Archives of physical medicine and rehabilitation最新文献

{"title":"Effects of Virtual Reality-Assisted Task-Oriented Training on Clinical and Psychosocial Outcomes in Individuals With Rotator Cuff Tears: A Randomized Controlled Single-Blind Trial.","authors":"Mehmet Canlı, İrem Canlı, Şafak Kuzu, Anıl Özüdoğru, Yusuf Topal, Hikmet Kocaman, Halil Alkan, Figen Tuncay","doi":"10.1016/j.apmr.2026.09.004","DOIUrl":"10.1016/j.apmr.2026.09.004","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this randomized controlled study was to examine the effects of virtual reality-assisted task-oriented training (VR-TOT) added to conventional physiotherapy in individuals with rotator cuff tears.</p><p><strong>Design: </strong>Prospective, single-blinded, 2-arm, randomized controlled trial.</p><p><strong>Setting: </strong>An outpatient physical therapy and rehabilitation clinic.</p><p><strong>Participants: </strong>A total of 60 individuals with partial rotator cuff tears were randomized to the VR-TOT group (VR-TOTG, n=30) or the control group (n=30).</p><p><strong>Interventions: </strong>Both groups received 6 weeks of progressive conventional physiotherapy, whereas the VR-TOTG additionally received VR-TOT based on activities of daily living.</p><p><strong>Main outcome measures: </strong>The primary outcome was upper extremity function assessed using the Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH). Secondary outcomes included pain intensity (visual analog scale), shoulder-related pain and disability (Shoulder Pain and Disability Index [SPADI]), kinesiophobia (Tampa Scale for Kinesiophobia [TSK]), pain catastrophizing (Pain Catastrophizing Scale [PCS]), psychological status (Hospital Anxiety and Depression Scale [HADS]), and grip and pinch strength.</p><p><strong>Results: </strong>For the primary outcome, the mean between-group difference in change in DASH was -3.93 points (95% confidence interval [CI], -4.79 to -3.08; P<.001), favoring the VR-TOTG. For the secondary outcomes, the mean between-group differences in change were -0.53 cm for resting pain (95% CI, -0.84 to -0.22; P=.001), -1.23 cm for activity pain (95% CI, -1.53 to -0.94; P<.001), -0.67 cm for night pain (95% CI, -0.87 to -0.46; P<.001), -8.70 points for SPADI (95% CI, -10.29 to -7.11; P<.001), -3.47 points for TSK (95% CI, -4.30 to -2.63; P<.001), and -1.33 points for PCS (95% CI, -1.89 to -0.77; P<.001), favoring the VR-TOTG. Between-group differences were not significant for HADS anxiety, HADS depression, HADS total score, hand grip strength, or pinch strength (P>.05).</p><p><strong>Conclusions: </strong>Adding VR-TOT to conventional physiotherapy resulted in a statistically greater short-term improvement in DASH, the primary outcome, along with additional improvements in pain, shoulder-related pain and disability, kinesiophobia, and pain catastrophizing. However, the between-group DASH difference did not reach the published minimal clinically important difference, and longer-term studies are needed.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148928854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Telerehabilitation Interventions for Stress Urinary Incontinence: A Systematic Review of Randomized Controlled Trials.","authors":"Noah Martin, Krithika Venkataramadas, Ashmita Singh, Emmanuella Osuji, Jane Schulz, Emily Nadon, Emily Armstrong, Martin Ferguson-Pell","doi":"10.1016/j.apmr.2026.08.020","DOIUrl":"10.1016/j.apmr.2026.08.020","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effectiveness of telerehabilitation-delivered pelvic floor muscle training (PFMT) for women with stress urinary incontinence (SUI), focusing on clinical outcomes, adherence, satisfaction, and health care accessibility.</p><p><strong>Data sources: </strong>A systematic search was conducted across 4 electronic databases: Embase, Scopus, CINAHL, and MEDLINE, in June 2024 and updated in May 2026.</p><p><strong>Study selection: </strong>Eligible studies were randomized controlled trials (RCTs) examining PFMT delivered via virtual platforms (eg, mobile applications, video conferencing, or internet-based programs) for women (≥18y) with SUI. A total of 13 RCTs met all inclusion criteria.</p><p><strong>Data extraction: </strong>Two independent reviewers extracted data regarding study characteristics, clinical outcomes, and implementation metrics (adherence and satisfaction). Methodological quality was assessed using the Cochrane Risk of Bias 2 tool.</p><p><strong>Data synthesis: </strong>Because of substantial methodological and clinical heterogeneity, findings were synthesized narratively using the Synthesis Without Meta-analysis reporting guidelines. Digital interventions consistently produced significant subjective reductions in SUI symptoms and improvements in condition-specific quality of life. Telerehabilitation often demonstrated superior clinical outcomes and higher adherence than passive management or no-treatment controls. When compared with active conventional care, such as face-to-face physiotherapy or paper booklets, digital tools generally showed comparable rather than superior efficacy. Adherence was a primary mechanism for success, although technological complexity was a barrier in some protocols. Interventions were safe, with no serious adverse events reported.</p><p><strong>Conclusions: </strong>Telerehabilitation-delivered PFMT has potential as a safe, feasible, and effective modality for managing SUI. It offers a robust, scalable alternative to traditional care, particularly by improving accessibility for women facing geographic or logistical barriers.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinicians' Ethical Considerations Regarding the Use of Prediction Models in Hand and Wrist Care: A Qualitative Study.","authors":"Grada R Arends, Yara E van Kooij, Joene Rutten, Ineke Bolt, Nina L Loos, Robbert M Wouters","doi":"10.1016/j.apmr.2026.08.019","DOIUrl":"10.1016/j.apmr.2026.08.019","url":null,"abstract":"<p><strong>Objective: </strong>To explore clinicians' ethical considerations regarding the use of prediction models in clinical decision making in hand and wrist care.</p><p><strong>Design: </strong>We conducted semistructured interviews and analyzed them using hermeneutic-interpretive phenomenology. An example prediction model was used to predict whether a patient will achieve the improvement they aim for in a domain relevant to them, given their baseline score.</p><p><strong>Setting: </strong>Data were collected in the Netherlands from 2 specialized clinics for hand and wrist care and 2 academic hospitals.</p><p><strong>Participants: </strong>We purposefully selected 7 hand surgeons and 5 hand therapists.</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcome measures: </strong>Semistructured interviews.</p><p><strong>Results: </strong>We identified 4 main themes. First, clinicians acknowledge the patient's voice in shared decision making, but ultimately, the clinician decides. Second, clinicians want to maintain their autonomy in treatment decisions because they have a strong clinical intuition and feel that a prediction model will never be as good as their clinical judgment. Third, deviating from predictions is sometimes needed because of equity issues, the right to receive care, and the principle of striving for the least invasive treatment. Fourth, clinicians require sufficient information to build confidence in using the prediction model effectively.</p><p><strong>Conclusions: </strong>Clinicians consider prediction models ethically acceptable when they support, rather than replace, clinical judgment. Their main concerns are preserving professional autonomy and responsibility, respecting patient needs, ensuring equitable access to care, and being able to deviate from predictions when necessary. As prediction models improve, increased accuracy and transparency may enhance trust but may not resolve broader ethical issues, including patient preferences, fairness, responsibility, and accountability. Addressing these concerns is an important step toward enabling prediction models to support meaningful patient involvement, which could contribute to shared decision making and improve quality of life.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Manual Lymph Drainage in Lower Extremity Lymphedema Management: An Essential Component or An Optional Extra? A Single-Blind, Randomized Non-Inferiority Trial.","authors":"Elif Duygu-Yildiz, Samet Genez, Mustafa Fatih Yaşar, Nuriye Özengin","doi":"10.1016/j.apmr.2026.09.001","DOIUrl":"https://doi.org/10.1016/j.apmr.2026.09.001","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether compression bandaging (CB) alone is non-inferior to CB combined with manual lymphatic drainage (MLD) in terms of reducing limb volume, tissue stiffness, and skin/subcutaneous thickness during the intensive phase of Stage 2-3 lower extremity lymphedema (LEL) treatment.</p><p><strong>Design: </strong>A single-blind, randomized non-inferiority trial.</p><p><strong>Setting: </strong>xxx University, Department of Physiotherapy and Rehabilitation, xxx Physical Therapy and Rehabilitation Training and Research Hospital.</p><p><strong>Participants: </strong>A total of 32 extremities with Stage 2-3 LEL were randomly assigned to either the CB group (n = 16) or the CB+MLD group (n = 16). Thirty-one extremities completed the study (CB: n = 16; CB+MLD: n = 15).</p><p><strong>Interventions: </strong>Interventions were administered 5 days a week for 4 weeks. The CB group received CB alone, while the CB+MLD group received a combination of compression bandaging and MLD.</p><p><strong>Main outcome measures: </strong>The primary outcome was percentage volume reduction (PVR), with a pre-specified non-inferiority margin (Δ) of -5%. Secondary outcomes included tissue stiffness measured via SkinFibroMeter, and skin and subcutaneous thickness evaluated using ultrasound at 17 standardized points across the lower extremity.</p><p><strong>Results: </strong>Both groups achieved significant reductions in limb volume (p<0.001, Cohen's d: 1.35 for CB, 1.49 for CB+MLD). No significant difference in PVR was observed between the CB (19.67±8.47%) and CB+MLD (22.23±8.74%) groups (p=0.466). The 95% confidence interval for the mean difference in PVR was [-4.57,9.68], which remained within the field non-inferiority margin. Both groups also demonstrated significant improvements in distal tissue stiffness (p<0.001, d: 1.27 for CB, 1.32 for CB+MLD) and subcutaneous thickness (p<0.001, d: 1.06-1.24), with no significant inter-group differences (p>0.05).</p><p><strong>Conclusions: </strong>CB alone is non-inferior to CB+MLD for reducing edema and tissue stiffness in Stage 2-3 LEL. Consequently, prioritizing appropriate compression may allow for more cost-effective and less time-consuming treatment strategies without compromising therapeutic efficacy.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gait Speed Changes in Stroke Rehabilitation Motor Lower Extremity Randomized Controlled Trials by Intervention and Time Poststroke: A Meta-analysis.","authors":"Cecilia Flores-Sandoval, Sarvenaz Mehrabi, Mohammad R Safaei-Qomi, Jamie L Fleet, Michael W Payne, Sue Peters, Emma A Bateman, Sean P Dukelow, Robert Teasell","doi":"10.1016/j.apmr.2026.08.017","DOIUrl":"10.1016/j.apmr.2026.08.017","url":null,"abstract":"<p><strong>Objective: </strong>To examine changes in gait speed in randomized controlled trials (RCTs) of lower-extremity (LE) motor rehabilitation after stroke across various interventions, compared with conventional care or sham controls, at different poststroke time points.</p><p><strong>Data sources: </strong>A meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Systematic searches were conducted in Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, and Psychological Information Database for RCTs published in English through December 2024.</p><p><strong>Study selection: </strong>RCTs were included if they examined an LE motor rehabilitation intervention in adults with stroke, used conventional care or sham as a control group, and evaluated gait speed.</p><p><strong>Data extraction: </strong>Two independent reviewers screened titles/abstracts and full texts and extracted data, with an independent reviewer available for conflict resolution.</p><p><strong>Data synthesis: </strong>A total of 106 RCTs met the inclusion criteria; 63.2% were conducted in the chronic phase poststroke. Five interventions were evaluated in both the acute/subacute and chronic phases; 3 (treadmill training, body weight-supported treadmill training, and training with exoskeletons) showed significant benefits in the acute/subacute phase compared with conventional care, but none showed any significant benefit in the chronic phase. Of the interventions evaluated solely in the chronic phase, overground walking training, trunk training, mirror therapy, and virtual reality demonstrated significant benefits compared with conventional care. Interventions studied during the acute/subacute phase poststroke demonstrated a significantly greater magnitude of improvement in gait speed than those in the chronic phase.</p><p><strong>Conclusions: </strong>Overall, interventions for LE motor function poststroke evaluated in the acute/subacute phase demonstrated a greater magnitude of effect on gait speed than in the chronic phase, although more RCTs are being conducted in the chronic phase.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and Safety Evaluation of Hybrid Assistive Limb-Based Neurorehabilitation for Patients With Central Motor Dysfunction: A Single-Center Study.","authors":"Yuichiro Soma, Shigeki Kubota, Yukiyo Shimizu, Hideki Kadone, Aiki Marushima, Hiroki Watanabe, Hiroaki Kawamoto, Yasuhiro Homma, Yasushi Hada, Masashi Yamazaki","doi":"10.1016/j.apmr.2026.08.018","DOIUrl":"10.1016/j.apmr.2026.08.018","url":null,"abstract":"<p><strong>Objective: </strong>Motor impairments caused by central nervous system (CNS) disorders lead to significant loss of functional independence in activities of daily living. The Hybrid Assistive Limb (HAL) is a wearable robotic device that augments voluntary movement and promotes CNS recovery via interactive biofeedback. We aimed to evaluate the feasibility and safety of HAL-assisted rehabilitation across inpatient and outpatient settings in patients with diverse CNS disorders.</p><p><strong>Design: </strong>Nonrandomized, single-arm study.</p><p><strong>Setting: </strong>Single-center study.</p><p><strong>Participants: </strong>Patients (N=229) with CNS-related motor impairment enrolled between July 2014 and March 2024, contributing 238 HAL intervention episodes.</p><p><strong>Interventions: </strong>Participants received HAL-assisted rehabilitation using bilateral-leg, single-leg, or single-joint HAL devices based on their clinical presentation.</p><p><strong>Main outcome measures: </strong>The primary outcomes were feasibility and safety, evaluated by adverse event profile, treatment discontinuation rates, intervention exposure (duration and session frequency), and applicability.</p><p><strong>Results: </strong>In total, 238 HAL intervention episodes were analyzed (229 patients; mean age, 54.1±20.1y). No serious adverse events were identified. At least 1 adverse event occurred in 20 of 238 intervention episodes (8.4%), comprising a total of 23 adverse events. All events were mild and resolved with conservative management or observation without the permanent discontinuation of HAL therapy. The mean number of HAL sessions was 10.5±9.5, with a mean intervention duration of 105.9±163.4 days. The frequency of intervention episodes with adverse events differed significantly according to diagnostic category and HAL device type but not according to the clinical setting. HAL-assisted rehabilitation was successfully implemented across multiple CNS disorders in inpatient and outpatient settings, demonstrating clinical feasibility in heterogeneous rehabilitation settings.</p><p><strong>Conclusions: </strong>HAL-assisted rehabilitation was associated with no serious adverse events and a low incidence of minor adverse events. These findings indicate an acceptable safety profile and support the feasibility of HAL-assisted rehabilitation across diverse CNS disorders and care settings.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148878735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-Scientists: Lived Experience Combined With Academic Rigor in Rehabilitation Research","authors":"Sonya Kim PhD, CRC, BCB, FACRM,&nbsp;JohnRoss Rizzo MD, FACRM,&nbsp;Patricia C. Heyn PhD, FGSA, FACRM","doi":"10.1016/j.apmr.2026.03.020","DOIUrl":"10.1016/j.apmr.2026.03.020","url":null,"abstract":"<div><div>Historically hindered by a lack of access to academic, political, financial, technological, scientific, and social resources, most people living with disability have been unable to successfully merge their lived experience with the traditional research process. The lack of this community’s perspective has been an ongoing missed opportunity for broadening and relevance of research around disability. Patient-scientists, however, bridge the gap. They are individuals who act as patient research partners, with the valuable addition of a research and/or medical degree. Their embodied expertise, combined with their academic accreditation, seamlessly positions them to work within the academic system. With a foot in both worlds, they are equipped to generate real change for themselves and others living with their condition. Patients are encouraged to participate in their own clinical care, although patient research partners remain relatively uncommon. Even more scarce are patient-scientists, who serve as intellectual peers with expertise in technical and experiential domains. Their research training gives them an invaluable role: to act as both scientist and patient at once. This special communication builds on ongoing efforts to bolster patient participation in rehabilitation research by focusing on patient-scientists and highlighting their potential to enhance rehabilitation research processes.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 9","pages":"Pages 2614-2618"},"PeriodicalIF":4.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147626986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Progressive Exercise Snacking for Middle-Aged and Older Adults With Knee Osteoarthritis: A Systematic Review and Meta-analysis","authors":"Lidian Meng MS,&nbsp;Jiayi Chen MS,&nbsp;Xinxin Huo MS,&nbsp;Yating Zhang MS,&nbsp;He Zheng MS","doi":"10.1016/j.apmr.2026.02.493","DOIUrl":"10.1016/j.apmr.2026.02.493","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the effects of progressive exercise snacking (PES) in middle-aged and older adults with knee osteoarthritis (KOA) using meta-analysis.</div></div><div><h3>Data Sources</h3><div>PubMed, Web of Science, CINAHL, Cochrane Library, and Scopus were searched from inception to October 5, 2025, with additional reference-list screening.</div></div><div><h3>Study Selection</h3><div>Randomized controlled trials (RCTs) assessing PES for KOA were included. Two reviewers independently screened studies using predefined criteria.</div></div><div><h3>Data Extraction</h3><div>Data on study characteristics, intervention protocols, outcomes, and adverse events were extracted. Outcomes included pain, joint function, gait performance, and quality of life at 4, 12, and 24 weeks postintervention.</div></div><div><h3>Data Synthesis</h3><div>Eighteen RCTs (n=1200) were included. PES improved pain at short-term follow-up (standardized mean difference [SMD]=−1.09; 95% confidence interval [CI]=−1.51 to –0.68; moderate certainty) and enhanced joint function (SMD=1.31; 95% CI=0.98-1.64; moderate certainty) and quality of life (SMD=0.97; 95% CI=0.14-1.79; low certainty). At midterm follow-up, PES improved gait performance (SMD=0.62; 95% CI=0.25-0.98; low certainty). Meta-regression suggested that benefits for pain, joint function, and gait performance diminished with longer follow-up. Subgroup analyses suggested that larger effects may be associated with shorter intervention duration (≤12 wk), higher weekly exercise dose (≥300 metabolic equivalent·min/wk), and walking as the primary modality. PES did not appear to increase adverse events (risk ratio=1.80; 95% CI=0.41-2.54; <em>P</em>&gt;.05).</div></div><div><h3>Conclusions</h3><div>PES may provide short-term improvements in pain, joint function, and quality of life, and midterm improvements in gait performance in KOA, but long-term efficacy remains uncertain. Larger, high-quality RCTs with longer follow-up and standardized protocols are needed to confirm long-term effectiveness and safety.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 9","pages":"Pages 2567-2578"},"PeriodicalIF":4.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147389170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diaphragmatic Training for Nonspecific Low Back Pain: A Systematic Review and Meta-analysis","authors":"Hai Wei Li PhD,&nbsp;Chen Jia MSc,&nbsp;Yu Xiang Yang MSc,&nbsp;Jia Hao Wang MSc,&nbsp;Shikai Jin","doi":"10.1016/j.apmr.2026.03.001","DOIUrl":"10.1016/j.apmr.2026.03.001","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the effectiveness of diaphragmatic training interventions in adults with nonspecific low back pain.</div></div><div><h3>Data Sources</h3><div>PubMed (MEDLINE), Embase, Web of Science, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and China National Knowledge Infrastructure databases were systematically searched from inception to December 2024, with an updated search conducted through December 2025.</div></div><div><h3>Study Selection</h3><div>Inclusion criteria included the following: (1) adults (≥18y) with nonspecific low back pain; (2) interventions involving diaphragmatic training, either as a standalone treatment or in combination with other therapies; (3) any comparator; (4) pain intensity and functional disability as primary outcomes and diaphragmatic thickness as a secondary outcome; and (5) randomized controlled trial designs. Two reviewers independently screened the studies.</div></div><div><h3>Data Extraction</h3><div>Data were extracted independently by 2 reviewers. The Cochrane Risk-of-Bias assessment and Grading of Recommendations, Assessment, Development, and Evaluation certainty ratings were conducted by 4 reviewers.</div></div><div><h3>Data Synthesis</h3><div>Thirteen studies (626 participants) were included. Diaphragmatic training likely reduced pain intensity compared with control interventions (standardized mean difference=−0.60; 95% confidence interval=−0.86 to −0.34; 11 trials, n=465; moderate-certainty evidence). It also likely improved functional disability (standardized mean difference=−0.71; 95% confidence interval=−0.90 to −0.53; 9 trials, n=469; moderate-certainty evidence). Evidence for changes in diaphragmatic thickness was of very low certainty. Subgroup analyses suggested that better pain outcomes typically occurred with 2-3 sessions/wk.</div></div><div><h3>Conclusion</h3><div>Moderate-certainty evidence suggests that diaphragmatic training may be considered as an adjunct to rehabilitation to reduce pain intensity and improve functional disability in adults with nonspecific low back pain. Prespecified trials with longer follow-up are needed to clarify effects on diaphragm thickness and the influence of training parameters.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 9","pages":"Pages 2579-2589"},"PeriodicalIF":4.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147430406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-Administered Mobile Cognitive Assessments for Individuals With Stroke: A Feasibility and Validation Study","authors":"Yun Shi PhD,&nbsp;Mandy W.M. Fong PhD,&nbsp;Christopher L. Metts MD,&nbsp;Stephanie E. Tomazin MPH,&nbsp;Katherine J. Kaufman BA,&nbsp;Elizabeth G.S. Munsell PhD,&nbsp;Bridget Regan OTD,&nbsp;Alex W.K. Wong PhD, DPhil","doi":"10.1016/j.apmr.2026.04.030","DOIUrl":"10.1016/j.apmr.2026.04.030","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the feasibility, learning effects, stability, and validity of mobile cognitive assessments (MCAs) among individuals with stroke.</div></div><div><h3>Design</h3><div>Longitudinal observational study using frequent, brief, repeated, in vivo self-administered mobile assessments of cognitive functions.</div></div><div><h3>Setting</h3><div>Everyday life settings.</div></div><div><h3>Participants</h3><div>Twenty participants with mild-to-moderate stroke (mean age, 55.5y; 60% men; 45% Whites; 70% ischemic stroke).</div></div><div><h3>Intervention</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Over 14 days, participants used smartphones to complete a digital assessment protocol. The protocol included 6 ecological momentary assessment surveys on self-reported health status, along with 4 MCAs, each administered twice daily. MCAs included the Mobile Stroop Color Word Test (M-SCWT), Mobile Spatial Memory Test Forward and Backward, Mobile Trail Making Test Parts A and B (M-TMT A &amp; B), and Mobile Tower of Hanoi Test. Thus, participants completed the entire 14-day protocol with ≤84 ecological momentary assessment surveys and 28 MCA tasks. Participants also completed a lab-based neuropsychological test battery during the initial lab visit.</div></div><div><h3>Results</h3><div>High adherence rates were observed (77% for M-TMT B to 85% for M-SCWT) during repeated administration of MCAs. Learning effects were observed in nearly all tests (<em>P</em>&lt;.024-.001), except for the Mobile Spatial Memory Test Forward. Stability estimates across MCAs ranged from poor to moderate, with higher reliability for M-SCWT and lower stability for M-TMT A and Mobile Tower of Hanoi Test. Agreement between MCAs and corresponding neuropsychological tests varied by domain, with stronger concordance for memory tasks and weaker agreement for inhibition and cognitive flexibility tasks.</div></div><div><h3>Conclusions</h3><div>These findings are the first to demonstrate the feasibility and initial psychometric properties of smartphone-based assessments of cognitive function in individuals with stroke in daily life. MCAs may serve as a promising complement to traditional neuropsychological assessments, with further refinement needed to maximize their impact on rehabilitation research and practice.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 9","pages":"Pages 2481-2489"},"PeriodicalIF":4.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147810191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}