Rehabilitation Approaches Research Articles

Rehabilitation delivery models to foster healthy ageing - a scoping review

Abstract Background Rehabilitation is crucial for healthy ageing among older adults, who face heightened risks of non-communicable diseases, infections, injuries, and mental health issues. Yet, understanding tailored rehabilitation for this demographic remains limited. To fill this gap, we conducted a scoping review to identify rehabilitation delivery models targeting older adults’ functioning and healthy ageing. Methods We systematically searched Medline and Embase (January 2015 to May 2022) for English-language studies on rehabilitation approaches for older adults. Three authors independently screened records for eligibility and synthesized findings through quantitative and qualitative analysis. Results Among 6,933 records, we assessed 585 articles, identifying 283 studies with 69,257 participants. Six main rehabilitation delivery models emerged, with outpatient (24%) and telerehabilitation (22%) being predominant. Multidisciplinary teams (31.5%) often followed integrated care principles (30.4%). However, most studies adopted a disease-centric approach (59.0%), neglecting prevalent issues like pain, sensory impairments, incontinence, and sexual dysfunctions. Therapeutic exercises (54.1%) and self-management education (40.1%) were common interventions. Conclusions Our scoping review outlines diverse rehabilitation delivery models for older adults, highlighting gaps in addressing prevalent issues and emphasizing evidence-based strategies to promote healthy ageing. It underscores the need for systematic functional assessment and expansion of rehabilitation programs to cover prevalent health concerns. While limitations include reliance on published research and not assessing model effectiveness, this review lays groundwork for future research and innovation in rehabilitation and healthy ageing. Key messages • The scoping review identifies six rehabilitation delivery models for older adults. • The scoping review advocates for evidence-based strategies for enhancing healthy ageing through rehabilitation.

Rehabilitation is [still] necessary to optimize function in neuromuscular disorders.

The landscape of care for children and adults with neuromuscular disorders (NMDs) is rapidly changing as more disease-modifying treatments (DMTs) become available. These DMTs provide hope and opportunity for evolving phenotypes, though none (yet) are curative. Rehabilitation has been the standard of care for patients with NMDs and should remain so, even with the advent of novel DMTs. An interdisciplinary rehabilitation approach is holistic and comprehensive, addressing functional needs, musculoskeletal complications, pain, durable medical equipment, and bracing needs. This care will continue to be essential for patients who experience impairments and disability, despite receiving DMTs. Additionally, we must consider how to care for a new rapidly expanding cohort of patients aging with NMDs. Children with NMDs are expected to live longer into adulthood; a population that we may not have the workforce to support at this time. At this point, we have the perfect opportunity to reemphasize the importance of rehabilitation in the care of persons with NMDs, while we reexamine historical rehabilitation practices and innovatively deliver services to optimize the effects of these high-cost DMTs.

The Impact of Virtual Reality as a Rehabilitation Method Using TRAVEE System on Functional Outcomes and Disability in Stroke Patients: A Pilot Study

Background: Stroke is the third leading cause of disability. Virtual reality (VR) has shown promising results in post-stroke rehabilitation. The VR TRAVEE system was designed for the neuromotor rehabilitation of the upper limb after a stroke and offers the ability to track limb movements by providing auditory feedback and visual augmentation. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), aligned with the International Classification of Functioning, Disability, and Health (ICF) principles, is a valid tool for measuring disability regardless of its cause. This study aimed to investigate the feasibility of the VR TRAVEE system in upper limb rehabilitation for stroke patients. Methods: A total of 14 stroke patients with residual hemiparesis were enrolled in the study. They underwent a 10-day program combining conventional therapy (CnvT) with VR rehabilitation. At baseline (T0), the upper limb was assessed using the Modified Ashworth Scale (MAS), active range of motion (AROM), and the Numeric Rating Scale (NRS) for pain. These assessments were repeated after the 10-day rehabilitation program (T1). Additionally, disability was measured using WHODAS 2.0 at T0 and again 30 days after completing the program. Results: Significant improvements were observed in AROM and MAS scores for the shoulder, elbow, wrist, and metacarpophalangeal joints, as well as in the reduction in shoulder pain (p ˂ 0.001). WHODAS scores decreased across all six domains, with a statistically significant improvement in the Cognition domain (p = 0.011). Conclusions: Combining CnvT with VR as a rehabilitation approach enhances motor function in the upper limb. This method has the potential to reduce disability scores and promote neuroplasticity.

The Effectiveness Of Physical Therapy And Rehabilitation Approaches In Low Back Pain On Pain Severity And Disability; A Systematic Review

Low Back Pain encompasses nociceptive pain, neuropathic pain radiating to the legs, and nociplastic pain, often classified as non-specific due to central nervous system exaggeration. Globally, Low Back Pain is a leading cause of activity restriction and loss of productivity, significantly impacting finances. Objective; This study aimed to review the efficacy of physical therapy and rehabilitation approaches for LBP, focusing on pain intensity and disability. Materials and Methods; A literature review was conducted in PubMed and Web of Science databases up to January 30, 2024. English studies were required, using keywords: “low back pain,” “pain intensity,” “pain severity,” “disability,” and “physical therapy.” Pain intensity was measured using the Visual Analog Scale (VAS) and Numeric Rating Scale (NRS), including the 11-point Pain Intensity Numerical Rating Scale (PI-NRS). Disability was assessed using ADL, IADL scales, Roland Morris Disability Questionnaire (RMDQ), and Oswestry Disability Index (ODI). Results; Seven study met the inclusion criteria from 665 initial records. Interventions included osteopathic manipulative treatment (OMT), core muscle exercise with interferential current (IFC), cognitive functional therapy (CFT), dry cupping therapy, high-intensity machine-based core muscle resistance training (C-IPU), heat therapy, TENS, pelvic traction, Reiki, dynamic muscular stabilization technique (DMST), and McGill Big 3 (MB3). Sample sizes ranged from 30 to 1090 participants. IFC combined with core muscle exercises significantly reduced pain intensity compared to each method alone, though not statistically significant (p > 0.05). The C-IPU group had greater pain relief (P 0.05). Dry cupping did not outperform sham cupping. CFT reduced absenteeism in the first two years but not later. Reiki showed significant improvement in pain and ADL compared to drug therapy, but not to physiotherapy. Conclusions; Physical therapy interventions effectively alleviate symptoms and improve outcomes in LBP. However, variability in interventions and outcome measures necessitates cautious interpretation. Further research with standardized protocols is essential to understand the effectiveness and optimal duration of physical therapy for LBP. Keywords; low back pain; pain intensity; pain severity; disability; physical therapy

The challenge of thigh tendon reinjuries: an expert opinion.

This review critically examines the issue of thigh tendon reinjury in athletes, drawing on recent advancements and diverse perspectives in sports medicine. The findings underscore the paramount importance of an early and accurate diagnosis, which significantly influences treatment efficacy and rehabilitation outcomes. We explore the intricacies of tendon anatomy and the mechanisms underlying injuries, highlighting how these factors interplay with athlete-specific risk profiles to affect reinjury rates. A major finding from the review is the necessity for individualized rehabilitation approaches that integrate both traditional methods and emerging technologies. These technologies show promise in enhancing monitoring and facilitating precise adjustments to rehabilitation protocols, thus improving recovery trajectories. Additionally, the review identifies a common shortfall in current practices- premature to play (RTP)- which often results from inadequate adherence to tailored rehabilitation strategies or underestimation of the injury's severity. Such premature RTP significantly heightens the risk of further injury. Through this synthesis of contemporary research and expert opinion, the review advocates for a multidisciplinary approach in managing thigh tendon injuries, emphasizing the need for ongoing research to refine RTP criteria and optimize rehabilitation techniques. The ultimate goal is to support athletes in achieving safer and more effective recoveries, thereby reducing the likelihood of tendon reinjury.

Utilizing a fully digital approach for oral squamous cell carcinoma treatment and zygomatic implant-based rehabilitation for maxillary defects.

This clinical report details the functional and aesthetic rehabilitation of a patient with a severe maxillary defect secondary to subtotal maxillectomy for oral squamous cell carcinoma (OSCCM) using a maxillary prosthesis anchored by four zygomatic implants. The procedure involved meticulous subtotal maxillectomy and defect repair with zygomatic implant support, incorporating advanced digital surgical methods, including 3D reconstruction, computer-guided surgery, and photogrammetry (Icam4D). A 3D finite element analysis (FEA) was conducted to assess the method's efficacy in analyzing stress distribution around the zygomatic implants. The patient expressed high satisfaction with the prosthesis's functionality, aesthetics, speech, and swallowing capabilities, underscoring the value of zygomatic implant-supported maxillofacial prosthetics. This synergy of advanced planning, surgical precision, and biomechanical analysis marks a significant advancement in maxillofacial prosthetics.

Outcome of End to Side Nerve Modified Double Oberlin Procedure and End to End Dorsal Approach Spinal Accessory to Suprascapular Nerve in Partial Postganglionic BPI: A Case Report

Introduction: Brachial plexus injury (BPI) is a devastating peripheral nerve injury that mostly affecting young men, often due to motor vehicle accidents. BPIs can be classified into preganglionic and postganglionic lesions, with postganglionic injuries allowing potential nerve regeneration. The Oberlin method, aimed at reinnervating the biceps, and the Mackinnon technique, targeting both biceps and brachialis muscles, have shown promising outcomes in BPI management. Case report: A 45-year-old man presented with right hand weakness and occasional tingling in the upper arm and fingers two months after a motorcycle accident. Motor examination revealed muscle strength of 0/5 in the right trapezius, rhomboids, serratus anterior (positive winging scapula), pectoralis minor and major, latissimus dorsi, deltoid, biceps, and elbow flexion. Wrist and finger functions remained intact. Diagnosed with post-ganglionic BPI, the patient underwent two nerve transfer surgeries: the Mackinnon technique, transferring the spinal accessory nerve to the suprascapular nerve to reinnervate shoulder muscles, and the Double Oberlin procedure, transferring fascicles from the median and ulnar nerves to the musculocutaneous nerve for reinnervation of the biceps and brachialis muscles. Post-surgery, the patient engaged in an aggressive rehabilitation program focusing on strength, range of motion, and sensory re-education. Over nine months, the patient showed significant improvement in elbow flexion (MRC grade 3), wrist extension (MRC grade 5), hand grip strength (MRC grade 3) with improved sensation across the affected limb. He returned to work and daily activities with mild residual weakness and sensory deficits. Discussion: This case illustrates the effectiveness of the Mackinnon and Double Oberlin nerve transfer techniques in restoring function in a patient with total post-ganglionic BPI. The Mackinnon technique enabled shoulder muscle reinnervation, essential for abduction and stabilization, while the Double Oberlin procedure enhanced elbow flexion by reinnervating both the biceps and brachialis muscles. The combined surgical and intensive rehabilitation approach facilitated significant functional recovery. Conclusion: The successful application of the Double Oberlin and Mackinnon techniques in this case demonstrates their potential in managing total post-ganglionic BPI. Early surgical intervention and consistent rehabilitation are crucial for optimizing recovery outcomes. This case highlights the importance of a multidisciplinary approach in treating complex peripheral nerve injuries. Keywords: Double Oberlin, Mackinnon, Brachial Plexus Injury

Dosing overground robotic gait training after spinal cord injury: a randomized clinical trial protocol

BackgroundRobotic exoskeletons have changed rehabilitation care available to people after spinal cord injury (SCI). Yet, the current evidence base is insufficient to identify the optimal dose and neurophysiological mechanism of robotic exoskeleton gait training (RGT) as an effective rehabilitation approach. This study will (1) examine whether the frequency of RGT after motor incomplete SCI impacts function and health outcomes, (2) analyze the neuroplastic effects of RGT dose, and (3) evaluate the safety, tolerability, and feasibility of delivering RGT.MethodsWe will enroll 144 participants with motor incomplete SCI admitted to inpatient rehabilitation within 6 months of SCI. Participants will be randomized based on injury severity and level into one of 3 RGT frequency groups (high, moderate, low) or none/usual care only. Participants will complete 24 RGT sessions and be assessed at admission and discharge to inpatient rehabilitation, post-RGT intervention, 1-month post-RGT, and 9-month post-SCI. Outcomes include Walking Index for Spinal Cord Injury-II, health outcomes (gait speed, Spinal Cord Independence Measure, pain, fatigue, spasticity, general health, quality of life, physical activity), and motor evoked potential amplitudes obtained using transcranial magnetic stimulation.DiscussionSuccessful completion of this study will provide an evidence-based intervention, specifically tailored to meet the unique needs of people with SCI, which supports walking recovery; maximizing health, function, and ultimately participation. The intervention will further support widespread clinical implementation of exoskeleton use during acute rehabilitation.Trial registrationClinicalTrials.gov NCT05218447. Registered on June 23, 2022.

Charting the Course of Aphasia Recovery: Factors, Trajectories, and Outcomes

Aphasia, a neurological condition primarily resulting from stroke, significantly impairs communication and quality of life. This review focuses on aphasia recovery and emphasizes the interplay of clinical impairment, neural adaptation, and therapeutic intervention. Natural recovery varies with factors such as lesion characteristics, white matter integrity, and demographics, and neuroplasticity and cognitive compensation play crucial roles. Treatment-induced recovery encompasses traditional language therapies and innovative strategies, including the integration of advanced neurological techniques like neuromodulation and neurofeedback. Emerging trends, such as self-managed digital therapeutics and precision medicine approaches, offer promising avenues for enhancing language recovery. By bridging the gap between neurological understanding and clinical application, this review highlights the multifaceted nature of aphasia recovery and the latest advancements in treatment strategies, paving the way for more targeted and effective rehabilitation approaches.

Modern concepts about the problem of endometrial infertility against the backdrop of the "thin endometrium" (literature review)

Endometrial infertility is the cause of inadequate implantation and serves as an obstacle to the onset and progression of spontaneous pregnancy and the implementation of assisted reproductive technology (ART) programs. One of the most common mechanisms for the development of infertility is endometrial thinning. Despite the abundance of publications, today there are no generally accepted diagnostic criteria and treatment and rehabilitation approaches for this pathology, which encourages continued scientific research in this direction. Aim was to highlight the problem of decreased fertility caused by “thin endometrium”. To create the review, the bibliographic method was applied and domestic and foreign literary sources from the Pubmed, MedLine, RSCI, e-library and Cyberleninka search engine databases were used. The search depth was 10 years. The following search phrases were used: “uterine factor of infertility”, “endometrial factor of infertility”, “thin endometrium”. Seventy five sources that were included in this review were studied and analyzed. Data presented in the literature indicate that endometrial causes of infertility are associated with incompetence of the uterine cavity mucosa, which may manifest itself as a phenomenon of ”thin endometrium”, the development mechanisms of which have not yet been fully studied. Determining the functional status of the endometrium is very important for predicting the onset of pregnancy in the natural cycle or in ART programs, since even in the presence of a good quality embryo, endometrial deficiency can prevent adequate implantation. Thus, before planning a subsequent pregnancy, it is necessary to diagnose and, if possible, neutralize or correct endometrial causes of infertility. One of the main markers of readiness for implantation at the moment is the thickness of the endometrium.

Cost analysis of technological vs. conventional upper limb rehabilitation for patients with neurological disorders: an Italian real-world data case study.

Most patients suffering from neurological disorders endure varying degrees of upper limb dysfunction, limiting their everyday activities, with only a limited number regaining full arm use. Robotic and technological rehabilitation has been demonstrated to be a feasible solution to guarantee an effective rehabilitation to recover upper limb performance or to prevent complications of upper limb immobility. However, there is currently a lack of studies which analyze the sustainability of robotic and technological rehabilitation by comparing its costs to conventional rehabilitation pathways. Since technology-based and conventional rehabilitation of the upper limb have been demonstrated to have comparable efficacy when the rehabilitation dose is matched, our study concentrates on a cost minimization analysis. The aim of the study is to compare the costs of a "mixed" rehabilitation cycle, which combines conventional and technology-based treatments (the latter delivered with a single therapist supervising several patients), with a cycle of purely conventional treatments. This has been done by developing a cost model and retrospectively analyzing the costs sustained by an Italian hospital which has adopted such a mixed model. A sensitivity analysis has been done to identify the parameters of the model that have the greatest influence on cost difference and to evaluate their optimal values in terms of efficiency of mixed rehabilitation. Finally, probabilistic simulations have been applied to consider the variability of model parameters around such optimized values and evaluate the probability of achieving a given level of savings. We found a cost difference of 49.60 € per cycle in favor of mixed rehabilitation. The sensitivity analysis demonstrated that, in the situation of the hospital under investigation, the parameter having the largest influence on the cost difference is the number of robotic treatments in a mixed rehab cycle. Probabilistic simulations indicate a probability higher than 98% of an optimized mixed rehabilitation cycle being less expensive than a pure conventional one. Through a retrospective cost analysis, we found that the technology-based mixed rehabilitation approach, within a specific organizational model allowing a single physiotherapist to supervise up to four patients concurrently, allowed cost savings compared to the conventional rehabilitation model.

Impact of core muscle strengthening on knee pain, patient outcomes, physical function, and cartilage thickness in knee osteoarthritis: Protocol for a randomized controlled trial

Knee Osteoarthritis (KOA) is a degenerative condition that significantly impacts individuals, causing disability. Routine rehabilitation methods primarily involve knee and hip strengthening exercises. While there is limited evidence supporting the potential benefits of core muscle strengthening in KOA rehabilitation, further research is needed to examine the effects of a structured core muscle strengthening protocol on pain, functional abilities, quality of life, and knee cartilage health. This double-blind, randomized controlled trial seeks to investigate the impact of integrating core muscle strengthening into routine rehabilitation. The study will randomly assign 80 participants to either routine rehabilitation or experimental groups, with both groups receiving routine rehabilitation combined with core strengthening exercises in the experimental group over a twelve-week period. The outcomes measured will include pain levels, patient-reported outcomes, physical functional abilities, core muscle and leg muscle strength, and cartilage height of the femur and tibia. Follow-up assessments will occur in the 4th, 8th, and 12th weeks. This novel study aims to provide valuable insights into the role of core strengthening in KOA rehabilitation, potentially influencing rehabilitation approaches and managing disease progression.•Incorporating core muscle strengthening into routine rehabilitation for KOA could open new possibilities for KOA management.•This study employs outcome measures recommended by OARSI for a thorough evaluation.•Additionally, it will investigate the impact on cartilage health, offering fresh insights into disease progression and the effects of exercise

Understanding and enhancing post-stroke recovery: Insights from a nested qualitative study within the MindFit Project randomized clinical trial

BackgroundStroke survivors experience a wide range of physical, cognitive, and emotional challenges. In the MindFit Project, a randomized clinical trial, 141 chronic stroke patients were divided into three groups: mindfulness-based stress reduction (MBSR) with computerized cognitive training (CCT), physical exercise (PE) with CCT, and CCT alone. The interventions were conducted remotely over 12 weeks, including online group and individual sessions. ObjectiveThis exploratory nested qualitative study aimed to investigate chronic stroke survivors’ experiences, opinions, and perceived changes due to the interventions within the MindFit Project. The secondary objective was to describe the broader experience of their recovery journey. MethodsTwenty-seven participants were recruited through purposive sampling and engaged in semi-structured one-on-one interviews. Twelve received MBSR+CCT, nine received PE+CCT, and six received CCT-only. The interviews were recorded, transcribed, and analyzed using thematic analysis. ResultsParticipants shared insights into their lives after stroke, including emotional and physical challenges, coping mechanisms, and the impact of societal perceptions. The interventions were generally positively valued, with MBSR aiding in emotional regulation, PE enhancing physical capabilities, and CCT improving cognition. The group setting provided valuable peer support and motivation, although some participants noted challenges owing to the heterogeneity. The telematic format was also appreciated for its accessibility, although it posed challenges to personal interaction and intervention supervision. ConclusionsOur study emphasizes the complexity of stroke recovery and the importance of holistic, patient-centered rehabilitation approaches. It also highlights the value of combining physical and non-physical interventions in a group setting, along with the potential of remote platforms to enhance the accessibility of rehabilitation programs. These findings generate hypotheses for future randomized clinical trials aimed at improving post-stroke recovery.

Effectiveness of robotic rehabilitation for gait and balance in people with multiple sclerosis: a systematic review.

This review investigated the effectiveness of robotic-assisted gait training (RAGT) in improving gait and balance performance in adults with multiple sclerosis (MS). Databases and registers were searched from inception to December 2023 to identify randomized controlled trials (RCTs) that analyzed the effects of RAGT on gait speed, function, balance, fatigue, and adverse events. Three reviewers screened studies for eligibility and extracted key information such as participants and intervention characteristics, as well as outcomes of interest. The reviewers assessed the risk of bias of included studies using Cochrane Risk of Bias tool. From the 948 records identified, 8 RCTs were included, involving 335 participants. The studies have demonstrated significant heterogeneity in patient characteristics, intervention protocols, and outcomes measured. The risk of bias assessment revealed concerns, mainly in terms of performance and detection bias. The evidence is uncertain on the effectiveness of RAGT on balance and gait in people with MS, but a multimodal rehabilitation approach, including RAGT, should be encouraged. No serious adverse events seem to be associated with RAGT, suggesting that these interventions are generally safe for use in people with MS. Further studies of higher methodological quality should be led to confirm these positive results.

Physiotherapy Rehabilitation Approach for Enhancing Stability and Gait in a Patient With Cerebellar Ataxia: A Case Report

Physiotherapy Rehabilitation Approach for Enhancing Stability and Gait in a Patient With Cerebellar Ataxia: A Case Report

CuePD: An IoT Approach for Enhancing Gait Rehabilitation in Older Adults Through Personalized Music Cueing

<i>CuePD</i>: An IoT Approach for Enhancing Gait Rehabilitation in Older Adults Through Personalized Music Cueing

Effectiveness of physiotherapy rehabilitation approaches for Parkinson's disease: A Durrës case study.

The article's significance lies in the substantial rise in the risk of developing Parkinson's disease (PD), necessitating the exploration of various approaches to rehabilitation and medical treatment. The purpose of the article is to detect the direct effect of physiotherapy for patients with PD and to identify how it helps in slowing down cardio-pulmonary failure, improving the posture, balance, bradykinesia and tremor. The research utilised clinical data from 407 PD patients aged 30-100 years at the Central Polyclinic of Durrës, spanning 2011-2022, and included a systematic literature review and statistical analysis comparing physiotherapy outcomes with European Union standards. The research demonstrates the efficiency of physiotherapy in the short and long term in the treatment of PD for patients and medical personnel. All information can be used to increase the functional abilities of patients and minimise complications after physiotherapy and to estimate the effectiveness of different exercises in delaying PD. Older adults, particularly those aged 71-80, are most affected by PD, with males more likely to be diagnosed. Physiotherapy rehabilitation improves motor symptoms, posture, and balance in 30-80-year-olds, but its effectiveness declines with age. Advanced rehabilitation methods in Italy lead to better outcomes, suggesting the potential for improvement in Durres disease. The study emphasises the need for improved rehabilitation strategies for older patients by recommending tailored programs, advanced methods, standardisation, training, and long-term monitoring. Further research should concentrate on the long-term sustainability of physiotherapy benefits, the development of targeted interventions for older patients, and the integration of innovative therapeutic approaches.

Educational therapy for caregivers of children with obstetric brachial plexus palsy: a scoping review.

Obstetric brachial plexus palsy (OBPP), a condition resulting from the stretching of nerve structures in an infant's upper limb during childbirth, necessitates early physiotherapy intervention. Continuation of rehabilitative activities at home is critical for optimal recovery, highlighting the need for effective caregiver education in managing this condition. This scoping review seeks to consolidate and examine existing research on physiotherapy treatments for OBPP, with a specific focus on the educational support provided to caregivers. The ultimate objective is to develop an informative booklet for caregivers, offering essential guidance for home management of affected children. A comprehensive search was conducted across PubMed, Cochrane Library, Scopus and PEDro from May to October 2023, with no restrictions on study design, evidence level, publication date, geography, or language. Articles were selected based on preset eligibility criteria. The search yielded 13 relevant studies, encompassing a diverse range of research designs including reviews, systematic reviews, case reports, controlled trials, and a retrospective study. This review underscores the necessity of a personalized rehabilitation approach in treating OBPP, with parental involvement being crucial. It also identifies a gap in research regarding the long-term effectiveness of these interventions, suggesting the need for further studies to ascertain optimal treatment modalities.

What can I do for my low back pain? The Work In Progress questionnaire!

There is growing evidence on Commitment Therapy for people with low back pain (LBP). A self-reported questionnaire is lacking which evaluates commitment by relying on the most recommended actions, the most important core outcome domains, and the most evidenced treatment options. To describe the development and psychometric validation of the Work In Progress (WIP) questionnaire. Development and psychometric validation of the WIP questionnaire in the context of people with LBP, as a means to evaluate Commitment. Outpatient facilities. People with LBP. The new instrument was created by item generation and selection. Face validity, appropriateness, acceptability and feasibility were investigated. Psychometric testing was carried out in a cross-sectional study and included: 1) exploratory factor analysis; 2) reliability by internal consistency (Cronbach's alpha) and test-retest measurement (Intra-class Correlation Coefficient, ICC<inf>2.1</inf>); and 3) construct validity by hypothesis testing the correlation of the WIP questionnaire with the Pain Catastrophizing Scale (PCS), the Oswestry Disability Index (ODI), and a pain intensity Numerical Rating Scale (NRS) (Pearson's r correlations). The WIP questionnaire was successfully developed based on international guidelines and the testing of face validity, appropriateness, acceptability and feasibility were satisfactory. The instrument was administered to 102 people with LBP (39 females, mean age of 49.7±14.6 years [range 20-80], pain median duration of 42.1 weeks [range 3-360]). Factor analysis revealed a two-factor 10-item solution (57% of explained variance). The internal consistency was good (α=0.70-85) and test-retest assessment was excellent (ICC<inf>2.1</inf>=0.91-94). Construct validity was good, as ≥75% of hypotheses were confirmed. The WIP questionnaire is a self-reported tool to evaluate commitment in persons with LBP showing satisfactory psychometric properties. It can be recommended for clinical and research purposes. This study adds original new data to the existing knowledge in the field of Commitment within the bio-psychosocial paradigm for disabled people. It is expected to contribute to the evaluative, clinical and rehabilitative approach of individuals with low back pain.

Improving patient outcomes in acute and subacute stroke using a wearable device-assisted rehabilitation system: a randomized controlled trial.

Multidisciplinary rehabilitation facilitates post-stroke functional recovery, but is associated with resource and accessibility barriers. This study evaluated the combination of a wearable device-assisted system (WEAR) and conventional therapy for post-stroke rehabilitation. This randomized, controlled, parallel group, clinical trial was conducted at two rehabilitation centers. A WEAR system was developed featuring sensors and application program-embedded smartphones. Stroke patients within 12 weeks of onset and modified Rankin Scale (mRS) scores of 2 to 4 were randomized into a wearable group (WG, WEAR + conventional rehabilitation) or control group (CG, conventional rehabilitation) for 90 days. The primary outcome was mRS score changes within 90 days. Among 127 stroke patients enrolled (76 men [59.8%]; mean age: 57.5 years), 63 and 64 patients were randomized to WG and CG, respectively. Both groups showed significant improvements in mRS scores. Between-group repeated measures analysis adjusted for sex, age and number of rehabilitation sessions showed greater improvement in mRS scores within 90 days in the WG than in the CG (estimate: 0.73). This combined WEAR and conventional rehabilitation approach may improve post-stroke functional recovery compared with conventional rehabilitation alone. The WEAR system permits remote monitoring and recording of rehabilitation in various settings.This clinical trial was retrospectively registered at www.clinicaltrials.gov with the Unique Identifier NCT04997408.