搜索结果：Annals of physical and rehabilitation medicine

Recovering standing balance after a stroke is an important milestone. However, the factors that affect post-stroke quiet standing balance remain unclear. To determine the clinical profile of individuals according to their standing ability. This cross-sectional study was conducted as part of the DOBRAS (Determinants of Balance Recovery After Stroke) cohort, which included individuals aged 18 to 80 years who had experienced a first unilateral hemisphere stroke. Three groups were formed based on the Postural Assessment Scale for Stroke score at 30 days post-stroke (D30): those unable to stand alone, those able to stand alone with difficulty, and those able to stand alone rather well. Sensorimotor and cognitive impairments were comprehensively assessed at D30. Data were analyzed by multivariate regression (14 impairments + age). We analyzed data for 221 individuals (median age 67 years; 67 % male). Almost half (103/221, 47 %) could stand rather well, 33 % (73/221) could stand with difficulty, and 20 % (45/221) could not stand at all. The probability of being unable to stand alone increased with the severity of motor weakness (standardized logistic regression coefficient β0 = 6.4), lateropulsion (β0 = 4.4), and hypoesthesia (β0 = 3.3). The probability of standing with difficulty increased with the severity of motor weakness (β0 = 3.7), lateropulsion (β0 = 2.1), and hypoesthesia (β0 = 1.3) as well as with age (β0 = 0.7). One month after a hemisphere stroke, 53 % (118/221) of individuals do not stand or stand with difficulty, a proportion stable for 20 years. The standing posture should be considered more explicitly in modern post-stroke balance assessments, with more manageable postural tasks. The clinical profile of individuals with difficulty standing or inability to stand combines impairments in the elementary motor command (weakness), vertical orientation (lateropulsion), and somatosensory perception (hypoesthesia). They are also older. Focusing on these impairments and balance training could help people recover their standing posture after a stroke. Older individuals require more balance training.

Prehabilitation has been proposed to enhance recovery after total hip arthroplasty (THA). Understanding its preoperative effectiveness across modalities is an important step towards clarifying its potential role in optimizing recovery. To compare the preoperative effectiveness of various prehabilitation modalities with standard care on physical function, pain, health-related quality of life (HR-QoL), and Timed Up and Go (TUG) performance in individuals awaiting THA, and to summarize other performance-based, strength, and hip-specific outcomes when data were insufficient for network meta-analysis. A systematic review and network meta-analysis of randomized controlled trials (RCTs) was conducted following PRISMA guidelines. Eligible studies included individuals undergoing THA for end-stage osteoarthritis who received any form of preoperative prehabilitation targeting physical, educational, nutritional, or behavioral domains, either alone or in combination. Comparators were standard care or another prehabilitation intervention. Confidence in the evidence was assessed using CINeMA. 21 RCTs involving 1061 participants were included, comprising 10 prehabilitation modalities: lower-extremity strength training, clinic-based multidomain exercise, home-based exercise (with or without protein supplementation), tele-prehabilitation, neuromuscular electrical stimulation, Tai Chi, upper-body high-intensity training, heat-plus-resistance training, and education. Multidomain exercise, lower-extremity strength training, and Tai Chi demonstrated beneficial preoperative effects, whereas no statistically significant effects were observed for the other modalities. Tai Chi improved physical function (SMD = 0.94; 95% CI 0.07-1.80; I2 = 54%) and TUG performance (SMD = 1.50; 95% CI 0.92-2.07; I2 = 0%). Multidomain exercise reduced pain (SMD = 0.54; 95% CI 0.16-0.92; I2 = 52%) and enhanced HR-QoL (SMD = 0.44; 95% CI 0.16-0.71; I2 = 30%). Lower-extremity strength training improved HR-QoL (SMD = 0.49; 95% CI 0.03-0.94; I2 = 30%). Overall confidence was low to very low due to imprecision, and moderate for Tai Chi versus standard care (TUG). Tai Chi, multidomain exercise, and lower-extremity strength training showed preoperative benefits, with moderate-to-low confidence in the evidence. Well-powered trials with standardized outcomes are needed to confirm these effects. PROSPERO (CRD42024490615).

Persistent post-concussion symptoms (pPCS) affect one-third of individuals following mild traumatic brain injury (mTBI), yet interdisciplinary treatment is difficult to access in non-metropolitan areas of Australia. Telehealth-delivered interdisciplinary concussion care may improve equity of access; however, the feasibility and efficacy of this approach are unknown. We adapted our previously piloted in-person treatment, Interdisciplinary Rehabilitation for Concussion Recovery (i-RECOVER), for telehealth delivery (i-RECOVER-TH) and aimed to evaluate its feasibility and preliminary efficacy. Thirteen adults completed a non-concurrent multiple-baseline A-B single-case experimental design. The sample was 62% female, with a mean (SD) age of 43 (15.51) years and a mean (SD) post-injury days of 581 (629.19). Participants were randomized to 2-, 3-, or 4-week baselines before receiving a 12-week interdisciplinary neuropsychology, physiotherapy, and medical intervention. The primary outcome was feasibility, assessed through recruitment and retention rates, treatment adherence and fidelity, participant acceptance of the telehealth intervention, and adverse events. Secondary outcomes included changes in pPCS severity, functional improvement, mood, fatigue, sleep, and physical functioning. Data were analyzed descriptively, visually (systematic visual analysis), and statistically (Tau-U non-overlap method). i-RECOVER-TH was feasible based on a priori criteria. Over half of participants (7/13) showed statistically meaningful reductions in pPCS from baseline to post-intervention. Most (10/13) achieved at least 1 personalized functional goal. Despite residual pPCS for some, improvements in functional goals and other secondary outcomes were possible. As the first global evaluation of interdisciplinary concussion treatment via telehealth, the results support the feasibility of i-RECOVER-TH and its potential efficacy in improving patient-centered outcomes for those with pPCS after mTBI. These preliminary outcomes justify progression to a phase-II randomized controlled trial to more thoroughly evaluate treatment efficacy and to identify sources of variability in treatment response.

Brace treatment is the most common conservative approach for adolescents with idiopathic scoliosis (AIS). However, lived experiences with the brace may influence adherence and the achievement of successful outcomes. To synthesize qualitative studies on the lived experiences, perceptions, and challenges faced by AIS during brace treatment, and strategies they use to enhance or ensure adherence. A systematic review of qualitative studies, followed by a meta-synthesis. MEDLINE, CINAHL, Web of Science, Cochrane Library, Scopus, Physiotherapy Evidence Database, and PsycINFO were searched (from inception to September 1, 2025). References included in these studies and studies included in the ISICO (Italian Scientific Spine Institute) website were also reviewed. We selected primary qualitative or mixed methods studies with identifiable qualitative data, focused on the lived experiences of adolescents with AIS aged 10-18 years, and published in English or Italian. The methodological quality of the studies was assessed with the Joanna Briggs Institute and the Mixed Methods Appraisal tools. Extracted data in the form of texts and quotes were thematically synthesized. Ten studies involving 135 adolescents, mainly female (78.5%), aged 10-18 years, with a Cobb angle of 25.8° to 37.2° and an overall duration of bracing from 7.7 months to 2.9 years. Three analytical themes emerged: 1) "Losing and reconstructing selfhood through and beyond brace treatment," 2) "Redefining self and social roles," and 3) "Regaining agency." Bracing involves a dynamic process of developmental and relational transitions. Adolescents' experiences shift from an initial disruption characterized by psychological shock, physical discomfort, and social stigma, to gradual adaptation and self-regulation, during which they reconstruct their sense of self, identity, and autonomy. Support from parents, peers, teachers, and healthcare professionals is crucial. At the same time, active involvement in treatment planning enhances adolescents' sense of agency, helping them overcome resistance and burden and integrate the brace into daily life.

People with multiple sclerosis (PwMS) are ageing and exposed to multiple impairments. We described the use of health care procedures in a physical and rehabilitation medicine setting for PwMS &#x2265;70 years and identified specific participant clusters. In this observational cohort study using a local data hub (2012 to March 2024), PwMS were identified with ICD-10 codes (G35). An age filter (&#x2265;70) was applied. Medical procedures were systematically coded according to a specific French classification over time, including dates of occurrence, and then extracted and grouped by impairment domains: upper motor neuron syndrome and orthopedic deformities (UMN-OD), respiratory and sleep disorders (RSD), and neurogenic lower urinary tract dysfunction (NLUTD). Clinical data were retrospectively collected from medical files. We conducted descriptive analyses and multiple-component and clustering analyses to identify and characterize the participants' profiles. Among 206 participants aged 75.7 (4.3) years, 62% (128) were women, 19% (39) had died, and MS had evolved for 43.3 (12.4) years. The Expanded Disability Status Scale (EDSS) was 7.5 (6.5-8.5), and the Charlson Comorbidity Index (CCI) was 6 (5-7). A total of 2794 procedures were performed for 187 participants, mainly in NLUTD (1424 for 170), which was associated with RSD (P = 0.001), but not UMN-OD (P = 0.262). Three groups were identified (Group 1 = isolated NLUTD, Group 2 = RSD and intrathecal baclofen procedures, and Group 3 = no in-hospital management). People in Group 2 had more severe comorbidities (P < 0.001) than those in the other two groups (P = 0.016). In PwMS &#x2265;70 years, the hospital management of MS-related impairments was directly associated with disease severity and overall comorbidities. Participants who were followed only for NLUTD exhibited severity and comorbidity profiles similar to those of participants who did not require hospital procedures. Our institutional health data warehouse and all derived extracted databases within the scope of the health team perimeter are approved by the French Data Protection Authority under the No. 1980120.

There is limited information on the course of recovery and long-term outcome of people with prolonged disorders of consciousness (PDOC). To determine long-term outcomes (mortality, recovery of consciousness, disability, functioning, and independence) in people with PDOC after early intensive neurorehabilitation (EIN) within a novel nationwide PDOC care pathway. Prospective cohort study with 2-year follow-up. All people with PDOC admitted to EIN at a single rehabilitation center in the Netherlands were screened for inclusion. Baseline measurements of level of consciousness (CRS-R), disability (DRS), and functioning (FIM) were collected at rehabilitation admission, and follow-up was at 14, 28, 40, 52 and 104 weeks post admission. Of 129 participants included (mean age 38.1 years, SD 16.4), 33 (26%) patients died, and 80 (62%) regained consciousness within the 2-year follow-up. From them, 56 (43%) regained consciousness during 14 weeks of EIN, 14 (11%) within 6 months after admission, and 10 (8%) between 6- and 24-month follow-up. Mean level of disability and functioning significantly increased over time, with the largest improvement between 14- and 28-week post admission. Amongst responders who regained consciousness, the proportion of participants functioning independently (FIM total score &#x2265;78) increased from 4% (3/78) at 14 weeks to 41% (25/61) at 2-year follow-up. Improvement of level of consciousness, disability, and functioning in people with PDOC occurs beyond the early stages of specialized neurorehabilitation until 2 years post injury, despite substantial mortality. These results highlight the need for specialized care for people with PDOC during the first 2 years after their injury, which focuses on both functional recovery and personalized decision-making. International Clinical Trial registry Platform (ICTRP) of the World Health Organization (WHO): NL-OMON23779.

Exercise reduces health complications related to early rheumatoid arthritis (RA). No previous review has systematically evaluated the effects of exercise in pre-clinical and early RA. This systematic review and meta-analysis aimed to assess the effectiveness of exercise in pre-clinical and early RA and to identify which intervention characteristics are associated with better clinical outcomes. We searched PubMed/MEDLINE, Scopus, and Web of Science up to January 2026 for randomized controlled trials examining effects of exercise in pre-clinical and early RA on: (i) inflammation markers and disease activity, (ii) muscle strength, cardiovascular fitness, functional capacity, and body composition, and (iii) pain, fatigue and quality of life. Effect sizes (ES) with 95% confidence intervals (95% CI) were calculated using random-effects meta-analyses. Meta-regressions and RoB 2 risk-of-bias assessments were conducted. Fifteen studies involving 1154 participants with early RA were identified. Most studies showed a moderate-to-high risk of bias. No randomized trials were identified in pre-clinical populations. Exercise improved hand status (ES = 0.33; 95% CI, 0.10-0.57; P = 0.001), self-reported functional capacity (ES = 0.36; 95% CI, 0.00-0.73; P = 0.049), muscle strength (ES = 0.66; 95% CI, 0.16-1.15; P = 0.022), and pain (ES = 0.66; 95% CI, 0.00-1.22; P = 0.049). No effects appeared for disease activity (ES = 0.17; 95% CI, -0.05-0.40; P = 0.101), morning stiffness (ES = 0.13; 95% CI, -0.25-0.52; P = 0.351), test-based functional capacity (ES = 0.38; 95% CI, -0.12-0.89; P = 0.112), and quality of life (ES = 0.42; 95% CI, -0.18-1.02; P = 0.134). Sensitivity analyses revealed benefits for test-based functional capacity (P = 0.047) and morning stiffness (P = 0.024). Meta-regression showed no moderating effect of disease duration, intervention type, or supervision (P &#x2265; 0.089). Exercise confers modest benefits in strength, hand function, functional capacity, pain, and morning stiffness in early RA, supporting its integration alongside pharmacologic care. Major evidence gaps remain for cardiovascular fitness, fatigue, mental health, inflammation, and the pre-clinical population. Well-designed preventive and early-phase trials are needed. PROSPERO identifier: CRD42024522163.

The semantic variant of primary progressive aphasia (svPPA), a rare neurodegenerative disorder, leads to anomia due to a progressive loss of word meaning. In the absence of pharmacological treatment, speech therapy is preferred in clinical practice. However, semantic rehabilitation, which has shown beneficial effects in vascular aphasia when used in combination with metacognitive training, is poorly studied in degenerative pathologies and specifically in svPPA. The aim of this study was to assess the effect of semantic therapy combined with metacognitive training on naming performance in persons with svPPA. The study followed a Single Case Experimental Design (SCED) methodology with a multiple baseline AB design. Phase A (baseline period with non-specific phonological rehabilitation) lasted for 6-10 weeks, randomly. Phase B (a specific intervention period combining semantic rehabilitation with metacognitive training) lasted 5 weeks. Three 45-minute treatment sessions were carried out per week. Participants' performance of a rapid naming task (RNT) was measured repeatedly during every second session and constitutes the primary endpoint. In this study, 8 participants were included, comprising 6 men and 2 women aged 59 and 72 years with a diagnosis of svPPA. Six out of 8 participants showed a significant improvement in naming performance on trained items on repeated measurement, as a result of the semantic rehabilitation. Two of the 6 participants who showed significant improvement in naming trained items also showed significant improvement in naming untrained items. The results show that specific semantic rehabilitation had a beneficial effect on svPPA participants and promise generalization of these effects. The study was approved by the Ethics Committee for the Protection of Persons on June 22, 2021 (ID-RCB Number: 2021-A01698-33) and was conducted in accordance with the Declaration of Helsinki.

Low back pain (LBP) is a leading cause of work-related disability. Comprehensive instruments such as the Work Rehabilitation Questionnaire (WORQ) capture multiple domains of functioning but are lengthy and impractical for routine use. To develop and evaluate a LBP-specific brief form of the WORQ. A secondary psychometric analysis of clinical cohort data using the LBP-validated version of the WORQ using Rasch analysis. Data analysis was conducted at the Spine Center of Southern Denmark. The cohort comprised 425 adults with LBP, aged 18-65, employed or seeking work. not applicable. Work-related disability was measured using the LBP-validated WORQ (psychological, physical, and cognitive subscales), the Oswestry Disability Index, a numerical pain rating scale, and a single-item Work Ability Index. Rasch analysis was applied at the subscale level to guide item reduction and evaluate model fit, item performance, unidimensionality, category functioning, and differential item functioning. The brief WORQ-LBP comprised 15 items: 6 cognitive, 4 physical, 3 psychological, and 2 additional items (fatigue and sleep disturbances). Rasch analysis confirmed good model fit for the physical and psychological subscales and acceptable fit for the cognitive subscale. All subscales demonstrated acceptable internal consistency (Cronbach's &#x3b1; &#x2265;0.79) and reliability. Measurement precision was highest for individuals with moderate impairments, and minor disordered thresholds occurred mainly in lower response categories. No substantial item dependence or differential item functioning was detected. Transformed scores enable interval-level interpretation, supporting use in clinical and research contexts. The brief WORQ-LBP is a psychometrically robust, multidimensional instrument for assessing work-related disability in individuals with LBP. Because responsiveness and predictive validity were not evaluated, further longitudinal studies are needed to confirm evaluative applications.

Neurological disorders are leading contributors to global disability, yet the scale and distribution of rehabilitation needs remain insufficiently quantified. Accurate estimates are essential for informing global health strategies amid population ageing and epidemiological transitions. We analyzed data from the Global Burden of Disease Study 2021 to estimate rehabilitation needs for 10 neurological disorders across 204 countries and territories from 1990 to 2021. Outcomes included age-standardized prevalence rates (ASPR), years lived with disability (YLD), and absolute case numbers, disaggregated by sex, age, region, and Socio-demographic Index (SDI). Temporal trends were assessed using estimated annual percentage change (EAPC) with 95% CIs. In 2021, an estimated 225.4 million (95% UI, 210.4-241.8) individuals worldwide required rehabilitation for neurological disorders, representing a 92% increase from 117.1 million (107.5-128.1) in 1990. The global ASPR rose from 3066.4 (2810.3-3330.2) to 3133.1 (2926.3-3351.7) per 100&#x2009;000 population (EAPC = 0.17; 95% CI, 0.16-0.18]). Age-standardized YLD rates increased from 314.2 (290.7-339.5) to 331.1 (309.2-354.7) per 100000 (EAPC = 0.13; 95% CI, 0.12-0.14). Cerebral palsy accounted for the largest share of rehabilitation needs, with 70.8 million (63.2-79.1) cases, followed by cerebrovascular disease (57.4 million [54.9-60.1]). Regionally, South Asia and Sub-Saharan Africa exhibited the highest ASPRs and YLD rates, whereas High-income regions showed moderate rates but the steepest increases over time, driven by population ageing. East and Southeast Asia experienced the largest absolute growth in the number of individuals requiring rehabilitation. Age-specific burden peaked among females aged &#x2265;95 years, with an ASPR of 45706.3 (43321.9-48223.0) per 100000. Strong positive correlations with the SDI were observed for motor neuron disease (ASPR and YLD rate: R = 0.885; P < 0.001), whereas neural tube defects showed the strongest inverse association. Global rehabilitation needs for neurological disorders have nearly doubled since 1990, driven by demographic ageing, population expansion, and improved survival with disabling conditions. Large regional, national, and socio-demographic disparities demand targeted investment in community-based rehabilitation, long-term care infrastructure, and integration of rehabilitation into universal health coverage schemes.

Cardiovascular-kidney-metabolic syndrome (CKM) and chronic kidney disease (CKD) exhibit bidirectional associations. Limited research has explored the relationship between physical activity patterns and CKD risk among middle-aged and older adult participants with stage 1 CKM. This longitudinal analysis used China Health and Retirement Longitudinal Study (CHARLS) data from 2015, 2018, and 2020, including 2569 participants with stage 1 CKM. Physical activity was assessed using the International Physical Activity Questionnaire with Metabolic Equivalent of Task (MET) calculations. A Latent Class Growth Model was constructed to examine patterns in physical activity across follow-up points. Restricted Cubic Spline analysis examined nonlinear associations between MET and CKD risk, while a Generalized Linear Model evaluated associations between physical activity patterns and CKD incidence. The CKM stage 1 participants' mean [SD] age was 59 years, 69% (1766/2569) were female, and 59% (1518/2569) had low educational attainment. During the 5-year follow-up, 55% (1415/2569) of participants progressed to CKD. Two physical activity patterns were identified: a high-level parabolic physical activity pattern (HPPA; n = 428) and a low-level continuously decreasing physical activity pattern (LCDPA; n = 2167). Significant nonlinear associations existed between physical activity levels and CKD risk. CKD risk was significantly reduced when weekly physical activity reached 2613 MET at baseline, 3066 MET at 3 years, and 5907 MET at 5 years (all P < 0.001). Compared with LCDPA, HPPA significantly reduced CKD risk (OR = 0.18; 95% CI, 0.13-0.24; P < 0.001), with consistent protective effects across all subgroups. Physical activity in stage 1 CKM participants is nonlinearly associated with CKD risk. Maintaining specific MET thresholds at diagnosis, 3 years, and 5 years post-diagnosis significantly reduced CKD incidence. HPPA significantly reduced CKD risk compared to LCDPA, and suggests that encouraging higher sustained physical activity could be valuable for CKD prevention in this population. This study used data from the China Health and Retirement Longitudinal Study (CHARLS), publicly available at http://charls.pku.edu.cn (registration required). The processed datasets and analysis code are openly available in the Zenodo repository: https://zenodo.org/records/17840857 (10.5281/zenodo.17840857).

Total hip arthroplasty (THA) is the standard treatment for end-stage hip osteoarthritis, providing pain relief and functional improvement, yet gait deficits often persist despite good radiological and clinical outcomes. Minimally invasive approaches, such as the direct anterior (DAA) and anterolateral (ALA) techniques, are hypothesized to enhance early recovery compared with the conventional posterior approach (PA). We aimed to determine the impact of surgical approach on early gait restoration and patient-centered outcomes after THA. A prospective cohort of 189 participants undergoing primary unilateral THA for severe osteoarthritis was evaluated: DAA (n = 63), PA (n = 61), ALA (n = 65). Assessments were performed pre-operatively and 3 months post-operatively using the WHO-ICF framework: radiographic parameters and Oxford Hip Score (OHS) for body structure/function; 3-dimensional instrumented gait analysis for activity (spatiotemporal, kinematics, kinetics, mechanical work, and energy cost); and the Short Form 36 Health Survey (SF-36) physical and mental scores for participation. Paired-ANOVA tested treatment effects and between-approach differences (P <0.05). Principal-component analysis explored relationships between biomechanical and clinical outcomes. THA significantly improved OHS, SF-36 scores, step length, sagittal hip/pelvic kinematics, hip-flexion moment, pendular recovery, and reduced external mechanical work and metabolic cost of walking (all P <0.05). Clinical and participation gains were similar across approaches, but gait analysis revealed approach-specific advantages: ALA showed greater step-length gain and lower energy cost, whereas DAA exhibited larger reductions in external work and better pendular recovery. THA markedly enhances function and quality of life regardless of approach, yet minimally invasive DAA and ALA confer earlier biomechanical benefits in gait efficiency compared with PA. Combining gait analysis with clinical scores highlights these mechanistic differences and supports targeted rehabilitation strategies to optimize locomotor recovery after THA.

Severe COVID-19 infection leads to profound pulmonary, cardiovascular, and neuromuscular impairments, resulting in marked exercise deconditioning and reduced functional walking capacity after hospital discharge. Eccentric cycling offers high mechanical load with low metabolic cost and may therefore represent a relevant rehabilitation strategy to restore functional capacity in people after COVID-19. To compare functional recovery after 8 weeks of eccentric (ECC) or concentric (CON) training in individuals discharged 1 month previously after a COVID-19 infection. The CovExc trial was a multicenter, randomized, controlled, open-label study conducted in 3 centers. Adults (<80 years) at least 1 month after hospital discharge for severe COVID-19 were randomized (1:1) to 8 weeks of ECC or concentric CON ergometer training (3 30-min sessions per week). The primary outcome was change in the 6-minute walk test (6MWT) distance between baseline and post-intervention (M2). Secondary outcomes included physical performance, muscle strength (handgrip), fatigue, and quality of life. Analyses were conducted in the modified intention-to-treat (mITT) population using mixed models. Of the 60 participants enrolled, 56 (median age (IQR): 54.5 (48; 62)) were included in the modified intention-to-treat population, including 33 men (59%). Forty-four participants completed the program. Intergroup analysis showed no significant differences between the ECC and CON for any variable. However, within-group analyses of the primary endpoint (mITT and per-protocol) revealed a significant change between baseline and 2 months (P = 0.002 and P = 0.001 for ECC and CON groups on mITT and P = 0.001 for ECC and CON groups on per-protocol). 6MWT improved by 18 m in ECC (0; 72) and 28 m in CON (0; 53) (median difference -10 m; 95% CI (-42 to 22). Both eccentric and concentric training improved walking distance in participants after COVID-19, with no difference between groups. Further randomized controlled trials are needed to confirm the effectiveness of these approaches for people who survived COVID-19. NCT04649086.

The use of postoperative lumbar bracing after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCFs) remains controversial, and evidence comparing brace types is limited. This study evaluated the impact of four postoperative bracing strategies-no-brace, soft-brace, rigid-brace, and a mixed protocol-on recovery, pain, vertebral height maintenance, and quality of life after PVP. We conducted a prospective randomized controlled trial at a single tertiary spine center between July 2024 and March 2025. A total of 160 people with single-level OVCFs were randomized equally to No-Brace, Soft-Brace, Rigid-Brace, or Mixed-Brace (rigid brace for 4 weeks followed by soft brace for 8 weeks). Follow-up assessments were performed at 4, 8, and 12 weeks. Primary outcomes were the Oswestry Disability Index (ODI), visual analog scale (VAS) scores for back pain and stiffness, and Japanese Orthopedic Association (JOA) scores. Secondary outcomes included the physical and mental component scores of the Short Form-36 (SF-36) and anterior body compression ratio (ABCR) on radiographs to assess vertebral height preservation. All groups showed significant improvements in function and pain over 12 weeks. At 12 weeks, the Mixed-Brace group had the lowest ODI (mean 22.5, SD 3.2), significantly lower than Rigid-Brace (mean 28.2, SD 4.5, P < 0.05) and comparable to Soft (mean 22.8, SD 4.7) and No-Brace (mean 24.2, SD 3.7). The Mixed group also achieved the highest JOA (mean 23.4, SD 1.8), best mental component score (mean 48.2, SD 5.1), and lowest stiffness VAS (mean 2.4, SD 0.7). Radiographically, Rigid and Mixed Braces preserved vertebral height better than Soft or No-Brace. No crossovers or serious adverse events occurred. A sequential mixed-brace protocol-early rigid support followed by soft bracing-offered the best balance of stability, comfort, and psychological well-being after vertebroplasty, outperforming rigid- or soft-only bracing in short-term recovery. Chinese Clinical Trial Registry (ChiCTR2400091529).

Alternative or adjunctive rehabilitation treatments have emerged for obstructive sleep apnea (OSA) to address low patient compliance with conventional treatments, improve sleep quality, and reduce the number of apnea episodes. To conduct a comprehensive review of respiratory muscle training as a therapeutic adjunct for OSA. Namely, oromyofunctional therapies (OMF), inspiratory muscle training (IMT), and expiratory muscle training (EMT). English language articles were selected from the PubMed, Cochrane Library, and ASHA databases, and their methodological quality was assessed using AMSTAR 2. A qualitative review and random-effects meta-analyses were performed on the variables of interest. Because of a specific focus on rehabilitation approaches, we excluded pharmacological therapies and hypoglossal nerve stimulation, thereby centering the research on airway musculature. A total of 247 articles were identified. Four studies were selected for review, comprising a total of 1468 adult patients and 106 pediatric patients. The meta-analyses showed that only OMF, as an adjunctive or stand-alone therapy (mean difference, MD -14.26 events/hour; P < 0.0001; CI 95% -20.98 to -7.54) and EMT (MD -8.42 events/hour; P < 0.0001; CI 95% -12.41 to -4.43) significantly reduced the apnea-hypopnea index (AHI). However, the 3 therapies were all effective in reducing daytime sleepiness (MD -3.50/24 points; P = 0.003; 95% CI -5.78 to -1.22), and IMT, EMT, or a combination of both also improved sleep quality (MD -2.75, P = 0.01; 95% CI -4.85 to -0.66). The results of this review suggest that respiratory muscle training improves AHI and has a beneficial effect on clinical symptoms such as sleep quality and daytime sleepiness. Included studies are based on a low level of evidence, despite the generally good methodological quality of the systematic reviews.

Resistance training is recommended for knee osteoarthritis, although its effectiveness and safety across different clinical stages and optimal prescription parameters remain unclear. To assess the effectiveness and safety of resistance training across all stages of knee osteoarthritis, explore potential moderators, and compare it with other exercises. Medline, Web of Science, Scopus, and Cochrane were searched from inception to July 10, 2024. Randomised controlled trials evaluating resistance training in individuals with knee osteoarthritis were included. Random-effects meta-analyses were conducted, with sensitivity analyses. Primary outcomes addressed physical function (eg, mobility tests); secondary outcomes included knee-specific patient-reported outcomes (eg, WOMAC). Safety was analysed using risk differences. Certainty of evidence was assessed using GRADE. 120 trials (10 253 participants) were included: 88 on early knee osteoarthritis, 13 on preoperative phases, and 19 after knee replacement. For primary outcomes, resistance training improved mobility, walking capacity, and knee extension strength in early osteoarthritis ccompared with control (SMD 0.46-0.81; moderate-to-high GRADE), knee extension strength in the preoperative phase (SMD 0.47; high GRADE), and mobility after knee replacement (SMD 0.58; moderate GRADE). For secondary outcomes, resistance training improved pain, stiffness/symptoms, physical function, and quality of life in early osteoarthritis (SMD 0.43-0.63; moderate-to-high GRADE), showed no significant effects preoperatively, and reduced knee pain after knee replacement (SMD 0.40; high GRADE). Moreover, resistance training showed non-significant risk differences versus controls in early osteoarthritis and in pre- and post-surgical phases. Resistance training may provide clinically relevant benefits across the knee osteoarthritis continuum without increasing risk. Resistance training should be considered as a core component of rehabilitation and conservative management strategies across all stages of knee osteoarthritis. CRD42024513524.

The efficacy of commonly used medication and physical interventions for cervicogenic headache (CGH) in adults remains insufficiently assessed. To evaluate the efficacy of nonsurgical interventions for managing adults with CGH. A comprehensive search was conducted across 6 databases through September 2025, identifying randomized controlled trials (RCTs) that examined the efficacy of nonsurgical interventions in reducing CGH-related outcomes, including headache frequency, intensity, duration, neck disability, medication intake, and quality of life. 2 reviewers independently extracted data using a standardized form. Risk of bias was assessed with the Cochrane RoB 2.0 tool, and certainty of evidence with the GRADE approach. Meta-analyses were conducted for trials with similar interventions, comparators, and outcomes. Standardized mean differences (SMD) with 95 % confidence intervals were calculated using a random-effects model and the inverse-variance method. Heterogeneity was assessed using &#x3c7;&#xb2; and I&#xb2; statistics. Effect sizes were interpreted according to Cohen's thresholds. For RCTs not eligible for meta-analysis, a structured narrative synthesis was conducted. 29 RCTs were included. Low-certainty evidence suggests that manual therapy reduced headache intensity compared with sham at 0-2 weeks post-intervention (SMD -1.60; 95 %CI -2.40 to -0.79; 5 RCTs; n = 144), but not at 12 months (SMD 0.09; 95 %CI -0.59 to 0,76; 2 RCTs; n = 265). Low-certainty evidence indicates that exercise therapy alone may reduce headache compared with usual care, but the difference was not statistically significant at 1-3 months (SMD -1.30; 95 %CI -2.61 to 0.02; 2 RCTs; n = 116) and at 12 months (SMD -1.25; 95 %CI -2.35 to -0.14; 2 RCTs; n = 116). Evidence is uncertain regarding the efficacy of both manual therapy and the combination of manual therapy and exercise therapy compared with usual care. Manual therapy may offer short-term relief for adults with CGH. However, the long-term effects and added benefits of combined approaches remain unclear. TRIAL REGISTRATION PROSPERO: #CRD42023390280.

Traumatic brain injury (TBI) is a major public health issue, associated with significant mortality and long-term disability. Little is known about the typical trajectories of patients with TBI, particularly before and after injury. This study aimed to describe care pathways surrounding TBI and to identify the determinants associated with these trajectories, with the ultimate goal of supporting the development of coordinated and optimized care strategies for patients with TBI. A retrospective cohort study was conducted using data from Toulouse University Hospital and the French National Health Data System. People treated for TBI between 2014 and 2018 were identified using ICD-10 codes, and their healthcare trajectories were reconstructed over a period spanning 2 years before and after the injury. A multidomain sequence analysis was conducted across 3 domains: type of care unit, outpatient care type, and mental health status. A multinomial logistic regression model was implemented to analyze the relationship between covariates and care trajectories. Among the 23 395 people with TBI, 6 distinct care trajectories were identified, 3 per age group. For young individuals aged 10 to 52 years, 4 trajectories ranged from low-complexity and prevention-oriented to high healthcare needs linked with pre-existing mental health vulnerability. Among seniors (aged 53 to 107 years), 3 pathways reflected varying degrees of autonomy loss, reliance on rehabilitation, and psychotropic medication use. Mental health fragility and high hospitalization needs were key discriminants of complex trajectories in both groups. Among the younger group, clustering was largely determined by socioeconomic deprivation, while among the senior group, it was primarily influenced by sex and comorbidity profiles. This study highlights the heterogeneity of TBI care pathways and underscores the need for age-specific and personalized care strategies. Understanding these trajectories can inform early identification of vulnerable people and guide targeted interventions, ultimately improving equity and continuity of care. The methodology also offers valuable applications for managing other complex health conditions.

Research indicates that impairment of instrumental activities of daily living (IADLs) leads to reduced physical activity (PA) in daily life. However, these studies often rely on subjective measures such as questionnaires and interviews to assess PA. This study examined the association between IADL frequency and objectively measured PA in stable individuals with cardiovascular disease (CVD). In this cross-sectional study, we included people with CVD who had been receiving outpatient care under stable conditions for at least 6 months. IADL frequency was assessed using the Frenchay Activities Index (FAI). PA was measured using accelerometers over 2 weeks to calculate the daily average number of steps, low-intensity PA (LPA), and moderate-to-vigorous-intensity PA (MVPA). A multivariate linear regression model analyzed the associations between the FAI scores (total and sub-items) and PA levels. This study included 1126 stable participants with CVD (median age, 74.0 years; 278 females). After adjusting for clinical confounding factors, a high FAI total score was significantly associated with higher levels of PA (number of steps per day, unstandardized coefficient [&#x412;] = 78.1, LPA per day, &#x412; = 0.7, and MVPA per day, &#x412; = 0.2). In the FAI subitems, 4 housework and 6 leisure activities were positively associated with the daily average number of steps and LPA, and 2 leisure activities were positively associated with daily MVPA. Greater IADL frequency was associated with higher objectively measured PA in stable participants with CVD. Leisure-related activities were associated with increased MVPA, suggesting that encouraging these activities may help promote meaningful PA engagement in this population.