Cooperative rehabilitation enhances engagement, task performance, and social-motor interaction, yet it demands physical co-presence: users must transmit forces, coordinate movements, and infer intent through haptic contact. Telerehabilitation promises to expand access for patients constrained by distance, mobility, or clinical disparities, yet current techniques remain predominantly audiovisual while leaving users haptically and physically isolated. Here, we introduce HaptiNet, a networked haptic robotic system enabling physical co-presence for geographically distributed users via force-mediated interaction. Each robotic terminal features a low-inertia, long-stroke design with high force-feedback capacity, tailored for haptic rendering in upper-limb training. Building on these terminals, HaptiNet creates a distributed haptic network with an imitation-learning-based delay compensator, enabling users to physically perceive and coordinate with one another over distance. We validated HaptiNet in 284 healthy participants and 111 patients with neurological impairments across progressively realistic settings, including laboratory tests, cross-city deployments, and clinical applications. HaptiNet preserved task-level force rendering consistency across single-user and multi-user scenarios. Compared with solo and visual cooperative training, haptic cooperation improved task performance by 24

Abstract Background Extracorporeal shockwave therapy (ESWT) can effectively relieve post-stroke spasticity; however, research comparing the impact of different ESWT frequencies is limited. In this study, we investigated the therapeutic efficacy of different ESWT frequencies for post-stroke ankle plantar flexor spasticity. Methods In this prospective, single-blind, randomized controlled trial, we recruited patients treated in the Rehabilitation Department of Shenzhen Second People’s Hospital for post-stroke ankle plantar flexor spasticity between January 2024 and September 2024. The participants were randomly assigned to the control (n = 15), 4 Hz ESWT (n = 15), and 10 Hz ESWT (n = 15) groups. All groups received conventional rehabilitation therapy; the 4 Hz and 10 Hz ESWT groups received additional ESWT. The ESWT intervention lasted for 3 weeks, with two interventions per week. ESWT was administered at 2 bar, 4 Hz, and 2000 pulses for the 4 Hz group and 2 bar, 10 Hz, and 2000 pulses for the 10 Hz group. Assessments were conducted before treatment, after the first treatment, and at the end of intervention using the modified Ashworth scale (MAS), passive joint range of motion (PROM), ankle clonus score, medial gastrocnemius muscle oscillation frequency (MGF), lateral gastrocnemius muscle oscillation frequency (LGF), medial gastrocnemius muscle dynamic stiffness (MGS), lateral gastrocnemius muscle dynamic stiffness (LGS), and the Fugl-Meyer assessment of the lower extremity (FMA-LE). Visual analog scale (VAS) tool was used before and after each ESWT session. Results The 4 Hz and 10 Hz ESWT groups showed significant difference in LGS after a single treatment (P < 0.05). Following 3 weeks of treatment, both ESWT groups exhibited significant improvements in MAS, PROM, MGF, and LGS compared with the control group (P < 0.05). The 4 Hz ESWT group also demonstrated a significant improvement in MGS compared with the control group (P < 0.05), and the 4 Hz and 10 Hz ESWT groups differed significantly in LGS (P < 0.05). We found that only five patients reported mild pain, which resolved rapidly after treatment and rest. Conclusion Both single and 3-week ESWT treatments safely reduced the severity of ankle plantar flexor spasticity. The results showed the possibility of superiority of 4 Hz intervention to 10 Hz intervention. Trial registration: This study was registered in the Chinese Clinical Trial Registry on 10 January 2024 (registration Number: ChiCTR2400079721), https://www.chictr.org.cn/bin/project/edit?pid=217074 .

Objective Faced with the challenge of ageing populations and growing rehabilitation demands, misallocating healthcare resources may impede tiered service. This study aimed to (1) evaluate gaps between patients’ healthcare-seeking behaviour, doctors’ clinical judgement and rehabilitation tiered service (RTS) tool results using the first-hand data from the field survey in China and (2) identify factors associated with these gaps across institution, doctor and patient levels.Design Population-based, multicentre cross-sectional study.Setting 41 medical institutions across 21 cities in China.Participants 5856 participants were included in our study. The inclusion criteria of participants were (1) he/she had dysfunctional problems, (2) he/she had visited rehabilitation doctors, (3) he/she was outpatients, (4) he/she would complete all evaluation procedures and (5) he/she agreed to participate in our study.Main outcome measures Gaps between patients’ healthcare-seeking behaviour, doctors’ clinical judgement and RTS tool results. The results included outpatient rehabilitation treatment, visiting other clinical departments, admission to primary healthcare, secondary hospitals, tertiary hospitals, nursing homes and other clinical departments.Results The mean age of participants was 47.5 years (SD: 24.4), and half (53.6%) were male. Most were diagnosed with orthopaedic disorders (55.2%) and neurological disease (29.0%). The majority had mobility difficulty (81.8%), self-care ability (69.8%), controlled disease (89.5%) and stable vital signs (98.9%). The minority participants had an onset of over 1 year (8.5%). The first gap (the rate of misalignment between patients’ healthcare-seeking behaviour and doctors’ clinical judgement) was 21.0%; doctors with higher educational level (OR=4.89, 95% CI 1.35 to 17.73), those who majored in western medicine (OR=2.97, 95% CI 1.15 to 7.67), elder patients (OR=1.01, 95% CI 1.01 to 1.02) and patients with neurological disease (OR=2.11, 95% CI 1.34 to 3.30), geriatric diseases (OR=1.60, 95% CI 1.17 to 2.19) and childhood diseases (OR=2.72, 95% CI 1.04 to 7.13) were associated with the increased first gap, whereas doctors from public institution (OR=0.10, 95% CI 0.02 to 0.44), receiving more medical training (OR=0.94, 95% CI 0.88 to 1.00) and patients with cardiopulmonary disease (OR=0.44, 95% CI 0.29 to 0.67) were associated with reduced first gap. The second gap (the rate of misalignment between doctors’ clinical judgement and RTS tool results) was 49.3%; doctors from primary healthcare (OR=24.60, 95% CI 7.82 to 77.42), male doctors (OR=2.66, 95% CI 1.45 to 4.86), those who majored in western medicine (OR=1.91, 95% CI 1.04 to 3.51) or Chinese and western medicine (OR=4.19, 95% CI 1.47 to 11.91) and elder patients (OR=1.01, 95% CI 1.00 to 1.01) were associated with increased second gap, whereas doctors from public institution (OR=0.13, 95% CI 0.05 to 0.36) and having higher monthly income (OR=0.52, 95% CI 0.34 to 0.78) were associated with reduced second gap.Conclusion Gaps exist between patients’ healthcare-seeking behaviour, doctors’ clinical judgement and RTS tool results. Target interventions such as enhancing training for private institutions, western medicine doctors and elderly patients diagnosed with neurologic, cardiopulmonary or childhood diseases may help reduce these gaps.

Falls are common during stroke rehabilitation, leading to physical injuries and psychosocial consequences. While prior studies have explored the association between falls and life satisfaction, the effect of fall-related injury severity remains unclear. This multicenter cross-sectional study included 6,068 stroke inpatients undergoing rehabilitation. Standardized face-to-face interviews were conducted to collect data on fall experiences within the past three months, severity of fall-related injuries, life satisfaction, and other demographic and clinical characteristics. Logistic regression models were used to analyze the relationships between fall experiences, injury severity, and life satisfaction. After adjusting for confounding factors such as age, sex, and activities of daily living, patients who had experienced a fall in the past three months exhibited significantly lower life satisfaction (OR = 0.77, 95% CI: 0.61-0.98, P = 0.0325). However, no significant association was observed between the severity of fall-related injuries and life satisfaction (P > 0.05). These findings highlight the need for fall prevention and psychosocial support in stroke rehabilitation to improve well-being. Future research should explore the mechanisms linking fall-related injuries and life satisfaction to refine rehabilitation strategies.

BackgroundFalls are a common risk in older rehabilitation inpatients, with psychotropic medications potentially increasing fall risk. This study aims to assess the correlation between falls and the use of psychotropic medications in older inpatients at different activity levels in rehabilitation departments.MethodsA multi-center cross-sectional study analyzed patient characteristics, medications, fall incidents, and physical levels using the Longshi Scale. Chi-square tests, ANOVA, and binary logistic regression were applied.ResultsThis study enrolled a total of 6,425 patients, among them 711 cases (11.07%) experienced falls, and 333 cases (5.18%) had a history of psychotropic medication use. Psychotropic use was an independent fall risk factor P < 0.05), with significant correlation in bedridden (OR = 1.77, 95% CI: 1.18-2.64) and domestic (OR = 1.99, 95% CI: 1.12-3.53) groups, but not in the community group (P > 0.05).ConclusionBedridden and domestic group individuals, as per Longshi Scale classification, are vulnerable to psychotropic-induced falls. Targeted prevention and monitoring are necessary for these groups.Trial RegistrationThe study is approved by the Regional ethical committee and registered at Chinese Clinical Trial Registry (https://www.chictr.org.cn), ChiCTR-2000034067.

Burnout and working motivation are two interconnected concepts that significantly influence doctors’ working performance and overall well-being. However, the relationship between burnout and working motivation among rehabilitation doctors remain unclear. Therefore, the purpose of this study was to explore the association between burnout and working motivation among rehabilitation doctors in China. A multistage sampling scheme was employed to select rehabilitation doctors as study participants. A total of 220 participants from 21 medical institutions in 7 cities in China were included in the final analysis. The measurement included working motivation, burnout, and general characteristics (such as age, sex, educational level, title, working experience, etc.). Structural equation modelling (SEM) was used to analyse the association between burnout and working motivation among rehabilitation doctors. Among 220 rehabilitation doctors, the mean age of participants was 37.0 years (SD: 7.7), and 43.6% were male. The prevalence of emotional exhaustion, depersonalisation, and lack of personal accomplishment was 20.9, 16.4, and 24.1%. The average total score of working motivation was 47.7 (SD: 8.0). SEM results indicate that burnout had a negatively correlation with working motivation (β = −0.63, 95% CI −0.77, −0.50) after controlling confounders. Burnout decreases the working motivation among rehabilitation doctors. The strategies to balance burnout and enhance working motivation should be strengthened.

Polysomnography (PSG), the gold standard for sleep monitoring, remains limited by its high cost and technical complexities in operation and data analysis. The flexible electrode sleep patch (FESP) is a novel wearable frontal single-channel EEG device for rapid sleep monitoring via FP1 and FP2 sites. Although preliminary studies support its reliability in healthy individuals, its feasibility for stroke patients remains unexplored. We compared the two devices in terms of consistency, correlation, specificity, and sensitivity regarding sleep parameters, sleep structures and EEG characteristic waves in stroke survivors. Initially, a stroke-specific sleep staging algorithm was trained using recorded sleep data from 26 healthy individuals and 26 stroke patients. Subsequently, 45 stroke patients were monitored with single night-time synchronised PSG and FESP for approximately 6-8 h. Our results indicated that FESP and PSG exhibit significant agreement in sleep metrics among stroke survivors. For sleep stages, the Cohen Kappa values ranged from 0.68 to 0.83. For sleep-related metrics, Pearson correlation coefficients (PCC) ranged from 0.720 to 0.890, and intra-class correlation coefficients (ICC) ranged from 0.661 to 0.889. The specificity of Deep stages was 95.76% with high accuracy of 93.79%. FESP offers a clinically viable alternative for initial sleep assessment, with significant potential to enhance the diagnosis and management of stroke-related sleep disorders.

Falls are among the most common complications after stroke, potentially delaying functional recovery. Although the modified Rankin Scale (mRS) is widely used in stroke assessment, its relationship with fall risk remains poorly understood. The study aims to identify the association between mRS scores and fall risk in stroke patients. In this multicenter cross-sectional study, data on sociodemographics, clinical factors, fall characteristics, and mRS scores were collected via face-to-face interviews. Univariate analysis, binary logistic regression, and threshold effect models were employed to examine the association between fall risk and mRS scores. Among 6,192 enrolled patients, 524 (8.46%) experienced falls. The mRS showed a non-linear association with fall risk, peaking at mRS = 3 (P < 0.05). For scores < 3, each 1-point increase in mRS raised fall risk by 34% (OR = 1.32, 95% CI: 1.09- 1.60, P = 0.0046), whereas for scores > 3, each 1-point increase reduced risk by 26% (OR = 0.74, 95% CI: 0.61-0.90, P = 0.0027). An inverted U-shaped relationship exists between mRS scores and fall risk, peaking at an mRS score of 3, identifying a potential priority group for fall prevention.

Early detection of individuals at elevated risk for type 2 diabetes (T2D) is critical for effective prevention strategies. We developed a novel metabolic marker, the triglyceride-glycated hemoglobin index (TyH-i), which integrates lipid and glycemic parameters to improve T2D risk prediction. This study sought to evaluate the relationship between TyH-i and T2D risk and to examine its predictive performance with the triglyceride-glucose index (TyG-i). A large-scale retrospective cohort study was conducted using data from 15,464 Japanese adults without T2D at baseline. The TyH-i was calculated as Ln[glycated hemoglobin index (%)×triglycerides (mg/dL)/2], and its association with incident T2D was assessed using Cox proportional hazards models and smooth curve fitting and cubic spline functions. The predictive performance of the TyH-i was compared with the TyG-i using receiver operating characteristic curves. Over a median follow-up of 5.39 years, 373 participants developed T2D. After accounting for confounders, the TyH-i was significantly associated with T2D risk (HR: 1.55, 95% CI: 1.22-1.97, P = 0.00031). Additionally, a J-shaped relationship between the TyH-i and incident T2D was identified. A significant positive correlation was identified between TyH-i and T2D only when TyH-i levels were above 4.92 (HR: 1.73, 95%CI: 1.35-2.23, P < 0.0001). Furthermore, TyH-i and TyG-i possess comparable discriminatory ability in predicting incident T2D (AUC: 0.751 vs. 0.750, P = 0.8873). Moreover, TyH-i yielded lower Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) values than TyG-i (AIC: 3211.60 vs. 3211.91; BIC: 3226.89 vs. 3227.20), indicating a more parsimonious model with better overall model fit. The TyH-i is a novel and effective predictor of T2D risk, exhibiting a non-linear relationship with T2D. Furthermore, TyH-i and TyG-i exhibit comparable discriminatory abilities in predicting incident T2D. These results highlight the potential of TyH-i as a valuable instrument for T2D risk stratification, particularly in individuals with elevated TyH-i levels.

Understanding the relationship between cardiorespiratory function (CRF) and activities of daily living (ADL) in stroke patients is essential for improving rehabilitation outcomes. A total of 153 participants were enrolled in this study. Cardiopulmonary exercise was tested at admission. A multivariable linear regression was performed to identify variables associated with peak oxygen uptake (VO2peak). Participants with low ADL exhibited poorer responses to exercise than those with high ADL levels. After adjusting for confounders, the multiple linear regression analysis showed that albumin-to-globulin ratio (AGR) and left ventricular posterior wall thickness (LVPW) were significantly associated with VO2peak in all patients. In the low ADL subgroup, the positive association between AGR and VO2peak was consistent. Conversely, the negative association between LVPW and VO2peak was uncertain. Otherwise, no significant association were found between AGR, LVPW, and VO2peak in the high ADL subgroup. This study provides new insights into the relationship between CRF and ADL in stroke patients, with a focus on ARG and LVPW. Future studies with larger sample sizes are needed to further explore the role of AGR and LVPW in improving the CRF in stroke patients.

Background There is growing interest in the combination of botulinum toxin (BoNT) and rehabilitation techniques for the treatment of post-stroke spasticity. Nevertheless, systematic evaluations of this approach are scarce. Objective To systematically evaluate the efficacy of BoNT combined with rehabilitation techniques for post-stroke spasticity. Methods The PubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched from their inception to May 2024 for randomized controlled trials of BoNT combined with rehabilitation treatments for post-stroke spasticity. Reductions in the Modified Ashworth Scale (MAS) score at short-term and medium-term weeks after treatment were calculated. Results Eighteen studies were analyzed. Regarding the short-term effect of BoNT combined with rehabilitation treatments on post-stroke spasticity, the top one ranked combination treatments were BoNT plus conventional therapy (CT) and splinting. The results showed that two evidence networks regarding the medium-term efficacy of BoNT combined with rehabilitation treatments for post-stroke spasticity. The top one ranked combination treatments for Network A were BoNT plus CT and electrical stimulation, and for Network B, BoNT plus casting. Conclusions The limited quantity of literature included in these studies did not permit the ordering of probabilities. Consequently, these results must be interpreted with caution and further validated using high-quality studies.

AbstractBackgroundThe Longshi Scale is a pictorial assessment tool for evaluating activities of daily living (ADL) in patients with stroke. The paper-based version presents challenges; thus, the WeChat version was created to enhance accessibility. Herein, we aimed to validate the inter-rater and test–retest reliabilities of the WeChat version of the Longshi Scale and explore its potential clinical applications.MethodsWe recruited 115 patients with stroke in the study. The ADL results of each patient were assessed using both the WeChat and paper-based version of the Longshi Scale; each evaluation was conducted by 28 health professionals and 115 caregivers separately. To explore the test–retest reliability of the WeChat version, 22 patients were randomly selected and re-evaluated by health professionals using the WeChat version. All evaluation criteria were recorded, and all evaluators were surveyed to indicate their preference between the two versions.ResultsConsistency between WeChat and the paper-based Longshi Scale was high for ADL scores by health professionals (ICC2,1 = 0.803–0.988) and caregivers (ICC2,1 = 0.845–0.983), as well as for degrees of disability (κw = 0.870 by professionals; κw = 0.800 by caregivers). Bland–Altman analysis showed no significant discrepancies. The WeChat version exhibited good test–retest reliability (κw = 0.880). The WeChat version showed similar inter-rater reliability in terms of the ADL score evaluated using the paper-based version (ICC2,1 = 0.781–0.941). The time to complete assessments did not differ significantly, although the WeChat version had a shorter information entry time (P < 0.001, 95% confidence interval: –43.463 to –15.488). Health professionals favored the WeChat version (53.6%), whereas caregivers had no significant preference.ConclusionsThe WeChat version of the Longshi Scale is reliable and serves as a suitable alternative for health professionals and caregivers to assess ADL levels in patients with stroke. The WeChat version of the Longshi Scale is considered user-friendly by health professionals, although it is not preferred by caregivers.Trial registrationThis study was approved by the Ethics Committee of the Second People’s Hospital of Shenzhen (approval number: 20210812003-FS01) and registered on the Clinical Trial Register Center website: clinicaltrials.gov on January 31, 2022 (registration no.: NCT05214638).

Functional near-infrared spectroscopy (fNIRS) seems opportune for neurofeedback in robot-assisted rehabilitation training due to its noninvasive, less physical restriction, and no electromagnetic disturbance. Previous research has proved the cross-session reliability of fNIRS responses to non-motor tasks (e.g., visual stimuli) and fine-motor tasks (e.g., finger tapping). However, it is still unknown whether fNIRS responses remain reliable 1) in gross-motor tasks, 2) within a training session, and 3) for different training parameters. Hence, this study aimed to investigate the within-session reliability of fNIRS responses to gross-motor tasks for different training parameters. Ten healthy participants were recruited to conduct right elbow extension-flexion in three robot-assisted modes. The Passive mode was fully motor-actuated, while Active1 and Active2 modes involved active engagement with different resistance levels. FNIRS data of three identical runs were used to assess the within-session reliability in terms of the map- ( R 2 ) and cluster-wise ( Roverlap ) spatial reproducibility and the intraclass correlation (ICC) of temporal features. The results revealed good spatial reliability ( R 2 up to 0.69, Roverlap up to 0.68) at the subject level. Besides, the within-session temporal reliabilities of Slope, Max/Min, and Mean were between good and excellent (0.60 < ICC < 0.86). We also found that the within-session reliability was positively correlated with the intensity of the training mode, except for the temporal reliability of HbO in Active2 mode. Overall, our results demonstrated good within-session reliability of fNIRS responses, suggesting fNIRS as reliable neurofeedback for constructing closed-loop robot-assisted rehabilitation systems.

Dysfunction is a common clinical symptom among rehabilitation patients; however, whether there are sex differences in dysfunctions remains unclear. Therefore, this study aimed to explore this issue by examining a large sample of the population with dysfunctional problems. A multi-stage sampling scheme was used to select the rehabilitation outpatients as study participants. A total of 3415 participants from 21 medical institutions in seven cities in China were included in the final analysis. The measurement included general characteristics (age, sex, educational level, marital status, and household income) and disease-related characteristics (dysfunctions, self-care ability, vital signs, disease status, and disease course). The logistic regression was used to analyse the sex difference in dysfunctions among rehabilitation outpatients. Among 3415 rehabilitation outpatients, the mean age of participants was 45.3 years (SD:24.9), and more than half (54.0%) were male. The male patients were more likely to have cognitive impairment (OR = 1.74; 95% CI = 1.42, 2.13), speech disorders (OR = 2.00; 95% CI = 1.62, 2.48), dysphagia (OR = 1.55; 95% CI = 1.12, 2.16), and multiple dysfunctions (OR = 2.00; 95% CI = 1.57, 2.54) than female. Female patients were more likely to have motor dysfunctions (OR = 0.63; 95% CI = 0.50, 0.78). There are sex differences in dysfunctions among rehabilitation outpatients. This sex difference may provide potential clinical value for the treatment of rehabilitation patients.

The actual bending shape of the rope-driven spine-like continuum mechanism deviates from the standard arc shape, and it is difficult to establish an accurate motion control model. In order to solve the problem of precise control of the end position of the two-stage flexible robot by fusing genetic algorithm and backpropagation neural network GABP, this paper studies the problem of precise control of the end position of the two-stage flexible robot. Through the joint simulation of Solidworks and ADAMS, the mapping database of the X, Y, and Z coordinates at the end of the flexible robot and the tensile length of the six soft axes were established, and the standard backpropagation BP neural network and GABP neural network models were trained by using the database, and the model parameters were optimized. Finally, the end motion trajectory of the robot was designed, and the BP and GABP neural network models were used to verify the position accuracy of the end of the flexible robot. The results show that both the standard BP and GABP models can realize the position control of the end of the flexible robot, and the position accuracy of the neural network model fused with genetic algorithm (maximum error: epsilon(x) = 0.73 mm, epsilon(y) = 0.78 mm, epsilon(z) = 1.82 mm) in controlling the motion of the flexible robot has been significantly improved compared with the standard BP neural network model (maximum error: epsilon(x) = 3.13 mm, epsilon(y) = 1.78 mm, epsilon(z) = 1.95 mm).

In recent years, the continuous advancement of medical technology has led to the growing adoption of minimally invasive surgery by surgeons, primarily due to its advantages, including reduced blood loss, smaller incisions, and shorter recovery times. This paper introduces a novel positioning arm for minimally invasive surgical robots, designed to assist manipulators in performing precise operations within constrained surgical environments. The mechanical structure of the positioning arm is first determined based on functional requirements, followed by its three-dimensional modeling and prototype fabrication. The modified Denavit-Hartenberg (DH) method is then utilized to establish both the forward and inverse kinematic models, and a workspace analysis is conducted. Finally, trajectory planning algorithms for spatial straight lines and arcs are analyzed and experimentally validated. The results demonstrate that the designed positioning arm satisfies the functional requirements and offers significant practical application potential.

BACKGROUND: Patients with prolonged disorders of consciousness (pDOC) pose significant challenges to healthcare workers due to their severe motor impairments and limited interaction with the environment. Non-invasive brain stimulation such as high-definition transcranial direct current stimulation (HD-tDCS) and music stimulation show promise in awakening this population. OBJECTIVE: In this study, we present a protocol aiming at investigating the efficacy of combined HD-tDCS and music stimulation in awakening patients with pDOC through a single-blind, randomized controlled trial. METHODS: Ninety patients with pDOC will be randomly divided into three groups: active HD-tDCS with music stimulation, active HD-tDCS, and sham HD-tDCS. All participants will receive 20 treatment sessions over a period of 10 days and the Coma Recovery Scale-Revised, Glasgow Outcome Scale and electroencephalogram will be used as assessment measures to evaluate their level of consciousness throughout the study. Adverse events and complications will be recorded during treatment. Within-group pre-post comparisons and between-group efficacy comparisons will be conducted to identify the most effective intervention approach. Statistical analysis will be performed using SPSS software with a significance level set at P < 0.05. CONCLUSION: The pursuit of awakening therapy for patients with pDOC remains a clinical research challenge. This study protocol is designed with the aim of introducing an innovative non-pharmacological approach which combined HD-tDCS and music stimulation to facilitate the reinstatement of consciousness in patients with pDOC.

AbstractStroke survivors frequently experience difficulties in daily activities, such as bathing, feeding, and mobility. This study aimed to evaluate the reliability and validity of a computer-adaptive test-Longshi scale (CAT-LS) for assessing activities of daily living (ADL) in stroke survivors. This cross-sectional study collected data using an electronic application. The ADL function of stroke survivors in rehabilitation departments of hospitals was assessed using both the CAT-LS and BI. Correlations between the CAT-LS and Barthel index (BI) and concurrent validity were evaluated using Pearson’s correlation test and multiple linear regression. Interrater reliability was evaluated using the intraclass correlation coefficient based on a two-way random effect. The internal consistency of the CAT-LS was assessed using Cronbach’s coefficient (α) and corrected item-total correlations. Overall, 103 medical institutions in China were used in this study. In total, 7151 patients with stroke were included in this study. The CAT-LS classified patients into three ADL groups (bedridden, domestic, and community) with significantly different BI scores (P < 0.05). The CAT-LS results obtained using the decision-tree scoring model were consistent with the scores for each BI item. A strong correlation was observed between CAT-LS and BI (Pearson’s r: 0.6–0.894, P < 0.001). The CAT-LS demonstrated good internal consistency (Cronbach’s α, 0.803–0.894) and interrater reliability (ICC, 0.928–0.979). CAT-LS is time-efficient and requires < 1 min to administer. The CAT-LS is a reliable and valid tool for assessing ADL function in stroke survivors and can provide rapid and accurate assessments that reduce the burden on healthcare professionals. Further validation of this tool in other populations and settings is necessary.Study registration number: No.: ChiCTR2000034067; http://www.chictr.org.cn/showproj.aspx?proj=54770.

Objective:To compare the difference of reimbursement payments between diagnosis-related group (DRG) and a novel patient classification-based payment system, diagnosis-intervention packet (DIP), among rehabilitation inpatients in tertiary hospitals. Design:Retrospective cohort study. Setting:TTertiary hospitals in Shenzhen, China. Participants:We assessed the records of 268,362 individuals who visited tertiary hospitals providing rehabilitation services. Interventions:Not applicable. Main Outcome Measures:The outcome variable was the patients' rehabilitation hospitalization cost of in our study. A quantile regression analysis was conducted to estimate the effects of DIP payment on the rehabilitation hospitalization cost. Results:The results showed that the predicted marginal hospitalization cost with DRG payment were 9%, 7%, 14%, and 10% higher than that with DIP payments in 2019, 2020, 2021, and 2022. The total difference in predicted marginal hospitalization cost between DRG and DIP was -1269 RMB (-193 USD). This difference in 2019, 2020, 2021, and 2022 was -1419 RMB (-228 USD), -1088 RMB (-158 USD), -1585 RMB (-246 USD), and -1034 RMB (-154 USD), respectively. All differences in predicted marginal hospitalization cost between DRG and DIP was significant (P<.001), after controlling for patients' age, sex, public or private hospital, the type of disease, and the length of stay of hospitalization. Conclusions:The findings of DIP payment reduced the rehabilitation hospitalization cost would be helpful in developing more effectively and efficiently tailored interventions for rehabilitation health care in China. Furthermore, the results of this study could provide advice on building more effective strategies and intervention options for other countries that struggle with controlling rehabilitation hospitalization costs.

Injurious falls pose a significant threat to the safety of stroke patients, particularly among older adults. While the influence of activities of daily living (ADL) on falls is acknowledged, the precise connection between ADL ability and fall-related injuries in older stroke patients undergoing rehabilitation, particularly those with varying mobility levels, remains unclear. This multicenter cross-sectional study in China recruited 741 stroke patients aged 65 years and above, categorized into bedridden, domestic, and community groups based on their mobility levels using the Longshi Scale. ADL ability was assessed using the Barthel Index. Logistic regression models, generalized additive models, smoothed curve-fitting, and threshold effect analysis were employed to explore the relationship between ADL ability and injurious falls across the three mobility groups. Results revealed an inverted U-shaped relationship between ADL ability and injurious falls among patients in the domestic group (p = 0.011). Below the inflection point of 35 on the Barthel Index, the likelihood of injurious falls increased by 14% with each unit increase in ADL ability (OR = 1.14, 95% CI 1.010–1.29, p = 0.0331), while above the inflection point, it decreased by 3% per unit increase (OR = 0.97, 95% CI 0.95–0.99, p = 0.0013). However, no significant association between ADL ability and injurious falls was observed in either the bedridden or community groups (p > 0.05). These findings suggest that only older stroke patients capable of engaging in activities at home demonstrate a correlation between ADL ability and injurious falls. The identified inverted U-shaped relationship may aid in identifying fall injury risk in this population.