Search Results (1,377)

Background/Objectives: Tinnitus can have an adverse impact on some patients’ lives, affecting the daily functioning for a proportion of patients. In recent years, audiologists in Singapore who are specialised in tinnitus and hyperacusis rehabilitation have increasingly been providing tinnitus and/or hyperacusis management. The aim of this study was to evaluate the outcome of audiologist-delivered tinnitus management at a public hospital in Singapore. Methods: Retrospective data from patients seen between 2016 and 2019 were extracted from the hospital’s electronic medical record system. Outcomes were analysed using pre-treatment and three-month post-treatment Tinnitus Handicap Inventory (THI) scores among patients referred to the audiologist-led tinnitus clinic. Results: A total of 201 patients aged 18 to 86 years received tinnitus management. Among patients who returned for follow-up, 93% showed a reduction in THI score three months after treatment. Mean THI scores decreased significantly from 46.9 to 24.3, with a corrected effect size of 1.16, indicating a large treatment effect. Among patients with moderate or greater tinnitus handicap at baseline, 81% improved by at least one severity grade. Conclusions: This is one of the first studies to report outcomes of an audiologist-led tinnitus management service in Singapore. The findings are consistent with a potential role for structured, audiologist-led tinnitus services in Asian healthcare settings, although controlled studies are needed to confirm treatment effectiveness. General practitioners, otolaryngologists and other healthcare providers can play an important role in recognising tinnitus-related distress, offering early reassurance and directing patients to appropriate audiological and supportive care. Full article

Background/Objectives: Early childhood caries (ECC) is a common, preventable, and socially patterned disease, yet the literature on ECC is vulnerable not only to limitations in evidence generation but also to errors in evidence translation. This conceptual framework paper focuses on evidence translation rather than estimating a new treatment effect. Methods: Literature and framework development were informed by targeted narrative searches of PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar, with an emphasis on ECC literature from 2010 onward and foundational methodological sources. Sources were purposively retained if they clarified an evidentiary domain, a cross-domain bridge, or a competing interpretation; priority was given to systematic reviews, trials, longitudinal and causal studies, natural experiments, clinical guidance, and implementation evaluations. No pooled effect estimates were produced. Results: Evidence drift is the movement of a finding into a stronger or different claim without adequate bridging evidence. The proposed framework comprises association, mechanism, causation, consequence, disease control, and policy implementation, with commercial and structural determinants operating as a cross-cutting upstream layer. It classifies the inference advanced rather than study design alone and permits primary and secondary domain tags. A four-question test asks whether the research question and conclusion occupy the same domain, what bridge supports the movement, and whether uncertainty is retained. Five trajectories illustrate the framework: vitamin D, dental rehabilitation under general anesthesia, oral microbiome research, silver diamine fluoride (SDF), and sugar taxation. In the SDF case, lesion-arrest evidence is explicitly separated from the still-unproven implementation hypothesis that endpoint-only pathways may create differential standards of care. Conclusions: The original contribution is an integrated vocabulary, decision procedure, and validation agenda for ECC evidence appraisal. The framework generates three prespecified, testable hypotheses: (1) trained raters will classify claims with reproducible inter-rater agreement (kappa ≥ 0.70); (2) claims judged to contain evidence drift will be significantly less likely than domain-concordant claims to include an explicit bridge; and (3) using the structured framework will improve the transparency and proportionality of reviews compared with usual appraisal. Prospective testing of content and construct validity, as well as practical utility, in peer review, guideline development, education, and policy evaluation is required before standardized implementation. Full article

Background: The management of complete mandibular edentulism in frail patients with severe bone atrophy is a clinical challenge. Ultrashort implants (≤4 mm) have been proposed as a minimally invasive alternative to bone augmentation procedures; however, long-term evidence in full-arch rehabilitations remains limited. Methods: This retrospective single-center cohort study presents the 10-year follow-up of patients treated with full-arch mandibular rehabilitation under immediate loading supported by 4 mm ultrashort implants. Patients were originally treated between 2015 and 2017. The primary outcome was prosthetic success at 10 years, defined as a stable and functional prosthesis supported by four implants. Secondary outcomes included implant survival, timing of implant loss, and biological and prosthetic complications. Results: Fourteen patients were available for evaluation at the 10-year follow-up. The success of the prosthetic structure was 100%, with all patients maintaining stable and functional rehabilitation. As regards the implants, a total of 82 implants had been placed, with 14 implant losses, resulting in a cumulative implant survival rate of 82.9%. Implant losses occurred mainly in early (1 week, 4 months) and late phases (between 3 and 10 years), while no losses were observed between 1 and 3 years. Overall, 71.43% of patients experienced at least one implant loss; however, this did not compromise prosthetic function. Conclusions: In this retrospective cohort, all full-arch prostheses remained functional at 10 years, although cumulative implant survival was 82.9%. These findings suggest that rehabilitation supported by 4 mm ultrashort implants may represent a treatment option for carefully selected frail patients with severe mandibular atrophy. Prospective controlled studies are needed to confirm these findings and compare this approach with standard-length implants and bone augmentation procedures. Full article

Perioperative management of antirheumatic medications in adults with rheumatoid arthritis (RA) undergoing orthopedic surgery requires balancing postoperative infection and impaired wound healing against disease flare, pain, and delayed rehabilitation. This systematic review aimed to evaluate how perioperative continuation, withholding, interruption timing, restart timing, dose modification, or exposure to antirheumatic medications relates to postoperative outcomes in adults with RA undergoing arthroplasty and non-arthroplasty orthopedic procedures. PubMed, Scopus, and the Cochrane Central Register of Controlled Trials were searched from database inception to 18 April 2026 for English-language full-text clinical studies. The primary outcomes were surgical site infection/periprosthetic joint infection, delayed wound healing, and postoperative RA flare. Secondary outcomes included reoperation, revision, readmission, mortality, venous thromboembolism, dislocation, and other procedure-specific complications. Original studies were classified as direct perioperative strategy evidence, medication-exposure evidence, or supportive clinical-context evidence. Forty-three original clinical studies were included, together with six non-original contextual sources. The evidence was predominantly observational, clinically heterogeneous, and of very low certainty. Methotrexate continuation was not associated with an evident increase in early postoperative complications, whereas direct evidence for other conventional synthetic agents was limited. Longer interruption of biologic or targeted synthetic therapy did not consistently reduce infection or wound-healing complications, while several studies associated treatment interruption with postoperative flare. Chronic baseline glucocorticoid exposure was associated with adverse outcomes but was clinically distinct from short-term perioperative administration; stress-dose supplementation was not directly evaluated. Medication decisions should therefore be individualized according to drug class, disease control, glucocorticoid burden, surgical procedure, and patient risk profile. Full article

Unilateral spatial neglect (USN) is a neuropsychological syndrome characterized by a reduced awareness of, and attention toward, stimuli located in the contralesional space. The left side of the space is most frequently affected, due to the higher incidence of the disorder following right-hemisphere lesions, particularly within the territory of the right middle cerebral artery and, less commonly, the right anterior cerebral artery. Although USN can also occur following left-hemisphere damage, it is typically less severe and tends to resolve more quickly. USN is a common consequence of acquired brain injury, especially of vascular origin, and significantly impairs a patient’s functional abilities and quality of life. Its high incidence in the acute phase after stroke, together with its potential persistence into the chronic stage, makes early diagnosis and timely rehabilitation essential. In this narrative review, we provide an overview of current assessment tools and rehabilitation approaches for post-stroke USN, with a focus also on recent advances and emerging therapeutic strategies. To illustrate diagnostic and therapeutic decision making, a representative case of a patient admitted to a Stroke Unit is reported, illustrating the application of assessment methods in a real-world setting. The aim of this review is to offer clinicians practical tools and evidence-based strategies to support a more effective and individualized management of patients affected by this complex and disabling condition. Full article

Background: Fatigue during intense activity challenges the neuromuscular system and can reveal deficits not evident during lower-demand functional tasks. In individuals with anterior cruciate ligament reconstruction (ACLR), differences in graft source may be associated with graft-specific neuromuscular adaptations. Although fatigue-related neuromuscular deficits after ACLR have been reported, few studies have examined whether these responses differ according to graft type during running. This study investigated the effects of running-induced fatigue on lower-limb muscle activity during the stance phase in ACLR patients with different graft types, compared with healthy controls. Methods: Fifty-three active males were allocated into four groups: single-bundle hamstring tendon (SB-HT), double-bundle hamstring tendon (DB-HT), allograft, and healthy controls. Participants completed a treadmill-based fatigue protocol that was terminated when they reached a Borg score > 17, which served as the primary criterion for confirming a high level of perceived fatigue. Heart rate ≥ 85% of estimated maximum heart rate was recorded as a complementary physiological indicator of high-intensity exertion. Electromyography (EMG) amplitudes of eight lower-limb muscles were recorded during the early and late stance phases of running, before and after fatigue. A two-way mixed-model ANOVA evaluated the effects of graft type and fatigue condition. Results: Fatigue reduced semitendinosus (p = 0.042, ηp² = 0.091) and gluteus medius (p < 0.001, ηp² = 0.442) activation during early stance regardless of group. Late-stance group effects were significant for the tibialis anterior, gastrocnemius, rectus femoris, biceps femoris, semitendinosus, and gluteus medius (p ≤ 0.05). Across stance phases, the SB-HT group showed greater hamstring and gluteus medius activation than healthy controls (p = 0.003–0.041), while the allograft group showed greater tibialis anterior, gastrocnemius, and rectus femoris activation during late stance (p = 0.005–0.043). The only significant group × fatigue interaction was observed for vastus medialis (p = 0.002, ηp² = 0.279), reflecting a fatigue-related reduction in the DB-HT group. Conclusions: Graft type was associated with distinct lower-limb EMG activation patterns during running after ACLR. Fatigue revealed a DB-HT-specific reduction in vastus medialis activation, while the allograft and SB-HT groups showed different compensatory activation profiles. These findings suggest that graft-specific neuromuscular adaptations during fatigue should be considered when developing rehabilitation protocols to improve functional stability and future joint health. Full article

Accelerated Bridge Construction (ABC) projects in the United States (U.S.) have consistently demonstrated the significant advantages of prefabrication over conventional construction methods. Since the early 2010s, the adoption of ABC has expanded steadily, with projects achieving substantial reductions in construction duration while concurrently mitigating traffic disruptions. Screening-level evaluation and decision-making tools for selecting between ABC and conventional construction methods emerged in the U.S. in the mid-2000s. These tools, together with cost-estimation tools developed to support them, have continued to evolve. This paper presents a comprehensive literature review examining the evolution of screening-level evaluation, decision-making, and cost-estimation tools for ABC projects in the U.S. The review indicates that existing qualitative and quantitative evaluation and decision-making approaches remain practically useful for the selection of ABC methods but exhibit limited methodological robustness when applied to support decisions across a broad range of influencing factors. However, hybrid approaches based on the Analytic Hierarchy Process (AHP) represent an important advancement toward more structured Multi-Criteria Decision-Making (MCDM). In particular, AHP hybrid models constitute a significant progression beyond traditional AHP by mitigating several of its inherent limitations. The review also highlights that early cost-estimation approaches incorporated within evaluation and decision-making frameworks primarily focused on short-term construction costs and road user costs associated with the construction phase. However, with sustainability becoming a principal objective of modern infrastructure management, Life-Cycle Cost (LCC) estimation should comprehensively incorporate long-term Maintenance and Rehabilitation (M&R) expenditures throughout the entire service life of bridge infrastructure. Furthermore, the review highlights the need for improved screening-level MCDM tools capable of strengthening the identification and selection of preferred ABC alternatives during the earliest stages of project development while enhancing their long-term sustainability. Full article

Purpose: Upper extremity motor impairments following stroke substantially limit independence in daily living. Hand-tracking virtual reality (VR) rehabilitation systems may support intensive task-oriented practice while enhancing motivation; however, evidence integrating objective kinematic indicators with usability and patient-reported outcomes for controller-free consumer-grade VR remains limited. The primary aim of this single-arm pilot study was to evaluate the feasibility, safety (tolerability), and usability of a hand-tracking VR rehabilitation system delivered as an adjunct to conventional physiotherapy in individuals with stroke; describing its preliminary in-game kinematic profile and exploring participants’ experiences through open-ended feedback were secondary aims. The study was explicitly not designed or powered to test clinical efficacy. Materials and Methods: Ten individuals with stroke completed a 20-session (8-week) single-arm pilot intervention; all participants concurrently received standard hospital-based physiotherapy (median 3 sessions/week, ∼45 min/session). Early-phase (sessions 1–5) and late-phase (sessions 16–20) within-subject performance were compared using the Wilcoxon signed-rank test with Holm–Bonferroni correction across four pre-specified primary outcomes. Movement smoothness was assessed using the Spectral Arc Length (SPARC), usability was evaluated using the System Usability Scale (SUS), and cybersickness was monitored with the Simulator Sickness Questionnaire (SSQ). Results: Sixteen patients were screened, of whom fourteen started the intervention and ten completed the 8-week per-protocol program (intervention completion rate, 10/14 = 71.4%; per-protocol session adherence among the ten completers, 200/200 = 100%; no SSQ-defined adverse events). Within-subject comparisons showed a $+10.6$-point increase in success rate (adjusted $p=0.020$), a $+0.10$ m/s increase in mean movement speed (adjusted $p=0.020$), a $-341$ ms reduction in pause duration (adjusted $p=0.022$), and a $+27.0$-point Hodges–Lehmann median-difference increase in SS-QOL (95% CI $14.0$–$41.0$; participant-level median $\mathsf{\Delta }$$+18.5$; adjusted $p=0.020$). The mean SUS score was $78.5\pm 5.4$, indicating “good” usability. Thematic analysis of post-intervention open-ended feedback identified three themes—motivation and engagement, the value of feedback, and design and comfort suggestions—that converged with the high adherence and good usability ratings. Correlations between VR-derived kinematic change and clinical change were non-significant trends ($p\ge 0.12$). Conclusions: A controller-free hand-tracking VR system was found to be feasible, well tolerated, and rated as having good usability when delivered as an adjunct to conventional therapy. Because the study used a single-arm design, included only ten participants, and did not control for the confounding effect of concurrent conventional physiotherapy or natural recovery, the observed within-subject changes cannot be causally attributed to the VR intervention and should be interpreted as exploratory feasibility signals. Adequately powered randomized controlled trials with stroke-specific clinical scales (e.g., FMA-UE, ARAT) are required before clinical efficacy can be claimed. Full article

Adhesive capsulitis (AC) is a common fibroinflammatory shoulder disorder, affecting 2–5% of the general population and up to 20% of people with diabetes mellitus. Although historically considered self-limiting, the course frequently exceeds two years and imposes a substantial functional burden. Intra-articular corticosteroids remain the predominant first-line option, but their benefit is often short-lived and is offset by transient hyperglycemia in diabetic patients, potential tissue toxicity with repeated use, and limited durability. These limitations have prompted interest in non-steroidal, ultrasound-guided alternatives. This narrative review appraises two complementary strategies: ultrasound-guided regenerative injectates (hyaluronic acid, hypertonic dextrose prolotherapy, and platelet-rich plasma) and ultrasound-guided perineural hydrodissection of the suprascapular, axillary, and subscapular nerves. We summarize comparative efficacy with corticosteroids, durability, injection anatomy, and the subgroups most likely to benefit. We then propose—explicitly as a clinically defensible framework rather than a validated guideline—a phase-specific paradigm in which a timely non-steroidal injection provides early pain control while stage-appropriate rehabilitation drives functional recovery. The hypothesis that this sequence may compress the symptomatic course to approximately three to six months is supported by preliminary evidence and requires prospective validation. Because no head-to-head trial has compared the proposed paradigm with the corticosteroid-first standard, these recommendations warrant corresponding caution. Full article

Background/Objectives: Chronic dust-induced lung diseases, including pneumoconiosis and asbestosis, require long-term monitoring and individualized management. Conventional rehabilitation and follow-up often depend on in-person visits and may not provide continuous assessment outside clinical settings. This scoping review mapped evidence on digital technologies used to monitor patients, assess respiratory symptoms and functional status, and support rehabilitation follow-up in chronic dust-induced lung diseases. Methods: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and Joanna Briggs Institute methodology. PubMed, Scopus, and Web of Science were searched from inception to 29 June 2026 without language restrictions. Five eligible publications were included. Results: The evidence was grouped into three categories: wearable monitoring of activity and respiratory symptoms, analysis of data from a digital rehabilitation platform, and electronic medical record (EMR) analysis. Wearable sensors showed high performance in recognizing basic activity states and cough events under controlled conditions. Platform- and EMR-based approaches showed potential for using clinical and functional data to support patient stratification and monitoring. However, most studies were limited to early technical or algorithmic validation and did not assess long-term home use, patient adherence, integration into clinical workflows, or clinical and rehabilitation outcomes. Conclusions: Digital technologies may support objective monitoring and rehabilitation follow-up in chronic dust-induced lung diseases, but the evidence base remains small and clinically immature. Prospective studies in real-world settings should evaluate usability, external validity, workflow integration, and clinically meaningful outcomes. Full article

Walking recovery is a central goal of geriatric rehabilitation, but it is shaped by multiple interacting factors rather than by muscle impairment alone. This mini-review examines whether sarcopenia-related weakness, low muscle quality, and reduced physical reserve identify a clinically important vulnerability phenotype relevant to delayed gait recovery in older adults after hospitalization, hip fracture, surgery, or cardiac procedures. We summarize current consensus definitions of sarcopenia, explain why muscle strength and physical performance are often more clinically informative than muscle mass alone, and review the mechanistic pathways that may connect sarcopenia with impaired walking, including anabolic resistance, inflammation, disuse, neuromuscular remodeling, trunk weakness, and cognitive–emotional modifiers. Across community, orthogeriatric, post-acute, and cardiac rehabilitation settings, sarcopenia markers are generally associated with slower gait or poorer attained mobility; however, findings for change in mobility are inconsistent, and most available studies are observational, heterogeneous, or indirect. Sarcopenia should therefore be interpreted as one potential marker of reduced reserve and mobility risk rather than as a determinant of walking recovery or evidence that sarcopenia-aware rehabilitation improves outcomes. Future work should use more consistent diagnostic frameworks and test whether a sarcopenia-aware rehabilitation integrating early strength assessment, individualized nutrition care, and multicomponent gait rehabilitation improve walking outcomes in medically complex older adults beyond current standards of care. Full article

Background: The management of pediatric microtia and congenital hearing loss typically necessitates coordinated multidisciplinary input. Traditional fragmented care pathways across multiple specialties may contribute to delayed diagnosis and treatment intervention, inconsistent counselling, increased logistical burden, and suboptimal care integration. Objectives: We aimed to evaluate family-reported outcomes following implementation of a multidisciplinary Hearing Disorder and Microtia (HDM) clinic, focusing on family satisfaction, perceived care efficiency, understanding of disease and treatment, and early uptake of hearing rehabilitation. Methods: A prospective observational study was conducted on families attending the HDM clinic at a tertiary pediatric center between 2022 and 2024. A structured post-visit survey assessed satisfaction, perceived efficiency, understanding of disease and treatment options, and overall experience. Quantitative data were analyzed descriptively, while qualitative responses underwent thematic analysis. Results: Twenty families were included. Overall satisfaction was high, with 95% rating the clinic experience as very good to excellent and expressing willingness to recommend the service. Improved care coordination and clarification of counselling were reported by the majority of respondents, alongside reduced logistical burden. Notably, 65% of families initiated hearing rehabilitation at the first visit. Thematic analysis identified convenience, unified specialist communication, and clarity of management planning as key strengths of the multidisciplinary model. Conclusions: A structured multidisciplinary HDM clinic significantly improves caregiver experience and facilitates earlier hearing rehabilitation in children with microtia and congenital hearing loss. Integrated care delivery enhances communication, reduces fragmentation, and supports timely, family-centered decision-making. This model may serve as a framework for other complex pediatric otologic conditions requiring longitudinal multidisciplinary management. Full article

The aim of this article is to provide a literature review of current approaches and recommendations for medical rehabilitation in stroke patients, with the goal of achieving the best possible outcomes for their condition and improving their quality of life. Materials and Methods: A narrative review was conducted of articles published in the databases available to us (PubMed, ScienceDirect, Google Scholar, PEDro, ResearchGate) that contain information regarding therapeutic management of stroke and, in particular, interventions aimed at motor recovery and improving quality of life. Included in this literature review were: scientific articles, guidelines on stroke and motor rehabilitation, clinical studies, longitudinal clinical studies, controlled clinical studies, systematic reviews, and meta-analyses published before April 2026, covering a ten-year period. Results: Data showing a trend toward higher patient survival rates following acute stroke were identified. For this reason, existing non-pharmacological approaches to motor recovery should be optimized. The rehabilitation process must begin as early as possible. Motor recovery depends on the establishment of motor control and the neuroplastic processes occurring in brain tissue. Rehabilitation is conducted by a rehabilitation team with the patient’s active participation, while monitoring motor rehabilitation potential. Conclusions: Rehabilitation is an essential component of post-stroke treatment. When timely and adequate medical rehabilitation is provided to stroke patients, there is a significant improvement in their overall condition and motor functions, as well as in their independence, self-care, and quality of life. Full article

Background: The timing and efficacy of Achilles tendon lengthening (ATL) in Duchenne muscular dystrophy (DMD) remain controversial because indiscriminate surgery can accelerate ambulation loss. Case Description: This report presents a 5-year longitudinal comparative analysis (2021–2026) of monozygotic twins with identical genetic backgrounds (DMD exon 30–43 deletion) who received comparable rehabilitation and pharmacological management, including concurrent gene therapy in 2025. Twin A was managed conservatively with orthosis and subsequent serial casting for progressive equinus contracture, whereas Twin B underwent early bilateral ATL during transition to the non-ambulatory phase. Despite a temporary postoperative decline, Twin B demonstrated a more stable longitudinal motor trajectory, outperforming Twin A in gross motor function (Gross Motor Function Measure-88: 38.60% vs. 32.85% in 2026) by preserving residual standing and crawling dimensions. Longitudinal KIDSCREEN-52 assessments revealed a clinically meaningful improvement in psychological well-being in Twin B (+10.9 points) relative to Twin A. Conclusions: This single-pair twin case serves as a hypothesis-generating observation, highlighting a potential longitudinal association between early surgery and attenuated progressive motor decline within a multi-disciplinary care regimen. Given highly variable psychosocial outcomes, these trends cannot be directly attributed to surgery alone. When evaluating such orthopedic interventions, clinical decisions may benefit from looking beyond immediate gait metrics toward broader, long-term functional trends, though the relative contributions of concurrent therapies remain to be elucidated. Full article

Background: Microtia is a congenital anomaly of the external ear that is frequently associated with conductive or mixed hearing impairment and potential developmental consequences. Although genetic factors may contribute to some cases, social and economic conditions can influence access to diagnosis, hearing rehabilitation, and specialized care. This study examined clinical severity, hearing disability, and socioeconomic characteristics among patients with isolated and familial microtia evaluated in Ecuador. Methods: A cross-sectional study was conducted at a tertiary referral center in Quito, Ecuador. A total of 143 patients with microtia were included. Clinical variables included hearing impairment, hearing device use, microtia severity, associated risk factors, and family history. Sociodemographic variables included age, sex, residence, economic level, and healthcare access. Categorical variables were summarized as frequencies and percentages, and continuous variables as medians with interquartile ranges. Group comparisons were performed using the chi-square test and the Mann–Whitney test. Multivariable logistic regression was used to assess factors associated with hearing device use. Statistical significance was set at p < 0.05. Results: Hearing impairment was present in 41.78% of patients, with similar prevalence in isolated and familial cases. Hearing device use was reported by 19.86% of the sample. Familial microtia showed a significantly different distribution of right-ear severity, with higher frequencies of grade 1 and grade 4 anomalies, whereas isolated microtia was more commonly grade 3. Significant differences were also observed in sex distribution and economic level. Isolated cases were more frequent among males, whereas familial cases showed a higher proportion of females. Familial microtia was concentrated mainly in the low-middle economic stratum. In multivariable analysis, no factor was independently associated with hearing device use, and confidence intervals were wide, indicating limited precision. Conclusions: In this tertiary referral sample, microtia-related disability and access to care appeared to reflect the combined influence of clinical vulnerability, familial aggregation, and socioeconomic disadvantage. The low use of hearing devices despite frequent hearing impairment indicates an important gap between clinical need and rehabilitation. Equity-oriented strategies, including early hearing screening, timely referral, financial protection for assistive devices, and improved access to specialized care, may help reduce unmet needs among patients with microtia. Full article