搜索结果：Disability and rehabilitation

Web-based surveys involving self-reported questionnaires are vulnerable to fraudulent responses. Advancements in artificial intelligence and bots have introduced additional challenges to preventing and identifying fraudulent responses to online questionnaires. This study aimed to describe our experiences with fraudulent responses, strategies for preventing and identifying fraudulent responses, lessons learned when conducting a web-based survey with adults living with Long COVID, and recommendations for web-based survey research. The Long COVID and Episodic Disability Study is an international community-engaged study among adults living with Long COVID in Canada, Ireland, the United Kingdom, and the United States. We conducted a longitudinal web-based survey, with online administration of a self-reported questionnaire at 2 timepoints (Time 1 and Time 2), 1 week apart. We recruited through Long COVID community groups using social media, emails, and word of mouth. The survey was disrupted by fraudulent responses, including bots. To defend data integrity, we implemented the following strategies: (1) pausing our initial launch (Wave 1), (2) developing and implementing screening criteria to identify fraudulent responses, and (3) relaunching the web-based survey (Wave 2) with revised recruitment strategies and questionnaire design to prevent and identify fraudulent responses. We received 4663 responses for Time 1 and 1281 responses for Time 2, of which we retained 798 of 4663 (17%) responses and 629 of 1281 (49%) responses. Strategies for preventing fraudulent responses included enabling survey protection features in survey software, shutting down compromised survey links, avoiding recruitment via public social media groups, and removing mention of a financial incentive from recruitment materials. Strategies for identifying fraudulent responses included monitoring response completion times, start and end time stamps, geolocation, and screening for suspicious email address characteristics and duplicates. Our lessons learned fell into the following three areas: (1) survey-design and implementation to prevent and identify fraudulent and bot-generated responses, (2) recruitment strategies to mitigate the risk of disruption by bots, and (3) responding to disruptions caused by fraudulent and bot responses. We recommend the following tactics to prevent and mitigate the risks of fraudulent and bot responses when administering online web-based questionnaires: (1) review current literature and connect with researchers and Research Ethics Boards about strategies before launching, (2) invest in survey software with rigorous information security technology, (3) use bot-detection features available in survey software before launching, (4) design questionnaire items to identify bots and fraudulent actors, (5) tailor criteria for identifying fraudulent and bot responses to the characteristics of the target population, (6) avoid recruitment in public social media groups, (7) engage community leaders in tailored and targeted recruitment, (8) avoid advertising incentives, (9) shut down compromised links rapidly, (10) communicate with the Research Ethics Board about disruptions, and (11) combine automated and manual methods to identify potentially fraudulent responses on time.

With total hip arthroplasty (THA) volumes rising worldwide, scalable home rehabilitation strategies are needed. Home-based digital physiotherapy can improve recovery after THA, and adding wearable motion sensor feedback may further enhance exercise performance and adherence. However, the impact of sensor-augmented digital rehabilitation on patient outcomes and cost-effectiveness remains unclear. This study aimed to evaluate the clinical effectiveness (including adherence) and cost-effectiveness of adding wearable sensor feedback to a home-based digital THA rehabilitation program compared with the same digital program without sensors. We conducted a single-center randomized controlled trial in Shanghai from June 2023 to June 2024. A total of 240 patients who had undergone primary THA were randomized (1:1) to a 12-week home exercise program delivered via a mobile app either with wearable motion sensors for real-time feedback (intervention) or without sensors (control). Both groups received identical exercise content and weekly teleconsultations. Outcomes were assessed at 6, 12, and 24 weeks by blinded evaluators. The primary outcome was the Hip Disability and Osteoarthritis Outcome Score (HOOS) at 24 weeks. Secondary outcomes included HOOS subscales, timed up-and-go (TUG), Berg Balance Scale, 36-item Short Form Health Survey (SF-36) physical and mental scores, Hospital Anxiety and Depression Scale (HADS) anxiety/depression, patient satisfaction, adherence metrics, and total 24-week costs. Intention-to-treat analyses were used. Mixed effects models and &#x3c7;&#xb2; tests were used for group comparisons. Cost-effectiveness was evaluated from a societal perspective. The sensor-based rehabilitation group showed significantly greater improvement in the primary outcome (HOOS overall) than the control group at 24 weeks (P=.01). Early postoperative gains were larger: At 6 weeks, 4 of the 5 HOOS subscales, TUG time, and all patient-reported outcomes remained significant after Bonferroni correction for 47 secondary comparisons (adjusted P<.001). By 24 weeks, hip-specific functional differences had narrowed, but SF-36 physical and mental scores (both P<.001) and HADS anxiety and depression scores (both P<.001) remained significant after correction. Total 24-week costs were similar between the groups (&#xa5;87,967 vs &#xa5;94,396 [US $12,879.80 vs $13,821.10] per patient; P=.32). The sensor intervention was associated with numerically lower costs on average (&#xa5;6428.98 [US $941.31] less per patient), yielding negative incremental cost-effectiveness ratios, though the cost difference was not statistically significant. Adherence was high in both groups but higher with sensors: The intervention group completed more exercise sessions (P=.002) and showed greater participation in weekly assessments and follow-up calls (both P<.001). Adverse events were uncommon in both groups (5.8% vs 7.5%) and mostly minor, with no serious events reported. Augmenting home-based digital rehabilitation with wearable sensor feedback led to statistically significant improvements in the primary hip function outcome and in patient-reported quality of life and psychological outcomes that persisted after Bonferroni correction through 24 weeks. Several early hip-specific secondary outcome differences did not survive correction for multiple comparisons. The between-group HOOS differences were below the established minimal clinically important difference. Exercise adherence was significantly higher in the sensor group. These benefits were achieved with no increase in cost, suggesting the sensor-enhanced program is a safe and feasible approach to THA rehabilitation that enhances adherence and accelerates early recovery.

Students with hearing impairments face elevated risks of executive function (EF) deficits due to limited auditory-linguistic scaffolding. Augmented reality (AR) offers visually grounded cognitive rehabilitation affordances aligned with these learners' visual-spatial strengths. This study designed and evaluated an AR-based assistive technology to enhance EF in hearing-impaired elementary students and explored usability from learners' perspectives. An explanatory sequential mixed methods design was employed. In Phase 1 (QUAN), 50 hearing-impaired students (Grades 1-6) were randomly assigned to experimental (n&#x2009;=&#x2009;25) or control (n&#x2009;=&#x2009;25) groups across eight AR intervention sessions. In Phase 2 (QUAL), 12 participants were purposively selected via maximum variation sampling for group semi-structured interviews facilitated by Thai Sign Language teachers. Quantitative and qualitative strands were integrated via a joint display. Between-group analysis revealed a significant improvement in verbal working memory (p = .005, r&#x2009;=&#x2009;0.43; surviving Bonferroni correction, &#x3b1;&#x2009;=&#x2009;0.008); inhibition response time showed a marginal effect (p = .029) that did not reach the corrected threshold. Codebook thematic analysis (&#x3ba; = 0.80) produced five themes. Joint display integration yielded four meta-inference types: confirmation (QUAN and QUAL mutually reinforce findings), expansion (QUAL extends interpretation of marginal QUAN effects), discordance-explanation (null cognitive-flexibility effect attributed to limited task variety), and confirmation of null (QUAL corroborates practice/maturation as alternative explanation for within-group TMT gains). AR-based assistive technology grounded in visual-spatial learning principles shows promise for cognitive rehabilitation in hearing-impaired students. Mixed methods integration revealed intervention mechanisms that neither strand could yield independently. AR-based assistive technology that leverages visual-spatial modalities can serve as a viable cognitive rehabilitation tool for children with hearing impairments, particularly for targeting executive functions such as inhibition and working memory that are often underserved by conventional auditory-linguistic approaches.Designing assistive technology in alignment with the ICF framework&#x2014;addressing activity limitations and participation restrictions rather than impairment alone&#x2014;can support more holistic rehabilitation outcomes by reducing environmental barriers to cognitive engagement for hearing-impaired learners.Incorporating usability evaluation guided by ISO 9241-11 (effectiveness, efficiency, and satisfaction) into assistive technology development ensures that rehabilitation tools are not only clinically effective but also accessible and acceptable to the target population, which is essential for sustained engagement and real-world adoption.Rehabilitation practitioners working with hearing-impaired children should consider integrating AR-based interventions with visual scaffolding, sign-language support, and immediate feedback mechanisms as complementary tools within cognitive rehabilitation programs, as these features were associated with improved self-regulation, motivation, and confidence among learners.Systematic instructional design models such as ASSURE can provide a structured, replicable framework for developing assistive technologies tailored to specific rehabilitation needs, enabling interdisciplinary teams&#x2014;including rehabilitation professionals, educators, and technology developers&#x2014;to collaboratively design evidence-based cognitive rehabilitation tools for diverse populations with sensory impairments.

The war in Gaza since October 2023 has resulted in unprecedented rates of traumatic limb loss. Local evidence on the functional and psychiatric consequences for survivors and caregivers remains limited. We conducted a cross-sectional comparative study across three rehabilitation centers in Gaza, recruiting 96 adults with war-related limb amputations, 53 primary caregivers, and 95 community-based controls matched for age, sex, and education. Functional disability was assessed using WHODAS 2.0, and psychiatric symptoms with PHQ-9, GAD-7, and PC-PTSD-5. Predictors of disability were examined using multivariable ordinal logistic regression. Amputees reported significantly greater disability than caregivers and controls (WHODAS 51.8 vs. 18.8 and 11.3; p&#x2009;<&#x2009;0.001) with large effect sizes across domains. Psychiatric symptoms were markedly elevated among amputees, and 74% screened positive for two or more disorders versus 52.8% of caregivers and 16.9% of controls. In adjusted models, belonging to the amputee group (OR 48.1), higher depressive symptom severity (OR 1.38 per point), and older age (OR 1.06 per year) were independently associated with greater disability, while income, sex, education, and other sociodemographics were not. Integrated interventions combining functional rehabilitation with sustained mental-health and psychosocial support are urgently needed to address the impacts of war-related amputation in Gaza. Rehabilitation for war-related amputation must address multidimensional disability&#x2014;spanning mobility, self-care, emotional functioning, and social participation&#x2014;rather than physical recovery alone.Depression is a critical determinant of functional outcomes and should be routinely screened and treated as part of rehabilitation to optimize engagement and recovery.Caregivers bear a substantial psychological burden; targeted support and education for caregivers are essential components of an effective rehabilitation response.Older amputees are at heightened risk of functional decline, requiring age-adapted rehabilitation strategies with close longitudinal monitoring.In conflict-affected settings, rehabilitation delivery must prioritize community-based, scalable models&#x2014;including mobile teams, task shifting to trained non-specialists, and peer support networks.Sustained improvements in outcomes require integrated programs that combine physiotherapy, mental health care, and social reintegration, with continuity of care ensured despite resource constraints.

The aim of this qualitative study was to explore service providers' experiences with, and the impact of, ENVISAGE-Service Providers, a professional development program aiming to increase participants' knowledge of, attitudes towards, and skills to apply contemporary evidence-informed, family-centred approaches in childhood-onset disability. Participants in ENVISAGE-Service Providers were health professionals working with children with disability. Online semi-structured interviews were undertaken with 27 purposively selected consenting participants from Australia and Canada on program completion. A reflexive thematic analysis approach guided data analysis. A thematic metaphor of constructing family-centred approaches described the program's impact. Four Themes described how [1] participants come with their own foundations for family-centred service (FCS) [2]; ENVISAGE-SP provides scaffolding for FCS, describing the programs' active ingredients [3], participants build what they need to support FCS, and [4] ENVISAGE-SP can support building a family-centred ecosystem. Constructions included connections between ways of thinking and doing; bridges between providers and families; and plans for future construction as ENVISAGE ideas translate into practice. Participants described the program's active ingredients as providing the scaffold that supported them to build on their existing foundations in FCS in ways that enhanced their confidence and ability to translate family-centred principles in practice. Service providers working in childhood-onset disability should be aware that both personal and professional experiences and attributes contribute to learning and practice.Supporting service providers to adopt and implement holistic, strengths-based, family-centred approaches and work collaboratively with families relies on development of their competence and confidence.Professional development programs for service providers working in childhood-onset disability should support participants to build on their existing personal and professional foundations to develop their ability to work collaboratively with families.A professional development program combining the active ingredients of evidence base, parent voices, opportunities for reflection and discussion, and practical tools and strategies can lead to changes in ways of thinking, feeling, and acting for participants, and support the translation of learning into practice.

Fine particulate matter (PM2.5) is a modifiable risk factor for stroke, yet the long-term trajectory of PM2.5-attributable hemorrhagic stroke in China-and its standing among G20 nations-remains inadequately characterized. We quantified this burden (1990-2023), examined its drivers, and projected trends through 2050. Using Global Burden of Disease 2023 data, we analyzed PM2.5-attributable hemorrhagic stroke deaths, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs). We evaluated temporal trends using estimated annual percentage changes (EAPCs), quantified demographic and epidemiological drivers via decomposition analysis, and projected future burden using Bayesian age-period-cohort models. In 2023, China remained among the most heavily burdened G20 nations, with the burden disproportionately concentrated in older males. From 1990 to 2023, China's age-standardized death and YLL rates declined steeply (EAPCs: -3.93 and -&#x2009;4.18), whereas the YLD rate declined more modestly (EAPC: -1.29). Decomposition revealed that substantial epidemiological improvements successfully offset the upward pressure driven by rapid population aging and growth. Projections to 2050 indicate that while mortality metrics will continue declining, the disability (YLD) trajectory remains highly uncertain. Despite severe demographic headwinds, China achieved substantial reductions in PM2.5-attributable hemorrhagic stroke mortality. The divergence between the steep decline in age-standardized mortality and the more modest decline in the age-standardized disability burden is consistent with several non-mutually-exclusive hypotheses, including improved acute survival that increases the surviving pool of disabled patients, changes in case-mix and disability ascertainment, and slower progress in post-stroke rehabilitation; the ecological design of this study does not permit these mechanisms to be distinguished. Sustaining progress requires combining strict environmental PM2.5 control with strategically expanded post-stroke rehabilitation capacity.

The burden of ischaemic stroke in Europe has evolved over recent decades, shaped by changes in prevention, acute care and population ageing. Understanding long-term trends in mortality and disability is essential for guiding policy and service planning. Using Global Burden of Disease (GBD) 2023 estimates, we analysed age-standardised disability-adjusted life years (DALYs), years of life lost (YLLs) and years lived with disability (YLDs) for ischaemic stroke across all European countries from 1990 to 2023. We estimated country-specific annual percentage changes (EAPCs), assessed non-linear trajectories, examined shifts in the fatal vs non-fatal composition of DALYs and synthesised trends using mixed-effects models and descriptive meta-analytic pooling. Disability-adjusted life year rates declined in every European country, with the steepest reductions in Central and Western Europe and more modest improvements in parts of Eastern and Southeastern Europe. Years of life lost declines closely paralleled DALY trends, indicating that falling premature mortality was the main driver of the overall reduction. Years lived with disability trends were smaller and more heterogeneous across countries. Mixed-effects modelling indicated average European EAPCs of -3.40% (95% CI, -3.74 to -3.05) for DALYs, -1.26% (-1.43 to -1.09) for YLLs and&#xa0;-3.86% (-4.26 to -3.46) for YLDs. Meta-analytic pooling of national patterns showed large declines in YLLs (random-effects EAPC -3.81%) relative to YLDs (-0.86%). Ischaemic stroke burden has fallen substantially across Europe, driven primarily by reductions in premature mortality. Slower progress in disability outcomes and persistent regional disparities highlight the need to strengthen long-term rehabilitation and address uneven improvements across the continent.

Medicaid Home and Community Based Service (HCBS) waivers provide services for individuals with disabilities in the United States (U.S.) who are at risk of institutionalization. Assistive technology (AT) is a covered service category that includes devices, systems, and supports such as adapted or mainstream technologies to enhance independence and participation. However, variation in state HCBS waiver policies may facilitate or hinder access to AT devices and related services, resulting in differences in availability, coverage, and implementation. This study examined the availability, scope, and disparities in AT services across state Medicaid HCBS waivers serving persons with physical disabilities (PwPD) in the U.S. Methods We conducted a content analysis of standalone AT services and AT-related services within Medicaid HCBS waivers for PwPD. AT-related services include home modifications, personal emergency response systems (PERS), remote supports, specialized medical equipment and supplies (SMES), and state-created AT services. The analysis included 57 waivers (22% of all HCBS waivers) from 38 states serving PwPD and included an AT service, AT-related service, or both. Seventeen waivers (30%) across 13 states included both AT and AT-related services, while 40 waivers (70%) across 30 states offered only AT-related services. Collectively, these waivers provided 20 AT services, 55 home modification services, 46 PERS services, three remote support services, 36 SMES services, and 11 state-created AT services. Substantial variability exists in AT coverage within HCBS waivers for PwPD. Many states lack clear AT definitions, and some exclude mainstream technology acquisition, potentially creating service gaps that hinder long-term AT use and increase institutionalization risk. The study shows that inconsistent inclusion of standalone AT services within Medicaid HCBS waivers may limit awareness and access for persons with physical disabilities. When AT is embedded within broader service categories rather than clearly identified, rehabilitation professionals must actively help waiver recipients recognise and navigate available pathways for acquiring needed technology.Inconsistent coverage of essential service delivery components, such as assessment, customisation, training, and ongoing technical support, may increase the risk of inappropriate device selection and technology abandonment. Comprehensive AT service provision should be integrated into rehabilitation planning to promote long-term functional independence and sustained technology use.The selective inclusion or exclusion of mainstream technologies within waiver language may restrict access to cost-effective, socially integrated solutions that enhance partici&#xad;pation and independence. Rehabilitation providers should document functional needs clearly and frame mainstream technology recommendations around independence, safety, and prevention of institutionalisation to improve approval outcomes.

In Uganda and similar low-resource settings, little is known about the lived experiences and expectations of people with upper limb loss, particularly regarding access to prosthetic devices. This gap limits the development of prosthetics that address both functional and psychosocial needs. This study aimed to explore experiences and expectations related to prosthetic access and to inform contextually appropriate prosthetic design in urban Uganda. A pragmatic qualitative study using a Patient and Public Involvement and Engagement (PPIE) framework was conducted. Seventeen participants, recruited through convenience sampling, took part in semi-structured interviews. Data were analysed descriptively and thematically to identify key issues related to access and design needs. Only three of the 17 participants had prior experience with a prosthesis. Four themes were identified: (1) psychosocial experiences, including stigma and aesthetic concerns; (2) activities of daily living, with self-care a key priority; (3) design requirements, highlighting functionality, appearance, and reliability; and (4) service provision, highlighting gaps in access, training, and user engagement. Significant barriers to prosthetic access were identified. Findings highlight the need for culturally relevant, user-informed prosthetic solutions to improve service provision in urban Uganda. Rehabilitation services in Uganda should actively involve people with upper limb loss in the design, development, and evaluation of prosthetic devices and services to improve their relevance and acceptability.Person-centred qualitative approaches can help identify users&#x2019; experiences, priorities, and barriers to prosthesis use, informing service improvement.Structured feedback mechanisms between prosthesis users, rehabilitation professionals, and device developers can support user-informed prosthetic innovation.Integrating the perspectives of people with limb loss into rehabilitation education and training may strengthen person-centred practice and improve service responsiveness in Uganda.

Sensory substitution devices (SSDs) translate information from one sensory modality into another to assist individuals with sensory impairments. This paper presents the first direct usability comparison of a visual-to-tactile SSD (BrainPort) and a visual-to-auditory SSD (Colorophone). Two studies were conducted with visually impaired participants. The pilot study used the BrainPort V100, and the main study used the BrainPort Vision Pro; the Colorophone mobile 1.1 was used in both. Participants completed comparable training protocols for each device, followed by usability testing based on scavenger-hunt tasks in naturalistic settings (kitchen, bedroom, toilet, and park). Usability was assessed via the System Usability Scale (SUS), task completion rates, task completion times, and qualitative structured interviews. In both studies, the Colorophone obtained significantly higher usability scores and satisfaction ratings than the BrainPort across nearly all participants, and showed better task-level time performance. The BrainPort showed better efficacy for some kitchen-based tasks requiring greater spatial precision. Using both devices simultaneously did not enhance usability and introduced device-incoherence issues. The Colorophone outperformed the BrainPort on most usability metrics. Suggestions for improving usability include redesigning the devices for hygiene and aesthetics, adding automatic camera adjustments, and enhancing integration between devices for combined use. Human-centered UX methods can inform the development of more usable and widely adoptable sensory substitution solutions. Prioritise user-centered, context-aware design and training. Select SSDs to match task demands and user preferences: deploy auditory Colorophone for rapid colour identification and categorisation; favour tactile BrainPort for spatially precise, gestalt-dependent tasks (e.g., shape discrimination, navigation). Provide targeted, scenario-based training that builds sensorimotor contingencies and manages cognitive load.Avoid simultaneous multi-SSD use. Combining BrainPort and Colorophone in parallel increased cognitive burden and reduced usability; rehabilitation protocols should favour single-device workflows with clear task handovers rather than concurrent streams.Address social, aesthetic, and equity factors as core design requirements. SSDs must complement existing non-visual adaptations, combat ableism, be customisable, discreet/acceptable in public use, and remain affordable and accessible to disadvantaged users to support real-world adoption and independence.Embed iterative usability evaluation into rehabilitation. Use standardised measures (e.g., workload, satisfaction, task accuracy/time) to refine device settings and training plans, tailoring to individual differences and real-life goals to sustain long-term functional gains without surgical intervention.

Globally, the growth of ageing populations is significant, with more people requiring supported living environments, including residential aged care (RAC). Given the influence of the environment on health outcomes, it is important to consider approaches to evaluate aged care design, including both the built environment and products and technology. With the overarching aim to identify the scope of RAC-built environment and assistive technology design interventions and the way this data is captured methodologically, this review (i) identified methods and measures used to evaluate RAC-built environment and assistive technology design, and examined populations these methods and measures were used with, and (ii) mapped identified approaches to the International Classification of Functioning, Disability and Health (ICF). An a priori review protocol was developed, and a scoping review was then conducted. Eight databases were searched for publications between January 2000 and February 2023, resulting in 81 included studies, which were then mapped to ICF activity, participation and environment domains. Twenty methods and 16 methodologies were identified. Sixty-one articles collected data directly from resident populations, primarily including older adults (n = 52). Forty-nine publications reported on the evaluation of built design, 23 reported on products and technology, and nine reported on both, but with limited inclusion of valued participation as a goal or outcome. While some participatory methods were identified, 25% of the studies did not include consumer perspectives. Analyzing aged care design can identify ways to facilitate, or remove barriers to, healthier spaces and lives in RAC. Use of internationally recognized terminology and an integrative lens on the relationship between technology and environmental design is recommended.

In the absence of standards or guidelines for custom moulded seating (CMS) provision for children and young people (CYP), this study explored clinicians' perspectives on best practice in this provision for CYP. A qualitative exploratory design using a participatory "World Caf&#xe9;" workshop approach explored the perspectives of 54 multinational clinicians attending the European Seating Symposium in June 2024. Data collected was analysed using thematic analysis. Five main themes were identified: (1) The child and family's needs are central (2) Varying perspectives on when to recommend CMS (3) The need for efficient and effective CMS processes and pathways (4) Advanced practice knowledge, skills and competencies required (5) Manufacturing of high-quality, adaptable CMS product options. Despite a strong emphasis on early intervention using CMS to protect body shape, some clinicians considered it "a last resort" highlighting clinical tensions. Pain and the achievement of functional goals were key considerations for recommending CMS. Responsive manufacturing of a range of adaptable CMS options was emphasised. Seating clinicians must have advanced practice competencies from assessment to shape capture and CMS provision. This research highlighted the inherent complexity within decision making aligned to individualised prescription of CMS. Further examination of when to introduce CMS and its contribution to the prevention and/or management of destructive postures and to participation and quality of life is needed. Service planning and policies must ensure CMS provision is child- and family-centred, with efficient processes that meet users' needs effectively. Planning and policies related to specialised seating services must ensure child and family goals are central in the provision of custom moulded seating (CMS).Services must ensure CMS processes and pathways are efficient and effective in providing timely assessments and reviews for CYP.Education for parents and caregivers on correct positioning in CMS is essential to ensure successful outcomes related to CMS provision.There is a need for training and education in the field of specialised seating that is focused on CMS provision, including when to recommend CMS, the assessment process, as well as CMS product selection and design.Seating clinicians must have advanced practice knowledge, skills and competencies in the full process from assessment to shape capture and CMS provision.Further research is needed to establish consensus on best practice in the provision of CMS for CYP, including the development of standardised international clinical pathways and recommendations.

Traumatic brain injury (TBI) is a major cause of disability and socioeconomic burden worldwide. Using updated Global Burden of Disease Study 2021 estimates, this study assessed global TBI burden from 1990 to 2021 and projected future patterns to 2050. Global Burden of Disease Study 2021 estimates were used to evaluate TBI incidence, prevalence, and years lived with disability (YLDs) in 204 countries and territories. Age-standardized rates were stratified by age, sex, region, and sociodemographic index (SDI). Age-period-cohort (APC) modeling, frontier analysis, and inequality metrics were applied to characterize temporal patterns and disparities. Bayesian APC models projected population-level burden to 2050, and eXtreme Gradient Boosting-SHapley Additive exPlanation models were used as supplementary tools for prediction and interpretation. Model performance was assessed using cross-validation. From 1990 to 2021, incident, prevalent, and YLD cases increased by 22.35%, 53.27%, and 52.65%, respectively, whereas the corresponding age-standardized rates declined by 20.16%, 16.52%, and 16.19%. Men consistently had a higher burden than women. The APC model suggested a transition around 52.5 years, indicating a shift toward older populations. In low-SDI regions, the age-standardized YLD rate changed by 1.14% (95% uncertainty interval: -2.32 to 5.03), indicating no statistically significant change. SDI showed an inverted U-shaped association with YLD rates. Age-standardized incidence rate increased in the Caribbean and Oceania. Cross-validation showed close agreement between observed and predicted values (cross-validated R2&#x2005;=&#x2005;0.997-0.998; mean absolute error&#x2005;=&#x2005;2.27-16.64). Projections suggested declining age-standardized rates through 2050. Global TBI burden increased in absolute numbers but declined in age-standardized rates. Persistent age, sex, socioeconomic, and regional disparities support targeted prevention, trauma-care strengthening, and rehabilitation planning.

Musculoskeletal conditions are a leading global cause of disability, yet the factors influencing long-term musculoskeletal health, particularly following trauma, remain incompletely understood. Machine learning could be applied to identify previously unknown patterns in large-scale, multimodal datasets. This study aims to test the ability of a new sparse group factor analysis method to uncover hidden patterns in large-scale multimodal datasets and generate testable, clinically relevant hypotheses. This study applies sparse group factor analysis, a hierarchical unsupervised machine learning method, to the Armed Services Trauma and Rehabilitation Outcome (ADVANCE) cohort to identify latent structures in multimodal clinical data. ADVANCE is a prospective longitudinal dataset of 1145 UK military personnel and veterans who served in Afghanistan. Half the cohort sustained combat injuries, and the remainder were frequency matched on deployment, service, rank, role, age, and ethnicity. Study 1 validated the approach by rediscovering known group-level patterns between combat-injured and noninjured participants, including poorer outcomes in pain, mobility, and bone health among those with lower limb loss. Study 2 explored the injured, nonamputee subgroup without prespecified labels to identify new hypothesis-generating clusters that could subsequently be tested using standard hypothesis-testing methods. The ADVANCE cohort was 34.1 (SD 5.4) years old and 8.3 (SD 2.1) years postinjury or 7.7 (SD 1.9) years since matched deployment. A subgroup of 125 individuals with worse musculoskeletal outcomes was uncovered. This group had greater body mass (mean 92.6, SD 14.7 kg vs mean 88.0, SD 13.4 kg; P=.002), higher injury severity (median 12, IQR 5-22 vs median 9, IQR 4-14; P=.002), and reduced health-related quality of life with head injury. These findings led to a novel hypothesis that head injury, including potential traumatic brain injury, is associated with long-term musculoskeletal deterioration. This hypothesis is supported by literature in both athletic and military populations and will be tested in follow-up analyses. Our findings demonstrate how sparse group factor analysis, combined with clinical insight, can uncover hidden patterns in large-scale datasets and generate testable, clinically relevant hypotheses that inform prevention, treatment, and rehabilitation strategies.

This systematic review aimed to explore and synthesise the effectiveness of dysphagia rehabilitation on swallow function in inpatients with brainstem stroke. Five electronic databases were searched using pre-specified criteria in June 2025. Independent screening, data extraction, and quality ratings were completed. Interventions were categorised into "traditional swallowing therapy" or "inclusion of devices." Studies were appraised using the Mixed Methods Appraisal Tool. Narrative synthesis was used to describe study characteristics, intervention details, and study outcomes. Meta-analyses were conducted when three or more randomised controlled trials on a single intervention were available. Twelve studies were included with 443 participants. Five studies investigated "traditional swallowing therapy" alone, and seven investigated devices. All studies demonstrated improvement in swallowing function with low certainty. Meta-analysis of Repetitive Transcranial Magnetic Stimulation (rTMS) indicated initial improvements in swallow function immediately post-intervention compared to controls; however, findings were not maintained by 2 months post-intervention. Both traditional swallowing therapy and therapy with devices may be effective at improving swallowing function and reducing reliance on enteral feeding in inpatients with brainstem stroke. Further high-quality research is required to understand which interventions and dosages are most effective for brainstem stroke. Dysphagia Rehabilitation in Brainstem StrokesBrainstem strokes are associated with the greatest risk of dysphagia, as they contain the central pattern generators for swallowing.Not much is known about whether and how rehabilitation for dysphagia in these stroke types should differ (compared to cortical-level strokes).Dysphagia rehabilitation may be described as traditional swallowing therapies or rehabilitation with the use of a device (e.g., rTMS).All rehabilitation options described demonstrated benefits in improvements in dysphagia severity rating and/or reduced reliance on enteral feeding.There are potential benefits for rTMS to reduce dysphagia severity rating scales immediately post-intervention.

Adequate fruit and vegetable (FV) intake is the foundation of a healthy diet; however, intake is especially low among stroke survivors. This study explores barriers and motivators to FV intake in female stroke survivors and informs strategies to improve well-being. Female stroke survivors completed questionnaires and attended either a focus group or an interview, with the resulting transcripts analysed using reflexive thematic analysis. Ten female stroke survivors aged (mean [SD]) 66.3 [17.1] years completed the study. Across the focus groups (n&#x2009;=&#x2009;3) and interviews (n&#x2009;=&#x2009;2), three themes emerged: (1) "Navigating alone," reported that survivors felt left to fend for themselves for dietary support and education. (2) "If it's good for me" identified a willingness to improve FV intake and nutrition literacy. (3) "Make it easy" highlighted the need for compensatory strategies to raise FV intake. Barriers to FV intake included physical impairments, fatigue, and memory loss. These barriers impacted food shopping, preparation, and consumption, necessitating reliance on family and compensatory strategies. Motivators included education, simplified recipes, reminders, and pre-prepared options. Female stroke survivors wanted more dietary education, FV knowledge, support, and practical stroke-appropriate resources. Incorporating these findings into rehabilitation planning may improve the well-being of female stroke survivors. Female stroke survivors participating in this study reported inconsistent (suboptimal or absent) delivery of dietary education, post-stroke support, and dietary and stroke-related resources to optimise their rehabilitation.Participants were heavily reliant on family for ongoing dietary, emotional, and physical support.Participants reported that the lack of clear, relevant, and timely dietary and stroke-related resources negatively impacted their quality of life.Improved strategies for the delivery of dietary education, support, and practical stroke-appropriate resources will likely improve the quality of life of female stroke survivors, with likely repercussive benefits to overall health and wellbeing and recovery.

While previous research has established the clinical applicability of anti-gravity treadmill (AGT)-assisted rehabilitation after lower-limb fracture fixation, longitudinal biomechanical recovery in patients with complex AO/OTA C3 tibial plateau and pilon fractures remains poorly understood. This prospective single-center cohort study included 17 adults (18-65&#x2009;years) who underwent ORIF for AO/OTA C3 tibial plateau (n&#x2009;=&#x2009;8) or pilon fractures (n&#x2009;=&#x2009;9), followed by a structured AGT-assisted rehabilitation program. Independence in activities of daily living (ADLs), return to work and sport, radiographic outcomes, and gait analysis were assessed at 6&#x2009;weeks, 3&#x2009;months, and 6&#x2009;months. Pain, ADLs, weight-bearing, and gait symmetry improved throughout follow-up. No mechanical complications, loss of reduction, or hardware failure were observed. ADL independence was achieved by 94% of patients at 6&#x2009;weeks and by all at 3&#x2009;months. Pilon fractures showed earlier restoration of loading symmetry, whereas tibial plateau fractures reached comparable values by 6&#x2009;months. Gait analysis demonstrated progressive normalization of loading symmetry. This pilot study provides preliminary longitudinal clinical and laboratory-based biomechanical data on recovery after complex tibial plateau and pilon fractures managed within an AGT-assisted rehabilitation pathway. However, without a control group, the observed improvements cannot be attributed specifically to AGT. Using an anti-gravity treadmill for rehabilitation seems to be a safe and practical method for patients recovering from complex tibial plateau and pilon fractures after surgery.Progressive body-weight-supported gait training can help restore natural loading symmetry, all while adhering to prescribed weight-bearing limits during the early recovery period.Objective gait analysis can supplement traditional clinical measures by offering quantitative data on biomechanical recovery and assisting in tracking rehabilitation progress following complex lower-limb fractures.

To investigate reliability, validity and responsiveness of the French Lymph-ICF-LL questionnaire for lower limb lymphedema (LLL). In this observational study, patients with stable LLL completed the Lymph-ICF-LL twice with an interval of 1-2&#x2009;days. Test-retest reliability was determined with Intraclass Correlation Coefficients (ICC), standard error of measurement and smallest real difference. Internal consistency was analyzed with Cronbach's alpha (&#x3b1;). To assess construct validity, Spearman rank correlation coefficients between the Lymph-ICF-LL and SF-36 were calculated. For responsiveness, the Global Perceived Effect scale (GPE) and Lymph-ICF-LL were completed after 2&#x2009;months. Other patients completed the Lymph-ICF-LL at start of an intensive treatment and 1&#x2009;month later together with the GPE. Wilcoxon signed rank test, Standardized Response Mean, Minimal Clinically Important Difference and correlations between the change on Lymph-ICF and GPE were determined. (NCT07075549). For the total score, excellent reliability (ICC&#x2009;=&#x2009;.94) and good internal consistency (&#x3b1;&#x2009;=&#x2009;.86) were found. Convergent validity was confirmed with significant moderate correlations with SF-36 (r&#x2009;=&#x2009;-0.48--0.72; p<.001). A significant change in total score was found after intensive treatment (p=.017). Significant correlations between change scores and GPE were obtained (p&#x2009;<&#x2009;.05). The French Lymph-ICF-LL is a reliable, valid and responsive questionnaire to evaluate lymphedema-specific quality of life in patients with LLL. The French Lymphedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphedema (Lymph-ICF-LL) is a reliable and valid questionnaire to evaluate lymphedema-specific quality of life in patients with lymphedema at the leg and/or foot.The French Lymph-ICF-LL can be used to determine improvement in the lymphedema-specific quality of life after treatment in patients with lower limb lymphedema (LLL).A decrease of 14 points on the total score equals a real minimal clinically important improvement in lymphedema-specific quality of life.

Mental disorders are leading causes of disability worldwide but remain underprioritized in many low- and middle-income countries, including sub-Saharan Africa (SSA), where access to care, workforce capacity, and mental health infrastructure remain limited. This study quantified the burden of mental and substance use disorders (SUDs) in SSA from 1990 to 2023 using Global Burden of Disease (GBD) 2023 estimates, with attention to long-term trends, late-period changes, country-level heterogeneity, sex differences, and risk-factor attribution. We analyzed GBD 2023 estimates for 46 SSA countries from 1990 to 2023, including prevalence, disability-adjusted life years (DALYs), age-standardized rates, sex-specific estimates, country-level burden, and selected risk factors. Percentage changes were calculated for 1990-2023, with sensitivity analyses for 1990-2019 and 2019-2023 and segmented log-linear trend models using 2019 as the breakpoint. From 1990 to 2023, the age-standardized prevalence rate of mental disorders increased from 11,138.8 to 14,841.0 per 100,000 (+33.24%), while the age-standardized DALY rate increased from 1634.9 to 2218.9 per 100,000 (+35.73%). Anxiety disorders showed the largest relative increases in age-standardized prevalence (+90.99%) and DALY rates (+92.11%). Depressive disorders also increased, while ADHD age-standardized rates remained largely stable. SUDs showed rising absolute burden despite declining age-standardized prevalence and DALY rates. Late-period analyses showed larger increases after 2019, particularly for anxiety disorders. Females had higher age-standardized rates and larger relative increases for anxiety and depressive disorders, whereas males had higher rates of ADHD and SUDs. Among selected risk factors, sexual violence against children had the highest age-standardized attributable DALY rate in 2023, while bullying victimization and intimate partner violence showed the largest relative increases. Mental and SUDs represent a growing public health challenge in SSA. Strengthening mental health systems, integrating services into primary and general healthcare platforms, expanding SUD prevention and treatment, addressing violence-related risk factors, and reducing stigma are essential to improving mental health outcomes across the region.