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.

Abstract Background Our recent estimate of the global 1-year prevalence of headache among those aged 18–65 years was 65%: considerably higher than previous estimates, but based solely on high-quality epidemiological data derived from a large population-based sample. Here we present complementary estimates of 1-day prevalence. Methods We performed a meta-analysis of individual participant data from cross-sectional surveys among population-representative samples (age range 18–65 years) from 15 countries and all world regions. All used the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire, including the question “did you have a headache yesterday?”, from which 1-day prevalence was determined. An algorithmic process applying modified ICHD criteria yielded separate estimates for migraine, tension-type headache (TTH) and probable medication-overuse headache (pMOH: the association of headache on ≥ 15 days/month and medication overuse). We analysed associations with age, gender and country-income level, and adjusted prevalence estimates for these factors. We calculated predicted 1-day prevalence from 1-year prevalence and reported headache frequency. Results Among the 38,512 participants, females (53.4%) and participants from low- (17.1%) or lower-middle-income countries (64.6%) were overrepresented, but age distribution fairly matched that of the world. Overall, 13.7% (95% CI: 13.3–14.0) reported headache yesterday, females (17.1% [16.6–17.6]) more than males (9.7% [9.3–10.2]). Migraine was the most common headache type yesterday (6.0% [5.8–6.3]), followed by TTH (4.1% [3.9–4.3]) and pMOH (2.3% [2.2–2.5]). One-day headache prevalence was higher in low/lower-middle-income countries (13.9% [13.6–14.3]) than in high/upper-middle-income countries (12.4% [11.6–13.2]). Predicted 1-day prevalence (10.9% [10.7–11.1]) was considerably lower than observed 1-day prevalence (13.7% [13.3–14.0]), although not among those with pMOH (3.1% [3.0-3.3] versus 2.3% [2.2–2.5]). Adjusted for age, gender and country-income level, global 1-day prevalence estimates were 13.1% (12.8–13.5) for any headache, 5.7% (5.5–5.9) for migraine, 3.9% (3.7–4.1) for TTH and 2.4% (2.3–2.6) for pMOH, with 1.0% undiagnosed. Conclusion Assuming yesterday was no different from any other day, an estimated 13.1% (N = 641,900,000) of the world’s population aged 18–65 years will have headache tomorrow; almost half will be migraine. People with migraine or TTH underestimate the frequency of headache episodes. Since headache-attributed burden is usually estimated from recalled frequency over 1–12 months, this also may be underestimated.

Background/Objective: Knee osteoarthritis (OA) is a common and debilitating condition affecting older adults, often progressing to advanced stages and requiring total joint replacement. Exercise therapy is widely recognized as the first-line approach for the prevention and initial management of OA. This systematic review assessed the effectiveness of home-based exercises (HBEs) compared to supervised exercises in alleviating pain and reducing disability among patients with knee OA. Methods: A systematic search of PubMed, Cochrane Library, and ScienceDirect identified randomized controlled trials (RCTs) published between January 2001 and October 2024. Methodological quality was evaluated using the Physiotherapy Evidence Database (PEDro) scale, and a meta-analysis was conducted to quantify the efficacy of these interventions. Results: Ten RCTs involving 917 patients were included, ranging in moderate to high methodological quality (PEDro score: 6.3 ± 1.2). Intervention durations ranged from 4 to 12 weeks. Both supervised and HBEs were found to be effective, but supervised exercises demonstrated statistically significant improvements in pain (SMD = −0.45 [95% CI −0.79; −0.11], p = 0.015) and disability (SMD = −0.28 [95% CI −0.42; −0.14], p < 0.001) compared to HBEs. Conclusions: Despite the superiority of supervised exercises over HBEs, considering the cost-effectiveness and ease of implementation of HBEs, we developed recommendations to create a hybrid rehabilitation program that combines both approaches to maximize clinical outcomes.

BACKGROUND:High-intensity interval training (HIIT) has emerged as a potentially effective exercise promoting functional recovery post-stroke. OBJECTIVE:This study examined the efficacy of adding HIIT cycling vs. combining unloaded cycling (SHAM) to conventional physiotherapy on exercise capacity, functional ability, disability level, and health-related quality of life (HRQoL) early post-stroke. METHODS:Forty-four acute stroke survivors were randomly assigned to the HIIT cycling or SHAM group for 6 weeks of exercise training, 3 days/week. The primary outcome was exercise capacity (peak work load [WRpeak]) measured by a maximal exercise test. Secondary outcomes included balance: Berg Balance Scale, walking ability: 6-minute and 10-meter walk tests (6MWT and 10mWT), lower-extremity muscle strength: 5-Repetition Sit-To-Stand test, disability level: modified Rankin Scale (mRS), and HRQoL by EuroQOL 5-dimension questionnaire. RESULTS:The 2-way factorial analysis of variance showed a significant interaction of time × group on WRpeak (P < .001), 6MWT (P < .001), 10mWT (P < .001), and mRS (P = .012). The significant interaction indicates that the change in WRpeak (mean +17.7 W [95% CI, 10.2-25.1]), 6MWT (mean +126.8 m [77.9-175.7]), 10mWT (mean +0.5 m/s [0.3-0.7]), and mRS (mean -0.7 point [-1.2 to -0.2]) after 6-week of training was significantly greater for HIIT cycling versus SHAM. These changes are also significantly greater in the HIIT group vs the SHAM group up to 6 months (P < .001) post-training. CONCLUSIONS:In individuals with acute stroke, individuals, combining HIIT cycling with conventional physiotherapy significantly maximizes recovery of exercise capacity and walking ability, and reduces the level of disability early post-stroke, compared to SHAM.Protocol Registration number:NCT06179173.

In low and middle-income countries (LMICs), the burden of disability and the need for rehabilitation services are substantial (1). Rehabilitation encompasses a wide array of interventions and is defined by the World Health Organization (WHO) as "a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment" (2). According to the WHO, an estimated 2.4 billion people globally are in need of rehabilitation, with a significant portion residing in LMICs (3). These countries indeed face a variety of challenges due to pervasive poverty, limited healthcare infrastructure, and constrained resources, which contribute to the high prevalence of disability and limited access to necessary rehabilitation services (4). Disabilities not only arise from congenital conditions and non-communicable diseases but are also exacerbated by external factors such as armed conflicts and inadequate medical facilities (5). Therefore, the need for rehabilitation is expected to rise due to population aging and the increasing prevalence of chronic conditions, making access to quality rehabilitation services more critical than ever (3), as the WHO projects that non-communicable diseases will account for 80% of the disease burden in LMICs by 2030 (6). Additionally, demographic shifts show rapid population aging in these regions, with estimates suggesting a 200% increase in older populations by 2050 (7). These trends, combined with high rates of trauma and injury, create an urgent need for accessible rehabilitation services.The integration of rehabilitation into health systems can improve quality of life, reduce healthcare costs, and enhance workforce productivity (8). Studies have indeed demonstrated that every dollar invested in rehabilitation service yields a 9-11 return through reduced healthcare costs and improved workforce participation (9). Research shows that integrated rehabilitation programs reduce hospital readmission rates by up to 30% and improve patients' functional outcomes by 40-60% (10). Nevertheless, LMICs often face significant challenges in providing equitable access to quality rehabilitation care (2). These countries indeed often face a multitude of obstacles, including limited resources, infrastructure constraints, and geographical barriers, all of which impede their ability to provide equitable access to high-quality rehabilitation care (11). The most critical points are the shortage of rehabilitation professionals (with ratios as low as 0.5 therapists per 10,000 population in some regions), limited infrastructure (particularly in rural areas) (12), and financial barriers where out-of-pocket expenses can exceed 40% of household income (13). These factors further exacerbate the already substantial burden of rehabilitation needs in these regions (14).In recent years, digital technology has demonstrated significant potential for delivering public health, health systems and health interventions remotely in LMICs (15). Particularly, serious mobile games and open-source technologies have promising evidence in supporting improved efficacy of public health solutions in LMIC settings (16). Serious games are a form of interactive digital media designed for a specific purpose beyond mere entertainment (17). They are specifically "games that do not have entertainment, enjoyment, or fun as their primary purpose." Serious games aim to achieve objectives such as education, training, human resource management, and health improvement (18). These games encompass interactive computer applications that may include extensive hardware components, offering users valuable skills, knowledge, or attitudes while remaining challenging, entertaining, and engaging. Serious games integrate therapeutic exercises with engaging game mechanics, such as challenges, rewards, and progress tracking, to motivate patients to participate actively in their rehabilitation programs. have demonstrated considerable potential in improving rehabilitation outcomes in high-income countries (19). By integrating therapeutic exercises and engaging gameplay mechanics, serious games offer an innovative approach to rehabilitation that can potentially address the challenges faced by LMICs and help to overcome the shortage of rehabilitation specialists. This paper seeks to explore the potential of serious games to bridge the gap in rehabilitation access in LMICs, particularly by offering cost-effective, accessible solutions to regions where conventional rehabilitation services may be unavailable or prohibitively expensive. Serious games have the potential to reduce the burden on healthcare systems by allowing patients to participate in homebased rehabilitation (20,21), thereby alleviating the strain on limited healthcare facilities. Additionally, serious games can address barriers to rehabilitation adherence, as they offer engaging, user-friendly formats that increase motivation and engagement among patients. We will examine the potential of serious games for rehabilitation in LMICs, evaluating both their opportunities and limitations. By highlighting the current barriers and proposing strategies to overcome these challenges, we aim to demonstrate how serious games can be transformative tools for rehabilitation in LMICs. Furthermore, we will discuss how technological advancements, policy support, and stakeholder collaborations can contribute to making serious games an accessible and effective component of rehabilitation in LMICs, ultimately reducing healthcare disparities and improving outcomes for patients.Digital games can enhance rehabilitation by improving both quality and efficiency. They offer a welcome alternative to traditional methods, mitigating the potential for monotony and providing scalable therapeutic interventions. Serious games have several characteristics that make them particularly suitable for rehabilitation in LMICs. First, they can provide accessible and cost-effective rehabilitation solutions (22). In regions with limited healthcare resources, serious games can be deployed on low-cost devices such as smartphones or tablets, enabling remote access to rehabilitation programs (23). This not only expands the reach of rehabilitation services but also reduces the financial burden on individuals and healthcare systems, through the provision of home-based therapy and reduced therapist time per patient. Furthermore, their digital nature facilitates widespread distribution via the internet, enabling personalized experiences and accessibility in home and remote settings (24).Second, serious games have the potential to enhance patient motivation and engagement, which is crucial for successful rehabilitation (17). By incorporating game elements such as rewards, challenges, and social interaction, serious games can make therapy sessions more enjoyable and encourage patients to adhere to their rehabilitation programs (25). This can be especially beneficial in LMICs where access to traditional rehabilitation centres might be limited, and patients may struggle with adherence due to various barriers (26).Third, serious games can address cultural and contextual factors by offering localized content and incorporating culturally relevant narratives and characters (27). Cultural sensitivity is crucial in healthcare, and serious games can be designed to resonate with the values, beliefs, and practices of the target communities. This customization can enhance the acceptability and engagement of rehabilitation interventions in LMICs, making them more effective in addressing the specific needs of the population.( 28) Locally developed serious games offer sustainability and customization to cater to cultural preferences and specific patient needs. They can be adapted for various conditions and task-oriented training, helping patients transfer acquired skills to real-life daily tasks.To assess the current use of serious games in LMICs, we conducted a bibliometric analysis. This method quantitatively evaluates research trends and the impact of studies within a specific field (29). We systematically searched two major databases, Web of Science and Scopus, for publications related to serious games, rehabilitation, and LMICs. A total of 1,564 articles were included in the analysis, with data processed using VOSviewer to visualize and map collaboration networks (30).Our analysis identified 88 countries with at least one author contributing to these studies. To ensure meaningful statistical analysis while maintaining representativeness, we established a threshold of 10 publications per country, resulting in 42 countries for further analysis. This threshold was chosen based on several considerations: (i) it provides a balanced trade-off between including a sufficient number of countries for robust comparative analysis while excluding those with limited research activity, (ii) it aligns with statistical requirements for minimum sample sizes in comparative studies (31,32), and (ii) it captures approximately 90% of the total publication output while reducing noise from countries with sporadic research contributions. As shown in Figure 1, the retained countries formed significant research clusters in Europe, the Middle East, North America, and Australia. Unfortunately, the African continent shows minimal representation, with only Algeria contributing 12 publications.However, different mHealth solutions have already been developed and implemented in Africa, mostly to provide relevant information to patients and increase health literacy (33): Hello Doctor (South Africa): advice and medical assistance; Mobile Widewife (Nigeria): voice messages sent to pregnant women for follow-up pregnancy; M-Pedigree (Kenya): drug identification; My Healthline (Cameroon): answers to questions on sexuality, family planning and HIV/AIDS; mHero (Liberia): information on the virus outbreak Ebola; Djobi (Mali, Senegal): mobile application contributing to reducing infant mortality and kindergarten in Senegal and Mali through mutual health insurance. These first experiences have shown the interest that SSA has regarding the use of mobile telephony for health actions. In rehabilitation Captain Log's has been used in Uganda to improve knowledge and cognition (34), MyDailyRoutine, is a serious game designed to assist patients with cerebral dysfunction, incorporating activities like virtual coffee preparation (35). RehabCity simulates a city environment, requiring users to engage in everyday tasks within its virtual streets, buildings, and parks (36). But commercial solutions (e.g., Nintendo Wii Fit) have also been successfully implemented to provide rehabilitation in low-income community in South-Africa (37). Other studies have also demonstrated the feasibility and a good adherence to rehabilitation program provided with the Microsoft Xbox Kinect in LMICs (38).Despite their potential, serious games for rehabilitation in LMICs face various limitations and challenges that need to be addressed before taking full advantage of their benefits. Figure 2 outlines a consolidated framework for implementing serious games in LMICs, serving as a foundation for addressing current limitations and maximizing the effectiveness of rehabilitation strategies. This framework, based on an implementation research model, incorporates multilevel strategies to overcome the infrastructural, cultural, and educational barriers prevalent in these regions and illustrates the complex interplay between these domains and how they influence the successful implementation. It highlights that success depends not only on the technology itself but also on the broader ecosystem in which it is implemented. The adoption of serious games faces multiple barriers beyond technical issues. These include ethical considerations, policy limitations, administrative challenges, disparities in healthcare access, and insufficient resources. There are also concerns about the quality and reliability of research evidence. From a technical standpoint, key obstacles include disconnected systems that lack long-term sustainability, undefined industry standards, questionable data accuracy, limited technological infrastructure, and insufficient skilled personnel. To address these challenges, several approaches have been suggested: gaining support from policymakers, fostering partnerships across different sectors, increasing financial support, developing consistent regulatory guidelines, conducting flexible research studies, enhancing healthcare workers' skills, and maintaining open dialogue with the public through clear communication channels (39).More in details, one significant challenge is the lack of technological infrastructure, digital health literacy or skills and access to appropriate devices (40). Many LMICs struggle with limited internet connectivity, inadequate power supply, and outdated hardware, which can hinder the effective deployment of serious games of other portable technologies (41). However, Sub-Saharan Africa (SSA) has seen a surge in mobile phone, computer, and internet usage. The GSMA projects substantial growth in the SSA mobile market, forecasting a compound annual growth rate of 4.6% between 2019 and 2025, outpacing the global average of 3% (42). This rapid expansion positions SSA as one of the world's fastest-growing regions for mobile phone subscriptions.However, investments in improving technological infrastructure is crucial, including initiatives to expand internet connectivity and provide affordable and suitable devices for game-based rehabilitation. Power generation shortages, leading to electricity load shedding and power cuts is also a common occurrence in LMICs, which can be a major barrier in the implementation of serious games for healthcare and rehabilitation purposes (43).Additionally, the cultural context of LMICs may influence the design and content of serious games. Localization efforts must consider language barriers, cultural sensitivities, and the diversity of healthcare practices to ensure meaningful engagement and effective healthcare outcomes (44). One crucial note is that a significant portion of the population in LMICs may not be accustomed to technology, impacting user acceptance and adoption. Collaborating with local stakeholders, such as healthcare providers, patients, and community representatives, during the development of serious games can ensure their relevance and cultural sensitivity (45). This approach helps bridge the gap between inadequate or unavailable rehabilitative therapy and effective medical treatment Developing serious games in collaboration with local stakeholders, including healthcare providers, patients, and community representatives, can help ensure that the games are relevant and sensitive to the cultural context (45), this will ensure the medical transition between unsuitable and unavailable rehabilitative therapy as well as effective therapy.However, integrating serious games into existing healthcare systems presents challenges, as it necessitates collaborative efforts among game developers, healthcare providers, policymakers, and local communities (46). This requires interdisciplinary cooperation and resource allocation, highlighting the obstacles faced in successfully implementing and sustaining serious games in rehabilitation practices (47).As digital health initiatives progress from the experimental phase to wider implementation, there is a growing emphasis on effective expansion and integration to offer lasting advantages to healthcare systems (Figure 2). To overcome the limitations and challenges, several strategies can be implemented. Insights from real-world case studies of serious games scaling in LMICs highlight five crucial focal areas for achieving success (48).First, these programs or initiatives must possess inherent qualities that provide concrete solutions to unmet needs, incorporating input from end-users right from the beginning. Partnerships between game developers, rehabilitation specialists, and local stakeholders are essential to ensure the development of culturally appropriate and context-specific serious games (49). Collaborative efforts can also help leverage existing infrastructure, expertise, and resources to facilitate the deployment and evaluation of serious games (50). By involving all relevant stakeholders from the early stages of development, the games can be tailored to meet the specific needs and preferences of the target population (51).Second, it is vital for all stakeholders to be actively engaged, well-trained, and motivated to support new implementations. Capacity building initiatives and the role of north-south training programs (52) can be implemented to enhance the skills of healthcare professionals in utilizing serious games for rehabilitation. This would empower local healthcare providers to effectively integrate serious games into their practice and maximize their potential impact. Training can include not only technical aspects of using the games but also understanding their potential benefits and limitations, as well as strategies to ensure patient compliance and engagement (53). At the WHO level, a rehabilitation competency framework has been developed to provide foundations for curricula for rehabilitation specialists (54). It is advocated to include serious games and new technologies related to rehabilitation in the competency framework.Third, the technical design should prioritize simplicity, interoperability, and adaptability. Efforts should be made to improve technological infrastructure in LMICs, including expanding internet connectivity and ensuring access to affordable and suitable devices for game-based rehabilitation. Africa currently indeed faces the challenge of having the lowest internet penetration rate among continents, with 42% of its population having access to the internet (55). The introduction of the new technology necessitates a careful adjustment to the specific context, taking into consideration local physical barriers, particularly the availability of clinical facilities (56). Furthermore, it requires a conscientious adaptation to the existing lack of internet access, which involves advocating for offline applications and carefully limiting contacts between users and healthcare professionals. This may require collaboration with governments, non-governmental organization, and private sector entities to invest in and support the necessary infrastructure improvements.The fourth focus is on the policy landscape, emphasizing the need for alignment with comprehensive healthcare policies and securing sustainable funding, including contributions from the private sector when applicable. From a public health perspective, it is imperative to engage in concerted and harmonized endeavours aimed at the successful integration of novel interventions into the healthcare system. These efforts span three distinct tiers: the macro level (57), encompassing legal, regulatory, and economic facets; the meso level (46), which pertains to local health services and community dynamics; and the micro level (50), which is intricately linked with patient-level considerations. The integration of multilevel models elucidating the interplay between immediate and distal determinants of health has markedly enriched our comprehension of the mechanisms underlying health disparities. Consequently, the inclusion of these multifaceted dimensions is of paramount significance in our analytical pursuits.Lastly, consideration must be given to the external ecosystem, ensuring the availability of the necessary infrastructure to support large-scale digital initiative deployment. The development of local scientific research capability is a crucial undertaking, supported by the need to gather evidence that supports the effectiveness of innovative solutions (58). This necessitates careful examination of local and cultural nuances, in addition to technical limitations like inadequate infrastructure. Currently, research efforts focused on exploring emerging serious games advancements and assessing their effectiveness predominantly occur in countries with high-income economies. As a result, the practical implementation of these discoveries in LMICs presents complex difficulties, underscoring the need for prompt development of local scientific evidence.It is imperative to determine the viability and acceptance of modified technology within the scope of both patients and professionals. Following this assessment, there is a need to determine the amount of evidence at the regional level, which is particularly relevant in the context of evidence-based practice. It is crucial to acknowledge that the rehabilitation goals in LMICs may differ from those in high-income nations, highlighting the need for research endeavours that are specific to the local context (59).Serious games have the potential to revolutionize rehabilitation in LMICs by overcoming barriers to access and delivering cost-effective, engaging, and culturally relevant interventions. However, to unlock this potential, it is crucial to address the current limitations and challenges. By fostering collaborations, improving infrastructure, and promoting capacity building, serious games can become transformative tools that contribute to the improvement of rehabilitation outcomes and the reduction of healthcare disparities in LMICs.Embracing this innovative approach can pave the way for a more inclusive and effective healthcare system, ensuring that all individuals have access to the rehabilitation services they need for a better quality of life

Background: The Participation Measurement Scale (PM-Scale) is an International Classification of Functioning, Disability and Health-based and Rasch-built scale developed specifically to assess participation in people with stroke.Objectives: Our study aimed to estimate the minimal clinically important difference (MCID) for the PM-Scale.Method: We performed a secondary analysis of data from the ‘Circuit walking, balance, cycling and strength training’ trial. Participants underwent mixed and collective physical activities or sociocultural activities for 12 weeks, and participation data were collected before and after the interventions. The activity limitations (ACTIVLIM)-Stroke scale was used as the anchor of importance. The MCID for the PM-Scale was estimated using receiver operating characteristic (ROC) curves and the Youden index.Results: Data were collected from 46 people with chronic stroke, of which 22% were female, with median (Percentile 25, Percentile 75) age of 54 (44; 60) years, and time since stroke is 24 (11; 37) months. For all participants, the PM-Scale measures range from –2.98 logits to 5.02 logits. The area under the curve (AUC) for the receiver operating characteristic (ROC)-analysis was 0.74 yielding an estimated MCID of 1.98 logit for the PM-Scale.Conclusion: Our study estimated the MCID of the PM-Scale at 1.98 logit, enabling a more precise interpretation of the outcome in the clinical and research settings.Clinical implications: An improvement of at least 1.98 logit on the PM-Scale is required to induce a clinical change in the independence in activities of daily living in people with chronic stroke.

Recent studies indicate that migraine affects 14–15

Background:Access to rehabilitation services in sub-Saharan Africa is severely limited, with the WHO reporting that more than 63 % of people in the region do not receive needed rehabilitation services. This study analyzes how the exclusion of rehabilitation from medical curricula in Cameroon affects care access and evaluates implications for implementing the WHO Regional Strategy to Strengthen Rehabilitation in Health Systems 2025-2035. Methods:We employed a sequential mixed-methods design comprising: (1) qualitative interviews with medical education leaders (n = 12) from 7 medical schools, analyzed using reflexive thematic analysis; and (2) clinical observation of 847 consecutive rehabilitation consultations over 24 months at Bafoussam Regional Hospital, evaluating referral patterns, prescription quality, and geographic patient distribution. We implemeted and assessed a 4 h rehabilitation education module for 2 promotions (year five) medical students. Results:Interviews revealed three mechanisms maintaining rehabilitation's exclusion from medical education: coercive (all 12 interviewees noted absence from accreditation requirements), normative (10/12 cited professional hierarchies that devalue rehabilitation), and mimetic (8/12 described uncritical curriculum replication from other schools). Analysis of 847 rehabilitation consultations showed that only 4.8 % of prescriptions included adequate clinical context; nearly half of patients (47 %) traveled over 100 km to access care. Physician specialty (OR = 3.7, 95 % CI: 2.1-6.4), recent graduation (OR = 1.9, 95 % CI: 1.1-3.2), and personal rehabilitation experience (OR = 4.3, 95 % CI: 2.5-7.6) predicted higher-quality referrals. The 4-h educational intervention at University of Dschang improved students' rehabilitation knowledge from 41.3 % to 78.7 % (p < 0.001) and referral confidence from 23 % to 87 % (p < 0.001). Conclusion:The exclusion of rehabilitation from medical curricula in Cameroon is associated with widespread "Single Practitioner Syndrome"-a phenomenon where care becomes centralized around rare practitioners, creating systemic inefficiencies and access barriers. Even minimal educational interventions show potential for significant improvement in knowledge and referral practices. Implementation of the WHO Regional Strategy will require addressing these foundational educational barriers while acknowledging resource constraints in Central African health systems.

Continuing the series of population-based studies conducted within the Global Campaign against Headache, here we report estimates of headache-attributed burden among adults in Benin, West sub-Saharan Africa, adding to those already published of prevalence. In a cross-sectional survey using cluster-randomized sampling, we visited households unannounced in three geographical regions of Benin: Borgou, Atlantique and Littoral. We randomly selected and interviewed one adult member (18–65 years) of each household, using the HARDSHIP structured questionnaire. Screening and diagnostic questions based on ICHD-3 were followed by burden enquiry in multiple domains including symptom burden and impaired participation. Enquiry timeframes were 1 year, 3 months, 1 month and 1 day (headache yesterday). Data collection took place from May to July 2020. There were 2,400 participants. Those reporting any headache spent, on average, 8.0

Introduction:sleep disorders are diverse and increasingly common among Africans, but their true prevalence is little known on the continent. The objective of this study was to determine the prevalence of sleep disorders and factors associated with sleep quality in rural areas of Nikki, Bénin, in 2022. Methods:this was an analytical cross-sectional study of subjects aged at least 18 years in the commune of Nikki in 2022. Patients were selected by two-stage random sampling. Sleep disorders were diagnosed on the basis of validated scales such as the Pittsburgh Sleep Quality Questionnaire, the Berlin Questionnaire, the Epworth Score, the Restless Legs Syndrome Questionnaire, the Insomnia Severity Index and the Munich Parasomnia Screening Questionnaire. Results:at the end of the study, 879 participants were included. Females predominated, with a sex ratio (F/H) of 1.9. Sleep quality was poor in 52.21% of cases. The prevalence of insomnia was 9.44%, restless leg syndrome 21.39% and daytime sleepiness 21.16%. Sleep apnea syndrome was present in 2.50% of participants. Male gender and active smoking were associated with poor sleep quality, with p=0.03 and p=0.021, respectively. Conclusion:sleep disorders are common in Nikki's rural area, requiring mass screening campaigns to reduce the burden.

Headache is a public health problem in Africa and is a significant cause of neurological consultations, imposing a heavy burden. Data on its actual economic burden are scarce in Africa. This study aims to evaluate the direct cost of headache management in 2023 and to identify factors associated with the high direct cost of headache management. This cohort study with descriptive and analytical aims was conducted from June 15 to October 15, 2023, in the neurology unit of the teaching hospital of Borgou in Parakou, on 91 subjects with headaches, including migraine, tension type headache, trigeminal neuralgia, cluster headache, paroxysmal hemicrania and secondary headache. Any patient who had experienced headaches in the past 12 months, who was aged at least 18 years and who provided informed consent was included. The direct cost of headache management was defined as the sum of costs by consumption level category (consultation, diagnostic tests, treatments, transport, hospitalization costs, other nonmedical costs) and the monetary value of the main companion. This cost was expressed in Benin’s local currency (West African francs XOF), with a corresponding amount in euros. The direct cost of headache care was considered high when the mean monthly direct cost was more than 10

Objectif Développer et valider une échelle d’évaluation fonctionnelle spécifiquement adaptée aux personnes âgées en milieu rural africain, afin de combler les lacunes des outils occidentaux inadéquats dans ce contexte culturel et environnemental. Méthodes Étude prospective mixte menée en quatre phases méthodologiques entre juillet 2023 et mai 2024. Phase 1 : observation ethnographique de 45 personnes âgées dans quatre zones rurales de l’Ouest-Cameroun. Phase 2 : consultation participative auprès de 30 acteurs locaux (soignants et aidants familiaux). Phase 3 : conception multidisciplinaire collaborative des items et du système pictographique. Phase 4 : validation préliminaire auprès de 30 patients âgés (65–88 ans) à l’Hôpital Régional de Bafoussam et dispensaires ruraux affiliés. Résultats L’Échelle Fonctionnelle d’Évaluation des Personnes Âgées en Milieu Rural Africain (EFAMRA) comprend 20 items organisés en quatre domaines : mobilité contextuelle (7 items), activités domestiques adaptées (5 items), activités productives (4 items) et participation sociale (4 items). Elle évalue des tâches culturellement significatives : port de charges sur la tête, puisage d’eau, participation aux cérémonies communautaires. La validation préliminaire a démontré une excellente acceptabilité (96 %), un temps d’administration court (18minutes en moyenne), et une fiabilité inter-évaluateurs élevée (kappa=0,82). Les innovations majeures incluent un système pictographique accessible aux non-alphabétisés et une représentation en diagramme étoilé facilitant la communication thérapeutique. Conclusion L’EFAMRA constitue une avancée pour l’évaluation gériatrique contextualisée, offrant un outil culturellement pertinent, biomécaniquement valide et applicable sans équipement spécialisé. Elle a montré une bonne sensibilité pour détecter les limitations fonctionnelles pertinentes et orienter des interventions de réadaptation adaptées aux réalités rurales africaines.

The ABILHAND is among the most widely used questionnaires in upper limb rehabilitation. This study aimed to evaluate whether self-report procedure of the ABILHAND-Stroke is concordant with performance observation-based procedure. Two assessments were performed with each patient on the same day using the Beninese version of the ABILHAND. Intraclass correlation coefficient (ICC2,1) and Bland–Altman plot were used to evaluate the agreement and the relationships between ABILHAND measures. A total of 123 people with chronic stroke were included in the study. ICC was .77 (95% confidence interval [CI] = [.67, .82]) with p < 10 −6 demonstrating a good concordance between both assessment methods despite significant difference between patients’ mean measures (self-report = −0.06 ± 2.64 logit; performance-based = 1.28 ± 3.57 logit; p value < .0001). Results confirmed the concordance of the self-report regarding the performance-based measures. In clinical routine self-report of ABILHAND scale might be useful for initial screening purposes while for further investigation the performance observation-based procedure should be preferred.

Objective This review aimed to investigate the effectiveness of mHealth-supported active exercise interventions to reduce pain intensity and disability level in persons with hip or knee OA. Data Sources Three databases (PubMed, Cochrane Library, and Web of science) were systematically searched for randomized-controlled trials (RCTs) published between 01-01-2012 and 31-07-2023. PROSPERO registration number of this review was CRD42023394119. Study Selection We included only RCTs that were identified and screened by two independent reviewers (JM and GN). In addition, the reference lists of the identified studies were manually checked for further inclusion. Included studies had to provide a mHealth-supported active exercises for persons with hip or knee OA, and evaluate pain intensity and disability using both questionnaires and performance tests. Data Extraction From the included studies, the two independent authors extracted data using a predetermined Excel form. Characteristics of the interventions were described and a meta-analysis was performed. Data Synthesis Twelve RCTs were included, representing 1,541 patients with a mean age of 58.7±5 years, and a BMI of 28.8±3.1; females being more predominant than males with a total ratio female/male of 2.2. The methodological quality of the included studies was of moderate quality in 75% of the studies. There was no statistically significant difference between mHealth-supported active exercises compared to the interventions without mHealth in terms of pain reduction (SMD= −0.42 [95%CI −0.91; 0.07], p = 0.08) and disability mitigation (SMD = −0.36 [95%CI −0.81; 0.09], p = 0.10). However, a statistically significant difference was found between patient education combined with mHealth-supported active exercises compared to patient education alone in terms of pain (SMD= −0.42 [95%CI −0.61; −0.22], p<0.01) and disability (SMD= −0.27 [95%CI −0.46; −0.08], p < 0.01) reduction. Conclusion mHealth-supported exercises were found to be effective, especially when combined with patient education, in reducing pain and mitigating disability in patients with hip or knee OA.

Introduction La charge des accidents vasculaires cérébraux est importante en Afrique. L'objectif de cette étude est de faire le point sur l’épidémiologie des AVC au Bénin en utilisant les ressources disponibles. Méthodes Nous avons réalisé une revue systématique des données publiées de 2000 à 2021 sur l’épidémiologie les accidents vasculaires cérébraux au Bénin en interrogeant du 01/09/2021 au 01/11/2021 les bases suivantes : PubMed - Embase - Web of science – Google scholar et Research4Life. La méthodologie classique des revues systématiques a été utilisée en utilisant les équations de recherche appropriées. Résultats Nous avons inclus 16 articles dont 11 études transversales et 5 de cohortes. Elle a porté sur 38 526 sujets. L’âge moyen était de 44,62±17,70 ans. La qualité méthodologique des études était bonne dans 62,50 % La prévalence hospitalière globale des AVC était de 22,00 % (IC95 % : 9,10-38,30) des admissions et la prévalence en population générale de 0,80 % (IC95 % : 0,40-1,30). Le taux de mortalité globale était estimé à 23,20 % (IC95 % : 14,10-33,70). On notait une grande hétérogénéité dans les études. Conclusion Les AVC représentent un véritable problème de santé publique au Bénin de par leur fréquence et leur mortalité et il est urgent de mettre en place des stratégies de prévention.

Abstract Background The Global Burden of Disease (GBD) study is increasingly well informed with regard to headache disorders, but sub-Saharan Africa (SSA) remains one of the large regions of the world with limited data directly derived from population-based studies. The Global Campaign against Headache has conducted three studies in this region: Ethiopia in the east, Zambia in the south and Cameroon in Central SSA. Here we report a similar study in Benin, the first from West SSA. Methods We used the same methods and questionnaire, applying cluster-randomized sampling in three regions of the country, randomly selecting households in each region, visiting these unannounced and randomly selecting one adult member (aged 18–65 years) of each household. The HARDSHIP structured questionnaire, translated into Central African French, was administered face-to-face by trained interviewers. Demographic enquiry was followed by diagnostic questions based on ICHD-3 criteria. Results From 2,550 households with eligible members, we recruited 2,400 participants (participating proportion 94.1%). Headache ever was reported by almost all (95.2%), this being the lifetime prevalence. Headache in the last year was reported by 74.9%. Age-, gender- and habitation-adjusted estimates of 1-year prevalence were 72.9% for all headache, 21.2% for migraine (including definite and probable), 43.1% for TTH (also including definite and probable), 4.5% for probable medication-overuse (pMOH) and 3.1% for other headache on ≥ 15 days/month. One-day (point) prevalence of headache was 14.8% according to reported headache on the day preceding interview. Conclusions Overall, these findings are evidence that headache disorders are very common in Benin, a low-income country. The prevalence of pMOH, well above the estimated global mean of 1–2%, is evidence that poverty is not a bar to medication overuse. The findings are very much the same as those in a similar study in its near neighbour, Cameroon. With regard to migraine, they are reasonably in accord with two of three earlier studies in selected Beninese populations, which did not take account of probable migraine. This study adds to the hitherto limited knowledge of headache in SSA.

Objective Modern clinical rehabilitation practice aligned to the International Classification of Functioning, Disability and Health and the Convention on the Rights of Persons with Disabilities highlights the importance of attention to participation in the rehabilitation formulation. This systematic review investigates the efficacy of rehabilitation interventions evaluated in common neurological disorders reported to influence participation outcomes. Data sources PubMed, Web of Science and PsycINFO databases were searched from inception to 25 April 2023. Only randomised controlled trials were considered for inclusion. Review methods The data were extracted by two independent reviewers in the following categories: characteristics of the included study publications, description of intervention and outcome measures. Results A total of 1248 unique article records were identified through the databases. Twenty-eight randomized controlled trials were included with 15 publications having participation as a primary outcome measure. Articles were related to multiple sclerosis (N = 4), spinal cord injury (N = 2), stroke (N = 16) and traumatic brain injury (N = 6). Four publications showed significant differences in pre- and post-intervention within experimental groups. All four articles described participation as primary outcome measure. Conclusion There is a limited evidence of the identified rehabilitation interventions to improve participation in common neurological conditions. However, there was a paucity of articles involving individual with Parkinson's disease that met the inclusion criteria.

Background: Integrating high dosage bilateral movements to improve upper limb (UL) recovery after stroke is a rehabilitation strategy that could potentially improve bimanual activities. Objectives: This study aims to compare the effects of bilateral with unilateral UL training on upper limb impairments and functional independence in (sub)acute stroke. Method: Five electronic databases (PubMed, Scopus, PEDro, ScienceDirect, Web of Science) were systematically searched from inception to June 2023. Randomised controlled trials comparing the effect of bilateral training to unilateral training in stroke survivors ( 6 months poststroke) were included. The treatment effect was computed by the standard mean differences (SMDs). Results: The review included 14 studies involving 706 participants. Bilateral training yielded a significant improvement on UL impairments measured by FMA-UE compared to unilateral training (SMD = 0.48; 95% CI: 0.08 to 0.88; P = 0.02). In addition, subgroup analysis based on the severity of UL impairments reported significant results in favour of bilateral UL training in improving UL impairments compared to unilateral training in “no motor capacity” patients (SMD = 0.66; 95% CI: 0.16 to 1.15; P = 0.009). Furthermore, a significant difference was observed in favour of bilateral UL training compared to unilateral UL training on daily activities measured by Functional Independence Measure (SMD = 0.45; 0.13 to 0.78; P = 0.006). Conclusion: Bilateral UL training was superior to unilateral training in improving impairments measured by FMA-UE and functional independence in daily activities measured by Functional Independence Measure in (sub)acute stroke. Clinical implications: Bilateral upper limb training promotes recovery of impairments and daily activities in (sub)acute phase of stroke.

Physical functioning can be increased in people with stroke by using a mobile health application. This study aimed to investigate the feasibility of a 10-week community-based program using the WalkWithMe (WWM) application in people with late sub-acute and chronic stroke in Benin. An interventional pilot study with mixed methods research design was used examining the application of an unsupervised individualized mobile Health (mHealth) instructed training program. Main outcome included the application usage, safety, adherence, perceived enjoyment, mHealth quality, patient experiences and pre-post efficacy measures. Nine adults, five males, median age of 60 years and time since stroke of 12 months participated in this study. For most participants adherence with the application was over 70%. However, some usability problems were observed due to incorrect understanding and use by participants and technical problems. The application was very fun, stimulating and enjoyable. Significant improvements were found with median (pre/post measures) of locomotors skill (1.4/3.4); impairments (38/40), Barthel Index (85/95), activity limitation (2.1/3.1), and quality of life (194/218). A trend towards significant improvement was found with 6 minutes walking test (181/220, p = 0.06). The WWM application is perceived as a potential approach to increase physical activity and functioning among people with stroke in Benin.