Objective To evaluate the effectiveness of telerehabilitation-delivered pelvic floor muscle training (PFMT) for women with stress urinary incontinence (SUI), focusing on clinical outcomes, adherence, satisfaction, and healthcare accessibility. Data Sources A systematic search was conducted across four electronic databases: Embase, Scopus, CINAHL, and MEDLINE, in June 2024 and updated in May 2026. Study Selection Eligible studies were randomised controlled trials (RCTs) examining PFMT delivered via virtual platforms (e.g., mobile applications, video conferencing, or internet-based programs) for women (≥18 years) with SUI. A total of 13 RCTs met all inclusion criteria. Data Extraction Two independent reviewers extracted data regarding study characteristics, clinical outcomes, and implementation metrics (adherence and satisfaction). Methodological quality was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. Data Synthesis Due to substantial methodological and clinical heterogeneity, findings were synthesized narratively using the Synthesis Without Meta-analysis (SWiM) reporting guidelines. Digital interventions consistently produced significant subjective reductions in SUI symptoms and improvements in condition-specific quality of life (QoL). Telerehabilitation often demonstrated superior clinical outcomes and higher adherence compared to passive management or no-treatment controls. When compared to active conventional care, such as face-to-face physiotherapy or paper booklets, digital tools generally showed comparable rather than superior efficacy. Adherence was a primary mechanism for success, though technological complexity was a barrier in some protocols. Interventions were safe, with no serious adverse events reported. Conclusions Telerehabilitation-delivered PFMT has potential as a safe, feasible, and effective modality for managing SUI. It offers a robust, scalable alternative to traditional care, particularly by improving accessibility for women facing geographical or logistical barriers.
OBJECTIVE:To explore clinicians' ethical considerations regarding the use of prediction models in clinical decision-making in hand and wrist care. DESIGN:We conducted semi-structured interviews and analysed them using hermeneutic-interpretive phenomenology. An example prediction model was used to predict whether a patient will achieve the improvement they aim for in a domain relevant to them, given their baseline score. SETTING:Data were collected in the Netherlands from two specialized clinics for hand and wrist care and two academic hospitals. PARTICIPANTS:We purposefully selected seven hand surgeons and five hand therapists. INTERVENTIONS:Not applicable MAIN OUTCOME MEASURE: Semi-structured interviews RESULTS: We identified four main themes. First, clinicians acknowledge the patient's voice in shared decision-making, but ultimately, they decide. Second, clinicians want to maintain their autonomy in treatment decisions because they have a strong clinical intuition and feel that a prediction model will never be as good as their clinical judgment. Third, deviating from predictions is sometimes needed due to equity issues, the right to receive care, and the principle of striving for the least invasive treatment. Fourth, clinicians require sufficient information to build confidence in using the prediction model effectively. CONCLUSIONS:Clinicians consider prediction models ethically acceptable when they support, rather than replace, clinical judgment. Their main concerns are preserving professional autonomy and responsibility, respecting patient needs, ensuring equitable access to care, and being able to deviate from predictions when necessary. As prediction models improve, increased accuracy and transparency may enhance trust but may not resolve broader ethical issues, including patient preferences, fairness, responsibility, and accountability. Addressing these concerns is an important step toward enabling prediction models to support meaningful patient involvement, which could contribute to shared decision-making and improve quality of life.
OBJECTIVE:To determine whether compression bandaging (CB) alone is non-inferior to CB combined with manual lymphatic drainage (MLD) in terms of reducing limb volume, tissue stiffness, and skin/subcutaneous thickness during the intensive phase of Stage 2-3 lower extremity lymphedema (LEL) treatment. DESIGN:A single-blind, randomized non-inferiority trial. SETTING:xxx University, Department of Physiotherapy and Rehabilitation, xxx Physical Therapy and Rehabilitation Training and Research Hospital. PARTICIPANTS:A total of 32 extremities with Stage 2-3 LEL were randomly assigned to either the CB group (n = 16) or the CB+MLD group (n = 16). Thirty-one extremities completed the study (CB: n = 16; CB+MLD: n = 15). INTERVENTIONS:Interventions were administered 5 days a week for 4 weeks. The CB group received CB alone, while the CB+MLD group received a combination of compression bandaging and MLD. MAIN OUTCOME MEASURES:The primary outcome was percentage volume reduction (PVR), with a pre-specified non-inferiority margin (Δ) of -5%. Secondary outcomes included tissue stiffness measured via SkinFibroMeter, and skin and subcutaneous thickness evaluated using ultrasound at 17 standardized points across the lower extremity. RESULTS:Both groups achieved significant reductions in limb volume (p<0.001, Cohen's d: 1.35 for CB, 1.49 for CB+MLD). No significant difference in PVR was observed between the CB (19.67±8.47%) and CB+MLD (22.23±8.74%) groups (p=0.466). The 95% confidence interval for the mean difference in PVR was [-4.57,9.68], which remained within the field non-inferiority margin. Both groups also demonstrated significant improvements in distal tissue stiffness (p<0.001, d: 1.27 for CB, 1.32 for CB+MLD) and subcutaneous thickness (p<0.001, d: 1.06-1.24), with no significant inter-group differences (p>0.05). CONCLUSIONS:CB alone is non-inferior to CB+MLD for reducing edema and tissue stiffness in Stage 2-3 LEL. Consequently, prioritizing appropriate compression may allow for more cost-effective and less time-consuming treatment strategies without compromising therapeutic efficacy.
Objective To examine gait speed changes in randomized controlled trials (RCTs) of motor lower extremity (LE) stroke rehabilitation across various interventions, compared to conventional care or sham controls, at different time points post-stroke. Data Sources A meta-analysis was conducted, in accordance with PRISMA guidelines. Systematic searches in MEDLINE, Embase, CINAHL and PsycINFO, were conducted for RCTs published in English, up to December 2024. Study Selection RCTs were included if they examined a LE motor rehabilitation intervention in adults with stroke, used conventional care or sham as control group, and evaluated gait speed. Data Extraction Two independent reviewers performed the screening of title/abstract, full-text screening and data extraction, with an independent reviewer available for conflict resolution. Data Synthesis A total of 106 RCTs met the inclusion criteria; 63.2% were conducted in the chronic phase post-stroke. Five interventions were evaluated in both the acute/subacute and chronic phases, of which, three, treadmill training, body weight-supported treadmill training, and training with exoskeletons, showed significant benefits in the acute/subacute phases, compared to conventional care, however, none showed any significant benefit in the chronic phase. Of the interventions evaluated solely in the chronic phase, overground walking training, trunk training, mirror therapy, and virtual reality demonstrated significant benefits compared to conventional care. Interventions studied during the acute/subacute phases post-stroke demonstrated significantly greater magnitude of improvement in gait speed compared to those in the chronic phase. Conclusions Overall, interventions for LE motor function post stroke evaluated in the acute/subacute phase demonstrated a greater magnitude of effect on gait speed compared to those assessed in the chronic phase, although more RCTs are being conducted in the chronic phase.
Objective To examine Inpatient Rehabilitation Facilities, market, and regional characteristics associated with operational AI adoption across three functional domains and breadth of use. Design Retrospective cohort study using multivariable linear probability models. Setting United States Inpatient Rehabilitation Facilities (IRFs). Participants 276 IRFs (providing 766 hospital-years of data) that responded to the American Hospital Association (AHA) Annual Survey (mean response rate of 58%). Interventions Not applicable (observational study). Main Outcome Measure(s) Any operational AI use; domain-specific use (predicting patient demand, staff scheduling, and optimizing operational efficiency); breadth of adoption. Results Operational AI use more than doubled from 11.1% in 2021 to 24.9% in 2024, led by system-affiliated, non-profit, and teaching facilities. Organizational structure explained 50-67% of adoption variance, exceeding the combined role of market conditions, volume, and region. Optimizing operational efficiency was the dominant domain, reaching 20.0% by 2024, compared with 8.1% for predicting patient demand and 7.0% for staff scheduling. Staff scheduling declined after 2022, suggesting domain-specific implementation barriers beyond resource constraints. Conclusions Operational AI in IRFs is spreading along the same organizational lines as earlier health IT, concentrating in system-affiliated, non-profit, and teaching facilities. Reaching smaller, independent, and for-profit IRFs will take targeted financing and shared infrastructure. Staff-scheduling tools lag the most, so wider use of these tools will depend on clear rules and clinician input on how algorithms guide staff schedules.
Objective To examine whether lower multidimensional prestroke rehabilitation reserve was associated with adverse mobility/self-care status after incident stroke. Design Harmonized longitudinal cohort study. Setting Population-based aging cohorts in China, the United States, England, and continental Europe. Participants Adults who were stroke-free at prestroke assessment and reported incident stroke at follow-up (descriptive sample, N=7486; mean age, 70.0 years [SD, 10.2]). The first stroke-report interview typically occurred 2 to 3 years after the prestroke wave. Interventions Not applicable. Main Outcome Measures Adverse mobility/self-care status, defined as at least 2 limitations in walking, transferring, dressing, bathing, toileting, or stair climbing at the first interview reporting stroke. Results The adjusted sample included 7429 participants and 2104 events. Each 1-SD lower cohort-standardized prestroke rehabilitation reserve score was associated with 27.7% higher risk (risk ratio [RR], 1.277; 95% CI, 1.230-1.327). Descriptive adjusted risks were 20.6%, 26.0%, and 37.4% for high, intermediate, and low reserve, respectively; the low-vs-high adjusted risk difference was 16.8 percentage points (95% CI, 14.0-19.7). Results were consistent across cohorts and functional-overlap sensitivity analyses. The cohorts lacked harmonized National Institutes of Health Stroke Scale scores, acute treatment, and rehabilitation dose. Conclusions Lower prestroke reserve was associated with a higher subsequent mobility/self-care burden. The score may describe group-level vulnerability but is not an individual prediction or treatment-allocation tool. Future studies should test whether prevention or prehabilitation strategies targeting modifiable reserve domains can reduce poststroke disability.
Objective To estimate the effect of focal muscle vibration (FMV) on post-stroke upper limb spasticity and explore whether frequency, amplitude, or target joint moderates effects. Data Sources PubMed, EMBASE, Web of Science, CINAHL, PEDro, and Cochrane Central Register of Controlled Trials were searched from inception through March 2026. Study Selection Studies of adults with post-stroke upper limb spasticity were eligible if they applied FMV to the upper limb and reported the Modified Ashworth or Tardieu Scale. Controlled parallel, randomized crossover, and comparative repeated-measures studies were eligible, including peer-reviewed reports and preprints with sufficient outcome data. Data Extraction Two reviewers independently extracted data and assessed risk of bias. Hedges' g was calculated from pre-to-post change scores and synthesized with a three-level random-effects model (restricted maximum likelihood). Certainty was assessed with GRADE. The review was registered in PROSPERO (CRD420251181549). Data Synthesis Eleven reports representing 11 independent participant samples contributed 32 effect estimates from 285 participants assigned to or receiving an FMV condition. The three-level pooled effect was g=-0.526 (95% CI, -0.742 to -0.310; p<.001). All three frequency-band estimates favored FMV, with 95% CIs below zero, and no differences were detected among frequency bands (Wald; p=.948); continuous frequency was not associated with effect size (β=0.00117 per Hz; 95% CI, -0.00117 to 0.00352; p=.326). All 12 finger estimates were negative. Leave-one-out analyses retained confidence intervals below zero, and Egger's regression on 10 independent report-level aggregates suggested possible small-study effects (bias coefficient=-6.10; p=.002). Certainty in the primary outcome was moderate. Conclusions FMV probably reduces post-stroke upper limb spasticity. The antispasticity effect was observed across the 30-300 Hz range studied, with no frequency-related modification detected, and finger estimates showed the most uniform effect direction. These findings support flexible frequency selection within studied protocols. Larger trials are needed to refine amplitude, dose, and muscle targeting.
Objective To investigate the clinical validity of finger-worn accelerometers for providing a comprehensive assessment of upper-limb motor performance in individuals post-stroke in real-world environments, compared to wrist-worn accelerometers, and to examine how the clinimetric properties of wearable-based motor performance measures vary with the duration of patient data collection. Design Cross-sectional observational design. Setting Research laboratory and free-living environments. Participants Twenty-seven participants aged 18-80 years with ischemic or hemorrhagic stroke at least six months prior to enrollment and mild-to-moderate upper-limb impairment without severe range-of-motion restrictions were enrolled. Three participants were ineligible and four withdrew, resulting in a final cohort of 20 participants (N = 20). Interventions Not applicable. Main Outcome Measures Wearable-based motor performance measures derived from fine-hand movements, gross-arm movements, and the combination of fine-hand and gross-arm movements captured by finger-worn and wrist-worn accelerometers in naturalistic settings for 6.4 ± 1.8 days. Results Wearable-based motor performance measures from fine-hand movements demonstrated the strongest convergent validity with standardized clinical assessments of motor capacity and performance—including the Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Wolf Motor Function Test (WMFT), and Motor Activity Log (MAL)—as well as the strongest known-group validity in distinguishing impairment levels and the highest test-retest reliability, followed by measures from combined and gross-arm movements. Convergent validity and test-retest reliability improved with longer monitoring durations, with four days being sufficient to obtain accurate and reliable upper-limb measures. Conclusions Wearable-based motor performance measures from finger-worn accelerometers provide a more comprehensive assessment of upper-limb motor performance than those from wrist-worn accelerometers, supporting their use for real-world monitoring in individuals post-stroke. Furthermore, the improvements in clinimetric properties of wearable-based motor performance measures with longer monitoring durations highlight the importance of multi-day monitoring to mitigate day-to-day variability and ensure robust assessment.
OBJECTIVE:To assess the short-term (immediately post-intervention) and long-term (post-intervention follow-up) effects of exercise-based interventions and to compare the effects of different exercise modality for improving subjective and objective cognitive function. DATA SOURCES:A comprehensive literature search was conducted in PubMed, Scopus, Embase, Web of Science, and the Cochrane Library. STUDY SELECTION:Randomized controlled trials evaluating exercise-based interventions for cognitive outcomes in adult cancer patients were included. DATA EXTRACTION:Pairwise and network meta-analyses were conducted to estimate the standardized mean difference (SMD) with 95% confidence interval (CI). The Surface Under the Cumulative Ranking Curve (SUCRA) was used to estimate the intervention ranking probability. DATA SYNTHESIS:Twenty-seven studies (28 articles, 2,809 participants) were included. Exercise-based interventions significantly improved short- and long-term subjective cognitive function (SMD: 0.44, 95% CI: 0.27 to 0.61; SMD: 0.37, 95% CI: 0.16 to 0.57), executive function (SMD: -0.28, 95% CI: -0.43 to -0.14; SMD: -0.32, 95% CI: -0.56 to -0.08), working memory (SMD: 0.27, 95% CI: 0.14 to 0.41; SMD: 0.31, 95% CI: 0.06 to 0.55), and processing speed (SMD: -0.16, 95% CI: -0.31 to -0.01; SMD: -0.31, 95% CI: -0.55 to -0.07). In the short term, combined exercise and non-exercise intervention had the highest SUCRA ranking for subjective cognitive function (SUCRA: 93.50%), resistance exercise for executive function (SUCRA: 81.60%), multicomponent exercise for working memory (SUCRA: 77.74%), and mind-body exercise for processing speed (SUCRA: 78.39%). In the long term, aerobic exercise ranked highest for subjective cognitive function (SUCRA: 83.81%) and multicomponent exercise ranked first for executive function (SUCRA: 75.22%), working memory (SUCRA: 86.35%), and processing speed (SUCRA: 77.39%). CONCLUSION:Exercise-based interventions provide short- and long-term benefits across subjective and objective cognitive domains in cancer patients, with varying probabilistic advantages by exercise modality. No single modality demonstrated superiority across all outcomes. Further studies are warranted given the low to moderate certainty of evidence.
OBJECTIVE:To examine demographic differences in health outcomes among adults with mobility limitations who participated in the telewellness health promotion program Mindfulness, Exercise, and Nutrition to Optimize Resilience (MENTOR), and to assess the influence of social support on program outcomes. DESIGN:Retrospective secondary analysis of longitudinal survey data from participants completing pre- and post-assessments of the MENTOR program. SETTING:MENTOR is delivered remotely via a telewellness platform. PARTICIPANTS:Adults with mobility limitations (N = 599) who completed both assessments. INTERVENTIONS:MENTOR, an 8-week, 40-hour telewellness intervention incorporating mindfulness, exercise, and nutrition education, offered free to U.S. residents with mobility limitations. MAIN OUTCOME MEASURES:Change in overall wellness scores across physical, mental, and emotional domains. Differences were examined by age, sex, race, residence, education, income, disability onset, assistive device use, and functional limitation. Social support was assessed via employment, marital status, household composition, and perceived emotional support. RESULTS:MENTOR produced statistically significant improvements in wellness across participants, even after adjusting for demographic and social support variables. Individual characteristics modestly explained variation in improvement magnitude. Age and unmarried status slightly reduced gains. Higher baseline emotional support was linked to smaller improvements, suggesting greater benefit among participants with lower initial levels of perceived support. CONCLUSION:MENTOR improves wellness for adults with mobility limitations regardless of demographic or social support factors. Smaller gains among participants with higher baseline emotional support highlight the program's potential to particularly benefit individuals with mobility limitations who have lower initial levels of support.
OBJECTIVE:To compare the effectiveness of a 12-week complementary and alternative medicine (CAM) program for people with multiple sclerosis (pwMS) delivered by a therapist in a clinic (DirectCAM) versus self-initiated at home (TeleCAM). DESIGN:Pragmatic cluster-randomized controlled trial. SETTING:Forty-three clinics across Alabama, Mississippi, and Tennessee. PARTICIPANTS:A total of 759 adults with MS were enrolled (DirectCAM, n=382; TeleCAM, n=377). Eligible participants were aged 18-70 years, self-reported a diagnosis of MS, had a Patient-Determined Disease Steps (PDDS) score between 0 and 7, were able to use their arms or legs for exercise, and had physician clearance. INTERVENTIONS:Participants received the same 12-week CAM exercise program delivered either onsite by a therapist (DirectCAM) or at home using preloaded exercise videos (TeleCAM). MAIN OUTCOME MEASURE(S):Patient-reported outcomes included the Modified Fatigue Impact Scale (MFIS), the 36-Item Short Form Health Survey (SF-36) Pain domain, the SF-36 physical and mental component scores, and Godin Leisure-Time Exercise Questionnaire (GLTEQ). Performance-based outcomes included the Berg Balance Scale (BBS), the Five Times Sit-to-Stand Test (FTSST), the Timed Up and Go (TUG) test, the Timed 25-Foot Walk (T25-FW), the six-minute walk test (6MWT), and grip strength. Outcomes were assessed at baseline and 3, 6, and 12 months. RESULTS:Of the 759 participants across 43 clinics, 382 were assigned to DirectCAM and 377 to TeleCAM. No statistically significant between-group differences were observed for patient-reported outcomes at 3, 6, or 12 months. For performance-based outcomes, improvement in BBS from baseline to 12 months was greater in DirectCAM than TeleCAM (2.1 [95% CI, 1.4-2.9], adjusted P<.001). No statistically significant between-group differences were observed for changes in 6MWT, FTSST, or T25-FW. CONCLUSIONS:DirectCAM and TeleCAM produced comparable improvements in patient-reported outcomes. DirectCAM was superior only for BBS. Therefore, the hypothesis that TeleCAM would be superior to DirectCAM was not supported.
OBJECTIVES:This study aimed to compare 3 movement-evoked pain (MEP) calculation methods following commonly used performance-based tests in knee osteoarthritis and to investigate their construct validity, test-retest reliability, Standard Error of Measurement (SEM), and smallest detectable change (SDC). DESIGN:Test-retest reliability study as secondary analysis from an observational longitudinal study. SETTING:Department of Physiotherapy at the Federal University of São Carlos (Brazil). PARTICIPANTS:A total of 111 participants. INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURES:Three performance-based tests were performed on 2 visits. The Western Ontario and McMaster Universities Osteoarthritis Index was applied. Pain was measured using the Numeric Pain Rating Scale at rest and immediately after each task. Three MEP calculation methods were evaluated: MEP-index (postmovement minus rest), MEP-max (maximum pain across tasks), and MEP-avg (average postmovement pain). Differences among methods were analyzed using the Friedman test. Construct validity was assessed using Spearman correlation coefficient based on predefined hypotheses and reliability was assessed with intraclass correlation coefficients (ICCs). SEM and SDC were also calculated. RESULTS:Significant differences were found among all MEP methods (P<.001). Construct validity was confirmed only for MEP-avg (77.7%). Reliability was excellent for MEP-max (ICC=0.70, 95% CI 0.59-0.78) and MEP-avg (ICC=0.84, 95% CI 0.77-0.89), but poor for MEP-index (ICC=0.38, 95% CI 0.11-0.57). SEM and SDC were 1.43 and 3.9 for MEP-max, 1.33 and 3.7 for MEP-avg, and 1.53 and 4.2 for MEP-index. CONCLUSION:MEP-avg showed validity, higher reliability, and lower SDC, making it the preferred method for clinical research and practice.
OBJECTIVE:To validate the diagnostic properties of orthopedic tests and qualitative and quantitative high-resolution ultrasound-based (HRUS) assessments in the diagnosis of long head of the biceps tendon (LHBT) pathologies. DESIGN:Single blind prospective study evaluating orthopedic tests and HRUS diagnostic performances compared to surgery. SETTING:Hospital orthopaedic department. PARTICIPANTS:Seventy-one adults scheduled for open or arthroscopic shoulder surgery were included within six weeks of their scheduled surgery. INTERVENTION:Participants underwent a preoperative clinical examination, including the Speed's, O'Brien's, Uppercut, and Yergason's tests, and palpation of the bicipital groove, as well as both qualitative and quantitative HRUS evaluation of the LHBT. Afterwards, the LHBT was evaluated during surgery to confirm the diagnosis, with the surgeon blinded from the clinical and HRUS examination. MAIN OUTCOME MEASURE(S):Diagnostic properties were determined for 1) each individual orthopedic test and combinations of tests, 2) qualitative HRUS data alone and in combination with orthopedic tests, and 3) quantitative HRUS data. A receiver operating characteristic (ROC) curve was used to assess the ability of quantitative HRUS to discriminate the presence of LHBT tendinopathy. RESULTS:The overall diagnostic performance of the orthopedic special tests was low. Qualitative HRUS exhibited promising diagnostic properties for identifying full-thickness tears (Sensitivity 63%, Specificity 86%) and LHBT dislocation/subluxation (Sensitivity 38%, Specificity 81%). However, combining qualitative HRUS with orthopedic tests and participant age yielded the best properties (i.e., improvement in sensitivity and specificity across all LHBT diagnoses). The diagnostic performance of quantitative HRUS varied depending on the cut-off values used; the best results observed using a maximal surface area greater than 21 mm² (Sensitivity 55%, Specificity 86%). CONCLUSION:Qualitative HRUS shows promising diagnostic potential but should be used in conjunction with orthopedic tests. Further research is needed to validate these preliminary results and refine the pathological cut-offs values of quantitative HRUS assessments.
OBJECTIVE:To observe the respiratory function of individuals participating in a rehabilitation program with neuromuscular electrical stimulation (NMES). DESIGN:Cross-sectional study. SETTING:A tertiary care hospital offering outpatient care. PARTICIPANTS:A convenience sample of adults with chronic SCI (≥10 years), tetraplegia or paraplegia, classified as AIS A, B, or C. All participants had been enrolled in the NMES rehabilitation program for at least three years. Twenty-five individuals were recruited and allocated to two groups: group A, individuals with tetraplegia (n=6) and group B, individuals with paraplegia (n= 16). Three individuals were excluded from group B because they had lung disease prior to spinal cord injury. INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURE:Measurement of respiratory function using spirometry in individuals with SCI in a rehabilitation program. RESULTS:The spirometry was performed, measuring forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and Tiffeneau index. Overall, 77% completed the maneuvers satisfactorily. No participants reported dyspnea during daily activities. In Group A, mean FVC was 51% ±10.9 of predicted, FEV1 was 50.8% ±9.4, and Tiffeneau index was 101% ±3.7, with mean injury duration of 18 years ±6.7. In Group B, mean FVC was 90.3% ±12.7, FEV1 was 89.3% ±12.4, and Tiffeneau index was 99% ±4.7, with mean injury duration of 15 years ±5.8. Significant differences were found in FVC and FEV1 between groups (p < .001). CONCLUSIONS:Individuals with paraplegia demonstrated spirometric values within the normal range despite long-standing injuries, even at higher neurological levels. The tetraplegic individuals showed values around 50% of predicted. However, no abnormalities were detected on pulmonary auscultation, and no clinical symptoms were reported. These findings suggest that a potential clinical practice implications of NMES rehabilitation program is the preservation of respiratory function in individuals with chronic SCI.
OBJECTIVE:To evaluate the safety and usability of an exoskeleton designed for personal use in real-world settings in children with motor disability. DESIGN:Prospective, multicenter, open-label safety and usability study SETTING: Participants' homes and their usual community environments. PARTICIPANTS:Fifty children aged 2 to 17 years (25 boys, 25 girls) diagnosed with neurological or neuromuscular disease. INTERVENTION:Participants completed eight sessions using the Explorera personal exoskeleton in home and community settings guided by their caregivers and the researchers. MAIN OUTCOME MEASURES:Safety was assessed by monitoring adverse events, while usability outcomes included donning time, level of assistance required, user satisfaction (QUEST 2.0 questionnaire), and device usage data (usage time, number of steps, number of environments where the device was used). RESULTS:The device was used in 94% of planned sessions and no serious adverse events were recorded. Donning times averaged 4.7 ± 1.8 minutes, and satisfaction scores were high with median QUEST 2.0 scores of 4/5. The device was used equally in indoor (52.7%) and outdoor (47.3%) environments, including schools and playgrounds and the average time of use per session was 21.2 ± 15.1 minutes, while the average number of steps taken per session was 392.0 ± 244.0 steps. CONCLUSION:The study provides preliminary evidence that the pediatric exoskeleton is safe and usable in real‑world settings. Its use in the daily lives of children with motor disabilities may contribute to improved mobility and support participation in everyday activities, aligning with WHO recommendations for physical activity and the F-Words framework for child development.
OBJECTIVE:To predict self-care and mobility function at discharge from inpatient rehabilitation for adults with stroke using only variables from the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI), which are mandated in the United States by the Centers for Medicare and Medicaid Services. DESIGN:Retrospective cohort study. SETTING:Inpatient rehabilitation facilities (IRFs) in the United States. PARTICIPANTS:National sample (n=43,745) of adults with a primary diagnosis of stroke who were admitted to IRFs in FY2023. INTERVENTIONS:N/A MAIN OUTCOME MEASURES: Section GG self-care and mobility subscales. RESULTS:We used random forest regression, an ensemble machine learning approach that trains multiple models and combines their predictions to improve overall performance. We then created global summary trees from the random forest models to visually represent the outcome and aid in clinical interpretation. After data cleaning and quality checks, 39,870 records were available for analysis. Records were divided into training (n=26,580), validation (n=6,645), and test (n=6,645) datasets. Each model included 29 predictors. Random forest models explained 58% (RMSE=5.6) and 62% (RMSE=13.3) of the total variation in self-care and mobility outcomes, respectively, when applied to the test split. In both summary trees, the respective functional measure at admission was the strongest predictor. Bladder and bowel incontinence were strong predictors of both self-care and mobility outcomes at discharge. CONCLUSIONS:The results show that standard data elements from mandatory Medicare reporting can generate robust, clinically interpretable prediction models of self-care and mobility function at discharge from inpatient rehabilitation for adults with stroke. Application of such models in practice can inform treatment planning and early discharge preparation to support personalized rehabilitation approaches.
