Objective: Compare rehabilitation process and outcomes between patients with and without mental health disorders. Design: Observational cohort study. Subjects: 130 patients receiving post-acute inpatient rehabilitation after acute injury or illness. Methods: Mental health disorders were assessed with diagnostic interviews. Adjusted regression analysis examined associations between mental health disorders and rehabilitation processes, func-tional improvement, pain, and patient satisfaction. Results: Patients with mental health disorders had more psychologist sessions (B = 5.87, 95% CI 3.87–7.87), more cancelled physiotherapy sessions (B = 1.15, 95% CI 0.38–1.93), multiprofessional team members collaborated more with external partners (B = 6.10, 95% CI 2.88–9.32), and nurses and team coordinators found their roles more demanding (OR = 5.47, 95% CI 1.38–21.76; OR = 7.43, 95% CI 2.21–24.94). Mental health disorders were associated with higher pain intensity and pain interference (B = 1.25, 95% CI 0.38–2.12; OR = 6.81, 95% CI 1.39–33.30). Opioid use was comparable on admission, but the mental health disorder group used more on discharge (OR = 4.5, 95% CI 1.75–11.55). Change in functional independence and patient satisfaction was comparable. Conclusion: Comorbid mental health disorders were associated with several aspects of the post-acute rehabilitation process, including resource use and pain management. These findings may inform the planning and organization of rehabilitation services for patients with mental health challenges.
Objective: To assess the validity of Polar Verity Sense, an arm-worn heart rate (HR) monitor, for measuring HR in individuals with obesity during the submaximal ergometer cycle Ekblom-Bak test. Subjects/Patients: Adults in an inpatient rehabilitation programme for individuals with obesity. Methods: Participants completed the Ekblom-Bak test wearing the Polar H10 chest strap and 2 Verity Sense devices on the forearm and upper arm. Statistical analyses included intraclass correlation coefficient (ICC), Lin’s concordance correlation coefficient (CCC), Bland–Altman analyses with 95% limits of agreement (LoA), and mean absolute percentage error (MAPE). Feasibility was assessed with a post-test questionnaire. Results: 49 participants were included in the analyses of estimated maximal oxygen consumption (VO2max), while 48 were included in analyses of HR data. ICC and CCC values ranged from 0.998–0.999 between the H10 chest strap and Verity Sense measures. Small differences were observed in Bland–Altman plots. MAPE ranged from 0.46% to 0.51%. Feasibility responses from the questionnaire showed that participants preferred the Verity Sense to the H10. Conclusion: Polar Verity Sense accurately measures HR and estimates VO2max in adults with obesity during the Ekblom-Bak test. Individuals with obesity may freely opt for either device without sacrificing accuracy during steady-state activities at low and moderate intensities. This choice may eliminate a barrier in assessing their cardiorespiratory fitness.
Background: Relative fat mass is a novel anthropometric indicator that outperforms body mass index in assessing obesity. Although obesity is a known risk factor for knee osteoarthritis, the prospective association between relative fat mass and symptomatic knee osteoarthritis in middle-aged and older adults with metabolic syndrome remains unclear. Methods: This prospective cohort study used CHARLS data, including 3,301 middle-aged and older metabolic syndrome patients free of knee osteoarthritis at baseline. Participants were grouped into relative fat mass quartiles. Incident symptomatic knee osteoarthritis was the primary outcome. Multivariable Cox models, restricted cubic spline analyses, subgroup analyses, and receiver operating characteristic curves were used to assess associations and predictive performance. Results: Knee osteoarthritis incidence increased across relative fat mass quartiles (Q1: 21%; Q4: 37%). In fully adjusted models, those in the highest relative fat mass quartile had a 50% higher knee osteoarthritis risk compared with the lowest quartile (HR = 1.50, 95% CI: 1.18–1.90), with a significant dose–response trend. Restricted cubic spline analysis indicated a non-linear association. The relationship was stronger among rural residents. Relative fat mass demonstrated better predictive ability than body mass index (AUC: 0.587 vs 0.532). Conclusions: Among Chinese middle-aged and older adults with metabolic syndrome, higher relative fat mass was independently and non-linearly associated with an increased risk of incident symptomatic knee osteoarthritis. Relative fat mass outperformed body mass index as a predictive measure, supporting its use as a simple and effective tool to identify high-risk individuals and guide targeted prevention strategies.
Objective: To identify latent classes with distinct disability profiles among patients with persistent neck pain using item-level responses from the Neck Disability Index, and to examine demographic, clinical, and lifestyle factors associated with class membership. Design: Cross-sectional survey-based study. Patients: 962 patients with persistent neck pain. Methods: This survey-based study included 962 patients with persistent neck pain. Latent class analysis was performed using the 10 dichotomized items of the Neck Disability Index (NDI) as indicator variables. Demographic, clinical, and lifestyle characteristics were subsequently examined across the identified latent classes. Results: The mean age was 50 (SD 32.5) years and 647 (67%) were women. Three distinct classes were identified: class with no or mild disability (47% of the sample); class with moderate disability in reading, driving, and lifting but not in personal care and concentration (15% of the sample); and class with overall severe disability (37% of the sample). Lower educational level, obesity, physical inactivity, worse pain, and lower occupational status were associated with a higher probability of belonging to the severe disability class. Conclusion: Patients with persistent neck pain appear to exhibit distinct disability profiles rather than a single uniform pattern of functional limitation. Identifying these profiles may improve the characterization of patient heterogeneity and provide a basis for future research evaluating their clinical and prognostic relevance. Further studies are needed to determine whether these profiles are reproducible in other populations and whether they have implications for treatment planning and outcomes.
Objective: To compare the clinical effectiveness and cost-effectiveness of a 12-week home-based digital exercise programme with 12-week hospital-supervised physiotherapy for plantar fasciitis in routine Chinese tertiary-hospital care. Design: Single-centre retrospective cohort study with 1:2 propensity-score matching on 13 baseline covariates. Subjects/Patients: 587 adults with a clinician-confirmed diagnosis of plantar fasciitis treated in 2022–2024 were matched. Methods: The primary outcome was first-step morning pain at 3 months on a 0–10 numeric rating scale (non-inferiority margin 1.3 points; sensitivity margins 0.9 and 1.9). A 12-month cost–utility analysis took payer and societal perspectives. Results: The adjusted mean difference was −0.63 points (95% confidence interval −0.92 to −0.35; p < 0.001), non-inferior against all 3 margins (E-value 2.84). Incremental payer cost was −¥4,920 (−US$684), incremental societal cost −¥7,008 (−US$974), and incremental quality-adjusted life-years +0.011, with dominance in 96.7% of bootstrap replications. Conclusion: Home-based digital exercise was non-inferior for 3-month first-step pain and less costly from both perspectives. Matching left 12 of 13 covariates imbalanced and only 6.3% of screened patients were eligible, so residual confounding and selection bias are likely. These observational findings are provisional and require confirmation in a pragmatic multicentre randomized controlled trial before informing reimbursement.
Objective: This study aimed to assess the organization and delivery of post-stroke rehabilitation services across Europe, focusing on the role of Physical and Rehabilitation Medicine physicians. Design and Methods: A cross-sectional online survey was conducted by the ESPRM Working Group of Stroke Rehabilitation from 30 European countries. The survey followed the International Classification of Service Organization in Rehabilitation framework and covered stroke care levels, rehabilitation services, registries, and quality control. Descriptive statistics were used for analysis. Results: With an 81% response rate, the study revealed both commonalities and disparities in service provision in 30 European countries. Stroke unit rehabilitation was available in 90% of countries, and inpatient services in 100%. However, early supported discharge (53%), community-based rehabilitation (63%), and telerehabilitation (57%) were less common. Countries joining ESPRM after 1991 had significantly lower rates of early supported discharge (−48%, p=0.01) and community-based care (−55%, p=0.02). Conclusion: Despite widespread inpatient services, major gaps remain in community- and technology-supported rehabilitation. Addressing these disparities requires targeted policy changes, altered resource allocation, and enhanced training to ensure equitable and effective stroke recovery across Europe.
Objective: To examine the associations of motor recovery stage, proprioceptive function, and working memory with motor imagery ability in patients with subacute stroke. Design: Multicentre cross-sectional study. Subjects/Patients: Forty patients with subacute stroke who had complete data. Methods: Motor imagery ability was assessed using mental chronometry during a Purdue Pegboard task. Associations with motor recovery stage, proprioceptive function, and working memory were examined using correlation and multiple regression analyses. An exploratory linear support vector machine analysis was performed to classify participants into groups with higher and lower motor imagery ability using these variables. Results: Motor imagery ability was significantly associated with motor recovery stage and proprioceptive function in the correlation analyses. However, these associations were no longer independently significant after adjustment in the multiple regression analysis. A linear support vector machine achieved an area under the curve of 0.716, with an accuracy of 0.700, sensitivity of 0.800, and specificity of 0.600. Permutation testing confirmed that the classification performance was above chance. Conclusion: Motor imagery ability may be related to a combination of motor, sensory, and cognitive functions rather than any single functional domain.
Objective: Rehabilitation is a health strategy implemented with specific programmes across multiple health conditions. This study aimed to identify rehabilitation programmes’ commonalities among health conditions and partners, as required by the PREPARE (Personalised REhabilitation via Novel AI PAtient StRatification StratEgies) project. Design: Qualitative study. Subjects/Patients: Seven rehabilitation programmes in Europe covering diverse health conditions were chosen according to PREPARE research needs for their availability of large clinical databases. Methods: The Guideline for Interventions Description in Rehabilitation (GUIDE-Rehab) was used to describe targets, components, and ingredients of rehabilitation programmes. These elements were mapped to the International Classification of Functioning, Disability, and Health (ICF) domains. Results: The programmes’ interventions covered all ICF domains collectively, but not individually. Body functions and structures were the most frequent domains, whereas participation and contextual factors were underrepresented. Similar components (e.g., exercise, orthoses) were applied to different objectives depending on the underlying intervention theory. Pharmacological and surgical elements were also integral parts of rehabilitation programmes. Conclusion: We found differences and incomplete coverage of ICF domains in highly specialized programmes, incorporating organ-based and functioning-based approaches. Future studies should check (i) the generalizability and (ii) if results are justified by differences among health conditions or due to incomplete rehabilitation programmes/description.
PURPOSE:To determine the effects of kinesiology taping on reduced limb oedema using shear-wave elastography. METHODS:A randomized trial with concealed allocation and intention-to-treat analysis. Fifty patients with limb oedema were randomly allocated to 2 groups: kinesiology taping at 25% tension applied to the oedematous tissue (25% kinesiology taping), and kinesiology taping at 0% tension applied to the oedematous tissue (0% kinesiology taping). The primary outcome was the elastic coefficient of shear-wave elastography (dermis and adipose layers), and the secondary outcome was limb circumference, which were assessed at days 0, 9, and 16. RESULTS:Compared with the 0% kinesiology taping at day 9, the 25% kinesiology taping significantly reduced the elastic coefficient of the dermis layer (12.57 kPa, 95% CI 4.97 to 20.16, p = 0.001) and adipose layer (5.29 kPa, 95% CI 2.20 to 8.38, p < 0.001), and the length of limb circumference (2.18 cm, 95% CI 0.79 to 3.56, p < 0.001). The benefits of the dermis layer (p = 0.002) and adipose layer (p = 0.005), and the limb circumference (p < 0.001) were maintained at day 16. These findings demonstrate the sustained biomechanical improvements of oedematous tissues induced by 25% kinesiology taping, providing objective clinical evidence supporting the application of kinesiology taping for limb oedema management. CONCLUSION:Kinesiology taping at 25% tension reduces the elastic coefficient and limb circumference of limb oedema. We recommend kinesiology taping as a complementary, synergistic adjunct to limb oedema in patients with severe hyper-dependency.
Importance: Multimodal prehabilitation improves outcomes in colorectal surgery, but its effectiveness and cost-effectiveness before metabolic and bariatric surgery are unknown. Objective: To evaluate the effectiveness and cost-effectiveness of a 6-week multimodal prehabilitation programme compared with standard preintervention education in patients undergoing bariatric surgery. Design, setting, and participants: Propensity score matched cohort observational study at Shanghai Tenth People’s Hospital, China, January 2022 to January 2025. Sixty prehabilitation patients were matched 1:1 to 60 controls from 254 standard care candidates using nearest-neighbour matching on the logit of the propensity score. Follow-up was 12 months. Interventions: A 6-week programme of supervised exercise, nutritional counselling, and psychological support vs 2 standard preoperative counselling sessions. All patients underwent Roux-en-Y gastric bypass or sleeve gastrectomy. Main outcomes and measures: Total weight loss at 12 months. Secondary outcomes included body composition, metabolic parameters, functional capacity, patient-reported outcomes, safety, and healthcare costs. Results: Among 120 matched patients (mean [SD] age, 32.6 [5.2] years; 65.8% male; mean body mass index [BMI], 38.2 [3.2] kg/m2), total weight loss at 12 months did not differ between groups (23.7 [5.1] vs 23.4 [2.7] kg; difference, 0.3 kg; 95% CI, −1.3 to 1.8; p = 0.75). At 3 months, prehabilitation showed significantly greater weight loss (adjusted β = 2.85 kg; 95% CI, 1.77 to 3.93; p < 0.001), lower body fat, lower diastolic blood pressure, and higher Short Form-36 (SF-36) mental scores. All differences were attenuated by 6 months. No serious adverse events occurred. Total costs were modestly higher in the prehabilitation group (mean, ¥84 843 vs ¥78 051), a difference attributable almost entirely to the prehabilitation programme itself; because the incremental effect on weight loss at 12 months was not statistically significant, a meaningful incremental cost-effectiveness ratio could not be estimated. Conclusions and relevance: A 6-week multimodal prehabilitation programme accelerated early postoperative weight loss and improved short-term functional outcomes but did not improve total weight loss at 12 months. Because prehabilitation added cost without a demonstrable difference in 12-month weight loss, a cost-effectiveness advantage could not be established. The dominant metabolic effects of bariatric surgery appear to override the incremental gains of preoperative conditioning over time.
Objective: To systematically evaluate the clinical efficacy of heat therapy for hand osteoarthritis. Design: Systematic review and meta-analysis of randomized controlled trials (RCTs). Subjects/Patients: 9 RCTs (n = 627) from 13 identified studies included in meta-analysis. Methods: Databases were searched up to 19 December 2025. Risk of bias was assessed via RoB 2.0. Standardized mean differences (SMD) and meta-regression were calculated using Stata 17.0. Results: Heat therapy significantly reduced Visual Analog Scale (SMD = −0.60, p = 0.01), Australian/Canadian Osteoarthritis Hand Index – Pain Score and Health Assessment Questionnaire (p < 0.05), and improved grip strength (SMD = 0.43, p = 0.01). No significant changes were observed for other outcome indicators. Subgroup analysis showed multimodal therapy (paraffin: heat + mechanical compression; mud: heat + chemical/mechanical stimulation) outperformed monotherapy (-heated gloves: pure thermal) for pain (SMD = –0.85) and grip strength (SMD = 0.55). Additionally, meta--regression analysis found that longer single -treatment duration (p = 0.03) and higher weekly t-reatment frequency (p = 0.04) were key moderators for better grip strength recovery. Conclusion: Heat therapy, especially multimodal approaches, effectively alleviates short-term pain and improves grip strength in hand osteoarthritis. Clinicians may ensure adequate treatment frequency and duration to optimize outcomes.
Objective: Post-COVID-19 condition (PCC) is associated with persistent cognitive dysfunction and fatigue, but limited evidence is available regarding long-term outcomes beyond one year. Design: Longitudinal follow-up assessment. Patients: Patients who had been previously hospitalized or treated in primary care after COVID-19 infection. Methods: Cognitive performance (WAIS-III subtests, Rey Complex Figure, RAVLT, and D2 Test of Attention) and fatigue (MFI-20 and MFS) were examined in 82 participants at 18 months post-infection; 59 of these participants were reassessed at 36 months. Activity limitations were evaluated using structured interviews. Results: At 18 months, the scores on most cognitive tests were significantly below expected premorbid levels (mean differences: 7–17 T-points). At 36 months, deficits persisted in most domains, with only WAIS Matrices and D2 KL showing modest improvement (Cohen’s d: ~0.4). Fatigue remained high across all dimensions of MFI-20, and 75–78% of patients exceeding the mental fatigue cut-off of MFS. Self-reported cognitive impact and activity limitations showed minimal change over time. Conclusions: Post-COVID-19 cognitive dysfunction and fatigue remain prevalent for up to three years post-infection, particularly affecting attention, processing speed, and working memory. These deficits pose substantial barriers to daily functioning and return to work, highlighting the need for targeted rehabilitation strategies.
Objective: To determine whether adding tailored primary care rehabilitation to Device-Aided Therapy in Parkinson’s disease improves outcomes more than Device-Aided Therapy alone. Design: Open randomized controlled intervention trial. Subjects/Patients: Parkinson’s patients initiating Device-Aided Therapy. Methods: Participants were randomized to receive standard care either with or without 3 months of tailored primary care rehabilitation. The primary outcome was Assessment of Motor and Process Skills, while secondary outcomes included cognitive measures and overall treatment efficacy. Results: The study was completed by 45 of 54 included patients. The primary outcome variable indicated that rehabilitation resulted in better maintenance of patient motor skills at 6 and 12 months. However, among several secondary measures, only perceived health improved more in the intervention group. Motor fluctuations improved in both groups and several other disease-specific scales demonstrated non-significant improvements. The rehabilitation group showed better cognitive performance at 12 months. Conclusion: Motor skills and perceived health were improved by a 3-month rehabilitation period after the start of Device-Aided Therapy for advanced Parkinson’s disease. An observed positive effect of rehabilitation on cognition in the first year after the therapy requires further confirmation.
OBJECTIVE:To compare timed stair test performance between individuals with knee osteoarthritis and healthy older adults, examine reliability under loaded and unloaded conditions, explore correlations with functional measures, and identify optimal cut-off times. DESIGN:Cross-sectional study. SUBJECTS/PATIENTS:Sixty individuals with knee osteoarthritis and 30 healthy older adults. METHODS:Participants completed unloaded and loaded timed stair test trials 7 days apart. Knee strength, balance, mobility, and self-reported outcomes were assessed. RESULTS:Mean completion times for osteoarthritis participants were 23.91 s (unloaded) and 25.40 s (loaded). Intra-rater (ICC3,1 = 0.951-0.990 across raters and assessment days) and inter-rater (ICC3,2 = 0.999 [unloaded] to 1.000 [loaded]) reliabilities were excellent. Test-retest reliability was good for loaded (0.835) and excellent for unloaded (0.918) conditions. Times correlated negatively with affected side knee strength, balance, and confidence, and positively with pain severity, mobility tests, and daily activity difficulty. Optimal cut-offs were 18.67 s (unloaded) and 19.94 s (loaded), demonstrating sensitivities of 70.0% (unloaded) and 68.3% (loaded), a specificity of 86.7%, and area under the curve values of 0.78 (unloaded) and 0.77 (loaded). CONCLUSION:The timed stair test is a reliable, valid, and practical measure of functional performance in knee osteoarthritis, effectively distinguishing movement capability under loaded and unloaded conditions.
Background: Neurogenic bladder causes impaired bladder emptying, urinary complications, and reduced quality of life. This trial evaluated whether structured multimodal autonomous bladder training improves bladder function in patients with neurogenic bladder. Methods: In this single-centre randomized controlled trial, 168 adults were assigned 1:1 to autonomous bladder training plus routine rehabilitation care or routine care alone. The 4-week intervention included induced voiding, sensory awareness training, pelvic floor muscle training, bladder–sphincter coordination exercises, and bladder desensitization. The primary outcome was change in post-void residual urine volume (RUV) at 4 weeks. Secondary outcomes included urodynamic parameters, Neurogenic Bladder Symptom Score (NBSS), symptomatic urinary tract infection (UTI) requiring antibiotics, and adverse events. Results: At 4 weeks, RUV improved more with autonomous bladder training than with routine care (adjusted mean difference in change, –55.8 mL; 95% CI, –64.7 to –46.9). Maximum urinary flow rate, maximum detrusor pressure, and NBSS also favoured the intervention. RUV reduction ≥50 mL occurred in 79.8% versus 42.9% of participants. Symptomatic UTI requiring antibiotics occurred in 9.5% versus 27.4%, although urine culture confirmation was incomplete. Exploratory 12-week follow-up suggested partial maintenance of benefit. Adverse events were uncommon, and no serious adverse events occurred. Conclusions: Autonomous bladder training improved short-term urodynamic and patient-reported outcomes, with exploratory evidence of partial benefit maintenance at 12 weeks. Infection-related findings require cautious interpretation because culture confirmation was incomplete. Longer multicentre trials are warranted.
OBJECTIVE:To identify a 5-year medical and psychosocial vulnerability profile among adults living at home 1 year after severe TBI and examine associated early characteristics. DESIGN:Retrospective secondary analysis of a multicentre longitudinal cohort. SUBJECTS/PATIENTS:Adults aged 16 years or older with operationally defined severe traumatic brain injury, private residence at 1 year, linked 5-year follow-up, and complete data for 4 profile indicators. METHODS:Latent class analysis used 5-year rehospitalization, PHQ-9, GAD-7, and Satisfaction With Life Scale scores dichotomized with prespecified clinically interpretable thresholds. External rehabilitation outcomes and early associated factors were examined descriptively and with multivariable logistic regression. RESULTS:Among 2,835 participants, a 2-class solution identified a lower-vulnerability profile (n = 2,361) and a multidomain vulnerability profile (n = 474). The latter showed more depressive symptoms, anxiety symptoms, low life satisfaction, and rehospitalization, with poorer 5-year functioning, participation, health, productive status, and higher frequency of non-private residence. Better 1-year global outcome was protective; female sex, preinjury illicit drug use, and living alone at 1 year were associated with assignment to this profile. CONCLUSION:Home return after severe traumatic brain injury should be treated as a transition point for longitudinal rehabilitation surveillance.
OBJECTIVE:To investigate lung function and ventilatory response during cardiopulmonary exercise testing in adults with cerebral palsy and assess the relationship between perceived breathlessness and breathing reserve at maximal exertion. DESIGN:Prospective, cross-sectional study. Inclusion period October 2023-June 2024. SUBJECTS:Adults with spastic cerebral palsy, Gross Motor Function Classification Score (GMFCS) I-III (n = 100). METHODS:Spirometry and cardiopulmonary exercise testing were conducted. Ventilatory response during exercise was assessed via tidal volume and respiratory rate. Perceived breathlessness was compared with breathing reserve at maximal exertion. RESULTS:89 participants completed all tests (GMFCS I = 62, GMFCS II = 20, GMFCS III = 7); 90% had lung function within normal limits. Age- and sex-adjusted maximal oxygen uptake was lowest in group III (p < 0.01). At maximal exertion, 70% had breathing reserve < 20%, indicating ventilatory limitation. Breathing reserve did not significantly differ between those who did and did not report breathlessness as the limiting factor at maximal exertion. Tidal volume and respiratory rate showed expected values at maximal exertion. CONCLUSION:Lung function was normal in most participants, yet ventilatory limitations were common during maximal exercise. Perceived breathlessness was not related to breathing reserve at maximal exertion.
