Multimodal prehabilitation improves outcomes in colorectal surgery, but its effectiveness and cost-effectiveness before metabolic and bariatric surgery are unknown. To evaluate the effectiveness and cost-effectiveness of a 6-week multimodal prehabilitation programme compared with standard preintervention education in patients undergoing bariatric surgery. Propensity score matched cohort observational study at Shanghai Tenth People's Hospital, China, January 2022 to January 2025. Sixty prehabilitation patients were matched 1:1 to 60 controls from 254 standard care candidates using nearest-neighbour matching on the logit of the propensity score. Follow-up was 12 months. A 6-week programme of supervised exercise, nutritional counselling, and psychological support vs 2 standard preoperative counselling sessions. All patients underwent Roux-en-Y gastric bypass or sleeve gastrectomy. Total weight loss at 12 months. Secondary outcomes included body composition, metabolic parameters, functional capacity, patient-reported outcomes, safety, and healthcare costs. Among 120 matched patients (mean [SD] age, 32.6 [5.2] years; 65.8% male; mean body mass index [BMI], 38.2 [3.2] kg/m2), total weight loss at 12 months did not differ between groups (23.7 [5.1] vs 23.4 [2.7] kg; difference, 0.3 kg; 95% CI, -1.3 to 1.8; p = 0.75). At 3 months, prehabilitation showed significantly greater weight loss (adjusted β = 2.85 kg; 95% CI, 1.77 to 3.93; p < 0.001), lower body fat, lower diastolic blood pressure, and higher Short Form-36 (SF-36) mental scores. All differences were attenuated by 6 months. No serious adverse events occurred. Total costs were modestly higher in the prehabilitation group (mean, ¥84 843 vs ¥78 051), a difference attributable almost entirely to the prehabilitation programme itself; because the incremental effect on weight loss at 12 months was not statistically significant, a meaningful incremental cost-effectiveness ratio could not be estimated. A 6-week multimodal prehabilitation programme accelerated early postoperative weight loss and improved short-term functional outcomes but did not improve total weight loss at 12 months. Because prehabilitation added cost without a demonstrable difference in 12-month weight loss, a cost-effectiveness advantage could not be established. The dominant metabolic effects of bariatric surgery appear to override the incremental gains of preoperative conditioning over time.
Heart failure (HF) significantly reduces functional capacity and quality of life in patients classified as New York Heart Association (NYHA) functional class II-III. While cardiopulmonary rehabilitation (CR) is beneficial, innovative strategies are required to improve accessibility and effectiveness for individuals unable to tolerate high hemodynamic loads. To compare the effects of conventional moderate-to-high intensity resistance training (CRT) versus low-load resistance training combined with blood flow restriction (BFRRT) on clinical, functional, and biochemical outcomes in HF patients. This randomized, prospective, parallel-group clinical trial will include 52 patients (NYHA II-III) allocated into CRT (60-80% 1RM) or BFRRT (20-30% 1RM, calibrated at 50% arterial occlusion pressure) groups. The supervised intervention lasts 4 months, with an 8-month post-intervention follow-up. The primary outcome is the change in serum NT-proBNP levels. Secondary outcomes include quality of life, echocardiographic ventricular function, functional capacity, and clinical events. Advanced statistical models and exploratory machine learning analyses with k-fold cross-validation will be utilized for predictive modeling and exploring personalized medicine strategies. The REHAB-WASHOUT HF trial aims to establish an effective, safe, and accessible therapeutic approach for HF rehabilitation, potentially enhancing clinical outcomes and guiding personalized prescriptive strategies in cardiovascular rehabilitation. Approved by the local institutional review board (No. 5.848.965; CAAE 64955022.9.1001.0029). Trial registration: RBR-5y8k7d7.
To evaluate trends of international medical graduates (IMGs) matching into U.S. physical medicine and rehabilitation (PM&R) residency programs. This retrospective cohort study analyzed National Resident Matching Program data from 2005 to 2025. The primary outcome was the annual proportion of PM&R positions filled by IMGs. Secondary outcomes included temporal trends in match rates among IMGs, U.S. medical doctors (U.S. MDs), and doctors of osteopathic medicine (DOs), identifying trend breakpoints, and associations between IMG match rates and program characteristics. From 2005 to 2025, PM&R programs and positions increased steadily, while IMG representation declined substantially. IMGs filled nearly 13% of positions in 2005 but only 7% in 2025. IMG match share decreased by 0.65 percentage points per year (β=-0.0065, P<0.001; R²=0.75). DO match rates increased significantly, while U.S. MD rates remained stable. In multivariable analysis, U.S. MD and DO match rates independently predicted IMG decline. PM&R exhibited the steepest decline compared with other specialties. IMG representation in PM&R declined markedly over two decades, while U.S. MD representation remained constant and DO representation increased. Examining the causes and consequences of this shift is essential to evaluating its impact on workforce diversity in PM&R.
To compare clinical outcomes after unipolar versus bipolar sternocleidomastoid (SCM) release for congenital muscular torticollis (CMT), and to describe how patient age, chronicity, and postoperative rehabilitation varied across studies and may have contributed to between study differences. Following PRISMA guidelines, 17 observational studies were included, comprising 382 surgical procedures (unipolar 228; bipolar 154). The primary outcome was achievement of a global good-excellent clinical result using validated composite scoring systems (Lee, Cheng-Tang, Tanabe, or Lee-Kang). Secondary outcomes were recurrence and complications. Comparative quantitative synthesis was restricted to studies reporting both techniques within the same cohort and extractable technique-specific data. For recurrence, comparative quantitative synthesis was feasible in two cohorts. For global good-excellent outcome, head-to-head data were too sparse and confounded for a robust pooled comparison, and evidence remained descriptive. Heterogeneity was assessed using I². Only a small number of studies provided extractable head-to-head comparisons. In these cohorts, no statistically significant difference was observed between unipolar and bipolar release in achieving a good-excellent global clinical outcome, and recurrence rates did not differ significantly between techniques, although confidence intervals were wide and events were sparse. Across single-arm cohorts, both techniques were associated with high rates of good-excellent outcomes and low recurrence, with greater variability observed in bipolar cohorts that more frequently included older or neglected cases. Complications were uncommon overall and were predominantly minor; technique-stratified reporting suggested a higher frequency of minor complications following bipolar release. Where reported, cervical alignment and range of motion improved substantially after both procedures, with no consistent radiographic advantage of one technique over the other. Across studies, postoperative rehabilitation intensity and patient chronicity appeared to influence durability of correction at least as much as release extent. Within the limits of available observational evidence, unipolar and bipolar SCM release yield comparable global clinical outcomes with low recurrence and complication rates. No consistent comparative advantage of greater release extent was demonstrated. Between-study differences may also reflect variation in patient age, deformity chronicity, and postoperative rehabilitation. Comparative certainty remains limited by small head-to-head cohorts, heterogeneous outcome definitions, and incomplete arm-level reporting.
Variability in functional response to exercise interventions in Parkinson's disease (PD) remains poorly understood. Sex-related differences in motor performance and rehabilitation outcomes have been described but are rarely examined within intervention studies. This study presents a secondary sex-stratified analysis of a previously published randomized controlled trial (RCT) to explore factors associated with differential improvements in physical performance. To analyze sex-specific factors associated with improvements in physical performance following a 12-week SSM Fisior® walking training program in individuals with PD. Secondary analysis of a RCT with a sex-stratified approach. Fifty-two community-dwelling older adults (57.7% men; mean age 71.4 ± 8.0 years) participated in the study. Physical performance was assessed using the Short Physical Performance Battery (SPPB), FallSkip system, and Timed Up and Go (TUG) test. Changes in SPPB scores were analyzed using sex-stratified Spearman correlations and multivariable linear regression models adjusted for age, body mass index, baseline Barthel Index, sensory aids, polypharmacy, falls history, and prosthesis use. Women showed greater improvements in SPPB total score compared with men (0.73 ± 0.09 vs. 0.50 ± 0.09). In women, SPPB changes were significantly correlated with TUG performance, and TUG improvement remained independently associated with SPPB gains (β = 9.07; 95% CI: 1.34-19.49). In men, SPPB improvements were correlated with FallSkip gait, sit-to-stand performance, FallSkip total score, FallSkip time, and TUG performance. In adjusted models, SPPB gains were independently associated with age, TUG improvement, balance, and sit-to-stand performance. Functional improvements following the intervention differed by sex. In women, mobility performance was the primary determinant of SPPB improvement, whereas in men, gains were associated with multiple domains including balance, strength, gait, and age. These findings support sex-specific considerations in exercise-based interventions for older adults. Parkinson’s disease affects movement, balance, and daily independence. As the condition progresses, many people find it harder to walk safely, stand up, or keep their balance. This study looked at whether a special walking training program, called the SSM Fisior® program, could help improve these abilities. We were also interested in seeing whether women and men responded differently to the program. We included 52 adults aged 50 or older with mild-to-moderate Parkinson’s disease from two centers in Spain. Participants were randomly assigned to one of two groups: one received standard physiotherapy, and the other received standard physiotherapy plus the SSM Fisior® walking training. The program lasted 12 weeks. Before and after the program, we tested participants’ walking, balance, standing-up ability, and general physical performance. Overall, women showed greater improvement in their physical performance scores than men. For women, improvements were closely linked to walking speed and mobility. For men, the program seemed to help especially with balance, gait, and the ability to sit down and stand up, and older men benefited the most. Both women and men showed improvements in functional mobility. These results suggest that the SSM Fisior® program can help people with Parkinson’s disease strengthen their mobility and independence. However, women and men may improve in different ways. This highlights the importance of designing rehabilitation programs that take sex-related differences into account, so each person receives the type of training that benefits them most. Understanding how different groups respond to treatment can help clinicians personalize exercise programs and improve the quality of life for people living with Parkinson’s disease.
To map and describe the digital health technologies and technology-supported interventions used by advanced practice nurses for cardiovascular risk management in primary health care, including the advanced nursing functions they support. A scoping review was conducted in accordance with the Joanna Briggs Institute methodology and reported following PRISMA-ScR. A systematic search was performed in PubMed/MEDLINE, Web of Science, Embase, Scopus, CINAHL, Cochrane Library and SciELO, as well as grey literature sources, including the CAPES Portal and Epistemonikos. International studies published between January 2005 and May 2026 were eligible, without language restrictions. Two reviewers independently selected and charted the evidence; a third reviewer resolved unresolved disagreements. A total of 3919 records were identified and 12 studies met the inclusion criteria. The evidence was grouped into four categories: technology-supported structured nurse-led care programmes; clinical decision support and algorithm-based software; telehealth, telenursing and telerehabilitation; and mobile or home-based self-management technologies. The structured programmes combined nursing care pathways with organizational, educational, communication, protocol-based, algorithmic or digital resources that supported programme delivery. The studies covered primary prevention, secondary prevention, chronic disease management and cardiac rehabilitation. The technologies and interventions supported clinical decision-making, risk stratification, monitoring and follow-up, health education, self-management support and lifestyle counselling and care coordination. Digital health technologies and technology-supported interventions can strengthen advanced cardiovascular nursing practice when embedded in clearly defined care pathways. Their principal contribution is to connect clinical decision support, longitudinal follow-up and supported self-management; their broader value depends on workflow integration, role clarity, equitable access and appropriate governance. The protocol was registered in the Open Science Framework on May 22, 2024.
Postoperative nursing assessment plays an important role in helping detect any possible complication and enabling functional rehabilitation following the operation due to the risk associated with fluid imbalance, decreased mobility, respiratory problems, and leg complications such as deep vein thrombosis and pulmonary embolism. The aim of the study was to design and test the piloted Hydration, Early mobilisation, Active breathing and Limb Assessment Monitoring checklist developed in collaboration with the local nursing team. The study evaluated the validity and reliability of this tool. Development of the Hydration, Early mobilisation, Active breathing and Limb Assessment checklist involved conducting a focused narrative review of postoperative care literature and routine practice of nurses working in the clinical context of postoperative abdominal surgical units. The face and content validities of the items were analysed by seven experts from various professional disciplines rating the relevance and clarity of the items; content validity indices at item level and at scale level were determined according to conventional methodology. The face validity and feasibility of the checklist were tested by the clinical nurses practicing postoperative abdominal surgical care. Piloting was conducted on adult patients undergoing elective abdominal surgery. Two trained nurses independently completed the checklist for each patient. Inter-rater reliability was estimated using kappa coefficients and intraclass correlation coefficients. There were high levels of agreement among experts regarding the relevance and comprehensibility of items, with high content validity indices at the scale level confirming the content validity of the Hydration, Early mobilisation, Active breathing and Limb Assessment checklist. Nurses who are currently practicing reported that the checklist is comprehensible, clinically relevant, and easy to conduct in the context of routine care delivery. The checklist generated an intraclass correlation coefficient of 0.88, with kappa coefficients at the item level falling between 0.76 and 0.91, reflecting moderate to high inter-rater reliability. This pilot study provides initial evidence supporting the use of the Hydration, Early mobilisation, Active breathing and Limb Assessment checklist as a valid, reliable and practicable tool led by nurses for structured postoperative monitoring after abdominal surgery. There is a need for more multicentre studies that will focus on setting appropriate Hydration, Early mobilisation, Active breathing and Limb Assessment scores and developing the corresponding patient escalation protocol.
Physical activity is vital for the health of mothers and their newborns during pregnancy and postpartum. However, many pregnant women do not meet recommended activity levels. This study investigates the barriers and facilitators affecting physical activity in pregnant and postpartum women in Saudi Arabia to inform targeted interventions. A qualitative descriptive approach guided this study. Twenty participants were recruited through purposive convenience sampling from antenatal and postnatal clinics at Alyamamh Hospital in Riyadh until data saturation was achieved. Data were collected through semi-structured interviews lasting 40 to 50 minutes, focusing on experiences, barriers, and motivators related to physical activity. The interviews were audio-recorded, transcribed verbatim, and analyzed using NVivo 20 software via thematic analysis. The research team consisted of rehabilitation sciences professionals who engaged in reflexive practices throughout data collection and analysis. Participants had diverse socioeconomic backgrounds, with ages ranging from 23 to 39. Pregnant participants were between 9 and 36 weeks of gestational age, while postpartum participants were within four weeks of delivery. Five key themes emerged: Navigating Physical and Emotional Barriers, Motivated by Health and Well-being, Misinformation and Missed Opportunities, Safe and Practical Choices, and Broader Implications. This study examines the challenges and facilitators of physical activity among pregnant and postpartum women in Saudi Arabia. Culturally relevant interventions and improved healthcare support can enhance maternal and neonatal health and promote physical activity during these critical periods.
Pediatric intestinal failure resulting from short bowel syndrome remains a significant source of morbidity and mortality despite advances in parenteral nutrition and multidisciplinary intestinal rehabilitation. While native intestinal adaptation provides a foundation for recovery in many patients, those with the most severe forms of short bowel syndrome face limited therapeutic options, including lifelong parenteral nutrition dependence, surgical lengthening procedures, and intestinal transplantation-each associated with substantial complications. The field of bowel regeneration has expanded dramatically over the past two decades, drawing on advances in stem cell biology, biomaterials science, mechanotransduction, and bioengineering. This review examines the current landscape of bowel regeneration strategies through a conceptual framework that progresses from native adaptation, through cellular and biological therapies, to structural and mechanical approaches, and ultimately to tissue engineering as the integration of cellular and structural strategies. Emerging technologies including gene editing for regional reprogramming of intestinal identity, three-dimensional bioprinting, and advanced organoid-scaffold systems are discussed as they relate to the future of clinical translation. Although significant hurdles remain-particularly in vascularization, innervation, and scaling of engineered constructs-the trajectory of the field suggests that regenerative approaches may fundamentally alter the management of pediatric intestinal failure within the coming decades.
By mapping the full-course management journey of elderly patients undergoing radical esophagectomy for esophageal cancer, this study systematically identifies core needs, pain points, and shortcomings in health education across different disease stages, providing empirical evidence for optimizing full-cycle care strategies for elderly patients undergoing radical esophagectomy. A purposive sampling method was used to conduct semi-structured interviews with 15 elderly patients who underwent radical esophagectomy for esophageal cancer. Data were collected on their physical and psychological experiences and service needs during the disease diagnosis, hospitalization, and home rehabilitation stages. Colaizzi's seven-step method was applied for thematic extraction and coding, and a full-course management journey map was developed based on the disease timeline. The constructed journey map, structured along the three-stage disease timeline, covers four dimensions: tasks, core pain points, emotional experiences, and needs. A total of 25 themes were extracted, clarifying the core demands of elderly patients undergoing radical esophagectomy in areas such as information disclosure, personalized care, age-appropriate support, and psychosocial adaptation, as well as existing service gaps. The full-course management needs of elderly patients undergoing radical esophagectomy are characterized by stage-specific and personalized features. Issues such as inadequate age-appropriate and personalized health education persist. Intervention targets identified through the journey map, such as establishing multidisciplinary teams and continuous out-of-hospital guidance platforms, can be used to construct a full-cycle, precise care system, thereby improving the postoperative quality of life for elderly patients with esophageal cancer.
Low back pain (LBP) is frequently classified as non-specific, which reduces the capacity of the healthcare system to offer targeted rehabilitation. Previous work has suggested a link between motor control and low back dysfunction. Identifying motor control phenotypes indicative of dysfunction often requires complex and costly laboratory equipment. Recent advancements in computer vision and the widespread availability of smartphones have made human motion capture more accessible. This study aimed to examine whether outcomes derived from consumer-grade video and open-source pose estimation tools are associated with motor control patterns linked to self-reported low back dysfunction. A self-guided online questionnaire was employed to gather data from 448 participants, worldwide. Participants completed validated questionnaires and video-recorded themselves performing four functional movements. Pose-derived kinematic features were extracted and reduced using principal component analysis (PCA), followed by a stepwise linear regression modelling to examine associations between movement features and individual participant reported outcome measures as well as a composite index of low back function. Participants were split into low and high function groups. PCA-derived features of movement were significantly associated with measures of disability, kinesiophobia, pain catastrophizing, and physical activity. Trunk flexion demonstrated the strongest association with the composite index (R2 = 0.71). The results between low vs high function participants depict biomechanically relevant differences (i.e. reduced movement speed and range of motion) typically found in the low back pain (LBP) population. Results highlight the feasibility of using consumer-grade video and open-source pose estimation tools for large-scale biomechanical data collections, to enhance our understanding of LBP. Although strong associations were observed between video-derived movement features and self-reported dysfunction, prospective validation and external testing may be required before clinical screening performance can be established. With appropriate validation, this approach has the potential to support the development of a scalable and accessible digital movement assessment tool for low back dysfunction.
Virtual reality is increasingly recognized as a potential tool for motor rehabilitation in individuals with intellectual disabilities. However, its effectiveness in balance training has not been extensively examined. The current meta-analysis aims to evaluate the impact of virtual reality-based interventions on balance abilities in individuals with intellectual disabilities and examines key moderating factors. Twelve randomized controlled trials comprising 34 effect sizes were analyzed. The results indicate a moderate overall effect size (ES=0.551) of virtual reality training on balance improvement. Specifically, the intervention demonstrated a greater effect on static balance (ES=1.000) compared to dynamic balance (ES=0.380), suggesting that virtual reality interventions may be effective in improving balance ability. Furthermore, subgroup analyses revealed that participant age, intervention length, and frequency significantly influenced the outcomes, highlighting the importance of adapting virtual reality training to individual characteristics to maximize their effectiveness.
To investigate the clinical effectiveness of perioperative nursing interventions based on the Knowledge-Attitude-Practice (KAP) theory in patients undergoing robot-assisted dental implant surgery. A total of 54 patients who underwent robot-assisted dental implant surgery were allocated to either a conventional perioperative care group (control group) or a KAP intervention group. The control group received routine perioperative care according to the hospital's standard protocols, whereas the intervention group received perioperative care based on the KAP theory in addition to the standard care. The KAP-based care followed a progressive pathway characterized by knowledge dissemination, attitude cultivation, and behavioral guidance. The intervention period lasted for 8 weeks. Primary outcome measures included self-care ability, negative emotions, postoperative swelling and pain, follow-up compliance, and patient satisfaction. After 8 weeks, the intervention group exhibited significantly greater improvements in all domains of self-care behavior (regular follow-up, correct toothbrushing, and balanced diet) as well as in total self-efficacy scores compared with the control group. Dental anxiety and dental fear scores decreased significantly in both groups, with greater reductions in the intervention group. Postoperative pain scores were significantly lower and satisfaction scores significantly higher in the intervention group. At 3 and 6 months, compliance rates in the intervention group were significantly higher than those in control group. Perioperative nursing based on the Knowledge-Attitude-Practice (KAP) theory enhanced self-care ability, alleviated negative emotions, increased long-term follow-up compliance, and improved patient satisfaction in individuals undergoing robot-assisted dental implant surgery. This model effectively standardizes patient care behaviors and optimizes postoperative recovery.
To identify the independent predictors of mental health and quality of life (QOL) among elite youth soccer athletes. Cross-sectional observational study. Study materials were distributed to the Elite Clubs National League (ECNL) clubs through an online survey. 668 adolescent athletes aged 13 to 18 years. Independent variables included age, sex, previous week sleep duration, athletic identity (AI), previous injury, and racial/ethnic minority status. Main outcome measures were anxiety (Generalized Anxiety Disorder-7), depression (Patient Health Questionnaire-9), and QOL (PedsQL). Separate multivariable regression models evaluated independent predictors of each outcome. Independent predictors of anxiety were age (β = 0.28 ± 0.072, P < 0.001), female sex (β = -1.7±-0.40, P < 0.001), sleep (β = -0.88 ± 0.16, P < 0.001), AI (β = 0.11±-0.034, P = 0.002), and injury (β = 1.2±-0.37, P = 0.001), but not racial/ethnic minority status (β = 0.35 ± 0.39, P = 0.37). Independent predictors of depression included age (β = 0.29 ± 0.070, P < 0.001), female sex (β = -1.4 ± 0.41, P < 0.001), sleep (β = -1.2 ± 0.16, P < 0.001), injury (β = 0.88 ± 0.37, P = 0.019), and racial/ethnic minority status (β = 0.81 ± 0.40, P = 0.004), but not AI (β = 0.049 ± 0.035, P = 0.16). Independent predictors of QOL were age (β = -0.60 ± 0.19, P = 0.001), sleep (β = 2.6 ± 0.43, P < 0.001), injury (β = -3.7 ± 0.98, P < 0.001), and AI (β = -0.22 ± 0.092, P = 0.016), but not sex (β = 1.8 ± 1.1, P = 0.10) or racial/ethnic minority status (β = -1.5 ± 1.0, P = 0.16). In all models, sleep had the greatest relative importance (38%-56%). Among youth soccer athletes, greater age, female sex, previous injury, and less sleep were independent predictors of anxiety and depression, whereas greater age, previous injury, less sleep, and higher AI predicted lower QOL. Sleep emerged as the strongest modifiable factor, highlighting its importance in psychosocial wellbeing, to the extent that sleep contributes to these outcomes.
Tango has therapeutic potential to improve gait and quality of life in populations with locomotor impairments. However, quantitative biomechanical and metabolic evidence remains limited. Tango walking in the leader role involves gait modifications that may affect locomotor economy. This study quantified metabolic cost, mechanical work, centre of mass motion and energetics during tango walking, and compared these variables with self-selected walking at similar speeds. We hypothesized that tango walking would increase cost of transport, reduce efficiency, and be associated with modifications in centre of mass motion and spatiotemporal gait parameters. Seventeen advanced tango dancers participated in the study, performing two 5-minute trials: self-selected walking and tango walking in the leader role just Milonga music. Oxygen consumption was measured to compute net metabolic power and cost of transport. Whole-body kinematics were recorded using a 3D motion capture system to reconstruct the centre of mass trajectories and compute spatiotemporal and mechanical variables. Statistical comparisons between conditions were performed using paired tests for discrete variables and Statistical Parametric Mapping (SPM) for time-series data. Walking speed did not differ between conditions. Tango walking increased metabolic power and cost of transport (≈+50%) and reduced efficiency, without significant changes in mechanical work. SPM analyses revealed centre of mass trajectories with reduced lateral oscillations during mid-stance and greater knee flexion throughout stance. Tango walking to a milonga rhythm (stride frequency: 0.87 ± 0.22 Hz) increases metabolic demand without proportional changes in mechanical work. These changes are accompanied by alterations in knee kinematics and centre of mass trajectory. The findings suggest potential mechanisms underlying the therapeutic effects of tango on gait and balance, which require confirmation in neurological populations.
Traumatic injury affects every age group, payer, and care setting in the United States, yet how injury-related spending distributes across these dimensions has not been comprehensively quantified. To estimate US health care spending on injuries in 2022 by mechanism, payer, and type of care. Cross-sectional analysis using the Institute for Health Metrics and Evaluation's Disease Expenditure Project, which harmonizes over 40 billion claims across Medicare, Medicaid, and commercial payers. Spending was attributed to injury diagnoses, adjusted for comorbidities, and stratified across 38 age and sex groups, 9 mechanism categories, 4 payers, and 5 types of care to evaluate for distinct spending phenotypes. US injury spending totaled $106.7 billion in 2022, with 52% occurring outside acute care settings and ambulatory care ($42.2B, 40%) nearly equaling inpatient care ($42.3B, 40%). Falls predominated ($56.2B, 53%), followed by transport injuries ($23.3B, 22%). Distinct spending phenotypes varied by mechanism: falls concentrated among women aged 65 and older with heavy post-acute utilization, while firearms and assault concentrated among men aged 15 to 39 with predominantly acute care. Payer burden stratified by mechanism (falls: 40% Medicare; transport injuries: 58% private; assault: 52% Medicaid). For patients under age 65, private insurance spent 3 times more per inpatient encounter than Medicaid across all mechanisms, while Medicare and private insurance had similar spending per inpatient encounter for those over 65. This first comprehensive, claims-based accounting of the nearly $107 billion spent annually on injuries in the United States reveals distinct spending phenotypes defined by mechanism, demographics, and payer, with direct implications for how trauma systems are planned, financed, and sustained.
This study aimed to investigate the acute effects of dynamic stretching (DS) combined with different blood flow restriction (BFR) pressures on explosive performance in healthy young males, and to examine whether these effects differed across estimated arterial occlusion pressure (AOP) levels and performance tasks. In a randomized crossover design, 20 participants completed four warm-up protocols: DS alone, and DS combined with BFR at 30%, 50%, or 70% of estimated AOP applied to the proximal thighs. Explosive performance was assessed before and after each warm-up protocol using countermovement jump (CMJ), standing long jump (SLJ), 10-m sprint (10mSS), and 505 change-of-direction (505COD) tests. CMJ showed a significant time × condition interaction. All DS+BFR protocols produced greater CMJ change scores than DS alone (all p < 0.01), with mean changes of 5.80 ± 1.99 cm, 5.95 ± 2.33 cm, and 5.15 ± 1.90 cm for the 30%, 50%, and 70% estimated AOP conditions, respectively, compared with 3.50 ± 2.21 cm in the DS condition. No significant differences were observed among the three BFR pressures. In contrast, SLJ, 10-m sprint, and 505COD showed no significant time × condition interactions, indicating that adding BFR did not provide statistically greater acute benefits than the DS condition for these tasks. Adding BFR to dynamic stretching produced an additional acute benefit for CMJ, but this effect was not pressure-dependent across the estimated AOP levels tested. The additional benefit of BFR was not observed for SLJ, 10-m sprint, or 505COD, suggesting that the acute effects of DS+BFR may be task-specific.
暂无摘要（点击查看详情）
To evaluate the effects of exercise snacks on cardiorespiratory fitness, body composition, and blood lipids among adults of different age groups. PubMed, Web of Science, CINAHL, Embase, the Cochrane Library, and Scopus were searched from inception to April 15, 2026. Randomized controlled trials evaluating exercise snacks in adults were included. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment. Subgroup analyses, meta-regression, sensitivity analyses, and publication bias assessments were conducted. Twenty-one studies involving 921 participants were included. Exercise snacks significantly improved maximal oxygen uptake (VO2max; g = 1.04, 95% CI = 0.68-1.39; moderate-certainty evidence) and peak power output (PPO; g = 0.68, 95% CI = 0.25-1.10; moderate-certainty evidence), whereas body fat percentage showed an overall increase (g = 0.51, 95% CI = 0.01-1.02; low-certainty evidence). No statistically significant effects were observed for total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, or triglycerides. VO2max improved in studies with mean participant ages <25 and 25-50 years, but not >50 years, whereas PPO improved across all three age strata. Further analyses suggested that a greater number of exercise bouts per day, an intervention frequency of 4-5 days per week, and an intervention duration of 7-9 weeks may be associated with greater improvements in cardiorespiratory fitness. Exercise snacks may improve cardiorespiratory fitness in adults, although effects may vary by age and intervention characteristics. Evidence for body composition and blood lipids remains inconsistent, and the age-based findings require confirmation using individual participant data.