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20 pages, 562 KiB  
Article
Effectiveness of a Post-Acute-Care Rehabilitation Program in Patients with Stroke: A Retrospective Cohort Study
by Yi-Pang Lo, Mei-Chen Wang, Yao-Hsiang Chen, Shang-Lin Chiang and Chia-Huei Lin
Life 2025, 15(8), 1216; https://doi.org/10.3390/life15081216 - 1 Aug 2025
Abstract
Early rehabilitation is essential for restoring functional recovery in patients with stroke, particularly during the early phase of post-acute care (PAC), or the subacute stage. We aimed to evaluate the effectiveness of a 7-week PAC rehabilitation program in improving muscle strength, physical performance, [...] Read more.
Early rehabilitation is essential for restoring functional recovery in patients with stroke, particularly during the early phase of post-acute care (PAC), or the subacute stage. We aimed to evaluate the effectiveness of a 7-week PAC rehabilitation program in improving muscle strength, physical performance, and functional recovery. A total of 219 inpatients with stroke in the subacute stage were initially recruited from the PAC ward of a regional teaching hospital in Northern Taiwan, with 79 eligible patients—within 1 month of an acute stroke—included in the analysis. The program was delivered 5 days per week, with 3–4 sessions daily (20–30 min each, up to 120 min daily), comprising physical, occupational, and speech–language therapies. Sociodemographic data, muscle strength, physical performance (Berg Balance Scale [BBS], gait speed, and 6-minute walk test [6MWT]), and functional recovery (modified Rankin Scale [mRS], Barthel Index [BI], Instrumental Activities of Daily Living [IADL], and Fugl–Meyer assessment: sensory and upper extremity) were collected at baseline, 3 weeks, and 7 weeks. Generalized estimating equations analyzed program effectiveness. Among the 56 patients (70.9%) who completed the program, significant improvements were observed in the muscle strength of both the affected upper (B = 0.93, p < 0.001) and lower limbs (B = 0.88, p < 0.001), as well as in their corresponding unaffected limbs; in physical performance, including balance (BBS score: B = 9.70, p = 0.003) and gait speed (B = 0.23, p = 0.024); and in functional recovery, including BI (B = 19.5, p < 0.001), IADL (B = 1.48, p < 0.001), and mRS (B = −0.13, p = 0.028). These findings highlight the 7-week PAC rehabilitation program as an effective strategy during the critical recovery phase for patients with stroke. Full article
(This article belongs to the Special Issue Advances in the Rehabilitation of Stroke)
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14 pages, 604 KiB  
Article
Functional Benefits of Inpatient Cardiac Rehabilitation After Open Aortic and Valvular Surgery: A Retrospective Cohort Study
by Younji Kim, Suk-Won Song, Ha Lee, Myeong Su Kim, Seoyon Yang and You Gyoung Yi
Healthcare 2025, 13(15), 1816; https://doi.org/10.3390/healthcare13151816 - 25 Jul 2025
Viewed by 161
Abstract
Background/Objectives: Patients undergoing open aortic and valvular surgery often experience postoperative deconditioning, yet research on the role of inpatient cardiac rehabilitation (CR) in this population remains limited. This study aimed to examine the effects of inpatient CR on muscle strength, mobility, psychological well-being, [...] Read more.
Background/Objectives: Patients undergoing open aortic and valvular surgery often experience postoperative deconditioning, yet research on the role of inpatient cardiac rehabilitation (CR) in this population remains limited. This study aimed to examine the effects of inpatient CR on muscle strength, mobility, psychological well-being, and quality of life in patients recovering from open aortic surgery. Methods: We conducted a retrospective study using the medical records of patients who participated in inpatient CR after open aortic surgery. Functional and psychological outcomes were evaluated using the Medical Research Council (MRC) sum score, Timed Up and Go (TUG) test, Five Times Sit-to-Stand test (5STS), Six-Minute Walk Distance (6MWD), Berg Balance Scale (BBS), Modified Barthel Index (MBI), Patient Health Questionnaire-9 (PHQ-9), and the EuroQol-5D (EQ-5D). Pre- and post-rehabilitation scores were compared to assess changes in functional status, mobility, and quality of life. A post-discharge satisfaction survey was also analyzed. Results: A total of 33 patients were included. Significant improvements were observed in MBI (p < 0.001), MRC sum score (p < 0.001), 6MWD (p < 0.001), BBS (p < 0.001), TUG (p = 0.003), 5STS (p < 0.001), EQ-5D (p = 0.011), and PHQ-9 (p = 0.009) following inpatient CR. Patients with lower baseline mobility (6MWD ≤ 120 m) exhibited greater improvement in MBI (p = 0.034). Of the 33 patients, 26 completed the satisfaction survey; most reported high satisfaction, perceived health improvements, and willingness to recommend the program. Conclusions: Inpatient CR following open aortic and valvular surgery resulted in significant gains in muscle strength, mobility, psychological health, and overall quality of life. Patients with greater initial impairment demonstrated especially notable functional improvement, supporting the value of tailored CR in this population. Full article
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18 pages, 401 KiB  
Article
Physiotherapy in Prehabilitation for Bariatric Surgery—Analysis of Its Impact on Functional Capacity and Original Predictive Models of Functional Status Outcome
by Katarzyna Gierat-Haponiuk, Piotr Wąż, Julia Haponiuk-Skwarlińska, Maciej Wilczyński and Ireneusz Haponiuk
J. Clin. Med. 2025, 14(15), 5265; https://doi.org/10.3390/jcm14155265 - 25 Jul 2025
Viewed by 228
Abstract
Background/Objectives: Prehabilitation is a multimodal intervention introduced in preparation for various surgical procedures. The most effective treatment for obesity is bariatric surgery. Physiotherapy during prehabilitation for bariatric surgery may be an effective method of functional capacity improvement. We aimed to evaluate the [...] Read more.
Background/Objectives: Prehabilitation is a multimodal intervention introduced in preparation for various surgical procedures. The most effective treatment for obesity is bariatric surgery. Physiotherapy during prehabilitation for bariatric surgery may be an effective method of functional capacity improvement. We aimed to evaluate the impact of an individual outpatient 12-week, exercise-based physiotherapy program featuring prehabilitation on functional status, exercise tolerance, everyday mobility, and fatigue among patients qualified for bariatric surgery. Methods: The completion of an individual outpatient 12-week, exercise-based physiotherapy program during prehabilitation was an inclusion criterion for the study group. Participants included in the study and control groups were assessed twice, after enrollment into the prehabilitation program (the first assessment) and after prehabilitation but before surgery (the second assessment). Both assessments involved functional tests (a six-minute walking test [6MWT], a timed up and go test [TUG], a chest mobility test, anthropometric measures, a mobility index [Barthel], and a modified Borg scale). The collected anthropometric data and values from the 6MWT were used to create original linear models. This study followed STROBE recommendations. Results: The study group and control group did not differ statistically in terms of their anthropometric data. Statistically significant results were obtained between the first and second assessments in both groups in terms of body weight and waist circumference. However, only the study group showed improved results in the TUG test (p = 0.0001) and distance in the 6MWT (p = 0.0005). The study group presented with the normalization of blood pressure (BP) after exertion in the second assessment (systolic BP p = 0.0204; diastolic BP p = 0.0377), and the 6MWT results were close to the norms. According to the original linear model used to predict performance in the 6MWT, the primary modifiable determinant of exercise tolerance was the participant’s weight, while gender served as a non-modifiable determinant. Conclusions: Exercise-based physiotherapy in prehabilitation was associated with improved functional capacity in patients preparing for bariatric surgery, contributing to the improvement in 6MWT results in relation to the norms as well as exercise tolerance. Body weight may be an independent factor determining distance in the 6MWT for patients undergoing prehabilitation for bariatric surgery. Full article
(This article belongs to the Special Issue Clinical Advances in Obesity and Bariatric Surgery)
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12 pages, 229 KiB  
Article
Long-Term Follow-Up of Patients with West Nile Neuroinvasive Disease
by Nataša Nikolić, Branko Milošević, Stojanović Miloš, Ljubisavljević Mila, Ivana Milošević, Nikola Mitrović, Jovan Malinić, Ana Filipović, Nevena Todorović, Uroš Karić, Boris Jegorović, Miloš Šabanović, Ivana Gmizić, Branko Beronja and Jasmina Poluga
Viruses 2025, 17(7), 878; https://doi.org/10.3390/v17070878 - 23 Jun 2025
Viewed by 447
Abstract
Human West Nile virus (WNV) infection is usually asymptomatic. Less than 1% of patients develop neuroinvasive disease (WNND) which may result in permanent neurological impairment. The aim of this study was to assess the functional and cognitive status of patients with WNND approximately [...] Read more.
Human West Nile virus (WNV) infection is usually asymptomatic. Less than 1% of patients develop neuroinvasive disease (WNND) which may result in permanent neurological impairment. The aim of this study was to assess the functional and cognitive status of patients with WNND approximately one year after the onset of symptoms. This prospective observational cohort study involved patients with WNND. Patients’ functional and cognitive abilities one year post-infection were assessed by telephone interviews using the Modified Rankin Scale (mRS), Barthel Index, and Telephone Interview for Cognitive Status. Sixty-two participants were analyzed. All patients had encephalitis, and 7 (11.3%) also had acute flaccid paresis/paralysis (AFP). At discharge, 40 (64.5%) patients had no or minimal neurological deficit (mRS 0–1), and 14 (22.6%) were functionally dependent (mRS 3–5). One year later, 52 (83.9%) patients were functionally independent (mRS 0–2), none was severely dependent (Barthel index 0–60), and 50 (90.9%) had a Barthel index score of 91–100. Among 14 functionally dependent patients at discharge, 3 (21.4%) remained functionally dependent one year later. During the follow-up, 7 (11.3%) patients died. No significant difference was observed in the fatality rate between patients with and without AFP, mRS 3–5 at discharge, or age over 65. The most common persistent symptoms were muscle weakness, walking instability, and issues with focus and memory. Using TICS, it was found that 33/55 patients (60%) had unimpaired and 2 (3.6%) had moderately or severely impaired cognitive status. The long-term prognosis after WNV encephalitis is satisfying. The majority of patients reached functional independence and 60% had unimpaired cognitive status. Full article
(This article belongs to the Section Human Virology and Viral Diseases)
14 pages, 595 KiB  
Article
The Effect of Integrative Treatment on Improving Functional Level in Stroke Patients: A Retrospective Chart Review
by Daegil Kwon, Sun Hee Ahn, Ki-cheul Shon and Hyun Jung Jung
Healthcare 2025, 13(12), 1452; https://doi.org/10.3390/healthcare13121452 - 17 Jun 2025
Viewed by 376
Abstract
Objectives: This study aimed to evaluate the effects of integrative treatment on functional recovery in stroke patients by comparing medical records of those receiving Western rehabilitation treatment only versus integrative treatment in a single hospital. Methods: Medical records of 174 stroke patients were [...] Read more.
Objectives: This study aimed to evaluate the effects of integrative treatment on functional recovery in stroke patients by comparing medical records of those receiving Western rehabilitation treatment only versus integrative treatment in a single hospital. Methods: Medical records of 174 stroke patients were analyzed, divided into three groups based on Korean medicinal treatment frequency: Western rehabilitation only (WO), Western rehabilitation with low-frequency Korean medicine (WLK), and Western rehabilitation with high-frequency Korean medicine (WHK). Patients were further categorized into subacute (last 3 months) and chronic (last 6 months) stroke groups. Functional recovery was assessed using tools like the Berg Balance Scale (BBS), Modified Barthel Index (MBI), and others. Results: Overall, BBS and MBI scores showed significant improvements in WLK and WHK groups compared to the WO group. In subacute patients at 3 months post-treatment (MPT), BBS scores increased by 1.7 ± 2.0 (WO), 3.3 ± 4.8 (WLK), and 5.6 ± 5.2 (WHK), with significant differences between WO and WHK (p < 0.05). In chronic patients at 6 MPT, BBS scores rose by 0.4 ± 1.1 (WO), 1.8 ± 1.7 (WLK), and 5.3 ± 6.4 (WHK), again significant between WO and WHK (p < 0.05). MBI scores in subacute patients at 3 MPT increased by 0.7 ± 2.1 (WO), 2.5 ± 2.9 (WLK), and 3.9 ± 5.5 (WHK), with significant differences between WO and WHK (p < 0.05). Conclusions: Integrative treatment with Korean medicine significantly enhanced balance, daily activity performance, and functional levels in stroke patients compared to Western rehabilitation alone. Full article
(This article belongs to the Special Issue Chronic Disease Management for Older Adults)
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14 pages, 650 KiB  
Article
Personalized Post-Stroke Rehabilitation in a Rural Community: A Pilot Quasi-Experimental Study on Activities of Daily Living and Disability Outcomes Using Participatory Action Research
by Mallika Piromboon, Kwanjai Suebsunthorn, Kanokwan Wisaddee, Le Ke Nghiep and Kukiat Tudpor
Healthcare 2025, 13(11), 1275; https://doi.org/10.3390/healthcare13111275 - 28 May 2025
Viewed by 1012
Abstract
Background: Early rehabilitation is crucial for predicting post-stroke outcomes. In rural Thailand, previous works identified limited access to prompt rehabilitation services, discontinuity of home visits, and a lack of interdisciplinary management, hindering comprehensive resolution. Objective: This participatory action research-based pilot quasi-experimental [...] Read more.
Background: Early rehabilitation is crucial for predicting post-stroke outcomes. In rural Thailand, previous works identified limited access to prompt rehabilitation services, discontinuity of home visits, and a lack of interdisciplinary management, hindering comprehensive resolution. Objective: This participatory action research-based pilot quasi-experimental study investigated the effects of personalized intermediate care (IMC) programs led by physical therapists on clinical outcomes in post-ischemic stroke older adults living in rural areas. Methods: Participatory stakeholders (two physical therapists, a physician, a nurse, and a nutritionist) convened to coordinate with relevant stakeholders (community leaders, village health volunteers (VHVs), and family caregivers (CGs)). Thirty-four acute post-stroke patients were included in the study. The interventions consisted of three action research cycles (planning, action, observation, and reflection) of home-based neurorehabilitation and comprehensive treatments by a healthcare professional network for six months and another six-month follow-up. The primary outcome was the Barthel index for activities of daily living (BI-ADL). The modified Rankin scale (mRS) was a secondary outcome for assessing disability levels. Results: Results showed that the BI-ADL gradually and significantly increased from a baseline median (IQR) of 55 (15) to 100 (20) after 6 months (p < 0.05). This improvement of the BI-ADL was maintained after 12 months (100 (15)). Furthermore, the mRS at 6 months post-discharge reduced considerably from the first month of rehabilitation (p < 0.05). Conclusions: In conclusion, the early and continuous personalized IMC rehabilitation program effectively enhanced ADL and reduced disability levels and should be disseminated to the community. Full article
(This article belongs to the Special Issue Rehabilitation Program for Orthopedic and Neurological Patients)
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29 pages, 1918 KiB  
Study Protocol
Rehabilitation with and Without Robot and Allied Digital Technologies (RADTs) in Stroke Patients: A Study Protocol for a Multicentre Randomised Controlled Trial on the Effectiveness, Acceptability, Usability, and Economic-Organisational Sustainability of RADTs from Subacute to Chronic Phase (STROKEFIT4)
by Irene Giovanna Aprile, Marco Germanotta, Alessio Fasano, Mariacristina Siotto, Maria Cristina Mauro, Arianna Pavan, Giovanna Nicora, Giuseppina Sgandurra, Alberto Malovini, Letizia Oreni, Nevio Dubbini, Enea Parimbelli, Giovanni Comandè, Christian Lunetta, Pietro Fiore, Roberto De Icco, Carlo Trompetto, Leopoldo Trieste, Giuseppe Turchetti, Silvana Quaglini and Cristina Messaadd Show full author list remove Hide full author list
J. Clin. Med. 2025, 14(8), 2692; https://doi.org/10.3390/jcm14082692 - 15 Apr 2025
Viewed by 941
Abstract
Background: Rehabilitation after stroke often employs Robots and Allied Digital Technologies (RADTs). However, evidence of their effectiveness remains inconclusive due to study heterogeneity and limited sample sizes. Methods: This is a protocol of a pragmatic multicentre, multimodal, randomised, controlled, parallel-group (1:1) [...] Read more.
Background: Rehabilitation after stroke often employs Robots and Allied Digital Technologies (RADTs). However, evidence of their effectiveness remains inconclusive due to study heterogeneity and limited sample sizes. Methods: This is a protocol of a pragmatic multicentre, multimodal, randomised, controlled, parallel-group (1:1) interventional study with blinded assessors aimed at assessing the effectiveness and sustainability of RADT-mediated rehabilitation compared to traditional rehabilitation. The trial will recruit 596 adult subacute post-stroke patients. Participants will be randomised into either the experimental group (using RADTs and two therapists supervising four to six patients) or the control group (individual traditional rehabilitation). Patients in both groups will undergo a comprehensive rehabilitation treatment, targeting (a) upper limb sensorimotor abilities; (b) lower limb sensorimotor abilities and gait; (c) balance; and (d) cognitive abilities. Patients will undergo 25 sessions, each lasting 45 min, with a frequency of 5 (inpatients) or 3 (outpatients) times a week. The primary endpoint is the non-inferiority of RADTs in the recovery of the activities of daily living (ADL) using the modified Barthel Index. If non-inferiority is established, the study will evaluate the superiority. Secondary endpoints will analyse the improvements in the aforementioned domains, as well as changes in neural plasticity and biochemical aspects. Upper limb dexterity and gait recovery rates during treatment will be monitored. The study will also evaluate ADL and quality of life during a six-month follow-up period. Acceptability and usability of integrated RADTs-based rehabilitation for patients, families, and healthcare providers, along with economic and organisational sustainability for patients, payers, and society, will also be assessed. Conclusions: This study aims to establish stronger evidence on the effectiveness of RADTs in post-stroke patients. Trial registration number: NCT06547827. Full article
(This article belongs to the Section Clinical Neurology)
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14 pages, 1494 KiB  
Article
Clinical Application Research on Stroke Situational Intelligent Rehabilitation Training System Based on Wearable Devices: A Randomized Controlled Trial
by Ying Lu, Kangjia Ding, Yayuan Dai, Jie Yin, Jianjun Yao, Liquan Guo, Jiping Wang and Xiaojun Wang
Healthcare 2025, 13(7), 708; https://doi.org/10.3390/healthcare13070708 - 23 Mar 2025
Viewed by 946
Abstract
Background/Objectives: With the advancement of intelligent sensing technology, rehabilitation systems based on wearable devices have a positive impact on the functional recovery and quality of life of stroke patients. This study aims to evaluate the application value of a contextualized intelligent rehabilitation training [...] Read more.
Background/Objectives: With the advancement of intelligent sensing technology, rehabilitation systems based on wearable devices have a positive impact on the functional recovery and quality of life of stroke patients. This study aims to evaluate the application value of a contextualized intelligent rehabilitation training system for stroke survivors, which is based on wearable devices, in the rehabilitation of motor function impairments following stroke. Methods: A randomized controlled trial design was employed, in which 100 stroke patients were randomly divided into a control group (n = 50, receiving standard physical therapy rehabilitation interventions) and an experimental group (n = 50). The experimental group additionally underwent motor function rehabilitation interventions and intelligent assessments through a wearable device-based contextual intelligent rehabilitation training system, with sessions conducted twice daily for 30 min each, five days a week, over a duration of eight weeks. Both groups of patients underwent clinical scale evaluations and data collection before and after the treatment, with primary outcome measures including motor ability (Fugl–Meyer Assessment, FMA), activities of daily living (Modified Barthel Index, MBI), and participation in rehabilitation therapy. The intervention effects of both groups were compared after eight weeks of rehabilitation. Results: Prior to the intervention, there were no significant differences in Fugl–Meyer Assessment (FMA) and Modified Barthel Index (MBI) scores between the experimental group and the control group (p > 0.05). After eight weeks of rehabilitation, the experimental group demonstrated significantly superior performance in motor function (FMA scores) and activities of daily living (MBI scores) compared to the control group (p < 0.01). Conclusions: The intelligent rehabilitation system significantly enhances motor function and activities of daily living in stroke survivors. Compared to traditional rehabilitation methods, it improves patient adherence to rehabilitation training and overall outcomes. Full article
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22 pages, 4837 KiB  
Systematic Review
Safety and Efficacy of Stem Cell Therapy in Ischemic Stroke: A Comprehensive Systematic Review and Meta-Analysis
by Abdulrahim Saleh Alrasheed, Tala Abdullah Aljahdali, Israa Aqeel Alghafli, Ghadeer Aqeel Alghafli, Majd Fouad Almuslim, Noor Mohammad AlMohish and Majed Mohammad Alabdali
J. Clin. Med. 2025, 14(6), 2118; https://doi.org/10.3390/jcm14062118 - 20 Mar 2025
Viewed by 2594
Abstract
Background: Although recent advancements in ischemic stroke management have reduced associated mortality rates, there remains a pressing need for more reliable, efficacious, and well-tolerated therapeutic approaches due to the narrow therapeutic window of current treatment approaches. The current meta-analysis sought to evaluate the [...] Read more.
Background: Although recent advancements in ischemic stroke management have reduced associated mortality rates, there remains a pressing need for more reliable, efficacious, and well-tolerated therapeutic approaches due to the narrow therapeutic window of current treatment approaches. The current meta-analysis sought to evaluate the safety and efficacy of stem cell-based therapeutic options for patients with ischemic stroke. Methods: PubMed, Web of Science, and Cochrane library databases were searched to retrieve randomized controlled trials (RCTs) evaluating the efficacy and safety of stem cell therapy (SCT) in ischemic stroke patients. Key outcomes included the National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), Barthel Index (BI), Fugl–Meyer Assessment (FMA), infarct size, and safety profile. The random effects model with the continuous method was used to calculate the pooled effect size in Review Manager 5.4.1, and subgroup analyses were performed based on demographics, stroke duration, and SCT delivery protocols. Results: A total of 18 RCTs involving 1026 patients were analyzed, with 538 in the treatment group and 488 in the control group. The mean change in NIHSS score was comparable between groups [MD = −0.80; 95% CI: −2.25, 0.65, p < 0.0001]. However, SCT showed better outcomes in mRS [MD = −0.56; 95% CI: −0.76, −0.35, p = 0.30] and BI scores [MD = 12.00; 95% CI: 4.00, 20.00, p = 0.007]. Additionally, the mean change in FMA score was significantly greater with SCT [MD = 18.16; 95% CI: 6.58, 29.75, p = 0.03]. The mean change in infarct volume also favored stem cell therapy [MD = 8.89; 95% CI: −5.34, 23.12, p = 0.08]. The safety profile was favorable, with adverse event rates comparable to or lower than controls. Conclusions: SCT offers a safe and effective approach to improving functional outcomes in stroke patients, particularly with early intervention. These findings highlight the potential of SCT in ischemic stroke rehabilitation while underscoring the need for standardized protocols and long-term safety evaluation. Full article
(This article belongs to the Special Issue Current Treatment and Future Options of Ischemic Stroke)
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13 pages, 639 KiB  
Article
The Effect of Vitamin D Supplementation on Functional Outcomes in Patients Undergoing Rehabilitation After an Ischemic Stroke: A Prospective, Single-Blind, Randomized, Placebo-Controlled Study
by Wojciech Borowicz, Lucyna Ptaszkowska, Rafał Małecki and Małgorzata Paprocka-Borowicz
J. Clin. Med. 2025, 14(6), 1848; https://doi.org/10.3390/jcm14061848 - 9 Mar 2025
Viewed by 1476
Abstract
Background/Objectives: A vitamin D deficiency is prevalent in post-stroke patients and may impair neurological recovery. While observational studies highlight the neuroprotective role of vitamin D, there is limited evidence from interventional studies evaluating its impact on functional recovery during stroke rehabilitation. This [...] Read more.
Background/Objectives: A vitamin D deficiency is prevalent in post-stroke patients and may impair neurological recovery. While observational studies highlight the neuroprotective role of vitamin D, there is limited evidence from interventional studies evaluating its impact on functional recovery during stroke rehabilitation. This study aimed to assess whether daily vitamin D3 supplementation enhances functional recovery. Methods: This prospective, randomized, placebo-controlled, single-blind study included 159 patients (mean age: 62.5 ± 8.4 years) with a first ischemic stroke that were admitted for early rehabilitation. The participants were randomly allocated to receive 2000 IU of vitamin D3 daily (n = 79) or a placebo (n = 80) for six weeks. The functional outcomes were measured using the Barthel index (BI) and modified Rankin scale (mRS) at baseline and after 42 days. The serum 25-hydroxyvitamin D [25(OH)D] and insulin-like growth factor 1 (IGF-1) levels were analyzed. Results: Vitamin D3 supplementation significantly increased the serum 25(OH)D levels (p < 0.001). Supplementation was associated with improved BI scores (β = 0.07, p = 0.006). A higher BMI (β = −0.06, p = 0.033), higher NIHSS scores (β = −0.18, p = 0.036), hypertension, and statin use negatively impacted functional recovery. Anticoagulant use was correlated with higher mRS scores, indicating greater disability (p = 0.04). Conclusions: Vitamin D3 supplementation positively influences the functional outcomes during post-stroke rehabilitation, supporting its potential role in enhancing neuroplasticity and recovery. Larger multi-center trials are needed to confirm these findings and optimize vitamin D supplementation strategies. Full article
(This article belongs to the Special Issue Advances in Rehabilitation Care for Geriatric Diseases)
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15 pages, 477 KiB  
Article
Comparison of Five Rehabilitation Interventions for Acute Ischemic Stroke: A Randomized Trial
by József Tollár, Szilvia Kóra, Petra Kós, Zoltán Vadászi, István Drotár, Péter Prukner, György Wersényi, Tamás Haidegger, Tomas Vetrovsky and Tibor Hortobágyi
J. Clin. Med. 2025, 14(5), 1648; https://doi.org/10.3390/jcm14051648 - 28 Feb 2025
Viewed by 2064
Abstract
Background: Comparative efficacy of rehabilitation interventions in persons with acute ischemic stroke (PwS) is limited. This randomized trial assessed the immediate and lasting effects of five interventions on clinical and mobility outcomes in 75 PwS. Methods: Five days after stroke, 75 PwS were [...] Read more.
Background: Comparative efficacy of rehabilitation interventions in persons with acute ischemic stroke (PwS) is limited. This randomized trial assessed the immediate and lasting effects of five interventions on clinical and mobility outcomes in 75 PwS. Methods: Five days after stroke, 75 PwS were randomized into five groups: physical therapy (CON, standard care, once daily); walking with a soft robotic exoskeleton (ROB, once daily); agility exergaming once (EXE1, once daily) or twice daily (EXE2, twice daily); and combined EXE1+ROB in two daily sessions. Interventions were performed 5 days per week for 3 weeks. Outcomes were assessed at baseline, post-intervention, and after 5 weeks of detraining. Results: Modified Rankin Scale (primary outcome) and Barthel Index showed no changes. EXE1, EXE2, ROB, and EXE1+ROB outperformed standard care (CON) in five secondary outcomes (Berg balance scale, 10m walking speed, 6-min walk test with/without robot, standing balance), with effects sustained after 5 weeks. Dose effects (EXE1 vs. EXE2) were minimal, while EXE1+ROB showed additive effects in 6-min walk tests. Conclusions: These novel comparative data expand evidence-based options for therapists to design individualized rehabilitation plans for PwS. Further confirmation is needed. Full article
(This article belongs to the Special Issue Acute Ischemic Stroke: Current Status and Future Challenges)
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24 pages, 5261 KiB  
Article
Novel Robotic Balloon-Based Device for Wrist-Extension Therapy of Hemiparesis Stroke Patients
by Klaudia Marek, Aleksandra Olejniczak, Elżbieta Miller and Igor Zubrycki
Sensors 2025, 25(5), 1360; https://doi.org/10.3390/s25051360 - 23 Feb 2025
Viewed by 1508
Abstract
Upper-limb paresis is one of the main complications after stroke. It is commonly associated with impaired wrist-extension function. Upper-limb paresis can place a tremendous burden on stroke survivors and their families. A novel soft-actuator device, the Balonikotron, was designed to assist in rehabilitation [...] Read more.
Upper-limb paresis is one of the main complications after stroke. It is commonly associated with impaired wrist-extension function. Upper-limb paresis can place a tremendous burden on stroke survivors and their families. A novel soft-actuator device, the Balonikotron, was designed to assist in rehabilitation by utilizing a balloon mechanism to facilitate wrist-extension exercises. This pilot study aimed to observe the functional changes in the paralyzed upper limb and improvements in independent and cognitive functions following a 4-week regimen using the device, which incorporates a multimedia tablet application providing audiovisual feedback. The device features a cardboard construction with a hinge at wrist level and rails that guide hand movement as the balloon inflates, controlled by a microcontroller and a tablet-based application. It operates on the principle of moving the hand at the wrist by pushing the palm upwards through a surface actuated by a balloon. A model was developed to describe the relationship between the force exerted on the hand, the angle on hinge, the pressure within the balloon, and its volume. Experimental validation demonstrated a Pearson correlation of 0.936 between the model’s force predictions and measured forces, supporting its potential for real-time safety monitoring by automatically shutting down when force thresholds are exceeded. A pilot study was conducted with 12 post-stroke patients (six experimental, six control), who participated in a four-week wrist-extension training program. Clinical outcomes were assessed using the Fugl–Meyer Assessment for the Upper Extremity (FMA-UE), Modified Rankin Scale (mRS), Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MOCA), wrist Range of Motion (ROM), and Barthel Index (BI). Statistically significant results were obtained for the Barthel index (p < 0.05) and FMA-UE, indicating that the experimental use of the device significantly improved functional independence and self-care abilities. The results of our pilot study suggest that the Balonikotron device, which uses the principles of mirror therapy, may serve as a valuable adjunct to conventional rehabilitation for post-stroke patients with hemiparetic hands (BI p = 0.009, MMSE p = 0.151, mRS p = 0.640, FMA-UE p = 0.045, MOCA p = 0.187, ROM p = 0.109). Full article
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16 pages, 1257 KiB  
Article
Acupuncture and Kinesitherapy Improve Physical Activity More than Kinesitherapy Alone in Patients with Acute Decompensated Chronic Heart Failure with Reduced Ejection Fraction Who Are Already on Optimal Drug Therapy: A Randomized, Sham-Controlled, Double-Blind Clinical Study
by Dejan Ilic, Zoran Jovic, Zorica Mladenovic, Vesna Pejovic, Branislava Lung, Aleksandra Kozic and Slobodan Obradovic
Biomedicines 2025, 13(1), 176; https://doi.org/10.3390/biomedicines13010176 - 13 Jan 2025
Viewed by 1747
Abstract
Background/Objectives: It is unknown how early exercise therapy combined with acupuncture (AP) affects the speed of recovery in patients suffering from heart failure with reduced ejection fraction (HFrEF) who are hospitalized due to worsening HF. Methods: A prospective, sham-procedure-controlled, double-blind, randomized [...] Read more.
Background/Objectives: It is unknown how early exercise therapy combined with acupuncture (AP) affects the speed of recovery in patients suffering from heart failure with reduced ejection fraction (HFrEF) who are hospitalized due to worsening HF. Methods: A prospective, sham-procedure-controlled, double-blind, randomized clinical trial with three patient groups was conducted. The study included patients with HFrEF who were hospitalized for worsening HF. After initial stabilization, patients were randomly assigned to three groups, the controls (C) treated with optimal drug therapy (ODT); E1 received ODT with kinesitherapy, and sham AP; E2 received ODT, kinesitherapy, and needle AP aiming to enhance compensation. Improvement in physical activity was measured by the modified Barthel index (A test), 2 or 6 min walking tests, an endurance walking test, and decrease of blood brain natriuretic peptide (BNP). Results: A total of 120 patients completed the study. The average age was 74 years, 73.3% were male, median EF was 32%, and 83.3% were New York Heart Association (NYHA) Class III. After the fifth day of therapy, the E2 group showed the greatest improvement in the A test compared to other groups (p = 0.022). After 5 days, 80%, 50%, and 10% achieved an A test score of 30 or higher, demonstrating functional independence, (p < 0.01) in the E2, E1, and C groups, respectively. At hospital discharge, the E2 group showed significantly better walking endurance compared to the E1 and C groups (p < 0.001). At discharge, BNP decreased significantly more in both E groups, compared to the C group. Conclusions: Short-term early rehabilitation with AP and kinesitherapy significantly improves the functional status of HFrEF decompensated patients when compared to kinesitherapy alone and ODT. Full article
(This article belongs to the Special Issue Heart Failure: New Diagnostic and Therapeutic Approaches)
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13 pages, 949 KiB  
Article
Factors Determining Rehabilitation Needs After Intradural Spinal Tumor Surgery: A Prospective Study
by Stanisław Krajewski, Jacek Furtak, Monika Zawadka-Kunikowska, Michał Kachelski, Jakub Soboń and Marek Harat
Brain Sci. 2025, 15(1), 51; https://doi.org/10.3390/brainsci15010051 - 8 Jan 2025
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Abstract
Background/Objectives: While most studies on the postoperative condition of patients with spinal cord tumors describe long-term outcomes, data are needed on immediate surgical outcomes demanding rehabilitation to make informed assessments for postoperative planning. The aim of this study was to identify factors predicting [...] Read more.
Background/Objectives: While most studies on the postoperative condition of patients with spinal cord tumors describe long-term outcomes, data are needed on immediate surgical outcomes demanding rehabilitation to make informed assessments for postoperative planning. The aim of this study was to identify factors predicting function and rehabilitative needs after intradural spinal tumor surgery. Methods: Eighty-five prospectively recruited patients underwent surgery for intradural intramedullary (ID-IM; n = 23) and extramedullary (ID-EM; n = 62) tumors. Neurological and functional status were assessed before surgery, after surgery, and at discharge using the modified McCormick scale (MMS), Karnofsky performance status (KPS) scale, Barthel index (BI), and the gait index (GI). Results: There were no significant predictors of early postoperative rehabilitation in the ID-IM group. In the ID-EM group, age, thoracic level, subtotal resection (STR), repeat surgery, and functional scale scores predicted the need for rehabilitation. In multivariable analysis, MMS (odds ratio (OR) 8.7; 95% confidence interval (CI): 2.37–32.44) and STR (OR 13.00; 95%CI: 1.56–107.87) remained independent predictors of rehabilitation need (area under curve, 92%). Despite their younger age, most patients with ID-IM tumors, especially ependymomas, required rehabilitation but improved quickly (KPS, BI, p < 0.001). Among ID-EM tumors, meningiomas were characterized by poorer preoperative function and low gross total resection (GTR) rates, but did not deteriorate neurologically after surgery. Patients with schwannoma and ID-EM ependymomas achieved the highest GTR rate and had the best function both before and after surgery. Conclusions: These results may be useful for estimating early rehabilitation needs after intradural tumor surgery and counseling patients before surgery about the expected postoperative course. Full article
(This article belongs to the Special Issue Recent Advances in Translational Neuro-Oncology)
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10 pages, 311 KiB  
Article
Urinary Incontinence in Men with Stroke: A Cross-Sectional Study
by İsmail Uysal, Özgür Nadiye Doğrukök, Yalcin Golcuk, Fatih Özden, Mehmet Özkeskin, Miray Başer, Bircan Yücekaya and Zeynep Nisa Karakoyun
Medicina 2025, 61(1), 52; https://doi.org/10.3390/medicina61010052 - 1 Jan 2025
Viewed by 1393
Abstract
Background and Objectives: To evaluate urinary incontinence (UI) and its effect on quality of life (QoL) in male stroke patients. Materials and Methods: A quantitative cross-sectional study was conducted with 103 adult male stroke survivors. The individuals’ degree of disability was [...] Read more.
Background and Objectives: To evaluate urinary incontinence (UI) and its effect on quality of life (QoL) in male stroke patients. Materials and Methods: A quantitative cross-sectional study was conducted with 103 adult male stroke survivors. The individuals’ degree of disability was evaluated using the Modified Rankin Scale (MRS) and Barthel Index (BI). The UI assessment was performed with the Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire-7 (IIQ-7). In addition, the QoL was questioned with EuroQoL 5-Dimension 3-Level (EQ-5D-3L)”. Results: The mean age of the participants was 68.4 ± 9.9 years. The average scores of the IIQ-7 and UDI-6 were 9.7 ± 7.2 and 36.6 ± 26.3, respectively. According to these scores, both UI questionnaire results were slightly above the reference cut-off value. According to the UDI-6 scores, 52.4% of the participants exhibited symptoms, while 55.3% demonstrated symptoms according to the IIQ-7 scores. The IIQ-7 was strongly correlated with the MRS (p < 0.001, r = 0.740), BI (p < 0.001, r = −0.770), EQ-5D-3L Index (p < 0.001, r = −0.804), and EQ-5D-3L VAS (p < 0.001, r = −0.679) scores. In addition, the UDI-6 was strongly correlated with the MRS (p < 0.001, r = 0.697), BI (p < 0.001, r = −0.730), EQ-5D-3L Index (p < 0.001, r = −0.726), and EQ-5D-3L VAS (p < 0.001, r = −0.623) scores. Furthermore, the IIQ-7 and UDI-6 scores were statistically higher in patients with cortical-level involvement (p < 0.05). Regression results showed that the IIQ-7 was associated with the MRS, BI, EQ-5D-3L Index, and EQ-5D-3L VAS scores (R2 = 0.627, p < 0.001). Similarly, the UDI-6 was significantly associated with the MRS, BI, EQ-5D-3L Index, and EQ-5D-3L VAS scores in a multiple hierarchical regression model (R2 = 0.423, p < 0.001). Conclusions: The severity of UI was classified as high. As expected, UI was higher in individuals with increased disability. The QoL of individuals with UI is more negatively affected. Finally, the severity of UI was higher in individuals with cortical stroke. Full article
(This article belongs to the Section Urology & Nephrology)
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