Cochrane Rehabilitation continues to promote evidence dissemination and research quality in rehabilitation. The year 2024 marked a pivotal milestone with the transition from a field to a thematic group, officially named “Cochrane Rehabilitation, Functioning, and Disability.” This evolution broadens the scope to additional rehabilitation domains and strengthens global collaboration. Key activities included the production of clinically relevant evidence (with 21 new Cochrane Corners), development of methodological and educational projects (such as the General Index of Rehabilitation Knowledge and the ISPRM 2024 course), and the launch of strategic collaborations, including a joint initiative with the World Health Organization to synthesize health policy and systems research evidence. The Thematic Group structure introduces a unit-based organization to enhance global impact in evidence generation and implementation, with a mission centered on inclusivity, scientific rigor, and relevance across diverse contexts.
Bruck syndrome (BS) is a rare connective tissue disorder that describes a group of symptoms of arthrogryposis multiplex congenita associated with osteogenesis imperfecta. Patients with BS have a poor quality of life due to congenital multiple joint contractures, bone fractures, muscle weakness, and inability to ambulate. While its primary impact is on the musculoskeletal system, the involvement of the peripheral nervous system and muscles remains largely underexplored. We present a 3-year-old boy with congenital joint contractures and bone fractures who underwent a nerve conduction study and electromyography as part of the diagnostic workup for motor dysfunction. An electrodiagnostic study revealed motor sensory neuropathy in the upper and lower extremities, denervation, and neuropathic irritation in various muscle samples. This case highlights the potential utility of electrodiagnostic studies for assessing peripheral nerve and muscle involvement in BS, particularly in patients with severe musculoskeletal manifestations.
Cochrane Rehabilitation bridges rehabilitation research and the Cochrane community to enhance evidence dissemination and research quality. The year 2022 marked its sixth anniversary with a revision of its mission, vision, and goals. Knowledge translation towards the global south and health policymakers, and research education will be focused more. Key activities included the transition to project-based work, extensive review and tagging of rehabilitation literature, and publication of “Cochrane Corners.” In addition, it focused on global communication, launching educational and methodological initiatives and special projects like defining rehabilitation for scientific purposes and contributing to World Health Organization guidelines on post rehabilitation.
A 49-year-old male experienced right traumatic brachial plexus C5-C7 avulsion in a motorcycle accident. He underwent unsuccessful neurotization surgery and was chronically suffering from traumatic brachial plexus (TBP) avulsion for 4 years. His clinical examination revealed residual severe neuropathic chronic pain with tingling sensations, numbness, distal itching, dorsal anaesthesia, palmar hypoesthesia, and recurrent painful electric shocks even with daily medication intake. After several therapeutic failures, sequential therapy comprising 12 sessions of anodal transcranial direct current stimulation and video-feedback observation therapy was proposed. The patient experienced significant pain relief after the protocol, with sustained benefits at follow-up. Only a few studies have reported such sequential strategies, and the results appear to be promising. Although TBP avulsion is a relatively rare condition, it mostly affects young adults whose pain relief is a major challenge to their quality of life.
Quadrilateral space syndrome (QSS) is a relatively rare condition caused by compression of the axillary nerve and/or posterior circumflex humeral artery within the quadrilateral space. It is characterized by pain in the posterolateral aspect of the shoulder, paresthesia in the axillary nerve distribution, muscle weakness, and vascular complications. Diagnosis is challenging due to nonspecific symptoms and the absence of a gold-standard test. Magnetic resonance imaging plays a crucial role in identifying underlying causes, such as paralabral cysts. The authors present the case of a 34-year-old weightlifter diagnosed with QSS due to a posterior-inferior paralabral cyst compressing a branch of the axillary nerve, a rather uncommon finding. Conservative treatment, including patient re-education and nonsteroidal anti-inflammatory medication, led to complete symptom resolution. This case highlights a condition that is often misdiagnosed and the potential effectiveness of conservative management, particularly in athletes.
Virtual reality (VR) technology can be incorporated as a technical platform for the application of motor learning principles to deliver personalized interventions. The effects of VR-based rehabilitation on poststroke upper limb (UL) motor improvement have primarily been assessed using motor impairment and activity limitation outcomes. Comparatively less attention has been paid to the effects of the intervention on self-perceived use of the UL in the performance of daily life activities. Information on self-perceived use (assessed using the Motor Activity Log; MAL) provides insight into real-life use of the more-affected UL in daily activities. We conducted a systematic review and meta-analyses to examine the influence of VR-based interventions on the self-perceived quantity and quality of poststroke UL use using the MAL. Using standard methodology, we conducted a literature search of databases including MEDLINE and ISI Web of Science using keywords related to stroke and VR. The PEDRo scale helped assess the quality of the retrieved studies. Meta-analyses helped assess change in Quality of Movement (QoM) and Amount of Use (AoU) scores. Effect sizes (ES) were quantified based on the Rehabilitation Treatment Specification System as follows: small (0.08–0.18), medium (0.19–0.40), and large (≥0.41). We retrieved a total of 14 studies. The quality of the published studies ranged from moderate to good. Use of VR-based interventions resulted in an increase in QoM scores postintervention (large ES; 0.50; 95% CI: 0.15–0.85, P<0.005) and at retention testing (medium ES; 0.39; 95% CI: 0.08–0.71, P=0.02). Similar positive effects were reported for AoU scores postintervention (medium ES; 0.4, 95% CI: 0.05–0.75, P=0.03) and at retention testing (medium ES; 0.36; 95% CI: 0.02–0.7, P=0.04). VR-based rehabilitation is beneficial in improving self-perceived quality and quantity of post-stroke UL use for the performance of daily life activities in the real-world setting.
Balance and postural control impairments are common in patients post-stroke. Vibration interventions are among the recently researched interventions and have been shown to positively affect gait and proprioception post-stroke. This review aimed to determine the efficacy of plantar foot vibration in improving balance and postural control outcomes after stroke. As a first review of this topic, the purpose was to identify current literature limitations and provide recommendations for future research. A systematic search of CINAHL Ultimate, MEDLINE, SPORTDiscus with Full Text, and The Allied and Complementary Medicine Database (AMED) was conducted in April 2025. Due to heterogeneity across outcome measures, a systematic review in the form of a narrative synthesis of results was performed. Methodological quality analysis was assessed using the modified Downs and Black checklist. Eight articles that met the inclusion criteria were identified, 7 of which could be retrieved and used in the narrative synthesis. Results of the narrative synthesis provide evidence to suggest plantar vibration can improve balance and postural control post-stroke, even immediately after treatment and in chronic-stroke patients. Based on different outcome measures, results suggest that dynamic standing balance may benefit more than static standing balance. Current research shows promising results for the beneficial effects of plantar vibration on improving balance and postural control post-stroke. However, high-quality research investigating the effects of vibration frequency and length of plantar vibration treatment is required to determine the optimal treatment approach.
A structured pulmonary rehabilitation protocol can have favorable effect on the respiratory dysfunction in patients with spinal cord injuries (SCI) of different duration. In a pre-post quasi-experimental study patients with traumatic and nontraumatic SCI admitted in the unit for inpatient rehabilitation were assessed with pulmonary function tests (PFT) on day 1 and after 2 weeks of training (24 sessions). A structured pulmonary rehabilitation program was provided to all the recruited patients. Parameters like tidal volume (VT), vital capacity (VC), forced vital capacity (FVC), forced expiratory flow at 1sec (FEV1), FEV1/FVC ratio, peak expiratory flow (PEF), and chest expansion were recorded and compared pretraining and posttraining. Thirty-four patients (21 males) completed the training with ages ranging from 18 to 65 years (mean: 39.3, SD: 14.2). Nineteen had nontraumatic SCI and duration of lesion less than 12 weeks. Thirteen patients had complete motor and 21 had incomplete motor lesions. Chest expansion (22.2 vs 29.9 mm) and VC (1.7 vs 2.11 L) showed significant improvement posttraining (P < 0.001). SBC and FVC showed significant improvement posttraining in lower cervical and dorsal but not in upper cervical lesions. No significant posttraining effect was observed according to severity or duration of SCI (P> 0.05). A well-structured pulmonary rehabilitation program has a positive effect on respiratory function, which in turn improves SCI patients' endurance, independence, and quality of life, and decreases the risk of pulmonary complications.
Changes in phonation can occur after acquired brain injury, significantly impacting patients’ rehabilitation and community integration. Despite the prevalence of voice disorders after brain injury, the management of aphonia is rarely discussed in the literature. Due to a significant knowledge gap in etiology, diagnosis, and treatment, the treatment of voice disorders after brain injury can be challenging. We describe a case of persistent complete aphonia after hypoxic-ischemic brain injury despite numerous therapeutic interventions. Voice production consists of numerous pathways and components; thus, multimodal rehabilitation approaches should be used to maximize functional communication and achieve independence in patients with voice disorders.
The increase in interest in physical medicine and rehabilitation (PM&R) among physicians has not always been accompanied by an improvement in the quality of the residency training sites (RTS), especially in Latin America. To our knowledge, there are no publications that have specifically analyzed the PM&R RTS in Peru. The aim of the study is to characterize the PM&R RTS in Peru. Cross-sectional study performed between May 2023 and May 2024. Resources, rotations, and positions data were obtained from the RTS websites, through consultation with Delegados MFyR Peru 2023, and from the National Medical Residency Council of Peru website, respectively. Rotations that RTS were expected to have were specified by International Society of PM&R (ISPRM) in 2019. Data analysis was performed using Stata v17. 21 out of the 23 PM&R RTS were fully characterized. Of the total, 73.9% were in Lima. No RTS included more than 50% of the rotations specified in the ISPRM standards. Only 6, 5, and 1 RTS had musculoskeletal ultrasound, electrodiagnostic medicine, and sensory conditions rotations, respectively. From 2019 to 2023, 268 residency positions were offered for the 23 RTS, and 88.5% were offered in RTS from Lima. There was a positive association between higher scores for entering PM&R residency and a greater number of rotations across RTS. Most RTS did not include all the rotations specified in ISPRM standards, with the most concerning gaps in ultrasound, electrodiagnostic medicine, and sensory conditions, among others. Most RTS and residency positions offered were in Lima. These findings confirm the need to increase the number of rotations in all RTS, as well as to decentralize them to offer more positions outside of Lima.
The advent in the field of Information and Communication technology, especially the mobile technology, has also impacted the Physiotherapy education immensely. The delivery of education and learning pace has a significant influence, but its effectiveness is yet to be established among physiotherapy students. The study aims to evaluate the effectiveness of student learning using the modified GAIT Mobile App on Kinesiology of the Gait. Student participants (n=128) from different Physiotherapy institutions of Delhi were recruited as volunteers and were randomly assigned to form the control group and the intervention group. The control group received instructions in a blended format (online + offline); while the experimental group, in addition was given the GAIT mobile App. Students in both groups received the teaching intervention for 8 hours of theory and 4 hours of practical. All students were tested following a 2-week period of self-study using self-developed and validated theory and practical MCQ achievement test, as well as the level of satisfaction. The use of the GAIT App significantly improved the test scores of students compared with students who did not use the App in both theory and practical. There was a significant main effect for group for theory, F 1,139 =35.63, P =0.000, and main effect for question difficulty (2, 278) =113.20, P =0.000. These main effects were qualified by a Question Difficulty x Group interaction, F 2,278 =15.86, P =0.000. There was a significant main effect for group for the practical test, F 1,139 =38.18, P =0.000, and a main effect for question difficulty (2, 278) =52.05, P =0.000. These main effects were qualified by a Question Difficulty x Group interaction, F 2, 278 =24.10, P =0.000. The results of this study suggest that the mobile App was a powerful facilitator in augmenting learning along 2 dimensions of Bloom taxonomy, along with the 4-star rating on level of satisfaction, thus proving that mobile Apps can assist instructors in incorporating novel m-learning technologies into their pedagogy.
To critically appraise existing clinical practice guidelines (CPGs) for colorectal cancer (CRC) and synthesize evidence-based recommendations from a rehabilitation perspective. Comprehensive literature search was conducted using health databases, CPG clearinghouse/developer websites, and grey literature up to October 2024. All CRC CPGs published in the last decade that reported systematic methods for evidence search, and clearly defined recommendations supporting evidence for rehabilitation interventions were included. Two authors independently selected potential CPGs and assessed their methodological quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Recommendations from included CPGs were qualitatively summarized from a rehabilitation perspective. Twelve of 65 CPGs met the inclusion criteria. The majority of CRC CPGs were of low-moderate quality (AGREE scores of 2–6/7). The recommendations were generic, with only the American Cancer Society (ACS) guidelines providing detailed recommendations on rehabilitation interventions for longer-term issues in CRC survivors. Existing CPGs recommend coordinated multidisciplinary survivorship care, monitoring of longer-term issues, and follow-up support for patients with CRC. However, supporting evidence for these management strategies remains limited. Detailed comparison between the CPGs was not possible due to inconsistent recommendations, making it difficult to summarize the optimal rehabilitation approaches. Despite rehabilitation being an integral component of the management of CRC, it is notably absent in many published CPGs. Future CPGs should explicitly incorporate rehabilitation-specific interventions for improved clinical outcomes tailored to the needs of this population.
Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome. In the literature, several conservative treatments have been proposed but, to our notice, a practical and ready-to-use guide as regards different rehabilitation techniques is lacking. In this sense, by combining scientific evidence and expert opinion, the present manuscript aims to display the conservative and rehabilitation approach to this challenging pathology. From a total of 145 items identified, the authors analyzed 79 articles—excluding studies that had recruited patients without clinical and/or instrumental diagnosis of CTS or those who had undergone surgery. Four categories of nonsurgical approaches have been defined; injections, rehabilitation techniques, orthoses, and physical therapies. Carpal tunnel injection with 5% dextrose, night wrist orthosis, and extracorporeal shockwave therapy seemed to be the most effective nonsurgical treatment in CTS. Considering the poor description of specific upper limb rehabilitation techniques in the literature, an in-depth focus has also been provided based more on the authors’ experience in hand rehabilitation. Future clinical studies are awaited to establish standardized conservative protocols whereby the injection dose/technique, physical therapy, and the specific rehabilitation technique are reported. Further, a better understanding of the dynamic relationship between the median nerve and the nearby soft tissues inside the tunnel (eg, perineural loose connective tissue) would be noteworthy to optimize the treatment outcome and the hand function in the long term.
This study was carried out to assess the quality of life (QOL) of adults with intrathecal baclofen (ITB) pump therapy. A cross-sectional survey was conducted between February 2020 and April 2023 and included patients who have been on ITB therapy for more than 6 months and were following up in the clinic. Chart review data included demographics, diagnoses, medical comorbidities, baclofen dose, and ITB side effects. The poll uses the World Health Organization Quality-of-Life (WHOQOL-BREF) in Arabic. The Arabic version of the WHOQOL-BREF Scale was used in the survey. The study included 33 eligible participants the majority of the participants were males (63.3%), with a mean age of 37.1 ± 14.5 years. Of the participants, 69.7% were single. Most diagnosis was spinal cord injury (52%). Contractures occurred in 30.3% and pressure injuries in 18.2. Most of the participants (84.8%) were satisfied with baclofen therapy. The duration of ITB therapy was 6–80 months (31.5 ± 18.4). The total sample mean score or perceived overall QOL was 3.2 ± 1.2, whereas the mean score for perceived overall health was 3.3 ± 1.3. The mean scores of the WHOQOL-BREF domains varied among the participants, with the highest being psychological (60.0 ± 20.6) and the lowest being physical (40.8 ± 18.6). The environmental domain mean score was significantly higher among the younger age group (P = 0.03), whereas the mean overall health score was significantly associated with pressure injuries (P = 0.009). The correlation of the current dose was only significant with the psychological domain (r = 0.405; P = 0.019). QOL scores were not significantly associated with age, gender, marital status, pain, contractures, or adverse effects associated with ITB. The results show favorable outcomes in terms of QOL with ITB therapy.
Lipoma arborescence (LA) is an extremely rare condition that commonly involves the knee joint; however, it can be noted in the other appendicular joints. It has been associated with trauma as well, without any predilection for any specific ligamentous injuries. We are presenting a case of a young male patient who presented with recurrent knee joint swelling and was clinically suspected to have pigmented villonodular synovitis. However, he was diagnosed with lipoma arborescence with a completely torn anterior cruciate ligament (ACL) and RAMP lesion of the meniscus on magnetic resonance imaging (MRI) which were subsequently confirmed on arthroscopy at our center. We strongly underscore to consider this condition as a possible differential in patients presenting with atraumatic pain and recurrent swelling of the joint to ensure timely diagnosis to avoid early onset degenerative changes. We also strongly emphasize the need to do additional studies in the future to find out if this condition may occur as a complication or sequelae to any specific ligamentous injury.
Guillain-Barre syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy often preceded by a gastrointestinal or respiratory illness. There is an association between the development of GBS and coronavirus disease 2019 (COVID-19) infection. We present a case of COVID-related acute motor and sensory axonal neuropathy with severe limb paresis, bulbar involvement, autonomic dysfunction, and respiratory failure. A 67-year-old man presented with ascending paralysis 11 days after being diagnosed with COVID-19 infection. Cerebrospinal fluid analysis confirmed GBS, and nerve condition studies confirmed acute motor and sensory axonal neuropathy subtype. He required a period of mechanical ventilation due to respiratory failure. He suffered from multiple complications, including quadriparesis, dysautonomia, fatigue, neuropathic pain, and mood disorders. Despite initial poor prognostication, based on conventional scoring tools, he achieved a good functional outcome. We highlight the pitfalls in prognostication, as well as the anticipated challenges with regard to the rehabilitation of such patients.
Thoracic outlet syndrome (TOS) is a diverse group of clinical disorders manifested upon impingement or compression of the neurovascular structures at the thoracic outlet, presenting a wide spectrum of neurovascular signs and symptoms. A high index of clinical suspicion complemented with a detailed clinical examination and optimal use of radiologic and electrodiagnostic studies must be employed to reach an early diagnosis for successful management since the symptoms are severely disabling and a residual neurological or vascular sequelae is expected in cases with the delayed or wrong diagnosis. We are discussing an interesting case where an air rifle shooter who presented to us with intermittent episodes of right-sided precordial chest pain for the last 3 months with a short history of breathing difficulty and occasional episodes of tingling and numbness in the right arm, diagnosed with hydro-pneumothorax on initial imaging and with neurological and arterial variants of TOS on subsequent workup during the course of hospital stay. The article intends to explain the relation of chest pain in patients with TOS.
