Rehabilitation is described as the care needed when a person is experiencing, or is likely to experience, limitations in everyday functioning. In 2019, it was estimated that 2.4 billion people were living with a condition that could benefit from rehabilitation. Chiropractors have contributed meaningfully to the delivery of rehabilitation due to their training in musculoskeletal health and person-centred care. Building on the World Federation of Chiropractic's chiropractic rehabilitation competency framework, this commentary highlights chiropractic's role in strengthening rehabilitation in health systems. Under the "Role of Chiropractic in Rehabilitation", we explore the postoperative setting, sports injury recovery, and neurorehabilitation. We share how the "Integration of Chiropractors into Health Systems" exists in multidisciplinary rehabilitation teams, publicly funded health systems and in hospitals. We discuss the "Economic and Social Impacts" of the chiropractic profession in low- and middle-income countries, for equity, diversity and inclusion, and regarding cultural competencies. We present "Challenges for the Chiropractic Profession" that include varying legislations within and between countries, limited recognition among other healthcare professionals, and advanced integration within multidisciplinary rehabilitation programs. Finally, we make a "Call to Action" for theory driven implementation strategies, to advocate for improved recognition of the chiropractic profession, and to enhance interprofessional education and advance rehabilitation in chiropractic curricular. Chiropractors can play an important role in strengthening rehabilitation in health systems as they deliver interventions for rehabilitation for people with health conditions throughout the life course, and across the continuum of care. However, barriers remain. As a profession we must align with global rehabilitation priorities and uptake taxonomies to enable equitable access to chiropractors focused on optimising function and participation.
Maintaining activities of daily living is of great importance for patients who have cancer, and dependency is associated with psychological distress. However, evidence for rehabilitation remains scarce in this setting. The objective of this study was to evaluate the efficacy of a structured rehabilitation program for maintaining activities of daily living among patients with terminal cancer. This multicenter randomized controlled trial across 19 Japanese inpatient hospices/palliative care units enrolled patients who had terminal cancer with an Eastern Cooperative Oncology Group performance status of 2-3, a life expectancy ≥3 weeks, and no severe symptoms. Participants were randomly assigned (1:1, stratified by performance status and site) to either a 3-week structured rehabilitation program that incorporated key elements of rehabilitation for patients with terminal cancer or usual unstructured rehabilitation. The primary outcome was a change in the total modified Barthel Index from baseline to day 22. Secondary outcomes included the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core 15-Palliative Care score and safety. Between July 8, 2019, and February 20, 2024, 130 patients were randomized (59 to the intervention group, 71 to the control group; 56 patients [43.0%] were women). The primary analysis included 77 participants who had complete data available. The mean change in total modified Barthel Index was -1.31 (95% confidence interval [CI], -10.89, 8.08) in the intervention group and -15.51 (95% CI, -24.02, -7.01) in the control group. The between-group difference was 14.21 (95% CI, 1.77-26.64; p = .026), exceeding the minimally clinically important difference (9.25). Patient-reported physical functioning on the European for Research and Treatment of Cancer Quality-of-Life Questionnaire Core 15-Palliative Care instrument was also significantly higher in the intervention group than in the control group. No serious harms occurred. Structured rehabilitation maintained activities of daily living better than unstructured rehabilitation in patients with terminal cancer, supporting its integration into routine care even in the last stage of cancer.
Family carers have a key role in supporting malnourished older adults; yet, intervention evidence is lacking in the rehabilitation setting. This study aimed to explore the preliminary effects and acceptability of a family-centred, telehealth-enhanced dietary counselling intervention for treating protein-energy malnutrition (PEM) in rural-living older adults transitioning from rehabilitation to home, compared with usual care, in matched patient-carer dyads. A pragmatic, historically controlled, prospective, two-arm non-randomised controlled trial was conducted as a pilot study. Fifteen malnourished older adults admitted to rural rehabilitation units in New South Wales, Australia, and their family carers, were recruited and matched to 15 historical controls. The Patient-Generated Subjective Global Assessment (PG-SGA) was the primary outcome for nutrition status assessed at rehabilitation admission, discharge, and 3 months post-discharge. Quality of life, physical function, length of stay, discharge location, institutionalisation, mortality, carer burden, and service satisfaction were secondary outcomes. The historical control group received usual care. The intervention group received a telehealth-enhanced dietary counselling intervention developed with co-design principles, which engaged the family carer as a partner in the nutrition care team, delivered during the rehabilitation admission and for 3 months post-discharge. The difference in PG-SGA score from baseline to 3 months post-discharge between the two groups was 3.46 (95%CI: -2.07, 9.01; p = 0.238). The intervention group had a higher proportion of patients who were well-nourished at 3 months post-discharge compared to controls (60% vs 13%). At 3 months post-discharge, the intervention group had lower odds of being rated malnourished or with more severe malnutrition (i.e., moderate vs. well-nourished, severe vs. moderate) on the PG-SGA (OR 0.01, 95%CI: 0.00, 0.27; p = 0.005). There was a trend towards the intervention group having reduced odds of being discharged to a location other than home (OR 0.18, 95%CI: 0.03, 1.07; p = 0.06). The intervention was perceived as acceptable to patients and family carers. There were no differences between groups in other outcomes. Compared with usual care, the family-centred telehealth-enhanced dietary counselling intervention for the treatment of PEM in rural-living older adults transitioning from rehabilitation to home demonstrated preliminary efficacy and was acceptable to both patients and family carers. Future research aiming to improve PEM should meaningfully engage family carers as partners in the nutrition care team.
Impairment in blood supply to the brain deprives its cells of the much-needed nutrients and molecules such as oxygen and glucose necessary for its development, growth and survival. This will set up a host of pathological processes such as impaired homeostasis, energy failure, excitotoxicity, oxidative stress, impaired protein synthesis, inflammation, cytokine-mediated toxicity and impairment of blood-brain barrier. These pathological processes will result in the damage or death of the cells depending on the extent of the deprivation. Similarly, they will impair synthesis of acetylcholine (Ach) and norepinephrine (NE), which are important neurotransmitters in the cholinergic and adrenergic systems responsible for cellular communication and functions. Thus, interventions to help arrest and/or modulate the initial and subsequent pathological states and help recover the functions of the brain are needed. One of such interventions is vagus nerve stimulation, which helps activate the cholinergic and the adrenergic systems via projections of the afferent fibers of the vagus nerve to the nucleus of the solitary tract (NTS). Activation of the cholinergic and the adrenergic systems results in reduction in pro-inflammatory factors such as tumor necrosis α, increase in pro-angiogenic factors and increase in firing of adrenergic neurons in the central nervous system (CNS).
Cervical spondylotic myelopathy (CSM) often leads to persistent impairment in motor function and activities of daily living (ADL) even after surgical decompression. Although postoperative rehabilitation is widely implemented, factors associated with ADL outcomes during the convalescent rehabilitation phase remain unclear. This study aimed to investigate ADL outcomes and their associated factors in postoperative patients with CSM admitted to a convalescent rehabilitation ward. This retrospective observational study included postoperative patients with CSM admitted to a convalescent rehabilitation ward. All patients underwent intensive multidisciplinary rehabilitation. ADL outcomes were assessed using the functional independence measure (FIM). Associations between ADL outcomes, disease severity, and rehabilitation-related factors were analyzed. At discharge, 91.2% of patients achieved independent transfer function, and 97.1% were discharged home. Although motor FIM scores at discharge remained lower in the severe group, greater improvement in motor FIM scores was associated with longer rehabilitation duration, particularly in patients with severe impairment. Most postoperative patients with CSM achieved favorable ADL outcomes during the convalescent rehabilitation phase. The findings suggest that the duration of intensive rehabilitation may be an important factor associated with motor function improvement after surgery for CSM, particularly in patients with severe impairment.
Contemporary clinical neuropsychologists primarily provide assessment and consultative services rather than direct intervention. This study examined the extent to which cognitive rehabilitation remains part of contemporary neuropsychological practice and explored reimbursement pathways and perceived barriers to implementation. An anonymous national survey was distributed to members of the National Academy of Neuropsychology through listserv and newsletter announcements. The survey included structured multiple-choice and open-ended questions assessing whether respondents provide cognitive rehabilitation, years of practice, clinical setting, insurance reimbursement patterns, and experiences with insurance denials. Descriptive statistics were used to summarize responses. Twenty-two respondents completed the survey. Eighteen (81.8%) reported currently providing cognitive rehabilitation services. Reimbursed Current Procedural Terminology (CPT) codes most commonly included 97129/97130 (54.5%) and 96116/96121 (45.5%), with additional endorsement of health and behavior intervention codes (96158/96159) and group therapy codes (97150). Insurance denial experiences were mixed, with most respondents reporting occasional or conditional denials rather than consistent rejection of claims. Respondents also described variability in session limits and billing approaches across practice settings and payer policies. Cognitive rehabilitation was reported by a majority of respondents, though service models and reimbursement pathways varied considerably. Given the small, self-selected sample, findings should be interpreted as exploratory rather than representative of broader neuropsychological practice. Larger investigations are needed to clarify training expectations, billing practices, and interdisciplinary collaboration.
Post-Acute Sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC) is characterized by persistent and heterogeneous symptoms that impair health-related quality of life (HRQoL). Although several studies have identified symptom subgroups in Western populations using person-centered approaches, data on Asian populations remain limited. In this study, we aimed to classify the symptom profiles of Korean adults with PASC using latent profile analysis (LPA) and examine the differences in HRQoL and associated factors between the identified profiles. We conducted an online survey of 629 adults in Korea who experienced persistent symptoms ≥12 weeks after coronavirus disease (COVID-19) diagnosis. Symptom burden was assessed using the Long COVID Symptom Tool (26 items), and HRQoL was measured using the SF-36 v2®. LPA was performed to identify the symptom subgroups. One-way analysis of variance (ANOVA) and multiple linear regression were used to compare HRQoL across profiles and explore predictors. A four-class model provided the best fit: Class 1 (Low symptom, 23.3%), Class 2 (Moderate multisystem, 44.1%), Class 3 (Fatigue/post-exertional malaise dominant, 15.9%), and Class 4 (High multisystem burden, 16.7%). HRQoL differed significantly between classes (p < .001), with a clear gradient of decreasing scores from low to high symptom burden. The independent predictors of lower HRQoL included lower education, presence of chronic disease, poor subjective health, hospitalization during acute infection, and prolonged symptom persistence. The model explained 32.9% of the variance in HRQoL. Korean adults with PASC exhibit heterogeneous symptom patterns that substantially affect their HRQoL. The identification of distinct symptom profiles supports the need for tailored interventions, including rehabilitation, cognitive training, and psychological support. Our findings provide crucial evidence for developing Korean population-specific screening tools and management guidelines for PASC.
Pulmonary rehabilitation (PR) is an effective intervention for patients with chronic obstructive pulmonary disease (COPD), yet its utilization remains very limited. Tele-pulmonary rehabilitation (TPR) may improve access, but the safety and feasibility of asynchronous, app-based programs remain insufficiently studied, especially for patients with severe disease. This is a retrospective study of patients with COPD who participated in an asynchronous AI-supported TPR program using the ActiveLungs© mobile application between 2022 and 2025. Patients were included if they had spirometry-validated COPD and completed ≥10 training sessions in the application. Safety, feasibility, and adherence with the app trainings were evaluated. A total of 124 patients were included (median age 74 years, 54% female, median FEV1 50%predicted), of whom 55% used long-term oxygen therapy. During the study period, 17,399 trainings and 61,706 exercise sessions were completed. No serious adverse events were reported. Self-reported respiratory worsening occurred in 23% of patients and was associated only with chronic oxygen use (HR 2.68, 95% CI 1.08-6.65, p=0.033). Median (IQR) program use was 129 days (65-433), with trainings performed in 49% (31-64) of the days, and 79% completing more than 24 trainings. All four exercise sessions (2 aerobic and 2 resistance) were completed in 82% of the trainings. An asynchronous, AI-integrated TPR mobile application demonstrated a favorable safety profile and good patient engagement, even in patients with severe COPD. Prospective studies are warranted to evaluate its effectiveness on clinical outcomes.
Hearing-related quality of life is a crucial outcome for adults with cochlear implants. The Cochlear Implant Quality of Life (CIQOL)-35 Profile is a patient-reported outcome measure originally developed in English. In a previous study, this instrument was cross-culturally adapted into German to address the need for standardized assessment tools in German-speaking regions. To ensure the adapted instrument meets psychometric criteria, validation is required. The German adaptation of the CIQOL-35 Profile was validated through an online survey including questions on demographics, the German CIQOL-35 Profile, and the German Nijmegen Cochlear Implant Questionnaire (NCIQ). The collected data were analyzed for reliability and validity. A total of 204 adults (aged 19-87 years) with bilateral hearing loss completed the online survey. Cronbach's α between 0.84 and 0.91 demonstrates good internal consistency for all subscales of the CIQOL-35 Profile and the global outcome. Moderate to strong correlations (rs = 0.55-0.85) between the CIQOL and NCIQ indicate good convergent validity. Confirmatory factor analysis established construct validity for the German CIQOL instruments. These findings confirm that the adapted German version of the CIQOL instruments is a reliable and valid measure for assessing hearing-related quality of life in adults with cochlear implants and demonstrates higher validity than the NCIQ. The availability of the CIQOL in multiple languages facilitates international comparability of research results and increases clinical application. Implementing quality of life instruments in clinical practice enables a more comprehensive evaluation of patient outcomes and may help identify patient needs that may be addressed in therapy and rehabilitation.
To investigate the occurrence and consequences of medical complications during inpatient rehabilitation of children with central nervous system (CNS) injury. A prospective observational study conducted at a tertiary rehabilitation centre. Participants aged 2 to 17 years with acquired CNS injury requiring multidisciplinary inpatient rehabilitation. Data were collected from medical charts and questionnaires on admission and discharge, assessing predefined complications and associated impacts on the rehabilitation process. Of the 64 participants, 59 experienced a total of 183 instances of medical complications, comprising 19 distinct complication types. Most common were sleep disturbances, pain, -constipation, anaemia, infections, spasticity, and malnutrition. No significant correlation was observed between the occurrence of complications and age, gender, or diagnosis group. In total, 74% of the complications were found to have no impact on the rehabilitation process; however, malnutrition, infections, and spasticity could notably lead to interrupted or prolonged stays, altered rehabilitation goals, and worsened functional prognoses. Medical complications frequently occur during inpatient rehabilitation. While many have no significant consequences, malnutrition, infections, and spasticity in particular warrant further attention clinically and in future research.
For youth living with neurodisabilities and rare conditions, transitioning from pediatric to adult care results in significant loss of services and supports. This article examines transition-related health systems, policies and provider roles in the context of Duchenne muscular dystrophy (DMD). DMD is a multi-systemic X-linked disorder mainly characterized by progressive muscle degeneration, with about 30% of patients presenting with neurodevelopmental comorbidities. Due to advances in respiratory and cardiac care, life expectancy has increased significantly, creating a new population of adults living with DMD. This demographic shift has exposed critical gaps in the transition from pediatric to adult health care. To date, there is no systematic review covering existing transition policies and programs. This article utilizes integrated care and continuity of care frameworks to examine transition-related health systems, policies, and provider roles. We conducted a PRISMA-compliant systematic review searching OVID Medline, Embase, PsycINFO, CINAHL, Web of Science, and SCOPUS from January 1, 2000, to August 31, 2025. Studies were included if they reported on health systems, programs, policies or health care providers' roles in DMD. For synthesizing evidence, we utilized Popay's Narrative Synthesis framework to analyze health systems, policies, and provider roles across included studies, allowing for an aggregation of a body of heterogenous data (quantitative, qualitative and mixed-methods). This methodological approach ensured that the review moved beyond a simple aggregation of findings to generate new insights into the structural gaps. 42 studies met the inclusion criteria. The programs described in these studies varied from residential life-skills training to respiratory-focused transition protocols. A significant disconnect was identified between international care guidelines and implementation; most initiatives are project-based rather than policy-driven. While neurology is central in pediatric care, respiratory and sleep medicine often become the de facto "medical home" for adults. Crucially, support for patients with neurodiverse development was only discussed in 4 of the 42 studies. This review underlines a lack of comprehensive care models for DMD transition, specifically within the high-resource settings that dominate the literature. Future policies must bridge the gap between project-based funding and sustainable health systems, specifically addressing neurodiversity and caregiver burden.
Core outcome measurement sets (COMS) enhance the consistency and comparability of outcome reporting in clinical research. However, their effectiveness depends on the selection of valid, reliable, and feasible measurement instruments. Core outcome sets (COS) and COMS have been developed for specific intensive care unit (ICU) patient subgroups. The aim of this study is to establish a standardised approach to outcome measurement and operationalisation for adults acutely admitted to the ICU who are participating in clinical trials and other clinical research. This protocol describes the development of a COMS for adults acutely admitted to the ICU, the CoreMS-ICU, consisting of six core outcomes: survival, free of life support, free of delirium, out of hospital, health-related quality of life, and cognitive function. We will follow the Consensus-based Standards for the Selection of Health Measurement Instruments guideline and report according to the Core Outcome Set-STAndardised Protocol Items guideline. The development of the CoreMS-ICU will follow five predefined steps: (1) conceptual considerations for the six core outcomes; (2) systematic searches for outcome measurement instruments, including consideration of existing COMS; (3) quality assessment of relevant outcome measurement instruments; (4) consensus-based selection of outcome measurement instruments; and (5) recommendations and guidance on how to operationalise and report the measurement of the six core outcomes. We will involve research panels consisting of key stakeholders: patients, family members, healthcare professionals, and researchers in steps 1 and 4. We aim to develop a COMS for adults acutely admitted to ICU patients to facilitate the consistent use of outcomes in trials and enhance the translation of research findings into clinical practice.
Inflammatory rheumatic diseases (IRDs) present substantial risks of infection-related comorbidities during pregnancy. This study evaluates the knowledge, experience, and perceptions of healthcare professionals concerning the prevention of these risks. An international, cross-sectional survey was administered using the SurveyMonkey platform. The survey was disseminated to healthcare professionals specializing in rheumatology, obstetrics, infectious diseases, internal medicine, general practice, and related disciplines through social media channels. Developed in accordance with European Alliance of Associations for Rheumatology (EULAR) recommendations, this survey comprised 30 questions, including multiple-choice, Likert-type, and open-ended formats. A total of 201 healthcare professionals from thirty-six countries participated in the study, with rheumatologists comprising the majority (n = 145, 72.1%). Systemic lupus erythematosus (n = 183), systemic vasculitis (n = 141), and rheumatoid arthritis (n = 86) were identified as the diseases associated with the highest risk of infection-related comorbidities. The most frequently recommended infectious conditions for screening included Hepatitis B (n = 142), urinary tract infections (n = 141), and Hepatitis C (n = 129). The primary risk factors were uncontrolled disease activity (n = 176), high-dose corticosteroid use (n = 164), and high disease severity (n = 162). The most significant systemic barriers were insufficient number of specialists (n = 156), and absence of multidisciplinary teams (n = 155). This study identifies structural and educational deficiencies in the management of infection-related comorbidities among pregnant patients with IRD. The results underscore the need for targeted clinical guidelines, enhanced multidisciplinary care models, and expanded pre-pregnancy counseling.
Accurate preoperative diagnosis of papillary thyroid carcinoma (PTC) remains difficult, especially for small thyroid nodules and lesions with indeterminate cytology. This prospective diagnostic study evaluated the clinical value of serum-based v-Raf murine sarcoma viral oncogene homolog B1 (BRAF) V600E mutation detection and its performance in combination with ultrasound-guided fine-needle aspiration cytology (US-FNAC). A total of 145 patients with thyroid nodules classified as TI-RADS 3 to 5 and measuring 3 cm or less were enrolled. All patients underwent US-FNAC and serum BRAF V600E testing using allele-specific quantitative PCR, with postoperative histopathology used as the reference standard. Among the enrolled patients, 64 were diagnosed with PTC and 81 had benign nodules. US-FNAC showed a sensitivity of 68.75% and specificity of 83.95%, while serum BRAF V600E testing showed a sensitivity of 62.50%, specificity of 81.48%, and an area under the curve (AUC) of 0.792. In patients with papillary thyroid microcarcinoma, serum BRAF V600E testing demonstrated higher sensitivity than US-FNAC, 94.12% versus 64.71%, with an AUC of 0.841. However, its diagnostic sensitivity remained limited in poorly differentiated PTC, at 57.14%. A combined model integrating US-FNAC and serum BRAF V600E testing improved diagnostic performance, with a sensitivity of 81.25%, specificity of 85.19%, and AUC of 0.873, significantly outperforming either method alone. These findings suggest that serum BRAF V600E detection is a useful complementary, minimally invasive approach for diagnosing PTC, particularly micro-PTC, and may improve early detection and risk stratification when combined with US-FNAC.
A good limb position (GLP) plays an important role in the rehabilitation process of patients who have had a stroke with hemiplegia. However, there remains a lack of effective assessment tools for clinical nurses to evaluate their GLP management practices. This study aimed to develop and test the psychometric properties of the Good Limb Position Management Scale for Stroke Patients with Hemiplegia by Nurses (GLPMSSPHN). A quantitative and cross-sectional design. 89 hospitals in 16 cities of China. A total of 516 participants completed the questionnaire and were finally used for the analyses. An initial scale was developed based on the Capability, Opportunity and Motivation-Behaviour model combined with a comprehensive literature review, semi-structured interviews, Delphi expert consultations and a pilot test. A field survey was then performed using the initial scale to test the reliability and validity of the scale. Reliability analysis was conducted by calculating Cronbach's α coefficients and test-retest reliability. The results of exploratory factor analysis and confirmatory factor analysis were used as the validity index to further verify the model structure of the scale and develop a formal scale. The GLPMSSPHN was formulated with 4 dimensions and 35 items. Exploratory factor analysis extracted four factors, with a cumulative variance contribution rate of 81.842%, and confirmatory factor analysis indicated that the scale had good construct validity. The Cronbach's α coefficient of the scale was 0.978, and the test-retest reliability was 0.863. The GLPMSSPHN has ideal reliability and validity and provides a valid and reliable tool for clinical nurses to identify and assess the management level of GLP in patients who have had a stroke with hemiplegia.
Despite the centrality of successful conversation to well-being, psychometrically developed and validated tools to measure this construct are lacking. The purpose of this study was to develop and validate the Person-Reported Outcome of Conversational Success (PROCS), a measure of conversational success. We define success as the degree to which an interlocutor evaluates a conversation as beneficial, worthwhile, and/or satisfactory. In phase one of development, an initial draft of the PROCS was created based on a literature review, expert input, and established frameworks in communication research. In phase two, cognitive interviews were conducted with 39 participants to assess the measure's content, format, and usability and further refine the measure. In phase three, 50 participants completed the PROCS in live embodied conversations to assess the measure's practical effectiveness and usability. Finally, in phase four, psychometric validation was completed using data from 817 participants who completed the PROCS based on recently recalled conversations. The final version of the PROCS can be used to quantify the success of a single conversation. Careful planning of the initial draft of the PROCS coupled with input from participants from a diverse set of user groups across multiple phases of development, ensures the measure's validity, clarity, usability, and versatility. The PROCS is a valuable tool for assessing conversational success, with applications in both research and clinical practice.
Spinal cord injury is a critical issue in neurosurgery, lacking established clinical methods for functional restoration. This study reports the effects of a fusogen sealant, composed of polyethylene glycol and chitosan, in an experimental model of complete spinal cord transection in pigs. To evaluate the functional and morphological recovery of the spinal cord in an animal model of complete transection following treatment with a polyethylene glycol-chitosan conjugate. Hungarian Mangalica pigs (m = 20.0 ± 2.0 kg, N = 5) underwent complete transection of the thoracic spinal cord, followed by an extended laminectomy and transpedicular fixation. In the experimental group (N = 3), a synthesized gel based on a polyethylene glycol-chitosan conjugate was applied to the spinal gap; the other group (N = 2) served as a control. The postoperative period lasted 60 days and included multi-component rehabilitation. Clinical-functional status was assessed using established neurological scales. In vivo retrograde tracing of the spinal cord was performed using hydroxystilbamidine (FluoroGold). Following the experiment, immunofluorescent histology was conducted using primary antibodies to neurofilament (NF-200), a fluorochrome-conjugated secondary antibody, and the nuclear dye 4',6-diamidino-2-phenylindole (DAPI). The resulting morphology was examined via fluorescence and light microscopy. Control animals maintained lower paraplegia, anesthesia, and pelvic dysfunction throughout the experiment. In contrast, the experimental group showed positive changes, including the return of sensation from day two. By the end of the study, all animals in this group could assume an upright posture and ambulate on all limbs. These outcomes were statistically significant. Microscopy revealed axons traversing the injury site in the experimental group, whereas control samples showed degenerative post-traumatic changes. This study demonstrates that a fusogen sealant based on a polyethylene glycol-chitosan conjugate promotes significant morpho-functional recovery after complete spinal cord transection, supporting its therapeutic potential.
This study examined longitudinal associations between spirituality and quality of life (QoL) in women newly diagnosed with breast cancer and undergoing chemotherapy at a large tertiary cancer center. Women (N = 114) completed measures of spirituality (3 subscales of the Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being Scale: Meaning, Peace, and Faith) and health-related QoL (36-Item Short Form Health Survey) at study entry and 3- and 15-months later. Bias-corrected bootstrap tests were used to examine whether baseline Faith was indirectly associated with mental and physical QoL 15 months later via Meaning and Peace at 3 months. Baseline Faith was positively associated with Meaning (β = .31, p = .001) and Peace (β = .38, p < .001) at 3 months. Both Meaning [n = 94, effect = .07 (95% CI: .002, .17)] and Peace [n = 93, effect = .13 (95% CI: .02, .28)] mediated the association between Faith and mental QoL at 15 months. When baseline Meaning was controlled, the indirect effect of baseline Faith on mental QoL remained significant, [n = 94, effect = .07 (95% CI: .001, .18)], and increases in Meaning over the first 3 months became an even stronger predictor of later mental QoL (β = .36, p = .004), suggesting that change in meaning during active treatment is an especially important predictor of mental QoL. Overall, findings demonstrate that Faith is indirectly associated with long-term QoL through early increases in Meaning and Peace. Because 90% of participants were within 6 weeks of diagnosis, the study provided a unique perspective on spirituality during the early treatment period. Clinically, results highlight the importance of early assessment of spiritual well-being and suggest that meaning-focused interventions may enhance long-term QoL for women undergoing chemotherapy.
Neck pain, impaired cervical motor control, fear of falling, and balance limitations may be relevant but under-recognized concerns in inpatient ophthalmologic rehabilitation for patients with visual impairment (VI). To investigate whether onset/duration and type of VI influence neck and balance complaints in visually impaired patients. Exploratory cross-sectional study of 80 participants (median age 58 years; 43 women, 37 men). Outcomes included neck pain (NRS), neck disability (NDI), cervical motor control, fear of falling (FES-I), balance (FABS), and vision-related quality of life (NEI VFQ-25 C). Associations were analyzed by VI duration (Group I < 1 year; Group II > 3 years; Group III 1-3 years) and VI type (unilateral; unilateral blindness; bilateral; bilateral blindness; other; not classifiable). Neck pain was reported by 71.3% (NRSmean 4.6/10, SD 1.7 (median: 4.0 (IQR: 2.0-7.0)); NDI 13.5/50, SD 6.0). Participants performed a mean of 2.3/4 motor control tests incorrectly (SD 1.1). Fear of falling was moderate (FES-I 24.8/64, SD 7.7), balance performance was below age average (FABS 33.2/40, SD 3.6), and NEI VFQ-25 C averaged 0.65 logits (SD 1.91). Higher fear of falling was associated with longer-lasting VI (f = 0.31; χ² = 8.94; p = .01) and with more severe VI types (f = 0.41; χ² = 10.82; p = .03). This assessment captures frequent neck pain, impaired cervical motor control, increased Fear of Falling and non-age appropriate Balance in this population. Findings show greater Fear of Falling with longer lasting VI-Symptoms and increasing VI severity, ranging from visual impairment to blindness and from unilateral to bilateral involvement. Trial registration German Clinical Trials Registration-Number: DRKS00035125, registered on 30.09.2024.
Acute heart failure often leads to impaired physical function, high rehospitalization rates, and poor quality of life. Although exercise-based rehabilitation benefits chronic heart failure patients, its feasibility in acute heart failure is limited. Neuromuscular electrical stimulation offers a potential alternative by safely inducing muscle contractions without causing dyspnea. The protocol was registered with the International Prospective Register of Systematic Reviews (registration number CRD42023453116). Following PRISMA guidelines, a comprehensive search of PubMed, Cochrane Library, and Embase was conducted up to October 13, 2025. Randomized controlled trials comparing neuromuscular electrical stimulation to control treatments in patients with acute heart failure were included. Data synthesis was performed using Review Manager 5.4. Seven randomized controlled trials, with methodological quality ranging from fair to excellent (Physiotherapy Evidence Database (PEDro) scores 5-9), were included. Pooled data analysis revealed that neuromuscular electrical stimulation significantly improved 6-min walking distance (mean difference = 69.92 m, 95% confidence interval CI [32.17-1 07.68], p = 0.0003), quality of life (standardized mean difference = 1.53, 95% CI [1.03-2.03], p < 0.00001), and showed preliminary evidence of improvement in leg muscle strength (standardized mean difference = 0.77, 95% CI [0.25-1.29], p = 0.004), whereas no significant difference was observed in left ventricular ejection fraction (mean difference = 1.94%, 95% CI [-3.91 to 7.79], p = 0.52). Neuromuscular electrical stimulation was generally well tolerated, with no serious adverse events directly attributable to the intervention. Neuromuscular electrical stimulation was noted to be effective for improving physical capacity and quality of life in patients with acute heart failure. It offers a promising option for patients unable to engage in conventional rehabilitation. Further large-scale, multicenter Randomized Controlled Trials (RCTs) are needed to confirm these findings.