Search Results (1,712)

Power grid maintenance tasks often involve sustained arm elevation, asymmetric upper-limb loading, and repetitive pulling, all of which may increase the risk of work-related musculoskeletal disorders. This study evaluated the effects of a passive upper-limb exoskeleton on muscle activity, subjective fatigue, task workload, and usability in three representative power grid maintenance tasks: insulator installation, insulated rod handling, and hand-chain hoist operation. A randomized crossover design was adopted, and twenty-two healthy young male participants completed all tasks under exoskeleton (EXO) and no-exoskeleton (NoEXO) conditions. Surface electromyography was used to quantify muscle activity, and subjective assessments included Borg CR-10, NASA-TLX, an exoskeleton wearing experience questionnaire, and the System Usability Scale (SUS). In the static tasks, the exoskeleton significantly reduced %MVC of the trapezius, deltoid, and biceps brachii, while in the dynamic task, significant reductions were mainly observed in the deltoid and trapezius during the arm-raising phase. The exoskeleton also reduced local discomfort in the shoulders, elbows, and wrists and improved selected workload dimensions, particularly physical demand and effort. The mean SUS score was 74.2, indicating acceptable usability. These findings suggest that the passive upper-limb exoskeleton can effectively reduce proximal upper-limb loading in power grid maintenance tasks, with the greatest benefit observed in static overhead work. Full article

Repeated sit-to-stand and stand-to-sit transitions load the knee extensors and may contribute to work-related musculoskeletal disorders. Reducing this load requires assistive devices and monitoring of knee function, which depend on real-time onset/offset detection and direction-aware classification of each transition. However, no prior wearable surface electromyographic system has delivered this capability for real-time. This study presents a deep learning method that computes both onset/offset detection and direction discrimination of sit-to-stand and stand-to-sit in a developed wearable surface electromyographic system in real-time. Two ESP32-S3 nodes and a hub record from the vastus lateralis and vastus medialis and run a per-burst convolutional detector, while the hub runs a dual-branch classifier with seventeen handcrafted features. Trained offline on the public Gait120 dataset, the networks are deployed unchanged with embedded-firmware parity to the MATLAB reference. Under leave-one-subject-out evaluation on Gait120, the offline classifier separated each transition with 99.6% accuracy and the detector achieved 96.6% completeness. In real-time recordings from thirty healthy adults, the system retained 85.6% classification and 82.0% detection accuracy, with ≈100 ms latency and a 618 KB network footprint. Results show that a low-power wearable delivers combined detection and phase discrimination in real-time, supporting the potential application in assistive-device control and knee-joint monitoring. Full article

Background: Shoulder disorders are among the leading causes of musculoskeletal pain and disability worldwide. Despite the widespread use of corticosteroid injections, concerns regarding their short-term efficacy and potential adverse effects have encouraged research into alternative therapies such as oxygen–ozone therapy. This systematic review aimed to evaluate the efficacy of oxygen–ozone therapy in the management of shoulder disorders. Methods: A systematic search of PubMed, Scopus, and Web of Science was conducted up to 16 March 2026, according to PRISMA guidelines. Randomized controlled trials investigating localized oxygen–ozone injections for shoulder disorders were included. Pain scores and shoulder function were the main outcomes considered. Study quality was assessed using the Cochrane Risk of Bias 2 tool. Results: Five randomized controlled trials involving 263 participants with shoulder impingement syndrome, adhesive capsulitis, or chronic rotator cuff syndrome were included. Given the heterogeneity of the included studies, we only performed a qualitative synthesis. Oxygen–ozone therapy demonstrated significant improvement in pain and shoulder function across all of the included studies. Corticosteroid injections generally showed superior short-term pain relief, whereas oxygen–ozone therapy demonstrated more persistent clinical improvements during medium-to-long follow-up periods. Studies employing multiple ozone injection protocols reported more stable outcomes when compared with single-injection approaches. No major adverse events related to oxygen–ozone therapy were reported. However, substantial heterogeneity was observed regarding injection protocols, ozone concentrations, number of injections, and follow-up duration. Conclusions: Oxygen–ozone therapy appeared to be a potentially effective treatment option for shoulder disorders, particularly in patients with contraindications to corticosteroids or chronic degenerative conditions. While corticosteroid injection might provide short-term symptom relief, repeated oxygen–ozone injection protocols seemed to offer sustained clinical benefits over time. Further high-quality randomized controlled trials with standardized protocols and longer follow-ups are needed to better define the role of oxygen–ozone therapy in shoulder rehabilitation. Full article

Background and Objectives: Oral health is a key but often overlooked component of healthy aging and functional wellbeing in older adults. Population aging, multimorbidity, and social determinants of health interact in order to shape oral disease patterns, particularly in primary care settings. Understanding age- and sex-specific distributions of oral diseases is essential for informing integrated public health strategies aimed at promoting healthy aging. Materials and Methods: We conducted a cross-sectional population-based analysis using the SIMEF primary care database, including 7386 adults aged 60 years and older, who were attended between January and December 2022. Oral diseases were identified using ICD-10 codes K00–K14. Prevalence estimates were calculated by life decade and sex. Associations were assessed using chi-square tests and sex-stratified analyses. Results: The overall prevalence of oral diseases was 5.2%, with a significant and progressive decline across age groups, from 6.5% in sexagenarians to 1.6% in nonagenarians (p < 0.001). The most prevalent conditions were disorders of teeth and supporting structures (2.6%, 95% confidence interval [95% CI] 2.3–3.0), dentofacial anomalies (2.2%, 95% CI 1.8–2.5), and dental caries (1.7%, 95% CI 1.4–2.0). Women showed a slightly higher prevalence of selected oral and mucosal conditions. Among older adults with oral diseases (n = 384), the most frequent comorbidities were hypertension (40.4% 95% CI 35.7–45.3), type 2 diabetes (29.2% 95% CI 24.7–33.8), and dyslipidemia (21.1% 95% CI 17.2–25.3), with marked sex-specific differences in endocrine, urinary, musculoskeletal, and mental health conditions. Conclusions: Oral disease burden in older adults decreases with advancing age but remains strongly linked to cardiometabolic and systemic comorbidities, reflecting shared risk factors relevant to healthy aging. The observed age- and sex-specific patterns underscore the need to integrate oral health into primary care and public health policies targeting aging populations, supporting comprehensive and equitable strategies for healthy longevity. Full article

Background: Operating room (OR) nurses are at high risk for work-related musculoskeletal disorders (WMSDs) due to physically demanding tasks and the use of heavy lead aprons. Objectives: This study evaluated the impact of a multidimensional ergonomic intervention on injury prevention awareness, compliance, and health outcomes among OR staff. Methods: A prospective quality improvement pilot study was conducted with 33 OR nurses. The intervention, based on the Health Belief Model and Human Factors Engineering, integrated ergonomic education with environmental modifications. Outcomes were assessed via questionnaires, field audits, and sick leave records at baseline, post-intervention, and 6-month follow-up. Results: Awareness scores improved from 68.7% to 98.8% (p < 0.001). Observational audits demonstrated a reduction in non-ergonomic actions from 2227 to 440 (mean deviations per nurse: 111.4 to 22.0, p < 0.001), with improvements sustained at 6 months. Annual sick leave cases decreased from three to one. Conclusions: A multifaceted real-world pilot intervention combining education with system-level engineering was associated with enhancing ergonomic compliance and reducing unsafe behaviors. This approach fosters the self-efficacy necessary for sustainable WMSD risk mitigation in high-intensity clinical settings. Full article

Introduction: Work-related musculoskeletal disorders are common among nursing staff and may affect functionality, psychological well-being, and work performance. Brief, culturally adapted, and psychometrically sound instruments are needed to characterize musculoskeletal risk in occupational settings. This study aimed to translate, culturally adapt, and examine the structural validity and internal reliability of the abbreviated version of the Örebro Musculoskeletal Screening Questionnaire in Peruvian nurses with musculoskeletal symptoms. Methods: An instrumental, cross-sectional study was conducted with a sample of 170 Peruvian nurses. The Spanish-adapted version of the ÖMSQ-12S was administered. Descriptive statistics, corrected item-total correlations, confirmatory factor analysis using the robust maximum likelihood estimator, internal reliability through Cronbach’s alpha and composite reliability, convergent validity through average variance extracted, and discriminant validity using the Fornell–Larcker criterion were analyzed. Results: The original three-dimensional 12-item model showed inadequate fit: χ²(51) = 276.301, CFI = 0.713, TLI = 0.628, RMSEA = 0.161, and SRMR = 0.190. Due to low and divergent factor loadings, a refined 11-item, four-factor solution was evaluated: functionality/satisfaction, fear-avoidance, psychological aspects, and characteristics of the musculoskeletal problem. This model showed better fit: χ²(37) = 58.190, CFI = 0.971, TLI = 0.957, RMSEA = 0.058, and SRMR = 0.039. Reliability was adequate across all factors (α = 0.773–0.893; CR = 0.779–0.895). Convergent validity was acceptable in most dimensions, although discriminant validity was limited between psychological aspects and characteristics of the musculoskeletal problem. Conclusions: The ÖMSQ-11S showed preliminary evidence of structural validity and internal reliability in Peruvian nurses with musculoskeletal symptoms. However, its use as a predictive tool or universal occupational screening instrument requires further studies with longitudinal designs, more heterogeneous samples, and external clinical or occupational criteria. Full article

Background: Scurvy, a condition caused by vitamin C deficiency, has traditionally been considered eradicated in high-income countries (HICs; World Bank classification). However, emerging evidence suggests its re-emergence within identifiable vulnerability clusters, challenging the conventional assumptions about nutritional adequacy in affluent settings. This study aimed to systematically characterize the contemporary clinical and epidemiological profile of scurvy in HICs and quantify its multisystem burden. Methods: A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420251013454). PubMed, Embase, Web of Science, and Scopus were searched (2012–2025). Case reports, case series, and observational studies reporting clinically or biochemically confirmed scurvy in HICs were included in this review. A multilevel random-effects meta-analysis was performed using restricted maximum likelihood estimation, incorporating robust variance estimation to account for within-study dependence and hierarchical data structures. Multisystem involvement was modeled as a count outcome, and system-specific prevalence was estimated using logit-transformed proportions. Results: Twenty-five studies, including 147 patients, were analyzed. Patients diagnosed with scurvy frequently presented with involvement of multiple organ systems, with a pooled mean of 2.29 affected organ systems per patient (95% CI: 1.62–2.96; I² = 66.8%), highlighting clinically relevant heterogeneity in presentation. Musculoskeletal involvement was the most frequent clinical domain (OR 1.82; 95% CI: 0.98–3.38), whereas neurological manifestations were significantly less common (OR 0.42; 95% CI: 0.28–0.62; p < 0.001). Age was the only significant moderator, showing a modest inverse association with musculoskeletal involvement (OR 0.97; p = 0.035). Across studies, cases predominantly clustered in pediatric patients with neurodevelopmental disorders, restrictive dietary patterns, medically complex conditions, and psychosocial vulnerability. Conclusions: Scurvy persists in high-income countries as a clinically under-recognized condition occurring predominantly in vulnerable populations with restrictive dietary patterns, neurodevelopmental disorders, and psychosocial vulnerability. The available evidence suggests that contemporary scurvy is frequently associated with multisystem manifestations; however, the contribution of concomitant micronutrient deficiencies cannot be excluded. These findings highlight the need for comprehensive nutritional assessment and targeted nutritional screening in high-risk populations to prevent diagnostic delays and avoidable morbidity. Full article

Background/Objectives: Knee injuries and overuse-related disorders are common among athletes participating in jumping sports such as handball and basketball. Musculoskeletal ultrasonography is increasingly used for the assessment of knee pathology; however, evidence regarding the prevalence and clinical relevance of ultrasonographic abnormalities in young athletes remains limited. The aim of this study was to investigate the prevalence of ultrasonographic knee abnormalities in young male handball and basketball athletes and to examine their association with pain intensity. Methods: A cross-sectional observational study was conducted between June 2025 and June 2026 and included 69 competitive male athletes (35 handball players and 34 basketball players). All participants underwent bilateral knee ultrasonographic examination using a standardized assessment protocol and completed a questionnaire regarding demographic and training characteristics. Knee pain intensity was evaluated using the Visual Analogue Scale (VAS). Comparisons between sports were performed using χ² and t-tests, while associations between participant-level ultrasonographic findings and pain were evaluated using independent-samples t-tests (or Mann–Whitney U tests, as appropriate), with Cohen’s d effect sizes and exploratory multivariable linear regression. Sensitivity analyses stratified by sport were additionally performed. Results: Patellar tendinopathy was the most prevalent ultrasonographic abnormality (21.0%), followed by medial meniscal abnormality (15.9%) and infrapatellar bursitis (13.0%). Athletes with patellar tendinopathy, medial meniscal abnormality, or infrapatellar bursitis had significantly higher VAS pain scores than athletes without the corresponding ultrasonographic abnormality. Patellar tendinopathy demonstrated the strongest association with participant-reported pain (VAS: 4.1 ± 1.3; Cohen’s d = 1.24; p < 0.001). Handball athletes exhibited a significantly higher prevalence of patellar tendinopathy than basketball athletes (34.3% vs. 11.8%; OR = 3.90, 95% CI: 1.09–13.95; p = 0.027). In multivariable regression analysis adjusted for age, BMI, sport type, previous knee injury, and weekly training volume, patellar tendinopathy (β = 1.34, p < 0.001), medial meniscal abnormality (β = 0.70, p = 0.017), and infrapatellar bursitis (β = 0.54, p = 0.046) remained independently associated with higher pain scores. The regression model explained 39% of the variance in VAS pain scores (R² = 0.39). Conclusions: Ultrasonographic knee abnormalities are common among young male handball and basketball athletes and are significantly associated with pain intensity. Because ultrasonography has limited ability to characterize intra-articular pathology, particularly the menisci, the ultrasonographic abnormalities identified in this study should not be interpreted as definitive diagnoses, and MRI remains the reference imaging modality when comprehensive evaluation of intra-articular pathology is clinically indicated. Patellar tendinopathy was the most prevalent ultrasonographic abnormality and was most strongly associated with pain intensity. These findings support the use of musculoskeletal ultrasonography as a complementary imaging modality alongside clinical assessment in the evaluation of symptomatic athletes. However, prospective longitudinal studies are required to determine whether these ultrasonographic abnormalities have prognostic value for future pain, functional limitation, or time-loss injury. Full article

Background and Objectives: Knee osteoarthritis (OA) is a prevalent musculoskeletal disorder. This study aims to assess the hip-knee-ankle anatomical alignment in patients with OA at different stages. Materials and Methods: Radiological images of 200 OA patients were analyzed to measure parameters such as femoral and tibial lengths (both anatomical and mechanical), abductor length, hip center length, femoral offset, collum femoris length, and shaft angle using ImageJ software (version 1.53k; National Institutes of Health, Bethesda, MD, USA). Results: The female-to-male ratio was 2.17:1. Male participants exhibited greater values for femoral and tibial lengths, abductor length, hip center length, femoral offset, collum femoris length, and collum femoris shaft angle, whereas females showed higher Q angle, hip–knee–ankle angle, mechanical lateral distal femoral angle, mechanical medial proximal tibial angle, and femoral angle measurements. Significant differences in both linear and angular parameters were observed among age groups. Q angle, hip–knee–ankle angle, femoral mechanical axis shaft angle, plateau angle, and ankle tilt angle values were significantly higher in individuals aged 62–75 years. According to Kellgren–Lawrence staging, significant increases were observed in Q angle, hip–knee–ankle angle, femoral mechanical axis shaft angle, plateau angle, and ankle tilt angle in advanced-stage disease (Stage 4) (p < 0.05). Although mechanical lateral distal femoral angle, femoral Q angle, tibial Q angle, condylar plateau angle, and tibiotalar angle showed numerical differences across disease stages, these findings did not reach statistical significance. Conclusions: Comprehensive assessment of lower-extremity alignment may provide complementary information regarding biomechanical changes associated with knee osteoarthritis progression and could support individualized clinical follow-up and treatment planning. Full article

Musculoskeletal (MSK) disorders—osteoporosis, osteoarthritis, rheumatoid arthritis, intervertebral disc degeneration, tendinopathy, and skeletal muscle injury—contribute the largest share of years lived with disability worldwide. Conventional therapy relies on systemic dosing or repeated intra-articular and peri-tissue injections, which suffer from off-target toxicity, poor lesional bioavailability, and low adherence. Polymer microneedles (MNs)—micron-scale projections of biodegradable, dissolving, hydrogel-forming, or composite polymers—have rapidly matured into a versatile platform for minimally invasive, spatially localized, and temporally programmable delivery of small molecules, biologics, nucleic acids, extracellular vesicles, and cells to MSK tissues. This review synthesizes 2018–2026 advances in polymer MN systems engineered specifically for MSK regeneration. We classify dominant polymer chemistries and MN architectures; map fit-for-purpose across bone, cartilage, joint, intervertebral disc, tendon, and skeletal muscle; and survey “smart” MN designs that exploit reactive oxygen species, pH, mechanical, triboelectric, optogenetic, and ultrasonic triggers. We close with a concise conclusion and forward perspective that identifies the key design levers—hybrid MN–scaffold combination products, stimuli-responsive platforms tuned to the MSK micro-environment, and cell- and EV-loaded formats—most likely to have clinical impact. Full article

Background/Objectives: Irritable bowel syndrome (IBS) is among the most prevalent disorders of gut–brain interaction, yet its implications for spine surgery remain poorly characterized. This narrative review examines how IBS influences symptom presentation and postoperative outcomes in spine surgery patients. Methods: We synthesized the neurobiologic, epidemiologic, and perioperative literature linking IBS with musculoskeletal pain, spine-related symptomatology, and surgical outcomes, drawing on spine-specific data where available and on related surgical and chronic-pain populations where it was not. Results: IBS is characterized by central sensitization, impaired descending inhibition, increased temporal summation, autonomic dysregulation, and a high prevalence of psychiatric comorbidity, which manifest as widespread hyperalgesia and symptom amplification that overlap with pain mechanisms common in spine surgery patients. Epidemiologic studies indicate that patients with IBS undergo musculoskeletal and spinal procedures at disproportionately high rates, reflecting both symptom burden and diagnostic uncertainty from viscerosomatic overlap. These same factors have been associated with greater postoperative pain, elevated opioid requirements, slower functional recovery, and reduced satisfaction after spine surgery, although direct IBS-specific spine data remain limited. IBS may also confound preoperative assessment by mimicking radicular, discogenic, or sacroiliac pain. Conclusions: IBS represents an under-recognized potential modifier of symptom localization, perioperative pain trajectories, and functional recovery in spine surgery. Greater awareness of IBS-related nociplastic and psychosocial mechanisms may improve preoperative evaluation, risk stratification, perioperative management, and the design of future outcome studies. Full article

Musculoskeletal disorders (MSDs) represent a critical global challenge to workforce productivity. In Thailand, these disorders are particularly prevalent in labor-intensive industries such as ice manufacturing, where workers face significant ergonomic hazards. Addressing this gap, the present study aimed to assess the occupational health, safety, and ergonomic risks facing workers in ice production facilities. This cross-sectional descriptive study investigated production workers who were employees in two of eight ice manufacturing plants in Surat Thani, Thailand, using the Rapid Entire Body Assessment (REBA) method. A structured occupational health and safety risk assessment questionnaire and the REBA evaluation form were used to collect data. All participants were male, averaging 30.4 (±8.5) years old. Regular pain areas included the upper/lower back, hips/thighs, shoulders, wrists, and ankles. Ergonomic assessments showed high overall risk due to heavy lifting, repetitive tasks, and cold environments. Based on REBA scores, 13.04% were in the very-high-risk group (score ≥ 11) and 65.22% in the high-risk group (score 8–10). Most production workers in ice plants faced high ergonomic risks, especially from postures affecting the upper and lower back. Training should be provided to promote awareness of risky postures and proper lifting techniques. Mechanical aids and back-support equipment are also recommended to help prevent musculoskeletal injuries. Full article

Background/Objectives: Sarcopenia may compound mobility limitations and fall vulnerability among older adults with coexisting knee osteoarthritis (KOA) and chronic spinal pain. This secondary analysis of a previously reported or substantially overlapping cohort estimated the proportion meeting Asian Working Group for Sarcopenia (AWGS) 2019 criteria and explored additional adjusted associations in a selected Vietnamese outpatient sample. Methods: A hospital-based secondary cross-sectional analysis included 88 outpatients aged ≥ 60 years (mean age, 70.5 ± 6.7 years; 69 women, 78.4%) with coexisting KOA and chronic spinal pain who were recruited by convenience sampling at Thai Binh General Hospital from May to October 2024. Source-record verification confirmed that all of the analytic participants had both diagnoses. Their muscle mass, grip strength, and gait speed were assessed using the InBody 770, an InGrip handgrip dynamometer, and a 15-foot walk test, respectively. The prespecified primary classification used AWGS 2019. The AWGS 2025 framework was considered during revision, but numerical reclassification was not feasible because the retained participant-level analytic dataset contained the derived AWGS 2019 outcome and covariates used in the reported regression and CHAID analyses, but not the original continuous age, appendicular skeletal muscle mass index, handgrip values, or a complete raw component record sufficient to independently reconstruct the AWGS 2019 status or apply AWGS 2025 thresholds. Multivariable logistic regression and CHAID were treated as exploratory. Results: Under AWGS 2019, 36/88 participants (40.9%) had sarcopenia, including 15 (17.0%) with severe sarcopenia. All 88 participants had both KOA and chronic spinal pain; therefore, diagnostic-category subgroup comparisons were not applicable. In the exploratory adjusted analysis, an age > 70 years (adjusted odds ratio [AOR]: 9.00, 95% confidence interval [CI]: 2.40–33.60), a history of falls (AOR: 6.33, 95% CI: 2.77–14.45), low educational attainment (AOR: 2.86, 95% CI: 1.46–5.61), and a higher Pittsburgh Sleep Quality Index score (AOR: 1.16, 95% CI: 1.02–1.32) remained associated with sarcopenia. Wide CIs and approximately 4.5 events per regression coefficient indicated substantial imprecision. Conclusions: This secondary report provides setting-specific descriptive evidence rather than independent replication, a validated prediction tool, or a fully auditable reconstruction of the original AWGS component measurements. Because AWGS 2025 reclassification could not be reconstructed from the retained dataset and raw component records, the AWGS 2019 estimate should not be treated as directly interchangeable with the estimates generated under the updated framework. The observed associations and within-sample subgroup patterns require confirmation in larger, prospectively auditable studies. Full article

Background: Prolonged occupational standing is associated with increased plantar pressure, impaired postural stability and fatigue, contributing to lower-limb musculoskeletal disorders. Passive lower-limb exoskeletons have been proposed as an ergonomic solution to reduce mechanical load without external power. Objective: To evaluate the effects of a passive lower-limb exoskeleton (Chairless Chair^® 2.0) on plantar pressure distribution, postural stability, perceived fatigue and user satisfaction in workers exposed to prolonged standing. Methods: A quasi-experimental pre–post study was conducted in 25 asymptomatic restaurant workers. Participants performed static standing and walking trials on a baropodometric platform with and without the exoskeleton. Plantar pressures were recorded in static and dynamic conditions and postural stability was assessed by centre-of-pressure (COP) displacement and velocity. Perceived fatigue was measured with the Borg CR10 scale, and usability and comfort with the QUEST 2.0 questionnaire. Repeated-measures ANOVA and non-parametric tests (p < 0.05) were applied. Results: Compared with standard footwear, the exoskeleton significantly reduced plantar contact area and peak and mean plantar pressures during standing and walking. Posturographic analysis revealed a significant effect of condition on COP-related variables, with significantly lower oscillation and velocity measures observed in the exoskeleton condition. Perceived fatigue remained low to moderate and did not differ significantly between tasks (p = 0.96). QUEST 2.0 scores reflected high perceived effectiveness, ease of use and comfort, although device weight was the least favourable characteristic. Conclusions: The Chairless Chair^® 2.0 improved plantar pressure redistribution and was associated with lower COP displacement and velocity values without increasing perceived exertion. The device was generally well accepted by participants, supporting its potential use as an ergonomic aid in occupations requiring prolonged standing. Full article

Introduction: This systematic literature review (SLR) provides an analytical framework for clinical trials evaluating clinical outcomes of artificial intelligence-based digital health interventions (AI-DHI). Methods: The SLR was conducted in accordance with the PRISMA guidelines. Search was conducted (September 2025) in PubMed and Embase. Population included patients using AI-DHI. Only clinical trials exploring clinical outcomes, written in English, were considered. NICE checklist was used to assess studies’ quality. Results were analyzed descriptively. Results: Final sample had 84 studies, with metabolic (28.6%), musculoskeletal (20.2%), and mental health disorders (19.0%) as the most common indications. Most studies (75.0%) were controlled, parallel-group trials with 2+ arms, mostly comparing AI-DHI with standard-of-care or waitlist. Although type of intervention often precludes blinding (64.3% were open-label), a double-blinding is strongly recommended (only 6.0%). Only 9.5% of studies were conducted at multiple sites across different countries. Dropout rates in the total sample and each study arm should be <20% at all endpoints (64.3%). Statistical tests were used based on the outcome measures. The small sample sizes and limited generalizability of findings were reported as the main limitations. Conclusions: This SLR emphasized current methodological gaps and an urgent need for unified global guidelines. Standard SLR limitations apply to this research. Full article