Journal of Clinical Medicine最新文献

{"title":"Stratified Care for Musculoskeletal Conditions in Primary Care: A Prospective Sequential Cohort Study of the STarT MSK Tool and the eSELF-MSK Virtual Self-Management Program.","authors":"Norah AlMuhana, Dalia Alimam, Walaa Moslem, Ibraheem Alsmari, Fahad Alfarraj, Ameerah S Alharthi, Muteb Aldosari, Abdullah Alassaf, Hamad M Aloraini, Hana Alsobayel","doi":"10.3390/jcm15208105","DOIUrl":"https://doi.org/10.3390/jcm15208105","url":null,"abstract":"<p><p><b>Background/Objectives:</b> To compare changes in pain intensity, musculoskeletal health and function, and psychosocial risk between usual care and implementation of a bundled STarT MSK-guided care pathway among low-risk adults. <b>Methods:</b> In this non-randomized sequential cohort study, the usual-care cohort was recruited before clinician training and pathway implementation, followed by recruitment of the stratified-care cohort. Both cohorts comprised adults classified as low risk by the STarT MSK Tool. The pathway combined risk classification feedback, clinician training, one in-person physiotherapy assessment, education and exercise prescription, supported self-management, and five weekly virtual consultations. NPRS and MSK-HQ, the prespecified primary outcomes, and ÖMPQ, a prespecified secondary longitudinal outcome, were assessed at baseline, 6 weeks, and 12 weeks and analyzed using linear mixed-effects models; satisfaction was a secondary outcome assessed at 12 weeks. <b>Results:</b> Of 750 patients screened, 136 were enrolled: 63 in usual care and 73 in stratified care. At 12 weeks, the bundled-pathway cohort showed greater improvement than usual care in NPRS (-2.12; 95% CI, -2.95 to -1.29), MSK-HQ (+7.08; 95% CI, +3.70 to +10.47), and ÖMPQ (-27.83; 95% CI, -37.90 to -17.76). Clinically important pain reduction occurred in 68.3% versus 25.9% of participants, and 88.9% versus 51.7% reported satisfaction with care. <b>Conclusions:</b> Implementation of the bundled STarT MSK-guided eSELF-MSK pathway was associated with greater 12-week improvements than usual care among low-risk patients. Because the pathway combined multiple components, their independent contributions cannot be separated. The non-randomized design, unblinded participants, self-reported outcomes, and possible residual confounding preclude causal conclusions and support further randomized evaluation.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 20","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149268575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Venous Disease in Pregnancy: Pathophysiology, Diagnostic Pitfalls, and a Trimester-Stratified Management Framework-A Narrative Review.","authors":"Raluca Stefana Stan Bran, Iustina Petra Solomon Condriuc, Raluca Maria Haba, Vasile Adrian Sescu, Raluca Anamaria Mogos, Claudia Florida Costea, Alexandru Carauleanu","doi":"10.3390/jcm15208111","DOIUrl":"https://doi.org/10.3390/jcm15208111","url":null,"abstract":"<p><p>Chronic venous disease (CVD) in pregnancy is common, poorly codified, and interpreted with diagnostic thresholds, severity instruments and treatment algorithms all derived outside pregnancy. This narrative review synthesises the mechanistic, epidemiological, diagnostic and therapeutic literature, keeping pregnancy-specific evidence separate from evidence extrapolated from non-pregnant populations. Gestational change is characterised principally by increased venous capacitance and vein-wall distension; ambulatory venous hypertension was not demonstrated in the two pregnancy studies assessing it; and new reflux develops in a minority, undetectable postpartum in the one study reporting it. Physiological adaptation, CVD and thrombotic pathology overlap clinically, deep vein thrombosis and superficial vein thrombosis being at once the principal differential diagnoses and potential complications. Management is correspondingly conservative: compression relieves symptoms but has not been shown to prevent varicose veins, routine initiation of venoactive drugs is not supported, and intervention is deferred other than in exceptional circumstances. A venous finding first detected in pregnancy warrants postpartum reassessment before it is taken for established disease. A trimester-stratified framework spanning preconception to late postpartum reassessment is proposed; it is evidence-informed rather than prospectively validated, and is not a guideline.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 20","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149268096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a Robotic Colorectal Surgery Program: Early Outcomes from a Tertiary Referral Center.","authors":"Gaia Cicioni, Immacolata Iannone, Daniele Crocetti, Michelangelo Miccini, Daniele Biacchi, Enrico Spalice, Antonietta Lamazza, Michele Marchese, Enrico Fiori, Paolo Sapienza","doi":"10.3390/jcm15208097","DOIUrl":"https://doi.org/10.3390/jcm15208097","url":null,"abstract":"<p><p><b>Background:</b> Robotic-assisted colorectal surgery is increasingly adopted; however, evidence regarding outcomes during the early implementation phase remains limited. This study aimed to evaluate the feasibility and short-term outcomes of a newly established robotic colorectal surgery program at a tertiary referral center. <b>Methods:</b> All consecutive patients undergoing robotic colorectal resection between November 2019 and February 2026 were prospectively recorded and retrospectively analyzed. Perioperative outcomes, conversion rates, postoperative complications, in-hospital mortality, and histopathological results were assessed. <b>Results:</b> A total of 177 patients were included, with a progressive increase in surgical volume over time. Most procedures were performed for oncological indications (159, 90%), while 18 (10%) were performed for benign diseases. The most frequent procedures were right hemicolectomy (45%), left hemicolectomy (32%), and low anterior rectal resection (23%). Mean operative time was 331.1 ± 75.0 min. Conversion to open surgery occurred in 15 patients (8.5%), mainly due to extensive intra-abdominal adhesions, particularly during the early phase of the program. Postoperative complications occurred in 20 patients (11%), while 3 patients (2%) died during hospitalization. Major complications (Clavien-Dindo ≥ III) occurred in 7%, and anastomotic leakage in 3%. Mean hospital stay was 10.1 ± 7.6 days. R0 resection was reported in all cases, with adequate lymph-node retrieval for staging. <b>Conclusions:</b> In this single-center, non-comparative series, robotic colorectal surgery was feasible during program implementation, with acceptable short-term perioperative outcomes. Comparative studies are needed to determine its relative performance compared with laparoscopy.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 20","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149268221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mandibular Distraction Osteogenesis for Upper Airway Obstruction in Infants and Neonates: Airway Outcomes, Hospitalization Burden and Procedure Application in the Polish Population.","authors":"Patryk Kołodziejski, Aleksandra Kołodziejska, Sebastian Radziak, Anna Krzykowska, Barbora Hocková, Krzysztof Dowgierd","doi":"10.3390/jcm15208109","DOIUrl":"https://doi.org/10.3390/jcm15208109","url":null,"abstract":"<p><p><b>Objectives</b>: This study retrospectively evaluated the respiratory outcomes and hospitalization burden of infants and neonates diagnosed with upper airway obstruction who underwent bilateral mandibular distraction osteogenesis in the Polish population. <b>Methods</b>: The study analyzed 40 patients aged 0-12 months who underwent bilateral MDO for respiratory insufficiency associated with mandibular hypoplasia between 2013 and 2025. Successful airway management was defined as tracheostomy avoidance, without the need for further respiratory support in non-tracheostomized patients, or successful decannulation, with no requirement for additional respiratory support in patients with pre-existing tracheostomy. Duration of hospitalization and intensive care unit stay were also evaluated. <b>Results</b>: Twenty three patients had iPRS and 17 had sPRS. An overall successful airway outcome was achieved in 30/40 patients (75.0%), with a significantly higher success rate in iPRS than sPRS (95.7% vs. 47.1%, <i>p</i> < 0.001). MDO prevented tracheostomy in 28/30 (93.3%) patients, including all 20 patients with iPRS. In contrast, only 2/10 (20.0%) previously tracheostomized patients were successfully decannulated, both with iPRS. Patients with successful airway outcomes were younger at MDO (median 54 vs. 138 days, <i>p</i> = 0.015). The multivariable analysis indicated sPRS as an independent predictor of respiratory failure after adjustment for age. <b>Conclusions</b>: Bilateral MDO provided effective airway management, particularly in patients with iPRS, and was highly effective in avoiding a new tracheostomy. Syndromic diagnosis and pre-existing tracheostomy characterized patients with substantially less favorable airway outcomes, highlighting clinically important differences within this heterogeneous population.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 20","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149268342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anemia and Red-Cell Size Across Estimated Glomerular Filtration Rate in a Hospital Laboratory Cohort.","authors":"Yahya Madkhali","doi":"10.3390/jcm15208120","DOIUrl":"https://doi.org/10.3390/jcm15208120","url":null,"abstract":"<p><p><b>Background/Objective</b>: Anemia patterns may differ between population and hospital-tested cohorts. This paper aims to examine anemia frequency and red-cell size across estimated glomerular filtration rate (eGFR) in hospital records. <b>Methods</b>: This retrospective cross-sectional study included 37,831 adults aged 18-100 years tested at King Khalid Hospital, Saudi Arabia, during 2017-2021. For each individual, one complete blood count (CBC) record and one creatinine record from the same calendar month were analyzed. eGFR was calculated using the 2021 CKD-EPI creatinine equation. Modified Poisson, logistic and natural cubic spline models adjusted for age, sex, and calendar year. <b>Results</b>: Anemia occurred in 8762 participants (23.2%): 22.9%, 17.1%, 34.6%, and 72.1% at eGFR ≥ 90, 60-89, 30-59, and <30 mL/min/1.73 m², respectively. Relative to eGFR 60-89, adjusted prevalence ratios (PRs; 95% confidence intervals [CIs]) were 1.26 (1.19-1.33) for ≥90, 1.90 (1.75-2.07) for 30-59, and 3.98 (3.69-4.30) for <30. The association was nonlinear (<i>p</i> < 0.001). Among participants with anemia, the normocytic proportion increased from 56.6% at eGFR ≥ 90 to 82.7% at <30. In men, the adjusted normocytic-versus-microcytic odds ratio (OR) for <30 versus 60-89 was 2.70 (1.71-4.27). <b>Conclusions</b>: eGFR < 60 was associated with more frequent anemia. The proportion of anemia classified as normocytic was also greater in lower eGFR categories. Based on same-month CBC and creatinine records, these associations do not confirm CKD or determine anemia etiology.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 20","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149268024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Internal Validation of a Preintubation Prediction Model for Postintubation Hypotension in Trauma Patients Undergoing Emergency Endotracheal Intubation: A Retrospective Cohort Study.","authors":"Chanatthee Kitsiripant, Komet Thongkhao, Osaree Akaraborworn, Siriwimon Tantarattanapong","doi":"10.3390/jcm15208102","DOIUrl":"https://doi.org/10.3390/jcm15208102","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Postintubation hypotension (PIH) is an important complication of emergency endotracheal intubation in trauma patients. However, the applicability of preintubation predictors of PIH in trauma patients undergoing emergency endotracheal intubation in the emergency department (ED) remains uncertain. Here, we aimed to develop and internally validate a preintubation prediction model for PIH in such patients. <b>Methods:</b> This retrospective cohort included trauma patients aged ≥ 15 years undergoing emergency endotracheal intubation in the ED during 2015-2023. PIH was defined as systolic blood pressure < 90 mmHg within 30 min after intubation. Eight preintubation candidate predictors were evaluated using logistic regression with backward elimination. Internal validation used 2000 bootstrap resamples repeating the entire variable-selection procedure. <b>Results:</b> Among 348 patients, 60 (17.2%) developed PIH; 345 patients with 57 PIH events had complete data for model development. The final model retained systolic blood pressure, body temperature, hematocrit, and torso injury, with adjusted odds ratios of 1.19 per 10-mmHg lower systolic blood pressure, 1.48 per 1 °C lower temperature, 1.33 per 5-percentage-point lower hematocrit, and 3.26 for torso injury. The apparent and optimism-corrected areas under the receiver operating characteristic curve were 0.742 and 0.700, respectively. <b>Conclusions:</b> A four-variable preintubation prediction model demonstrated modest optimism-corrected discrimination and substantial model-selection uncertainty. External validation and assessment of clinical utility are required before clinical implementation.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 20","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149268126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gallstone Ileus Presenting as Small Bowel Obstruction in an Elderly Patient: Diagnostic Approach and Surgical Management.","authors":"Yerkhanat Khuanbai, Berik Rovgaliyev, Tlek Karimov, Ruslan Khassenov, Saken Kozhakhmetov","doi":"10.3390/jcm15208122","DOIUrl":"https://doi.org/10.3390/jcm15208122","url":null,"abstract":"<p><p><b>Background</b>: Gallstone ileus is an uncommon cause of mechanical intestinal obstruction that predominantly affects older adults. It results from migration of a gallstone through a biliary-enteric fistula, most commonly a cholecystoduodenal fistula. <b>Methods</b>: An 84-year-old woman with hypertension and hypothyroidism presented with a four-day history of right upper quadrant abdominal pain, nausea, and vomiting. Laboratory investigations showed a marked inflammatory response and severe renal dysfunction with a substantial reversible acute component, most likely related to volume depletion and reduced renal perfusion. Computed tomography demonstrated an ectopic gallstone impacted in the distal small bowel, proximal bowel dilatation, pneumobilia, and a cholecystoduodenal fistula. Emergency laparotomy confirmed gallstone ileus. After assessment of the operative risk and local anatomy, a one-stage procedure was performed, comprising enterolithotomy, cholecystectomy, division of the fistula, and primary repair of the duodenal defect. <b>Results:</b> Postoperative management included continued monitoring of the admission renal dysfunction, together with treatment of postoperative tracheobronchitis, anemia, electrolyte disturbances, and transient elevation in pancreatic enzymes. These abnormalities were managed with supportive and multidisciplinary care. Renal function, inflammatory markers, and electrolyte concentrations improved substantially before discharge. Pancreatic amylase returned to its reference interval, whereas total α-amylase was below its stated reference interval at discharge, although anemia persisted. The patient was discharged in satisfactory condition on postoperative day 13. <b>Conclusions</b>: Computed tomography enabled preoperative diagnosis and characterization of the cholecystoduodenal fistula. Although a one-stage operation was feasible in this patient, this single outcome does not establish its superiority. Surgical management should be individualized according to the patient's physiological condition, comorbidities, and intraoperative findings.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 20","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149268363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obesity and Atrial Fibrillation: Weighing the Evidence.","authors":"Francis J Ha, Jit Yoei Tang, Shaun Khanna, Adam J Brown, Emily Kotschet, Nitesh Nerlekar","doi":"10.3390/jcm15208101","DOIUrl":"https://doi.org/10.3390/jcm15208101","url":null,"abstract":"<p><p>Obesity is a major, modifiable risk factor for atrial fibrillation (AF). Potential mechanisms include haemodynamic and metabolic changes, inflammation, changes in epicardial adipose tissue (EAT) composition and cardiovascular-kidney-metabolic (CKM) syndrome. EAT is increasingly recognised as a dynamic, pro-arrhythmic fat depot with a possible bidirectional relationship with AF, whereby AF itself may modulate EAT independent of weight change. CKM syndrome also underlies the complex interplay between obesity and AF. Despite guideline recommendations for at least 10% weight reduction in obese patients with AF, recent randomised trials focusing on weight reduction have largely failed to demonstrate clinically meaningful improvements in AF outcomes compared with catheter ablation or usual care. Incretin-based therapies including glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are a promising therapy offering sustained weight loss alongside broader cardiometabolic benefits, although randomised trials with AF as a primary endpoint are lacking. Comprehensive multidisciplinary lifestyle risk factor modification (LRFM) clinics that address cardiometabolic risk factors, AF education and medication adherence have shown benefit beyond weight reduction alone, although their delivery has been heterogeneous. This narrative review examines the evolving relationship between obesity and AF including a multidimensional cardiometabolic lens, EAT characterisation, contemporary randomised trials of weight reduction, and the emerging role of incretin-based therapies and LRFM clinics.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 20","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149268237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Therapeutic Use of Local Anesthetics in Chronic Myogenous Temporomandibular Disorders: A Pilot Study and Evidence Gap Assessment.","authors":"Güzin Neda Hasanoğlu Erbaşar, Onur Odabaşı, Sercan Dolanbay, Kevser Tütüncüler","doi":"10.3390/jcm15208112","DOIUrl":"https://doi.org/10.3390/jcm15208112","url":null,"abstract":"<p><p><b>Background/Objectives:</b> The therapeutic use of local anesthetics has been discussed in several musculoskeletal pain conditions, but its role in myogenous temporomandibular disorders (TMDs) remains unclear. This study evaluated clinical outcomes after a therapeutic local anesthetic injection protocol in patients with chronic myogenous TMDs and examined whether comparable clinical evidence exists in the literature. <b>Methods:</b> This retrospective study included patients diagnosed with myalgia according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) criteria. Patients received six weekly sessions of therapeutic local anesthetic injections targeting trigeminal nerve exit points, myofascial trigger points in the masticatory and cervical muscles, the projection area of the otic ganglion, and upper cervical segments. Mandibular mobility, pain intensity, and DC/TMD Axis II measures were compared between baseline and 3-month follow-up. A structured literature search was also performed in PubMed, Cochrane Library, LIVIVO, Ovid MEDLINE, Scopus, and Web of Science. <b>Results:</b> Twenty-seven patients were included. Pain-free mouth opening, maximum unassisted mouth opening, and maximum assisted mouth opening increased after therapy. Pain intensity and patient-reported measures of jaw function, depressive and anxiety symptom scores, somatic symptom scores, and oral behavior scores decreased. The literature search identified 1406 records; after duplicate removal, 561 records were screened. Several studies investigating local injections for TMDs were identified; however, none appeared to evaluate the specific injection protocol used in this cohort. <b>Conclusions:</b> Therapeutic local anesthetic injections were associated with improvements in pain, jaw function, and patient-reported outcomes in this retrospective pilot cohort. Owing to the lack of a control group, the findings should be interpreted with caution.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 20","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149268239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Effects of Three Active Laser Therapy Protocols and a Sham Protocol on Neurophysiological and Functional Outcomes in Patients with Bell's Palsy: A Four-Arm Randomized Controlled Trial.","authors":"Ahmed Eid Lafi Aljohani, Mahmoud Ewidea, Amr Abo Gazia, Yasmein Mohammad","doi":"10.3390/jcm15208113","DOIUrl":"https://doi.org/10.3390/jcm15208113","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Although laser therapy is commonly used to manage Bell's palsy, optimal treatment parameters have not been established. The present randomized controlled trial compared three active laser therapy protocols with a sham-control protocol for neurophysiological and functional recovery in patients with acute Bell's palsy. <b>Methods:</b> The primary analysis included all 104 randomized participants (26 per group) and used multiple imputation for missing six-week outcomes, followed by baseline-adjusted pooled treatment comparisons. In this four-arm trial (NCT07519421), 104 patients were randomized (26 per group) to receive either a sham laser, 808 nm low-level laser therapy (LLLT), 980 nm LLLT, or 1064 nm high-intensity laser therapy (HILT). All participants received standard care, including corticosteroids, electrical stimulation, and facial exercises. Interventions were administered three times per week for six weeks. Compound muscle action potential (CMAP) amplitude was the primary outcome; distal motor latency and the physical and social Facial Disability Index subscales (PFDI/SFDI) were additional outcomes. Eighty patients (20 per group) completed the six-week assessment and constituted the supporting complete-case analysis population. <b>Results:</b> In the primary intention-to-treat analysis, overall between-group differences were significant for CMAP amplitude (Wald χ²(3) = 1844.49), distal motor latency (χ²(3) = 284.90), PFDI (χ²(3) = 359.44), and SFDI (χ²(3) = 842.37; all <i>p</i> < 0.001). The Group C complete treatment protocol was superior to the sham, Group A, and Group B protocols on all four six-week outcomes in Bonferroni-adjusted pairwise comparisons (all <i>p</i> < 0.001). The 80-participant complete-case analysis supported the general direction of these findings. An additional baseline-adjusted complete-case sensitivity analysis showed broadly concordant treatment estimates and pairwise inference. No adverse events were reported. <b>Conclusions:</b> Among the complete treatment protocols evaluated, the 1064 nm HILT protocol was associated with the greatest short-term improvements at six weeks. Because the active protocols differed in multiple treatment parameters beyond wavelength, these findings should not be interpreted as demonstrating superiority of the 1064 nm wavelength itself. Longer-term multicenter trials are needed to confirm durability and generalizability. The ITT estimates rely on a missing-at-random assumption for the 24 participants without six-week outcome assessments. Post-imputation diagnostic checks identified departures from regression assumptions, particularly for functional outcomes; inferential results should therefore be interpreted cautiously.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 20","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149268178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}