Introduction: With the growing population of older adults, predicting survival through clinical examinations has gained an increased interest. We aimed to evaluate the relationship between balance measures, such as postural sway and voluntary stepping performance and survival. METHODS:This study analyzed balance parameters, collected from previous studies conducted between 2005 and 2011, including postural sway, stabilogram diffusion analysis (SDA) in standing, and voluntary step execution. Cox proportional hazards regression analyses were performed to examine associations between balance parameters and mortality. RESULTS:Voluntary stepping performance, especially under dual-task (DT) condition, was associated with survival. Slower step initiation time was associated with higher mortality risk; with every 0.100 s increase, the survival hazard rate ratios decreased by 28%. Postural sway parameters, particularly increase in anterior-posterior sway velocity, demonstrated predictive ability but less effective than voluntary stepping test parameters. Among SDA measures, higher critical displacement tended to show an association with lower survival in older adults. CONCLUSION:These findings align with prior research regarding physical performance indicators, such as gait speed, to survival. Voluntary stepping under DT conditions extends this understanding by capturing both physical and cognitive functions, offering a more integrated survival assessment. Voluntary stepping performance, in DT conditions, may be a valuable predictor of survival in older adults. Incorporating DT-based assessments into clinical evaluations could improve survival prediction and guide early interventions targeting cognitive-motor health. Future studies should explore the longitudinal impact of voluntary stepping on survival, assessing whether cognitive-motor training for balance rehabilitation can enhance survival rates. .

Stroke is a leading cause of long-term sensorimotor disability, with upper limb deficits often persisting into the chronic stage. For many patients with stroke, the active muscle control zone, i.e., the angular range of typical muscle activation patterns, is reduced, leading to abnormal patterns and spasticity. When the displayed angle in a virtual environment is smaller than the actual angle, participants may implicitly perceive that their arm remains within the control zone. This discrepancy between visual and proprioceptive information may promote visuo-proprioceptive recalibration and sensorimotor adaptation. The current study included two preliminary investigations, one with healthy participants and one with participants with stroke, each divided into two groups (offset, control). Twenty-one healthy participants underwent a 30-min training session, after which they were tested with the actual elbow angle. Twelve hospitalized individuals with sub-acute stroke underwent three 30-min training sessions over one week. In both studies motion duration of participants who trained with an offset differed from motion of controls who trained with actual feedback. However, Fugl-Meyer Assessment upper limb scores in participants with stroke increased similarly for both groups. Additional testing is required to examine whether the method may be a potential direction for individualized impairment-based intervention.

BACKGROUND:A cohort of patients in the rehabilitation wards also suffer from Fibromyalgia, which is considered the most prevalent cause of chronic pain. Poor function, subjective cognitive impairment, instability and imbalance are all common features of Fibromyalgia, among other more prominent features such as the use of chronic pain medication. The main purpose of this study was to examine the differences in Length of Stay (LOS) and functional outcome parameters. METHODS:A retrospective cohort trial was conducted at the Soroka University Medical Centre. The time of data collection was conducted from January 2015 to December 2021. Patients were divided into two groups based on their exposure status: With Fibromyalgia (n = 43) and Control group Without Fibromyalgia (n = 1119). A 1:10 matching process and regression analysis were performed to avoid confounding factors. Matching was based on age, gender, and ethnicity. Various rehabilitation outcomes were collected along with pain assessment and pain medication use during the hospitalisation. Statistical analysis was performed using R software. A p value of < 0.05 will be considered statistically significant. RESULTS:No statistically significant difference was found in the duration of hospitalisation, the FIM index at admission and discharge, or the change in the FIM index (ΔFIM) during hospitalisation between the two groups. No statistically significant differences were demonstrated in stability and balance indices (DGI, BBS) or cognitive assessment tests (MoCA). CONCLUSIONS:The stigma is incorrect, as patients with fibromyalgia can improve their functional parameters during an inpatient rehabilitation programme to the same degree as those without fibromyalgia.

The need for medical rehabilitation is growing rapidly, including functional assessment and rehabilitation management of outpatients. The wide diversity of the out of the hospital PRM programs leads to define the basic principles and the role of the PRM specialist in the field. The aim of this article is to outline the core professional principles of the PRM for outpatient care, according to the Physical and Rehabilitation Medicine Section of the European Union of Medical Specialists. A Working Group (WG) on "Physical and Rehabilitation Medicine for Outpatients" was formed in March 2023. The final version was unanimously approved at the General Assembly on September 13th, 2024. The principal aspects of PRM management of outpatients, according to the UEMS PRM Section, are reported. It is essential that PRM programs for outpatients are planned, developed, and implemented according to the professional principles of Physical and Rehabilitation Medicine in appropriate settings. They must be conducted by a multiprofessional team led by a PRM physician. These efforts aim to maximize functional outcomes and enhance the quality of life for individuals at risk of disability and chronic conditions.

INTRODUCTION:The evidence on the utility and effectiveness of rehabilitation interventions delivered via telerehabilitation is growing rapidly. Telerehabilitation is expected to have a key role in rehabilitation in the future.AIM:The aim of this evidence-based position paper (EBPP) is to improve PRM physicians' professional practice in telerehabilitation to be delivered to improve functioning and to reduce activity limitations and/or participation restrictions in individuals with a variety of disabling health conditions.METHODS:To produce recommendations for PRM physicians on telerehabilitation, a systematic review of the literature and a consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section.RESULTS:The systematic literature review is reported together with the 32 recommendations resulting from the Delphi procedure.CONCLUSIONS:It is recommended that PRM physicians deliver rehabilitation services remotely, via digital means or using communication technologies to eligible individuals, whenever required and feasible in a variety of health conditions in favor of the patient and his/her family, based on evidence of effectiveness and in compliance with relevant regulations. This EBPP represents the official position of the European Union through the UEMS PRM Section and designates the professional role of PRM physicians in telerehabilitation.

Background/Aims Dry needling is widely used to treat myofascial pain and related musculoskeletal conditions. Recently, the use of dry needling for the management of post-stroke spasticity has been proposed. The aim of this study was to evaluate the immediate effect of dry needling of spastic muscles on pain, spasticity, and pain pressure threshold in the elbow and wrist muscles of patients who have had a stroke. Methods This quasi-experimental, pre–post design feasibility study implemented dry needling in wrist or elbow flexors. Outcome measures evaluated muscle spasticity using the Modified Modified Ashworth Scale, pain pressure threshold and range of motion. Results A total of eight participants (seven men and one woman) were included in the study. The average age was 57.00 ± 13.88 years. The Modified Modified Ashworth Scale scores decreased from 1.81 ± 0.84 to 1.25 ± 0.46 in the elbow flexors (P=0.066) and from 1.86 ± 0.69 to 1.29 ± 0.49 in the wrist extensors (P=0.046). Range of motion increased in the elbow, and there was a statistically significant increase in the range of motion in the wrist (P=0.027). Pain pressure threshold also increased statistically significantly in muscles related to the wrist and elbow (P=0.043 and P=0.035 respectively). Conclusions Dry needling may decrease spasticity, increase range of motion and pain pressure threshold in treated muscles and improve functional gains in the spastic limb. Further, more extensive studies are essential to assess the use of dry needling in managing post-stroke spasticity. Implications for practice Physiotherapists can use dry needling in spastic muscles when treating patients who have had a stroke.

INTRODUCTION:Medical rehabilitation is developing rapidly in Israel and around the world due to the aging of the population, improvement of results of medical care, and growing awareness of the importance of rehabilitation medicine. An option of comprehensive community rehabilitation treatment is also developing quickly, both in the model of replacing hospitalization and as a professional treatment after early discharge from an inpatient program. Rehabilitation in the community has many benefits, including financial, high patient satisfaction, and in some cases even more successful results of rehabilitation. The key to successful community rehabilitation lies in team cooperation and synchronization and in transferring the weight of rehabilitation from the inpatient department to rehabilitation in the community by the rehabilitation doctor as a team manager and the multi-disciplinary team. A 2018 Ministry of Health document defines home rehabilitation as "An orderly, multi-professional and vigorous program, intended for all ages, to achieve goals in rehabilitation according to a functional assessment and a rehabilitation plan, in the patient's home." In writing this article we defined two main goals. The first is to review current data, which can be found in the scientific literature on community rehabilitation. The second goal was to define the principles and systems of community rehabilitation, relevant to the State of Israel.

BACKGROUND:The field of Physical Medicine and Rehabilitation is as diverse and broad as any field in medicine. The two, seemingly different, fields developed separately and over time (as later presented) merged into one specialty. This resulted in an initial asymmetry of focus amongst training programs - and indeed countries. In Israel, although rehabilitation medicine is on par with the highest levels in the world, its partner, physical medicine (PM) has suffered to the extent that it is practically invisible in some of the training hospitals in our country. OBJECTIVES:We will define PM, explain why it is less developed in Israel, and present the methods being employed to rectify the training imbalance. METHODS:A systematic literature review was performed for prior descriptions and issues in PM in Israel. The search was conducted using four databases (PubMed, Google Scholar, ScienceDirect and the Cochrane Library). Searches were not limited by language or date, reflecting all available data. RESULTS:No articles were identified. This was anticipated as the field of PM is in the process of development in Israel. CONCLUSIONS:Whereas PM has been an official partner of rehabilitation medicine in Israel and prominently featured in academic syllabi, the reality has been otherwise. Our article delineates why this developed and the plans and methods on how it is changing, allowing Israel to be a world leader in all aspects of Physical Medicine and Rehabilitation.

INTRODUCTION:Modern rehabilitation medicine focuses on evaluating and treating patients whose quality of life has been compromised by medical conditions. This field endeavors to enhance well-being and independence levels by adopting a comprehensive approach that addresses physical, mental, psychological, and social aspects, while incorporating advancements in medical research. Grounded in the International Classification of Functioning, Disability, and Health (ICF) model by the World Health Organization, rehabilitation targets diverse levels of functional impairment. A collaborative effort among professionals from various disciplines characterizes the rehabilitative process, guided by an Individual Rehabilitation Project, and oversight by a specialist in physical medicine and rehabilitation. Through initiated prompt post-injury, rehabilitation progresses through hospital-based interventions and extends to community-based therapies upon the patient's return home. In this special edition of "Harefuah" readers will find profound scientific articles and literature reviews spanning a breadth of topics within the realm of physical medicine and rehabilitation. These insights offer a glimpse into the expansive domain of rehabilitation medicine.

Community-based medical rehabilitation encompasses diverse programs that cater to patients outside of inpatient settings, such as home rehabilitation, day rehabilitation centers, and ambulatory clinics. While inpatient rehabilitation principles are widely standardized, outpatient programs display significant variability influenced by healthcare models, local environments, economic constraints, and available resources. This narrative review aims to explore and synthesize the various models of non-inpatient rehabilitation services, evaluating their effectiveness, cost-efficiency, and patient satisfaction. The review also seeks to identify optimal practices and strategies to enhance community-based rehabilitation, alleviate the burden on inpatient facilities, and improve patient outcomes through multidisciplinary and patient-centered approaches. Additionally, the study examines the critical role of a professional program coordinator and the importance of effective clinical communication in outpatient rehabilitation. A comprehensive search of peer-reviewed literature was conducted across multiple databases, focusing on studies that examined community-based rehabilitation models. The findings suggest that community-based rehabilitation programs are generally more cost-effective than inpatient programs, with their success being heavily dependent on the intensity and timing of interventions. Multidisciplinary approaches and high-intensity rehabilitation have shown promise in improving patient quality of life, though their effectiveness varies by condition. Despite limited research, the involvement of a Physical and Rehabilitation Medicine (PRM) physician as a program coordinator appears vital for ensuring continuity of care. Moreover, effective clinical communication is essential, impacting all aspects of patient care and interprofessional collaboration, with continuous adaptation required to meet the evolving needs of diverse patient populations.

Conversion disorder (CD) is a psychological disorder characterized by neurological symptoms, without evidence of an organic etiology. CD is more common in women, and is recognized in children and adolescents. Functional MRI (fMRI) has been shown to be useful in providing functional correlation to patients’ symptoms, and that information opens a new window of understanding. We present a case in which the objective evidence provided by fMRI led to the successful rehabilitation of an adolescent patient: A 16-year-old presented with left hemiplegia and once a diagnosis of CD was made, was admitted to the rehabilitation department. An fMRI was performed – using a block design targeting motor and somatosensory stimulation tasks to the body parts with the greatest motor and sensory loss. The results enabled the patient to understand the physiologic correlates to her symptoms and improved rapidly. Validation of the patient’s condition provided the psychological spark allowing recovery to begin.

Background/Aims There is great demand for the beds in the new rehabilitation department in the authors' hospital. To determine ethical criteria for admission to the department, all senior rehabilitation physicians in the country were surveyed regarding their willingness to admit patients in various ethical scenarios. The aim was to determine whether there are consensus ethical principles governing whom to admit to the limited beds. Methods The survey was administered to senior medical personnel responsible for admissions decisions. Out of the 54 people contacted, 30 completed the surveys (all were fully completed apart from one survey in which one clinical scenario was not answered). Results Over 90% of respondents agreed to not admit non-compliant patients or to give precedence to those who were considered to be very important people, and 88% agreed on admitting a homeless patient. First come, first served was not considered an important criterion. Cronbach's alpha was <0.6. There was no consensus on most of the issues presented. Conclusions It remains difficult to pinpoint what rehabilitation physicians consider ethical ‘givens’. This research suggests that no specific ethical principle underlying the triage decisions in rehabilitative medicine can be discerned. Larger studies are warranted. Implications for practice No ethically or specific principle underlying the triage decisions in rehabilitative medicine can be discerned. What one doctor may consider a clear ethical decision another physician may not concur.

Functional Neurological Disorders (FNDs) are one of the most common and disabling neurological disorders, affecting approximately 10–30% of patients in neurology clinics. FNDs manifest as a range of motor, sensory, and cognitive symptoms that are not explained by organic disease. This narrative review aims to assess the current state of knowledge in physical-based rehabilitation for motor/movement FNDs in the adult population, with the goal of improving research and medical care for this patient population. To ensure optimal outcomes for patients, it is critical to consider several domains pertaining to FNDs, including which field of discipline they should belong to, how to investigate and test, methods for rating outcome measures, and optimal courses of treatment. In the past, FNDs were primarily treated with psychiatric and psychological interventions. However, recent literature supports the inclusion of physical rehabilitation in the treatment of FNDs. Specifically, physical-based approaches tailored to FNDs have shown promising results. This review utilized a comprehensive search of multiple databases and inclusion criteria to identify relevant studies.

Persons with chronic stroke (PwCS) have a decreased ability to ambulate and walk independently. We aimed to investigate the differences between the motor adaptation process for two different perturbation methods: split-belt treadmill walking and unilaterally applied resistance to the swing leg during walking. Twenty-two PwCS undergo split-belt treadmill walking and unilaterally applied resistance to the swing leg during walking, each one week apart. The test included three phases: the baseline period, the early-adaptation period and the late-adaptation period, as well as the early-de-adaptation period and the late-de-adaptation period. The average step length, swing duration, double-limb support duration, and coefficient of variance (CV) of these parameters were measured. During the split-belt treadmill walking, PwCS showed an adaptation of double-limb support duration symmetry (p = 0.004), specifically a trend between baseline versus early-adaptation (p = 0.07) and an after-effect (late-adaptation compare to early-de-adaptation, p = 0.09). In unilaterally applied resistance to the swing leg during walking, PwCS showed lower swing phase duration CV, in the adaptation period (baseline compare to adaptation, p = 0.006), and a trend toward increased variability of gait in the de-adaptation period compare to the adaptation periods (p = 0.099). The rate of adaptation and de-adaptation were alike between the two perturbation methods. Our findings show that the learning process happening in the central nervous system of PwCS may be dependent on the nature of the perturbation (mechanical resistance vs. split-belt) and that PwCS are able to adapt to two types of errors.

Abstract Ethical allocation of scare medical resources is a ubiquitous challenge in many, if not all, medical specialties. The field of physical medicine and rehabilitation is no exception and presents its own unique dilemmas. We report on a small inpatient rehabilitation unit at a large university medical center with a large catchment area representing a vast range of socioeconomic classes. The decision of whom to admit is a constant challenge. We review the existing literature regarding ethical considerations in rehabilitation department admission criteria and attempt to analyze criteria used to admit patients to a general physical medicine and rehabilitation ward. Finally, we discuss our medical center approach to the ethical dilemma of admission priority. A systemic search was conducted in six sources (PubMed, Google Scholar, ScienceDirect, Cochrane Library, LILACS, Embase). Searches were limited to English language articles with no date restriction, reflecting all available data. A reviewer applied the inclusion criteria to identify relevant articles. This review highlights a number of important ethical issues in evaluation and selection criteria that may assist clinicians in improving selection procedures and standardizing access to inpatient rehabilitation. Further high-quality empirical studies and reviews of ethical admission practice with regard to rehabilitation acceptance are required.

To facilitate the interaction between the health professional and the patient, a framework to guide the rehabilitation process is needed. This framework would encompass three interwoven aspects: the rehabilitation management plan, Individual Rehabilitation Project (IRP), and rehabilitation cycle(s). All three framework aspects focus on the patient and on the aim of rehabilitation, i.e. to optimize a person's functioning across the continuum of care. An IRP is a multi-element, person-centered rehabilitation management scheme, in which rehabilitation is generally provided by a multiprofessional team under the leadership of a physical and rehabilitation medicine (PRM) physician, working in an interdisciplinary manner and together with the patient (or proxy). A reference system for operationalizing functioning and standardizing the process is the International Classification of Functioning, Disability and Health (ICF) - for assessing functioning needs, defining rehabilitation goals and outcomes. The objective of this paper is to present the IRP as a framework for rehabilitation in Europe (EUR-IRP). The specific aims are: 1) to introduce the IRP; and 2) to describe the framework components, elements and variables of the IRP. Demonstration projects (case studies) using the EUR-IRP will be conducted. The present paper presents the efforts to date for developing the EUR-IRP, a key part of the action plan of the PRM Section and Board of the European Union of Medical Specialists to implement the ICF systemwide across the care continuum. This paper serves as another step to bring together practice, science and governance in calling for contribution from rehabilitation clinicians and researchers and professional societies in PRM and beyond.