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Upper limb impairments are common consequences of stroke. Noninvasive brain stimulation (NIBS) and virtual reality (VR) play crucial roles in improving upper limb function poststroke. This review aims to evaluate the effects of combined NIBS and VR interventions on upper limb function post-stroke and to provide recommendations for future studies in the rehabilitation field. PubMed, MEDLINE, PEDro, SCOPUS, REHABDATA, EMBASE, and Web of Science were searched from inception to November 2023. Randomized controlled trials (RCTs) encompassed patients with a confirmed stroke diagnosis, administrated combined NIBS and VR compared with passive (i.e., rest) or active (conventional therapy), and included at least one outcome assessing upper limb function (i.e., strength, spasticity, function) were selected. The quality of the included studies was assessed using the Cochrane Collaboration tool. Seven studies met the eligibility criteria. In total, 303 stroke survivors (Mean age: 61.74 years) were included in this review. According to the Cochrane Collaboration tool, five studies were classified as "high quality," while two were categorized as "moderate quality". There are mixed findings for the effects of combined NIBS and VR on upper limb function in stroke survivors. The evidence for the effects of combined transcranial direct current stimulation and VR on upper limb function post-stroke is promising. However, the evidence regarding the effects of combined repetitive transcranial magnetic stimulation and VR on upper limb function is limited. Further randomized controlled trials with long-term follow-up are strongly warranted. [ABSTRACT FROM AUTHOR]

Introduction: The Berg Balance Scale, possibly the most widely used balance-related measure, has gained popularity in clinical trials. It provides information about patients' balance-related abilities and can be used to assess improvement or worsening after rehabilitation. The aim of this study is to determine the cut-off value of the Berg Balance Scale for the fall risk in patients with multiple sclerosis (MS). Methods: This study was designed as a prospective descriptive trial, and 186 patients with MS were included. Fall history was recorded by interview; balance was assessed using the Berg Balance Scale (BBS). Results: The mean ages of 96 patients with a fall history within the previous month and 90 patients without a fall history were 35.98 ± 8.58 and 35.71 ± 9.33 years, respectively. The mean value of the BBS score of the faller group was 49.44 ± 5.43 while 52.36 ± 3.53 in non-faller group. The cut-off value of the BBS for fall risk in patients with MS was determined as 50.50 points. Conclusions: For patient safety and the success of rehabilitation, it is crucial to evaluate the risk of falling in patients with MS, one of the neurological patient groups where complaints about falling are most prevalent. The results showed that BBS is a sensitive and specific measure for identifying in patients with MS at risk of falling. [ABSTRACT FROM AUTHOR]

Hip-related pain is a common issue in active adults affecting their quality of life, mobility, and overall function, and it can lead to persistent disability. However, diagnosing hip-related pain is challenging due to the many potential sources and causes, including intra-articular and extra-articular pathology, and referred pain from other areas (lumbar or groin related pain). To address this, there is a need for a clinical algorithm based on the best available evidence and expert consensus. This algorithm could guide healthcare professionals in assessing and managing patients with hip-related pain, during the diagnosis, test selection, intervention, monitoring, and promoting collaboration among various healthcare providers. This clinical algorithm for hip-related pain is a comprehensive, flexible, adaptable to different settings, and regularly updated to incorporate new research findings. This literature review aims to establish a clinical algorithm specifically for prescribing exercise treatment to patients with hip-related pain, addressing their individual needs and enhancing their overall care. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effects of exercise-based pulmonary rehabilitation (PR) on lung function, muscle strength and functional performance in patients with post-COVID-19 symptoms. Methods: This is a quasi-experimental prospective study including 29 patients (aged 54 ± 11 years, 59% male) with post-COVID-19 persistent symptoms. Exercise training was performed during 6 weeks, twice a week, with each session consisting of aerobic, resistance, and inspiratory muscle training. Before and after exercise-based PR program, all patients were assessed for lung function, respiratory and peripheral muscle strength, and functional performance. Results: After exercise-based PR program, patients showed an improvement in lung function, including forced vital capacity, forced expiratory volume in one second, peak expiratory flow, and maximal voluntary ventilation (P < 0.05). Maximal respiratory pressures and upper limb muscle strength were increased (P < 0.05). Functional performance in timed up and go test, 1-min stair-climbing test, 1-min sit-to-stand test, and 6-min walk test were also improved (P < 0.05). Subgroup analyzes according to COVID-19 severity showed no significant difference in magnitude of response to the exercise-based PR program. Conclusion: Exercise-based PR improves lung function, respiratory and peripheral muscle strength, and functional performance in patients with persistent symptoms of COVID-19. These benefits were independent of disease severity. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to verify the association between pre-stroke physical fitness and acute ischemic stroke (AIS) outcomes. Methods: Forty patients were evaluated within a window of 72 h was used for assessments. Stroke outcomes were analyzed by two scales: the modified Rankin Scale for the global outcome, and the Motor Assessment Score for the motor outcome. Thereafter, patients performed two physical fitness tests to evaluate pre-stroke function: the handgrip strength test and the 30-s arm curl test. Results: Arm curl performance and handgrip strength were associated with stroke global outcome (arm curl performance R2 = 0.353; p < 0.001; handgrip strength R2 = 0.275; p = 0.001) and motor outcome (arm curl performance R2 = 0.223; p = 0.002; handgrip strength R2 = 0.199; p = 0.004). Conclusion: Pre-stroke physical fitness is related to better global and motor stroke outcomes. Future studies could confirm if these associations between pre-stroke physical fitness and stroke outcomes can predict the long-term sequelae after an event. [ABSTRACT FROM AUTHOR]

Physical activity (PA) is recommended to optimize well-functioning in people with schizophrenia. PA has been found to improve quality of life, general symptomatology, depression, anxiety and stress symptoms, global and social functioning. In PA research, most of the interventions are based on one-on-one interventions but there is poor information about group-based PA interventions. Using a randomized controlled, clinician-blinded trial, subjects are randomized into two arms: the PA group or control group. Our first objective is about to evaluate the effects of a multimodal 6 week collective PA intervention on depression, anxiety, and stress symptoms in people with schizophrenia. Our second objective is about to evaluate these effects on secondary outcomes especially smoking, well-being, physical fitness and on care utilization. All participants are evaluated before and after the 6 week intervention period, and only participants in the PA group are called in a follow-up interview 3 and 6 months after the intervention. Trial registration Individual Protection Committee of Ile-de-France II, n ID RCB: 2018- A00583-52. Registered on 8 April 2018. [ABSTRACT FROM AUTHOR]

Background: Rehabilitation plays an important role in addressing the many challenges of living with cancer, but a large proportion of people with cancer do not participate in available cancer rehabilitation. Hence, reasons for non-participation in cancer rehabilitation need to be explored. Objective: The present study undertakes a scoping review of research examining reasons for non-participation in cancer rehabilitation among people with cancer. Design: A systematic search was conducted in PubMed, Scopus and CINAHL for articles published until July 2023. Included studies were hand searched for relevant references and citations. Eligibility criteria: Method: Studies with qualitative, quantitative or mixed-method design. Population: Studies targeting adults (> 18) living with cancer, not participating in rehabilitation. Program type: The review included all studies defining program as rehabilitation but excluded clinical trials. Outcome: Studies examining reasons for non-participation in available rehabilitation. Data extraction: The extracted data included author(s)/year of publication, aim, population, information, rehabilitation type and main reasons for non-participation. Results: A total of nine studies were included (n = 3 quantitative, n = 2 qualitative, n = 4 mixed methods). Reasons for non-participation included physical, psychosocial and practical aspects. The main reason across studies was ‘no need for public support’ related to receiving sufficient support from family and friends. All studies focused on individual reasons, and structural conditions were rarely present. Conclusion: Research within this field is sparse. Future research should explore how individual reasons for non-participation relate to structural conditions, especially among people in socially disadvantaged positions living with cancer. [ABSTRACT FROM AUTHOR]

Background: eHealth applications can support early mobilization and physical activity (PA) after surgery. This systematic review provides an overview of eHealth services to enhance or record PA after visceral surgery interventions. Methods: Two electronic databases (MEDLINE PubMed and Web of Science) were systematically searched (November 2023). Articles were considered eligible if they were controlled trials and described digital devices used to promote PA after visceral surgery. The Cochrane risk of bias (RoB-2) tool was used to determine the methodological quality of studies. Results: A total of nine randomized controlled studies (RCT) were included in this systematic review. The studies differed with respect to the interventions, surgical indications and evaluation variables. The risk of bias of the individual studies was moderate. The six studies using activity trackers (AT) predominantly showed insignificant improvements in the postoperative step count. The more complex fitness applications could partially reveal significant advantages compared to the control groups and the home-based online training also showed a significant increase in functional capacity. Conclusion: Activity tracking alone has so far failed to show clinically relevant effects. In contrast, the more complex eHealth applications revealed advantages compared to usual postoperative care. More high-quality studies are needed for evidence-based recommendations for eHealth services in conjunction with visceral surgery. [ABSTRACT FROM AUTHOR]

Orofacial pain can significantly affect physical, psychological, and overall quality of life. This study aimed to compare the effectiveness of combining photobiomodulation (PBM) with orofacial myofunctional therapy (OMT) in managing orofacial pain disorders. An electronic search of randomized controlled trials in electronic databases was performed until March 2024. Randomized controlled trials (RCTs) focusing on PBM and OMT for the management of orofacial pain were included. Risk of bias across individual studies was performed using the Cochrane risk of bias tool for interventions. A total of 10 RCTs were included, out of which 7 RCTs revealed that the combined approach of PBM and OMT had a more pronounced impact on diminishing pain and enhancing functional activity in patients with orofacial disorders. One study reported significant increases in pressure pain threshold for TMJ, masseter, and anterior temporalis muscles at both sides in the post-treatment compared with the pre-treatment in both groups. The risk of bias was low in 7, moderate in 2, and high in 1 study. The efficacy of a combined modality treatment of PBM with OMT for orofacial pain disorder shows promising results. However, further randomized controlled trials with extended follow-up periods standardized PBM and OMT parameters are warranted to obtain firm conclusions. [ABSTRACT FROM AUTHOR]

Purpose: This systematic review aims to identify, critically appraise, and summarize current evidence regarding the feasibility and efficacy of pelvic floor muscle training in telerehabilitation. Methods: Three bibliographic databases, PubMed, Embase, and Scopus were searched from inception to October 1, 2023. Clinical trials assessing the feasibility and efficacy of pelvic floor muscle training in telerehabilitation were eligible for inclusion. The Physiotherapy Evidence Database scale and National Institutes of Health Study Quality Assessment Tool were used for methodological quality assessment. Study selection, data extraction, and quality assessment were completed by two independent reviewers. Meta-analyses were performed to determine the effects of pelvic floor muscle training in telerehabilitation. Results: Five randomized controlled trials and three single cohort clinical trials were included in this review. Four studies were evaluated as good quality, and four as fair. Pelvic floor telerehabilitation was well tolerated and demonstrated good patient compliance and satisfaction. Pooled analysis indicated significant effects of pelvic floor telerehabilitation on the severity of urinary incontinence with a large effect size, pelvic floor muscle strength with a large effect size, and quality of life with a medium effect size. Conclusion: This systematic review demonstrates that pelvic floor muscle training in telerehabilitation is a feasible and effective approach and highlights its efficacy in patients with urinary incontinence. This review supports the application of pelvic floor muscle training in telerehabilitation and informs further clinical and research endeavors to incorporate digital health technologies in managing pelvic floor dysfunction. [ABSTRACT FROM AUTHOR]

Purpose: Pain is highly prevalent in spinal cord injury (SCI) and a key determinant of quality of life (QoL). This is the first study to examine reciprocal associations between pain and QoL in patients undergoing their first inpatient rehabilitation after SCI. Methods: Longitudinal data, with three measurement time points (1 month and 3 months after SCI onset, and at discharge from inpatient rehabilitation) from the Inception Cohort of the Swiss Spinal Cord Injury Cohort Study. Participants were 381 individuals aged ≥ 16 years with a newly diagnosed traumatic or non-traumatic SCI. 75.1% were male and the average age was 53.2 years. Random intercept cross-lagged panel models were conducted to examine the reciprocal association between pain intensity and QoL, as measured with the International SCI QoL Basic Data Set three individual items (satisfaction with life, physical health, and psychological health) and total score (mean of the three individual items). Results: Both item and total QoL scores increased over time. 1 month: 5.3 (SD = 2.7), 3 months: 5.9 (SD = 2.3), discharge: 6.6 (SD = 2.0). Participants reported relatively low levels of pain intensity that remained stable over the course of inpatient rehabilitation. 1 month: 2.7 (SD = 2.3), 3 months: 2.6 (SD = 2.4), discharge: 2.7 (SD = 2.5). There were no significant cross-lagged associations between QoL and pain intensity across time. Conclusion: Results indicate that pain intensity does not predict changes in QoL during first rehabilitation, and vice versa. Associations between pain intensity and QoL reported by previous studies may be attributable to individual characteristics and timely events that simultaneously influence pain and QoL. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the association between muscle density as an indicator of fatty infiltration of lower extremity muscles and physical activity (PA) after total hip arthroplasty (THA) and identify the patient characteristics with high postoperative PA. Methods: This study included 62 female patients who underwent THA for unilateral hip osteoarthritis. Muscle density of the gluteus maximus, gluteus medius, iliopsoas, and quadriceps muscles was measured using computed tomography (CT). PA was assessed using University of California, Los Angeles (UCLA) activity scores. CT and UCLA activity score were obtained before and 1 year after THA. The patients were divided into two groups, sufficient (score ≥ 6) and insufficient (score < 6) activity groups, based on their level of PA as determined by their UCLA activity score 1 year after THA. The association of PA with the amount of changes in muscle density was examined with Spearman's rank correlation coefficient. Logistic regression analysis was performed to identify postoperative factors determining PA at 1 year after THA. Results: Spearman's rank correlation coefficient showed a significantly positive association between recovery in PA and an increase in muscle density of the gluteus maximus, gluteus medius, iliopsoas, and quadriceps muscles. Additionally, logistic regression analysis confirmed that postoperative muscle densities of the gluteus maximus and quadriceps muscles were variables determining the PA 1 year after THA. Conclusion: The findings of this study indicated that the improvement of fatty infiltration in lower limb muscles, especially in the gluteus maximus and quadriceps, is likely to promote the increase in postoperative PA. [ABSTRACT FROM AUTHOR]

After stroke rehabilitation, patients need to reintegrate back into their daily life, workplace and society. Reintegration involves complex processes depending on age, sex, stroke severity, cognitive, physical, as well as socioeconomic factors that impact long-term outcomes post-stroke. Moreover, post-stroke quality of life can be impacted by social risks of inadequate family, social, economic, housing and other supports needed by the patients. Social risks and barriers to successful reintegration are poorly understood yet critical for informing clinical or social interventions. Therefore, the aim of this work is to predict social risk at rehabilitation discharge using sociodemographic and clinical variables at rehabilitation admission and identify factors that contribute to this risk. A Gradient Boosting modelling methodology based on decision trees was applied to a Catalan 217-patient cohort of mostly young (mean age 52.7), male (66.4%), ischemic stroke survivors. The modelling task was to predict an individual’s social risk upon discharge from rehabilitation based on 16 different demographic, diagnostic and social risk variables (family support, social support, economic status, cohabitation and home accessibility at admission). To correct for imbalance in patient sample numbers with high and low-risk levels (prediction target), five different datasets were prepared by varying the data subsampling methodology. For each of the five datasets a prediction model was trained and the analysis involves a comparison across these models. The training and validation results indicated that the models corrected for prediction target imbalance have similarly good performance (AUC 0.831–0.843) and validation (AUC 0.881 - 0.909). Furthermore, predictor variable importance ranked social support and economic status as the most important variables with the greatest contribution to social risk prediction, however, sex and age had a lesser, but still important, contribution. Due to the complex and multifactorial nature of social risk, factors in combination, including social support and economic status, drive social risk for individuals. [ABSTRACT FROM AUTHOR]

Purpose: Adolescents and young adults (AYAs) experience vast symptom burden resulting from cancer treatment-related toxicities (TRTs). Evidence supports integrated exercise to mitigate several TRTs in other cohorts; however, evidence in AYAs is lacking. Conventional reporting of TRTs adopts a maximum grade approach failing to recognise the trajectory over time, of persistent, or lower grade toxicities. Alternatively, longitudinal analysis of toxicities over time (ToxT) may provide clinically meaningful summaries of this data. We evaluated the longitudinal impact of an exercise intervention on TRTs in AYAs undergoing cancer treatment. Methods: A prospective, randomised trial allocated participants to a 10-week exercise intervention (EG) or control group (CG) undergoing usual care. Detailed information on TRTs was collected throughout the intervention. All TRTs were graded per the Common Terminology Criteria for Adverse Events (CTCAE v5.0). Results: Forty-three (43) participants (63% male, mean age 21.1 years) were enrolled. When categorised to reflect the maximal worst grade experienced (Grade 0, Grade 1–2 and ≥ Grade 3), the CG reported an increased incidence of severe fatigue (≥ Grade 3) compared with the EG (p = 0.05). No other differences between groups were evident (p > 0.05). ToxT analysis of the four most common toxicities (fatigue, pain, nausea and mood disturbances) demonstrated no difference in the mean grade of each over time (p > 0.05). Conclusion: A 10-week exercise intervention reduces the severity of fatigue in AYAs undergoing treatment. While the ToxT approach provided insight into the toxicity profile, adequately powered studies are needed to better understand these differences within a homogenous sample. Trial registration: (ACTRN12620000663954) 10th June 2020. [ABSTRACT FROM AUTHOR]

Introduction: Mal de Debarquement Syndrome (MdDS) is a rare central vestibular disorder characterised by a constant sensation of motion (rocking, swaying, bobbing), which typically arises after motion experiences (e.g. sea, air, and road travel), though can be triggered by non-motion events. The current standard of care is non-specific medications and interventions that only result in mild-to-moderate improvements. The vestibular ocular reflex (VOR) rehabilitation protocol, a specialised form of rehabilitation, has shown promising results in reducing symptoms amongst people with MdDS. Accumulating evidence suggests that it may be possible to augment the effects of VOR rehabilitation via non-invasive brain stimulation protocols, such as theta burst stimulation (TBS). Methods: The aim of this randomised controlled trial was to evaluate the effectiveness of intermittent TBS (iTBS) over the dorsolateral prefrontal cortex in enhancing the effectiveness of a subsequently delivered VOR rehabilitation protocol in people with MdDS. Participants were allocated randomly to receive either Sham (n = 10) or Active (n = 10) iTBS, followed by the VOR rehabilitation protocol. Subjective outcome measures (symptom ratings and mental health scores) were collected 1 week pre-treatment and for 16 weeks post-treatment. Posturography (objective outcome) was recorded each day of the treatment week. Results: Significant improvements in subjective and objective outcomes were reported across both treatment groups over time, but no between-group differences were observed. Discussion: These findings support the effectiveness of the VOR rehabilitation protocol in reducing MdDS symptoms. Further research into iTBS is required to elucidate whether the treatment has a role in the management of MdDS. TRN: ACTRN12619001519145 (Date registered: 04 November 2019). [ABSTRACT FROM AUTHOR]

Objective: To evaluate the olfactory acuity and quality of life in patients who have undergone total laryngectomy. The study also aims to identify any specific patient-related risk factors linked to worse olfactory outcomes. Methods: This is a prospective cross-sectional study conducted at the University Malaya Medical Centre. A total of 30 patients who have undergone total laryngectomy were assessed objectively using the Sniffin' Sticks test and compared against normal age-matched Malaysians. Subsequently, they also filled out the modified Questionnaire on Olfactory Disorders. Correlations of patient demographics, disease and treatment variables against olfactory outcomes were conducted. Results: All subjects suffered olfactory impairment, with 66.7% of them being anosmic after total laryngectomy. The Sniffin' Sticks test demonstrated a statistically significant difference between laryngectomees and the normal age-matched Malaysian population in all three subtests for odor threshold, discrimination and identification. 37% of patients developed olfactory adaptive methods, which resulted in higher olfactory scores and a better quality of life. There were no patient demographics, disease or treatment variables associated with a poorer olfactory outcome identified. Conclusion: Olfactory impairment should not be overlooked among patients after total laryngectomy. Although as many as a third of patients developed some sort of olfactory adaptive behavior, early rehabilitation should be integrated into the multidisciplinary rehabilitation program after total laryngectomy. [ABSTRACT FROM AUTHOR]

Purpose: Head and neck cancer (HNC) treatment often leads to physical and psychosocial impairments. Rehabilitation can overcome these limitations and improve quality of life. The aim of this study is to obtain an overview of rehabilitation care for HNC, and to investigate factors influencing rehabilitation provision, in Dutch HNC centers, and to some extent compare it to other countries. Methods: An online survey, covering five themes: organizational structure; rehabilitation interventions; financing; barriers and facilitators; satisfaction and future improvements, among HNC healthcare- and financial professionals of Dutch HNC centers. Results: Most centers (86%) applied some type of rehabilitation care, with variations in organizational structure. A speech language therapist, physiotherapist and dietitian were available in all centers, but other rehabilitation healthcare professionals in less than 60%. Facilitators for providing rehabilitation services included availability of a contact person, and positive attitude, motivation, and expertise of healthcare professionals. Barriers were lack of reimbursement, and patient related barriers including comorbidity, travel (time), low health literacy, limited financial capacity, and poor motivation. Conclusion: Although all HNC centers included offer rehabilitation services, there is substantial practice variation, both nationally and internationally. Factors influencing rehabilitation are related to the motivation and expertise of the treatment team, but also to reimbursement aspects and patient related factors. More research is needed to investigate the extent to which practice variation impacts individual patient outcomes and how to integrate HNC rehabilitation into routine clinical pathways. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to compare the 5‐year clinical and functional outcomes, including repaired tendon healing status, between early and delayed rehabilitation after arthroscopic rotator cuff repair Methods: A total of 75 patients with rotator cuff tears (less than 5 cm) underwent arthroscopic repairs over a 60‐month period. Participants were randomly assigned to early and delayed postoperative rehabilitation groups with distinct protocols. Clinical and functional outcome measures included Constant score, University of California at Los Angeles (UCLA) score, visual analogue scale for pain and isokinetic dynamometer test for muscle strength recovery. Clinical and functional scores were compared between baseline and 5 years postoperatively. Radiologic assessment via magnetic resonance imaging was performed at a minimum of 12 months postoperatively for evaluations of tendon integrity and recurrent tears. Results: Baseline characteristics showed no statistically significant differences between groups. Both groups demonstrated equivalent improvement in range of motion and pain scores with no statistical differences. Clinical scores improved significantly in both groups by postoperative 12 months and plateaued. At the postoperative 5‐year mark, the early group showed better improvement in the visual analogue scale and UCLA score, while the delayed group had superior Constant scores. Postoperative magnetic resonance imaging revealed six recurrent tears, two in the early group and four in the delayed group, with no statistical differences. Muscle strength recovery showed no differences between the two groups. Conclusion: Both the early and the delayed rehabilitation groups showed similar outcomes in postoperative range of motion, functional scores, muscle strength recovery and tendon healing in the short‐ and mid‐term follow‐ups. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

This study explored the application of generative pre-trained transformer (GPT) agents based on medical guidelines using large language model (LLM) technology for traumatic brain injury (TBI) rehabilitation-related questions. To assess the effectiveness of multiple agents (GPT-agents) created using GPT-4, a comparison was conducted using direct GPT-4 as the control group (GPT-4). The GPT-agents comprised multiple agents with distinct functions, including "Medical Guideline Classification", "Question Retrieval", "Matching Evaluation", "Intelligent Question Answering (QA)", and "Results Evaluation and Source Citation". Brain rehabilitation questions were selected from the doctor-patient Q&A database for assessment. The primary endpoint was a better answer. The secondary endpoints were accuracy, completeness, explainability, and empathy. Thirty questions were answered; overall GPT-agents took substantially longer and more words to respond than GPT-4 (time: 54.05 vs. 9.66 s, words: 371 vs. 57). However, GPT-agents provided superior answers in more cases compared to GPT-4 (66.7 vs. 33.3%). GPT-Agents surpassed GPT-4 in accuracy evaluation (3.8 ± 1.02 vs. 3.2 ± 0.96, p = 0.0234). No difference in incomplete answers was found (2 ± 0.87 vs. 1.7 ± 0.79, p = 0.213). However, in terms of explainability (2.79 ± 0.45 vs. 07 ± 0.52, p < 0.001) and empathy (2.63 ± 0.57 vs. 1.08 ± 0.51, p < 0.001) evaluation, the GPT-agents performed notably better. Based on medical guidelines, GPT-agents enhanced the accuracy and empathy of responses to TBI rehabilitation questions. This study provides guideline references and demonstrates improved clinical explainability. However, further validation through multicenter trials in a clinical setting is necessary. This study offers practical insights and establishes groundwork for the potential theoretical integration of LLM-agents medicine. [ABSTRACT FROM AUTHOR]

Endosseous implants have revolutionized the field of Implants and Prosthodontics. Implant placement is a viable option in the treatment of partial and full edentulism. However, placement of implants in alveolar deficiencies may lead to adverse angulations, mechanical overload and esthetic dissatisfaction. When minimum dimensions for implant placement are not present in alveolar process, it is necessary to augment the size of the ridge. This can be achieved by various methods and materials. Here in this article presented a successful case of a 27 year old male patient with horizontal ridge augmentation in anterior left central incisor region using autogenous chin graft followed by the placement of implants after a period of six months of grafting and finally the prosthesis given after a period of six months of healing of implants. [ABSTRACT FROM AUTHOR]

Dysphagia or difficulty in swallowing is a common condition affecting millions worldwide. It can occur due to structural problems, neurological disorders, cancer treatment, aging, etc. Swallowing rehabilitation aims to help patients regain safe and efficient swallowing function through compensatory strategies and exercises. This literature review examines the recent advancements in swallowing rehabilitation techniques over the past three decades, with a focus on innovations in diagnostics, personalized medicine, and patient care. [ABSTRACT FROM AUTHOR]

The article discusses the ecological rehabilitation of mine tailings, which are residue minerals left behind from mining and processing ores. The rehabilitation of tailings is a challenging task due to their extreme geochemical properties and high levels of toxic metals. Ecological engineering of tailings has been proposed as a promising technology to improve their mineralogy and accelerate soil formation, allowing for the colonization of plants and the development of sustainable ecosystems. The article highlights various research papers that explore the adaptation of plants and microbes to tailings environments, the role of plants and microbes in modifying tailing properties, and agricultural management techniques for tailings rehabilitation. [Extracted from the article]

Purpose: The aim of the present study was to investigate the effectiveness of a novel approach involving permissive weight bearing (PWB) in surgically treated trauma patients with peri- and intra-articular fractures of the lower extremities. Methods: Prospective comparative multicenter cohort study in one level 1 trauma center and five level 2 trauma centers. Surgically treated trauma patients with peri- and intra-articular fractures of the lower extremities were included. Permissive weight bearing (PWB) in comparison to restricted weight bearing (RWB) was assessed over a 26-week post-surgery follow-up period. Patients' self-perceived outcome levels regarding activities of daily living (ADL), quality of life (QoL), pain and weight bearing compliance were used. Results: This study included 106 trauma patients (N = 53 in both the PWB and RWB groups). Significantly better ADL and QoL were found in the PWB group compared to the RWB group at 2-, 6-, 12- and 26-weeks post-surgery. There were no significant differences in postoperative complication rates between the PWB and RWB groups. Conclusion: PWB is effective and is associated with a significantly reduced time to full weight bearing, and a significantly better outcome regarding ADL and QoL compared to patients who followed RWB regimen. Moreover, no significant differences in complication rates were found between the PWB and RWB groups. Level of evidence: Level II. Registration: This study is registered in the Dutch Trial Register (NTR6077). Date of registration: 01-09-2016. [ABSTRACT FROM AUTHOR]

Background: Clinical guidelines suggest that patients should be referred to exercise while undergoing cancer treatment. Oncology clinicians report being supportive of exercise referrals but not having the time to make referrals. Toward the goal of making exercise referrals standard of care, we implemented and evaluated a novel clinical workflow. Methods: For this QI project, a rehabilitation navigator was inserted in chemotherapy infusion clinics. Patients were offered a validated electronic triage survey. Exercise or rehabilitation recommendations were communicated to patients during a brief counseling visit by the rehabilitation navigator. The implementation approach was guided by the EPIS framework. Acceptability and feasibility were assessed. Results: Initial meetings with nursing and cancer center leadership ensured buy-in (exploration). The education of medical assistants contributed to the adoption of the triage process (preparation). Audit and feedback ensured leadership was aware of medical assistants’ performance (implementation). 100% of medical assistants participated in implementing the triage tool. A total of 587 patients visited the infusion clinics during the 6-month period when this QI project was conducted. Of these, 501 (85.3%) were offered the triage survey and 391 (78%) completed the survey (acceptability). A total of 176 (45%) of triaged patients accepted a referral to exercise or rehabilitation interventions (feasibility). Conclusions: Implementation of a validated triage tool by medical assistants and brief counseling by a rehabilitation navigator resulted in 45% of infusion patients accepting a referral to exercise or rehabilitation. The triage process showed promise for making exercise referrals standard of care for patients undergoing cancer treatment. [ABSTRACT FROM AUTHOR]

Comorbidities may contribute to inadequate response to therapy and accelerate disability in various rheumatic diseases such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and psoriatic arthritis (PsA). Cardiovascular, oncological, and infectious comorbidities are common in rheumatic patients. The rehabilitation of patients with inflammatory rheumatic diseases (IRDs) with comorbidities requires a multidisciplinary approach to improving patients' functional mobility, slowing down the disease progression and minimizing the risks of complications. The evidence suggests that cardiac rehabilitation can be implemented in daily practice in patients with IRDs to reduce mortality for those with established risk factors. Physical exercises reduce the severity, improve the clinical course, and reduce hospitalization rates in patients with rheumatic diseases. A rehabilitation program with focused physical therapy can lead to functional improvements and reduction of disease activity in patients with lowered quality of life (QoL). Health professionals should provide evidence-based recommendations for patients with rheumatic diseases and comorbidities to initiate the self-management of their diseases and prevent complications. [ABSTRACT FROM AUTHOR]

Ataxia telangiectasia (A-T) is a rare, multisystem progressive condition that typically presents in early childhood. In the absence of cure, people with A-T require coordinated multidisciplinary care to manage their complex array of needs and to minimize the disease burden. Although symptom management has proven benefits for this population, including improved quality of life and reduced complications, there is a need for guidance specific to the nursing and allied healthcare teams who provide care within the community. A scoping review, adopting the Joanna Briggs Institute methodology, was undertaken. It aimed to identify and map the available expertise from nursing and allied healthcare and management of children and young people with A-T ≤ 18 years of age. A rigorous search strategy was employed which generated a total of 21,118 sources of evidence, of which 50 were selected for review following screening by experts. A range of interventions were identified that reported a positive impact on A-T-related impairments, together with quality of life, indicating that outcomes can be improved for this population. Most notable interventions specific to A-T include therapeutic exercise, inspiratory muscle training, and early nutritional assessment and intervention. Further research will be required to determine the full potential of the identified interventions, including translatability to the A-T setting for evidence related to other forms of ataxia. Large gaps exist in the nursing and allied health evidence-base, highlighting a need for robust research that includes children and young people with A-T and their families to better inform and optimize management strategies. [ABSTRACT FROM AUTHOR]

In order to reduce the treatment cost required for the recovery of patients with nerve injury, a rehabilitation training robot based on single-degree-of-freedom eight-link leg mechanism is proposed. The robot imitates human gait by repeatedly and naturally moving the legs. Clinical cases show that this training can help patients to carry out targeted exercises, such as leg activity exercises, improving balance, physical training and so on. The motion cycle of the mechanism is matched with the generalized gait cycle in clinic. Then, based on the support phase and swing phase of the gait cycle, the mechanism is optimized by adjusting the link length through kinematic analysis. The theoretical calculation and virtual simulation are carried out by using SOLIDWORKS, MATLAB and ADAMS software, and the feasibility of the mechanism is verified. The conclusion of theory and simulation is that the design of this single-degree-of-freedom eight-link leg walking mechanism can provide a basis for low-cost rehabilitation training based on patients with spinal injury. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to determine whether preoperative depressiveness, stress, and personality influence quality of life (QOL) after cochlear implant (CI) surgery. Methods: In this prospective study, 79 patients undergoing CI surgery were evaluated preoperatively and 12 months postoperatively. Disease-specific QOL was assessed with the Nijmegen Cochlear Implant Questionnaire (NCIQ) and general QOL with the WHOQOL-BREF. Depressiveness and stress were assessed with the Patient Health Questionnaire (PHQ-D). The Charlson Comorbidity Index (CCI) was used to classify comorbidities. The Big Five Personality Test (B5T) was used to assess the basic personality dimensions. Speech comprehension was evaluated in quiet with the Freiburg monosyllable test and in noise with the Oldenburg sentence test. Results: After CI surgery, the total NCIQ score improved significantly (Δ 17.1 ± 14.7, p < 0.001). General QOL (WHOQOL-BREF, Δ 0.4 ± 9.9, p = 0.357), stress (Δ 0.25 ± 3.21, p = 0.486), and depressiveness (Δ 0.52 ± 3.21, p = 0.121) were unaffected by CI surgery. Patients without elevated depressiveness (p < 0.01) or stress (p < 0.001) had significantly better total NCIQ scores. The results of the multiple regression analyses show that, after adjusting for the CCI, personality, age, and mental health stress (ß = − 0.495, p < 0.001) was significantly associated with postoperative NCIQ outcome scores. Depressiveness and neuroticism had the strongest influence on the generic QOL (ß = − 0.286 and ß = − 0.277, p < 0.05). Conclusion: Stress symptoms and personality traits are significant predictive factors for disease-specific QOL, as well as hearing status. This should be considered in the preoperative consultation and in optimizing the rehabilitation process. [ABSTRACT FROM AUTHOR]

The importance of community involvement for both older adults and individuals coping with mental illness is well documented. Yet, barriers to community integration for adults with mental illness such as social stigma, discrimination, and economic marginalization are often exacerbated by increased health and mobility challenges among older adults. Using photovoice, nine older adults with mental illness represented their views of community in photographs and group discussions over a six-week period. Participant themes of community life included physical spaces, valued social roles, and access to resources in the community. Themes were anchored by older adults' perceptions of historical and cultural time comparisons between 'how things used to be' and 'how things are now.' Barriers to community integration were often related to factors such as age, mobility, and resources rather than to mental health status. Program evaluation results suggest photovoice can promote self-reflection, learning, and collaboration among older adults with mental illness. [ABSTRACT FROM AUTHOR]

Purpose: Community rehabilitation is crucial for the long-term treatment of people with chronic psychotic disorder. Ethnic minorities are less likely to seek care and have accessible treatment. This study examines whether the use of rehabilitation services and the relationship between rehabilitation and number of hospitalization days differ between Arabs and Jews. Methods: Data from the Israel National Psychiatric Case Register on 18,684 adults with schizophrenia/schizoaffective disorders hospitalized in 1963–2016 were merged with data from the national Mental Rehabilitation Register. Associations between the use of rehabilitation services and demographic and clinical characteristics were assessed through logistic regression modeling. Associations between ethnicity and duration of rehabilitation (housing or vocational) and annual hospitalization days during Period1: 2001–2009 and Period2: 2010–2016 were analyzed using ANOVA. Results: Among Jewish patients (N = 2556), 37% and 57% used rehabilitation services during Period1 and Period2, respectively, compared with 18% and 40% among Arab patients (N = 15,145) (p < 0.0001). The use of rehabilitation services was significantly higher among Jews (adjusted OR = 2.26, 95% CI 2.07–2.47). Average duration of housing and vocational rehabilitation services did not differ between Arab and Jewish patients. In both groups, duration of rehabilitation was inversely associated with annual hospitalization days. Conclusions: The ethnic disparity in the use of rehabilitation services has narrowed over time, yet remains. Although fewer Arab patients use rehabilitation, Jewish and Arab benefit similarly from the services with regard to reduced hospitalization days. To further close the ethnic gap, greater efforts must be made to expand the availability of culturally appropriate rehabilitation services for the Arab minority. [ABSTRACT FROM AUTHOR]

Introduction: There is evidence to demonstrate that plasticity is "use-dependent" and that intensive practice may be necessary to modify neural organization. Purpose: The main aim of this work is to investigate the REACT usability, an innovative app, to assist People with Parkinson Disease (PwPD) at home. Methods: A pilot study has been conducted enrolling 20 consecutive PwPD. Before home rehabilitation activities started, each patient received training on the REACT app and how to use the device and the services in daily practice. Motor and cognitive evaluations were administered to assign personalized exercises, tailored to patients' needs and potential. PwPD carried out REACT home program for 1 month, four times a week. The app included motor exercise and tutorial of activities of daily living (ADL) and functional cognitive stimulation. REACT-app usability was evaluated with the System Usability Scale (SUS). Results: The results from SUS questionnaire were, on average, above the threshold of "good usability" (SUS score > 68), as reported in the literature. The 47% of PwPD that used the app rated the usability of the solution as "excellent." Almost all SUS items reached the reference benchmark (except items 4, 5, and 7). No adverse events occurred. Conclusions: REACT can be considered a useful and safe tool to support the continuity of care and treatment at home, in PwPD. Larger-scale trials are needed to validate the good acceptance and efficacy of home rehabilitation through technology applications. [ABSTRACT FROM AUTHOR]

Study design: We conducted a mixed-methods sequential explanatory study. In India, most spinal cord injuries (SCI) occur within low socioeconomic status populations, typically resulting in poor vocational outcomes post-injury and difficulty reintegrating into the community. This study will increase our understanding of how vocational rehabilitation affects patients with SCI. Objectives: This study aims to understand the factors affecting vocational outcomes, quality of life and social inclusion for patients who have completed the Amar Seva Sangam (ASSA's) rehabilitation program, by examining both quantitative and qualitative measures. Methods: Conducted at the University of Toronto, we used self-administered questionnaires via REDCap for quantitative data collection and semi-structured interviews for qualitative data collection to capture aspects of lived SCI experience for five participants. Results: Thirty-two participants completed the quantitative phone questionnaire of which 17 were paraplegic and 15 were quadriplegic. Four themes emerged including physical barriers to employment, social inclusion of SCI patients, low income, and state of mental health. Conclusion: This study provided a detailed examination of demographic information and lived experiences of ASSA participants. The findings will be relevant and applicable to both clinical and public health sectors in SCI rehabilitation in India and other low- and middle-income countries by directing rehabilitation programs to better address areas of function that allow patients to find success following rehabilitation. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to assess the validity and informational value of TikTok content about epicondylitis. The hypothesis tested herein was that TikTok video content would not provide adequate and valid information. Methods: The term "epicondylitis" was used as a keyword to comprehensively search for TikTok videos, and the first 100 videos that were retrieved were subsequently included for analysis. The duration, number of likes, number of shares and number of views were recorded for each video. Furthermore, the videos were categorized on the basis of their source (medical doctor, physiotherapist, or private user), type of information (physical therapy, anatomy, clinical examination, etiopathogenesis, patient experience, treatment, or other), video content (rehabilitation, education, or patient experience/testimony), and the presence of music or voice. Assessments of video content quality and reliability were conducted using the DISCERN tool, the Journal of the American Medical Association (JAMA) benchmark criteria, and the Global Quality Score (GQS). Results: A total of 100 videos were included in the analysis: 78 (78.0%) were published by physiotherapists, 18 were published by medical doctors (18.0%), and 4 were published by private users (4.0%). Most of the information pertained to physical therapy (75; 75.0%) and most of the content was about rehabilitation (75; 75.0%). The mean length of the videos was 42.51 ± 24.75 seconds; the mean number of views was 193,207.78 ± 1,300,853.86; and the mean number of comments, likes, and shares were 22.43 ± 62.54, 1578.52 ± 8333.11, and 149.87 ± 577.73, respectively. The mean DISCERN score, JAMA score, and GQS were 18.12 ± 5.73, 0.80 ± 0.53, and 1.30 ± 0.52, respectively. Videos posted by medical doctors/private users had higher scores (p < 0.05) than videos posted by physiotherapists. Videos that focused on education or patient experience had higher scores (p < 0.05) than videos based on rehabilitation. Conclusions: TikTok can be an unreliable source of information regarding epicondylitis treatment. It is common to find nonphysicians who share medical advice on the platform, with medical treatments demonstrating the weakest level of supporting evidence. Elbow surgeons should advise their patients that treatment recommendations from TikTok may not align with established guidelines. Level of Evidence: Level IV—Cross-sectional study. [ABSTRACT FROM AUTHOR]

Purpose: Immobilization, especially of the lower extremity, after orthopaedic surgery has been associated with reduced physical activity. Previous interventions from our study group showed even in young, healthy people reduced activity levels after immobilization of the shoulder. Therefore, this study investigates the change in physical activity due to shoulder immobilization after a reconstructive surgery. Methods: This prospective study includes 40 patients undergoing surgery from May 2019 to December 2020. Daily activity was measured before surgery, after discharge and three weeks postoperatively each time for six days. Activity including step counts and active time were measured by Fitbit™ inspire. Range of motion before and after surgery as well as Pain (VAS) were documented. Results: Steps became significantly less immediately postoperatively with an immobilized shoulder joint than before surgery (9728.8 vs. 6022.6, p < 0.05). At follow-up, the number of steps increased again, but still showed a significantly lower number of steps (mean 8833.2) compared to preoperative. Patients preoperatively showed mostly an "active" activity pattern, whereas postoperatively a "low active" behaviour predominated. The proportion of sedentary behaviour ("basal activity" and "limited activity") was almost three times higher postoperatively (12.5% vs. 30%). Conclusion: General physical activity is restricted during upper limb immobilization in adults. Therefore, activity-enhancing measures should be implemented in the early phase of rehabilitation after upper extremity surgery. [ABSTRACT FROM AUTHOR]

This longitudinal study examined the psychosocial health trajectories of children following reunification from residential care and the associated contextual factors. Data were drawn from a randomised controlled trial evaluating the effects of a parenting programme on the successful reunification and reintegration of 1–13-year-old children with their families, in nine districts in Uganda. Families were randomised to receive either a basic reintegration package consisting of a reunification grant and case management (standard intervention) or an enhanced package consisting of the basic package plus 13 bi-weekly training sessions of a parenting programme (enhanced intervention). Data were collected from caregivers at home and the residential care facilities, as well as the children (n = 55 dyadic pairs) through prospective interviews at baseline (before reunification), and at 6- and 12-months post-reunification. Predictive growth curve analyses assessed longitudinal changes in child psychosocial problems (externalizing, internalizing, total behavioural problems) and associated contextual factors. In age, sex, and study arm stratified analyses, we found declining linear trajectories in children's psychosocial problem scores at 6 and 12 months post-reunification. Taking covariates into account, persistent externalizing, internalizing, and total behavioural problems at endline were associated with children's depressive symptoms, caregiver characteristics and quality of caregiving. Our findings suggest that children who are reunified from residential to family-based care have fewer psychosocial problems post-reunification compared to their time in residential care. These findings did not differ by age and sex of the child or type of reintegration package received. Although findings from our small single study have limited generalizability and should be interpreted with caution for policy and programming, they underscore the potential benefits of reunification programmes for children's psychosocial well-being. Highlights: This study examined the psychosocial health trajectories of children reunified from residential to family-based care and associated factors. Reunified children had fewer psychosocial problems at 6 and 12 months after reunification compared with their baseline when in residential care. Findings did not differ with child age, sex or type of reintegration package received. Persistent psychosocial problems were associated with caregiver unemployment, child depressive symptoms, poorer caregiver health, and low-quality caregiving. Larger studies with longer follow-up periods are required to validate our findings in a resource-limited setting. [ABSTRACT FROM AUTHOR]

Pediatric acute kidney support therapy (paKST) programs aim to reliably provide safe, effective, and timely extracorporeal supportive care for acutely and critically ill pediatric patients with acute kidney injury (AKI), fluid and electrolyte derangements, and/or toxin accumulation with a goal of improving both hospital-based and lifelong outcomes. Little is known about optimal ways to configure paKST teams and programs, pediatric-specific aspects of delivering high-quality paKST, strategies for transitioning from acute continuous modes of paKST to facilitate rehabilitation, or providing effective short- and long-term follow-up. As part of the 26th Acute Disease Quality Initiative Conference, the first to focus on a pediatric population, we summarize here the current state of knowledge in paKST programs and technology, identify key knowledge gaps in the field, and propose a framework for current best practices and future research in paKST. [ABSTRACT FROM AUTHOR]

Clinical care following a severe brain injury often requires a host of physical and psychological rehabilitation interventions. However, a brain injury affects the entire family. Therefore, a family-level approach to neurorehabilitation services should be favoured over an individual one. Social workers are often well positioned to assess and address family-level processes. By exploring key family-level theories, models, and approaches to brain injury intervention, this article provides clinical social workers with practical guidance. Illustrated through a descriptive case example, it serves as a user-friendly resource for application in real-world settings. The skills and tools discussed will likely be familiar even to those without practice experience in neurorehabilitation. The value of emphasizing clinical process skills related to common factors in therapy rather than content expertise related to brain injuries is discussed. References for comprehensive brain injury family interventions and reliable sources of information for clinicians and families are provided throughout the article. [ABSTRACT FROM AUTHOR]

Background: Reconstructions of the proximal femur after massive resections represent one of the main challenges in orthopedic oncology. Among the possible treatments, megaprostheses represent one of the most used and reliable reconstructive approaches. Although literature about their outcomes has flourished through the last decades, a consensus rehabilitative treatment is still far from being established. Materials and methods: We evaluated the functional results of all our oncologic cases treated between 2016 and 2022 that could follow our standardized post-operative rehabilitative approach, consisting in progressive hip mobilization and early weight-bearing. Results: Twenty-two cases were included in our study. On average, their hospitalization lasted 15.1 days. The seated position was achieved on average within 3.7 days after surgery, the standing position reached 5.4 after surgery, while assisted deambulation was started 6.4 days after surgery. After a mean post-operative follow-up of 44.0 months, our patients' mean MSTS score was 23.2 (10–30). Our data suggested a statistically significant inverse linear correlation between post-operative functionality and patients' age, resection length, and the start of deambulation. Conclusions: A correct rehabilitation, focused on early mobilization and progressive weight-bearing, is crucial to maximize patients' post-operative functional outcomes. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19), which arose in late 2019, caused extensive destruction, impacting a substantial proportion of the worldwide population and leading to millions of deaths. Although COVID-19 is mainly linked to respiratory and pulmonary complications, it has the potential to affect neurologic structures as well. Neurological involvement may manifest as minimal and reversible; however, a notable proportion of cases have exhibited pronounced neurological consequences, such as strokes. Endothelial inflammation, hypercoagulation, renin–angiotensin–aldosterone system alterations, and cardiogenic embolism are the pathophysiological mechanisms of stroke under COVID-19 circumstances. Physical activity and exercise have improved several aspects of post-stroke recovery, including cardiovascular health, walking capacity, and upper limb strength. They are commonly used to assist stroke survivors in overcoming their motor restrictions. Furthermore, stroke rehabilitation can incorporate a range of specific techniques, including body-weight-supported treadmill applications, constraint-induced movement therapy, robotic rehabilitation interventions, transcranial direct current stimulation, transcranial magnetic stimulation, and prism adaptation training. Under pandemic conditions, there were several barriers to neurological rehabilitation. The most significant of these were individual's fear of infection, which caused them to postpone their rehabilitation applications and rehabilitation areas being converted into COVID-19 units. The primary emphasis had turned to COVID-19 treatment. Several valuable data and views were gained in reorganizing rehabilitation during the pandemic, contributing to establishing future views in this regard. [ABSTRACT FROM AUTHOR]

Background: Exercise, particularly resistance exercise, is beneficial for sarcopenia in patients with liver cirrhosis. However, the effects of exercise on events remain unclear. We aimed to examine the effects of exercise on serious events in patients with liver cirrhosis using a meta-analysis of randomized controlled trials (RCTs). Methods: A literature search was conducted in 2022. Eleven RCTs were selected for the meta-analysis (exercise group, n = 232; control group, n = 193). Serious events were defined as death or serious complications according to the original articles. A meta-analysis was performed using a random-effects model. The primary outcome was the incidence of serious events. Results: In the 11 RCTs, the incidence of serious events was 5.6% (13/232) and 12.3% (24/193) in the exercise and control groups, respectively. However, a meta-analysis demonstrated no significant difference in the incidence of serious events between the two groups (risk difference [RD] − 0.03, 95% confidence intervals (CI) − 0.07 to 0.02). In a stratification analysis based on a combination of aerobic and resistance exercise, five RCTs (n = 185) were enrolled. The incidence of serious events was 6.25% (7/112) and 24.7% (18/73) in the combination exercise and control groups, respectively. A meta-analysis demonstrated a significant reduction in the incidence of serious events in the combination exercise group compared with the control group (RD − 0.12; 95% CI − 0.21 to − 0.03). Conclusions: Resistance exercise in combination with aerobic exercise reduces serious events in patients with liver cirrhosis. A combination of aerobic and resistance exercise may be beneficial to improve the prognosis of patients with liver cirrhosis. [ABSTRACT FROM AUTHOR]

Heart failure (HF) with preserved ejection fraction (HFpEF) is a prevalent global condition affecting approximately 50% of the HF population. With the aging of the worldwide population, its incidence and prevalence are expected to rise even further. Unfortunately, until recently, no effective medications were available to reduce the high mortality and hospitalization rates associated with HFpEF, making it a significant unmet need in cardiovascular medicine. Although HFpEF is commonly defined as HF with normal ejection fraction and elevated left ventricular filling pressure, performing invasive hemodynamic assessments on every individual suspected of having HFpEF is neither feasible nor practical. Consequently, several clinical criteria and diagnostic tools have been proposed to aid in diagnosing HFpEF. Overall, these criteria and tools are designed to assist healthcare professionals in identifying and evaluating patients who may have HFpEF based on a combination of signs, symptoms, biomarkers, and non-invasive imaging findings. By employing these non-invasive diagnostic approaches, clinicians can make informed decisions regarding the best pharmacological and rehabilitation strategies for individuals with suspected HFpEF. This literature review aims to provide an overview of all currently available methods for diagnosing and monitoring this disabling condition. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Despite exercise being the standard approach to diastasis recti abdominis (DRA) rehabilitation, there is no consensus on the most effective exercise routine and adjunct modalities for reducing DRA and improving functional parameters. The present study is aimed at investigating evidence for DRA rehabilitation in postpartum women, as well as knowledge gaps and areas for future research. Methods: For this scoping review a systematic search was conducted in MEDLINE, AMED, CINAHL, Embase, ScienceDirect, Scopus, and PEDro up to November 2022. Selection criteria included studies investigating exercise therapy interventions both with and without adjunct modalities for postpartum DRA. Sample characteristics, diagnostic criteria, program design, and outcome measures were recorded. Critical appraisal of clinical trials was performed using PEDro classification. Results: Twenty-eight studies were included: 14 clinical trials, 3 case series, and 11 observational studies. DRA exercises that focused on deep and superficial muscles, pelvic floor muscles, respiratory maneuvers, functional exercises, or alternative interventions (yoga, suspension training, hypopressive exercise) and adjunct modalities showed promising results in reducing the inter-recti distance and related dysfunction. However, there was great variability in diagnostic criteria and methods, DRA severity, time post-birth, and exercise program design. Conclusions: Reviewed studies provide valuable insights into exercise therapy, but it is important to recognize their limitations, as variability in diagnostic criteria, sample characteristics, and exercise program design hinder the generalizability of the findings. Further high-quality research is needed to strengthen the evidence in this area and provide reliable recommendations for clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: To determine the clinical efficacy of different respiratory training interventions on swallowing function in patients with swallowing disorders through the systematic review. Methods: We reviewed the literature regarding the application of respiratory training therapy in patients with swallowing disorders, followed by a PRISMA search of published literature in five databases (PubMed, Web of Science, The Cochrane Library, CINAHL and EMBASE) in December 2022. Two reviewers performed study selection, quality evaluation, and risk of bias, followed by data extraction and detailed analysis. Results: A total of six randomized controlled studies with a total sample size of 193 cases were included. Respiratory training improved swallowing safety (PAS (n = 151, SMD = 0.69, 95% CI − 1.11 to − 0.26, I2 = 36, p < 0.001)) and swallowing efficiency [residual (n = 63, SMD = 1.67, 95% CI − 2.26 to − 1.09, I2 = 23%, p < 0.001)] compared to control groups. The results of the qualitative analysis conducted in this study revealed that respiratory training enhanced hyoid bone movement but had no effect on swallowing quality of life. Conclusions: Respiratory training interventions may improve swallowing safety and efficiency in patients with dysphagia. However, the level of evidence is low, and there is a limited amount of research on the effectiveness and physiology of this intervention to improve swallowing function. In the future, there is a need to expand clinical studies, standardize measurement tools, and improve study protocols. [ABSTRACT FROM AUTHOR]

Background: Tourniquet use during total knee arthroplasty (TKA) remains controversial. The purpose of this study is to determine the impact of tourniquet use only during cementation compared with its use throughout the entire surgery concerning early outcomes in functional recovery, pain, quadriceps function, and rehabilitation. Methods: Between November 2019 and March 2020, 118 patients were enrolled in this study, with 59 patients undergoing TKA with a tourniquet during the entire surgery (group 1) and 59 patients with a tourniquet only during cementation (group 2). Twenty-eight patients were unable to complete follow-up leaving fifty in group 1 and forty in group 2. Primary endpoints were surgical time, postoperative knee and thigh pain, and functional recovery. Secondary endpoints were 6-month clinical scores and blood loss. Results: Patients in group 1 had statistically significantly increased knee pain on postoperative day 3 (p = 0.004), and thigh pain on postoperative day 1 (p < 0.001), 2 (p < 0.001), and 3 (p = 0.027), and longer time intervals to achieve straight leg raise maneuver (p = 0.006) compared to group 2. However, it did not affect overall narcotic consumption, knee pain (day 1–2), functional recovery, ROM, ability to do the first walk, Oxford knee score, length of stay, and complication rate. There was no statistically significant difference in terms of 6-month postoperative knee score, surgical time, and blood loss between the two groups. Conclusion: Tourniquet use diminishes quadriceps function and increases postoperative thigh pain and, to a lesser extent, knee pain. We, therefore, recommend the use of a tourniquet only during cementing. Level of evidence: 1; prospective randomized study. [ABSTRACT FROM AUTHOR]

Purpose: To assess the perceptions, barriers, and facilitators of sustaining the use of outcome measures of physical and occupational therapists following a three-year knowledge translation intervention. Methods: A phenomenological qualitative study was conducted at an inpatient rehabilitation hospital on 13 clinicians (6 physical therapists and 7 occupational therapists) participating in the knowledge translation intervention. Data collection used semi-structured interviewing during three focus groups to understand the lived experience of clinicians participating in the knowledge translation project. Data were analyzed using the Consolidated Framework for Implementation Research (CFIR) codebook. Results: Two investigators coded twelve CFIR constructs into barriers and facilitators for outcome measure use. Four key themes emerged as determinants for outcome measures use: (1) Organizational support and clinician engagement; (2) the knowledge translation intervention; (3) the outcome measures themselves; and (4) the patients. Clinicians reported using outcome measures for patient education, treatment planning, and goal setting, while they found other outcome measures lacked functional significance. Facilitators included organizational support, access to knowledge, ongoing training, and clinician engagement. Ongoing barriers included the need for more training and the need to select different tests. Conclusions: This study found proper selection of outcomes measures is important and attributed the sustainability of the knowledge translation intervention to organizational support, clinician engagement and ongoing training. The clinicians wanted continued training to overcome new barriers. Barriers identified in this study were unique to the typical barriers identified for outcome measure use. Ongoing barrier assessments are needed for continued refinement of knowledge translation interventions to enhance sustainability. [ABSTRACT FROM AUTHOR]

The purpose of this study is to investigate the role of core muscles in female sexual dysfunction (FSD) and develop comprehensive rehabilitation programs to address this issue. We aim to answer the following research questions: what are the roles of core muscles in FSD, and how can machine and deep learning models accurately predict changes in core muscles during FSD? FSD is a common condition that affects women of all ages, characterized by symptoms such as decreased libido, difficulty achieving orgasm, and pain during intercourse. We conducted a comprehensive analysis of changes in core muscles during FSD using machine and deep learning. We evaluated the performance of multiple models, including multi-layer perceptron (MLP), long short-term memory (LSTM), convolutional neural network (CNN), recurrent neural network (RNN), ElasticNetCV, random forest regressor, SVR, and Bagging regressor. The models were evaluated based on mean squared error (MSE), mean absolute error (MAE), and R-squared (R2) score. Our results show that CNN and random forest regressor are the most accurate models for predicting changes in core muscles during FSD. CNN achieved the lowest MSE (0.002) and the highest R2 score (0.988), while random forest regressor also performed well with an MSE of 0.0021 and an R2 score of 0.9905. Our study demonstrates that machine and deep learning models can accurately predict changes in core muscles during FSD. The neglected core muscles play a significant role in FSD, highlighting the need for comprehensive rehabilitation programs that address these muscles. By developing these programs, we can improve the quality of life for women with FSD and help them achieve optimal sexual health. [ABSTRACT FROM AUTHOR]

Background: Evidence-based data are required to provide insightful information on the timing of rehabilitation after lumbar spine surgery (LSS). Objectives: The aim of this study is to systematically review the outcomes of early rehabilitation interventions and conduct its meta-analysis in patients after LSS. Patients and methods: A total of 1183 articles were retrieved through PubMed (n = 793), Web of Science (n = 721), Scopus (n = 335), and ScienceDirect (n = 83) databases. Fourteen studies were included in the systematic review. The quality analysis and risk of bias assessment of the trials included in the systematic review were performed using the Physiotherapy Evidence Database (PEDro) scoring and classification system. Narrative synthesis and standardized mean difference based pooling results were given for the systematic review and meta-analysis, respectively. Results: The additional benefit of early rehabilitation on physical function was moderately effective (ES: − 0.62, 95% CI − 1.00; − 0.25) at the 1-month follow-up. In terms of pain, early rehabilitation provided additional improvement at 1 month (ES: 0.34, 95% CI − 0.03; 0.71), 3 months (ES: − 0.14, 95% CI − 0.37; 0.10), 6 months (ES: 0.35, 95% CI 0.04; 0.65) and 1 year (ES: 0.21, 95% CI − 0.09; 0.52) follow-up at a low level of evidence. Conclusions: This systematic review demonstrated that early rehabilitation mainly improved disability in the early period (1-month follow-up). Regarding pain, short-term (1 month) and mid-term (6 months) follow-ups showed the most significant additional benefit. The positive effects of starting rehabilitation early after surgery on pain may have positively affected disability, specifically in the early period (1 month). [ABSTRACT FROM AUTHOR]

Background: Spastic movement disorder (SMD) develops in up to 43% of cases as a sequela of stroke. In the event of a functionally relevant or daily life impairing SMD or to avoid an impending complication, the medicinal treatment of a focal, multifocal and segmental increase in muscle tone with botulinum neurotoxin A (BoNT-A) is recommended; however, treatment data reveal a lack of guideline-conform treatment with BoNT‑A in Germany. Objective: The aim of the reported expert meeting was to discuss solutions to the incorrect treatment and undertreatment of patients with SMD and to formulate consensus recommendations to improve the care situation. Methods: At a consensus meeting held in April 2022, eight experts from the fields of neurology, physical medicine and rehabilitation discussed the causes for the incorrect treatment and undertreatment and formulated consensus solution approaches. Results: Possible reasons for the current incorrect treatment and undertreatment in SMD management in Germany include insufficient awareness of SMD among physicians, a lack of treatment capacities, a lack of information transfer in discharge management as well as staff shortages in the specialized inpatient and outpatient SMD treatment centers. The committee therefore recommended a patient pathway in which affected patients with SMD are provided with correctly implemented BoNT‑A treatment in combination with physical measures. Conclusion: The recommended treatment pathway for use in stroke patients is intended to close gaps in care and thus ensure guideline-conform treatment of post-stroke SMD. [ABSTRACT FROM AUTHOR]

Background: Certification of centers for weaning from a ventilator in neurological neurosurgical early rehabilitation (NNER) by the German Society for Neurorehabilitation (DGNR) is possible since 1 October 2021. Objective: The results of certification of facilities in the first year after starting the procedure are presented. Material and methods: As part of the certification process 28 criteria are assessed including a set of mandatory characteristics of the facility. The criteria are divided into structural criteria (i = 7), diagnostic criteria (i = 6), personnel criteria (i = 3), internal organization criteria (i = 7), and quality management criteria (i = 5). Results: A total of 13 centers were certified in the first year, with a combined total of 283 beds for weaning from a ventilator in the NNER and served 2278 persons to be weaned from a ventilator in the year before certification, with a median of 134 per facility (range 44–414). Only rarely was weaning unsuccessful, requiring conversion to home mechanical ventilation before discharge (invasive home mechanical ventilation median per facility 10 persons, range 2–25; non-invasive home mechanical ventilation median 0 persons, range 0–57). A high level of process and structural quality was documented for the certified centers: across all areas of assessment, the individual certification criteria were met in the vast majority of cases (median degree of complete fulfilment 86%) or met with improvement potentials documented by the auditors (median 11%). Conclusion: Successful weaning in NNER and a high level of process and structural quality can be demonstrated by the certification results of centers that follow this integrative approach to weaning from a ventilator in a NNER setting. [ABSTRACT FROM AUTHOR]

Purpose: A treatment‐specific rehabilitation protocol and well‐defined return‐to‐play criteria guide clinical decision‐making on return to normal function, activity, sports and performance after surgical treatment for osteochondral lesion of the talus (OLT). The optimal rehabilitation protocols in the current literature remain unclear. The purpose of this study was to explore the existing literature on rehabilitation protocols from the early postoperative phase to return to sport onwards after different types of surgical treatment of OLTs. Methods: PubMed, Embase, CDSR, DARE and Central were searched systematically from inception to February 2023 according to the PRISMA 2020 guidelines. All clinical studies with a description of postoperative rehabilitation criteria after surgical treatment of OLTs were included. The primary outcome of this study is the extent of reportage for each rehabilitation parameter expressed in percentage. The secondary outcome is the reported median time for each parameter in rehabilitation protocols for all different treatment modalities (type of surgery). The median time, expressed as number of weeks, for each parameter was compared between different types of surgery. Results: A total of 227 articles were included reporting on 255 different rehabilitation protocols from seven different types of surgery. Weight‐bearing instructions were reported in 84%–100% and the use of a cast or walker was prescribed in 27%–100%. Range of motion exercises were described in 54%–100% whereas physical therapy was advised in 21%–67% of the protocols. Any advice on return to sport was described in 0%–67% protocols. A nonparametric analysis of variance showed significant differences between the different surgical treatment modalities for the following parameters between the treatment groups: time to full weight‐bearing (p < 0.0003) and return to high impact level of sports (p < 0.0003). Subjective or objective criteria for progression during rehabilitation were reported in only 24% of the studies. Conclusion: An in‐depth exploration of the current literature showed substantial variation in postoperative rehabilitation guidelines with an associated underreporting of the most important rehabilitation parameters in postoperative protocols after surgical treatment of OLTs. Furthermore, nearly all rehabilitation protocols were constructed according to a time‐based approach. Only one out of four reported either objective or subjective criteria. Level of Evidence: Level IV, systematic review. [ABSTRACT FROM AUTHOR]