants of quality of life and may support personalized rehabilitation and clinical decision-making in MS.
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 →Medicine
Prevalence and long-term outcomes of brain fog and cognitive impairment in individuals with long COVID: A systematic review
BACKGROUND: Long COVID is increasingly recognized as a complex multisystem condition, with brain fog and cognitive impairment emerging as some of its manifestations. Despite growing literature, the pooled prevalence, subgroup differences, and underlying mechanisms remain incompletely understood. METHODS: We systematically reviewed 47 studies (2000-2025) encompassing over 25,000 patients to evaluate the prevalence of brain fog and cognitive impairment among long COVID populations. Data were extracted on study design, patient demographics, follow-up duration, and subgroup variables including gender, hospitalization, vaccination, and geographic region. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS v9.0) and JBI checklists. Quantitative synthesis was performed with subgroup and temporal analyses, presented in forest plots and summary figures. RESULTS: The pooled prevalence of brain fog was 30% (95% CI: 28-32), while cognitive impairment was 25% (95% CI: 23-27). Female patients consistently showed higher rates compared to males (34% vs 23% for brain fog; 29% vs 21% for cognitive impairment). Community-managed patients demonstrated higher prevalence compared to hospitalized cohorts, and unvaccinated individuals had a greater burden than vaccinated ones. Temporal analyses indicated that prevalence increased with longer follow-up, suggesting symptom persistence or late manifestation. Pathophysiological explanations include neuroinflammation, microvascular injury, immune dysregulation, and psychosocial stressors. CONCLUSION: Brain fog and cognitive impairment are common, persistent, and clinically significant features of long COVID. Gender differences, vaccination status, and follow-up duration influence prevalence. Future studies should focus on mechanisms, preventive strategies, and targeted interventions to mitigate long-term cognitive sequelae.
31 May 2026
Read appraisal →BMC musculoskeletal disorders
The effectiveness of telerehabilitation in upper limb musculoskeletal disorders: a systematic review.
BACKGROUND: Telerehabilitative services have been increasingly used in recent years, raising questions about their effectiveness. In musculoskeletal disorders, evidence supports telerehabilitation but methodological quality of evidence is limited and focused on lower limb disorders. Hence, this systematic review aimed to assess the effectiveness of telerehabilitation in upper limb musculoskeletal disorders. METHODS: We conducted electronic searches in MEDLINE, Embase, and AMED (up until 11/27/2024), complemented by hand searches. Randomized (RCTs) and non-randomized studies of interventions (NRSIs) assessing upper limb musculoskeletal disorders reporting on pain, activities of daily living (ADL), or health-related quality of life (HrQol) were included. We focused on studies from high-income countries in English or German. Risk of bias was assessed using RoB 2 and ROBINS-I. Standardized mean differences (SMDs) and 95% confidence intervals were derived from meta-analysis, where negative values favor telerehabilitation. Certainty of evidence was rated using GRADE. We grouped studies comparing telerehabilitation to standard care (subgrouped into in-person or minimal intervention) and separately examined studies with a tele-adjunct. Compared to in-person rehabilitation we assessed whether outcomes were similarly improved with telerehabilitation. For tele-interventions as adjunct or compared to minimal care we assessed whether telerehabilitation improved outcomes. RESULTS: We included twenty RCTs representing 1,285 participants. All NRSIs were excluded due to critically high risk of bias. Compared to in-person rehabilitation, telerehabilitation showed similar improvements with very low certainty of evidence in pain (SMD: -0.33 [-1.16 to 0.5] VAS/NRS), moderate in ADL (SMD: -0.07 [-0.31 to 0.17] QuickDASH/DASH), and low in HrQol (SMD: -0.26 [-0.82 to 0.31]). Compared to brochure-based exercising, certainty of evidence was low for improved pain (SMD: -0.28 [-0.58 to 0.03]), moderate in ADL (SMD: -0.56 [-0.88 to -0.24]), and low in HrQol (SMD: -0.31 [-0.65 to 0.02]). Tele-adjunct yielded low certainty of evidence for improvements in pain (SMD: -0.38 [-0.71 to -0.05]) and moderate in ADL (SMD: -0.51 [-0.88 to -0.14). CONCLUSIONS: Our results tend to support the effectiveness of telerehabilitation across different comparisons although certainty of evidence is inconclusive. Future studies should particularly investigate the non-inferiority of telerehabilitation compared to in-person rehabilitation and the added benefit of tele-adjunct. TRIAL REGISTRATION: Prospero registration ID: CRD42024622465.
31 May 2026
Read appraisal →Journal of translational medicine
Mesenchymal stem cell-derived extracellular vesicles for osteochondral defect regeneration: a systematic review and meta-analysis of preclinical studies
BACKGROUND: In recent years, the number of animal studies investigating mesenchymal stem cell-derived extracellular vesicles (MSC-EVs) therapy for osteochondral defects has steadily increased. However, a comprehensive and systematic quantitative analysis is lacking. This meta-analysis aimed to evaluate the efficacy of MSC-EVs in animal models of osteochondral defect through a meta-analysis. METHODS: PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched up to January 31, 2025, to identify and select preclinical studies on MSC-EVs therapy for osteochondral defect models. No restrictions were applied regarding the specific characteristics of MSC-EVs or animal models. A random-effects model was used to perform pooled analyses of osteochondral repair scores, bone structural parameters, and histological scores. Subgroup analyses were conducted to explore potential sources of heterogeneity. Sensitivity analyses, funnel plots, and Egger's test were employed to assess the robustness and stability of the results. RESULTS: A total of 19 studies met the inclusion criteria. MSC-EVs intervention improved International Cartilage Repair Society (ICRS) and Modified O'Driscoll Scale (MODS) scores at both 3 and 6 months, and significantly increased BV/TV, Tb.Th, as well as histological scores of cartilage and subchondral bone. Subgroup analyses indicated that none of the examined subgroups were significant sources of heterogeneity. Sensitivity analyses demonstrated the robustness of the results. CONCLUSIONS: MSC-EVs improved osteochondral repair scores, bone structural parameters, and histological outcomes in preclinical models, indicating their potential for promoting osteochondral regeneration. However, the evidence is primarily derived from small animal models with methodological variability and publication bias. Future studies should focus on large-animal models, standardized EVs preparation and dosing protocols, and long-term safety evaluations to facilitate clinical translation.
31 May 2026
Read appraisal →JMIR formative research
Wearable- and Mobile App-Based Activity Pacing and Fatigue Management in Post-COVID-19 Condition: Exploratory Observational Study
BACKGROUND: Post-COVID-19 fatigue affects millions worldwide; yet, evidence-based management strategies remain limited. Activity pacing, regulating activity to match available energy and minimize symptom exacerbation, may support symptom management, although optimal pacing approaches remain unclear. OBJECTIVE: This study aimed to explore associations between activity pacing strategies delivered through a mobile app and daily fatigue levels in individuals with post-COVID-19 fatigue. METHODS: In this exploratory observational study, 19 adults with post-COVID-19 fatigue used wearable devices (Fitbit Inspire 3) for objective activity monitoring and a mobile app (FatigueSense) to self-report daily symptoms (fatigue and energy levels) and optionally select activity pacing goals (light, balanced, or active) over a period of 3 months. We examined associations between pacing strategies and symptom outcomes by using mixed-effects linear models with random intercepts. Same-day outcomes (fatigue and energy reported on the day of goal selection) were analyzed controlling for age and sex. Next-day outcomes (fatigue and energy reported the day following goal selection) were analyzed controlling for age, sex, and prior-day symptoms. RESULTS: Across 2182 observation days, participants self-selected pacing goals on 816 (37.4%) days, demonstrating symptom-responsive behavior with higher baseline fatigue on pacing days (mean score 1.74, SD 0.59 vs 1.58, SD 0.54 on nonpacing days on a 0-3 scale where 0="none" and 3="severe"; P=.004). On pacing days (584/816, 71.6% with complete data from 18 participants), active pacing was associated with reduced same-day fatigue (β=-0.34, 95% CI -0.49 to -0.19; P<.001) and increased same-day energy (β=8.8, 95% CI 4.7-12.9; P<.001) compared to light pacing. Balanced pacing also showed significant reductions in fatigue (β=-0.15; P=.008) and increases in energy (β=5.8; P<.001) compared to light pacing. Next-day effects were attenuated and nonsignificant (fatigue: β=-0.05, P=.53; energy: β=1.1, P=.61). Individual heterogeneity was substantial, with an intraclass correlation coefficient of 0.32, indicating that 32% of the variance was attributable to between-person differences. Among participants trying multiple strategies, 58.3% (7/12) showed meaningful responses (≥0.3-point fatigue reduction) to structured pacing strategies. CONCLUSIONS: Structured activity pacing strategies (active and balanced) were associated with improved same-day symptom management in individuals with post-COVID-19 fatigue. However, substantial confounding by indication (self-selection of pacing based on symptom state) and individual heterogeneity limit causal interpretation. These exploratory findings warrant testing in randomized controlled trials to establish efficacy and identify responder characteristics.
30 May 2026
Read appraisal →Journal of medical Internet research
Effects of Multicomponent Digital Health Interventions on Multidimensional Physical Activity in Older Adults: Systematic Review, Meta-Analysis, and Meta-Regression of Randomized Controlled Trials
BACKGROUND: The comprehensive effects of multicomponent digital health interventions (DHIs) on multidimensional physical activity indicators and sedentary behavior (SB) remain controversial. OBJECTIVE: This systematic review aimed to evaluate the impact of multicomponent DHIs on daily steps, moderate-to-vigorous physical activity (MVPA), light physical activity, total physical activity, and SB in older adults. METHODS: PubMed, Web of Science, Embase, The Cochrane Library, and CINAHL were searched up to February 20, 2026. Randomized controlled trials concerning multicomponent DHIs for promoting exercise behavior in older adults were included. RoB 2.0 was used to evaluate study quality. Meta-analyses were performed using the Hartung-Knapp-Sidik-Jonkman random-effects model, and 95% prediction intervals (PIs) were calculated via Nagashima adjustment to evaluate effect dispersion. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system was used to evaluate evidence certainty. RESULTS: A total of 26 randomized controlled trials (n=4129) were included. The results showed that multicomponent DHIs significantly improved daily steps (mean difference [MD] 822.8, 95% CI 198.3 to 1447.3 steps/d; 95% PI -1452.4 to 3098.0) and MVPA (MD 45.9, 95% CI 23.9 to 67.9 min/wk; 95% PI -9.4 to 101.2). However, the improvements in SB (MD -283.7, 95% CI -610.8 to 43.5 min/wk; 95% PI -984.5 to 417.1), total physical activity (MD 104.4; 95% CI -109.2 to 318.0 min/wk; 95% PI -444.4 to 653.2), and light physical activity (MD 39.3, 95% CI -96.2 to 174.7 min/wk; 95% PI -227.6 to 306.2) did not reach statistical significance. As some included studies combined digital tools with human support, the independent contribution of digital technology remains uncertain. PIs indicated a certain degree of dispersion across different clinical contexts. Subgroup analysis showed higher effect sizes for standalone wearables, human-assisted interventions, and populations with chronic disease risks. Meta-regression showed that effect sizes remained stable across different ages and durations. The trim-and-fill method confirmed the robustness of MVPA results. GRADE assessment indicated "moderate" certainty for MVPA and "low" for daily steps and other indicators. CONCLUSIONS: This systematic review suggests that multicomponent DHIs may serve as an effective means for enhancing daily steps and MVPA in older adults. The innovation lies in evaluating the true effect distribution of multicomponent DHIs through Hartung-Knapp-Sidik-Jonkman random-effects models and Nagashima PIs. Compared with previous studies, this review identified the impact of population characteristics and control group differences on effect estimates using PI and subgroup models, confirming that advanced age did not significantly diminish the good adaptability of older adults to DHIs. Evidence limitations include high heterogeneity, lack of long-term follow-up, and differences between objective and subjective measurement tools. In practice, priority should be given to hardware carriers with simplified interaction and integrated human support, with tailored strategies developed for different risk subgroups.
30 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 →The Cochrane database of systematic reviews
Botulinum toxin type A for subacute/chronic neck pain
RATIONALE: Botulinum toxin type A (BoNT-A) intramuscular injections are commonly administered for neck pain unresponsive to other therapies, but the benefit-harm profile remains uncertain. OBJECTIVES: To assess the benefits and harms of intramuscular BoNT-A injection for people with subacute to chronic neck pain. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, CINAHL and trial registers, together with reference checking, citation searching and contact with study authors up to 4 March 2026. ELIGIBILITY CRITERIA: Randomised controlled trials (RCTs), including cross-over, pragmatic, or cluster designs, were included for adults with subacute to chronic neck disorder without radicular findings, with or without cervicogenic headache, and compared BoNT-A to placebo or no-treatment. OUTCOMES: Our outcomes were pain, function-disability, health-related quality of life, participant-reported treatment success, adverse events and costs at both short-term (< 24 weeks) and long-term (≥ 24 weeks) follow-up. RISK OF BIAS: We assessed the risk of bias (RoB) using the ROB 2 tool. SYNTHESIS METHODS: We synthesised results using meta-analyses with random-effects models to calculate mean differences (MD) and risk ratios (RR) with 95% confidence intervals (CIs), or using SWiM (Synthesis Without Meta-analysis) methods. We assessed certainty with GRADE. INCLUDED STUDIES: This update included 16 trials (855 participants) compared to six (252 participants) in the previous review: 13 parallel RCTs and three cross-over RCTs. One other trial is awaiting classification. Short-term follow-up ranged from 3 to 12 weeks post-treatment, and long-term follow-up was six months. Participants (mean age 45 years; 64% female; pain severity 56 on the Visual Analogue Scale (VAS 0 to 100)) were from ambulatory care settings in North America (five trials), Central America (one trial), Europe (six trials), the Middle East (one trial), Central Asia (one trial), and the East Asia & Pacific region (two trials), from upper (12 trials) or upper-middle (four trials) income economies. Disorder classifications included non-specific neck pain - myofascial (eight trials), whiplash-associated disorder (four trials), and cervicogenic headache (four trials). Overall, 88% of participants had chronic pain. The dose varied from 10 to 400 units over 1 to 10 trigger points. The RoB was high or raised some concern across all outcomes. SYNTHESIS OF RESULTS: Since 2011, evidence has shifted from no benefit to a potentially slight-to-small short-term benefit for BoNT-A compared with placebo. No trials compared BoNT-A with no treatment, and evidence was limited by bias (no studies with an overall low RoB), imprecision, and potential publication bias. For pain intensity measured on the VAS (scale 0 to 100), BoNT-A may result in a slight-to-small improvement in the short term (MD 5.95 points lower, 95% CI 10.89 lower to 1.02 lower; I2 = 0%; 12 studies, 393 participants; low-certainty evidence; downgraded two levels due to high overall RoB and indirectness), but not in the long term (MD 11.74 points lower, 95% CI 35.63 lower to 12.16 higher; I² = 50%; 2 studies, 43 participants; low-certainty evidence; downgraded two levels due to high RoB and imprecision). Mean pain in the placebo group was 46.66 points compared to 40.71 in the BoNT-A group, representing an absolute improvement of 6% (95% CI 11% better to 1% better). Additionally, there may be a moderate risk reduction in pain events in the short term (RR 0.68, 95% CI 0.56 to 0.83; I² = 0%; 2 studies, 292 participants; low-certainty evidence; downgraded two levels due to high overall RoB and dissemination bias, including potential conflict of interest from funding sources that may overestimate effects). Assuming a 70% risk with placebo, the corresponding risk with BoNT-A is 47%, representing a 23% absolute risk reduction. Five people (95% CI 3 to 9) would need BoNT-A treatment for one person to benefit. For physical function measured on the Neck Disability Index (scale 0 to 100), BoNT-A may have little to no effect in the short term, but the evidence is very uncertain (MD 2.49 points higher, 95% CI 9.72 lower to 14.70 higher; I² = 0%; 3 studies, 76 participants; very low-certainty evidence; downgraded three levels due to high overall RoB, indirectness, and wide confidence intervals). For health-related quality of life (change score), BoNT-A may make little to no difference in the short term (MD 2.30 points higher, 95% CI 12.57 lower to 17.17 higher; 1 study, 28 participants; low-certainty evidence; downgraded two levels due to imprecision). For participant-reported treatment success, BoNT-A may provide a small improvement in the global rating of change. Short-term results: MD 1.16 points lower on a 1 to 5 Verbal Rating Scale (95% CI 1.86 lower to 0.46 lower; 1 study, 31 participants; low-certainty evidence), corresponding to an absolute improvement of 20% (95% CI 10% to 36%). Long-term results were similar: MD 2.00 points lower on a 0 to 10 Patient Global Assessment (95% CI 3.80 lower to 0.20 lower; 1 study, 19 participants; 20% absolute risk reduction, low-certainty evidence). Evidence was downgraded by two levels for RoB and imprecision. No studies evaluated participant satisfaction or serious adverse events. For non-serious adverse events, participants treated with BoNT-A may have a small, negligible increased risk (RR 1.51, 95% CI 1.04 to 2.20; I² = 28%; number-needed-to-treat for an additional harmful outcome (NNTH) 6, 95% CI 4 to 12; 7 studies, 489 participants; low-certainty evidence; downgraded two levels due to RoB and indirectness). Participants treated with BoNT-A have a 16% increased absolute risk of experiencing non-serious adverse events lasting up to three weeks, such as injection soreness, muscle fatigue, and headache. AUTHORS' CONCLUSIONS: BoNT-A may provide slight-to-small short-term pain relief (6%) and perceived treatment success (20%) for subacute and chronic neck pain, but may offer no long-term physical function or health-related quality of life benefits. The moderate (23%) risk reduction in pain events may be overestimated due to publication bias. Non-serious adverse events are 16% more frequent. Uncertainty remains due to wide confidence intervals, short-term single-dose trials, and dose variation, highlighting the need for larger, high-quality studies with comprehensive adverse event reporting. FUNDING: This Cochrane review had no dedicated funding. REGISTRATION: Protocol and previous versions available via doi.org/10.1002/14651858.CD008626, doi.org/10.1002/14651858.CD008626.pub2 and doi.org/10.1002/14651858.CD008626.pub3 (withdrawn).
30 May 2026
Read appraisal →Behavioural brain research
Efficacy of repetitive transcranial magnetic stimulation at different frequencies for post-stroke cognitive impairment: A network meta-analysis
PURPOSE: Post-stroke cognitive impairment (PSCI) affects nearly half of stroke survivors, necessitating effective interventions. This Bayesian network meta-analysis evaluated the efficacy of various repetitive transcranial magnetic stimulation (rTMS) protocols for PSCI. METHODS: We systematically searched PubMed, Cochrane Library, and Chinese databases up to December, 2025, including 37 randomized controlled trials (2543 patients) comparing rTMS protocols with different frequencies (low/high) and sites (left/right). Outcomes were measured using the Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), and Modified Barthel Index (MBI). RESULTS: Results indicated that high-frequency left dorsolateral prefrontal cortex stimulation (HFL-rTMS) most effectively improved MoCA scores (MD=3.38, SUCRA=87.6%), high-frequency right-sided stimulation (HFR-rTMS) ranked highest for MMSE improvement (MD=2.93, SUCRA=79.7%), and high-frequency bilateral stimulation (HFB-rTMS) yielded the greatest MBI enhancement (MD=13.47, SUCRA=89.6%). CONCLUSIONS: High-frequency rTMS demonstrated superior efficacy in cognitive and functional recovery. HFL-rTMS, HFR-rTMS, and HFB-rTMS are recommended as optimal interventions for MoCA, MMSE, and MBI outcomes, respectively. Further studies are warranted to validate stimulation parameters and expand multicenter evidence for clinical application.
30 May 2026
Read appraisal →ACS applied materials & interfaces
Breathable and Washable E-Textile with Readily Integrated Piezoelectric Perfluoroalkoxy Fiber for Wide Temperature Range Human Machine Interfaces
Flexible wearable sensors are widely explored for human-machine interaction and health monitoring. Electronic textiles (E-textiles) offer a promising pathway toward comfortable wearable devices by integrating sensing fibers directly into fabric structures. Among them, compared with piezoresistive and capacitive fiber sensors, piezoelectric fiber sensors require no external power supply. Compared with triboelectric fiber sensors, which are highly sensitive to humidity and temperature, piezoelectric fiber sensors provide more stable and reliable electrical signals. However, conventional piezoelectric fiber sensors still face challenges in achieving long-term wearing comfort and reliability under harsh environments. Herein, we develop a breathable, washable, and wide-temperature-tolerant based on piezoelectric perfluoroalkoxy (PFA) fibers, which can be readily integrated into E-textiles. The textile is produced via a weft knitting process that integrates coaxially structured PFA fibers with wool yarns, combining stable piezoelectric performance with wearing comfort. The fibers exhibited a charge sensitivity of (2.6 ± 0.2) pC/N at 0.2 MPa. The resulting E-textile exhibits a charge sensitivity of up to (316.6 ± 45.9) pC/N and a voltage sensitivity of (744.9 ± 73.9) mV/N. The textile maintains stable operation over a wide temperature range from -78 °C to 150 °C. Its weft-knitted structure provides breathability, while the textile also offers washability, UV resistance, and mechanical durability exceeding 10,000 stretching or bending cycles. Furthermore, the textile can effectively monitor various human motions. A smart glove constructed from five-channel PFA fibers achieved recognition accuracies above 95% for five hand gestures, demonstrating the potential offer self-powered E-textile as a wearable sensor for human-machine interaction.
30 May 2026
Read appraisal →ACS applied materials & interfaces
A High-Sensitivity MXene Tactile Sensor with Dynamic Point-Contact Networks for a Wearable Healthcare Device
The self-stacking of the MXene material can diminish its interlayer spacing and active surface area, thereby diminishing the sensitivity and response speed of pressure sensors. Here, we introduce a high-performance flexible tactile sensor utilizing a composite of MXene, polystyrene (PS) microspheres, and bacterial cellulose (BC). PS microspheres are integrated within the MXene nanosheet layers to mitigate the self-stacking. By employing an innovative point-to-point conductive network design, the self-aggregation issue of MXene materials is effectively mitigated, leading to the formation of dynamic point-contact structures among PS microspheres. This configuration notably enhances detection sensitivity within the low-pressure range to 568.8 kPa-1 (20-200 Pa). Furthermore, the incorporation of BC enhances the interfacial bonding strength through hydrogen bonding, thereby enhancing sensor stability. The sensor exhibits a rapid response time of 29 ms, a wide detection range of up to 0-50 kPa, a low limit of detection of 2 Pa, and consistent signal stability over 20,000 cycles. It has demonstrated the capability to monitor a broad spectrum of physiological activities, including joint movements, facial microexpressions, and radial pulse. Integration with wireless transmission technology enables remote health monitoring, flexible touch keyboard functionality, and human-computer interaction. Additionally, the electromyography (EMG) skin sensor based on the MXene/PS/BC (MPB) composite film accurately distinguishes muscle movements, gestures, acoustic vibrations, and facial microexpressions by detecting surface EMG signals. This comprehensive approach offers a comprehensive solution for wearable medical devices that combine high sensitivity with practicality.
30 May 2026
Read appraisal →Nano letters
Hierarchical Structural-Interfacial Engineering with Dynamic Soft-Hard Cross-Linking Enables Full-Range, Ultrasensitive MXene Piezoresistive Sensors
Human tactile perception inspires flexible piezoresistive sensors, yet simultaneously achieving high sensitivity, a wide pressure range, and mechanical robustness remains challenging. Here, we report a hierarchical stress-regulation strategy that integrates multiscale surface microstructures with a dynamically cross-linked MXene/carboxymethyl cellulose/borax sensing network. Replicated microtopographies induce progressive and spatially distributed stress localization, while heterogeneous soft-hard cross-linking regulates nanoscale deformation through adaptive hydrogen bonding and rigid borate anchoring. This coupled structural-interfacial regulation generates abundant stress-concentrated sites, stabilizes conductive pathways, and enables continuous resistance modulation across a broad pressure spectrum. Consequently, the sensor exhibits ultrahigh sensitivity (774.48 kPa-1), a wide working range (334.16 kPa), and fast response/recovery times (8.58/17.22 ms). It reliably captures both subtle physiological signals and large mechanical loads and further supports gesture recognition and robotic control when integrated with real-time feedback and machine learning. This work establishes a general framework for designing robust, full-range tactile sensors through hierarchical stress regulation.
30 May 2026
Read appraisal →Science robotics
Embodied or virtually represented: Navigating the embodiment debate in human-robot interaction.
The validity of virtually represented robots in HRI experiments depends on when, where, and for whom it matters.
30 May 2026
Read appraisal →Neurology
Vamorolone for Duchenne Muscular Dystrophy: A Cross-Trial Efficacy Comparison With Classic Corticosteroids From the FOR-DMD Trial
BACKGROUND AND OBJECTIVES: Vamorolone demonstrated similar efficacy for Duchenne muscular dystrophy (DMD) compared with prednisone in a 24-week exploratory analysis and may reduce key side effects compared with classic corticosteroids. In this study, we compare the efficacy and anthropometric effect of vamorolone 6 mg/kg/d with prednisone 0.75 mg/kg/d and deflazacort 0.9 mg/kg/d in steroid-naïve boys aged 4 to <7 years using data from 2 trials. METHODS: VISION-DMD was a phase 2b, 48-week randomized, double-blind trial assessing vamorolone 2 and 6 mg/kg/d vs placebo and prednisone 0.75 mg/kg/d to 24 weeks. Finding the Optimum Steroid Regimen for DMD (FOR-DMD) was a double-blind, parallel-group randomized trial comparing daily prednisone 0.75 mg/kg/d, daily deflazacort 0.9 mg/kg/d, and intermittent prednisone 0.75 mg/kg (10/10 days on/off). Entropy balancing generated weighted data for mixed model for repeated measures analyses that compared VISION-DMD vamorolone 6 mg/kg/d efficacy and anthropometric outcomes with FOR-DMD prednisone and deflazacort outcomes at 6 and 12 months. Inclusion criteria were boys with genetically confirmed DMD, age 4 to <7 years, ambulatory, and able to complete a time-to-stand (TTSTAND) assessment in <10 seconds at baseline. RESULTS: All interventions showed motor improvements relative to baseline at 6 and 12 months. Using the weighted cohorts and at 12 months, vamorolone 6 mg/kg/d (n = 28) had similar changes in TTSTAND velocity, the primary motor endpoint component in both trials, vs daily prednisone (n = 50) or deflazacort (n = 55; mean baseline age 5.42 years all groups), but with CIs overlapping minimal clinically important thresholds of 0.023 rises per second (TTSTAND velocity least squares mean [LSM] difference [95% CI]: vamorolone 6 mg/kg/d vs prednisone 0.75 mg/kg/d, 0.004 rises per second [-0.025 to 0.032] and vs deflazacort 0.9 mg/kg/d, 0.001 rises per second [-0.027 to 0.028]). Body mass index (BMI) Z-scores increased in all groups, greatest with vamorolone (12-month LSM difference [95% CI]: vamorolone vs prednisone 0.57 [0.24-0.90]; vamorolone vs deflazacort 0.29 [0.03-0.56]), whereas growth slowdown occurred in prednisone- and deflazacort-treated boys but not vamorolone (12-month LSM difference in height Z-scores [95% CI]: vamorolone vs prednisone 0.57 [0.24-0.90]; vamorolone vs deflazacort 0.72 [0.53-0.91]). DISCUSSION: Vamorolone demonstrated numerically similar TTSTAND velocity changes to prednisone and deflazacort at 1 year; however, interpretations of differences are limited by 95% CIs crossing minimally important difference thresholds. Further evidence of the growth-protective effect of vamorolone was observed; however, all treatments increased BMI. Vamorolone provides a linear growth-protective classic corticosteroid alternative. TRIAL REGISTRATION INFORMATION: NCT03439670; NCT01603407. CLASSIFICATION OF EVIDENCE: This Class III study did not definitively identify differences in efficacy between vamorolone and classic corticosteroids but found that vamorolone protects linear growth in boys with DMD.
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 →BMC surgery
Improvement of mobility and motivation in patients with elective colorectal resection using tracking devices and utilizing self-awareness (IMPETUS): a randomized controlled trial in a traditional non-ERAS clinical setting
BACKGROUND: Early postoperative mobilization is a cornerstone of modern perioperative care, including in elective colorectal surgery. Here we evaluated the effectiveness of smart wearables for improving patients' mobility and motivation during the recovery period after elective colorectal resection. METHODS: This prospective randomized two-armed clinical trial enrolled 62 patients undergoing elective colorectal resection. These patients were randomized into an intervention group that received hourly active reminders to mobilize via a smartwatch, and a control group that received only passive monitoring. All patients were given a wearable device that tracked their daily step counts. The primary end-point was the total number of steps taken within five postoperative days. Secondary end-points included complication rates, length of hospital stay, and subjective motivation, assessed using a structured questionnaire. RESULTS: Compared to the control group, the intervention group achieved significantly higher step counts (p = 0.039), and reported increased motivation for mobilization (p = 0.016). The groups did not significantly differ in overall complication rates or duration of hospital stay. CONCLUSION: Smart wearable devices with hourly active reminder functionalities effectively promoted postoperative mobility and motivation. TRIAL REGISTRATION: German Clinical Trials Register (DRKS), DRKS00039731. Registered 24.03.2026. Retrospectively registered.
29 May 2026
Read appraisal →BMC medicine
WISE-Therapy (What's Important: Schedule and Engage) and bouldering psychotherapy for depression: A randomized clinical trial
BACKGROUND: Group therapies address the growing treatment demand-supply gap for depression. This study evaluated whether the novel WISE-Therapy (WISE-T; What's Important: Schedule and Engage) and Bouldering Psychotherapy (BPT) are more effective in reducing depressive symptoms in an outpatient group therapy setting than treatment as usual (TAU). METHODS: This randomized, controlled, assessor-blinded, longitudinal, clinical trial was conducted in a naturalistic monocentric setting in Erlangen (Germany) between April 2022 and March 2023, with follow-up until July 2024. 128 adults were randomly assigned to WISE-T (44), BPT (40), or TAU (44). In 10 weekly 2-hour group sessions, WISE-T focused on identifying what is important, scheduling meaningful activities, and engaging in them for long-term mental health, and BPT combined psychotherapy with bouldering, while the control group received TAU. Depression severity was measured with the Montgomery-Asberg Depression Rating Scale at baseline, post-intervention, and one-year follow-up, and analyzed with a hybrid marginal model. RESULTS: Both intervention groups showed significantly greater reduction in depressive symptoms than controls at post-intervention (WISE-T: -5.5 points, 95%-CI [-9.5 to -1.5], P = .007, d = 0.62; BPT: -4.2 points, 95%-CI [-8.2 to -0.3], P = .037, d = 0.48). Response rates were 35.3% for WISE-T, 29.7% for BPT, and 21.1% for controls. Remission rates were significantly higher in WISE-T (17.6%) than in controls (2.6%, P = .047). Treatment adherence was good with minimal adverse events reported. The secondary outcomes showed significant results for anxiety, sense of coherence, self-efficacy, and mindfulness during physical activity. CONCLUSIONS: Both interventions demonstrated efficacy in reducing depressive symptoms compared with controls in this single-center setting. The study supports the integration of both therapies into outpatient care settings. TRIAL REGISTRATION: Study procedures received approval from the Friedrich-Alexander-Universität Erlangen-Nürnberg Ethics Committee (Ref. 21-332-B) on December 13, 2021. The Trial was preregistered in March 2022 via ISRCTN12347878 .
29 May 2026
Read appraisal →Progress in biomedical engineering (Bristol, England)
Soft pneumatic actuators for wearable systems: a structural classification and integration-oriented evaluation
Soft pneumatic actuators promise gentle, body-safe assistance, yet many fail at the moment of integration: inflation alters geometry, increases profile, and stresses seams and ports. This topical review reframes actuator selection through a structure-first lens that links how an actuator is built to how it deforms and how it embeds in garments. Actuators are classified by structural architecture, deformation behavior, and fabrication method, and evaluated against four integration criteria central to wearable systems: geometric compatibility, fabrication scalability, system integration readiness, and actuation simplicity. A staged selection pathway is proposed and presented as a literature-informed mapping table that links reported wearable application contexts to dominant integration priorities and a practical structural-class starting point. Planar sheet designs can preserve a thin, predictable pressurized envelope at modest pressures when seam paths, constraint layers, and attachment features are co-designed. Pouch and bladder actuators are thin at rest, simple to fabricate, and readily integrated with textiles, but commonly bulge under load without external constraint; envelope control and port or manifold routing frequently limit garment integration. Fiber-constrained actuators deliver high specific force but often require rigid end terminations and elevated pressures. Segmented elastomers provide rich kinematics through chamber layout while tending toward bulging and routing burden in multi-segment formats. Mechanical metamaterials realize geometry-programmed motion when hinge fidelity and pattern alignment are maintained; durability of compliant joints and consistent crease formation set current limits. The resulting synthesis identifies practical priorities for wearable use: preserve thin profiles under load, embed stitchable or bondable attachment features, document reproducible process windows, minimize dead volume, routing, and valve count with compact pneumatic architectures, and target low-pressure operation compatible with lightweight hardware. Framing integration in structural terms standardizes comparison across actuator classes, clarifies the narrow feasible design space for compact, body-conforming devices, and supports deliberate actuator choice for biomedical wearables.
29 May 2026
Read appraisal →JAMA
The Veterans Affairs' Whole Health Approach for Chronic Pain Management: The wHOPE Randomized Clinical Trial
IMPORTANCE: The US Department of Veterans Affairs (VA) Whole Health approach was congressionally mandated in 2016 for patients with chronic pain receiving care in VA hospitals, but no randomized clinical trials have tested its benefits. OBJECTIVE: To evaluate the effectiveness of a whole health team intervention in VA patients with chronic pain compared with cognitive behavioral therapy and with usual care, and to evaluate the effectiveness of cognitive behavioral therapy compared with usual care in reducing long-term pain interference. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial involving 6 VA health systems in the US enrolled participants between September 18, 2020, and January 19, 2024. Final follow-up occurred on January 27, 2025. Analyses took place between April 1, 2025, and February 3, 2026. Participants were patients with chronic pain receiving VA primary care. INTERVENTIONS: Patients with chronic pain were randomized (11:11:2) to receive a whole health team intervention (n = 343), cognitive behavioral therapy for chronic pain delivered in group sessions (n = 339), or usual care (n = 82) for 12 months. The whole health team included a primary physician or nurse practitioner, a second clinician providing nonpharmacological or integrative pain care, and a coach. The team provided interdisciplinary, individualized care consistent with the VA Whole Health model to attain personal health goals aligned with patients' personal values and life goals. MAIN OUTCOMES AND MEASURES: The primary outcome was the Brief Pain Inventory interference (BPI-I) subscale score (range, 0-10 points; higher scores indicate worse interference from pain; minimal clinically important difference, 1.0) at 12 months. RESULTS: Of 764 randomized patients (mean [SD] age, 60.5 [12.3] years; 66.5% were men), 632 (82.7%) completed 12-month follow-up. At 12 months, the whole health group had significantly improved pain interference scores (from 6.6 to 4.9) compared with the cognitive behavioral therapy (from 6.4 to 5.5) (mean difference, -0.58 [97% CI, -1.11 to -0.05]; P = .02) and usual care (from 6.4 to 5.7) (mean difference, -0.77 [99% CI, -1.40 to -0.15]; P = .002) groups. At 12 months, cognitive behavioral therapy did not improve pain interference scores significantly more than usual care (mean difference, -0.19 [99% CI, -0.89 to 0.50]; P = .46). The most common adverse event was suicidal ideation, which occurred in 15.9% of patients in the cognitive behavioral therapy group, 13.7% in the whole health team group, and 13.4% in the usual care group. CONCLUSIONS AND RELEVANCE: These results support use of the whole health team approach to attain a statistically significant but small improvement in pain interference in VA patients with chronic pain. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04330365.
29 May 2026
Read appraisal →Progress in biomedical engineering (Bristol, England)
Wearable sensors for monitoring neurogenic dysphagia: a scoping review
Neurological disorders, such as Parkinson's disease and stroke, often lead to neurogenic dysphagia, a swallowing disorder that compromises nutrition and increases the risk of malnutrition, aspiration of food, and even death. Although instrumental assessments remain the gold standard for evaluating swallowing function, their invasiveness, cost, and reliance on specialized clinical facilities limit their routine use. A systematic search was conducted in PubMed, Scopus, IEEE Xplore, and Web of Science, including only peer-reviewed studies using non-invasive wearable devices for assessing and monitoring dysphagia in neurological disorders. The initial search identified 1669 records, and an updated search retrieved 128 additional records. After screening, 24 studies met the inclusion criteria. Accelerometers and surface electromyography sensors were the most frequently used, either alone or in multimodal configurations. Multimodal approaches generally provided more accurate and comprehensive assessments than single-sensor systems. However, validation with gold-standard methods was performed in only half of the studies, and considerable heterogeneity was observed in sensor placement, study protocols, and signal-processing strategies. Wearable sensing technologies represent a non-invasive and scalable solution for assessing neurogenic dysphagia. To enable clinical translation, future research should focus on standardized methodologies, robust validation, and the integration of artificial intelligence for more precise swallowing assessment in individuals with neurological disorders.
29 May 2026
Read appraisal →JMIR aging
e-Counseling for Fall Prevention in Older Adults: Scoping Review
BACKGROUND: Falls are a major contributor to injury, disability, and mortality among older adults worldwide. Digital health-based e-counseling has emerged as a scalable strategy to support fall prevention by addressing physical, behavioral, and cognitive risk factors. OBJECTIVE: This scoping review aimed to map the scope, characteristics, and outcomes of e-counseling interventions for fall prevention among adults aged 60 years or older. METHODS: Guided by Arksey and O'Malley's framework and reported in accordance with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews), we searched PubMed, ScienceDirect, CINAHL, and ProQuest for studies published between January 2019 and May 2025. Eligible studies evaluated digital or telehealth-based counseling interventions for fall prevention. Data were synthesized descriptively, and methodological quality was appraised using the Mixed Methods Appraisal Tool. RESULTS: A total of 13 studies were included, comprising randomized controlled trials, feasibility studies, qualitative research, and retrospective cohorts conducted across Asia, Europe, and North America. e-Counseling modalities included virtual reality, mobile health application, teleconsultations, and wearable-triggered feedback systems. Reported outcomes included reductions in fall incidence ranging from 15% to 90.9%, improvements in balance and mobility, increased fall risk awareness, and enhanced self-efficacy. Interventions incorporating cultural tailoring and digital literacy support demonstrated higher engagement and adherence. CONCLUSIONS: e-Counseling appears to be a promising and scalable approach for fall prevention in older adults, with benefits across physical and behavioral domains. Future research should focus on long-term effectiveness, equitable access in low- and middle-income settings, and integration into routine health care systems.
29 May 2026
Read appraisal →ACS applied materials & interfaces
Boosting Piezoelectricity and Mechanical Properties of Silk Fibroin Films via Polyethylene Glycol Phase Manipulation
Piezoelectric silk fibroin (SF) shows great potential in fabricating sustainable wearable electronics toward health monitoring and human-machine interfacing, yet the processing difficulty and brittleness restrict its practical applications severely. This study proposes a simple strategy to achieve the boosted piezoelectricity and mechanical properties in electrospun regenerated silk fibroin (RSF) nanofiber mats by adding polyethylene glycol (PEG) with different molecular weights to induce the formation of β-sheets via hydrogen bonding and the regulation of PEG phase morphology. Specifically, RSFs consisting of PEG of 2000 and 1000 Da exhibit a significant improvement in the tensile strength (from 6.1 to 9.92 MPa) and elongation at break (from 5.72% to 117.58%), respectively. Meanwhile, RSFs consisting of PEG with a molecular weight of 2000 and 400 Da show a direct piezoelectric force sensitivity of 0.2 mV/N·μm and 0.14 mV/N·μm respectively, superior to that of pure RSF (0.04 mV/N·μm). The piezoelectric force sensors fabricated with RSFs show potential applications in the detection of diverse human motions, including finger tapping for Morse code, grip strength, and knee flexion. Thus, this work unveils a facile strategy to fabricate RSF-based biodegradable piezoelectric force sensors with a trade-off in processability, mechanical ductility, and piezoelectricity.
28 May 2026
Read appraisal →Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
Exercise effects on cognitive function and molecular markers in post-stroke patients with cognitive impairment: a systematic review and meta-analysis
INTRODUCTION: Exercise may improve cognitive function in stroke survivors. However, no study has yet examined the most effective exercise modalities and associated changes in biomarkers. This study aims to investigate the effects of different exercise types on cognitive function and biomarker trends, providing evidence-based guidance for early rehabilitation interventions. METHODS: Data from randomized controlled trials were collected from January 1, 2000, to March 6, 2025, using medical subject headings combined with free-text terms from PubMed, Cochrane Library, Embase, Wanfang, CNKI, CSTJ, and the China Medical Information Database. The Cochrane Risk of Bias Tool was used to assess the quality of the studies. Review Manager version 5.4.1 was employed to conduct all statistical syntheses. RESULTS: The forty-four original studies involving 4,450 patients with PSCI(Post-stroke cognitive impairment) were analyzed. Subgroup analysis by exercise intervention type revealed larger effect sizes when combining aerobic exercise with other task-based interventions(cognitive-motor dual-tasking and functional motor training) [SMD = 1.18, 95% CI (0.68, 1.68)]. Patients also showed improvements in motor function [MD = 13.98, 95% CI (10.06, 17.89)] and activities of daily living [MD = 16.78, 95% CI (12.97, 20.58)]. Concerning molecular biomarkers, serum levels of brain-derived neurotrophic factor (BDNF), glutathione (GSH), and neuron-specific enolase (NSE) increased significantly, whereas interleukin-6 (IL-6) levels decreased notably in PSCI patients following exercise therapy. CONCLUSION: Structured exercise effectively improves cognitive recovery, motor skills, and daily functioning in patients with PSCI. These clinical gains are accompanied by favorable peripheral biomarker modulations, characterized by significantly increased serum BDNF and GSH, as well as markedly decreased IL-6 levels.
28 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 →Archives of orthopaedic and trauma surgery
Comparative analysis of the improvement in shoulder rotation in complex shoulder fractures treated by reverse shoulder arthroplasty compared to open reduction and internal fixation: a systematic review and meta-analysis
PURPOSE: To compare the clinical and functional outcomes of open reduction and internal fixation (ORIF) and reverse shoulder arthroplasty (RSA) in patients aged ≥ 65 years with complex proximal humeral fractures (PHFs). METHODS: A systematic review and meta-analysis was conducted according to the PRISMA guidelines. PubMed, Web of Science, ScienceDirect, EBSCO, and the Cochrane Library were searched for randomized controlled trials (RCTs) and cohort studies published in English without date restrictions. Eligible studies compared RSA and ORIF in elderly patients with PHFs and reported functional, radiographic, or complication outcomes. Pooled data were analyzed using a random-effects model. RESULTS: Twenty-two studies involving > 34,000 patients were included. RSA was associated with greater forward flexion and a trend toward improved abduction, whereas internal rotation favored ORIF without reaching significance. No significant differences were observed in external rotation. The functional scores (Constant-Murley, Oxford Shoulder Score) were similar, and the complication and reoperation rates did not differ significantly between the groups. CONCLUSION: RSA offers modest advantages in forward flexion compared with ORIF but does not consistently improve overall functional scores or reduce complications. RSA may be preferred in elderly patients with poor bone stock or rotator cuff pathology, whereas ORIF remains appropriate for patients in whom joint preservation is feasible. High-quality RCTs with standardized outcome reporting are needed to clarify the optimal surgical management.
28 May 2026
Read appraisal →Acta oncologica (Stockholm, Sweden)
Change in skeletal muscle mass during systemic cancer treatment: a systematic review and meta-analysis
BACKGROUND AND PURPOSE: Loss of skeletal muscle mass (SMM) is common during systemic cancer treatment, but the magnitude and variability across cancer and treatment types remain uncertain. We aimed to describe changes in SMM during systemic cancer treatment supported by pooled quantitative estimates. PATIENTS/MATERIAL AND METHODS: We systematically searched PubMed, Embase, and Web of Science until April 2025 for longitudinal studies reporting SMM during chemotherapy and/or immunotherapy (± targeted therapy) in patients with cancer (PROSPERO CRD42022308388). Standardized mean changes (SMC) were pooled in random-effects meta-analyses using the restricted maximum-likelihood estimator with Hartung-Knapp adjustment. Heterogeneity was assessed using I². Risk of bias was assessed with the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. RESULTS: Seventy-eight studies (n = 10,502; 52% male; median age 64 years [interquartile range, IQR: 34-77]) were included. Meta-analysis across cancers showed an association between systemic cancer treatment and decline in SMM (59 studies; n = 6,373; SMC = -0.24, 95% confidence interval [CI]: -0.29 to -0.20; I² = 92%), corresponding to -5% over a median interval of 90 (IQR: 71-129) days among studies (62%) reporting assessment intervals. Declines were most pronounced during chemotherapy (± targeted therapy). INTERPRETATION: Declines in SMM are frequently observed during systemic cancer treatment, particularly during chemotherapy (± targeted therapy), although effect sizes were generally small per Cohen's thresholds. However, substantial heterogeneity limits interpretation of a single pooled estimate. Prospective studies with standardized methods are needed to clarify trajectories, mechanisms and clinical implications of SMM loss.
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 →ACS nano
All-Printed MXene-Based Springs for Concurrent Bidirectional Hand Motion Capture
Accurately capturing hand movements remains a challenge because the skin undergoes stretching, compression and bending at the same time, yet most flexible sensors respond only to tension. Achieving high sensitivity and a wide range often means making the sensor thick, which causes the sensing layer to shift under complex deformations and distorts the signal. Here, we address this by placing the strain-accommodating space within a plane parallel to the strain direction. Using a MXene/polyurethane ink with glycerol as a molecular bridge, we create a dense hydrogen-bonding network that enables high-resolution printing of a planar spring architecture. The resulting all-printed sensor achieves a gauge factor of 83.7 across a linear bidirectional range of ±60% strain. With just two sensors, we track and decode complex wrist motions with ±10° accuracy. When attached to finger joints, they enable real-time, dexterous control of a virtual hand. This work provides an alternative approach for skin strain capture through synergistic innovation in materials and architecture.
27 May 2026
Read appraisal →Journal of neural engineering
Non-invasive somatotopic proprioceptive feedback for closed-loop robotic hand aperture control
Objective.Current robotic prostheses developed for individuals with transradial amputation often lack physiological feedback, particularly proprioceptive information, which limits control precision and increases reliance on vision.Approach.This study investigates the effect of introducing non-invasive somatotopic feedback using transcutaneous electrical nerve stimulation (TENS) to convey hand aperture information, as an artificial form of proprioceptive feedback. Twenty healthy participants with intact limbs were divided into two groups: one receiving TENS-based feedback and one without feedback. Participants performed an aperture control task under visual and non-visual conditions, with some trials including a concurrent Stroop task to assess cognitive load. We hypothesized that providing non-invasive somatotopic proprioceptive feedback via TENS mitigates key control and integration challenges, leading to improved accuracy, faster learning, and reduced reliance on vision, without increasing cognitive demands.Main results.Under visual deprivation, participants receiving TENS feedback achieved significantly smaller aperture control errors than those without feedback, both under alternating visual conditions (p<0.001) and under prolonged visual deprivation conditions (p=0.017). From the very first trial, TENS-based feedback enabled control accuracy comparable to that with visual input. Although perceptual shifts affected control accuracy under dual-task conditions, the +TENS group maintained high cognitive performance and effective control toward perceived functional targets, suggesting that the artificial feedback nonetheless supported hand control in the presence of a secondary task.Significance.These findings highlight the potential of non-invasive somatotopic proprioceptive feedback delivered through TENS to provide physiologically meaningful information and support future strategies for restoring proprioceptive function in prosthetic hand users.
27 May 2026
Read appraisal →Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
How can social cognition be improved in neurological patients? a systematic review.
BACKGROUND: The neural network underlying social cognition (SC) may be vulnerable to different types of lesions, but also amenable to recovery through interventions that stimulate brain plasticity. This review assessed current non-pharmacological interventions (NPIs) and their effects on SC in neurological patients. METHODS: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Randomized controlled studies, cohort studies, cross-sectional studies, case series, case reports, and literature reviews were included if they reported a precise description of the NPI in subjects older than 6 years, with brain or cerebellar lesion. RESULTS: Among 5.077 screened articles, 17 fulfilled the eligibility criteria. These articles provided 19 face-to-face, online or hybrid methods, involving 344 patients with multiple sclerosis, stroke, Parkinson disease, cerebellar ataxia, traumatic brain injuries or mixed acquired brain injuries. The methods were applied in observational and randomized study designs using group or individual settings, involving SC, general cognition, and relational aspects. These NPIs, classifiable into training, rehabilitation or combined interventions, improved SC in patients with various diagnosis and age. CONCLUSIONS: Results show that NPIs for SC in neurological patients is being addressed with insightful methods and study designs with improvement possibility in children and adults suffering different pathologies. This is not sufficient for thorough consensus but can trigger a range of broader high-quality and interdisciplinary clinical and research applications.
27 May 2026
Read appraisal →Scientific reports
Depressive symptoms are a key determinant of health-related quality of life in ICU survivors with psychological distress
Survivors of critical illness frequently experience persistent impairments in health-related quality of life (HRQoL), with psychological symptoms contributing substantially to this burden. The relative contribution of co-occurring depression, anxiety, and post traumatic stress symptoms remains insufficiently understood. To address this gap, we conducted a cross-sectional analysis of pre-randomization data from the PICTURE randomized controlled trial, a multicenter study of a brief primary care-based psychological intervention for post-traumatic stress disorder symptoms following critical illness, including 319 intensive care unit survivors. Clinical, demographic, and mental health assessments were obtained after ICU discharge. Latent profile analysis, random forest modeling, and quantile regression were applied to identify determinants of HRQoL measured by the EuroQol Five-Dimension Five-Level (EQ-5D-5L) index and visual analog scale (VAS). The mean EQ-5D-5L index was 0.71 (SD 0.27; median 0.81) and the mean EQ VAS score was 60.7 (SD 19.4; median 60.0), indicating considerable overall impairment. Depression, anxiety, and post-traumatic stress symptoms showed substantial overlap and formed four distinct symptom profiles associated with specific functional impairments. Screening positive for depression on the 2-item Patient Health Questionnaire (PHQ-2) with ≥ 3 points was associated with a median reduction of -0.13 (95% CI -0.19 to -0.07) on the EQ-5D-5L index and -12.45 points (95% CI -17.93 to -6.96) on the EQ VAS, exceeding clinical and demographic predictors. These findings indicate that depressive symptoms are a major determinant of impaired health related quality of life among intensive care survivors with psychological distress and support routine brief depression screening in post-intensive care follow up.Trial registration: ClinTrials.gov: NCT03315390 (Registration date: 2017-10-20); German Clinical Trials Register: DRKS-ID: DRKS00012589 (Registration date: 2017-10-17).
26 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 →Archives of orthopaedic and trauma surgery
Extracorporeal shockwave therapy in bone fractures: a systematic review
INTRODUCTION: The increasing incidence of fractures and cases of delayed union or nonunion has encouraged the search for non-invasive therapies. Extracorporeal shockwave therapy (ESWT) has been proposed as a strategy to stimulate bone regeneration and improve fracture healing. MATERIALS AND METHODS: A systematic review was conducted following PRISMA guidelines, with searches performed in PubMed, Scopus, Web of Science, and Embase (2005-2025). Clinical studies evaluating ESWT for fracture treatment with radiographic assessment of bone healing and the presence of a control group were included. RESULTS: A total of 834 studies were initially identified, of which 7 were included in the final analysis. Most studies demonstrated positive effects of ESWT, including improved bone healing, pain reduction, and functional recovery. However, there was considerable heterogeneity in treatment protocols and relatively small sample sizes. CONCLUSION: ESWT shows potential as a non-invasive therapy to stimulate fracture healing, particularly in cases of delayed union or nonunion. However, further controlled clinical trials and standardized protocols are needed to confirm its clinical effectiveness.
25 May 2026
Read appraisal →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 →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Facilitators and barriers to the implementation of traditional Chinese exercises in cancer patients: a mixed-methods systematic review
PURPOSE: To identify barriers and facilitators to the implementation of traditional Chinese exercises in cancer patients. METHODS: This was a mixed-methods systematic review. It searched for published studies from nine different sources. Data synthesis followed a convergent integrated approach according to the Joanna Briggs Institute methodology for mixed-methods systematic reviews. Quantitative data were qualitized using thematic analysis and synthesized with qualitative data using thematic synthesis. RESULTS: Twenty-one studies were included. Forty-three implementation determinants were identified across five domains of the Consolidated Framework for Implementation Research (CFIR), including 25 facilitators and 18 barriers. Key facilitators included perceived benefits, simplicity, social support, and flexible delivery, whereas major barriers involved symptom burden, resource constraints, competing life demands, and limited organizational support. CONCLUSIONS: The implementation of traditional Chinese exercises in cancer patients is shaped by multilevel determinants across CFIR domains. Implementation outcomes depend on the alignment between intervention characteristics, patient capacity, and contextual conditions. Context-sensitive and tailored strategies are required to improve uptake and long-term sustainability.
25 May 2026
Read appraisal →Medicine
Predicting poor wrist function recovery after internal fixation of distal radius fractures: A retrospective study based on multivariate analysis and machine learning models
This study aimed to identify independent risk factors associated with poor wrist function recovery 6 months after internal fixation of distal radius fractures (DRF) and develop machine learning models for early risk prediction. This retrospective study included 328 patients who underwent internal fixation for DRF at our hospital between January 2022 and June 2025. Wrist function was evaluated using the Cooney Wrist Score at 6 months postoperatively. Poor recovery was defined as a Cooney score <75. The overall incidence of poor wrist function recovery was 21.56% (71/328). Clinical variables including demographic characteristics, comorbidities, laboratory indicators, fracture type, postoperative pain scores, and rehabilitation compliance were collected. Rehabilitation compliance referred to patients' adherence to prescribed postoperative functional training and follow-up plans. Variables with P <.05 in univariate analysis were entered into multivariate logistic regression to identify independent risk factors. These variables were subsequently used to construct random forest (RF), XGBoost, and backpropagation (BP) neural network models. Model performance was evaluated using ROC curves and classification metrics. Multivariate analysis identified low rehabilitation compliance, age ≥65 years, AO type C fractures, postoperative visual analogue scale scores >3 at 1 week, and decreased serum albumin levels as independent predictors of poor wrist function recovery. Among the machine learning models, the RF model demonstrated the best performance (AUC = 0.939, accuracy = 0.946), followed by the BP neural network (AUC = 0.924). The XGBoost model showed comparatively lower predictive performance (AUC = 0.876). Poor wrist function recovery after internal fixation of DRF is influenced by multiple clinical factors. Machine learning models based on identified independent risk factors, particularly the RF model, show strong predictive ability and may assist clinicians in early risk stratification and individualized rehabilitation planning.
25 May 2026
Read appraisal →Science advances
Bioinspired ionic thermoreceptors with anisotropic architecture for thermotactile perception in robots
Emulating human skin's ability to perceive temperature and identify material through thermotactile perception is critical for human-machine interaction, robotics operation, and prosthetic sensory feedback systems. However, conventional artificial thermal sensors are largely limited to temperature measurement and cannot replicate the thermotactile-mediated material recognition capabilities inherent in biological systems. Here, we present a bioinspired ionic thermoreceptor with anisotropic thermal response characteristics, enabling high-fidelity material recognition and accurate temperature monitoring. The device incorporates spatially specialized sensing elements that encode thermal signals into modality-specific temporal response patterns, allowing the extraction of the thermal contact coefficient for material discrimination and the absolute temperature for precise thermal monitoring. It achieves high-accuracy material recognition (98.9%) and substantial temperature resolution (0.81 millikelvins). Furthermore, robust covalent bonding between functional layers ensures mechanical durability, signal stability, and environmental resilience. This work establishes a physically grounded and energy-autonomous thermotactile sensing platform for safe, intuitive, and intelligent human-machine interaction.
25 May 2026
Read appraisal →PloS one
A randomised crossover trial comparing photobiomodulation therapy with other recovery strategies in CrossFit athletes
BACKGROUND: This study compared the effects of different therapeutic modalities on recovery following the workout of the day (WOD) in CrossFit athletes, focusing on reducing muscle damage and improving functional performance. METHODS: In a randomised, controlled, crossover design, twelve CrossFit athletes underwent four post-WOD recovery interventions across four weeks: passive recovery (PR), intermittent pneumatic compression (IPC), extracorporeal shock wave therapy (ESWT), and photobiomodulation therapy combined with a static magnetic field (PBMT-sMF). Assessments were conducted at baseline, and at 1, 24, and 48 hours post-WOD. The primary outcome was vertical jump performance (countermovement jump [CMJ] height) at 1-hour post-WOD; secondary outcomes included lactate dehydrogenase (LDH) levels, superoxide dismutase (SOD) and catalase (CAT) activity, thiobarbituric acid reactive substances (TBARS), carbonylated proteins, perceived exertion, and intervention satisfaction. RESULTS: There was no significant difference between interventions in CMJ height at 1-hour post-WOD. In contrast, PBMT-sMF outperformed the other interventions in the secondary outcomes. PBMT-sMF significantly improved CMJ height at 24 and 48 hours compared with PR (p < 0.05) and led to greater reductions in LDH at both time points (p < 0.05 and p < 0.001, respectively). PBMT-sMF also produced lower TBARS and carbonylated protein levels, with higher CAT and SOD activities at 24 and 48 hours (p < 0.05 and p < 0.0001, respectively). CAT and SOD activities were also significantly elevated at 1 hour post-WOD compared with PR (p < 0.05). CONCLUSIONS: PBMT-sMF may be an effective recovery strategy for CrossFit athletes, with its benefits possibly related to the modulation of oxidative stress as an underlying mechanism. TRIAL REGISTRATION: Trial registration number: NCT06628609.
24 May 2026
Read appraisal →Medicine
Applying digital technologies for remote care in the real life context: A 3-year experimentation with postoperative lung cancer patients
Surgery remains the main curative treatment for lung cancer patients. However, operation has resulted in some-degree reduction in postoperative pulmonary function. The decreased pulmonary function could be rehabilitated to the preoperative level through restoring exercise, which is related to the ways and exercise time of rehabilitating. The Dignio platform is 1 digital telemedicine system and has been used maturely in Norway, however, it has not yet been widely promoted in China. In the present study, we adopted the telemedicine system, according to the formulated rehabilitation exercise program, to design a good way to recover pulmonary function for postoperative lung cancer patients, promoting early and quick recovery, and reducing the long-term postoperative complications and outpatient visits. This retrospective controlled study enrolled 250 postoperative lung cancer patients using a remote digital care platform and 250 matched controls receiving standard instructions. In the postoperative 1-week follow-up, we found that the forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), forced expiratory volume in 6 seconds, FVC25-75, peak expiratory flow had an obvious upward trend, although there were no significant differences in the measurements on postoperative day 7 compared with day 1. From the long-term data at 1 month/3 months/6 months post-operation, we found that the recovery was better to varying degrees in the experiment group using the remote care digital platform, compared with that of the control, especially the FEV1 at 3 (P = .065) and 6 months post-operation (P = .037), and forced Expiratory Flow between 25% and 75% of forced vital capacity at 3 months post-operation (P = .084). However, most pulmonary values, such as the FEV1/FVC, FVC and peak expiratory flow have no significant difference (all P > .05) in the recovery at 1 month post-operation between the experimental group and control, the second time at 3 months and the third time at 6 months after surgery. Especially in the experimental group, 2 patients with sudden pneumothorax were timely detected after discharge through the Digino platform, the patient returned to the hospital in time, and both patients were out of danger ultimately. The Digino remote care indeed has some benefit in the pulmonary function recovery in the long-term follow up, and reduces postoperative complications obviously.
24 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 →Scientific reports
A randomized controlled trial of adjunctive speleotherapy in asthma, COPD and long COVID
Speleotherapy (underground climate therapy) is a non-pharmacological intervention for chronic respiratory diseases. This randomized controlled trial investigated whether a 3-week speleotherapy course (6 sessions, 2 h/week) improves respiratory outcomes in patients on standard background therapy with asthma, COPD, or Long COVID, and whether it affects blood CO2 levels. The control group did not receive speleotherapy but continued their standard therapy. A total of 208 patients (asthma: n = 107; COPD: n = 59; Long COVID: n = 42) were enrolled across nine centers in Germany, Austria, and Italy. Assessments were conducted pre-intervention (T1), post-intervention (T2), and at 3-month follow-up (T3). Outcome measures included airway inflammation (FeNO), pulmonary function parameters (FVC% predicted values, FEV₁% predicted values, FEV₁/FVC, PEF% predicted values), and respiratory muscle strength (MIP and MEP in absolute values). In addition the following validated questionnaires were administered: Asthma Control Test (ACT), Asthma Quality of Life Questionnaire (AQLQ), COPD Assessment Test (CAT), St. George's Respiratory Questionnaire (SGRQ), Nijmegen Questionnaire (NQ), and Fatigue Assessment Scale (FAS), along with the Long COVID questionnaire from the Median Clinic Group. CO2 levels were assessed via capillary blood (SpCO2) and end-tidal CO2 (PetCO2). Between-group comparisons used the Mann-Whitney U test; within-group changes were assessed with the Wilcoxon signed-rank test (Bonferroni-Holm corrected). In patients with asthma, the predefined primary endpoint (FeNO) showed no significant improvement. In contrast, patient-reported outcomes improved significantly, with clinically relevant gains in asthma control (ACT: p < 0.001) and asthma-related quality of life (total AQLQ: p = 0.005). Lung function parameters showed statistically significant but modest improvements at T2 (FVC: p = 0.011; PEF: p = 0.010; FEV₁ in participants < 70 years: p = 0.035). In patients with COPD, symptom burden improved according to CAT scores (p = 0.036), while no improvements in lung function were observed. Patients with Long COVID reported significant improvements in dysfunctional breathing (NQ: T2: p = 0.014), dyspnea (T2: p = 0.026; T3: p = 0.001), and "problems with stair climbing/muscle exertion" (T2: p = 0.042), as well as improvements in anxiety and sleep-related symptoms (T2: p = 0.021). No improvements in lung function were observed in this group. In the total cohort, the intervention group showed statistically significant improvements compared to controls in respiratory muscle strength (MIP: p = 0.002; MEP: p = 0.018) and dysfunctional breathing (NQ scores at T2: p = 0.007; T3: p = 0.017). In CO₂-rich speleotherapy centers, both SpCO₂ (p = 0.026) and PetCO₂ (p < 0.001) increased at T2. While speleotherapy did not improve FeNO, it was associated with clinically relevant improvements in patient-reported outcomes across disease groups. Changes in lung function and respiratory muscle strength were statistically significant but modest and should be interpreted with caution. Overall, speleotherapy may have direct effects on the airways and breathing regulation, with more consistent evidence for improvements in breathing patterns than for direct effects on the airways.Trial registration: DRKS00033365 (retrospectively registered).
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 →Studies in health technology and informatics
Long Covid and Digital Health in Switzerland: Potentials and Limitations
Post-COVID-19 (or Long Covid) presents a complex and persistent health challenge affecting a growing number of individuals worldwide. Digital health interventions (DHIs) offer potential support for symptom monitoring, self-management, and information access. However, their availability, quality, and sustainability remain uncertain, particularly in smaller healthcare markets such as Switzerland. This study provides a descriptive assessment of ten representative DHIs for Long Covid available from Switzerland. Each tool was evaluated using a 19-item framework derived from validated instruments. Three independent reviewers tested all interventions on iOS and Android devices, with consensus ratings across five quality categories. Results showed strong usability (average 6.3/8) and practical usefulness (5/8), but consistent weaknesses in accessibility (3.7/8) and data protection (4.6/8). Total scores ranged from 14.7 to 26.3 out of 38. Several Swiss-based apps were discontinued during the study period, highlighting market fragility. Findings underscore the need for inclusive design, transparent data practices, and institutional support if DHIs are to complement Long Covid care sustainably.
24 May 2026
Read appraisal →Studies in health technology and informatics
Machine Learning Applications Within the Earlier Medicine Framework for Stroke: A Scoping Review
This scoping review explores how machine learning (ML) has been applied to stroke research within the Earlier Medicine framework, which promotes proactive and personalized care through primary (preventive care), secondary (acute care), and tertiary (chronic care) prevention levels. Following PRISMA-ScR guidelines, studies were identified from PubMed and Scopus, yielding 105 eligible studies. Most studies focused on tertiary prevention, such as predicting in-hospital mortality, complications, and functional outcomes, while fewer addressed early risk prediction or acute-phase detection. Common predictors included age, NIHSS score, glucose, stroke volume, BMI, hypertension, and diabetes, reflecting reliance on routine clinical data. Traditional ML models (e.g., logistic regression, random forest, SVM) remain dominant, although Ensemble/Hybrid and Deep Learning models have increased steadily since 2021. ML demonstrated promising predictive accuracy and clinical potential, though challenges remain in data heterogeneity, model transparency, and external validation.
24 May 2026
Read appraisal →Journal of ethnopharmacology
Efficacy and safety of medicine-food homology Shenqi paste in older adults with diabetic sarcopenia: A randomized, double-blind, placebo-controlled trial
ETHNOPHARMACOLOGICAL RELEVANCE: Diabetic sarcopenia (DS), an emerging diabetes complication, poses an increasing challenge to the elderly population. Shenqi paste (SQP) consists of 8 medicine-food homology substances: Astragalus membranaceus (Fisch.) Bge., Codonopsis pilosula (Franch.) Nannf., Polygonatum sibiricum Red., Dioscorea opposita Thunb., Poria cocos (Schw.) Wolf, Eucommia ulmoides Oliv., Hordeum vulgare L., and Ophiopogon japonicus (L.f.) Ker Gawl. SQP has shown potential benefits for sarcopenia in clinical practice. Its efficacy and safety in DS have not been validated in a randomized controlled trial. AIM OF THE STUDY: This study aimed to evaluate the efficacy, safety, and limitations, and provide insights into methods and strategies for utilizing SQP in DS management. MATERIALS AND METHODS: In this randomized, double-blind, placebo-controlled trial, community-dwelling older adults (≥60 years) with DS and spleen-kidney deficiency syndrome were allocated 1:1 to receive either SQP or placebo paste for 12 weeks. Primary outcomes were skeletal muscle mass index (SMI), handgrip strength, and five-time chair stand test (FCST) duration. Secondary outcomes included health-related scales and biochemical indicators. Assessments were conducted at the baseline (T0), week 6 (T1), and week 12 (T2). Safety evaluation included blood routine, liver and kidney function tests. Intention-to-treat analysis was applied to the primary outcomes data from all participants, with per-protocol analysis for sensitivity. Generalized estimating equations with covariate adjustment and t-tests or Wilcoxon rank-sum tests were used for statistical analysis. RESULTS: Of 90 randomized participants, the SQP group showed greater improvements in handgrip strength (T2: interact p < 0.001), SMI (T2: interact p < 0.001), and FCST (T2: interact p < 0.001) versus control. Secondary outcome measures of 74 participants, including frailty, nutrition, physical activity, sleep quality, depression, and TCM syndrome scores, significantly improved (p < 0.05), with significant fasting blood glucose reduction (T2: interact p = 0.018) and C-reactive protein decrease (T2: interact p < 0.001). There was no statistically significant difference in the change in the difference between the two groups in fasting insulin, glycated hemoglobin and insulin resistance index before and after intervention (p > 0.05). Within-group analysis demonstrated significant reductions of SQP group in inflammatory cytokines, and sarcopenia-related biomarkers (p < 0.001) post-intervention. No serious adverse events occurred. CONCLUSION: A 12-week SQP intervention enhanced muscle mass, strength, function, and metabolic and inflammatory profiles in older adults with DS, with good tolerability, supporting its potential as a safe, complementary therapy.
23 May 2026
Read appraisal →The journal of trauma and acute care surgery
Cognitive dysfunction after polytrauma in the absence of traumatic brain injury: A systematic review of incidence.
BACKGROUND: Polytrauma patients frequently experience long-term health impacts, including cognitive impairments. While traumatic brain injury (TBI) is a recognized nonmodifiable cause, polytrauma patients are likely to face cognitive challenges potentially linked to systemic inflammation and multiple surgical interventions even in the absence of TBI. This review aims to describe the incidence and identify factors associated with cognitive dysfunction in adult multiple injury patients without Frank TBI. METHODS: A systematic search was conducted across MEDLINE, CINAHL, EMBASE, and Scopus databases on August 17, 2023, to identify studies reporting on cognitive dysfunction in adults with polytrauma, excluding brain injuries. The Critical Appraisal Skills Programme checklists guided study appraisal, and findings were narratively synthesized. RESULTS: From 2719 articles identified (including one through citation searching), 47 were fully screened, yielding 10 cohort studies for inclusion. The reported incidence of cognitive dysfunction among multiple injury patients without TBI varied widely, from 0% to 60%, with a majority (eight out of ten studies) noting incidences of 30% or higher. No consensus was found for a relationship of other studied factors with cognitive dysfunction. Injury Severity Score was found to not be associated with cognitive dysfunction in selected studies which analyzed this factor. CONCLUSION: This review suggests a high prevalence of cognitive dysfunction in multiple injury patients without TBI. The evidence base is limited by heterogeneity of the inclusion criteria, and the cognitive outcome measures. IMPLICATIONS OF KEY FINDINGS: Multiple injury is associated with long term cognitive dysfunction even without primary brain injury. This aspect of the disease of multiple injury needs further characterization to identify predictors and potential preventive and therapeutic interventions. Standardized reporting is also required to be able to monitor incidence and prevalence. ( J Trauma Acute Care Surg . 2026;100: 973-981. Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: Systematic Review; Level II.
23 May 2026
Read appraisal →ACS sensors
In Situ Formation of Mechanical Interlocking Skin and Electronics Interfaces through Dual-Phase Transition of Conductive Materials
The increasing demand for daily health monitoring has accelerated the development of wearable devices. However, conventional wearables, typically based on rigid materials and external fixation methods, suffer from interfacial instability during dynamic motion and heavy sweating, leading to signal distortion and device delamination. Skin-like wearable electronics and in situ fabrication strategies have emerged to improve conformability and signal stability. However, challenges remain in achieving a stable skin-device interface and reliable performance under dynamic conditions using simplified fabrication methods. Here, we present a flexible multiparameter monitoring device that integrates with the skin through a skin-electronics interface undergoing a dual-phase transition from hydrogel to liquid and subsequently to a solid state via in situ heating and photonic crosslinking. This transition forms mechanically interlocked structures that ensure robust adhesion and stable skin contact even under humid and high-acceleration conditions. Rapid curing enabled by an integrated heating layer and optical waveguide reduces the fabrication time to 1 min, allowing efficient on-demand deployment. The device achieves stable monitoring of ECG, PPG, acceleration, and temperature signals and supports Bluetooth data transmission under accelerations up to 11 g, as well as during swimming and showering. Furthermore, machine-learning-based motion recognition and individual identification models achieve 100% accuracy. This work advances in situ-fabricated wearable electronics by improving fabrication efficiency, interfacial robustness, and environmental adaptability, providing a promising platform for portable physiological monitoring.
23 May 2026
Read appraisal →Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
Prediction and diagnosis of post-stroke epilepsy using artificial intelligence approaches: a systematic review and meta-analysis
INTRODUCTION: Post-stroke epilepsy (PSE) is a common complication following a stroke and is a major cause of epilepsy in the elderly. Artificial intelligence (AI) is currently developing rapidly in the medical field and has a promising outlook in disease diagnosis, treatment, and prognosis. METHODS: We screened five studies that fully met the requirements from the PubMed, Web of Science, and EMBASE databases using relevant search terms such as PSE and AI, and analyzed the role of AI in predicting and diagnosing PSE in these studies. RESULTS: The results showed that the sensitivity of AI in predicting and diagnosing PSE was 88% (95% CI 0.78-0.94), and the specificity was 83% (95% CI 0.79-0.86). The area under the summary receiver operating characteristic (SROC) curve was 0.90 (95% CI 0.87-0.92). CONCLUSION: These results indicate that using AI to predict and assist in diagnosing PSE demonstrates high specificity and sensitivity, and has certain prospects in the future auxiliary diagnosis of PSE.
23 May 2026
Read appraisal →Journal of medical systems
Advances in Technology-Assisted Visual Rehabilitation Therapies: Scoping Review
Visual impairment (VI) is a growing condition associated with aging, neurological diseases, and chronic eye conditions. In 2023, more than 2.2 billion people experienced VI, and at least 1 billion could have been prevented or remain untreated. Visual rehabilitation (VR) is essential for optimizing residual vision and promoting functional independence; however, only a minority have access to these services. In recent years, the development of technologies such as artificial intelligence (AI), mobile applications, and virtual reality (VRt) has transformed VR, offering accessible and personalized alternatives. This scoping review aimed to map and categorize the available evidence on technology-assisted visual rehabilitation therapies, identifying the types of technologies used, their applications, and reported clinical and functional outcomes. A scoping review was conducted following the Joanna Briggs Institute (JBI) methodology and PRISMA-ScR guidelines to map the literature published between 2015 and 2025 on technology-assisted VR therapies in adults with VI worldwide. Twenty-five studies, mainly from developed countries, were included. Interventions included videoconferencing, computerized systems, portable devices, VRt, artificial vision (AV), and smart sensors. Overall, digital technologies were shown to improve visual function, autonomy, and quality of life, with high patient satisfaction and adherence. Telerehabilitation (TR), understood as the remote delivery of visual rehabilitation services through videoconferencing and digital monitoring platforms, has emerged as a viable and cost-effective strategy. In contrast, immersive virtual reality technologies (VRt), head-mounted display systems, and multisensory integration devices have demonstrated potential to stimulate neuroplasticity and enhance functional visual outcomes.Telerehabilitation platforms, immersive virtual reality systems, portable electronic vision enhancement devices, artificial vision technologies, and sensor-based monitoring tools are emerging as promising interventions. These technologies have demonstrated improvements in visual acuity, reading performance, visual field sensitivity, patient adherence, and functional autonomy, although most studies remain small-scale and geographically concentrated in high-income settings.
23 May 2026
Read appraisal →Journal of neurology
Effectiveness of telemedicine-based rehabilitation after stroke: a systematic review
BACKGROUND: Access to timely post-acute stroke rehabilitation remains inconsistent, contributing to persistent disability despite advances in acute stroke care. Telemedicine has been proposed as a strategy to improve continuity and access to rehabilitation services, but its effectiveness across functional domains remains incompletely defined. OBJECTIVE: To evaluate the effectiveness of telemedicine-delivered post-acute follow-up and rehabilitation on functional recovery and disability outcomes among adult stroke survivors. METHODS: A systematic review was conducted in accordance with PRISMA guidelines. PubMed, Embase, Scopus, and Web of Science were searched for studies published between January 2015 and December 2025. Eligible studies included adult stroke populations receiving telemedicine-based post-acute follow-up or rehabilitation and reporting functional, motor, balance, quality-of-life, or feasibility outcomes. Randomized controlled trials and observational studies were included. Risk of bias was assessed using validated tools, and findings were synthesized narratively without quantitative pooling due to heterogeneity. RESULTS: Twenty-eight studies comprising approximately 1237 participants were included. Telerehabilitation was associated with improvements in activities of daily living, although between-group differences varied across studies. Activities of daily living improved post-discharge (Barthel Index + 23.3 vs + 9.3; p < 0.001), and Functional Independence Measure scores increased in tele-CIMT and wearable-assisted interventions. Upper limb performance improved (WMFT time - 2.28 s; Box and Block Test + 5.57 vs 1.0; Nine-Hole Peg Test - 71.6 s; Jebsen-Taylor - 26.6 s). Spasticity decreased (MAS) with wrist improvements maintained at 6 months. Mobility and balance also improved, with intervention groups walking farther (6MWT 141.6 ± 8.7 m vs 129.5 ± 7.1 m; p < 0.001) and showing comparable improvements in BBS outcomes across groups. Technology-assisted telerehabilitation programs were more frequently associated with statistically significant improvements; however, these findings were not consistently superior to standard rehabilitation across all studies. Most randomized trials had some concerns for bias, and half of non-randomized studies were rated as serious risk, limiting overall certainty. CONCLUSIONS: Telemedicine-based post-acute stroke rehabilitation is feasible and associated with functional improvements comparable to in-person care. Reported adverse events were infrequent and generally minor, though safety outcomes were inconsistently measured across studies. High feasibility, adherence, and patient satisfaction support its role as a scalable component of post-stroke rehabilitation pathways.
23 May 2026
Read appraisal →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 →JMIR mHealth and uHealth
mHealth-Supported Exercise Rehabilitation to Reverse Frailty After Autologous Transplantation in Multiple Myeloma: Randomized Controlled Trial
BACKGROUND: Frailty is highly prevalent in survivors of multiple myeloma (MM) after autologous hematopoietic cell transplantation and is associated with poor functional recovery and adverse clinical outcomes. Although exercise is known to improve physical function, traditional center-based rehabilitation models are often inaccessible to this population during early posttransplant recovery. Mobile health (mHealth)-supported exercise may offer a scalable alternative; however, evidence in hematologic malignancies remains limited. OBJECTIVE: This study aimed to evaluate the effects of a 16-week mHealth-supported exercise rehabilitation program on frailty phenotype and physical function in survivors of MM within 180 days after autologous hematopoietic cell transplantation. METHODS: In this single-center randomized controlled trial, participants who self-reported as prefrail or frail were randomized 1:1 to an mHealth-supported exercise group (n=16) or usual care control (n=16). Remote assessments were conducted at baseline (week 0), midpoint (week 9), and follow-up (week 17). The intervention consisted of 8 weeks of supervised tele-exercise (3 sessions/week, 50 minutes/session), followed by 8 weeks of independent home-based exercise using the same mHealth platform. Exercise intensity was prescribed using a repetitions-in-reserve-based rating of perceived exertion approach with symptom-guided progression. The primary outcome was change in the 5-component Fried frailty phenotype score (0-5). Secondary outcomes included Short Physical Performance Battery components, chair stand time, gait speed, and handgrip strength. Intention-to-treat analyses were conducted using generalized estimating equations to evaluate between-group differences over time. RESULTS: Participants had a mean age of 64.6 (SD 7.1) years and were enrolled a mean of 136 (SD 36.3) days posttransplant. At baseline, 94% (30/32) of participants were classified as frail. Adherence to the supervised sessions was 85% (326/384 sessions), and adherence during the unsupervised phase was 78% (298/384 sessions). The exercise group demonstrated a significantly greater reduction in frailty score compared with control from baseline to week 17 (P<.001). Between-group difference estimates showed a clinically meaningful improvement favoring exercise at both week 9 and week 17 (P<.001). Chair stand time improved significantly in the exercise group compared with control, with faster completion times observed at week 9 and sustained through week 17 (P=.002). Improvements in other Short Physical Performance Battery components and handgrip strength favored the exercise group but did not reach statistical significance. No serious adverse events occurred. CONCLUSIONS: A 16-week mHealth-supported, progressively prescribed exercise rehabilitation program was feasible, safe, and effective in reversing frailty phenotype and improving functional mobility in survivors of MM early after autologous transplantation. This approach provides a scalable model for delivering structured rehabilitation during a high-risk recovery window. Larger trials incorporating attention-matched controls and longer follow-up are warranted. TRIAL REGISTRATION: ClinicalTrials.gov NCT05142371; https://clinicaltrials.gov/study/NCT05142371.
22 May 2026
Read appraisal →BMJ open respiratory research
Symptom-based rehabilitation in people with post-COVID-19 condition (RELOAD study): a randomised controlled trial
RATIONALE: Post-COVID condition (PCC) is characterised by persistent symptoms that impair health-related quality of life (HRQoL); rehabilitation (REHAB) strategies remain scarce. OBJECTIVE: To investigate the effect of a symptom-based REHAB programme versus usual care on HRQoL in people with PCC. METHODS: In this single-blind randomised controlled trial, a total of 132 people with PCC were randomised to either a REHAB group or a control group, with 104 completing the trial. The REHAB group received a multimodal 3-week REHAB programme tailored to the participant's primary symptom-based group (fatigue, cognitive problems or somatic symptoms); the control group received usual care. The primary endpoint was the between-group difference in change in HRQoL, measured by the 12-item Short Form Health Survey (SF-12) physical component summary (PCS) score at 3 weeks post baseline (intervention period). Changes from baseline to a 3-month follow-up after the intervention period were also analysed as a secondary measure. Additional outcomes included mental HRQoL (SF-12 mental component summary (MCS)), depression symptoms (Patient Health Questionnaire 9 (PHQ-9)) and anxiety symptoms (Generalized Anxiety Disorder 7 (GAD-7)). RESULTS: Participants (mean age 47±12.3 years, 90.4% not hospitalised during acute SARS-CoV-2 infection, 69.2% female) in the REHAB group (n=47) showed a significantly greater improvement in PCS compared with the control group (n=57) (mean difference (Δ) 2.9 points, 95% CI 0.2 to 5.7, p=0.038) at 3 weeks post baseline. This difference remained significant at the 3-month follow-up (Δ 4.2 points, 95% CI 1.5 to 6.9, p=0.003). The REHAB group also showed significant improvements in mental HRQoL (MCS: Δ 5.7 points, 95% CI 2.0 to 9.4, p=0.003), as well as in depression symptoms (PHQ-9: Δ -2.7 points, 95% CI -4.2 to -1.2, p<0.001) and anxiety symptoms (GAD-7: Δ -2.4 points, 95% CI -3.7 to -1.1, p<0.001) at 3 weeks post baseline compared with the control group. At the 3-month follow-up, the reduction in depression symptoms remained significant, while no significant differences were observed for mental HRQoL or anxiety symptoms. CONCLUSION: A symptom-based rehabilitation programme significantly improved HRQoL in individuals with PCC after 3 weeks, with some benefits persisting at 3 months. TRIAL REGISTRATION NUMBER: NCT05172206.
22 May 2026
Read appraisal →JBJS reviews
Medial Parapatellar vs. Transpatellar Approach in Tibial Intramedullary Nailing: A Systematic Review and Meta-Analysis of Pain and Function
BACKGROUND: Tibial intramedullary nailing (IMN) is the standard treatment for tibial shaft fractures, yet anterior knee pain (AKP) remains common, affecting nearly 47% of patients. Despite the reported advantages of suprapatellar techniques, infrapatellar approaches-medial parapatellar (MPP) and transpatellar (TP)-remain the most commonly used methods for tibial IMN. This systematic review and meta-analysis compares MPP and TP approaches regarding pain, AKP incidence, range of motion (ROM), knee function, and fracture healing. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed, Embase, Scopus, and Web of Science were searched up to November 2024. Randomized clinical trials (RCTs) and comparative observational studies in adults undergoing tibial IMN via MPP or TP approaches were included. Outcomes were AKP incidence, pain intensity, knee function, ROM, and union-related variables. Pooled mean differences (MDs) and risk ratios (RRs) were calculated using random-effects and common-effects models. RESULTS: Twelve cohort studies (782 patients) and 9 RCTs (462 patients) were included. Across cohort studies, MPP was associated with a significantly lower AKP risk at latest follow-up (RR = 0.76 [0.63; 0.90]) and at 6 months. Visual analog scale pain at 3-month postoperative also favored MPP (MD = -1.27 [-1.94; -0.60]) but did not reach the minimal clinically important difference. RCTs demonstrated similar trends toward lower pain and AKP with MPP, but without statistical significance. Functional outcomes and ROM generally favored MPP across both study designs, though findings were inconsistent and unsuitable for pooling. Fracture healing and union rates were comparable between approaches. CONCLUSION: The MPP approach for tibial IMN was linked to a lower incidence of AKP compared with the TP approach, while offering comparable or better functional outcomes, ROM, and pain intensity. These findings suggest MPP as the preferred infrapatellar approach in appropriate clinical settings. Nonetheless, high-quality studies with standardized outcome measures are essential to validate these findings. LEVEL OF EVIDENCE: Level III (systematic review of RCTs and retrospective comparative studies). See Instructions for Authors for a complete description of levels of evidence.
21 May 2026
Read appraisal →Brain topography
fNIRS-STCT: A Novel Hybrid Spatial and Temporal CNN and Transformer Network for fNIRS Signal Classification
Functional near-infrared spectroscopy (fNIRS) is a non-invasive brain imaging method that detects neural activity by monitoring blood oxygen levels and circulation changes in the brain. Some current fNIRS classification models are simply adapted from deep learning models such as Transformer and fail to effectively leverage both temporal and spatial information from fNIRS. In this paper, we develop a hybrid deep learning model for fNIRS classification, fusing spatial convolutional neural network (CNN), a temporal CNN, and Transformer, named as fNIRS-STCT. Primarily, the architecture employs dual large convolutional kernels - one for temporal feature extraction and another for spatial feature extraction. Second, spatial and temporal CNNs are respectively integrated with Transformer by feeding CNN-extracted features as input to Transformer and then concatenating CNN and Transformer features. Third, spatial and temporal features are fused by element-wise addition. Finally, we exploit cross-entropy as the loss function, which integrates both online label smoothing and flooding strategies to avoid overfitting. The model's effectiveness is demonstrated through testing on two public fNIRS datasets. Across subject-dependent, subject-semi-dependent, and subject-independent evaluation schemes, fNIRS-STCT model consistently outperforms other compared models for all given performance metrics. Specifically, on the unilateral finger- and foot-tapping dataset, our model achieves accuracies of 83.29%, 81.73%, and 79.60% across three evaluation schemes, surpassing the second-best model by margins of 3%, 2%, and 1%, respectively. The findings underscore fNIRS-STCT's effectiveness in cross-subject mental state and brain activity interpretation.
21 May 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Nutritional prehabilitation in patients with head and neck cancer: an evidence mapping analysis
BACKGROUND: Head and neck cancer patients are often at high risk of malnutrition due to the disease and its treatment, and pretreatment nutritional prehabilitation is an important strategy for improving prognosis; however, the existing evidence still needs to be systematically synthesized. PURPOSE: To systematically describe and evaluate the evidence related to pretreatment nutritional prehabilitation in patients with head and neck cancer through evidence mapping to provide a basis for clinical practice. METHODS: Computerized searches of CNKI, Wan-fang, VIP, SinoMed, PubMed, Web of Science, Cochrane Library, Embase, and CINAHL were performed from the time of database construction to May 2025, to include systematic review/meta-analysis of nutritional prehabilitation of patients with head and neck cancer, randomized controlled trials, and observational studies. The Risk of Bias Tool, Newcastle-Ottawa Scale (NOS), and AMSTAR-2 scale were used to evaluate the methodological quality of the included studies, respectively, and the current status of the studies was demonstrated using a combination of text and graphs. RESULT: Then, 6 systematic evaluations/meta-analyses, 13 randomized controlled trials, and 4 observational studies were finally included. The largest number of studies was published in China, and all study populations consisted exclusively of patients with head and neck cancer. Interventions include pretreatment immunonutritional interventions, nutritional risk screening-guided interventions, standard enteral nutritional support, disease-specific nutritional formula support, nutritional counseling, and pretreatment swallow training. The outcome indicators mainly focused on the patients' nutritional status, complication rates, length of hospital stay, body weight, and BMI, etc. However, the methodological quality of the included studies needs to be improved. The results of the studies all showed that nutritional prehabilitation benefits the prognosis of patients with head and neck cancer. CONCLUSION: Overall evidence suggests that nutritional prehabilitation can improve patients' nutritional status and enhance their prognosis and quality of life, showing beneficial effects. More high-quality, large-sample clinical studies should be conducted in the future to guide the clinical implementation of nutritional prehabilitation.
21 May 2026
Read appraisal →PloS one
Deep Learning outperforms physicians in myopathy and neuropathy classification based on Needle Electromyography Signal
Needle electromyography (nEMG) is a valuable tool for diagnosing patients with neuromuscular diseases. However, it is labor-intensive and is prone to diagnostic inaccuracies stemming from human biases. To address these challenges, we validated an nEMG diagnosis-aiding system with minimal preprocessing using deep learning model to classify patients into three categories: normal, myopathy, and neuropathy. Using 376 nEMG signals from 57 patients from a tertiary university hospital database through nested k-fold cross validation, deep learning model surpassed the classification performance of six electromyographers. The median patient classification accuracy, precision, sensitivity, and specificity of the deep learning model was 0.70, 0.70, 0.70, and 0.85, respectively, whereas those of the physicians were 0.55, 0.60, 0.54, and 0.78, respectively. Model interpretability and failure analysis showed that the deep learning model classifies based on relevant signal features. Despite higher accuracy of DL model, the number of unanimously misclassified cases were higher in the DL model than physicians. Our study validates deep learning is a fast, accurate, and practical application to aid physicians in diagnosing patients using nEMG signals.
20 May 2026
Read appraisal →Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
Parkinson disease severity detection based On OPtFuzNet with fused features
BACKGROUND: Parkinson's disease (PD) is a progressive neurodegenerative disorder affecting millions of people worldwide. It severely impairs patients' mobility. For effective treatment strategies, it is essential to determine the severity of the disease at an early stage. METHODS: In this study, an optimized feature-fusion framework is developed to detect the severity of Parkinson's disease using gait data via an Optimized Fuzzy Neural Network (OPtFuzNet). This feature-fusion framework can be categorized into three stages: pre-processing, feature extraction, and classification. In the pre-processing stage, a median filter is employed to reduce noise present in the gait images. During feature extraction, local and global features of the gait images are captured using SAE and IDCN, respectively. Subsequently, these features are fused and fed into the OPtFuzNet classifier, where parameter optimization is performed using IGWO-Lévy. RESULTS: The proposed model is evaluated on the GAIT-IT and GAIT-IST benchmark datasets using standard metrics, achieving superior performance with accuracies of 98.08% and 98.12%, respectively. Furthermore, a feature importance analysis is conducted to identify the most influential gait characteristics that contribute to determining the severity of the impairment, thereby enhancing the clinical interpretability of the model.The proposed model is evaluated on the GAIT-IT and GAIT-IST benchmark datasets using standard metrics, achieving superior performance with accuracies of 98.08% and 98.12%, respectively. Furthermore, a feature importance analysis is conducted to identify the most influential gait characteristics that contribute to determining the severity of the impairment, thereby enhancing the clinical interpretability of the model. CONCLUSION: These results validate the efficacy of the proposed feature fusion and optimization strategy in identifying discriminative gait patterns associated with the severity of Parkinson's disease. However, as the datasets are based on simulated gait patterns rather than real clinical data, further validation on real-world datasets is necessary for practical applicability.
20 May 2026
Read appraisal →Bioinspiration & biomimetics
Designing McKibben muscles: a critical review for practical implementation
McKibben artificial muscles (AMs) are known as a prominent class of pneumatic actuators in soft robotics and biomechanical engineering, due to their unique structure and multifunctionality. This paper presents a comprehensive review of recent advancements in McKibben AMs, focusing on their performance, structural variations, and operational principles. A systematic literature search on Scopus identified 146 relevant articles, which were analysed for both performance metrics and design characteristics. Inspired by natural muscle behaviour, McKibben AMs enable complex motions such as bending, linear extension, and twisting. These actuators can be organised as individual or bundled systems: individual units are typically arranged in linear or circular patterns, while bundled systems occur in serial, parallel, braided, convergent, or pennate configurations. Recent innovations in smart actuation methods, braided sleeves and internal bladders have expanded their capabilities, enabling embedded sensing, environmental adaptability and untethered operation. Additionally, alternative manufacturing methods offer promising solutions for developing McKibben muscles with enhanced functionality and tailored properties.
19 May 2026
Read appraisal →Journal of medical Internet research
Efficacy of Digital Speech Therapy for Poststroke Dysarthria: Randomized Noninferiority Trial
BACKGROUND: Poststroke dysarthria, a common speech impairment, affects up to half of all stroke survivors, often reducing their ability to communicate, and adversely affecting their quality of life. Although conventional speech therapy for poststroke dysarthria is effective, access is often limited by time and geographical constraints. Here, digital speech therapy may serve as a remotely deliverable alternative for selected patients. However, few trials have assessed its efficacy, safety, and usability. OBJECTIVE: This study aimed to evaluate whether a smartphone-based speech therapy app is noninferior to conventional workbook-based therapy in improving speech intelligibility among individuals with poststroke dysarthria. METHODS: This single-blind, randomized controlled, noninferiority trial was performed at 3 hospitals in South Korea. Adults (≥19 y) with poststroke dysarthria who were cognitively intact, without aphasia, and able to use a smartphone were eligible. Participants were enrolled between July 20, 2023, and April 15, 2024. Participants were randomly assigned (1:1), stratified by stroke phase, using a block randomization method, to receive either a smartphone-based digital therapy app or a conventional workbook-based therapy for 4 weeks. The primary outcome was speech intelligibility (0-100 perceptual rating) after the intervention. Primary analysis was intention-to-treat using analysis of covariance. A noninferiority margin of 19 points was pre-defined. RESULTS: A total of 73 participants were enrolled (median age 62.00 years). Among them, 38 were assigned to the digital speech therapy group and 35 to the control group. Intelligibility scores improved from 80.48 (SD 18.92) to 92.08 (SD 12.38) in the intervention group, and from 80.94 (SD 16.74) to 88.11 (SD 18.06) in the control group. The adjusted between-group difference was 4.49 (95% CI 0.61-8.37), and the lower bound of the 95% CI was above the prespecified noninferiority margin (-19), which supported noninferiority. No significant between-group differences were observed in the secondary outcomes related to speech function or psychological status. The system usability score was 89.6, and adherence in the digital speech therapy group was 64.6% based on app logs, with no treatment-related adverse events. CONCLUSIONS: Digital speech therapy was noninferior to conventional workbook-based therapy in improving speech intelligibility and was feasible across acute to early subacute and chronic stroke phases in cognitively intact stroke survivors with predominantly mild-to-moderate dysarthria. However, feasibility and efficacy in older stroke survivors with cognitive deficits or co-occurring aphasia, or in those unable to use smartphones, remain to be established.
19 May 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Effectiveness of survivorship programmes to enhance health-related quality of life of colorectal cancer survivors: a systematic review and meta-analysis of randomised controlled trials
PURPOSE: This study aimed to assess the effectiveness of the survivorship programmes by synthesising and analysing the available evidence to enhance health-related quality of life (HRQoL) amongst colorectal cancer (CRC) survivors. METHODS: Ten English-language databases were searched from inception to June 2025 in this systematic review and meta-analysis. All randomised controlled trials (RCTs) were included. Available data were pooled in a meta-analysis using RevMan (version 5.4.0). Two independent reviewers performed the database searches, extracted the data, assessed the methodological quality by using the Cochrane Risk-of-Bias tool (version 2) and evaluated the overall quality of findings by using Cochrane GRADE. RESULTS: A total of 22 RCTs involving 2949 CRC survivors were identified. The meta-analysis results (thirteen studies) indicated a significant improvement in the physical (standardised mean difference [SMD] = 0.52, 95% confidence interval [CI, 0.18, 0.86], P = 0.002, I2 = 88%) and mental domains of HRQoL (SMD = 0.4, 95% CI [0.06, 0.74], P = 0.02, I2 = 86%). Sensitivity analysis involved reducing the heterogeneity after removing one study. No publication bias was found. The overall quality of findings was from 'low' to 'moderate'. CONCLUSIONS: The detailed components of the survivorship programme can enhance HRQoL in physical and mental domains, indicating its potential as valuable evidence for health providers to support CRC survivors post-treatment. Future research should focus on expanding the delivery of such programme comprehensively by integrating mobile health into a nurse-led approach to optimise geographic diversity and improve social HRQoL.
19 May 2026
Read appraisal →Cerebellum (London, England)
Inhibitory Circuits of the Sensorimotor Network are Not Modulated By Cerebellar Transcranial Direct Current Stimulation in Isolated Cervical Dystonia
Impaired cerebellar influence on motor cortical excitability and plasticity has been reported in cervical dystonia (CD) patients, accompanied by the absence of cerebellar brain inhibition (CBI). Polarity-specific modulation of CBI in healthy individuals using cerebellar transcranial direct current stimulation (ctDCS) suggested that ctDCS could normalize abnormal cerebellar output and improve clinical symptom severity in CD. The objective of this study was to determine whether anodal or cathodal ctDCS can modulate neurophysiological parameters of cortico-cortical, cerebello-cortical or afferent inhibition and improve motor symptom severity in CD patients. Fifteen patients with isolated CD participated in a randomized, double-blinded crossover study consisting of three sessions of anodal, cathodal, or sham ctDCS. Before and after each intervention, motor symptom severity and inhibitory circuits of the sensorimotor network were investigated using transcranial magnetic stimulation (TMS), including short-interval intracortical inhibition (SICI), short-latency afferent inhibition (SAI) and CBI. Baseline TMS measurements showed inhibitory influence of SICI (p < 0.001) and SAI (p < 0.001) in CD patients, whereas CBI had no inhibitory effect (p = 0.281). The different ctDCS interventions caused no significant modulation in any of the inhibitory TMS paradigms investigated. Similarly, motor symptom severity remained unchanged after the ctDCS interventions. A single session of ctDCS was not effective to modulate inhibitory circuits of the sensorimotor network in isolated CD patients. Future studies focusing on repetitive ctDCS interventions or multifocal stimulation protocols are needed to assess the influence on network excitability and connectivity as well as on motor symptoms.
18 May 2026
Read appraisal →Journal of neurology
Diagnostic and prognostic value of blood neurofilament light chain in ischemic stroke: an individual patient data meta-analysis
BACKGROUND: We aimed to conduct an individual patient data meta-analysis on blood neurofilament light chain (NfL) in ischemic stroke (IS) to enhance its clinical applicability. METHODS: We performed a systematic literature search of studies on blood NfL measured in adult patients within 30 days after IS onset and derived age- and BMI-adjusted Z-scores based on a previously published reference population of healthy controls. We collected clinical, radiological and biochemical parameters of IS patients and tested associations of NfL at defined timepoints after IS onset (D1: < 24 h; D2: 24-48 h; D3: 48-72 h; D4-5: 72-120 h; D6-7: 120-168 h; D8-30: > 168 h) with baseline characteristics and 3-month follow-up outcomes (modified Rankin Scale, mRS; survival). RESULTS: We included 4081 blood NfL values from 2872 participants (IS n = 1985, transient ischemic attack n = 88, healthy controls n = 799) of 18 published studies and 3 unpublished cohorts. In patients with IS, NfL Z-score progressively increased from D1 [median: 2.0 (IQR: 0.9-2.9)] to D6-7 [median: 3.5 (IQR: 3.0-3.8)], with discriminative ability being high for IS vs. controls (AUC: 0.79-0.97) and fair for IS vs. TIA (AUC: 0.64-0.80). Higher NfL Z-score at D1 was associated with greater risk of symptomatic intracranial hemorrhage (aOR = 1.33, p = 0.014) and, from D2 onwards, with larger infarct lesion volume (highest Spearman's rho: 0.795 at D6-7). NfL independently predicted a mRS > 2 (aOR = 1.31, p < 0.001) and mortality (aOR = 1.67, p < 0.001) at 3 months. CONCLUSIONS: Blood NfL level was progressively elevated after IS, could discriminate IS from healthy controls with high accuracy and had prognostic value for intra-hospital complications and 3-month clinical outcomes in IS.
18 May 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Effects of yoga on depressive symptoms in breast cancer patients: a meta-analysis of randomized controlled trials
BACKGROUND: While yoga is known to benefit depression in breast cancer patients, its efficacy as an adjunct to diverse treatment regimens remains unclear. This study evaluated yoga's efficacy in alleviating depression during varied breast cancer therapies and supports its clinical integration as a complementary intervention. METHODS: Following PRISMA 2020 guidelines, we systematically searched for RCTs in English and Chinese. Literature quality was assessed using the Cochrane Risk of Bias tool. Data were analyzed with Review Manager 5.4.1, including subgroup analyses by treatment type and assessment scale. RESULTS: Analysis of 21 studies showed yoga significantly reduced depression levels [SMD = -0.58, 95% CI (-0.83, -0.32), P < 0.00001]. Subgroup analyses revealed a significant combined mean difference among the surgery group [SMD: -1.04], the postoperative radiotherapy group [SMD: -2.47], and the postoperative chemotherapy group [SMD: -0.46]. The group receiving postoperative radiotherapy demonstrated a significantly greater improvement in depression. Subgroup analyses of scale-assessed effects confirmed the validity of the Beck Depression Inventory (BDI), the Center for Epidemiologic Studies Depression Scale (CESD), the Hospital Anxiety and Depression Scale (HADS), and the Zung Self-Rating Depression Scale (SDS). The HADS demonstrated a greater effect size [SMD = -1.19, 95% CI (-2.13, -0.24), P = 0.01]. CONCLUSIONS: The impact varied among those undergoing different treatment regimens. Notably, the degree of improvement in depression appeared to be greater in the postoperative radiotherapy group. HADS is a practical self-assessment scale that has demonstrated considerable improvement and is recommended for use in breast cancer patients with depression.
18 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 →Computer methods and programs in biomedicine
Integrating multimodal data and deep learning for functional assessment and rehabilitation prediction after cerebral hemorrhage
BACKGROUND: Intracerebral hemorrhage (ICH) is a leading cause of long-term disability, particularly in China. Post-stroke motor recovery exhibits considerable heterogeneity, presenting substantial challenges for clinicians in establishing realistic goals. While integrative AI paradigms have shown success in other complex medical domains, existing models often rely on single-modality data, limiting their predictive accuracy and clinical utility. This study aims to develop and validate a multimodal predictive model integrating CT imaging, clinical data, and rehabilitation assessments to simultaneously predict motor recovery and global rehabilitation outcomes following cerebral hemorrhage. METHODS: We conducted a retrospective study involving 739 patients (315 for motor function prediction and 424 for rehabilitation outcome assessment) who received rehabilitation therapy after cerebral hemorrhage. To predict motor function, we constructed a late-fusion deep learning model leveraging 3D-DenseNet for CT neuroimaging and Multi-Layer Perceptron (MLP) for clinical and laboratory features. To predict rehabilitation outcomes, a Gradient Boosting Decision Tree (GBDT) model was developed and validated using 5-fold and 10-fold cross-validation, comparing it against other machine learning algorithms, including SVR, Random Forest and AdaBoost. Model performance was assessed using metrics including AUC and R². Additionally, univariate and multivariate regression analysis were performed to identify significant factors influencing motor recovery and rehabilitation outcomes. RESULTS: A total of 739 patients were included. The multimodal fusion model achieved an AUC of 0.856 (95 % CI: 0.741-0.971) and an F1 score of 0.897 (95 % CI: 0.819-0.975), significantly outperforming the imaging-only (AUC: 0.833) and clinical-only (AUC: 0.749) models. For rehabilitation outcome prediction, the GBDT model achieved an R2 of 0.849 (95 % CI: 0.803-0.887), demonstrating superior stability and accuracy over other models. Additionally, multivariate analysis revealed that serum albumin (ALB), neutrophil percentage (NEUT%), triglycerides (TG), and thrombin time (TT) were independent predictors of motor recovery, while age, admission mBI, and time to start rehabilitation significantly influenced functional outcomes. CONCLUSION: This study confirms that a multimodal deep learning framework integrating routinely available CT imaging and clinical biomarkers provides high predictive value for simultaneously forecasting motor recovery and global functional outcomes after ICH. This proof-of-concept approach offers a reproducible, data-driven tool for early risk stratification, facilitating the formulation of individualized rehabilitation strategies and optimizing resource allocation in clinical workflows.
17 May 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Effects of activity pacing-related interventions on cancer-related fatigue and classification of behavior change techniques: A systematic review and meta-analysis
PURPOSE: Although physical activity is recommended for managing cancer-related fatigue (CRF), activity pacing (AP) and energy conservation are also implemented to balance activity and rest. This systematic review assessed the effectiveness of AP-related interventions and behavior change techniques (BCTs) employed in AP-related interventions for CRF management. METHODS: We searched PubMed, CINAHL, CENTRAL, and Ichu-shi databases for articles published up to February 28, 2026. After assessing the risk of bias, we performed meta-analyses for quantitative synthesis. We also identified and classified BCTs using data from the Behavior Change Technique Taxonomy version 1. RESULTS: Among the 1257 identified studies, 10 (7 randomized controlled trials [RCTs] and 3 non-RCTs) met the inclusion criteria. The effect size was small but not significant (standardized mean differences [SMD] = - 0.36; 95% confidence intervals [CI]: - 0.73 to 0.00; 5 studies; 617 participants), with substantial heterogeneity (I2 = 66%). Compared with controls, the intervention showed a moderate, statistically significant effect in the subgroup of patients undergoing chemotherapy (SMD = - 0.58; 95% CI: - 0.87 to - 0.29; three studies; 197 participants with breast cancer). The primary BCTs used in AP-related interventions were "goal setting," "social support," and "graded tasks." CONCLUSION: AP-related interventions may provide some benefit in improving CRF, particularly during chemotherapy. However, the certainty of the current evidence is extremely low. Although these interventions represent useful approaches, further RCTs are needed, and digitization of AP-related intervention programs incorporating effective BCTs may be beneficial.
17 May 2026
Read appraisal →JMIR human factors
A Chronic Pain Self-Management Mobile App (Dolodoc): Cross-Sectional Acceptability Study
BACKGROUND: Approximately 19% of adults in Europe are affected by chronic pain, which reduces the quality of life. Pain-management mobile health (mHealth) apps offer a promising solution for self-management, but user engagement and adherence can limit their clinical impact. User experience design and research play a crucial role in optimizing usability and long-term adoption of digital health interventions. OBJECTIVE: This study aims to evaluate the user experience of Dolodoc, a mobile app for chronic pain self-management, using a mixed methods approach that assesses acceptability through a content quality survey and examines use by analyzing overall use patterns. METHODS: A cross-sectional acceptability study of the main content of Dolodoc was conducted among patients with chronic pain recruited from the Geneva University Hospitals pain center and through snowball sampling. Participants rated 84 evidence-based self-management strategies by using a 5-point Likert scale based on 5 acceptability criteria: understandability, motivation, feasibility, relevance, and alignment with the related quality-of-life dimension. To reduce participant fatigue and avoid random responses, the 84 strategies were randomly divided across survey versions. Use was assessed through metrics collected over 6 months with Piwik PRO Analytics to observe real-world use behaviors among Dolodoc users. RESULTS: In the acceptability study, 33 participants rated the self-management strategies positively across all dimensions. On a scale from -2 to 2, the strategies were well understood (mean 1.47, SD 0.76), motivational (mean 1.12, SD 0.96), feasible (mean 1.01, SD 1.05), relevant (mean 0.99, SD 1.09), and aligned with the dimensions (mean 1.33, SD 0.89). The use study demonstrated that 60% (486/802) of the patients used Dolodoc only once, indicating that long-term adherence remains a challenge. Within Dolodoc, pain tracking, useful links, and medication logging were the most actively used features. CONCLUSIONS: This study highlights the gap between acceptability and long-term adherence to mHealth solutions. Improving personalization and accessibility could increase user engagement and long-term adherence. Future iterations of the app should incorporate tailored interventions and real-time feedback mechanisms. In addition, leveraging a digital navigation follow-up could facilitate user adoption and sustained engagement.
17 May 2026
Read appraisal →PloS one
Effect of intra-dialytic pedaling exercise on dialysis adequacy: A randomized controlled trial
BACKGROUND: In patients with chronic kidney disease undergoing hemodialysis, physical activity and rehabilitation are crucial for preventing declines in muscle strength and functional capacity. This study aimed to assess the impact of physical activity during hemodialysis on dialysis adequacy in patients undergoing hemodialysis. METHODS: This randomized controlled trial (RCT) investigated the impact of pedaling exercise on dialysis effectiveness in 84 hemodialysis patients at hospitals in Bushehr. Participants were randomly assigned to either an experimental group (n = 42) that performed 30 minutes of pedaling exercise during their 4-hour dialysis sessions or a control group (n = 42) that received routine hemodialysis. Dialysis adequacy was assessed by comparing pre- and post-dialysis blood samples obtained from the arterial line. A conservative intradialytic exercise protocol, blood samples, and patient weight were measured using a calibrated digital scale. Data analysis was performed using SPSS version 24 software. RESULTS: The experimental and control groups were similar in demographic characteristics, except for age (X2 = -3.84, p = 0.001) and education levels (X2 = 10.100, p = 0.006). While there was no significant difference in weight between the groups before and after the intervention (t = 0.223, p = 0.82 before; t = 0.203, p = 0.84 after), both groups showed a substantial weight reduction overall (p < 0.0001). There were no statistically significant differences in weight change (t = 0.80, p = 0.25), BUN (t = 0.13, p = 1.52), or Kt/V (t = 1.62, p = 0.11) between the experimental and control groups. CONCLUSION: This study found that incorporating pedaling exercise during hemodialysis did not significantly improve dialysis effectiveness, as measured by weight change, BUN levels, or Kt/V. While both groups showed weight loss, there were no statistically significant differences between them. However, the study was limited by its small sample size and the specific exercise protocol employed. Further research with larger cohorts and a broader range of physical activities is needed to determine whether physical activity during hemodialysis can improve dialysis adequacy and overall patient outcomes. TRIAL REGISTRATION: IRCT code number 20150529022466N15 and trial Code of Ethics IR.BPUMS.REC.1398.130E.
16 May 2026
Read appraisal →JMIR formative research
Use of Commercially Available Large Language Models to Generate Information Leaflets on Post-Intensive Care Syndrome: Clinical Utility Assessment
BACKGROUND: Patients and their families without medical knowledge may find professional health care information difficult to understand. The use of large language models (LLMs) to simplify and translate complex medical content holds promise for improving comprehension while reducing the burden on health care providers tasked with delivering explanations. OBJECTIVE: This study aims to evaluate the quality of information leaflets generated using commercially available LLMs. METHODS: Informational texts on post-intensive care syndrome were generated using 6 different LLMs and 4 prompt designs with varying levels of instructional guidance. Clinical practice guideline documents were uploaded and provided to the models as reference context, reflecting a pragmatic clinical scenario without model tuning or advanced retrieval pipelines. In total, 72 texts were generated (6 models × 4 prompts × 3 outputs). After excluding texts shorter than 500 characters (n=16) and those without explicit mention of post-intensive care syndrome (n=3), 53 texts remained. To enable balanced human evaluation across model-prompt combinations, the longest eligible response from each pair was selected (4 prompts × 4 models; n=16). Following independent expert review by 2 medical specialists, 7 texts were excluded, leaving 9 texts for final analysis. Ten individuals, including health care professionals and nonmedical personnel, assessed the texts using a 10-point Likert scale across multiple quality domains. An LLM-based parallel assessment was also conducted, and scores were compared across models and evaluator groups. RESULTS: In the human evaluation of the selected 9 texts, the generated texts achieved an average score of 6.8 or higher across all evaluation criteria, with no potentially harmful content identified. The text generated by LLaMA 3 70B, using a step-by-step approach combined with text-augmented prompting based on clinical guidelines, received the highest overall score, whereas the lowest-rated text was produced using a simple prompt without text augmentation. Although no consistent trends were observed across LLMs or prompt engineering strategies, text-augmented prompting was generally associated with higher evaluation scores. Ratings differed between professional and nonprofessional evaluators. Given the feasibility-driven screening process and the resulting limited sample size, the findings should be interpreted as exploratory and descriptive rather than definitive estimates of overall model performance. CONCLUSIONS: Among the selected texts included in the final human evaluation, informational materials generated using commercially available LLMs were generally rated as acceptable by human evaluators, and none contained harmful content. These findings suggest that LLMs may support the development of patient-facing informational materials under feasibility-constrained conditions, although further validation with larger and more diverse samples is warranted.
16 May 2026
Read appraisal →Spine
Identifying Predictors of Failed Back Surgery Syndrome Following Lumbar Spine Surgery: A Machine Learning Approach
STUDY DESIGN: Retrospective cohort study from a tertiary academic medical center. OBJECTIVE: To build a prognostic machine learning model to predict 1-year FBSS incidence after lumbar spine surgery. SUMMARY OF BACKGROUND DATA: A minority of patients who undergo degenerative lumbar spine surgery will have persistent postoperative pain, characterized as "Failed Back Surgery Syndrome" (FBSS). Adequate preoperative identification of patients at risk of having an undesirable outcome after surgery is an essential part of a spine surgeon's workflow. Although several studies have proposed mechanisms and risk factors for FBSS, no studies have developed a prognostic machine learning model to quantify and functionalize predictions. METHODS: A cohort of lumbar fusion and lumbar decompression surgeries was queried from a tertiary academic medical center from 2002 to 2022. Patient and operative characteristics were systematically extracted for each surgery. Several machine learning algorithms were used and optimized to predict FBSS occurrence within 1 year of surgery. SHAP feature importance values were computed for the top-performing model. RESULTS: A total of 10,128 unique lumbar decompression surgeries and 2890 unique lumbar fusion surgeries were included. The Random Forest model had the highest performance of tested models (AUROC of 0.715 for lumbar decompression, 0.701 for lumbar fusion). For lumbar decompression, the top three predictors of FBSS were absence of microdiscectomy, lack of preoperative immunosuppressant usage, and preoperative benzodiazepine usage. For lumbar fusion, prior FBSS diagnosis, lack of preoperative immunosuppressant usage, and operating room duration were the most important predictors. Other key variables spanned several domains, including preoperative medication usage, patient demographics, and operative indications and characteristics. CONCLUSION: This study demonstrates the successful creation of a prognostic machine learning model for prediction of FBSS within one year postoperatively. These models, after external validation, have the potential to be instrumental aspects of a spine surgeon's workflow. LEVEL OF EVIDENCE: Level III.
16 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 →The Journal of neuroscience : the official journal of the Society for Neuroscience
Stable Mechanoreceptive Somatotopy in Chronic Low Back Pain: Is Cortical Map Reorganization a Myth?
Chronic low back pain (CLBP) has been linked to maladaptive cortical plasticity in sensorimotor regions, which may contribute to pain persistence through less distinct ("smudged") somatotopic maps of afferent input from the back. However, empirical support for such functional reorganization, especially in the primary somatosensory cortex (S1), is limited. To delineate precise sensory representations of the back in humans and test for altered somatotopic processing in CLBP, we utilized an MR-compatible pneumatic vibration device and applied frequency-specific vibrotactile stimuli at nine thoracolumbar paraspinal sites in 45 patients with CLBP and 41 healthy controls (53 females in total). Representational similarity analysis was employed via a whole-brain searchlight method, and the neural representational patterns were contrasted against theoretical models including a segmental (based on anatomical proximity), simple (upper vs lower back division), and a random model. In addition, a machine learning classifier was trained to predict afferent input from the upper versus lower back in healthy controls and tested in CLBP patients. Both groups displayed well-organized segmental representations spanning somatosensory, motor, and posterior parietal cortices. Posterior parietal regions exhibited the best model fits, followed by S1. No evidence for differences in representational patterns between groups was found. In CLBP patients, these patterns did not show associations with pain duration, severity, and self-reported back perception. The classifier, trained on healthy controls, accurately predicted upper versus lower back afferent input in CLBP patients. These findings indicate preserved cortical maps of the back in CLBP, challenging the hypothesis of sensory cortical reorganization in this condition.
16 May 2026
Read appraisal →Journal of neurology, neurosurgery, and psychiatry
Intravenous methylprednisolone as add-on induction therapy for chronic inflammatory demyelinating polyradiculoneuropathy: a randomised controlled trial
BACKGROUND: Most patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) require maintenance treatment. We aimed to determine whether combined treatment with intravenous immunoglobulin (IVIg) and intravenous methylprednisolone (IVMP) increases remission rates compared with IVIg and placebo. METHODS: We performed a randomised, double-blind, placebo-controlled study. Adults with CIDP who were treatment naive, relapsed after a remission or required continued treatment after a single IVIg dose were included. Participants were treated with IVMP (1000 mg) or placebo (sodium chloride) every 3 weeks for 18 weeks. All participants received IVIg treatment consisting of a loading dose (2 g/kg) and serial maintenance treatments (1 g/kg). The primary outcome was remission, defined as sustained improvement on disability scales at 52 weeks without need for further treatment. RESULTS: Enrolment was halted after the inclusion of 77 of the 96 planned participants because of safety concerns: four thromboembolic events occurred in the IVIg/IVMP group compared with none in the IVIg/placebo group. 14 of 37 (38%) participants in the IVIg/IVMP group were in remission at 52 weeks compared with 11 out of 40 (28%) in the IVIg/placebo group, with a difference of 10% (95% CI -11 to 31; p=0.47). Several secondary outcomes showed a greater magnitude of improvement in disability and impairment at 18 and 52 weeks in the IVIg/IVMP group. CONCLUSIONS: The study was prematurely stopped due to safety concerns after four thromboembolic events in the IVIg plus IVMP group. Combined treatment did not lead to significantly more frequent remissions than IVIg alone in the doses used in this study. TRIAL REGISTRATION NUMBER: ISRCTN15893334.
16 May 2026
Read appraisal →Journal of neurology
The effects of computerized cognitive training on cognitive function in patients with mild cognitive impairment: a systematic review and meta-analysis
BACKGROUND: We sought to quantify the effects of computerized cognitive training (CCT) on patients with mild cognitive impairment (MCI), to inform the development of clinical non-pharmacological intervention strategies. METHODS: We searched PubMed, Cochrane Library, Embase, and Web of Science databases from 2007 to February 2026 for randomized controlled trials (RCTs) of CCT in patients with MCI. Outcomes including global cognition, specific cognitive domains, psychosocial functioning, and activities of daily living were analyzed separately by stata 18 and Review Manager 5.4. RESULTS: We included 30 studies and 2056 participants. Our meta-analysis revealed that, compared with control conditions, CCT led to a significant moderate improvement in overall cognitive function, standardized mean difference (SMD) = 0.62, 95% confidence interval (CI) = 0.43-0.81; I2 = 73%. Subgroup analysis showed that intervention characteristics-including session duration, training device, total intervention length, weekly frequency, sample size, and assessment tools-yielded similar improvements in global cognition, with no statistically significant differences between subgroups. These findings indicate that the cognitive benefits of CCT are consistent and robust. CONCLUSION: This systematic review and meta-analysis shows CCT significantly improves global cognitive function in MCI patients, with stable benefits across subgroups. Despite clear overall effects, high heterogeneity, varying training protocols and assessment tools exist. Further large, long-term RCTs are needed to clarify CCT's long-term effects and support its standardized clinical application. TRIAL REGISTRATION: PROSPERO International prospective register of systematic reviews CRD420261328762; https://www.crd.york.ac.uk/PROSPERO/view/CRD420261328762 .
15 May 2026
Read appraisal →Journal of medical Internet research
Machine Learning and Deep Learning Models for Predicting Future Falls in Community-Dwelling Older Adults: Systematic Review and Meta-Analysis of Longitudinal Evidence
BACKGROUND: Machine learning (ML) and deep learning (DL) show promise for fall risk prediction, but prior reviews focused mainly on real-time fall detection, in-hospital falls, or conventional statistical models. The performance of ML-DL-based models for predicting future falls in community-dwelling older adults remains unclear. OBJECTIVE: This study aimed to review ML-DL studies for predicting future falls among community-dwelling older adults and meta-analyze discrimination where feasible. METHODS: Six databases were searched from inception to September 23, 2024, with updates on August 31, 2025, and February 28, 2026. We included longitudinal studies developing or validating ML-DL models to predict future falls in community-dwelling adults aged ≥60 years and excluded real-time detection, simulated or no fall, and inpatient studies. Risk of bias was assessed using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Areas under the curve (AUCs) were meta-analyzed using Hartung-Knapp-Sidik-Jonkman random-effects models with 95% CIs. Heterogeneity, 95% prediction intervals (PIs), sensitivity analyses, and subgroup analyses were conducted. RESULTS: After screening 10,253 records, 28 (0.3%) studies were included; 18 (64.3%) focused on general older adults. Prediction horizons ranged from 3 months to 7 years, and fall incidence ranged from 1.6% to 46.6%. Twenty-three (82.1%) studies applied ML, and 5 (17.9%) studies used DL. Input modalities included text (n=18, 64.3%), sensor (n=5, 17.9%), image (n=1, 3.6%), and multimodal data (n=4, 14.3%). Common predictors included age, sex, fall history, depression, and basic daily activities. Only one model underwent external validation. Calibration reporting was sparse. All models were rated at high risk of bias. Ten models were meta-analyzed, yielding a pooled AUC of 0.79 (95% CI 0.69-0.87) with extreme heterogeneity (τ2=0.64; τ=0.80; I2=99.8%; Q=4128.99). The confidence-distribution bootstrap PI was 0.20 to 0.99, indicating substantial uncertainty in expected performance across new populations. Subgroup analyses indicated moderation by sample size and population type, with higher discrimination in specific populations than in general samples; however, the specific population subgroup included only 2 studies. Although all participants were community dwelling, some cohorts were recruited through clinically enriched pathways rather than general community sampling. CONCLUSIONS: ML-DL models show potential for identifying community-dwelling older adults at elevated future fall risk; however, wide PIs, limited external validation, and high risk of bias suggest real-world performance may be optimistic. The pooled AUC should be interpreted as a summary of reported discrimination under study-specific conditions, predominantly from internally validated, high-risk-of-bias models, rather than as a robust estimate of transportable real-world performance. This review extends prior reviews by focusing on community-dwelling settings and by integrating PROBAST, Hartung-Knapp-Sidik-Jonkman meta-analysis, PIs, and modality-specific synthesis to evaluate both discrimination and uncertainty. Findings support the use of ML-DL models for proactive fall prevention while emphasizing the need for validation and context-specific implementation.
15 May 2026
Read appraisal →Scientific reports
Exploring the psychological and physiological effects of a virtual reality-based bicycle exercise in hemodialysis patients: a randomized controlled trial
This study aimed to evaluate the efficacy of a virtual reality (VR)-based bicycle exercise in psychological distress (depression and anxiety) and selected biochemical parameters among patients receiving maintenance hemodialysis (MHD). A total of 70 patients from the dialysis station at Changzhou Medical District of the No. 904th Hospital were randomly allocated into study group(VR-based bicycle exercise, n = 35) and control group(routine nursing care, n = 35). The depression and anxiety levels were assessed by Self-rating Depression Scale (SDS), and Self-rating Anxiety Scale (SAS) respectively. Physiological indicators, including serum creatinine (Scr) and blood urea nitrogen (BUN) levels, were also analyzed. Following the intervention, the study group exhibited significant reductions in SDS and SAS scores (both P < 0.05). The levels of Scr and BUN in peripheral blood were also observed to be significantly decreased in study group (P < 0.05). Correlation analysis revealed a significant positive correlation between SAS/SDS scores with both Scr and BUN levels (P < 0.05 or P < 0.01). Furthermore, regression models identified SAS scores as significant predictors of Scr and BUN levels, accounting for 27.8% and 31.9% of their variance, respectively (P < 0.05 or P < 0.01). VR-based bicycle exercise can improve psychological well-being, and was associated with beneficial changes in pre-dialysis serum biomarkers (Scr and BUN) in MHD patients. This integrated intervention represents a promising non-pharmacological strategy to complement standard care in MHD patients.
15 May 2026
Read appraisal →BMJ open
Prediction of Oswestry Disability Index and Numeric Rating Scale scores after lumbar spine surgery: machine learning model development and fairness assessment
BACKGROUND: One-third of patients operated for degenerative conditions in the lumbar spine do not report substantial improvement after 12 months. Most previous outcome prediction models are classifiers. This constrains nuances in prediction and use for decision support. OBJECTIVES: To develop and test models for the prediction of continuous outcome scores and retrieval of similar patients' outcomes, and to evaluate the models' fairness. SETTING: Norwegian public and private specialist healthcare. PARTICIPANTS AND DATA SOURCE: All cases recorded with an elective operation for lumbar disc herniation (LDH, n=18 377) or lumbar spinal stenosis (LSS, n=24 540) in the Norwegian Registry for Spine Surgery from 1 January 2007 to 23 May 2023. OUTCOME MEASURES: All outcomes were patient-reported 12 months after the operation. The primary outcome was the Oswestry disability index (ODI), modelled on a scale ranging from 0 to 100. Numeric Rating Scale scores (range 0-10) for back and leg pain were secondary outcomes. MODEL BUILDING AND PERFORMANCE: We selected 22 predictors recorded preoperatively by patients and clinicians based on Shapley Additive Explanations values. Data were split into 80%/20% training/test samples for LDH and LSS. Six machine learning methods for regression, that is, with a continuous outcome (extreme gradient boosting (XGBoost), Gaussian process regression, gradient boosting regression, artificial neural networks and linear regression), were trained for both conditions using fivefold cross-validation. We report the magnitude and distribution of errors as mean absolute error (MAE) with 95% CIs, and explanatory power as the coefficient of determination (R2). Fairness and calibration were assessed with violin and calibration plots of error. We developed a patient-similarity function that uses a K-nearest neighbour model to retrieve the individual outcomes of the 50 most similar patients and evaluated it by calculating L1 distances (Manhattan distances) across subgroups. RESULTS: XGBoost regression performed best for both conditions. The models showed good calibration and predicted ODI with MAE 11.32 (95% CI 11.00 to 11.63) and R2 0.27 (95% CI 0.24 to 0.29) for LDH and MAE 12.05 (95% CI 11.76 to 12.32) and R2 0.31 (95% CI 0.28 to 0.34) for LSS. The MAEs for back and leg pain were 2.09 (95% CI 2.04 to 2.15) and 1.95 (95% CI 1.90 to 2.00) for LDH and 2.33 (95% CI 2.28 to 2.38) and 2.13 (95% CI 2.08 to 2.16) for LSS. All models were fair with differences in error between subgroups for sex, age, education level and native language. In the patient-similarity function, distances at baseline were evenly distributed across subgroups. CONCLUSIONS: Our machine learning models predicted continuous outcomes with MAEs close to the SEs of measurements. The models were fair across sociodemographic subgroups. We succeeded in developing a patient-similarity function which supplements the predictions.
15 May 2026
Read appraisal →PloS one
Evaluation of the diagnostic value of the Modified Evan's Blue Dye Test for assessing aspiration in tracheostomized critically ill patients: A systematic review and meta-analysis
Dysphagia and aspiration are common complications in tracheostomized critically ill patients. The Modified Evan's Blue Dye Test (MEBDT) is a non-invasive, bedside, adjunctive rule-in signal for aspiration when positive. However, its diagnostic accuracy compared to the gold standard Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in these patients remains unclear. We conducted a systematic review and meta-analysis to evaluate the diagnostic accuracy of the MEBDT for the detection of aspiration in tracheostomized critically ill patients. Study protocol was prospectively registered on PROSPERO (CRD:42023479920). A systematic search was performed across three databases (PubMed, Cochrane Central, and Embase), followed by a systematic screening process against predetermined selection criteria and included studies that provided data on the sensitivity and specificity of MEBDT versus FEES. The risk of bias and the level of evidence certainty in the included papers were assessed by the QUADAS-2 tool and GRADE approach respectively. Six out of 2227 screened studies were included. We found that MEBDT had a high specificity 95.42% (95% CI [67.38%, 99.53%]) and positive predictive value 95% (95% CI [81, 100]). In conclusion, the MEBDT can serve as a bedside adjunctive tool that indicates a potential aspiration risk when the result is positive. However, if the result is negative, further diagnostic assessments, like FEES, are recommended for high-risk patients.
15 May 2026
Read appraisal →PloS one
The impact of walking on creative thinking: A systematic review and meta-analysis
BACKGROUND: Walking is associated with many benefits, from improved mental health to a reduced risk of mortality - but can it boost creative thinking? Current evidence suggests a positive effect of physical activity on creative thinking, but the specific effect of walking has not been adequately explored. METHODS: We conducted a systematic search of the PsycINFO, MEDLINE, Scopus, and ProQuest databases from inception to 8 January 2025 using search terms related to walking and creativity. We then performed meta-analyses of Cohen's d effect sizes to assess the effect of walking on creative thinking, as represented by divergent thinking (the ability to generate novel and useful ideas) and convergent thinking (the ability to analyze and select ideas to find the best solution). We assessed study quality using a creativity-specific tool, and the certainty of the evidence with the Grading of Recommendations Assessment, Development and Evaluation Framework. RESULTS: We identified 23 studies (12 randomized experimental studies, nine non-randomized experimental studies, two observational studies) from 16 articles including a total of 1,036 participants, most of whom were post-secondary students. We found moderate certainty evidence of a large effect of walking on divergent thinking (d = 0.93 [95% CI 0.44, 1.42]), and very uncertain evidence of a null effect of walking on convergent thinking (d = 0.16 [95% CI -0.31, 0.63]). Sensitivity analyses of randomized trials only found similarly large effects of walking on divergent thinking ability (d = 0.82 [95% CI 0.35, 1.28]). CONCLUSION: Results suggest that walking likely results in a large increase in divergent thinking, indicating its potential as an intervention to stimulate creative idea generation.
15 May 2026
Read appraisal →Fluids and barriers of the CNS
Cognitive assessment methods and outcomes following shunt surgery in idiopathic normal pressure hydrocephalus (iNPH): a systematic review and meta-analysis
INTRODUCTION: Core cognitive deficits in iNPH include slowed information processing, psychomotor slowing and executive dysfunction. However, cognitive outcomes following shunt surgery are not well understood. This review synthesised evidence on cognitive assessment methods and outcomes following shunt surgery in iNPH. METHODS: PubMed, Scopus, PsycINFO and Web of Science were searched for peer-reviewed studies including adults with iNPH who underwent shunt surgery and had within-subject cognitive evaluations pre- and post-operatively. Key data were extracted and study quality was assessed. Random-effects meta-analyses were performed on pooled baseline and post-shunt difference scores for frequently reported cognitive tests with comparable outcome data. RESULTS: Of 1,876 records, 195 met the inclusion criteria, comprising 11,445 patients. Cognitive evaluation methods ranged from subjective reports and NPH grading scales to brief screening tools and comprehensive test batteries. Over 193 distinct tests were reported and 54.4% of studies did not formally assess any core iNPH cognitive deficits. Post-shunt improvement rates, follow-up times and criteria for defining improvement varied widely. Eighty-five studies contributed data to meta-analyses of ten outcomes. Pooled estimates indicated post-shunt cognitive improvement, with Trail Making Test-A, Grooved Pegboard-Dominant and Trail Making Test-B showing changes exceeding thresholds for clinically significant improvement. CONCLUSIONS: Cognitive assessment in iNPH is highly heterogeneous and frequently omits core domains, limiting detection of treatment effects. When domain-relevant cognitive measures are used, shunt surgery is associated with statistically and clinically significant cognitive improvement. These findings highlight the need for standardised iNPH-appropriate cognitive evaluation tools with validated criteria for detecting clinically meaningful change and have direct implications for clinical assessment, interpretation of shunt response and the selection of cognitive endpoints in future interventional studies.
15 May 2026
Read appraisal →The Cochrane database of systematic reviews
Pharmacological treatments for Friedreich ataxia
RATIONALE: Friedreich ataxia (FRDA) is a rare inherited autosomal recessive neurological disorder, characterised initially by unsteadiness in standing and walking, and slowly progressing to wheelchair dependency, usually in the late teens or early twenties. Scoliosis, pes cavus and cardiomyopathy are often present at diagnosis. As the disease progresses, individuals usually develop slurred speech, auditory impairment (especially in a noisy environment), urinary tract morbidity, diabetes, anxiety, depression, muscle spasticity and visual disturbances. Cardiac abnormalities cause premature death in 60% of people with FRDA. There is no easily defined clinical or biochemical marker to assess progression and no known curative treatment. This is the third update of a review published in 2009 and updated in 2012 and 2016. OBJECTIVES: To assess the effects of pharmacological treatments for people with Friedreich ataxia (FRDA) after 12 months of treatment. SEARCH METHODS: To identify studies for inclusion in this review, we searched CENTRAL, MEDLINE, Embase, CINAHL Plus, TRIP, Orphanet, WHO International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov. We also checked reference lists of relevant studies and contacted study authors. The most recent search was on 4 February 2025. ELIGIBILITY CRITERIA: We were interested in randomised controlled trials (RCTs) and quasi-RCTs of pharmacological treatments (including vitamins) in people with genetically-confirmed FRDA. To be included in the review, studies had to last at least 12 months. OUTCOMES: We assessed the following outcomes after 12 months of treatment: change in score on a validated ataxia rating scale; change in interventricular septal thickness in diastole (IVSTd) by cardiac magnetic resonance imaging or echocardiogram; change in activities of daily living (ADL) using a validated questionnaire; change in upper limb dexterity; and change in cardiopulmonary exercise testing (CPET). We also assessed treatment-related adverse events with medication continued for the study period, and treatment-emergent adverse events leading to cessation of medication or death during the study period. RISK OF BIAS: Using the Cochrane risk of bias tool RoB 2, we assessed the risk of bias in the seven outcomes reported in our summary of findings tables. SYNTHESIS METHODS: We synthesised the results of the studies for each outcome using meta-analysis, where possible. We calculated the mean difference (MD) or standardised mean difference (SMD) for continuous outcomes, and the risk ratio (RR) for dichotomous outcomes, all with 95% confidence intervals (CIs). We used GRADE to assess the certainty of evidence for our prespecified outcomes as high, moderate, low or very low. INCLUDED STUDIES: We included eight RCTs in this updated review. We included seven of them in meta-analysis, and these studies enroled a total of 574 participants, with sample sizes ranging from 29 to 232 participants per study. One study was international, with centres in North America, Europe and Australia. There were four other multicentre studies (three in Europe and one in North America). Single-centre studies were conducted in the UK, Italy and France. Participants in the studies ranged from eight to 70 years of age at enrolment, with the mean age in each study being between 18 years and 35 years (with an unweighted pooled mean age across studies of 25.9 years). All of the studies enroled both males and females, with the proportion of female participants ranging from 21% to 58%. Sixty-eight per cent of participants had severe ataxia, while the other 32% had moderate ataxia. The studies tested epoetin alpha, CoQ10 and vitamin E, idebenone, leriglitazone, omaveloxolone, and RT001. One study tested pioglitazone but has not published any results. Four of the studies were pharmaceutical-industry-controlled. SYNTHESIS OF RESULTS: Meta-analysis of seven studies demonstrated that pharmacological treatment probably makes little or no difference to scores on the ataxia rating scale after 12 months of treatment (SMD 0.02, 95% CI -0.23 to 0.26; I² = 42%; 7 studies, 513 participants; moderate-certainty evidence). The evidence was very uncertain about the effects of treatment on IVSTd (MD -0.51, 95% CI -1.10 to 0.09; I² = 80%; 2 studies, 72 participants; very low-certainty evidence) and on ADL (MD -0.59, 95% CI -1.39 to 0.21; I² = 24%; 3 studies, 167 participants; very low-certainty evidence). Meta-analysis of three studies showed that treatment probably improves upper limb dexterity (SMD -0.42, 95% CI -0.73 to -0.11; I² = 0%; 3 studies, 166 participants; moderate-certainty evidence). We are very uncertain about the effect of pharmacological treatment on CPET (SMD -0.16, 95% CI -0.46 to 0.13; I² = 0%; 3 studies, 181 participants; very low-certainty evidence). We are very uncertain whether pharmacological treatment has any effect on treatment-related adverse events (RR 0.88, 95% CI 0.63 to 1.22; I² = 0%; 2 studies, 104 participants; very low-certainty evidence). There were only 104 participants in this analysis out of a total of 545 participants, so the result may have little relevance. Meta-analysis of six studies found that there may be little to no difference between pharmacological treatment and placebo in treatment-emergent adverse events leading to cessation of medication or death (RR 1.24, 95% CI 0.44 to 3.48; I² = 0%; 6 studies, 313 participants; low-certainty evidence). Our certainty in the evidence ranged from very low to moderate. We downgraded all outcomes by one or two levels for imprecision, with further downgrades for inconsistency (for the outcomes of IVSTd, ADL, CPET) and suspected publication bias (for the outcomes of IVSTd, ADL, CPET and adverse events). AUTHORS' CONCLUSIONS: In this updated Cochrane systematic review, meta-analysis of results on the ataxia rating scale showed that pharmacological treatments probably make little or no difference compared with placebo after 12 months of treatment. Given this result, the probable improvement that we found in upper limb dexterity was unexpected. Treatment-emergent adverse events leading to cessation of medication or death may be no more common in treatment groups than placebo groups as there were few adverse events detected in the treated groups. However, the studies may not have detected all rare and serious adverse events. FUNDING: The authors in this review received no funding. REGISTRATION: Protocol (2009) DOI: 10.1002/14651858.CD007791 Original review (2009) DOI: 10.1002/14651858.CD99791.pub2 Update (2012) DOI: 10.1002/14651858.CD007791.pub3 Update (2016) DOI: 10.1002/14651858.CD007791.pub4.
14 May 2026
Read appraisal →Behavior research methods
A stroke-level large-scale database of Chinese character handwriting and the OpenHandWrite_Toolbox for handwriting research
Understanding what linguistic components (e.g., phonological, semantic, and orthographic systems) modulate Chinese handwriting at the character, radical, and stroke levels remains an important yet understudied topic. Additionally, there is a lack of comprehensive tools for capturing and batch-processing fine-grained handwriting data. To address these issues, we constructed a large-scale handwriting database in which 42 Chinese speakers each handwrote 1200 characters in a handwriting-to-dictation task. Additionally, we enhanced the existing handwriting package and provided comprehensive documentation for the upgraded OpenHandWrite_Toolbox. This toolbox allows users to easily modify the experimental design, capture the stroke-level handwriting trajectory, and batch-process handwriting measurements (e.g., latency and duration). Analysis of our large-scale database indicates that orthographic predictors affect handwriting preparation and execution at the character, radical, and stroke levels. Phonological factors influence handwriting at character and radical levels. Importantly, these lexical effects demonstrate hierarchical attenuation: they were most pronounced at the character level, followed by the radical, and weakest at the stroke level. These findings demonstrate that handwriting preparation and execution at the radical and stroke levels are closely intertwined with linguistic components. This database and toolbox offer valuable resources for future psycholinguistic and neurolinguistic research on the handwriting of characters and sub-characters across different languages.
14 May 2026
Read appraisal →JMIR research protocols
Technology-Based Prehabilitation for Patients With Cancer Before Elective Treatment: Protocol for a Scoping Review
BACKGROUND: Advances in cancer treatment have improved survival rates; however, patients continue to experience significant treatment-related side effects, leading to reduced quality of life. Prehabilitation is an intervention that occurs before treatment and can improve patients' functional capacity, recovery, and well-being through exercise, nutrition, and psychological support. Typical hospital-based prehabilitation is not accessible to all patients due to geographical, socioeconomic, and time-related barriers. Technology-based approaches, including eHealth and mobile health (mHealth) interventions, may overcome these barriers by enabling remote, patient-centered delivery. However, the current evidence base is heterogeneous and lacks synthesis regarding feasibility, acceptability, and outcomes. OBJECTIVE: This protocol for a scoping review aims to outline how we will systematically map and synthesize the evidence on technology-based prehabilitation interventions for people with cancer to identify intervention designs, assess feasibility and accessibility, and highlight knowledge gaps to guide future research and practice. METHODS: The review will follow the Joanna Briggs Institute (JBI) methodology and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. A 3-step search strategy will be applied across multiple databases and gray literature sources. Eligible studies will include adults (aged ≥18 years) with a cancer diagnosis who are scheduled for elective treatment (surgery, radiotherapy, chemotherapy, immunotherapy, or hormone therapy). Interventions must involve eHealth or mHealth approaches supporting unimodal or multimodal prehabilitation activities such as exercise, nutrition, psychological support, or lifestyle modification. Outcomes of interest include functional fitness, quality of life, psychological well-being, treatment preparedness, recovery, adherence, and feasibility. Two independent reviewers will conduct title, abstract, and full-text screening, with disagreements resolved through discussion or consultation with a third reviewer. Data will be charted and presented in tables and figures and as a narrative synthesis. Critical appraisal using JBI tools will contextualize methodological quality but not exclude studies. Risk of bias will be assessed using the Cochrane Risk of Bias Tool for Randomized Trials version 2 (RoB 2) and Risk of Bias in Non-Randomized Studies of Interventions version 2 (ROBINS-I V2) tool. This will not be used to exclude studies, but to determine the quality of articles included. RESULTS: The search strategy has been pilot tested and finalized. Database searches are scheduled to commence in March 2026, with study selection and screening anticipated to be completed by April 2026. Data analysis and synthesis are expected to begin in May 2026, and final results will be available by October 2026. CONCLUSIONS: This protocol outlines a rigorous and transparent approach to mapping the current evidence on technology-based prehabilitation in cancer care. By systematically characterizing intervention features, outcome domains, and evidence gaps, the review will provide an up-to-date evidence map to guide future research priorities, inform clinical implementation, and support the development of more standardized and inclusive prehabilitation pathways.
14 May 2026
Read appraisal →Progress in biomedical engineering (Bristol, England)
Cross-subject generalization for EEG decoding: a survey of deep learning methods
Deep learning for cross-subject electroencephalography (EEG) decoding is hindered by high inter-subject variability, which introduces a severe domain shift between training and unseen test subjects. This survey presents a comprehensive review of deep learning methodologies specifically engineered to address this cross-subject generalization challenge. To ground this analysis, we formalize the cross-subject setting as a multi-source domain problem and delineate the rigorous, subject-independent evaluation protocols required for valid assessment. Central to this survey is a systematic taxonomy of the current literature into discrete methodological families, including feature alignment, adversarial learning, feature disentanglement, and contrastive learning. We conclude by examining three critical elements for advancing robust, real-world decoding: the theoretical limitations of current methodologies, the structural value of subject identity, and the emergence of EEG foundation models.
14 May 2026
Read appraisal →Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
Oral antipyretics for fatigue alleviation and exercise enhancement in adults with multiple sclerosis: a systematic review and meta-analysis
AIMS: This review aims to explore the potential role of oral antipyretics (aspirin (ASA)/ acetaminophen), commonly known for fever and pain control, in managing fatigue, temperature regulation, and exercise capacity in patients with Multiple Sclerosis (MS), with a focus on nursing implications for symptom management. DESIGN: A systematic review of existing clinical studies assessing the effects of aspirin/ acetaminophen on MS-related fatigue, thermoregulation, and exercise performance. DATA SOURCES: Electronic databases including Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, PubMed, Scopus, Web of Science, Wiley, Google Scholar, and ClinicalTrials.gov were searched up to March 2024. REVIEW METHODS: Quality assessment was conducted using the Cochrane risk of bias tool 2. to evaluate the methodological rigor of included studies. Outcomes analyzed included clinically assessed fatigue scores, exercise endurance, and post-exercise thermoregulation, with attention to potential risks associated with aspirin use. RESULTS: After assessment of 57 reports for eligibility, only seven studies met inclusion criteria; results indicated that aspirin pretreatment significantly improved Time to Exhaustion (TTE) in heat-sensitive MS patients (p = 0.013), though one study reported no significant effect. Aspirin reduced post-exercise temperature rise by 56%, but this was not statistically significant in one trial (p = 0.178), while another showed significant reductions (p = 0.002). CONCLUSION: Aspirin and acetaminophen may offer benefits in alleviating fatigue, enhancing thermoregulation, and improving exercise endurance in MS patients. These findings suggest that nurses should consider the potential role of aspirin in symptom management, with further research needed to confirm efficacy and safety. IMPACT: This review highlights a potential adjunct therapy for nurses to incorporate into comprehensive MS care, emphasizing symptom control and quality of life improvements. PATIENT OR PUBLIC CONTRIBUTION: Not applicable. TRIAL REGISTRATION: This review is PROSPERO registered having ID CRD420251000875.
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 →Physiological measurement
Turning glasses into sensors: capacitive facial expression recognition under frame geometry constraints
Objective.Wearable facial expression recognition requires sensing modalities that are unobtrusive, illumination-independent, and compatible with everyday eyewear form factors. Existing optical and electromyographic approaches are limited by line-of-sight requirements, skin contact, or restricted action unit (AU) coverage. This work investigates the feasibility of non-contact capacitive sensing for facial muscle activity monitoring within the strict geometric constraints of standard eyewear.Approach.We developed FERGlasses, integrating eight loading-mode capacitive channels via a custom flexible PCB and active shielding to detect skin-to-frame displacement. A validation study with 40 participants was conducted to elicit seven facial action coding system-defined AUs. Signal fidelity was assessed using independent Random Forest regressors and benchmarked against commercial optical-proximity (OCOsense) and computer-vision (Py-Feat) standards.Main results.The system demonstrated high agreement for upper-face activity, achieving median cosine similarities of 0.97 for the Outer Brow Raiser (AU02) and 0.87 for the Nose Wrinkler (AU09), while lower-face actions such as the Chin Raiser (AU17) yielded a median of 0.33, consistent with mechanical signal attenuation along the frame. Channel-ablation analysis quantified the specific anatomical contributions of each electrode group, identifying eyebrow and rhinion sensors as primary signal drivers for upper-face and perinasal actions, respectively, and temple sensors as critical for cheek raiser detection.Significance.This study provides the first metrological validation of multi-channel capacitive sensing for AU-level recognition in eyewear. The results establish the modality as a robust, privacy-preserving, and illumination-independent alternative to optical methods for longitudinal physiological monitoring, with the current prototype serving as a wired research platform and full consumer-grade integration identified as a future engineering objective.
14 May 2026
Read appraisal →Journal of medical Internet research
Effectiveness of Digital Health Interventions in Older Adults With Frailty and Sarcopenia: Systematic Review and Meta-Analysis of Randomized Controlled Trials
BACKGROUND: Frailty and sarcopenia represent substantial global health challenges, frequently diminishing patients' quality of life through impaired muscle function and physical performance. Digital health interventions (DHIs) have shown promise in mitigating these conditions among older adults. However, outcomes of such interventions in this demographic are inconsistent, and a thorough synthesis of existing evidence is lacking. OBJECTIVE: This study aimed to evaluate the effectiveness of DHIs in older adults with frailty and sarcopenia. METHODS: A comprehensive search of PubMed, Web of Science, MEDLINE, Embase, and Cochrane Library was conducted from their inception until January 2026 to identify randomized controlled trials. Meta-analyses were performed using R software (R Foundation for Statistical Computing). Study quality was evaluated using the revised Cochrane Risk of Bias Tool 2.0 (Cochrane Collaboration), and evidence certainty was assessed using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). RESULTS: From 3506 records, 16 studies were included. DHIs significantly improved total skeletal muscle mass (weighted mean difference [WMD] 1.01, 95% CI 0.08-1.94, 95% prediction interval [PI] -0.95 to 2.96), gait speed (WMD 0.09, 95% CI 0.03-0.15, 95% PI -0.1 to 0.26), Timed Up and Go Test (TUGT: WMD -0.52, 95% CI -1.02 to -0.03, 95% PI -1.93 to 0.85), 30-second Chair Stand Test (30CST: WMD 2.19, 95% CI 0.89-3.48, 95% PI -1.59 to 5.66), balance (standardized mean difference [SMD] 0.61, 95% CI 0-1.21, 95% PI -0.94 to 2.13), and quality of life (SMD 0.16, 95% CI 0.05-0.27, 95% PI 0.04-0.28). No significant improvements were observed in Appendicular Skeletal Muscle Mass Index (ASMI), grip strength, 6-minute walk test (6MWT), 2-minute walk test (2MWT), Short Physical Performance Battery (SPPB), or BMI. Although the pooled effect was favorable, the wide 95% PI suggests substantial between-study heterogeneity. Subgroup analysis stratified by intervention duration revealed significant intersubgroup differences in ASMI (χ²₁=9.93; P=.0016), indicating interventions lasting ≥12 weeks were more effective for improving ASMI (WMD 0.28, 95% CI 0.06-0.50, 95% PI -0.30 to 0.83). Subgroup analysis stratified by intervention type showed significant intersubgroup differences in balance (χ²₃=9.89; P=.0195), with exergame-based interventions showing significant effects (SMD 0.83, 95% CI 0.26-1.40). CONCLUSIONS: This systematic review is the first to quantify the disease-specific efficacy of DHIs in improving muscle function, physical performance, and quality of life among older adults with frailty and sarcopenia, demonstrating their unique value as a scalable complementary approach. By overcoming geographical and resource constraints, DHIs support underserved populations. However, low evidence quality and heterogeneity warrant cautious interpretation. The 95% PIs indicate that actual effects may vary with population characteristics and implementation contexts. Nonetheless, DHIs represent a promising and cost-effective strategy for service expansion. Future high-quality studies are needed to better understand their effectiveness and implementation across settings.
13 May 2026
Read appraisal →European journal of pediatrics
Machine learning-based integration of respiratory oscillometry and spirometry for predicting clinical outcomes in spinal muscular atrophy
UNLABELLED: Assessing respiratory function in spinal muscular atrophy (SMA) is challenging due to the effort-dependent nature of traditional spirometry. While respiratory oscillometry offers a passive alternative, its clinical utility in predicting clinical status remains underexplored. This study evaluates the efficacy of integrating spirometric and respiratory oscillometric indices through machine learning (ML) to predict ambulatory status and the requirement for bilevel positive airway pressure (BiPAP) in SMA patients. We retrospectively analyzed forty-five patients with a genetically confirmed diagnosis of SMA. To address data imbalance, we utilized the SMOTETomek technique and validated Random Forest models through leave-one-out cross-validation. SHAP (SHapley Additive exPlanations) analysis was used to interpret the contribution of individual physiological markers. In univariate logistic regression, forced vital capacity (FVC), peak expiratory flow (PEF), and forced expiratory flow at 75% of vital capacity (FEF75) were significant predictors for walking support. FEF25, FEF50, FEF75, and FEF 25-75 were associated with the requirement for BiPAP use. None of the respiratory oscillometric parameters reached statistical significance in regression models. However, ML models achieved high predictive accuracy, with SMOTETomek improving BiPAP requirement recall from 0.00 to 1.00. SHAP analysis revealed that respiratory oscillometry gained significant predictive weight that traditional models overlooked. R20Hz emerged as a key predictor for ambulatory status, while R5-20 Hz was identified as a decisive feature for predicting the BiPAP use. CONCLUSION: The integration of effort-independent respiratory oscillometry with traditional spirometry via ML has the potential to enhance risk stratification in SMA. WHAT IS KNOWN: • SMA requires lung function monitoring, but traditional spirometry is challenging due to the need for forceful expiratory maneuvers. • Respiratory oscillometry provides an effort-independent assessment of respiratory mechanics through tidal breathing. WHAT IS NEW: • Machine learning successfully integrates effort-independent respiratory oscillometry with spirometry to significantly enhance clinical predictions in SMA. • It identifies R20Hz and R5-20 Hz as critical physiological markers for predicting ambulatory status and the requirement for respiratory support, respectively.
13 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 →Neurosurgical review
Deep brain stimulation for freezing of gait in Parkinson's disease: An updated systematic review, meta-analysis, and a single-center clinical experience.
Freezing of gait is a disabling and treatment-resistant manifestation of Parkinson's disease (PD). The effectiveness of deep brain stimulation (DBS) for freezing of gait remains inconsistent across stimulation targets, frequencies, and medication states. We conducted a systematic review and meta-analysis following PRISMA guidelines to examine how DBS affects freezing of gait in patients with PD. We searched Medline, Scopus, Web of Science, and Cochrane up to September 28, 2025. For synthesis, we combined mean differences and 95% confidence intervals for the Freezing of Gait Questionnaire (FOG-Q) and the Unified Parkinson's Disease Rating Scale (UPDRS) part III across different medication and stimulation settings to calculate the final effect size. Thirty-one studies with 905 patients were included. Of these, 21 provided FOG-Q data, and all reported UPDRS-III results. DBS led to a modest decrease in FOG-Q scores (mean difference [MD] = - 2.99; 95% CI = - 5.69 to - 0.29). The biggest improvement in FOG was seen when stimulation was used while patients were off medication (Med-OFF/Stim-OFF vs. Med-OFF/Stim-ON: MD - 5.88; 95% CI - 9.28 to - 2.47). Stimulation during the medication-ON state had smaller effects (Med-ON/Stim-OFF vs. Med-ON/Stim-ON: MD - 2.65; 95% CI - 4.99 to - 0.32), and there was no significant benefit when comparing Med-ON/Stim-OFF to Med-OFF/Stim-ON (MD - 0.70; 95% CI - 3.88 to 2.48). UPDRS-III scores improved substantially in the medication-OFF state with stimulation (MD - 14.35; 95% CI - 17.39 to - 11.32). High-frequency stimulation targeting the subthalamic nucleus provided more consistent benefits, yet substantial variation persisted across studies. The results of our small cohort showed significant improvement in FOG-Q and UPDRS-III (P values = 0.034, 0.022, respectively). DBS improves freezing of gait primarily in the medication-OFF state, with greater effects observed using high-frequency stimulation and subthalamic nucleus targets. Significant heterogeneity and limited data for alternative targets warrant cautious interpretation and further controlled studies.
13 May 2026
Read appraisal →Brain topography
rTMS Modulates Static and Dynamic Brain Functional Networks in Children with Autism Spectrum Disorder: An EEG Microstate Study
Repetitive Transcranial Magnetic Stimulation (rTMS) shows promise for treating Autism Spectrum Disorder (ASD), but its impact on the temporal dynamics of large-scale brain networks remains unclear. This study investigated the modulatory effects of rTMS on static and dynamic brain functional networks in children with ASD. Thirty-two children were randomized into an active rTMS group (1 Hz over the dorsolateral prefrontal cortex) and a sham control group. Resting-state EEG and behavioral assessments were conducted before and after a 9-week intervention. We employed a multi-dimensional analysis approach, combining microstate temporal parameters, static functional connectivity based on the weighted Phase Lag Index (wPLI), and dynamic complexity measured by Fuzzy Entropy. Results indicated that intrinsic features of Microstate B were significantly correlated with social relating deficits. Although rTMS did not induce significant interaction effects in standard microstate temporal parameters, it significantly enhanced static functional connectivity strength and increased the dynamic complexity of brain networks across all microstates. These findings suggest that rTMS exerts its therapeutic effects by strengthening network integration and restoring neural flexibility rather than simply altering the duration of brain states. The study underscores the value of network-based EEG metrics in elucidating the neuroplastic changes induced by neuromodulation in ASD.
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 →BMJ open
Multimodal personalised executive function intervention (E-Fit) for school-aged children with complex congenital heart disease in Switzerland: a randomised controlled feasibility study
OBJECTIVE: To explore the feasibility of a novel multimodal executive function intervention in school-aged children with complex congenital heart disease (cCHD). DESIGN: Single-centre, single-blinded, randomised-controlled 8-week multimodal personalised executive function intervention (E-Fit) study. Outcomes were measured throughout the intervention, post-intervention (T1) and at 4-month follow-up (T2). SETTING: Tertiary care centre between May 2022 and May 2024. PARTICIPANTS: Children 10 to 12 years (M=11.0, SD=0.9) with cCHD without a genetic diagnosis with infant open-heart surgery and reported difficulties (T-scores ≥60) on any of the summary scales of the parent- or teacher-reported Behavior Rating Inventory for Executive Function (BRIEF). INTERVENTIONS: Children with cCHD were randomly assigned to one of two groups: the intervention or the control group. The 8-week intervention was multimodal including three modalities: (1) computerised executive function (EF) training 3×20 min/week with CogniFit; (2) a weekly, remote standardised 1:1 individual EF strategy coaching; (3) analogue games played at convenience. The control group completed activity logs. FEASIBILITY MEASURES: Acceptability: Acceptance and Feasibility Scale (AFS) and coach-rated engagement during coaching sessions. Demand: Number of completed computerised training, strategy coaching and analogue game sessions. IMPLEMENTATION: E-Fit Fidelity Measurement System, assessing adherence to core components. Practicality: Retention rate. Integration: AFS integration items. Exploratory efficacy: BRIEF, neuropsychological EF testing and psychosocial variables at baseline, post-intervention (8 weeks) and at 4-month follow-up. RESULTS: We recruited 42 participants (Nfemale=20). Acceptability: The intervention was acceptable, with moderate observed engagement. Demand: median number of computerised training sessions completed was 16 of 24 sessions (67%, (IQR; 6 to 19)), all children attended all scheduled coaching sessions, analogue games were played in total a median of 9 times (IQR 4 to 14). IMPLEMENTATION: Coaching sessions could be implemented by the coaches as intended. Practicality: Overall retention rate was 90%. Integration: E-Fit was well integrable into the home setting. Exploratory efficacy favoured the intervention group with improvements in the parent-rated Behavioral Regulation Index of the BRIEF (adjusted Hedge's (gA1) = -0.408 to -0.903) and in social responsiveness (gA1 = -0.427 to -0.521) at T1 and at T2. CONCLUSIONS: E-Fit is a feasible intervention suggesting EF and social responsiveness improvements in children with cCHD. Motivational strategies to improve adherence to computerised training should be refined before a full-scale efficacy trial. TRIAL REGISTRATION NUMBER: NCT05198583.
12 May 2026
Read appraisal →American journal of speech-language pathology
Effect of the Fake Phone Call App on Patient Adherence Behavior and Motivation in Conversation Training Therapy: A Randomized Crossover Trial
PURPOSE: The Fake Phone Call app was previously developed and feasibility-tested for conversational target voice practice in resonant voice therapy. The purpose of the present study was to examine its effect on adherence and motivation for conversational practice in conversation training therapy (CTT) as well as its usability and utility in CTT. METHOD: Eleven patients referred for voice therapy served as their own control in a randomized crossover trial comparing 1 week of app-supported homework practice with 1 week of standard-of-care homework completion in CTT. Dependent variables included adherence and motivation variables. In addition, usability and utility as well as outcomes were examined at study completion. RESULTS: App support significantly increased practice frequency, practice fidelity, and goal commitment for practice. Usability and utility were good. Exploratory investigation revealed that patients randomized to receive the app condition first and the standard-of-care condition second had greater gains on all study variables and significantly greater self-reported generalization at treatment completion. CONCLUSION: Fake Phone Call support significantly improves adherence and motivation for CTT, with additional benefits when provided earlier in therapy.
11 May 2026
Read appraisal →Transactions of the Royal Society of Tropical Medicine and Hygiene
Quality of life in Indian people affected by leprosy? A systematic review from the country with the highest burden of leprosy cases.
Quality of life (QoL) is important for people with leprosy since the disease can cause physical and psychological problems. These problems may result in stigma and social discrimination. India reported 107 851 new leprosy cases for the year 2023-24, accounting for 61.6% of new cases detected globally. This systematic review was conducted to assess the QoL among people affected by leprosy in India using existing literature. The Scopus, PubMed and Infolep databases were searched for articles for this systematic review and included only studies conducted in India. The critical appraisal tool of cross-sectional studies (AXIS) was used to assess the study quality and risk of bias. The search identified 253 articles. After screening titles and abstracts, 23 full-text articles were assessed for eligibility and 12 studies were included in the systematic review. The World Health Organization Quality of Life-Bref instrument was used to measure QoL. Of the 12 studies, the factors of disability (9 studies) and old age (8 studies) were highly associated with low levels of QoL. Five studies identified that low levels of QoL are associated with being female with the leprosy. Early identification and prevention of disabilities are important steps in improving the QoL. Increased investment is needed in leprosy programmatic activities and research to achieve the target of zero leprosy.
10 May 2026
Read appraisal →Archives of orthopaedic and trauma surgery
Healthcare utilization following hip fractures based on social vulnerability status in the US: an analysis of 2016-2020 nationwide readmissions data
INTRODUCTION: Social vulnerability (SV) influences rehabilitation and postoperative care for patients with hip fracture. However, most previous work relies on area-level measures that overlook interindividual variation. The recent adoption of ICD-10 Z-codes allows clinical identification of patient-level SV and may offer a better understanding of its impact. This study aimed to evaluate healthcare utilization, including readmissions, discharge disposition, and length of stay (LOS) in surgically treated hip fracture patients with and without clinically acknowledged SV. METHODS: Adults surgically treated for hip fracture between 2016 and 2020 were included from the Nationwide Readmissions Database. SV was defined as having at least one documented relevant ICD-10 Z-code. Primary outcome measures included complications, LOS, discharge disposition, and 30- and 90-day readmissions, stratified by SV and evaluated using chi-square analyses. Multivariable logistic regression assessed long LOS (≥ 5 days) and discharge to home, adjusting for age, insurance/income status, and substance use. RESULTS: Patients with SV were younger (35.6% with SV vs. 50.1% without SV were 81+), had a lower median household income (38.8% with SV vs. 25.7% without SV were in the lowest quartile), and were more often insured by Medicaid (19.3% vs. 3.8%). Alcohol/drug use disorders were significantly more prevalent in patients with SV (18.5% vs. 4.5%). SV was associated with 47% higher odds for long LOS (1.47, 1.41-1.54) and 23% higher odds for discharge to home (1.23, 1.16-1.30) but comparable 90-day readmissions (21.2% vs. 19.8%). CONCLUSION: Among surgically treated hip fracture patients, SV was associated with higher odds of long LOS and discharge to home but no meaningful difference in readmissions. The small number of patients with clinically documented SV highlights the limited reporting by healthcare workers. This analysis of a nationwide all-payer database highlights the need to identify these higher risk patients and implement appropriate care pathways to reduce healthcare utilization.
10 May 2026
Read appraisal →Journal of physiology and biochemistry
Effects of acute, subacute, and chronic exercise on plasma s-Klotho levels: a systematic review and meta-analysis
Exercise exerts beneficial effects on multiple physiological systems, influencing biomarkers associated with aging processes and chronic diseases. This systematic review and meta-analysis aimed to evaluate the acute, subacute, and chronic effects of exercise on s-Klotho levels in healthy individuals and patients with chronic diseases. A comprehensive search was conducted in electronic databases. Included studies were randomized and non-randomized studies assessing the effects of aerobic, resistance, or combined exercise on s-Klotho levels. Interventions were classified as acute (single session), subacute (< 12 weeks), or chronic (≥ 12 weeks). Risk of bias was assessed using RoB 2 and ROBINS-I tools, and quality of evidence was evaluated with the GRADE framework. Forty-one studies were included in the qualitative synthesis, and 30 in the meta-analysis, comprising 2,765 participants (18-85 years). Twenty-five involved healthy individuals, while 21 included patients with chronic diseases. Acute and subacute aerobic exercise increased s-Klotho levels in healthy individuals (SMD 0.69; 95%CI 0.41-0.97) and diseased populations (SMD 0.62; 95%CI 0.11-1.12). Chronic exercise (12-36 weeks) showed significant increases in healthy (SMD 0.57; 95%CI 0.33-0.82) and diseased populations (SMD 1.51; 95%CI 0.87-2.16). Resistance exercise thrice weekly demonstrated the highest effect (SMD 1.60; 95%CI 0.81-2.38). Most studies had high risk of bias, with quality of evidence ranging from very low to moderate. Exercise significantly increases s-Klotho levels, with acute and subacute aerobic sessions benefiting healthy and diseased populations, while chronic resistance exercise elicited greater responses in diseased populations. Despite promising findings, low methodological quality suggests cautious interpretation.
10 May 2026
Read appraisal →Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation
Quality of life after tranexamic acid in subarachnoid hemorrhage: post-hoc analysis of the ULTRA trial
PURPOSE: The ULTRA trial evaluated the impact of ultra-early and short-term tranexamic acid (TXA) treatment in patients with subarachnoid hemorrhage (SAH) and found no clinical benefit at six months. This post-hoc analysis examines whether TXA improves quality of life (QoL) at three and six months. METHODS: The ULTRA trial was a randomized, controlled, multicenter study conducted from July 2013 to July 2019. Patients received either TXA or standard care. This analysis included patients who completed at least one QoL questionnaire. The primary endpoint was QoL, assessed using the EQ-5D-3L questionnaire at three and six months. Linear mixed models adjusted for confounders were used to analyze the association between TXA and QoL. RESULTS: Of the 955 ULTRA patients, approximately 25% died, and 63% completed at least one QoL questionnaire. At three months, the TXA group had a mean EQ-5D index score of 0.75 versus 0.71 in the control group (p = 0.11) and a mean EQ-5D Visual Analogue Scale (VAS) score of 89 versus 86 (p = 0.10). At six months, the mean EQ-5D index score was 0.84 in the TXA group compared to 0.82 in the control group (p = 0.23), and the mean VAS was 92 in the TXA group compared to 89 in the control group (p = 0.13). CONCLUSION: Ultra-early and short-term TXA did not result in a significant improvement in QoL at three or six months in patients with SAH. Given the lack of benefit on both clinical outcome and QoL, routine use of TXA is not recommended. TRIAL REGISTRATION: Netherlands Trial Register: NTR3272. CLINICALTRIALS: gov: NCT02684812.
10 May 2026
Read appraisal →Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation
Responsiveness and clinical utility of patient-reported outcome instruments in head and neck cancer: a systematic review
PURPOSE: To synthesize and evaluate current evidence on the responsiveness, interpretability (MID/MIC), and clinical utility of validated health-related quality of life (HRQoL) patient-reported outcome (PRO) instruments used in adults with head and neck cancer (HNC). METHODS: A systematic search of PubMed, Scopus, Web of Science, Embase, and Cochrane Library (Central) identified studies published from January 2015 to July 2025. The review was registered in PROSPERO (CRD420251128978) and followed PRISMA 2020 guidelines. Observational and interventional studies assessing HRQoL using validated HNC instruments (EORTC QLQ-C30, QLQ-H&N35/H&N43, UW-QOL, FACT-H&N or MDADI) were included. Eligible studies reported responsiveness (ability to detect meaningful change) or clinical applicability. Methodological quality was evaluated using the COSMIN Risk of Bias checklist, and results were narratively synthesized due to methodological heterogeneity. RESULTS: Thirteen studies involving 8,075 patients met the inclusion criteria. The EORTC QLQ-C30 and H&N35/43, UW-QOL, FACT-H&N, and MDADI exhibited consistent responsiveness, capturing expected HRQoL deterioration during treatment and partial recovery within 6-12 months. Reported minimal important difference (MID) and minimal important change (MIC) values typically ranged from 4 to 15 points for improvement and 10-20 points for deterioration, supporting the interpretability of change scores. Several patient-reported outcome measures (PROMs) also demonstrated prognostic relevance, with early HRQoL changes associated with survival or recurrence. CONCLUSION: Validated HRQoL questionnaires in HNC demonstrate robust responsiveness and meaningful clinical applicability, supporting their integration into routine oncology practice. Their use may enhance early detection of complications, guide rehabilitative interventions, and facilitate more individualized, patient-centered care.
10 May 2026
Read appraisal →Neurosurgical review
Sequesterectomy versus standard micro‑/open discectomy for lumbar disc herniation: a systematic review and meta-analysis
Lumbar disk herniation is a common clinical entity affecting about 1% of the entire population every year. The purpose of the present work is to provide a systematic review and meta-analysis comparing the safety and efficiency of sequesterectomy and discectomy in the management of lumbar disk herniation. A systematic review and meta-analysis using the random effects method was performed. This search was applied through the 6th of March 2025 to PubMed, Scopus, Cochrane Central Register of Controlled Trials and the Directory of Open Access Journals. The data collected included patient demographics, spinal level at which the operation occurred, duration of operation and hospital stay, outcome, recurrence rate as well as potential immediate and delayed complications. A total of 18 original studies with a cumulative number of 4394 patients were identified. No statistically significant difference was found in the re-herniation and complication rate between the two groups (OR: 1.058, 95% CI: 0.726-1.541, p=.769 and OR: 1.399, 95% CI: 0.964-2.032, p=.077 respectively). The same applied for mean hospital stay (standard difference in means: 0.206, SE = 0.167, p= .219). In contrast, mean operating time was found to be significantly shorter in the sequesterectomy group than in the discectomy group (mean 58.086 min versus 72.885 min respectively). As or the patient reported outcomes, VAS score for back pain two years after the operation was the only index that was significantly higher in patients with discectomy (standard difference in means: 0.348, SE = 0.172, p= .04). Based on the available data, the two approaches do not differ in terms of risk of reherniation, reoperation rate and postoperative complications. Nevertheless, patients that have undergone sequesterectomy could potentially benefit from a more significant reduction in back pain in the long run.
10 May 2026
Read appraisal →Sleep & breathing = Schlaf & Atmung
What is the most effective non-pharmacological treatment for poor sleep quality in Chronic obstructive pulmonary disease patients? a systematic review.
BACKGROUND: Chronic obstructive pulmonary disease (COPD) features poor sleep quality due to nocturnal dyspnea and psychological distress, leading to increased hospital admissions and reduced quality of life. Considering patient preference and existing evidence, non-pharmacological intervention, i.e. cognitive behavioral therapy for insomnia (CBT-I), on sleep for COPD patients had its potential efficacy. However, current guidelines do not include sleep management as standard care, and there is a lack of comprehensive reviews on this topic. This systematic review hence evaluated the effectiveness of non-pharmacological treatments for poor sleep in COPD patients. METHODS: Literature identification was conducted through MEDLINE, CINHAL PLUS, AMED and ScienceDirect under PRISMA guidance. Randomized controlled trials, cohort studies and cross-sectional studies regarding poor sleep quality among COPD population were retrieved. Abstract, title and full text screening were performed by the author and assessed by a second reviewer. Risk of bias and quality appraisal was done with JBI scale. RESULTS: 12 articles (783 patients) were identified, including 9 randomized controlled trials, 1 cohort study and 2 cross-sectional studies. The risk of bias (quality) was ranked: low (high) for 3, moderate (moderate) for 7 and high (low) for 2. Several interventions were identified (number of study): CBT-I (2) and cognitive behavioral therapy (1), pulmonary rehabilitation (PR) (2), progressive muscle relaxation technique (PMRT) (2), non-invasive ventilation (NIV) (3), relaxation exercise (RE) (1) and therapeutic touch (TT) (1). Significant improvement in sleep quality was reported in PMRT, TT and RE. CONCLUSION: PMRT, TT and RE showed improvement in sleep quality in COPD patients yet unable to rank their effectiveness as heterogeneous outcome measures across studies. No substantial evidence was capable to demonstrate effectiveness of CBT-I, CBT, PR and NIV to explicit COPD patients. Moreover, future research including combination of non-pharmacological treatments is needed.
10 May 2026
Read appraisal →Neuropsychologia
Sparsity and memory constraints interact with training sequence to bias learning of associative maps.
Cognitive maps support inference and planning by representing associations between experiences encoded in memory. These map-like representations are thought to carry information not only about directly observed links but also about longer paths. The ability to make judgments based on multi-step associations varies with one's experience in an environment and with changes in memory abilities across the lifespan. However, it remains unclear exactly how representations of associative structure are influenced by learning curricula and memory constraints. Prior studies have suggested a tradeoff: memory representations can either be more integrated to improve inference, or more separated to recall distinct direct associations. Whether overlapping associations are experienced nearby in time (interleaved) or spaced apart (blocked) can bias memory representations toward integration or separation. However, key recent findings about how blocked versus interleaved experience bias integration or separation have been inconsistent. Here, we introduce a computational framework that helps reconcile these apparent discrepancies. Using neural network simulations of three separate memory-guided inference tasks, we show that variations in memory capacity and the sparsity of neural codes interact with learning sequence to shape network representations. Specifically, blocked learning promotes integration when memory capacity is low, while interleaved learning promotes integration when memory capacity is high. Integration is especially likely to result from representations formed when neural codes are both sparse and distributed. These results offer a principled computational account of how flexible, map-like representations can arise from experience and suggest avenues for individualized memory interventions to improve inference, generalization, and planning.
10 May 2026
Read appraisal →Carbohydrate polymers
Multifunctional starch-based eutectogels with high mechanical properties, adhesion, self-healing, fatigue resistance and degradability for flexible wearable sensing
Flexible wearable sensors have developed rapidly due to the urgent demands for human motion monitoring. Eutectogel-based soft materials have exhibited great potential for wearable sensing applications. However, it is still a challenge to develop multifunctional eutectogels with excellent mechanical properties, adhesion, self-healing, fatigue resistance and degradability. In this work, a multifunctional starch-based eutectogel was developed by a one-pot and in-situ photo-polymerization method. The eutectogel had excellent stretchability (2710%), high strength (5.43 MPa), toughness (94.38 MJ/m3), Young's modulus (10.23 MPa), adhesion, fatigue resistance (1000 cycles), degradability and a certain degree of self-healing ability. These properties were closely correlated to the synergistic effect among the amylopectin, polyacrylic acid and choline chloride via hydrogen-bond and electrostatic interactions. The mechanical properties of eutectogel can be adjusted by changing the starch content. A wearable sensor based on the eutectogel was realized accurate and stable monitoring of human joint motions. This study addressed the limitations of the dehydration and single function of the traditional hydrogels, and provides a novel way for the development of the multifunctional bio-based gels for next-generation flexible wearable devices.
9 May 2026
Read appraisal →ChemistryOpen
Ionic Hydrogel Triboelectric Sensor for Real-Time Swimming Kinematics Monitoring and Stroke Recognition
Recently, wearable sports electronics have attracted increasing attention for their potential to enable continuous motion tracking and energy-autonomous operation in complex athletic environments. In this work, we present a flexible triboelectric nanogenerator (PAC-TENG) constructed from a PVA/Ala/CaCl2 ionic hydrogel electrode and a compliant silicone triboelectric layer. The PAC hydrogel provides high stretchability, stable ionic conductivity, and strong deformation tolerance, while the silicone surface ensures efficient and repeatable charge generation. Benefiting from this synergistic design, the PAC-TENG achieves excellent electrical outputs, including a peak voltage of 472.9 V, a short-circuit current of 37.1 µA, and a transferred charge of 104.1 nC, along with high power density under matched load. The device exhibits strong sensitivity to bending angle, applied force, and motion frequency, enabling accurate perception of human biomechanics. When mounted on swimming-related joints, the PAC-TENG can reliably monitor stroke patterns and detect abnormal motion signals, highlighting its promise for self-powered aquatic sports analytics and intelligent safety monitoring.
6 May 2026
Read appraisal →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 →Science advances
An AI-driven, wearable, conformal ring system for real-time and user-independent sign language interpretation.
Sign language translation systems have long aimed to bridge the communication between signers and nonsigners. However, preliminary systems rely on glove-type wearables or wired sensor arrays, which constrain hand movement, reduce comfort, and require nonpersonalized sensor positions that limit adaptability across users. Here, we introduce a wirelessly connected, ring-type sign language translator (WRSLT) designed to overcome these limitations by enabling full finger mobility through independent sensor rings and multilink communication. The system supports static and dynamic gesture detection using selected fingers via quantitative relevance analysis and achieves robust user-independent performance without per-user calibration. WRSLT demonstrated high recognition accuracy on large-scale datasets comprising 100 American Sign Language and 100 International Sign Language words, achieving 88.3 and 88.5% accuracy, respectively, under unseen-user conditions (i.e., test users not included in model training). Furthermore, a custom sequential word detection framework enables sentence-level translation from continuous signing input without requiring separate training on entire sentence structures.
5 May 2026
Read appraisal →International journal of psychophysiology : official journal of the International Organization of Psychophysiology
Task-evoked brain network dynamics underlying cognitive control using source-localized EEG and machine learning
OBJECTIVE: Functional connectivity (FC) coordinates brain activity during cognitive tasks, yet the influence of demographic variables and health factors on task-related dynamic FC remains underexplored. We examined FC within and between seven core brain networks: Default Mode (DMN), Ventral Attention (VAN), Somatomotor (SMN), Dorsal Attention (DAN), Frontoparietal (FPN), Visual (VIN), and Limbic (LIN) during a modified Eriksen flanker task. We aimed to identify distinct network configurations linked to varying cognitive control demands and assess the influence of demographic and health factors. METHODS: Secondary analyses of source-localized EEG data from 255 adults (mean age 38.97 ± 11.65 years; BMI 30.21 ± 9.29 kg/m2) were conducted. A hidden Markov model extracted spatiotemporal dynamics, quantifying within- and between-network correlations. Extreme Gradient Boosting with recursive feature elimination identified connectivity metrics predicting reaction time (RT) of high performers (>80% accuracy). Regression models assessed effects of age, sex, BMI, and income on task-related FC. RESULTS: Classification accurately predicted RT in both congruent (AUC = 0.81) and incongruent (AUC = 0.86) trials. Key FC features included VAN-LIN, VIN-VAN, and SMN-DAN for congruent trials; SMN-DMN, LIN-FPN, and VIN-DAN for incongruent trials. Age was linked to reduced FC, while higher BMI showed modest positive FC associations in LIN-FPN and VIN-DAN. Sex and income were not significant predictors of RT or FC. CONCLUSIONS: These findings reveal the relevance of specific dynamic network interactions in cognitive control and highlight the need to consider age and BMI as contributors to brain connectivity during task performance.
4 May 2026
Read appraisal →International journal of neural systems
Data-related Ablation for Reinforcing Deep Learning in Explaining Complex Phenomena
Deep Learning (DL) models excel at automatically learning intricate patterns within complex data, but their black box nature undermines human trust. To address this, current validation strategies typically focus on the model itself, modifying its architecture to assess the role and importance of the components. However, this model-centric view overlooks the critical learning substrate, which is represented by the data, implicitly assuming that it accurately represents the target phenomenon. This implicit trust in data means that evaluation may fail to detect whether high performance stems from exploiting biases or data quirks rather than learning relevant patterns. We present a novel data-related ablation as a complement to the traditional architectural ablation. Using this framework for Electroencephalography (EEG) signals of Emotional Recognition (ER) and Motor Execution (ME) as a case study, we show that seemingly high-accuracy models often rely heavily on process-irrelevant features, maintaining performance even when key information is eliminated. This shows that a standard, data-independent evaluation can be misleading about whether a model truly captured the intended process; the proposed approach helps distinguish robust learning from leaning on incidental characteristics. Therefore, incorporating data-related ablation is essential for developing reliable and generalizable DL models in fields that rely on data derived from complex and often not completely known phenomena.
4 May 2026
Read appraisal →Journal of medical Internet research
Online Community Support for Stroke Survivors and Caregivers: Scoping Review
BACKGROUND: Previous studies found that online communities are critical in supporting stroke survivors and caregivers for stroke recovery. However, it is unclear how such online communities are designed, or could be designed. OBJECTIVE: This review aims to identify the key design elements of an online community to support stroke survivors and caregivers, that is, the actors, types of community support, and supporting technologies. METHODS: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. We included journal articles related to online community support for stroke. Editorials, registers, opinion pieces, letters, and conference papers were excluded. Online databases PubMed/MEDLINE, Scopus, Web of Science, ScienceDirect, and ProQuest were searched for articles published from January 2015 to June 2025. Articles were screened based on the title, abstract, and full text using Covidence software. After screening and full-text review, we read the selected articles in detail to analyze and synthesize information on key actors, types of support, and technologies used to support stroke survivors and caregivers. RESULTS: A total of 77 articles were included. These articles discussed digital support technologies (52 articles), community functions and roles (18 articles), online stroke community systems (6 articles), and the stroke ecosystem (1 article). Our review found that the online community of support for stroke survivors and caregivers includes the caregivers themselves (46 articles), health workers (24 articles), and the local community/society (14 articles). Online communities mainly provide informational support, including giving advice (28 articles) and tangible aids (29 articles), followed by social support to create a sense of belonging (26 articles). Technologies discussed included mobile health (25 articles), web-based systems (12 articles), virtual/augmented reality (8 articles), sensors/wearable technology (8 articles), video-guided exercise apps (4 articles), and telehealth/telerehabilitation/teleconsultation/telestroke (4 articles). Only one examined how cultural differences influence technology. CONCLUSIONS: Although technologies are essential in online communities of support for stroke survivors and caregivers, this review shows a lack of studies that analyze the use and role of technologies in such online communities. This could be because the key actors of the online communities are the caregivers, who mainly seek social support and therefore do not require sophisticated technology. Nevertheless, technologies such as telerehabilitation and video-guided exercise apps could be important for other actors, including the local community and health workers, to enable them to support stroke survivors and their caregivers.
3 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 →Neurology
Hypnotic Cognitive Therapy for Chronic Pain in Spinal Cord Injury: A Randomized Controlled Trial
BACKGROUND AND OBJECTIVES: Chronic pain is highly prevalent, disabling, and difficult to treat in people with spinal cord injury (SCI). Our objective was to determine whether hypnotic cognitive therapy (HYP-CT) significantly reduces average pain intensity. METHODS: This single-blind, randomized, parallel-group trial investigated the efficacy of HYP-CT in treating moderate-to-severe chronic pain in community-residing adults with SCI. Participants were recruited nationwide through SCI organizations and randomized 1:1 to HYP-CT vs usual care (UC). We used computerized permuted block randomization with variable block sizes and stratified by sex and worst pain type. HYP-CT was delivered by a psychologist over the telephone or through Zoom and consisted of 6 weekly 60-minute sessions plus instructions to practice self-hypnosis daily independently by listening to session recordings. Controls were encouraged to continue current treatments or seek additional pain treatments. The primary outcome was average pain intensity assessed 4 times per week on a 0-10 numerical rating scale and averaged. The primary end point was at 6 weeks after randomization, with a follow-up assessment at 12 weeks. All outcomes were assessed through structured telephone interviews performed by blinded assessors. RESULTS: A total of 127 participants were randomized to HYP-CT (n = 64) vs UC (n = 63). Forty-eight percent were treated over the telephone and 52% through Zoom. The group was 42% female, had a mean age of 51.3 years (15.4 years after SCI), and had a mean baseline pain intensity of 5.93. The worst pain was neuropathic in 57% of cases. The primary outcome, average pain intensity, decreased more in the HYP-CT group compared with UC controls at 6 (-0.55, 95% CI -1.04 to -0.06) and 12 (-0.79, 95% CI -1.28 to -0.29) weeks. Depression declined significantly more in the HYP-CT vs UC groups at 6 and 12 weeks. Planned exploratory analyses suggested that the effect of HYP-CT on pain intensity was similar when delivered over the telephone vs through Zoom, and that pain intensity decreased more in those with all neuropathic pain vs those with mixed pain at 12 weeks. DISCUSSION: The study suggests that HYP-CT is an effective adjunctive treatment for SCI-related pain. Replication studies are needed. TRIAL REGISTRATION INFORMATION: The study was registered on ClinicalTrials.gov (NCT03857672) on February 28, 2019 and study enrollment commenced on April 24, 2019. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that, in patients with SCI, HYP-CT improves average pain intensity at 6 weeks compared with UC.
3 May 2026
Read appraisal →Bone research
A phase 2 trial of burosumab for treatment of fibroblast growth factor-23-mediated hypophosphatemia in children and adults with fibrous dysplasia
Fibrous dysplasia (FD) is a rare disorder associated with fractures and deformities. FD lesions produce excess phosphaturic hormone fibroblast growth factor 23 (FGF23), leading to hyperphosphaturia in most patients, and hypophosphatemia in those with high FD burden. Skeletal complications are associated with both low-normophosphatemia and frank hypophosphatemia. Burosumab is approved for other forms of FGF23 excess, but there is little evidence to inform use in FD. A phase 2 study investigated the safety and efficacy of burosumab in patients with FD. The primary endpoint was the proportion of participants achieving phosphate levels within the mid to upper part of the normal range (age and sex-adjusted Z-score -1 to +2). 12 participants (7 children, 5 adults) received burosumab for 48 weeks. Median phosphate Z-score increased from -2.88 (1.65) to 0.22 (1.37), meeting the target in 100% of participants. Alkaline phosphatase levels were elevated at baseline in 8 participants [median 846 U/L (464)] and declined by 49% at week 48, representing a median decline of -364 (244.5) U/L. PROMIS questionnaires showed trends toward improvements in all domains in children; adult scores showed no identifiable trends. Two children experienced transformational mobility gains, including advancement from full-time wheelchair use to independent ambulation. Lesion biopsies showed no changes in cellularity or composition, and 18F-NaF PET/CT scans showed no changes in tracer uptake, suggesting burosumab did not adversely impact lesional activity. Adverse events were mild, and none resulted in treatment withdrawal. Burosumab treatment in patients with FD was well-tolerated, restored phosphate homeostasis, and reduced alkaline phosphatase levels. Burosumab has the potential to lead to functional improvements and ambulation gains in severely affected patients and is a valuable tool to reduce the impact of FD-related disability.
2 May 2026
Read appraisal →Behavioural brain research
Non-pharmacotherapy for craving in methamphetamine use disorder: A systematic review and network meta-analysis of randomised controlled trials
OBJECTIVES: We evaluated the effects of non-pharmacotherapy on quality of life (QOL) and craving in individuals with methamphetamine use disorder (MUD), ranking the efficacy of various protocols. METHODS: We searched multiple databases for randomized controlled trials from inception to Dec 2025. The analysis included 53 studies with 3174 participants, investigating interventions such as exercise, transcranial magnetic stimulation (TMS), transcranial direct current stimulation, behavioral therapy, and acupuncture. The protocol was prospectively registered in PROSPERO (CRD42023443291). RESULTS: For craving reduction, both exercise and TMS demonstrated statistically significant benefits compared to conventional rehabilitation. Combined aerobic/resistance exercise and 10 Hz repetitive TMS targeting the left dorsolateral prefrontal cortex emerged as the most effective specific protocols within their respective categories. Furthermore, preliminary evidence from a limited number of studies indicated that exercise, acupuncture, and behavioral therapy improved patients' QOL. CONCLUSION: This study confirms that several non-pharmacotherapies are effective for managing craving in MUD. Exercise and TMS are particularly promising for reducing craving. The findings, synthesized within a novel "Intervention-Circuit-Symptom" integrative framework, provide a robust evidence base to inform clinical decision-making and guide the future development of MUD treatment guidelines.
1 May 2026
Read appraisal →Proceedings of the National Academy of Sciences of the United States of America
Neural reservoir control of a bio-hybrid soft arm
A long-standing engineering problem, the control of soft robots is difficult because of their highly nonlinear, heterogeneous, anisotropic, and distributed nature. Here, bridging engineering and biology, neural reservoirs are employed for the dynamic control of a bio-hybrid model arm made of multiple muscle-tendon groups enveloping an elastic spine. We show how the use of reservoirs facilitates simultaneous control and self-modeling across challenging tasks, outperforming classic neural network approaches. Further, through the use of spiking reservoirs on neuromorphic hardware, energy efficiency gains of up to 75 and 45 times are obtained relative to standard and high-efficiency CPUs, with implications for the on-board control of untethered, small-scale systems.
28 Apr 2026
Read appraisal →Behavior research methods
Lexique 4: A major upgrade of the Lexique French lexical database
Lexique 4, an updated French lexical database, expands upon its predecessor, Lexique 3, by incorporating several significant improvements to enhance its utility in psycholinguistics, computational linguistics, and education. The new version is based on a larger corpus of 316 million words derived from 65,317 documents, including movie, TV show, and documentary subtitles, which offers more accurate frequency estimates and includes contemporary neologisms. Lexique 4 introduces new variables, such as orthographic surface frequency, contextual diversity (CD), and detailed morphological structure, which provide a more comprehensive view of lexical properties. We find that contextual diversity is a slightly better predictor than word frequency, in line with previous work. Moreover, the integration of lexical decision times from the French Lexicon Project into Lexique 4 facilitates more in-depth linguistic research. Enhancements to the user interface, including a redesigned web platform, enable dynamic searches and sorting capabilities, increasing accessibility and usability for researchers. Statistical analyses indicate that the updated frequency measures in Lexique 4 are better predictors of lexical decision times compared to Lexique 3, supporting the value of these enhancements. Overall, Lexique 4 represents a comprehensive and flexible tool for analyzing French lexical properties, making it an essential asset for a broad range of users.
27 Apr 2026
Read appraisal →Biomedizinische Technik. Biomedical engineering
Evaluation of an adaptive system for breathing control in closed-loop diaphragm pacing
OBJECTIVES: Existing diaphragm pacing (DP) system use an open-loop control method with a fixed stimulation mode to control breathing. It requires doctors to manually adjust stimulation parameters to meet the patient's ventilation needs. METHODS: A neural network adaptive controller was tested to control breathing in DP system. For the diaphragm motion model, the respiratory airflow of healthy adults and rabbits was collected and compared with the simulation calculation results to verify the accuracy of the model. The performance of the adaptive controller was evaluated comparatively with that of the PID controller. Adaptive controller consists of a neural network and adaptively adjusts stimulation parameters to produce the desired respiratory volume waveform. Superiority of the output performance of the adaptive controller was further studied by setting various diaphragm model parameters. We further verified the feasibility of the adaptive controller through animal testing. RESULTS: The adaptive controller is better than the PID controller in maintaining the stability of the desired breath volume. Application of the adaptive controller can reduce the root mean square (RMS) error between the desired breath volume and the actual value to less than 6 %. CONCLUSIONS: This study demonstrates the potential application of adaptive controllers in closed-loop DP systems.
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
Comparison of deep learning-based three-dimensional human pose estimation methods with motion capture for gesture research
Humans often make gestures while speaking. These gestures have been extensively researched in psychology and cognitive science, revealing their functions and roles in communication. Despite being produced in three-dimensional (3D) space, gestures and gesture space have primarily been measured and analyzed using two-dimensional planes. Optical motion capture (MoCap) is commonly used for 3D gesture measurement. However, MoCap is expensive, requires a large space, and the attachment of retroreflective markers can interfere with the natural generation of gestures by the speaker. Recent advances in deep learning-based human pose estimation (HPE) offer promising alternatives by enabling 3D keypoint estimation from standard video cameras. This study investigates the accuracy of four HPEs-two monocular and two stereo with triangulation methods-in estimating upper-body keypoints commonly used in natural scenarios for gesture research. Ten participants were recorded performing gesture-rich speech by both a MoCap system and three video cameras. We compared 13 keypoints, including the wrists, elbows, shoulders, fingers, and face, with MoCap data, using Euclidean distance as an error metric. Statistical analyses revealed that stereo methods significantly outperformed monocular methods across all keypoints. The most accurate method achieved an average error of 49.4 mm with respect to MoCap, suggesting sufficient accuracy for practical gesture analysis. Additionally, we visualized 3D gesture spaces and found a 75.4% overlap between HPE and MoCap at a voxel size of 50 mm, indicating high spatial agreement. Our findings demonstrate that stereo HPE methods are viable, cost-effective alternatives to MoCap in gesture-related applications. Our ultimate objective is to create a toolbox that is accurate and easy to use for measuring human gestures in 3D space by exploiting the recent advances in HPE as an alternative to MoCap. Such a toolbox will be suitable for non-experts in machine learning, and these results lay the foundation for it.
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 →ACS sensors
Wearable Flexible Acoustic Alarm Device Based on MXene/Laser-Induced Graphene@Polyimide Thermoacoustic Film
Flexible acoustic devices have advantages of high flexibility and large sound output area, capable of adhering to the surface of the skin or clothing, which shows great potential in the field of wearable electronics. However, the design of acoustic material structures and their functional applications are still difficult. Here, we fabricated a porous laser-induced graphene (LIG) microarray layer on a polyimide (PI) film by laser direct writing. Subsequently, we uniformly coated the few-layer MXene nanosheets onto the LIG surface to obtain an MXene/LIG@PI film featuring low specific heat capacity per unit area, large interlayer spacing, excellent electrical conductivity, and high thermal conductivity. Meanwhile, the MXene/LIG@PI-based acoustic device composed of flexible copper electrodes exhibits excellent acoustic performance with a high sound pressure level of 77.6 dB and maintained a stable acoustic spectrum as the frequency increased from 20.0 Hz to 20.0 kHz. Finally, the portable acoustic alarm device composed of the piezoelectric module and the MXene/LIG@PI-based acoustic module was designed, which can be worn on various parts of the human body clothing, to provide audible alarm reminders in case of accidental falls or drops during outdoor activities. This study provides a novel approach for designing new flexible acoustic materials and devices.
26 Apr 2026
Read appraisal →JMIR formative research
Exploring User Experiences of an Augmented Reality Smartphone App Prescribing Exercise for Children and Young People With Cancer: Results From a Qualitative Study
BACKGROUND: Mobile health (mHealth), and specifically smartphone apps, have grown exponentially in both functionality and accessibility and are becoming an important component of health care. Research exploring the use of mHealth for managing or treating chronic diseases, such as cancer, has shown promising effects. Yet, comparatively little work has examined how such technologies can enhance exercise interventions for young people with cancer. To optimize the effectiveness of mHealth in these contexts, it is essential to build a stronger evidence base on user experience. OBJECTIVE: This study aimed to investigate how healthy children and young people engaged with an augmented reality (AR) app developed specifically for children and young people undergoing cancer treatment, and to identify design features that may support engagement and behavior change in the intended clinical population. METHODS: School and university students, aged 8-21 years, were eligible to participate in the study. Practical workshops allowed participants to engage with the AR exercise app before taking part in focus groups to explore user experiences. Data were analyzed using qualitative content analysis, which also involved a critical friend approach using 2 researchers (HM and KS). Suggested improvements were mapped against the motivational affordances' taxonomy. RESULTS: A total of 39 participants aged 8-21 years took part in the focus group study. Participants found the demonstrations and varied exercises useful but expressed some concerns regarding data safety and functionality of the novel AR avatar. It was proposed that additional educational components, challenges, and rewards, as well as a customizable avatar, social support features, and audio instructions for a more inclusive design would be desirable and could enhance user experience. When mapped against the motivational affordances taxonomy, the suggested improvements aligned primarily with mechanisms of user education, challenges, feedback, cooperation, and comparison. CONCLUSIONS: This study provides an understanding of how apps that prescribe exercise can be optimized to enhance motivation and user experience. By assessing feedback and suggestions for improvements, the findings highlight key design features that may support engagement. While this initial work focused on healthy, age-matched participants, further evidence specifically in children and young people with a childhood cancer diagnosis is needed.
26 Apr 2026
Read appraisal →European journal of preventive cardiology
Economic evaluation of alternative cardiac rehabilitation programmes compared to centre-based cardiac rehabilitation programmes: a systematic review.
AIMS: Traditional centre-based cardiac rehabilitation (CBCR) has several drawbacks, including high costs, limited accessibility, and low utilisation rates. As a result, alternative cardiac rehabilitation programmes (ACRPs), such as home-based rehabilitation and telerehabilitation, have been developed. This systematic review aims to synthesise existing evidence on the economic evaluation of ACRPs compared to CBCR. METHODS AND RESULTS: We searched databases of MEDLINE, Embase, CINAHL, Cochrane CENTRAL, Web of Science, and EconLit, as well as trials registers of Clinicaltrials.gov, International Clinical Trials Registry Platform, and EU Clinical Trials Register. The last search date was 20 March 2025. We included randomised controlled trials that directly compared ACRP with CBCR in terms of cost and effectiveness. Study quality was assessed using the Cochrane Risk of Bias tool and the Drummond 10-item checklist. Both qualitative and quantitative syntheses were conducted, with random-effects models applied in the meta-analysis. Thirteen studies met the inclusion criteria, comprising 2040 participants. Meta-analysis showed a non-significant trend favouring CBCR over ACRP for EQ-5D (SMD = -0.32; 95% CI: -0.71 to 0.06; I2 = 79%). For QALY, there was no difference between ACRP and CBCR (SMD = -0.02; 95% CI: -0.19 to 0.15; I2 = 0). Ten of the thirteen studies reported lower costs for ACRP compared with traditional CBCR. Three of five economic evaluations found ACRP to be cost-effective. CONCLUSION: ACRPs demonstrate cost-effectiveness comparable to traditional CBCR. This review highlights the potential of ACRPs, such as home-based rehabilitation and telerehabilitation, as solutions for broader implementation in CR practice. This study reviewed existing research to compare the cost and effectiveness of alternative cardiac rehabilitation programmes with traditional centre-based programmes.Alternative cardiac rehabilitation programmes provide similar health benefits to centre-based programmes.They are often less expensive, with most studies showing lower costs.
26 Apr 2026
Read appraisal →Archives of orthopaedic and trauma surgery
Analysis of mental health outcomes in major versus minor upper extremity amputations: a retrospective national database study
BACKGROUND: Upper extremity amputations are associated with developing psychiatric conditions. The aim of this study is to identify differences in mental health outcomes for patients undergoing major versus minor upper extremity amputations. METHODS: Data were obtained from the PearlDiver database between 2010 and 2022 using Current Procedural Terminology and International Classification of Diseases codes. Patients aged 10 and above without prior mental health diagnoses or antidepressant prescription records who underwent upper extremity amputations were stratified by major (shoulder disarticulation, arm, forearm, wrist, transmetacarpal) versus minor (single metacarpal, digit, phalanx) amputations. Demographic characteristics and rates of mental health diagnoses, antidepressant prescriptions, and psychotherapy care were assessed for 90 days and one year postoperatively, using Welch's T-tests and Pearson's chi-squared tests. RESULTS: Patients with major amputations had increased risk of mental health diagnoses at 90 days (OR: 3.29, p < 0.001) and at one year (OR: 2.01, p < 0.001). Both groups had higher rates of mental health diagnoses than the general population. Patients undergoing major amputations had higher odds of starting antidepressants at 90 days (OR 3.82, p < 0.001) and at one year (OR 2.38, p < 0.001). Psychotherapy care was significantly increased after major amputations at 90 days (OR 5.47, p < 0.001) and at one year (OR 4.18, p < 0.001). CONCLUSIONS: Mental health disorders, antidepressant use, and psychotherapy care are significantly higher for major upper extremity amputations compared to minor amputations. Surgical teams should provide mental health resources to mitigate negative effects from mental health needs after upper extremity amputation. LEVEL OF EVIDENCE: III.
26 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 →PloS one
RMETNet: A cross-subject motor imagery EEG signal classification model based on TSLANet and riemannian geometry features
Motor imagery electroencephalogram (MI-EEG) analysis is essential for natural interaction and autonomous control in brain-computer interfaces (BCIs). However, deep learning models often struggle with inter-subject variability, which limits their ability to generalize across subjects. This study proposes RMETNet, a novel framework that integrates TSLANet, a spatio-temporal convolution module, and a multi-scale Riemannian geometry feature module. TSLANet suppresses noise and captures complex temporal patterns for preliminary signal decoding, while the spatio-temporal convolution module extracts higher-order representations. The Riemannian branch learns geometry-based distribution features across subjects, and the fused features are used for classification. To address inter-subject distribution shifts, RMETNet incorporates Maximum Mean Discrepancy (MMD) loss for domain adaptation, aligning feature distributions between source and target domains. Experiments show that on the four-class BCI Competition IV 2a (BCICIV2a) dataset, RMETNet achieved accuracies of 71.39% in the cross-subject setting and 80.71% in the subject-dependent setting; on the two-class BCI Competition IV 2b (BCICIV2b) dataset, it achieved 80.93% and 86.76%, respectively. The model consistently outperformed baseline algorithms. Ablation and visualization analyses further validated its effectiveness in reducing inter-subject feature distribution disparities and enhancing MI-EEG decoding. The code is available at: https://github.com/rokanfeermecer486/RMETNet.
26 Apr 2026
Read appraisal →Journal of ethnopharmacology
Neuroprotective effects of Tongxinluo capsule in acute ischemic stroke: A systematic review and meta-analysis
ETHNOPHARMACOLOGICAL RELEVANCE: Tongxinluo capsule is widely used in patients with acute ischemic stroke (AIS), although the literature does not consistently agree on its efficacy and safety. AIM OF THE STUDY: We aimed to assess the efficacy and safety of Tongxinluo capsule for patients with AIS. MATERIALS AND METHODS: A systematic search of the databases PubMed, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang data, VIP Chinese Journal Service Platform, and SinoMed was conducted from their inception dates to January 2025. Randomized controlled trials (RCTs) that enrolled patients with AIS who receive Tongxinluo capsule and compared effects with placebo or as an add-on therapy to usual care were included. Literature screening, risk of bias assessment, and data extraction were independently conducted in duplicate. Fixed-effects or random-effects models were used to perform meta-analysis for pooling data from eligible studies. The primary outcome was long-term functional independence (defined as modified Rankin Scale [mRS] grade less than 2). Secondary outcomes included all-cause mortality, improvements in activities of daily living (measured with the Barthel Index [BI]), and neurological impairment (measured with the National Institutes of Health Stroke Scale [NIHSS]). Incidence of adverse events were identified as safety outcomes. RESULTS: We included 4842 patients with AIS from 12 RCTs (2422 [50.02 %] treated with Tongxinluo capsule) in the final analysis. Tongxinluo capsule treatment in AIS significantly improved the proportion of patients with mRS less than 2 (RR, 1.21; 95 % CI, 1.02 to 1.44), improved the change in BI score (MD, 11.47; 95 % CI, 10.34 to 12.60) and NIHSS score (MD, 3.48; 95 % CI, 2.87 to 4.09). No significant differences were detected in all-cause mortality (RR, 0.57; 95 % CI, 0.17 to 1.95), or the incidence of overall adverse events (RR, 1.01; 95 % CI, 0.91 to 1.12). CONCLUSION: Administration of Tongxinluo capsule for AIS demonstrated potential benefits in improving the long-term functional outcomes and activities of daily living, and relieving neurological impairment, without observing major safety concerns.
25 Apr 2026
Read appraisal →PloS one
The journey to diagnosis and care of functional neurological disorder (FND).
PURPOSE: Functional neurological disorder (FND) is a common condition, associated with high disability and healthcare costs, and poor treatment access. This qualitative study aimed to explore participants' experiences of being diagnosed with functional neurological disorder (FND), accessing treatment, and navigating life after diagnosis. Participants were drawn from a randomised feasibility study of eye movement desensitisation and reprocessing therapy for people with FND (MODIFI, Trial Registration: NCT05455450 (www.clinicaltrials.gov)). METHODS: Reflexive thematic analysis was used to analyse the data from eighteen semi-structured interviews with participants diagnosed with FND. RESULTS: Six main themes were identified: (1) the process of seeking a diagnosis and initial relief from the physical struggles, (2) receiving a diagnosis of FND, (3) treatment for FND, (4) the burden of FND in day-to-day life, (5) the need to assert agency and return to normal, and (6) hopes for the future. CONCLUSION: The findings emphasize the need for personalised and compassionate care for individuals suffering from FND, underpinned by increased service provision within the healthcare system.
25 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 →Science advances
Wearable thumb sleeves enabled by self-supervised learning with few stretchable sensors and few-shot data for switchable finger tasks
Human fingers exhibiting remarkable dexterity are ideal for natural human-machine interaction. Traditional methods require at least one device per finger and extensive labeled data, often limiting models to a single user and task. Here, we propose a wearable thumb sleeve integrated with self-supervised learning, which exhibits user independence and data efficiency, enabling recognition of various finger-related tasks. The thumb sleeve is equipped with only two stretchable sensors at the thumb joints and learns latent features from unlabeled random thumb movement data. By using fine-tuning with five-shot labeled data, it can rapidly adapt to new users and tasks, including eight directional commands and 10 knuckle key inputs. It allows free switching between tasks without the need to reconstruct or retrain the model. The proposed approach demonstrates strong potential for real-world applications, serving as a substitute for a mouse and keyboard to enable tasks such as online shopping.
25 Apr 2026
Read appraisal →Annals of medicine
Artificial intelligence and wearable sensors in sports injury risk prediction: current status and future perspectives.
BACKGROUND: Artificial intelligence (AI) and wearable sensors are increasingly reshaping sports injury risk prediction by enabling continuous, individualized, and data-driven assessment. DISCUSSION: This review summarizes recent advances in wearable technologies - including inertial measurement units (IMUs), electromyography (EMG), physiological monitors, and flexible electronics - and their use in capturing biomechanical, physiological, and psycho-physiological indicators relevant to injury risk. Deep learning (DL) models, particularly those capable of temporal and multimodal fusion, have shown promise in predicting injuries such as anterior cruciate ligament (ACL) tears, muscle fatigue, and stress fractures. Through representative applications and mechanism-informed analysis, we highlight the growing role of interpretable AI, real-time feedback, and behavior-integrated predictive systems. CONCLUSIONS: Key challenges remain, including data heterogeneity, limited generalizability, compliance issues, and privacy concerns. Future directions point toward personalized modeling, explainable systems, federated learning, and digital twin frameworks. Together, these advancements mark a shift toward proactive, intelligent injury prevention across athletic and clinical settings.
24 Apr 2026
Read appraisal →European journal of preventive cardiology
Comparison of patient characteristics and health outcomes between self-selected centre-based cardiac rehabilitation and hybrid cardiac telerehabilitation: a prospective cohort study
AIMS: Data on self-selected modes of delivery of cardiac rehabilitation (CR) are limited. This study compared centre-based CR (cbCR) with hybrid cardiac telerehabilitation (hCTR) in terms of patient characteristics, change in physical and mental functioning, and achievement of guideline-directed treatment targets. METHODS AND RESULTS: From May 2022 to December 2023, consecutive patients with cardiovascular diseases were enrolled at a tertiary centre into a 3 month cbCR or hCTR programme based on shared decision-making. Changes in exercise capacity, anxiety, depression, and health-related quality of life (hrQoL) scores from admission to the discharge visit were compared between CR modalities. The achievement of two-step blood pressure and LDL-cholesterol (LDL-C) goals, as well as the HbA1c goal in patients with diabetes at the discharge visit, was compared between CR modalities. Out of 1292 patients screened, 406 (21% females, age 60.4 ± 12.7 years) were eligible and completed the study. Of those, 72% chose cbCR and 28% chose hCTR. Patients in hCTR were 3 years younger and exhibited higher baseline peak VO2 (91 vs. 80% of predicted), better hrQoL, and lower depression and anxiety scores. No significant differences were found in improvements in physical or mental functioning or in meeting blood pressure and HbA1c targets between the two groups. A smaller proportion of hCTR participants achieved the LDL-C Step I target (56 vs. 69% in cbCR). CONCLUSION: Overall, hCTR attracted slightly younger patients with better baseline health, but both modalities showed similar effects on most health outcomes. Centre-based cardiac rehabilitation was associated with tighter lipid control, which could be related to more intense counselling or patient preference. Outpatient cardiovascular rehabilitation was equally effective when performed with thrice weekly supervised exercise training sessions or partly performed at home while monitored with fitness trackers and a biosensor vest. Patients who self-select digitally monitored home training were slightly younger, fitter, and had better quality of life with lower levels of anxiety and depression. Blood lipid control, weight loss, and smoking cessation therapies need to be enhanced by tighter control and more intensive medical therapy particularly in patients choosing to perform part of the exercise sessions at home.
23 Apr 2026
Read appraisal →Journal of Korean medical science
Comparison of the Hearing Benefits and User Satisfaction With Hearing Aids and Personal Sound Amplification Products: A Multicenter Prospective Randomized Crossover Trial
BACKGROUND: While hearing aids (HAs) remain the primary intervention for hearing loss, their high cost creates barriers to access. Personal sound amplification products (PSAPs) are a more affordable alternative, but few studies have compared their efficacy to those of HAs. This multicenter, prospective, randomized, crossover trial was conducted to compare audiologic performance and user satisfaction between HAs and PSAPs to evaluate PSAP potential as alternatives for hearing rehabilitation. METHODS: A total of 73 participants with sensorineural hearing loss was enrolled. Participants used one hearing device (HA or PSAP) for 3 months before changing to the other for 3 months. Outcome measures were pure-tone audiometry, word recognition score, and Hearing in Noise Test score. Subjective satisfaction was measured using standardized questionnaires-the Abbreviated Profile of Hearing Aid Benefit and the International Outcome Inventory for Hearing Aids-and two custom surveys. RESULTS: HAs showed superior performance in high-frequency functional gain, speech perception in noise, and user satisfaction compared to PSAPs. Premium HAs demonstrated better performance than basic HAs, while basic HAs significantly outperformed both high-end and basic PSAPs. No significant differences were found between high-end and basic PSAPs. CONCLUSION: The superior audiologic performance of and user satisfaction with HAs compared to PSAPs support their continued preference for hearing rehabilitation. Although PSAPs offer a more affordable option, they may not meet the needs of individuals with hearing loss, particularly in terms of high-frequency gain and speech perception. TRIAL REGISTRATION: iCreaT Identifier: C220078.
23 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 →Spinal cord series and cases
Early transanal irrigation in spinal cord injury-related neurogenic bowel dysfunction: preliminary insights.
STUDY DESIGN: Prospective, randomized, open-label, multicenter, parallel group study. OBJECTIVES: Neurogenic bowel dysfunction (NBD) is a common complication in spinal cord injury (SCI) patients, severely affecting quality of life. While transanal irrigation (TAI) has shown superior efficacy over conservative treatments (CT), its early adoption during the first hospitalization post-injury remains unexplored. This study aimed to compare early TAI initiation versus CT in managing NBD in SCI patients. SETTING: This study involved four spinal units across Italy. METHODS: SCI patients were randomized to receive TAI or CT during a four-week hospital stay, followed by continued treatment at home for 6 months. Bowel function, constipation, and continence were assessed using the Wexner scales, while quality of life was measured using the EQ-5D-5L and Spinal Cord Independence Measure (SCIM) questionnaires. Stool transit time and patient independence were also monitored. RESULTS: Twenty-two patients were enrolled, with the TAI group showing significant improvements in constipation (Wexner score reduction from 13.43 ± 4.24 at baseline to 7.55 ± 2.38 and 8.80 ± 4.16 at 4 weeks and 6 months, p = 0.02) and a trend toward continence improvement. A significant increase in the total SCIM score was observed in the TAI group (p = 0.02), particularly in respiratory and sphincter management. Quality of life improved in both groups, with a notable enhancement in self-care activities for the TAI group (p = 0.006). CONCLUSIONS: These preliminary results suggest early TAI adoption improves bowel management, especially constipation, and enhances patient independence. Larger studies are needed to validate these findings and assess long-term benefits.
22 Apr 2026
Read appraisal →BMJ open
Implementation of a digital tool for monitoring and managing the emotional and cognitive sequelae of post-intensive care syndrome: ICURA study protocol for a randomised clinical trial
INTRODUCTION: Intensive care units (ICUs) can be a particularly challenging environment for patients who are mentally vulnerable. In addition to the physical stress associated with critical illness and its management, there are physiological and psychosocial factors that can negatively impact a patient's mental health. Approximately half of ICU survivors will experience post-intensive care syndrome, a set of emotional, neuropsychological and physical sequelae that can significantly affect patients' functionality and quality of life, both in the short and long term. The main objective of this study is to investigate whether the ICU Recovery Answers (ICURA) digital follow-up platform can effectively detect emotional and cognitive problems in critically ill patients and its impact on functionality and health-related quality of life during the first year after ICU discharge. METHODS AND ANALYSIS: Multicentre longitudinal prospective study involving ICU adult patients, with randomised follow-up comparing a telemedicine monitoring programme versus usual medical care during 1 year after discharge. A total of 360 participants will be recruited during their ICU admission in two hospitals in Spain. Efficacy outcomes will focus on participants' level of functioning, assessed with the WHO Short Disability Assessment Schedule, and quality of life, measured with the 12-Item Short Form Survey at 1, 6 and 12 months after ICU discharge. Emotional state and cognitive impairment will be evaluated using the Patient Health Questionnaire-9, Generalised Anxiety Disorder-7 and Treatment-Outcome Post-Traumatic Stress Disorder Scale and the Montreal Cognitive Assessment by telephone at 1, 3, 6, 9 and 12 months after ICU discharge. ETHICS AND DISSEMINATION: The implementation of this project is expected to have a direct impact on the satisfaction of ICU survivors, improving their well-being, personalised follow-up and quality of life. Results from this study will be disseminated at various scientific conferences, national and international meetings, and will be shared with the general public and other relevant parties. The dissemination of these results will occur through scientific publications, allowing the medical and scientific community to benefit from the study's findings. Ethics approval from the Ethics Board of Parc Taulí Foundation and Balearic Islands with reference numbers 2022/3031 and IB 5072/22 PI: Protocol version 1 of 18 November 2022. TRIAL REGISTRATION NUMBER: NCT06504979.
20 Apr 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Artificial intelligence in cancer survivorship: evaluating ChatGPT's performance in rehabilitation-related queries
PURPOSE: This study aimed to evaluate the performance of ChatGPT in responding to patient-centered queries related to cancer rehabilitation. It examined the accuracy, completeness, and overall quality of ChatGPT's responses across major domains of cancer rehabilitation from a physical therapy perspective. METHODS: Fifteen representative patient queries covering eight domains of cancer rehabilitation-including general exercise, fatigue, bone metastasis, neuropathy, balance and falls, breast cancer, women's health, and pediatric cancer-were developed by two licensed physical therapists. Each query was input into ChatGPT-4, and responses were independently evaluated for accuracy, completeness, and global quality based on established clinical practice guidelines and expert consensus. RESULTS: ChatGPT demonstrated a mean accuracy score of 3.93 (SD = 1.10) on a 5-point scale, a mean completeness score of 2.13 (SD = 0.83) on a 3-point scale, and a mean global quality score of 3.60 (SD = 1.12) on a 5-point scale. Responses were generally accurate and clinically relevant but often lacked details regarding exercise dosage, safety precautions, and guideline-concordant recommendations. CONCLUSION: ChatGPT shows potential as an accessible tool for general cancer rehabilitation education but requires refinement to ensure accuracy, contextual relevance, and safety. IMPLICATIONS FOR CANCER SURVIVORS: AI-driven conversational models may improve patient access to rehabilitation information and self-management support when used under professional oversight and guided by evidence-based frameworks.
19 Apr 2026
Read appraisal →Journal of medical Internet research
Comparing Pulmonary Telerehabilitation and Center-Based Pulmonary Rehabilitation for Effectiveness and Adherence in Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis of Randomized Controlled Trials
BACKGROUND: Pulmonary rehabilitation (PR) is a cornerstone of chronic obstructive pulmonary disease (COPD) management; however, access to traditional center-based PR (CBPR) remains limited. Digital and remote models, collectively termed pulmonary telerehabilitation (Tele-PR), have increasingly been used, but their heterogeneity in technology use, supervision, and interaction mode may influence effectiveness and sustainability. OBJECTIVE: This systematic review and meta-analysis aimed to compare the effectiveness and adherence of Tele-PR with those of CBPR in adults with COPD while systematically evaluating the impacts of supervision intensity and delivery models on key clinical outcomes. METHODS: This review followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 and PRISMA-S (Preferred Reporting Items for Systematic reviews and Meta-Analyses literature search extension) guidelines. PubMed, Embase, the Cochrane Library, and the Web of Science were searched from inception to December 10, 2025, to identify randomized controlled trials comparing Tele-PR or home-based PR (HBPR) with CBPR in adults with COPD. Random effects meta-analyses were conducted using the Hartung-Knapp-Sidik-Jonkman method. Between-study heterogeneity was assessed using τ², I², and 95% prediction intervals. Risk of bias was evaluated with the Cochrane Risk of Bias 2 tool, and certainty of evidence was graded using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. RESULTS: Seventeen randomized controlled trials involving 1658 participants were included. After intervention, Tele-PR and CBPR showed comparable average effects on exercise capacity by 6-minute walk distance (k=9; n=950, 57.3%; mean difference -5.37 m, 95% CI -15.68 to 4.95; P=.26; τ²=103.97; I²=28.2%; 95% prediction intervals=-32.73 to 22.27). Although pooled effects were not statistically significant, substantial heterogeneity was observed across remote delivery models. Subgroup analyses linked digitally supported, synchronously supervised Tele-PR to less between-study variance across several outcomes, indicating greater consistency in treatment effects across different settings while revealing that low-technology HBPR yielded more variable outcomes, particularly in symptom burden. At long-term follow-up (≥6 mo), between-group differences in functional and symptom outcomes diminished, and short-term gains in exercise capacity did not consistently translate into increased daily physical activity. Certainty of evidence ranged from moderate to very low, mainly downgraded for performance bias, inconsistency across intervention models, and imprecision. CONCLUSIONS: Tele-PR may achieve short-term clinical outcomes comparable to CBPR. Distinct from prior reviews, we stratified remote programs by delivery models and supervision, identifying digitally supported Tele-PR and low-technology HBPR as 2 clinically distinct paradigms with differing consistency of effects. We further propose a structured "supervision gradient" to interpret model-dependent variability in effects across Tele-PR approaches, providing a context-sensitive framework for evidence-informed, model-specific implementation. Future remote rehabilitation should integrate real-time professional supervision and long-term behavioral maintenance to sustain benefits. Tele-PR may be particularly valuable for expanding PR access, while CBPR remains essential for patients requiring close in-person supervision or complex multidisciplinary care.
18 Apr 2026
Read appraisal →Acta orthopaedica
Migration patterns of uncemented femoral stems in hip replacement: a systematic review and meta-analysis of clinical radiostereometric analysis cohort studies
BACKGROUND AND PURPOSE: We conducted a systematic review and meta-analysis of radiostereometric analysis studies of primary uncemented femoral stems to investigate their subsidence and retroversion patterns and the migration patterns according to implant, patient, and study characteristics. METHODS: A systematic search of PubMed, Web of Science, Cochrane, and Embase databases to identify all radiostereometric analysis studies on femoral stem migration following primary uncemented total hip replacement was performed. Clinical studies with 2 or more postoperative radiostereometric measurements within 2 years were included. Subsidence and retroversion at 6 weeks, 3 and 6 months, 1, 2, 5, and 10 years were included for analysis. Extracted implant characteristics included implant design, coating, and surgical approach. Data was analyzed using a random effects model. RESULTS: 73 studies on 120 cohorts and 2,970 uncemented stems were included. 119 cohorts reported on subsidence and 91 on retroversion. The pooled subsidence at 3 months was 0.29 mm (95% confidence interval [CI] 0.19-0.39) and 0.32 mm (CI 0.21-0.43) at 2 years. The pooled retroversion at 3 months was 0.51° (CI 0.33-0.70) and 0.70° (CI 0.48-0.93) at 2 years. Hydroxyapatite-coated stems showed the least migration (subsidence 0.26 mm; CI 0.13-0.40; retroversion 0.51°; CI 0.22-0.80) among different coating types. The anterior approach showed more migration (subsidence 1.04 mm, CI 0.53-1.55; retroversion 1.52°, CI 1.08-1.95) than other surgical approaches. CONCLUSION: Our study shows that most subsidence and retroversion of uncemented femoral stems occurs during the first 3 months. Stabilization of subsidence occurred after 3 months, and retroversion stabilized after 2 years. Migration patterns differ based on stem type, coating, surgical approach, the time period when inclusion started, and timing of baseline measurement.
18 Apr 2026
Read appraisal →Journal of the International Society of Sports Nutrition
Effects of eight weeks of eicosapentaenoic acid and medium-chain triacylglycerol structured lipid intake on EPA/AA ratio and muscle performance in young men
BACKGROUND: Structured triglycerides (STGs), in which eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are esterified with medium-chain triglycerides (MCTs), have demonstrated greater bioavailability and potential benefits in improving endurance and reducing post-exercise strength loss compared with physical mixtures (PMs) of EPA and MCTs. However, it remains unclear whether STGs have superior effects on blood EPA levels and muscular endurance and fatigue. This study compared the effects of 8-week STG and PM intake on blood EPA levels, muscular endurance, and fatigue following resistance exercise. METHODS: Twenty-eight healthy young men were randomly assigned to an STG group (n = 15) or a PM group (n = 13) in a double-blind, parallel-group, active comparator trial. Participants consumed 4,560 mg/day of the test oil (600 mg EPA, 260 mg DHA) for 8 weeks. After the intervention, the participants performed four sets of leg extensions to exhaustion at 40% of their body weight. Muscular endurance was assessed by the number of repetitions, and fatigue was evaluated by changes in maximal voluntary contraction, range of motion, thigh circumference, muscle thickness, echo intensity, and jump performance. RESULTS: The STG group showed a significantly greater increase in the serum EPA/arachidonic acid (AA) ratio compared with the PM group. However, no significant differences were found between groups in repetition counts or fatigue-related measures. CONCLUSION: Eight weeks of STG supplementation improved the blood EPA/AA ratio more than a PM, but did not yield superior effects on muscle endurance or fatigue.
18 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
Effectiveness of cognitive behavioral therapy for depression in patients with multiple sclerosis: A systematic review and meta-analysis
BACKGROUND: The efficacy and methodologies of cognitive behavioral therapy (CBT) for treating depression in multiple sclerosis (MS) require further comprehensive research. METHODS: Two researchers conducted independent literature searches across 5 databases, utilizing the keywords "multiple sclerosis," "cognitive behavioral therapy," and "depression," without any restrictions on publication year. The Cochrane Risk of Bias Tool 2.0 was utilized to assess the included studies. Statistical analyses were conducted using standardized mean difference as the effect size with Stata 17.0 software. RESULTS: This meta-analysis included 22 studies. The results indicate that, regardless of whether delivered face-to-face, online, or via telephone, both individual and group CBT effectively alleviate depression in patients with MS. Significant improvements in depressive symptoms were observed starting from the second month of intervention and persisted for up to 6 months post-intervention. CONCLUSION: Patients with MS can flexibly choose the delivery modality of CBT based on their individual circumstances while engaging in treatment for around 2 months. They are encouraged to reengage in CBT within 6 months post-intervention to ensure the continuity and stability of depression treatment outcomes. Healthcare providers can offer various CBT delivery modalities based on the individual preferences and circumstances of patients with MS, while developing corresponding plans to enhance the effectiveness of depression management.
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 →Journal of neurointerventional surgery
Explainable machine learning model for predicting functional outcomes in posterior circulation stroke after thrombectomy
BACKGROUND: The early prediction of functional outcomes in patients with posterior circulation stroke (PCS) is crucial for timely interventions and optimizing treatment plans. We have developed and validated a machine learning (ML) model for predicting 3-month functional outcomes in patients with PCS undergoing endovascular thrombectomy (EVT). METHODS: The derivation cohort, consisting of 202 patients with PCS who underwent EVT at four medical centers from January 2020 to December 2023, was separated for training and internal validation, and an external dataset of 54 patients admitted from January 2020 to July 2023 was used for external validation. The target outcome was a good functional outcome, defined as a modified Rankin Scale score of 0-3 at 3 months. Seven ML models were trained using preoperative features, with the primary evaluation metric being the area under the receiver operating characteristic curve (AUC). The top performing model was further trained using intraoperative and postoperative features. Model interpretations were generated using the Shapley additive explanations (SHAP) method. RESULTS: The Random Forest model demonstrated the best discriminative ability among the models considered. After feature selection, the final preoperative model used seven features, achieving an AUC of 0.83 in the test set and 0.81 in the external validation cohort. The inclusion of intraoperative and postoperative features further enhanced the model's performance, resulting in an AUC of 0.84 and 0.90 in the test set and 0.83 and 0.90 in the external validation cohort, respectively. These models have been incorporated into a publicly accessible web-based calculator (https://zhelvyao-123-60-basilarz.streamlit.app). CONCLUSION: The interpretable ML models provide dynamic accurate predictions of functional outcomes in patients with PCS after EVT, offering valuable insights for personalized risk stratification and optimizing perioperative management, with potential for integration into clinical workflows.
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 →Spine
An Unsupervised Learning Approach for Multimodal Low Back Pain Stratification
STUDY DESIGN: Cross-sectional study. OBJECTIVE: This study proposes a novel stratification framework for individuals with low back pain (LBP). The method integrates Northern Finland Birth Cohort data comprising imaging biomarkers from deep learning (DL)-based analysis of lumbar spine MRI with the data on smoking status, demographics (sex and BMI), self-reported data from Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) short and the STarT Back Tool (SBT). Furthermore, the utility of this stratified approach was validated by demonstrating a superior net benefit compared with "treat-all" strategy. BACKGROUND: Current risk stratification for individuals with LBP relies on ÖMPSQ short and SBT among others. While these tools are invaluable for capturing psychosocial characteristics predictive of future disability and functional outcomes, LBP's multifactorial nature necessitates a more comprehensive framework for effective risk stratification. MATERIALS AND METHODS: A method for multimodal unsupervised patient stratification has been developed that allows for the integration of imaging biomarkers of disc degeneration (DD) and facet tropism (FT), extracted using DL models, with nonimaging data. The framework utilized robust K-Means clustering to stratify individuals. Clusters were characterized using LBP frequency and bothersomeness, and their robustness was validated with a multi-class logistic regression model. Net benefit was assessed through decision curve analysis. RESULTS: Three distinct subgroups were characterized by LBP frequency and bothersomeness. One subgroup was dominated by psychosocial characteristics (psychosocial risk P < 0.05), the second by physical degenerative changes (DD P < 0.05), and the third by a mix of both. Predictive models for cluster assignment were robust, achieving high mean accuracies (SBT-based: 0.89; ÖMPSQ-short-based: 0.87). The net benefit is superior throughout a range of threshold probabilities compared with a "treat-all" strategy. CONCLUSION: A novel framework was developed that integrates multimodal data to identify distinct subgroups differentiated by their physical and psychosocial characteristics in a population-based cohort, demonstrating potential for advancing personalized care.
17 Apr 2026
Read appraisal →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 →Journal of rehabilitation medicine
Does aerobic exercise affect memory, attention, working memory, and fatigue after acquired brain injury? A single-blinded, randomized controlled pilot study.
OBJECTIVE: To explore potential effects of aerobic exercise on cognitive function, fatigue, and neuroplasticity after stroke or traumatic brain injury. DESIGN: A randomized controlled pilot study. SUBJECTS/PATIENTS: Twelve participants, 10 men and 2 women aged 16-65 years diagnosed with acquired brain injury (moderate to severe stroke or traumatic brain injury), enrolled in an outpatient rehabilitation programme at least 3 months post-injury. METHODS: The intervention group (n = 6) participated in 30 min of aerobic exercise 3-4 times/week for 8 weeks during their outpatient rehabilitation. The control group (n = 6) received routine physical therapy. In addition, both groups received rehabilitation according to their rehabilitation plan. Neuropsychological and endurance testing was performed before and after the intervention and at a 3-month follow-up. Functional magnetic resonance imaging was performed before and after the intervention. RESULTS: Preliminary findings show no significant difference between the groups regarding cognitive variables, fatigue, or neuroplasticity. However, working memory/executive demanding processing speed, measured with the Paced Auditory Serial Addition Test, improved significantly (p = 0.042) in the aerobic exercise group and there were trends of improvements on several other executive tests in the aerobic exercise group. Automatic visual search speed improved in the control group (p = 0.027). CONCLUSION: The question of whether aerobic exercise promotes cognition and fatigue after brain injury remains unanswered. This randomized controlled pilot study and its preliminary findings indicate greater improvements in executive processing speed in the aerobic exercise group, while more automatized attention speed improved more in the control group. The experiences from this study might facilitate the design of future studies on this intriguing topic. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT07429526.
17 Apr 2026
Read appraisal →NeuroImage
Convergent neural signatures of optimal creative performance: A systematic review and meta-analysis
The neural architecture that supports optimal creative performance across diverse contexts remains unclear. To address this question, we conducted a quantitative meta-analysis to identify convergent patterns of brain activation associated with enhanced creativity and to examine their relationships with behavioral improvements. A total of 33 neuroimaging studies involving 965 participants were included, encompassing four enhancement contexts: creativity training, domain-specific expertise, trait-level creativity, and positive stimulus conditioning. Across these contexts, superior creative performance (Hedges' g = 0.668) was consistently characterized by increased activation in the left middle frontal gyrus (LMFG), left superior frontal gyrus (LSFG), and left inferior parietal gyrus (LIPG), together with decreased activation in the right precuneus (95 % CI [0.508, 0.828]). Meta-regression analyses revealed that longer intervention duration and greater professional experience predicted stronger LSFG and LIPG activation, whereas age and sex ratio showed no significant effects. LSFG activation was attenuated during convergent thinking tasks, suggesting task-specific modulation of creative neural circuits. These findings provide systematic evidence for a convergent neural signature of superior creative performance across multiple enhancement pathways, offering empirical targets for future training and neuromodulation-based interventions to optimize creative potential.
17 Apr 2026
Read appraisal →Journal of neurology, neurosurgery, and psychiatry
Breaking the PROMISE: poor association between brain volume loss and clinical disability worsening over 2 years of follow-up in primary progressive multiple sclerosis.
BACKGROUND: Phase 2 clinical trials in primary progressive multiple sclerosis (PPMS) often use MRI brain volume measures as their primary endpoint. Here, we investigate the longitudinal association between change in MRI outcomes and change in disability over 2 years of follow-up in a large and well-characterised PPMS trial dataset. METHODS: Using the dataset from PROMISE (n=943, mean age of 58.0 years, mean Expanded Disability Status Scale (EDSS) 5.0, and mean disease duration of 10.5 years at baseline), a phase 3 trial of glatiramer acetate in PPMS, we described the change in MRI and disability measures during follow-up and used multivariable logistic regression models to investigate whether change in four MRI outcomes (grey matter volume, white matter volume, brain fraction and total burden of disease) was associated with seven measures of clinical disability worsening (including the EDSS, Timed 25 Foot Walk, Nine-Hole Peg Test and Paced Auditory Serial Addition Test). RESULTS: We found only weak and inconsistent associations between change in MRI and physical and cognitive outcome measures over 2 years of follow-up. Change in MRI measures in year 1 of the trial did not predict change in physical nor cognitive disability in year 2. DISCUSSION: The association of the investigated volumetric MRI measures and clinical disability outcomes was noticeably weak and inconsistent. Our findings question the suitability of brain volume loss and lesion burden accumulation as functionally relevant trial endpoints in PPMS and inform the design and interpretation of clinical trials in PPMS.
17 Apr 2026
Read appraisal →Scientific reports
Predicting post-stroke functional outcome using explainable machine learning and integrated data
Functional outcome after acute ischemic stroke (AIS) varies widely, and existing prognostic scores may not capture complex relationships. We evaluated a diverse set of clinical characteristics and blood biomarkers with multiple machine learning models to predict 3-month functional outcome after AIS, and used explainable artificial intelligence to identify key drivers of performance. Models were trained on 506 patients aged 18-69 years with AIS enrolled at four stroke units in western Sweden. We compared extreme gradient boosting, multilayer perceptron (MLP), and L1- and L2-regularized logistic regression. Feature importance was assessed with Shapley additive global explanations. Of the 506 patients, 105 had an unfavorable outcome (modified Rankin Scale score > 2). All models showed high area under the curve (AUROC, 0.900-0.906). The MLP achieved the highest precision-recall performance (AUPRC, 0.773 ± 0.080) and sensitivity (0.655 ± 0.096), though with lower specificity (0.920 ± 0.035). Stroke severity (NIH Stroke Scale score) was the dominant predictor across models. Among biomarkers, brain-derived tau (BD-tau) was most informative, followed by inflammation-related plasma proteins. In conclusion, machine learning accurately predicted functional outcome after AIS. BD-tau and inflammation-related proteins contributed predictive information above stroke severity, suggesting a potential for blood biomarkers to enhance individualized prognostication after AIS.
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 →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
The effectiveness of electroacupuncture in the treatment of cancer-related fatigue: a systematic review
INTRODUCTION: Cancer-related fatigue (CRF) is a frequent, subjective, and difficult-to-manage symptom, for which few interventions have proven effective. Recent evidence suggests that electroacupuncture (EA) can reduce fatigue, although specific studies on this technique remain scarce. OBJECTIVE: To evaluate the efficacy of EA in treating CRF in cancer patients. METHODS: A systematic review registered in PROSPERO was conducted, including clinical trials assessing the effects of EA in patients with CRF. Searches were performed in the PubMed, Embase, Virtual Health Library, Scopus, and CAPES databases, with no restrictions on date, language, sex, ethnicity, or type of cancer. We assessed the methodological quality using the PEDro scale and evaluated the risk of bias using the RoB-2 tool. RESULTS: A total of 2,110 studies were identified. After applying inclusion criteria, five trials were included: three randomized, one non-randomized, and one single-arm clinical trial. In total, 251 patients were analyzed, 132 of whom received EA treatment. Interventions varied from two to three weekly sessions, each lasting 20 to 30 minutes, over a period of four to eight weeks. Acupuncture points and electrical frequencies (0.2-25 Hz) differed between studies. Outcomes were measured by the Brief Fatigue Inventory, Functional Assessment of Cancer Therapy - Fatigue, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. Despite the potential benefits observed in EA-treated groups, the findings remain inconsistent. CONCLUSION: EA shows promising therapeutic potential for managing CRF. However, the small number of studies, methodological heterogeneity, and small sample sizes limit generalizability. Multicenter clinical trials with larger samples and standardized protocols are needed to confirm efficacy.
16 Apr 2026
Read appraisal →Progress in biomedical engineering (Bristol, England)
Navigation paradigms for non-invasive BCI-controlled wheelchairs: a systematic review
Brain-controlled powered wheelchairs represent a promising advancement for individuals with neurological conditions that significantly impair motor function. Despite substantial progress, brain-controlled wheelchairs have not been adapted for real-world settings. This article systematically reviews recent trends in brain-computer interface (BCI) technology for wheelchair navigation and control, highlighting the contributions and limitations of various navigation paradigms. The review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, sourcing studies from four databases (PubMed, Scopus, IEEE Xplore, Google Scholar) published between 2000 and April 2025. It focused on non-invasive BCI paradigms and real-world navigation experiments. The results were narratively synthesized and classified into two primary categories: BCI-based navigation paradigms and wheelchair-based navigation paradigms, along with intersecting concepts such as single-variant BCI, hybrid BCI, control switches, and proportional control. Of the 149 full-text articles reviewed, 47 were included and categorized by navigation paradigm, comprising 20 BCI-based and 27 wheelchair-based studies, with 6 involving participants with motor disabilities. Quality assessment scores ranged from 40% to 95%, with approximately 40% of the studies demonstrating a low risk of bias. The findings indicate that low-level navigation control was predominant in BCI wheelchair studies, with 31 studies employing minimal or no obstacle avoidance. Most studies (57%) integrated sensors for obstacle avoidance, localization, mapping, and autonomous navigation. Twenty-two studies utilized control switches, and five incorporated proportional control for wheelchair navigation. Additionally, motor imagery and steady-state visually evoked potential paradigms have emerged as the most common approaches for generating control commands, highlighting their potential for effective navigation. Given the potential societal impact on a large number of individuals, future research should prioritize enhancing the reliability and adaptability of BCI wheelchair systems in real-world environments.
16 Apr 2026
Read appraisal →JMIR research protocols
Integrating Gait Analysis and AI Into Knee Osteoarthritis Care: Protocol for a 3-Phase Participatory Qualitative Study
BACKGROUND: Knee osteoarthritis (OA) leads to pain, disability, and reduced quality of life. For advanced stages, knee arthroplasty surgery is the standard treatment, yet dissatisfaction and persistent mobility deficits remain common. Current surgical decision-making processes seldom incorporate objective predictors of outcomes, such as biomechanical data. Advances in computer vision, wearable sensors, and artificial intelligence now enable efficient capture and interpretation of clinically prognostic gait features in real-world settings. However, the clinical adoption of such innovations remains limited, hindered by usability challenges, misalignment with stakeholder needs, and system-level barriers. OBJECTIVE: This study aims to inform the development of a knee OA clinical decision support (CDS) tool that integrates gait analysis and artificial intelligence with clinical decision-making. More broadly, it seeks to advance a framework for participatory digital health CDS tool implementation by identifying and addressing suboptimal workflows, stakeholder priorities, and organizational challenges. METHODS: This study uses a 3-phase participatory design process, with in-depth interviews conducted in each phase to generate insights that inform subsequent stages. Phase 1 investigates perceived barriers to and facilitators of the implementation of a digital CDS tool and examines current workflow processes in knee OA management. Phase 2 focuses on identifying and defining user requirements to guide solution ideation for translational digital decision support. Phase 3 assesses user acceptance of prototyped solutions. Field observations in phase 1 and usability testing in phase 3 will supplement interview findings with real-world evidence. RESULTS: The study was funded in November 2024. Ethics approval was granted by the Nova Scotia Health Research Ethics Board on July 28, 2025. Data collection began in September 2025. As of February 2026, a total of 6 clinicians have been interviewed, with all 6 interviews transcribed and 4 coded as part of phase 1 analysis. Study completion is anticipated by August 2026. Findings will be published by January 2027. CONCLUSIONS: Our stakeholder-driven approach prioritizes both technological rigor and practical usability, addressing key human factors for successful implementation. While initially focused on Nova Scotia's orthopedic setting, this research provides a scalable framework for integrating digital decision support tools into broader clinical environments, advancing innovation in knee OA care and beyond.
16 Apr 2026
Read appraisal →Spine
Predictors for Unsuccessful Outcome of Lumbar Spinal Stenosis Surgery: A Secondary Analysis of the 2 Randomized NORDSTEN Trials
STUDY DESIGN: Observational cohort study. OBJECTIVE: To evaluate potential predictors of unsuccessful outcomes after surgery in patients with lumbar spinal stenosis (LSS). SUMMARY OF BACKGROUND DATA: LSS is a common cause of disability in adults and the leading indication for spine surgery in Norway. Despite advances in surgical techniques, nearly one-third of patients report either minor or no improvement or worsening of symptoms after surgery. Identifying predictors of unsuccessful outcomes is essential for improving patient selection and shared decision-making. MATERIALS AND METHODS: This secondary analysis used data from the 2 NORwegian Degenerative spondylolisthesis and spinal STENosis (NORDSTEN) randomized trials, which included 704 surgically treated patients with LSS, with (n=267) or without (n=437) degenerative spondylolisthesis. The Oswestry Disability Index (ODI) was the primary outcome measure. A reduction in ODI score of <30% from baseline to 2 years postoperatively was defined as an unsuccessful outcome. Multivariable logistic regression analysis was used to evaluate whether carefully selected baseline variables were associated with an unsuccessful outcome at 2-year follow-up. RESULTS: Longer duration of radiating pain (>12 mo; OR: 2.58, 95% CI: 1.54-4.29), psychological distress (HSCL-25 ≥1.75; OR: 1.60, 95% CI: 1.01-2.53), and advanced disc degeneration (Pfirrmann grades 4-5; OR: 1.98, 95% CI: 1.26-3.12) were independently associated with an unsuccessful outcome. Commonly discussed factors such as age, BMI, smoking, ASA grade, and predominant back pain did not reach statistical significance for association with the outcome. CONCLUSION: Among patients undergoing surgery for LSS, longer symptom duration, psychological distress, and advanced disc degeneration were associated with a higher risk of unsuccessful postoperative outcomes.
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 →Renal failure
Benefits of physical exercises in chronic kidney disease: a systematic review and meta-analysis of randomized controlled trials
Physical exercise has been proven to be beneficial for chronic kidney disease (CKD) patients; however, there is a lack of a comprehensive summary of existing literature, especially the results from randomized controlled trials (RCTs). We had conducted a systematic review and meta-analysis to evaluate the benefits of physical exercise in chronic kidney disease. Outcomes were classified into all-cause mortality, cardiovascular, pulmonary, and renal outcomes, inflammatory indices, laboratory tests, and physical indices. The risk of bias was assessed using the Cochrane criteria. Relative risk ratios with 95% confidence intervals (CIs) for categorical variables, and weighted mean difference or standardized mean differences with 95% CIs for continuous variables were pooled using a random-effects model. Publication bias was assessed using Funnel plot analysis and Egger's Test. At last, 82 studies were included, and the results of the meta-analysis show that the physical exercises can significantly reduce all-cause mortality, particularly in dialysis dependent patients. Cardiovascular function, reflected by 6-minute walk test and blood pressure and pulmonary function, reflected by peak oxygen uptake, forced expiratory volume in 1 second, and forced vital capacity, all improved after physical exercise interventions. Physical exercises helped to increase the dialysis adequacy and preserve the residual renal function. C-reactive protein and interleukin-6 levels decreased, and hemoglobin and albumin levels increased upon physical exercise interventions. The fat mass decreased after physical exercise interventions in non-dialysis patients. We concluded that physical exercise is beneficial for CKD patients, independent of the modes or locations of exercise.
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 →Biomedical physics & engineering express
EEG-CMT: spatial-temporal representation of EEG for emotion recognition using convolutional neural networks and vision transformers
Background. Recent researches on electroencephalogram (EEG) based emotion recognition face challenges in effectively mapping the spatial positional relationships of EEG acquisition electrodes. Additionally, conventional models struggled to simultaneously capture both fine-grained temporal-spatial features and long-range dependencies in EEG signals.New method. To address these limitations, we propose a novel EEG data processing method that incorporates spatial relative position encoding and a hybrid neural architecture integrating convolutional neural networks (CNNs) with self-attention mechanisms. This approach systematically encodes the spatial topology of electrodes to enhance the representation of temporal-spatial information. CNNs are employed to extract localized temporal-spatial micro-patterns, while self-attention modules model global contextual dependencies across extended sequences, thereby enhancing model's representational capacity.Results. The experimental results and feature visualizations demonstrate that our method achieves state-of-the-art (SOTA) subject-dependent performance on two benchmark emotion recognition datasets, reaching an average accuracy of 97.51% on the SEED dataset and 96.13% on the SEED-IV dataset. Moreover, the learned spatial features align well with known neuroscientific patterns of emotional processing. Comprehensive ablation studies further validate the necessity and effectiveness of both the spatial-encoded data processing strategy and the hybrid architecture design.Comparison with Existing Methods. Compared to other hybrid neural network models, our proposed method (EEG-CMT) achieves the highest classification accuracy. Specifically, it outperforms baseline algorithms by margins ranging from 0.86% to 11.43% on the SEED dataset, and from 9.49% to 39.52% on the SEED-IV dataset.Conclusions. The proposed method effectively addresses key limitations in existing EEG-based emotion recognition models by jointly leveraging spatial topology and hybrid modeling techniques. These innovations significantly improve the model's ability to recognize emotions from EEG data and provide neural interpretable insights, offering a promising direction for future research in affective brain-computer interfaces.
15 Apr 2026
Read appraisal →Current pain and headache reports
Stellate Ganglion Block in the Treatment of Long COVID: A Systematic Review
OBJECTIVES: This review evaluates stellate ganglion block as a treatment for long COVID, seeking to evaluate the treatment's efficacy by various symptoms and the limitations of the current literature. STUDY DESIGN: Systematic Review. SETTING: Ambulatory or Outpatient Setting. METHODS, SUBJECTS: A systematic review of the current literature regarding use of stellate ganglion block in patients with long COVID was conducted. 2 databases were searched on August 28th, 2025. Search terms were "long COVID" and "stellate ganglion block", yielding 45 results. Studies examining patient outcomes after stellate ganglion block were included. Case reports, case series, basic science studies and previous reviews were excluded. Seven studies met inclusion criteria. RESULTS: Patients received a single stellate ganglion block in some studies and multiple stellate ganglion blocks in others. All studies reported symptomatic improvement without control groups. Response rates ranged from 55.8% to 100%. The most robust improvements (> 80% patients reporting relief) were seen in cough, dyspnea, headache, joint pain, pain interference/intensity, pins/needles, subjective relief. CONCLUSION: Stellate ganglion block is a promising treatment that appears to generate substantive benefit for many of the symptoms seen in long COVID. However, the current literature has small, uncontrolled studies with heterogenous study designs and follow-up periods. Standardized research with larger sample sizes, control groups, and longer-term follow up is necessary to elucidate the degree of benefit. IRB approval and clinical trial registration not required.
15 Apr 2026
Read appraisal →Blood advances
HCT Pre-App program: a telemedicine-based prehabilitation for allogeneic hematopoietic cell transplant candidates
Frailty has emerged as a key component of allo-HCT candidate assessment and is closely associated with transplant outcomes. Exercise-based prehabilitation may improve transplant candidacy, yet real-world implementation is limited. Our institution implemented a structured Frailty Program (FP) to assess frailty and introduce prehabilitation interventions. This study describes the program's evolution and evaluates the impact of prehabilitation. Between April 2021 and April 2025, 185 consecutive allo-HCT candidates were included in 3 sequential FP phases. In the first phase (No-Prehab, n = 76), patients underwent frailty assessment only. In the second phase (Pilot-Prehab, n = 59), patients received a home-based, nonsupervised prehabilitation program. In the third phase (Tele-Prehab, n = 50), patients participated in the HCT Pre-App Program, a structured digital telemedicine intervention supervised by rehabilitation physicians. Frailty was assessed at first consultation and HCT admission using the HCT Frailty Scale. Median prehabilitation duration was 6 weeks. Adherence was high across frailty groups (76%-88%), with no adverse events. Prehabilitation improved frailty status: fit patients increased from 22% to 42% in the Pilot-Prehab cohort (P = .009) and from 34% to 56% in the Tele-Prehab cohort (P = .001). Tele-Prehab independently increased the odds of being fit at admission (odds ratio [OR], 3.86; P = .001) and reduced frailty incidence (OR, 0.17; P = .031). One-year OS and NRM were comparable across cohorts (OS, 74.5%, 84.5%, and 78.1%; P = .367) with a trend toward lower NRM among prehabilitated patients (NRM, 14.6%, 5.1%, and 5.6%; P = .075). Frailty is dynamic in allo-HCT candidates, and results support how home-based digital prehabilitation improves fitness before transplantation.
15 Apr 2026
Read appraisal →JMIR cancer
Physical Activity Monitoring in Adolescents and Young Adults With Cancer: Observational Feasibility Study
BACKGROUND: There is a growing interest in characterizing the relationship between long-term physical activity (PA) habits and cancer-related outcomes such as treatment-related toxicities, recurrence, and complications. Wearable devices can provide critical information to achieve this goal; however, inferences are significantly influenced by device wear adherence. OBJECTIVE: This study aimed to assess the feasibility of using wearable devices to monitor short- and long-term PA in adolescent and young adult (AYA) patients with sarcoma during and after chemotherapy in a free-living environment and evaluate the ability to accurately capture changes in PA over 3 years. METHODS: A total of 63 AYA patients with sarcoma were provided with a Fitbit Charge 3 to track daily steps, sedentary time, and heart rate for up to 3 years. RESULTS: On average, during the first 30 days of follow-up, 57.1% (36/63) of patients wore their device at least 10 hours per day, and only 23.8% (15/63) of patients wore their devices thereafter. Patients spent a mean of 80% (SD 11%) of their day in a sedentary state. Despite low adherence, daily step count trends increased over time. CONCLUSIONS: This study highlights the adherence challenges met with longitudinal PA monitoring in AYA patients with sarcoma. Wearer discomfort, lost devices, and lack of data uploading compliance contributed to data missingness and attrition. Caution is warranted when relying on wearable activity trackers to inform program decisions, accurately assess PA outcomes, and monitor program adherence longitudinally without consideration of wearer bias. Alternative methods that would be more broadly accepted by AYA patients for effective long-term monitoring should be considered.
15 Apr 2026
Read appraisal →Blood advances
MPN-FIT: a randomized controlled pilot trial of supervised exercise in myeloproliferative neoplasms
Myeloproliferative neoplasms (MPN) are associated with a high symptom burden and impaired quality of life (QoL), often unaided by available treatments. Physical activity has demonstrated benefits in other cancers; however, its potential has yet to be explored in MPN. This randomized controlled trial aimed to evaluate the feasibility, acceptability, and efficacy of a supervised exercise program for patients with MPN based on longitudinal assessment of symptom burden, QoL, and clinical/inflammatory markers (C-reactive protein, erythrocyte sedimentation rate, ferritin, lactate dehydrogenase [LDH], and serum cytokines). Patients with MPN (n = 55) were randomized 3:2 to a 12-week home-based exercise intervention (flexibility/resistance/aerobics) supervised by a kinesiologist vs waitlist control. Measures included patient-reported outcome questionnaires, peripheral blood sampling, and postintervention interviews with participants. Forty-seven patients completed the trial (FIT group, n = 26; control group, n = 21). Median age was 66 years (range, 27-86), and 60% were female. All feasibility benchmarks were met, with 88% of participants satisfied and 92% with intent to continue an exercise program on a regular basis. A significant reduction in LDH was observed in FIT patients compared with controls (-14.5 U/L vs +4.0 U/L; P = .03). Patients interviewed described positive effects of the intervention on symptoms and would unanimously recommend the program to others with MPN. In this pilot study, supervised exercise was feasible, acceptable, and showed potential benefits on inflammatory/disease markers.
14 Apr 2026
Read appraisal →Biomacromolecules
Highly Flexible, Adhesive, Antimicrobial, and Self-Powered Hydrogel Strain Sensor for Human Motion Monitoring
Piezoelectric hydrogel sensors are a recent innovation that combines the flexibility of hydrogels with the self-powering of piezoelectric materials. Here, we present a self-powered hydrogel strain sensor by incorporating piezoelectric Na0.5Bi0.5TiO3 nanoparticles into a dual-network hydrogel composed of poly(vinyl alcohol), acrylamide, and 2-acrylamido-2-methyl-1-propanesulfonic acid. The hydrogel exhibits excellent mechanical properties, achieving a tensile strength of 1.28 MPa, an elongation at break of 1127%, and strong tissue adhesion (55.97 kPa on porcine skin). The sensor delivers a maximum output voltage of 237.4 mV, a sensitivity of 17.99 mV under small compressive strain, and a broad tensile strain detection range of 30 to 400%. It reliably monitors both subtle physiological activities (facial expression, swallowing, pulse) and large joint movements. Moreover, it exhibits notable antibacterial performance via ultrasound-driven piezocatalysis, reducing bacterial viability to below 1.5%. This tough, adhesive, and antibacterial piezoelectric hydrogel sensor holds significant promise for wearable electronics and human-machine interfaces.
14 Apr 2026
Read appraisal →Journal of speech, language, and hearing research : JSLHR
A Speech-Segregation Algorithm for Spatial Hearing Aids to Operate With Multiple Sound Sources
PURPOSE: Hearing-aid users often face challenges in noisy environments due to time, level, and spectral cues being compromised by current generation hearing aids. This study explored a physiologically based speech-segregation algorithm that selectively removes or attenuates unwanted sound sources. METHOD: In our previously developed localization algorithm, the time-frequency responses after a unique normalization approach always reside inside the unit circle of the model space. Given the "sparseness" property of daily sound, the model forms distinct clusters that correspond to the source locations. In the present study, the localization model was adapted to segregate speech by using a binary mask to remove the cluster of unwanted sound. The speech target was one of 200 intelligible sentences. The interfering sound was time-reversed sentences in a random sequence spoken by the same speaker. Automatic speech recognition transcribed the sound mixture before and after the segregation algorithm. RESULTS: When both target and noise were located at the front, applying a hard mask (i.e., 1 or 0) almost perfectly removed the energy of noise. When the sound sources moved to the side or back with smaller angular separations, clusters were less distinguishable, leading to worse intelligibility performance. Applying a soft mask (i.e., 1 or 0.2) instead showed slightly lower performance for the front but improved performance for the back and side. CONCLUSION: Our algorithm performs localization and segregation in a combined and straightforward manner, potentially for spatial hearing aids to function better in challenging listening environments.
12 Apr 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Effectiveness of prehabilitation strategies in enhancing recovery and postoperative outcomes in laparoscopic sleeve gastrectomy patients
OBJECTIVE: This study aims to explore the application of a multimodal prehabilitation strategy in patients undergoing laparoscopic sleeve gastrectomy (LSG) and to evaluate its impact on postoperative recovery, weight loss, and quality of life. METHODS: This was a single-center, prospective, randomized controlled trial. A total of 120 eligible patients undergoing elective LSG were enrolled and randomly assigned to either the control group (n = 60), receiving routine perioperative care, or the observation group (n = 60), receiving a structured 5-7-day prehabilitation program. RESULTS: Compared to the control group, the observation group had a significantly shorter postoperative hospital stay (mean difference [MD] -1.23 days; 95% CI -1.67 to -0.79; P < 0.001) and a lower incidence of complications (1.7% vs. 11.7%; odds ratio 0.13, 95% CI 0.02-0.89; P = 0.038). At 6 months, the prehabilitation group showed a greater reduction in BMI (MD -3.78 kg/m2; 95% CI -5.10 to -2.46; P < 0.001) and higher quality of life scores across all eight SF-36 domains (P < 0.001 for all). CONCLUSION: The application of prehabilitation strategies in patients undergoing laparoscopic sleeve gastrectomy can effectively promote faster postoperative recovery, enhance weight loss, improve quality of life, and reduce the incidence of postoperative complications. It is a safe and effective approach, worthy of clinical promotion. Furthermore, the principles of this multimodal prehabilitation framework offer valuable translational insights for optimizing perioperative supportive care in surgical oncology.
12 Apr 2026
Read appraisal →Journal of speech, language, and hearing research : JSLHR
Auditory-Somatosensory Interactions in Speech Perception in Individuals With Hearing Impairment: An Exploratory Case Study
OBJECTIVES: Individuals with hearing impairment can perceive speech sounds with the help of cochlear implants or hearing aids. Recent studies have shown that orofacial somatosensory inputs may modify speech perception. This study explored the potential role of such somatosensory inputs in speech perception in individuals with hearing impairment. DESIGN: Twenty-one native French-speaking participants with various profiles of bilateral hearing impairment and wearing hearing aids and/or cochlear implants were tested to explore the extent to which an orofacial somatosensory stimulation, consisting in facial skin stretch provided by a robotic device, would affect their speech perception performance in a vowel identification task, in comparison with 25 participants with normal hearing. This potential somatosensory effect was evaluated in relation to their hearing ability assessed by both their hearing threshold of digits in acoustic noise and their audiological profile, and with their production ability assessed by variability in a vowel production task. RESULTS: The somatosensory effects varied depending on participants' hearing ability, with three different profiles. A first group of eight participants, who were able to identify the vowels auditorily though with thresholds in noise higher than for individuals with normal hearing, did not show any somatosensory effect, with identical vowel identification scores without and with facial deformation. The other 13 participants were unable to auditorily identify the vowels and had high thresholds in noise. Among them, eight participants who had used a hearing device for a long duration (≥ 18 years) showed a strong somatosensory bias modifying vowel identification when facial deformation was present. These participants also showed greater variability in vowel production. The last five participants in this second group showed no somatosensory effect at all. CONCLUSION: These three profiles were related to the role of auditory experience and hearing ability in the development of auditory-somatosensory integration.
12 Apr 2026
Read appraisal →PloS one
Effects of complex training on jump performance and neuromuscular activation in volleyball athletes: A controlled study
This study examined the integrated effects of complex training combining barbell back squats (BBS) and drop jumps (DJ) on jump performance and concentric-phase neuromuscular activation in volleyball athletes. In a randomized controlled design, twenty male volleyball athletes were allocated to an intervention group (IG, n = 10) or a control group (CG, n = 10). The IG completed an 8-week, twice-weekly complex training protocol (BBS followed by DJ), with loads progressively adjusted according to individual 1RM values, whereas the CG performed an intensity-matched BBS protocol. Primary outcomes were countermovement jump (CMJ) and approach jump (AJ) height and propulsion impulse (expressed in BW·s), while concentric-phase integrated electromyography (iEMG) and root mean square (RMS) amplitude were secondary outcomes. The results showed that, compared with the CG, the IG exhibited greater improvements in both CMJ and AJ height (CMJ: Δ = 6.13 vs 2.65 cm; AJ: Δ = 7.28 vs 2.78 cm; both p < 0.05). In addition, gains in propulsion impulse were larger in the IG (CMJ: Δ = 0.06 vs 0.02 BW·s; AJ: Δ = 0.08 vs 0.03 BW·s; both p < 0.05). Furthermore, electromyography revealed task-specific recruitment patterns: under BBS, the quadriceps and tibialis anterior showed higher iEMG and RMS values, whereas under DJ the lateral and medial heads of the gastrocnemius were more strongly activated, indicating complementary effects across key lower-limb muscle groups. Taken together, these findings indicate that an 8-week BBS-DJ complex program, compared with resistance training alone, is more effective in improving jump performance and propulsion impulse and in optimizing task-specific concentric activation patterns of the lower-limb musculature in volleyball athletes, and may serve as a feasible and evidence-based prescription for volleyball-specific conditioning.
12 Apr 2026
Read appraisal →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 →Journal of speech, language, and hearing research : JSLHR
Information Load Predicts Stuttering Events
PURPOSE: One potential contributor to the variability of stuttering events is information load, quantified by assessing word predictability based on preceding context. This study investigated whether words with greater information load are more likely to be stuttered using word surprisal as an index while controlling for relevant linguistic variables. We also examined whether this relationship varied with stuttering severity and impact. METHOD: We analyzed spontaneous speech samples from 35 adults who stutter, drawn from the FluencyBank corpus. Word surprisal values were computed using the Generative Pretrained Transformer 2 large language model and analyses controlled for six linguistic predictors of stuttering. We also tested whether clinical measures of stuttering severity and overall impact predicted individuals' sensitivity to surprisal. RESULTS: Higher word surprisal significantly increased the likelihood of stuttering, even after controlling for linguistic covariates. However, we found no evidence that stuttering severity or overall impact moderated this relationship. CONCLUSIONS: These findings suggest that words with greater information load are more likely to elicit stuttering during spontaneous speech. This pattern may reflect increased communicative demands associated with high-surprisal words. The absence of a moderating effect of stuttering severity or impact may indicate that individual differences in coping with communicative pressure, rather than clinical severity alone, shape stuttering variability.
11 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 →Journal of speech, language, and hearing research : JSLHR
Rhotic Acquisition Is More Rapid in Biofeedback Than Motor-Based Treatment for Residual Speech Sound Disorder: Primary Outcome of a Randomized Controlled Trial
PURPOSE: Residual speech sound disorder (RSSD) is a high-prevalence condition that can limit children's academic and social participation, with negative consequences for overall well-being. Previous studies have described visual biofeedback as a promising option for RSSD, but results have been inconclusive due to study design limitations and small sample sizes. METHOD: In a preregistered randomized controlled trial, 108 children aged 9-15 years with RSSD affecting American English /ɹ/ were randomly assigned to receive treatment incorporating visual biofeedback (subdivided into ultrasound and visual-acoustic types) or a comparison condition of motor-based treatment consistent with current best practices in speech therapy. An acoustic measure (the distance between the second and third formants, which is smaller in perceptually accurate /ɹ/) was used to quantify progress in the first three sessions of treatment in participants' assigned condition. The focus on the early stages of treatment was grounded in principles of motor learning: As a type of knowledge of performance feedback, biofeedback is expected to have its greatest impact during initial acquisition of a new speech-motor plan. RESULTS: A linear mixed-effects regression model revealed a statistically significant interaction between treatment type and session: While both groups made progress over time, the rate of progress was significantly faster in the biofeedback condition compared to motor-based treatment. No statistically significant difference was observed between the ultrasound and visual-acoustic types of biofeedback. DISCUSSION: This large-scale randomized controlled trial supports previous small-scale research in finding that biofeedback can help children with RSSD acquire American English /ɹ/. A companion study will compare participants' generalization learning after the end of all treatment. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.29971501.
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 →Scientific data
Continuous observation of Parkinsonian symptoms using symptom diaries & wearable accelerometry
Treatment adjustments in Parkinson's Disease (PD) are often based on clinical evaluations at single time points which are insufficient to adequately assess real-life motor fluctuations. Patient-written symptom diaries on the other hand are highly subjective and require well-educated and adherent patients to provide reliable results. Wearable accelerometry might provide a reliable, objective, and continuous diagnostic method to assess PD motor symptoms & fluctuations. However, large datasets of simultaneous sensor data and symptom diaries are needed for such method development and validation. We here provide a well-described, open-science dataset of simultaneous, bilateral, wrist-worn accelerometry and symptom diary data from 66 participants (41 male, 25 female) with PD. On average, participants provided data for 6.0 consecutive days resulting in a total of 393.8 days for the dataset as a whole. Symptom diaries include data on kinetic state, tremor, freezing of gait, falls, and PD-related medication intake. Further demographic information is also provided. This dataset will support the development and validation of accelerometry-based approaches to assessing motor symptoms and fluctuations in PD.
11 Apr 2026
Read appraisal →PloS one
MSCNet: Efficient and accurate semantic segmentation of LiDAR data using Multi-scale Convolution
In autonomous driving and intelligent robotics, the semantic information of LiDAR (Light Detection and Ranging) sensor data is crucial for understanding the surrounding environment. However, directly operating on point clouds is computationally expensive. To address this, some researchers have projected three-dimensional LiDAR data onto a two-dimensional spherical range view and used two-dimensional convolutional neural networks to segment the projected images. While the results are promising, many of these models are structurally complex, with high spatiotemporal complexity, which makes them unsuitable for real-time applications. To solve these issues, this paper proposes a multi-scale LiDAR data semantic segmentation method, MSCNet, with fewer parameters and higher segmentation accuracy. In the encoding phase, a single-channel multi-scale feature fusion block is introduced to alleviate the distribution differences between input channels. To obtain more stable local features, multi-scale dilated convolution residual blocks are designed to encode information from different receptive fields. To quickly capture global features, a pyramid pooling module is introduced. Experimental results on the SemanticKITTI, SemanticPOSS, and Pandaset datasets show that MSCNet achieves a good balance between parameter, accuracy, and running time. Particularly on the SemanticPOSS and Pandaset datasets, MSCNet achieves the best performance. Under the same parameter conditions, this method outperforms existing point cloud-based and projection-based methods.
10 Apr 2026
Read appraisal →ACS applied materials & interfaces
Physically Cross-Linked Biopolymer-Based Strong and Stretchable Organohydrogel with Self-Healing and Biocompatibility for Environmentally Tolerant Strain Sensors
The development of wearable strain sensors increasingly focuses on multifunctional materials that integrate mechanical robustness, self-repairing capacity, temperature-resilient conductivity, and biocompatibility. Herein, we developed a physically cross-linked biopolymer-based organohydrogel by incorporating gelatin (Gel) and β-cyclodextrin-grafted chitosan (CDCS), designated as Gel/CDCS, reinforced through hydrogen bonding, ionic interactions, and host-guest complexation. The optimized Gel/CDCS1 organohydrogel with 1% of CDCS exhibited outstanding stretchability, with a tensile strain at break of 410.9% and a tensile strength of 92.2 kPa, while maintaining 85% of its mechanical properties after self-healing at 40 °C. The introduction of kosmotropic salts (Na3Cit and NaCl) and a glycerol-water binary solvent system conferred remarkable environmental adaptability, allowing stable performance from -20 to 37 °C. Notably, it achieved a high ionic conductivity of 0.946 S m-1 at room temperature, alongside 0.606 S m-1 at -20 °C and 0.330 S m-1 at 37 °C, ensuring operation under extreme conditions. The strain sensor displayed high sensitivity with a gauge factor (GF) increasing from 1.06 to 1.34 over a broad strain range and maintained a stable electrical response over 600 consecutive stretching cycles. Additionally, it enabled reliable detection of diverse human motions, including facial expressions, joint bending, and breathing, demonstrating excellent conformability and signal stability during on-body monitoring. Additionally, Gel/CDCS1 exhibited excellent biodegradability, degrading by over 80% in soil within 4 days, and showed high biocompatibility with fibroblast viability of around 80%. These attributes establish Gel/CDCS1 as a promising eco-friendly candidate for next-generation flexible electronics, wearable strain sensors, and biomedical applications.
10 Apr 2026
Read appraisal →ACS applied materials & interfaces
Bioinspired Janus Electronic Textiles with Moisture and Thermal Management
Wearable electronics have attracted great attention in recent decades. However, excessive sweat accumulation on skin often has a significant effect on the signal stability, comfort, and safety of electronic skin in practical applications. Herein, a skin-comfortable Janus electronic textile (e-textile) that integrates unidirectional liquid transport and passive radiative cooling properties is developed. This e-textile is fabricated through laser ablation and single-side plasma treatment of carbon nanotubes (CNTs) doped with polydimethylsiloxane (PDMS). The resulting e-textile features a conical pore structure and asymmetric wettability, enabling unidirectional sweat transport from the skin surface to a superhydrophilic silk layer, thereby maintaining a dry and comfortable skin microenvironment. The Janus e-textile achieves a solar reflectivity of 69.2% and a mid-infrared emissivity of 98.3%, reducing the temperature by approximately 5.0 °C compared with a cotton fabric under solar intensity, demonstrating a superior radiative cooling performance. Moreover, the Janus e-textile exhibits stable resistance changes under cyclic stretching and bending, accurately detecting subtle movements across various body parts while reliably acquiring electromyography (EMG) signals. This work positions the Janus e-textile as a pioneering solution for next-generation wearable technologies, integrating thermal and moisture management with advanced resistive strain sensing and EMG capabilities for applications in sports, rehabilitation, and health monitoring.
10 Apr 2026
Read appraisal →ACS applied materials & interfaces
Textile-Based Wearable Electrothermal Pad Using Woven AgNW/EG-PEDOT:PSS Heaters and PS/PEDOT:PSS Thermistor Yarns
Wearable thermal management devices are gaining increasing attention for healthcare, rehabilitation, and personal comfort applications. Here, we present a textile-based wearable electrothermal pad that integrates a woven heater with a yarn temperature sensor on a flexible, breathable fabric platform. The heater element was fabricated using cotton yarn coated with silver nanowires (AgNW) and poly(3,4-ethylenedioxythiophene):poly(styrenesulfonate) (PEDOT:PSS) doped with ethylene glycol (EG-PEDOT:PSS), enabling uniform heat distribution, washability, and low-voltage operation. The AgNW/EG-PEDOT:PSS yarn heater rapidly reached 45 °C within 60 s at an applied voltage of 1.5 V and demonstrated good thermal stability and repeatability over 2,000 stretching-releasing cycles. The temperature sensor, based on polystyrene-coated PEDOT:PSS (PS/PEDOT:PSS) yarn, exhibited thermistor behavior with resistance decreasing as the temperature increases. It showed a negative temperature coefficient of resistance of 0.25%°C-1 and a response time of less than 130 s. The yarn temperature sensor also maintained resistance stability under bending and stretching-releasing conditions. To demonstrate a wearable electrotherapy platform, the PS/PEDOT:PSS yarn temperature sensor was integrated with a woven AgNW/EG-PEDOT:PSS heater to enable closed-loop feedback for thermal regulation. Programmable, on-demand thermotherapy and real-time thermal management could be wirelessly controlled via a smartphone. This custom-designed electrothermal pad offers a promising solution for wearable thermotherapy and smart clothing applications.
10 Apr 2026
Read appraisal →JMIR formative research
A Gamified Pain Management Intervention for Adults With Chronic Pain in Mainland China: Single-Arm Pre-Post Pilot Study With Machine Learning Predictive Modeling
BACKGROUND: The widespread prevalence of chronic pain (CP) significantly impacts daily functioning worldwide. In mainland China, maintaining engagement in biopsychosocial interventions remains challenging. Gamification, designed based on self-determination theory, can enhance motivation, while machine learning (ML) algorithms can assist clinicians in dynamically optimizing pain management. OBJECTIVE: This study aimed to (1) evaluate the preliminary effectiveness of a gamified pain management (GPM) program on CP and psychological outcomes and (2) identify key factors of significant pain improvements through the application of ML to guide intervention adjustments. METHODS: A single-arm, pre-post study was conducted with 16 participants with CP in mainland China, recruited via social media using convenience sampling. Participants engaged in a 10-week web-based GPM intervention consisting of education, physical activities, and gamified elements, including points, avatars, and feedback. Primary outcomes were pain intensity and interference measured by the Brief Pain Inventory. Secondary outcomes included anxiety, depression, and quality of life. Analysis included paired t tests, and ML models were trained to predict clinically meaningful pain reductions. Shapley additive explanations, least absolute shrinkage and selection operator regression, association rule mining, and Kaplan-Meier survival analysis were used to identify key predictors and optimal sessions and intervention durations across subgroups. RESULTS: A total of 16 participants were engaged, with a mean age of 27.63 (SD 9.584) years. Results from paired t tests reported significant improvements in pain intensity (decreased by 27.3%, 95% CI 1.061 to 3.064; P=.001), pain interference (decreased by 27.3%, 95% CI 8.159-17.216; P<.001), and psychological distress, including anxiety (t15=3.538, 95% CI 0.969 to 3.906; P=.003) and depression (t15=4.559, 95% CI 2.230 to 6.145; P<.001). The gradient boosting model demonstrated the highest predictive accuracy (area under the curve=0.89 and accuracy=0.82). Least absolute shrinkage and selection operator regression identified session 3 (β=-0.45, 95% CI -0.68 to -0.22; P<.001) and session 5 (β=-0.32, 95% CI -0.59 to -0.05; P=.02) as most predictive of clinical success, while association rule mining revealed effective session combinations for different patient subgroups. Time-to-event analyses indicated that individuals with low back pain and higher baseline severity required longer intervention durations for improvement (5 wk; P=.03). CONCLUSIONS: This pilot study presents an innovative method that combines ML with dynamic engagement data from a GPM program during interventions, rather than relying on static baseline data in prior studies. The results show preliminary efficacy and identify specific optimal session combinations and personalized treatment durations for different pain subgroups. These exploratory findings contribute to the field by providing a data-driven method for adaptive, personalized digital health interventions that move beyond one-size-fits-all strategies, potentially enabling clinicians to modify content and dosage to improve engagement and outcomes if validated in larger sample trials.
10 Apr 2026
Read appraisal →ACS applied materials & interfaces
Evolving Beyond Nature: AI-Driven Rapid Advancements of Bio-Inspired Electronic Skin
Electronic skin (e-skin) is a rapidly developing technology at the intersection of humans and machines with tremendous applications in robotics, healthcare, sports performance, and other fields of wearable electronics. With the recent popularization of artificial intelligence (AI), data-driven approaches to materials design and geometric functional optimization have accelerated e-skin development, enabling optimized microstructures, novel functionalities, and improved usability. Recent progress in bioinspired materials design and functionality enhancements for e-skin is paving the way for future-facing machine learning-powered tools to further accelerate their development. In this review, we discuss the traditional properties of e-skins, their sensing mechanisms, and suitable applications. Then, we investigate and categorize bioinspired structures from material, structural, and functional perspectives. Next, we outline the fundamentals of AI for data-driven optimization and how it can be utilized toward bioinspired e-skin design. This blended e-skin design framework culminates in novel applications, from customizable layouts for personalized therapeutics to dynamic environment recognition for enhanced robotics. Finally, we will explore the challenges of e-skin human-machine interfaces, including their hardware limitations, sensitivity, and longevity issues, and offer insights into future-proof research.
10 Apr 2026
Read appraisal →European journal of orthopaedic surgery & traumatology : orthopedie traumatologie
Memantine as a pain management strategy post-total knee arthroplasty: a randomized controlled trial
INTRODUCTION: Total knee arthroplasty (TKA) provides significant pain relief and improved function for patients with knee osteoarthritis. Despite its effectiveness, postoperative pain remains a major challenge. Effective management of this acute postoperative pain is critical for enhancing recovery. The study investigates the effectiveness of memantine in reducing postoperative pain in patients undergoing TKA. METHODS: This double-blind, randomized controlled trial aimed to evaluate the efficacy of memantine for managing postoperative pain after TKA. Conducted from April to September 2022, eligible participants over 18 years with ASA grades I or II were recruited. Exclusions included patients with substance abuse histories, chronic opioid use, significant comorbidities, or contraindications to memantine. Participants were randomly assigned to receive either memantine (20 mg daily preoperatively for three days and 10 mg daily postoperatively for two weeks) or a placebo. Both groups received standard analgesics during hospitalization and upon discharge. Pain levels were assessed using Visual Analog Scale (VAS) scores and Short-Form McGill Pain Questionnaire (SF-MPQ) at various time points. Secondary outcomes measured included opioid usage and nocturnal awakening. RESULTS: Memantine did not significantly lower pain levels compared to placebo, as measured by VAS (mean difference: 0.138, CI 95%: - 0.468-1.103, P = 0.418) and SF-MPQ (mean difference: 1.962, CI 95%: - 1.013-4.936, P = 0.190). Patients receiving memantine needed opioid analgesia (2.85 ± 0.67 times) significantly (P < 0.001) less frequently than the Placebo patients (4.14 ± 1.06 times). Nocturnal awakening did not differ significantly between the two groups (Memantine: 3.59 ± 2.15, Placebo: 2.33 ± 2.12, P = 0.067). CONCLUSION: The comparison of pain levels between oral memantine and placebo indicates that memantine does not significantly reduce pain in patients undergoing TKA. However, it significantly lowers the need for opioids postoperatively.
10 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 →European journal of orthopaedic surgery & traumatology : orthopedie traumatologie
Predicting minimal clinically important difference after hip arthroscopy: logistic regression versus machine learning
PURPOSE: Hip arthroscopy outcomes for femoroacetabular impingement (FAI) remain heterogeneous, with 30-40% of patients failing to achieve meaningful improvement. We aimed to develop and validate a predictive model for achievement of minimal clinically important difference (MCID) using routine preoperative variables, and to compare logistic regression with machine learning algorithms. METHODS: We retrospectively analyzed 310 consecutive patients undergoing hip arthroscopy for FAI (2010-2024) at a single institution. Predictor variables included age, sex, body mass index (BMI), morphological etiology, preoperative pain (VAS), and Hip Outcome Score-Activities of Daily Living (HOS-ADL). The outcome was achievement of MCID (≥ 9-point improvement in HOS-ADL). We developed logistic regression, random forest, and gradient boosting models. Internal validation used 10-fold stratified cross-validation. Temporal external validation used 80% of patients for training and 20% for testing. RESULTS: Mean age was 39.7 ± 12.0 years; 59.7% were male. MCID was achieved by 213 patients (68.7%). Lower preoperative HOS-ADL (OR 0.911, 95% CI 0.883-0.940, p < 0.001) and lower BMI (OR 0.846, 95% CI 0.771-0.928, p < 0.001) independently predicted MCID achievement. Logistic regression achieved AUC 0.804 (95% CI 0.76-0.85) on internal validation and AUC 0.819 on temporal external validation (accuracy 81.4%). Logistic regression outperformed random forest (AUC 0.787) and gradient boosting (AUC 0.777). Calibration was excellent. CONCLUSION: A parsimonious logistic regression model using routine preoperative variables demonstrated excellent and externally validated discriminative ability for predicting MCID after hip arthroscopy. The model outperformed machine learning algorithms while maintaining superior interpretability. The developed nomogram provides a practical tool for individualized outcome prediction.
9 Apr 2026
Read appraisal →Brain : a journal of neurology
Multimodal multicentre investigation of diagnostic and prognostic markers in disorders of consciousness
Severely brain-injured patients may enter a spectrum of conditions collectively known as disorders of consciousness. This spectrum includes clinical conditions such as unresponsive wakefulness syndrome or minimally conscious state, where the behavioural assessment of consciousness can often be deceptive. To bridge this dissociation, neuroimaging techniques are employed to identify the residual brain functions. Each neuroimaging modality imperfectly captures distinct aspects of brain preservation-functional, anatomical, or both. In this study, we adopt a comprehensive approach by integrating the neurophysiology and neuroimaging modalities available from the standard and advanced clinical assessments through interpretable machine learning. The electrophysiological modalities included high-density EEG (resting state and task), whereas neuroimaging modalities included anatomical and resting-state functional MRI, diffusion MRI and 18F-fluorodeoxyglucose PET. Our investigation reveals that specific modalities, such as functional assessments, provide comprehensive insights into the currently evaluated state of consciousness, the diagnosis of the patients. Conversely, structural modalities offer valuable information about the patient's evolution within the consciousness spectrum. We validate the proposed analysis with data coming from other centres with different acquisition parameters. Importantly, we demonstrate that model performance improves with an increase in the number of modalities. We observe a higher inter-modality disagreement for minimally conscious state patients and those patients who improve. Lastly, we observe a difference in feature importances between diagnosis and prognosis, with an interaction between modality and anatomical structures: some subcortical markers tend to contribute more to prognosis, while other cortical markers are more informative for diagnosis. This integrative multimodal and machine learning methodology presents a promising avenue for a more nuanced understanding of disorders of consciousness, contributing to enhanced diagnostic precision, prognostic capabilities and the personalization of rehabilitative strategies in clinical practice.
9 Apr 2026
Read appraisal →Blood pressure
Effects of whole-body vibration training on resting blood pressure in adults: a systematic review and meta-analysis of randomised controlled trials
OBJECTIVE: To investigate the effect of whole‑body vibration training (WBVT) on resting blood pressure (BP) in adults and its moderating factors through a meta‑analysis. METHODS: PubMed, Cochrane Library, Embase, and Web of Science were systematically searched up to 2 December 2025, with systolic BP (SBP) and diastolic BP (DBP) as the primary outcomes. Using Stata 17.0 software, effect sizes were pooled with a random‑effects model, and results were reported as weighted mean differences (WMDs) with 95% confidence intervals. RESULTS: This meta-analysis included 14 randomised controlled trials (RCTs) involving 490 adult participants. WBVT significantly reduced SBP (WMD = -6.57 mmHg, 95% CI [-8.84, -4.29]; p < 0.01) and DBP (WMD = -3.01 mmHg, 95% CI [-4.32, -1.71]; p < 0.01) in adults. Subgroup analyses showed greater BP reduction in individuals with higher baseline BP (SBP: -11.34 mmHg [95% CI: -13.45, -9.23]; p < 0.01; DBP: -6.15 mmHg [95% CI: -7.46, -4.83]; p < 0.01) and in those who were overweight or obese (SBP: -8.99 mmHg [95% CI: -11.18, -6.80]; p < 0.01; DBP: -3.98 mmHg [95% CI: -5.17, -2.78]; p < 0.01). Interventions using combined movement patterns also yielded more pronounced effects (SBP: -7.12 mmHg [95% CI: -9.73, -4.51]; p < 0.01; DBP: -3.30 mmHg [95% CI: -5.61, -0.79]; p < 0.01). CONCLUSION: WBVT significantly reduced resting BP in adults, particularly effective in those with higher baseline BP, overweight/obese, or using combined exercise protocols, but further high-quality RCTs are needed. This meta-analysis demonstrates that WBVT significantly reduces resting BP in adults, with an average reduction of 6.57 mmHg in SBP and 3.01 mmHg in DBP. Subgroup antihypertensialyses further revealed that the anve effect was more pronounced in individuals with elevated baseline BP (SBP ≥130 mmHg or DBP ≥80 mmHg) and in those who were overweight or obese (BMI ≥25 kg/m2). Additionally, training protocols incorporating compound movements, such as squats combined with heel raises, were superior to those using simple standing postures. These findings hold clear clinical significance. The magnitude of BP reduction achieved by WBVT, particularly the approximate 6.57 mmHg decrease in SBP, is expected to translate into a significant reduction in cardiovascular risk. Prior evidence indicates that for every 5 mmHg reduction in SBP, the risk of major cardiovascular events decreases by approximately 10%. Therefore, WBVT provides an effective, safe, and promising non-pharmacological adjunctive management strategy for adults, especially for higher-risk groups (e.g. individuals with hypertension or those who are overweight/obese) and for those who have difficulty engaging in traditional exercise.
9 Apr 2026
Read appraisal →JBJS reviews
Treatment Outcomes for Distal Radius Fractures: A Meta-Analysis
BACKGROUND: Distal radius fractures (DRFs) are among the most prevalent in upper-extremity injuries, particularly in older adults and individuals with osteoporosis. The common treatment options include surgical interventions such as volar locking plate (VLP) fixation and percutaneous pinning, as well as conservative strategies like splinting and bracing. However, the comparative effectiveness of these modalities remains unclear. This study aims to compare the functional outcomes and complication rates associated with VLP, percutaneous pinning, bracing, and splinting in the treatment of DRFs. METHODS: A systematic search of PubMed, Google Scholar, and the Cochrane Library (September 2001-February 2025) identified randomized controlled trials, prospective cohort studies, and retrospective cohort studies comparing DRF treatments. Functional outcomes and complication rates (superficial infection, malunion, nonunion, delayed union) were analyzed. Data were analyzed using Review Manager Web with significance set at p ≤ 0.05. RESULTS: Twenty-seven studies involving 3,200 patients met inclusion criteria: VLP fixation (n = 896), percutaneous pinning (n = 666), splinting (n = 718), and bracing (n = 903). No significant differences were observed between VLP and splinting or between bracing and splinting for Disabilities of the Arm, Shoulder, and Hand (DASH); Patient-Rated Wrist Evaluation (PRWE); or grip strength. Compared with VLP, percutaneous pinning demonstrated better PRWE scores but a higher infection rate. Compared with bracing, percutaneous pinning showed significantly better DASH, PRWE, and grip strength outcomes, although with substantial heterogeneity. Compared with bracing, VLP fixation yielded significantly better DASH, PRWE, and grip strength outcomes and a lower malunion rate. CONCLUSION: All 4 treatments achieved acceptable outcomes, but with key trade-offs: Percutaneous Pinning had the best functional results but a higher infection risk. VLP provided better function and lower malunion rates than bracing. Splinting and bracing were effective conservative options, often yielding results similar to VLP, but were inferior in some specific measures. The findings suggest that a perfect anatomic repair is not always necessary for a good recovery. Ultimately, the choice of treatment must be individualized, weighing the functional benefits against the risks of complications, while considering patient health factors and preferences. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
8 Apr 2026
Read appraisal →The bone & joint journal
Robotic-assisted surgery and functional alignment in total knee arthroplasty: the RASKAL registry-nested 2 × 2 factorial randomized trial
AIMS: Robotic-assisted surgery and functional alignment are increasingly being adopted in total knee arthroplasty (TKA). This study assessed the individual and combined effectiveness of robotic-assisted surgery and functional alignment in improving outcomes in TKA, compared with computer-assisted surgery and mechanical alignment, respectively. METHODS: A registry-nested, multicentre, blinded, 2 × 2 factorial, randomized trial was performed with 303 TKA patients randomized to robotic-assisted or computer-assisted surgery, and functional or mechanical alignment. The primary outcome was the between-group differences in postoperative change over two years in the mean Knee Injury and Osteoarthritis Outcome Score (KOOS-12). Secondary outcomes included knee-specific and general patient-reported outcome measures (PROMs), operative and functional outcomes, and adverse events. Primary modified intention-to-treat and secondary per-protocol analyses were performed. RESULTS: There were no differences comparing robotic-assisted with computer-assisted surgery in KOOS-12 at three months, six months, one year, and two years (mean two-year difference -2.8; 95% CI -6.4 to 0.9; p = 0.137), and no differences comparing functional with mechanical alignment at three months, six months, one year, and two years (mean two-year difference 0.3 (95% CI -3.4 to 4.0); p = 0.867). No differences were found in Oxford Knee Score, Forgotten Joint Score, EuroQol five-dimension five-level visual analogue scale, patient satisfaction, joint-related improvement, and pain comparing technology or alignment groups at three months, six months, one year, and two years. Robotic-assisted surgery had a shorter mean operating time by 11.5 minutes (95% CI 7.3 to 15.9; p < 0.001) and better mean posterior cruciate ligament macroscopic soft-tissue injury score (mean difference 0.7 (95% CI 0.3 to 1.1); p = 0.001) compared with computer-assisted surgery. Mechanical alignment had a higher soft-tissue release rate compared with functional alignment (44.8% vs 8.1%; OR 9.2 (95% CI 4.6 to 18.3); p < 0.001). In most cases, surgeons preferred the use of robotics and functional alignment. CONCLUSION: Robotic-assisted surgery and functional alignment were not superior to computer-assisted surgery and mechanical alignment, respectively, in improving clinical and functional outcomes up to two years post-TKA.
8 Apr 2026
Read appraisal →Journal of neural engineering
Large-scale training data enhances silent speech decoding with around-ear EEG.
Objective. Silent speech decoding (SSD) offers a potential communication alternative for individuals with impaired vocalization. However, conventional multi-electrode electroencephalography (EEG) or facial electromyography (EMG) systems require cumbersome preparation and are unsuitable for daily use. This study evaluates the practicality of SSD using a wearable around-ear EEG device, focusing on data scaling, cross-subject transfer, vocabulary extensibility, and online decoding performance.Approach. We collected 72 h of around-ear EEG from 24 healthy participants and one individual with incomplete locked-in syndrome (LIS) during silent, vocalized, and attempted speech, and integrated these around-ear EEG recordings with prior EMG + high-density EEG datasets, yielding 282.4 total h of training data. Using a 64-word classification task as the evaluation metric, we assessed: (1) whether larger datasets improve around-ear EEG-based SSD, (2) whether healthy-participant data supplement limited LIS-participant data despite articulatory differences, (3) transferability to unseen vocabulary, and (4) online user-interface performance.Main results. Large-scale EEG/EMG data improved SSD accuracy in both healthy participants and the LIS participant. Training on the heterogeneous dataset achieved 56.6% accuracy for healthy users and 47.3% for the LIS participant. Fine-tuning this decoder for new vocabulary increased the accuracy by 22 percentage points relative to training from scratch. Regression analysis showed that, for decoding in the LIS participant, data from the LIS participant contributed approximately four times the weight of healthy-participant data, quantifying data strategies for SSD. Online experiments achieved top-1/top-5 accuracies of 47.2%/76.0% for healthy users and 26.5%/49.1% for the LIS participant.Significance. The results indicate that lightweight, commercially feasible around-ear EEG can enable practical SSD when combined with large-scale healthy-participant data, supporting online operation. Moreover, models trained on a 64-word vocabulary facilitate decoding of a new vocabulary, providing a path toward SSD systems requiring minimal LIS-participant data. This study advances non-invasive SSD systems suitable for everyday communication.
8 Apr 2026
Read appraisal →Journal of neural engineering
EDAPT: towards calibration-free BCIs with continual online adaptation
Objective.Brain-computer interfaces (BCIs) suffer from accuracy degradation as neural signals drift over time and vary across users, requiring frequent recalibration that limits practical deployment. Our goal is to develop a framework that eliminates the need for separate calibration phases by enabling continual, real-time model adaptation to new users and changing signal characteristics.Approach.We propose EDAPT, a task- and model-agnostic framework for continual online learning. EDAPT first establishes a robust baseline decoder through population-level pretraining (PRE) on data from multiple users. It then personalizes this model during deployment using supervised continual finetuning on a trial-by-trial basis. Due to its modular design, EDAPT can be composed with unsupervised domain adaptation (UDA) techniques to further address distribution shifts.Main results.We validate EDAPT across nine datasets, three BCI paradigms, and four deep learning architectures. EDAPT consistently improves decoding accuracy over static models for nearly all subjects and datasets, raising mean balanced accuracy from 0.80 to 0.87 on representative datasets (table3). Ablation studies confirm that the combination of PRE and online finetuning is the primary driver of this performance gain, with further improvements on some datasets when using UDA techniques. We demonstrate real-time feasibility of the framework, with adaptation latencies under 200 ms on consumer-grade hardware. Our scaling analysis further reveals that decoding accuracy is primarily determined by the total pretraining data budget, rather than its specific allocation between subjects and trials.Significance.These findings demonstrate that continual online learning is a practical and effective strategy for creating high-performance, user-adaptive BCIs. By systematically addressing the bottleneck of model recalibration, EDAPT reduces a major barrier to the widespread adoption of BCI technology and helps advance neurotechnology toward robust, user-friendly, real-world applications.
8 Apr 2026
Read appraisal →PloS one
Effects of virtual reality training on racket sports performance: A systematic review and meta-analysis of controlled trials
BACKGROUND: Virtual reality (VR) interventions are increasingly used in racket sports, and quantitative evidence is emerging. PURPOSE: To synthesise controlled trials examining the effects of VR-based training on racket sports performance outcomes. METHODS: A systematic search of five databases (PubMed, Web of Science, Scopus, SPORTDiscus, PsycINFO) up to 15 August 2025 was conducted following PRISMA 2020 guidelines. Eligible studies were controlled trials (randomised or non-randomised) comparing VR-based training (immersive or exergaming) with non-VR controls in tennis or table tennis players. Risk of bias was assessed using Cochrane RoB 2 (randomised) and ROBINS-I (non-randomised). Standardised mean differences (Hedges' g) were pooled using a random-effects model with Paule-Mandel τ² and Hartung-Knapp-Sidik-Jonkman (HKSJ) adjustment. The protocol was registered (PROSPERO CRD420251132325). RESULTS: Six controlled trials(total N = 426; analysed N = 401) were included. The pooled meta-analysis indicated a moderate overall effect favouring VR (Hedges' g = 0.78; HKSJ 95% CI [0.41, 1.15]), with moderate heterogeneity (I² = 52%). The 95% prediction interval was [-0.01, 1.57], which spans the null effect, indicating that in some future populations or settings VR training may not yield a meaningful performance advantage. One trial investigated perceptual-cognitive VR training (Anguera et al., 2025), showing a substantial but imprecise effect (g = 0.81, 95% CI [-0.05, 1.67]). As only a single study was available, this evidence is presented descriptively rather than meta-analytically. A subgroup examination of five physically engaging VR interventions found a similarly large effect (*g* = 0.78, 95% CI [0.31, 1.25]) despite considerable heterogeneity (I² = 62%). CONCLUSION: According to six controlled trials, VR training was associated with average performance enhancements in racket sports; however, the 95% prediction interval [-0.01, 1.57] encompasses the null effect, indicating that a future study could plausibly show no benefit. Due to the limited evidence base (k = 6), significant heterogeneity (I² = 52%), and considerable statistical uncertainty, the existing evidence does not allow for definitive conclusions regarding the efficacy of VR. The current findings should be regarded as a preliminary signal rather than confirmation of effectiveness. Larger, more methodologically robust RCTs with standardised outcomes are needed before definitive recommendations can be made.
7 Apr 2026
Read appraisal →PloS one
Appreciating the complexity of frailty and user context in digital health intervention design: A qualitative study with personas
Frailty is a complex and dynamic process that is becoming increasingly common as the population ages. Early intervention has been shown to reverse or slow progression, but requires support from increasingly limited healthcare resources. Digital health interventions could potentially assist, but first it is vital to understand older adults' experiences and perspectives. This study describes feedback from older adults with symptoms of pre or early frailty on the design concept of a digital device intended to function as an adjunct to physiotherapy and occupational therapy by increasing frequency and quality of safe movement at home. Objectives were to better understand experiences of frailty, and to identify potential influencing factors on adoption and adherence. In-person audio-recorded qualitative interviews were conducted with 17 older adults and 5 carers recruited from community settings. Reflexive thematic analysis generated two themes: 'autonomy and prompts: importance of personalisation'; and 'digital interfaces and accountability: importance of usability and purpose'. In addition, three personas were generated from the data, each describing different needs and preferences for such a device. Situating the results of analysis in the context of current literature, a set of Guiding Principles was created to support future design development in this area. These highlight important factors for consideration when designing for this population, and provide key design feature suggestions and implementation strategies to address these factors including: ensuring the device has clear purpose; is adaptable to the diversity of needs within this clinical population; any form of feedback is safe, relevant, useful and rewarding to multiple users; and technical support is accessible and ongoing. It is recommended that the target population, and clinical purpose be more clearly defined within the healthcare context to encourage personal rehabilitation through enhancing the therapeutic alliance rather than focussing on individual behaviour change of diverse older adults.
7 Apr 2026
Read appraisal →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 →Neuroscience
Effects of single/dual-target transcranial alternating current stimulation on working memory in healthy individuals
This study compared the effects of single- and dual-target high-definition transcranial alternating current stimulation(tACS) on working memory and explored the associated neural mechanisms using functional near-infrared spectroscopy(fNIRS). In a randomized, single-blind, sham-controlled design, 45 healthy participants received either dual-target stimulation, single-target stimulation, or sham stimulation, before and after which working memory performance was performed using n-back tasks with simultaneous fNIRS recording. Behavioral results showed that dual-target stimulation improved working memory performance, particularly under higher cognitive load, and yielded a greater proportion of responders when compared with sham stimulation, whereas single-target stimulation induced relatively limited effects. fNIRS findings indicated that dual-target stimulation modulated task-related cortical activation in prefrontal and temporal regions and enhanced both intra- and inter-hemispheric functional connectivity. Moreover, improvements in task accuracy were associated with strengthened functional connectivity within the frontoparietal and default mode networks. These findings suggest that dual-target tACS may be a promising strategy for enhancing working memory and highlight the importance of network-level modulation in cognitive enhancement.
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 →Medicine
Prediction model for frailty risk in ischemic stroke patients: Application and validation of support vector machines and nomograms
This study aimed to develop a prediction model based on nomograms and support vector machines (SVM) to assess frailty risk in ischemic stroke patients. Clinical information of ischemic stroke patients admitted to our hospital from January 2023 to December 2024 was retrospectively collected. First, independent risk factors associated with frailty in ischemic stroke patients were identified through univariate and multivariate logistic regression analyses. Subsequently, a nomogram was constructed based on regression analysis results and validated using 10-fold cross-validation. Data were divided into training (70%) and validation (30%) sets. A SVM predictive model was constructed on the training set. The predictive performance of both models was compared using receiver operating characteristic curves. This study included 867 ischemic stroke patients, among whom 296 (34.14%) were classified as frail. The entire cohort was randomly divided into a training set (n = 607) and a validation set (n = 260) at a 7:3 ratio. Logistic regression analysis identified hypertension, impaired self-care ability, physical inactivity, reduced prognosis nutrition index, and depressive status as independent risk factors for frailty in ischemic stroke patients (P < .05). The nomogram demonstrated an area under the receiver operating characteristic curve (AUC) of 0.814 for frailty prediction, while the SVM model achieved an AUC of 0.842, indicating superior predictive capability. Further comparison revealed that while the nomogram offers greater intuitiveness and operational convenience in clinical practice, the SVM model demonstrated superior predictive accuracy. Hypertension, impaired self-care ability, physical inactivity, reduced prognosis nutrition index, and depressive states are independent risk factors for frailty in ischemic stroke patients. Both predictive models (nomogram and SVM) demonstrated high predictive accuracy; however, the SVM model outperformed the nomogram in predictive capability, while the latter retains unique advantages due to its simplicity and clinical applicability.
5 Apr 2026
Read appraisal →PloS one
Patterns and predictors of variability in patient-generated daily pain severity collected via a mobile health smartphone app.
Digital-health technologies support the collection of patient-generated health data that is frequent, longitudinal, and collected in participant's own environments. Such high-frequency data could detect patterns of variation in disease and associated symptoms, but characterizing, interpreting, and understanding the reasons for this variability remain open questions. Here, we examine 2070 people living with chronic pain to quantify daily variability in pain severity across seven-day periods and identify factors associated with that variability. Data were collected via a smartphone application from a population-based mobile-health study, Cloudy with a Chance of Pain. Summary statistics and distributions of pain changes on consecutive days were calculated within 13,052 complete weeks of data, which had been assigned to one of four clusters via a previously published k-mediods clustering algorithm: no/low pain, mild pain, moderate pain, and severe pain. Cumulative-probit models were used to identify associations between changes in pain severity and changes in exposure data. Across the four clusters, the no/low-pain cluster had the highest proportion of weeks with no within-week changes (59%) in pain severity compared to the other clusters (48-53%). When pain did change, it changed one unit (out of five) about 20% of the time, but larger changes of two to four units also occurred. Changes in pain severity were associated most strongly with changes in pain interference (i.e., how pain impacts daily activities) and were also associated with changes in fatigue, morning stiffness, mood, and participant well-being. Thus, this study showed that data collected frequently through digital-health technologies can be used to explore variability in symptoms and their associations with other variables. That pain severity was associated with changes in modifiable variables (e.g., fatigue, mood) suggests opportunities for different treatment and self-management regimes for different patient subtypes within the four clusters.
5 Apr 2026
Read appraisal →BMJ open
Development and acceptability of a patient decision aid for people with degenerative cervical myelopathy: an international mixed-methods study
OBJECTIVES: To develop and user-test a patient decision aid for people diagnosed with degenerative cervical myelopathy and who are considering surgery. DESIGN: Mixed-methods study describing the development of a patient decision aid. SETTING: A draft decision aid was developed by a multidisciplinary steering group (including study authors with degenerative cervical myelopathy, health professionals and researchers) informed by the best available evidence, authorship consensus and existing patient decision aids. PARTICIPANTS: Patient-participants and health professional-participants who manage people with degenerative cervical myelopathy were recruited through social media and the steering group's research and practice network. Quantitative questionnaires were used to gather baseline data, descriptive feedback, refine the decision aid and assess its acceptability. Qualitative semi-structured interviews were conducted online to gather feedback on the decision aid and were analysed using reflexive thematic analysis. RESULTS: We conducted 32 interviews: 19 patient-participants and 13 health professional-participants who manage people with degenerative cervical myelopathy (neurosurgeons, neurologists, physiotherapists, orthopaedic surgeons, general practitioners, rehabilitation and pain specialists and consultant occupational physicians and chiropractors). Participants were from 10 countries (Australia, Canada, Cyprus, Germany, Ireland, New Zealand, Sweden, Switzerland, United Kingdom and USA). Most participants rated the decision aid's acceptability as good-to-excellent and agreed with most aspects of the decision aid (eg, defining degenerative cervical myelopathy, management recommendations, potential benefits and harms, questions to consider asking a health professional). CONCLUSION: Our patient decision aid was rated as an acceptable tool by both health professional-participants who treat degenerative cervical myelopathy and patient-participants with lived experience of degenerative cervical myelopathy. This decision aid can be used by clinicians and people with degenerative cervical myelopathy to help with shared decision making following a diagnosis of degenerative cervical myelopathy. A study testing the potential benefits of this decision aid in a clinical setting is recommended.
5 Apr 2026
Read appraisal →Journal of special operations medicine : a peer reviewed journal for SOF medical professionals
Combat-Related Orthopedic Trauma in the Russo-Ukrainian War: A Systematic Review
INTRODUCTION: The Russo-Ukrainian conflict has produced large numbers of military and civilian casualties, with orthopedic and musculoskeletal trauma representing a major proportion of combat injuries. Explosions, gunshots, and blast mechanisms frequently generate complex wounds that demand specialized surgical and rehabilitative management. This review summarizes injury types, mechanisms, severity, clinical responses, and gaps in current knowledge. METHODS: Following PRISMA guidelines, a comprehensive search of PubMed, Scopus, Web of Science, and MEDLINE via WoS was conducted in February 2025. Eligible studies published from 2014 to 2024 included case reports, case series, cohort studies, and observational research describing orthopedic injuries in military or civilian populations affected by the conflict. Two reviewers independently screened studies, performed quality assessments using Joanna Briggs Institute tools and STROBE criteria, and synthesized data qualitatively with descriptive statistics when available. RESULTS: Thirty-one studies were included, primarily case reports and retrospective analyses from Ukrainian military hospitals and frontline facilities. Explosive and ballistic trauma produced high-energy fractures, traumatic amputations, severe soft-tissue loss, and neurovascular damage. Management strategies included external and internal fixation, bone grafting, microsurgical reconstruction, distraction osteogenesis, and the progressive use of 3D-printed implants to support limb salvage. Rehabilitation, including pain control, physiotherapy, and prosthetic training, was essential for functional recovery. Long-term complications included neuromas, phantom pain, stump morbidity, and psychological trauma. Telemedicine enabled remote consultation and continuity of care under resource-limited conditions. CONCLUSIONS: Combat-related orthopedic injuries in this conflict require advanced surgical techniques, coordinated multidisciplinary support, and prolonged rehabilitation. Expanded data collection, standardized reporting, and long-term follow-up are essential to improve functional outcomes and reintegration.
4 Apr 2026
Read appraisal →Journal of medical Internet research
Predictive Value of Machine Learning for Poststroke Mortality Risk: Systematic Review and Meta-Analysis
BACKGROUND: People with stroke face a high mortality risk, and an accurate prediction model is essential to the guidance of clinical decision-making in this population. Recently, with growing attention paid to machine learning (ML) in stroke care, some researchers have investigated the effectiveness of ML in predicting the mortality risk in stroke. However, systematic evidence is still lacking for its effectiveness. OBJECTIVE: This systematic review aims to evaluate the value of ML in predicting the stroke mortality risk. The findings are expected to offer an evidence-based basis for developing and assessing clinical risk prediction tools. METHODS: A search was made in Cochrane Library, PubMed, Embase, and Web of Science up to June 23, 2025, and studies that reported a complete performance of ML in predicting stroke mortality were included. Studies with only risk factors analyzed were excluded. The risk of bias of the included studies was assessed using PROBAST (Prediction model Risk of Bias Assessment Tool). Pooled risk ratios with 95% CIs and prediction intervals (PIs) were derived using the Hartung-Knapp-Sidik-Jonkman method under a random-effects model. Subgroup analyses were also conducted by model type, stroke type, patient source, and treatment background. Moreover, a metaregression was conducted on the C-index for out-of-hospital mortality at different time points to explore the influence of time factors on the model's predictive performance. RESULTS: Sixty-eight studies were included (23 predicting in-hospital mortality and 45 predicting out-of-hospital mortality), describing the development of 75 prediction models and 43 external validations. The follow-up period was 1 month to 15 years. For predicting in-hospital mortality, the external validation set had a pooled C-index of 0.727 (95% CI 0.677-0.781, 95% PI 0.521-1.000), with sensitivity and specificity of 0.64 (95% CI 0.57-0.70) and 0.74 (95% CI 0.70-0.77), respectively. For predicting out-of-hospital mortality, the pooled C-index was 0.847 (95% CI 0.808-0.887, 95% PI 0.750-0.956) in the external validation set, with sensitivity and specificity of 0.71 (95% CI 0.55-0.82) and 0.76 (95% CI 0.74-0.78), respectively. Comparatively, the overall pooled C-indexes were 0.788 (95% CI 0.766-0.810, 95% PI 0.621-0.999) and 0.812 (95% CI 0.798-0.826, 95% PI 0.693-0.952), respectively. The metaregression revealed a gradual decline in the predictive performance of the overall model and logistic regression model alone, whereas a random forest model maintained sustained performance. Age, National Institutes of Health Stroke Scale score, and stroke-related complications were the most frequently used variables for modeling. CONCLUSIONS: This is the first meta-analysis to demonstrate that ML-based prediction of stroke mortality is feasible. The performance of ML supports its role as an auxiliary tool for identifying high-risk populations, thereby optimizing clinical monitoring and resource allocation. However, due to substantial heterogeneity and a relatively high risk of bias in available studies, caution is warranted in real-world application. The effectiveness of ML may vary across settings, and external validation is recommended before broader implementation. TRIAL REGISTRATION: PROSPERO CRD420251086321; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251086321.
4 Apr 2026
Read appraisal →Advanced science (Weinheim, Baden-Wurttemberg, Germany)
A Wireless, Battery-Free Artificial Throat Patch with Deep Learning for Emotional Speech Recognition
Technologies for sensing and translating throat signals into speech have advanced the communication for people with vocal impairments. However, the practical deployment of these technologies is currently hindered by tethered system, bulky components and the lack of emotional recognition capability. Here, we demonstrate a wireless, battery-free artificial throat patch system (ATPS) coupling with deep learning method to enable simultaneous recognition of speech and emotion. The sensing module of the ATPS integrates a carbon nanotube-based thin-film strain sensor and a miniaturized flexible printed circuit board (FPCB). Real-time sensing and transmission of throat signals is facilitated by a smartphone-linked system incorporating an FPCB with an embedded near-field communication antenna and low-power electronic components. Furthermore, the information-rich sensor readouts are further extracted and successfully demonstrated to be sufficient to emotional recognition of speech by implementing a hybrid deep learning architecture. This proposed system expands the arsenal of tools available for mute patients in speech recognition and communication and further realizes personalized clinical implementations.
4 Apr 2026
Read appraisal →Transl Psychiatry
Application of artificial intelligence in schizophrenia rehabilitation management: a systematic scoping review
Artificial intelligence (AI) is increasingly used in mental health, yet its rehabilitation-oriented applications in schizophrenia have not been systematically mapped. We conducted a systematic scoping review of PubMed, Web of Science, IEEE Xplore and the ACM Digital Library (January 1, 2012-October 31, 2025; two search rounds), applying operationalized rehabilitation boundaries and excluding diagnostics-only case-control studies. We extracted data on data sources, feature engineering, model families, validation, calibration, interpretability, application domains, outcomes and implementation readiness. Eighty-three studies met inclusion criteria (median sample size 160; 55% longitudinal). Applications focused on symptom monitoring (48/83), medication management (19/83) and risk management (16/83), whereas functional training (1/83) and psychosocial support (3/83) were rarely targeted. Supervised learning predominated (53/83, 63.9%) over representation learning (20/83, 24%), most commonly using speech/text, electronic health records and smartphone sensing. Across classification tasks, the median AUC was 0.79 (IQR 0.71-0.86); relapse early-warning models showed a median sensitivity of 31.5% at 88.0% specificity. Only four studies reported external validation and three described closed-loop deployment, including one randomized trial that improved adherence. Proxy endpoints were more common than clinical endpoints, and reporting of calibration/uncertainty and fairness auditing was sparse. Overall, AI shows promise for monitoring, adherence support and relapse risk stratification, but routine-care deployment will require externally validated and calibrated human-in-the-loop decision support, privacy-preserving multimodal pipelines and pragmatic trials targeting functional outcomes and participation.
1 Mar 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
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