BACKGROUND:Cancer is a significant psychological burden for patients. Previous evidence syntheses suggest creative arts therapies (CATs) may improve psychological outcomes, but are limited by heterogeneity in intervention types, study designs, and outcomes, and the lack of a certainty of evidence assessment. AIMS:We conducted a robust systematic review and meta-analysis of current randomized trial literature to explore the efficacy of CATs in improving anxiety, depression, and quality of life in cancer patients. METHODS:We searched PubMed, Embase, and PsycInfo databases for peer-reviewed randomized trials evaluating the effectiveness of CATs against a control in patients with current cancer diagnoses. We performed pairwise random-effects meta-analyses of standardized mean differences (SMD) for anxiety, depression, and quality of life, stratified by time-interval. We conducted subgroup analyses by session frequency, intervention type, treatment setting, and region. For studies not pooled quantitatively, results were qualitatively summarized. RESULTS:67 randomized trials with 6259 patients were included. The majority of interventions were music-based (80.6%), multi-session (59.7%), inpatient-based (73.1%), and conducted in North America (29.9%). Meta-analyses demonstrated positive effects of CATs on anxiety at < 7 days (SMD = -0.62 [95% CI -1.01, -0.24]), 4-6 weeks (-1.21 [-2.08, -0.34]), and 2-3 months (-1.19 [-2.14, -0.24]); depression at 1-3 weeks (-0.44 [-0.87, -0.00]) and 4-6 weeks (-1.14 [-1.76, -0.52]); and quality of life at 1-3 weeks (0.65 [0.05, 1.25]), 4-6 weeks (1.17 [0.02, 2.32]), 2-3 months (1.42 [0.55, 2.29]), and 4-6 months (0.42 [0.04, 0.80]. Qualitative results corroborate these findings. GRADE assessment revealed low-to-very-low certainty of evidence. CONCLUSION:Creative arts therapies may improve anxiety, depression, and quality of life among cancer patients.

Objectives:The burden of orthopaedic trauma has continued to increase with a disproportionate impact on low- and middle-income countries (LMICs), in part due to inadequacy of resources for operative fracture fixation. The objective of this study was to evaluate the available literature regarding the availability of equipment and implants for operative fracture care in LMICs and the barriers to accessing these resources. Data Sources:A comprehensive literature search was conducted in the PUBMED, SCOPUS, EMBASE, and WEB OF SCIENCE databases for the period January 2003 to December 2023 using search terms including "implants," "hardware," "availability," "accessibility," and "access" to identify relevant records published in English. Study Selection:All studies that assessed the availability of implants for operative fracture fixation in LMICs were included. Data Extraction:Articles were critically appraised for their methodological quality using the JBI critical appraisal checklist for qualitative research. Data were manually extracted into a predesigned data extraction template. Data Synthesis:Data were synthesized through basic pooling and summarized using descriptive statistics, including percentages and proportions. Results:Seven hundred twenty-two records were identified, and 11 articles comprising 488 health care facilities from 8 LMICs met the inclusion criteria for analysis. The included studies were all observational, including 8 cross-sectional surveys and 3 qualitative case studies. Findings included little to no capability of performing internal or external fixation at small, community hospitals. Resources were still generally inadequate for treating orthopaedic injuries at larger, tertiary hospitals. Private hospitals and tertiary hospitals with medical schools are the best equipped. Barriers identified included the high cost of implants and reliance on imported implants, lack of government funding and trauma system organization, patients needing to procure their own implants, and even corruption and poor leadership. Solutions proposed included improved funding for trauma care, prioritizing orthopaedic services and providing continuing trauma education, defining essential equipment necessary for orthopaedic care, strengthening resource monitoring and organization, and encouraging local implant manufacturing. Conclusions:Inadequate availability of fracture fixation implants and equipment is a major challenge in LMICs. There is little known about the availability of specific orthopaedic equipment and implants at the specialist level of fracture care. A future study aimed at evaluating the availability of specific orthopaedic equipment and implants necessary for specialized fracture care in these countries is recommended to identify key areas for improvement. Ideally, orthopaedic surgeons working in these settings could be surveyed to determine which resources are most critically lacking and should be prioritized to enhance the delivery of adequate care. Level of Evidence:IV.

Background: Intraoperative PTH (IOPTH) is standard-of-care for minimally invasive parathyroidectomy when managing primary hyperparathyroidism (PHPT). Controversy persists in determining the value and cost-effectiveness of IOPTH in parathyroid surgery. Objective: To evaluate the quality of economic evaluations of IOPTH in parathyroid surgery for PHPT. Methods: A search was performed of the following databases: MEDLINE, EMBASE, EMCARE, and Scopus from January 1990 to January 2025. Screening and full-text review stages were performed in duplicate. We included studies that performed any economic analyses (e.g., cost analyses or descriptions, cost-effectiveness analyses, cost-benefit analyses) using IOPTH during surgery for parathyroid disease. We described study, disease, and economic analysis-specific questions. Risk of bias and methodological quality were evaluated in duplicate using ECOBIAS, CHEERS, and related tools. Results: Of the 355 articles that underwent screening and full-text review, 22 articles met eligibility criteria. Most studies were published after 2005 (63.6%) and observational (77.3%). Most studies investigated PHPT (95.5%). Studies were primarily partial economic analyses (90.9%), such as cost analyses and descriptions, while few (9.1%) were full economic analyses (i.e., cost-effectiveness analyses). Direct costs were calculated with heterogeneous reporting of cost sourcing and no studies examined indirect costs. Most studies (90.9%) reported 50% or fewer economic methodological quality items, including study perspective, discounting, summary measures, and sensitivity analysis. Due to unstandardized reporting of outcomes, meta-analysis was not performed. Conclusions: The debate underlying the economics of IOPTH is informed by poor quality studies that do not permit meta-analysis and fail to comprehensively evaluate the cost-effectiveness of IOPTH. These studies are primarily partial economic analyses and often fail to report critical economic elements including study perspective, short- and long-term costs, and sensitivity analyses. Better methods should be applied when evaluating the economics of technological adjuncts for parathyroid surgery.

PURPOSE:To evaluate the cost-effectiveness of using allograft and xenograft augmentation at the time of primary rotator cuff repair (RCR) using a decision tree analysis. METHODS:An expected-value decision tree analysis was developed to compare the costs and outcomes of primary RCR for large tears performed with or without graft augmentation. Input parameters, including procedural costs, outcome probabilities, and health utility values, were derived from a comprehensive literature review. Health utility was quantified using European Quality of Life 5 Dimension scores to estimate quality-adjusted life years (QALYs) gained over a 10-year postoperative period. Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio, defined as the additional cost per QALY gained with graft augmentation. An intervention was considered cost-effective if the incremental cost-effectiveness ratio was below the $100,000/QALY threshold, consistent with established benchmarks in the literature. RESULTS:Based on the current model, the total cost of conventional RCR was $22,183, compared with $24,074 for allograft augmentation and $25,314 for xenograft augmentation. Allograft augmentation displayed dominance over xenograft in terms of cost-effectiveness, with an incremental cost-effectiveness ratio of $18,844 versus $62,620. Both strategies remained cost-effective under the $100,000/QALY threshold. Sensitivity analyses showed cost thresholds for maintaining cost-effectiveness were $12,505 for allograft and $6225 for xenograft. Retear rate threshold analysis revealed that both augmentation types remained cost-effective if the retear rate was below 27%, representing at least an 8% absolute reduction compared with conventional RCR. CONCLUSIONS:Although associated with higher initial costs, graft augmentation during primary RCR may be a cost-effective strategy, particularly with allograft, which showed superior cost-effectiveness. LEVEL OF EVIDENCE:Level IV, economic analysis: decision tree with input from Level II and III studies.

BACKGROUND:Previous reviews comparing mobile-bearing and fixed-bearing implants in unicompartmental knee arthroplasty report mixed results. It has yet to be explored whether such differences are influenced by study design. This systematic review and meta-analysis aimed to compare adverse events, patient-reported outcomes, and range of motion between the two implant types, overall and by study design (randomized trial, observational study, and registry study). METHODS:We searched three databases up to February 4, 2025, for primary research studies comparing mobile- and fixed-bearing implants in unicompartmental knee arthroplasty patients. The outcomes of interest were adverse events, patient-reported outcomes, and range of motion. We performed DerSimonian-Laird random-effects meta-analyses, stratified by study design; assessed the risk of bias using the Cochrane and Risk Of Bias In Non-Randomized Studies-of Interventions tools; and assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development, and Evaluation framework. A total of 30 observational studies (9,454 patients), six randomized trials (485 patients), and three registry studies (60,461 patients) were included. RESULTS:The meta-analyses found that fixed-bearing implants lowered the risk of revision (relative risk [RR] 0.65 [95% confidence interval [CI] 0.48 to 0.86]) and dislocation (RR 0.16 [95% CI 0.07 to 0.37]) and improved Western Ontario and McMaster University Osteoarthritis Index scores (mean difference 1.44 [95% CI 0.71 to 2.17]). Tests of subgroup differences revealed few differences in treatment estimates by study design, although observational studies had greater statistical power and thus demonstrated statistically significant findings more often. The certainty of the evidence for most outcomes was low to very low. CONCLUSIONS:Fixed-bearing implants may provide a significantly lower risk of revision and dislocation and improved function compared to mobile-bearing implants for unicompartmental knee arthroplasty patients. The lack of randomized trials limits the certainty of the evidence and remains a priority to confirm observational study findings.

Endoscopic sleeve gastroplasty (ESG) is a minimally invasive endoluminal bariatric procedure, but long-term outcomes beyond 5 years remain limited. This study reports 6-year weight loss, comorbidity outcomes, and safety data from a large single-center cohort. This retrospective cohort study included adults undergoing ESG between June 2019 and June 2025 with mean follow up of 3.8 ± 1.4 years. Primary outcomes were percent total weight loss (

Background: The Innovation and Entrepreneurship in Surgical Training (INVEST) curriculum was developed to introduce surgical residents to basic concepts of innovation and entrepreneurship. The INVEST curriculum involves a series of 4 academic sessions teaching pillars of surgical innovation and entrepreneurship: identifying needs, value assessment, exploring feasibility, and telling a story. We prospectively examined participant perceptions before and after the INVEST curriculum. Methods: This longitudinal survey study included consecutive surgical trainees in their first year of training across 9 surgical specialties who partook in the INVEST curriculum at McMaster University. The primary outcome was change in perceived ability to succeed in achieving meaningful contributions to surgical innovation. Change in willingness to complete future training in surgical innovation was a secondary outcome. We used McNemar tests and Wilcoxon matched-pairs signed-rank tests to analyze differences in pre- and postcourse data. Results: Forty-seven residents attended the INVEST sessions and 36 completed both the pre- and post-INVEST surveys (76.6%). The mean age of respondents was 27.0 years and 53.2% were female. Resident confidence in health care innovation and entrepreneurship knowledge improved 2.2-fold (14.9% to 33.3%, p < 0.01) following completion of the INVEST curriculum. The curriculum sparked interest in further education among 17% of participants, while reducing interest in 14%. Conclusion: Participants' self-perceived ability to partake in entrepreneurial exploits increased following completion of the INVEST curriculum. Similar to training curricula in research, entrepreneurship education sparked interest in some, while decreasing interest in others. Early exposure to entrepreneurship in surgical training may help residents identify opportunities for investment of time.

Tele-robotic surgery represents an evolving model for delivering advanced surgical care using robotic platforms operated from a physically separate console within a connected institutional network. To evaluate the feasibility, safety, and short-term outcomes of robotic tele-robotic inguinal hernia repair using the SSI Mantra system in a simulated tele-robotic surgery model. This prospective case series involved ten adult patients with primary inguinal hernias including six indirect and four direct operated in July 2025. All surgeries were performed using the SSI Mantra robotic platform, with the surgeon operating remotely from a console within the same institutional network in different locations. Operative and postoperative data were collected and analyzed descriptively. All ten procedures were completed successfully without conversion or device malfunction. The mean docking time was 7 min, console time 36.8 ± 4.5 min, and total operative time 42.6 ± 5.3 min. Intraoperative blood loss was < 20 ml in all cases. No intraoperative complications occurred. Patients were ambulated the same day and resumed oral intake within 24 h. The average hospital stay was 1.6 ± 0.4 days, and pain was well-managed with a mean VAS score of 2.1 on postoperative day one. No readmissions or early wound complications were noted. This case series marks a in documenting India’s first clinical experience with robotic tele-robotic inguinal hernia repair using the SSI Mantra system. We emphasize that the outcomes reported are restricted to short-term feasibility and early postoperative safety, not long-term efficacy or recurrence outcomes.

BACKGROUND:Walking is associated with many benefits, from improved mental health to a reduced risk of mortality - but can it boost creative thinking? Current evidence suggests a positive effect of physical activity on creative thinking, but the specific effect of walking has not been adequately explored. METHODS:We conducted a systematic search of the PsycINFO, MEDLINE, Scopus, and ProQuest databases from inception to 8 January 2025 using search terms related to walking and creativity. We then performed meta-analyses of Cohen's d effect sizes to assess the effect of walking on creative thinking, as represented by divergent thinking (the ability to generate novel and useful ideas) and convergent thinking (the ability to analyze and select ideas to find the best solution). We assessed study quality using a creativity-specific tool, and the certainty of the evidence with the Grading of Recommendations Assessment, Development and Evaluation Framework. RESULTS:We identified 23 studies (12 randomized experimental studies, nine non-randomized experimental studies, two observational studies) from 16 articles including a total of 1,036 participants, most of whom were post-secondary students. We found moderate certainty evidence of a large effect of walking on divergent thinking (d = 0.93 [95% CI 0.44, 1.42]), and very uncertain evidence of a null effect of walking on convergent thinking (d = 0.16 [95% CI -0.31, 0.63]). Sensitivity analyses of randomized trials only found similarly large effects of walking on divergent thinking ability (d = 0.82 [95% CI 0.35, 1.28]). CONCLUSION:Results suggest that walking likely results in a large increase in divergent thinking, indicating its potential as an intervention to stimulate creative idea generation.

Background There has been recent debate surrounding the necessity of reaming the medullary canal prior to the insertion of intramedullary nails (IMN) for trochanteric fracture fixation. We aimed to use data from the INSITE trial to compare outcomes between patients managed with reamed vs. unreamed IMN. Methods The INSITE study followed ambulatory patients aged 18 years and older with trochanteric fractures for one-year post surgery. Our current analysis only included patients who were managed with an IMN device and had complete data concerning whether the medullary canal was reamed prior to nail insertion. Our outcomes included medical (organ failure, respiratory distress, stroke, deep vein thrombosis [DVT] gastrointestinal upset, pneumonia, myocardial infarction, sepsis, or urinary tract infection [UTI] and fracture-related adverse events (AE, femoral shaft fracture, implant failure, surgical site infection, nonunion, limb shortening, and pain). We used Chi-Square and Fisher exact tests to compare the unadjusted rates of these outcomes between groups, and logistic regression to examine the independent association between reaming and outcomes. Results A total of 409 patients were included in our analysis, 267 (65.3%) in the reamed group, and 142 (34.7%) in the unreamed group. Patients in the unreamed group had higher rates of comorbidities, unstable fractures, long nails (260-460mm, vs. short [170-200mm]) and were more likely to weight-bear on postoperative day one. We observed a higher rate of medical AE in the unreamed group (14.1%) compared to the reamed group (7.9%). Similarly, the rate of fracture-related AEs was higher in the unreamed group (8.5% vs. 3.4%). The most common fracture-related AEs in the unreamed group included hardware failure (1.4%), surgical site infection (1.4%), and screw protrusion (2.1%). Patients in the unreamed group continued to show a higher odds of fracture-related AE following adjustment for nail length and relevant comorbidities (odds ratio [OR] 2.98 [1.12–7.89]). Alternatively, we found no significant association between reamed vs. unreamed IMN and medical AE [OR 1.83 [0.92–3.66]) following adjustment for relevant covariables. Conclusion These data suggest that reaming the medullary canal prior to nail insertion may be beneficial in managing patients with trochanteric fractures via IMN. However, further research with larger sample sizes is required to confirm these findings.

Obesity in India is rising rapidly, with higher body fat at lower BMI and younger age compared to Western populations, leading to earlier onset of type 2 diabetes and cardiovascular disease in a resource-constrained health system. Protocols for obesity care therefore need to address region-specific challenges and ensure culturally acceptable, feasible treatment options. The Obesity and Metabolic Surgery Society of India (OSSI) and the Endocrine Society of India (ESI) jointly developed India-specific obesity management protocols using a modified Delphi consensus. A protocol development team generated 73 statements based on literature review and expert experience. Seventy-eight experts (38 OSSI, 40 ESI) participated; 100

Background Bariatric surgery is effective for severe obesity, but rapid postoperative weight-loss may result in lean body mass loss, reduced bone density, sarcopenia, and impaired physical function. Supervised exercise may improve postoperative recovery and body composition, although evidence from randomized controlled trials (RCTs) remains inconsistent. Objectives To evaluate the effects of supervised exercise interventions on weight-loss, body composition, bone health, and physical function after bariatric surgery. Data Sources PubMed, Scopus, Web of Science, and Cochrane Library were searched for RCTs published between 2011 and December 2024, with an updated search in March 2026. Study Selection RCTs involving adults following bariatric surgery receiving supervised exercise interventions were included. Synthesis Methods Two reviewers independently performed study selection, data extraction, and risk of bias assessment (Cochrane RoB2). Meta-analysis used standardized mean differences (SMD) with confidence intervals (CI), and heterogeneity was assessed using I². Results Ten RCTs were included. Supervised exercise significantly improved % total weight-loss (SMD 0.45; 95% CI 0.30–0.60) and % excess weight-loss (SMD 0.52; 95% CI 0.35–0.69). Exercise also preserved lean body mass (SMD 0.40; 95% CI 0.25–0.55), reduced fat mass (SMD −0.50; 95% CI −0.65 to −0.35), attenuated bone mineral density loss (SMD 0.38; 95% CI 0.20–0.56), and improved physical function (SMD 0.50; 95% CI 0.35–0.65). Heterogeneity was low to moderate (I² 25–48%). Limitations Variability in exercise protocols, follow-up duration, and outcome assessment among studies. Conclusion Supervised exercise provides clinically meaningful postoperative benefits and should be integrated into multidisciplinary bariatric care pathways.

There is renewed interest in investigating the analgesic properties of cannabis for musculoskeletal joint pain; however, available data remain limited. This cross-sectional study was designed with the objective of evaluating patients’ perceptions regarding the effect of cannabis on arthritis pain. Patients with arthritis pain presenting at one of three orthopedic clinics were asked to complete the study questionnaire. Outcomes were the perceived effect of cannabis on arthritic pain (measured using the continuous visual analog scale, with scores ranging from 0% to 100%) and association between preferences, attitudes, and barriers to the clinical use of cannabis for arthritic pain (evaluated using multivariable linear regression analyses). Sample size was also calculated using multivariable regression analysis. The study included 406 patients, including 105 (26.3%) who had already previously used cannabis for medical purposes and 63 (15.8%) who had used it during the past year. Approximately one-third of the patients who were prescribed opioids (78/256, 30.5%) had used them in the last week. On an average, patients stated that cannabis could treat 53.6% ± 2.6% of their pain (95% confidence interval = 51.1%–56.1%) and helped them replace 50.4% ± 3.2% of their analgesic medications (95% confidence interval = 47.2%–53.6%). Additionally, 88.8% of the patients (135/152) believed that cannabis would aid pain management. Individuals who had used cannabis for medical purposes (odds ratio = 7.2, 95% confidence interval = 1.6–12.8, p = 0.001) and patients reporting more severe baseline pain (β = 0.2 per point, 95% confidence interval = 0.1–0.3, p = 0.012) were more likely to report meaningful pain improvement. A quarter of the patients with arthritis already used cannabis, and many patients regarded cannabis as an effective pain treatment option. Patient preferences regarding administration and distribution, timing, and indications may help inform clinicians regarding the optimal utilization of cannabis in patients with joint and arthritis pain.

Abstract Background As the global demand for hip and knee arthroplasty procedures grow, advancements in orthopedic research are vital for progress. Pilot and feasibility trials play a critical role in optimising research efficiency, highlighting methodological gaps, and maximising study insights. However, the completeness of reporting in hip and knee arthroplasty pilot and feasibility trials remains unclear. Objectives The primary objective was to evaluate reporting completeness, assessed using the CONSORT checklist extension to pilot and feasibility trials. Secondary objectives included evaluating the reporting of key feasibility items and exploring factors associated with reporting completeness. Setting and methods This methodological survey analysed pilot and feasibility trials in hip and knee arthroplasty. A PubMed search identified relevant manuscripts published between January 1, 2017, and December 31, 2023. A minimum acceptable sample size of 147 (of 278 eligible) was identified, based on a calculation involving an estimated reporting completeness of 25% of the CONSORT checklist, a 95% confidence interval, and a 5% margin of error. Descriptive statistics were reported, and a multivariable linear regression with robust (HC1) standard errors was completed. Results Of 278 eligible publications identified from PubMed, a random sample of 147 studies was included. Reporting completeness was low, with studies accounting for a mean of 54.98% (16.95) of applicable CONSORT extension items. Notably, pilot-specific objectives and future study implications were often underreported. Similarly, manuscripts missed approximately 71.35% (10/14) of key feasibility elements. Studies that referenced reporting guidelines in the manuscript text were associated with better reporting, while those that failed to disclose their funding sources and lacked more key feasibility items demonstrated weaker reporting completeness. Conclusion Hip and knee arthroplasty pilot and feasibility trials exhibit suboptimal reporting completeness with several missing feasibility elements. Improved adherence to CONSORT guidelines and enhanced transparency are needed.

Background:The prevalence and characterization of specific types of musculoskeletal (MSK) conditions associated with menopausal transition remains unclear and is often underreported. Our objectives were twofold: (1) to systematically review, and conduct meta-analysis whenever appropriate, to compare the prevalence of MSK symptoms across the different stages of menopause and (2) to characterize the specific MSK conditions associated with transition to menopause. Methods:We searched Medline, EMBASE, CENTRAL, and PubMed from inception to May 2024. Articles were eligible for inclusion if they included perimenopausal women and reported any primary data on MSK symptoms or pathology. The outcomes we aimed to find included muscle and joint pain, back pain, and the prevalence of various MSK conditions. A pairwise meta-analysis was performed using a DerSimonian-Laird random-effects model for all comparative data, and subgroup analyses were used to explore heterogeneity. Results:After screening 5,556 relevant records, 37 observational studies across 22 countries enrolling 93,021 women were included in the quantitative analysis. Four in 10 women experienced muscle or joint pain during the premenopausal phase (40% [95% confidence interval {CI}: 32%-49%]). Whereas over half of perimenopausal women (57% [95% CI: 48%-65%]) and postmenopausal women (59% [95% CI: 50%-67%]) experienced muscle or joint pain, representing a 1.35-fold increased risk (risk ratio [RR] 1.35, 95% CI: 1.25-1.46, p < 0.001, I2 = 88.6%; absolute risk difference 130 more per 1,000 [95% CI: 93-171]) and a 1.40-fold increased risk (RR 1.40, 95% CI: 1.28-1.53, p < 0.001, I2 = 95.0%; absolute risk difference 148 more per 1,000 [95% CI: 104-197]) on pairwise comparison with premenopausal women, respectively. Geographic study location nor measurement scale explained the considerable heterogeneity in the pooled analyses. There was underreporting of specific MSK conditions beyond the generic descriptors of muscle and/or joint pain. Conclusion:Women transitioning to menopause appear to be at increased risk of developing muscle or joint pain. However, as these findings are based on observational studies, specific causes of MSK pain are underreported, and there is significant heterogeneity. Further high-quality research is needed to confirm and clarify this association. Level of Evidence:Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

INTRODUCTION:Stroke is a leading cause of long-term disability and mortality worldwide. Survivors can experience a range of physical and emotional challenges, often leading to depression, anxiety, and a poorer quality of life. Creative arts therapies (CATs), an umbrella term encompassing music, art, dance/movement, drama, and creative writing therapies, have increasingly been explored in stroke survivor populations as interventions to improve psychological outcomes. Qualitative analysis suggests these therapies can be helpful, but the exact efficacy of CATs in stroke rehabilitation, as well as the optimal intervention types and treatment protocols, has yet to be established. This systematic review and meta-analysis plans to evaluate the effect of CATs on depression, anxiety, and quality of life among adults recovering from stroke. METHODS:This protocol has been prospectively registered with PROSPERO (CRD420251237926). Eligible studies will include primary quantitative research involving creative arts interventions. Searches will be conducted in Medline, Embase, and PsycInfo from inception to December 2025. Two reviewers will independently screen records, extract data, and assess study quality and the certainty of the evidence using the RoB 2, ROBINS-I, and GRADE tools. Restricted maximum likelihood random-effects meta-analyses of Cohen's d effect sizes and risk ratios will be performed to calculate pooled effect sizes for each outcome. Subgroup analyses will explore moderators such as the effect of study design, intervention type, session frequency, and patient setting. DISSEMINATION OF RESULTS:Results will be disseminated through a peer-reviewed publication, conference presentations, and clinical networks to inform evidence-based guidelines on the use of CATs in multidisciplinary stroke care.

Bariatric surgery remains underutilized despite rising global obesity rates, with less than 2