bims-ricfun 2025-10-05 papers

bims-ricfun

Biomed News

on Rehabilitation ICF

Issue of 2025–10–05
37 papers selected by
Gerardo Amilivia, Médica Uruguaya Corporación de Asistencia Médica

Extensor indicis proprius rupture mimicking dorsal wrist ganglion: Role of dynamic ultrasound in diagnosis.
Characterizing participation measures developed with input from persons with acquired brain injury using the International Classification of Functioning, Disability and health.
The secret hero of the lumbopelvic region: A cite to gluteus medius muscle and its trigger point.
Artificial intelligence versus physical medicine and rehabilitation residents: Can ChatGPT compete in clinical exam performance?
Psychosocial and rehabilitation interventions and health gains in older persons in long-term care: A systematic review.
Comment on "Assessing knowledge about the Americans with Disabilities Act and comfort level in treating persons with disabilities among fourth-year medical students following a clerkship in physical medicine and rehabilitation".
Trigger Point Injection: A Therapeutic Propellant for Myofascial Pain Syndromes.
The FROSTBLOCK trial: Protocol for a randomized controlled trial of intra-articular corticosteroid injection with or without suprascapular nerve block in frozen shoulder.
Closing the Gap, A Commentary on Sex Differences in Efficacy of Multidomain Rehabilitation Among Older Adults With Acute Heart Failure: The REHAB-HF Trial.
A systematic review on the associations between low back pain and frailty in community-dwelling older adults.
Acupuncture in Knee Osteoarthritis: A Narrative Review of Clinical Efficacy and Neuroimmune-Endocrine Mechanisms.
Comparison of the efficacy of radial and focused extracorporeal shock-wave therapy (ESWT) in myofascial pain syndrome: a randomized, sham-controlled study.
Postural Control Measures in Randomized Controlled Trials for Older Adults Balance: A Systematic Scoping Review.
Acupuncture Provides Lasting Relief for Older Adults With Low Back Pain.
Can Meaningful Activity Mediate the Relationship Between Social Support and Cognitive Health Among Community-Dwelling Older Adults?
Prevalence of perioperative functional disability using WHODAS 2.0 and associated adverse outcomes in surgical populations: A systematic review and meta-analysis.
Role of dexmedetomidine in brain injury: a systematic review.
Barriers and facilitators to physical activity in rural communities: using the Behaviour Change Wheel to identify intervention functions.
Factors influencing cardiovascular patients to complete phase II cardiac rehabilitation - a qualitative study.
Ultrasonographic evaluation of ulnar innervated muscles in ulnar neuropathy at the elbow.
Rehabilitation goals for hand and upper extremity function after cervical spinal cord injury: A retrospective study.
Exploring the Ethical Dimensions of Care Dependency in Older People: A Transpersonal View.
Exploring the experiences and rehabilitation needs of patients with coronary artery diseases: an effort to design a contextual home-based cardiac rehabilitation through a qualitative enquiry.
Increasing self-efficacy and meeting the physical activity needs of community older adults through a community-based learning project.
A Systematic Review of Management of Cramping Pain in Patients with Amyotrophic Lateral Sclerosis.
Development of physical activity recommendations for adults living with lower limb amputation.
Prevalence and characteristics of medical and rehabilitation utilization among Canadians with arthritis from 2001 to 2018: a cross-sectional population-based study.
Inclusion Body Myositis.
Physical activity, sports participation, and sustainable development in the Ibero-American region: a pilot implementation of indicators in Chile, Costa Rica, and Ecuador.
Irisin: Its significance in the diagnosis and treatment of post-stroke depression.
Understanding Cancer-Related Pain: Pathophysiology, Classification, and Treatment Modalities.
Health economic studies in clinical rehabilitation: A new collection of papers and a discussion of issues involved in research.
Noncredible Complaints and Symptom Validity in Patients With Chronic Pain.
10 years of real-world data: long-term efficacy and safety of HyalOne® for hip osteoarthritis.
The paravertebral fascial plane block: A novel, ultrasound-guided technique for paraspinal neck and back pain.
Instruments to Measure Frailty in Patients with Heart Failure: a Narrative Review.
Recovery After Critical Illness: A Meta-Ethnography of Patient, Family and Staff Perspectives.

PM R. 2025 Sep 30.

Extensor indicis proprius rupture mimicking dorsal wrist ganglion: Role of dynamic ultrasound in diagnosis.

Wei-Ting Wu, Ke-Vin Chang, Levent Özçakar.

DOI: https://doi.org/10.1002/pmrj.70011
Disabil Rehabil. 2025 Sep 29. 1-13

Characterizing participation measures developed with input from persons with acquired brain injury using the International Classification of Functioning, Disability and health.

Gabriele Phillips, Camden Waterhouse, Kimberly Erler, Caitlin Rajala, Mary Slavin, Lewis E Kazis, Emily Evans.

   PURPOSE: To characterize participation outcome measures developed with input from persons with acquired brain injury (ABI).
MATERIALS AND METHODS: We conducted a scoping review to identify participation outcome measures that were developed with input from individuals with ABI. We used the standardized International Classification of Functioning, Disability, and Health (ICF) linking rules to characterize the concepts, perspectives, and response options reflected in each measure.
RESULTS: We identified five participation measurements that met our inclusion criteria. Across these measures, items primarily reflected ICF chapters d9 (community, social, or civic life), d8 (major life areas), and d7 (interpersonal interactions and relationships). Most items were characterized as descriptive, i.e. providing details about participation, or involved appraisal, indicating whether expectations were met.
CONCLUSIONS: The concepts identified in these measures aligned with previous definitions of participation, however demonstrated some variability across measures, highlighting the multiple aspects of participation that may be reflected in measurement tools, and the need for standardized approaches to measure comparison.

Keywords:  Brain injuries; Community participation; NINDS common Data elements; Rehabilitation; Stroke; health care; outcome assessment; traumatic

DOI:  https://doi.org/10.1080/09638288.2025.2564292
Agri. 2025 Oct;37(4): 251-252

The secret hero of the lumbopelvic region: A cite to gluteus medius muscle and its trigger point.

Ebru Kübra Taşpolat, Ozan Volkan Yurdakul, Fatih Bağcıer.

DOI: https://doi.org/10.14744/agri.2023.71542
PM R. 2025 Oct 03.

Artificial intelligence versus physical medicine and rehabilitation residents: Can ChatGPT compete in clinical exam performance?

Aylin Ayyıldız, Selda Çiftci İnceoğlu, Banu Kuran, Kadriye Öneş.

BACKGROUND: Artificial intelligence has begun to replace human power in many areas today.
OBJECTIVE: To assess the performance of Chat Generative Pretrained Transformer (ChatGPT) on examinations administered to physical medicine and rehabilitation (PM&R) residents.
DESIGN: Cross-sectional study.
SETTING: Tertiary-care training and research hospital, department of physical medicine and rehabilitation.
PARTICIPANTS: ChatGPT-4o and PM&R residents.
INTERVENTION: ChatGPT was presented with questions from the annual nationwide in-training exams administered to PM&R residents at different postgraduate years. The exam is a national requirement for the majority of PM&R residents in Turkey and is administered annually.
MAIN OUTCOME MEASURES: The responses to these multiple-choice questions were evaluated as correct or incorrect, and ChatGPT's performance was then compared to that of the residents of each postgraduate year (PGY) term. The time taken by ChatGPT to answer each question was also recorded. Additionally, its learning ability was assessed by reasking the questions it initially answered incorrectly, this time providing the correct answers to evaluate improvement.
RESULTS: ChatGPT received a score of 88 out of 100 points in the PGY1 exam, 84 points in the PGY2 exam, 78 points in the PGY3 exam, and 80 points in the PGY4 exam. When compared with the performance distribution of residents, ChatGPT ranked in the 40th-50th percentile for PGY1, 70th-80th percentile for PGY2, 30th-40th percentile for PGY3, and 40th-50th percentile for PGY4. It has been demonstrated that ChatGPT has achieved a learning rate of 65%.
CONCLUSION: Despite the potential of ChatGPT to surpass PM&R physicians in terms of learning capabilities and extensive knowledge network, several functional limitations remain. In its current form, it is not capable of replacing a physician, especially in the field of PM&R, where clinical examination and patient interaction play a critical role.

DOI: https://doi.org/10.1002/pmrj.70032
Int J Nurs Stud. 2025 Sep 17. pii: S0020-7489(25)00229-9. [Epub ahead of print]172 105219

Psychosocial and rehabilitation interventions and health gains in older persons in long-term care: A systematic review.

António José Lista, Lara Guedes de Pinho, Tânia Correia, Catarina Afonso, Inês Cardoso, César Fonseca.

   BACKGROUND: Global aging and the rising global prevalence of multimorbidity contribute to increasingly complex and substantial long-term healthcare needs. Person-centred psychosocial and rehabilitation interventions targeting older adults are essential in addressing these challenges effectively.
OBJECTIVE: To identify person-centred psychosocial and rehabilitation interventions targeting older adults in long-term care and the health gains associated with these interventions.
STUDY DESIGN: Systematic literature review of randomized controlled trials with narrative synthesis.
METHODS: Included studies were: (1) those with older adults (65+) in long term care with multimorbidity; (2) studies comparing person-centred rehabilitation and/or psychosocial interventions with usual care; and (3) those reporting outcomes indicating a positive change or stabilization of health trajectories, including improved mental health, maintained or slowed decline in functioning, and enhanced well-being. The risk of bias was assessed using the Cochrane RoB 2 tool.
DATA SOURCES: Database searches (Pubmed, CINAHL ultimate, MedicLatina, SPORTDiscus, MedLine Ultimate, Psychology and Behavioral Sciences Collection, CENTRAL, LILACS, ClinicalTrials.gov and Google Scholar) and manual searches were conducted, with the final search performed in June 2025.
RESULTS: Eighteen studies involving 9132 participants were included, identifying and normalizing 51 person-centred interventions using the International Classification for Nursing Practice taxonomy, categorized as psychosocial (15), rehabilitation (15), and complementary (21). Psychosocial interventions demonstrated consistent effectiveness across diverse long term care contexts, notably in improving symptom management in palliative care and health-related quality of life. Rehabilitation interventions, particularly when integrated with psychosocial components, showed robust improvements in health-related quality of life among participants with clear potential for functional stabilization or improvement. Significant heterogeneity was observed among the included interventions, populations, and care settings, limiting direct comparisons and quantitative synthesis. The strongest and most methodologically robust evidence was specifically observed in interventions implemented among frail and complex multimorbid older adults.
CONCLUSIONS: The identified person-centred interventions effectively address complex health needs in older adults with multimorbidity. Psychosocial approaches demonstrated broad effectiveness, while rehabilitation interventions were most beneficial for participants with clear potential for functional improvement. These findings highlight the importance of integrating these approaches within multidisciplinary long term care models. Key limitations include the inability to conduct a quantitative synthesis due to heterogeneity and a focus on high-income countries. Future research should assess the cost-effectiveness, sustainability, and applicability of these interventions across diverse settings to inform clinical practice and policy development in long term care.
REGISTRATION: PROSPERO, CRD42022363860, registered in October 2022.
SOCIAL MEDIA ABSTRACT: For older adults (65+) with multimorbidity in long-term care, person-centred psychosocial and rehabilitation interventions lead to significant health gains across multiple domains.

Keywords:  Aged; Aging; Elderly; Long-term care; Nursing; Patient-centered care; Psychosocial intervention; Rehabilitation; Systematic review

DOI:  https://doi.org/10.1016/j.ijnurstu.2025.105219
PM R. 2025 Oct 01.

Comment on "Assessing knowledge about the Americans with Disabilities Act and comfort level in treating persons with disabilities among fourth-year medical students following a clerkship in physical medicine and rehabilitation".

Rachana Mehta, Ranjana Sah.

DOI: https://doi.org/10.1002/pmrj.70026
Tissue Eng Part B Rev. 2025 Sep 29.

Trigger Point Injection: A Therapeutic Propellant for Myofascial Pain Syndromes.

Yi Wang, Peng Luo, Ping Chen, Guochen Luo, Fujun Wu, Chong Wang, Jin Li, Yi Zhang, Xin Wang.

  Myofascial pain syndromes, stemming from trigger points within the muscles, represent a prevalent cause of localized or generalized pain in clinical practice. They have a high incidence rate and currently lack specific curative methods. Trigger point injection therapy is the most popular clinical approach, focusing primarily on these trigger points. Injectable drugs like glucose, normal saline, local anesthetics, botulinum toxin type A, steroid preparations, and platelet-rich plasma are available for this purpose. This treatment is advantageous due to its low cost and minimally invasive nature, showing promising results in early clinical use. However, the lack of consensus on the optimal injectable substance presents a significant challenge in clinical practice. This article reviews the progress in clinical research on trigger point injection therapy and drug efficacy, along with precautions for drug administration in managing myofascial pain syndrome. It aims to offer fresh perspectives for future studies and establish a theoretical foundation for treating and caring for myofascial pain syndrome.

Keywords:  injections; myofascial pain syndrome; pain; therapy; trigger points

DOI:  https://doi.org/10.1177/19373341251364757
Trials. 2025 Sep 29. 26(1): 383

The FROSTBLOCK trial: Protocol for a randomized controlled trial of intra-articular corticosteroid injection with or without suprascapular nerve block in frozen shoulder.

Marc Schiltz, Jonas Croes, Lina van Brabander, Stijn Roggeman, Lisa Goudman, Maarten Moens, Jo Nijs, Nicole Pouliart, Bénédicte Forthomme, Samar M Hatem.

   BACKGROUND: Frozen shoulder is a challenging musculoskeletal disorder, affecting between 2 and 5% of people, with a higher incidence among those with diabetes and thyroid issues. This condition can persist for years and can be very demanding for both patients and healthcare providers due to the intense pain and restricted shoulder movement. Literature shows that intra-articular corticoid injection (IACI) and suprascapular nerve block (SSNB) can improve pain and range of motion in these patients. The objective of this study is to investigate if there is any significant difference in pain reduction and functional recovery when treated with a combination of gleno-humeral IACI and SSNB compared to a gleno-humeral IACI paired with a placebo SSNB.
METHODS: A two-arm, single-centre, randomized, parallel-group controlled trial will be conducted. Eligible patients will be randomly assigned (1:1 allocation) to long-acting SSNB + IACI and placebo SSNB + IACI. The primary endpoint is the mean change from baseline to 3 months in the Shoulder Pain and Disability Index (SPADI) score. Secondary outcomes will evaluate quality of life, functionality, pain (measured by a Numeric Pain Rating Scale), kinesiophobia, work status, health care service, and a safety assessment. The main paper will be based on the repeated measures collected up to 12 months from baseline.
DISCUSSION: The aim of this study is to determine the additional effect on pain relief and functional improvement in frozen shoulder patients when a long-acting SSNB is administered, compared to a placebo SSNB, in combination with an intra-articular corticosteroid injection. Additionally, we will aim to determine which patients benefit most from these treatments. This study could lead to a change in the standard of care for patients in the painful phase of frozen shoulder.
TRIAL REGISTRATION: ClinicalTrials.gov NCT06229964. Registered on 9 January 2024.

Keywords:  Adhesive capsulitis of the shoulder; Bursitis; Frozen shoulder; Intra-articular corticosteroid injection; Joint Diseases; Musculoskeletal diseases; Randomized controlled trial; Suprascapular nerve block,; Ultra-sound guided injection

DOI:  https://doi.org/10.1186/s13063-025-09123-y
JACC Heart Fail. 2025 Sep 29. pii: S2213-1779(25)00597-9. [Epub ahead of print]13(11): 102669

Closing the Gap, A Commentary on Sex Differences in Efficacy of Multidomain Rehabilitation Among Older Adults With Acute Heart Failure: The REHAB-HF Trial.

Ileana L Piña, Virginia L Gonzalez, Daniel D Moylan.



Keywords:  acute heart failure; cardiac rehabilitation; multidomain rehabilitation; sex differences

DOI:  https://doi.org/10.1016/j.jchf.2025.102669
Chiropr Man Therap. 2025 Sep 29. 33(1): 40

A systematic review on the associations between low back pain and frailty in community-dwelling older adults.

Munkh-Erdene Bayartai, Sum Yi Lam, Kei Yan Chan, Wai Ying Lau, Suet Ying Lee, Chun Yin Yip, Jeremy R Chang, Edmond C M Wong, Manuela L Ferreira, Arnold Y L Wong.

   BACKGROUND: Frailty and low back pain (LBP) may negatively affect each other in older adults, yet no systematic review has summarized their cross-sectional, temporal, or causal associations. Exploring these associations could provide valuable insights for reducing frailty risk in older adults with LBP. This systematic review aimed to consolidate evidence on the association between frailty and LBP in older adults.
METHODS: Four databases (EMBASE, CINHAL, MEDLINE, and SPORTDiscus) were systematically searched from their inception until July 31, 2024. Studies investigating the association between LBP, regardless of chronicity, or LBP-related disability and frailty in older adults were included. LBP was defined as pain occurring between the 12th ribs and inferior gluteal folds. Due to the lack of consensus on the definitions of older adults or frailty, studies were included based on the authors' definitions. Three pairs of independent reviewers screened abstracts and full texts, extracted data, assessed risk of bias, and determined the certainty of evidence.
RESULTS: Out of 1,690 articles identified, six cross-sectional studies and one prospective study were included. Low-certainty evidence from four cross-sectional studies suggested that both acute and chronic LBP, with odds ratios from 1.34 to 7.50, separately showed significant correlation with frailty. Pre-frail or frail older adults reported higher chronic LBP intensity, scoring 0.5 to 0.8 points more on the numeric rating scale, and greater LBP-related disability, with scores 1.7 to 7.2 points higher on the Roland Morris Disability Questionnaire, compared to non-frail counterparts. However, there was low-certainty evidence that acute LBP intensity was unrelated to frailty. Very low-certainty evidence from the prospective study indicated that higher acute LBP intensity and disability were associated with transitioning from non-frail to prefrail or frail status.
CONCLUSIONS: Our systematic review revealed that older adults with higher LBP intensity or associated disability were more likely to have prefrail or frail status, albeit with low-certainty evidence. However, the findings are limited by the small number of studies, especially prospective research. Future high-quality research should clarify the causation between LBP intensity or disability and frailty in community-dwelling older adults. Research should also explore potential mediators or moderators influencing the LBP-frailty association. These findings could help develop effective prevention and rehabilitation strategies to mitigate the impacts of LBP on frailty, or vice versa.

Keywords:  Aging; Correlation; Frailty; Low back pain; Older adults; Systematic review

DOI:  https://doi.org/10.1186/s12998-025-00601-3
J Pain Res. 2025 ;18 4989-4998

Acupuncture in Knee Osteoarthritis: A Narrative Review of Clinical Efficacy and Neuroimmune-Endocrine Mechanisms.

Junru Jiao, Baoqiang Dong, Yiyan Han, Qu Zheng, Xingxing Lin.

   Purpose: Knee osteoarthritis (KOA) is a leading cause of global pain and disability and warrants complementary therapy. This review provides evidence of the clinical efficacy of acupuncture and the multisystem regulatory mechanisms of KOA.
Methods: We analyzed clinical trials and mechanistic studies of acupuncture in the treatment of KOA.
Results: Acupuncture-particularly electroacupuncture (EA) significantly reduced pain (VAS/WOMAC) compared with sham acupuncture and conventional care (P < 0.05). Clinical trials demonstrate that combining acupuncture with exercise significantly enhances functional outcomes. Mechanistically, acupuncture modulates neuroendocrine pathways through three key actions: (1) suppressing pro-inflammatory cytokines (eg, TNF-α, IL-1β); (2) activating the Melatonin/cAMP/PKA/CREB signaling cascade; (3) altering functional connectivity in central pain-processing regions. Controversies persist regarding the mechanisms, optimal techniques, and outcome standardization.
Conclusion: Acupuncture is an effective complementary therapy for KOA. Future research should prioritize long-term efficacy, personalized protocols, technology integration, and multidisciplinary strategies.

Keywords:  acupuncture; electroacupuncture; knee osteoarthritis; mechanisms; neuroimmune modulation; pain management

DOI:  https://doi.org/10.2147/JPR.S546687
Lasers Med Sci. 2025 Oct 03. 40(1): 404

Comparison of the efficacy of radial and focused extracorporeal shock-wave therapy (ESWT) in myofascial pain syndrome: a randomized, sham-controlled study.

Hüma Bölük Şenlikci, Özlem Yücealp, Pınar Borman, Zeynep Ince Keskin, Sevgi Gümüş Atalay, Evren Yaşar.

  Myofascial pain syndrome (MPS) is one of the most common pain syndromes characterized by painful trigger points. Active trigger points may cause spontaneous pain, reduce quality of life, and result in workforce loss. Extracorporeal shock-wave therapy (ESWT), using radial or focused acoustic waves created outside the body, is a treatment method used for musculoskeletal problems. In Focused ESWT (F-ESWT), the depth of the body part to be targeted can be adjusted. Penetration into the tissue is better than radial waves. Radial ESWT (R-ESWT) has a more superficial effect, and its spread in liquids with a density similar to tissues is half that of focused ESWT. Previous studies have shown that radial and focused ESWT waves applied to trigger points in the upper trapezius fibres reduce reflected and local pain in myofascial pain syndrome. The aim of this study was to compare the effectiveness of radial and focused ESWT types on trigger points in upper trapezius fibres in patients with myofascial pain syndrome. This prospective, randomized, sham-controlled study included 57 patients, randomly assigned to one of 3 groups. The patients underwent R-ESWT, F-ESWT and sham protocols for 4 sessions. Evaluations were made with a Visual Analog Scale (VAS) to assess pain, the Health Assessment Questionnaire (HAQ), and the Beck Depression Inventory (BDI) before treatment, post-treatment, then at 1, 3 and 6 months after completion of the treatment. Symptom duration was the only parameter that was significantly different between the groups before the treatment (p = 0.025). VAS scores improved after treatment compared to baseline for all groups (p < 0.05), with improvements continuing in the ESWT groups. The BDI and HAQ scores did not differ between the groups, and the F-ESWT group showed a significant improvement in BDI and HAQ (p < 0.01, p = 0.018, respectively). The VAS scores of the ESWT groups were similar and significantly higher than those of the sham group, but mid-long term changes did not differ across the groups (p = 0.065). In patients diagnosed with myofascial pain syndrome who underwent R-ESWT, F-ESWT and sham therapy on active trigger points in the upper trapezius fibres, an improvement in pain was observed in the R and F-ESWT groups even in the long term. While the improvement in pain scores was the same for the radial and focused types at all time points, the improvement in both was significantly higher compared to the sham application.

Keywords:  Pain; Pain management; Trapezius muscle; Trigger points

DOI:  https://doi.org/10.1007/s10103-025-04676-5
Ann Geriatr Med Res. 2025 Sep;29(3): 305-313

Postural Control Measures in Randomized Controlled Trials for Older Adults Balance: A Systematic Scoping Review.

Romain Pichon, Jeremy Enez, Kathryn M Sibley, Benjamin Landre, Karim Jamal.

  The aim of this work was to identify and characterize the measures employed for assessing postural control in randomized controlled trials (RCTs) of balance interventions in older adults with the reference to the Systems Framework for Postural Control. A scoping review was conducted, and RCTs of balance interventions in older adults published from 2013 to March 2023 were considered for inclusion. Two hundred and seventy-one studies were included with a total of 49 different measures used; the Timed Up and Go test being the most commonly employed. The median number of components of postural control assessed per study was five. The most frequently assessed components were motor systems and static stability, while reactive postural control, cognitive influences and verticality were the least frequently assessed. Postural control in RCTs of balance in older adults was assessed using a wide range of measures, but also from the perspective of a limited number of components.

Keywords:  Aged; Health care outcome assessment; Postural balance

DOI:  https://doi.org/10.4235/agmr.25.0019
JAMA. 2025 Oct 03.

Acupuncture Provides Lasting Relief for Older Adults With Low Back Pain.

Samantha Anderer.

DOI: https://doi.org/10.1001/jama.2025.17487
J Appl Gerontol. 2025 Sep 29. 7334648251381401

Can Meaningful Activity Mediate the Relationship Between Social Support and Cognitive Health Among Community-Dwelling Older Adults?

Eunyoung Lee, Jaclyn M Williams.

  As the population continues to age, cognitive health becomes increasingly vital. Although social support and meaningful activities impact cognitive and psychological outcomes, how these factors are interrelated remains unclear. Using cross-sectional data from the Well Elderly II study (n = 460), this study examined (1) the effects of social support on cognitive health (measured by the Digit Symbol Substitution Test) and (2) whether engagement in meaningful activities mediates the relationship among community-dwelling older adults. After controlling for socio-demographic variables, researchers found a positive association between social support and cognitive health (β = .08, p < .05), with engagement in meaningful activities mediating this relationship (B = .57, SE = .12; 95% CI [.35, .83]). Findings suggest that practitioners should consider strategies that aid older adults in engaging in personally meaningful activities and help them find greater meaning in their existing routines, thereby strengthening the cognitive benefits of social support.

Keywords:  cognitive health; meaningful activity; older adults; social support

DOI:  https://doi.org/10.1177/07334648251381401
Anaesth Crit Care Pain Med. 2025 Sep 26. pii: S2352-5568(25)00155-9. [Epub ahead of print] 101623

Prevalence of perioperative functional disability using WHODAS 2.0 and associated adverse outcomes in surgical populations: A systematic review and meta-analysis.

Priyanjli Sharma, Ellene Yan, Andy Cui, Rihana Kukkadi, Emily Au, Marina Englesakis, Frances Chung.

   BACKGROUND: Functional disability affects a significant proportion of surgical patients. The World Health Organization Disability Assessment Schedule (WHODAS) version 2.0 is a validated measure of functional disability in surgical populations. This systematic review and meta-analysis uses the WHODAS to investigate the pooled prevalence of perioperative functional disability and its associated adverse postoperative outcomes.
METHODS: A comprehensive literature search was conducted across multiple databases for studies published between January 2010 and July 13, 2024. The primary outcome was the prevalence of functional disability at perioperative time points among adult surgical patients. Functional disability was defined using the following WHODAS thresholds: ≥16% exceeded patient-acceptable levels, while ≥25% and ≥35% indicated clinically significant disability.
RESULTS: Twenty studies (9,797 participants, mean age 70 ± 12 years, 38% female) were included in qualitative synthesis, with 14 included in meta-analysis. Pooled prevalence of preoperative functional disability exceeding patient-acceptable levels (WHODAS ≥ 16%) was 32% (95% CI: 23%, 42%). For clinically significant disability, preoperative prevalence was 34% (95% CI: 24%, 45%) using WHODAS ≥ 25% and 21% (95% CI: 11%, 35%) using WHODAS ≥ 35%. Postoperative prevalence of clinically significant disability (WHODAS ≥ 25%) decreased to 14% (95% CI: 8%, 23%) at 6 months and 15% (95% CI: 14%, 17%) at 12 months. Preoperative functional disability was associated with postoperative delirium, longer length of stay, non-home discharge, and greater postoperative pain.
CONCLUSION: Functional disability is prevalent in surgical patients and associated with adverse outcomes. Identifying functional disability perioperatively assists in making informed decisions to optimize functionality and improve surgical outcomes.
REGISTRATION: PROSPERO database under ID CRD42024574108 (https://www.crd.york.ac.uk/PROSPERO/view/CRD42024574108).

Keywords:  WHODAS 2.0; adverse outcomes; and meta-analysis; functional disability; patient-reported outcome measures (PROMs); surgery; systematic review

DOI:  https://doi.org/10.1016/j.accpm.2025.101623
Inflammopharmacology. 2025 Sep 30.

Role of dexmedetomidine in brain injury: a systematic review.

Rania Zekry, Rehab H Werida, Ehab S Hegazy, Tarek M Mostafa.

   BACKGROUND: Brain injuries are major health concern worldwide, that have debilitating effects on patients and affect patients' quality of life; therefore, we are in urgent need of identifying medications that have neuroprotective properties and help to maintain the patients' cognitive function. Dexmedetomidine is a sedative medication commonly used in ICU situations; recent studies show that it may have neuroprotective properties via different mechanisms.
AIM: The aim of this article is to review available literature regarding the impact of using dexmedetomidine in various types of brain injury.
METHOD: A systematic review of the published papers on the PubMed and google scholar that investigated the effects of dexmedetomidine on patients with different brain injuries was employed.
RESULTS: A total of 17 papers were included in this review, of which 1 was a case report, 6 were animal studies, 1 was a retrospective descriptive study, 2 were retrospective cohorts, 5 were randomized controlled trials, 1 was a scoping review, and 1 was a meta-analysis. These papers demonstrated the effects of dexmedetomidine on patients with traumatic brain injury, intracerebral hemorrhage, ischemic brain injury, status epilepticus, and on patients undergoing craniocerebral surgeries.
CONCLUSION: Dexmedetomidine is a very promising drug to be used in different types of brain injuries and in craniocerebral surgeries because it has demonstrated impressive neuroprotective properties by a variety of mechanisms.

Keywords:  Brain injury; Dexmedetomidine; Neuroprotection Anti-inflammatory

DOI:  https://doi.org/10.1007/s10787-025-01946-0
BMC Public Health. 2025 Oct 03. 25(1): 3315

Barriers and facilitators to physical activity in rural communities: using the Behaviour Change Wheel to identify intervention functions.

Chelsea Pelletier, Kirsten Ward, Cameron Aird, Mary Jung, Gloria Fox, Anne Pousette, Guy Faulkner.

   BACKGROUND: People living in rural communities face increased barriers and fewer opportunities for regular participation in physical activity compared to those living in urban centers. This project aimed to map barriers and facilitators of physical activity in rural communities to the Theoretical Domains Framework and Behaviour Change Wheel to identify intervention functions.
METHODS: We conducted individual semi-structured interviews with participants from rural communities in two sparsely populated regions in British Columbia, Canada. Interview questions were framed using the Theoretical Domains Framework and focused on beliefs and lived experiences of physical activity. Deductive analysis involved identifying barriers and facilitators to physical activity and mapping them to the Theoretical Domains Framework and capability, opportunity, and motivation (COM-B) of the Behaviour Change Wheel. Barriers and facilitators were used to identify potential intervention functions and policy levers to change physical activity behaviour in rural communities.
RESULTS: Participants included 46 individuals aged 22 to 77 years (36 women) living in rural communities (population size < 100-13,000 people). Barriers and facilitators to physical activity were predominant in the domains of Social Influences, Environmental Context and Resources, and Beliefs About Consequences. Specific barriers and facilitators were identified related to the availability of friends or family with whom to be physically active; weather-related factors; programming and infrastructure for physical activity; knowledge of local opportunities; and beliefs about healthy aging and fear of injuries. Based on mapping barriers and facilitators to the Behaviour Change Wheel, physical activity intervention strategies for rural communities should focus on environmental restructuring, modelling, and enablement.
CONCLUSION: To improve physical activity in rural communities, interventions at municipal and provincial levels should focus on addressing barriers, such as infrastructure and policy supportive of physical activity, and leveraging existing facilitators, such as access to outdoor physical activity opportunities.
CLINICAL TRIAL NUMBER: not applicable.

Keywords:  Behaviour change wheel; Exercise; Physical activity behaviour; Recreation; Rural health; Small town; Theoretical domains framework

DOI:  https://doi.org/10.1186/s12889-025-24672-2
BMC Cardiovasc Disord. 2025 Sep 29. 25(1): 688

Factors influencing cardiovascular patients to complete phase II cardiac rehabilitation - a qualitative study.

Zhehao Zhang, Yiwei Liu, Zhan Gao, Yan Weng, Songhuan Jiang, Wanqi Yu, Yan Zhang, Lei Zhuang, Jing Tang, Xuechen Hu.

   BACKGROUND: Cardiac rehabilitation (CR) is essential for improving health outcomes and quality of life in patients with cardiovascular disease. Despite its proven effectiveness, global adherence to CR remains low, particularly in China. This qualitative study aimed to explore the factors influencing sustained participation in Phase II CR among cardiovascular patients, including both motivators and barriers, with the aim of providing insights to enhance program design and patient engagement.
METHODS: This qualitative, phenomenological study explored the feelings and experiences of 18 cardiovascular patients who completed at least 25 outpatient CR sessions at three tertiary hospitals in Shanghai. Participants were recruited through purposive sampling. Data were collected through face-to-face, semi-structured interviews conducted from July 2024 to February 2025. Transcripts were analyzed using Colaizzi's method, supported by NVivo 15 software.
RESULTS: Analysis revealed five primary themes encompassing 13 sub-themes: (1) Strong health belief, including desire for health recovery and belief in the value of CR; (2) Perceived benefits of CR, comprising improvements in physical endurance, psychological and emotional well-being, and health behavior changes; (3) Social support, from family, peers, and healthcare professionals; (4) Barriers to participation, involving financial costs, time and logistical constraints, and psychological concerns; (5) Opportunities for improvement in CR programs, highlighting the need for better accessibility, increased insurance reimbursement, and diversified and flexible program formats.
CONCLUSION: Sustained participation in Phase II CR was largely influenced by personal motivations driven by strong health beliefs and reinforced by perceived health benefits and robust social support. Addressing identified barriers-particularly financial constraints and limited accessibility-through targeted strategies like enhancing insurance coverage, raising awareness, and providing flexible, diversified CR formats is imperative. Such improvements could significantly increase adherence rates and optimize cardiovascular health outcomes during and immediately following Phase II CR.
CLINICAL TRIAL NUMBER: not applicable.

Keywords:  Adherence; Cardiac rehabilitation; Determinants; Psychological barriers; Qualitative study; Social support

DOI:  https://doi.org/10.1186/s12872-025-05174-w
PM R. 2025 Oct 01.

Ultrasonographic evaluation of ulnar innervated muscles in ulnar neuropathy at the elbow.

Emmanuel Ogalo, Lee Bauer, Christopher Doherty, Sean G Bristol, Kristine M Chapman, Bc Neuromuscular Disease Group, Emily Krauss, Michael J Berger.

BACKGROUND: Quantitative muscle ultrasound (qMUS) provides morphological measurements that can support clinical observation of muscle atrophy and weakness. As the use of qMUS continues to expand, and its potential for broader implementation in neuromuscular evaluation grows, there is a clear need for further validation, particularly in pathologies frequently encountered in electrodiagnostic laboratories, such as cubital tunnel syndrome caused by ulnar neuropathy at the elbow (UNE).
OBJECTIVE: To evaluate the validity of qMUS evaluation of ulnar-innervated intrinsic hand muscles.
DESIGN: Cross-sectional study.
PARTICIPANTS: Individuals 18 years or older with chronic UNE and healthy controls (HC).
MAIN OUTCOME MEASUREMENT: qMUS parameters (muscle thickness [MT], cross-sectional area [CSA], echogenicity) were measured in the first dorsal interosseous (FDI) and abductor digiti minimi (ADM) and were correlated to corresponding negative peak amplitude of the compound muscle action potential measured (CMAP) and key pinch grip strength.
RESULTS: Sixteen adults (8 HC, 8 UNE) participated in the study. Key pinch strength was significantly correlated with FDI MT (r = 0.45, p = .03 [95% CI, 0.05-0.73]) and echogenicity (rho = -0.60, p = .002 [95% CI, -0.82 to -0.24]). FDI MT and echogenicity explained 20% and 36% of pinch strength variance, respectively. Echogenicity was significantly correlated with corresponding CMAP amplitudes (FDI: rho = -0.59, p = .004 [95% CI, -0.81 to -0.21]; ADM: rho = -0.62, p = .002 [95% CI, -0.83 to -0.26]). No statistically significant relationship was found between key pinch strength and FDI CSA (r = 0.35 p = .104 [95% CI, -0.08-0.67]). Furthermore, FDI CMAP was not significantly associated with FDI MT (rho = 0.14, p = .55 [95% CI, -0.32-0.54]) or FDI CSA (rho = 0.041, p = .86 [95% CI, 0.04-0.47]).
CONCLUSION: qMUS measures of echogenicity and MT (indicators of muscle fibrosis and size, respectively), correlated with key pinch strength and CMAP amplitudes in the FDI and ADM, in a heterogenous group including UNE and HC limbs. qMUS parameters may provide useful complementary markers and deeper insight into neuromuscular health in entrapment neuropathy.

DOI: https://doi.org/10.1002/pmrj.70020
J Spinal Cord Med. 2025 Oct 01. 1-10

Rehabilitation goals for hand and upper extremity function after cervical spinal cord injury: A retrospective study.

Tamara Selman, Rachel Holland, Julia M Harrison, Ben Keefe, Edman Abukar, Sonja McVeigh, Alexander Whelan, Emily M Krauss.

   CONTEXT: Patient goals are critical when determining surgical options for restoration of hand function in spinal cord injury (SCI).
OBJECTIVE: We characterized the discussion of goals specific to hand function during acute rehabilitation admission at a single Canadian center following cervical SCI, before the introduction of a hand surgery program for the tetraplegia population.
METHODS: A retrospective chart review of a single-center adult rehabilitation hospital from 2012 to 2022 of traumatic cervical SCI admissions was conducted. Charts were reviewed for discussion of specific goals that require hand function and recorded for analysis. Hand function goals were categorized and mapped to Canadian Occupational Performance Measures (COPM) domains, and patterns were analyzed on a population level.
RESULTS: Over ten years, 134 individuals with acute traumatic SCI were admitted, 88 met study inclusion criteria with documented goals requiring hand function, and 32 unique goal types were recorded. The most common goal domain across all AIS categories was functional mobility. Motor complete patients primarily had self-care goals. Leisure and productivity goals were overall rarely captured. Most documented goals focused on basic activities of daily living (ADLs).
CONCLUSIONS: We observed a historical emphasis on hand function goals of ADLs, but not capturing the depth and breadth of other domains where hand function is essential. With the development of hand surgery programs in the tetraplegia population, standardized tools and detailed discussion of hand function goals may better capture patient priorities, including productivity and leisure, and improve our discussion of functional outcomes when evaluating the success of surgery.

Keywords:  Cervical spinal cord injury; Functional recovery; Hand function; Patient goals; Upper limb reanimation

DOI:  https://doi.org/10.1080/10790268.2025.2557080
Scand J Caring Sci. 2025 Dec;39(4): e70127

Exploring the Ethical Dimensions of Care Dependency in Older People: A Transpersonal View.

Ana-María Porcel-Gálvez, Enrique-Octavio Iñiguez-Castro, Gloria Martínez-Lacovic, Regina Allande-Cussó.

   INTRODUCTION: Care dependency in older adults is a growing global concern, driven by population ageing and the increasing prevalence of chronic conditions. Beyond its clinical implications, care dependency involves ethical, cultural, and transpersonal dimensions that shape the lived experiences of individuals and caregivers. This study aims to refine the concept of care dependency through an explicitly transpersonal and culturally sensitive lens, informing practice, education, and policy.
METHODS: Following Walker and Avant's concept analysis framework, a systematic review of the literature was conducted. Key attributes, antecedents, and consequences were identified through an iterative process of data synthesis and theoretical reflection, including the development of model, borderline, and contrary cases to explicitly illustrate conceptual application.
RESULTS: The analysis identified four defining attributes: loss of autonomy; erosion of identity and self-image; biographical rupture; and negative coping. Antecedents include physiological ageing, chronic degenerative disease, cognitive decline, and psychosocial/cultural factors that constrain autonomy. Consequences extend beyond functional limitations, affecting emotional well-being and generating ethical and context-specific decisions. The cases demonstrate a continuum from full dependency to complete autonomy and make visible how context and culture shape these attributes.
CONCLUSIONS: Care dependency emerges as a multidimensional, ethically situated phenomenon, shaped by relationships, culture, and context. The proposed conceptual framework offers practical guidance for applying a transpersonal approach, prioritizing mutual presence, active listening, cultural attunement, and shared decision-making to preserve dignity, meaning, and connection in daily care. Future research should explore the framework's applicability through qualitative studies in diverse settings to translate it into actionable, ethically grounded tools and interventions.

Keywords:  care dependency; concept analysis; ethics; older adults; transpersonal nursing

DOI:  https://doi.org/10.1111/scs.70127
BMC Sports Sci Med Rehabil. 2025 Oct 02. 17(1): 288

Exploring the experiences and rehabilitation needs of patients with coronary artery diseases: an effort to design a contextual home-based cardiac rehabilitation through a qualitative enquiry.

Adnan Yaqoob, Laila Ladak, Aamir Hameed Khan, Asif Hanif, Wajeeha Sahar, Furqan Yaqub Pannu, Rubina Barolia.

   BACKGROUND: Cardiovascular diseases (CVDs) continue to be a major global public health concern, accounting for a considerable portion of the burden of morbidity and mortality. The CAD in Pakistan imposes a substantial economic and social burden on individuals, families, and the healthcare system. Despite advances in medical interventions and therapies, comprehensive cardiac rehabilitation programs in Pakistan remain underdeveloped and inaccessible to many patients, particularly those residing in rural or underserved areas.
AIM: This study aims to explore the experiences and rehabilitation needs of Pakistani patients with heart disease in helping to design contextual home-based cardiac rehabilitation.
METHODS: Based on the data saturation, 20 individuals were interviewed using a qualitative descriptive exploratory approach. Semi-structured, in-depth interviews that lasted 40 to 50 min were used to gather the data. Thematic analysis was performed using an inductive coding approach.
RESULTS: Five major themes with 24 subthemes emerged from the data: (1) Understanding of Heart Disease which revealed limited awareness and prevalent misconceptions; (2) Cardiac Anxiety which showed emotional distress, fear of recurrence, and financial concerns; (3) Challenges Faced by Patients which included difficulties with follow-up, family resistance to physical activity, dietary modifications, medication adherence, and gendered recovery experiences; (4) Difficulties for Behaviour Change which showed ongoing unhealthy habits and skepticism toward lifestyle modification; and (5) Patient Readiness for Home-Based Cardiac Rehabilitation which reflected openness to behavior change, preference for telephonic guidance, and the need for culturally tailored support and family involvement.
CONCLUSION: The study highlights significant gaps in awareness, emotional and behavioral challenges, and sociocultural barriers influencing recovery after myocardial infarction. Participants expressed readiness for a flexible, family-inclusive, and home-based cardiac rehabilitation model. These insights provide essential direction for developing a culturally sensitive and contextually appropriate cardiac rehabilitation program in Pakistan.

Keywords:  Cardiac patients' needs; Cardiac rehabilitation needs; Challenges faced by CAD patients; Home-based cardiac rehabilitation; Patients’ understanding of CAD

DOI:  https://doi.org/10.1186/s13102-025-01288-y
Gerontol Geriatr Educ. 2025 Sep 30. 1-19

Increasing self-efficacy and meeting the physical activity needs of community older adults through a community-based learning project.

Michael J Landram, Debra L Fetherman.

  Community-based learning (CBL) best serves students and community members when organizers reflect on the needs, concerns, and intentions of society. Worldwide, an area of focus within communities is their rapid expansion of older adults (OA) and a general increased population age. Within the U.S. it is estimated that a quarter of the population will be 65 or older by 2060. This concern is mirrored in the goals of government and professional organizations. For instance, some goals of Healthy People 2030 are to reduce the risk of diabetes, osteoporosis and fall-related injuries in OA. Increasing physical activity (PA) among OA is a key strategy to prevent chronic disease, sudden fall injuries and improve quality of life. A central learning outcome of health science and exercise science (HES) undergraduate curricula is teaching students how to help individuals combat sedentary lifestyles by increasing their PA. CBL is recognized as a pedagogical method for students to engage with the community and practice hands-on learning. This article describes how a 10-year CBL partnership between HES faculty and a community organization serving OA was developed for an undergraduate HES program and evolved to support curricular and community needs.

Keywords:  Self-efficacy; community-based learning; health and exercise science; older adult; service-learning

DOI:  https://doi.org/10.1080/02701960.2025.2568610
Eur Neurol. 2025 Oct 03. 1

A Systematic Review of Management of Cramping Pain in Patients with Amyotrophic Lateral Sclerosis.

Hannah Katherine Hall, Elizabeth Austin, Karen Hutchinson, Colleen Cheek, Robyn Clay-Williams.

BACKGROUND/INTRODUCTION: Pain, particularly cramping, in people living with Amyotrophic Lateral Sclerosis (ALS) is often underrecognized and under-treated. Despite affecting over 70% of people living with ALS (plwALS), cramping pain remains inadequately managed due to its complex nature and the difficulties plwALS face in communicating their symptoms as the disease progresses. This systematic review explores both pharmacological and non-pharmacological treatments for cramping pain in ALS, aiming to assess and compare their efficacy.
METHODS: The systematic review was conducted following PRISMA guidelines and the protocol was registered with PROSPERO (ID CRD42024521649). A comprehensive search was performed across MEDLINE, Embase, Scopus, and Cochrane databases from inception until February 1, 2024, using specific search terms related to ALS and cramping.
RESULTS: The search resulted in the identification of 368 studies. After duplicates were removed, abstracts screened, and full texts reviewed, nine studies were included. Pharmacological interventions such as Mexiletine demonstrated significant reductions in cramp frequency and intensity in several trials, with varying doses showing distinct levels of effectiveness. Other medications like Dronabinol and Levetiracetam were also tested but showed limited efficacy in reducing cramp severity. Among non-pharmacological options, supervised exercise programs, particularly those incorporating stretching and functional mobility, were effective in reducing cramping pain intensity, while unsupervised home exercise programs did not show significant improvements.
CONCLUSION: The review demonstrates the scarcity of high-quality research on cramping pain management in ALS. Mexiletine emerged as the most promising pharmacological intervention, providing notable relief, while supervised exercise therapy demonstrated beneficial effects.

DOI: https://doi.org/10.1159/000548820
Disabil Rehabil. 2025 Sep 30. 1-12

Development of physical activity recommendations for adults living with lower limb amputation.

Frédérique Dupuis, Kathleen A Martin Ginis, Crystal MacKay, Krista L Best, Virginie Blanchette, Maxime T Robert, William C Miller, Cameron Gee, Natalie Habra, Kirsten Woodend, Magali Brousseau-Foley, Diana Zidarov.

   PURPOSE: To develop evidence-based physical activity recommendations for people living with lower-limb amputation (LLA).
METHODS: The Appraisal of Guideline, Research and Evaluation protocol (AGREE) II tool was used. A panel of clinicians and researchers with expertise in LLA and guideline development, people with LLA, and a nonprofit advocacy organization for people with LLA was formed. The expert panel then met to refine the scope of the guidelines, review the evidence (based on a systematic review), and formulate the guidelines. Feedback was obtained from partners.
RESULTS: For benefits in balance and mobility outcomes, adults with a unilateral major LLA of any etiology, living in the community and using a prosthesis, should perform at least 60 min per week of moderate to vigorous aerobic exercise. This aerobic exercise prescription should be combined with strengthening or balance exercises. Strengthening exercises should include at least 3 sets of 10 repetitions of strengthening exercises for the major muscle groups of the lower limbs at least 2 times per week. Balance exercises should include at least 20 min of balance exercises 3 times per week. There was insufficient evidence to make recommendations for other fitness-related outcomes.
CONCLUSION: The AGREE II process led to the development of the first physical activity recommendations for people living with LLA.

Keywords:  balance; exercise; guideline; lower limb amputation; mobility; physical activity

DOI:  https://doi.org/10.1080/09638288.2025.2563015
BMC Health Serv Res. 2025 Oct 02. 25(1): 1290

Prevalence and characteristics of medical and rehabilitation utilization among Canadians with arthritis from 2001 to 2018: a cross-sectional population-based study.

Sheilah Hogg-Johnson, Dan Wang, Jessica J Wong, Silvano A Mior, Pierre Côté.



Keywords:  Arthritis; Health care utilization; Population-based study; Prevalence

DOI:  https://doi.org/10.1186/s12913-025-13471-5
Continuum (Minneap Minn). 2025 Oct;31(5): 1372-1384

Inclusion Body Myositis.

Elie Naddaf.

OBJECTIVE: This article addresses the clinical presentation, diagnostic workup, and management of patients with inclusion body myositis (IBM). It also provides an overview of the clinical trial landscape and explores future directions in the pursuit of an effective treatment for the disease.
LATEST DEVELOPMENTS: Muscle biopsy remains the cornerstone of the diagnosis, and cytosolic nucleotidase 1A antibodies and muscle imaging have been increasingly used to support the diagnosis. The 2024 European Neuromuscular Centre diagnostic criteria offer a new diagnostic framework that integrates these developments. The clinical trial landscape for IBM remains limited, and the complex nature of the underlying pathophysiology of IBM and other diseases of aging presents a significant challenge for the development of effective treatments.
ESSENTIAL POINTS: IBM is a disease of aging that is more prevalent in males. It is characterized by slowly progressive weakness, predominantly affecting deep finger flexors and quadriceps muscles, with a predilection for swallowing and respiratory muscles. However, this clinical phenotype is not specific to IBM, as other inherited and acquired myopathies may present similarly. Furthermore, atypical presentations of IBM occur and may manifest with a wide range of weakness patterns, most commonly with isolated dysphagia. The diagnosis of IBM requires the integration of historical, clinical, and laboratory data. Management consists of a multidisciplinary approach to address comorbidities and potential complications. Untangling the complexity of aging-related disorders will help advance the field in IBM and facilitate the discovery of effective treatments.

DOI: https://doi.org/10.1212/cont.0000000000001616
Front Sports Act Living. 2025 ;7 1607167

Physical activity, sports participation, and sustainable development in the Ibero-American region: a pilot implementation of indicators in Chile, Costa Rica, and Ecuador.

Robert Bauer, Raúl Sánchez-García, Daniela Hernández, Domingo F Hernández-Angeles, Silvia González, Inés Nieto, Xián Mayo, Alfonso Jiménez.

   Background: In recognition of the potential contributions of sports and physical activity to national development and responding to international calls from organizations like UNESCO and the World Health Organization, a coalition of agencies and Ibero-American sports ministers endorsed the creation of an indicator set to assess the impact of sports participation and physical activity on sustainable development.
Methods: The Ibero-American Sports Council, UNESCO, and the German Agency for International Cooperation developed a set of twelve Sports and Development indicators and four key data points for the Ibero-American region. In 2024, the first national-level pilot implementation was completed in Chile, Costa Rica, and Ecuador, collecting data using specifically designed formulae.
Results: Each country was able to partially provide relevant data for the defined indicators, with Chile completing eight, Costa Rica four, and Ecuador seven indicators. All countries provided data for the key data points.
Conclusions: The first national pilot implementation of the proposed indicators-as part of its validation process-highlights the need for improved quality and accessibility of reliable data across the Ibero-American region. These indicators have the potential to assess, track, and compare policies related to physical activity and sports, and to identify challenges and opportunities for improvement.

Keywords:  Ibero-American indicators model; United Nations 2030 Agenda; evaluation; framework; health; monitoring; policy coordination

DOI:  https://doi.org/10.3389/fspor.2025.1607167
J Psychiatr Res. 2025 Sep 26. pii: S0022-3956(25)00581-3. [Epub ahead of print]191 285-293

Irisin: Its significance in the diagnosis and treatment of post-stroke depression.

Chengyan Han, Ruixue Guan, Jianxing Zhao, Peng Sun.

  Irisin, a myokine secreted by muscles, has recently garnered extensive attention in the medical field. Irisin exhibits multiple biological functions, such as enhancing energy metabolism, regulating neurotransmitters, and providing neuroprotection via diverse signaling pathways. Over recent years, a growing body of research has been engaged in exploring the connection between irisin and post-stroke depression (PSD). Clinical trials have confirmed that irisin level in stroke patients generally shows a downward trend. Irisin's role in the relationship with PSD might be related to its regulation of neural plasticity, modulation of neuroinflammation, production of brain-derived neurotrophic factor (BDNF), regulation of neuroendocrine function and neurotransmitters, and maintenance of mitochondrial homeostasis. Furthermore, numerous studies have demonstrated that injecting recombinant irisin into animal models or elevating the irisin level through exercise may have a promising therapeutic effect on PSD. Nevertheless, there remains a lack of unified conclusions regarding the optimal injection dosage of irisin and the most effective exercise protocol, which urgently require further exploration. In summary, available evidence suggests that irisin may serve as a potential indicator for the early detection and treatment of PSD, providing new perspectives for future clinical applications and scientific research.

Keywords:  Irisin; Physical exercise; Post-stroke depression

DOI:  https://doi.org/10.1016/j.jpsychires.2025.09.058
Cureus. 2025 Sep;17(9): e91395

Understanding Cancer-Related Pain: Pathophysiology, Classification, and Treatment Modalities.

Jerish Murari, Ish Sharma, Siddharth Arjun Atwal, Aparna Sharma, Sukanta Bandyopadhyay, B Shalini, Manish Kumar.

  Cancer-related pain (CRP) is a complex, multidimensional challenge in oncology that undermines quality of life, psychological well-being, and treatment adherence. This narrative, mechanism-informed review synthesizes pathophysiology, classification systems, and multidisciplinary management strategies to provide clinical insights and research priorities. It connects nociceptive, neuropathic, and mixed pain mechanisms to practical interventions, emphasizing peripheral and central sensitization in chronicity. Major frameworks, including the WHO analgesic ladder, International Classification of Diseases, 11th Revision, Edmonton Classification System for Cancer Pain, and European Pain Federation standards, are appraised alongside assessment tools such as the Visual Analogue Scale, Brief Pain Inventory, and Hospital Anxiety and Depression Scale, with examples of their clinical application. Management is framed within a flexible, mechanism-based, multimodal model that integrates pharmacologic, adjuvant, interventional, and psychosocial approaches, delivered through coordinated, multidisciplinary teams. Evidence for complementary modalities, such as acupuncture and mindfulness-based stress reduction, remains preliminary and heterogeneous, requiring further high-quality trials, whereas opioid-based pharmacologic approaches and structured psychosocial interventions such as cognitive behavioral therapy are supported by more robust, established evidence. Similarly, innovations like AI-driven monitoring and pharmacogenomics hold promise but are still in the early validation phase, underscoring the need to distinguish between evolving and well-established domains of cancer pain management. The principal actionable priorities are to adopt mechanism-based classification, embed multidisciplinary collaboration, expand multimodal access in low-resource settings, and rigorously validate emerging pharmacogenomic and digital health innovations before widespread clinical integration.

Keywords:  artificial intelligence; cancer-related pain; mechanism-based treatment; precision oncology; translational pain research

DOI:  https://doi.org/10.7759/cureus.91395
Clin Rehabil. 2025 Oct 03. 2692155251381743

Health economic studies in clinical rehabilitation: A new collection of papers and a discussion of issues involved in research.

Derick T Wade.

  ObjectiveTo review challenges associated with health economic studies in rehabilitation, providing a context for the new Clinical Rehabilitation collection of papers concerned with health economics.RehabilitationAnalysis of the health economic effects associated with rehabilitation must recognise that rehabilitation consists of both a problem-solving process that facilitates the person's adaptation by providing information, advice, and sometimes specific interventions targeting multiple areas. Second, it operates within a complex, adaptive system, specifically the biopsychosocial model of illness. Third, its goals are to enhance well-being and quality of life through its effects on lower-level systems. Consequently, the effects of rehabilitation are unpredictable and typically manifest in several domains. Comprehensive single or multiple focused outcome measures are needed. As evidence-based selection of people who might benefit from rehabilitation is impossible, evaluative studies should have broad inclusion criteria.SystemsRehabilitation is a healthcare service. Traditionally, it is delivered in series, after the biomedical treatment has ended. This allows researchers, including health economists, to isolate the influence of rehabilitation. However, it will be more effectively delivered in parallel, with biomedical care from the outset, as happens, for example, in trauma and intensive care units. Evaluating individual components of healthcare in isolation is unnecessary. Rehabilitation will always involve non-healthcare services. Conversely, the effects of rehabilitation may significantly reduce non-healthcare costs. This close interrelationship necessitates a societal perspective on the economics of rehabilitation.ConclusionsUsing a combination of a global, comprehensive clinical outcome measure and societal-level health economic data will increase the likelihood of detecting effects.

Keywords:  Economic evaluation; health economics; rehabilitation process

DOI:  https://doi.org/10.1177/02692155251381743
Pain Res Manag. 2025 ;2025 7422265

Noncredible Complaints and Symptom Validity in Patients With Chronic Pain.

Jared G Smith, Linda Monaci, Martin D van den Broek.

  Introduction: The multifactorial nature of pain complicates assessment of the validity of presenting symptoms and behaviours in people with chronic pain. Recently, the Personal Problems Questionnaire (PPQ) was developed to assess genuine and noncredible cognitive, emotional and physical complaints. Here, the PPQ was used to investigate the extent to which patients with chronic pain report noncredible complaints and the relationship with pain severity and measures of cognitive performance validity and symptom over-reporting. Materials and Methods: Seventy-five participants with chronic pain recruited from outpatient and pain management programme clinics completed the clinical and validity scales of the PPQ, the short-form McGill Pain Questionnaire (SF-MPQ) subscales and the Medical Symptom Validity Test (MSVT), and a subsample (n = 27) completed the Personality Assessment Inventory (PAI). Results: Significant mean (T-score±SD) elevations were observed across the PPQ cognitive (64.5 ± 13.1), emotional (65.1 ± 13.2) and physical (77.4 ± 11.0) clinical domains. Endorsement of implausible complaints on the PPQ was common; 35.6% of patients endorsed noncredible pain/physical complaints, while 19.2% and 33.3%, respectively, reported implausible cognitive and emotional difficulties. Multivariate analyses indicated that the odds of likely noncredible responding significantly increased in cognitive (34%) and emotional domains (26%) and in the physical domain (12%) for every point increase on the SF-MPQ affective and sensory pain subscales, respectively. Noncredible symptom reporting was elevated in those receiving disability benefits/involved in litigation (n = 27), but not significantly after controlling for pain severity. Negative impression management on the PAI was associated with implausible cognitive and emotional symptom endorsement, but there was a limited relationship between PPQ validity scales and MSVT underperformance. Conclusion: The PPQ is a potentially useful tool in the assessment of chronic pain patients, with implausible symptom endorsement found in a significant proportion, although this may not reflect intentional exaggeration.

Keywords:  chronic pain; malingering; noncredible; over-reporting; personal problems questionnaire; symptom validity

DOI:  https://doi.org/10.1155/prm/7422265
Drugs Context. 2025 ;pii: 2025-3-4. [Epub ahead of print]14

10 years of real-world data: long-term efficacy and safety of HyalOne® for hip osteoarthritis.

Alberto Migliore, Nazzareno Iannarelli, Luca Saccone, Francesca Giovannangeli, Umberto Massafra, Orazio de Lucia, Annamaria Paglionico, Sergio Crimaldi, Eugenio Cunego, Raffaele Saporito, Gabriele Al Khayyat Suhel, Giovanni Boni.

   Background: Hip osteoarthritis (OA) is a leading cause of disability in older adults, yet long-term, non-surgical treatment options remain limited. Viscosupplementation with intra-articular hyaluronic acid has shown promise, but evidence for its sustained efficacy in hip OA is scarce. This study evaluates the 10-year efficacy and safety of repeated ultrasound (US)-guided injections of HyalOne®/Hyalubrix® 60 in patients with symptomatic hip OA.
Methods: A retrospective, observational, open-label study was conducted on 681 patients with symptomatic hip OA treated with HyalOne® between 2010 and 2013, with follow-up through 2023. Patients received one US-guided intra-articular injection every 6 months, with additional injections as needed. Pain and functional outcomes were assessed using the Visual Analogue Scale and the Lequesne Index. Non-steroidal anti-inflammatory drug (NSAID) consumption and adverse events were also monitored.
Results: Overall, 481 patients completed the 10-year follow-up. Pain reduction was observed across all age and body mass index groups, with the highest improvement in patients under 40 years old (-54.3%). Functional status improved significantly, with the greatest reduction in Lequesne Index scores observed in patients over 80 years old (-32.5%). NSAID use decreased by 84% in younger patients and by 62-71% in older patients or those with obesity. No major systemic adverse events were reported, and transient local reactions occurred in 4% of patients.
Conclusions: This study provides the first real-world evidence of the sustained efficacy and safety of a 10-year US-guided HyalOne® injection regimen in managing hip OA, highlighting significant improvements in pain, function and NSAID reduction across diverse patient populations.

Keywords:  hip; hyaluronic acid; osteoarthritis; viscosupplementation

DOI:  https://doi.org/10.7573/dic.2025-3-4
Am J Emerg Med. 2025 Sep 23. pii: S0735-6757(25)00650-3. [Epub ahead of print]99 123-128

The paravertebral fascial plane block: A novel, ultrasound-guided technique for paraspinal neck and back pain.

Umar A Aulia, Richard J Gawel, Jeffrey A Kramer, Michael Gottlieb, Michael Shalaby.

   INTRODUCTION: Paraspinal myofascial pain syndrome (MPS) is a common cause of emergency department (ED) visits, but existing therapies often provide incomplete or short-lived relief. Increasing evidence implicates the fascia as a key driver of the pain in MPS, supporting targeted interfascial interventions.
METHODS: We conducted a single-center retrospective observational cohort study of adult ED patients who received a novel, ultrasound-guided paravertebral fascial plane block (PFPB) between September 1, 2024 - August 31, 2025. Eligible patients presented with focal cervical, thoracic, or lumbar paraspinal pain consistent with MPS and had either inadequate response to ED analgesics or a history of refractory paraspinal MPS. The PFPB procedure consisted of two components: (1) injection of a combination of anesthetic, normal saline, and dexamethasone within the fascial planes between the paraspinal muscles, and (2) needling of the muscular fasciae. Numeric Rating Scale (NRS) pain scores were documented for clinical care purposes at pre-block baseline, ED discharge, and 24-48-h follow-up.
RESULTS: Eleven patients (median age 48 years, 64 % female) underwent the PFPB. Median NRS pain score decreased significantly from 9/10 (interquartile range [IQR] 8-9) pre-block to 3/10 (IQR 0-4) at discharge (n = 11, p = 0.004). At 24-48 h (n = 10), the median pain score was 1/10 (IQR 0-2.75), with 80 % reporting sustained or improved relief relative to discharge. No complications occurred, and none of the treated patients returned to any of our health system's EDs within 48 h following initial discharge.
CONCLUSIONS: The PFPB provided rapid and sustained pain reduction for ED patients with intractable paraspinal MPS. These preliminary findings support further prospective studies to validate the PFPB's efficacy and inform its implementation in emergency care.

Keywords:  Fascia-targeted needling; Hydrodissection; Interfascial injection; Myofascial pain; Ultrasound-guided nerve blocks

DOI:  https://doi.org/10.1016/j.ajem.2025.09.039
Curr Heart Fail Rep. 2025 Oct 03. 22(1): 26

Instruments to Measure Frailty in Patients with Heart Failure: a Narrative Review.

Cristiana Vitale, Ilaria Spoletini, Walter Gianni, Giuseppe Mc Rosano, Camilla Hage.

   PURPOSE OF REVIEW: Frailty is a common multidimensional syndrome in patients with heart failure (HF); it is associated with worse outcomes, including poor quality of life, disability, hospitalizations, and increased mortality. This narrative review critically summarizes the most widely used instruments in clinical practice for frailty assessment in HF, compares their strengths and limitations, and discusses their role in predicting adverse outcomes.
RECENT FINDINGS: Various tools have been developed to assess frailty in the HF patient population, aiming to guide clinical decisions and improve patient management. These scoring systems vary in their complexity and applicability and follow two main different approaches (the Fried phenotype and the frailty index). Recently, a new Heart Failure Frailty Score (HFFS) specifically designed to assess frailty in HF patients has been proposed. Frailty is a critical prognostic modifier in HF, making its systematic assessment in clinical practice essential for guiding therapeutic decision-making and optimizing clinical outcomes in this vulnerable population.

Keywords:  Domain; Frailty; Heart failure; Multidimensional

DOI:  https://doi.org/10.1007/s11897-025-00716-x
J Adv Nurs. 2025 Oct 02.

Recovery After Critical Illness: A Meta-Ethnography of Patient, Family and Staff Perspectives.

Elizabeth King, Owen Gustafson, Annabel Williams, Francine Toye, Mark Williams, Sarah Vollam.

   AIM: To synthesise primary qualitative studies reporting experiences of post-hospital recovery for critical care survivors, their family and the healthcare professionals supporting them with a particular focus on physical impairment.
DESIGN: The review was conducted through a meta-ethnography using the seven stages of Noblit and Hare.
METHODS: Qualitative studies or mixed-method studies which included qualitative research were included if they were based on the phenomenon of interest. Study quality was assessed using the Critical Appraisal Skills Programme checklist and confidence in the findings with the GRADE CERQual framework.
DATA SOURCES: Five electronic databases (PubMed, EMBASE, CINAHL, AMED and PEDro) were searched from inception to February 2022 and updated in November 2024. Grey literature for primary qualitative studies was also searched.
RESULTS: A total of 26,249 studies were initially screened, and 38 eligible studies were analysed. Four themes were distilled describing the experiences of critical care survivors, their family members and staff involved in their care: 'I survived, but I didn't thrive', 'Healthcare was there to save my life, but not for my long-term recovery', 'I am a burden on my family, and they feel the weight of carrying me' and 'My body still doesn't work like it used to'.
CONCLUSION: This meta-ethnography is unique in bringing together the experiences of patients recovering from critical illness, their families, and the staff who support them after hospital discharge. Ongoing diverse physical impairments prevented patients from thriving, significantly impacting family members. All groups clearly identified unmet rehabilitation needs following critical illness.

Keywords:  critical care; family; patients; qualitative; rehabilitation; teamwork

DOI:  https://doi.org/10.1111/jan.70189