BACKGROUND:Developing clinical reasoning is a critical component of physiotherapy education. Active strategies such as simulation- and digital-based learning have been proposed to enhance these skills. However, their effectiveness, but also the best modalities remain largely unknown. Therefore, this systematic review aimed to evaluate the effectiveness of various educational strategies on clinical reasoning among physiotherapy students and clinicians. METHODS:A systematic search of PubMed, Scopus, PsycINFO, and ProQuest Central was conducted for studies published between January 1, 2015 and February 28, 2026. Eligible designs included randomized controlled trials, controlled before - after studies, pre - post studies, and quasi-experimental designs. Methodological quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI) for quantitative studies and the Mixed Methods Appraisal Tool (MMAT) for qualitative or mixed-methods studies. Data were narratively synthesized by grouping studies into three pedagogical categories: (i) simulation- and digital-based learning, (ii) active and case-based learning methods, and (iii) structured educational programs and training. RESULTS:Thirty four studies (n = 3,048 participants) of moderate-to-high methodological quality were included in this study. Participants ranged from entry-level physiotherapy students to licensed clinicians. Simulation- and digital-based approaches, such as standardized patients, virtual reality, mobile applications, and computer-assisted learning, showed consistent improvements in clinical decision-making and performance, as well as gains in self-efficacy and motivation. Active and case-based learning strategies, including problem-based learning and concept mapping, were associated with increased satisfaction, reflective practice, and usability. Structured programs, such as residencies, workshops, and mentorship models, produced notable benefits in decision-making, self-efficacy, and professional attitudes. Overall, simulation-, digital-based and structured programs demonstrated the most consistent evidence of effectiveness across studies. CONCLUSION:Simulation, digital technologies, active learning, and structured programs effectively foster clinical reasoning in physiotherapy education. Simulation-based and active approaches appear particularly impactful. Future research should emphasize high-quality randomized trials and long-term outcomes, including patient-related measures.

Physical inactivity (PI) has emerged as a “forgotten pandemic” in global health. Over a quarter of adults worldwide fail to meet recommended physical activity (PA) levels, a proportion that has remained largely unchanged since 2001. This inactivity drives a rising non-communicable disease burden, deepens health inequities, and generates substantial economic costs. Yet preventive action and dedicated funding remain insufficient. Despite international frameworks and national PA plans, with nearly 75

Background Children with cerebral palsy (CP) experience both motor and cognitive impairments. While balance deficits are well-documented in CP, the relationship between cognition, more specifically executive function (EF), and balance remains unclear. Digital tools offer a promising approach to capturing these domains. This cross-sectional study aimed to compare balance and EF between children with CP and typically developing (TD) peers, and to investigate their inter-relationships within and between groups using a digital phenotyping approach. Methods 30 children with CP (GMFCS I-III) and 30 age- and sex-matched TD children underwent digital assessments. Both static balance, quantifying total sway path of the length (DOT) and related parameters and a dynamic balance, measuring the extends of the body sways during gamified test were used. EF tasks, including reaction time (RT), inspection time (IT), impulse control (IC), working memory (WM), and reverse number counting (RNC), were assessed using digital tool. Group comparisons were performed using t-tests or Mann-Whitney U tests. Linear regressions and Pearson’s correlation tests with Holm correction examined relationships between variables within and across groups. Results Children with CP showed significantly worse performance across nearly all balance and EF measures. EF measures were mostly dissociated in both experimental and control group with slightly stronger inter-relation in TD controls (r = 0.25 and 0.36, for CP and TD respectively). Significant moderate correlations between DOT and EFs were found only in the CP group for RT (r = 0.43), IC (r = 0.47), and RNC (r = 0.45). For dynamic balance, two moderate negative significant correlations for IC and both planes of DBT in participants with CP were found (anterior-posterior: r = − 0.41; medio-lateral r = − 0.40), no correlation was found in TD children. Conclusions Different EFs, specifically inhibitory control, are coupled with postural control demands in children with CP, but not in their TD peers, suggesting an altered and more integrated use of executive resources for maintaining stability. Digital phenotyping effectively captured this altered motor-cognitive interplay, revealing a dissociation among EF domains alongside a specific coupling between IC and balance, which may have implications for both assessment and intervention planning.

Innovative technologies like serious games (SGs) and virtual reality (VR) may revolutionize the way Autism Spectrum Disorder (ASD) is assessed, offering new pathways to understand the complexities of body representations (BRs) and sensorimotor coordination. Traditional tools often fail to capture the dynamic and multifaceted nature of ASD-related challenges, including spatial awareness, body image, and daily functioning. This study explores the potential of SG and immersive VR to provide ecologically valid, engaging, and personalized assessments for adults with ASD. The STATISM platform, incorporating wearable sensors, gamified tasks, and real-time feedback, was used to evaluate motor coordination, balance, and visuospatial skills. Complementing this, VR systems like PICO Neo3 provided insights into the sense of embodiment and cognitive functioning. The combination of SG and VR demonstrated high participant engagement and compliance, supporting their usability in ASD assessments. This integrated approach paves the way for precise, tailored interventions and a deeper understanding of ASD, showcasing the transformative potential of technology to bridge the gap between clinical evaluation and real-life application.

IntroductionCognitive function is closely linked to brain energy metabolism and may be compromised by aging, metabolic stress, and neuropsychiatric disease. Ketone bodies can serve as an alternative cerebral fuel and may also exert signaling effects relevant to cognition. Exogenous ketones (EK) offer a practical means of increasing circulating ketone concentrations without dietary carbohydrate restriction. However, the overall effect of EK supplementation on cognitive performance in humans has not been systematically quantified.MethodsA systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. PubMed, Web of Science, and Embase were searched through October 2025 for randomized controlled trials investigating the effects of EK on cognitive outcomes in healthy adults or individuals with neuropsychiatric conditions. Data extraction and quality assessment were performed independently by multiple reviewers using the PEDro scale. Standardized mean differences (SMD) were calculated using random-effects models. Subgroup and meta-regression analyses examined the influence of ketone formulation, intervention duration, dose, population type, and presence of acute cognitive stressors.Results38 studies comprising 41 protocols (1,602 participants) were included in the systematic review, with 29 protocols (1,117 participants) eligible for meta-analysis. EK supplementation was associated with a statistically significant improvement in cognitive performance compared with placebo (SMD = 0.29, 95% CI 0.16–0.41; p < 0.001). Sub-group analyses did not show statistically significant differences between the type of supplementation (p = 0.083), study duration (acute vs. intermediate; p = 0.11), population type (healthy vs. Alzheimer’s disease; p = 0.077), or the presence of acute cognitive stressors (p = 0.89). Meta-regression revealed a positive association between daily EK dose and cognitive improvement.DiscussionEK supplementation is associated with modest improvements in cognitive performance across diverse populations and study designs. These findings support EK as a flexible nutritional strategy for cognitive support and warrant further investigation in well-powered, long-term trials to clarify optimal dosing, formulation, and clinical applicability.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD42023471727, CRD42023471727.

Virtual reality (VR) is transforming rehabilitation and training, offering immersive (IVR) and non-immersive (NIVR) approaches with distinct benefits and applications. IVR uses head-mounted displays and motion tracking to create fully immersive environments, enhancing user engagement and simulating realistic tasks. NIVR, on the other hand, relies on standard screens, providing more accessible and cost-effective solutions. This systematic review and meta-analysis evaluated the comparative effectiveness of IVR and NIVR in improving activities of daily living (ADL) and quality of life (QoL) in stroke survivors. Data from 30 randomized controlled trials involving 1564 participants showed that IVR demonstrated statistically significant greater outcomes (p = 0.03) in ADL (SMD = 0.54, 95

Purpose: Physical activity (PA) is essential for healthy ageing, yet accurately assessing PA in older adults remains challenging due to the biases and limitations of traditional clinical assessments. This study aimed to optimise digital phenotyping strategies for evaluating PA patterns in older adults by integrating ecological momentary assessment (EMA) with continuous wearable sensor data. Methods: Over a two-week period, 108 community-dwelling older adults participated in the study. PA was continuously monitored using Garmin Vivo 5 wearable sensors, while participants provided real-time responses to EMA prompts. Feasibility was assessed based on adherence to EMA, and associations between psychological factors (motivation, self-efficacy) and PA intensity were analysed. Results: The combined EMA and wearable sensor approach proved feasible, with 67.2% overall adherence to EMA prompts (morning: 68.1%; evening: 65.4%). PA was primarily of low (51.4%) and moderate (46.2%) intensity, with activity peaks around midday. Motivation and self-efficacy were significantly associated with low-intensity PA (R = 0.20 and 0.14, respectively), particularly in the morning. Notably, no correlation was found between objective step counts and self-reported PA (R = −0.026, p = 0.65), emphasising the importance of combining both data sources. Conclusions: Integrating EMA with wearable sensor data within a temporal framework enhances the ecological validity and accuracy of PA assessment in older adults. This approach offers valuable, personalised insights that can inform targeted, time-sensitive interventions to promote PA in ageing populations. Support/Funding Source: PXL University of Applied Sciences and Arts [2/DWO/2021/HC/P133] and by Flanders Innovation and Entrepreneurship [2/DWO/2022/HC/VL041]. Keywords: Physical activity, older adults, ecological momentary assessment, wearable sensors

Body representations (BR) are multidimensional constructs that shape everyday functioning, autonomy, and quality of life. They include body schema (BS): the action-oriented representation of the body that supports movement and sensorimotor regulation, and body image (BI): the conscious perceptual, affective, and cognitive experience of the body. In autism, alterations in BR have been linked to sensory processing, motor coordination, social interaction, self-perception, and identity, yet the overall structure of these components remains unclear. This systematic review aimed to define a conceptual framework for BR in autism, identify the domains most consistently reported as different from non-autistic comparison groups, and synthesize current evidence on assessment approaches and clinical implications. Following PRISMA guidelines, we reviewed 54 studies published between 2000 and 2025, comprising 2982 participants. The findings showed a marked predominance of research on BS (81% of studies), particularly sensorimotor dimensions such as interoception (9 studies), proprioception (4 studies), and multisensory integration (3 studies). By contrast, BI was substantially less investigated, despite emerging evidence linking it to body dissatisfaction, body dysmorphic concerns, and identity-related difficulties. Across studies, BR differences were most often described in relation to bodily awareness, movement regulation, emotional processing, and self-referential perception. The review also highlighted major methodological limitations, including heterogeneity of constructs and an overreliance on self-report tools. Overall, BR emerges as a clinically relevant but still underdeveloped domain in autism research, underscoring the need for more comprehensive, developmentally sensitive, and multimodal assessment approaches.

Health research has shifted from a disease-centered approach towards emphasizing functioning and more specific lived health. Lived health, the actual performance of daily activities in one's environment, has nevertheless received limited attention, and its assessment remains methodologically challenging. Ecological Momentary Assessment (EMA), a real-time method capturing behaviors, emotions, and context in natural settings, holds promise in this regard. Although EMA research is increasing, insight into its use for studying daily activities is still limited. To address this gap, this study systematically maps EMA applications across diverse health and disability populations to better understand lived health, defined as actual engagement in daily activities. A bibliometric analysis was conducted using a literature search on Web of Science with keywords related to EMA combined with daily activity terms, yielding 3,692 English-language articles. Publications were classified according to general characteristics, distribution of disability and health populations, actual engagement in daily activities following the person-environment-occupational model (PEO-model), and interaction analyses combining the last two analyses. The results show that mental disorders dominate the EMA research on daily activities, representing 75% of the dataset, which has significantly shaped the overall research landscape. Moreover, while personal factors are frequently highlighted, occupational and environmental dimensions remain underrepresented. These findings suggest that future EMA research should better integrate aspects of person, occupation, and environment, for instance by using tools such as geolocation and passive sensing to capture daily functioning more holistically. Expanding research beyond mental health and increasing secondary analyses will further strengthen the relevance and impact of EMA on health research.

Maternal depression, encompassing prenatal (PND) and postpartum (PPD) phases, remains a global health concern, adversely affecting maternal well-being and infant development. Traditional interventions, such as antidepressant medication and psychological therapies, often face barriers related to accessibility, stigma, and inconsistent efficacy. Technology-supported mindfulness-based interventions (MBIs) offer an innovative, scalable approach, leveraging digital tools to enhance accessibility, engagement, and effectiveness. This systematic review and meta-analysis synthesized evidence from 18 studies involving 2481 participants. The findings revealed that technology-supported MBIs significantly reduced maternal depression symptoms compared to control groups (Standardized mean difference (SMD) −0.55, 95

BackgroundDaily activities shape individuals’ health and well-being, reflecting functioning and lived health. For people with neurological conditions, these activities are often disrupted, affecting autonomy and quality of life. Traditional assessments miss subtle, real-time fluctuations, whereas ecological momentary assessment (EMA) captures moment-to-moment activity within natural contexts, offering insight into person-environment-occupation interactions. Despite its growing use, it remains unclear how EMA protocols conceptualize daily activities and integrate person-environment-occupation dimensions in applications for neurological populations. ObjectiveThis scoping review aims to map the existing literature on the use of EMA to capture daily activities, ranging from basic self-care to more complex activities, in individuals with neurological disorders. MethodsA scoping review was conducted to map studies using EMA to capture daily activities in adults with neurological conditions, with a specific focus on content and practical application. A total of 341 articles were identified. ResultsA total of 20 studies using EMA to assess daily activities in neurological populations were included; most were observational, with 2 longitudinal studies and 2 randomized controlled trials. Daily activity questions and response formats varied, often using multiple-choice lists; only 1 study allowed open-ended responses. In addition to daily activity questions, EMA captured person (physical, affective, and cognitive), environment (physical and social), and occupation domains, as well as motivation and EMA disturbance. Protocols differed in setting, schedule, technology, and adherence, with most reporting completion rates above 70%. ConclusionsEMA captures daily activities in neurological populations and demonstrates generally high adherence despite variability in study designs, questions, and technologies. The findings suggest that the phrasing of EMA items, the predominance of closed-response formats, and the narrow focus on the verb “doing” limit the depth and nuance of the data collected, often overlooking important aspects of performance, engagement, or both in daily activities.

Osteoarthritis (OA) is a highly prevalent musculoskeletal disorder and a major cause of disability, posing growing challenges for healthcare systems worldwide. Conventional supervised clinical assessments provide valuable insights but are largely limited to cross-sectional snapshots and often fail to reflect the variability of real-world functioning, physical activity patterns, and symptom fluctuations experienced by individuals with OA, especially those with knee OA. This perspective introduces a multisensor digital phenotyping framework for smart knee OA assessment, integrating supervised laboratory evaluations with unsupervised continuous monitoring in daily living environments using wearable sensors, smart insoles, activity trackers, and mobile devices. Feasibility was tested in 40 participants (20 knee OA patients, 20 controls). Raw data from questionnaires, electronic goniometry, dynamometry, force plate, connected insoles, and seven-day home monitoring were harmonized via a standardized pipeline aligned with the ICF framework. The pipeline employed anomaly detection, missing data imputation, z-score normalization, and cloud-based storage. This framework is envisioned to facilitate advanced data integration and machine-learning-ready analytics, enabling longitudinal monitoring, pattern recognition, and individualized health profiling. By conceptually bridging cross-sectional and continuous sensing modalities, this approach has the potential to enhance ecological validity, support earlier identification of functional decline, and inform data-driven clinical decision-making. Key methodological, technological, and ethical challenges—including data quality, interpretability, privacy, digital literacy, and clinical adoption—are also highlighted. Overall, this paper underscores the promise of AI-enabled multisensor digital phenotyping to advance smart, personalized, and precision healthcare for individuals with knee OA.

The burden of disability is rising rapidly in Africa, where a severe shortage of rehabilitation professionals and limited infrastructure create a major treatment gap. Immersive virtual reality and serious games have shown promise for upper limb rehabilitation, but current extended reality (XR) solutions lack personalization, cultural adaptability, real-time feedback, and scalability. This perspective paper proposes a conceptual AI-enhanced XR framework tailored to African low- and middle-income countries. We identify how generative AI, large language models, multiagent systems, and explainable AI can address specific rehabilitation barriers. The framework integrates these four pillars into a three-layer architecture covering content creation, interaction, and decision support. We analyze implementation considerations specific to African contexts—infrastructure, capacity building, cultural adaptation, ethics, and financing—and outline a detailed research agenda with near, medium, and longer term priorities. Realizing this vision requires co-design with African communities, investment in local capacity, adaptation to infrastructure constraints, and development of ethical frameworks. AI-enhanced XR has the potential to democratize access to quality rehabilitation across Africa, but this potential must be validated through rigorous, context-sensitive research.

Cognitive function (CF) is essential for daily life and rehabilitation outcomes, but assessing it in children with developmental disabilities (CDD) is challenging due to variability in disabilities and limitations of traditional tools. Computerized cognitive assessments (CCAs) offer innovative, scalable, and accessible alternatives. This scoping review examined 25 studies covering 19 CCAs used to evaluate CF in 2455 СDD. Most tools (80

Physical activity (PA) is an important factor for maintaining health and well-being, especially in older adults. This study aims to apply machine learning methods to predict PA patterns and identify key factors influencing these behaviors among community-dwelling older adults. Linear and Logistic Regression, Elastic Net, and Light Gradient Boosting Machine (LightGBM) models were used to analyze cross-sectional data. While longitudinal data collected over 14 days were analyzed using LightGBM, Gated Recurrent Unit (GRU), and Long Short-Term Memory (LSTM). The most important predictors identified in the cross-sectional analysis were the Exercise Self-efficacy Scale (ESES) for PA levels and the Geriatric Depression Scale (GDS) for the International Physical Activity Questionnaire (IPAQ) as a continuous measurement. In the longitudinal analysis, using a seven-day sequence of step count data provided the best performance for forecasting physical activity for the entire next day. Overall, the findings indicate that combining wearable sensor data with machine learning and deep learning methods can provide valuable insights into physical activity behaviors among older adults. In the cross-sectional analysis, psychological and motivational factors such as self-efficacy were identified as important factors for activity levels, while in the longitudinal analysis, using a week of past step count data provided the most reliable predictions of future-day physical activity.

This perspective explores the transformative impact of the Nintendo Wii on rehabilitation practices and the challenges arising from its discontinuation. The Wii's motion-sensing technology revolutionized rehabilitation by providing an engaging, low-cost and accessible platform for various patient populations. Its success catalysed the development of serious games and exergames specifically designed and adapted for therapeutic purposes. Research has demonstrated the Wii's efficacy in improving balance, motor function, and patient engagement across multiple conditions, including stroke, Parkinson's disease, and cerebral palsy. However, the Wii's discontinuation has created a significant void in the rehabilitation landscape, raising concerns about the sustainability of technology-driven therapies. This non-empirical paper examines the Wii's novelty, its influence on rehabilitation techniques, and the critical need for innovative solutions to address the gap left by its absence. We emphasize the importance of continued collaboration between the gaming and healthcare industries to develop accessible, affordable, and effective rehabilitation technologies that build upon the Wii's legacy.

The traditional paradigms in global health, often characterized by power imbalances similar to the racial disparities between White and Black populations, are insufficient for addressing the complex health challenges of the 21st century. These disparities not only exist within national borders but also mirror the limitations of the North-South paradigm on an international scale. This framework perpetuates systemic inequalities, undermines local agency, and neglects the valuable expertise within communities of color. The evolving landscape of global health, marked by emerging infectious diseases, antimicrobial resistance, non-communicable diseases, and climate change impacts, necessitates a paradigm shift toward partnerships based on mutual respect, shared responsibility, and equitable collaboration. This paper explores the limitations of the conventional paradigms and highlights the multifaceted benefits of a more collaborative approach. It demonstrates how equitable partnerships can enhance health security, foster innovation, and promote sustainable development across racial lines. Successful examples of equity-focused cooperation illustrate the potential of diverse partnerships in strengthening health systems and promoting knowledge sharing between White and Black communities. A new framework for health cooperation is proposed, emphasizing mutual respect, transparency, accountability, and sustainable capacity building. By recognizing the agency and expertise of Black communities, we can create a more inclusive and democratic health architecture. This shift from a charity-based mindset to one rooted in solidarity acknowledges that investing in health equity is a strategic investment in our collective future. Embracing this interconnected approach will enable us to tackle pressing racial health challenges and ensure a healthier and more equitable future for all.

Age and the ε4 variant of the apolipoprotein E gene (APOE ε4) are two major drivers of Alzheimer’s disease (AD). APOE is also the major determinant of longevity. How age and APOE interact in the development of AD is largely unknown. In this study we integrate metabolomics (N = 274,259) and proteomics (N = 54,219) data in plasma from the UK Biobank with the metabolomics (N = 514) and proteomics (N = 618) data in brain from the Religious Orders Study and the Rush Memory and Aging Project (ROSMAP) to understand the interplay of age, APOE ε4 and metabolome in the development of AD. We find that levels of β-hydroxybutyrate (BHBA) and branch-chained amino acids (BCAAs) are dysregulated in plasma and brains of AD patients. APOE ε4 carriers manifest significantly higher plasma concentration of BHBA that is detectable as early as 37 years of age and remains high throughout the studied age range of 37–73 whereas the plasma concentrations of BCAAs decline in APOE ε44 carriers after the age of 58 years. Proteomic signatures of APOE ε4, BHBA and BCAAs suggest downregulation of lysosome, immune and insulin-like growth factor (IGF1) transport/uptake pathways in plasma, and downregulation of the tricarboxylic acid (TCA) cycle, neurexins/neuroligins and clathrin-mediated endocytosis pathways in brain. Our data identifies two major shifts in metabolism occurring decades apart over the age course in AD in APOE ε4 carriers. These include early ketogenesis that manifests around late 30 s and gluconeogenesis, which manifests around the age of 60 years.