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.
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
NASA lean test detects postural orthostatic tachycardia in chronic post-COVID
Copyright (c) 2026 Mario Siebler, Andrea Maier, Stephan Theiss, Sarah Bergé, Anna Bittner, Grit Schiefelbein, Jürgen Wagner, Dominik Raab https://creativecommons.org/licenses/by/4.0
A scoping review of outcome and outcome measure sets for adults with spinal cord injury, stroke, and traumatic brain injury
Background: Standardized outcome measurement is essential for embedding neurorehabilitation within learning health systems. However, existing core outcome sets and standard outcome measure sets for stroke, traumatic brain injury, and spinal cord injury have not been synthesized across conditions. Objective: To synthesize outcome domains and measures included in core outcome sets and standard outcome measure sets for stroke, traumatic brain injury, and spinal cord injury, and examine involvement of persons with lived experience in their development. Methods: A scoping review was conducted following JBI methodology and PRISMA-ScR guidelines. MEDLINE, Embase, CINAHL, and PsycINFO were searched (May 2025). Studies describing development or evaluation of core outcome sets or standard outcome measure sets for adults with stroke, traumatic brain injury, or spinal cord injury were included. Outcomes and measures were mapped to the International Classification of Functioning, Disability and to “meaningful outcomes”. Results: Forty-eight studies were included. Over half (54%) of meaningful outcomes were shared across all 3 conditions; however, only 3% of outcome measures were recommended across conditions. Measures were absent for some patient-​prioritized domains, including accessible environments and attitudes of others. Persons with lived experience were involved in 35% of studies. Conclusion: While rehabilitation priorities are conceptually aligned across conditions, measurement remains fragmented and patient engagement is limited. Harmonized, patient-informed, and implementable outcome strategies are needed to support learning health systems-driven neurorehabilitation.
Copyright (c) 2026 Snigdha Widge, Ahlam Zidan, Alyson Kwok, Mahtab Azhdar, Sarah Kalis, Liz Dennett, Erin McCabe https://creativecommons.org/licenses/by/4.0
Early rehabilitation in trauma patients: an observational study from two Norwegian trauma centers
Objective: To examine the provision of consultation by a specialist in physical and rehabilitation medicine, and timing of early rehabilitation services for severely injured trauma patients as recommended in the Norwegian Trauma Plan. Design: Observational cohort study. Subjects/Patients: Adults aged ≥ 18 years admitted with severe (New Injury Severity Score > 12) traumatic injuries. Methods: Observational cohort study with data from the Norwegian Trauma Registry and medical records. Outcomes included consultation with a physical and rehabilitation medicine specialist, timing of assessment, and involvement of health professions. Results: Among 317 patients, 10% received assessment by a physical and rehabilitation medicine specialist within 72 h. Early assessment occurred in 43% (n = 6) of patients with spinal cord injury, 12% (n = 8) with traumatic brain injury, and 7% (n = 17) with multitrauma. Overall, 31% (n = 99) of all patients were assessed by a physical and rehabilitation medicine specialist, including 93% (n = 13) of spinal cord injury patients, 57% (n = 39) with traumatic brain injury, and 19% (n = 43) with multitrauma. Physiotherapists assessed 72% of patients, while involvement from other rehabilitation professionals was limited. Conclusion: Despite recommendations, only one-third of patients were assessed by a physical and rehabilitation medicine specialist, and 10% within 72 h. Physiotherapy was common, but other rehabilitation input was limited. Patients with spinal cord injury received more comprehensive care than those with traumatic brain injury or multitrauma.
Copyright (c) 2026 Ingri G. Olsen, Marianne Wesnes, Hanne Næss, Eike Wehling, Eirik Vikane, Geir Arne Sunde, Oddvar Uleberg, Lars Gunnar Johnsen https://creativecommons.org/licenses/by/4.0
Suprapubic catheter insertion in people with multiple sclerosis: long-term complications and survival in a retrospective cohort study
Objective: To evaluate complications and survival following radiologically guided suprapubic catheter insertion in people with multiple sclerosis. Design: Retrospective cohort study. Subjects/Patients: All patients with multiple sclerosis who underwent radiologically guided suprapubic catheter insertion at a tertiary regional multiple sclerosis centre in the United Kingdom between 2014 and 2020. Methods: Clinical and demographic data were obtained from medical records. Immediate complications occurring within 30 days and delayed complications occurring after 30 days were recorded. Kaplan–Meier and Cox regression analyses were performed to assess survival predictors. Results: Fifty-five patients underwent suprapubic catheter insertion. At the time of insertion, mean age was 62 years (standard deviation 11) and median duration of multiple sclerosis was 17.5 years (1st quartile = 12.0; 3rd quartile = 25.8). Immediate and delayed complication rates were 16% (9) and 27% (15), respectively. Five-year survival was 73%. Older age, higher disability scores, longer disease duration, and discharge to residential care were associated with poorer survival. Complications, sex, and mobility status were not associated with mortality. Conclusion: Radiologically guided suprapubic catheter insertion was associated with moderate complication rates and long-term survival in people with multiple sclerosis. These findings may allow better understanding of the potential complications of suprapubic catheterization in advanced multiple sclerosis.
Copyright (c) 2026 Lisa Grandidge, Amin Mohamed Abu Baker, Steven Kennish, Krishnan Padmakumari Sivaraman Nair https://creativecommons.org/licenses/by/4.0
The association of daily urinary and bowel incontinence with emotional functioning in young adults with spina bifida: an ecological momentary assessment study
Objective: Urinary and bowel incontinence are common in young adults with spina bifida and may affect emotional functioning and health-related quality of life. Prospective data describing day-level incontinence experiences in this population are limited. This study used ecological momentary assessment to characterize daily variability in urinary and bowel incontinence and to examine associations with mood, incontinence-related anxiety, and health-related quality of life. Methods: In a 30-day ecological momentary assessment study of adults with spina bifida and recent incontinence, young adults with spina bifida (n = 23; ages 18–26) completed 643 end-of-day assessments. Daily measures included urinary and bowel incontinence frequency, amount, dry intervals, management independence, activity avoidance, positive and negative mood, and incontinence-related anxiety. Health-related quality of life was assessed at study completion. Analyses were exploratory and used nonparametric methods appropriate for ordinal and intensive repeated measures data. Results: Urinary incontinence was reported on 54.1% of study days and bowel incontinence on 20.8%. For urinary incontinence, greater frequency, shorter dry intervals, larger amounts, and activity avoidance were associated with lower positive mood, higher negative mood, and greater urinary incontinence-related anxiety. For bowel incontinence, greater symptom severity, management dependence, and activity avoidance were associated with poorer mood and higher bowel incontinence-related anxiety. Multiple day-level incontinence characteristics and daily emotional responses were associated with lower end-of-month health-related quality of life. Conclusion: In young adults with spina bifida, day-level incontinence burden is associated with same-day emotional functioning and longer-term health-related quality of life. These findings highlight the relevance of day-level symptom variability for rehabilitation assessment and individualized continence management.
Copyright (c) 2026 Devon J. Hensel, Audrey I. Young, Konrad M. Szymanski 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
Outpatient rehabilitation can prevent suicide after acquired brain injury
Objective: The frequency of suicide after stroke and traumatic brain injury has been found to be higher than in the general population. This article presents an outpatient rehabilitation programme for adults with acquired brain injuries and compares the frequency of suicides among treated patients with that in a matched control group. Methods: A registry study was supplemented with reviews of medical records. Data were obtained from the Swedish Cause of Death Register, and 5 controls for each patient treated by the Outpatient Brain Injury Team were identified in the Swedish National Patient Register. Controls were matched by ICD-9 or ICD-10 diagnosis codes, age, gender, and date of first delivery of care. Results: A total of 591 patients were included in the treated group, and 2,932 individuals were included in the control group. No suicides were identified in the treated group, whereas 26 cases classified as intentional self-harm and a total of 40 suicides, including 14 probable suicides coded as events of undetermined intent, were identified among the controls. Conclusion: Treatment by a specialized outpatient rehabilitation team may help reduce suicide risk. A follow-up rehabilitation programme should be considered for patients who have sustained a brain injury.
Copyright (c) 2026 Ann KM Sörbo, Ragnhild I Björklund 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
Subtype-specific optimal cut-off values of the Berg Balance Scale for predicting independent walking in inpatient stroke rehabilitation: a multicentre cohort study
Objective: To determine whether admission Berg Balance Scale score independently predicts independent walking on discharge after adjustment for major confounders, and to derive subtype-specific optimal cut-off values for ischaemic and haemorrhagic stroke. Design: Multicentre retrospective cohort study. Subjects/Patients: A total of 565 stroke patients (316 ischaemic, 249 haemorrhagic) admitted to 3 inpatient rehabilitation centres in the Republic of Korea. Methods: Multivariable logistic regression was used to evaluate the independent predictive value of the Berg Balance Scale. Optimal cut-off values were derived using receiver operating characteristic curve analysis and the Youden index. Bootstrap internal validation, calibration analysis, and decision curve analysis were performed. Results: Admission Berg Balance Scale was a significant independent predictor of independent walking (adjusted odds ratio 1.053, 95% confidence interval 1.030–1.076). The difference in discriminative ability between the Berg Balance Scale only and multivariable models was not statistically significant (p = 0.097). The overall optimal cut-off was 24 points; subtype-specific cut-offs were 33 for ischaemic and 12 for haemorrhagic stroke. Conclusion: The Berg Balance Scale has different optimal cut-off values by stroke subtype and, as a standalone assessment, maintains discriminative ability equivalent to a multivariable model, providing clinical evidence for subtype-specific precision rehabilitation strategies.
Copyright (c) 2026 Jeong-Soo Kim, In-Geon Hwang, Eu-Jeong Ko https://creativecommons.org/licenses/by/4.0
Occupational performance priorities and outcomes in long-term transitional rehabilitation for young adults with acquired brain injury
Background: In a new long-term transitional rehabilitation service following acquired brain injury, occupational performance problems are analysed. Aim: The objective was to describe these problems and the participants’ prioritization, and also to describe the changes between admission and discharge. Another objective was to describe changes in assessed independence-related disability. Design: Observational clinical study. Patients: Young adults (18–25 years), (n = 46), who had earlier undergone traditional medical rehabilitation following acquired brain injury. Methods: The Canadian Occupational Performance Measure (COPM) was used on both admission and discharge. Independence-related general disability was assessed using the Glasgow Outcome Scale–Extended (GOSE). Results: Patients identified 122 occupational performance problems as important. Most problems were in socialization (3/7), community activities (1/3), and finding paid or unpaid work (1/4). Self-rated levels of performance and satisfaction in COPM were significantly higher on discharge compared with admission. The range of GOSE scores increased from 4–6 to 4–8 between admission and discharge. Conclusion: Young adults with acquired brain injury tend to prioritize rehabilitation goals to reduce difficulties in establishing relationships and/or in professional life. On discharge, ratings of implementation and satisfaction of performance were distinctly elevated, while assessed global disability was decreased. Clinical rehabilitation impact: The results highlight the need for transitional rehabilitation for patient-centred remediating measures.
Copyright (c) 2026 Charlotte Heurlin, Marie-Louise Schult, Aniko Barfai, Annelie Rosén, Jan Ekholm, Monika Löfgren 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
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
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
Efficacy of kinesiotaping during rehabilitation following total knee arthroplasty: a prospective randomised controlled trial
Objective: To determine whether adding kinesiotaping to standard inpatient rehabilitation reduces early postoperative swelling and improves function after total knee arthroplasty. Design: Prospective, randomized, controlled clinical trial. Patients: 136 randomized post-total knee arthroplasty inpatients; 102 completed (kinesiotaping n = 51; control n = 51). Methods: Both groups received a standardized 3-week programme. Kinesiotaping was applied by a trained physician following K-Active protocols from postoperative day 10 to day 25. The primary outcome was change in knee circumference (cm) from day 10 to day 25. Secondary outcomes were numeric rating scale pain, passive range of motion, and functional tests (Timed Up and Go, chair stand, 10-m walk). Results: Swelling reduction was greater with kinesiotaping: mean change 2.1 (SD 1.7) cm vs 0.9 (1.4) cm; mean difference 1.2 cm (95% CI 0.7–1.7), p < 0.001. Flexion gain was larger with kinesiotaping: 18.3° (7.7°) vs 14.4° (10.0°); mean difference 3.9° (95% CI 0.4–7.4), p = 0.03. Pain reduction and other secondary outcomes did not differ significantly. No kinesiotaping-related adverse events occurred. Conclusion: Kinesiotaping added to standard rehabilitation reduced early postoperative knee swelling and produced a small improvement in flexion after total knee arthroplasty. Further work should examine durability and patient-centred outcomes. Trial registration: ClinicalTrials.gov Identifier: NCT06831682. Registration date: February 8, 2025.
Copyright (c) 2026 Ahmed Al-Saadi, Bernd Wegener, Andreas Veihelmann https://creativecommons.org/licenses/by/4.0
Ambulatory individuals with spinal cord injury using walking aids generally do not report better long-term outcomes than wheelchair users: results from the InSCI-NL survey
Objective: Greater mobility independence after spinal cord injury is thought to lead to better long-term outcomes. However, evidence is inconclusive for ambulation compared with wheelchair dependency. This study aimed to describe and compare long-term outcomes across mobility levels in individuals with spinal cord injury. Design: Cross-sectional survey. Subjects: Community-dwelling individuals with spinal cord injury in the Netherlands. Methods: Data were collected via the Dutch arm of the International Spinal Cord Injury (InSCI-NL) Survey (2018). Mobility level was assessed using the modified Spinal Cord Independence Measure-Self-Report. Long-term outcomes were compared across mobility levels, using generalised linear models. Results: 253 participants were included with a mean (standard deviation) age of 58.7 (13.6) years and median [interquartile range] time since injury of 10 [5.0–22.0] years. Electric wheelchair users reported lower functional independence, and more participation problems and secondary health conditions compared with manual wheelchair users (p < 0.001). Ambulatory individuals using walking aids reported no better outcomes than manual wheelchair users, except for functional independence (p < 0.001). Ambulatory individuals without walking aids reported more paid work than those with walking aids (62.7% vs 34.3%, p < 0.001). Conclusion: In general, electric wheelchair users reported the least favourable long-term outcomes. Remarkably, ambulatory individuals using walking aids generally did not report better outcomes than manual wheelchair users.
Copyright (c) 2026 Marthe C.G. Langerwerf, Karin Postma, Janneke Stolwijk-Swuste, Marga Tepper, Majanka Heijenbrok-Kal, Marcel Post , Rita J.G. van den Berg-Emons, Rutger Osterthun https://creativecommons.org/licenses/by/4.0
Participation restrictions in isolated cervical dystonia: a convergent mixed-methods study
Objective: To describe participation in adults with isolated cervical dystonia and to explore how restrictions are experienced in everyday life. Design: Convergent mixed-methods study with case- and theme-level integration through joint displays. Subjects/Patients: Adults with a self-reported specialist diagnosis of cervical dystonia. Methods: Respondents completed an online survey including the Utrecht Scale for Evaluation of Rehabilitation–Participation. A purposive subsample completed semi-structured interviews, analysed using reflexive thematic analysis. Quantitative data were summarized with 95% confidence intervals. Results: 108 respondents (73% women; mean age 51.6 [SD 14.1] years; mean disease duration 11.6 [SD 12.8] years) completed the survey. Mean scores indicated low frequency (36.6, 95% CI 34.3–38.8), moderate restrictions (67.6, 64.8–70.3), and low satisfaction (43.3, 40.5–46.1); the productivity domain was the most affected (31.6, 28.7–34.5), with leisure (51.3, 48.4–54.2) and social participation (51.5, 49.4–53.6) less restricted but still constrained. Ten participants were interviewed. Three themes were generated: living with unpredictability; invisibility and contested recognition; and a symptom-focused system in a participation-focused life. Conclusion: Participation was restricted across everyday domains and shaped by fluctuating symptoms, social recognition, and the structure of available care. Patient-reported participation may be a useful complementary outcome alongside impairment-focused assessment.
Copyright (c) 2026 Søren Bruno Elmgreen https://creativecommons.org/licenses/by/4.0
Long-term medical and psychosocial vulnerability after home return following severe traumatic brain injury
Objective: To identify a 5-year medical and psychosocial vulnerability profile among adults living at home 1 year after severe TBI and examine associated early characteristics. Design: Retrospective secondary analysis of a multicentre longitudinal cohort. Subjects/Patients: Adults aged 16 years or older with operationally defined severe traumatic brain injury, private residence at 1 year, linked 5-year follow-up, and complete data for 4 profile indicators. Methods: Latent class analysis used 5-year rehospitalization, PHQ-9, GAD-7, and Satisfaction With Life Scale scores dichotomized with prespecified clinically interpretable thresholds. External rehabilitation outcomes and early associated factors were examined descriptively and with multivariable logistic regression. Results: Among 2,835 participants, a 2-class solution identified a lower-vulnerability profile (n = 2,361) and a multidomain vulnerability profile (n = 474). The latter showed more depressive symptoms, anxiety symptoms, low life satisfaction, and rehospitalization, with poorer 5-year functioning, participation, health, productive status, and higher frequency of non-private residence. Better 1-year global outcome was protective; female sex, preinjury illicit drug use, and living alone at 1 year were associated with assignment to this profile. Conclusion: Home return after severe traumatic brain injury should be treated as a transition point for longitudinal rehabilitation surveillance.
Copyright (c) 2026 Andrea Calderone, Carmela Rifici, Donatella Bonaiuti, Alfredo Manuli, Daniele Bruschetta, Marco Piccione, Tina Balletta, Angelo Quartarone, Rocco Salvatore Calabrò https://creativecommons.org/licenses/by/4.0
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
Who may benefit from robot-assisted gait training with an exoskeleton in subacute stroke patients? A prespecified analysis
Objective: To identify factors associated with the achievement of independent gait after the robot-assisted gait training (RAGT) with an exoskeletal wearable robot in subacute stroke patients. Design: An international, multicentre, randomized, controlled trial. Subjects/Patients: This prespecified analysis was performed on 58 and 69 subacute stroke patients in the RAGT and control groups. Methods: Each RAGT and the conventional gait training was provided 5 times per week for a period of 4 weeks. A Functional Ambulation Categories score of > 3 immediately post-intervention was defined as independent ambulation and clinical significance. Univariate and multivariate binary logistic regression models were used to determine possible predictors of clinically significant response to the RAGT and the conventional gait training. Results: The 2 independent factors with the greatest impact on the response to RAGT for the achievement of independent gait were initial cognitive function and affected lower extremity power (p < 0.05). However, in the control group, stroke duration from onset to treatment and affected lower extremity power were significant independent factors (p < 0.05). Conclusion: This prespecified analysis suggests that the efficacy of RAGT with a wearable exoskeleton appears to be less dependent on time since onset within the early subacute phase, highlighting the importance of preserved cognitive function.
Copyright (c) 2026 Won Hyuk Chang, Tae-Woo Kim, Hyoung Seop Kim, Fazah Akhtar Hanapiah, Jong Weon Lee, Seung-Hyeon Han, Chai Wen Jia, Dae Hyun Kim, Deog Young Kim https://creativecommons.org/licenses/by/4.0
Autonomous bladder training for neurogenic bladder: a randomized controlled trial
Background: Neurogenic bladder causes impaired bladder emptying, urinary complications, and reduced quality of life. This trial evaluated whether structured multimodal autonomous bladder training improves bladder function in patients with neurogenic bladder. Methods: In this single-centre randomized controlled trial, 168 adults were assigned 1:1 to autonomous bladder training plus routine rehabilitation care or routine care alone. The 4-week intervention included induced voiding, sensory awareness training, pelvic floor muscle training, bladder–sphincter coordination exercises, and bladder desensitization. The primary outcome was change in post-void residual urine volume (RUV) at 4 weeks. Secondary outcomes included urodynamic parameters, Neurogenic Bladder Symptom Score (NBSS), symptomatic urinary tract infection (UTI) requiring antibiotics, and adverse events. Results: At 4 weeks, RUV improved more with autonomous bladder training than with routine care (adjusted mean difference in change, –55.8 mL; 95% CI, –64.7 to –46.9). Maximum urinary flow rate, maximum detrusor pressure, and NBSS also favoured the intervention. RUV reduction ≥50 mL occurred in 79.8% versus 42.9% of participants. Symptomatic UTI requiring antibiotics occurred in 9.5% versus 27.4%, although urine culture confirmation was incomplete. Exploratory 12-week follow-up suggested partial maintenance of benefit. Adverse events were uncommon, and no serious adverse events occurred. Conclusions: Autonomous bladder training improved short-term urodynamic and patient-reported outcomes, with exploratory evidence of partial benefit maintenance at 12 weeks. Infection-related findings require cautious interpretation because culture confirmation was incomplete. Longer multicentre trials are warranted.
Copyright (c) 2026 Yue Yang, Lianchi Li, Jing Ye, Hongxia Pan, Jianmei Zhang, Li Zeng, Yuyang Long, Xinling Gan https://creativecommons.org/licenses/by/4.0
The impact of persistent post-concussion symptoms and exercise intolerance on patient-specific functioning after mild traumatic brain injury: a biopsychosocial perspective
Objective: To explore activity limitations in a biopsychosocial context in a randomized controlled trial studying sub-symptom threshold aerobic exercise after mild traumatic brain injury. Design: Qualitative and quantitative approaches. Patients: Eighty-one participants (58% female; median age 32.3) with persistent post-concussion symptoms and exercise intolerance. Methods: Activity limitations assessed with the Patient Specific Functional Scale were categorized into main and subcategories using thematic analyses. Subcategories were linked to the International Classification of Functioning, Disability and Health. Group differences and changes over time were examined using linear mixed-effects models. Results: Of 390 activities, 6 main categories and 24 subcategories were identified: physical activity and exercise (31%), work/education (16%), activities of daily living (15%), social activities (15%), cognition/energy (14%), and sensory-demanding environments (9%). Most subcategories (86%) were linked to the activity and participation domain. There were no group differences in activity limitations at 3 (p = 0.60) and 6 (p = 0.48) months. However, all patients improved from 3.3 (2.9–3.7) at baseline to 5.4 (5.0–5.9, p < 0.001) at 3 months, and 6.2 (5.8–6.7, p < 0.001) at 6 months. Conclusion: Limitations in daily activities were reported across multiple domains. While no differences were found between groups, patient‑reported limitations showed significant improvement over time and may inform individualized rehabilitation strategies.
Copyright (c) 2026 Ingerid Kleffelgård, Lars-Johan Viddal Valaas, Helene Lundgaard Søberg, Nada Andelic, Cecilie Røe, Sophie Steenstrup, Johanna Myhrstuen, Tone Marigård, Lars Nysether, Mari Storli Rasmussen https://creativecommons.org/licenses/by/4.0
Inter-rater reliability and construct validity of a cross-diagnostic movement quality score for rehabilitation assessment
Objective: To examine the inter-rater reliability and construct validity of a Movement Quality Score (MQS) within the Standard Physical Therapy Assessment (SPTA) across diagnostic groups. Design: Cross-sectional study. Subjects and Methods: Eighty-four hospitalized patients undergoing rehabilitation for neurological, musculoskeletal, or internal medical conditions were included. Inter-rater reliability was assessed in 68 participants independently evaluated by 2 physiotherapists. The MQS was scored using the SPTA component. Inter-rater reliability of the summed score was analysed using the intraclass correlation coefficient (ICC [2,1]). Construct validity was examined using Spearman’s rank correlations between the MQS and the Functional Independence Measure (FIM) motor total score and its subdomains (self-care, sphincter control, transfers, and locomotion), as well as other SPTA components. Results: The MQS demonstrated excellent inter-rater reliability (ICC [2,1] = 0.93). It showed a very strong correlation with the FIM motor total score (ρ = 0.91, p < 0.001), with strong associations for transfers and locomotion (ρ = 0.92) and self-care (ρ = 0.86). The correlation with sphincter control was lower (ρ = 0.68). Conclusion: The MQS demonstrates excellent reliability and strong construct validity, supporting its use as a movement-focused complement to activities of daily living-based assessments in heterogeneous rehabilitation populations.
Copyright (c) 2026 Koji Ohata, Takeshi Kozakai, Kazuhisa Someya, Takatomi Narita, Natsuki Watanabe, Yuko Mine, Shinichi Daikuya https://creativecommons.org/licenses/by/4.0
Healthcare utilization in patients with spina bifida and bone fractures
Objective: To compare bone fractures and fracture-related healthcare costs in individuals with and without spina bifida (SB). Design: This is a retrospective observational trial. Subjects/Patients: California’s Healthcare Access and Information database was utilized to identify all individuals with SB who sought care in California emergency departments, inpatient hospitals, or ambulatory surgery centres between 2005 and 2017. Methods: Bone fracture encounters and associated healthcare utilization factors were compared among individuals with spina bifida vs individuals without spina bifida, matched 5:1 by birth year. Results: Between 2005 and 2017, 20,290 individuals with spina bifida sought care in California emergency departments, inpatient hospitals, or ambulatory surgery centres. Compared with 101,450 individuals in the comparison group, those with spina bifida were more likely to seek care for a bone fracture (OR 1.64, p < 0.001) and more likely to sustain repeat fractures (36% vs 26%, p < 0.001). Individuals with spina bifida sustained more bone fractures per capita at each body location studied, with more than double the fractures per capita at the chest (2.0x), foot (2.1x), pelvis (2.4x), leg (2.5x), and vertebrae (2.5x). Individuals with spina bifida spent more cumulative days hospitalized for bone fractures (mean 9.4 vs 7.6, p < 0.001). Conclusion: Individuals with spina bifida were diagnosed with more bone fractures per capita than age-matched persons without spina bifida.
Copyright (c) 2026 Adrian M. Fernandez, Than Kyaw, Debbie Goldberg, I. Elaine Allen, Yi Li, Alfredo Fernandez, Hillary Copp, Lindsay A. Hampson https://creativecommons.org/licenses/by/4.0
Effect of home-based rehabilitation in frail older adults after cardiac surgery: a prospective feasibility study
Introduction: Frail older adults undergoing cardiac surgery are vulnerable to postoperative complications and functional decline. Vivifrail is a structured, multicomponent exercise programme designed to enhance physical performance. This study evaluated its feasibility in the postoperative period. Methods: A non-interventional, prospective, single-centre, study was conducted at Nantes University Hospital between March and December 2024. Patients aged ≥ 75 years, with a baseline Short Physical Performance Battery test (SPPB) score < 9 were included. SPPB, Timed Up and Go (TUG), and handgrip tests were performed at baseline (D0) and 6 weeks (W6). The primary outcome was to assess feasibility based on recruitment, retention rate, and physical performance at W6. Results: Among 45 eligible patients, 38 accepted the programme; 29 returned for assessment at W6. Mean programme completion rate was 54%. All functional assessments improved meaningfully over time, but adherence did not significantly modify these trajectories. However, adherent participants showed lower frailty at W6. Conclusion: Home-based rehabilitation using Vivifrail proved to be feasible for frail older adults during postoperative recovery. Clinically meaningful improvements were observed in physical performance during the first 6 weeks of the programme. Future research should confirm this trend and consider Vivifrail for patients who cannot access specialized rehabilitation centres.
Copyright (c) 2026 Ambre Komonski, Killian Jouanneau, Anne Sophie Boureau, Jeremie HUET 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
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
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
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
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
Non-inferiority of digitally assisted outpatient rehabilitation in patients with back pain: 12-month follow-up of a randomized controlled trial
Objective: To examine the non-inferiority of digitally assisted, multimodal rehabilitation that utilizes a digital version of a standardized back school (intervention group) compared with a rehabilitation program applying the back school conventionally in person (control group). Design: Nonblinded, randomized, controlled, non-inferiority trial with 12-month follow-up after the end of rehabilitation. Subjects/Patients: Adults aged 18–65 years with back pain. Methods: The back school was part of a 3-week rehabilitation program along with other treatments in accordance with the therapy standards. Eight outpatient rehabilitation centers conducted the rehabilitation program. Self-reported pain self-efficacy (10–60 points) was the primary outcome. Non-inferiority was established if the lower limit of the one-sided 95% confidence interval was greater than –4 points for pain self-efficacy. Results: A total of 157 participants (55.3%) completed the 12-month follow-up. Multiple imputation of missing data allowed for inclusion of 270 participants in the analysis (intervention group: n = 127, control group: n = 143). Our primary adjusted intention- to-treat analysis demonstrated that digitally assisted rehabilitation was non-inferior to conventional rehabilitation at the 12-month follow-up (b = 0.48; 95% CI = –3.09 to ∞). Conclusion: This study supports the hypothesis that digitally assisted rehabilitation is a viable alternative to in-person rehabilitation for patients with back pain.
Copyright (c) 2026 Richard Albers, Stella Lemke, David Fauser, Franziska Schäffer, Sebastian Knapp, Gert Krischak, Matthias Bethge https://creativecommons.org/licenses/by/4.0
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
Prognostic profiles for discharge destination identified during intensive care unit admission: a decision tree analysis
Objective: This study aimed to develop a decision tree-based model to identify prognostic patient profiles associated with discharge destination during intensive care unit admission. Design: Historical cohort study using decision tree analysis. Subjects/Patients: 300 critically ill patients selected from 857 intensive care unit admissions after applying exclusion criteria. Methods: The primary outcome was discharge destination (home vs non-home). Candidate variables included demographics, frailty, illness severity scores, delirium, ventilator duration, intensive care unit length of stay, and physical function on intensive care unit discharge. Terminal nodes were interpreted as prognostic profiles. Results: Decision tree analysis identified profiles based on Acute Physiology and Chronic Health Evaluation II score, intensive care unit length of stay, Functional Status Score for the Intensive Care Unit, and age. A profile with lower initial severity and prolonged stay was associated with non-home discharge (area under the curve 0.76). Conversely, a profile with higher initial severity, preserved functional mobility (Functional Status Score for the Intensive Care Unit ≥ 5), and age < 80 years was associated with home discharge (area under the curve 0.77). Conclusion: Combinations of illness severity, length of stay, functional status, and age-defined prognostic profiles were associated with discharge destination during intensive care unit admission.
Copyright (c) 2026 Sho Otsubo, Daisuke Kawakami, Shota Okuno, Kenta Kawamitsu, Shumpei Yoshino 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
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
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
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
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
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
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
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
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
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
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
Medical complications in children with central nervous system injuries during inpatient rehabilitation
Objective: To investigate the occurrence and consequences of medical complications during inpatient rehabilitation of children with central nervous system (CNS) injury. Design: A prospective observational study conducted at a tertiary rehabilitation centre. Subjects: Participants aged 2 to 17 years with acquired CNS injury requiring multidisciplinary inpatient rehabilitation. Methods: Data were collected from medical charts and questionnaires on admission and discharge, assessing predefined complications and associated impacts on the rehabilitation process. Results: Of the 64 participants, 59 experienced a total of 183 instances of medical complications, comprising 19 distinct complication types. Most common were sleep disturbances, pain, -constipation, anaemia, infections, spasticity, and malnutrition. No significant correlation was observed between the occurrence of complications and age, gender, or diagnosis group. In total, 74% of the complications were found to have no impact on the rehabilitation process; however, malnutrition, infections, and spasticity could notably lead to interrupted or prolonged stays, altered rehabilitation goals, and worsened functional prognoses. Conclusion: Medical complications frequently occur during inpatient rehabilitation. While many have no significant consequences, malnutrition, infections, and spasticity in particular warrant further attention clinically and in future research.
Copyright (c) 2026 Kristine Marie M. Vege, Grethe Månum, Katharina S. Sunnerhagen, Frank Becker 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
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
Living with spinal cord injury in the community of Bangladesh: a comprehensive analysis using the ICF framework
Objective: To describe limitations in functioning (activities and participation) and environmental and personal factors that are associated with functioning using the ICF framework among persons living with spinal cord injury in the community of Bangladesh. Design: Cross-sectional study, Bangladesh arm of the International Spinal Cord Injury (InSCI) Community Survey (2023–2024). Subjects/Patients: 789 individuals with spinal cord injury. Methods: Face-to-face interview through culturally adapted InSCI questionnaires. Generalized linear models were used to determine the associated factors. Results: Participants were predominantly male (73%), aged 18–40 years (51%), and from rural areas (63%). More than one-third had tetraplegia (34%). Tetraplegic participants reported greater limitations across all ICF domains compared with paraplegics (all p < 0.01). Determinants of poorer outcomes included male sex, younger age, low education, rural residence, and severe injury of all ICF domains. Conclusion: Individuals with spinal cord injury in Bangladesh face severe restrictions in functioning and participation, shaped by sociodemographic and clinical factors. These findings echo global evidence from other InSCI countries and LMIC studies, highlighting systemic barriers common to resource-constrained settings. Addressing these disparities through accessible rehabilitation, policy reforms, and cross-national knowledge exchange is critical to advancing equitable spinal cord injury care worldwide.
Copyright (c) 2026 Taslim Uddin, Mohammad Tariqul Islam, Rijwan Bhuiyan, Anika Tasnim, Mohammad Sohrab Hossain, Md Atiqul Haque 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
Preoperative physiotherapy and one-year patient-reported outcomes after primary total knee arthroplasty: a registry-based cohort study of 1,688 patients
Objective: Preoperative physiotherapy in patients receiving primary total knee arthroplasty (TKA) aims to relieve pain, delay surgery, and improve postoperative recovery. This study investigates the change in PROMs and pain after primary TKA between patients who received preoperative physiotherapy (P) and those who did not (NP). Design: Registry-based cohort study with data from an institutional registry. Patients: 1,688 patients followed a standardized fast-track clinical pathway between August 2017 and January 2024 and were grouped in P or NP. Methods: Primary outcome was KOOS-PS at 2 months and 1 year postoperatively. Secondary outcomes included pain, the Forgotten Joint Score, and EQ-5d-5L. Two anchor questions related to self-perceived knee function and willingness to have the surgery again at 12 months’ follow-up were also evaluated. Results: The model estimate demonstrated no significant between-group difference in KOOS-PS at 2 months (1.12 points; p = 0.079) or 1-year follow-up (1.25 points; p = 0.097). Visual inspection of descriptive plots showed that NP patients had higher KOOS-PS, less pain, and better joint score and quality of life at all time points. At 12 months’ follow-up, both groups had similar responses to the anchor questions. Conclusion: After adjustment for baseline differences, no between-group differences in postoperative self-reported physical function were observed; consistently lower scores in the physiotherapy group may reflect systematic preoperative differences between groups.
Copyright (c) 2026 Siri B. Winther, Mani Izadi, Vigdis K.S. Husby, Otto S. Husby, Mathias F. Brobakken, Frank-David Øhrn, Jomar Klaksvik, Eivind Wang, Ole Kristian Berg 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
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.
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
Lung function and ventilatory response during high-intensity treadmill walking in adults with cerebral palsy: a cross-sectional study
Objective: To investigate lung function and ventilatory response during cardiopulmonary exercise testing in adults with cerebral palsy and assess the relationship between perceived breathlessness and breathing reserve at maximal exertion. Design: Prospective, cross-sectional study. Inclusion period October 2023–June 2024. Subjects: Adults with spastic cerebral palsy, Gross Motor Function Classification Score (GMFCS) I–III (n = 100). Methods: Spirometry and cardiopulmonary exercise testing were conducted. Ventilatory response during exercise was assessed via tidal volume and respiratory rate. Perceived breathlessness was compared with breathing reserve at maximal exertion. Results: 89 participants completed all tests (GMFCS I = 62, GMFCS II = 20, GMFCS III = 7); 90% had lung function within normal limits. Age- and sex-adjusted maximal oxygen uptake was lowest in group III (p < 0.01). At maximal exertion, 70% had breathing reserve < 20%, indicating ventilatory limitation. Breathing reserve did not significantly differ between those who did and did not report breathlessness as the limiting factor at maximal exertion. Tidal volume and respiratory rate showed expected values at maximal exertion. Conclusion: Lung function was normal in most participants, yet ventilatory limitations were common during maximal exercise. Perceived breathlessness was not related to breathing reserve at maximal exertion.
Copyright (c) 2026 Eivind Lundgaard, Hanna Kraggerud, Charlotta Hamre, Matthijs Wouda 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
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
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
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
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
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
Identification of spastic muscles involved in abnormal joint posture in patients with upper motor neuron syndrome: a narrative review
Few studies have specifically investigated which muscles are involved in abnormal joint posture (AJP) due to muscle spasticity and should therefore be targeted for botulinum toxin injections. This gap has significant implications for treatment efficiency, safety, health economics, and sustainable healthcare. A 2000 to 2025 (July) PubMed search identified 3,488 articles, but only 7 articles met the criteria for providing a method to determine the muscles involved in AJP due to muscle spasticity. Of these, just 2 have proposed how to measure each muscle contribution and only 1 focused on identifying the muscle actually responsible for the observed AJP. There are many strategies for determining the muscles involved in spasticity-related AJP, but they are primarily based on inference. They draw on clinical skills, which incorporate descriptive and functional anatomy, knowledge of different muscle and joint structures, simple rules of biomechanics, determination of the exact phase of the movement involved, consideration of compensatory AJP in these motor control deficient patterns, and, of course, the patient’s goals. Achieving the authors’ proposed objective would enable the standardization of clinical practices, confirm the effectiveness of treatments for spasticity, particularly botulinum toxin, and ensure that the correct dose is injected in the right muscle.
Copyright (c) 2026 Francois Genêt, Vincent Carpentier, Guillaume Chambinaud, Alberto Esquenazzi, Marjorie Salga 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
The effect of combined motor and cognitive rehabilitation on motor performance in Parkinson’s disease: a systematic review and meta-analysis
Objective: To evaluate the effectiveness of sequential and simultaneous motor and cognitive treatment on motor functions, activities of daily living, and quality of life in people with Parkinson’s disease. Design: Systematic review and meta-analysis. Subjects/Patients: Patients with Parkinson’s disease. Methods: A search was conducted in PubMed, Embase, Scopus, Web of Science, and Cochrane Library. Functional mobility was assessed as the main outcome, and balance, gait, activities of daily living, and quality of life as secondary outcomes. Meta-analyses were conducted using mean difference or standardized mean difference with 95% confidence intervals and fixed or random effect models. Heterogeneity was explored, setting a cut-off value of I2 = 50%. Results: Sixteen studies were included, with 8 -eligible for meta-analysis. Results showed that sequential combined treatment offered no clear advantage over motor rehabilitation alone for functional mobility, although a significant benefit was found for activities of daily living. Results on simultaneous combined treatment suggested improvements in quality of life, but no significant differences between treatments for functional mobility. Conclusion: Motor-cognitive approaches may enhance prefrontal cortex efficiency, supporting complex motor tasks and reducing the risk of falls. Future research should elucidate neural mechanisms and compare simultaneous and sequential strategies to develop personalized, multidisciplinary rehabilitation protocols.
Copyright (c) 2026 Luisa Cacciante, Alex Lando, Emine Gulden Ozcan, Daniela D’Imperio, Roberto Meroni, Agnieszka Guzik, Mariusz Drużbicki, Błażej Cieślik, Paweł Kiper 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
Theories, models, and frameworks in implementation science in the context of rehabilitation research: a scoping review
Objective: This review explores the use of implementation science theories, models, and frameworks in rehabilitation research by describing study characteristics and assessing how the applied theories, models, and frameworks align with study purposes. Methods: In the scoping review, peer-reviewed articles published in English between January 2010 and October 2023 were identified from 5 datbases. Eligible studies applied or were informed by implementation science theories, models, and frameworks in any rehabilitation cotext. Data extraction covered publication characteristics, target populations, setings, study designs, used theories, models, and frameworks, and study purposes. Descriptive statistics and deductive analysis were used to synthesize findings. Results: Of 2,277 citations, 121 articles met the inclusion criteria. Most of the articles focused on neurological and paediatric rehabilitation, with qualitative and mixed-methods designs predominating. A total of 34 theories, models, and frameworks were identified, mainly determinant frameworks and process models. Theories, models, and frameworks were primarily used to identify barriers and facilitators, evaluate implementation outcomes, and describe implementation processes. However, theories, models, and frameworks selection did not always align with the study purpose. Conclusion: The use of theories, models, and frameworks in rehabilitation research is increasing but remains limited. Their systematic and purposeful application is needed to enhance the usability and transferability of research findings, thereby bridging the research–practice gap, sustaining evidence-based interventions, and informing policy.
Copyright (c) 2026 Maarit Karhula, Hennariikka Heinijoki, Riitta Seppänen-Järvelä https://creativecommons.org/licenses/by/4.0
The Combined Use of Non-Invasive Neurostimulation with Interactive Digital Technologies in Spinal Cord Injury Rehabilitation: A Scoping Review
Objective: To map the empirical evidence regarding the combined use of non-invasive neurostimulation with interactive digital technologies in spinal cord injury rehabilitation. Design: Scoping review. Methods: Seven databases facilitated a systematic, 3-block search. Additional searches were performed in Google Scholar, PEDro, and via forward and backward snowballing. Studies were required to report original, clinical data from individuals with spinal cord injury participating in interventions that combine non-invasive neurostimulation with interactive digital technologies. Screening and data extraction were performed by 2 independent reviewers according to pre-specified criteria. Results: A total of 494 unique records were identified via the database searches, in addition to the 34 unique records identified via additional searches. Twelve studies met the eligibility criteria. Eleven studies delivered peripheral neurostimulation (i.e., neuromuscular/functional electrical stimulation), and 1 study delivered spinal-directed neurostimulation (i.e., transcutaneous spinal cord stimulation). Interactive digital technologies ranged from manual interfaces controlling 2D avatars to immersive, autonomous closed-loop feedback systems. Conclusion: The accumulated evidence suggests that combining non-invasive neurostimulation with interactive digital technologies may enhance task-specific motor recovery and engagement in spinal cord injury rehabilitation. However, the research area is characterized by a low evidentiary standard, prompting a need for higher-quality studies to establish long-term clinical viability.
Copyright (c) 2026 Samuel David Williamson, Magnus Møller Andersen, Anders Orup Aaby, Marianne Rahbek Vestergaard, Sophie Lykkegaard Ravn 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
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
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 “Factors associated with long-term functional outcomes and participation in patients with colorectal cancers”
Copyright (c) 2026 Mahesh alias Vibhav Sanzgiri, Saumya Dixit https://creativecommons.org/licenses/by/4.0
Commentary on: “Effect of inspiratory muscle training on inspiratory muscle strength in adults with post-COVID-19 condition and inspiratory muscle weakness: a randomized controlled trial”
Copyright (c) 2026 Raju Kumar, Palakdeep Kaur, Urvashi Chauhan https://creativecommons.org/licenses/by/4.0
Commentary on “Effects of incentive spirometer added to standard rehabilitation in previously hospitalized adults with Post-COVID-19 condition: a randomized controlled trial”
Copyright (c) 2026 Etika Rana https://creativecommons.org/licenses/by/4.0
Commentary on “Does aerobic exercise affect memory, attention, working memory, and fatigue after acquired brain injury? A single-blinded randomized controlled pilot study”
Copyright (c) 2026 Palakdeep Kaur, Raju Kumar, Nitin Kumar Indora 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
Exertional compartment syndrome and median nerve compression caused by a reversed palmaris longus
Copyright (c) 2026 Diogo Ferreira, João Gomes, Hugo Amorim https://creativecommons.org/licenses/by/4.0
Bone health after lung transplantation: a case report
Copyright (c) 2026 Vanessa Lee, Paula Bermel, James Foster 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
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