Shoulder rehabilitation is prolonged, feedback-dependent, and frequently limited by adherence, particularly after surgery. Virtual reality (VR) and related immersive or semi-immersive technologies may support rehabilitation by combining motion tracking, visual feedback, graded repetition, and gamified engagement. This narrative review summarizes current evidence on VR and digitally assisted shoulder and upper-limb rehabilitation and critically evaluates the extent to which these data can inform post-arthroplasty pathways. A narrative review was performed using PubMed/MEDLINE, PubMed Central, and targeted cross-checking in Scopus, Web of Science, and the Directory of Open Access Journals up to May 2026. Search domains combined shoulder and upper-limb terms, virtual reality, augmented reality, mixed reality, extended reality, and exergaming terms, rehabilitation and telerehabilitation terms, and postoperative shoulder surgery or arthroplasty terms. Priority was given to systematic reviews, randomized or controlled studies, validation studies, feasibility studies, and clinician-perspective studies relevant to shoulder biomechanics and rehabilitation implementation. The available literature supports three main conclusions. First, consumer-grade immersive systems can provide reliable within-system shoulder motion monitoring, although absolute agreement across devices remains imperfect. Second, VR, exergaming, and digitally assisted rehabilitation have shown feasibility, high acceptability, and potential benefits for adherence, pain, range of motion, and patient-reported function in rotator cuff repair, adhesive capsulitis, subacromial impingement, and other shoulder disorders. Third, evidence directly specific to anatomic or reverse shoulder arthroplasty rehabilitation remains limited; therefore, extrapolation from rotator cuff repair, conservative shoulder disorders, and digital home-based arthroplasty rehabilitation should be made cautiously. Rehabilitation clinicians support supervised or hybrid use rather than autonomous unsupervised replacement of conventional care. VR should be interpreted as an adjunct to clinician-led rehabilitation, not as a stand-alone substitute. Its most plausible current roles are improving engagement, enabling structured repetition, supporting within-system range-of-motion monitoring, and extending supervised practice into home settings. Future studies should test procedure-specific, phase-based VR protocols for anatomic and reverse shoulder arthroplasty, with explicit attention to compensation control, safety limits, long-term outcomes, cost-effectiveness, and multidisciplinary oversight.
IntroductionHip osteoarthritis is a degenerative joint disease that significantly impacts quality of life. When conservative treatments fail, total hip arthroplasty becomes necessary to alleviate pain and improve mobility. Rehabilitation plays a crucial role in functional improvement after hip surgery, as it contributes to full motor recovery. However, traditional face-to-face rehabilitation can present several challenges. Telerehabilitation is an emerging approach, using e-Health tools to allow patients to perform exercises remotely. This technique could enhance accessibility, reduce costs, and increase adherence to rehabilitation programs, but it has yet to be fully investigated in terms of beneficial effects.Materials and methodsThis review was conducted following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement guidelines. The scientific articles were identified through the PubMed, Google Scholar, Scopus and Cochrane Library databases. A qualitative assessment of the selected studies was performed using the modified Oxford quality scoring system. Five studies were included in this review. The risk of bias was evaluated using the Cochrane Collaboration tool. The protocol was registered at PROSPERO (n◦ CRD42025643872).ResultsThe review found that telerehabilitation is not inferior to traditional methods in improving functional outcomes and quality of life. Challenges include methodological differences, demographic variations, and the lack of long-term data.ConclusionsThe review suggests future research should focus on long-term outcomes, including older patients, to better understand telerehabilitation effectiveness in hip replacement rehabilitation.
An increasing amount of digital health data are being collected across rehabilitation settings, but their integration into routine clinical practice remains limited, despite its potential to motivate patients or inform clinical decision-making. Specifically, effective visualization and communication of assessment outcomes to both patients and health care practitioners (HCPs) represent a key gap in the neurorehabilitation practice. This study describes the development and evaluation of RehaLink (author ND, ETH Zürich), a proof-of-concept mobile app that delivers structured, interpretable feedback from conventional and technology-based assessments to neurorehabilitation patients and HCPs. The app was developed through a 3-step iterative co-design process involving 17 inpatients with multiple sclerosis and 15 HCPs from a single rehabilitation center. The app integrates a full battery of conventional assessments routinely conducted at the clinic, as well as digital health metrics from the Virtual Peg Insertion Test, a validated technology-based assessment of upper limb function, as a proof of concept for integrating technology-based assessment data into clinical workflows. Three structured feedback sessions were conducted, in which participants evaluated feedback types, visualization formats, and app usability using Likert-scale ratings, preference rankings, open-ended questions, and the System Usability Scale. Data were analyzed using descriptive statistics and directed content analysis. Across all 3 sessions, progress bars and color-coded indicators were consistently preferred over text-heavy or abstract formats by both patients and HCPs. A persistent set of competing demands was observed, with participants requesting both visual simplicity and access to absolute values and normative comparisons. HCPs tended to underestimate patients' preference for informative visualizations. The perceived value of structured feedback increased over the course of the study; patients' median ratings rose from 4.0 to 5.0 and HCPs' from 4.0 to 4.5 on a 5-point Likert scale. The resulting mobile app prototype demonstrated high usability, with patients achieving a mean System Usability Scale score of 93.6 (mean 6.4; best imaginable) and HCPs 80.9 (SD 8.1; good), according to established benchmarks. These findings demonstrate the feasibility and value of a co-designed digital feedback tool for neurorehabilitation. By combining conventional and technology-based assessment outcomes in an accessible, user-centered format, the app has the potential to enhance patient engagement, support clinical decision-making, and advance the implementation of value-based, personalized care.
Evaluate the effectiveness of exercise-based cardiac rehabilitation in improving aerobic capacity for people with stroke or TIA. This is a rapid review with meta-analysis. Four databases were searched from February 2015 - March 2025. Nine studies (n=490 participants) of low-moderate quality were included (two randomised controlled trials, two quasi-experimental trials, five pre-post studies), three of which were pooled for meta-analysis. Findings suggest cardiac rehabilitation improves aerobic capacity (28 m, 95% CI 16 m to 39 m, P=<0.00001) for people with TIA or stroke, with promising improvements also found for systolic blood pressure (95% CI -18 mm Hg to -5.3 mm Hg, P=0.0003), self-reported diet (95% CI 2.4 to 4.7, P=<0.00001) and self-reported physical activity (95% CI 1533 METmin/week to 5156 METmin/week, P=0.0003). No significant relationships were identified between program FITT (exercise frequency, intensity, type, time) principles and aerobic capacity outcomes. Cardiac rehabilitation may be effective in improving aerobic capacity post-TIA or stroke, however current evidence is limited and of low certainty. Further high-quality research on program effectiveness, and the influence of FITT principles, is needed to support evidence-based decisions making by clinicians, researchers and policy-makers.
In December 2024, the U.S. Department of Veterans Affairs (VA) and the U.S. Department of Defense (DoD) released a joint update of their 2017 clinical practice guideline (CPG) for the rehabilitation of individuals with lower limb amputation (LLA). This synopsis highlights the key aspects of the guideline development process and describes the CPG recommendations. The VA/DoD Evidence-Based Practice Work Group convened a joint VA/DoD guideline development work group (WG) that included clinical stakeholders and conformed to the Institute of Medicine's tenets for trustworthy clinical practice guidelines. The guideline WG conducted a patient focus group, developed key questions, and systematically searched and evaluated the literature from a eight year time frame (English-language publications from 6 July 2016 to 15 March 2024). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was utilized to evaluate the evidence and formulate recommendations. The WG developed 26 recommendations along with algorithms and supplemental materials to guide providers in providing evidence-based, interdisciplinary, patient-centered care through all phases of LLA rehabilitation. The CPG was reviewed by stakeholders outside the WG prior to approval by the VA/DoD Evidence Based Practice WG. This article summarizes key features of the guideline to help clinicians utilize the CPG to support patient-centered care.
IntroductionCognitive rehabilitation (CR) enhances the autonomy of patients with Alzheimer's disease. Their daily activities are likely dependent on attention networks.MethodThis pilot resting-state fMRI study investigated the cerebral correlates of CR in participants with mild Alzheimer disease (n = 22), compared to a control intervention in patients (n = 21) and in healthy participants (n = 27). Connectivity changes between dorsal and ventral attention networks were expected after 3 months of rehabilitation.ResultsA mixed ANOVA comparing pre- and post-intervention data across groups revealed increased connectivity between the dorsal and the ventral attention network following CR (FDR-corrected P = .0072). A post hoc correlation analysis of post-intervention data in the CR group showed that greater autonomy in daily activities was associated with stronger functional relationship between the two attention networks (FDR-corrected P = .0001).ConclusionEnhanced connectivity between attention networks may be a characteristic of CR benefits in individuals with mild Alzheimer disease.
Health advocacy is increasingly recognized as a core professional responsibility of physicians; however, formal training in advocacy remains limited within graduate medical education. Physiatrists are uniquely positioned to participate in advocacy given their care of individuals with disabilities and intrinsic interdisciplinary care coordination to navigate the social, economic, and systemic barriers affecting health outcomes for our patients. This manuscript reviews the current perceptions of physician advocacy, the existing advocacy training models across medical specialties, and the current state of advocacy opportunities and requirements within Physical Medicine and Rehabilitation (PM&R) residency education. Drawing on existing frameworks and educational models, we outline suggestions to integrate advocacy training into PM&R residency educational offerings. Incorporating advocacy education in PM&R training may better prepare residents to address health disparities, promote patient-centered systems change, and mitigate burnout by promoting engagement in professional activities that align with physiatrists' ethical and professional priorities.
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Frozen shoulder (FS) is characterized by a multifactorial progression, often worsened by metabolic factors such as diabetes. Effective management may require a multidisciplinary approach that includes therapeutic exercise, physiotherapy, metabolic control, psychological support, and healthy lifestyle interventions. However, current evidence remains fragmented and predominantly focused on isolated domains, with limited integration of these factors within a biopsychosocial framework. The aim of this study was to comprehensively evaluate the influence of exercise-based interventions, as well as metabolic, psychological, and lifestyle-related factors, on clinical outcomes, including pain, function, range of motion, and quality of life, in patients with FS. This systematic review with meta-analysis, reported following the PRISMA guidelines, included 31 studies published between 2010 and 2024, comprising randomized controlled trials, observational studies, Mendelian randomization studies, and qualitative studies. MEDLINE, Web of Science, CINAHL, SPORTDiscus, and Scopus were searched until April 2025. The risk of bias was assessed according to study design. The Cochrane Risk of Bias tool (RoB 1) was used for randomized controlled trials. Observational studies (including cross-sectional, case-control, and cohort studies) were assessed using the Newcastle-Ottawa scale (NOS). Mendelian randomization studies were evaluated using established methodological quality criteria for MR studies, including the assessment of instrument validity, pleiotropy, and heterogeneity. Qualitative studies were appraised using appropriate qualitative assessment criteria. The certainty of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Twelve studies evaluated physical interventions. Global effect summary of exercise versus control showed a small but statistically significant benefit favoring exercise (standardized mean difference [SMD], Hedges' g = 0.10; 95% CI 0.05-0.15) across clinical outcomes, particularly pain, function, and range of motion. Associations between FS and metabolic parameters (e.g., triglycerides, glucose, and HbA1c) were identified in 12 studies, although these results were synthesized narratively and no pooled effect estimates (e.g., odds ratios) were calculated due to heterogeneity. Seven studies showed that anxiety was consistently associated with FS severity, with potential impact on pain, functional outcomes, and quality of life, although this relationship may depend on sample characteristics. The risk of bias was low in exercise-related studies, unclear in those on quality of life, and high in metabolic studies. Overall, the certainty of evidence was rated as very low due to the risk of bias, heterogeneity, and imprecision. Evidence supports a multifactorial, biopsychosocial model for FS. Exercise-based interventions were associated with small improvements in pain, function, and range of motion, while metabolic dysfunction and anxiety were identified as factors associated with FS severity. However, the certainty of evidence was very low and findings should be interpreted with caution due to high heterogeneity and methodological variability across studies. Future research should prioritize integrated, multidisciplinary strategies to improve FS treatment.
The global community faces a significant disability burden from road traffic injuries (RTIs). This study investigated factors associated with disability three months after hospital discharge among patients with RTIs at the University Teaching Hospital, Lusaka, Zambia. We analysed secondary data from a prospective observational study, conducted between October 2021 and April 2022, of adults aged ≥ 18 with moderate-to-severe RTIs. Patients were contacted at three months after hospital discharge to assess their disability using WHODAS-II. We used multiple linear regression analysis to determine the risk factors of disability level using Stata 17. The study involved 147 patients, with 85.7% presenting with some level of disability ranging from mild to extreme disability (mean disability score = 9.8 ± 9.1), and 81.2% of participants who were working prior to the injury returned to work. Age, unemployed, spinal injuries, multiple injuries, moderate Glasgow Coma Scale score and length of hospital stay were significantly associated with higher disability score following RTIs. Most patients still experience disability three months after hospital discharge and this is influenced by sociodemographic and injury factors, emphasising the need to improve road safety infrastructure, enforce road traffic laws and invest in rehabilitation.
Methamphetamine (MA) use poses a serious threat to community safety and public health. Despite the existence of some treatment modalities, relapse rates remain high and the effectiveness of these treatments varies among individuals. Identifying behavioral, neuroimaging, and gene expression biomarkers associated with treatment efficacy can enhance our multiscale understanding of the neurobiological mechanisms underlying individualized responses to abstinence-based treatments. This approach has the potential to advance the development of personalized or innovative therapeutic strategies. Our study included 82 MA users and 68 healthy controls (HCs). Demographic information, craving scale scores, MA use assessment, and MRI scans were collected from the MA group prior to treatment. All MA users underwent abstinence-based treatment, during which they refrained from using MA and received only basic medical care and education on abstinent rehabilitation. Following long-term abstinence-based treatment, craving scale scores were reassessed. A reduction in craving scale scores greater than 30% was defined as the responders. Similarly, demographic information and MRI scans were collected from the 68 HCs. We calculated whole-brain functional connectivity based on fMRI data and applied principal component regression (PCR) with leave-one-out cross-validation to identify response network patterns predictive of abstinence response scores. Furthermore, we evaluated the stability of the predictive models from multiple perspectives. Network strength of the identified response network was then compared to that of HCs to assess its clinical relevance. We also assessed the efficacy of network strength in making binary predictions. Finally, we combined the discovered brain patterns with the Allen Human Brain Atlas data to explore the genetic basis associated with the identified response network. Among the 82 MA users, 39 were responders and 43 were non-responders. The 68 HCs had a mean age of 40.1 years, with 46 males. PCR identified a stable MA response network pattern, characterized by network connections positively associated with attention regulation and executive control abilities (within visual, between frontoparietal and default mode, and between visual and dorsal attention), as well as negative network connections associated with emotion regulation and behavioral automatization (within somatomotor, between somatomotor and default mode, and between default mode and ventral attention). HC exhibited moderate levels of network strength between responders and non-responders. The identified network pattern demonstrated efficacy in individual-level binary predictions. This neuroimaging pattern was further associated with synaptic signaling and inhibitory neurons. Together, our results not only provide new neuroimaging markers for predicting personalized treatment response, but also reveal the underlying neurobiological mechanisms associated with abstinence response, providing potential regulatory targets for addiction treatment.
After a stroke, individuals often experience mobility impairments because of weakness and loss of independent joint control in the lower limbs. As a result, gait recovery becomes a primary goal of physical rehabilitation, traditionally achieved through high-intensity therapist-led training. However, conventional therapist-led approaches involving manual assistance or resistance can be physically demanding and limit interaction at multiple joints simultaneously. Robotic exoskeletons have emerged as a promising solution, enabling multijoint support, reducing therapist strain, and offering objective performance feedback. However, typical exoskeleton control strategies limit the physical therapist's involvement and adaptability to the patient's needs, which may hinder clinical adoption and outcomes. In this study, we introduce a gait rehabilitation paradigm based on physical human-robot-human interaction that we call therapist-exoskeleton-patient interaction (TEPI), in which a therapist and a patient with stroke are each equipped with a lower-limb exoskeleton virtually connected at the hips and knees via spring-damper elements. This connection enables bidirectional physical interaction, allowing the therapist to guide the patient's movement while receiving real-time haptic feedback. We evaluated this approach with eight patients with chronic stroke using a within-subject design, comparing TEPI training with conventional therapist-guided mobilization during treadmill walking. Results showed that, compared with conventional therapy, TEPI led to greater joint range of motion, increased step length and height, similar muscle activation, and high self-reported motivation and enjoyment. These findings suggest that TEPI can integrate robotic precision with therapist intuition, offering a framework for enhancing gait rehabilitation outcomes in populations recovering from stroke.
Sierra Leone is confronting an escalating polydrug epidemic centered on Kush, a synthetic cannabinoid compound whose proliferation has produced a 4000% rise in drug-related psychiatric hospitalizations since 2020 in a context of acute mental health resource scarcity. Dominant policy responses have privileged punitive containment over rehabilitative and harm-reduction frameworks, recapitulating victim-blaming discourses that obscure the structural antecedents of polydrug use. This commentary establishes why the polydrug crisis is an epidemic rooted in structural violence and situates its emergence within Sierra Leone's intersecting legacies of civil war, recurrent epidemic shocks, and entrenched poverty. Drawing on critical pragmatism and the culture-centered tradition in critical health communication, we demonstrate how community mobilizations from past public health crises can provide insights for global health communication practitioners. We extract five health communication insights from Sierra Leone's 2014 Ebola response: centering community engagement and trust building; investing in youth livelihoods; decriminalizing and reintegrating people who use drugs; integrating mental health into primary care; and galvanizing coordinated international support. Leaning on these theoretical and experiential insights can guide communication interventions toward addressing the sociopolitical conditions in which the polydrug crisis emerges, as well as the individuals that use Kush.
Cycle ergometer in the postoperative period of open-heart surgery is a safe and economical exercise option. However, its specific effects, whether or not associated with conventional physiotherapy, are not well established in current literature. The objective of this study was to evaluate the effects of cycle ergometer exercise associated or not with conventional physical therapy, compared with only conventional physical therapy, on functional capacity, hospitalization time, peripheral muscle strength, and pulmonary complications of patients after open-heart surgery. MEDLINE, Cumulative Index to Nursing & Allied Health Literature, Latin American and Caribbean Health Sciences Literature, Web of Science, Scopus, Embase, Physiotherapy Evidence Database, and Cochrane Library were searched; manual searches were also conducted in the references of the included studies. Randomized controlled trials that analyzed the effects of cycle ergometer exercise associated or not with conventional physical therapy compared with only conventional physical therapy in adult patients after an open-heart surgery were included. Methodological quality was assessed by Cochrane risk-of-bias tool, and the meta-analysis was undertaken using RevMan 5.3. Mean difference in the six-minute walk test (31 meters, 95% confidence interval [CI]: 1.59 to 60.3 meters, P = 0.04) was higher and in intensive care unit stay was lower (-0.5 days, 95% CI: -0.86 to -0.14 days, P = 0.007) in the intervention group. The total hospitalization time (-0.18 days, 95% CI: -0.73 to 0.38 days, P = 0.53) didn't change between groups. Cycle ergometer exercises improved functional capacity but with no clinically relevant effects on hospitalization time after open-heart surgeries.
To systematically review and meta-analyze the clinical effectiveness of self-fitting over-the-counter (OTC) hearing aids compared with professionally fitted devices. PubMed, Scopus, Web of Science, Food and Drug Administration (FDA) 510(k) and De Novo databases, and ClinicalTrials.gov were searched in March 2025 and updated in August 2025. Reference lists were screened, and manufacturers were contacted for unpublished data. Two reviewers conducted screening, full-text review, and risk-of-bias assessment. Eligible studies were field trials comparing FDA-cleared self-fitting OTC hearing aids or software with audiologist-fitted prescription devices in adults. A random-effects meta-analysis using Hedges' g was performed. Risk of bias was evaluated with RoB 2 and ROBINS-I, and certainty of evidence with GRADE. From 712 records, 24 were included, representing 15 unique studies with 774 participants (739 analyzed). Most were short-term field trials (10 days to 8 weeks) comparing self-fitting and professional fittings of the same device. Pooled analyses showed no significant differences between groups for the Abbreviated Profile of Hearing Aid Benefit (Hedges' g = -0.05; 95% CI, -0.19 to 0.09), Speech, Spatial and Qualities of Hearing Scale - 12 (g = 0.01; 95% CI, -0.33 to 0.36), International Outcome Inventory for Hearing Aids (g = 0.12; 95% CI, -0.35 to 0.59), and Quick Speech-in-Noise test (g = 0.03; 95% CI, -0.22 to 0.28). Risk of bias was moderate to high, and certainty of evidence was low. Based largely on patient-reported measures, self-fitting OTC hearing aids provide outcomes comparable to professionally fitted devices. Larger, independent trials within standard clinical pathways are warranted.
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To evaluate the feasibility and safety of implementing a patient-oriented pole walking (PW) intervention in retirement home settings and preliminary changes in outcome measures related to physical function and other fall- and fracture-related risk factors to inform a future randomized controlled trial (RCT). This single-arm, non-randomized feasibility trial implemented a patient-oriented PW intervention across four retirement homes in Saskatoon, Saskatchewan, Canada. During Summer 2022, we assessed 24 residents for eligibility, of which 19 consented and 17 received the intervention. The intervention was offered as supervised group sessions (20-60 minutes) three times per week for 12 weeks. Each session consisted of posture and balance warm-up, PW, muscle strengthening, and stretching. The primary outcome measure was feasibility as assessed by consent, recruitment, retention, and adherence rates as well as by intervention acceptability, appropriateness, and feasibility scores. The secondary outcome measures included safety (evaluated by recorded adverse events) and preliminary 12-week changes in physical function and other fall- and fracture-related risk factors (examined with paired-samples t-tests or repeated measures analysis of covariance models). Fifteen participants (mean age 85.2 years; 93% female) completed the study. The consent, recruitment, retention, and mean adherence rates were 79%, 2.7 participants/site/month, 88%, and 90%, respectively. The mean participant- and instructor-reported scores for intervention acceptability, appropriateness, and feasibility were all > 4.0 (out of 5). There were no recorded intervention-related serious adverse events. Participants improved their functional balance/mobility (timed "up & go" test: -1.6 seconds; 95% CI: -2.7 to -0.4), lower-body strength (30-second chair stand test: 2.4 repetitions; 1.2 to 3.5), 36-item short-form survey physical functioning score (12.9; 3.7 to 22.2), and forearm muscle area (67.7 mm2; 12.9 to 122.6) over 12 weeks. It was feasible and safe to implement our patient-oriented PW intervention in retirement homes. Findings will inform our future RCT in these settings. ClinicalTrials.gov NCT05388227.