Search Results (377)

Childhood obesity increases chronic disease risk, but no comprehensive synthesis has evaluated the impact of school-based combined nutrition education and physical activity interventions on cardiometabolic biomarkers in children aged 3 to 12 years. This systematic review was conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD420251085194). Five databases were systematically searched through June 2025. Twelve randomized controlled trials involving 18,231 children were included and assessed using the PEDro scale. Ten trials demonstrated significant improvements in at least one cardiometabolic biomarker. Blood pressure (8 studies) outcomes showed systolic reductions of 1.41–6.0 mmHg in six studies. Glucose metabolism (5 studies) improved in two studies with reductions of 0.20–0.22 mmol/L. Lipid profiles (7 studies) improved in three studies, including total cholesterol (−0.32 mmol/L). Insulin levels (5 studies) decreased significantly in two investigations. Anthropometric improvements included BMI and body fat. Physical activity increased by >45 min/week and dietary habits improved significantly. Programs with daily implementation (90-min sessions 4x/week), longer duration (≥12 months), family involvement (parent education), and curriculum integration (classroom lessons) showed superior effectiveness. Interventions targeting children with overweight/obesity demonstrated higher changes compared to the general population. However, methodological limitations included a lack of assessor blinding, absence of subject/therapist blinding, and inadequate retention rates. School-based interventions combining nutrition and physical activity can produce significant improvements in cardiometabolic biomarkers, supporting comprehensive, sustained multicomponent programs for early chronic disease prevention. Full article

Background: Self-report physical activity (PA) scales, accelerometry, and heart rate (HR) monitoring are reliable tools for PA measurement for children with cerebral palsy (CP); however, there are limitations for those who are primary wheelchair users. The purpose of our study was to evaluate face and construct validity of the PROMIS^® Pediatric PA parent proxy short form 8a in measuring PA amount and intensity in children with CP who are non-ambulatory. Methods: Face validity: Semi-structured interviews with parents and pediatric physical therapists (PTs) were conducted about the appropriateness of each item on the PROMIS^® Pediatric PA short form. Construct validity: Children with CP who were non-ambulatory participated in a one-week observational study. PA amount and intensity were examined using PA monitors (Actigraph GT9X) and HR monitors (Fitbit Charge 4). Activity counts and time in sedentary and non-sedentary intensity zones were derived and compared to the PROMIS^® T-scaled score. Results: Twenty-two physical therapists (PTs) and fifteen parents participated in the interviews, and ten children completed 1-week PA observation. Eight and seven participants completed sufficient time of uninterrupted PA and HR monitor wear, respectively. Parents and PTs agreed that several questions were not appropriate for children with CP who were non-ambulatory. PA intensity via activity counts derived from wrist worn monitors showed a strong positive correlation with the PROMIS^® PA measure. Conclusions: Construct validity in our small sample was established between PROMIS^® scores and accelerometry activity counts when documenting PA amount and intensity; however, there were some differences on PROMIS^® face validity per parent and PT respondents. Despite some concerns regarding face validity, the PROMIS^® Pediatric PA parent proxy short form 8a shows promise as a valid measure of physical activity amount and intensity in non-ambulatory children with CP, warranting further investigation and refinement. Full article

Background/objective: Tailoring involves adapting research findings and evidence to suit specific contexts and audiences. This study examines how international stroke guidelines can be tailored to address gait issues after a stroke. Methods: A three-phase consensus method approach was used. A 10-member health experts panel extracted recommendations from three national clinical guidelines in the first phase. In the second phase, 362 physiotherapists completed an online questionnaire to assess the feasibility of adopting the extracted recommendations. In the third phase, a 15-physical therapist consensus workshop was convened to clarify factors that might affect the tailoring process of the extracted recommendations of gait disorder rehabilitation. Results: In phase one, 21 recommendations reached consensus. In the second phase, 362 stroke physiotherapists rated the applicability of these recommendations: 14 rated high, 7 rated low, and none were rejected. The third phase, a nominal group meeting (NGM), explored four themes related to tailoring. The first theme, “organizational factors”, includes elements such as clinical setting, culture, and regulations. The second theme, “individual clinician factors”, assesses aspects like clinical experience, expertise, abilities, knowledge, and attitudes toward tailoring. The third theme, “patient factors”, addresses issues related to multimorbidity, comorbidities, patient engagement, and shared decision-making. The final theme, “other factors”, examines the impact of research design on tailoring. Conclusions: Tailoring international clinical guidelines involves multiple factors. This situation brings home the importance of a systematic strategy for tailoring that incorporates various assessment criteria to enhance the use of clinical evidence. Future research should investigate additional implementation theories to enhance the translation of evidence into practice. Full article

Background/Objectives: Telehealth enhances access to specialty care, but stakeholder perspectives are often overlooked. The objective was to evaluate participant and provider satisfaction with a novel telehealth-enabled home safety program. Methods: This is a sub-investigation of a non-randomized pilot study of a novel telehealth-enabled home safety program that enrolled 23 persons with Parkinson’s Disease (PwPs) at risk for falls and their respective care partners (CPs). Dyads participated in four to six televisits over three months, where they performed “virtual home tours” using a mobile platform (tablet mounted on a rolling stand) with a physical therapist to identify and mitigate environmental fall hazards. Satisfaction was assessed using PI-developed surveys and open feedback. Mobile platform usability was assessed with the System Usability Scale (SUS). Results: A total of 95.65% of dyads were very to extremely satisfied with the entire program overall, and the therapist indicated the same for 73.91% of the dyads. Additionally, 95.65% of dyads reported gaining new awareness of home fall hazards. Difficulties maneuvering the mobile platform, using a tablet, and connectivity issues were common challenges noted. The mean score on SUS for the mobile platform was 65, indicating poor perceived usability, and most dyads indicated they would have preferred using a smartphone for the program. Other priorities, including competing health and personal obligations, along with resistance to change, were the primary barriers to implementing program recommendations. Conclusions: Our novel telehealth-enabled home safety program was well-received by patients and the study therapist. Using a smartphone and troubleshooting connectivity issues might help further improve the usability and accessibility of this program. Full article

Background/Objectives: Robot-led rehabilitative exercise offers a promising avenue to enhance the care provided by exercise specialists (ESs). ESs, such as physical and occupational therapists, prescribe exercise regimens to clinical populations to improve patients’ adherence to prescribed exercises outside the clinic, such as at home. Collaborative efforts among roboticists, clinical ESs, and patients are essential for developing interactive, personalized exercise systems that meet each stakeholder’s needs. This work builds upon research involving individuals with Parkinson’s disease (PD) that evaluated a robotic rehabilitative exercise system designed to address strength and flexibility deficits. Methods: To complement the findings of our previous work in people with PD (PWP), we conducted a pilot user study in which 11 ESs evaluated a novel robot-led exercise system for PWP, focusing on perceptions of the system’s efficacy and acceptance. Utilizing a mixed-methods approach, including technology acceptance questionnaires, task load questionnaires, and inductively coded semi-structured interviews, we gathered comprehensive insights into ES perspectives and experiences after interacting with the system. Results: Findings reveal a broadly positive reception, which highlights the system’s capacity to augment traditional rehabilitative exercise for PD, enhance patient engagement, and ensure consistent exercise support. We also identified two key areas for improvement: incorporating more human-like feedback systems and increasing the robot’s ease of use. Conclusion: This research emphasizes the value of incorporating robotic assistants into rehabilitative exercise for PD, offering insights that can guide the development of more effective and user-friendly rehabilitation technologies. Full article

Background and Objectives: Negative-pressure wound therapy (NPWT) expedites tissue repair, yet functional recovery depends on adjunct rehabilitation. Evidence from high-resource settings is difficult to translate to Romanian county hospitals, where advanced devices are scarce. The objective of this study is to determine whether two tiers of low-technology, therapist-delivered exercise improve mobility, oedema resolution, pain and quality-of-life (QoL) beyond NPWT alone in adults with acute lower-limb wounds. Methods: A single-centre, prospective observational study (January 2021–June 2024) enrolled 92 patients and randomised them unevenly into: Group A, NPWT only (n = 39); Group B, NPWT + routine physiotherapy (n = 33); Group C, NPWT + enhanced manual programme (n = 20). All received −125 mmHg continuous suction; rehabilitation started 48 h post-operation. Primary outcomes were ankle dorsiflexion and knee flexion at 12 weeks. Secondary outcomes included calf circumference, ultrasound oedema depth, Manual Muscle Testing (MMT), pain (VAS), analgesic use and SF-36 domains through 24 weeks. Results: Baseline characteristics were similar (p > 0.40). At 12 weeks dorsiflexion reached 20.1 ± 1.8° in Group C, surpassing Group B (18.4 ± 2.1°; p = 0.004) and Group A (16.0 ± 2.3°; p < 0.001). Knee flexion followed the same gradient (140.8 ± 3.2°, 137.6 ± 3.4°, 133.4 ± 3.8° respectively). Oedema depth fell fastest in Group C (0.4 ± 0.2 mm by day 42) versus B (0.6 ± 0.2 mm) and A (0.8 ± 0.3 mm). Week-12 MMT grade ≥ 4.5 was attained by 95% of Group C, 85% of B and 72% of A (χ² = 10.9, p = 0.004). VAS pain fell more steeply with each rehabilitation layer, paralleled by a stepwise decline in daily tramadol. All SF-36 domains were highest in Group C at 24 weeks (Physical Function 88.7 ± 4.8 vs. 85.1 ± 5.4 vs. 78.2 ± 5.9; p < 0.001). Mobility correlated positively with QoL (r = 0.66) and inversely with pain and oedema. Conclusions: In a resource-constrained Romanian setting, adding structured manual physiotherapy to NPWT produced meaningful functional and patient-centred gains, while an “enhanced” programme incorporating daily PNF and elastic-band strengthening delivered the largest observed benefit. These findings justify prioritising therapist-led interventions even where sophisticated equipment is unavailable. Full article

Background/Objectives: Mild traumatic brain injury (mTBI) presents with persistent, heterogeneous symptoms requiring multifaceted care. Although interdisciplinary rehabilitation is increasingly recommended, implementation remains inconsistent. This study aimed to synthesize existing literature and clinician perspectives to construct a practice-informed conceptual framework for interprofessional mTBI rehabilitation. Methods: Structured interviews were conducted with 94 clinicians—including neurologists, neuropsychologists, optometrists, occupational and physical therapists, speech-language pathologists, neurosurgeons, and case managers—across academic, private, and community settings in the United States. Interviews followed a semi-structured format adapted for the NIH I-Corps program and were analyzed thematically alongside existing rehabilitation literature. Results: Clinicians expressed strong consensus on the value of function-oriented, patient-centered care. Key themes included the prevalence of persistent cognitive and visual symptoms, emphasis on real-world goal setting, and barriers such as fragmented communication, reimbursement restrictions, and referral delays. Disciplinary differences were noted in perceptions of symptom persistence and professional roles. Rehabilitation technologies were inconsistently adopted due to financial, training, and interoperability barriers. Equity issues included geographic and insurance-based disparities. A four-domain conceptual framework emerged: discipline-specific expertise, coordinated training, technological integration, and care infrastructure, all shaped by systemic limitations. Conclusions: Despite widespread clinician endorsement of interprofessional mTBI care, structural barriers hinder consistent implementation. Targeted reforms—such as embedding interdisciplinary models in clinical education, expanding access to integrated technology, and improving reimbursement mechanisms—may enhance care delivery. The resulting framework provides a foundation for scalable, patient-centered rehabilitation models in diverse settings. Full article

This case report examines the impact of robotic-assisted therapy (Lokomat) on functional recovery in a 28-year-old male patient with acute dermatomyositis (DM), an autoimmune inflammatory myopathy causing progressive muscle weakness and disability. The patient underwent 21 sessions of robotic therapy combined with physical therapy, and occupational therapy over seven weeks. Assessments were conducted at baseline, week 10, and week 21 using standardized measures for balance, muscle strength, and functionality. Results demonstrated significant improvements across all domains: balance scores progressed from severe impairment (4/56 Berg, 0/28 Tinetti) to near-normal function (55/56, 24/28, respectively); muscle strength increased from grade 1/5 to 4/5 (MMT-8) in all tested muscle groups; and functionality improved from moderate dependence (59/126 FIM) to complete independence (126/126). The trunk functionality scores showed remarkable recovery from 12/100 to 100/100 (TCT), indicating restored trunk control. Lokomat-assisted therapy combined with conventional rehabilitation effectively improves proximal weakness and postural instability in DM. Robotic therapy enhances motor learning via repetitive movements and reduces therapist workload. Though limited by a single-case design, this study offers preliminary evidence for robotic rehabilitation in DM, previously unexplored. Controlled studies are needed to standardize protocols and validate results in larger cohorts. Advanced technologies show promise for functional recovery in inflammatory myopathies. Full article

Objective: The objective of this study was to examine 7 years of clinical physical therapy measures in a child with spastic diplegic cerebral palsy (CP) who received multiple botulinum toxin type A (BoNT-A) injections. Methods: A boy diagnosed with spastic diplegic CP, Gross Motor Function Classification System level II, received four episodes of BoNT-A from ages 4 to 10 years. Serial clinical measures of muscle strength, spasticity, lower extremity passive range of motion, gait kinematics, and gross motor function were collected in the gait analysis lab from age 3 to 10 years. Results: After improvements from ages 3 to 7 years, gait and motor function declined from ages 8 to 10 years with no improvement in spasticity or range of motion measurements. Muscle testing and gait kinematics defined a loss of plantarflexion strength. Conclusions: A decline in gross motor skills and gait is not typical for a child with spastic diplegia at age 8 years and its association with BoNT-A injections needs to be considered. This case demonstrates the importance of evaluating treatment outcomes for youth with spastic CP utilizing a set of reliable, and clinically useful measures of strength, spasticity, contracture, gait, and motor function. Critical examination of impairment and functional level measures defines goals, guides treatment, and evaluates outcomes. With this approach, pediatric therapists can empower families to make well-informed decisions. Full article

Background: Weight stigma describes the negative attitudes held toward people with obesity. Weight bias stereotypes have been previously reported in physicians, physician assistants, nurses, registered dieticians, psychologists, and students enrolled in healthcare professional education programs. Physical and occupational therapists (PTs and OTs) are healthcare providers who evaluate and treat individuals across their lifespan. A PT or an OT who harbors weight bias may create an environment where the patient may fail to optimize their rehabilitation recovery. The first purpose of this scoping review was to identify the prevalence of weight bias in PT and OT clinicians and students. The second purpose was to evaluate the effectiveness of interventions at reducing weight bias in these populations. Methods: The CINAHL, PubMed, and Google Scholar databases were searched, and 15 articles met the inclusion criteria. Results: In each study, PT and/or OT clinicians and/or students demonstrated weight bias. A minimum of approximately twenty percent of surveyed participants had weight bias, with one study reporting over eighty percent of subjects expressing negative attitudes. Three of the studies reported mixed results (i.e., improvement or worsening) regarding weight bias scores after intervention. Conclusions: PT and OT clinicians and students demonstrate weight bias similar to other healthcare professionals. Future research is warranted to identify educational interventions that reduce bias within these populations. Full article

Background: Transcranial direct current stimulation (tDCS) has exhibited potential in augmenting motor functions, neuroplasticity, and cognitive abilities within neurological rehabilitation contexts. Despite these promising outcomes, the utilization of tDCS in both research and clinical environments in Saudi Arabia remains relatively unexplored. Objective: This study aims to evaluate the knowledge, attitudes, and motivations of rehabilitation specialists in Saudi Arabia concerning tDCS. Methods: A cross-sectional observational study was conducted through an online questionnaire, involving 112 registered rehabilitation professionals. Results: While 58% of respondents acknowledged tDCS as a therapeutic tool, the overall knowledge level was modest, with a mean score of 3.0 ± 2.7 out of 9. Enhanced levels of knowledge were associated with individuals holding doctoral degrees (p = 0.02) and those with international training exposure (p = 0.03). Despite the limited knowledge base, an overwhelming 94.64% of participants displayed a neutral to positive attitude towards tDCS, with 52.7% recognizing its potential efficacy in neurological recovery. Principal obstacles to implementation included safety-related concerns (21.4%) and the need for specialized training (23.3%). Conclusions: Rehabilitation specialists in Saudi Arabia generally hold a favorable view of tDCS and demonstrate an eagerness to pursue further training. The results underscore the imperative for enhanced educational initiatives and practical training to address knowledge deficiencies and facilitate the seamless integration of tDCS into clinical routines. The implementation of structured training programs could not only reinforce adoption rates but also optimize the role of tDCS within rehabilitation. Full article

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

Background/Objective: Early mobilization (EM) of critically ill patients is a feasible and safe intervention that limits the implications of bed rest and improves lung function. However, its limited implementation suggests a gap between the research evidence and clinical practice. It is widely accepted that early mobilization faces a variety of barriers. This study aimed to investigate the perceptions of Greek physiotherapists on EM barriers and record their knowledge and practices. Methods: We conducted an electronic survey using the online platform “Microsoft Forms”, among critical care physiotherapists in 66 hospitals that had an Intensive Care Unit (ICU) department in Greece in 2024. We administered a questionnaire, developed based on valid and reliable international questionnaires, with the following domains: education and knowledge on early mobilization, practices, perception regarding EM, and perceived barriers to early mobilization. Results: A total of 126 Greek physical therapists participated. The majority of them worked in urban area hospitals and in a rotation schedule around all departments. Most physical therapists stated that early mobilization is a priority for the patient’s rehabilitation and an important factor in preventing the complications of bed rest. Yet, they do not use specific protocols. Most had knowledge of what EM involved and the international guidelines. The most common barriers reported were the hemodynamic instability and the incoherence with the ventilator. Dedicated physiotherapists singled out certain barriers like the presence of delirium and the lack of communication among ICU staff. Additionally, physiotherapists with more years of experience did not acknowledge tubes, connections, femoral lines and Body Mass Index (BMI) as barriers. Conclusions: Most Greek physiotherapists believe that early mobilization is crucial for the rehabilitation of critically ill patients. A significant percentage know the guidelines, yet they do not follow a specific protocol. Various barriers prevent its implementation, which depends on the patients, healthcare providers, and the overall process. Yet, It is recognized that practices and perceived barriers are influenced by experience and work schedule. Establishing clinical protocols is essential to facilitate the implementation of early mobilization and support patient rehabilitation. Future efforts should focus on designing strategies and EM protocols for physiotherapy in Greek ICUs. Also, we need to monitor changes in perceived barriers across other countries as focus on the matter via published studies and clinical seminars could lead to significant changes. Full article

This study aims to analyze the possibility of developing balance ability, highlighting symmetries, asymmetries, and levels of proprioception, in children aged 11–13 from practicing indoor and outdoor climbing and bouldering/escalation exercises. The research subjects were 54 children (both boys and girls) aged 11–13, divided into two groups: an experimental group of 28 students (14 boys and 14 girls) who participated in an extracurricular climbing activity twice a week during the 2023–2024 school year, and a control group of 26 students (13 boys and 13 girls) who did not engage in extracurricular motor activities. During the initial and final evaluations, 12 tests were used to assess balance ability, symmetries, and asymmetries—10 tests were conducted using the Sensbalance MiniBoard 1.0 platform in addition to the Standing Stork test for each leg. The analysis of the results showed statistically significant differences between the groups, with the experimental group recording improvements in symmetry and proprioception related to increased balance levels. This work is addressed to teachers, trainers, and physical therapists who, in the educational process, aim to develop balance and proprioception as objectives that improve children’s motor skills. In conclusion, the study results reveal the impact of a program based on climbing and escalating exercises in extracurricular activities on the development of static and dynamic balance ability. Full article

Robotic walking assistance devices support the rehabilitation of patients with neurological impairments. However, most commercialized systems rely on treadmill-based walking, which may not reflect real-world environments. This study aimed to evaluate the usability of a newly developed over-ground walking assistance robot (OWAR-MW) based on mecanum wheels compared with a commercial system (Andago) from the perspectives of physical therapists and patients with stroke. Nine physical therapists and nine stroke patients participated. Each participant walked 100 m using both the OWAR-MW and Andago systems. Subsequently, a satisfaction survey was conducted across three categories—safety, operability and functionality, and convenience—using a questionnaire adapted from the standard usability testing guidelines for walking assistive devices. Additionally, in-depth interviews were conducted to explore user experience and improvement needs. In both participant groups, the OWAR-MW showed a tendency for lower satisfaction scores than Andago across all categories. Stroke patients reported significantly lower scores in all three categories (safety: 4.90 vs. 4.04, operability and functionality: 4.83 vs. 4.33, convenience: 4.87 vs. 4.49, p < 0.05), whereas therapists noted a significant difference only in safety (4.02 vs. 3.37, p < 0.05). Key issues identified included a lack of handles, delay in actuator response, low motion detection sensitivity, non-intuitive controls, and discomfort caused by the harness, particularly the thigh straps. OWAR-MW demonstrated usability limitations in its current prototype form. Technical improvements in user interface, control accuracy, and harness design are necessary before clinical application. This study provides valuable feedback for the future development of user-centered rehabilitation robotics. Full article