This study was to examine the effects of high-intensity interval training (HIIT) interventions on exercise capacity and fatigue in people with MS. We performed a systematic review and meta-analysis. PubMed/Medline, Web of Science, Scopus and Google Scholar databases were systematically searched from inception to January 2024. We reviewed randomized controlled trials (RCTs) that focused their intervention on HIIT for people with MS to improve exercise capacity or fatigue. Two researchers performed the search process independently in the different databases and assessed methodological quality and risk of bias. Eleven studies were included in the systematic review and seven of them were meta-analyzed. The overall pooled effect favored HIIT interventions in improving exercise capacity (SMD = 0.29; 95% CI = 0-05,0.53; p = 0.02) and reducing fatigue (SMD = -0.26; 95% CI = -0.50, -0.02; p = 0.03) in people with MS. We generally found a low risk of bias and a good methodological quality. The results of this review and meta-analysis provide evidence that HIIT interventions improved and reduced fatigue in people with MS. HIIT intervention may be a good option to improve exercise capacity and reduce fatigue of these people.

The Accreditation Council for Graduate Medical Education (ACGME) introduced the Milestones to document learner development within a competency-based framework. On the other hand, board certifying examinations serve as a summative evaluation of a learner's readiness for independent medical practice. Scores in Part I of the American Board of Physical Medicine and Rehabilitation (ABPMR) examination, which measures medical knowledge, has been shown to correlate only with Milestones ratings in medical knowledge. We hypothesized that combined ratings of various Milestone competencies can predict subsequent performance in related ABPMR Part II certifying examination domains. Milestones data and ABPMR Part II examination scores of trainees in 3-yr PM&R residency programs in the United States from academic years (AY) 2014-2016 who sat for the ABPMR Parts I and II Examinations, immediately after completion of training, were reviewed. Regression analysis showed that Milestone sub-competencies, alone or in combination, did not correlate with Part II domain scaled scores. Medical Knowledge was the only Milestone sub-competency that was correlated with performance in the ABPMR Part I certifying examination. This current study found that no similar association exists between any of the Milestones Competencies and the ABPMR Part II certifying examination, suggesting that the two assessment tools measure different attributes.

There is a persistent underrepresentation of women and multiple ethnic minority groups among medical school and residency applicants and trainees, particularly in Physical Medicine and Rehabilitation (PM&R). There is limited information on what causes these demographic disparities in PM&R and on strategies to increase interest in the field. To address this gap and improve early recruitment efforts, the authors conducted the first-ever national survey to gather information on pre-medical students' perceived barriers to medical school admissions, career interests, perceptions of PM&R, and strategies to increase interest in PM&R. The survey received 1093 responses from 236 colleges with a diverse representation of participants, including 53.3% (n = 583) from historically underrepresented groups such as those Underrepresented in Medicine (URiM), and those from rural communities, and/or low socioeconomic backgrounds. Only 31.2% (n = 313) knew the existence of PM&R. However, 60.0% (n = 568) of respondents were interested in learning more about PM&R through shadowing a PM&R physician (82.2%, n = 780), attending workshops (75.9%, n = 720), and mentorship (58.9%, n = 559). The national survey revealed limited exposure to PM&R at the pre-medical level but a strong interest in dedicated mentorship and workshops, suggesting effective strategies to address underrepresentation.

The aim of this study was compare the effects of Combined Training (CombT), which included Robot-Assisted Gait Training in addition to Traditional Balance Training (TBT), and TBT alone on balance and fear of falling (FoF) in patients with stroke based on objective assessment methods. Patients were randomized into CombT Group (CombTG) (n = 21) and TBT Group (TBTG) (n = 21) for duration of 5-weeks. Balance were assessed with EncephaLog App recorded stand-up time (SUT), sit-down time (SDT), and directional sways during walking, Berg Balance Scale (BBS) and Timed Up and Go Test (TUG). International Fall Efficacy Scale (FES-I) measured fear of falling (FoF). Fugl Meyer Assessment-Lower Extremity (FMA-LE) assessed limb impairment. Foot posture were assessed with Foot Posture Index (FPI-6). After the treatments, EncephaLog sways (anterior, medial, lateral: P = 0.04, P = 0.01, P = 0.02), SUT (P = 0.006), SDT (P = 0.002); BBS (P < 0.001); FES-I (P = 0.002) improved in CombTG. TUG (P = 0.01) and FMA-LE (P < 0.001) improved in TBTG. SUT (P = 0.01) and SDT (P = 0.04) showed statistically significant improvement in CombTG compared to TBTG; FMA-LE (P = 0.002) demonstrated statistically significant improvement in TBTG compared to CombTG. Objective assessment indicated that combined treatments in subacute and chronic stroke rehabilitation enhance balance and reduce FoF more effectively than isolated approaches.

Ideal volume of 5% dextrose (D5W) for median nerve hydrodissection (HD) for treating carpal tunnel syndrome (CTS) is still unknown. This study assessed the efficacy of nerve hydrodissection using varying volumes of D5W for treating mild to moderate CTS. Eighty participants with unilateral mild to moderate CTS were randomized into groups to receive either 5 ml of normal saline (NS), 5 ml of D5W, 10 ml of NS, and 10 ml of D5W, with each group undergoing one session of ultrasound-guided HD. Visual Analogue Scale (VAS), Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), grip and pinch strength, cross-sectional area (CSA) of median nerve, and electrophysiological assessment were performed at baseline and weeks 4 and 12. In the 10 ml D5W group, VAS scores considerably improved compared with those in the NS groups. Although nerve CSA values decreased in all groups during follow-ups, the 10 mL D5W group showed a statistically significant improvement compared to the NS groups by the 12th week (p ≤ 0.01). Ultrasound-guided median nerve HD with 10 ml D5W was more effective in reducing pain and nerve size than the NS groups at the 12th week.

We investigated the therapeutic effect of transcranial direct current stimulation (tDCS) combined with routine physiotherapy on the neurological and upper limb motor function in ischemic stroke patients with hemiplegia. In a Randomized double-blind controlled trial study, 52 eligible stroke patients were assigned to real tDCS receiving bihemispheric electrical current with 1.5 mA for 30 minutes over the primary motor cortex, and sham tDCS with a current intensity of 0.5 mA for 30 seconds. Both groups received routine physiotherapy, 5 sessions per week for two weeks. The National Institute of Health Stroke Scale (NIHSS) and the Medical Research Council Scale for Muscle Strength were used to assess the neurological and upper limb motor functions, respectively. Both therapeutic approaches begot a significant improvement in upper limb motor function and neurological impairment at the last session of therapy and follow-up study. However, the treatment-induced neurological amelioration at the last session of therapy in real tDCS was significantly more than sham, especially in those identified as female and under 60 years old. A gender and age-specific protocol of real tDCS combined with routine physiotherapy might be beneficial to improve neurological impairment but not upper limb motor dysfunction after stroke.

Morton's neuroma presents a challenge in terms of pain management. This study aimed to evaluate the available evidence on the efficacy and safety of radiofrequency ablation for Morton's neuroma. PRISMA guidelines were followed. Prospective clinical trials, cohort studies, and case series were also included. Data analysis was performed using Review Manager 5.4. Meta-analysis applied fixed- or random-effects models depending on the heterogeneity. Sensitivity analyses were performed to assess the effects of temperature, radiofrequency cycles, and imaging guidance. Eight studies (n = 237) were included. Significant pain reduction was observed at the final follow-up (MD5.74, 95%CI 5.58, 5.90). At the final follow-up, 47.57% (95%CI 25.13%-70.00%) experienced complete pain relief, while 16.40% (95%CI 11.86%-20.94%) reported no benefit at final follow-up. Sensitivity analyses found higher temperature settings (≥85 °C) conferred greater relief on VAS (MD-6.97, 95%CI -6.75 to -7.18) compared to temperatures <85 °C (MD-3.94, 95%CI -3.68 to -4.19). Fewer radiofrequency cycles (≤3) also demonstrated significantly greater VAS improvement (MD-6.97, 95%CI -6.75 to -7.18) versus >3 cycles (MD-4.79, 95%CI -3.02 to -6.57). Complications were minimal (2.1%), and most resolved without significant interventions. Radiofrequency ablation, particularly at specific temperatures and cycle thresholds, is effective and safe for the management of Morton's neuroma.

To examine whether graded motor imagery (GMI) was as effective as transcutaneous electrical nerve stimulation (TENS) in improving pain and functionality in patients with knee osteoarthritis (PwKOA). Forty-six PwKOA were randomized (1:1) into the GMI and the TENS groups. Both groups participated in home-based and functional exercises. A visual analog scale (VAS), the pressure pain threshold, range of motion (ROM), muscle strength, the Timed Up and Go Test, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were evaluated at baseline, after 8 weeks of treatment, and after a 6-week follow-up period. The within-group comparisons showed significant improvements in outcomes for both treatments. However, the difference between the groups was significant in favor of the GMI group in knee flexion ROM, knee extensor muscle strength, and WOMAC-pain and WOMAC-function parameters at the end of the treatment, and VAS-activity, knee flexor muscle strength, and WOMAC-stiffness values showed greater improvement in the GMI group compared with the TENS group at the end of the 6-week follow-up (for all, p < 0.05). GMI seems to be a more effective adjuvant than TENS. If applied in PwKOA, pain and functional recovery improved, and results were maintained for up to 6 weeks.

To examine the long-term perioperative changes in lumbar bone density, muscle size and fatty atrophy, and facet degeneration after transfemoral amputation (TFA). All patients who underwent TFA at an academic center between 2002-2022 were retrospectively identified. Patients were required to have preoperative and postoperative CT (>1 year) and regularly utilize a prosthesis. Preoperative to postoperative changes in lumbar and muscular vertebral Hounsfield units (HU), facet degeneration, and bilateral psoas, quadratus lumborum, multifidus, and erector spinae cross-sectional area (CSA) were determined. A total of 42 patients met the inclusion criteria. There were significant preoperative to postoperative decreases in HUs in the L1 and L3 vertebral bodies were -17.69 and -25.35, respectively. There were significant pre- to post-operative increases in L4-5 and L5-S1 facet degeneration grade. There were significant pre- to post-operative decreases in amputated side psoas HU and CSA. There were also significant pre- to post-operative HU decreases in the bilateral multifidus and erector spinae muscles, where the changes were more pronounced on the contralateral side. TFA was associated with progression of lumbar facet degeneration, small scale decreases in lumbar bone quality, amputated side psoas atrophy, and bilateral fatty infiltration of the multifidus and erector spinae.

To examine the association between baseline multisite pain (two and three or more sites) and longitudinal risk of fall and recurrent falls among older adults with or at risk of knee osteoarthritis (OA). This prospective longitudinal cohort study included older adults with or at risk of knee OA. Fall, including the history of falls, number of falls, and recurrent falls, were assessed at baseline and during six follow-up visits at 12, 24, 36, 48, 72, and 96 months. Multisite pain was categorized into the following four categories: no pain, 1-site, 2-sites, ≥3-sites. This study included 2585 older adults. Baseline 2-sites (Odds Ratio [OR] 1.50, p = 0.018) and ≥ 3-sites (OR 1.89, p < 0.001) were significantly associated with increased risk of fall over time compared to no pain sites. Baseline 2-sites (Incidence Rate Ratio [IRR] 1.44, p = 0.024) and ≥ 3-sites (IRR 1.73, p < 0.001) were significantly associated with an increased number of falls over time. Only ≥3-sites were associated with the recurrent falls (OR 2.16, p = 0.003).Conclusions: Baseline multisite pain (≥3-sites) was longitudinally associated with increased fall incidence, number of falls, and recurrent falls over seven years of follow-up.