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Coccydynia is characterized by persistent tailbone pain that significantly impairs quality of life. Despite conservative treatments, many patients experience inadequate symptom relief. Prolotherapy, a regenerative injection technique for chronic musculoskeletal pain, shows promise; however, its efficacy for coccydynia has not been evaluated in controlled comparative studies. To the best of the authors' knowledge, this is among the first such studies. This retrospective comparative study evaluated 56 patients with primary chronic coccydynia refractory to conservative management. Twenty-nine patients received ultrasound-guided 10% dextrose prolotherapy combined with therapeutic exercises and patient education; 27 patients received exercises and education alone. Mean pain duration was 20.7 ± 17.3 months (prolotherapy) and 26.9 ± 17.3 months (control). Primary outcomes were pain intensity and functional disability at baseline, 1-month, and 3-month follow-up. Secondary outcomes comprised the Paris Functional Coccydynia Impact Questionnaire. Ultrasound-guided dextrose prolotherapy combined with therapeutic exercises demonstrated superior efficacy compared to exercises alone. The prolotherapy group achieved a 73% pain reduction at 3 months versus 26% in controls. An 82.8% clinical response rate and 37.9% complete pain resolution were observed, with a favorable safety profile. These results support prolotherapy as an effective, minimally invasive option for chronic coccydynia following failed conservative management. Tailbone pain (coccydynia) is a persistent pain at the base of the spine that gets worse with sitting or standing up. It affects daily life significantly and is more common in women. Many people do not get enough relief from standard treatments such as cushions, activity changes, and physiotherapy.This study looked at whether injecting a sugar-water solution (dextrose prolotherapy) into the tailbone area, guided by ultrasound imaging, could reduce pain and improve function in 56 patients who had tailbone pain for at least six months and had already tried standard treatments without adequate relief.Twenty-nine patients received three ultrasound-guided dextrose injections alongside a structured exercise and education program. Twenty-seven patients received the exercise and education program alone. Pain and ability to carry out daily activities were measured before treatment and at one and three months after starting treatment.Patients who received the injections had much greater reductions in pain (73%) and improvements in daily function (77%) at three months compared with those who received exercises alone (26% and 25%, respectively). The treatment was safe, with only minor and short-lived side effects such as temporary soreness at the injection site.These findings suggest that ultrasound-guided dextrose injections may be a useful and safe option for people whose tailbone pain has not responded to standard treatments.

Chronic spinal pain is a major public health challenge, but its management seldom considers the environmental impact of healthcare practices. This study aimed to identify consensus-based recommendations for integrating environmental sustainability into chronic spinal pain care. Clinical practice guidelines on chronic spinal pain and literature on sustainable practices were reviewed to develop an initial set of statements. Following the ACCORD reporting guideline, a modified three-round Delphi study was conducted to obtain international consensus on the statements' agreement and importance. Physiotherapists from clinical, educational, and research backgrounds participated. The initial domains included environmental advocacy and policies, education, research and innovation, community engagement, sustainable clinical practices. Consensus was defined as an interquartile range (IQR) ≤ 1 for both dimensions. The preparatory review of clinical guidelines and sustainability literature identified five domains and informed the development of 47 statements and seven questions. Of the 150 experts invited, 49 participated (44 in Round 1, 35 in Round 2, 30 in Round 3), representing diverse clinical, educational, and research backgrounds from multiple world regions. By the end of the three rounds, 49 statements were classified as consensus recommendations; items with a median of 3 were reported separately as uncertain statements. This international Delphi study achieved broad consensus on integrating sustainable physiotherapy practices for chronic spinal pain management. The findings contribute to a framework that can inform future guidelines and orient research, education, and policy toward more sustainable care. Chronic spinal pain management is increasingly promoted within conservative care models, yet its environmental sustainability remains largely unexplored in pain research. This international modified Delphi study establishes expert consensus on integrating sustainability considerations into physiotherapy for chronic spinal pain. By providing a structured framework, the findings inform future research agendas, guideline development, and professional education, contributing to more sustainable and responsible pain management aligned with planetary health challenges.

This study evaluated the effectiveness of web-based educational video module on diabetes knowledge, empowerment, and clinical outcomes among adults with poorly controlled type 2 diabetes in a primary care setting. A single-centre, parallel-group, randomised controlled trial was conducted at a public primary care clinic in Malaysia. Adults aged 18 years or older with type 2 diabetes for at least six months and poor glycaemic control were randomly assigned to receive either a web-based educational video intervention or standard care. The intervention consisted of culturally adapted, multilingual educational videos covering diabetes self-care, medication use, diet, physical activity, and complication prevention, supported by monthly follow-up reminders. Primary outcomes were diabetes knowledge and empowerment. Secondary outcomes included HbA1C, blood pressure, fasting lipid profile, body mass index, and waist circumference. Outcomes were assessed at baseline, three months, and six months. A total of 232 participants were randomised into intervention and control groups (n&#x2009;=&#x2009;116 each), with mean age of 59 years old, slight male predominance (53.0%) and mostly Malay (43.1%), with obesity (51.7%). Following the web-based intervention, participants demonstrated significant improvements in diabetes knowledge (&#x3b2;&#x2009;=&#x2009;23.74, 95% CI: 20.57-26.91) and empowerment (&#x3b2;&#x2009;=&#x2009;11.53, 95% CI: 9.98-13.09) compared with those receiving standard care at both three and six months (p&#x2009;<&#x2009;0.001). Improvements in HbA1C, blood pressure, fasting lipid profile, body mass index, and waist circumference were also observed in the intervention group relative to controls (p&#x2009;<&#x2009;0.05). A culturally adapted, web-based educational video module was associated with improvements in diabetes knowledge, empowerment, and cardiometabolic outcomes among adults with poorly controlled type 2 diabetes. These findings support the use of web-based education as a scalable adjunct to standard diabetes care in primary care settings.

Extended Reality (XR) technologies offer unprecedented opportunities to redefine physical rehabilitation experiences through embodied telepresence and full-body motion tracking. Realizing meaningful XR in physical rehabilitation requires stakeholder input addressing remote embodied therapy's unique design challenges. This study presents one of the first stakeholder co-design workshops on embodied telehealth for physical rehabilitation, engaging participants [N = 24 total including ten clinicians, eight patients, three designers, and three engineers] across five focus groups with stakeholders from clinical, academic, and industry settings. Through structured usability testing and a four-axis framework analysis, we evaluated immersive Virtual Reality (VR) applications supporting synchronous clinician-led embodied appointments and asynchronous clinician-authored patient home exercise programs with full-body tracked avatars and biomechanical assessments. Stakeholder feedback reinforced the need for embodied agency with adaptive input modalities for diverse patient needs, ensuring clinical authenticity through real-time full-body tracking for accurate movement correction and scaling interaction complexity from minimal interfaces for VR novices (78% of participants) to customizable clinical dashboards. Crossstakeholder prioritization identified minimalist XR interface navigation (19 votes) and flexible clinical assessment capabilities (17 votes) as the highest-priority design requirements, while exit surveys suggested high patient comfort (M = 4.50/5) and strong clinician adoption interest (M = 4.14/5). We propose six design principles for meaningful XR telehealth in physical rehabilitation: 1) embodied guidance with real-time feedback, 2) progressive complexity with minimalist defaults, 3) adaptive accessibility through multi-modal input, 4) clinical authenticity via domain-specific assessments, 5) biomechanical precision for trust and safety, and 6) contextual onboarding to improve therapeutic competency. These findings offer design considerations for developing embodied XR telehealth systems that support sustained therapeutic engagement and meaningful rehabilitation outcomes.

Regular physical activity (PA) improves clinical outcomes and quality of life after solid organ transplantation, yet many recipients remain inactive during early recovery. Health literacy (HL) may influence posttransplant health behaviors. In this prospective observational study, consecutive adult kidney, liver, and lung transplant recipients at the Centre hospitalier de l'Universit&#xe9; de Montr&#xe9;al (CHUM) between March 1 and December 1, 2023 were assessed approximately two months after discharge. Functional HL was measured using the Short Test of Functional Health Literacy in Adults (S-TOFHLA). Weekly moderate to vigorous PA was assessed using face-to-face interview during outpatient visits and categorized according to World Health Organization recommendations (<150&#xa0;vs. &#x2265;150 min/week). Multivariable logistic regression evaluated the association between HL and PA, adjusting for age, sex, body mass index, history of depression and/or current antidepressant treatment, education level, and transplant type. Eighty-five recipients were included; Thirty-two patients were not eligible for inclusion (language barrier, re-transplantation, refusal, or death). Thirty-nine participants (45.8%) met recommended PA levels. Higher HL was independently associated with achieving PA recommendations (OR per 1-point increase: 1.09; 95% CI 1.02-1.17; p = 0.01). PA engagement was not associated with age, sex, education level, history of depression and/or current antidepressant treatment, or transplant type. Nearly half of recipients achieved guideline-recommended PA approximately two months after transplantation, indicating that meaningful activity is feasible during early recovery. Higher functional HL was independently associated with PA engagement, supporting the integration of literacy-sensitive approaches into posttransplant rehabilitation.

Pulmonary rehabilitation (PR) has been widely studied and established as an effective intervention in several chronic pulmonary diseases. Nevertheless, evidence in adults with asthma remains inconclusive. . To assess the efficacy of PR, including at least education and exercise training (ET), in adults with asthma. . This systematic review followed PRISMA guidelines. Four databases were searched from inception to November 2025. We included randomized clinical trials in adults with asthma who underwent a PR intervention compared to other interventions (including PR within education and ET components), usual care, or no intervention. Primary outcomes were asthma control, lung function, exercise capacity, and airway inflammation. Certainty of evidence and risk of bias were assessed. . Sixteen studies were included, and thirteen in at least one meta-analysis. Most studies enrolled moderate-to-severe asthma. Meta-analysis results showed significant differences in favor of PR in asthma control, exercise capacity, quality of life, anxiety, and depression compared to control group (CG). PR showed significant differences at short-term follow-up in asthma control and quality of life. No significant differences were observed for lung function, airway inflammation, physical activity levels, and body composition. Most studies had a high risk of bias, and the certainty of evidence was very low for some outcomes. . PR improved asthma control, exercise capacity, quality of life, anxiety, and depression in adults with asthma compared to CG. Nevertheless, these findings should be interpreted cautiously because of the high risk of bias, low certainty of evidence for some outcomes, and uncertainty in sensitivity analyses.

Older adults exhibit unique risks associated with poor mental health and substance use. The Beyond 50 study is a longitudinal cohort investigating the determinants of healthy ageing, including relationships between physical and psychosocial health and substance use. We aim to characterise the Beyond 50 cohort and explore patterns of physical and psychosocial health and substance use. Baseline data collection was completed between September 2023 and August 2024. Annual follow-up data collection commenced in September 2024. Descriptive statistics will be used to characterise the cohort at the time of baseline survey completion. Of the 1059 participants, the mean age was 61 years (standard deviation 0.2 years) and 46.8% were female. Just over half (52.4%, n&#x2009;=&#x2009;555) received a positive screen for potentially hazardous alcohol consumption (past 12-month use), 8.7% (n&#x2009;=&#x2009;92) reported recent tobacco use, 3.7% (n&#x2009;=&#x2009;39) reported recent cannabis use and 5.5% (n&#x2009;=&#x2009;58) reported other nonmedical substance use. Twelve percent (n&#x2009;=&#x2009;134) screened positive for the symptoms of moderate to severe anxiety, 16.4% (n&#x2009;=&#x2009;174) screened positive for the symptoms of moderate to severe depression, 15.7% (n&#x2009;=&#x2009;166) were moderately to severely lonely and 22.6% (n&#x2009;=&#x2009;239) reported being dissatisfied with their social relationships. The Beyond 50 cohort displays high rates of alcohol use, with levels of social isolation, loneliness, anxiety and depression comparable to the broader Victoria population. This lends to the cohort's ability to provide further insight into factors that affect healthy ageing and will allow for detailed analysis into the impacts of various physical and psychosocial factors on overall health and wellbeing.

Frailty associated with aging, characterized by chronic inflammation and immune dysfunction, poses a significant public health challenge. Human umbilical cord-derived mesenchymal stem cells (HUC-MSCs) exhibit immunomodulatory properties; however, their mechanism of action in frail elderly populations remains unclear. Building on a prior clinical trial investigating HUC-MSCs for elderly frailty (Trial Registration: ClinicalTrials.gov, NCT04314011; PubMed ID: 38679727), this study was conducted to further elucidate the mechanism of action of HUC-MSCs. We performed a longitudinal single-cell RNA sequencing (scRNA-seq) study on peripheral blood mononuclear cells (PBMCs) from frail elderly patients before and after HUC-MSCs therapy. Immune cell dynamics were analyzed across multiple time points, and cell-cell communication networks were reconstructed. Spearman correlation analyses were performed to link immune changes with clinical frailty and physical performance metrics. HUC-MSCs induced a time-dependent recalibration of the immune system. An early, transient expansion of MAIT cells (p=0.049) was followed by a sustained reduction in B cell hyperactivity (p=0.032) and a phenotypic shift in na&#xef;ve B cells. NK cell cytotoxicity was enhanced (increased GNLY), while NKT cells showed modulated stress-response signatures. Cell-cell communication was reorganized, with the EPHA/NRG pathways highlighting CD4+ TEM, MAIT, and NKT cells as central signaling hubs. Critically, these immunomodulatory changes were quantitatively associated with clinical improvement: reductions in B cell and innate immune subsets correlated with gains in grip strength and gait speed, while regulatory T cell expansion was linked to improved lower-limb function. HUC-MSCs restore immune homeostasis in aging frailty through sequential, multi-faceted immunomodulation. The association between specific immune remodeling features and functional recovery positions HUC-MSCs as a promising mechanism-based therapy for aging frailty.

Pain and chronic pain are prevalent and costly. Integrative models of pain management including the biopsychosocial (BPS) model of pain are central to contemporary public health efforts to address pain, however, uptake of the BPS model of pain in patient care is inconsistent. Aspects of health professions education (HPE) have been identified as barriers to BPS use including emphasis on the medical model and the hidden curriculum. Similarly, hidden curriculum in HPE limits disability inclusion and reduces healthcare accessibility. This perspective offers a conceptual framing of ableism as a driving force for both marginalizing and exclusionary features in HPE. Ableism centers on normative ways of functioning, thinking, and being, which contributes to training of providers who may not apply holistic and multidimensional understanding of pain. Dismantling ableism and working toward anti-ableist HPE requires recognition of ableism, cultivating environments that model anti-ableist approaches, and addressing the contributing systems. By transforming learning environments and promoting anti-ableist HPE, the same dispositional and structural conditions needed for BPS approaches to pain can be achieved.

Exercise is a nearly ubiquitous recommendation in musculoskeletal (MSK) physiotherapy (PT), yet confidence, consistency, and clarity in how prescription decisions are made and communicated remain limited. Inconsistent reporting of exercise parameters obscures whether interventions are delivered at therapeutic intensities, while opaque prescription reasoning limits clinical practice translation. Current approaches often emphasize prescription outputs rather than longitudinal reasoning that links patient assessment to prescription, progression, and modification. Existing efforts have advanced exercise prescription by highlighting the complexity of mechanisms, specifying targets, and proposing region-specific models. Yet, no shared language or systematic processes allow exploration and explanation of the often-implicit reasoning strategies used to justify our prescription decisions across MSK presentations. High-quality exercise prescription is an iterative, progressive process that requires individualized integration of biopsychosocial patient factors into actionable and specific parameters. The purpose of this Professional Practice paper is to establish the rationale for a shared exercise prescription framework in MSK patients and to briefly introduce a novel Exercise Decision Making Framework. Greater standardization of the reasoning process, rather than prescription itself, may improve our ability to appraise exercise prescription and identify warranted, individualized practice from unwarranted variation. A clearer framework for how exercise is selected, dosed, progressed, and modified according to the patients' biopsychosocial profile may strengthen clinical reasoning, improve translation of research into practice, and better prepare graduates for contemporary MSK care. As PT continues to define expertise around movement, improving how we prescribe exercise should be a priority.

Standalone digital behavior change interventions (DBCIs) are increasingly used to promote physical activity (PA), but their post-intervention durability remains unclear. This focused mini review with quantitative synthesis examined maintenance and attenuation of standalone DBCI effects on PA in adults. PubMed, Web of Science Core Collection, and SPORTDiscus were searched without date restrictions, with the final search conducted on 3 May 2026. Eligible studies were randomized controlled studies involving adults, standalone DBCIs targeting PA, a comparator not receiving the target structured DBCI, and PA outcomes assessed post-intervention and at &#x2265;1 follow-up. Random-effects meta-analyses used Hedges' g, with the longest follow-up used for the primary maintenance analysis. Seventeen studies involving 8,990 participants were included in the review, of which 13 contributed effect sizes to the primary quantitative synthesis. Standalone DBCIs showed a small, non-significant effect at the longest follow-up (g&#x202f;=&#x202f;0.13; p&#x202f;=&#x202f;0.066; I 2&#x202f;=&#x202f;64.2%), with low-certainty evidence. Time-window analyses showed a small significant post-intervention effect (g&#x202f;=&#x202f;0.14; p&#x202f;=&#x202f;0.048), whereas follow-up effects were small and non-significant. Meta-regression showed no clear progressive attenuation. Standalone DBCIs showed small positive post-intervention point estimates, but evidence remains insufficient to establish reliable maintenance after active support is reduced or withdrawn. Future studies should use repeated follow-ups and report engagement, continued tool access, and post-intervention support.

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Current guidelines for the management of lumbar radiculopathy recommend patient education, staying active, manual therapy, and nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line treatments. Physiotherapy-specific interventions for low back pain that radiates to the leg include specific trunk muscle activation, muscle strengthening and endurance, movement control, centralisation, directional preference exercises and nerve mobilisation. While exercise therapy is widely recognised as an effective non-invasive intervention, there is currently limited evidence for a standardised framework that integrates different evidence-based exercise approaches and clinical expertise into a structured, practically applicable protocol. The purpose of this study was to develop and content-validate a structured, evidence-based exercise framework for the physiotherapy management of lumbar radiculopathy. A comprehensive review of the literature supplemented by expert input with at least 10&#xa0;years of experience was conducted to identify commonly prescribed exercise interventions for lumbar radiculopathy. Based on the identified impairments and functional deficits associated with the condition, an initial draft framework, which included trunk stabilization, mobility and flexibility training, was constructed. The draft framework was then subjected to expert validation using the content validity index (CVI) and modified kappa to confirm the relevance and perceived ease of performance of exercise by 10 physiotherapists. The 4-stage exercise framework demonstrated excellent agreement with high CVI (100%-90%) and modified kappa (1-0.90). While some exercises of phase 2 and phase 3 were considered slightly difficult to perform, they were relevant for the condition. The developed exercise framework exhibited excellent content validity, supporting its relevance and perceived ease of performance in physiotherapy practice for managing patients with lumbar radiculopathy.

To systematically evaluate the certainty of evidence for treatment strategies across age groups and mood phases in bipolar disorder, and develop an open access web platform to facilitate shared decision making. Living umbrella review, evaluation, analysis, and communication hub (U-REACH) project. PubMed, PsycInfo, and Cochrane library databases, from inception to 19 November 2024. Systematic reviews with network or pairwise meta-analyses of randomised controlled trials of pharmacological, nutraceutical, psychosocial, brain stimulation, or circadian rhythm based treatments, administered as monotherapy (without concurrent interventions), augmentation treatment (interventions added to an ongoing treatment regimen), or combination treatment (simultaneous initiation of two different interventions), examining any age group, bipolar disorder phase (ie, acute bipolar depression, mania or mixed episodes, or maintenance), treatment, control, or outcome. 77 studies met the inclusion criteria (21 network meta-analyses and 56 pairwise meta-analyses), including 116 unique pharmacological (n=74), brain stimulation (n=18), nutraceutical (n=13), psychosocial (n=8), and circadian rhythm based (n=3) treatments as monotherapy, augmentation, or combination therapy, along with five control interventions. These studies covered 133 unique outcomes (45 efficacy outcomes and 88 safety outcomes) resulting in 2510 meta-analyses with Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) ratings of the certainty of the evidence as high (n=236), moderate (n=827), low (n=986), and very low (n=461). A communication hub, the Evidence Based Interventions for Bipolar Disorder (EBI-BD) platform, was developed and the full results are freely available (https://ebibd-database.org), including the preference based tool (12 interventions and 17 safety outcomes). Interventions effective across outcomes varied by phases. For bipolar depression, effective interventions in adults were cariprazine, divalproex or valproate, fluoxetine, ketamine (augmentation), lamotrigine, lumateperone, lurasidone, olanzapine, olanzapine with fluoxetine, and quetiapine, whereas effective interventions in children and adolescents were lurasidone and olanzapine with fluoxetine. For mania episodes, effective interventions in adults were aripiprazole, asenapine, carbamazepine, cariprazine, divalproex or valproate, haloperidol, lithium, olanzapine, paliperidone, quetiapine (also augmentation), risperidone (also as augmentation), tamoxifen, and ziprasidone, whereas effective interventions in children and adolescents were aripiprazole, asenapine, olanzapine, quetiapine, and risperidone. For maintenance, interventions effective across outcomes in adults were aripiprazole (also the long acting injectable formulation), asenapine, divalproex or valproate, lithium, olanzapine, group psychoeducation (augmentation), quetiapine, and risperidone long acting injectable formulation. Interventions effective across phases were aripiprazole (also as augmentation and as a long acting injectable formulation), asenapine, cariprazine, cognitive behavioural therapy (augmentation), divalproex or valproate, lamotrigine, lithium, olanzapine (also as augmentation), paliperidone, quetiapine (also as augmentation), and risperidone (also as augmentation and the long acting injectable formulation) (adults). Treatment effects by neuroscience based nomenclature classes are also reported. The EBI-BD tool can help clinicians make evidence based, personalised treatment decisions for bipolar disorder. This resource can inform clinical guidelines and provides a foundation for continuously improving bipolar disorder care as new evidence emerges. Open Science Framework https://osf.io/pjmvn/ READERS' NOTE: This is a living systematic review and may be updated in the next two years if additional evidence emerges.

Within health science education, arts and humanities interventions are used to teach compassion, yet the connection between methodologies and outcomes is often tenuous. While evidence-based methods for cultivating compassion exist, they are rarely described as guiding frameworks for arts-based or humanities interventions. Additionally, arts practitioners and humanities educators familiar with the theory, pedagogy, and practices of their disciplines are often absent from interventions that could benefit from their expertise. Educational models that are grounded in the available evidence from social neuroscience and informed by creative writing theory and pedagogy can address these gaps. In 2024 and 2025, 2 "Dear Human" workshops were conducted for 25 health professions students, staff, and faculty associated with the Medical University of South Carolina in collaboration with the Gibbes Museum of Art. The workshop approach was informed by evidence-based frameworks for cultivating compassion, museum-based education, and creative writing. The educational session incorporated a sequence of creative writing exercises designed to promote presence, perspective-taking, and affective connection, a motivator of compassionate action. The authors constructed themes based on analysis of 25 participants' written workshop responses and found in those responses attitudes and motivations proximal to affective connection, common humanity, and applied compassion. They also determined that revision of the educational design could ensure the model aligns with best practices in compassion training, specifically by being more directive in the call to respond to imagined suffering. Next steps involve revising the final prompt of the "Dear Human" sequence to be more directive in its call to recognize and respond to the imagined suffering of humans depicted in visual art. After revision, the goal is to assess the new version, offer the innovation to larger groups of health science students and practitioners, and encourage mixed-methods research of the approach.

Cerebral palsy (CP) is a leading cause of physical disability worldwide, affecting approximately 2 -3 per 1,000 live births. In sub-Saharan Africa, access to assistive devices supporting participation in occupation remains constrained by inadequate rehabilitation services and limited evidence. This study examined the utilisation, perceived benefits and challenges associated with assistive devices use among children with CP attending rehabilitation centres in Rwanda. We conducted a cross-sectional study at Gatagara Orthopaedic and Rehabilitation Hospital and Gahini Rehabilitation Centre among 50 caregivers of children with CP using assistive devices. Data were collected using a sociodemographic questionnaire and the World Health Organisation's Rapid Assistive Technology Assessment. Descriptive and analytical analyses were performed. Improved playing skills were associated with standing frame use (AOR = 2.8, p&#x2009;=&#x2009;0.02). Self- feeding was associated with the use off adapted spoon use (AOR = 4.5, p&#x2009;=&#x2009;0.03); while improved dressing was associated with orthosis use (AOR = 3.1, p&#x2009;=&#x2009;0.047). Enhanced self-care was associated with higher caregiver education (AOR = 2.9, p&#x2009;=&#x2009;0.04). Better attention span was associated with daily rather than weekly assistive device use (AOR = 3.2, p&#x2009;=&#x2009;0.025). However, high device cost particularly among the poorest households, long travel distances, stigma, and lower parental education were associated barriers to the utilization of devices. Assistive devices improved play, self-care, dressing, and attention with caregiver support. However, persistent economic, geographic, and educational challenges limit equitable access, underscoring the need for affordability, context-approach, and community-based rehabilitation support. Assistive devices have meaningful implications for rehabilitation practice in low-resource contexts, particularly for Rwandan children with cerebral palsy (CP) who face substantial motor and functional limitations. The findings from this study demonstrate that when appropriately matched to functional goals and used consistently, devices such as standing frames, orthoses, and adapted utensils can enhance participation in play, self-care, attention, and dressing for the children. These findings underscore the necessity for rehabilitation professionals to strengthen caregiver training and promote regular device use at home, as caregiver competence is central to maximising functional gains. At the systems level, the significant barriers identified especially high costs, limited availability, long travel distances, and persistent stigma indicate the urgency of expanding community-based rehabilitation, establishing paediatric rehabilitation units, and improving maintenance and repair services to ensure sustained use. Addressing socioeconomic inequities through subsidised services, local production of low-cost devices, and integration of assistive technologies into national health schemes is also essential for improving accessibility. Furthermore, community awareness initiatives are desirable to reduce social stigma and support social acceptance of device use. Overall, our results reinforce that effective rehabilitation requires a combination of individualised device provision, empowered caregivers, and system-wide strategies that address structural and contextual challenges to promote equitable participation and quality of life for children with CP.

Women living with and beyond breast cancer or a gynecologic malignancy frequently face a combined burden of endocrine disruption, treatment-related symptoms, psychological distress, fatigue, fear of recurrence, and conflicting dietary information. These factors may impair nutrition literacy, weaken confidence in dietary self-management, and reduce adherence to evidence-informed nutrition recommendations. This Mini Review examines the behavioral pathway linking psychological and educational barriers to dietary behaviors in women with breast and gynecologic malignancies. We focus on four interconnected domains: hormone-related emotional vulnerability and treatment-related symptom burden; anxiety, depression, fatigue, and fear of recurrence as drivers of avoidant or inconsistent eating behaviors; nutrition misconceptions and restrictive dietary beliefs that may increase malnutrition risk; and structured nutrition education as a self-management strategy. Existing guidelines support nutrition screening, individualized counseling, healthy dietary patterns, weight management, and physical activity as survivorship priorities, but implementation is often limited by low health literacy, fragmented communication, and insufficient psychosocial support. We propose that survivorship nutrition programs should integrate psychological screening, myth correction, plain-language nutrition literacy education, symptom-responsive meal planning, family involvement, and digital follow-up. Such behaviorally informed education should be evaluated using measurable outcomes, including dietary adherence, nutritional status, body weight and body composition, symptom control, quality of life, and sustained self-management across survivorship.

Cancer affects multiple physical, psychological, and social aspects of an individual's life. Cancer survivors frequently report unmet needs long after diagnosis and require ongoing support. AI is increasingly embedded in patient-facing digital health technologies (DHTs) in oncology, yet its impact on different domains of patients' and survivors' health-related quality of life (HRQOL) remains unclear. This systematic review aims to (1) examine how AI has been integrated into patient-facing DHTs designed to support cancer survivors, (2) narratively synthesize the potential effects of these technologies on HRQOL and provide preliminary quantitative estimates through an exploratory meta-analysis, and (3) explore broader changes in additional patient-reported outcomes (PROs; secondary aim). PubMed, PsycINFO, Embase, Scopus, CINAHL, and the Cochrane Library were searched for articles published between January 2020 and August 2025. Reference lists of included articles were hand-searched for additional eligible studies. Eligible studies enrolled cancer survivors of any age and disease stage, evaluated a patient-facing DHT with AI components, and assessed HRQOL. Nonoriginal research and non-English reports were excluded. Risk of bias was assessed in all controlled studies using RoB 2 (revised Cochrane risk of bias 2) or ROBINS-I V2 (Risk of Bias in Non-Randomized Studies-of Interventions, Version 2), according to study design. Data on HRQOL and other PROs were synthesized narratively, and exploratory random-effects meta-analyses were conducted for HRQOL domains. Eight reports from 7 studies from China and the United States (N=2867 participants) met the inclusion criteria, and 3 (n=292 participants) contributed to the exploratory meta-analysis. All studies included adults with various cancers at different stages and times since diagnosis. Most studies showed low risk of bias or some concerns (RoB 2), but one was evaluated as having a serious risk of bias (ROBINS-I V2). AI applications ranged from symptom monitoring to targeted education. The narrative synthesis suggested positive effects on selected HRQOL domains, particularly general health, with more pronounced effects in studies conducted in China. Exploratory meta-analyses demonstrated provisional moderate positive effects on global health (Hedges g=0.77, 95% CI 0.15-1.40) and social functioning (Hedges g=0.75, 95% CI 0.08-1.42), but no effects on physical functioning, role functioning, or emotional well-being. Other PROs indicated generally high user satisfaction and adherence, improved mental health outcomes, and reductions in physical symptoms. Only minor and mild adverse events were reported. Current evidence, although limited, suggests that AI-enabled patient-facing DHTs may benefit survivors' HRQOL and other PROs, particularly in early survivorship. However, our findings are based on small and heterogeneous studies and should therefore be interpreted with caution. Robust trials with adequate sample sizes, longer follow-up, and appropriate control conditions, including DHTs without AI components, are needed to determine the specific contribution of AI.

To analyze self-assessment of voice and swallowing in the late postoperative period of total thyroidectomy and the impact of surgery on quality of life. This is a descriptive, observational, and cross-sectional study, approved by the Research Ethics Committee of the institution. Seventeen women aged between 32 and 58 years participated in the study, mostly married, with completed higher education, residing outside the metropolitan region, who underwent total thyroidectomy without cervical lymph node dissection, without adjuvant radiotherapy, and without postoperative speech therapy follow-up for at least 6 months. Demographic and clinical data were collected, as well as the results of the Thyroidectomy-Related Voice and Symptom Questionnaire (TVSQ) and the Thyroid-Related Patient-Reported Outcome - 39 (ThyPro-39) questionnaires. Data analysis was performed descriptively. The median total TVSQ score was 26, with the highest scores found in the two cases that underwent cervical lymph node dissection. Domain 1 (vocal symptoms) of the TVSQ contributed most to the total score (48.52%). In domain 2 (oropharyngolaryngeal symptoms) of the TVSQ, scores were closer to the upper limit, representing a higher frequency of symptoms. The ThyPro-39 results revealed a greater impact of thyroidectomy on fatigue, anxiety, cognitive problems, emotion, and depression. Women undergoing total thyroidectomy present vocal and swallowing symptoms, with a predominance of vocal symptoms in the long term, associated with the negative impact of surgery on physical, emotional, and mental well-being. Furthermore, there is a compromise in quality of life regarding fatigue, emotional aspects, anxiety, cognitive problems, and depression. Analisar a autoavalia&#xe7;&#xe3;o da voz e degluti&#xe7;&#xe3;o no p&#xf3;s-operat&#xf3;rio tardio de tireoidectomia total e o impacto da cirurgia na qualidade de vida. Trata-se de um estudo descritivo, observacional e transversal, aprovado pelo Comit&#xea; de &#xc9;tica em Pesquisa da institui&#xe7;&#xe3;o. Participaram do estudo 17 mulheres com idades entre 32 e 58 anos, majoritariamente casadas, com ensino superior completo, residentes fora da regi&#xe3;o metropolitana submetidas &#xe0; tireoidectomia total sem esvaziamento cervical, sem radioterapia adjuvante e sem acompanhamento fonoaudiol&#xf3;gico p&#xf3;s-operat&#xf3;rio h&#xe1;, no m&#xed;nimo, 6 meses. Foram coletados dados demogr&#xe1;ficos, cl&#xed;nicos e os resultados dos question&#xe1;rios Thyroidectomy-Related Voice and Symptom Questionnaire (TVSQ) e Thyroid-Related Patient-Reported Outcome - 39 (ThyPro-39). A an&#xe1;lise dos dados foi realizada de forma descritiva. A mediana do escore total do TVSQ foi 26 e os escores mais elevados foram encontrados nos dois casos que fizeram esvaziamento cervical. O dom&#xed;nio 1 (sintomas vocais) do TVSQ foi o que contribuiu mais para o escore total (48,52%). No dom&#xed;nio 2 (sintomas orofaringolar&#xed;ngeos) do TVSQ, os escores ficaram mais pr&#xf3;ximos do limite m&#xe1;ximo, que representa maior frequ&#xea;ncia dos sintomas. Os resultados do ThyPro-39 revelaram maior impacto da tireoidectomia nos aspectos fadiga, ansiedade, problemas cognitivos, emo&#xe7;&#xe3;o e depress&#xe3;o. Mulheres submetidas &#xe0; tireoidectomia total apresentam sintomas vocais e de degluti&#xe7;&#xe3;o, com predom&#xed;nio dos sintomas vocais em longo prazo, associados ao impacto negativo da cirurgia no bem estar f&#xed;sico, emocional e mental. Al&#xe9;m disso, h&#xe1; um comprometimento na qualidade de vida no que se refere &#xe0; fadiga, aspectos emocionais, ansiedade, problemas cognitivos e depress&#xe3;o. Analisar a autoavalia&#xe7;&#xe3;o da voz e degluti&#xe7;&#xe3;o no p&#xf3;s-operat&#xf3;rio tardio de tireoidectomia total e o impacto da cirurgia na qualidade de vida. Trata-se de um estudo descritivo, observacional e transversal, aprovado pelo Comit&#xea; de &#xc9;tica em Pesquisa da institui&#xe7;&#xe3;o. Participaram do estudo 17 mulheres com idades entre 32 e 58 anos, majoritariamente casadas, com ensino superior completo, residentes fora da regi&#xe3;o metropolitana submetidas &#xe0; tireoidectomia total sem esvaziamento cervical, sem radioterapia adjuvante e sem acompanhamento fonoaudiol&#xf3;gico p&#xf3;s-operat&#xf3;rio h&#xe1;, no m&#xed;nimo, 6 meses. Foram coletados dados demogr&#xe1;ficos, cl&#xed;nicos e os resultados dos question&#xe1;rios Thyroidectomy-Related Voice and Symptom Questionnaire (TVSQ) e Thyroid-Related Patient-Reported Outcome - 39 (ThyPro-39). A an&#xe1;lise dos dados foi realizada de forma descritiva. A mediana do escore total do TVSQ foi 26 e os escores mais elevados foram encontrados nos dois casos que fizeram esvaziamento cervical. O dom&#xed;nio 1 (sintomas vocais) do TVSQ foi o que contribuiu mais para o escore total (48,52%). No dom&#xed;nio 2 (sintomas orofaringolar&#xed;ngeos) do TVSQ, os escores ficaram mais pr&#xf3;ximos do limite m&#xe1;ximo, que representa maior frequ&#xea;ncia dos sintomas. Os resultados do ThyPro-39 revelaram maior impacto da tireoidectomia nos aspectos fadiga, ansiedade, problemas cognitivos, emo&#xe7;&#xe3;o e depress&#xe3;o. Mulheres submetidas &#xe0; tireoidectomia total apresentam sintomas vocais e de degluti&#xe7;&#xe3;o, com predom&#xed;nio dos sintomas vocais em longo prazo, associados ao impacto negativo da cirurgia no bem estar f&#xed;sico, emocional e mental. Al&#xe9;m disso, h&#xe1; um comprometimento na qualidade de vida no que se refere &#xe0; fadiga, aspectos emocionais, ansiedade, problemas cognitivos e depress&#xe3;o.