OBJECTIVE:To examine the associations of rehabilitation dose, sarcopenia, and nutritional status with functional efficiency after inpatient rehabilitation for first-ever ischemic stroke. DESIGN:A single-center retrospective cohort included 1,036 adults with first-ever ischemic stroke. The outcome was Modified Barthel Index efficiency, defined as gain divided by inpatient rehabilitation days. Sarcopenia was defined as concurrent low skeletal muscle mass index and low non-paretic hand grip strength. Multivariable linear regression used HC3 robust standard errors. RESULTS:Poor functional efficiency occurred in 419 (40.4%) patients. Rehabilitation dose per 30 min/day was associated with higher efficiency (β=0.17, 95% CI 0.12 to 0.21; P<0.001). Sarcopenia was associated with lower efficiency (β=-0.22, 95% CI -0.28 to -0.15; P<0.001), whereas Geriatric Nutritional Risk Index per 5-point increase was associated with higher efficiency (β=0.05, 95% CI 0.03 to 0.07; P<0.001). The dose × sarcopenia interaction was negative (β=-0.12, 95% CI -0.20 to -0.05; P=0.001), and the dose × Geriatric Nutritional Risk Index interaction was small and positive (β=0.02, 95% CI 0.00 to 0.05; P=0.039). CONCLUSION:Rehabilitation dose, sarcopenia, and nutritional status are associated with functional efficiency after inpatient stroke rehabilitation.
Objectives: Current guidelines for preclinical mobility limitation (PCML) screening recommend habitual and fast gait speed testing; however, comparative evidence on their discriminative accuracy is limited, and empirical gait speed thresholds for PCML have not been established. We aimed to (i) compare habitual and fast gait speed on their discriminative ability and (ii) derive interpretation thresholds for PCML among community-dwelling middle-aged and older adults. Design: In this cross-sectional study, 235 participants (mean[SD], 68[7.3]years) completed the 4-metre gait speed assessment. PCML classification was based on questions regarding the use of compensatory stair gait strategy. Results: In multinomial regression, reduced habitual and fast gait speed were associated with increased odds of “PCML likely” (versus “PCML unlikely”): adjusted interquartile-range odds ratios (95%CI) were 2.6 (1.2-5.7) and 5.8 (1.5-22.5) for habitual and fast gait speed, respectively. Fast gait speed showed greater discriminative ability (pairwise AUC [95%CI], 0.80 [0.68-0.92]) than habitual gait speed (0.74 [0.62-0.87]). The interpretation thresholds (95% CI) for PCML were 1.24 m/s (1.20-1.31m/s) and 1.67m/s (1.61-1.78m/s) for habitual and fast gait speed, respectively. Conclusions: Fast gait speed was more adept than habitual gait speed in differentiating between individuals with and without PCML, and empirically-derived thresholds were estimated to complement existing cut-points for PCML.
OBJECTIVE:To determine the prevalence of current musculoskeletal pain among former NCAA Division I female athletes and examine associations with prior injury history, anatomical distribution of symptoms, and functional outcomes. DESIGN:Cross-sectional web-based survey of former NCAA Division I female athletes. Participants completed questionnaires regarding athletic history, prior injuries, current pain, osteoarthritis diagnosis, physical activity, and PROMIS Pain Interference outcomes. RESULTS:A total of 428 former NCAA Division I female athletes were included, of whom 305 (71.3%) reported current musculoskeletal pain. Athletes with pain were more likely to report injuries before college (71% vs. 46%), injuries during college (80% vs. 62%), continued training despite injury (73% vs. 55%), career-ending injuries (8.5% vs. 1.6%), and prior NSAID use (72% vs. 54%) (all P≤0.008). Pre-collegiate injury (adjusted OR 2.84, 95% CI 1.72-4.68) and career-ending injury (adjusted OR 4.85, 95% CI 1.10-21.45) independently predicted current pain. Current pain was concentrated primarily in the knee, spine, and hip/pelvis. Despite frequent symptoms, 94% of participants remained physically active. CONCLUSION:Persistent musculoskeletal pain is common among former NCAA Division I female athletes and is associated with cumulative injury burden. Longitudinal studies are needed to better understand musculoskeletal health across the female athletic lifespan.
Adaptive sports improve health and quality of life for people with disabilities, yet the extent of adaptive sports exposure in physical medicine and rehabilitation (PM&R) training is unclear. This cross-sectional study reviewed the public websites of 115 accredited physical medicine and rehabilitation residency programs and 26 sports medicine fellowship programs for any mention of adaptive sports, characterizing exposure type, target populations, and associated program characteristics. Adaptive sports were mentioned by 32 residency programs (27.8%) and 8 fellowship programs (30.8%). Mention varied significantly by geographic region in both cohorts (residency, West 64% vs. South 19%, P=.017; fellowship, Midwest 80% vs. South 0%, P=.035) and, among residencies, was associated with larger program size and a greater number of associated subspecialty fellowships. Residency exposure was predominantly volunteer-based, whereas fellowship exposure was exclusively clinical or undisclosed; target populations served were frequently unspecified. Programs have an opportunity to expand structured adaptive sports training and to clearly convey these opportunities to applicants and patients.
It is unexpected when initial certification examinees pass the American Board of Physical Medicine and Rehabilitation (ABPMR) Part I Examination with a top score and subsequently fail the Part II Examination. This study aims to determine individual and residency program factors associated with this outcome. A retrospective, observational review of ABPMR data between 1999 and 2025 identified 161 individuals (1.6% of all examinees) who passed Part I with top quartile performance but subsequently failed one or more attempt at Part II. Multinomial logistic regression models demonstrated a lower odds ratio for Part II failure among female physicians (OR=0.60, P=0.016) and those enrolled in fellowship training (OR=0.53, P=0.006). A higher odds ratio was found for physicians aged >40 years (OR=3.80, P<0.001), non-white ethnicity (OR=1.80, P=0.004), and those who completed newer (<10 years, OR=3.13, P=0.026) and smaller (2-4 and 5-7 residents per year, OR=1.98 and 2.13, P=0.009 and 0.001) residency programs. Awareness of this potential outcome should prompt rigorous preparation for the Part II Examination, even for the highest performing Part I examinees.
OBJECTIVE:To evaluate the efficacy and safety of transcranial direct current stimulation (tDCS) initiated strictly within the acute ischemic stroke. DESIGN:A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted via PubMed, Embase, and Cochrane Library. Outcomes included neurological deficit, upper limb and lower limb motor function, and functional independence. Data were synthesized using random-effects models to calculate weighted mean differences (WMD) and standardized mean differences (SMD). RESULTS:Ten RCTs involving 419 participants were included. Active tDCS significantly reduced neurological deficits compared to sham stimulation (WMD=-0.86, 95% CI: -1.38 to -0.34, P=0.001). While tDCS did not significantly improve short-term or long-term upper limb function, it demonstrated a significant improvement on lower limb motor recovery (SMD=3.50, 95% CI: 2.56 to 4.44, P<0.001), which was sustained at follow-up. No significant difference was found in functional independence or safety outcomes between groups. CONCLUSIONS:tDCS initiated in the acute phase is safe and effective for reducing neurological deficits and enhancing lower limb motor recovery. The discrepancy between lower and upper limb outcomes suggests distinct neuroplastic mechanisms, highlighting the potential of tDCS, particularly bilateral montages, as a targeted intervention for early gait rehabilitation.
The increasing use of implantable neuromodulation devices in patients with chronic post-stroke sequelae raises the possibility of unintended device-device interactions. We report a case of recurrent intrathecal baclofen pump motor stalls in a patient with longstanding spasticity following an intracranial hemorrhage, ultimately attributed to magnetic interference from a recently implanted vagus nerve stimulator (VNS) activator magnet. Recognition of this interaction led to prompt resolution and highlights the importance of interdisciplinary awareness and patient education in individuals with multiple implanted neuromodulation systems.
OBJECTIVE:To synthesize the available evidence on the association between quadriceps myosteatosis and muscle strength and physical function in individuals with knee osteoarthritis. DESIGN:A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Joanna Briggs Institute (JBI) guidelines and was prospectively registered with PROSPERO. PubMed, EMBASE, Web of Science, Scopus, and CINAHL were searched from inception to February 2026. Studies quantifying quadriceps myosteatosis using objective imaging and reporting muscle strength or physical function were eligible. Methodological quality was assessed using the JBI critical appraisal tools. Due to clinical and methodological heterogeneity, findings were synthesized narratively following the Synthesis Without Meta-analysis (SWiM) framework. RESULTS:Seven studies were included. Most demonstrated low to moderate risk of bias. Quadriceps myosteatosis may be associated with reduced muscle strength and poorer physical function, with the association varying by muscle region, fat compartment, and imaging modality. The most consistent associations were observed for vastus medialis and intermuscular fat, and in MRI-based studies with multivariable adjustment. CONCLUSION:Quadriceps myosteatosis may be associated with poorer muscle function in knee osteoarthritis, most consistently for vastus medialis. Findings should be interpreted cautiously, given the limited evidence base and methodological heterogeneity.
OBJECTIVE:To investigate the clinical effectiveness of a newly developed trunk-lower limb rehabilitation robot in patients with chronic stroke. DESIGN:Randomized controlled trial conducted at a rehabilitation center. Forty patients with chronic stroke (mean age 59.48±7.63 years) were randomized to an intervention group (n=20) or a control group (n=20). The intervention group received individualized robotic trunk-lower limb training applying Jacob® (LDS Co., Ltd, Daegu, Korea) once daily, 5 times per week for 3 months, in addition to conventional rehabilitation. The control group received conventional rehabilitation only. The primary outcome was the change in Functional Ambulatory Category (FAC) from baseline to 3 months. Secondary outcomes included manual muscle testing, the Modified Ashworth Scale, Berg Balance Scale, the Mini-Mental State Examination, and robot-based multiple kinematic parameters. RESULTS:Compared with the control group, the intervention group showed significant improvements in FAC. Multiple kinematic parameters, particularly lateral bending, forward bending, weight transfer and gait ability also significantly improved (P<0.05). The control group exhibited no significant changes. CONCLUSIONS:Robot-assisted trunk-lower limb training combined with conventional rehabilitation significantly improved trunk control and ambulatory function in patients with chronic stroke, supporting its potential clinical utility.
Objective: To investigate the clinical effectiveness of a newly developed trunk–lower limb rehabilitation robot in patients with chronic stroke. Design: Randomized controlled trial conducted at a rehabilitation center. Forty patients with chronic stroke (mean age 59.48±7.63 years) were randomized to an intervention group (n=20) or a control group (n=20). The intervention group received individualized robotic trunk–lower limb training applying Jacob ® (LDS Co., Ltd, Daegu, Korea) once daily, 5 times per week for 3 months, in addition to conventional rehabilitation. The control group received conventional rehabilitation only. The primary outcome was the change in Functional Ambulatory Category (FAC) from baseline to 3 months. Secondary outcomes included manual muscle testing, the Modified Ashworth Scale, Berg Balance Scale, the Mini-Mental State Examination, and robot-based multiple kinematic parameters. Results: Compared with the control group, the intervention group showed significant improvements in FAC. Multiple kinematic parameters, particularly lateral bending, forward bending, weight transfer and gait ability also significantly improved ( P <0.05). The control group exhibited no significant changes. Conclusions: Robot-assisted trunk–lower limb training combined with conventional rehabilitation significantly improved trunk control and ambulatory function in patients with chronic stroke, supporting its potential clinical utility.
OBJECTIVE:To map the scope, thematic focus, and contribution of publications based on the International Spinal Cord Injury Community Survey (InSCI), and to identify remaining knowledge gaps in the literature. DESIGN:We conducted a structured evidence map of peer-reviewed publications derived from InSCI. InSCI is a cross-sectional survey of adults with spinal cord injury/disease (SCI/D). Wave 1 (2017 to 2019) included 12,591 participants across 22 countries; wave 2 (2022 to 2024) included 15,249 participants across 32 countries. Publications were tracked and classified into 7 IPSCI-based domains. RESULTS:By April 2026, InSCI generated 117 peer-reviewed publications (including 11 from wave 2). Health care needs were the largest category, followed by epidemiological studies, enabling environments, and education/employment. InSCI-based publications reported cross-country differences in quality of life, health care access, unmet needs, environmental barriers, and employment. Publications also reported a high burden of secondary health conditions, variation in health service use, and lower employment rates among persons with SCI/D compared with the general population. CONCLUSIONS:InSCI offers an expanding international data set on the lived experiences of individuals with SCI/D. Although publication activity is high across several IPSCI domains, critical research gaps remain regarding equity, gender, education, younger populations, and general population comparisons.
Patients in cardiac intensive care units (ICUs) often require mechanical circulatory support (MCS) devices. Phase I cardiac rehabilitation for patients requiring a single MCS device appears safe and feasible. However, the simultaneous use of multiple MCS devices is relatively new and rehabilitation practices have had less evaluation in these circumstances. This case report describes phase I cardiac rehabilitation delivery in a 73-year-old man with cardiogenic shock supported with simultaneous femoral-femoral, veno-arterial extracorporeal membrane oxygenation and percutaneous ventricular assist device, commonly referred to as ECPella. The patient participated in structured rehabilitation before and after heart transplantation, including during ECPella support. Rehabilitation sessions during ECPella support were tolerated well with no adverse events. The patient's functional mobility improved from completely dependent for all mobility to independent with ambulation and activities of daily living by discharge from acute comprehensive inpatient rehabilitation unit. This case describes the individualized approach to delivering phase I cardiac rehabilitation in a patient with a complicated hospital course requiring multiple MCS devices and a heart transplant. Additionally, it suggests the implementation of rehabilitation interventions when a patient is supported by multiple MCS devices appears to be safe and feasible via an interdisciplinary approach.
OBJECTIVE:To investigate changes in disability and health-related quality of life following lumbar fusion surgery and to examine the influence of baseline demographic, clinical, and lifestyle factors on postoperative outcomes. DESIGN:This prospective cohort study assessed disability (ODI) and quality of life (SF-36) after lumbar fusion at hospitals affiliated with Kashan University of Medical Sciences using linear mixed-effects models. Analyses were performed in R (v4.5.1). RESULTS:A total of 100 patients who underwent lumbar spine fusion surgery were enrolled. Among the variables included, higher baseline pain intensity (β =2.94, P < 0.001), greater age (β = 0.55, P = 0.003), higher BMI (β = 0.93, P = 0.03), smoking status (β = -14.99, P < 0.001) were significantly associated with higher disability scores. Compared with baseline, the ODI score was significantly lower at both 3 and 6 months following surgery. Furthermore, the reduction in disability observed between 3 and 6 months postoperatively remained statistically significant (P < 0.05 for all comparisons). CONCLUSIONS:Beyond the effect of postoperative recovery time, social and lifestyle factors exert a substantial influence on surgical outcomes following lumbar fusion surgery. These determinants should be carefully considered in the planning and implementation of postoperative care strategies.
OBJECTIVES:To examine the effects of anterior load carriage on dynamic sagittal spinal alignment during the gait cycle in younger (<65 y) and older (≥65 y) adults. DESIGN:Cross-sectional study of 47 participants aged 20-80 years categorized as young and older adults. Participants walked at self-selected speeds with and without a 4.5 kg anterior chest load. Whole-body kinematics were recorded using a 19-camera infrared motion capture system. Outcome measures included lumbar lordosis (LL), thoracic kyphosis (TK), trunk inclination (TI), sagittal trunk shift (STS), and pelvic tilt (PT). Gait-cycle-dependent differences were analyzed using statistical parametric mapping. RESULTS:The mean age was 41 years in young adults (n=28) and 70 years in older adults (n=19). Anterior load carriage increased LL during portions of the gait cycle and reduced TI throughout the entire gait cycle. Younger adults demonstrated greater LL and lower TI than older adults. A significant age-by-load interaction for TI was observed during portions of the gait cycle. CONCLUSIONS:Anterior load carriage alters spinal alignment by increasing LL and reducing TI during walking, with distinct age-related patterns. These results provide valuable reference data and a foundation for future studies on load management and ergonomic interventions across the adult lifespan.
Objectives: To examine the effects of anterior load carriage on dynamic sagittal spinal alignment during the gait cycle in younger (<65 y) and older (≥65 y) adults. Design: Cross-sectional study of 47 participants aged 20–80 years categorized as young and older adults. Participants walked at self-selected speeds with and without a 4.5 kg anterior chest load. Whole-body kinematics were recorded using a 19-camera infrared motion capture system. Outcome measures included lumbar lordosis (LL), thoracic kyphosis (TK), trunk inclination (TI), sagittal trunk shift (STS), and pelvic tilt (PT). Gait-cycle–dependent differences were analyzed using statistical parametric mapping. Results: The mean age was 41 years in young adults (n=28) and 70 years in older adults (n=19). Anterior load carriage increased LL during portions of the gait cycle and reduced TI throughout the entire gait cycle. Younger adults demonstrated greater LL and lower TI than older adults. A significant age-by-load interaction for TI was observed during portions of the gait cycle. Conclusions: Anterior load carriage alters spinal alignment by increasing LL and reducing TI during walking, with distinct age-related patterns. These results provide valuable reference data and a foundation for future studies on load management and ergonomic interventions across the adult lifespan.
