Journal of Rehabilitation Medicine is an international Open Access journal covering a wide variety of topics related to rehabilitation medicine. With a publication history going back more than 50 years and a high impact factor it reaches a wide group of healthcare professionals from all over the world.
All digitalized JRM contents is available freely online. The Foundation for Rehabilitation Medicine owns the copyright for all material published until volume 40 (2008), as from volume 41 (2009) authors retain copyright to their work and as from volume 49 (2017) the journal has been published Open Access, under CC-BY-NC licences (unless otherwise specified). The CC-BY-NC licenses allow third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work. From 2024, articles are published under the CC-BY licence. This license permits sharing, adapting, and using the material for any purpose, including commercial use, with the condition of providing full attribution to the original publication.
Effect of inspiratory muscle training on inspiratory muscle strength in adults with post-COVID-19 condition and inspiratory muscle weakness: a randomized controlled trial
Objective: Evaluate the effect of inspiratory muscle training in adults with post-COVID-19 condition (PCC) and inspiratory muscle weakness. Design: Randomized controlled trial. Subjects/Patients: Adults with PCC and inspiratory muscle weakness. Methods: Participants were randomized to inspiratory muscle training twice daily plus individualized exercise twice weekly or exercise alone, with weekly follow-ups over 8 weeks. Primary outcome: inspiratory muscle strength (Maximal Inspiratory Pressure). Secondary outcomes: expiratory muscle strength (Maximal Expiratory Pressure); functional capacity (Six‑Minute Walk Test; One‑Minute Sit‑to‑Stand); lung function (spirometry); dyspnoea (mMRC); respiratory symptoms (chest tightness, impaired deep breathing, breathing‑related pain); cough frequency (CAAT cough item); fatigue (Fatigue Severity Scale); physical activity (Frändin–Grimby Activity Scale); activity limitations (Patient‑Specific Functional Scale); and health-related quality of life (EQ‑5D‑5L). Intention-to-treat analyses used imputed missing data. Estimated sample size: 90. Results: Forty-four participants were included (median age 47; 82% women; n = 22/group). Between‑group differences favoured the intervention for inspiratory muscle strength (mean difference: 18%; 95% CI: 5–30; OR for clinically meaningful improvement: 7.08, 95% CI: 1.31–38.32) and cough frequency. No other between-group differences were observed. Conclusion: Inspiratory muscle training may improve inspiratory muscle strength and reduce cough frequency, but limited sample size and underrepresentation of the most severely affected warrant cautious interpretation.
Copyright (c) 2026 Anna Törnberg, Anna Svensson-Raskh, Elisabeth Rydwik, Alexandra Halvarsson, Judith Bruchfeld, Malin Nygren-Bonnier https://creativecommons.org/licenses/by/4.0
Prevalence and biopsychosocial predictors of post-stroke fatigue in patients with minor strokes
Background: The majority of stroke patients suffer minor stroke. Little is known about the prevalence of post-stroke fatigue (PSF) and which factors are associated with fatigue in minor stroke patients. Objective: To investigate the prevalence of PSF in a sample of minor stroke patients and to explore associations between biopsychosocial factors and fatigue 12 months post stroke. Methods: In this observational study of 72 minor stroke patients fatigue symptoms were measured in the acute phase and 12 months post stroke using the Fatigue Severity Scale (FSS). At 12 months, data on psychological distress symptoms, coping strategies, balance, cognitive function, and self- report of stroke-related symptoms were collected using standardized questionnaires and tests. To explore the possible associations between fatigue and the different variables the Mann–Whitney U test and Spearman’s correlations were used. A multiple regression was conducted to identify which of the factors had the strongest association with fatigue Results: Almost 20% of the sample were fatigue cases 1 year post stroke using a cut off of 5 on the FSS. PSF was strongly associated with having psychological distress symptoms. In univariate analyses, PSF was also associated with fatigue in the acute phase, stroke-related physical impairments, and self-report of symptoms of cognitive impairments. Conclusions: PSF is present in a subgroup of patients with minor stroke. To identify patients at risk of developing chronic PSF, minor stroke patients should be screened for fatigue early after stroke. A short screening of factors associated with fatigue, such as psychological distress and impaired motor, visual, or cognitive function is also advisable. There is a need for further research in larger samples on PSF and associated factors in minor stroke.
Copyright (c) 2026 Anita Kjeverud, Stein Andersson, Anners Lerdal, Anne-Kristine Schanke, Kristin Østlie https://creativecommons.org/licenses/by/4.0
Long-term outcomes following a pulmonary telerehabilitation trial for people with respiratory post-acute sequelae of COVID: a 12-month follow-up study
Objective: To determine whether changes in physical and psychological outcomes occurred in the 12 months following completion of a randomized controlled trial comparing a 4-week pulmonary telerehabilitation programme with a control group of usual care in people with respiratory post-acute sequelae of COVID. Methods: This was a prospective, observational, multi-site, assessor-blinded study. Primary outcome: 1-minute sit-to-stand test. Secondary outcomes: 5-repetition sit-to-stand test; Montreal Cognitive Assessment; COVID-19 Yorkshire Rehabilitation Scale; COPD Assessment Test; 36-Item Short-Form Health Survey; Hospital Anxiety and Depression Scale; Fatigue Severity Scale; and the Kessler Psychological Distress Scale. All outcomes were assessed at baseline and 12 months following randomized controlled trial participation. All participants were analysed as a single group at 12 months, given there were no significant differences in the randomized controlled trial. Results: Of 50 participants enrolled in the randomized controlled trial, 29 (58%) participated in the 12-month follow-up. Compared with baseline, at the 12-month follow-up there was no statistically significant improvement in the primary outcome of the 1-min sit-to-stand test (1.5 points, CI: –1.3 to 4.2), yet statistically significant differences in the 5-repetition sit-to-stand test (–1.4 seconds CI: –2.7 to –0.1), COPD Assessment Test (–4.1 points CI: –6.8 to –1.4), and some domains of SF-36 and COVID-19 Yorkshire Rehabilitation Scale. Conclusion: This study demonstrated that people reporting respiratory post-acute sequelae of COVID experienced some recovery at 12 months, despite not improving initially during a 4-week pulmonary telerehabilitation programme or control period.
Copyright (c) 2026 Jack M. Reeves, Lisa M. Spencer, Ling-Ling Tsai, Andrew J. Baillie, Joshua Bishop, Amanda McAnulty, Yuna Han, Regina Leung, Jennifer A. Alison https://creativecommons.org/licenses/by/4.0
Latent profile analysis of social participation in stroke survivors with limb dysfunction: a mixed-methods study
Objective: This study aimed to identify profiles of social participation among stroke survivors with limb dysfunction and explore the factors influencing these profiles. Design: A convergent mixed-methods design. Methods: The quantitative phase involved 499 participants recruited from 5 neurorehabilitation centres in Shanghai between December 2023 and June 2025. Participants completed measures including the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P), the Connor-Davidson Resilience Scale (CD-RISC-10), and the Modified Rankin Scale (mRS). Qualitative semi-structured interviews were performed with 16 participants to explore lived experiences of social participation. Results: Latent profile analysis revealed 4 distinct social participation profiles: “Active Integration”, “Contented Conservatism”, “Cautious Conservatism”, and “Alienated Disengagement”. A multivariate analysis identified age, resilience, and physical function as significant predictors of profile membership. Qualitative findings uncovered 2 core emotional experiences (a sense of loss vs a sense of rebuilding) and 3 behavioural patterns (activist, conservative, alienated), which effectively explained the quantitative profiles’ characteristics and their underlying mechanisms. The integration of data provided a nuanced person-centred framework depicting the heterogeneity in post-stroke social participation. Conclusion: Social participation among stroke survivors is heterogeneous and can be classified into 4 distinct profiles shaped by the interplay of physical function, resilience, and sociodemographic factors. The findings underscore the necessity of implementing profile-specific, stepped-care interventions for effectively enhancing post-stroke social participation.
Copyright (c) 2026 Xuan Zhou, Ying Wang, Lanshu Zhou https://creativecommons.org/licenses/by/4.0
Different approach to bone mineral density in non-traumatic spinal cord injury: a comparison with traumatic spinal cord injury
Objective: The incidence of non-traumatic spinal cord injury (NTSCI) is rising with an ageing population. This study identified diagnostic bone sites and risk factors for low bone mineral density (BMD) in patients with NTSCI and those with TSCI according to age category. Design: Retrospective cross-sectional study. Subjects/Patients: 1,159 with TSCI and 475 with NTSCI at the National Rehabilitation Center in Korea. Methods: Diagnostic bone sites and BMD using dual-energy X-ray absorptiometry (DXA) were compared between groups and BMD risk factors were assessed. Results: The lumbar spine BMD and T-score values of osteoporosis were lower in the NTSCI group than in the TSCI group over 50 years old (p < 0.001, p < 0.001). There was no significant difference in the DXA results between the NTSCI and TSCI under 50 years of age. As an osteoporotic diagnostic site in the NTSCI group (≥ 50 years) (43%), the lumbar spine had higher proportions than in the TSCI group (29%). Female sex and low body mass index were risk factors for osteoporosis in both groups (≥ 50 years). Conclusion: BMD evaluation in patients aged 50 years and older with NTSCI should include the lumbar spine area. Individuals with risk factors for SCI must undergo BMD assessment and close monitoring.
Copyright (c) 2026 Onyoo Kim, Jisun Lim, Geun-Young Park https://creativecommons.org/licenses/by/4.0
Quality of rehabilitation care in Portuguese stroke units: findings from 2017–2018 and 2023 national cross‑sectional surveys
Objective: To evaluate adherence to stroke rehabilitation guidelines in Portuguese stroke units from the physicians’ perspective and examine changes over 6 years. Design: A national cross-sectional survey across 2 time periods (2017–2018 and 2023). Methods: Stroke units recognized by the Portuguese Stroke Society were invited to participate: 27 in 2017–2018 and 35 in 2023. A structured questionnaire, aligned with national and international guidelines, assessed 5 domains: team composition, care coordination, early assessment and planning, dysfunction assessments, and post-discharge planning. Results: Response rates were 93% (n = 25) and 80% (n = 28). Most units (> 75%) had a physiatrist, physiotherapist, speech therapist, rehabilitation nurse, and social worker; only 20% had the full recommended team. Weekly stroke unit meetings were stable (88–89%), while rehabilitation team meetings increased markedly between the 2 periods (20% vs 72%). Rehabilitation started earlier on weekdays (89% vs 79%) than at weekends (68% vs 57%). Dysphagia screening was common (96% vs 89%), but neurogenic bladder assessment was rare (< 8%). The Modified Rankin Scale and Barthel Index were consistently used. Post-discharge planning remained high (92% vs 89%), with improved coordination between teams (48% vs 89%). Conclusion: Portuguese Stroke Units demonstrated moderate-to-high adherence to rehabilitation guidelines, with progress in teamwork communication and care coordination, although important gaps remain.
Copyright (c) 2026 Joana Teles Sarmento, Ana Alves, Paulo Castro-Chaves, Bárbara M. Cruz, Cristina Jácome https://creativecommons.org/licenses/by/4.0
Efficacy of ultrasound-guided intra-articular hyaluronic acid injection in the management of adhesive capsulitis: a randomized controlled trial
Objective: To compare the efficacy and safety of ultrasound-guided intra-articular hyaluronic acid injection versus supervised rehabilitation in patients with frozen-phase adhesive capsulitis. Design: Single-center, parallel-group, randomized controlled trial with 26-week follow-up. Subjects/Patients: Forty-six adults aged 40–70 years with clinically and radiologically confirmed frozen-phase adhesive capsulitis. Methods: Participants were randomly assigned to receive either three weekly ultrasound-guided intra-articular hyaluronic acid injections or supervised physical therapy twice weekly for six weeks. Outcomes assessed at baseline and at weeks 4, 6, 8, and 26 included the Shoulder Pain and Disability Index (SPADI) and shoulder range of motion. Results: Both groups achieved significant within-group improvements in SPADI and range of motion over 26 weeks (all p < 0.01 vs. baseline). No statistically significant between-group differences were observed in total SPADI or its pain and disability subscales at any follow-up time point (all p > 0.05). At week 26, the hyaluronic acid group’s mean total SPADI decreased from 43.0 ± 17.7 to 16.1 ± 12.8 (p < 0.01), while the rehabilitation group improved from 52.0 ± 18.4 to 23.2 ± 21.8 (p < 0.01). Pain subscores were reduced by 64.3% (hyaluronic acid) and 56.1% (rehabilitation); function subscores decreased by 60.9% and 54.8%, respectively (all p < 0.01). Both groups showed significant gains in active and passive flexion, abduction, and external rotation, without significant between-group differences (all p > 0.05). No treatment-related adverse events were observed. Conclusion: Ultrasound-guided hyaluronic acid injection and supervised rehabilitation produced comparable and clinically meaningful improvements in pain, function, and shoulder mobility in frozen-phase adhesive capsulitis.
Copyright (c) 2026 Chih-Ya Chang, Ching-Ting Chen, Yung-Hsiang Lin, Chi-Fu Chiang, Yi-Wen Mao, Li-Wei Chou https://creativecommons.org/licenses/by/4.0
Beyond spasticity reduction: botulinum toxin-a injection is associated with changes in abnormal flexor synergies of the upper limb in chronic stroke
Objective: This study aimed to investigate the association between botulinum toxin type A treatment and changes in spasticity and abnormal flexor synergies in patients with chronic stroke. Subjects: Twenty-eight patients with chronic stroke (mean age 56.5 years; mean time since onset 6.3 years) who received botulinum toxin type A injections into upper-arm flexor muscles (biceps brachii, brachialis, or brachioradialis) were enrolled. Methods: This was a retrospective, single-centre cohort study. Assessments were performed before and approximately 2 months after injection. Primary outcomes were changes in spasticity measured by the Modified Ashworth Scale and the abnormal flexor synergy index based on kinematic analysis. Secondary outcomes included changes in voluntary shoulder flexion angle and subgroup analyses according to baseline upper extremity motor severity and responder/non-responder status based on changes in the Modified Ashworth Scale scores of the elbow flexors. Results: Generalized estimating equation analyses showed significant changes in Modified Ashworth Scale elbow flexor scores and the abnormal flexor synergy index after injection. In severity-stratified analyses, significant Time × Severity interactions were observed for Modified Ashworth Scale scores of the elbow and wrist flexors, whereas no significant interaction was found for the abnormal flexor synergy index. In responder/non-responder analyses, a significant Time × Responder-status interaction was observed for the abnormal flexor synergy index. Non-responders showed no significant changes in Modified Ashworth Scale scores or the abnormal flexor synergy index and showed reduced maximum voluntary shoulder flexion angle. Conclusion: This study suggests that botulinum toxin type A treatment was associated with changes in abnormal flexor synergies, in addition to reducing muscle tone. These findings highlight the value of incorporating kinematic assessments such as the abnormal flexor synergy index into the clinical evaluation of botulinum toxin treatment.
Copyright (c) 2026 Michiyuki Kawakami, Daisuke Ito, Ken Azuma, Takayuki Kamimoto, Arisa Kawabata, Tetsuya Tsuji https://creativecommons.org/licenses/by/4.0
Effects of incentive spirometer added to standard rehabilitation in previously hospitalized adults with post-COVID-19 condition: a randomized controlled trial
Objective: Post-COVID-19 condition is associated with persistent respiratory symptoms and impaired functional capacity. This study evaluated the effects of adding an incentive spirometer to standard rehabilitation in adults with post-COVID-19 condition, with peak expiratory flow, dyspnoea, and quality of life as the prespecified primary outcomes. Design: Randomized controlled trial. Subjects/Patients: Eighty-two previously hospitalized adults diagnosed with post-COVID-19 condition, were randomly assigned to an experimental group (rehabilitation plus incentive spirometer, n = 41) or a control group (rehabilitation alone, n = 41). Methods: Eight outcomes were assessed at baseline and 1 month, including peak expiratory flow, Medical Research Council dyspnoea scale, EQ-5D-5L, and functional performance tests. Results: Both groups improve at 1-month follow-up. The experimental group showed greater improvements in peak expiratory flow (between-group difference = 65.85 L/min; 95% CI: 4.35 to 127.35; p = 0.007), and dyspnoea (MRC difference = −1.08; 95% CI: −1.54 to −0.62; p < 0.001) compared with the control group. No significant between-group differences were observed for quality of life or functional performance measures. Conclusion: Adding incentive spirometry to standard rehabilitation improved peak expiratory flow and reduced dyspnoea in adults with post-COVID-19 condition, supporting its use as a low-cost adjunct for respiratory symptom management.
Copyright (c) 2026 Marina Kloni, Alexandros Heraclides, Theognosia Panteli, Alexios Klonis, Panagiotis Rentzias, Christos Karagiannis https://creativecommons.org/licenses/by/4.0
Does aerobic exercise affect memory, attention, working memory, and fatigue after acquired brain injury? A single-blinded, randomized controlled pilot study
Objective: To explore potential effects of aerobic exercise on cognitive function, fatigue, and neuroplasticity after stroke or traumatic brain injury. Design: A randomized controlled pilot study. Subjects/Patients: Twelve participants, 10 men and 2 women aged 16–65 years diagnosed with acquired brain injury (moderate to severe stroke or traumatic brain injury), enrolled in an outpatient rehabilitation programme at least 3 months post-injury. Methods: The intervention group (n = 6) participated in 30 min of aerobic exercise 3–4 times/week for 8 weeks during their outpatient rehabilitation. The control group (n = 6) received routine physical therapy. In addition, both groups received rehabilitation according to their rehabilitation plan. Neuropsychological and endurance testing was performed before and after the intervention and at a 3-month follow-up. Functional magnetic resonance imaging was performed before and after the intervention. Results: Preliminary findings show no significant difference between the groups regarding cognitive variables, fatigue, or neuroplasticity. However, working memory/executive demanding processing speed, measured with the Paced Auditory Serial Addition Test, improved significantly (p = 0.042) in the aerobic exercise group and there were trends of improvements on several other executive tests in the aerobic exercise group. Automatic visual search speed improved in the control group (p = 0.027). Conclusion: The question of whether aerobic exercise promotes cognition and fatigue after brain injury remains unanswered. This randomized controlled pilot study and its preliminary findings indicate greater improvements in executive processing speed in the aerobic exercise group, while more automatized attention speed improved more in the control group. The experiences from this study might facilitate the design of future studies on this intriguing topic. Trial registration: ClinicalTrials.gov Identifier: NCT07429526
Copyright (c) 2026 Eygló Ingólfsdóttir, Ulla Bergfeldt , Märta Berthold Lindstedt , Lennart Bergfeldt , Tie-Qiang LI , Tomas Jonsson , Marika C. Möller https://creativecommons.org/licenses/by/4.0
Comparing people with persisting post-concussion symptoms from an emergency department-based research sample with patients in a clinical rehabilitation sample: an explorative, retrospective analysis
Objective: To compare characteristics of people with persisting post-concussion symptoms in a sample referred for treatment and in a sample from a prospective research study. Design: Observational study. Subjects: Participants, aged 18–60 years, with persisting post-concussion symptoms 3–18 months after mild head injury, 92 with mild traumatic brain injury followed from the emergency department (“prospective emergency department sample”) and 106 patients with either mild traumatic brain injury or minimal head injury, referred to an outpatient rehabilitation clinic (“clinical rehabilitation sample”). Methods: Persisting post-concussion symptoms were defined as having British Columbia Post-Concussion Symptom Inventory scores indicating at least moderate persisting post-concussion symptoms and/or Rivermead Post Concussion Symptoms Questionnaire (RPQ) scores ≥ 12. Symptoms, functional outcome, work/school participation, resilience, and fatigue were examined at 3–18 months post injury. Results: Compared with the prospective emergency department sample, the clinical rehabilitation sample had higher education, higher RPQ scores (30 vs 17), lower Glasgow Outcome Scale Extended scores (median 6 vs 7), and more had not returned to work or school (43% vs 18%). Conclusion: Treatment-seeking patients with persisting post-concussion symptoms differed in clinically important ways from people who developed persisting post-concussion symptoms in an emergency department-based mild traumatic brain injury study. Results from studies of mild traumatic brain injury seen in the emergency department may not generalize to patients seeking specialized treatment for persisting post-concussion symptoms.
Copyright (c) 2026 Maria I. Sandboe, Linda Fordal, Alexander Olsen, Grant L. Iverson, Helge Skirbekk, Mille Møller Thastum, Jørgen Fældbæk Nielsen, Simen Berg Saksvik, Toril Skandsen https://creativecommons.org/licenses/by/4.0
Comparison of the predictive value of upper limb somatosensory evoked potentials and motor evoked potentials for functional recovery in subacute stroke: a retrospective study
Objective: To compare the prognostic value of somatosensory evoked potentials and motor evoked potentials for upper limb functional recovery in patients with subacute stroke. Design: Retrospective observational analysis. Subjects/Patients: A total of 111 inpatients with subacute stroke who underwent upper limb somatosensory evoked potentials and motor evoked potentials testing within 1 week of admission and completed a standardized rehabilitation programme. Methods: Somatosensory evoked potentials and motor evoked potentials were categorized as non-responsive, abnormal, or normal. Discharge outcomes included the Fugl-Meyer Assessment for upper limb, Box and Block Test, Functional Independence Measure, and Korean version of the modified Barthel Index. Mixed-effects models were applied to examine associations between somatosensory evoked potentials or motor evoked potentials status and discharge outcomes, adjusting for baseline score and admission duration, with patient ID as a random intercept. Effect sizes were calculated using Cohen’s f 2. Results: Normal somatosensory evoked potentials were associated with higher Functional Independence Measure and Korean version of the modified Barthel Index scores than non-responsive somatosensory evoked potentials, while abnormal somatosensory evoked potentials showed non-significant trends. For motor evoked potentials, the normal group showed higher Box and Block Test scores, and both abnormal and normal groups had higher Korean modified Barthel Index scores than non-responsive. Conclusion: Admission somatosensory evoked potentials and motor evoked potentials provide complementary prognostic information in subacute stroke rehabilitation.
Copyright (c) 2026 Jungwoo Shim, Changju Kim https://creativecommons.org/licenses/by/4.0
Evolution of goal setting and attainment over repeated cycles of botulinum toxin A for upper limb spasticity in real-life clinical practice: longitudinal analyses from the observational ULIS-III cohort study
Objective: This post-hoc analysis evaluated how goal attainment evolved over repeated cycles of botulinum toxin A (BoNT-A) treatment in adults with upper-limb spasticity. Methods: ULIS-III (NCT02454803) was a 2-year observational study involving adults treated with BoNT-A. The analysis included 538 patients who received ≥ 4 BoNT-A injection cycles and had Goal Attainment Scaling (GAS) assessments for each of the first 4 cycles. GAS T-scores were used to measure treatment response. Multivariate models assessed predictors of achieving a GAS T-score ≥ 50 and being in the top tertile (best) of responders. Results: Patients generally maintained consistent goal domains across cycles. Mean change in GAS T-scores remained above the minimal clinically important difference of 10 throughout. The proportion of patients achieving a GAS T-score ≥ 50 increased from 64.5% in Cycle 1 to 75.8% in Cycle 4. Use of injection guidance techniques significantly increased the odds of achieving treatment goals (OR 1.92; 95% CI 1.45–2.55) and being a “best” responder (OR 2.44; 95% CI 1.47–4.06). Higher BoNT-A doses were also associated with better outcomes. Conclusions: Repeated BoNT-A treatment supports sustained goal attainment in upper limb spasticity. Success rates improve with each cycle, particularly when guided injection techniques are used.
Copyright (c) 2026 Lynne Turner-Stokes, Klemens Fheodoroff, Jorge Jacinto, Mathieu Beneteau , Pascal Maisonobe, Christian Hannes, Stephen Ashford https://creativecommons.org/licenses/by/4.0
Specific components of manual dexterity are affected in patients with writer’s cramp: an observational comparative study and preliminary rehabilitation report
Objective: To compare manual dexterity in patients with writer’s cramp and healthy controls to determine which components of dexterity are impaired in writer’s cramp. In addition, to assess the effects of rehabilitation. Design: Cross-sectional primary study, longitudinal secondary study. Subjects/Patients: 23 patients with writer’s cramp and 20 healthy age- and sex-matched control subjects. Methods: Degree of manual dexterity (through 3 tasks) and handwriting symptoms were assessed, and effects of rehabilitation probed. Results: Patients with writer’s cramp showed significantly lower handwriting speed (97 letters/min) and legibility (BFM score = 1.3) compared with control subjects (171 letters/min, p < 0.001; BFM score = 0.15, p < 0.001). Only the task quantifying finger independence showed weaker finger selectivity (median = 0.84) in patients compared with controls (median = 0.89, p = 0.01). The other 2 tasks, maximal finger tapping and visuomotor finger force-tracking, did not reveal significant group differences (all p > 0.44). In patients, automated writing legibility correlated with finger selectivity (r = 0.50, p = 0.02). Rehabilitation improved dexterity (selectivity and force-tracking) and automated writing legibility. Conclusion: In this multi-component analysis of manual dexterity, reduced selectivity of finger movements was identified as the main behavioural mechanism (deficit) in writer’s cramp, associated with writing speed. In contrast, force control and tapping speed were unaffected. Selective finger activation can be improved with therapy targeting dextrous finger movements.
Copyright (c) 2026 Jean-Pierre Bleton, Raphael B. Takyi, Marion Verneau, Cedric Monchaud, Thierry Peron Magnan, Sophie Sangla, Amélie Yavchitz, Marc A. Maier, Påvel G. Lindberg https://creativecommons.org/licenses/by/4.0
Early multidimensional mobility assessments for discriminating discharge-level ambulation and functional independence in subacute stroke inpatients: a retrospective cohort study
Objective: To examine whether early multidimensional mobility assessments discriminate independent ambulation and functional independence on discharge in subacute stroke inpatients with supervised walking ability. Design: Retrospective cohort study. Subjects/Patients: Fifty subacute stroke inpatients (≤ 5 months post-stroke). Methods: Independent ambulation and functional independence were defined as Functional Ambulation Category ≥ 4 and Modified Barthel Index 75 on discharge, respectively. Discriminative ability of admission assessments was evaluated using univariate binary logistic regression and receiver operating characteristic curve analysis. Results: The Berg Balance Scale and the modified Four Square Step Test demonstrated the highest discriminative performance. For independent ambulation, the Berg Balance Scale (≥ 40.5) yielded an area under the curve of 0.74 (95% confidence interval: 0.60–0.88) with 82% accuracy, and the modified Four Square Step Test (≤ 31.52 s) yielded an area under the curve of 0.78 (0.64–0.91) with 80% accuracy. For functional independence, the Berg Balance Scale (≥ 42.5) yielded an area under the curve of 0.74 (0.60–0.88) with 74% accuracy, and the modified Four Square Step Test (≤ 32.88 s) yielded an area under the curve of 0.71 (0.57–0.86) with 70% accuracy. Conclusion: Early balance and multidirectional stepping performance may be useful for screening to support goal-setting and discharge planning.
Copyright (c) 2026 Seung Heun An, Eun Joo Kim, Jun Min Lee https://creativecommons.org/licenses/by/4.0
Impact of multidisciplinary rehabilitation on functioning and quality of life in stroke survivors: a longitudinal retrospective analysis
Objective: This study investigates the impact of different rehabilitation approaches on functional recovery and health-related quality of life (HRQoL) in stroke patients. Design: A longitudinal retrospective observational study. Subjects: The study included all 538 consecutive stroke patients treated in Satakunta County, Finland, between January 2021 and January 2022. Methods: Functional recovery was assessed using the modified Rankin Scale (mRS), WHODAS 2.0, and HRQoL using the EQ-5D. Outcomes were evaluated at 1, 3, 6, and 12 months. Patients were categorized into 3 groups: no rehabilitation, primary care (PC) rehabilitation, and multidisciplinary (MD) rehabilitation. Longitudinal changes in mRS, WHODAS, and EQ-5D were further assessed at a 3-year follow-up. Results: MD rehabilitation resulted in significantly greater improvements in HRQoL and functional recovery compared with PC rehabilitation and no rehabilitation. Female patients reported lower HRQoL and poorer functioning than males; however, rates of improvement were similar between the sexes. Dependency (mRS > 2) was associated with lower HRQoL, although changes over the 1-year follow-up were comparable between dependent and independent patients. Depression emerged as the strongest predictor of HRQoL improvements. Substantial correlations were observed among mRS, EQ-5D, and WHODAS 2.0 scores, with the strength of these correlations increasing over time. At the 3-year follow-up, stroke survivors continued to exhibit decreasing HRQoL and functional status. Conclusions: Multidisciplinary rehabilitation substantially enhances functional recovery and HRQoL during the first year after stroke compared with primary care or no rehabilitation. Although women and patients with greater dependency report lower HRQoL, their rates of improvement are similar to those of other groups. Depression is a key determinant of HRQoL gains, underscoring the importance of integrating mental health support into rehabilitation pathways. The persistently low HRQoL observed 3 years post-stroke highlights the long-term burden of stroke and the need for sustained, comprehensive follow-up and rehabilitation strategies to address ongoing functional limitations.
Copyright (c) 2026 Aet Ristmägi, Hannu Heikkila, Olavi Airaksinen https://creativecommons.org/licenses/by/4.0
Factors associated with long-term functional outcomes and participation in patients with colorectal cancers
Objective: To assess the longer-term functional, psychosocial, and participation outcomes in colorectal cancer (CRC) survivors. Methods: Adult CRC survivors (n = 100) living in the community completed validated questionnaires. Descriptive statistics summarized participant characteristics, while multivariate linear regression (p < 0.05) identified predictors of functional and psychosocial outcomes, and a binary logistic regression model was applied to identify factors associated with poorer QoL. Results: Participants (mean age: 62.2 ± 12.7 years, 53% male, 64% with grade III–IV CRC, mean time since diagnosis of 2.4 ± 1.6 years), reported persistent challenges, including fatigue (77%), bowel dysfunction (50%), sleep disturbances (49%), fear of recurrence (48%), and pain (42%). Despite this, functional recovery was good (Clinical Functioning Information Tool (Mean): 50.3 ± 42.4), with minimal mental health impact (Depression Anxiety Stress Scale: 11.3 ± 17.2). CRC-specific quality of life was poor (Functional Assessment of Cancer Therapy-Colorectal: 97.4 ± 14.5). Community integration was fair (Community Integration Questionnaire: 18.4 ± 6.5), with moderate satisfaction in overall health (Euro Quality of Life: 71.5 ± 18.6). Regression analysis identified age > 60 years, female gender, fatigue, pain, radiotherapy, and time since diagnosis > 3 years as significant predictors of poorer outcomes. Conclusion: Persistent challenges faced by CRC survivors underscore the need for personalized, interdisciplinary rehabilitation-inclusive survivorship care addressing ongoing disabilities, psychosocial issues, and unmet needs.
Copyright (c) 2026 Bhasker Amatya, Helen Mohan, Krystal Song, Alexander Heriot , Fary Khan https://creativecommons.org/licenses/by/4.0
Associations between heart rate and physical activity in people with post-COVID-19 condition accounting for myalgic encephalomyelitis/chronic fatigue syndrome symptoms
Background: Tachycardia after mild activity or during rest is a common complaint among people with post-COVID-19 condition (PCC). Understanding the relationships between heart rate (HR) and physical activity (PA) in this population is crucial for developing appropriate rehabilitation protocols. Objective: To investigate the associations between HR and PA in individuals with PCC, accounting for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) symptoms. Design: Observational study. Subjects: Sixteen adults with PCC (81% females, mean age 51 ± 12 years). Methods: Participants were instructed to use 2 wearable devices (Garmin smartwatch and ActiGraph accelerometer) during waking hours over 4 days while performing daily activities. Average HR, percentage of time in tachycardia (time with HR > 100 bpm), and daily step count were assessed. The accelerometer counts per minute was used to categorize daily PA as sedentary, light intensity, and moderate-to-vigorous (MVPA). Results: Participants wore the watches and accelerometers for a mean of 11.36 ± 2.60 and 12.51 ± 1.94 h per day, respectively. Average daily HR increased with increasing PA levels from sedentary to MVPA. However, the percentage of time in tachycardia was significantly lower during periods of MVPA compared with sedentary periods, even after adjusting for ME/CFS symptoms. Conclusion: Individuals with PCC in our study experienced more tachycardia during periods of minimal physical activity compared with periods categorized as MVPA.
Copyright (c) 2026 Rachel Adodo, Antonio Sarmento Da Nobrega, Rodrigo Villar, Sandra C. Webber, Diana C. Sanchez-Ramirez https://creativecommons.org/licenses/by/4.0
Effect of early hybrid assistive limb assisted rehabilitation on functional outcomes and patient satisfaction after total knee arthroplasty: a randomized controlled trial
Background: Early rehabilitation within 4 h following total knee arthroplasty involves passive exercise with manual therapy. Objective: The aim was to determine the beneficial effects of the single-joint hybrid assistive limb for rehabilitation within 4 h after total knee arthroplasty. Methods: This single-blinded randomized controlled trial included 68 participants who underwent primary total knee arthroplasty for knee osteoarthritis and were assigned to the early single-joint hybrid assistive limb (n = 22), HAL-SJ (n = 23), and control (n = 23) groups. Results: The Knee Injury and Osteoarthritis Outcome Score quality of life (p = 0.007) scores of the early single-joint hybrid assistive limb group showed significantly higher values than the control groups at 12 months. The recovery time for extension lag was significantly improved in the early single-joint hybrid assistive limb group compared with the single-joint hybrid assistive limb (p = 0.006) and control (p < 0.001) groups. Additionally, the knee flexion range of motion of the early single-joint hybrid assistive limb group showed significantly higher values than the single-joint hybrid assistive limb (p = 0.029) and control (p = 0.031) groups at 1 week. Conclusions: Early single-joint hybrid assistive limb rehabilitation may improve patient-reported quality of life at 12 months without exacerbating postoperative pain or swelling. These results suggest that the single-joint hybrid assistive limb may be a feasible adjunct to early postoperative rehabilitation after total knee arthroplasty, while further studies are required to clarify its clinical relevance and long-term benefits.
Copyright (c) 2026 Takaya Watabe, Ryota Muramatsu, Takuya Sengoku, Goro Sakurai, Shinya Yoshida, Yuta Taniguchi https://creativecommons.org/licenses/by/4.0
Real-world use of botulinum toxin-A for post-stroke spasticity in the Netherlands: a retrospective claims study
Objective: The aim of this observational study was to describe the real-world use of botulinum toxin-A in patients with a stroke in the Netherlands. Methods: This study used longitudinal insurance claims data between 2012 and 2016 with 30% nationwide coverage and included patients with both stroke-related and botulinum toxin-A claims. All analyses were descriptive and displayed as summary statistics. Results: 60,222 patients with a stroke were identified, of whom 18,141 (30.1%) were treated in a rehabilitation centre or hospital and 1.7% (1,036 patients) were treated with botulinum toxin-A. A total of 2,855 botulinum toxin-A claims from 890 patients were included in the analysis (1.5% of all patients in the database). Mean age was 63.4 (SD ± 14.0) years at index injection cycle, with a median follow-up of 3.7 years (interquartile range [IQR] 2.2–4.5 years). Patients received up to 16 injection cycles with a median of 2 injection cycles (IQR 1–5 cycles). The median Time-To-Next-Injection-Cycle was 17 weeks (IQR 13–25 weeks). The total number of injection cycles was 604 for abobotulinumtoxinA (22.1%) and 2,251 (78.8%) for onabotulinumtoxinA. Doses per cycle ranged from 200–660 for abobotulinumtoxinA and 101–400 units for onabotulinumtoxinA. Discussion: Claims data from a national healthcare insurance fund in the Netherlands showed that only 1.7% of patients with post-stroke spasticity received botulinum toxin-A. Botulinum toxin-A treatment doses and intervals varied widely across patients and most patients received only 1 or 2 botulinum toxin-A injection cycles. Our results suggest undertreatment of spasticity with botulinum toxin-A and suboptimal treatment adherence in Dutch clinical practice.
Copyright (c) 2026 Max van Wijk, Mary Verhoeven, Thom S. Lysen, Hanne van Ballegooijen, Alexander C.H. Geurts https://creativecommons.org/licenses/by/4.0
Patient satisfaction with hospital-based outpatient rehabilitation after stroke in Sweden and its association with life satisfaction and health-related quality of life: a longitudinal national register study
Objective: To examine stroke survivors’ satisfaction with hospital-based outpatient rehabilitation and its association with life satisfaction and health-related quality of life (HRQoL), and whether sex and age affect possible associations. Design: A longitudinal national register study. Methods: Data from the Swedish national quality register were used and included 1,068 patients with stroke performing outpatient rehabilitation. Self-reported questionnaires collected on admission, discharge, and at 1-year follow-up were analysed. Regression analyses were used to assess possible associations between patient satisfaction and life satisfaction (Life Satisfaction Questionnaire, LiSat-11) and HRQoL (EuroQol Five Dimensions questionnaire, EQ-5D). Results: Over 71% of the included patients were satisfied with their rehabilitation process on discharge. Satisfied patients also reported higher scores on global LiSat-11 and higher EQ-5D values. Older patients (> 58 years) satisfied with their rehabilitation process were more likely to be satisfied with global LiSat-11. Women dissatisfied with the rehabilitation process had lower EQ-5D values on discharge. Conclusion: Patient satisfaction with hospital-based outpatient rehabilitation was associated with life satisfaction and HRQoL. Potential differences linked to sex and age support the importance of individually tailored rehabilitation strategies. Evaluating self-reported outcomes and experiences over time is essential for improving long-term recovery and for further development of person-centred stroke rehabilitation.
Copyright (c) 2026 Anna Bråndal, Britt-Marie Stålnacke, Gudrun M. Johansson https://creativecommons.org/licenses/by/4.0
Evolution of bowel function and quality of life after spinal cord injury: a longitudinal registry and survey study
Objective: To assess changes in bowel function and quality of life over time in adults with spinal cord injury. Design: Retrospective cohort study linking clinical registry data with patient-reported outcomes. Subjects: 236 adults with spinal cord injury in Sweden; 157 had both baseline and follow-up data. Methods: Data from the Swedish National Quality Registry for Rehabilitation Medicine were merged with responses from the 2024 Swedish International Spinal Cord Injury Community Survey. Bowel dysfunction was assessed using the Spinal Cord Injury Secondary Conditions Scale, Constipation Scoring System, and St. Mark’s Incontinence Score. Quality of life was measured using the 3L EQ-5D questionnaire at baseline and the 5L version at follow-up, converted to a common scale. Group differences were analysed using χ2 and Mann–Whitney U tests. Logistic regression identified predictors of bowel outcomes; linear regression assessed factors associated with quality-of-life scores. Results: At baseline, 70% had bowel dysfunction and a mean quality-of-life score of 0.33. Bowel dysfunction was the only independent predictor of lower baseline quality of life. At follow-up, severe incontinence and high bowel burden predicted lower scores. Incomplete injury predicted improvement. Conclusion: Bowel dysfunction is common and closely linked to reduced quality of life after spinal cord injury. Early and sustained management is essential.
Copyright (c) 2026 Charlotta Josefson, Katharina Stibrant Sunnerhagen https://creativecommons.org/licenses/by/4.0
Correlation between controlled-pressure provocative test duration and electrodiagnostic severity in carpal tunnel syndrome
Objective: To assess the correlation between controlled-pressure provocative test duration and electrodiagnostic severity in carpal tunnel syndrome. Design: Cross-sectional correlational study. Patients: Patients with clinical symptoms consistent with carpal tunnel syndrome were recruited from the electrodiagnosis clinic of the Department of Rehabilitation Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, between September 2023 and July 2024. Methods: Patients underwent electrodiagnostic studies, and the severity of carpal tunnel syndrome was classified as mild, moderate, or severe according to the 2011 criteria of the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM). Each participant subsequently received a controlled-pressure provocative test. The time to symptom provocation was recorded, with a maximum duration of 30 s. Spearman’s rank correlation was used to assess the association between test duration and electrodiagnostic severity. Results: In 124 hands, 31, 45, and 48 hands were categorized by the degree of electrodiagnostic severity as mild, moderate and severe, respectively. There was no correlation (ρ = –0.16, p-value = 0.074) between controlled-pressure provocative test duration and electrodiagnostic severity. Conclusions: There was no correlation between controlled-pressure provocative test duration and electrodiagnostic severity in patient with carpal tunnel syndrome.
Copyright (c) 2026 Apiphan Iamchaimongkol, Khanin Leeareekun, Waree Chira-Adisai, Apisara Keesukphan https://creativecommons.org/licenses/by/4.0
Exercise modalities and outcome measures used in older adults after hip fracture with or without signs of cognitive impairment: a national cross-sectional e-survey of 90 out of 98 municipalities in Denmark
Objective: To investigate rehabilitation settings, exercise modalities, and assessments provided post-discharge to older adults with hip fracture with and without signs of cognitive impairment. Design: National cross-sectional e-survey. Subjects: Rehabilitation managers and development physiotherapists from all 98 Danish municipalities. Methods: Information was collected on rehabilitation after discharge across four settings: 24-h-care, home-based care, outpatient-healthcare-centers, and nursing-home-facilities. Results: Ninety municipalities (92%) responded. About half used standardized screening tools to guide rehabilitation, but only 4% screened for cognitive impairment. Rehabilitation was typically delivered by physiotherapists 1–2 times/week, lasting 5–12 weeks, with 24-h-care and nursing-home facilities settings offering shorter but more frequent sessions. Common exercise modalities included strengthening, balance, and functional tasks, where these were more used in hip fracture than hip fracture with signs of cognitive impairment. Patient-Reported-Outcome-Measures (PROMs) were infrequently used; the Patient-Specific-Functional-Scale and Numerical-Rating-Scale were most often used. Cognitive PROMs were rarely applied, except the Montreal-Cognitive-Assessment at 24-h-care. Performance-based tests were more widely used, particularly the 30s-sit-to-stand and Timed Up&Go tests. Conclusion: The survey had a high response rate. Few municipalities used cognitive screening tests and pain scales whereas performance-based testing was more predominant. The preferred exercise modality was functional exercise, used more often for patients with hip fracture than those with hip fracture and signs of cognitive impairment.
Copyright (c) 2026 Jan A. Overgaard, Morten T. Kristensen, Lauren A. Beaupre, Kristian S. Frederiksen, Søren T. Skou https://creativecommons.org/licenses/by/4.0
Significant differences in evaluation of disability and health (ICF) core sets between stroke rehabilitants and rehabilitation team during the first year
Objective: Assessing functional abilities in stroke rehabilitation is essential, combining subjective self-reports with objective clinical evaluations. Methods: This study aimed to compare self-reported impairments from stroke patients with rehabilitation team evaluations using the ICF stroke core set at 3 time points: 1 month post-discharge, after 6 months, and 12 months post-diagnosis. Additionally, the study sought to identify ICF subdomains most impacting health-related quality of life (HRQOL) as measured by EQ-5D. This longitudinal, retrospective observational study included consecutive 118 stroke patients at the Satahospital Rehabilitation Unit (2021–2022). Results: Results showed that, 1 month after discharge, patients rated their functioning higher than team assessments, particularly in cognitive domains. By 12 months, patients’ self-reports indicated lower functioning than team evaluations, with discrepancies diminishing over time. Objective assessments revealed significant improvements in mobility, self-care, and cognitive functions, while patients reported progress in life activities and social interactions but little change in physical or cognitive domains. Depression levels and self-care ability (washing) were the strongest predictors of improved HRQOL. Conclusion: These findings reveal that patients initially overestimate their abilities, influenced by a lack of awareness and emotional factors, while rehabilitation teams provide more objective evaluations and individualized rehabilitation. Integrated assessment frameworks combining subjective and objective perspectives are crucial to optimizing rehabilitation outcomes.
Professional consensus on UK national statements of best practice for ways of working to deliver orthotic interventions after stroke: an eDelphi study
Objective: To reach consensus on statements of best practice for ways of working to deliver orthotic interventions after stroke among expert professionals in the UK involved in the delivery of orthotic intervention to patients after stroke. Design: A 2-round modified electronic Delphi exercise (eDelphi). Subjects: Thirty-two orthotic professionals with 2 years’ or more experience of delivering orthotic intervention within stroke rehabilitation, from varied geographical locations and experience levels participated in the eDelphi. Methods: For the eDelphi exercise, 65 statements of best practice were assessed by participants. A 7-point Likert scale was used to determine agreement with statements. A consensus threshold of 75% was pre-determined in line with other studies. Results: After the first round, consensus was reached for 62 of the statements. All statements had 75% or above agreement. An 87.5% retention rate was maintained between rounds. After the second round 64 statements of best practice achieved 75% consensus. Conclusion: Overall consensus 94.3% was achieved on the first UK-wide professionally agreed statements of best practice detailing the optimal ways of working when delivering orthotic interventions to enhance rehabilitation outcomes and reduce complications for stroke survivors.
Copyright (c) 2026 Miriam Golding-Day, Shirley Thomas, Phillip Whitehead, Jane Horne, Marion Walker https://creativecommons.org/licenses/by/4.0
Comparison of muscular activity and metabolic response between a novel handle-based and a push-rim wheelchair in a simulated daily mobility circuit
Objective: To compare the muscular activity and metabolic response between a novel handle-based wheelchair drive (KURT) and conventional push rim propulsion in a simulated daily mobility circuit. Design: Single-group comparative study between 3 wheelchair configurations. Participants: 22 healthy individuals without prior wheelchair experience. Methods: Participants completed a multi--movement circuit including ramps, obstacle avoidance, and directional changes using KURT and 2 push-rim wheelchairs with different wheel sizes (small wheels, SW; large wheels, LW). Electromyographic data were collected bilaterally from 7 upper body muscles, and cardiopulmonary variables were -continuously monitored. Results: Biceps brachii activity was significantly higher with KURT than with SW and LW for both arms (all p < 0.001), while triceps brachii and pectoralis major activity were significantly lower (all p < 0.001). Other monitored muscles showed smaller relative differences between configurations, often resulting in limited or no statistically significant effects. Metabolic demand was lower with KURT: heart rate, oxygen consumption, and carbon dioxide production were reduced compared with LW (all p < 0.05), while respiratory exchange ratio was unchanged and respiratory frequency was higher than with SW (p < 0.05). Conclusion: KURT appears to be a promising, more energy-efficient alternative to push-rim wheelchairs, reducing upper limb muscle demand and metabolic cost. These findings motivate studies in regular wheelchair users and longer-term use in daily living scenarios.
Copyright (c) 2026 Georgios Aronis, Sebastian Pfau, Marvin Abass, Thomas Angeli, Margit Gföhler https://creativecommons.org/licenses/by/4.0
Establishing levels of arm–hand activities in stroke patients: the arm-hand-activities-scale (AHAS)
Objective: Post-stroke limitations in arm–hand activities are prevalent, yet a system for categorizing these limitations like the Functional Ambulation Categories (FAC) is lacking. The Arm-Hand-Activities-Scale (AHAS) was developed and psychometric properties of this classification were investigated. Design: Mixed methods to examine comprehensibility, inter-rater reliability, correlations with the Fugl-Meyer Assessment (FMA) and the Action Research Arm Test (ARAT), and sensitivity to change. Subjects/Patients: 76 professionals answered a comprehensibility questionnaire and 85 professionals an inter-rater reliability questionnaire. Methods: For comprehensibility and inter-rater reliability, standardized video sequences of each category were assessed. Cut-off values were identified by comparing the AHAS categories with the FMA (n = 10) and the ARAT (n = 71). For sensitivity-to-change studies, 71 stroke patients were followed for 4 weeks of inpatient rehabilitation. Spearman correlation coefficients were calculated to examine the relationship between AHAS, FMA, and ARAT outcomes. A Wilcoxon signed-rank test was applied for sensitivity to change. Results: The results on comprehensibility of the AHAS categories and the FMA cutoff values were highly consistent. Inter-rater reliability was good to excellent. A significant and strong correlation was found between ARAT and AHAS. The Wilcoxon signed-rank test for sensitivity to change was also significant. Conclusion: The AHAS provides a quick and simple classification system to assess the severity of arm–hand activity limitations after stroke This may help in selecting appropriate treatment strategies.
Copyright (c) 2026 Christina Hebenstreit, Miriam Binter, Jörg Wissel, Klemens Fheodoroff https://creativecommons.org/licenses/by/4.0
Women and men profit equally from cardiac rehabilitation: a secondary analysis of the OPTICARE RCT
Purpose: To explore sex-specific differences in cardiac rehabilitation (CR) outcomes. Methods: Aerobic capacity (6-Minute Walk Test), physical behaviour (accelerometer), cardiovascular risk profile (weight, blood pressure, cholesterol), and psychosocial well-being (questionnaires) were measured in patients after an acute coronary syndrome (147 women, 642 men) at CR start and completion, and 18 months’ follow-up. Sex differences were studied using GEE models adjusted for age and differences in baseline characteristics. Additionally, whether men and women met targets associated with health risk reductions was assessed. Results: Both sexes experienced similar CR benefits. Only for depressive symptoms did women show larger improvements (HADS score; ♀: –2.7 vs ♂: –1.1; p = 0.017). Nevertheless, long-term follow-up revealed women still lagged in meeting targets for physical activity (♀: 76.5% vs ♂: 93.1%; p < 0.001) and anxiety symptoms (♀: 75.5% vs ♂: 86.8%; p < 0.001), while men lagged in meeting aerobic capacity targets (♀: 71.3% vs ♂: 58.8%; p < 0.001). Conclusion: Women experience similar CR benefits to men in aerobic capacity, physical behaviour, cardiovascular risk profile, anxiety, and quality of life, with greater improvement in depressive symptoms. However, target values were less often met by women in physical behaviour and psychosocial well-being, and by men in aerobic capacity. Tailored CR programmes may be needed to address the unique needs of women and men.
Copyright (c) 2026 Nienke ter Hoeve, Marie de Bakker, Madoka Sunamura, Jeanine E. Roeters van Lennep, Eric Boersma, Rita J.G. van den Berg-Emons https://creativecommons.org/licenses/by/4.0
Longitudinal assessment of lower limb muscle quantity and quality in acute stroke patients
Objective: This longitudinal study evaluated acute-phase stroke patients, examining changes in skeletal muscle quantity and quality. The research aimed to determine when muscle quality deteriorates, its relationship with muscle quantity, and contributing factors. Design: Prospective observational study. Patients: Forty stroke patients. Methods: Muscle quantity was assessed as the thickness of the anterior and lateral mid-thigh, while muscle quality was assessed by echo intensity of the rectus femoris and vastus lateralis. Measurements on paretic and non-paretic limbs were taken on the first day after stroke onset and on the 10th day. Results: Muscle thickness of all regions of paretic and non-paretic limbs significantly decreased at 10 days, whereas echo intensity significantly increased only in the paretic limb. A significant negative correlation between changes in muscle thickness and echo intensity was observed in the paretic limb only. Multiple regression analysis revealed that the only variable that explains the changes in echo intensity was the changes in muscle thickness of the paretic limb. Conclusion: Muscle quality begins to deteriorate as early as the acute phase of stroke. To prevent this deterioration, it is important to encourage skeletal muscle activity during the acute phase of immobilization and to minimise the reduction in muscle quantity.
Copyright (c) 2026 Wataru Yamauchi, Hiroshi Akima https://creativecommons.org/licenses/by/4.0
Towards an understanding of disturbed sleep phenotypes after traumatic spinal cord injury
Objective: Examine the Spinal Cord Injury-Pressure Injury Resource (SCI-PIR) database to assess the prevalence and identify relationships among sleep disorders and cardiometabolic risk after spinal cord injury. Design: Retrospective observational cohort study using the Department of Veterans Affair SCI-PIR database. Subjects/Patients: 18,894 Veterans living with spinal cord injury. Methods: The SCI-PIR database was queried for ICD9 codes related to cardiovascular, metabolic, psychological, and sleep conditions to identify subgroups of spinal cord injury individuals with sleep disorders and associated clustering of cardiometabolic risk factors and sleep diagnoses. Multiple correspondence analysis probed the underlying associations. Cramer V statistics confirmed and quantified the associations. Results: Sleep apnoea (6.7%) and insomnia (4.3%) were the most common sleep diagnoses. Multiple correspondence analysis demonstrated 2 phenotypic clusters: Cluster A showed robust links between sleep apnoea, hypersomnia, heart failure, and arrhythmias, and secondary associations with coronary artery disease, chronic kidney disease, obesity, diabetes, and hyperlipidaemia. Cluster B showed strong relationships between insomnia, anxiety, and post-traumatic stress disorder. Conclusion: 2 distinct sleep clusters were identified for persons with spinal cord injury. This analysis supports previous findings that sleep disorders associate with overall health in individuals with spinal cord injury, and particularly cardiovascular health. ICD9 coding may under-report sleep diagnoses. Data-driven statistical analysis can uncover insights into the complex interplay between spinal cord injury and secondary health conditions.
Copyright (c) 2026 Letitia Y. Graves-Dixon, Anna May, Susan Redline, Zixiang Xu, Jiayang Sun, Adam R. Ferguson, Kath M. Bogie https://creativecommons.org/licenses/by/4.0
Physical activity levels are low in the days, weeks, and months following dysvascular major lower limb amputation
Objective: To determine physical activity levels and their associated factors post-dysvascular major lower limb amputation. Design: Multicentre longitudinal observational study. Subjects: Eighty-one adults with dysvascular major lower limb amputation. Method: Physical activity was assessed via questionnaire (adapted-SQUASH: total min, moderate/vigorous min, MET-min/week), self-reported adherence to Dutch physical activity guidelines, and accelerometer (Activ8: min, bouts, fragmentation) at < 12 days, 5 weeks, 6 months, and 9 months post-amputation. Associated factors were assessed using mixed model analysis. Results: Median [interquartile range] questionnaire-assessed activity increased: 240 [90;600], 525 [245;880], 678 [334;1176], and 885 [525;1733] min/week (p = 0.004). Dutch guideline adherence was 16%, 55%, 47%, and 27%, respectively. Accelerometer-derived activity was 5 [5;9], 26 [13;50], 50 [33;64], and 54 [44;67] min/day. Number of active bouts ranged from 0.0 [0.0;0.0] to 2.0 [1.0;3.0] per day, with fragmentation between 0.0 [0.0;0.0] and 0.4 [0.4;0.5]. Questionnaire-assessed physical activity was negatively associated with age (β = –16 min/week, p = 0.009) and undernutrition (β = –270 min/week, p = 0.013), and positively with grip strength (β = 14 min/week, p = 0.014). Conclusion: Physical activity levels increase but remain low post-lower limb amputation. Age, undernutrition, and grip strength are associated with physical activity. These findings underscore the need for targeted physical activity interventions for individuals post-amputation, to optimize health and clinical outcomes.
Copyright (c) 2026 Aniek K. Kolen, Leonie A. Krops, Harriët Jager-Wittenaar, Herwin Horemans, Johannes B.J. Bussmann, Martijn L. Dijkstra, Paul J.A. Keller, Jacques Oskam, Bastiaan Vierhout, Jean-Paul P.M. de Vries, Laurens van Walraven, Wim P. Krijnen, Jan H.B. Geertzen, Rienk Dekker https://creativecommons.org/licenses/by/4.0
Predicting effect and evaluating cost-effectiveness of a family intervention after acquired brain or spinal cord injury: a randomized controlled trial
Objective: To predict treatment response of a family intervention and investigate its cost-effectiveness from a healthcare payer perspective. Design: Explorative predictor analyses and trial-based economic evaluation. Subjects/Patients: Participants (n=157) were enrolled 4 months to 2 years after discharge from a specialized neurorehabilitation unit. Methods: Injury type, time since injury, delivery format, and relationship (individual with injury vs family member) were explored as predictors of effect using linear mixed-effect regression. Cost-effectiveness was analysed from a healthcare payer perspective, with incremental cost based on delivery. Incremental health effect was reported for measures on mental health and anxiety and depression symptoms. Results: The 4 predictors had negligible to small effects on the treatment response. Incremental cost for the family intervention was estimated at €798.16 (CI: €700.9; €895.5). Incremental health effect was estimated at 5.64 (CI: 2.71, 8.56) points on the Mental Component Summary at 2 months’ follow-up. At a willingness-to-pay threshold of €300, the probability of the intervention being cost-effective was 99.8% for the Mental Component Summary. Conclusion: The predictors showed no or little effect on the treatment response, and the cost-effectiveness analysis showed the probabilities of the intervention being cost-effective from a health payer perspective.
Copyright (c) 2026 Karoline Yde Andersen, Frederik Have Dornonville de la Cour, Mia Moth Wolffbrandt, Fin Biering-Sørensen, Juan Carlos Arango-Lasprilla, Pernille Langer Soendergaard, Anne Norup https://creativecommons.org/licenses/by/4.0
Recruitment of the central nervous system in different hand tasks in patients with hand dysfunction after stroke based on functional near-infrared spectroscopy: an exploratory study
Objective: This study aimed to examine the central nervous system activation in stroke patients with hand dysfunction during various hand tasks, reflecting central nervous system recruitment. Design: A single-centre cross-sectional observational study. Patients: This research selected stroke patients with hand dysfunction hospitalized in the authors’ hospital from October 2022 to November 2023. Participants were aged 25–75 years, with a post-stroke duration ranging from 2 to 24 weeks. Methods: A 35-channel functional near-infrared spectroscopy system was used to record cortical activity during the resting state, affected-hand grasping tasks, and hand-crank cycling tasks. The study compared the average brain activation extent and functional connectivity between grasping and handbike tasks, focusing on the primary sensorimotor cortex, dorsolateral prefrontal cortex, primary motor cortex, and primary somatosensory cortex as regions of interest. Results: Comparative analysis of brain region activation revealed significant increases in activation across all regions of interest compared with the resting state (p < 0.001). When comparing grasping with handbike tasks, significant increases in activation were observed in all regions of interest except the right primary somatosensory cortex (p < 0.05). Additionally, the right dorsolateral prefrontal cortex exhibited stronger functional connectivity with bilateral primary motor cortex, primary sensorimotor cortex, and left primary somatosensory cortex during the grasping task compared with the handbike task (p < 0.05). Conclusion: This study shows that grasping tasks recruit cognitive, sensory, and motor cortex activities in stroke patients with hand dysfunction relatively higher than handbike tasks.
Copyright (c) 2026 Ning Zhang, Haolin Tian, Yuanbin Yang, Qinxuan Shen, Ziyi Li, Long He, Jing Zhou, Xuechao Li, Jingfeng Tian, Mengying Wan, Wei Yao, Longyue Yi https://creativecommons.org/licenses/by/4.0
Translation, reliability, and validity of the trunk impairment scale in a Polish population after stroke
Objective: This study was conducted to estimate the reliability and validity of the translated and culturally adapted Polish version of the Trunk Impairment Scale in post-stroke patients and to determine the strength of the relationship between trunk and upper limb physical function after stroke. Design: The Polish version of the Trunk Impairment Scale was developed through cultural adaptation. Internal consistency, test–retest reliability, and inter-rater reliability were determined, and construct validity was evaluated by analysing the Polish version of the Trunk Impairment Scale, the Polish version of the Fugl-Meyer Assessment Scale, and the Polish version of the Action Research Arm Test. Participants: Eighty patients with diagnosed stroke in the subacute and chronic stages. Results: The internal consistency for the Polish version of the Trunk Impairment Scale was excellent (α = 0.85–0.91). Test–retest and inter-rater reliability were almost perfect (ICC = 0.94–1.0, κ = 0.92–1.0). Construct validity was moderate (rho = 0.71–0.76). A moderate correlation was also found between the Polish version of the Trunk Impairment Scale and Polish version of the Action Research Arm Test total scores (rho = 0.60). Conclusion: The Polish version of the Trunk Impairment Scale is a reliable and moderately valid outcome measure to assess trunk impairment in Polish stroke survivors. Trunk function is moderately related to gross and fine motor skills of the arm, hand, and fingers among individuals with stroke.
Copyright (c) 2026 Joanna Małecka, Magdalena Goliwąs, Katarzyna Adamczewska, Jacek Lewandowski, Geert Verheyden, Dawid Łochyński https://creativecommons.org/licenses/by/4.0
Robot-assisted therapy following stroke: what effects on quality of life, cognitive and psychosocial outcomes? A systematic review
Objective: Robot-assisted therapy (RAT) has shown promise in post-stroke motor recovery. However, its effects on non-motor outcomes remain unclear. This systematic review evaluated RAT impact on post-stroke quality of life (QoL), cognition, and psychosocial functioning. Methods: Following PRISMA guidelines, electronic searches were performed from Web of Science, PubMed, Cochrane Library, CINAHL, Embase, and PsycINFO. Risk of bias was assessed using NIH Quality Assessment Tools. Data on study design, participants, intervention characteristics, outcomes, and results were extracted and synthetized descriptively. Results: A total of 90 studies met the inclusion criteria. Considerable heterogeneity was found in participants’ characteristics, intervention duration (2–52 weeks), and dosage (20–240 min/session). Most studies reported significant RAT effects on QoL (emotional, physical, cognitive, social subdomains), cognition (attention, executive functions, memory, language, visuo-spatial abilities, intelligence), and psychosocial outcomes (anxiety, depression, self-efficacy, fear of falling, motivation, coping). Some studies also showed greater improvements compared with conventional training controls. Longitudinal effects were generally absent, except for QoL variations observed up to 12 months. Cognitive and psychological factors were also identified as moderators/predictors of RAT response. Conclusion: Despite variability across studies, findings suggest RAT may have a broad impact beyond motor recovery. Future large-scale, standardized, longitudinal trials are recommended to confirm these results.
Copyright (c) 2026 Francesco Zanatta, Alessandra Gorini, Luca Fiorentino, Silvia Traversoni, Cira Fundarò, Marco D'Addario, Patrizia Steca https://creativecommons.org/licenses/by/4.0
Better sleep is associated with improved mobility in adults: a scoping review
Objective: To review the literature on whether sleep impacts mobility in adults. Methods: Ovid Medline, Web of Science, Embase, and CINAHL databases were searched. Citations were randomly divided so that each was screened separately by 2 authors. Data were extracted from included articles independently by 2 reviewers. Results: The search strategy generated 8,772 references, 697 articles underwent full-text screening, and 108 eligible articles were included in the scoping review. Most studies (n = 69; 64%) included only self-reported sleep, and “walking” was the most common mobility category (n = 99). Most studies (n = 60; 56%) reported a positive association between sleep and mobility, indicating better sleep was associated with better mobility or worse sleep was associated with worse mobility. Most studies, including people with cardiovascular, kidney, metabolic, mental health, neurological, and pulmonary conditions, reported a positive association between sleep and mobility. Conclusions: Most studies reported a positive association between sleep and mobility. However, due to the variety of sleep and mobility outcomes used, it was challenging to compare studies and synthesize results. Further, due to a relatively small sample size and variety of health conditions, conclusions cannot be drawn, and further research is needed.
Copyright (c) 2026 Catherine Siengsukon, Mahya Beheshti, Sarah J. Donkers, Silvana J. Costa, Prasanna Vaduvathiriyan, Allison Glaser, Garrett Baber, Joy Williams https://creativecommons.org/licenses/by/4.0
The role of a multidisciplinary team in the rehabilitation of a patient with quadruple amputation
Copyright (c) 2026 Oleh Burii, Roman Oliinyk, Serhii Dushenko, Denys Nahornyi, Mariia Kosovska, Volodymyr Lykhach, Nataliia Soroka https://creativecommons.org/licenses/by/4.0
Sacroiliac joint synostosis as an atypical cause of sports-related groin pain: a case report
Copyright (c) 2026 Lina Van Brabander, Tom Nonneman, Marc Schiltz, Bernard Floré, Samar M. Hatem https://creativecommons.org/licenses/by/4.0
Commentary on: exploring exercise intolerance in adult patients with persistent post-concussion symptoms after mild traumatic brain injury
Copyright (c) 2026 Tao Jun, Hongjian Li, Wenqi Feng https://creativecommons.org/licenses/by/4.0
Commentary on “Examining and Comparing the Clinical Characteristics of Adults with Persisting Post-Concussion Symptoms Presenting for Outpatient Rehabilitation Following a Mild Traumatic Brain Injury or a Minimal Head Injury”
Copyright (c) 2026 Wenjing Zhang, Linyan Zhao https://creativecommons.org/licenses/by/4.0
Coupling auditory cues and bilateral transauricular vagus nerve stimulation in Parkinson’s disease with freezing of gait: an open-label feasibility study
Copyright (c) 2026 Andrea Di Maio, Mario Meloni, Jae-Jun Song, Vincenzo Di Lazzaro, Massimo Marano https://creativecommons.org/licenses/by/4.0
Commonalities in rehabilitation data across diverse health conditions: a comparison of seven large European databases
Objective: To investigate whether rehabilitation data share common characteristics across different health conditions and care settings within the EU Horizon PREPARE project. Design: Qualitative content analysis, with a comparative study of existing clinical databases. Subjects/Patients: Individuals with hand and wrist disorders, idiopathic scoliosis, intermittent claudication, lower limb amputation, Parkinson’s disease or Parkinsonism, hip or knee replacement, and temporomandibular disorders. Methods: Seven rehabilitation-oriented clinical databases were analysed using the International Classification of Functioning, Disability and Health (ICF) framework. Variables were categorized as outcomes, modifiers, or baseline measurements. Commonalities and differences across data domains were identified through iterative consensus meetings among PREPARE partners. Results: Substantial heterogeneity was observed in data type and depth. Pain and quality of life were the most commonly reported outcomes, whereas discharge status and participation-related measures were rarely reported. The most prevalent modifiers were pharmacological treatments, orthoses or prostheses, and exercise-based interventions. All databases reported baseline information on diagnosis, anthropometry, and demographics; however, assessments of gait autonomy and daily activities were inconsistently documented. Conclusion: Despite some overlapping domains, rehabilitation data collection remains fragmented and predominantly focused on biomedical aspects. Greater standardization and systematic inclusion of psychosocial and contextual variables are needed for robust predictive modelling and personalized rehabilitation.
Copyright (c) 2026 Carlotte Kiekens, Helena Burger, Paolo Capodaglio, Maria G. Ceravolo, Esther Janssen, Greta Jurenaite, Calogero Malfitano, Federico Pennestri, Ruud Selles, Gianluca M. Tartaglia, Stefano Negrini https://creativecommons.org/licenses/by/4.0
Andorra as a living lab? The inSCI example
Objective: In light of the persistent concern identified by the World Health Organization (WHO) that small population countries tend to be ignored in international health research, preventing them from developing research capacity, this paper describes the participation of Andorra in an international spinal cord injury survey (InSCI) and resulting benefits. Methods: Descriptive analysis of Andorra’s health research situation and participation in InSCI. Results: Andorra has successfully participated in an international survey improving health research capacity and governmental support. Conclusion: In line with WHO recommendations to improve small country health research capacity, and specifically to improve their health information collection capacity, the described participation of Andorra in an international health survey demonstrates how this capacity can be improved without sacrificing methodological restrictions.
Copyright (c) 2026 Mercè Avellanet, Gerold Stucki, Esther Pages, Anna Boada-Pladellorens, Christian Grillo, Juli Minoves-Triquell, Jerome Bickenbach https://creativecommons.org/licenses/by/4.0