bims-ricfun 2025-09-21 papers

bims-ricfun

Biomed News

on Rehabilitation ICF

Issue of 2025–09–21
twenty-two papers selected by
Gerardo Amilivia, Médica Uruguaya Corporación de Asistencia Médica

Outcomes of selective dorsal rhizotomy in ambulatory children and young people with cerebral palsy: A scoping review.
Ultrasound imaging and guidance for traumatic distal saphenous neuropathy.
A game changer in orofacial pain: ultrasound-guided dry needling of the digastric muscle.
Psychometric comparison and score conversion between World Health Organization Disability Assessment Schedule 2.0 and activities of daily living scales in community-dwelling older adults.
Diagnostic ultrasound of muscle injuries: what the sports medicine clinician should know.
Physiatrists as champions for a unified field of limb loss, difference, and preservation rehabilitation (LDPR)-perspectives on challenges and interventions.
Temporal fossa radio- and sonoanatomy revisited: a multimodal approach to standardizing temporalis muscle thickness measurement.
Intelligent sports rehabilitation: integrating deep learning and real-time monitoring to achieve personalized rehabilitation.
Botulinum Toxin Type A in the Management of Plantar Fasciitis: A Step Forward in Pain Relief.
Neurogenic pectoralis minor syndrome in the differential diagnosis of neck pain: A case series with diagnostic ultrasound-guided pectoralis minor muscle block.
Chronic Morel-Lavallée Lesion Treated With Percutaneous Ultrasonic Debridement.
Horns of the ram and wings of the seagull: 'sono-story' for medial meniscopathy.
The breath-back connection: A systematic review.
Effects of musculoskeletal rehabilitation in patients with lumbosacral transitional vertebra: A systematic review.
Impact of Early Mobilisation on the Clinical Outcomes of Patients With Traumatic Brain Injury.
Identifying Barriers and Place-Based Solutions to Physical Activity for Older Adults in East Tennessee.
Step-by-step insight into gait analysis: A narrative review unlocking knee biomechanics.
Ultrasonographic assessment of digital ulcers in systemic sclerosis: Quantitative and qualitative insights for evaluation and follow-up.
Potential role of integrin αV as irisin receptor and advances in research.
Cognitive Muscular Therapy™ for low back pain: a pilot study.
Treatment of Refractory Cancer Pain with Methadone.
Assessing the sensibility, utility and implementation considerations of the Episodic Disability Questionnaire with older adults living with complex health needs: a cross-sectional measurement study.

Dev Med Child Neurol. 2025 Sep 19.

Outcomes of selective dorsal rhizotomy in ambulatory children and young people with cerebral palsy: A scoping review.

Deepti Chugh, Eleanor Main, Gillian Waite, Lucy Alderson, Kristian Aquilina, Cherry Kilbride, Tim Theologis, Hortensia Gimeno.

AIM: To identify outcomes reported after selective dorsal rhizotomy (SDR) in ambulant children and young people with cerebral palsy in different domains of the International Classification of Functioning, Disability and Health (ICF).
METHOD: A scoping review using the JBI Scoping Review methodology was conducted. Six databases were searched for literature published between 1993 and 2024.
RESULTS: A total of 214 published papers met the inclusion criteria. Outcomes under the body function and structure domain were most frequently investigated (n = 199, 93%), followed by activity (n = 123, 58%) and participation (n = 33, 15%) across all studies. Quality of life was reported in 16 (8%) studies, and four (2%) studies mentioned individualized goals for SDR surgery. A combination of validated measures and subjective outcomes was used, with 119 (56%) studies reporting outcomes in two or more domains.
INTERPRETATION: Impairment-based outcomes remain the primary focus in SDR research. A small shift in emphasis towards participant-reported outcome measures has been seen in recent years. Few studies reported on the impact of personal and environmental factors. Future SDR studies need to incorporate all domains of the ICF to enhance understanding and capture holistic, meaningful changes in the lives of children and young people with cerebral palsy and their families.

DOI: https://doi.org/10.1111/dmcn.16496
Neurol Sci. 2025 Sep 16.

Ultrasound imaging and guidance for traumatic distal saphenous neuropathy.

Beytullah Yazar, Burak Tolga Başoluk, Levent Özçakar.



Keywords:  Cruris; Hydro-dissection; Pain; Sono-Tinel; Ultrasonography

DOI:  https://doi.org/10.1007/s10072-025-08485-0
Med Ultrason. 2025 Sep 17. 27(3): 372-373

A game changer in orofacial pain: ultrasound-guided dry needling of the digastric muscle.

Fatih Bagcier, Mustafa Turgut Yildizgoren, Mustafa Hüseyin Temel, Bulent Alyanak, Burak Tayyip Dede.

DOI: https://doi.org/10.11152/mu-4549
Eur Geriatr Med. 2025 Sep 15.

Psychometric comparison and score conversion between World Health Organization Disability Assessment Schedule 2.0 and activities of daily living scales in community-dwelling older adults.

Siqi Cheng, Chengbei Hou, Yue Wu, Xinyan Du, Hongjun Liu, Rui Li, Shaoyuan Lei, Xiaolin Yue, Yansu Guo.

   PURPOSE: To compare the performance of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) with activities of daily living (ADL) scales for disability assessment and to explore the score conversion between these two measures in a community-dwelling geriatric population.
METHODS: Data were drawn from the observational cohort study, the Beijing Longitudinal Disability Survey in Community Elderly, including 2170 community-dwelling adults aged ≥ 65 years. The 12-item WHODAS 2.0, ADL scales, and other corresponding measurements (mobility, cognition, depression, pain, nutrition, frailty, and sarcopenia) were evaluated face-to-face by well-trained assessors. Receiver operating characteristic (ROC) curve analysis was used to assess the accuracy of discriminating participants with ADL disability. Spearman's correlation coefficients were calculated to evaluate the associations between WHODAS 2.0, ADL scales, and other geriatric assessment tools. Equipercentile equating was performed to develop a conversion table between the WHODAS 2.0 and ADL scales.
RESULTS: Among 2170 community-dwelling older adults, the mean (SD) age was 74.1 (7.2) years, and 867 (40.0%) were male. Using the ADL scales, 1660 participants (76.5%) were defined as independent and 510 (23.5%) as dependent. Our results found an agreement between WHODAS 2.0 and ADL in categorizing older adults with disability. WHODAS 2.0 had a sensitivity of 95.1% and specificity of 77.3% in detecting disabled versus non-disabled older adults, with an area under the ROC curve of 0.963. WHODAS 2.0 also presents strong correlations with ADL scales and other geriatric assessment tools. In addition, a conversion table between WHODAS 2.0 and ADL scores was built with high precision.
CONCLUSION: WHODAS 2.0 demonstrates good discriminative ability for ADL disability and correlates strongly with various geriatric assessments, supporting that it is an applicable, sensitive, and comprehensive measure for disability assessment in community-dwelling older adults. The conversion between the WHODAS 2.0 and ADL scales allows for the comparison and synthesis of scores across studies and offers clinicians valuable references when interpreting results from different disability scales.

Keywords:  ADL; Conversion; Disability; Geriatric assessment; WHODAS 2.0

DOI:  https://doi.org/10.1007/s41999-025-01306-9
Br J Sports Med. 2025 Sep 18. pii: bjsports-2025-110255. [Epub ahead of print]

Diagnostic ultrasound of muscle injuries: what the sports medicine clinician should know.

Stefano Palermi, Alberto Scavone, Mattia Anzà, Emanuele Gregorace, Marco Vecchiato, Marcelo Bordalo, Bruce B Forster, Jon A Jacobson, Chris Myers, Iñigo Iriarte, Carles Pedret.

  Muscle injuries are among the most prevalent musculoskeletal conditions in athletes, contributing significantly to morbidity and time lost from competition. The use of ultrasound (US) is advantageous in assessing these injuries due to its low cost, accessibility, portability, dynamic real-time capabilities and utility in prognosis and rehabilitation planning. This state-of-the-art review offers a comprehensive synthesis of current evidence on the anatomical, technical and clinical aspects of diagnostic US in evaluating sports-related muscle injuries. Key topics include the differentiation between direct and indirect injury mechanisms, classification systems, prognostic indicators and common complications such as fibrosis, haematoma and myositis ossificans. Emphasis is placed on a practical, stepwise approach to US examination and reporting, incorporating anatomical detail and functional assessment to support individualised return-to-play decisions. Despite certain limitations, the US remains a cornerstone imaging modality in sports medicine. Emerging technologies, including advanced imaging techniques, hold promise for enhancing diagnostic accuracy and optimising clinical outcomes.

Keywords:  hamstring muscles; muscle, skeletal; quadriceps muscle; sports medicine; ultrasonography

DOI:  https://doi.org/10.1136/bjsports-2025-110255
PM R. 2025 Sep 16.

Physiatrists as champions for a unified field of limb loss, difference, and preservation rehabilitation (LDPR)-perspectives on challenges and interventions.

Prateek Grover, Marlís González Fernández.

DOI: https://doi.org/10.1002/pmrj.70016
J Ultrasound. 2025 Sep 13.

Temporal fossa radio- and sonoanatomy revisited: a multimodal approach to standardizing temporalis muscle thickness measurement.

Buğra İnce, Levent Özçakar.

  Temporalis muscle thickness (TMT) has gained increasing importance as a parameter for predicting sarcopenia, dysphagia, and functional outcomes, particularly in cranial pathologies such as stroke. However, the complex anatomy of the temporal fossa presents a significant challenge for the reliable assessment of TMT. This review aims to overcome this difficulty by providing a comprehensive analysis of the sonoanatomy and radiologic structure of the temporal fossa. Detailed anatomical relationship, including fascial planes, fat pads, and bony structures are presented with high-resolution images and videos. In addition to this thorough anatomical evaluation, the study introduces a novel, standardized TMT measurement technique designed to be applicable across CT, MRI, and ultrasound modalities. This technique aims to enhance the comparability of measurements and to support the use of TMT as a more effective biomarker in the evaluation and follow-up of sarcopenia, dysphagia, and other orofacial conditions.

Keywords:  Computed tomography; Magnetic resonance imaging; Sarcopenia; Temporalis; Ultrasound

DOI:  https://doi.org/10.1007/s40477-025-01084-x
Disabil Rehabil Assist Technol. 2025 Sep 19. 1-15

Intelligent sports rehabilitation: integrating deep learning and real-time monitoring to achieve personalized rehabilitation.

Sen Zhang, Qiao Meng.

   BACKGROUND: Personalized rehabilitation is gaining increasing importance, especially in sports-related activities where injury rates are high. Evidence-based and human-focused rehabilitation approaches emphasize health equity, individual rights, and creativity in care.
OBJECTIVE: This study aimed to examine the psychological advantages of incorporating Tai Chi into mandatory drug rehabilitation programs for sports athletes.
METHODS: A randomized controlled trial was conducted with 172 participants, equally divided into a Tai Chi intervention group and a control group. The intervention group performed Tai Chi three times per week for 16 weeks under uniform guidance, while the control group received conventional rehabilitation care.
RESULTS: Pre- and post-intervention psychological assessments demonstrated that the Tai Chi group showed significant improvements in emotional well-being, self-regulation, and psychological resilience compared to the control group.
CONCLUSION: Tai Chi practice enhances mental and physical recovery in rehabilitation settings. Integrating culturally relevant and holistic practices into recovery programs supports sustainable, person-centered rehabilitation and confirms the value of incorporating conventional movement therapies into contemporary care.

Keywords:  Sports rehabiltion; Tai Chi process; assistive treatment; physical health; psychological test

DOI:  https://doi.org/10.1080/17483107.2025.2559187
Cureus. 2025 Aug;17(8): e90415

Botulinum Toxin Type A in the Management of Plantar Fasciitis: A Step Forward in Pain Relief.

Chaimaa Iziki, Sara Skalli, Lina Lahbabi, Naila Haltout, Samia Karkouri.

  Plantar fasciitis is a prevalent cause of heel pain in adults, particularly among the middle-aged population. It is characterized by microtrauma that exceeds the regenerative capacity of the plantar fascia. Although most cases respond well to conservative treatment, such as stretching exercises, orthotic use, and nonsteroidal anti-inflammatory drugs, some cases progress to chronic stages that require second-line therapies, including extracorporeal shockwave therapy, corticosteroid or platelet-rich plasma injections, or surgical plantar fascia release. This review aims to evaluate the efficacy of botulinum toxin type A (BTA) injections in the management of chronic plantar fasciitis. A narrative review was conducted without any date restrictions, covering the period from 1994 to 2025, through databases including PubMed, Scopus, ScienceDirect, and Google Scholar. Included studies focused on patients with plantar fasciitis unresponsive to conservative treatments, using pain and functional outcomes as endpoints. Three randomized controlled trials demonstrated that BTA injections significantly reduced pain and improved function across short, mid-, and long-term follow-ups. BTA acts at the neuromuscular junctions to reduce muscle tone and modulate pain pathways. BTA injections appear to be a safe and effective option for patients with chronic plantar fasciitis unresponsive to first-line therapies. Image-guided injections (ultrasound or electromyographic) are recommended to enhance accuracy. Further research is necessary to establish standardized protocols regarding the injection site, dosage, guidance technique, and reinjection timing.

Keywords:  botulinum toxin; corticosteroid injection; heel pain; plantar fasciitis; shockwave therapy

DOI:  https://doi.org/10.7759/cureus.90415
Medicine (Baltimore). 2025 Sep 12. 104(37): e44387

Neurogenic pectoralis minor syndrome in the differential diagnosis of neck pain: A case series with diagnostic ultrasound-guided pectoralis minor muscle block.

Kubra Neslihan Kurt Oktay, Feyza Unlu Ozkan, Ilknur Aktas.

   RATIONALE: Neurogenic pectoralis minor syndrome (NPMiS) is an underdiagnosed cause of persistent neck, shoulder, and upper extremity pain. It can mimic cervical radiculopathy or other musculoskeletal disorders, often resulting in misdiagnosis and ineffective treatment. This case series presents 5 patients with NPMiS who achieved symptomatic relief through diagnostic ultrasound-guided pectoralis minor muscle (PMiM) block followed by targeted rehabilitation.
PATIENT CONCERNS: All patients presented with persistent neck pain often radiating to the scapula or anterior chest wall, along with paresthesia and impaired sleep quality. Prior treatments, including non-steroidal anti-inflammatory drugs, muscle relaxants, and physical therapy, were ineffective. One patient was referred for spine surgery before alternative evaluation.
DIAGNOSES: The diagnosis of NPMiS was based on detailed clinical history, positive physical exam findings (e.g., Roos test, focal PMiM tenderness), and exclusion of cervical radiculopathy and peripheral neuropathies via imaging and electrophysiological studies. Confirmatory diagnosis was established with significant symptom relief following ultrasound-guided PMiM block.
INTERVENTIONS: Patients received diagnostic ultrasound-guided injection of 1% lidocaine into the PMiM. This was followed by an individualized rehabilitation program including posture correction, ergonomic adjustments, and physical therapy focused on pectoral muscle stretching and shoulder stabilization.
OUTCOMES: Patients experienced rapid pain reduction, improved function, reduced medication use, and better sleep. Sustained symptom relief was achieved through adherence to rehabilitation.
LESSONS: NPMiS should be considered in the differential diagnosis of chronic, non-dermatomal neck and upper extremity pain, particularly when standard treatments fail. Ultrasound-guided PMiM block is a valuable tool both for confirming diagnosis and initiating effective, personalized therapy strategies.

Keywords:  brachial plexus compression; neck pain; neurogenic pectoralis minor syndrome; pectoralis minor muscle block; ultrasound-guided injection

DOI:  https://doi.org/10.1097/MD.0000000000044387
J Clin Ultrasound. 2025 Sep 16.

Chronic Morel-Lavallée Lesion Treated With Percutaneous Ultrasonic Debridement.

John D Karp, Samuel O Oduwole, Levon N Nazarian.

  Morel-Lavallée lesion is defined as an internal degloving injury. A trauma involving shearing forces causes separation of the superficial fascia from the overlying subcutaneous tissue and skin, creating a potential space for hemolymphatic fluid to accumulate. This leads to the development of a self-resolving or potentially chronic collection. Classically, lesions arise in the lateral thigh. Imaging features depend on the duration of the lesion. Acutely, ultrasound and MR imaging will demonstrate a hematoma-like mass that is parallel to the underlying fascia. As the lesion evolves over time, calcifications with a dense capsule can form. Patients typically present with a persistent, localized swelling and pain that may radiate throughout the thigh. Initially, conservative therapy can be efficient; however, once a capsule forms, surgical management is the current gold standard therapy. Tenex (Tenex Health, Lake Forest, CA) is a device that uses high-frequency ultrasonic waves to perform percutaneous debridement to disrupt and remove calcifications in the setting of various chronic musculoskeletal conditions. This case describes the successful use of this technology in a 68-year-old female with a 10-year history of a Morel-Lavallée lesion. Treatment of Morel-Lavallée lesions using the Tenex device is a feasible, minimally invasive alternative to conventional surgery.

Keywords:  Morel‐Lavallée; Tenex; tenotomy; ultrasound

DOI:  https://doi.org/10.1002/jcu.70082
Med Ultrason. 2025 Sep 17. 27(3): 371-372

Horns of the ram and wings of the seagull: 'sono-story' for medial meniscopathy.

Hasan Ocak, Hilmi Berkan Abacıoğlu, Levent Özçakar.

DOI: https://doi.org/10.11152/mu-4546
J Bodyw Mov Ther. 2025 Oct;pii: S1360-8592(25)00192-5. [Epub ahead of print]44 63-72

The breath-back connection: A systematic review.

A Mirtaleb, N Rahmani, K Kazemi, M Javaherian, M H Azarsa.

BACKGROUND: Recent research studies highlight a complex interplay between respiratory function and spinal stability, particularly involving the diaphragm and core stabilizing muscles in individuals with low back pain (LBP).
OBJECTIVE: This systematic review aimed to investigate diaphragm and stabilizer muscle thickness and function in individuals with LBP compared to healthy subjects during breathing.
METHODS: A comprehensive literature search was conducted in Web of Science, Science Direct, PubMed, Scopus, and Medline databases up to April 2024. Studies assessing the function and thickness of the diaphragm, abdominal muscles, and lumbar multifidus during breathing in individuals with LBP and healthy subjects were included. The Critical Appraisal Skills Program (CASP) checklist was used to assess study quality.
RESULTS: A total of 14 studies met the inclusion criteria, comprising eight case-control and six cross-sectional studies. Findings indicated variations in diaphragm thickness, excursion, and fatigability among LBP patients, with inconsistent evidence regarding its function. Abdominal muscle activity and recruitment patterns differed significantly between LBP patients and healthy controls, with altered transversus abdominis (TrA) and internal oblique (IO) activation. Some studies reported increased TrA and IO thickness in LBP patients, potentially compensating for diaphragm dysfunction, while others observed reduced thickness and activity. Lumbar multifidus size showed no significant differences during breathing.
CONCLUSION: This review highlights altered diaphragm and abdominal muscle function in individuals with LBP, supporting the theory of a breath-back connection influencing spinal stability. However, inconsistencies in findings suggest a need for further research focusing on LBP subgroups. Understanding these interactions may contribute to improved rehabilitation strategies targeting core muscle function and respiratory mechanics in LBP management.

DOI: https://doi.org/10.1016/j.jbmt.2025.05.038
J Bodyw Mov Ther. 2025 Oct;pii: S1360-8592(25)00276-1. [Epub ahead of print]44 632-638

Effects of musculoskeletal rehabilitation in patients with lumbosacral transitional vertebra: A systematic review.

Mateus Dos Santos de Albuquerque Guilherme, Laura Beatriz Alves Costa, Weslley Barbosa Sales.

   INTRODUCTION: The lumbosacral transition vertebra (LSTV) is a common anatomical variation of the spine, presenting changes in the structure or position of the lower lumbar and/or upper sacral vertebrae.
OBJECTIVE: To systematically map the existing evidence on the evaluation and physical therapy treatment of the lumbosacral transition vertebra.
METHODS: The systematic review followed the PRISMA guidelines and used the protocol registered in PROSPERO (CRD42024530434). Using the PICO strategy, the research sought evidence on musculoskeletal rehabilitation in patients with lumbosacral transition vertebra, covering databases such as PubMed, Lilacs, SciELO, Scopus, Web of Science, PEDro and Google Scholar. The inclusion criteria were primary/original, complete articles, freely available and with no restriction of year of publication, as long as they were related to the evaluation and physical therapy treatment of the lumbosacral transition vertebra. Meanwhile, the exclusion criteria were articles published in annals of scientific events, articles published in journals without peer review, and articles unavailable at the time of full reading.
RESULTS AND DISCUSSION: 1315 articles were initially identified during the search carried out between March and July 2024. After the analysis of duplicates, 1219 articles remained, whose titles and abstracts were evaluated. Of these, 8 articles were considered eligible for full reading. To expand the sample, the reference lists of these articles were examined, resulting in the inclusion of 1 more article.
CONCLUSION: The reviewed interventions, including lumbosacral manipulation, mobilization, therapeutic exercises, and radiofrequency, showed promise in reducing pain and improving functionality in patients with LSTV-associated low back pain.

Keywords:  Musculoskeletal rehabilitation; Physical therapy services; Spine

DOI:  https://doi.org/10.1016/j.jbmt.2025.06.038
Nurs Crit Care. 2025 Sep;30(5): e70166

Impact of Early Mobilisation on the Clinical Outcomes of Patients With Traumatic Brain Injury.

Fei Xia, Caiyun Li, Yiwen Liu.

   BACKGROUND: Early mobilisation (EM) is a rehabilitative approach hypothesised to improve functional and clinical outcomes in patients with traumatic brain injury (TBI). However, its benefits remain controversial.
AIM: The aim of this study was to evaluate the influence of EM on neurological recovery, motor function, quality of life (QoL) and clinical outcomes in patients with TBI.
STUDY DESIGN: A systematic review and meta-analysis was performed. We systematically searched PubMed, Embase, Cochrane Library, Wanfang and CNKI databases for relevant randomised controlled trials (RCTs). Outcomes included changes in National Institutes of Health Stroke Scale (NIHSS), Fugl-Meyer Assessment (FMA), Functional Independence Measure (FIM), QoL, mortality and adverse events. A random-effects model was used to pool the results by incorporating heterogeneity.
RESULTS: Eleven RCTs with 898 patients with TBI were included. EM significantly reduced NIHSS scores (MD: -4.51, 95% CI: -5.60 to -3.43, p < 0.001; I2 = 0%) and improved FMA scores (MD: 5.39, 95% CI: 3.81-6.97, p < 0.001; I2 = 31%), indicating enhanced neurological recovery and motor function. QoL scores also improved with EM (SMD: 0.80, 95% CI: 0.48-2.12, p < 0.001; I2 = 42%). However, EM did not significantly influence FIM (p = 0.15) or mortality (p = 1.00). Trends towards lower adverse event rates were observed but did not reach statistical significance.
CONCLUSIONS: EM is associated with improved neurological and motor recovery and enhanced QoL in patients with TBI. While its impact on mortality and adverse events requires further validation, this evidence supports incorporating EM into standard TBI rehabilitation protocols.
RELEVANCE TO CLINICAL PRACTICE: The findings of this meta-analysis highlight the importance of early mobilisation (EM) as a key component of rehabilitation for patients with traumatic brain injury. EM significantly improves neurological recovery, motor function and quality of life, supporting its integration into standard clinical practice. Given the potential for improved patient outcomes, healthcare providers, particularly nurses and rehabilitation specialists, should prioritise safe and individualised EM protocols to enhance functional recovery while minimising risks.
TRIAL REGISTRATION: The protocol of the meta-analysis has been registered at PROSPERO with the identifier CRD42025640625.

Keywords:  adverse events; early mobilisation; functional outcome; meta‐analysis; traumatic brain injury

DOI:  https://doi.org/10.1111/nicc.70166
J Appalach Health. 2025 ;7(3): 105-119

Identifying Barriers and Place-Based Solutions to Physical Activity for Older Adults in East Tennessee.

Lydia Hoskins, Jodi Southerland.

   Introduction: Older adults in East Tennessee (TN), the fastest growing demographic, face significant health challenges, with 44% reporting four or more chronic conditions. The state ranks 45th in physical inactivity among older adults, exacerbating chronic disease risks, fall-related injuries, and mental health issues. Urban-rural disparities in East TN further complicate efforts to promote active living, particularly for rural residents.
Purpose: This qualitative study explored socioecological barriers and solutions to increase physical activity (PA).
Methods: In April 2024, two focus group were conducted in East TN, with a total of 11 participants composed of six community partners and five older adults. A semi-structured interview guide explored PA attitudes, beliefs, and behaviors and gathered recommendations for increasing physical activities among older adults. Data were analyzed thematically using a socioecological framework at individual, organizational, and community levels.
Results: Barriers at the individual level included poor physical, psychological, and social health, and low digital literacy skills. Organizational-level barriers included limited capacity to support PA programming (e.g., staffing, facilities, and funding limitations) and overlapping community program efforts. Community level barriers included limited social support networks and inadequately built environmental features for active living. Solutions highlighted the role of relationships (e.g., peer-to-peer, trusted facilitators) at the individual level, tailored programming and marketing efforts at the organizational level, and leveraging local resources and multi-system collaborations at the community level.
Implications: The findings highlight socioecological factors contributing to physical inactivity in East TN older adults and identifies strategies to address them. These findings can inform sustainable, multi-systems interventions to promote PA in the region.

Keywords:  Aged; Appalachia; physical activity; physical exercise; public health; social determinants of health

DOI:  https://doi.org/10.13023/jah.0703.08
Knee Surg Sports Traumatol Arthrosc. 2025 Sep 16.

Step-by-step insight into gait analysis: A narrative review unlocking knee biomechanics.

Giovanni Spallone, Letizia Mancini, Arianna Carnevale, Stefano Campi, Alessandro de Sire, Emiliano Schena, Pieter D'Hooghe, Michael T Hirschmann, Rocco Papalia, Umile Giuseppe Longo.

  Gait analysis offers a powerful tool for clinical and orthopaedic decision-making. By quantifying spatiotemporal, kinematic and kinetic parameters during walking, it provides a dynamic window into joint function that static imaging cannot capture. Despite its potential, gait analysis remains largely confined to specialised centres, with limited integration in clinical pathways, mainly due to its perceived complexity and lack of standardisation. This narrative review aims to bridge that gap through a step-by-step approach to guide orthopaedic surgeons, sports medicine physicians and musculoskeletal clinicians in understanding and interpreting key biomechanical markers relevant to common knee pathologies, such as osteoarthritis and anterior cruciate ligament injury. Particular attention is given to how deviations in parameters like joint angles and moments, dynamic alignment and centre of pressure trajectories can offer actionable insights into disease progression, treatment response and surgical planning. The urgent need for standardised protocols, encompassing marker placement, biomechanical modelling and data processing, is also underscored, as they are essential to ensure reproducibility and facilitate clinical translation. By clarifying the clinical meaning of gait metrics, this review empowers healthcare professionals to integrate dynamic functional data into everyday decision-making and move towards more personalised, biomechanically informed care. Level of Evidence: Level IV.

Keywords:  anterior cruciate ligament deficiency; kinematics; kinetics; knee osteoarthritis; optoelectronic motion capture systems

DOI:  https://doi.org/10.1002/ksa.70067
J Scleroderma Relat Disord. 2025 Sep 15. 23971983251343459

Ultrasonographic assessment of digital ulcers in systemic sclerosis: Quantitative and qualitative insights for evaluation and follow-up.

Luca Idolazzi, Riccardo Bixio, Denise Rotta, Francesca Pistillo, Giulia Zanetti, Antonio Carletto, Maurizio Rossini, Ombretta Viapiana.

   Objective: The objective of this study is to examine the efficacy of ultrasonography in evaluating and tracking the healing process of digital ulcers in patients with systemic sclerosis.
Methods: The study cohort comprised 23 patients with systemic sclerosis and digital ulcers. Gray Scale and Power Doppler ultrasonography was employed for the assessment of lesions. Subsequently, a sharp debridement was administered, followed by the application of hydrocolloid dressings. The healing process was then monitored through follow-up and using ultrasonography.
Results: Of the 46 ulcers observed, 34 demonstrated complete healing, while 12 did not. The use of Power Doppler ultrasonography was found to be a highly significant indicator of healing. Significant statistical differences were observed in lesion dimensions (length, width, depth) between the healed and non-healed groups and a strong correlation was observed between the reduction in lesion dimensions and the healing process. The results of the point-biserial correlation analysis indicated a robust positive correlation between healing and alterations in length (r = 0.600) and width (r = 0.576), and a moderate positive correlation with depth (r = 0.400).
Conclusion: The findings of this study indicate that the ultrasonography is a feasible and objective method to assess digital ulcers and their healing. Reduction of length and width and presence of Power Doppler ultrasonography are strong indicators of wound repair. Furthermore, the presence of necrotic tissue is not an indicator for a poor outcome. Ultrasonography offers comprehensive qualitative and quantitative data that facilitate a deeper comprehension and monitoring of the healing process.

Keywords:  Systemic sclerosis; digital ulcers; ultrasound

DOI:  https://doi.org/10.1177/23971983251343459
Peptides. 2025 Sep 13. pii: S0196-9781(25)00100-7. [Epub ahead of print] 171439

Potential role of integrin αV as irisin receptor and advances in research.

Zina Bai, Zelin Chen, Tongxinwei Sun, Cuiqing Ma, Aihong Meng.

  Irisin, initially described as a myokine, is widely distributed throughout the body and is released during physical exercise. It exerts beneficial effects on multiple tissues and, organs, and in systemic diseases, including neurological, metabolic, cardiovascular, pulmonary, and musculoskeletal disorders. Recent studies have highlighted the role of irisin receptors in various disease models and cell types, identifying integrin αV, particularly integrin αVβ5, as a key irisin-binding receptor. This review summarizes the current findings on irisin receptor biology and elucidates the mechanisms by which irisin mediates its effects via these receptors in various diseases. We propose that integrin αVβ5 receptors may represent promising therapeutic target for the treatment of diseases associated with exercise-induced irisin, offering a novel perspective for the alleviation of systemic diseases through exercise and rehabilitation.

Keywords:  exercise; integrinαV; irisin; receptor; signal pathway

DOI:  https://doi.org/10.1016/j.peptides.2025.171439
Musculoskelet Sci Pract. 2025 Sep 13. pii: S2468-7812(25)00163-8. [Epub ahead of print]80 103415

Cognitive Muscular Therapy™ for low back pain: a pilot study.

Stephen J Preece, Jason Smith, Nathan Brookes, Sally Gates, Daniela Ghio.

  Cognitive Muscular Therapy™ for Chronic Low Back Pain.
BACKGROUND: Chronic low back pain (cLBP) is a major cause of disability. Research shows that people with cLBP over activate the abdominal and superficial paraspinal muscles and this may indicate an underlying pattern of antagonistic flexor-extensor tone. This study was designed test a new intervention for cLBP, Cognitive Muscular Therapy™ (CMT). CMT integrates biomechanical training to improve postural tone with psychological techniques for pain management.
METHODS: The CMT intervention included five components: Understanding back pain, General relaxation, Postural deconstruction, Contextual triggers, and Functional integration and incorporated Electromyography (EMG) biofeedback to visualise erector spinae activity. An observational case series was carried out on fifteen participants with cLBP, who each received seven weekly sessions of CMT. Alongside disability and psychological factors, the activation profile of the erector spinae was measured during walking, using EMG. Five participants provided qualitative feedback through interviews.
RESULTS: Significant clinical improvements were observed. The Roland-Morris Disability Questionnaire score reduced by 7 points, the Pain catastrophizing scale reduced by 13.2 points and the Tampa scale of kinesiophobia reduced by 7.8 points. EMG data suggested improved phasic activation of the erector spinae during walking, while interviews showed increased self-efficacy and improved pain management.
CONCLUSION: This is the first study of CMT for cLBP, showing promising results in reducing pain and disability. By integrating psychological strategies within a biomechanical framework, CMT offers a novel approach to retraining muscle activity. Future work is now required to explore the proposed mechanism of action and fully quantify the clinical effectiveness of this new intervention.
TRIAL REGISTRATION: NCT05611476.

Keywords:  Biopsychosocial rehabilitation; Chronic low back pain; Electromyography; Physiotherapy; Postural tone

DOI:  https://doi.org/10.1016/j.msksp.2025.103415
J Coll Physicians Surg Pak. 2025 Sep;35(9): 1200-1202

Treatment of Refractory Cancer Pain with Methadone.

Xiaoting Zeng, Qianyu Wang, Weiping Zhang.

One-third of cancer patients currently experience cancer-related pain, significantly affecting their quality of life. Since the introduction of the World Health Organization (WHO)'s analgesic ladder, pain management has become increasingly standardised, facilitating more effective treatment strategies. Methadone, classified as a step 3 opioid analgesic on the WHO ladder, is primarily utilised for managing refractory cancer pain. This article explored the advantages and disadvantages of methadone in the context of refractory cancer pain, focusing on its metabolism and pharmacokinetic properties. In conclusion, methadone demonstrates significant advantages in pain relief for cancer patients. With ongoing research into its metabolic mechanisms and dosing strategies, methadone has the potential to become a safer and more widely used opioid in the treatment of refractory cancer pain in the future. Key Words: Methadone, Refractory cancer pain, Metabolism.

DOI: https://doi.org/10.29271/jcpsp.2025.09.1200
BMJ Open. 2025 Sep 18. 15(9): e097504

Assessing the sensibility, utility and implementation considerations of the Episodic Disability Questionnaire with older adults living with complex health needs: a cross-sectional measurement study.

Shaheer Khawar, Shelby Cameron, Jahanvi Patel, Simona Kukuruzovic, Kiana Wong, Ann Stewart, Soo Chan Carusone, Kelly K O'Brien.

   OBJECTIVES: The Episodic Disability Questionnaire (EDQ) was developed to measure the presence, severity and episodic nature of disability experienced among persons with chronic conditions. Our aim was to assess the sensibility, utility and implementation considerations of the EDQ among older adults with complex health needs.
DESIGN: Cross-sectional measurement study involving quantitative and qualitative methods of data collection.  PARTICIPANTS: We recruited community-dwelling older adults (65 years of age or older) living with complex health needs receiving care from a primary healthcare team in Toronto, Canada.
METHODS: We administered the EDQ, sensibility questionnaire (assessing face and content validity, and ease of usage, with each item scored from 0 to 7 with greater scores indicating greater sensibility) and demographic questionnaire, followed by a semi-structured interview in the home or clinical setting. Using an interview guide, we asked participants about their perspectives on utility, format and implementation of the EDQ in clinical practice. We considered the EDQ sensible if the median score on the sensibility questionnaire was ≥5/7 for ≥80% of items and if none of the items had a median score of ≤3/7. We conducted a team-based directed content analysis of the interview transcripts.
RESULTS: The median age of the 11 participants in this study was 83 years of age. All participants reported living with two or more chronic health conditions, with osteoarthritis (n=5) and diabetes (n=4) most frequently reported. The EDQ met the criterion for sensibility as measured by the sensibility questionnaire. Interview data from participants (n=10) indicated that the EDQ represents the health-related challenges among this sample of older adults with complex health needs, captures the episodic nature of disability and was easy to use. Utility of the EDQ included providing clinicians with a holistic understanding of health challenges older adults face, aiding in intervention planning and measuring changes in disability over time. Six of the participants also expressed uncertainty as to how the EDQ specifically could be used by clinicians in their care. Considerations for implementation included mode of administration (paper or electronic) and the importance of communicating EDQ scores with older adults based on individual preferences.
CONCLUSIONS: The EDQ possesses sensibility and utility for use among this sample of older adults living with complex health needs in home or clinical care settings.

Keywords:  GERIATRIC MEDICINE; Patient Reported Outcome Measures; REHABILITATION MEDICINE

DOI:  https://doi.org/10.1136/bmjopen-2024-097504