Search Results (521)

Background/Objectives: Physical activity (PA) is widely recognized as a beneficial approach to improving the health-related quality of life (HRQoL) of breast cancer survivors. This study explored key research topics and emerging trends in studies related to PA and HRQoL among breast cancer survivors. Methods: Titles and abstracts of 3847 English-language research articles (2000–2024) were retrieved from PubMed, EMBASE, Web of Science, and Scopus using keywords related to ‘breast cancer’, ‘PA/exercise’, and ‘HRQoL’. A text-mining algorithm based on the Dirichlet-multinomial regression approach in Python was applied to identify the top 10 research topics and their trends over time. Results: In total, 10 key topics emerged: (1) Quality of Life and Well-being, (2) Cancer Treatment and Health-Related Fitness, (3) Supportive Care and Psychosocial Factors, (4) Survivorship, Palliative Care, and Integrative Medicine, (5) Physical Activity and Sedentary Behaviors, (6) Upper Limb-Related Side Effects, (7) Cancer-Related Fatigue and Symptoms, (8) Epidemiological and Clinical Factors, (9) Side Effects of Cancer Treatment, and (10) Weight Management. Among these, Topics 1, 2, 3, 8, and 9 followed upward trajectories, while others showed relatively stable trends. Conclusions: Findings highlight that PA research on breast cancer survivors’ HRQoL spans all stages of survivorship and considers both clinical outcomes and psychosocial and emotional well-being. Understanding how PA and HRQoL have been represented in research helps clarify which survivor needs have received attention and which remain underexplored. These thematic patterns underscore growing acknowledgement of survivors’ lived experiences and offer a roadmap for addressing future research and care gaps. Full article

Objective: This study aimed to evaluate the effect of simultaneously combining therapeutic scapular retraction exercise with and without Neuromuscular Electrical Stimulation (NMES) in amateur female handball players with scapular dyskinesis. Methods: In a randomized, single-blind, controlled trial, the sample (n = 34) was randomized into two groups (Group 1 (n = 17) and Group 2 (n = 17)). The intervention consisted of applying a supervised scapular retraction exercise (SRE) program alone or combined with NMES for 4 weeks (2 ss/week). Scapular Static Positioning Assessment parameters (upper and lower horizontal distance of the scapula from the spine (mm)), internal rotation range of motion (degrees), and external rotation strength (newtons and BW%) were measured. Results: A significant interaction was found to favor the group that received the supervised SRE program + NMES (Group 1) in upper horizontal distance (F_1,30 = 30.93 [p < 0.000]; d = 0.65); lower horizontal distance (F_1,30 = 12.79 [p = 0.001]; d = 0.72); ER Strength (N) (F_1,30 = 19.58 [p < 0.000] d = 0.71); and ER Strength (BW%) (F_1,30 = 16.84 [p < 0.000]) d = 0.69), which was statistically significant (p ≤ 0.001 for p < 0.05). In the analysis for treatment benefit, the number needed to treat (NNT) was 2 for upper scapular positioning and 4 for external rotation strength. Conclusions: NMES improves the Scapular Static Positioning and ER Strength when combined with an SRE program in amateur female handball players diagnosed with scapular dyskinesis, with clinically relevant effects. These findings, while promising, are based on a small sample and should be confirmed in larger studies. Full article

Study Design: Prospective observational study. Background: Lumbar spinal stenosis (LSS) impairs balance and gait function, increasing fall risk and limiting quality of life. Although postoperative recovery of balance is clinically important, longitudinal data using multidimensional balance assessments are limited. Methods: A prospective cohort study was conducted in 101 patients (mean age 74.9 ± 6.9 years) undergoing surgery for LSS. The Brief Balance Evaluation Systems Test (Brief BESTest), Oswestry Disability Index (ODI), Modified Falls Efficacy Scale (MFES), Zurich Claudication Questionnaire (ZCQ), and Visual Analog Scales (VAS) for pain/numbness were evaluated preoperatively and at 6 and 12 months postoperatively. Changes over time and correlations between Brief BESTest and PROMs were analyzed. Results: The total Brief BESTest score significantly improved from 13.3 ± 5.3 preoperatively to 16.1 ± 5.1 at 6 months and 16.0 ± 5.1 at 12 months (p < 0.01). Subdomains including Anticipatory Adjustments, Postural Responses, Sensory Orientation, and Stability in Gait improved significantly, while Stability Limits did not. At 12 months postoperatively, ODI decreased by 19.1%, ZCQ symptom and function scores improved by 0.8 and 0.9 points, respectively, and VAS scores improved by 17.1 mm for low back pain, 26.5 mm for lower limb pain, and 19.5 mm for numbness, all showing marked improvements from baseline. MFES also increased significantly postoperatively. The Brief BESTest score correlated significantly with MFES and ZCQ-PFS at baseline, and with ODI, ZCQ, and VAS scores at 12 months. Conclusions: Balance ability in LSS patients improved after surgery, as measured by the Brief BESTest, with clinically meaningful changes maintained for 12 months. Improvements in balance were significantly associated with reductions in pain, disability, and fear of falling, suggesting the Brief BESTest is a comprehensive indicator of postoperative recovery. Full article

Background/Objectives: Feigning spectrum behavior (FSB) is the exaggeration, fabrication, or false imputation of symptoms. It occurs in compensable injury with great cost to society by way of loss of productivity and excessive costs. The aim of this study is to identify feigning by developing cut scores on the long and short forms (SF) of the Orebro Musculoskeletal Pain Screening Questionnaire (OMPSQ and OMPSQ-SF) and the Perceived Stress Scale (PSS and PSS-4). Methods: As part of pre-screening for a support program, 40 injured workers who had been certified unfit for work for more than 2 weeks were screened once with the OMPSQ and PSS by telephone by a mental health professional. A control sample comprised of 40 non-injured community members were screened by a mental health professional on four occasions under different aliases, twice responding genuinely and twice simulating an injury. Results: Differences between the workplace injured people and the community sample were compared using ANCOVA with age and gender as covariates, and then receiver operator characteristics (ROCs) were calculated. The OMPSQ and OMPSQ-SF discriminated (ρ < 0.001) between all conditions. All measures discriminated between the simulation condition and workplace injured people (ρ < 0.001). Intraclass correlation demonstrated the PSS, PSS-4, OMPSQ, and OMPSQ-SF were reliable (ρ < 0.001). Area Under the Curve (AUC) was 0.750 for OMPSQ and 0.835 for OMPSQ-SF for work-injured versus simulators. Conclusions: The measures discriminated between injured and non-injured people and non-injured people instructed to simulate injury. Non-injured simulators produced similar scores when they had multiple exposures to the test materials, showing the uniformity of feigning spectrum behavior on these measures. The OMPSQ-SF has adequate discriminant validity and sensitivity to feigning spectrum behavior, making it optimal for telephone screening in clinical practice. Full article

Background/Objectives: Predicting comprehensive patient characteristics is essential for optimal individualized rehabilitation plans for acute stroke patients. However, current models primarily predict single outcomes. This study aimed to assess the applicability of latent class analysis (LCA) in rehabilitation practice by identifying comprehensive characteristics and associated predictors in acute stroke patients. Methods: We conducted a retrospective observational study using the Japan Association of Rehabilitation Database, including 10,270 stroke patients admitted to 37 acute-care hospitals between January 2005 and March 2016. Patients were classified using LCA based on outcomes at discharge, including Functional Independence Measure (FIM), National Institutes of Health Stroke Scale (NIHSS) subscales for upper-extremity function, length of hospitalization, and discharge destination. Predictor variables at admission included age, FIM scores, NIHSS subscales for upper-extremity function, stroke type, and daily rehabilitation volume. Results: 6881 patients were classified into nine distinct classes (class size: 4–29%). Class 1, representing the mildest cases, was noted for independent ambulation and good upper limb function. Class 2 comprised those with the most severe clinical outcome. Other classes exhibited a gradient of severity, commonly encountered in clinical practice. For instance, Class 7 included right-sided paralysis with preserved motor activities of daily living (ADLs) and modified dependence in cognitive functions, such as communication. All predictors at admission were significantly associated with class membership at discharge (p < 0.001). Conclusions: LCA effectively identified unique clinical subgroups among acute stroke patients and demonstrated that key admission variables could predict class membership. This approach offers a promising insight into targeted, personalized rehabilitation practice for acute stroke patients. Full article

Background: The influence of hospitalization owing to pneumonia on changes in body composition has not been specifically reported. We conducted a prospective cohort study of patients with community-acquired pneumonia (CAP) requiring hospitalization to test the hypothesis that hospitalization affects body composition. Methods: Sixty-four consecutive patients with CAP were recruited. Body composition was measured within 24 h of admission and 24 h before discharge using bioelectrical impedance analysis. The association between changes in body composition and variables obtained at admission was investigated. Index values were calculated as weight divided by height squared. Results: The mean age of the patients was 76.0 ± 8.7 years (78.1% males). The median length of hospitalization was 12.0 days. Weight, body mass index (BMI), skeletal muscle (SM), SM index, fat-free mass (FFM), and FFM index significantly decreased (p < 0.001 for each), but fat mass (FM) and FM index did not. The serum total protein level was the only independent predictor of the lowest quartile of change in SM index (<−0.4) after adjusting for age and sex (p = 0.004). Conclusions: In summary, weight and BMI significantly decreased during hospitalization in patients with CAP, which was attributed to SM reduction. Patients with low serum total protein levels on admission were at risk of an accelerated decrease in the SM index. Nutritional intervention and rehabilitation are important for these patients. Full article

Background/Objectives: Neck pain caused by myofascial pain syndrome (MPS) is a highly prevalent musculoskeletal condition. Repetitive peripheral magnetic stimulation (rPMS) is a promising treatment option; however, its therapeutic effect and optimal treatment frequency remain unclear. This study aimed to investigate the therapeutic effect and duration of effect of rPMS in patients with MPS of the neck. Methods: In this randomized, sham-controlled, crossover trial, 27 patients with neck MPS and baseline visual analog scale (VAS) scores ≥ 40 were enrolled. The mean age was 43.8 ± 9.1 years, and 63% were female. Participants were randomly assigned to receive either an initial rPMS treatment (a 10 min session delivering 3900 pulses at 5–10 Hz) or sham stimulation. After 7 days, groups crossed over. Pain intensity (VAS), disability (Neck Disability Index; NDI), and analgesic use were recorded daily for seven consecutive days. A linear mixed-effects model was used for analysis. Results: At baseline, the VAS and NDI scores were 61.8 ± 10.5 and 26.0 ± 6.3, respectively. rPMS produced a significantly greater reduction in both VAS and NDI scores, with the greatest differences observed on Day 4: the differences were −24.1 points in VAS and −8.5 points in NDI compared to the sham group. There was no significant difference in analgesic use between the two groups. Conclusions: A single rPMS session provides short-term improvement in pain and disability in neck MPS. Based on the observed therapeutic window, more frequent sessions (e.g., twice weekly) may provide sustained benefit and should be explored in future studies. Full article

Background: High-intensity gait training (HIT) is an evidence-based intervention recommended for stroke rehabilitation; however, its implementation in routine practice is inconsistent. This study examined the real-world implementation of HIT in an inpatient rehabilitation setting in Norway, focusing on fidelity, barriers, and knowledge translation (KT) strategies. Methods: Using the Knowledge-to-Action (KTA) framework, HIT was implemented in three phases: pre-implementation, implementation, and competency. Fidelity metrics and coverage were assessed in 99 participants post-stroke. Barriers and facilitators were documented and categorized using the Consolidated Framework for Implementation Research. Results: HIT was delivered with improved fidelity during the implementation and competency phases, reflected by increased stepping and heart rate metrics. A coverage rate of 52% was achieved. Barriers evolved over time, beginning with logistical and knowledge challenges and shifting toward decision-making complexity. The KT interventions, developed collaboratively by clinicians and external facilitators, supported implementation. Conclusions: Structured pre-implementation planning, clinician engagement, and external facilitation enabled high-fidelity HIT implementation in a real-world setting. Pragmatic, context-sensitive strategies were critical to overcoming evolving barriers. Future research should examine scalable, adaptive KT strategies that balance theoretical guidance with clinical feasibility to sustain evidence-based practice in rehabilitation. Full article

Introduction and Aim: Sarcopenia has emerged as a key prognostic factor in patients with chronic limb-threatening ischemia (CLTI), with potential implications for clinical decision-making. This study aimed to assess the association between sarcopenia and clinical outcomes, mortality, and amputation, using simple, accessible screening tools in a CLTI population. Methods: In this prospective, single-center study conducted between December 2023 and December 2024, 170 patients with CTLI were enrolled. Sarcopenia screening was performed using the SARC-F (strength, assistance in walking, rising from a chair, climbing stairs, falls) questionnaires, handgrip strength measurement, and calf circumference, adjusted for body mass index and sex. The primary outcome was 6-month all-cause mortality and/or major amputation. Results: Sarcopenia was identified in 77 patients (45.3%). Compared to non-sarcopenic individuals, sarcopenic patients were significantly older. They exhibited greater functional impairment, as well as poorer nutritional and muscle status. They also had significantly higher in-hospital mortality (16.9% vs. 3.2%, p = 0.002), 30-day mortality (24.7% vs. 4.3%, p = 0.001), and 6-month mortality (50.6% vs. 15.1%, p = 0.001). Sarcopenia was significantly associated with the primary outcome in univariate analysis (HR: 2.05; 95% CI: 1.31–3.20; p = 0.002) and remained an independent predictor after multivariate adjustment (HR: 1.95; 95% CI: 1.01–3.79; p = 0.048). Conclusions: Sarcopenia is a strong, independent predictor of poor outcome in patients with CLTI. Its detection through simple tools offers an easy and cost-effective strategy to improve risk stratification and guide early intervention through exercise-based therapy. Full article

Background: The rehabilitative treatment of muscle injuries is mostly conservative, but it does not always follow precise protocols. Appropriate physiotherapy, exercises, and training are essential components of the rehabilitation and reconditioning of injured muscles. The purpose of this review is to assess the good rehabilitative practices in the treatment of patients affected by muscle injuries. Methods: We performed research on Medline and Cochrane Database. Guidelines focusing on the rehabilitative treatment of muscle injuries were evaluated for inclusion. Statements about non-rehabilitative treatments were also reported only for the guidelines that mainly focused on rehabilitative treatments. Results: Eight guidelines meeting the inclusion criteria were included in the review. Results were framed into a narrative overview. Two of them mainly focused on hamstring rehabilitation, the others focused on several muscular districts. Conclusions: Conservative treatment of muscle injuries is currently the gold standard, with good results in terms of both rehabilitation times and post-injury sports performance. However, there is not a complete agreement on the type of exercises and the timing of rehabilitation when these should be performed. More research is needed to draw conclusions about the use of physical therapy instruments and other rehabilitation approaches and techniques. Full article

Introduction: Burnout syndrome, long described as an “occupational phenomenon”, now affects 15–20% of the general workforce and more than 50% of clinicians, teachers, social-care staff and first responders. Its precise nosological standing remains disputed. We conducted a mechanistic review of electroencephalography (EEG) studies to determine whether burnout is accompanied by reproducible brain-function alterations that justify disease-level classification. Methods: Following PRISMA-adapted guidelines, two independent reviewers searched PubMed/MEDLINE, Scopus, Google Scholar, Cochrane Library and reference lists (January 1980–May 2025) using combinations of “burnout,” “EEG”, “electroencephalography” and “event-related potential.” Only English-language clinical investigations were eligible. Eighteen studies (n = 2194 participants) met the inclusion criteria. Data were synthesised across three domains: resting-state spectra/connectivity, event-related potentials (ERPs) and longitudinal change. Results: Resting EEG consistently showed (i) a 0.4–0.6 Hz slowing of individual-alpha frequency, (ii) 20–35% global alpha-power reduction and (iii) fragmentation of high-alpha (11–13 Hz) fronto-parietal coherence, with stage- and sex-dependent modulation. ERP paradigms revealed a distinctive “alarm-heavy/evaluation-poor” profile; enlarged N2 and ERN components signalled hyper-reactive conflict and error detection, whereas P3b, Pe, reward-P3 and late CNV amplitudes were attenuated by 25–50%, indicating depleted evaluative and preparatory resources. Feedback processing showed intact or heightened FRN but blunted FRP, and affective tasks demonstrated threat-biassed P3a latency shifts alongside dampened VPP/EPN to positive cues. These alterations persisted in longitudinal cohorts yet normalised after recovery, supporting trait-plus-state dynamics. The electrophysiological fingerprint differed from major depression (no frontal-alpha asymmetry, opposite connectivity pattern). Conclusions: Across paradigms, burnout exhibits a coherent neurophysiological signature comparable in magnitude to established psychiatric disorders, refuting its current classification as a non-disease. Objective EEG markers can complement symptom scales for earlier diagnosis, treatment monitoring and public-health surveillance. Recognising burnout as a clinical disorder—and funding prevention and care accordingly—is medically justified and economically imperative. Full article

Background/Objectives: Frailty is a multifactorial clinical syndrome characterized by diminished physiological reserves and increased vulnerability to stressors. It is increasingly recognized as a predictor of poor outcomes in cardiac rehabilitation (CR). However, how frailty is defined, assessed, and addressed across outpatient CR programmes remains unclear. This scoping review aimed to map the extent, range, and nature of research examining frailty in the context of outpatient CR, including how frailty is measured, its impact on CR participation and outcomes, and whether sex and gender considerations or participation barriers are reported. Methods: Following the PRISMA-ScR guidelines, we conducted a comprehensive search across six electronic databases (from inception to 15 May 2025). Eligible peer-reviewed studies included adult participants assessed for frailty using validated tools and enrolled in outpatient CR programmes. Two reviewers independently screened citations and extracted data. Results were synthesized descriptively and narratively across three domains: frailty assessment, sex and gender considerations, and barriers to CR participation. The protocol was registered with the Open Science Framework. Results: Thirty-nine studies met inclusion criteria, all conducted in the Americas, Western Pacific, or Europe. Frailty was assessed using 26 distinct tools, most commonly the Kihon Checklist, Fried’s Frailty Criteria, and Frailty Index. The median pre-CR frailty prevalence was 33.5%. Few studies (n = 15; 38.5%) re-assessed frailty post-CR. Sixteen studies reported sex or gender data, but none applied sex- or gender-based analysis (SGBA) frameworks. Only eight studies examined barriers to CR participation, identifying physical limitations, emotional distress, cognitive concerns, healthcare system-related factors, personal and social factors, and transportation as key barriers. Conclusions: The literature on frailty in CR remains fragmented, with heterogeneous assessment methods, limited global representation, and inconsistent attention to sex, gender, and participation barriers. Standardized frailty assessments and individualized CR programme adaptations are urgently needed to improve accessibility, adherence, and outcomes for frail individuals. Full article

Background/Objectives: Left/right discrimination (LRD) training is increasingly being used in the treatment of chronic low back pain (CLBP). However, it is unclear whether trunk LRD-performance is impaired in CLBP patients and whether clinical parameters are related to LRD-performance. Therefore, this cross-sectional study aimed to examine (1) whether LRD-performance differs between CLBP patients and pain-free individuals; (2) whether these differences depend on the low back pain (LBP) history in pain-free individuals; (3) if clinical factors are related to LRD-performance; (4) whether LRD-task difficulty influences these results. Methods: Participants included 150 pain-free persons (107 with no LBP-history; 43 with past LBP) and 150 patients with CLBP. All participants performed the LRD-task in a simple and complex condition. Outcomes were reaction time and accuracy. Results: CLBP patients were significantly slower (Cohen’s d = 0.47 to 0.50, p < 0.001) and less accurate (Cohen’s d = 0.30 to 0.55, p < 0.001) than pain-free individuals without LBP-history, but not compared to those with past LBP (Cohen’s d reaction time = 0.07 to 0.15, p = 0.55; Cohen’s d accuracy = 0.03 to 0.28, p-value = 0.28). All participant groups were slower and less accurate in the complex condition, but between-groups differences were independent of task difficulty. Linear mixed models showed that older age and lower education were independently associated with less accuracy. When controlling for demographics, pain intensity, disability, fear of movement, pain-related worry and pain duration were not related to LRD-performance in patients with CLBP. Conclusions: Patients with CLBP showed impaired trunk LRD-performance compared to pain-free persons without LBP history, but not compared to those with past LBP. When controlling for demographics, clinical parameters were not related to LRD-performance in patients with CLBP. Our findings indicate that LRD-performance may remain impaired after recovering from LBP. Full article

Background/Objectives: Spacer dislocation is among the most frequent mechanical complications after revision total hip arthroplasty for periprosthetic hip infection. Spacer dislocations may be managed conservatively, but there are no guidelines on the rehabilitation of these patients, and the restriction of weight bearing is still under debate. Methods: We first report the case of a patient with hip spacer cranial dislocation, judged unfit to be surgically treated once more for a medium period, who started a rehabilitation program with partial weight bearing. Results: After two weeks of inpatient rehabilitation, the patient started to maintain the standing position with partial weight bearing on the affected side. Following hospital discharge we continued rehabilitation in the outpatient clinic. Despite the finding of the denervation of the ipsilateral quadriceps, three months after admission, she was able to walk for short distances using a walker, initially with the help of a therapist and then with supervision. About one year later, she was able to undergo the reimplantation of the definitive prosthesis. Conclusions: Despite the spacer dislocation, walking short distances is a feasible goal, even with assistance, wearing a brace and using a walker. Future research is needed to confirm and expand upon this observation and to understand the mechanisms underlying the development of neurological complications to implement effective prevention strategies. Full article

Background/Objectives: The objective of this review is to document the modalities to enhance the neuromuscular effects of botulinum toxin (BoNT) injection in spastic patients with multiple sclerosis (MS). Methods: We conducted a literature review focusing on studies involving BoNT administration for MS-related spasticity and the use of adjunctive therapies aimed at reducing dosage and increasing injection intervals. Results: The findings revealed a limited number of studies specific to MS patients, addressing only a few adjunct techniques, including electrical stimulation, vibration therapy, physical exercise, and extracorporeal shock wave therapy. Conclusions: These preliminary findings highlight the need for further research into integrative therapeutic strategies tailored specifically to the MS population. Full article