Objective To investigate the effects of different types of assistive products (APs) on the association between activities of daily living (ADL) and social participation among rural older adults in China. Methods A cross-sectional study was conducted among 301 rural older adults in China using a questionnaire. Parallel mediation and moderation analyses were employed to explore how different APs influence older adults’ social participation. Results This study found that all surveyed types of APs were negatively associated with ADL. However, only mobility APs mediated the relationship between ADL and social participation, and demonstrated a suppression effect (β = -0.028, P<0.01). Furthermore, mobility APs exhibited a positive moderating effect on the relationship between ADL and social participation (β=0.021, P<0.01). Conclusions This study reveals a complex mechanism through which APs influence the relationship between ADL and social participation. Future targeted nursing interventions prioritizing mobility APs may effectively reduce social participation disparities in rural aging populations

The normalized creatinine-to-cystatin C ratio (NCCR) has been identified as a viable metric for assessing skeletal muscle mass and diabetes risk. However, the relationship between NCCR and cardiovascular disease (CVD) remains insufficiently understood. This study aims to clarify this association within a national, longitudinal, and prospective cohort. Participants were selected from the China Health and Retirement Longitudinal Study to form the study cohort. Baseline NCCR was designated as the exposure variable, while the primary outcome was the incidence of newly diagnosed CVD. Participants were divided into four groups (Q1–Q4) based on the quartiles of baseline NCCR. The risk of CVD across different NCCR groups was assessed using Cox proportional hazards models and Kaplan–Meier survival curves. Restricted cubic spline (RCS) analysis was conducted to investigate the nature of the association between NCCR and CVD. Additionally, the receiver operating characteristic (ROC) curve was utilized to evaluate the predictive value of NCCR for CVD. A total of 5,486 individuals participated in the study, with a median age of 59 years, of whom 2987 (52.42

AIMS:To evaluate the efficacy and safety of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) on the right dorsolateral prefrontal cortex (DLPFC) in patients with post-stroke depression (PSD), and to explore the possible neural mechanism of repetitive transcranial magnetic stimulation (rTMS) using functional near-infrared spectroscopy (fNIRS). METHODS:28 patients were randomly assigned to the rTMS group (n = 14) and control group (n = 14). The treatment effect was assessed by the Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), National Institutes of Health Stroke Scale (NIHSS), and Barthel Index (BI). In addition, fNIRS was used to detect changes in blood oxygen concentration in the frontal cortex. RESULTS:After treatment, HAMD scores in the rTMS group decreased significantly more than those in the control group (p < 0.05). Oxyhemoglobin (HbO) in CH17 increased and deoxyhemoglobin (HbR) in CH6 decreased after rTMS (p < 0.05). HbR in CH6 and CH8 decreased significantly, while HbR in CH12 and CH15 increased significantly (p < 0.05). The rTMS group also showed significantly greater improvements in HAMA, NIHSS, and Barthel Index scores (p < 0.05). CONCLUSION:The findings from this pilot study suggest that LF-rTMS on the right DLPFC combined with conventional treatment may be a safe approach to alleviate depressive symptoms in patients with PSD. Furthermore, fNIRS revealed that the mechanism of action may be related to improving left-right brain tissue blood flow and activation balance.

Introduction Depression is a common complication of stroke that adversely affects functional recovery. Although a wide range of pharmacological and non-pharmacological interventions are used in clinical practice, evidence regarding their comparative efficacy and acceptability remains inconclusive. Therefore, we will conduct the first systematic review and network meta-analysis (NMA) to compare and rank available interventions for post-stroke depression (PSD).Methods and analysis The findings will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. In this systematic review and network meta-analysis, we will search PubMed, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, CINAHL, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform from database inception to 1 September 2025 to identify published and unpublished randomised controlled trials (RCTs). We will include studies comparing pharmacological and non-pharmacological treatments, or any control conditions as monotherapy for the treatment of patients with PSD. We will assess the certainty of evidence using the Confidence in Network Meta-Analysis framework. The primary outcomes will be the change score on depression scales from baseline to the end of treatment (efficacy) and all-cause discontinuation (acceptability). Secondary outcomes will include quality of life, cognitive and neurological function scores, anxiety and sleep quality. Two reviewers will independently screen and select eligible studies based on predefined inclusion and exclusion criteria. Risk of bias in all RCTs included in the NMA will be assessed using the revised Cochrane Risk of Bias tool (RoB 2). A frequentist NMA will be conducted in Stata and R. Meta-regression and sensitivity analyses will be performed to assess robustness.Ethics and dissemination This NMA does not need ethical approval, as the data used here are based on aggregated data in the public domain. Findings from the analysis will provide an overview and information on the relative efficacy and acceptability of non-pharmacological and pharmacological treatments in PSD. The results will be disseminated through peer-reviewed publication.PROSPERO registration number CRD420251136670

Fluoxetine is a widely used antidepressant, yet integrated analyses of its molecular mechanism remain limited. This study systematically investigated potential molecular mechanisms underlying the antidepressant effects of fluoxetine by integrating these scattered data. Using the ProMENDA database, we identified metabolites and proteins altered by fluoxetine in the brain of animal models of depression. We curated 273 differentially expressed metabolite entries and 791 differentially expressed protein entries from fluoxetine treatment and performed vote-counting, pathway enrichment, pathway crosstalk and drug-associated metabolite set enrichment analyses. Vote-counting analysis showed altered neurotransmitter levels, including increased levels of monoamines and decreased levels of neurotoxic quinolinic acid and glutamate. The results of pathway analyses based on both altered metabolites and proteins showed 121 significantly enriched pathways. Pathway crosstalk analysis identified four pathway-based modules, which were mainly involved in amino acid metabolism, neurotransmitters and multiple biological processes. Drug-associated metabolite set enrichment analysis revealed 76 significantly enriched drug-related pathways, which were mainly involved in antidepressants. This study provides a comprehensive understanding of the antidepressant effects of fluoxetine, which may provide insights for the development of novel antidepressants.

INTRODUCTION:Poststroke motor dysfunction places a heavy burden on individuals and society. Virtual reality (VR) offers enhanced motor skill transfer and active rehabilitation by overcoming the scenario-specific constraints of conventional therapies. Validating the efficacy of VR rehabilitation could lead to scalable and cost-effective solutions, potentially enabling home-based rehabilitation. However, the widespread clinical application remains constrained by the lack of rehabilitation-specific VR and multidimensional quantitative assessments. The aim of this study was to investigate the multidimensional effects and neural mechanisms of VR rehabilitation in poststroke motor recovery. METHODS AND ANALYSIS:This study is a prospective, randomised, controlled clinical trial protocol designed to evaluate the effects of multisensory VR training on motor dysfunction in patients who had a stroke using multidimensional assessments. The trial consists of a baseline assessment, a 4-week intervention period and an endpoint assessment. A total of 40 patients who had a stroke will be randomly allocated in a 1:1 ratio to either a VR combined with treadmill group or a treadmill-only group. The primary outcome measure is the Fugl-Meyer Assessment of Lower Extremity score, while secondary outcomes include three-dimensional gait analysis, the Berg Balance Scale score, the activities of daily living score and functional near-infrared spectroscopy results. Safety will be evaluated by monitoring the incidence of adverse events. This study aims to determine whether VR rehabilitation offers superior efficacy in improving motor function in patients who had a stroke by using a multidimensional assessment approach, including neural coupling function, muscle movement mechanics and clinical performance. The findings will provide robust, high-quality evidence to support the broader application of VR in clinical practice. ETHICS, REGISTRATION AND DISSEMINATION:The trial was approved by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University (2022-155). This study protocol was registered with the clinicaltrials.gov (NCT06275516). The results will be published in a peer-reviewed journal or presented at a conference. TRIAL REGISTRATION NUMBER:NCT06275516.

BACKGROUND:Post-stroke cognitive impairment (PSCI) is a common complication after stroke, and blood pressure management is vital for stroke survivors. However, the association between diastolic blood pressure (DBP) during post-stroke rehabilitation and the risk of PSCI remains unclear. This study aims to evaluate this association in a real-world stroke cohort. METHODS:A total of 508 consecutive stroke patients admitted between May 2022 and March 2024 were included in this study. Univariate and multivariate logistic regression analyses were conducted to identify risk factors for PSCI. Restricted cubic spline (RCS) analysis was performed to explore the association between DBP and PSCI. Logistic regression models were used to evaluate the risk of PSCI in different DBP groups. Subgroup analysis was employed to assess the effect of DBP across different subgroups. RESULTS:During a median follow-up of 5.5 months, 41% of patients were identified as having PSCI. Univariate and multivariate logistic regression analyses indicated that low DBP is an independent risk factor for PSCI (odds ratio [OR] = 0.960 by 1 mmHg, 95% confidence interval [CI] = 0.933-0.988, p < 0.01). RCS analysis revealed a nonlinear relationship between DBP and PSCI incidence, with an inflection point of around 80 mmHg (P overall < 0.001, P nonlinear = 0.002). Logistic regression models suggested a higher risk of PSCI in the group with DBP < 75 mmHg compared with the group with 75-80 mmHg (OR = 2.606, 95% CI = 1.445-4.699, p < 0.01). CONCLUSION:DBP during post-stroke rehabilitation is associated with the incidence of PSCI in a non-linear manner. Specifically, a low DBP level during this period is an independent risk factor for PSCI. Maintaining a DBP above 80 mmHg during rehabilitation is beneficial for preventing PSCI.

Stroke is an acute cerebrovascular disease with extremely high rates of disability and mortality, and has become a major public health issue requiring urgent clinical attention. In recent years, with the convergence of bioelectromagnetics and nanomaterial science, magnetic and its derivative intelligent biomaterials have demonstrated clear application potential in critical aspects of stroke diagnosis and treatment. Magnetic therapy constitutes a non-invasive method for brain function intervention based on the principles of bioelectromagnetics. This technology achieves targeted regulation of the brain tissue microenvironment through the biophysical effects generated by time-varying magnetic fields, combined with multimodal neuroimaging guidance. Magnetic-responsive smart biomaterials primarily form a multifunctional system through the integration of superparamagnetic iron oxide nanoparticles with biocompatible carriers. Following surface modification, this system can be precisely guided by an external magnetic field to reach target lesions and perform diagnostic or therapeutic tasks. This article systematically reviews the research progress in magnetic therapy and magnetic-responsive smart biomaterials for stroke under the framework of “diagnosis, treatment, and the integration of diagnosis and treatment”. First, the pathological mechanisms and clinical management strategies for different stroke subtypes and stages were summarised. Subsequently, the role of magnetic therapies, represented by magnetoencephalography (MEG) and repetitive transcranial magnetic stimulation (rTMS), in stroke diagnosis and treatment was explored. Finally, the focus was placed on elaborating the design strategies for different magnetically responsive smart biomaterials and their classic biomedical applications in the field of stroke. Although research on magnetic-responsive biomaterials for stroke is still in the preclinical stage, recent studies have nevertheless provided valuable directions and paved the way for their further exploration in stroke management.

BACKGROUND:Stroke is the third-leading cause of death and disability, and poststroke falls (PSF) are common at all stages after stroke and could even lead to injuries or death. Brain information from functional near-infrared spectroscopy (fNIRs) may precede conventional imaging and clinical symptoms but has not been systematically considered in PSF risk prediction. This study investigated the difference in brain activation between stroke patients and healthy subjects, and this study was aimed to explore fNIRs biomarkers for early screening of PSF risk by comparing the brain activation in patients at and not at PSF risk. METHODS:In this study, we explored the differences in brain activation and connectivity between stroke and healthy subjects by synchronizing the detection of fNIRs and EMG tests during simple (usual sit-to-stand) and difficult tasks (sit-to-stand based on EMG feedback). Thereby further screened for neuroimaging biomarkers for early prediction of PSF risk by comparing brain activation variability in poststroke patients at and not at fall risk during simple and difficult tasks. The area under the ROC curve (AUROC), sensitivity, and specificity were used to compare the diagnostic effect. RESULTS:A total of 40 patients (22 not at and 18 at PSF risk) and 38 healthy subjects were enrolled. As the difficulty of standing task increased, stroke patients compared with healthy subjects further increased the activation of the unaffected side of supplementary motor area (H-SMA) and dorsolateral prefrontal cortex-Brodmann area 46 (H-DLFC-BA46) but were unable to increase functional connectivity (Group*Task: p < 0.05). More importantly, the novel finding showed that hyperactivation of the H-SMA during a simple standing task was a valid fNIRs predictor of PSF risk [AUROC 0.74, p = 0.010, sensitivity 77.8%, specificity 63.6%]. CONCLUSIONS:This study provided novel evidence that fNIR-derived biomarkers could early predict PSF risk that can facilitate the widespread use of real-time assessment tools in early screening and rehabilitation. Meanwhile, this study demonstrated that the higher brain activation and inability to increase the brain functional connectivity in stroke patients during difficult task indicated the inefficient use of brain resources.

Post-stroke cognitive impairment (PSCI) is a major stroke consequence that has a severe impact on patients' quality of life and survival rate. For this reason, it is especially crucial to identify and intervene early in high-risk groups during the acute phase of stroke. Currently, there are no reliable and efficient techniques for the early diagnosis, appropriate evaluation, or prognostication of PSCI. Instead, plenty of biomarkers in stroke patients have progressively been linked to cognitive impairment in recent years. High-throughput omics techniques that generate large amounts of data and process it to a high quality have been used to screen and identify biomarkers of PSCI in order to investigate the molecular mechanisms of the disease. These techniques include metabolomics, which explores dynamic changes in the organism, gut microbiomics, which studies host-microbe interactions, genomics, which elucidates deeper disease mechanisms, transcriptomics and proteomics, which describe gene expression and regulation. We looked through electronic databases like PubMed, the Cochrane Library, Embase, Web of Science, and common databases for each omics to find biomarkers that might be connected to the pathophysiology of PSCI. As all, we found 34 studies: 14 in the field of metabolomics, 5 in the field of gut microbiomics, 5 in the field of genomics, 4 in the field of transcriptomics, and 7 in the field of proteomics. We discovered that neuroinflammation, oxidative stress, and atherosclerosis may be the primary causes of PSCI development, and that metabolomics may play a role in the molecular mechanisms of PSCI. In this study, we summarized the existing issues across omics technologies and discuss the latest discoveries of PSCI biomarkers in the context of omics, with the goal of investigating the molecular causes of post-stroke cognitive impairment. We also discuss the potential therapeutic utility of omics platforms for PSCI mechanisms, diagnosis, and intervention in order to promote the area's advancement towards precision PSCI treatment.

STUDY OBJECTIVES:This meta-analysis aimed to investigate the feasibility and effectiveness of continuous positive airway pressure (CPAP) treatment in stroke patients with sleep apnea. METHODS:PubMed, EMBASE, and the Cochrane Library were searched from inception until July 28, 2022, for randomized controlled trials comparing the use of CPAP and usual treatment in patients with stroke or transient ischemic attack and sleep apnea. The primary outcome measures were the feasibility of CPAP therapy, neurological function, and functional status. RESULTS:After screening 5,747 studies, 14 studies with 1,065 patients were included in this meta-analysis. Overall, 8 of the 14 studies recorded CPAP use, and the mean CPAP use was 4.47 hours per night (95% confidence interval [CI]: 3.85-5.09). The risk ratio of discontinuing CPAP was 1.50 (95% CI: 0.76-2.94; P = .24). Analysis of the neurofunctional scales showed that CPAP treatment improved neurological function (standardized mean difference: 0.28; 95% CI: 0.02-0.53), but there was substantial heterogeneity (I2 = 57%, P = .03) across the studies. CPAP treatment had no significant effect on functional status vs the control (standardized mean difference: 0.25; 95% CI: -0.01 to 0.51), but the studies also had substantial heterogeneity (I2 = 55%, P = .06). CONCLUSIONS:CPAP treatment is feasible in patients with stroke and sleep apnea and may improve neurological outcomes in these patients. However, this finding should be interpreted with caution because of the substantial heterogeneity of current trials. CITATION:Fu S, Peng X, Li Y, Yang L, Yu H. Effectiveness and feasibility of continuous positive airway pressure in patients with stroke and sleep apnea: a meta-analysis of randomized trials. J Clin Sleep Med. 2023;19(9):1685-1696.

OBJECTIVE:To evaluate the effect of non-invasive brain stimulation (NIBS) in improving limb motor dysfunction and daily living activity during at the phase of acute stroke. MATERIALS AND METHODS:Randomized controlled trials about the effect of NIBS on hemiparesis in acute stroke were retrieved from databases of China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), Wanfang Data, CBM, PubMed, Embase, Cochrane Library, and Web of Science from inception until January 3rd 2022. The quality of the trials was assessed, and the data were extracted according to the Cochrane Handbook for Systematic Reviews of Interventions. A statistical analysis was carried out using Review Manager 5.3 and STATA 14. The effect size was evaluated by using the weighed mean difference (WMD) and a 95% confidence interval (CI). The stability and sensitivity of the results and sources of heterogeneity were also analyzed. RESULTS:12 studies involving 639 patients were included. Our meta-analysis showed that NIBS could improve the Fugl-Meyer Assessment (weighed mean difference = 3.96, 95% confidence interval = 3.45 to 4.48) and Barthel Index (weighed mean difference = 12.29, 95% confidence interval = 4.93 to 19.66), while reducing the National Institutes of Health Stroke Scale (weighed mean difference = -2.37, 95% confidence interval = -3.43 to -1.31). CONCLUSION:NIBS is effective in improving paretic limb motor function and activities of daily living in patients during at the phase of acute stroke.

Cognitive decline (CD) is devastating with a high incidence in patients after stroke. Although some studies have explored underlying associations between C-reactive protein (CRP) levels and cognitive decline after stroke, consistent results have not been obtained. Therefore, this meta-analysis aimed to explore whether or not higher levels of C-reactive proteins were associated with an increased risk of cognitive decline after stroke. To this end, PubMed, Embase, the Cochrane Library, and Web of Science were searched for eligible studies, and pooled effect sizes from eligible studies were calculated using random effect models. Furthermore, subgroups were established and meta-regression analyses were performed to explain the causes of heterogeneity. Eventually, nine studies with 3893 participants were included. Our statistical results suggested that the concentrations of peripheral CRP may be significantly increased for CD patients after stroke, compared to those of non-CD patients. Subgroup analyses showed that CRP was higher in CD than that in non-CD patients when the mini-mental state examination was used. A higher level of CRP in the acute phase of ischemic stroke may suggest an increased risk of CD after stroke. However, these results should be cautiously interpreted because of the limited sample sizes and the diversity of potential confounders in the studies included in this meta-analysis.

Purpose To investigate the current situation of assistive device (AD) usage among seniors in Tibet, China, and explore its influencing factors. Methods A mixed-methods design was used. Cognition, attitude, behavior, and preference toward ADs were assessed by a self-designed questionnaire. Additionally, participants responded to the open-ended questions. Anderson’s behavior model analyzed the impacts of the prerequisite factors, enabling factors, and demand factors influencing the utilization of ADs by Tibetan seniors. Results Of the 211 Tibetan seniors, 149 (70.6%) Tibetan seniors expressed the willingness to utilize ADs. Binary Logistic regression analysis showed that one prerequisite factor: age; one enabling factor: care situation, and one demand factor: dysfunctional condition were factors influencing the utilization of ADs. Qualitative comments described: psychological, physical environment, and social support factors were the main influencing factors. Conclusion This study presents the current situation to utilize ADs by Tibetan seniors on the Qinghai-Tibet Plateau, incorporates Anderson’s behavioral model for quantitative analysis, and combines qualitative research to explore the facilitating and hindering factors, to provide reference and basis for the development of ADs for seniors and policy formulation. The sample size of this study is relatively small and limited to ethnic groups, and we plan to increase the sample size and include more ethnic groups in the future study.

Background Manual lymphatic drainage (MLD) is widely used in the treatment of breast cancer–related postmastectomy lymphedema (BCRL). However, the therapeutic benefit of MLD on BCRL remains controversial. Objective The aim of this study was to analyze the efficacy of MLD for BCRL. Method Four electronic databases were systematically searched for trials comparing MLD and no MLD treatment as options for BCRL. Comparative treatment results included reduction of upper extremity limb volume with subgroup analysis by the number and duration of treatments. Results A total of 457 patients were included in the analysis. There was no significant difference in the amount of upper extremity edema between the MLD treatment and control or no MLD groups (P = .11). However, when the treatment course was ≥20 sessions, there was a significant reduction in the upper extremity volume (P = .03). There was also a significant reduction in the upper extremity volume when treatment duration was >2 weeks (P = .03). Conclusion Manual lymphatic drainage treatment statistically did not reduce the upper extremity limb volume of BCRL, but upper extremity volume was reduced at statistically significant levels when treatment number were ≥20 sessions or the duration of treatment was >2 weeks. Implication for Practice Reduction in upper limb volume is dependent on the number and duration of treatments. When treatment number were ≥20 sessions, or the duration of treatment was >2 weeks, reduction of upper limb volume was statistically achieved. Manual lymphatic drainage treatment can be clinically recommended to treat BCRL according to these parameters.

ObjectiveSocial participation has become a policy framework to address population aging. However, little is known about the social participation of older adults in western China, and extensive, multicenter, regional research is lacking. This research investigated the profiles of social participation of older adults in western China and explored the characteristics and factors influencing social participation.MethodThis cross-sectional study was conducted in 3 provinces (Chongqing, Sichuan, and Inner Mongolia) in western China from March 2021 to December 2021 and included 3,456 participants aged 60 years or older. Social participation was assessed using the Chinese version of the Impact on Participation and Autonomy Questionnaire (IPA). Latent profile analysis (LPA) was performed to extract latent classes of social participation among older adults in western China. The chi-square test and multinomial regression analyses were used to identify differences between these classes.ResultsThree social participation classes were identified by LPA: high social participation (25.2%), moderate social participation (55.1%), and low social participation (19.7%). Being older, having a primary school education level, having mobility or speaking impairment, using assistive devices, and having a chronic disease were highly associated with the low social participation class (P < 0.05). Furthermore, older adults with no dependence (OR = 0.018, 95% CI = 0.005–0.062) or mild dependence (OR = 0.039, 95% CI = 0.011–0.139) in activities of daily living (ADLs) were less likely to be in the low social participation class. Older adults who were cared for by non-spouse primary caregivers were more likely to be assigned to the moderate social participation group (OR = 2.097, 95% CI = 1.501–2.930) than to the high social participation group.ConclusionsMost older adults in western China have a moderate level of social participation. Advanced age, reduced ADL ability, reduced speech ability, reduced mobility, and non-spouse care are related to the level of social participation. Healthcare professionals should pay attention to the predictors for different classes, identifying high-risk groups as early as possible.

Post-stroke depression (PSD) is the most common and severe neuropsychiatric complication after stroke. However, the molecular mechanism of PSD is still unclear. Previous studies have identified peripheral blood and urine metabolites associated with PSD using metabolomics techniques. We searched and systematically summarized metabolites that may be involved in metabolic changes in peripheral blood and urine of patients with PSD from the Metabolite Network of Depression Database (MENDA) and other biomedical databases. MetaboAnalyst5.0 software was used for pathway analysis and enrichment analysis of differential metabolites, and subgroup analyses were performed according to tissue types and metabolomics techniques. We identified 47 metabolites that were differentially expressed between patients with and without PSD. Five differential metabolites were found in both plasma and urine, including L-glutamic acid, pyroglutamic acid, palmitic acid, L-phenylalanine, and L-tyrosine. We integrated these metabolites into metabolic pathways, and six pathways were significantly altered. These pathways could be roughly divided into three modules including amino acid metabolism, nucleotide metabolism, and glucose metabolism. Among them, the most significantly altered pathway was "phenylalanine metabolism" and the pathway containing the most associated metabolites was "aminoacyl-tRNA biosynthesis", which deserve further study to elucidate their role in the molecular mechanism of PSD. In summary, metabolic changes in peripheral blood and urine are associated with PSD, especially the disruption of "phenylalanine metabolism" and "aminoacyl-tRNA biosynthesis" pathways. This study provides clues to the metabolic characteristics of patients with PSD, which may help to elucidate the molecular pathogenesis of PSD.

Objective: This study aimed to understand the real-life experiences of Tibetans in China with dysfunction in the process of accepting assistive device services and to provide a reference for service quality improvement and policy formulation. Methods: Semi-structured personal interviews were used to collect data. Ten Tibetans with dysfunction representing three categories of different economic level areas in Lhasa, Tibet were selected to participate in the study by purposive sampling method from September to December 2021. The data were analyzed using Colaizzi’s seven-step method. Results: The results present three themes and seven sub-themes: identification of tangible benefits from assistive devices (enhancing self-care ability for persons with dysfunction, assisting family members with caregiving and promoting harmonious family relationships), problems and burdens (difficulty in accessing professional services and cumbersome processes, not knowing how to use it correctly, psychological burden: fear of falling and stigmatization), and needs and expectations (providing social support to reduce the cost of use, enhancing the accessibility of barrier-free facilities at the grassroots level and improving the environment for the use of assistive devices). Conclusion: A proper understanding of the problems and challenges faced by Tibetans with dysfunction in the process of accepting assistive device services, focusing on the real-life experiences of people with functional impairment, and proposing targeted suggestions for improving and optimizing the user experience can provide reference and basis for future intervention studies and related policy formulation.

脑卒中是全球第一大致残原因,也是第三大死因,预计2050年卒中的发病率将翻倍[1].卒中后认知功能障碍(post-stroke cognitive impairment,PSCI)是卒中后一种常见并发症,72％的脑卒中患者并发认知功能障碍[2],严重影响患者的生活质量[3].因此,促进PSCI的康复至关重要.传统的认知功能康复训练方式较为单一,对患者感官刺激过少,影响其在PSCI患者认知康复中的效果.虚拟现实技术(virtual reality,VR)是近年迅速发展的一种康复技术,具有沉浸性、构想性及交互性等特点[4],已逐渐应用于PSCI患者的康复治疗[5-6].

Objective: To investigate the efficacy and acceptability of virtual reality (VR) with time-dose-matched conventional therapy (CT) in patients poststroke with upper limb dysfunction. Data Sources: Cochrane, PubMed, Web of Science, Embase, and ProQuest were systematically searched up to May 24, 2021. Study Selection: Randomized controlled trials comparing VR with time-dose-matched CT in patients poststroke with upper limb dysfunction were included. Data Extraction: The extracted data included efficacy (mean change in structure/function, activity, and participation scores), acceptability (dropouts for all reasons), adverse events, and characteristics of the included studies. The Cochrane risk of bias assessment tool was used to assess the risk of bias. Data Synthesis: Thirty-one randomized controlled trails were included. VR was superior to time-dose-matched CT in terms of the World Health Organization's International Classification of Functioning, Disability and Health structure/function, with a standardized mean difference (SMD) of 0.35, but not activity and participation. Subgroup analyses demonstrated that virtual environment was superior to CT in structure/function (SMD=0.38) and activity (SMD=0.27), whereas there were no significant differences between commercial gaming and CT in any World Health Organization International Classification of Functioning, Disability and Health domain. VR mixed with CT was more effective than time-dose-matched CT in structure/function (SMD=0.56), whereas VR only was not significantly different from CT. There were no significant differences in the incidence of adverse events and dropout rates between VR and CT. Conclusions: The results suggest that VR is superior to time-dose-matched CT in terms of recovery of upper extremity motor function, especially when a virtual environment is used or VR is mixed with CT. However, VR (VR only or mixed with CT) does not improve patients' daily activity performance and participation compared with CT. Overall, VR appears to be safe and acceptable as CT. Large-scale definitive trials are needed to verify or refute these findings. (C) 2021 by the American Congress of Rehabilitation Medicine.