BackgroundIt remains unclear whether joint-line application of radial pressure wave therapy (RPWT) provides better outcomes than pain-site–guided application in knee osteoarthritis. We compared these strategies within a common exercise program.MethodsIn a single-center, open-label, three-arm randomized trial, adults aged 50–80 years received three weekly RPWT sessions (2,000 impulses, 2.0 bar, 10 Hz) targeting the two most painful points, the medial joint line, or both medial and lateral joint lines. All groups received supervised exercise and a subsequent home program. Pain intensity (NRS, 0–10) was primary and WOMAC total (0–96) secondary; four months was the primary assessment visit. We report the protocol-specified repeated-measures ANOVA and an exploratory post hoc reanalysis using baseline-adjusted mixed models for repeated measures. Four-month comparisons with pain-site–guided application were adjusted using the Holm method.ResultsOf 94 randomized participants, 82 provided post-baseline outcomes and 71 were assessed at four months. Mean pain and WOMAC scores improved from baseline in all three groups; ANOVA in 70 complete cases showed overall time effects (both p<0.001), with no evidence of group-by-time interactions. Exploratory four-month MMRM differences vs. pain-site–guided application were −0.01 NRS (95% CI −1.33 to 1.31) and −0.52 WOMAC (−10.78 to 9.74) for medial application, and 1.01 (−0.32 to 2.35) and 7.07 (−3.35 to 17.49) for combined application; none was significant after Holm adjustment. Imputation estimates were similar under a missing-at-random assumption, but findings remained sensitive to assumptions about unobserved outcomes. Six participants per group reported application pain (18.2%–20.0%), including three with concurrent erythema per group; the pain did not persist afterward, and no other adverse events were recorded.ConclusionsMean pain and WOMAC scores improved from baseline in all three groups. The primary ANOVA did not detect different trajectories; exploratory MMRM contrasts did not demonstrate four-month superiority. The estimates do not establish equivalence or support a preferred application site. Because all groups received RPWT and exercise, improvements cannot be attributed specifically to RPWT.Clinical Trial Registrationhttps://clinicaltrials.gov/study/NCT06622512, identifier NCT06622512.
BackgroundThe varied goals of postoperative management (PM) after arthroscopic rotator cuff repair (ARCR), including medication, immobilization, and rehabilitation, make recovery multifactorial and complex, which challenges the identification of prognostic factors for poor outcomes. The primary objective was to describe PM after ARCR and analytically identify groups with similar management pathways that could serve as prognostic strata in future analyses. The secondary objective was to compare the clinical outcomes of these groups at baseline, six and twelve months postoperatively.MethodsData were drawn from a Swiss-German multicentre ARCR cohort of 973 patients from 19 clinics. Standardized follow-ups at six weeks, six and twelve months captured medication use, immobilization practices, and rehabilitation details. Polytomous latent class analysis was applied to each PM domain to identify patient groups with similar management profiles. Group differences in Constant Scores (CS) up to twelve months were analysed using linear mixed models adjusted for relevant confounders.ResultsTwo distinct groups were identified for both medication and immobilization management, and four for rehabilitation. Baseline severity and management differed markedly between groups. For example, patients immobilized in abducted positions with delayed mobilization had more severe tears and lower baseline CS. Despite these differences and some divergence in the rate of improvement, absolute Constant Scores converged across all groups by twelve months, with between-group differences remaining below the minimal clinically important difference of 10.4 points.ConclusionUsing latent class analysis on real-world, patient-reported data, PM after ARCR could be structured into two medication, two immobilization, and four rehabilitation pathways. Despite differences in baseline severity and management approach, outcomes converged by twelve months, remaining below the minimal clinically important difference. These pathways reflected care driven by clinical presentation rather than standardized protocols and may serve as prognostic strata in future work, though causal conclusions cannot be drawn from this observational study.
BackgroundUpper-limb hemiparesis is a frequent, disabling post-stroke complication. While initial severity is a dominant predictor of long-term recovery, performing complex motor assessments is often challenging during the unstable, very acute phase.ObjectivesTo evaluate the association between very acute hand-finger paresis severity and subsequent subacute outcomes across multiple domains: motor impairment, motor capacity, and activities of daily living (ADL).MethodsThis retrospective cohort study included post-stroke individuals (N = 473) receiving continuous rehabilitation from acute to subacute phases between 2019 and 2021. Initial hand-finger motor paresis severity was assessed using the Stroke Impairment Assessment Set Finger-Function (SIAS-FF). Outcomes at hospital discharge were evaluated using SIAS-FF, SIAS Knee-Mouth (SIAS-KM) test for proximal function, the Simple Test for Evaluating Hand Function (STEF) for motor capacity, and Functional Independence Measure (FIM) selfcare items for ADL. Multivariable regression models (ordinal logistic regression and generalized linear models) adjusting for age and length of hospital stay were implemented to test associations between the acute hand-finger paresis severity and subacute outcomes.ResultsAnalyses included 356 participants (mean age, 66.7 years). Acute finger paresis severity (assessed at 1.7 days post-stroke) was associated with subacute outcomes (at 86.9 days) in multivariable regression models (p < 0.01). Participants with better SIAS-FF scores in the acute phase achieved better discharge outcomes across all measures, including SIAS-FF, SIAS-KM, STEF, and FIM selfcare scores, even after controlling for age and length of hospital stay.ConclusionsSeverity of hand-finger paresis in the very acute phase is significantly associated with global upper-limb recovery. The SIAS-FF is a simple clinical tool that provides useful information for estimating post-stroke functional outcomes.
ObjectiveBefore 2019, the Republic of Korea lacked a coordinated rehabilitation healthcare delivery system, which resulted in limited access to intensive rehabilitation during the subacute stage. To overcome this limitation, a specialized rehabilitation hospital system was implemented in 2020, whereby hospitals meeting predefined criteria were designated to provide intensive subacute rehabilitation. However, evidence regarding the effectiveness of the specialized rehabilitation hospital system is sparse. Therefore, this study evaluated changes in healthcare utilization for inpatient rehabilitation among patients with traumatic brain injury (TBI) before and after the implementation of the specialized rehabilitation hospital system.MethodsThis study used data from the National Health Insurance Service–Nationwide Health Insurance Database of the Republic of Korea. Patients were categorized into two groups: the case group, consisting of those admitted to a specialized rehabilitation hospital within 90 days of TBI onset, and the control group, consisting of those not admitted to a specialized rehabilitation hospital within 90 days of TBI onset. Propensity score weighting using the average treatment effect on the treated (ATT) was applied to improve comparability between the groups, followed by a difference-in-differences (DID) analysis of length of stay (LOS). Logistic regression was performed to identify factors associated with admission to a specialized rehabilitation hospital. Healthcare utilization pathways involving specialized rehabilitation hospitals and long-term care hospitals (LTCHs) within 90 days of TBI onset were evaluated.ResultsThe ATT-weighted DID analysis showed a significant 10.0% increase in LOS following implementation of the specialized rehabilitation hospital system (95% confidence interval [CI], 0.3–20.6; p = 0.043). The odds of admission to a specialized rehabilitation hospital were significantly higher in the post-implementation period than in the pre-implementation period (OR, 1.36; 95% CI, 1.18–1.55; p < 0.001). The proportion of patients who utilized a specialized rehabilitation hospital first increased from 4.0% to 7.2%, with significantly higher relative odds in the post-implementation period (OR, 2.00; 95% CI, 1.61–2.49; p < 0.001).ConclusionsImplementation of the specialized rehabilitation hospital system was associated with increased healthcare utilization and changes in post-acute healthcare utilization pathways among patients with TBI. These findings provide evidence regarding changes in healthcare utilization following implementation of the system.
BackgroundLimb-salvage surgery (LSS) for lower-extremity dedifferentiated liposarcoma (DDLPS) often leads to persistent functional deficits, impaired balance, and gait asymmetry due to extensive muscle resection. Evidence regarding long-term exercise-based rehabilitation (ExR) in this population remains scarce.MethodsA 68-year-old woman, 19 months post-LSS, completed an 18-month supervised ExR program integrating resistance, endurance, gait, and balance training. Assessments were performed at baseline (T0), 9 months (T1), and 18 months (T2). Clinical assessments included the 6-Minute Walk Test (6MWT), Mini-Balance Evaluation Systems Test (Mini-BESTest), Falls Efficacy Scale–International (FES-I), and Toronto Extremity Salvage Score (TESS). Instrumental evaluations comprised kinematic gait analysis during normal walking (NW) and fast walking (FW) using an inertial sensor, and physical activity monitoring via a tri-axial accelerometer.ResultsPost-intervention, positive trends were observed across all outcomes. NW gait speed increased by 0.40 m/s and 6MWT distance by 97 m, exceeding minimal clinically important differences. Step-length symmetry ratio (operated/non-operated limb) normalized in NW (1.16 at T0 vs. 0.98 at T2) and FW (1.13 vs. 1.00), while gait symmetry index increased from 85.0% to 94.7% in NW and 88.0% to 97.2% in FW. Mini-BESTest score (16 vs. 25), FES-I score (40 vs. 21), and TESS (62.7% vs. 100%) showed marked improvements. Daily steps increased from 3,534 to 6,757, while sitting time decreased from 459 to 318 min/day.ConclusionThe single-patient design and absence of a control condition prevent directly attributing the observed improvements to the rehabilitation program. However, these promising preliminary observations suggest that prolonged, individualized ExR may help target long-term deficits after LSS, warranting further investigation in larger prospective controlled cohorts.
