搜索结果：Complementary and Manual Therapy

The objective of this update to a previously published scoping review was to map how music therapists used virtual music therapy during the COVID-19 pandemic. Virtual music therapy underwent significant development during the COVID-19 pandemic. Likewise, the number of publications increased dramatically compared to early 2021, when only 10 records were available. An update to the previous scoping review was necessary to explore the current state of this emerging music therapy discipline and provide essential information for health care practitioners, scholars, and researchers. This scoping review included studies examining how music therapists (population) delivered virtual, remote, or online music therapy (concept) across all client groups during the COVID-19 pandemic (context). All types of evidence were included, except for literature reviews, newspaper articles, essays, editorials, letters to the editor, and bachelor's theses. The search strategy was conducted in English across relevant databases and journals. Following the JBI methodology for scoping reviews, we updated a scoping review published in 2021. Available evidence was searched in databases, including searches for unpublished studies, gray literature, and relevant journal archives, along with manual searches of reference lists. The search was limited from October 2020 (the date of the previous search) until December 2024. Two independent reviewers screened all reports against the eligibility criteria and performed the data extraction. The global music therapy community adapted to the restrictions resulting from the COVID-19 pandemic through a significant expansion of virtual music therapy. A total of 145 new records, along with 5 records from the original review, were included in this scoping review. The papers were from North America (n=63), Europe (n=34), Asia (n=19), Oceania (n=16) and the rest created in international cooperation (n=18). Most texts described virtual music therapy in the form of synchronous video calls. We reported the characteristics of the records, the types of texts, the client groups to which virtual music therapy was delivered, and the platforms and equipment used. We identified research papers (n=103), other texts (n=44), study protocols and an evidence implementation report. We also described the challenges, facilitators, and barriers along with the music therapy methods. Most frequently, a combination of active and receptive methods was used, with an emphasis on listening, singing, and music-based relaxation or imagery methods. Virtual music therapy was delivered to a wide variety of clients, including those with various medical diagnoses, and mental health issues; caregivers; and health care workers. Virtual music therapy took place in clients' homes, hospitals, or educational settings. The virtual music therapy field experienced significant growth during the COVID-19 pandemic and developed into a distinct area of music therapy. This scoping review reports on a substantial body of relevant evidence, providing detailed insights into the nuances of virtual music therapy practice, which may remain useful even beyond pandemic restrictions. Future research is needed to examine the impact of virtual music therapy in the post-COVID-19 era and its potential as a complementary approach to face-to-face therapy. OSF https://osf.io/tnw3c/.

Reiki plus manual therapy are utilized to improve relaxation, sleep, emotional state, and pain. Evidence within hospital settings was limited, and previous studies had weak designs. The purpose of this study was to examine the effects of Reiki plus manual therapy on depression, anxiety, sleep, postoperative pain, atrial fibrillation, hospital length of stay, and 30-day rehospitalization after open heart surgery. Using a 2-group randomized controlled trial design, patients were randomized to 20 minutes of nurse-delivered Reiki to 5 body areas plus manual therapy to the head and feet or quiet time for 3 consecutive days. Analyses included analysis of covariance, Poisson regression and logistic regression models. Among 272 patients (136/group), the mean (SD) age was 62.2 (12.2) years, and 75.4% were male. After adjusting for having a coronary artery bypass graft procedure, there were no between-group differences in change in depression, anxiety, or sleep (P = .21; P = .13; or P = .20, respectively), mean postoperative pain (P = .91), hospital length of stay (P = .92), intensive care length of stay (P = .67), and new onset atrial fibrillation (P = .59). There was no difference in the odds (95% confidence interval) of 30-day rehospitalization after Reiki plus manual therapy compared with usual care (0.31 [0.10, 1.01], P = .051); however, adjusted probabilities were low in both groups: Reiki plus manual therapy: 0.02 (95% confidence interval [CI]: 0.01-0.06) and usual care: 0.06 (95% CI: 0.03-0.13). When compared with 20 minutes of quiet time, postoperative Reiki plus manual therapy did not change clinical outcomes. Future research with different intervention steps and methods is needed to understand Reiki plus manual therapy effects on postoperative depression, anxiety, pain, and other clinical outcomes.

Chronic pain and hypertension (HTN) are worldwide epidemics that are difficult to manage and frequently encountered as comorbid conditions in patient care. There is a paucity of information regarding the effect that manual therapy has on blood pressure (BP), particularly in those with chronic pain and HTN. This case report describes the management of a patient with chronic pain and HTN. The patient was a 41-year-old female with chronic multisite pain and multiple comorbidities, including HTN. Her BP at the initial evaluation was 147/78 with an oscillated device and 142/82 with a sphygmomanometer in the right arm and 144/80 in the left. The physical examination of the patient warranted a mid-thoracic thrust manipulation in supine. Manual therapy, education, meditation, and aerobic exercise were used throughout the episode of care (seven visits across 9 weeks). Upon reassessment after the thoracic thrust manipulation (5 min of quiet sitting), BP in the right arm was 105/65 with an oscillated device and 105/68 with a sphygmomanometer. Significant improvements in the Patient Specific Functional Scale, Lower Extremity Functional Scale, Numeric Pain Rating Scale, and BP were noted throughout the episode of care. She was able to return to her previous walking program. Improvements in pain, BP, and patient-reported outcomes were made in a patient with chronic multisite pain and HTN. Manual therapy, in conjunction with education, meditation, and aerobic exercise, may have aided in improving this patient's function and BP. Caution should be used when interpreting results from this case report. Future studies should examine the effects of physical therapy intervention, including manual therapy, in those with chronic pain and HTN. Manual therapy could be considered as an intervention to improve chronic pain and HTN.

Deep learning (DL)-based auto-segmentation has rapidly become the state-of-the-art in radiotherapy planning, significantly reducing contouring time while achieving geometric accuracy comparable to expert-derived contours [1-3]. While AI contouring on CTp is now widely established, its application to cone-beam CT (CBCT) is less well explored, despite CBCT's critical role in daily image guidance for prostate radiotherapy. Current adaptive workflows rely on manual contouring or deformable image registration (DIR), both of which are resource-intensive and subject to limitations in accuracy and consistency. Recent advances in AI-based CBCT segmentation have shown promise in reducing manual workload, improving contour consistency, and supporting adaptive radiotherapy (ART) workflows [4]. To assess the clinical implications of these developments, this study retrospectively analyzed CBCT images from 20 prostate cancer patients, comparing AI- and DIR-generated contours to evaluate systematic differences and their potential impact on dosimetry and ART decision-making. Twenty prostate radiotherapy patients were retrospectively selected, treated with either 42.7 Gy in 7 fractions or 60 Gy in 20 fractions, and imaged on Halcyon linear accelerators using Hypersight CBCT ([Formula: see text]). AI-generated contours were produced with Limbus AI v1.8.0, while deformable image registration (DIR) contours were propagated from planning CTs in Velocity v4.2. Contour accuracy was assessed by two senior medical officers using a four-point Likert scale across 140 CBCTs. Prostate, bladder, and rectum were analyzed using Dice Similarity Coefficient (DSC), Hausdorff Distance (HD), mean surface distance (MSD), center-of-mass (COM) displacement, and volumetric change relative to the planning CT. Dosimetric evaluation included [Formula: see text], [Formula: see text], [Formula: see text], and clinically defined organ-at-risk metrics to assess potential implications for adaptive radiotherapy. Statistical significance was tested using paired Student's t-tests and Wilcoxon signed-rank tests with a threshold of [Formula: see text]. AI-generated contours achieved acceptable clinical accuracy in >80% of cases, with fewer severe or medium errors compared to DIR-derived contours, which required minimal changes of 49%. Quantitative analysis demonstrated broadly comparable Dice Similarity Coefficients (DSC), Hausdorff Distance (HD), and mean surface distance (MSD) across prostate, bladder, and rectum. Organ variation on CBCT revealed larger mean centre of mass shifts and volume differences for AI, particularly in bladder contours, whereas DIR showed smaller systematic deviations. Dosimetric comparisons highlighted that prostate dose metrics were significantly different between methods, while bladder differences were mostly non-significant except at high-dose volumes, and rectum analysis revealed consistent statistically significant variations. Overall, although both methods captured daily anatomical changes, suggesting complementary strengths depending on adaptive radiotherapy application. AI-generated contours for prostate radiotherapy on CBCT images demonstrate high geometric accuracy and clinical usability, requiring minimal expert correction, while DIR contours, although generally usable, show greater variability, particularly for organs subject to large anatomical changes such as the bladder and rectum. Despite similar geometric comparisons, statistically significant dosimetric differences highlight the importance of careful expert verification, especially for sensitive structures like the rectum. These findings support the integration of AI-based contouring into adaptive radiotherapy workflows to streamline clinical processes, reduce workload, and maintain treatment accuracy, while emphasizing that automated contours, whether AI- or DIR-derived, should always undergo expert review to ensure safe and effective patient care.

Published evidence on patient experiences, perceptions, and challenges related to early breast cancer (eBC) in Italy is limited. Understanding these aspects is critical for improving diagnosis, treatment outcomes, and quality of life (QoL). This study used social media listening (SML) to explore the patient journey, treatment perceptions, QoL, and unmet needs of patients with eBC, caregivers, and health care professionals (HCPs) in Italy. This retrospective noninterventional SML study analyzed publicly available posts from December 2021 to November 2023 using breast cancer-related keywords in English and Italian through Sprinklr, a web-based aggregator tool. Posts sourced from social media platforms, such as X (formerly known as Twitter), blogs, forums, Facebook, Instagram, and YouTube, were filtered by geographic location to include only users in Italy. Posts were filtered using natural language processing (NLP) for relevance and duplicates, followed by manual review and stakeholder identification (patients, caregivers, and HCPs). Key themes of discussion were identified through thematic analysis of posts across the stages of the patient journey (symptoms, diagnosis, treatment, etc). Ethical guidelines were followed by using anonymized, publicly available data. Descriptive statistics were used to analyze the data, and posts with missing data were excluded. Consequently, denominators varied across analyses and were adjusted based on data availability for specific variables. Of the 20,008 posts initially extracted, 1580 posts were retained following NLP filtering, and 530 posts were included after manual screening. The majority (493/518, 95%) of the posts were sharing information about diagnosis and treatment journeys, emotional challenges, QoL concerns, and symptoms (eg, lumps, breast pain), while 27% (141/518) of the posts sought information on diagnostic dilemmas, treatment options, and second opinions. Patients contributed 60% (318/530) of the posts, and caregivers contributed 21% (111/530) of the posts, with over half (57/107, 53%) discussing their mothers' diagnosis and treatment struggles. HCPs contributed 16% (85/530) of the posts, primarily sharing clinical trial updates, drug approvals, and disease awareness efforts. A total of 88 posts included discussions on QoL, and eBC significantly impacted patients' emotional, physical, functional, and social well-being. Discussions revealed key unmet needs, including limited awareness of adjuvant therapy options, lack of peer support groups, suboptimal patient-HCP communication, and insufficient access to specialty care facilities. This study highlights gaps in eBC management related to patient education, HCP communication, and access to specialty care and describes an associated worsening of QoL for patients as reflected in social media posts. Within the limitations of an observational SML design, increasing patient and caregiver awareness of available adjuvant therapies to improve adherence and reduce recurrence risk, alongside expanding access to regional breast cancer centers, may help optimize patient experiences and outcomes. Further research using complementary data sources is needed to confirm and extend these findings.

Autism spectrum disorder (ASD) is a neurodevelopmental condition marked by social communication deficits and cognitive impairment. As pharmacological and behavioral treatments often show inconsistent efficacy, massage therapy-a low-risk complementary approach including tuina and acupressure-is used to improve cognitive symptoms, yet its systematic efficacy and safety remain unevaluated. This systematic review and meta-analysis aims to evaluate the efficacy and safety of massage therapy (categorized into traditional Chinese medicine-based and Western-based approaches) for improving specific cognitive domains (eg, executive function, attention, and memory) in individuals with ASD. Randomized controlled trials (RCTs) and cluster RCTs will be identified across 9 English and Chinese databases (including PubMed, Cochrane Library, and China National Knowledge Infrastructure) through September 2025. Two reviewers will independently perform study selection, data extraction, and risk-of-bias assessment using version 2 of the Cochrane risk-of-bias tool. A random-effects model will be primarily applied due to anticipated clinical diversity, with fixed-effects models reserved for sensitivity analyses of homogeneous data (I2=0%). Subgroup analyses will explore age, intervention context, and massage type. Evidence for primary outcomes-including checklist scores and specialized cognitive scales-will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Selection results will be summarized in a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram. This review will synthesize evidence on massage therapy's effects on cognitive outcomes measured using scales such as the Autism Behavior Checklist, Childhood Autism Rating Scale, and Autism Treatment Evaluation Checklist, as well as safety profiles. This study was funded in 2024. Following the September 2025 search, analysis will be completed by June 2026, with final results expected for submission in December 2026. This study will evaluate massage therapy's role in managing cognitive impairment in ASD. By synthesizing available evidence from RCTs, the findings will provide an evidence-based foundation for clinical decision-making and clarify whether manual therapies serve as safe, effective nonpharmacological adjuncts to existing ASD interventions.

Pronator teres syndrome (PTS) is an uncommon neuropathy caused by compression of the median nerve at the proximal forearm, resulting in paresthesia and pain in the radial digits. Although conservative management is typically the preferred initial approach, chronic and refractory cases often require multimodal treatment strategies. A 55-year-old female truck driver presented with a five-year history of persistent bilateral numbness and pain radiating from the palms to the distal phalanges. Physical examination revealed positive pronator compression and bilateral upper limb neurodynamic tests, with a numerical rating scale (NRS) score of 8/10. Palpation during ultrasound imaging demonstrated localized tenderness and radiating pain around the pronator teres and median nerve. Cervical pathology and carpal tunnel syndrome were excluded. The patient underwent ultrasound-guided hydrodissection of the median nerve at the pronator teres level every two weeks, combined with manual mobilization and a prescribed home-based exercise program. Symptomatic relief was achieved after the first session, and after four treatment sessions over two months, the NRS score improved from 8/10 to 3/10. Functional recovery was achieved, and the patient successfully maintained symptom control through continued adherence to the home-based exercise program. This report highlights the potential effectiveness of a multimodal strategy for addressing chronic PTS. Ultrasound-guided hydrodissection may improve mobility of the median nerve by reducing perineural restrictions, while manual mobilization and gliding exercises are likely to provide complementary therapeutic effects. Given the chronicity of the patient's condition, the early and sustained response underscores the potential utility of combining these techniques in refractory cases. Ultrasound-guided hydrodissection, when combined with manual therapy and a structured home-based exercise program, may represent a minimally invasive and effective management option for chronic pronator teres syndrome that is unresponsive to conservative care.

Use of complementary and integrative health (CIH) therapies has increased over the past two decades. Accumulating evidence supports the effectiveness of CIH therapies for a range of health outcomes and an association between CIH therapy use and reduced use of opioid therapy. To describe differences in the use of evidence-based CIH therapies among individuals with chronic pain on long-term opioid therapy (LTOT) by sociodemographic and clinical characteristics. This was an observational study using a national retrospective cohort of patients developed from Veterans Affairs (VA) electronic health record data. The sample comprised 281,903 patients receiving LTOT upon cohort entry between July 1, 2017, and December 31, 2021, with a health care encounter in one of 54 VA medical centers. CIH therapy use was defined as chart-documented use of any of eight priority CIH therapies or chiropractic care in the year prior to cohort entry. LTOT was defined as having a prescribed opioid analgesic for ≥90 consecutive days, allowing ≤30 days between fills. Sociodemographic and clinical characteristic variables were assessed as covariates of CIH therapy use. Among the full cohort, the CIH therapy use rate was 9.5%. Use increased with each cohort entry year relative to 2017. In a multivariable model, variables associated with greater odds of CIH therapy use included being female, having a musculoskeletal pain condition, obesity, opioid use disorder, anxiety, depression, post-traumatic stress disorder, and receiving services in a flagship site. Lower odds of use were associated with being older, unmarried, prescribed higher opioid doses, smoking, and rural residence. CIH therapy use has increased over time, consistent with national trends; however, differential patterns of exposure suggest the need to explore pathways to use. These may elucidate opportunities to broaden access to these evidence-based therapies for patients with chronic pain.

Hepatocellular carcinoma (HCC) is an aggressive malignancy with limited treatment options. While natural products offer a vast chemical space for drug discovery, the literature at the oncology-phytochemistry interface remains fragmented. This study provides a high-resolution bibliometric curation to map research trends and pharmacological hotspots in HCC therapy over the last decade. A systematic search was conducted via Scopus for studies published between 2015 and 2025. Following manual curation of 1477 eligible articles, VOSviewer and the Bibliometrix R-package were utilized for analysis. A distinctive feature was the integration of taxonomic validation and manual text mining to ensure high accuracy of botanical and phytochemical data. Our findings reveal an exponential growth in scientific production, led by China, the USA, and India. The editorial landscape spans over 400 journals and 90 publishers, such as Elsevier, Frontiers, MDPI and Wiley. Phytomedicine and Journal of Ethnopharmacology were the most prolific journals. We identified over 700 distinct phytochemicals, notably quercetin, curcumin, and resveratrol, and approximately 600 plant species. Thematic clustering demonstrated that these compounds modulate critical cellular events, including apoptosis, oxidative stress, cell-cycle checkpoints, epithelial-mesenquimal transition, and distinct but complementary signaling pathway, such as Bax-Bcl-2, PI3K/Akt, mTOR, VEGF, SIRT1/NRF2, MAPK/ERK, CHOP and GRP78, and also different classes of miRNAs. Nanotechnology-based delivery systems emerged as a major trend to overcome bioavailability challenges. This bibliometric curation provides a mapping of the field, identifying critical thematic transitions and current knowledge gaps. The systematic cataloging of authors, institutions, publishers, journals, and phytochemicals offers a foundation for prioritizing molecules in future trials, providing objective insights for drug discovery and potential novel targeted therapies for HCC.

Stress, anxiety, and depression are prevalent mental health conditions that have the ability to significantly impact individuals' daily lives and overall well-being. These disorders can lead to physical symptoms, impaired functioning, and a reduced quality of life. In light of these challenges, osteopathic manipulative treatment (OMT) has emerged as a promising complementary therapy. The purpose of this study is to determine if OMT techniques, such as myofascial release, craniosacral therapy, and lymphatic drainage, can modulate this balance by reducing sympathetic nervous system dominance and enhancing parasympathetic activity, leading to improved relaxation and stress resilience. This systematic review, conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, identified 16 peer-reviewed studies examining the use of OMT for managing stress, anxiety, and depression through a comprehensive literature search and screening process spanning multiple scholarly databases. Studies have demonstrated both immediate and long-term benefits of OMT, as measured by patient-reported outcomes and physiological markers like heart rate variability. Control groups receiving sham treatments or no intervention further support the idea that the benefits of OMT are specific and not due to placebo effects. While traditional treatments, such as medication and psychotherapy, are commonly used as management modalities, they have limitations in terms of side effects, accessibility, and long-term effectiveness. This review highlights the potential of OMT as a complementary and adjunctive therapy to address mental health disorders, offering a holistic, non-invasive approach to enhance patients' well-being.

Central post-stroke pain (CPSP) severely impairs survivors' quality of life, and pharmacological therapies are often limited by resistance and safety. Acupuncture-related therapies (AT) shows potential, but evidence is fragmented. This umbrella review synthesizes existing systematic reviews/meta-analyses (SRs/MAs) to evaluate the efficacy and safety of AT for CPSP. This umbrella review included SRs/MAs of randomized controlled trials comparing AT with pharmacotherapy, placebo, or conventional therapy for CPSP. AT methods included traditional acupuncture methods such as manual acupuncture (MA) and electroacupuncture, as well as non&#x2011;pharmacological physical interventions such as repetitive transcranial magnetic stimulation (rTMS). The outcomes included pain, limb function, psychological status, quality of life, and adverse events (AEs). Methodological quality, reporting quality, risk of bias, and evidence certainty of the SRs/MAs were assessed using the AMSTAR&#x202f;2, PRISMA-A, ROBIS, and GRADE tools. A total of 9 SRs/MAs were included in this review. The reporting quality was relatively complete overall (median PRISMA-A score: 23.5/27). The methodological quality and certainty of evidence were predominantly low or critically low, with publication bias and risk of bias as the major downgrading factors. In terms of efficacy, AT significantly reduced pain scores versus control therapies (e.g. Visual analogue scale/ Numeric rating scale, mean difference [MD]=-1.11, 95% confidence intervals[CI] [-1.41,-0.81], p<0.00001), improved limb function (e.g. Modified Rankin Scale, MD=-0.62, 95% CI [-0.92,-0.32], p<0.00001), and enhanced quality of life (e.g. MOS 36-Item short-form health survey score, MD=6.77, 95% CI [2.50,11.04], p=0.002). Psychological outcomes did not show consistent improvement (e.g. Hamilton anxiety scale, MD=-0.96, 95% CI [-2.94,1.02], p=0.34). AEs were mostly mild and transient, although rTMS was associated with the highest incidence (61.08%). AT can alleviate pain and improve limb function and quality of life in CPSP, though its effect on psychological symptoms remains unclear. The treatment is generally safe; however, rTMS carries a high risk of AEs. These findings require confirmation through rigorous, high-quality studies. We collected and analyzed the findings from nine published reviews of clinical trials on acupuncture-related therapies (one type of complementary and alternative medicine) for central post-stroke pain (CPSP)&#x2014;a common and severe pain condition after stroke that greatly affects daily life. Our work showed that acupuncture-related therapies can meaningfully reduce pain, improve movement, and enhance quality of life for people with CPSP, although it does not appear to consistently help with emotional symptoms like anxiety or depression. Most (e.g. manual acupuncture, electroacupuncture, transcranial direct current stimulation) side effects were mild and short-lived, though one form of acupuncture-related therapies (repetitive transcranial magnetic stimulation) was linked to more side effects. While these results are promising, the overall quality of the existing evidence is still low. Our review highlights acupuncture as a generally safe and potentially useful option for survivors with CPSP, and calls for better-designed studies to provide clearer guidance for patients and clinicians in the future.

Osteopathic manipulative treatment (OMT) can be utilized as a primary or adjunctive treatment for headaches associated with musculoskeletal disorders. Although previous systematic reviews investigated the effectiveness of manual therapies for treating headaches, they did not focus specifically on OMT or perform a pooled meta-analysis to evaluate the effectiveness of outcomes. The aim of this study is to systematically evaluate the effectiveness of OMT for managing headaches associated with musculoskeletal dysfunction and to assess the associated harm outcomes. In September 2023, the following databases were searched for randomized controlled trials (RCTs) of adult patients with headaches associated with musculoskeletal dysfunction who were treated with OMT: Allied and Complementary Medicine Database, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Excerpta Medica (EMBASE), Osteopathic Medicine Digital Library (OSTMED), Ovid Emcare, Ovid MEDLINE, Physiotherapy Evidence Database (PEDro), PsycINFO, and PubMed. The search terms included osteopathic manipulative medicine, manual therapy, osteopath, headache, concussion, and head injury. The studies had to compare OMT techniques (e.g., articulatory [ART]; high-velocity, low-amplitude [HVLA]; soft tissues [ST]) to another form of treatment or a different type of OMT technique. Our primary outcomes included headache severity, headache frequency, disability associated with headaches, quality of life, and return to work (RTW); harm outcomes included all-cause dropout (ACD) rates, dropouts due to inefficacy, and adverse effects. The Cochrane Risk of Bias (ROB) tool was utilized to assess the ROB in the reviewed studies, and the quality of evidence was assessed utilizing the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Outcomes data were pooled for analysis and reported as standardized mean difference (SMD) and 95&#x202f;% confidence interval&#xa0;(CI). Our search identified 11,657 RCTs. After removing duplicates and screening titles and abstracts, 167 underwent full-text review, and 18 were included in our review. None of the reviewed RCTs met&#xa0;all of the Cochrane ROB criteria. Moderate-quality evidence indicated that combined ART-HVLA (SMD=-0.61, 95&#x202f;% CI=-1.0 to&#xa0;-0.23) and ST HVLA-ART (SMD=-0.48, 95&#x202f;% CI=-0.83 to&#xa0;-0.13) effectively reduced the severity of headache. Moderate-quality evidence also indicated that the combined techniques of ART-HVLA (SMD=-0.43, 95&#x202f;% CI=-0.74 to&#xa0;-0.13) and ST-ART-HVLA (SMD=-0.62, 95&#x202f;% CI=-0.89 to&#xa0;-0.35) effectively reduced the frequency of headaches. Moderate-quality evidence indicated that quality of life was improved with combined ART-HVLA (SMD=0.57, 95&#x202f;% CI=0.14 to 0.99). Low-quality evidence indicated no significant associations of OMT with disability or harm outcomes (all p>0.26). Results of our systematic review and meta-analysis suggested that a combination of multiple types of OMT techniques effectively reduced the frequency and severity of headaches and improved quality of life. However, high-quality RCTs with large sample sizes utilizing a variety of technique modalities and combinations of technique modalities are necessary to better evaluate the effectiveness of OMT for managing headaches.

High rates of mental health conditions have been reported among patients with idiopathic intracranial hypertension (IIH). Cognitive-behavioral therapy (CBT) has been suggested as a complementary treatment to help manage anxiety and headache pain in IIH. This study aims to assess the mental health of IIH patients through a psychiatric interview and to evaluate their suitability and interest in CBT. Participants with IIH were recruited from Stanford Byers Eye Institute. Demographic and clinical characteristics were collected, and participants completed self-rated scales for depression (PHQ-9), anxiety (GAD-7), headaches (HIT-6), and disability (WHODAS-12). Diagnostic and Statistical Manual of Mental Disorders, 5th edition diagnoses, patient's suitability for CBT (SSCT scale), and preferred therapy focus were identified through a formal psychiatric interview. Fifty-three participants were enrolled and completed surveys, and 43 participants went on to have the psychiatric interview (mean age 38 years, 91% female). Among them, 76.7% had a GAD-7 score &#x2265;5, indicating at least mild anxiety, and 76.7% of participants had a PHQ-9 score &#x2265;5, indicating at least mild depression. In total, 81.4% of participants suffered from a mood, anxiety, or trauma- and stressor-related disorder. Participants who had received a venous stent or VP shunt had higher anxiety levels (average GAD-7 11.75 vs 6.52; P = 0.007); 81.4% were interested in CBT, and 83.7% were deemed good candidates for CBT (SSCT &#x2265; 30). Anxiety management most often emerged as their favored therapeutic focus. Our results confirm the high prevalence of mental health conditions and symptoms among patients with IIH. A majority of patients are interested in CBT, and many would likely benefit from this approach. CBT should therefore be considered in the therapeutic management of IIH. Further research is warranted to validate the efficacy of this intervention in this specific clinical population.

Background: Central cord syndrome (CCS) is the most common incomplete spinal cord injury, producing more severe motor deficits in the upper than lower extremities and impairing sensory and autonomic function. Although transcutaneous spinal cord stimulation (tSCS) has shown benefits in motor and sensory recovery after spinal cord injury, studies have not explicitly documented whether CCS subjects were included. The aim of this study was to assess the effects of tSCS over 12 weeks on motor and sensory outcomes in a subject with CCS. Methods: A 20-year-old male with a C7 injury was evaluated at baseline and after 12 weeks with the American Spinal Cord Injury Impairment scale, Modified Ashworth Scale, Penn and Spasm Frequency Scale, 3-Meter Walk Test and 6-Minute Walk Test, 9-Hole Peg Test, Box and Block Test, hand dynamometry, and lower-limb EMG. tSCS was applied between T9 and L1 at 30 Hz. Results: At 12 weeks, upper-limb motor and sensory scores improved, while spasm frequency and hand spasticity were reduced. Manual dexterity improved bilaterally in the 9-Hole Peg and Box and Block Tests, with a 2 kg gain in right-hand grip strength. In the 6-Minute Walk Test, the distance covered increased from 224.4 m to 295.2 m, and a 1.36 s reduction in 3-Meter walking time was achieved. Conclusions: tSCS improved motor and sensory function and reduced spasticity and spasms. These findings suggest that tSCS may serve as an effective complementary intervention for motor and sensory rehabilitation in individuals with mild cervical injuries, including CCS.

To investigate the impact of massage therapy on pain syndrome and shoulder function in women undergoing mastectomy, specifically those referred to oncology centres in Kerman. This study was conducted as a randomised clinical trial, the convenience sampling method was employed, and the samples were randomly divided into two groups. The Swedish massage group (n=21) received Swedish hand massages for a duration of 3&#x2009;weeks, with two sessions per week, each lasting 20&#x2009;min. The sham group (n=21) underwent light stroking of the corresponding hand for the same duration and frequency. The data collection process involved gathering demographic and background information and utilising the Shoulder Pain and Disability Index. Data were collected prior to the intervention, immediately after the intervention and 1&#x2009;month after the intervention. In the massage group, the mean pain syndrome score was 5.62, 1.89 and 5.42 before the intervention, immediately and 1&#x2009;month after the intervention, respectively. In the sham group, the mean pain syndrome scores were 6.51, 4.94 and 6.32 before the intervention, immediately after the intervention and 1&#x2009;month later, respectively. Shoulder dysfunction mean scores in the massage group were 3.84, 1.20 and 3.43 before the intervention, immediately after the intervention and 1&#x2009;month later, respectively. In the sham group, the mean shoulder dysfunction scores were 3.73, 2.73 and 3.43 before the intervention, immediately after the intervention and 1&#x2009;month later, respectively. The pain syndrome score and shoulder dysfunction decreased immediately after the massage compared with the sham group (p<0.05). Swedish massage could effectively reduce pain syndrome and shoulder dysfunction in patients who underwent mastectomy surgery. Based on these findings, Swedish massage can be applied in clinical practice as a simple, low-cost and non-invasive complementary therapy to support pain relief and functional recovery in oncology and rehabilitation clinics. IRCT20221213056803N1; Iranian Registry of Clinical Trials on 8 January 2023. https://irct.behdasht.gov.ir/trial/67387; recruitment start date: 2023.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a common condition that can cause dyspnea, pain, and biomechanical-postural alterations, especially when overlapping with Myofascial Pain Syndrome (MPS). Balneological rehabilitation medicine can help manage COPD and MPS, but it lacks homogeneity and detailed descriptions of effective therapeutic protocols. Therefore, we conducted a case series to preliminarily evaluate the clinical effects of a detailed and codified approach, called Bio-Physico-Metric Integrated Thermal Care (BPM-ITC), for COPD+MPS. Methods: 10 patients were observed while undergoing 20 sessions of BPM-ITC in 4 weeks. Patients were assessed before and after the protocol using the Medical Research Council (MRC) dyspnea scale, Numeric Pain Rating Scale (NPRS), and the Bio-Postural Questionnaire (BPQ) for bio-physical health status. Treatments included manual therapy of key myofascial trigger points combined with crenotherapy, steam inhalations, mud therapy, vascular path, and water-based motor re-education. Results: At the end of the protocol, clinically relevant improvements were observed in almost all parameters considered in single observed cases; overall statistical analysis of the data highlighted significant positive effects in concomitance with the BPM-ITC protocol. Conclusions: The BPM-ITC protocol was followed by significant clinical improvements in the observed cases, suggesting its potential as a complementary approach for COPD+MPS. Further studies on this topic are recommended.

While studies have shown a possible link between antipsychotic medication and the development of breast cancer, results remain inconclusive. The aim of the study was to assess the relationship between antipsychotic therapy and breast cancer risk, providing relevant determinative insights. A systematic database search was conducted in PubMed, ScienceDirect, and Cochrane Library databases, along with a manual search of references, until October 13th, 2025, for literature on studies investigating the association between antipsychotic therapy and breast cancer in women. Primary analysis involved an overall hazard ratio meta-analysis, with secondary odds ratio analysis for complementary evidence. Further subgroup and meta-regression analyses were conducted. Subgroup and meta-regression analyses aimed to address heterogeneity and examine any potential association between the factors that varied, and the outcomes reported. The present meta-analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Seventeen studies with 3,347,235 patients were included. Results support that exposure to antipsychotics leads to an overall 21% increased risk for breast cancer (HR&#x2009;=&#x2009;1.21, 95% CI 1.03-1.42) compared to no exposure, which was more pronounced among retrospective studies. Furthermore, prolactin (PRL)-increasing antipsychotics pose an elevated risk (HR: 1.23, 95% CI 1.08-1.40) compared to PRL-sparing or none. Additionally, prolonged duration of therapy overall was associated with increased breast cancer risk (>&#x2009;5&#xa0;years: HR: 1.47, 95% CI 1.22-1.76), when compared to therapy for less than 1&#xa0;year. Furthermore, first generation antipsychotics (FGAs) showed a significant association with duration (OR: 1.46, 95%CI 1.32-1.62), although second generation antipsychotics (SGAs) had no statistically significant results (OR: 1.09, 95% CI 0.94-1.25). There is a statistically significant association between breast cancer risk in women and the use of antipsychotics. PRL-increasing medications seem to have a higher correlation with breast cancer risk compared to PRL-sparing drugs. Longer duration of exposure to FGAs results in a higher risk of breast cancer. While these findings are hypothesis-generating, they underline the need for definitive prospective studies accounting for confounding factors. Careful consideration of medical history is required when choosing antipsychotic therapy to optimize both effectiveness and safety.

Musculoskeletal pain can undermine athletic performance. Medical procedures that fall under Western medical acupuncture (WMA) such as dry needling, grounded in conventional scientific principles, represent a promising adjunct to conventional pain treatments. However, its effectiveness among athletes remains unclear. To address this gap, we conducted a systematic review and meta-analysis to assess whether WMA reduces pain in athletic populations. We searched PubMed, Web of Science, SPORTDiscus, Allied and Complementary Medicine databases, and Google Scholar (latest search: July 2023). We included primary studies that used WMA techniques, including dry needling, manual acupuncture, and percutaneous needle electrolysis, applied based on biomedical principles. Eligible studies diagnosed pain using conventional medical criteria or validated tools and selected evidence-based acupoints based on peer-reviewed research and/or conventional anatomy and physiology, without reference to traditional Asian acupuncture principles. Random-effects meta-analyses were conducted to assess pre-post and between-group changes in pain. We included 8 studies with overall good internal validity. Publication biases and heterogeneity between studies were identified. In pre-post within-group analyses, WMA techniques alone significantly reduced mean pain scores (number of studies (n)&#x202f;=&#x202f;5, p-value&#x202f;=&#x202f;0.002) whereas WMA techniques combined with exercise and/or physiotherapy showed a nonsignificant reduction (n =&#x202f;3, p-value&#x202f;=&#x202f;0.206). In between-group comparisons, significant decreases in mean pain scores were observed for both WMA techniques alone (n =&#x202f;1, p-value&#x202f;=&#x202f;0.0003) and WMA techniques combined with exercise and/or physiotherapy (n =&#x202f;3, p-value&#x202f;=&#x202f;0.011). The certainty of evidence was rated low for WMA techniques alone and moderate for WMA techniques combined with physiotherapy and/or exercise. Our findings suggest that WMA techniques alone or combined with physiotherapy and/or exercise may reduce pain among athletes. However, the current evidence base remains preliminary, and additional well-controlled trials are required to establish its efficacy with greater confidence. https://osf.io/qb9gc/overview, identifier osf.io/qb9gc.

Background/Objectives: Shoulder disorders are among the most prevalent musculoskeletal conditions, with lifetime prevalence reaching 67% and substantial associated disability and economic burden. Geographic barriers and workforce shortages impede access to optimal rehabilitation. This narrative review aims to synthesize current evidence on tele-diagnostics and tele-rehabilitation in shoulder disorders, evaluate clinical outcomes and implementation factors, and explore models for integrating these complementary approaches. Methods: A structured but non-systematic literature search was conducted across PubMed, Scopus, and Web of Science covering publications from January 2010 through December 2025, using terms related to telehealth, tele-rehabilitation, tele-diagnostics, and shoulder disorders. Priority was given to randomized controlled trials, systematic reviews, feasibility studies, and clinical practice guidelines in adult populations. A total of 97 articles were included in the final narrative synthesis. Results: Tele-diagnostic approaches demonstrate acceptable reliability for range-of-motion assessment and general diagnostic classification, though glenohumeral instability evaluation remains challenging remotely. Multiple randomized controlled trials suggest non-inferior outcomes for tele-rehabilitation compared to conventional physiotherapy across rotator cuff repair, shoulder arthroplasty, and conservative management, with generally high patient satisfaction. Certainty of evidence is currently low to moderate due to short follow-up durations, modest sample sizes, and heterogeneous protocols. Key implementation barriers include the digital divide, inability to deliver manual therapy, and insufficient long-term outcome data. Conclusions: Current evidence supports telehealth as a viable complement to conventional shoulder care, with the strongest evidence base for postoperative tele-rehabilitation. Hybrid care models appear clinically feasible, though widespread adoption requires standardized outcomes, longer-term trials, and strategies addressing health equity barriers.