bims-ricfun 2025-10-19 papers

bims-ricfun

Biomed News

on Rehabilitation ICF

Issue of 2025–10–19
thirty-two papers selected by
Gerardo Amilivia, Médica Uruguaya Corporación de Asistencia Médica

Ultrasound Examination for Brachial Plexus Injury Following Lat Pull-Down Exercises.
From Concept to Practice: The Development of ClinFIT for Musculoskeletal Disorders.
A Novel/Sonographic Approach for Immediate Mobility Restoration in Adhesive Capsulitis: Anterior-Inferior Glenohumeral Joint Hydrodilatation.
Harnessing artificial intelligence for cancer rehabilitation: A call to action.
Extensive lower limb neuropathies following coronary artery bypass surgery.
Ultrasonographic and Electrophysiologic Assessment of Radial Tunnel Syndrome in Patients with Treatment-Resistant Lateral Epicondylitis: Insights into Diagnostic Utility and Clinical Implications.
Ultrasound-guided Achilles tendon rupture repair using knotless barbed suture: a cadaveric study.
Sudden Hip Pain and Functional Decline in a Stroke Rehabilitation Patient with Antiphospholipid Syndrome.
Comparative Effectiveness of Radiofrequency Ablation, Cryoablation, and Endoscopic Denervation for Lumbar Facet Pain: A Multicenter Trial.
Sustained Post-Intervention Effects of Small Community Walking on Physical Activity, Well-Being, and Social Capital Among Older Patients With Cardiovascular Disease in the Chronic Phase　- A Follow-up Multicenter Randomized Controlled Trial.
Beyond Nerve Entrapment: A Narrative Review of Muscle-Tendon Pathologies in Deep Gluteal Syndrome.
Exploring the Effectiveness of Immersive Virtual Reality Rehabilitation for Parkinson's Disease: A Narrative Review.
Sonographic Findings of Latissimus Dorsi and Teres Major Injuries in Overhead Athletes: A Pictorial Review.
Innovative Dynamic Ultrasound Diagnosis of First Rib Stress Fracture in an Adolescent Athlete-A Case Report.
Hydration Status in Geriatric Patients-Subjective Impression or Objective Parameter? The Hydr-Age-Study.
Editorial: Advances on participation perspective in rehabilitation sciences.
The impact of community-based Tai Chi exercise on intrinsic capacity improvement in the elderly: a meta-analysis of randomized controlled trials.
Instruments for assessing social support in social networks and in the self-management and rehabilitation process of persons poststroke: a scoping review protocol.
Safety and effectiveness of Co-careldopa for motor recovery in post-stroke patients: A Systematic Review.
The role of exercise induced capillarization adaptations in skeletal muscle aging: a systematic review.
Review of Safety and Efficacy of Polmacoxib: A Novel Dual Inhibitor of Cyclo-oxygenase 2 and Carbonic Anhydrase in Osteoarthritis and Acute Painful Conditions.
Vitamin D and cancer-related fatigue in elderly patients: mechanisms and therapeutic insights-a narrative review.
Utility of GLFS-25 as a patient-reported outcome measure for older patients with lumbar spinal stenosis: A two-year retrospective cohort study.
Cognitive-motor dual task induces strategic kinematic adjustments with increased toe-obstacle clearance for older adults during obstacle crossing.
Urologic Manifestations of Nonrelaxing Pelvic Floor Dysfunction: Insights on Clinical Workup and Management.
SGLT-2 inhibitors for the prevention of autoimmune rheumatic diseases.
Neurocognitive Interventions Informed by Cognitive-Behavioral Therapy (CBT) Principles and Physical Exercise for Complex Regional Pain Syndrome: A Systematic Review.
Median Nerve Diameter Ratio on Ultrasound as a Complementary Tool to Electrodiagnostic Testing in Carpal Tunnel Syndrome.
Ultrasonographic measurement of talar cartilage thickness in patients with rheumatoid arthritis and healthy controls.
Revisiting the Extensor Hallucis Longus Tendon: Anatomical Classification and Orthopedic Implications.
Managing Chronic Pain: The Ketamine Option.
Discriminatory characteristics of responders and non-responders septic patients to neuromuscular electrical stimulation - A subanalysis of a randomized controlled double-blinded trial.

Pain Pract. 2025 Nov;25(8): e70095

Ultrasound Examination for Brachial Plexus Injury Following Lat Pull-Down Exercises.

Abdullah Emre Uğur, Beytullah Yazar, Levent Özçakar.



Keywords:  cervical root; pain; plexopathy; rehabilitation; ultrasonography

DOI:  https://doi.org/10.1111/papr.70095
Am J Phys Med Rehabil. 2025 Oct 07.

From Concept to Practice: The Development of ClinFIT for Musculoskeletal Disorders.

Max Mariotti, Melissa Selb, Marta Imamura, Alia Alghwiri, Bhasker Amatya, Maria Gabriella Ceravolo, Francesca Gimigliano, Mario Giraldo-Prieto, Xiaolei Hu, Sinforian Kambou, Carlotte Kiekens, Jianan Li, Shouguo Liu, Masahiko Mukaino, Aydan Oral, Gerold Stucki, Dominique van de Velde, Claudio Perret.

   OBJECTIVE: This study aimed to develop ClinFIT-MSK, an International Classification of Functioning, Disability and Health (ICF)-based clinical tool for the assessment and reporting of the functioning and rehabilitation potential of patients with a musculoskeletal condition.
DESIGN: This multistep, mixed-methods tool development process encompassed developing an initial shortlist of ICF categories (comprising the aggregation of the ICF Core Sets for musculoskeletal conditions and a literature search), identifying the ClinFIT-MSK items feasible for clinical use via a two-round Delphi survey, developing a simple description for each item and deciding on the rating scale through development working group consultations. These consultations were also instrumental at each step of tool development.
RESULTS: Based on a shortlist of 33 categories, the Delphi survey generated 17 items (7 body function and 10 activity and participation categories) which can be rated with a 0-4 scale (0 = no problem to 4 = complete problem) accompanied with rating specifications or with a 0-10 numeric rating scale without specification.
CONCLUSIONS: ClinFIT-MSK can be used by rehabilitation professionals to support individualized care and track functional outcomes. It can also be employed in research and public health. Psychometric testing and cross-cultural validation will be pursued to ensure ClinFIT-MSK's scientific robustness and applicability across diverse settings.

Keywords:  Functional Status; International Classification of Functioning, Disability and Health; Musculoskeletal Diseases; Rehabilitation

DOI:  https://doi.org/10.1097/PHM.0000000000002875
Am J Phys Med Rehabil. 2025 Nov 01. 104(11): 1038-1039

A Novel/Sonographic Approach for Immediate Mobility Restoration in Adhesive Capsulitis: Anterior-Inferior Glenohumeral Joint Hydrodilatation.

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

DOI: https://doi.org/10.1097/PHM.0000000000002805
Support Care Cancer. 2025 Oct 17. 33(11): 961

Harnessing artificial intelligence for cancer rehabilitation: A call to action.

Jie Hao.

  Recent evidence from the CHALLENGE trial confirms that structured exercise can significantly improve survival outcomes in colon cancer survivors, reinforcing the principle that exercise is medicine. However, implementing personalized and scalable rehabilitation programs remains challenging. This paper explores how artificial intelligence (AI), when integrated with the International Classification of Functioning, Disability and Health (ICF) framework, can transform cancer rehabilitation through personalized exercise prescriptions, real-time monitoring, virtual coaching, and data-driven decision-making. We also discuss the role of emerging technologies such as virtual reality, wearables, and telehealth in expanding access to care. While limitations regarding data bias, equity, and regulation persist, strategic research and implementation efforts are essential. A multidisciplinary, patient-centered approach is needed to harness AI's potential in the era of digital health.

Keywords:  Digital health; Exercise; Function; Oncology; Technology

DOI:  https://doi.org/10.1007/s00520-025-10047-1
Neurol Sci. 2025 Oct 13.

Extensive lower limb neuropathies following coronary artery bypass surgery.

Berkay Yalçınkaya, Ahmet Furkan Çolak, Hilmi Berkan Abacıoğlu, Alp Çetin.

DOI: https://doi.org/10.1007/s10072-025-08534-8
Am J Phys Med Rehabil. 2025 Oct 09.

Ultrasonographic and Electrophysiologic Assessment of Radial Tunnel Syndrome in Patients with Treatment-Resistant Lateral Epicondylitis: Insights into Diagnostic Utility and Clinical Implications.

Aslinur Keles, Deniz Palamar, Aysegul Gunduz, Ulku Akarirmak.

   OBJECTIVES: To evaluate radial tunnel syndrome (RTS) in patients with treatment-resistant lateral epicondylitis (LE) and assess the diagnostic utility of ultrasonographic, electrophysiologic, and clinical evaluations.
DESIGN: In this cross-sectional study, 32 patients with LE persisting for at least 6 months underwent comprehensive clinical, electrophysiological, and ultrasonographic assessments. RTS diagnosis was established using an ultrasound-guided posterior interosseous nerve (PIN) block as the reference standard and compared with diagnostic criteria based on nerve cross-sectional area (CSA) threshold values and side-to-side CSA comparison. Pre- and post-block pain levels during clinical tests were also analyzed.
RESULTS: RTS was diagnosed in 44% of patients using the injection test. The mean CSA of the PIN was larger on the symptomatic side but did not differ significantly between RTS-positive and RTS-negative cases. Electrophysiological findings were normal in all patients, and LE ultrasound findings did not vary based on the presence of RTS. Agreement between RTS diagnosis and US-CSA comparison with the contralateral side was slight (κ = 0.138; p = 0.4024), while threshold values showed no agreement (κ = 0.098; p = 0.118). Cozen's test demonstrated the highest reliability, with significant pain reduction following the block.
CONCLUSION: RTS frequently coexists with treatment-resistant LE. Comparing PIN-CSA with the asymptomatic side, along with the US-guided PIN block, enhances diagnostic accuracy.

Keywords:  Electromyography; lateral epicondylitis; posterior interosseous nerve; radial tunnel syndrome; ultrasonography

DOI:  https://doi.org/10.1097/PHM.0000000000002877
J Med Ultrason (2001). 2025 Oct 16.

Ultrasound-guided Achilles tendon rupture repair using knotless barbed suture: a cadaveric study.

Toru Omodani, Michael Khadavi, Yoshifumi Takatsume, Alexandre Lavigne.

   PURPOSE: To describe a novel, minimally invasive, ultrasound-guided Achilles tendon repair technique using a knotless barbed suture and to assess its feasibility in a cadaveric model.
METHODS: A midportion Achilles tendon rupture was simulated in a Thiel-embalmed cadaver. The tendon was repaired percutaneously under ultrasound guidance using a 0.6-mm USP 1 knotless barbed suture mounted on a 19-gauge, 3.5-inch curved needle. The needle was advanced intratendinously under continuous ultrasound guidance. Tendon reapproximation was assessed with ultrasound and confirmed by anatomical dissection. The resting plantar flexion angle was measured before and after the repair.
RESULTS: The Achilles tendon repair technique resulted in successful reapproximation of the tendon ends with anatomic alignment. Post-repair ultrasound and dissection confirmed accurate intratendinous suture placement and full tendon continuity. The resting plantar flexion angle increased from 23° to 50° after the repair.
CONCLUSION: This is the first report of an ultrasound-guided Achilles tendon repair using a knotless barbed suture. The technique appears feasible in a cadaveric model and may represent a promising minimally invasive option for patients requiring improved tendon approximation. Its office-based approach may reduce surgical risks associated with conventional repair and tendon elongation seen with conservative treatment. Further biomechanical and clinical studies are warranted to evaluate its safety, durability, and functional outcomes.

Keywords:  Achilles tendon repair; Achilles tendon rupture; Barbed suture; Ultrasound; Ultrasound-guided surgery

DOI:  https://doi.org/10.1007/s10396-025-01592-7
Am J Phys Med Rehabil. 2025 Oct 07.

Sudden Hip Pain and Functional Decline in a Stroke Rehabilitation Patient with Antiphospholipid Syndrome.

Muhammed Korkut, Yakup Erden, Mustafa Hüseyin Temel.



Keywords:  Antiphospholipid syndrome; Iliopsoas hematoma; Stroke Rehabilitation; Ultrasonography

DOI:  https://doi.org/10.1097/PHM.0000000000002868
Spine (Phila Pa 1976). 2025 Oct 14.

Comparative Effectiveness of Radiofrequency Ablation, Cryoablation, and Endoscopic Denervation for Lumbar Facet Pain: A Multicenter Trial.

Ladislav Kočan, Róbert Rapčan, Juraj Mláka, Martin Griger, Ľubomír Poliak, Peter Lenčeš, Lenka Kovaličová, Eva Manik, Nath Sherdil, Miroslav Burianek, Janka Vašková.

   STUDY DESIGN: Multicenter, prospective, randomized trial. Trial Registration: ClinicalTrials.gov Identifier: NCT05813639.
BACKGROUND: Lumbar facet joint syndrome is a common cause of chronic low back pain, often resistant to conservative treatment. Interventional options such as radiofrequency ablation (RF), cryoablation (Cry), and endoscopic facet denervation (ED) are increasingly used, yet head-to-head comparisons are limited.
OBJECTIVE: To compare the long-term clinical effectiveness of RFA, Cry, and ED in patients with confirmed facet-mediated low back pain.
METHODS: 62 patients with chronic lumbar back pain and ≥70% relief after controlled diagnostic medial branch blocks were randomized to receive RFA (n=19), Cry (n=23), or ED (n=20). Primary outcomes included changes in back and leg pain intensity (Numeric Rating Scale) and functional disability (Oswestry Disability Index) at 3, 6, 12, and 24 months post-intervention.
RESULTS: All three treatment groups showed significant and sustained improvements in back pain and functional status over the two-year follow-up. RFA provided the most consistent long-term relief. Cry showed comparable early and mid-term efficacy, though leg pain relief diminished by 24 months. ED achieved rapid early improvement in back pain, but had limited and less durable effects on referred leg pain. No statistically significant differences were observed between groups in any of the outcome measures.
CONCLUSIONS: RF, Cry, and ED are all effective and safe treatment modalities for lumbar facet joint syndrome. While RF remains the most established option, Cry and ED may be considered viable alternatives in appropriately selected patients. Treatment should be tailored based on clinical context, patient preferences, and available resources. Further large-scale studies are needed to refine patient selection and optimize outcomes.

Keywords:  chronic low back pain; cryoablation; endoscopic denervation; lumbar facet joint syndrome; radiofrequency ablation

DOI:  https://doi.org/10.1097/BRS.0000000000005539
Circ Rep. 2025 Oct 10. 7(10): 877-885

Sustained Post-Intervention Effects of Small Community Walking on Physical Activity, Well-Being, and Social Capital Among Older Patients With Cardiovascular Disease in the Chronic Phase　- A Follow-up Multicenter Randomized Controlled Trial.

Ryo Yamashita, Shinji Sato, Yasutomo Sakai, Kotaro Tamari, Eisaku Harada, Shigeki Tsuzuku, Taishi Nakamura, Shinsuke Hanatani, Yoshinori Yamanouchi, Akira Nozuhara, Tomonori Kanazawa, Kenichi Tsujita.

   Background: Because the sustained effects of physical activity (PA) and the positive psychological and social aspects during the chronic phase of cardiac rehabilitation (CR) have not been clarified, we examined the sustained post-intervention effects of small community walking (SCW) on PA, well-being, and individual-level social capital in older patients with cardiovascular disease (CVD) in the chronic phase and the influence of increased well-being and social capital on increased PA.
Methods and Results: The subjects were 48 older patients with CVD who were randomly divided into SCW and walking-alone groups and were available for a 6-month follow-up survey after a 3 months' intervention by healthcare workers. We measured PA, well-being (subjective happiness scale), and social capital before, 3 months after the intervention, and 6 months after the intervention ended. At 6 months post-intervention, only the SCW group maintained significant increases from the pre-intervention values in PA and well-being (P<0.01). Furthermore, increased well-being was a predictor of increased PA in the SCW group (P<0.01).
Conclusions: Our results suggest that SCW effectively maintains PA and well-being, even after the intervention ends, in older patients with CVD during the chronic phase. In addition, the effects of SCW are associated with PA and well-being. The relationship between PA and individual-level social capital should be further investigated.

Keywords:  Cardiac rehabilitation; Chronic phase; Physical activity; Small community walking; Well-being

DOI:  https://doi.org/10.1253/circrep.CR-25-0034
Diagnostics (Basel). 2025 Oct 07. pii: 2531. [Epub ahead of print]15(19):

Beyond Nerve Entrapment: A Narrative Review of Muscle-Tendon Pathologies in Deep Gluteal Syndrome.

Yong Hyun Yoon, Ji Hyo Hwang, Ho Won Lee, MinJae Lee, Chanwool Park, Jonghyeok Lee, Seungbeom Kim, JaeYoung Lee, Jeimylo C de Castro, King Hei Stanley Lam, Teinny Suryadi, Kwan Hyun Youn.

  Deep Gluteal Syndrome (DGS) has traditionally been defined as a clinical entity caused by sciatic nerve (SN) entrapment. However, recent anatomical and imaging studies suggest that muscle- and tendon-origin pathologies-including enthesopathy-may also serve as primary pain generators. This narrative review aims to broaden the current understanding of DGS by integrating muscle and tendon pathologies into its diagnostic and therapeutic framework. The literature was selectively reviewed from PubMed, Cochrane Library, Google Scholar, PEDro, and Web of Science to identify clinically relevant studies illustrating evolving concepts in DGS pathophysiology, diagnosis, and management. We review clinical features and diagnostic tools including physical examination, MRI, and dynamic ultrasonography, with special attention to deep external rotator enthesopathy. Treatment strategies are summarized, including conservative therapy, ultrasound-guided injections, hydrodissection, and prolotherapy. This narrative synthesis underscores the importance of recognizing muscle-origin enthesopathy and soft-tissue pathologies as significant contributors to DGS. A pathophysiology-based, multimodal approach is essential for accurate diagnosis and effective treatment.

Keywords:  deep gluteal syndrome; diagnostic algorithm; enthesopathy; hydrodissection; piriformis syndrome; prolotherapy; sciatic nerve entrapment; ultrasonography

DOI:  https://doi.org/10.3390/diagnostics15192531
J Clin Med. 2025 Sep 28. pii: 6858. [Epub ahead of print]14(19):

Exploring the Effectiveness of Immersive Virtual Reality Rehabilitation for Parkinson's Disease: A Narrative Review.

Roxana Nartea, Daniela Poenaru, Mariana Isabela Constantinovici, Claudia Gabriela Potcovaru, Delia Cinteza.

  Parkinson's disease (PD) presents an association of motor and non-motor impairments that impact the independence and quality of life of individuals. Rehabilitation programs must address multiple domains, simultaneously maintaining patients' adherence and the implications of the disease. Immersive virtual-reality-based rehabilitation (IVRBR) is a promising alternative tool, or can be used in conjunction with traditional or passive programs, using interactive tasks in valid environments with specific training programs adapted to each individual's needs. This narrative review synthesizes the medical literature published in the last decade from PubMed, Scopus, and Web of Science, on the effectiveness, limitations, and implementations of IVRBR in PD patients. Evidence from RTCs and non-RTCs suggests that IVRBR can improve balance, motor learning, and dual task performance. At the same time, the evidence suggests that it can improve cognitive and emotional status. The integration of objective assessment tools (motion and posture analyses, wearable sensors, center of pressures and machine learning models capable of predicting freezing gait-FoG) enhances clinical and individualized rehabilitation programs. However, the evidence base remains limited, with a small sample size, heterogeneity in measured outcomes, and short follow-up duration. In general, reported adverse reactions were minor, but required standardized reporting patterns. Implementation is challenging due to the equipment cost and varying technological demands, but also due to patient selection and training of the medical personnel. IVRBR is a feasible and engaging alternative or can form part of an individualized rehabilitation program in PD patients; however, future large RTCs, long-term follow-up with standardized protocols, cost-effectiveness analyses, and integration of predictive modeling are essential for its broader clinical usage.

Keywords:  Parkinson’s disease; immersive virtual rehabilitation; rehabilitation; virtual reality

DOI:  https://doi.org/10.3390/jcm14196858
J Ultrasound Med. 2025 Oct 16.

Sonographic Findings of Latissimus Dorsi and Teres Major Injuries in Overhead Athletes: A Pictorial Review.

Robert Pagan-Rosado, Jay Smith, Joshua Romero, Wesley Troyer, Brett Kindle.

  Latissimus dorsi (LD) and teres major (TMA) injuries are increasingly recognized as significant sources of pain in overhead athletes, particularly pitchers. These injuries are challenging to diagnose clinically, and conventional MRI often lacks sufficient detail to fully evaluate them. Musculoskeletal ultrasound (US) offers dynamic, high-resolution evaluation and may better characterize these injuries. This pictorial review illustrates the sonographic appearance of common LD and TMA injuries, aiming to enhance diagnostic accuracy, increase clinician familiarity with this region, and support future research in injury classification using ultrasound.

Keywords:  injuries; latissimus dorsi; overhead athletes; shoulder; teres major; ultrasound

DOI:  https://doi.org/10.1002/jum.70094
Diagnostics (Basel). 2025 Sep 24. pii: 2437. [Epub ahead of print]15(19):

Innovative Dynamic Ultrasound Diagnosis of First Rib Stress Fracture in an Adolescent Athlete-A Case Report.

Yonghyun Yoon, King Hei Stanley Lam, Chanwool Park, Jaeyoung Lee, Jangkeun Kye, Hyeeun Kim, Seonghwan Kim, Junhan Kang, Anwar Suhaimi, Teinny Suryadi, Daniel Chiung-Jui Su, Kenneth Dean Reeves, Stephen Cavallino.

  Background: First rib stress fractures (FRSFs) are exceptionally rare in skeletally immature athletes and are frequently overlooked because their symptoms mimic more common scapular conditions such as scapular dyskinesis or thoracic outlet syndrome. Early and accurate identification is critical to avoid delayed union, prolonged disability, and misdirected management. Case Presentation: We report a 12-year-old elite baseball pitcher with progressive scapular winging and audible snapping during pitching. Unlike typical posterior-type fractures near the costotransverse joint, imaging revealed a cortical discontinuity precisely at the serratus anterior enthesis, consistent with repetitive traction enthesopathy. High-resolution musculoskeletal ultrasound (MSK-US) identified cortical disruption with periosteal edema, and dynamic ultrasound reproduced the patient's snapping and pain in real time, establishing a direct clinical-imaging correlation. Conservative three-phase rehabilitation (scapular stabilization, serratus anterior activation, and structured return-to-throwing) led to complete union and pain-free return to sport within 12 weeks. Discussion: This case highlights the superior diagnostic efficacy of MSK-US for FRSFs in adolescents. The posterior scanning approach facilitated bilateral comparison and growth plate assessment. Dynamic examination provided a functional correlation beyond static imaging, identifying a novel snapping mechanism. This underscores the value of MSK-US in visualizing not just anatomy but also pathophysiology. Conclusions: This is among the youngest documented cases of first rib stress fracture diagnosed with dynamic ultrasound. Its novelty lies in the following: (1) occurrence at the serratus anterior enthesis, (2) reproduction of snapping during provocative maneuvers, and (3) expansion of the etiological spectrum of scapular dyskinesis to include rib pathology. Dynamic ultrasound should be considered a frontline modality for adolescent throwers with unexplained periscapular pain.

Keywords:  adolescent athletes; dynamic ultrasound; enthesopathy; first rib stress fracture; overhead throwing injury; scapular winging; ultrasound diagnosis

DOI:  https://doi.org/10.3390/diagnostics15192437
Nutrients. 2025 Sep 30. pii: 3129. [Epub ahead of print]17(19):

Hydration Status in Geriatric Patients-Subjective Impression or Objective Parameter? The Hydr-Age-Study.

Linda Deissler, Matthias Janneck, Rainer Wirth, Alexander Fierenz, Ulrich Thiem, Alexander Rösler.

  Background/Objectives: Assessing the hydration status (HS) in geriatric patients remains challenging due to multimorbidity, polypharmacy, and cognitive impairment. Common indicators like reduced skin turgor and dry mucous membranes are unreliable. The Hydr-Age-Study is a prospective observational pilot study with a post hoc analysis to evaluate the diagnostic accuracy of clinical, laboratory, and instrumental methods to assess HS in hospitalised older adults. Methods: Upon admission, patients underwent an assessment including their medical history, a clinical evaluation, laboratory tests, ultrasound examination, and bioimpedance analysis. These data were collected and independently reviewed by two experts who diagnosed each patient's current HS. This diagnosis served as the clinical reference standard for evaluating the diagnostic accuracy of each method. Results: Twenty-six methods were examined, of which four achieved an AUC > 0.8. Axillary dryness showed a high diagnostic accuracy for hypohydration (AUC = 0.854), with a sensitivity of 83.3% and a specificity of 82.8%. Inferior vena cava (IVC) ultrasound effectively detected both hypo- and hyperhydration. A subxiphoid IVC diameter ≤ 1.95 cm identified hypohydration with 90.9% sensitivity and 50.6% specificity. For hyperhydration, a diameter of ≥2.15 cm provided strong diagnostic performance in both subxiphoid and transcostal views. Conclusions: Axillary dryness and IVC sonography demonstrated the highest diagnostic accuracy. No other methods exceeded an AUC of 0.80. In the absence of a gold standard, a structured clinical consensus provides a feasible and reproducible approach to establish a clinical reference standard. These findings may contribute to the development of a standardised assessment protocol in geriatric medicine.

Keywords:  aged; axillary dryness; diagnostic accuracy; hydration; ultrasonography

DOI:  https://doi.org/10.3390/nu17193129
Front Rehabil Sci. 2025 ;6 1686925

Editorial: Advances on participation perspective in rehabilitation sciences.

Mert Doğan, Özgün Kaya Kara.



Keywords:  ICF; activity; body function and structure; framework; participation; rehabilitation

DOI:  https://doi.org/10.3389/fresc.2025.1686925
Postgrad Med J. 2025 Oct 11. pii: qgaf171. [Epub ahead of print]

The impact of community-based Tai Chi exercise on intrinsic capacity improvement in the elderly: a meta-analysis of randomized controlled trials.

Yanzhi Lan, Jordan Tovera Salvador, Sa Zhang, Meng Wu.

   BACKGROUND: With global population aging, the decline in intrinsic capacity-crucial for health and independence of older adults-has become a major concern.
OBJECTIVE: With global population aging, the decline in intrinsic capacity-crucial for health and independence of older adults-has become a major concern. To evaluate the effects of community-based Tai Chi on intrinsic capacity in elderly populations.
METHODS: A meta-analysis of 26 randomized controlled trials (RCTs) including 3275 participants aged ≥60 years was conducted. Intervention durations ranged from 6 to 72 weeks. Outcomes assessed included activities of daily living, cognitive function, motor function, and depressive symptoms. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated.
RESULTS: Tai Chi interventions significantly improved activities of daily living (SMD = 1.11), cognitive function (SMD = 0.44), motor function (SMD = -0.50), and depressive symptoms (SMD = -0.79). The intervention was consistently effective across various program lengths and settings.
CONCLUSION: Community-based Tai Chi is a low-cost, low-risk intervention that enhances intrinsic capacity, particularly motor, cognitive, and psychological domains, in older adults. It should be considered in managing age-related decline. Further large-scale, long-term RCTs are warranted to confirm these findings and clarify underlying mechanisms. Key message What is already known on this topic: Decline in intrinsic capacity threatens independence and well-being in older adults. Tai Chi has been reported to improve balance, cognition, and mood, but evidence on its overall effect across multiple domains of intrinsic capacity has been inconsistent. What this study adds: This meta-analysis of 26 RCTs demonstrates that community-based Tai Chi significantly improves activities of daily living, cognitive function, motor function, and depressive symptoms in elderly populations. How this study might affect research, practice or policy: Findings support the integration of Tai Chi into community-based aging programs as a safe, low-cost strategy to preserve intrinsic capacity. Future large-scale, long-term studies could refine protocols and inform public health policy on healthy aging.

Keywords:  Tai Chi; cognitive function; depression; meta-analysis; motor function

DOI:  https://doi.org/10.1093/postmj/qgaf171
BMJ Open. 2025 Oct 15. 15(10): e106975

Instruments for assessing social support in social networks and in the self-management and rehabilitation process of persons poststroke: a scoping review protocol.

Marcus Falk Johansson, Afsaneh Taei, Linnea McCarthy, Catharina Gustavsson, Signe Tomsone, Maya Kylén, Marie Elf.

   INTRODUCTION: As care and rehabilitation poststroke are increasingly moving into persons' home environment, the importance of support from social networks in self-management and rehabilitation has emerged as an important topic for research and practice. While there are instruments used to assess social support and collective efficacy, a clearer scope of the availability and quality of these instruments is needed. This clarification will enable the development of interventions integrating social network perspectives in poststroke rehabilitation.
METHODS AND ANALYSIS: To assess the availability and quality of instruments assessing social support and collective efficacy, a scoping review will be conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews guidelines (PRISMA-ScR). Literature searches conducted between 14 November 2024 and 15 November 2024 in the CINAHL and PubMed/Medline databases resulted in 4631 articles potentially eligible. After removing duplicates, 4121 articles' titles and abstracts were initially screened. Full-text screening, searches of reference lists and data extraction started in June 2025. Starting August 2025, two reviewers will assess the full texts against the inclusion criteria in Covidence using a coding template. Identified instruments will be appraised following the COSMIN (Consensus-based Standards for the selection of health Measurement INstruments guidelines) and analysed using a narrative descriptive method. Results will be reported in February 2026 according to PRISMA-ScR guidelines.
ETHICS AND DISSEMINATION: Ethical approval is not required for this scoping review, as it does not involve primary data. However, this review follows established ethical guidelines and best practices, and included studies will be reviewed to ensure that they received ethical approval and included informed consent. Results from the review will be disseminated through an article in a scientific journal, at relevant conferences and surmised to stroke organisations. A policy brief will be developed for health and social care professionals and policy makers.

Keywords:  Rehabilitation medicine; Social Support; Stroke

DOI:  https://doi.org/10.1136/bmjopen-2025-106975
Neurol Sci. 2025 Oct 18.

Safety and effectiveness of Co-careldopa for motor recovery in post-stroke patients: A Systematic Review.

Ayesha Younas, Maria Qadri, Rizwana Noor, Lamiya Pirzada, Tehreem Khan, Mariam Anwar, Iqra Shahid, Hafsa Arshad Azam Raja, Aqsa Munir, Brijesh Sathian, Javed Iqbal.

   BACKGROUND: Strokeremains a major global contributor to long-term disability, with motor impairments being among the most debilitating outcomes. Co-careldopa, a combination of levodopa and carbidopa, has been proposed as an adjunct to physiotherapy to enhance motor recovery. However, its clinical efficacy and safety profile are still under investigation. This systematic review evaluates the therapeutic potential and tolerability of co-careldopa in post-stroke motor rehabilitation.
METHODS: Acomprehensive literature search was conducted across PubMed, Google Scholar and Cochrane Library, up to July 2024. Randomized controlled trials and clinical trials comparing co-careldopa to placebo in post-stroke patients were included. Data extraction and screening were performed independently by two reviewers, and methodological quality was assessed using the Cochrane RoB 2.0 tool.
RESULTS: Follow-up periods across studies ranged from 5 weeks to 12 months. Short-term motor improvements were observed, along with reporting significant gains in Rivermead Motor Assessment scores, and another study noting a 79.1% improvement in motor indices among cortical stroke patients versus 49% in controls. However, the largest multicenter trial, found no significant long-term benefit in walking ability. Psychological outcomes showed modest improvements in mood and caregiver burden, while cognitive function remained largely unaffected. Adverse events were infrequent and mild, including nausea and muscle stiffness, with few serious drug-related incidents.
CONCLUSION: Co-careldopa may support motor recovery in early stroke phases and is generally well-tolerated. Nonetheless, further robust trials are needed to confirm its long-term efficacy and broader clinical utility.

Keywords:  Brain infarction; Cerebrovascular accident; Co-careldopa; Hemorrhagic stroke; Ischemic stroke; Levodopa; Rivermead Mobility Index; Stroke

DOI:  https://doi.org/10.1007/s10072-025-08492-1
Front Physiol. 2025 ;16 1681184

The role of exercise induced capillarization adaptations in skeletal muscle aging: a systematic review.

Yi Ding, Qiliang Wan, Jae Cheol Kim, Wenduo Liu, Weiping Ji.

   Background: Skeletal muscle aging is often accompanied by capillary rarefaction, which limits the effective delivery and distribution of hormones, nutrients, and growth factors within skeletal muscle. Furthermore, exercise is widely regarded as having the potential to improve microcirculation and delay skeletal muscle aging. This review aims to explore exercise-induced improvements in capillarization and related adaptations to mitigate the adverse changes that occur during the aging process of skeletal muscle.
Methods: This systematic review was conducted in accordance with the PRISMA guidelines and registered in the PROSPERO database under the identifier CRD420251055873. Studies involving exercise interventions in older adults were included, with the requirement that at least one original outcome related to skeletal muscle capillarization was reported. Articles were rigorously screened based on the PICOS criteria, and the quality of the included studies was assessed.
Results: Studies have shown that older adults still possess the capacity to improve skeletal muscle capillarization through exercise. Moderate-intensity aerobic exercise not only significantly enhances the level of capillarization but also induces effects that can be maintained even after cessation of training. Capillarization adaptations induced by resistance training exhibit marked inter-individual variability, which is primarily determined by each individual's baseline level of capillarization, thereby resulting in distinct patterns of adaptation. The studies also revealed that the regulation of capillarization depends on the synergistic action of VEGF and eNOS, and that different types of exercise may elicit adaptations through distinct molecular pathways.
Conclusion: During the aging process, exercise-induced improvements in capillarization can enhance nutrient delivery, metabolic efficiency, and regenerative capacity in skeletal muscle. To some extent, these adaptations help suppress degenerative changes in muscle function and provide a targeted foundation for anti-aging intervention strategies.

Keywords:  aerobic exercise; capillarization; exercise adaptation; resistance training; skeletal muscle aging

DOI:  https://doi.org/10.3389/fphys.2025.1681184
J Assoc Physicians India. 2025 Oct;73(10): 88-92

Review of Safety and Efficacy of Polmacoxib: A Novel Dual Inhibitor of Cyclo-oxygenase 2 and Carbonic Anhydrase in Osteoarthritis and Acute Painful Conditions.

Vijaya Sandeep Gunjal, Roshan Rambhau Pawar, Akhilesh Dayanand Sharma.

Osteoarthritis (OA) is a chronic degenerative joint disorder and a leading cause of pain and disability among the elderly. Traditional nonsteroidal anti-inflammatory drugs (NSAIDs), though effective in symptom relief, pose significant risks of gastrointestinal, cardiovascular, and renal complications, especially in long-term use. Polmacoxib (CG100649) is a newer NSAID with its dual inhibitory role on cyclooxygenase-2 (COX-2) and carbonic anhydrase (CA), planned to offer higher therapeutic efficacy and safety. This review critically examines the pharmacodynamic and pharmacokinetic properties of polmacoxib, along with its clinical efficacy and safety in OA and acute pain conditions. Clinical trials across phases I-III consistently show polmacoxib to be well tolerated and effective in pain relief and efficient improvement of the joint, with a safety profile comparable to or better than traditional COX-2 inhibitors like celecoxib. Recent trials also explore its role in combination therapies for acute pain management, including dental and postoperative settings, showing noninferiority to standard regimens and fewer adverse events. Its innovative mechanism and pharmacological profile support its potential as a next-generation NSAID for OA and pain management, particularly in populations at high risk for NSAID-induced adverse effects. Further larger long-term studies are warranted to confirm its medical benefits and broader therapeutic applications.

DOI: https://doi.org/10.59556/japi.73.1180
Front Nutr. 2025 ;12 1642166

Vitamin D and cancer-related fatigue in elderly patients: mechanisms and therapeutic insights-a narrative review.

Juan Wu, Jinzheng Chi, Yu Zhang.

  Cancer-related fatigue (CRF) is a prevalent and debilitating symptom in elderly cancer patients. According to the National Comprehensive Cancer Network (NCCN) and international consensus, CRF is defined as a persistent, multidimensional fatigue disproportionate to activity, unrelieved by rest, and involving physical, emotional, and cognitive domains. Diagnosis requires standardized patient-reported scales, objective biomarkers (e.g., inflammatory and metabolic indices), and exclusion of comorbidities such as anemia or organ dysfunction. In elderly patients, CRF arises from interrelated alterations, including chronic inflammation, neuroendocrine dysregulation, circadian disruption, and progressive muscle atrophy, that perpetuate a vicious cycle. Current treatments encompass pharmacological agents (e.g., corticosteroids, psychostimulants, antidepressants, and traditional Chinese medicine, primarily studied in China) and non-pharmacological modalities (e.g., exercise, acupuncture, and cognitive-behavioral therapy), yet efficacy remains inconsistent. Emerging approaches such as mitochondrial modulators and bright light therapy are expanding the therapeutic landscape. Vitamin D, particularly cholecalciferol (vitamin D3), is commonly deficient in older adults and shows promise in alleviating CRF through anti-inflammatory, immunomodulatory, neuroprotective, and myogenic effects. This narrative review summarizes current evidence on vitamin D3's mechanisms and clinical value, highlights its role as a multi-target modulator, and explores its integration into personalized CRF management. Future studies should refine dosing strategies, clarify responses in the elderly, and assess the synergy between conventional and novel interventions.

Keywords:  cancer-related fatigue; elderly cancer patients; inflammation; muscle atrophy; personalized therapy; vitamin D

DOI:  https://doi.org/10.3389/fnut.2025.1642166
J Orthop Sci. 2025 Oct 11. pii: S0949-2658(25)00281-7. [Epub ahead of print]

Utility of GLFS-25 as a patient-reported outcome measure for older patients with lumbar spinal stenosis: A two-year retrospective cohort study.

Kohei Shibata, Soya Kawabata, Yuki Akaike, Takehiro Michikawa, Takaya Imai, Sota Nagai, Hiroki Takeda, Shinjiro Kaneko, Nobuyuki Fujita.

   BACKGROUND: The 25-question Geriatric Locomotive Function Scale (GLFS-25) is a patient-reported outcome measure (PROM) for assessing locomotive syndrome, which reflects mobility limitations due to musculoskeletal decline in older adults. Although lumbar spinal stenosis (LSS) is a major contributor to locomotive syndrome, the utility of GLFS-25 in evaluating the clinical status of older patients with LSS remains unclear. This study aimed to evaluate the GLFS-25 as a disease-specific PROM for older adults with LSS by comparing it with established tools such as the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and Zurich Claudication Questionnaire (ZCQ).
METHODS: This retrospective cohort study included 206 patients aged ≥65 years who underwent surgery for LSS. GLFS-25, JOABPEQ, and ZCQ scores were collected preoperatively and at 6 months, 1 year, and 2 years postoperatively. Correlations between the GLFS-25 and other PROMs were analyzed. Locomotive syndrome stages were determined based on GLFS-25 scores. The predictive accuracy of ZCQ satisfaction scores for postoperative improvement in the locomotive syndrome stage was assessed using receiver operating characteristic analysis.
RESULTS: GLFS-25 showed weak to moderate correlations with the five JOABPEQ domains and both ZCQ subscales. Patients with greater improvements in the locomotive syndrome stage also demonstrated higher proportions of treatment efficacy in the JOABPEQ domains. The ZCQ satisfaction score at 2 years postoperatively was a strong predictor of locomotive syndrome stage improvement, with an area under the curve of 0.858. The optimal satisfaction score cutoff for improvement in the locomotive syndrome stage was 1.917 (sensitivity: 80.0 %, specificity: 80.6 %).
CONCLUSIONS: The GLFS-25 reflects clinical changes in older patients with LSS and correlates well with established PROMs. This tool may enable valid cross-sectional and longitudinal assessment of surgical outcomes for older patients with LSS. A ZCQ satisfaction score of approximately 1.9 indicates a meaningful improvement in the locomotive syndrome stage.

Keywords:  GLFS-25; JOABPEQ; Locomotive syndrome; Lumbar spinal stenosis; Older patient; ZCQ

DOI:  https://doi.org/10.1016/j.jos.2025.09.010
PLoS One. 2025 ;20(10): e0334321

Cognitive-motor dual task induces strategic kinematic adjustments with increased toe-obstacle clearance for older adults during obstacle crossing.

Shiuan-Huei Lu, Yi-Chun Kuan, Kuan-Wen Wu, Ting-Ming Wang, Tung-Wu Lu.

BACKGROUND AND OBJECTIVES: Falls among older adults, especially during obstacle crossing, lead to severe outcomes like fractures and higher healthcare costs due to declining cognitive and motor functions. The study aimed to quantify the kinematic adjustments at individual joints and end-points of the pelvis-leg apparatus in older adults during cognitive-motor dual task involved crossing obstacles of varying heights while performing serial subtraction.
METHODS: Sixteen healthy older adults each walked and crossed obstacle of three varying heights with leading and trailing limb under single-task and dual-task conditions. Toe-obstacle clearances and pelvic and lower limb angular motions were calculated. Two-way analyses of variance were conducted to study within-subject (task and height) effects on the variables.
RESULTS: Older adults showed significantly reduced crossing speed and increased leading and trailing toe-obstacle clearances. During dual-task obstacle crossing, there were increased pelvic anterior tilt, swing hip abduction and knee flexion, but decreased stance hip adduction at leading-limb crossing, compared to single-task (p < 0.05). There were increased in pelvic posterior tilt and swing knee flexion, but decreased pelvic upward list, stance hip adduction and stance knee flexion during dual-task obstacle crossing at trailing-limb crossing (p < 0.05).
DISCUSSION AND IMPLICATIONS: The study found healthy older adults showed reduced crossing speed and adapting behaviour, with distinct kinematic changes at the pelvis, hip, and knee joints, leading to increased toe-obstacle clearances. While this may affect balance adversely. To mitigate fall risks, older adults should consider balance training and avoid distractions like phone use during obstacle crossing. Future studies should explore unexpected obstacles and its effects on at-risk populations.

DOI: https://doi.org/10.1371/journal.pone.0334321
Curr Urol Rep. 2025 Oct 16. 26(1): 66

Urologic Manifestations of Nonrelaxing Pelvic Floor Dysfunction: Insights on Clinical Workup and Management.

Andrew S Afyouni, Narmina Khanmammadova, Alireza Bozorgi, Akhil K Das, Joel Gelman, Zhina Sadeghi.

   PURPOSE OF REVIEW: Non-relaxing pelvic floor dysfunction (NR-PFD) is a poorly understood and underdiagnosed cause of voiding dysfunction in patients without clear anatomic or neurologic obstruction. Symptoms may include pelvic pain, urinary complaints, defecatory dysfunction, and sexual issues, but their variability makes NR-PFD challenging to recognize and manage. This review focuses on the urologic manifestations of NR-PFD and outlines current diagnostic and treatment strategies.
RECENT FINDINGS: Video urodynamics and surface EMG, alongside focused physical examination, are key tools for diagnosing NR-PFD. Pelvic floor physical therapy remains the first-line treatment, with strong evidence supporting its efficacy across sexes. Adjunctive options, including biofeedback, trigger point injections, botulinum toxin, and sacral neuromodulation, can benefit patients with refractory symptoms. Cognitive behavioral therapy and integrative modalities are also increasingly utilized. NR-PFD is an underrecognized cause of functional bladder outlet obstruction and complex LUTS. Management should be individualized and multidisciplinary. Future studies are needed to standardize diagnostic criteria and refine treatment algorithms.

Keywords:  Dyssynergic voiding; Functional bladder outlet obstruction; Lower urinary tract symptoms; Non-relaxing pelvic floor dysfunction; Pelvic floor dysfunction; Voiding dysfunction

DOI:  https://doi.org/10.1007/s11934-025-01290-4
BMJ. 2025 Oct 15. 391 r2121

SGLT-2 inhibitors for the prevention of autoimmune rheumatic diseases.

Derin Karacabeyli, Diane Lacaille.

DOI: https://doi.org/10.1136/bmj.r2121
J Clin Med. 2025 Sep 26. pii: 6820. [Epub ahead of print]14(19):

Neurocognitive Interventions Informed by Cognitive-Behavioral Therapy (CBT) Principles and Physical Exercise for Complex Regional Pain Syndrome: A Systematic Review.

Leidy Tatiana Ordoñez-Mora, Daihana Stefany Quintero-López, Marco Antonio Morales-Osorio, Juan Fernando Gómez-Gómez, Giovanna Patricia Rivas-Tafurt, María Fernanda Serna-Orozco.

  Background: Complex Regional Pain Syndrome (CRPS) is a chronic pain condition that usually affects a limb following injury or surgery and is characterized by severe pain accompanied by sensory, motor, autonomic, and trophic disturbances. Methods: This systematic review aimed to synthesize the available evidence on the effectiveness of physical exercise and neurocognitive interventions grounded in cognitive-behavioral therapy (CBT) principles for the management of CRPS. A comprehensive search was conducted in Medline (via Ovid), LILACS, ScienceDirect, PEDro, OTseeker, and the Cochrane Central Register of Controlled Trials (CENTRAL). Eligible studies included clinical trials, cohort studies, and cross-sectional studies, whereas case reports, pediatric populations, and animal studies were excluded. Fifteen studies met the inclusion criteria. Results: The findings indicated that aerobic exercise was consistently associated with pain reduction and functional improvement. Neurocognitive interventions informed by CBT principles, such as mirror therapy and graded exposure, also demonstrated efficacy in decreasing pain and enhancing functional independence. Most studies supported the effectiveness of these approaches in the management of CRPS. Overall, both physical exercise and neurocognitive interventions grounded in CBT principles produced positive effects on pain modulation, physical function, and daily activity performance. Conclusions: These findings highlight the therapeutic potential of combining physical and psychologically informed interventions for the treatment of CRPS.

Keywords:  activities of daily living; complex regional pain syndrome; neurocognitive interventions informed by CBT principles; pain; physical function

DOI:  https://doi.org/10.3390/jcm14196820
Diagnostics (Basel). 2025 Sep 26. pii: 2464. [Epub ahead of print]15(19):

Median Nerve Diameter Ratio on Ultrasound as a Complementary Tool to Electrodiagnostic Testing in Carpal Tunnel Syndrome.

Thorsten Lehnhardt, Christian Soost, Jan Adriaan Graw, Rene Burchard, Christopher Bliemel, Artur Barsumyan.

  Background: Carpal tunnel syndrome is a common entrapment neuropathy of the upper limb that has a significant clinical and socioeconomic impact. Sonographic short-axis measurement of the median nerve cross-sectional area is a well-established complement to clinical examination and neurography. This study aimed to evaluate the correlation between the median nerve diameter ratio, distal motor latency, and sensory nerve conduction velocity. Methods: A total of 74 patients (94 hands and 93 evaluations) with carpal tunnel syndrome were examined. Ultrasound was performed using a Siemens Acuson X300 with a 10 MHz linear probe. Median nerve diameters proximal and within the carpal tunnel were measured in a longitudinal scan. The carpal tunnel ratio (proximal diameter/intratunnel diameter) was then calculated and correlated with distal motor latency. Results: No significant correlation was found between distal motor latency and the carpal tunnel ratio (r = 0.018, p = 0.8655). However, a weak, non-significant positive correlation was observed between sensory nerve conduction velocity and carpal tunnel ratio (r = 0.238, p = 0.326). Conclusions: Ultrasound cannot replace electrodiagnostic testing. In this cohort, no statistically significant association was observed between the carpal tunnel ratio and distal motor latency. While our findings do not support the use of this ultrasound parameter as a standalone diagnostic measure, sonographic assessment of the median nerve may still provide complementary information in selected clinical contexts.

Keywords:  carpal tunnel syndrome; distal motor latency; median nerve; ultrasound

DOI:  https://doi.org/10.3390/diagnostics15192464
Clin Rheumatol. 2025 Oct 11.

Ultrasonographic measurement of talar cartilage thickness in patients with rheumatoid arthritis and healthy controls.

Mazlum Serdar Akaltun, Elif Balbal, Ozlem Altindag, Ali Gur.

   AIM: This study aimed to compare talar cartilage thickness in patients with RA and healthy controls and to investigate its association with clinical and demographic variables.
METHOD: Thirty-seven healthy controls and 63 patients with RA diagnosed using the American College of Rheumatology's (ACR) 2010 criteria were included in this cross-sectional observational study. All participants' age, gender, and body mass index (BMI) were recorded. The hospital record system's data was retrieved for the patient group, including medication use, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), seropositivity, and disease duration. VAS was used to assess pain, and DAS-28 was used to assess disease activity. Talar cartilage thickness measurement was performed by the same doctor as the ultrasound. Descriptive statistics of the data obtained from the study were given by mean, standard deviation for numerical variables, and frequency and percentage analysis for categorical variables. Mann-Whitney U test was used for categorical variables with two groups, and Kruskal Wallis test was used for categorical variables with three or more groups in the comparison of parameters according to categorical variables. Analyses were performed with the help of SPSS 22.0 program. p < 0.05 significance level was selected.
RESULTS: There was no discernible difference between the patient and control groups in terms of age, height, weight, gender, or BMI values (p > 0.05). Talar cartilage thickness did not significantly correlate with age, BMI, ESR, CRP, CCP, DAS-28 RF, number of swollen joints, or sensitive joints (p > 0,05). However, talar cartilage thickness, VAS, HAQ values, and disease duration were significantly correlated negatively (p < 0.05).
CONCLUSION: Our study showed that there is a significant decrease in talar cartilage thickness in RA patients, and this decrease is associated with disease duration, pain severity, and functional impairment. Key Points • Talar cartilage thickness was found to be lower in RA patients compared to the control group • Talar cartilage measurements were negatively correlated with disease duration, VAS and HAQ scores • Talar cartilage thickness may be a potential biomarker for assessing early joint damage and monitoring disease progression in RA.

Keywords:  Ankle; Rheumatoid arthritis; Talar cartilage

DOI:  https://doi.org/10.1007/s10067-025-07722-3
J Clin Med. 2025 Sep 30. pii: 6925. [Epub ahead of print]14(19):

Revisiting the Extensor Hallucis Longus Tendon: Anatomical Classification and Orthopedic Implications.

Łukasz Olewnik, Ingrid C Landfald, Paloma Aragonés.

  Background: Anatomical variations of the extensor hallucis longus (EHL) tendon hold significant implications for foot and ankle surgery, yet they remain underrepresented in orthopedic literature. Accurate recognition of these variants is crucial for minimizing iatrogenic injuries and improving surgical outcomes. Aim: This narrative review aims to summarize current anatomical knowledge on EHL tendon morphology, with a particular focus on the classification system proposed by Olewnik et al. Emphasis is placed on its diagnostic, radiological, and surgical relevance. Methods: A comprehensive literature review was conducted, integrating findings from cadaveric dissections, imaging studies, and clinical observations. The Olewnik classification-based on the number and insertion of EHL tendon slips-serves as the organizing framework for the anatomical and surgical discussion. Findings: The Olewnik classification delineates three primary types: Type I (single slip), Type II (two slips, subdivided into IIa-IIc), and Type III (three slips). Each type is discussed in terms of anatomical features, diagnostic challenges on MRI and ultrasound, and implications for surgical exposure, tendon transfer, and graft harvesting. Comparative analysis with prior typologies underscores the enhanced clinical utility of the Olewnik system. Conclusions: The reviewed classification offers a reproducible, imaging-compatible, and surgically applicable framework for understanding EHL tendon variability. Incorporating this system into preoperative planning may enhance procedural safety and precision. Further clinical validation and broader integration into surgical education are warranted.

Keywords:  MRI; anatomical variation; extensor hallucis longus; foot and ankle surgery; imaging; tendon classification; ultrasound

DOI:  https://doi.org/10.3390/jcm14196925
CNS Drugs. 2025 Oct 16.

Managing Chronic Pain: The Ketamine Option.

Gisèle Pickering, Véronique Morel, Marion Voute.

Ketamine, an anaesthetic and sedative drug, has emerged as a promising therapeutic option for the management of chronic refractory pain, but is used off-label in this indication and known for its psychomimetic side-effects. The primary objective of this manuscript is to synthesize the current evidence on ketamine efficacy and safety for chronic refractory pain. Furthermore, it aims to identify critical knowledge gaps and propose a framework for its rational and safe clinical application. This narrative review analyses key findings from randomised and non-randomised clinical trials investigating ketamine's use in chronic pain conditions. It also examines existing clinical guidelines and expert consensus statements to reach a comprehensive clinical perspective. Current evidence demonstrates that ketamine can provide significant short-term analgesia, especially in neuropathic pain, and is fairly well-tolerated in patients with severe refractory pain. However, long-term data on efficacy, cognitive impact, addiction risk and optimal dosing are severely lacking. The intravenous route remains the most studied, while alternatives are still underexplored. Ketamine is not a first-line treatment for pain and must be prescribed and supervised by trained specialists within a structured standard of care. Its future role in pain management hinges on collaborative translational research to define optimal administration routes, establish phenotyping strategies (on the basis of pain type, comorbidities and comedication), and conduct long-term studies assessing mood, quality of life and cognitive function to ensure both efficacy and safety.

DOI: https://doi.org/10.1007/s40263-025-01234-z
Arch Phys Med Rehabil. 2025 Oct 11. pii: S0003-9993(25)00966-9. [Epub ahead of print]

Discriminatory characteristics of responders and non-responders septic patients to neuromuscular electrical stimulation - A subanalysis of a randomized controlled double-blinded trial.

Leandro Teixeira Saraiva, Wesla Neves da Silva Costa, Samantha Torres Grams, Isabel Chateaubriand Diniz Salles, Mariane Tami Amano, Wellington Pereira Yamaguti.

   OBJECTIVE: To define the discriminatory characteristics of patients with sepsis or septic shock, as well as responders and non-responders to the NMES protocol.
DESIGN: This was a sub-analysis of a randomized, controlled, double-blind clinical trial.
SETTING: An intensive care unit (ICU) at a private hospital.
PARTICIPANTS: Fifteen adult patients diagnosed with sepsis or septic shock underwent NMES sessions, among whom eight were classified as the responder group (RG) and seven were classified as the non-responder group (NRG) Interventions: The NMES protocol was initiated at 24 hours after admission with daily sessions. Assessments were performed through ultrasound measurements of the quadriceps femoris muscle and physical function scales.
RESULTS: The rectus femoris thickness was maintained for RG from day 1 to day 4 and reduced by more than 10% for NRG. The Surgical ICU Optimal Mobilization Score (SOMS) statistically differed (p = 0.04) between the RG (2 points; IQI 0.25-3.5) and NRG (score 0) in the initial assessment. De Morton Mobility Index (DEMMI) in the RG increased from 19 ± 20 points to 33 ± 30 points at the final evaluation (p = 0.04), suggesting higher levels of mobility. There was a strong correlation between the initial SOMS (r = 0.72, p = 0.04), DEMMI (r = 0.77, p = 0.02), and muscle thickness in the RG. The NRG exhibited a strong negative correlation between the Sepsis-related Organ Failure Assessment (SOFA) score and rectus femoris thickness at baseline (r = -0.82, p = 0.04).
CONCLUSION: The SOMS and DEMMI could characterize responders to the NMES protocol, whereas the SOFA score did not correlate with responders.

Keywords:  Electrical stimulation therapy; Muscle weakness; Rehabilitation; Sepsis

DOI:  https://doi.org/10.1016/j.apmr.2025.09.027