bims-ricfun Biomed News
on Rehabilitation ICF
Issue of 2025–09–28
forty-nine papers selected by
Gerardo Amilivia, Médica Uruguaya Corporación de Asistencia Médica
  1. Content analysis of PROMIS physical function banks using the international classification of functioning, disability and health.
  2. Problem analysis based on the international classification of functioning, disability and health (ICF) in patients with Takayasu arteritis.
  3. Ultrasound Imaging/Guidance for Superficial Radial (Dorsolateral Branch) Neuropathy After Ganglion Excision Surgery.
  4. Rehabilitation in Conflict (RiC) - a conceptual framework for the rehabilitation sector in fragile settings.
  5. Ultrasound-Guided Interventions for Neuropathic Pain: A Narrative Pictorial Review.
  6. Non-invasive brain stimulation for stroke-related motor impairment and disability: an umbrella review of systematic review and meta-analysis.
  7. Prolotherapy as a Regenerative Treatment in the Management of Chronic Low Back Pain: A Systematic Review.
  8. Revision Surgery for Achilles Tendon Rupture: A Comprehensive Review of Treatment Options, Outcomes, and Complications and the Role of Artificial Intelligence.
  9. Ultrasound-Guided Multi-Branch Rectus Femoris Nerve Block for Spasticity Assessment.
  10. Popliteus Tendon Morphology: Anatomical Classification and Clinical Implications-A Narrative Review.
  11. Lung ultrasound in cardiac rehabilitation: expert consensus on protocols, clinical use, and integration into patient management from the working group on cardiac rehabilitation and cardiovascular prevention of the Italian society of cardiology.
  12. Ultrasound Tissue Characterization of Human Achilles Tendon by Stability Quantification of Echo Patterns.
  13. Clinical Trials of a Stroke Rehabilitation Trainer Employing a Speed-Adapted Treadmill.
  14. Effectiveness of mobile apps in the rehabilitation of patients with low back pain. A systematic review with meta-analysis of randomized controlled trials.
  15. A Systematic Review of the Association Between Pain and Instrumental Activities of Daily Living Disability in Community-Dwelling Older Adults.
  16. Ultrasound-Guided Prolotherapy for Sciatica Secondary to Sacrospinous Ligament Calcification: A Potential and Previously Overlooked Etiological Factor in Deep Gluteal Syndrome-A Case Report and Literature Review.
  17. Association between financial social support and functional disability among older adults: analysis of the ELSI-Brazil.
  18. Latent profile analysis of depressive symptoms in older patients with chronic diseases and their relationship with social support study.
  19. Pain medication associated with decreased physical performance and rehabilitation progress.
  20. Botulinum Toxin: An Unconventional Tool for the Treatment of Depression?
  21. Evaluation of the effectiveness of a rehabilitation program for the improvement of musical performance in a sample of musicians with focal hand dystonia: A case series.
  22. The mediating effect of activities of daily living (ADL) disability on the association between depressive symptoms and cognitive impairment in older adults: a National study.
  23. Efficacy of Conservative Approaches on Pain Relief and Function in Patients With Rotator Cuff Calcific Tendinopathy: Which Is the Best Option? A Systematic Review and Network Meta-Analysis.
  24. Periprosthetic Hip Infections: the possible role of ultrasonography.
  25. Evidence of Multifidus Changes Post-Lumbar Radiofrequency Ablation: A Narrative Literature Review.
  26. Bioengineering Support in the Assessment and Rehabilitation of Low Back Pain.
  27. Feasibility of delivering TeleCHAT: A comprehensive high-dose aphasia treatment via telerehabilitation.
  28. "HOPE-FIT" in Action: A Hybrid Effectiveness-Implementation Protocol for Thriving Wellness in Aging Communities.
  29. Longitudinal Ultrasound Monitoring of Peripheral Muscle Loss in Neurocritical Patients.
  30. Disability Intersectionality and Visibility in Nursing.
  31. Pain in social context: a systematic review protocol.
  32. Ultrasound-guided multifidus injection with 5 % dextrose for lumbar facet syndrome in the emergency department.
  33. Auxiliary effect of clopidogrel on neurological rehabilitation in patients with post-stroke motor disorders.
  34. Comment on 'Adherence to Physical Activity and Incident Mobility Disability in Older Adults With Mobility Limitations' by Álvarez-Bustos et al.
  35. Qualitative evaluation of FMS movement patterns in the course of femoroacetabular impingement in people practising recreational long-distance running.
  36. A review and empirical findings of fasciae and muscle interactions in low back pain.
  37. Low-Cost AI-Enabled Optoelectronic Wearable for Gait and Breathing Monitoring: Design, Validation, and Applications.
  38. Beyond four heads: Should the quadriceps femoris be reclassified as multiceps muscle?
  39. Transcending Measurement: What Matters When Making-with-Music for Equitable Wellbeing in Health and Social Care Systems.
  40. Linkage Among Cognition, Emotion and Behavior: An Interdisciplinary Perspective.
  41. Musculoskeletal Ultrasound Assessment Changes Management Decisions in Rheumatoid Arthritis Patients With Moderate Disease Activity.
  42. Rotator Cuff Tear-induced Changes in Tendon Structure and Mechanics Measured by Quantitative Magnetic Resonance Imaging.
  43. Assessment of dynamic stability and identification of key tasks and parameters in patients with unilateral and bilateral vestibulopathy: a laboratory-based study.
  44. Conservative interventions for managing exercise-related musculoskeletal groin pain.
  45. The Role of Virtual Reality, Exergames, and Digital Technologies in Knee Osteoarthritis Rehabilitation Before or After Total Knee Arthroplasty: A Systematic Review of the Interventions in Elderly Patients.
  46. Rehabilitation Researchers Learning Health Systems Needs Assessment Survey: An Updated Assessment of Research Competencies.
  47. Thickening of the Intramuscular Fascia of the Iliacus Muscle as Evidence of Myofascial Pathology: A New Hip Pain Syndrome.
  48. Ultrasonographic Median Nerve Cross-Sectional Area and Clinical, Electrodiagnostic, and Laboratory Biomarkers in Electrodiagnostically Confirmed Carpal Tunnel Syndrome: A Single-Center Correlational Study.
  49. Lateral Extra-articular Procedures With Anterior Cruciate Ligament Reconstruction: International Consensus.
  1. Qual Life Res. 2025 Sep 25.
    Content analysis of PROMIS physical function banks using the international classification of functioning, disability and health.
    Michelle M Langer, Kathryn C Nesbit, Alex Dien, Theresa Jaramillo, Sang S Pak.
      
    Keywords:  Content validity; Functional measurement; International classification of functioning (ICF); PROMIS physical function; Patient-centered care
    DOI:  https://doi.org/10.1007/s11136-025-04071-1
  2. Respir Med. 2025 Sep 18. pii: S0954-6111(25)00417-2. [Epub ahead of print]248 108354
    Problem analysis based on the international classification of functioning, disability and health (ICF) in patients with Takayasu arteritis.
    Elif Gur Kabul, Sinem Bozcuk, Bilge Basakci Calik, Ayse Nur Bayındır Akbas, Veli Cobankara.
       BACKGROUND: Existing research on Takayasu arteritis has mainly focused on clinical, radiological, and immunological aspects, leaving a significant gap in understanding its functional, psychosocial, and multidimensional impact due to the absence of a disease-specific International Classification of Functioning, Disability, and Health (ICF) framework. This study aimed to analyze the problems of patients with Takayasu arteritis using a phenomenological approach based on the ICF.
    METHODS: A qualitative study was conducted with patients diagnosed with Takayasu arteritis. Eighteen patients were asked six open-ended questions. Their responses were audio-recorded and later transcribed. The responses were divided into meaningful units and linked to the most precise ICF categories by two independent health professionals. To evaluate the appropriateness of the linked ICF categories, sixteen rheumatologists were asked to indicate whether each category represented patients' problems, resources, or environmental aspects.
    RESULTS: Patients' responses were linked to 122 ICF categories by the two health professionals, with a kappa coefficient of 0.774 indicating substantial agreement. Sixteen rheumatologists reviewed the linked categories through two rounds and a mini-Delphi process. Ultimately, 74 ICF categories were confirmed for the Takayasu arteritis Core Set with ≥75 % agreement. Forty-eight patient-identified categories were not confirmed by the rheumatologists (<75 % agreement).
    CONCLUSIONS: The content validity of the ICF Core Set for Takayasu arteritis was supported by expert rheumatologists. This ICF Core Set can be applied to the evaluation of patients with Takayasu arteritis.
    Keywords:  Health; Outcome assessment; Takayasu arteritis
    DOI:  https://doi.org/10.1016/j.rmed.2025.108354
  3. J Clin Ultrasound. 2025 Sep 27.
    Ultrasound Imaging/Guidance for Superficial Radial (Dorsolateral Branch) Neuropathy After Ganglion Excision Surgery.
    Burak Tolga Başoluk, Beytullah Yazar, Levent Özçakar.
      
    DOI:  https://doi.org/10.1002/jcu.70089
  4. Arch Phys Med Rehabil. 2025 Sep 18. pii: S0003-9993(25)00909-8. [Epub ahead of print]
    Rehabilitation in Conflict (RiC) - a conceptual framework for the rehabilitation sector in fragile settings.
    Cornelia Anne Barth, Andreas Wladis, Maggie Donovan-Hall, Fekadu Elias Sadamo, Cliona O'Sullivan.
      Rehabilitation is an essential component of health systems. Yet in fragile, conflict-affected settings it remains neglected despite growing needs. Fragmented governance, disrupted health systems, and political instability hamper sector development. Existing frameworks, including the WHO health system building blocks, the International Classification of Functioning, Disability and Health, and operational tools such as STARS or Emergency Rehabilitation Standards, provide valuable global guidance. However, they are less suited to capture the systemic, cross-sectoral, and contextual complexity of rehabilitation in conflict. This Special Communication introduces the "Rehabilitation in Conflict" (RiC) framework - a conceptual model explicitly designed to support analysis and strengthening of rehabilitation in conflict-affected settings. Developed through a six-step process combining literature review, field-based research, and stakeholder engagement, the framework consists of four interdependent components: Context, Systems, Population, and Services. The RiC framework's novelty lies in its sector-wide perspective: it bridges health, social, political, and humanitarian systems, highlights their dynamic and multidirectional interactions, and positions rehabilitation within the broader realities of conflict. In doing so, the RiC framework fills a critical gap and responds to an urgent need for conceptual clarity to inform rehabilitation planning, assessment, and coordination and strengthening. It is particularly relevant for clinicians, researchers, and policymakers working in global rehabilitation, humanitarian response, and post-conflict recovery. By offering a structured yet flexible approach, the framework invites debate, further adaptation, and application across diverse fragile settings.
    Keywords:  Rehabilitation; armed conflict; crisis; disaster; framework; health system; low resources
    DOI:  https://doi.org/10.1016/j.apmr.2025.09.006
  5. Life (Basel). 2025 Sep 05. pii: 1404. [Epub ahead of print]15(9):
    Ultrasound-Guided Interventions for Neuropathic Pain: A Narrative Pictorial Review.
    Ting-Yu Lin, Ke-Vin Chang, Wei-Ting Wu, Kamal Mezian, Vincenzo Ricci, Levent Özçakar.
      Neuropathic pain presents a persistent therapeutic challenge, arising from diverse etiologies such as trigeminal neuralgia, postherpetic neuralgia, post-amputation pain, painful polyneuropathy, peripheral nerve injury pain, and painful radiculopathy. Given the limitations and side effects associated with pharmacologic treatments, interest in interventional therapies has surged. Herein, ultrasound guidance provides real-time, radiation-free visualization that enhances procedural accuracy and safety. This narrative review synthesizes current evidence on ultrasound-guided techniques-including nerve blocks, pulsed radiofrequency, hydrodissection, and peripheral nerve stimulation-in the management of neuropathic pain. These minimally invasive approaches demonstrate potential in providing significant and durable pain relief, enhancing functional outcomes, and reducing reliance on systemic medications. Notably, much of the existing literature comprises small-scale or observational studies and larger randomized controlled trials are therefore essential to confirm efficacy, define optimal treatment parameters, and inform clinical guidelines for broader adoption.
    Keywords:  chronic pain; injection; nerve block; sonography; ultrasound
    DOI:  https://doi.org/10.3390/life15091404
  6. Front Neurosci. 2025 ;19 1633986
    Non-invasive brain stimulation for stroke-related motor impairment and disability: an umbrella review of systematic review and meta-analysis.
    Beatriz Rithiely, Lívia Shirahige, Patrícia Lima, Maíra Souza, Déborah Marques, Rodrigo Brito, Adriana Baltar, Rafael J Duarte-Moreira, Gabriel Barreto, Rodrigo Andrade, Kátia Nunes-Sá, Abrahão Fontes Baptista, Daniele Piscitelli, Kátia Monte-Silva.
       Introduction: Non-invasive brain stimulation (NIBS) techniques, particularly repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), have shown potential in stroke rehabilitation. However, systematic reviews often reach conflicting conclusions, highlighting the need for an umbrella review.
    Objective: To synthesize, based on the principal domains of the International Classification of Functioning, Disability and Health (ICF) framework, the best available evidence on the effectiveness and safety of NIBS for improving motor impairment and disability after stroke.
    Methods: We conducted an umbrella review (PROSPERO: CRD42021239577) that included meta-analyses of controlled trials investigating NIBS effects in stroke survivors, retrieved from PubMed/MEDLINE from February 2020 to July 2025. Methodological quality was appraised using AMSTAR-2 and certainty of evidence using GRADE. Outcomes were mapped to ICF body structure/function and activity domains.
    Results: Fifty-six studies were included (2-48 primary trials each; 54-1,654 participants per meta-analysis). All included studies evaluated only rTMS and tDCS; no meta-analyses of other NIBS modalities met inclusion criteria. Methodological quality was high or moderate in 85.7% of the meta-analyses. Certainty of evidence was low or very low for 14/50 studies; only one rTMS review provided moderate-certainty evidence for activities of daily living. rTMS showed improvement in activities of daily living (ADL; SMD = -0.82, 95% CI -1.05 to -0.59), upper-limb motor impairment (SMD = -0.32, 95% CI -0.55 to -0.09) and variable effects on mobility from small (SMD = -0.35, 95% CI -0.45 to -0.24) to large (SMD = -0.97, 95% CI -1.28 to -0.66). tDCS was supported by very-low-certainty evidence: small effects were found for motor impairment (SMD = -0.22, 95 % CI -0.32 to -0.12) and upper-limb activity (SMD = -0.31, 95% CI -0.55 to -0.01), while a much smaller subset of trials suggested a large effect (SMD = -1.54, 95% CI -2.78 to -0.29). Effects on ADL and mobility with tDCS were inconsistent and generally non-significant.
    Conclusion: rTMS was more frequently associated with moderate to large effect sizes for body structure/function outcomes, particularly general neurological function. In contrast, tDCS demonstrated small effects on motor recovery, though evidence certainty was very low due to heterogeneity, imprecision, and protocol variability. Within the activity domain, NIBS showed modest effects, with rTMS showing more consistent benefits for ADL. tDCS effects were generally limited and supported by low to very low certainty of evidence.
    Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42021239577.
    Keywords:  evidence-based practice; motor function; neurological rehabilitation; neuroplasticity; recovery; stroke; transcranial direct current stimulation; transcranial magnetic stimulation
    DOI:  https://doi.org/10.3389/fnins.2025.1633986
  7. Medicina (Kaunas). 2025 Sep 02. pii: 1588. [Epub ahead of print]61(9):
    Prolotherapy as a Regenerative Treatment in the Management of Chronic Low Back Pain: A Systematic Review.
    Stelian-Ilie Mociu, Andreea-Dalila Nedelcu, Andreea-Alexandra Lupu, Andreea-Bianca Uzun, Dan-Marcel Iliescu, Elena-Valentina Ionescu, Madalina-Gabriela Iliescu.
      Background: Chronic low back pain markedly impairs quality of life and imposes a significant economic burden on public health. The complex pathophysiology of chronic low back pain arises from the complex anatomical configuration of the lumbar region, which includes a diverse array of structures. Consequently, etiologies may involve intervertebral disc degeneration, facet joint osteoarthritis, spinal stenosis, spondylosis, and spondylolisthesis. Therapeutic interventions for chronic low back pain are equally varied, ranging from pharmacological treatments to physiotherapy, kinetotherapy, balneotherapy, and image-guided local injectable procedures such as prolotherapy. Prolotherapy is a regenerative injection technique designed to stimulate the body's healing processes by applying a regenerative treatment (typically dextrose), which aims to modulate neurogenic inflammation and diminish nociceptive signaling. Methods: A systematic review of the literature was performed in alignment with the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Studies published within the last ten years evaluating the effects of prolotherapy on pain reduction in individuals with chronic low back pain were included, following a search across six databases. Results: The review revealed several studies evaluating the influence of prolotherapy on pain in chronic low back pain patients. Findings were heterogeneous, with some studies indicating significant pain reduction and others showing minimal or no improvement. Conclusions: The current evidence regarding the efficacy of prolotherapy for pain relief in chronic low back pain remains inconclusive, highlighting the necessity for further in-depth research. Continued and updated investigations into prolotherapy's role are imperative for enhancing the quality of life of affected patients.
    Keywords:  chronic low back pain; medical rehabilitation; prolotherapy; quality of life
    DOI:  https://doi.org/10.3390/medicina61091588
  8. Medicina (Kaunas). 2025 Sep 17. pii: 1684. [Epub ahead of print]61(9):
    Revision Surgery for Achilles Tendon Rupture: A Comprehensive Review of Treatment Options, Outcomes, and Complications and the Role of Artificial Intelligence.
    Elena Delmastro, Stefano Colace, Umile Giuseppe Longo, Pieter D'Hooghe, Alberto Marangon, Olimpio Galasso, Giorgio Gasparini, Michele Mercurio.
      Background and Objectives: Achilles tendon ruptures in middle-aged individuals with systemic comorbidities represent a growing clinical challenge. Revision surgery, indicated in cases of tendon re-rupture, remains technically demanding and lacks standardized treatment protocols. This comprehensive review aimed to summarize current evidence regarding indications, outcomes, and complications associated with the most commonly employed revision techniques and explores the potential of artificial intelligence (AI) in improving management and outcomes. Materials and Methods: A literature review was performed in accordance with PRISMA guidelines. The PubMed, MEDLINE, and Cochrane Central databases were used to search keywords. We included articles (1) reporting indications, outcomes, and/or complications of revision surgery for Achilles tendon rupture; (2) reporting a minimum mean follow-up of >12 months; and (3) written in English. Six studies met the inclusion criteria, with a total of 3250 patients analyzed. A methodological quality assessment using the Modified Newcastle-Ottawa Quality Assessment Scale was performed, and all articles were found to be of high quality. Results: Surgical strategies were stratified based on defect size: <2 cm: end-to-end anastomosis; 2-5 cm: V-Y myotendinous lengthening, often combined with tendon transfer; and >5 cm: fascial turndown flaps, autografts (e.g., semitendinosus), or allografts. Tendon transfers showed satisfactory functional outcomes but varied in complication rates. Allografts offered reduced donor site morbidity. The use of AI and wearable sensors has demonstrated potential in preoperative planning, complication prediction, and real-time rehabilitation monitoring. Conclusions: Achilles tendon revision surgery requires a patient-specific, defect-oriented approach. Combined surgical techniques are often necessary for large or non-viable lesions. The integration of AI represents a promising advancement in enhancing surgical decision-making, optimizing rehabilitation, and improving long-term clinical outcomes.
    Keywords:  Achilles tendon rupture; allograft; artificial intelligence; rehabilitation; revision surgery; tendon transfer; treatment algorithms; turndown flaps
    DOI:  https://doi.org/10.3390/medicina61091684
  9. Toxins (Basel). 2025 Sep 01. pii: 437. [Epub ahead of print]17(9):
    Ultrasound-Guided Multi-Branch Rectus Femoris Nerve Block for Spasticity Assessment.
    Stefano Carda, Elisa Grana, Thierry Deltombe, Rajiv Reebye.
      Background: Stiff-knee gait commonly involves rectus femoris spasticity in patients with central nervous system lesions. Diagnostic nerve blocks aid in predicting treatment outcomes; however, current techniques may overlook multiple nerve branches that innervate the rectus femoris muscle, potentially resulting in an incomplete assessment of treatment outcomes. Methods: We present an ultrasound-guided approach that we currently use in our practice, using anatomical landmarks, including the femoral artery, the sartorius muscle, and the rectus femoris' characteristic "J-shaped" internal tendon. The technique employs an "elevator" scanning method to identify all motor nerve branches (typically 2-3) entering the proximal third of the rectus femoris muscle. Each branch is blocked using an in-plane needle approach with 1-2 mL of 2% lidocaine. Results: The technique enables the visualization of hyperechoic nerve branches entering the rectus femoris muscle from medial to lateral, sometimes accompanied by small vascular branches that are identifiable with a Doppler ultrasound. Optimal ultrasound settings include probes >8 MHz, appropriate focus positioning, and dynamic range < 60 dB. The multi-branch approach produces rapid-onset motor weakness (5-10 min). Conclusions: This comprehensive multi-branch rectus femoris nerve block technique may enhance diagnostic accuracy for spasticity assessment, potentially leading to more informed treatment selection for stiff-knee gait.
    Keywords:  diagnostic nerve block; femoral nerve; rectus femoris; spasticity; stiff knee gait; ultrasound guidance
    DOI:  https://doi.org/10.3390/toxins17090437
  10. Biomedicines. 2025 Aug 22. pii: 2053. [Epub ahead of print]13(9):
    Popliteus Tendon Morphology: Anatomical Classification and Clinical Implications-A Narrative Review.
    Łukasz Olewnik, Ingrid C Landfald, Bartosz Gonera, George Triantafyllou, Daria Domosławska, Maria Piagkou, Robert F LaPrade.
      Purpose: The popliteus tendon (PT), though often overlooked, plays a vital role in the functional and mechanical stability of the posterolateral corner (PLC) of the knee. This narrative review consolidates the current anatomical, biomechanical, imaging, clinical, and surgical data on the PT, with an emphasis on its morphological variability and relevance in orthopedic sports medicine. Methods: A comprehensive review of the literature was conducted, including classical anatomical studies, recent classification systems, biomechanical evaluations, imaging protocols, and rehabilitation strategies. Particular focus was given to the anatomical classification proposed by Olewnik et al. and its implications in surgical and diagnostic contexts. Results: Anatomical investigations have demonstrated considerable variability in the PT, including bifid tendons and accessory fascicles. These variants have a measurable impact on preoperative planning, diagnostic imaging interpretation, and outcomes of surgical procedures, such as anterior cruciate ligament (ACL) and PLC reconstructions. The PT also contributes significantly to knee rotational control and meniscal stabilization, particularly in athletic populations. Imaging modalities, such as MRI and dynamic ultrasound, show high diagnostic utility, while arthroscopy remains the definitive diagnostic and therapeutic modality. Rehabilitation should emphasize neuromuscular re-education and progressive control of tibial rotation. A phase-based rehabilitation framework and clinical action table are proposed. Conclusions: The PT should be recognized as a critical structure in both the conservative and the surgical management of posterolateral and rotational knee instability. Enhanced awareness of its anatomical variability and functional importance can improve diagnostic accuracy, surgical precision, and clinical outcomes. In particular, MRI and high-resolution ultrasound can aid in identifying accessory fascicles and bifid tendons, while arthroscopy benefits from preoperative knowledge of PT variants to avoid misidentification and iatrogenic injury. Surgical planning for ACL and PLC reconstructions may be refined by applying the classification system described. Future research should focus on refining diagnostic algorithms, developing PT-specific functional tests, and integrating popliteus evaluation into high-level clinical decision-making and surgical navigation systems.
    Keywords:  ACL reconstruction; anatomical variation; diagnostic imaging; dial test; knee rehabilitation; knee stability; popliteus tendon; posterolateral corner; posterolateral drawer test; posterolateral knee surgery; rotational instability; sports orthopedics
    DOI:  https://doi.org/10.3390/biomedicines13092053
  11. Heart Fail Rev. 2025 Sep 22.
    Lung ultrasound in cardiac rehabilitation: expert consensus on protocols, clinical use, and integration into patient management from the working group on cardiac rehabilitation and cardiovascular prevention of the Italian society of cardiology.
    Costantino Mancusi, Francesco Giallauria, Mara Piccoli, Valeria Visco, Arturo Cesaro, Gerardina Fratianni, Elio Venturini, Nidal Turkmani, Antonello D'Andrea, Mario Pacileo, Raffaele Carluccio, Alessandro Maloberti, Nicola De Luca, Stefania Paolillo, Savina Nodari, Mauro Maniscalco, Pasquale Ambrosino, Alberto Palazzuoli, Paolo Calabrò, Michele Ciccarelli.
      Lung ultrasonography (LUS) is a reliable and reproducible tool across various clinical settings. Its high diagnostic accuracy, portability, and real-time imaging capabilities make it especially suitable for use in Emergency Departments, Intensive Care Units, and outpatient clinics. LUS has proven particularly effective in evaluating lung congestion. LUS also provides superior diagnostic accuracy for detecting pleural effusion and lung consolidations, offering real-time imaging with high spatial resolution and enabling precise monitoring throughout hospitalization. In the Cardiac Rehabilitation Unit, the routine use of LUS represents a reliable imaging modality for assessing patients with complex clinical conditions. In fact, early identification of lung congestion, pleural effusion, or lung consolidation in patients recovering from acute coronary syndrome, acute heart failure, or cardiac surgery is crucial for optimizing clinical management. Moreover, continuous monitoring of lung congestion can aid in the appropriate adjustment of diuretic therapy and exercise intensity. This review aims to present the latest evidence and recommendations for the use of LUS in the cardiac rehabilitation setting.
    Keywords:  Cardiac; Echocardiography; Lung; Prevention; Rehabilitation; Ultrasound
    DOI:  https://doi.org/10.1007/s10741-025-10560-9
  12. J Vis Exp. 2025 Sep 05.
    Ultrasound Tissue Characterization of Human Achilles Tendon by Stability Quantification of Echo Patterns.
    Chiara Busso, Marta Andrighetti, Elisabetta Quilico, Kristen M Meiburger, Marco A Minetto.
      The assessment of tendon size and structure is commonly included in the clinical management of healthy athletes and different types of patients to personalize their training or rehabilitation. The quantitative analysis of the Achilles tendon structure described here can be performed with a recently introduced system that is non-invasive, relatively inexpensive, portable, radiation-free, and enables the rapid collection of accurate and reproducible data. It uses a standard ultrasound probe that is automatically displaced by a tracker in precise steps of 0.2 mm across the region of interest to collect successive two-dimensional ultrasound images that are then compiled into three-dimensional data-block. The measurement procedure is simple: a subject can be tested in 10-15 min, and a comprehensive report is automatically generated. The quantification of four different echo types enables the evaluation of the tissue integrity: this quantification can be useful for the diagnostic and prognostic assessment of patients with Achilles tendinopathy.
    DOI:  https://doi.org/10.3791/68543
  13. Sensors (Basel). 2025 Sep 18. pii: 5834. [Epub ahead of print]25(18):
    Clinical Trials of a Stroke Rehabilitation Trainer Employing a Speed-Adapted Treadmill.
    Fu-Cheng Wang, Szu-Fu Chen, Pen-Ning Yu, Yin Keat Tan, Hsin Ti Cheng, Chia-Wei Chang, Lin-Yen Cheng, Yen-Chang Chien, Lik-Kang Koo.
      We propose a speed-adapted treadmill that can be incorporated into a rehabilitation trainer that applies neurodevelopmental treatment (NDT) for patients with stroke. NDT practice is effective for post-stroke patients, but its requirement for therapists' participation can limit the patients' rehabilitation during the golden period of recovery. Previous studies have proposed a trainer that can automatically reiterate therapists' interventions. However, that trainer employed a constant-speed treadmill, which required the users to frequently adjust their walking speeds during rehabilitation. This paper develops a speed-adapted treadmill that can regulate the treadmill motor to maintain the subject's position during the training process. First, we derive models of the treadmill and cable motors through experiments. Then, we design robust controls for the two systems and simplify them as proportional-integral-derivative controllers for hardware implementation. Finally, we integrate the system and invite healthy and stroke subjects to participate in clinical experiments. Among ten stroke subjects, all subjects' walking speeds and nine subjects' stride lengths were improved, while eight subjects showed improvement in the swing-phase asymmetry and pelvic rotation after receiving the NDT rehabilitation employing the speed-adapted treadmill. Our findings indicate that the NDT trainer effectively enhances users' gait characteristics, including swing-phase symmetry, pelvic rotation, walking speed, and stride length.
    Keywords:  control; gait; neuro-developmental treatment; rehabilitation; robust; stroke; trainer; treadmill
    DOI:  https://doi.org/10.3390/s25185834
  14. Arch Phys Med Rehabil. 2025 Sep 19. pii: S0003-9993(25)00907-4. [Epub ahead of print]
    Effectiveness of mobile apps in the rehabilitation of patients with low back pain. A systematic review with meta-analysis of randomized controlled trials.
    Alessandro Ferrero, Giorgia Lambert, Francesca Caretto, Marco Trucco, Leonardo Piano, Alessandro Chiarotto.
       OBJECTIVE: To investigate the effectiveness of mobile apps for the treatment of patients with nonspecific low back pain (LBP).
    DATA SOURCES: We searched CENTRAL, Embase, CINAHL, MEDLINE, Scopus and PEDro (up to April 2025). We also performed backward and forward citation tracking of included studies.
    STUDY SELECTION: We included randomized controlled trials (RCTs), identified and screened by 2 independent reviewers, in patients with acute, subacute and/or chronic nonspecific LBP, using mobile apps as unique form of treatment or in adjunction to the rehabilitation treatment, compared with rehabilitation alone or other types of apps. We considered pain intensity, physical function, self-efficacy and health-related quality of life as primary outcomes.
    DATA EXTRACTION: Two independent reviewers extracted data and performed risk of bias (RoB), which was assessed using the Risk of Bias 2.0 tool. We performed a random-effects meta-analysis for clinically homogeneous RCTs, and we assessed the certainty of evidence using the GRADE approach.
    DATA SYNTHESIS: We included 15 RCTs (n=3,986), eight of which were included in meta-analyses. Nine RCTs were in patients with chronic LBP, while six included any LBP duration. In a mixed duration LBP population, the use of apps in adjunction to rehabilitation was slightly more effective than rehabilitation alone on pain intensity at long-term (MD: -0.58; 95%CI: -1.00, -0.17; moderate certainty evidence). In a population of chronic LBP, the use of apps was significantly superior compared to rehabilitation alone on short-term pain intensity, but without a clinically relevant effect (MD: -0.74; 95%CI: -1.38, -0.10; very low certainty evidence).
    CONCLUSIONS: The use of an app in adjunction to in-person rehabilitation probably reduces pain intensity at long-term follow-up slightly, but probably not pain intensity at medium-term, and physical function and health-related quality of life at both medium- and long-term follow-up, when compared to rehabilitation alone in a mixed population of LBP.
    Keywords:  low back pain; meta-analysis; mobile applications; rehabilitation; smartphone; telemedicine; telerehabilitation
    DOI:  https://doi.org/10.1016/j.apmr.2025.08.023
  15. Geriatrics (Basel). 2025 Aug 23. pii: 113. [Epub ahead of print]10(5):
    A Systematic Review of the Association Between Pain and Instrumental Activities of Daily Living Disability in Community-Dwelling Older Adults.
    Yukiko Mizutani, Shigekazu Ukawa.
       INTRODUCTION: Pain is highly prevalent among community-dwelling older adults and can undermine their ability to perform Instrumental Activities of Daily Living (IADL), which are essential for independent living. This systematic review aimed to summarize existing research to clarify the relationship between pain and IADL disability in community-dwelling older adults.
    METHODS: We conducted a search of PubMed on 27 July 2025. Eligible studies met the following criteria: (1) assessed the association between pain and IADL disability; (2) included community-dwelling older adults aged 60 and older; and (3) were published in English.
    RESULTS: Of the 400 records screened, 29 studies met the inclusion criteria. Of these, 23 studies (18 cross-sectional and 5 cohort studies) reported a significant association between pain and IADL disability, while 6 cross-sectional studies did not. Pain was assessed using diverse instruments across varying recall periods and thresholds, and IADL disability was measured using multiple scales. Such methodological heterogeneity precluded quantitative synthesis.
    CONCLUSIONS: In community-dwelling older adults, pain consistently predicts IADL disability across designs and settings. However, the lack of standardized, multidimensional measures and incomplete adjustment for treatment, multimorbidity, and polypharmacy limits precise effect estimation. Future research should adopt harmonized assessment tools, control comprehensively for relevant confounders, and perform meta-analyses where data permit to clarify pain's true impact on functional independence.
    Keywords:  aged; instrumental activity of daily living; pain; systematic review
    DOI:  https://doi.org/10.3390/geriatrics10050113
  16. Life (Basel). 2025 Sep 22. pii: 1486. [Epub ahead of print]15(9):
    Ultrasound-Guided Prolotherapy for Sciatica Secondary to Sacrospinous Ligament Calcification: A Potential and Previously Overlooked Etiological Factor in Deep Gluteal Syndrome-A Case Report and Literature Review.
    Yonghyun Yoon, King Hei Stanley Lam, Jaeyoung Lee, Rowook Park, Jaehyun Shim, Jonghyeok Lee, Daniel Chiung-Jui Su, Kenneth Dean Reeves, Stephen Cavallino.
       BACKGROUND: Deep gluteal syndrome (DGS) is an underdiagnosed cause of sciatica-like pain, involving the entrapment of the sciatic nerve by various structures within the subgluteal space. While cases of ossification or calcification in the context of severe pelvic imbalance have been rarely reported, isolated SSL calcification as a primary cause of DGS remains largely unexplored and undocumented. This case report presents the first documented instance of sacrospinous ligament (SSL) calcification identified as the primary cause of DGS and its successful management with ultrasound-guided prolotherapy.
    CASE PRESENTATION: A 51-year-old female presented with severe, worsening left-sided sciatica of several months' duration. Physical examination revealed an antalgic gait, positive sacroiliac joint tests, and multiple positive DGS-specific provocative tests (FAIR, Pace sign, Seated Piriformis Stretch). Radiographs and musculoskeletal ultrasound (MSK-US) confirmed calcification within the left sacrospinous ligament, with associated sciatic nerve swelling. The patient underwent three sessions of ultrasound-guided prolotherapy (dextrose 10% with lidocaine) targeting the calcification site, followed by a structured rehabilitation program.
    RESULTS: The patient reported a significant reduction in pain, from a Visual Analog Scale (VAS) score of 10/10 to 1/10 within one month. All previously positive provocative tests converted to negative, indicating a resolution of the nerve entrapment. Functional mobility was fully restored.
    CONCLUSIONS: This case highlights isolated sacrospinous ligament calcification as a potential and previously overlooked pathological entity responsible for deep gluteal syndrome. To our knowledge, this is the first report to implicate ligamentous calcification as a primary etiological factor in DGS. Musculoskeletal ultrasound proved indispensable for both diagnosis and treatment guidance. Furthermore, ultrasound-guided prolotherapy emerged as a successful and minimally invasive therapeutic option in this case, potentially by stabilizing the ligament and reducing neurogenic inflammation. This case expands the differential diagnosis of sciatica, introduces a new target for intervention in refractory cases, and underscores the need for future studies in larger patient cohorts to validate these findings.
    Keywords:  deep gluteal syndrome; entrapment neuropathy; ligament calcification; non-discogenic pain; prolotherapy; sacrospinous ligament; sciatica; ultrasound-guided injection
    DOI:  https://doi.org/10.3390/life15091486
  17. BMC Geriatr. 2025 Sep 26. 25(1): 720
    Association between financial social support and functional disability among older adults: analysis of the ELSI-Brazil.
    Bruna Venturin, Andressa Souza Cardoso, María Del PilarFlores-Quispe, Franciéle Marabotti Costa Leite, Elaine Thumé, Fabíola Bof de Andrade, Maria Fernanda Furtado de Lima Costa, Luiz Augusto Facchini.
       BACKGROUND: Population aging requires attention. The increase in the number of older adults, accompanied by the growth of functional disabilities, can impact the social and economic adjustments of the individual, family, and communities, resulting in the need for financial support to meet the demands generated by these disabilities. The association between receiving financial support and the inability to carry out activities in quantitative studies is rarely reported in the literature. This investigation aims to estimate the occurrence of financial social support and its association with functional disability among older adults aged 60 years or older residing in urban areas of Brazil.
    METHOD: A cross-sectional analysis of a population-based longitudinal study conducted in Brazil with a baseline in 2015/16 and follow-up in 2019/20 was performed. The dependent variable of interest was financial support. The Katz and Lawton & Brody scales were used to measure functional disability to perform basic (BADL) and instrumental (IADL) activities of daily living, respectively. The association between financial support and functional disability for BADL and IADL was tested using logistic regression, expressed as Odds Ratio (OR) and 95% confidence intervals (95% CI).
    RESULTS: The frequency of receiving financial support among older adults was 13.8% (2015; CI95% 12.6-15.0) and 11.3% (2019; CI95% 9.7-13.1). Receiving financial support was significantly associated with functional disability in both BADL and IADL. After adjustments, older adults with functional disability in BADL were 1.35 (CI95% 1.01-1.81) and 1.75 (CI95% 1.25-2.44) times more likely to receive financial support in 2015 and 2019, respectively. Older adults with a disability to perform IADL were 1.53 and 1.42 times more likely to receive support compared to older adults without disabilities, after adjusting for confounders factors (OR 2015: 1.53; CI95% 1.22-1.92; OR 2019: 1.42; CI95% 1.10-1.83).
    CONCLUSIONS: The receipt of financial support is greater among older adults with basic and instrumental functional disabilities. The association identified highlights the importance of public policies aimed at improving socioeconomic conditions and quality of life for older adults.
    Keywords:  Aging; Cross-Sectional studies; Disabled persons; Financial support; Social support
    DOI:  https://doi.org/10.1186/s12877-025-05845-5
  18. BMC Psychol. 2025 Sep 25. 13(1): 1023
    Latent profile analysis of depressive symptoms in older patients with chronic diseases and their relationship with social support study.
    Langxuan Liu, Wenmian Wang, Xiaoxuan Gong, Yanping Zhang, Jing Zeng, Hao Zhang.
      Older people constitute a significant group of chronic disease patients. Chronic diseases place a significant financial burden on patients and cause both material and psychological stress. This stress tends to induce frequent depressive moods, which negatively affect the patient's physical and mental health. Although there is a large number of studies that have explored depressive problems, chronic illness, and social support among older people, there is relatively little research related to the heterogeneity of depressive symptoms among older people with chronic disease. In addition, the relationship between different categories of depressive symptoms and social support is unclear. The purpose of this research was to explore the potential categories of depressive symptoms and their relationship with social support in older patients with chronic diseases. We used data from the 2020 China Health and Retirement Longitudinal Study (CHARLS) to answer this question. We applied latent profile analysis methods to explore the potential categories of depressive symptoms in older patients with chronic diseases and to analyze the relationship between different depressive symptom categories and social support. The results demonstrate that depressive symptoms in older adults with chronic diseases can be categorized into four distinct subgroups: mild depression - persistent low mood with diminished hopefulness type (57.58%), moderate depression - balanced type(7.95%), major depression - high fearfulness type (15.71%), and major depression - low fearfulness type (18.76%). Furthermore, the stress-buffering effect of social support on adverse psychological outcomes demonstrates significant subtype-specific variations among these clinical subgroups.
    Keywords:  Chronic diseases; Depression; Latent profiling; Older patients; Social support
    DOI:  https://doi.org/10.1186/s40359-025-03376-7
  19. Pain Rep. 2025 Oct;10(5): e1323
    Pain medication associated with decreased physical performance and rehabilitation progress.
    Lara Mendes Fernandes, Philippe Vuistiner, Cyrille Burrus, Michel Konzelmann, Bertrand Léger, Marie Besson, François Luthi.
       Introduction: The effects of pain medication on physical performance in chronic pain are poorly understood. We examined the association between analgesics and physical performance in people with chronic musculoskeletal pain (CMSP) requiring rehabilitation.
    Methods: We classified participants into 3 categories according to the highest level of medication used at admission for rehabilitation: no analgesics (NAs), nonopioid analgesics (NOAs), and opioid analgesics (OPAs). We measured performance with functional tests (6-minute walk test [6MWT], progressive isoinertial lifting evaluation [PILE], steep ramp test, handgrip strength test [HST], 5 times sit-to-stand test, and 1-minute stair-climbing test [1MSCT]) at admission and discharge. Multiple regression models were used to assess the differences in functional capacity between the 3 groups, adjusting for potential confounders.
    Results: We included 4,339 individuals; 1,731 took no analgesics (40%), 1,742 took NOAs (40%), and 866 took OPAs (20%). The median consumption was 11.7 mg per day according to morphine-equivalent dose calculation. Physical performance was poorer for patients taking than those not taking analgesics in all tests examined. We found a negative gradient in performance with increasing WHO analgesic ladder. The odds of achieving clinically significant improvements in 4 tests (6MWT, PILE, HST affected side, and 1MSCT) was reduced for people taking opioids compared with the NA group.
    Conclusion: Given the inconclusive and limited evidence for the benefit of analgesics on pain and disability in CMSP, health professionals should be aware of these results for even low doses of opioids, which were associated with poor physical performance and rehabilitation progress.
    Keywords:  1-minute stair-climbing test; 5 times sit-to-stand test; 6-minute walk test; Analgesics; Chronic musculoskeletal pain; Function; Functional performance; Handgrip strength test; Opioids; Pain medication; Physical activity; Physical performance measures; Progressive isoinertial lifting evaluation; Rehabilitation; Steep ramp test
    DOI:  https://doi.org/10.1097/PR9.0000000000001323
  20. Brain Sci. 2025 Sep 10. pii: 971. [Epub ahead of print]15(9):
    Botulinum Toxin: An Unconventional Tool for the Treatment of Depression?
    Matteo Gambini, Riccardo Gurrieri, Gerardo Russomanno, Gianmatteo Cecchini, Federico Mucci, Manuel Glauco Carbone, Donatella Marazziti.
      Background/Objectives: Major depressive disorder (MDD) represents a leading cause of global disability, with approximately one-third of patients exhibiting treatment resistance (TRD) despite adequate pharmacological interventions. This treatment gap underscores the urgent need for novel therapeutic strategies. Recently, a series of data suggests that botulinum neurotoxin of type A (BoNT-A), traditionally used for neuromuscular and cosmetic indications, could constitute a potential antidepressant tool. This narrative review critically examines the current preclinical and clinical findings of BoNT-A in MDD. Methods: A comprehensive search of PubMed, Scopus, and Web of Science was conducted up to June 2025, including randomized controlled trials, observational studies, animal models, and mechanistic investigations. Search terms included "Botulinum Toxin," "BoNT type A", "Depression", "Major Depressive Disorder", "Facial Feedback", and "Neurobiology". Results: Some randomized and observational studies would indicate that glabellar BoNT-A injections might lead to significant reductions in depressive symptoms in patients with MDD and TRD. Proposed mechanisms include both peripheral modulation of emotional expression and brain effects, such as reduced amygdala hyperactivity, increased BDNF expression, and enhanced monoaminergic transmission. Preclinical studies confirm that BoNT-A modulates limbic and brainstem circuits, possibly implicated in affective regulation. The few comparative studies suggest therapeutic efficacy comparable to that of SSRIs, with a more rapid onset. Preliminary data also support its application in bipolar depression and comorbid anxiety disorders. Conclusions: The available literature would indicate that BoNT-A might constitute a promising candidate at least as an adjunctive treatment in MDD, although the impact of current findings is limited due to the methodological heterogeneity and the small sample sizes of patients examined. Further large-scale, placebo-controlled trials are warranted to elucidate the mode of action of BoNT-A and to validate or not its clinical effectiveness.
    Keywords:  botulinum neurotoxin type A; innovative therapeutic targets; major depressive disorder; treatment-resistant depression; unconventional treatment options
    DOI:  https://doi.org/10.3390/brainsci15090971
  21. J Hand Ther. 2025 Sep 23. pii: S0894-1130(25)00096-1. [Epub ahead of print]
    Evaluation of the effectiveness of a rehabilitation program for the improvement of musical performance in a sample of musicians with focal hand dystonia: A case series.
    Francescaroberta Panuccio, Rachele Simeon, Desiré Siviglia, Alessandra Carlizza, Ilaria Ruotolo, Giovanni Sellitto, Anna Berardi, Giovanni Fabbrini, Giovanni Galeoto.
       BACKGROUND: Musician's Dystonia is a neurological condition that mainly affects professional players when performing repetitive, finely controlled hand movements necessary for their musical practice.
    PURPOSE: The study in question aims to formulate a rehabilitation treatment protocol for patients with musician's hand dystonia, based on integrated occupational therapy and physiotherapy interventions.
    STUDY DESIGN: Case series.
    METHODS: The description of the treatment protocol will be shown through the presentation of three case reports (a pianist, a saxophonist, and a violinist) who enrolled and attended an intervention program based on four common steps. The outcomes measure used for the assessments were the Disability of the Arm, Shoulder and Hand, the ABILHAND, the Tubiana and Chamagne Scale, the Arm Dystonia Disability Scale, and the Jebsen-Taylor Hand Function Test. The results were then subjected to statistical analysis.
    RESULTS: No statistically significant results were obtained; however, clinically significant results were highlighted based on the observation of the raw scores of each musician. Every patient experienced varying degrees of improvement and reported significant gains in motor control, accuracy, sensory discrimination, and musical performance.
    CONCLUSIONS: The results of the study in question indicate that our rehabilitation program has good chances of effectiveness in improving the musical performance of musicians with focal hand dystonia.
    Keywords:  Case report series; Musician focal dystonia; Quality of life; Rehabilitation; Task-specific dystonia
    DOI:  https://doi.org/10.1016/j.jht.2025.07.002
  22. BMC Geriatr. 2025 Sep 26. 25(1): 713
    The mediating effect of activities of daily living (ADL) disability on the association between depressive symptoms and cognitive impairment in older adults: a National study.
    Xuemei Yao, Dognfang Han, Qinrui Lu.
       BACKGROUND: Numerous studies have demonstrated a correlation between depressive symptoms and a higher likelihood of cognitive impairment among older adults. Little is known about the underlying pathway connecting these two conditions.
    OBJECTIVE: This study aimed to investigate whether activities of daily living (ADL) disability potentially mediate the relationship between depressive symptoms and cognitive function.
    METHODS: This study is a cross-sectional design. A total of 6623 Chinese older adults aged 65 years and above from the 2018 China Longitudinal Healthy Longevity Survey (CLHLS) were included in this study. Multiple linear regression was conducted to examine the relationships among depressive symptoms, ADL disability and cognitive function, while accounting for all confounding factors. Mediation analyses were performed to examine whether ADL disability mediated the relationship between depressive symptoms and cognitive function via PROCESS macro version 4.0.
    RESULTS: The results indicated that the relationship between depressive symptoms and cognitive function was significantly mediated by ADL disability (estimated indirect effect = -0.040, bootstrapped SE = 0.020, bootstrapped standard 95% CI= -0.083 - -0.007), with ADL disability accounting for 7.5% of the total effect. Moreover, the mediating role of ADL disability was moderated by gender, as the interaction between depressive symptoms and gender on ADL disability was found to be significant (β=-0.102, p = 0.033, IMM: 0.005, 95%CI: 0.001-0.011). When stratified by gender, the mediating effect of ADL disability was observed exclusively in males (estimated indirect effect= -0.055, bootstrapped SE = 0.031, bootstrapped standard 95% CI= -0.123 - -0.004), with a relative proportion of 9.7%.
    LIMITATIONS: The causal relationship was not able to certain because of the cross-sectional design.
    CONCLUSION: This study revealed that ADL disability may partially mediate the relationship between depressive symptoms and cognitive function in older adults. Furthermore, the mediating effect of ADL disability was moderated by gender, and the effect was observed exclusively in males when analyzed hierarchically.
    Keywords:  ADL disability; Cognitive impairment; Depressive symptoms; Gender difference
    DOI:  https://doi.org/10.1186/s12877-025-06380-z
  23. Orthop Surg. 2025 Sep 26.
    Efficacy of Conservative Approaches on Pain Relief and Function in Patients With Rotator Cuff Calcific Tendinopathy: Which Is the Best Option? A Systematic Review and Network Meta-Analysis.
    Lucrezia Moggio, Nicola Marotta, Alessandro de Sire, Giorgia Lucia Benedetto, Giorgio Gasparini, Antonio Ammendolia, Elvira Immacolata Parrotta, Michele Mercurio.
       OBJECTIVE: Rotator cuff calcific tendinopathy is a leading cause of nontraumatic shoulder pain, frequently leading to articular and functional impairments, depicting an adhesive capsulitis-like clinical presentation. To date, there is a lack of evidence on the impact of conservative approaches, and no gold standard has been established for managing rotator cuff calcific tendinopathy. This systematic review aimed to identify the most effective conservative approach for reducing pain and improving function in rotator cuff calcific tendinopathy patients.
    METHODS: PubMed, Scopus, and Cochrane Library databases were systematically searched from their inception until January 2, 2025, for English-language randomized clinical trials including adults affected by rotator cuff calcific tendinopathy undergoing conservative treatment. Data extraction was performed independently by two reviewers using a customized data extraction form, with consensus reached by a third reviewer. A network meta-analysis was subsequently carried out to compare the efficacy of different interventions. The risk of bias within the included randomized clinical trials was assessed using Version 2 of the Cochrane risk-of-bias tool for randomized trials. The study has been registered with PROSPERO, registration number CRD420250650833.
    RESULTS: Nineteen articles were included. This study identified 1160 subjects affected by rotator cuff calcific tendinopathy. A pairwise comparison through a network meta-analysis indicated that platelet-rich plasma exhibited the highest probability (85%) of improving shoulder function, followed by disodium ethylenediamine tetra-acetic acid at 75%, aspiration techniques at 65%, and extracorporeal shockwave therapy at 57%. Regarding pain reduction, disodium ethylenediamine tetra-acetic acid showed the highest probability (66%), followed by kinesiotaping and needle aspiration, both at 61%.
    CONCLUSION: This systematic review and network meta-analysis identified several interventional techniques, including platelet-rich plasma and disodium ethylenediamine tetra-acetic acid injections, extracorporeal shockwave therapy, and needle aspiration, as more effective strategies for reducing pain and improving function in subjects affected by rotator cuff calcific tendinopathy.
    LEVEL OF EVIDENCE: I (systematic review of Level-I randomized controlled studies).
    Keywords:  bursectomy; extracorporeal shockwaves therapy; rehabilitation; rotator cuff calcific tendinopathy; shoulder pain
    DOI:  https://doi.org/10.1111/os.70175
  24. Clin Ter. 2025 Sep-Oct;176(5):176(5): 582-589
    Periprosthetic Hip Infections: the possible role of ultrasonography.
    L Di Sante, F Agostini, D De Meo, A Savina, M Conti, A Fisicaro, G Iudicelli, A Altarocca, M Mangone, M Paoloni.
       Background: Periprosthetic joint infections (PJI) of the hip represent a severe and debilitating complication following hip arthroplasty, associated with significant morbidity and healthcare costs. The early diagnosis of PJI is challenging due to its nonspecific clinical signs and symptoms, often overlapping with non-infectious conditions.
    Methods: Our study was conducted on 30 patients with periprosthetic hip infections to analyze specific ultrasonographic patterns. Ultrasound examinations were performed by experienced sonographers, blinded to patient clinical and laboratory data. The assessment included joint effusion, periprosthetic fluid collections, synovial thickening, fistulous tracts, and hyperemia using Doppler imaging, correlated with laboratory markers, such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), D-dimer and white blood cell count (WBC).
    Results: The most frequently observed ultrasonographic patterns associated with PJI were intra- and peri-articular tracts (80%), and joint effusion (73.33%), with supra-fascial effusion (60%) and sub-fascial effusion (56.67%). Doppler ultrasound revealed prosthetic hyperemia in 50% of patients and tissue hyperemia in 20%. Elevated CRP and ESR levels were present in 80% and 93.33% of patients, respectively. Indicative WBC count were found on the entirety of the examined sample and indicative D-dimer levels were present in 83.33% of patients.
    Conclusions: Ultrasonography, enhanced by Doppler imaging, is a valuable diagnostic modality for assessing periprosthetic joint infections of the hip. The presence of intra- and peri-articular tracts and joint effusion were the most consistent findings. Integrating ultra-sonographic findings with laboratory tests is crucial for the accurate and timely diagnosis of PJI, and further multicenter studies are required to standardize its use and improve its clinical applicability.
    Keywords:  diagnostic patterns; doppler imaging; multimodal diagnosis; periprosthetic joint infection (PJI); ultrasonography
    DOI:  https://doi.org/10.7417/CT.2025.5269
  25. J Clin Med. 2025 Sep 13. pii: 6462. [Epub ahead of print]14(18):
    Evidence of Multifidus Changes Post-Lumbar Radiofrequency Ablation: A Narrative Literature Review.
    Abigail Joy Garcia, David W Lee, Logan Leavitt, Vinicius Tieppo Francio.
      Background/Objectives: Chronic low back pain (CLBP) is a leading cause of disability worldwide, with lumbar medial branch radiofrequency ablation (LRFA) widely used to manage facet-mediated pain; however, emerging evidence raises concerns regarding its potential to denervate the multifidus muscle-an essential stabilizer of the lumbar spine-thereby exacerbating dysfunction. This narrative review synthesizes current evidence on multifidus atrophy and dysfunction following LRFA, emphasizes its clinical significance, and highlights gaps that warrant further research and therapeutic development. Methods: A comprehensive literature search was conducted using SANRA criteria across the Cochrane Library, Web of Science Core Collection, Scopus, PubMed, and MEDLINE. Studies assessing multifidus morphology or function after LRFA were identified and analyzed. Data were extracted from studies meeting predefined inclusion criteria. The narrative synthesis included a thematic analysis and interpretive integration focusing on clinical practice. Results: Six eligible studies were identified, five cohort studies and one case series. Of these, two confirmed decreased multifidus function post-LRFA. Four studies analyzed post-LRFA structural changes, two of which reported reduced cross-sectional area/fatty infiltration, one no measurable difference, and another an apparent enlargement. The findings are constrained by substantial differences in study design, patient populations, and outcome measures, which limit the ability to establish consistent conclusions. Conclusions: Current evidence suggests that LRFA may lead to structural and functional changes in the multifidus muscle, although findings remain inconsistent due to significant study heterogeneity. Further high-quality, prospective research with standardized imaging and functional assessments is needed to clarify the long-term clinical impact.
    Keywords:  low back pain; lumbar radiofrequency ablation; lumbar rhizotomy; multifidus atrophy; multifidus dysfunction; multifidus muscle
    DOI:  https://doi.org/10.3390/jcm14186462
  26. Bioengineering (Basel). 2025 Aug 22. pii: 900. [Epub ahead of print]12(9):
    Bioengineering Support in the Assessment and Rehabilitation of Low Back Pain.
    Giustino Varrassi, Matteo Luigi Giuseppe Leoni, Ameen Abdulhasan Al-Alwany, Piercarlo Sarzi Puttini, Giacomo Farì.
      Low back pain (LBP) remains one of the most prevalent and disabling musculoskeletal conditions globally, with profound social, economic, and healthcare implications. The rising incidence and chronic nature of LBP highlight the need for more objective, personalized, and effective approaches to assessment and rehabilitation. In this context, bioengineering has emerged as a transformative field, offering novel tools and methodologies that enhance the understanding and management of LBP. This narrative review examines current bioengineering applications in both diagnostic and therapeutic domains. For assessment, technologies such as wearable inertial sensors, three-dimensional motion capture systems, surface electromyography, and biomechanical modeling provide real-time, quantitative insights into posture, movement patterns, and muscle activity. On the therapeutic front, innovations including robotic exoskeletons, neuromuscular electrical stimulation, virtual reality-based rehabilitation, and tele-rehabilitation platforms are increasingly being integrated into multimodal treatment protocols. These technologies support precision medicine by tailoring interventions to each patient's biomechanical and functional profile. Furthermore, the incorporation of artificial intelligence into clinical workflows enables automated data analysis, predictive modeling, and decision support systems, while future directions such as digital twin technology hold promise for personalized simulation and outcome forecasting. While these advancements are promising, further validation in large-scale, real-world settings is required to ensure safety, efficacy, and equitable accessibility. Ultimately, bioengineering provides a multidimensional, data-driven framework that has the potential to significantly improve the assessment, rehabilitation, and overall management of LBP.
    Keywords:  artificial intelligence; bioengineering; electromyography; low back pain; rehabilitation; virtual reality; wearable sensors
    DOI:  https://doi.org/10.3390/bioengineering12090900
  27. Clin Rehabil. 2025 Sep 26. 2692155251375667
    Feasibility of delivering TeleCHAT: A comprehensive high-dose aphasia treatment via telerehabilitation.
    Genevieve Vuong, Jade Dignam, Clare Burns, David Copland, Hannah Wedley, Katherine O'Brien, Annie J Hill.
       OBJECTIVE: To evaluate the feasibility of delivering 50 h of comprehensive, high-dose aphasia treatment via telerehabilitation (TeleCHAT) to people with aphasia and their support people.
    DESIGN: A non-randomised one-armed quasi-experimental pre-post feasibility study.
    SETTING: TeleCHAT was delivered from dedicated tele-suites in university spaces within a tertiary hospital. Participants received therapy in their homes via telerehabilitation using a configured telerehabilitation system which used videoconferencing software Zoom®.
    PARTICIPANTS: Three cohorts of people with aphasia (n = 12), support people (n = 11), and speech-language pathologists (n = 2) participated.
    INTERVENTION: Participants completed technology training, goal setting, and clinical treatment planning prior to the intervention. The TeleCHAT intervention included 50 h of goal-directed aphasia therapy, delivered 3-5 days per week over 8 weeks.
    MAIN MEASURES: Mixed-methods data was collected on participant demographics, aphasia profiles, achievement of dose, comprehensiveness of therapy, and support people participation.
    RESULTS: A diverse group of people with aphasia completed TeleCHAT. Nine participants received the intended dose of 50 h, with the remaining three closely approaching dose. A high proportion of sessions were spent actively engaged in therapeutic tasks (94-100%). A comprehensive array of 42 therapy activities was delivered and tailored to goals across the International Classification of Functioning, Disability and Health Framework. All participants had a support person participate actively in at least one session.
    CONCLUSIONS: It was feasible to deliver the core components of the TeleCHAT programme via telerehabilitation. As intended, a heterogeneous group of people with aphasia received a high-dose of tailored, comprehensive aphasia therapy, with the active participation of support people.
    Keywords:  Aphasia; feasibility; intensive comprehensive aphasia programme; tailored support; telerehabilitation
    DOI:  https://doi.org/10.1177/02692155251375667
  28. J Clin Med. 2025 Sep 22. pii: 6679. [Epub ahead of print]14(18):
    "HOPE-FIT" in Action: A Hybrid Effectiveness-Implementation Protocol for Thriving Wellness in Aging Communities.
    Suyoung Hwang, Eun-Surk Yi.
      Background/Objectives: As global aging accelerates, there is a pressing and empirically substantiated demand for integrated and sustainable strategies, as evidenced by the rising prevalence rates of chronic conditions, social isolation, and digital exclusion among older adults worldwide. These factors underscore the urgent need for multidimensional interventions that simultaneously target physical, psychological, and social well-being. The HOPE-FIT (Hybrid Outreach Program for Exercise and Follow-up Integrated Training) model and the SAGE (Senior Active Guided Exercise) program were designed to address this need through a hybrid framework. These programs foster inclusive aging by explicitly bridging digitally underserved groups and mobility-restricted populations into mainstream health promotion systems through tailored exercise, psychosocial support, and smart-home technologies, thereby functioning as a scalable meta-model across healthcare, community, and policy domains. Methods: HOPE-FIT was developed through a formative, multi-phase process grounded in the RE-AIM framework and a Hybrid Type II effectiveness-implementation design. The program combines professional health coaching, home-based and digital exercise routines, Acceptance and Commitment Performance Training (ACPT)-based psychological strategies, and smart-home monitoring technologies. Empirical data from pilot studies, large-scale surveys (N = 1000), and in-depth user evaluations were incorporated to strengthen validity and contextual adaptation. Culturally tailored content and participatory feedback from older adults further informed ecological validity and program refinement. Implementation Strategy/Framework: The theoretical foundation integrates implementation science with behavioral and digital health. The RE-AIM framework guided reach, fidelity, and maintenance planning, while the Hybrid E-I design enabled the concurrent evaluation of effectiveness outcomes and contextual implementation strategies. Institutional partnerships with community centers, public health organizations, and welfare agencies further facilitated the translation of the model into real-world aging contexts. Dissemination Plan: The multi-pronged dissemination strategy includes international symposia, interdisciplinary academic networks, policy briefs, localized community deployment, and secure, authenticated data sharing for reproducibility. This design facilitates evidence-informed policy, empowers practitioners, and advances digital health equity. Ultimately, HOPE-FIT constitutes a scalable and inclusive model that concretely addresses health disparities and promotes active, dignified aging across systems and disciplines.
    Keywords:  ACT; RE-AIM; community-based intervention; digital health equity; hybrid aging model; implementation science
    DOI:  https://doi.org/10.3390/jcm14186679
  29. J Imaging. 2025 Sep 01. pii: 297. [Epub ahead of print]11(9):
    Longitudinal Ultrasound Monitoring of Peripheral Muscle Loss in Neurocritical Patients.
    Talita Santos de Arruda, Rayssa Bruna Holanda Lima, Karla Luciana Magnani Seki, Vanderlei Porto Pinto, Rodrigo Koch, Ana Carolina Dos Santos Demarchi, Gustavo Christofoletti.
      Ultrasound has become an important tool that offers clinical and practical benefits in the intensive care unit (ICU). Its real-time imaging provides immediate information to support prognostic evaluation and clinical decision-making. This study used ultrasound assessment to investigate the impact of hospitalization on muscle properties in neurocritical patients and analyze the relationship between peripheral muscle changes and motor sequelae. A total of 43 neurocritical patients admitted to the ICU were included. The inclusion criteria were patients with acute brain injuries with or without motor sequelae. Muscle ultrasonography assessments were performed during ICU admission and hospital discharge. Measurements included muscle thickness, cross-sectional area, and echogenicity of the biceps brachii, quadriceps femoris, and rectus femoris. Statistical analyses were used to compare muscle properties between time points (hospital admission vs. discharge) and between groups (patients with vs. without motor sequelae). Significance was set at 5%. Hospitalization had a significant effect on muscle thickness, cross-sectional area, and echogenicity in patients with and without motor sequelae (p < 0.05, effect sizes between 0.104 and 0.475). Patients with motor sequelae exhibited greater alterations in muscle echogenicity than those without (p < 0.05, effect sizes between 0.182 and 0.211). Changes in muscle thickness and cross-sectional area were similar between the groups (p > 0.05). Neurocritical patients experience significant muscle deterioration during hospitalization. Future studies should explore why echogenicity is more markedly affected than muscle thickness and cross-sectional area in patients with motor sequelae compared to those without.
    Keywords:  critical care outcomes; hospitalization; muscle weakness; muscular atrophy; ultrasonography
    DOI:  https://doi.org/10.3390/jimaging11090297
  30. Creat Nurs. 2025 Sep 25. 10784535251379534
    Disability Intersectionality and Visibility in Nursing.
    Anna Maria Valdez, Andrea Dalzell.
      Disability remains a largely invisible component of diversity within the nursing profession due to a lack of comprehensive data collection and ongoing systemic ableism. This article explores the multifaceted experiences of nurses with disabilities through an intersectional lens, illustrating how disability intersects with other marginalized identities to create unique and compounded barriers. Drawing on the authors' personal narratives, one with an apparent physical disability and the other with a nonapparent, dynamic disability, the paper highlights how disabled nurses navigate intersectional discrimination, exclusion, and invisibility in both educational and professional settings. Emphasizing that disability is a natural part of human diversity, this article calls for nurses and professional nursing organizations to reimagine equity, diversity, inclusivity, and belonging to include the experiences of people with disabilities and to ensure access in nursing.
    Keywords:  Disability; gender; intersectionality; nurse; nursing; race
    DOI:  https://doi.org/10.1177/10784535251379534
  31. BMJ Open. 2025 Sep 22. 15(9): e097442
    Pain in social context: a systematic review protocol.
    Nicolas Ureña Bautista, Rafael Serrano-Del-Rosal, Gema Serrano-Gemes.
       INTRODUCTION: Pain is an experience that is socially conditioned, like all human experiences. The scientific study of pain from a biopsychosocial perspective involves considering its complexity and multidimensionality. This means accounting for the anatomical and physiological elements of pain, as well as the psychological, social and cultural elements of pain. Despite the increasing acknowledgement of the biopsychosocial model, pain research still lacks standardised criteria for evaluating its social dimension. Moreover, the integration of social variables into empirical studies remains limited and fragmented. The aim of this review protocol is to analyse whether and how pain studies account for the social dimension, understood as the cultural, relational and contextual factors that shape the perception and experience of pain.
    METHODS AND ANALYSIS: A systematic review will be conducted by consulting five international databases: PubMed, Web of Science Core Collection, Scielo Citation Index, Scopus and CINAHL Complete. The review will include empirical or theoretical studies on pain that consider its social dimension, are written in Spanish or English, are applied to human beings and align with the review's objectives. The studies will then be exported to the Zotero bibliographic manager for further processing. The selection of studies will be carried out in two phases. The initial stage of the review process will involve a title and abstract analysis of the identified studies, followed by a full-text review. Data will be extracted using a bespoke tool created for this research. The quality of the studies will be assessed using a tool developed by our research group. Data synthesis will be carried out through descriptive and narrative analyses.
    ETHICS AND DISSEMINATION: This systematic review protocol did not require ethical approval; however, the project in which it is framed has been approved by the CSIC Ethics Committee (271/2023). These findings will be disseminated by publication in high-impact, peer-reviewed journals and by presentation at relevant scientific conferences and academic congresses. The results will provide an overview of the integration of the social dimension of pain into the scientific literature, thereby contributing to the advancement of the field and informing future research, interventions and public policy.
    PROSPERO REGISTRATION NUMBER: CRD42024601863.
    Keywords:  Clinical Protocols; PAIN MANAGEMENT; Systematic Review
    DOI:  https://doi.org/10.1136/bmjopen-2024-097442
  32. Am J Emerg Med. 2025 Sep 18. pii: S0735-6757(25)00644-8. [Epub ahead of print]
    Ultrasound-guided multifidus injection with 5 % dextrose for lumbar facet syndrome in the emergency department.
    Gabriel Rose, William Shank, Dasia Esener.
       INTRODUCTION: Lumbar facet syndrome is an under-recognized cause of chronic lower back pain. Treatment typically occurs in outpatient settings, with few procedural options available in the emergency department (ED).
    CASE PRESENTATION: We present the case of a 92-year-old female with refractory lower back pain and severe functional limitation due to lumbar facet syndrome, successfully treated with ultrasound-guided multifidus injections using 5 % dextrose (D5W) in the ED.
    DISCUSSION: This approach is novel in emergency medicine and offers a simple and effective treatment alternative. It is easier to perform and more accessible than medial branch or facet joint blocks and avoids the risks associated with local anesthetics.
    CONCLUSION: Ultrasound-guided multifidus injection with D5W may represent a practical, opioid-sparing option for older adults presenting to the ED with severe back pain.
    Keywords:  5 % dextrose; Back pain; Lumbar facet syndrome; Multifidus injection; Ultrasound
    DOI:  https://doi.org/10.1016/j.ajem.2025.09.033
  33. Pak J Pharm Sci. 2025 Sep-Oct;38(5):38(5): 1567-1576
    Auxiliary effect of clopidogrel on neurological rehabilitation in patients with post-stroke motor disorders.
    Lan Chen, Jianqiu Gong.
      This study investigates the auxiliary effect of clopidogrel on neurorehabilitation in patients with post-stroke movement disorders to evaluate its efficacy in rehabilitation treatment. A randomized controlled study is conducted, dividing patients into a conventional treatment group and a clopidogrel treatment group. The Fugl-Meyer score, Barthel Index, and NIHSS score are employed to assess and compare the patients' motor function, daily activity ability, and neurological function before and after treatment. The scores for the Experimental Group exceed those of the Control Group for all measures, with p-values less than 0.05 or 0.01. These results indicate that the clopidogrel treatment group outperforms the conventional treatment group in stroke rehabilitation. This study examines clopidogrel's auxiliary effect through a long-term experiment on the rehabilitation of patients with post-stroke movement disorders, offering new treatment ideas and methods for clinical practice.
    DOI:  https://doi.org/10.36721/PJPS.2025.38.5.REG.13260.1
  34. J Cachexia Sarcopenia Muscle. 2025 ;16(5): e70068
    Comment on 'Adherence to Physical Activity and Incident Mobility Disability in Older Adults With Mobility Limitations' by Álvarez-Bustos et al.
    Bo Zhang, Haijun Zhang.
      
    DOI:  https://doi.org/10.1002/jcsm.70068
  35. Acta Bioeng Biomech. 2025 Jun 01. 27(2): 189-198
    Qualitative evaluation of FMS movement patterns in the course of femoroacetabular impingement in people practising recreational long-distance running.
    Katarzyna Burdacka, Robert Walaszek, Wiesław Chwała, Marcin Burdacki.
      Purpose: The aim of this work was to evaluate the effect of a conservative therapeutic intervention on functional changes in the motor system assessed qualitatively with FMS motion patterns in people with femoroacetabular impingement practising long-distance recreational running. Methods: The study involved 44 men, regularly practising recreational long-distance running. Two runs of tests were conducted in the Laboratory of Biokinetics of the AWF in Cracow. The first measurements were carried out in January 2020, and the second ones - after a 6-month therapeutic intervention in July 2020. A qualitative assessment of movement patterns was made using five tests of the Functional Movement Screen (FMS). Results: The highest statistically significant gains in FMS scores were obtained in the total of the FMS score (FMST) and in the active straight-leg raise, FMS5. The greatest improvement was noted in the experimental group in the measurement for the affected lower limb. After the intervention, the results obtained in the tests of deep squat (FMS1) and in-line lunge (FMS3) improved significantly only in the experimental group and were approaching the values observed in the control group. Conclusions: Observations made in this work, documented by the results of the conducted analyses, allow for practical use of the proposed proprietary, 6-month rehabilitation protocol and of a comprehensive, objective protocol for functional changes monitoring by means of qualitative assessment of FMS movement patterns in the conservative treatment of people with femoroacetabular impingement.
    Keywords:  Femoroacetabular impingement; Functional Movement Screen; conservative treatment; long-distance running
    DOI:  https://doi.org/10.37190/abb/207537
  36. Front Physiol. 2025 ;16 1604459
    A review and empirical findings of fasciae and muscle interactions in low back pain.
    Robbert N van Amstel, Guido Weide, Eddo O Wesselink, Karl Noten, Karl Jacobs, Annelies L Pool-Goudzwaard, Richard T Jaspers.
       Background: Low Back Pain (LBP) is a global musculoskeletal disorder affecting quality of life, with 90% of cases categorized as nonspecific, indicating that the underlying cause is unknown. One of the current treatment modalities that physiotherapists use are fascia tissue manipulations (FTMs), such as soft tissue mobilization, myofascial release, and elastic tape, to enhance joint mobility and muscle flexibility in LBP individuals.
    Purpose: This review and experimental research explore the hypothetical mechanisms of FTMs using Skin Displacement (SKD), either by hand or with elastic tape.
    Methods: Several hypotheses regarding the working mechanisms of FTMs are discussed through inductive reasoning based on literature and new experimental results using ultrasonography and cadaver dissection. In this paper, stiffness is defined as the ratio of the applied force to the resulting strain, based on Hooke's law. We focus on the role of lumbar fasciae and skeletal muscles, as well as the linkages between skin, fasciae, skeletal muscles, and joints, including the SKD-induced stress transmission between these structures. Furthermore, we discuss how the mechanical properties and stiffness of these structures can be altered.
    Results: The skin connects densely to the fasciae, back muscles, and spine, contributing to the stiffness of structures in the lumbar region. SKD maneuvers transmit stress to deeper tissues, causing strain and displacement of the thoracolumbar fascia, back muscles, and arthrofascia. These deformations may alter the active and passive mechanical properties of deeper tissues including fascia and muscle, by triggering stress-relaxation as well as structural adaptation.
    Conclusion: This paper provides indications that the skin is strongly connected to the thoracolumbar fascia, back muscles, and spine. These connections are possibly enhanced in patients with LBP. Stress applied to the skin by SKD maneuvers is shown to be transmitted to the underlying anatomical structures via these connections and can alter the stiffness of fasciae and skeletal muscles. The working mechanisms of FTMs potentially alter the quantity and composition of matrix components, as well as the contractile activity of muscle fibers, and traction forces of (myo)fibroblasts and other cells within the matrices. FTM-induced stress and alterations in anatomical structures not only improve joint mobility but also promote regeneration and tissue adaptation via various mechanisms resulting in pain relief.
    Keywords:  biomechanics; connective tissue cells; fascia; muscle; physical therapy modalities; skeletal
    DOI:  https://doi.org/10.3389/fphys.2025.1604459
  37. Biosensors (Basel). 2025 Sep 16. pii: 612. [Epub ahead of print]15(9):
    Low-Cost AI-Enabled Optoelectronic Wearable for Gait and Breathing Monitoring: Design, Validation, and Applications.
    Samilly Morau, Leandro Macedo, Eliton Morais, Rafael Menegardo, Jan Nedoma, Radek Martinek, Arnaldo Leal-Junior.
      This paper presents the development of an optoelectronic wearable sensor system for portable monitoring of the movement and physiological parameters of patients. The sensor system is based on a low-cost inertial measurement unit (IMU) and an optical fiber-integrated chest belt for breathing rate monitoring with wireless connection with a gateway connected to the cloud. The sensors also use artificial intelligence algorithms for clustering, classification, and regression of the data. Results show a root mean squared error (RMSE) between the reference data and the proposed breathing rate sensor of 0.6 BPM, whereas RMSEs of 0.037 m/s2 and 0.27 °/s are obtained for the acceleration and angular velocity analysis, respectively. For the sensor validation under different movement analysis protocols, the balance and Timed up and Go (TUG) tests performed with 12 subjects demonstrate the feasibility of the proposed device for biomechanical and physical therapy protocols' automatization and assessment. The balance tests were performed in two different conditions, with a wider and narrower base, whereas the TUG tests were made with the combination of cognitive and motor tests. The results demonstrate the influence of the change of base on the balance analysis as well as the dual task effect on the scores during the TUG testing, where the combination between motor and cognitive tests lead to smaller scores on the TUG tests due to the increase of complexity of the task. Therefore, the proposed approach results in a low-cost and fully automated sensor system that can be used in different protocols for physical rehabilitation.
    Keywords:  gait analysis; inertial measurement units; optical fiber sensors; optoelectronic sensing
    DOI:  https://doi.org/10.3390/bios15090612
  38. Ann Anat. 2025 Sep 19. pii: S0940-9602(25)00364-4. [Epub ahead of print]263 152737
    Beyond four heads: Should the quadriceps femoris be reclassified as multiceps muscle?
    Łukasz Olewnik, Ingrid C Landfald, Kacper Ruzik, Judney Cley Cavalcante, Maria Piagkou, George Triantafyllou, Teresa Vázquez, Paloma Aragones, Fabrice Duparc.
       BACKGROUND: The quadriceps femoris (QF) is classically described as a four-headed muscle. However, anatomical and radiological studies increasingly reveal supernumerary heads and tendon stratifications, challenging this concept.
    OBJECTIVE: This review synthesizes current cadaveric, imaging, and surgical evidence to propose a reclassification of QF as a multiceps femoris (MF). A five-type tendon-based classification system is introduced, reflecting distinct morphological variants and layering complexities.
    METHODS: An extensive review of anatomical dissection studies, radiological investigations (MRI and ultrasound), and clinical reports were conducted to evaluate morphological variability and its implications for tendon harvesting and surgical access.
    RESULTS: Accessory heads such as the tensor vastus intermedius and caput tertium were present in over 60 % of cases, often contributing to distinct layers within the quadriceps femoris tendon (QFT). These configurations influence graft length, harvesting safety, and radiological interpretation. Misidentification of these structures may result in surgical complications or diagnostic errors. Functional and evolutionary analogies with other multiceps systems support the anatomical independence of these heads.
    CONCLUSION: The MF model aligns with modular systems seen in the triceps surae and biceps femoris. Recognizing QF as MF offers a more anatomically accurate and clinically relevant framework. Adoption of updated terminology and imaging protocols may improve diagnosis, reduce surgical risk, and support personalized interventions.
    Keywords:  MRI anatomy; anatomical variation; graft harvesting; multiceps muscle; quadriceps femoris; tendon classification
    DOI:  https://doi.org/10.1016/j.aanat.2025.152737
  39. Behav Sci (Basel). 2025 Sep 10. pii: 1230. [Epub ahead of print]15(9):
    Transcending Measurement: What Matters When Making-with-Music for Equitable Wellbeing in Health and Social Care Systems.
    Marisa de Andrade, Pamela Burnard, Deborah McArthur, Aaron Hawthorne, Leah Soweid.
      Research has long supported the use of and engagement with music as a catalyst for health and wellbeing. However, there is a lack of research exploring how the structures, rituals and 'minor gestures' that go alongside music-making, making-with the materiality of music and engagement, can positively impact health. Using assemblages of interconnected community music projects in North Lanarkshire, Scotland, as collective ethnographic entry points, we examine how collective routines and communal activities-through the interplay of material-discursive practices that play out in structural elements, memories, and shared experiences-contribute to the creation of meaningful social exchanges, stability, sense of belonging and becoming. We argue that the benefits of music 'interventions' are not solely outcomes from isolated activities, but from the accumulative habits and rituals they affect, offering a new perspective on health as a dynamic process. This reframing invites a transcending of measurement in relation to the impact of music on individual and social wellbeing. Through this, we challenge traditional, conventional wellbeing scales and measures and call for a broader understanding of music's potential in addressing health inequalities, concluding with implications for scalable community music models that contribute to expanding possibilities for research-practice-policy partnerships in health and social care systems.
    Keywords:  community; health and social care; health inequalities; material-discursive practices; measures; music; rhizomatic; systems; transcending measurement; wellbeing scales
    DOI:  https://doi.org/10.3390/bs15091230
  40. Brain Sci. 2025 Sep 04. pii: 962. [Epub ahead of print]15(9):
    Linkage Among Cognition, Emotion and Behavior: An Interdisciplinary Perspective.
    Carmelo Mario Vicario, Gabriella Martino.
      The Special Issue "Linkage among Cognition, Emotion and Behavior" offers a comprehensive exploration of the dynamic relationships between the emotional, cognitive, and behavioral domains [...].
    DOI:  https://doi.org/10.3390/brainsci15090962
  41. Int J Rheum Dis. 2025 Sep;28(9): e70415
    Musculoskeletal Ultrasound Assessment Changes Management Decisions in Rheumatoid Arthritis Patients With Moderate Disease Activity.
    Helena Crawshaw, Laura Rubio-Cirilo, Hilary Johnson, Safwan Jamal, Sarah Hickey, Jessica Gunn, Iman Ali, Gill Coombes, Carlos Acebes.
       BACKGROUND: Musculoskeletal ultrasound (MSUS) provides valuable information about disease activity and anatomical damage in rheumatoid arthritis (RA); therefore, in combination with clinical assessment, it may be a useful tool in clinical decision-making with treatment.
    OBJECTIVES: (1) To evaluate the impact of MSUS assessment on treatment decisions in patients with moderately active RA receiving conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). (2) To determine the level of concordance between MSUS assessment and DAS28 in these patients.
    METHODS: RA patients with a DAS-28 ranging from 3.22-5.1, inadequate response to csDMARDs, and indication for escalating treatment were enrolled. All patients underwent an ultrasound (US) examination (B and PD modes) of the bilateral 5-joint count (5USJC), the symptomatic joints of the DAS-28 score (28USJC), and of a comprehensive 78-joint count (78USJC). A Likert scale (pre- and post-MSUS) was used to assess patients' and clinicians' desires to escalate treatment. The outcome of the treatment decision based on US assessment was reviewed at 24 months' follow-up.
    RESULTS: Among the 27 patients included, the mean (SD) DAS-28 score was 4.4 (0.7). Following US assessment, there was a change in the decision to escalate treatment in 18 patients (66.7%), and at a median follow-up of 24 months, only in 5 of the 18 patients had the treatment had been escalated. Treatment escalation was associated with a higher US score across all assessments (5USJC, 28USJC, 78USJC) (p < 0.05). The 78USJC was the most reliably aligned with the treatment decision (p = 0.009). A comparison of the US and clinical assessment revealed poor concordance between all variables of the DAS-28 and US scores, except for the swollen joint count.
    CONCLUSION: The addition of MSUS assessment to the DAS-28 score affected management decisions in 66.7% of patients.
    Keywords:  DAS‐28 score; MSUS; disease activity; musculoskeletal ultrasound; power doppler; rheumatoid arthritis; synovitis; ultrasonography
    DOI:  https://doi.org/10.1111/1756-185x.70415
  42. Ann Biomed Eng. 2025 Sep 20.
    Rotator Cuff Tear-induced Changes in Tendon Structure and Mechanics Measured by Quantitative Magnetic Resonance Imaging.
    Mason J Garcia, Giovanni Intermesoli, Alberto Lalli, Gabriel Landi, Dev R Mehrotra, Erik E Ersland, Arun J Ramappa, Joseph P DeAngelis, Aaron Grant, Michael B Albro, Umile Giuseppe Longo, Ara Nazarian.
       INTRODUCTION: Rotator cuff (RC) tears are prevalent degenerative injuries associated with progressive loss of shoulder function. Although MRI is routinely used for diagnosing RC tears, the relationship between imaging biomarkers and tendon mechanical function remains poorly understood. This study investigates whether quantitative MRI (qMRI), particularly T2 relaxation time, reflects structural and mechanical changes in supraspinatus tendons with RC tears.
    METHODS: Twenty-four human cadaveric supraspinatus tendons (10 intact, 14 torn) were analyzed. Mechanical testing was performed to assess structural and material properties. T2 mapping using a 9.4T MRI scanner was employed to determine relaxation times. Raman spectroscopy and multiphoton imaging were used to assess biochemical composition and collagen organization.
    RESULTS: Torn tendons showed significantly reduced stiffness (p = 0.035) and failure force (p = 0.015) compared to intact tendons. T2 relaxation times were significantly elevated in the torn group (23.7 ± 3.5 ms vs. 20.6 ± 3.3 ms; p = 0.035), with higher heterogeneity and 90th percentile values. T2 metrics correlated strongly with mechanical properties (stiffness: rs = - 0.84, p = 0.002; failure force: rs = - 0.86, p = 0.002) and tear area (rs = - 0.79, p = 0.004). Raman spectroscopy showed reduced proline and hydroxyproline spectral biomarkers in torn tendons (p < 0.02), which correlated with mechanical weakening. Multiphoton imaging revealed significant collagen disorganization and damage in torn tendons.
    DISCUSSION: This study demonstrates that T2 relaxation time is a sensitive non-invasive biomarker of tendon mechanical health and collagen structure in RC tears. These findings support the clinical utility of qMRI in assessing tendon pathology and guiding treatment strategies.
    Keywords:  Multiphoton imaging; Quantitative MRI (qMRI); Raman spectroscopy; Rotator cuff tear; Supraspinatus tendon; T2 relaxation time; Tendon mechanics
    DOI:  https://doi.org/10.1007/s10439-025-03849-1
  43. Front Neurosci. 2025 ;19 1624948
    Assessment of dynamic stability and identification of key tasks and parameters in patients with unilateral and bilateral vestibulopathy: a laboratory-based study.
    Gautier Grouvel, Anissa Boutabla, Julie Corre, Romain Bechet, Samuel Cavuscens, Maurizio Ranieri, Jean-François Cugnot, Christopher McCrum, Raymond van de Berg, Nils Guinand, Stéphane Armand, Angélica Pérez Fornos.
      Chronic imbalance is the cardinal symptom in bilateral vestibulopathy patients (BV), and in a subset of symptomatic unilateral vestibulopathy patients (UV), leading to a significant impact on their daily lives. Despite these profound effects, such as the risk of falls, the mechanism of imbalance remains complex, posing challenges both for monitoring patients' functional status and for evaluating rehabilitation therapies. The aim of this study was to assess the dynamic stability of patients with BV and UV during multiple motor tasks and to provide a summary of the most relevant tasks and biomechanical parameters. The purpose was to propose a "short-form FGA" (Functional Gait Assessment) test to reduce the length and complexity of tests, to be able to evaluate future therapies longitudinally, and to monitor functional follow-up of patients. Dynamic stability, spatio-temporal and kinematic parameters were calculated for 10 BV patients, 10 UV patients and 10 asymptomatic controls while walking at three self-selected walking speeds, while performing dual tasks and while completing the 10 tasks of the FGA battery. Two (validity and interpretability) of the four COSMIN domains and clinical applicability were evaluated to identify relevant tasks and parameters to the study population, i.e., good discriminant and convergent validity, and good clinical applicability. The comfortable and slow gait, as well as the turn pivot, eyes closed, and tandem walk tasks were identified as the most relevant for characterizing dynamic stability in these patients. Easily interpretable and visually assessable parameters, such as walking speed, center of mass displacement, step width, trunk movement, stiffness of the head/trunk, and number of steps, were identified as the most relevant. In contrast, stability parameters such as margin of stability or whole body angular momentum did not prove to be effective parameters. These relevant parameters should enable future studies to evaluate rehabilitation therapies such as vestibular implants or physiotherapy, as well as to monitor patients' functional status. Future studies should validate these results and assess the missing psychometric properties of these parameters.
    Keywords:  COSMIN domains; bilateral vestibulopathy; dynamic stability; functional follow-up of patients; imbalance; short-form FGA
    DOI:  https://doi.org/10.3389/fnins.2025.1624948
  44. Cochrane Database Syst Rev. 2025 Sep 25. 9 CD016137
    Conservative interventions for managing exercise-related musculoskeletal groin pain.
    Anna Paula P Siqueira, Luiz Hespanhol, Anderson Js Oliveira, Brenda Andriolo, Regis B Andriolo, Álvaro N Atallah, Maria S Peccin, Matheus O Almeida.
       OBJECTIVES: This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the benefits and harms of conservative interventions for managing exercise-related musculoskeletal groin pain.
    DOI:  https://doi.org/10.1002/14651858.CD016137
  45. Medicina (Kaunas). 2025 Sep 02. pii: 1587. [Epub ahead of print]61(9):
    The Role of Virtual Reality, Exergames, and Digital Technologies in Knee Osteoarthritis Rehabilitation Before or After Total Knee Arthroplasty: A Systematic Review of the Interventions in Elderly Patients.
    Ludovica Di Curzio, Teresa Paolucci, Sandra Miccinilli, Marco Bravi, Fabio Santacaterina, Lucrezia Giorgi, Silvia Sterzi, Loredana Zollo, Andrea Bernetti, Federica Bressi.
      Background and Objectives: Osteoarthritis (OA) is a chronic, degenerative joint disease. The main symptoms include pain that can cause loss of function and stiffness, as well as swelling, reduced range of motion, crepitus, joint deformity, and muscle weakness. It leads to irreversible structural changes, that in advanced stages can require surgical interventions. The aim of this review was to summarize the current literature about the role of virtual reality (VR), exergames and digital technologies in patients with knee osteoarthritis before or after total knee arthroplasty, to understand if it is possible to prevent and reduce the symptoms and if these new technologies are more effective than conventional rehabilitation therapies. Materials and Methods: We conducted a systematic search of PubMed, Cochrane Library, Scopus, and PEDro from inception to November 2024. The review adhered to the PRISMA 2020 guidelines, and the protocol was prospectively registered in PROSPERO (registration number: CRD42024541890). We included randomized controlled trials (RCTs) enrolling participants aged 60 years or older, in which VR or telerehabilitation programs were compared with conventional rehabilitation approaches. Eligible studies had to report at least one of the following outcomes: pain, functionality, stability, or adherence. Two independent reviewers screened titles and abstracts, assessed full-text eligibility, extracted data, and evaluated the risk of bias using the Cochrane Risk of Bias 2 (RoB 2) tool. Results: Fourteen randomized controlled trails (RCTs) (1123 participants; mean age 68.2 years) were included. VR and telerehabilitation generally outperformed conventional rehabilitation for pain (8/13 studies, -0.9 to -2.3 VAS points) and functionality (7/13 studies, WOMAC improvement 8-15%, TUG -1.2 to -2.8 s). Compliance was higher in most technology-assisted programs (6/7 studies, 70-100% adherence). Stability outcomes were less consistent, with only 1/4 studies showing clear benefit. One study favored conventional rehabilitation for functionality. Overall risk of bias was low-to-moderate, with heterogeneity mainly driven by intervention duration, platform type, and supervision level. Conclusions: Structured telerehabilitation, non-immersive VR, and interactive online exercise programs, especially those offering real-time feedback, show comparable or superior benefits to conventional rehabilitation in older adults with knee OA or after TKA, particularly for pain reduction, functional gains, and adherence. These approaches enhance accessibility and home-based care, supporting their integration into clinical practice when in-person therapy is limited.
    Keywords:  compliance; exergames; functionality; knee osteoarthritis; pain; rehabilitation; stability; technologies; telerehabilitation; virtual reality
    DOI:  https://doi.org/10.3390/medicina61091587
  46. Arch Rehabil Res Clin Transl. 2025 Sep;7(3): 100492
    Rehabilitation Researchers Learning Health Systems Needs Assessment Survey: An Updated Assessment of Research Competencies.
    Pamela M Dunlap, Kathleen M Poploski, Catherine A Anderson, Thiru M Annaswamy, Melissa A Clark, Peter C Coyle, Natalie F Douglas, Ann Marie Flores, Janet K Freburger, Brian J Hafner, Ken J Harwood, Jeanne M Hoffman, Adam R Kinney, Linda Resnik, Kristin Ressel, Margarite J Whitten, Christine M McDonough.
       Objective: To use the updated Rehabilitation Researchers Learning Health Systems (LHS) Needs Assessment Survey for conducting a needs assessment and identify current knowledge and interest in LHS competencies among rehabilitation professionals.
    Design: The anonymous, cross-sectional online survey included 70 competency items related to LHS research core competencies across 8 domains.
    Setting: The respondents were recruited through the LHS Rehabilitation Research Network partners.
    Participants: There were 637 respondents (N=637) who indicated interest and knowledge in LHS research competency items and completed at least 1 competency item or 1 demographic question.
    Interventions: Not applicable.
    Main Outcome Measures: Rehabilitation Researchers Learning Health Systems Needs Assessment Survey.
    Results: The most common professions reported among respondents were physical therapy (24.5%), research (21.6%), and behavioral health (17.6%). The research questions and standards domain had the highest average proportion of respondents indicating "a lot" of interest (67.6%). The systems science domain had the highest average proportion of respondents indicating "none" or "some" knowledge (89%). Competency items that were of high interest and low knowledge were from the systems science, research methods and engagement, leadership, and research management, improvement and implementation, health and health care equity and justice, research questions and standards, and informatics domains.
    Conclusions: In this updated needs assessment survey of LHS competencies among the rehabilitation community, we found that there was continued high interest across LHS domains, high current interest in health and health care equity and justice domain topics, and limited knowledge related to systems science domain competency items. The results of the survey identified new directions for learning opportunities as well as areas for continued engagement to work toward achieving proficiency in LHS competencies among rehabilitation researchers.
    Keywords:  Learning health systems; Needs assessment survey; Rehabilitation
    DOI:  https://doi.org/10.1016/j.arrct.2025.100492
  47. Pain Ther. 2025 Sep 23.
    Thickening of the Intramuscular Fascia of the Iliacus Muscle as Evidence of Myofascial Pathology: A New Hip Pain Syndrome.
    Salvatore Massimo Stella, Annarita Saponara, Roberta Gualtierotti, Fabio Vita, Mario Miccoli, Marco Becciolini, Stefano Galletti, Filippo Cotellessa, Carlo Trompetto.
       INTRODUCTION: Hip/inguinal pain is a common symptom in athletes. Ultrasound (US) examination may discriminate causes, among which the iliopsoas muscle is often neglected. In the present case series study, we describe five patients with hip/inguinal pain where an accurate US evaluation of the iliopsoas muscle showed that the origin of the pain was due to alterations of the iliopsoas muscle complex, particularly of the fascia surrounding the medial fibers of the iliacus muscle (MFIM). We describe a novel pathological entity characterized by myofascial rigidity and hip/inguinal pain with thickening of the intramuscular fascia of the iliacus muscle and its epimysium, with increased stiffness of the muscle.
    METHODS: We studied five athletes with hip/inguinal pain on hip flexion-extension in the absence of hip and visceral pathologies. US was performed with linear probes studying the affected hip at the inguinal level, using longitudinal and axial scans. The examination was completed with power Doppler (PD), strain elastosonography (ELS), and strain ratio (SR) evaluation of the lateral and medial belly of the iliacus muscle.
    RESULTS: In all patients, we observed a thickening of the intramuscular fascia that surrounds the medial belly of the iliacus muscle. The mean ± standard deviation thickness of the intramuscular fascia of the iliacus muscle varied significantly between the affected and non-affected sides (2.70 ± 0.41 mm vs. 1.02 ± 0.15 mm, p value 0.012). In two out of five cases, an increase in the intramuscular perifascial vascular signals at PD was detected. All cases showed stiffness of the MFIM on ELS and altered SR in MFIM compared with the lateral ones in three out of five patients.
    CONCLUSIONS: We describe a novel cause of a pathological condition of the iliopsoas muscle due to the thickening of the medial belly of the iliacus muscle, easily verifiable with US. All subjects responded to physical therapy with high-energy laser and stretching of the muscle unit. Video available for this article.
    Keywords:  Fascia; Groin pain; Hip pain; Iliacus muscle; Iliopsoas; Inguinal pain; Myofascial pain syndrome; Ultrasonography; Ultrasound
    DOI:  https://doi.org/10.1007/s40122-025-00777-9
  48. Diagnostics (Basel). 2025 Sep 22. pii: 2407. [Epub ahead of print]15(18):
    Ultrasonographic Median Nerve Cross-Sectional Area and Clinical, Electrodiagnostic, and Laboratory Biomarkers in Electrodiagnostically Confirmed Carpal Tunnel Syndrome: A Single-Center Correlational Study.
    Hasan Kara, Hüseyin Kaplan, Fatma Nur Aba, Servin Karaca, İsa Cüce.
      Objectives: This study aimed to evaluate the relationship between the median nerve cross-sectional area (CSA, mm2) and clinical findings, blood test results, and electrodiagnostic (EDX) measurements in patients with carpal tunnel syndrome (CTS). Methods: This cross-sectional study included 62 patients (111 hands). The median nerve CSA was assessed using ultrasound (US). The clinical assessment included symptom duration, symptom severity, the Boston Carpal Tunnel Questionnaire (BCTQ), and physical examination. Patient-level analyses used the CSA of the most symptomatic hand for clinical and laboratory variables (n = 62 patients). Hand-level EDX analyses accounted for within-patient clustering by reporting right and left hands separately. Associations were summarized with Spearman's ρ and 95% confidence intervals (CIs); multiplicity was addressed using Benjamini-Hochberg false discovery rate (FDR). EDX units: latency ms, amplitude mV/µV, and velocity m/s. Results: CSA was not associated with global symptom burden (Visual Analog Scale; BCTQ). No laboratory marker remained significant after FDR across the full panel. By contrast, CSA correlated with EDX impairment at the hand level with low-to-moderate effect sizes; for example, distal motor latency was positively associated with CSA on the right (ρ = 0.557, 95% CI 0.334-0.733) and left (ρ = 0.318, 95% CI 0.022-0.578). CSA also correlated positively with CTS EDX severity (right: ρ = 0.449, 95% CI 0.223-0.646; left: ρ = 0.354, 95% CI 0.071-0.609). Conclusions: Ultrasonographic CSA was associated with electrophysiologic impairment and was not associated with overall symptom burden; laboratory signals did not survive FDR control. Accordingly, CSA may serve as a complementary morphologic adjunct to clinical assessment and EDX, with limited utility as a stand-alone severity metric.
    Keywords:  blood tests; carpal tunnel syndrome; cross-sectional area; electrodiagnosis; median nerve; nerve conduction studies; signs and symptoms; ultrasonography
    DOI:  https://doi.org/10.3390/diagnostics15182407
  49. Arthroscopy. 2025 Sep;pii: S0749-8063(25)00434-7. [Epub ahead of print]41(9): 3300-3302
    Lateral Extra-articular Procedures With Anterior Cruciate Ligament Reconstruction: International Consensus.
    Adnan Saithna, Andrew G Geeslin, Bertrand Sonnery-Cottet.
      The risk of anterior cruciate ligament (ACL) graft failure is increased in select patient populations. Lateral extra-articular procedures including anterolateral ligament reconstruction and lateral extra-articular tenodesis seek to reduce ACL graft failure rates and more reliably restore normal knee kinematics. An international consensus meeting was convened in 2024, and through a modified Delphi consensus process, 53 international experts debated 20 surgical indications. A lateral extra-articular procedure was "strongly recommended" in patients undergoing ACL reconstruction with a hamstring autograft in young/active patients, patients with grade III pivot-shift findings, patients with knee hyperextension, and skeletally immature patients; it was "recommended" for revision ACL reconstruction and chronic ACL deficiency; and it "should be considered" in young/active patients receiving patellar or quadriceps tendon autografts, athletes returning to pivoting sports, patients with grade 3 Lachman findings, patients with a posterior tibial slope greater than 12°, and patients with a history of a contralateral ACL injury.
    DOI:  https://doi.org/10.1016/j.arthro.2025.06.011
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