BACKGROUND:Rehabilitation following knee replacement typically includes joint mobilization, active and functional exercises. Recent studies have explored combining mirror-neuron system stimulation techniques with traditional rehabilitation, yielding promising results. This systematic review assessed the comparative effectiveness of Conventional Physiotherapy (CPT) combined with Mental Stimulation Strategies (MSS) versus CPT alone in improving pain and functional outcomes after knee replacement. METHODS:We conducted a systematic review and meta-analysis of Randomized Controlled Trials (RCTs). Two authors independently searched PubMed, CENTRAL, and Web of Science databases for articles comparing MSS in addition to CPT to CPT alone after knee replacement. The same authors independently extracted data, applied the Cochrane Risk of Bias 2 (RoB 2.0), conducted meta-analyses, and applied the GRADE for the certainty of evidence. Primary outcomes included pain, quadriceps strength, and Range of Motion (ROM). Secondary outcomes included mobility and motor function. Subgroup analysis was performed for the outcome pain and pROM, categorizing studies according to the type of mental stimulation technique used. RESULTS:We included 12 RCTs (324 patients). Meta-analyses showed effects favoring MSS in addition to CPT over CPT alone both in pain reduction (mean difference [MD] 1.23 cm, 95% confidence interval [CI] 0.72-1.75; N.=9; low certainty of evidence) and in quadriceps strength improvement (standardized mean difference 0.61, 95% CI: 0.21-1.02; N.=6; low certainty of evidence). No significant improvements were found for pROM (MD=1.68°, 95% CI: -1.55-4.91; N.=6; very low certainty of evidence) and active extension ROM (MD=0.15°, 95% CI: -0.28-0.75; N.=4; very low certainty of evidence). Regarding secondary outcomes, meta-analyses showed significant improvements in both mobility and motor function. Subgroup analysis revealed that both Action Observation Training and Motor Imagery, in addition to CPT, provided greater benefits for the outcome pain when compared to CPT alone. In contrast, neither technique appeared to offer additional benefits for pROM. CONCLUSIONS:The systematic review with meta-analysis showed a statistically significant benefit of MSS over CPT in motor and functional outcomes; however, the effect did not reach the minimal clinically important difference (MCID) for any studied outcome and, given the low certainty of evidence, warrants cautious interpretation and highlights the need for further studies.
BACKGROUND:Multiple sclerosis (MS) is a chronic neurodegenerative disease frequently associated with balance impairments, gait disturbances, and cognitive deficits. Dual-task training (DTT), integrating simultaneous motor and cognitive tasks, has been proposed as a rehabilitation strategy to improve functional performance. This systematic review with meta-analysis aimed to evaluate the effectiveness of DTT on postural balance and gait speed in people with MS (PwMS). METHODS:A systematic review with meta-analysis was conducted following PRISMA 2020 guidelines and the Cochrane Handbook recommendations. Randomized controlled trials assessing DTT effects on balance and gait in PwMS were included. Databases searched included PubMed/MEDLINE, Scopus, Web of Science, CINAHL Complete, and ScienceDirect. Risk of bias was assessed using the Cochrane Risk of Bias tool, and methodological quality was evaluated with the PEDro scale. Pooled effects were calculated using standardized mean differences (SMD) with 95% confidence intervals (CI) under a random-effects model. RESULTS:Seventeen randomized controlled trials including 649 participants were analyzed. Improvement was defined as score increases for BBS and gait speed, and decreases for TUG and posturography. DTT significantly improved functional balance (SMD=0.96; 95% CI 0.32-1.60), dynamic balance (SMD=-0.28; 95% CI -0.50 to -0.06), and static balance with eyes open (SMD=-0.33; 95% CI -0.62 to -0.04). Gait speed also showed significant improvement (SMD=0.26; 95% CI 0.09-0.44). Evidence quality ranged from low to moderate. CONCLUSIONS:Dual-task training may represent a promising intervention to improve balance and gait speed in PwMS. However, methodological heterogeneity and risk of bias warrant cautious interpretation. Future large-scale trials with standardized protocols and long-term follow-up are needed.
BACKGROUND:Artificial intelligence is increasingly applied to rehabilitation; however, persisting gaps in research, such as methodological heterogeneity, poor reporting, and lack of validation, reduce clinical translation. Living systematic reviews offer a dynamic approach to continuously monitor evolving evidence. The aim of this first update up to May 31st, 2025 is to expand current evidence base, identifying emerging trends and persistent gaps. METHODS:A total of 784 studies were screened, and 95 new studies were included, for a cumulative total of 335 studies across the first release and the update up to May 31st, 2025. RESULTS:In this update up to May 31st, 2025, 95 new studies were included, bringing the cumulative dataset to 335 studies. A strong recent growth in publications was observed, with China and the USA as the main contributors. There is an increase in the clinical-oriented use of AI. Of note, there is a slight increase in the adoption of reporting guidelines. Methodological limitations persisted, particularly a lack of adoption of reporting tools dedicated to and validated for AI. Explainability remains inconsistently described and applied (28.4%) with a growth trend (+18.2%); and external validation is infrequent (13.7%). Although randomized controlled trials showed a slight increase, they remain underrepresented overall, a finding consistent with the OCEBM distribution, which is still predominantly weighted toward lower-to-moderate levels of evidence (Level 3-4). This highlights persistent gaps in high-quality evidence. CONCLUSIONS:Literature trends of the update of the living systematic mapping review REHALISE up to May 31st, 2025, compared to the first release, suggest a slight and gradual shift toward more clinically oriented applications, though robustness and reproducibility remain critical concerns.
BACKGROUND:Shoulder-hand syndrome (SHS) is a common complication after stroke, characterized by pain, edema, and functional impairment of the upper limb. Myofascial trigger points (MTrPs) play a key role in its pathophysiology. Kinesio taping (KT) and dry needling (DN) have been used individually for pain management, but their combined efficacy in post-stroke SHS remains unclear. AIM:This study aimed to examine the efficacy of Kinesio taping combined with dry needling in the management of MTrPs among patients with post-stroke hemiplegic shoulder-hand syndrome. DESIGN:A prospective, double-blind randomized controlled trial. SETTING:Rehabilitation department of a tertiary hospital. POPULATION:Eighty-four individuals diagnosed with SHS were enrolled and allocated to three intervention groups. METHODS:Participants were randomly assigned to three groups: DN alone (Group A, N.=28), KT alone (Group B, N.=28), and combined DN+KT (Group C, N.=28). All participants received conventional rehabilitation therapy. Assessments included the Visual Analog Scale, Activities of Daily Living score assessed via the Barthel Index, Fugl-Meyer Assessment for Upper Extremity, passive range of motion (PROM), and an 8-figure volumetric measurement. Evaluations were conducted before and after a 28-day treatment period. Data were analyzed using SPSS version 27.0. Paired t-tests were applied for within-group comparisons, and independent sample t-tests for between-group differences, with a significance threshold of P<0.05. RESULTS:Each group exhibited significant improvements across all outcome measures (P<0.05). Group C demonstrated superior results compared to both Group A and Group B in every metric (P<0.05). Statistically significant differences between Group A and Group B were observed only in the 8-figure volumetric measurement (P<0.05). CONCLUSIONS:The combination of DN and KT yields greater benefits than either intervention alone in alleviating pain, reducing edema, and improving functional outcomes in patients with SHS. CLINICAL REHABILITATION IMPACT:This combined approach offers an effective, non-pharmacological strategy that can be readily integrated into routine rehabilitation practice to enhance upper limb recovery, reduce disability, and improve quality of life in post-stroke patients with SHS.
BACKGROUND:The feasibility study "Psychosomatic Hybrid-Reha" was the first to examine the practicability of a program combining a 4-week inpatient phase with a subsequent 1-week digital "Bridge Week" in the home environment. AIM:To investigate the feasibility, acceptance and satisfaction, and to explore preliminary health-related and work-related outcomes of a psychosomatic hybrid rehabilitation program. DESIGN:Single-arm prospective, exploratory intervention study using a mixed-methods approach. SETTING:Psychosomatic hybrid rehabilitation in one German rehabilitation clinic. POPULATION:Adults aged 18-60 years with mental health conditions undergoing psychosomatic rehabilitation. METHODS:Electronic questionnaires were processed at beginning of rehabilitation, before Bridge Week, at the end of rehabilitation, and six months after completing rehabilitation. Outcomes included social participation, mental and physical health, health-related quality of life, work ability, vocational expectations, and program-related evaluations. RESULTS:Of 150 consenting patients (mean age 47.4±10.5; 78% female), 134 completed baseline measures, 92 completed the pre-Bridge Week assessment, and 75 completed the six-month follow-up. Non-responder analyses indicated higher age, poorer general health, higher psychological distress, lower work ability, and greater participation restrictions among dropouts. Feasibility and acceptance were high: >80% attended synchronous digital sessions, and 83% rated the Bridge Week as good or very good. Participation in asynchronous exercises was lower (50-65%). Exploratory complete-case analyses (N.=74) showed improvements from baseline to six months in social participation (IMET, P=0.002), depression, anxiety and stress (all P<0.001). Mental health-related quality of life increased (P<0.001), whereas physical health-related quality of life, resilience, self-efficacy and social support remained stable. Work ability improved (P<0.001), and negative vocational expectations declined (P=0.017). CONCLUSIONS:The psychosomatic hybrid rehabilitation program demonstrated high feasibility and patient acceptance, with promising improvements in psychosocial and work-related indicators. However, due to the single-arm design and selective dropout, no conclusions about effectiveness can be drawn. Hybrid models appear to complement - rather than replace -traditional inpatient rehabilitation and may offer a flexible, patient-centered expansion of existing care structures. CLINICAL REHABILITATION IMPACT:The study indicates that psychosomatic hybrid rehabilitation with a structured digital Bridge Week is well accepted by patients. Future controlled studies are needed to determine their effectiveness.
INTRODUCTION:Motivational interventions have been tested in addition to pulmonary rehabilitation in order to increase and prolong the benefits obtained, however it is not well established. Therefore, the aim of this study was to investigate whether motivational interventions increase the benefits of pulmonary rehabilitation in physical and psychosocial outcomes in patients with chronic obstructive pulmonary disease (COPD). METHODS:A systematic review of studies comparing pulmonary rehabilitation "with" versus "without" motivational techniques for adults with COPD was registred on PROSPERO (CRD42020162921) and performed in PubMed, Embase, EBSCO, PEDro, LILACS, the Cochrane Central Register of Controlled Trials, and Google Scholar. The outcomes analyzed were PADL, sedentary behavior, psychosocial factors, exacerbation, dyspnea symptoms, and patient self-efficacy after the intervention and after the follow-up period. The methodological quality and certainty of evidence were evaluated by PEDro Scale and GRADE, respectively. The data were meta-analyzed for the pooled studies and motivational technique subgroups. RESULTS:Ten studies with a total of 832 patients with COPD were included. The motivational techniques in trials used were behavioral interventions with and without pedometer-based feedback, and pedometer-based feedback alone. Half of the studies have good methodological quality. With a low to very low certainty of evidence, the meta-analyses showed that the addition of motivational techniques to pulmonary rehabilitation does not increase physical and psychosocial outcomes on the short- or medium to long-term. CONCLUSIONS:Despite efforts to incorporate motivational strategies into pulmonary rehabilitation for individuals with COPD to prolong its benefits, current evidence does not support significant improvements in physical or psychosocial outcomes. Among the interventions evaluated separately, only behavioral strategies incorporating pedometer-based feedback demonstrated potential to increase daily step counts in the medium to long term. However, the certainty of the available evidence is still rated as low to very low.
Sarcopenia is a progressive and generalized disorder of skeletal muscles associated with accelerated loss of muscle mass and function. Individuals suffering from sarcopenia need rehabilitation services due to its significant impact on their functional abilities. The aim of this evidence-based position paper (EBPP) is to improve Physical and Rehabilitation Medicine (PRM) physicians' professional practice in sarcopenia. A systematic review of the literature and a consensus procedure by means of a Delphi method process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. The systematic literature review is reported together with the 25 main recommendations resulting from the Delphi procedure. It is recommended that PRM physicians play a significant role in taking preventive measures for sarcopenia in older individuals and in developing an Individual Rehabilitation Project for maintaining and improving functioning and reducing disability in individuals with sarcopenia. This EBPP represents the official position of the European Union through the UEMS PRM Section and designates the professional role of PRM physicians in persons with sarcopenia.
BACKGROUND:Posturography could serve as an early predictor of recovery of postural control and balance, especially if structural parameters are identified. AIM:This study aimed to explore the predictive value of posturographic measures for motor recovery after stroke using post-hoc analysis of a clinical trial cohort, to generate hypotheses for future confirmatory studies. DESIGN:A post hoc analysis was conducted in a cohort of thirty-eight individuals with subacute post-stroke hemiparesis presenting with balance and gait impairments. SETTING:All participants were recruited from the Rehabilitation Department of the Rey Juan Carlos Hospital (Spain). POPULATION:Participants included in the study were individuals who had experienced a stroke. METHODS:Posturographic variables were collected at baseline and after 4 weeks, and their changes were correlated with functional outcomes at follow-up. Univariate and multivariate binary logistic regression models were used to examine whether improvements exceeding the minimum detectable change in mediolateral structural parameters were associated with better functional outcomes based on Berg Balance Scale (BBS) scores ("High response)". Internal validation of the model was performed using bias-corrected and accelerated (BCa) bootstrap resampling." RESULTS:Participants who showed significant improvements in all three structural parameters of the X-axis demonstrated a strong association with High response in the univariate model (OR=6.8; 95% CI: 1.20-35.56; P=0.03). This association remained independently significant in the multivariable analysis (adjusted OR 6.9; 95% CI: 1.13-42.09; P=0.04). In contrast, no significant associations were observed for anteroposterior parameters. CONCLUSIONS:X-axis-related posturographic variables may have potential as predictors of rehabilitation response after stroke; however, given the post hoc nature of this analysis, these findings should be considered exploratory and require confirmation in prospective studies. CLINICAL REHABILITATION IMPACT:Early improvements in mediolateral posturographic parameters may help identify individuals with stroke who are more likely to achieve meaningful balance recovery. However, given the exploratory, proof-of-concept nature of this study, these findings should be interpreted with caution and require confirmation in prospective studies, while potentially providing a starting point for future research in this area.
BACKGROUND:Post-stroke spasticity is common, disabling, and difficult to treat, and clinicians lack clear comparative evidence on which peripheral somatosensory stimulation (PSS) modality offers the greatest benefit. We aimed to compare and rank PSS modalities for reducing post-stroke spasticity. METHODS:We conducted a PRISMA-guided systematic review and frequentist network meta-analysis of randomized controlled trials including adults with stroke and clinically defined spasticity (Web of Science, Medline, PubMed, Cochrane Library, Embase; inception to November 1st, 2025; PROSPERO CRD4202512476). Eligible trials evaluated prespecified PSS modalities - transcutaneous electrical nerve stimulation (TENS/TEAS/TES), neuromuscular electrical stimulation (NMES), repetitive peripheral magnetic stimulation (rPMS), vibration, extracorporeal shock-wave therapy (ESWT), cryotherapy, and prolonged cutaneous/mechanical stimulation - versus sham/usual care or another active modality. Two reviewers independently screened records, extracted data, and assessed risk of bias using the 13-item Joanna Briggs Institute checklist. The primary outcome was end-of-treatment Modified Ashworth Scale (MAS). A fixed-effect network meta-analysis estimated by generalized least squares, preserving multi-arm covariance, generated pooled mean differences and treatment rankings (P-scores/SUCRA); inconsistency (design-by-treatment approach), small-study effects (comparison-adjusted Egger regression), and prespecified sensitivity analyses were used to test robustness. RESULTS:Of 1135 records identified, 38 RCTs met eligibility criteria and were included. The evidence network was predominantly control-centered with few head-to-head comparisons among active modalities. Compared with control (lower MAS indicates less spasticity), several interventions showed superior effects: rPMS (mean difference [MD] -1.34, 95% CI -1.54 to -1.14), cryotherapy (-0.99, -1.40 to -0.57), vibration (-0.56, -0.70 to -0.41), NMES (-0.45, -0.73 to -0.18), prolonged cutaneous/mechanical stimulation (-0.34, -0.53 to -0.16), and TENS (-0.18, -0.23 to -0.12). ESWT did not demonstrate a clear benefit (-0.10, -0.30 to 0.10). Ranking favored rPMS (P-score 0.990), followed by cryotherapy (0.860), vibration (0.676), NMES (0.567), prolonged cutaneous/mechanical stimulation (0.460), TENS (0.262), ESWT (0.161), and control (0.024). Global and local assessments revealed no material inconsistency, funnel plots and regression suggested no small-study effects, and results were stable across sensitivity analyses. CONCLUSIONS:Multiple PSS modalities reduce post-stroke spasticity on the MAS, with the highest probability of benefit observed for rPMS and cryotherapy, followed by vibration and NMES, while ESWT did not show a clinically meaningful effect. These findings can inform selection of PSS options in rehabilitation practice, but the control-centered, star-shaped network and limited head-to-head evidence highlight the need for rigorously concealed, intention-to-treat RCTs directly comparing leading modalities and optimizing stimulation parameters to refine clinical decision-making.
BACKGROUND:Idiopathic scoliosis represents a complex spinal alteration characterized by lateral curvature and rotation of the spine. Among the numerous factors influencing treatment response, the role of the apical vertebra in idiopathic scoliosis remains a topic of significant interest and debate. The apical vertebra, situated at the apex of the scoliotic curve, holds a pivotal position in determining the overall spinal alignment and, consequently, the efficacy of conservative treatments. Several studies have shown that patients with apical vertebrae located in the thoracic spine are more likely to have progression of their curves than patients with apical vertebrae located in the lumbar spine. Additionally, patients with apical vertebrae located in the upper thoracic spine are more likely to have poorer outcomes than patients with apical vertebrae located in the lower thoracic spine. Therefore, understanding the nuanced relationship between the characteristics of the apical vertebra and treatment outcomes is paramount for tailoring therapeutic strategies and optimizing patient care. AIM:This study aims to comprehensively analyze the influence of apical vertebra location and rotation on the outcome of conservative treatment of idiopathic scoliosis. DESIGN:This is an observational controlled cohort study nested in a prospective clinical ongoing database in patients with idiopathic scoliosis. SETTING:Inpatient and outpatient in Rome. METHODS:From a consecutive series of patients included in a prospective database, we selected 491 patients with Adolescent Idiopathic Scoliosis with curves of 20-40° (mean: 27.89°±5.15°), Risser grade 0-2 who were treated with a brace at 2 years minimum follow-up (mean: 53.62±49.63 months). X-rays were used to obtain Cobb degrees and torsion of the apical vertebrae (Perdriolle's method). Three outcomes were distinguished according to SRS-SOSORT criteria: correction, stabilization, and progression. The location and rotation of the apex vertebra and8 the degrees of the curve were analyzed using statistical analysis. RESULTS:The results of our study showed that, among 491 patients with a definite outcome, the Cobb mean value was 27.89±5.158 SD at baseline and 16.99±15.85 SD at follow-up (P<0.0001; R=0.3228). Perdriolle was initially 11.9±7.319 and 7.319±7.816 at follow-up (P<0.0001, R=0.4865). Overall, 411 patients (84%) achieved curve correction, and stabilization was attained in 70 cases (14%). Ten patients (2%) experienced curve progression, and one patient was recommended for surgery because the curve at follow-up was greater than 45°. The analysis of subgroups shows statistically significant differences in the means of L1 and D9, L1 and D8, L1 and D7, L2 and D7, and D12 and D7; the P values are less than 0.05 (Table I). Moreover, a significant correlation was observed between the apex vertebra and the mean Cobb correction (P<0.0001) (R=0.64). CONCLUSIONS:Our study demonstrates that the apical vertebra plays a significant role in the outcome of conservative treatment for AIS. Patients with apical vertebrae located in the thoracic spine, particularly in the upper thoracic spine, were more likely to have poorer outcomes compared to patients with apical vertebrae located in the lumbar spine. CLINICAL REHABILITATION IMPACT:These findings highlight the importance of considering the location of the apical vertebra when determining the prognosis and treatment plan for patients with AIS. Moreover, we can affirm that brace treatment is an effective method for the treatment of AIS, in fact, the majority of patients achieved curve correction and stabilization, with a low incidence of curve progression and surgery.
BACKGROUND: Goal setting in stroke rehabilitation requires assessing patients' functional status, which involves both recovery and compensatory processes following stroke, underscoring the importance of identifying valid biomarkers. Functional connectivity measures derived from functional magnetic resonance imaging (fMRI) signals, which reflect underlying biological states, may offer value for characterizing functional status. AIM: We tested whether functional connectivity correlates with functional status and discriminates post-stroke functional independence. DESIGN: Observational study. SETTING: Inpatient rehabilitation ward at Fujita Health University Hospital, Japan. POPULATION: Fifty-eight patients with stroke. METHODS: Resting-state fMRI data were used to compute group-sparse inverse covariance matrices, which were negated to estimate partial correlations representing direct functional connectivity. Correlations between connectivity measures and functional independence measure (FIM) scores were examined. Principal component analysis (PCA) was applied to extract dominant connectivity features from connections associated with functional status. Connectivity-based discriminative performance was evaluated using receiver operating characteristic analysis. RESULTS: Connectome mapping revealed significant positive correlations between total FIM scores and interhemispheric connectivity in homotopic perisylvian regions, including the insulae, superior temporal sulci and temporoparietal junctions. PCA extracted a major connectivity component whose strength demonstrated within-sample discrimination of functional independence. Lesions were predominantly located in subcortical regions. CONCLUSIONS: The results support a significant association between homotopic functional connectivity within perisylvian, multifunctional regions located at the intersection of lobes and post-stroke daily functioning. Intrinsic interhemispheric functional connectivity, assessed using fMRI, may offer valuable insights into post-stroke functional status. CLINICAL REHABILITATION IMPACT: These findings highlight a promising direction for developing connectivity-based rehabilitation strategies for stroke-related disability.
BACKGROUND:Adherence to pulmonary rehabilitation (PR) among individuals with chronic obstructive pulmonary disease (COPD) is suboptimal and highly variable, attenuating real-world benefits. We sought to quantify PR adherence and its determinants across domains and to develop a parsimonious, clinically usable risk model for non-adherence. METHODS:We performed a PRISMA-guided systematic review and meta-analysis of observational studies including adults with COPD (inception to June 30, 2025; PROSPERO CRD420251068914). Random- or fixed-effects models pooled adherence proportions and odds ratios (ORs) for prespecified determinants spanning disease, patient, treatment, system/health-care personnel, and socioeconomic domains. Pooled log-odds were mapped to logistic coefficients to construct candidate prediction models; performance was assessed by AUC, calibration, and decision-curve analysis. RESULTS:Twenty-eight studies (N.=17,903; 1999-2025) were included. The pooled adherence rate was 58.36% (95% CI 52.8-63.8; I2=97.6%). Adherence was higher in high-income settings (66.84%) than in upper-/lower-middle income settings (49.76%); highest in hybrid hospital-community programs (67.03%) versus facility-based (62.89%) and home/remote programs (53.91%); and lower during AECOPD phases (46.46%) than in stable COPD (61.96%). Non-adherence was associated with greater symptom/HRQoL burden (OR=1.35), higher treatment intensity (OR=1.97), smoking exposure (OR 3.26), depression (OR=1.35), and recent exacerbation (fixed-effects OR=1.62); protective factors included better exercise capacity (OR=0.41), higher educational attainment (OR=0.44), and higher income/SES (OR=0.61). A 16-variable model achieved AUC=0.802 with good calibration, while a four-predictor parsimonious model (smoking, exercise capacity, acute exacerbation, higher education) maintained robust discrimination (AUC=0.752), good calibration, and superior net benefit versus "treat all/none" across clinically relevant thresholds. CONCLUSIONS:PR adherence in COPD is modest and highly heterogeneous, shaped by disease burden, psychological/behavioral factors, program design, and socioeconomic context. The parsimonious model should be interpreted as an evidence-informed screening framework rather than a definitive individual-level prediction tool; external validation, local recalibration, and prospective testing are required before routine implementation.
BACKGROUND:Myelomeningocele (MMC) is a congenital anomaly associated with neurological and urological complications, including overactive bladder. Overactive bladder is manifested by symptoms such as urgent and frequent urination, incontinence, and recurrent urinary tract infection, all of which can negatively affect children's quality of life. AIM:To investigate the efficacy of pulsed electromagnetic stimulation on overactive neurogenic bladder in MMC children. DESIGN:Randomized controlled trial. POPULATION:Forty children with MMC and overactive neurogenic bladder. METHODS:Children were recruited and allocated randomly into two groups of equal sizes; their ages ranged from four to twelve years. The sham PEMS group received standard anticholinergic medical treatment and sham pulsed electromagnetic stimulation for 20 minutes, while the real PEMS group received active pulsed electromagnetic stimulation (PEMS) for 20 minutes along with the same medical treatment as the sham group. For each group, treatment was delivered three times/week for three consecutive months. Urodynamic studies (UDS) were conducted, and daily scores for the frequency and severity of incontinence episodes were recorded. All the measured outcomes were evaluated at baseline and three months post-intervention. RESULTS:After treatment, UDS variables increased significantly in the real PEMS group compared to the sham PEMS group; detrusor leak point pressure increased, as did maximum cystometric capacity, expected maximum cystometric capacity, and first uninhibited detrusor contraction volume, while daily incontinence scores significantly decreased. CONCLUSIONS:Adding pulsed electromagnetic stimulation to conventional therapy was associated with controlling neurogenic overactive bladder in MMC children. CLINICAL REHABILITATION IMPACT:Pulsed electromagnetic stimulation has a notable effect on the neurogenic overactive bladder in MMC children.
BACKGROUND:Lung disease has a significant impact on patients' functional capacity, Health-Related Quality of Life (HRQoL) and psychological well-being, often leading to psychological symptoms and conditions such as anxiety, depression and stress. Such psychological consequences can affect rehabilitation outcomes, although they are often underdiagnosed. In addition, positive psychological resources, such as coping strategies may play a crucial role in disease progression and rehabilitation success. This study aimed to assess the prevalence of these factors in this specific setting and to analyze correlations and potential influence of psychological factors and rehabilitation outcomes. AIM:To assess the prevalence of these factors in this specific setting and to analyze correlations and potential influence of psychological factors and rehabilitation outcomes. DESIGN:Prospective observational study. SETTING:Inpatient pulmonary rehabilitation unit. POPULATION:Overall, 101 patients affected by lung diseases. METHODS:Patients with pulmonary disease undergoing inpatient rehabilitation completed self-report questionnaires assessing stress, anxiety, depressive symptoms, and coping strategies. Rehabilitation outcomes were also recorded as part of usual care. RESULTS:Among the participants (mean age 73.5±8.4 years), psychological screening revealed a high prevalence of anxious (48.5%) and depressive (67.3%) symptoms. The female sample had significantly higher levels of anxiety (P=0.032) and stress (P=0.019) compared to males. Only coping strategies, but not psychological symptoms, were predictive of rehabilitation outcomes: problem solving was predictive of less improvement in perceived symptoms (P=0.012) and turning to religion was predictive of less improvement in fall risk (P=0.025). CONCLUSIONS:This study highlights the importance of developing personalized interventions to promote coping strategies as an integral part of multidisciplinary pulmonary rehabilitation programs in order to improve rehabilitation outcomes. CLINICAL REHABILITATION IMPACT:Routine admission screening for anxiety, depression, stress, and coping in inpatient pulmonary rehabilitation is warranted. Coping styles, rather than symptom severity, predict rehabilitation gains; therefore, integrating a targeted coping training and sex-sensitive intervention into standard programs may enhance rehabilitation outcomes.
BACKGROUND:Balance dysfunction often affects stroke patients. While our earlier research indicated that aquatic exercise therapy could help, the evidence was initially rated as very low. With new studies emerging, this research aims to update the evidence on the effectiveness of water-based exercise in improving balance for stroke survivors. METHODS:The study followed PRISMA guidelines, retrieving records from five databases (Medline, Embase, CENTRAL, CINAHL, and SPORTDiscus) up to July 1, 2025. Two researchers independently conducted a two-step screening of titles, abstracts, and full texts to select studies. Quality was assessed using the ROB2 tool, and data extraction followed a set protocol. All steps were independently performed by two authors, with a third resolving any disagreements. Data extraction followed a set protocol, with two authors independently handling literature screening, bias assessment, and data extraction. Discrepancies were resolved by consulting a third party. Data analysis was conducted using RevMan 5.4 and Stata, calculating combined effect sizes using either SMD or MD based on the Q test results, and choosing between random- or fixed-effects models. Sensitivity analysis was done with Stata 15.0, and publication bias was evaluated using funnel plots and Egger's test. Evidence quality was assessed with the GRADE system. RESULTS:A total of 29 RCTs involving 1075 stroke patients were included in this study. The results indicated that the water-based exercise can improve the balance function of stroke survivors based on BBS score with moderate effect size (N.=523, SMD=0.71, 95% CI: 0.28-1.14, P=0.001) and FRT(n=107, SMD=0.97, 95% CI: 0.32-1.61, P=0.003), while test time for TUGT in the intervention group was not improved (SMD=-0.46, 95% CI: -0.96 to 0.04, P=0.07). The quality of the evidence for BBS was assessed as moderate, and the quality of evidence for TUGT and MBI was assessed as very low. CONCLUSIONS:Moderate strength of evidence suggests that aquatic exercise therapy may improve the balance function of stroke patients. However, due to methodological limitations, inconsistent results, and clinical heterogeneity, this result should be interpreted with caution. Future research employing more rigorous study designs is necessary to substantiate these results.
BACKGROUND:Stroke survivors often struggle with dual tasks, which involve simultaneous motor and cognitive activities essential for daily life, but few studies have systematically compared how distinct cognitive domains affect gait and cognitive performance after stroke. AIM:This study aimed to 1) quantify dual-task costs (DTCs) in gait and cognition across seven cognitive task types; 2) identify cognitive domains producing the greatest interference during walking; 3) explore associations between dual-task performance and clinical measures of motor, balance, and cognition; and 4) determine the most sensitive dual-task paradigms for identifying susceptibility to cognitive-motor interference in individuals with chronic stroke. DESIGN:An analytical cross-sectional, laboratory-based within-subject design. SETTING:Neurorehabilitation laboratory. POPULATION:Fifty-three individuals with chronic stroke. METHODS:Participants performed the Stand and Walk for a 20 m Round Trip (SWR) test under single- and dual-task conditions involving seven cognitive or motor tasks targeting executive, attention, working memory, verbal fluency, and visuospatial domains. Gait parameters were recorded using a wearable motion system, and cognitive performance was measured as correct responses per second. DTCs were calculated for both gait and cognitive speeds. RESULTS:Dual-task walking significantly reduced gait speed across all conditions (P<0.001), with the greatest decrements observed during Word Association (-19.00±12.93%) and Serial Subtraction (-15.59±12.61%). These were accompanied by the greatest corresponding declines in cognitive speed (-12.48±17.31% and -17.50±20.80%, P<0.001). The Attention Number and Visual Fixation tasks elicited smaller gait costs (-5.65±12.46%, and -8.47±9.79%, respectively) but demonstrated high diagnostic specificity (86%). Dual-task performance correlated strongly with motor (r=0.565-0.646) and balance functions (r=0.534-0.611), and moderately with cognition. CONCLUSIONS:Dual-task walking significantly compromises gait and cognition after stroke, particularly during executive and working memory tasks. Better motor, balance, and cognitive functions were associated with superior dual-task performance. Although attention and visuospatial tasks imposed lower interference, their high diagnostic specificity indicates potential value as practical tools for identifying susceptibility to cognitive-motor interference. CLINICAL REHABILITATION IMPACT:Integrating dual-task protocols into stroke rehabilitation may enhance concurrent motor and cognitive recovery while providing sensitive tools for assessing mobility safety risks.
The growth of musculoskeletal ultrasound (US) has led to an increasing trend of US-guided interventions also/sometimes being performed by allied health professionals who lack formal comprehensive medical training. This international expert opinion - developed through structured consultation among 20 Physical and Rehabilitation Medicine (PRM) physicians from 14 countries across five continents - addresses the patient safety, ethical, and medicolegal concerns arising from non-physicians performing such interventions. A narrative literature synthesis was conducted and iteratively reviewed by all contributing authors whereas formal consensus methodology was not employed. Having reviewed the international regulatory landscape, including regulations from the United States, Europe (Germany, France, Italy, Spain, Scandinavian countries, and the United Kingdom), and the Asia-Pacific region; we highlight inconsistencies that may compromise patient welfare. We call upon PRM associations to develop unified position statements establishing minimum competency standards. Policy recommendations would include establishing international complication registries, implementing enforceable supervision protocols, strengthening informed consent requirements, and ensuring transparent provider identification. Through these measures, professional organizations, regulators, and healthcare institutions can promote patient safety, transparency, and consistent standards worldwide.
BACKGROUND:Robotic exoskeletons offer a promising tool for gait rehabilitation in individuals with spinal cord injury (SCI). However, evidence of their additive benefit over conventional therapy, particularly in non-acute, motor-incomplete SCI, remains limited. AIM:To evaluate the efficacy of the EKSO-GT™ exoskeleton, used in an "add-on" mode, on walking performance and related clinical outcomes compared to standard neurorehabilitation alone. DESIGN:Randomized, controlled, multicenter trial. SETTING:Rehabilitation centers. METHODS:Thirty-six patients with chronic, motor-incomplete SCI (AIS C/D, 1-5 years post-injury) were randomized to receive either 4 weeks of exoskeleton-assisted training followed by 4 weeks of standard rehabilitation (RC+E), or 8 weeks of standard rehabilitation alone (RC). The primary outcome was the proportion of participants achieving ≥ 10% improvement in walking speed (10-meter walk test) at 4 weeks. Secondary outcomes included gait endurance, muscle strength, spasticity, proprioception, pain and mood. RESULTS:At 4 weeks, 33.3% of RC+E vs. 46.7% of RC patients improved in walking speed (P=0.44); at 8 weeks, 43.8% vs. 66.7%, respectively (P=0.20). No significant between-group differences were found for any outcome, including endurance, strength, or pain. Both groups demonstrated clinically relevant within-group improvements over time. No adverse events occurred. CONCLUSIONS:In individuals with chronic, motor-incomplete SCI, robotic gait training using the EKSO-GT™ exoskeleton was safe and well-tolerated, but did not show a superior statistical effect on walking performance compared with conventional rehabilitation when delivered as a short-term add-on intervention. These findings should be interpreted within the context of the study and small sample size. Continued structured rehabilitation remains essential for functional maintenance and improvement in this population. CLINICAL REHABILITATION IMPACT:While robotic exoskeletons are feasible and safe in chronic SCI rehabilitation, their routine use as a short-term add-on to standard therapy may not yield additional functional benefits under the tested conditions. Emphasis should remain on comprehensive, individualized rehabilitation programs tailored to patient-specific needs. Larger, adequately powered studies are needed to confirm these findings.
