Predictive factors for remission in post-stroke depression: A Markov model cohort study.

Recent randomized trials reported no overall functional benefit of endovascular treatment (EVT) for distal medium-vessel occlusion (DMVO) and did not identify consistent effect modifiers to guide patient selection. Consequently, the role of EVT-particularly for M2 occlusions-remains controversial. We investigated whether baseline clinical severity modifies the association between successful recanalization and 90-day outcome in patients with M2 occlusion. Multicenter retrospective cohort study at 2 tertiary stroke centers including consecutive adults with acute ischemic stroke due to M2 occlusion (January 2015-January 2023) triaged by multimodal CT and treated with EVT. The primary end point was functional independence (modified Rankin Scale [mRS] ≤ 2) at 90 days. Secondary end points included symptomatic intracerebral hemorrhage (sICH), mRS 0-1, and penumbra salvage volume (PSV). The primary analysis used multivariable logistic regression with baseline National Institutes of Health Stroke Scale (NIHSS) modeled linearly and an NIHSS×recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] ≥2b) interaction term. Johnson-Neyman probing and inverse probability weighting (IPW) were applied; a supplementary restricted cubic spline analysis was performed to explore potential nonlinearity. Among 147 patients, 85 (58%) achieved successful recanalization. The mean age was 74 years (SD 13), and 47% were female. Higher baseline NIHSS (adjusted odds ratio [aOR] 0.83 per point, 95% CI 0.73-0.94) and older age (aOR 0.96 per year, 95% CI 0.94-0.99) were associated with lower odds of functional independence. NIHSS significantly modified the association between recanalization and outcome (interaction p = 0.03). The magnitude of the association between successful recanalization and functional independence was larger at higher NIHSS. Model-based estimates suggested a descriptive crossover around NIHSS 10, whereas statistical evidence of benefit emerged only at higher NIHSS values. Successful recanalization was associated with greater PSV (+33 mL, p = 0.01). In the PSV interaction model, onset-to-imaging time differed by recanalization status (p < 0.01): time was positively associated with PSV in the mTICI ≤2a group, but near zero in mTICI ≥2b. IPW analyses were concordant. sICH occurred in 8.2% vs 4.8% (p = 0.42). In M2 occlusions, the magnitude of the association between successful recanalization and functional independence was larger at higher NIHSS and not reliably demonstrable at lower NIHSS. These findings support a severity-informed, individualized EVT approach while remaining hypothesis-generating rather than prescriptive for specific NIHSS thresholds. Major limitations include the retrospective observational design and potential residual confounding.

Impact of acute infections on the loss of functional independence in hospitalized older adults: a multicentre cohort study.

Assessment of patient-reported symptoms in Hermansky-Pudlak syndrome.

Early mobilization (EM) has become essential for improved recovery after surgery, but its particular advantages in cardiac surgery populations have not been consistently reported. To systematically evaluate the effects of early mobilization on functional recovery outcomes, hospital length of stay, and safety profiles in patients undergoing cardiac surgery. The systematic search was performed in six databases (PubMed, Google Scholar, Cochrane CENTRAL, PEDro, Embase, and Web of Science). The search included studies published between January 1, 2015, and August 2025. Inclusion criteria were that the studies must look at interventions of early mobilization (within 48h of postoperative) in patients undergoing cardiac surgery, and the outcome measures may include functional capacity, length of stay in the hospital, or precautionary measures. Risk of Bias 2.0 (RoB 2) and Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I) were used to evaluate the risk of bias. This review included 20 studies with 11,631 participants, 12 randomized controlled trials, four observational cohort studies, and four other study types. Most interventions were initiated within 24h after the operation. Functional recovery outcomes were predominantly favorable. Early mobilization improved 6-Minute Walk Test (6MWT) distance and functional independence scores in the majority of studies, whereas hospital length of stay results were inconsistent, with approximately half of the studies reporting significant reductions. The safety profiles were excellent throughout the studies, and few serious adverse events could be directly related to early mobilization. Subgroup analyses showed that Coronary Artery Bypass Grafting (CABG) had specific advantages, which were possible even in frail older patients. Early mobilization following cardiac surgery appears safe and is associated with improvements in functional recovery (e.g.,walking capacity and independence) and selected hospital outcomes (e.g.,length of stay), although the magnitude of benefit varies across studies. PROSPERO (CRD420251140353).

Development and validation of a semi-structured interview guide to explore patient perspectives on physiotherapy advancements in the management of diabetic peripheral neuropathy.

Futile recanalization (absence of functional independence despite successful endovascular treatment [EVT]) remains a limitation in the treatment of large vessel occlusion stroke. Inflammation has emerged as a key contributor to brain reperfusion injury. Leveraging EVT, we quantified a large panel of immunologic biomarkers in the intracranial and peri-procedural peripheral blood samples and probed their association with futile recanalization. We conducted a prospective single-center cohort study of patients with anterior-circulation large vessel occlusion, successful EVT (modified Thrombolysis in Cerebral Infarction ≥2b), and no reocclusion. We sampled intracranial blood distal to the thrombus before recanalization and collected peripheral blood immediately before and after EVT, and at 24 hours post-EVT. We measured 37 immune-vascular biomarkers selected a priori, using immunoassays, and tested their associations with futile recanalization (90-day modified Rankin Scale score, 3-6) using rank-based tests with false discovery rate control. Biomarkers meeting a prespecified effect-size threshold (≥0.5) entered multivariable logistic regression models adjusted for age, baseline National Institutes of Health Stroke Scale score and Alberta Stroke Program Early Computed Tomography Score, intravenous thrombolysis use, and time from last known well to groin puncture. Among 177 enrolled patients, 139 patients were included (median age, 77 years; 41% women), and 64 (46%) had futile recanalization. Six biomarkers showed at least a medium effect size at ≥1 timepoints: IL (interleukin)-6 (pre-EVT, intracranial, and 24-hour post-EVT), IL-10 (pre-EVT and intracranial), IL-15 (pre-EVT), VEGFR1 (vascular endothelial growth factor receptor 1; pre-EVT and 24-hour post-EVT), VCAM-1 (vascular cell adhesion molecule-1; intracranial and post-EVT), and SAA (serum amyloid A; post-EVT). In adjusted multivariable analyses, futile recanalization remained associated with VCAM-1 intracranially (adjusted odds ratio [aOR], 1.84 [95% CI, 1.11-3.05]) and post-EVT (aOR, 2.08 [95% CI, 1.03-4.19]), IL-10 pre-EVT (aOR, 3.87 [95% CI, 1.58-9.43]) and intracranially (aOR, 4.84 [95% CI, 1.68-13.90]), IL-15 pre-EVT (aOR, 1.60 [95% CI, 1.00-2.53]), and SAA post-EVT (aOR, 7.08 [95% CI, 1.95-25.59]). A core set of immune-vascular mediators measured in blood, both intracranially and peripherally, after EVT predicted futile recanalization. These findings support biomarker-guided risk stratification and motivate trials targeting microvascular inflammation.

To test whether the ABCDEF bundle, compared with usual care, decreases delirium incidence and duration, improves functional status in the ICU, and enhances 90-day post-ICU discharge quality of life in critically ill Australian adults. Single-center, pragmatic, randomized controlled trial. Eight-bed medical/surgical ICU in a metropolitan Australian hospital. Adult patients expected to remain in ICU for at least 48 hours. ABCDEF bundle or usual care. Complete ABCDEF bundle adherence was achieved in 50% of patients each study day. The primary outcome, cumulative incidence of delirium (measured with the Confusion Assessment Method for ICU), was similar between groups (ABCDEF, 37.9%; usual care, 36.4%; odds ratio, 1.1; 95% CI, 0.5-2.2; p = 0.86), as was median delirium duration (ABCDEF, 2.0 d; interquartile range [IQR], 1.3-3.5 d; usual care, 2.5 d; IQR, 1.0-4.4 d; mean difference, -0.4 d; 95% CI, -1.6 to 0.8 d; p = 0.53). Median functional scores at ICU discharge (measured with the Functional Independence Measure) were 55.0 (IQR, 37.0-67.3) in the ABCDEF group and 53.0 (IQR, 43.8-62.5) in the usual care group (mean difference, 0.0; 95% CI, -7.7 to 7.6; p = 0.83). At 90 days post-ICU discharge, the ABCDEF bundle group reported higher scores in the "usual activities" domain ( p < 0.001) (measured with the EuroQol 5D five-level questionnaire), with no differences in other domains. In adult ICU patients, the ABCDEF bundle, compared with usual care, did not reduce the cumulative incidence or duration of delirium. While no effect was observed on the primary outcomes, higher scores in the "usual activities" quality of life domain suggest potential long-term benefits that warrant further investigation.

Mobility deficits are the most common form of disability in the United States and can significantly impair function and activities of daily living. Assistive devices have the potential to reduce physical limitations and support functional independence. This pilot study evaluated the Gigstride wearable device for its effects on pain reduction and gait-related outcomes. This prospective, single-arm feasibility study was conducted at a tertiary academic center and included adults ≥18 years with lower extremity deficits. The primary outcome was pain, measured by the Numeric Rating Scale (NRS) during level ambulation and stair climbing. Secondary outcomes included performance on the modified 10-meter walk test with return and the Timed Up and Go (TUG) test. Patient-reported experience and the practicality of implementing the device in a larger-scale study were also assessed. A total of forty-four patients were enrolled (mean age 66 years; 57% female). Gigstride use significantly reduced pain during level ambulation and stair climbing, with no significant changes in secondary outcomes. Median walking pain decreased by 1 NRS point (p = 0.00032), and stair-related pain decreased by 0.5 NRS points (p = 0.00025). Gigstride wearable device use appears feasible and may provide modest reductions in mobility-related pain. However, the limited magnitude of pain reduction and absence of functional improvement in this study highlights the need for larger, controlled studies. The www.ClinicalTrials.gov identifier is NCT06548087.

Cerebral venous thrombosis is a rare stroke type that primarily affects younger women. Contemporary large international efforts have improved our understanding of the natural history and management of this rare disease, yet important evidence gaps persist across the disease continuum. Management of cerebral venous thrombosis can be conceptualized into multiple phases: acute management, post-acute management (including primary anticoagulation and secondary prevention), and recovery. Acute treatment centers on anticoagulation, including in the presence of intracranial hemorrhage. Endovascular therapy and decompressive craniectomy are reserved for selected severe cases. Direct oral anticoagulants appear comparable to vitamin K antagonists for most patients during primary treatment, though optimal lead-in duration and treatment length remain uncertain. Decisions regarding extended anticoagulation for secondary prevention require individualized assessment of recurrence and bleeding risk. Patients with cancer, antiphospholipid antibody syndrome, prior venous thromboembolism, and idiopathic events are at the highest thromboembolic risk. Long-term sequelae, including fatigue, headache, cognitive and mood disturbances, epilepsy, and intracranial hypertension, contribute substantially to morbidity despite high rates of functional independence. Heavy menstrual bleeding may impact young women on anticoagulation. Recognition and management of these outcomes are essential for comprehensive care.

This study aims to investigate the effects of increasing handgrip strength by applying Kinesio taping to the wrist extensors on the functional level in patients undergoing lower extremity surgery who ambulate with a walker. This retrospective study analyzed data from 100 patients aged 65years and older who underwent lower extremity surgery and ambulated with a walker. The patients were divided into two groups: a control group (CG) that was kept under the standard rehabilitation program and a Kinesio taping group (KT) in which Kinesio taping was applied to the forearm extensor muscles in addition to the group being under standard rehabilitation program. The patients' handgrip strength (HGS), pain, and functional levels (Functional Independence Measurements (FIM), Iowa Level of Assistance Scale (ILAS), and Iowa Walking Speed Scale (IWSS)) were retrospectively assessed before treatment and at discharge. Compared to the CG group, the right and left HGS, functional levels, and IWSS of the patients increased significantly in the KT group, and their activity-related pain levels decreased significantly (p<0.005). A significant positive correlation was observed between the change in HGS and the change in ILAS and FIM scores, and a statistically significant negative correlation was found between the change in HGS and the change in activity-related pain and IWSS (p<0.05). Our findings suggest that Kinesio taping application is a simple and cost-effective method that increases HGS in patients and is an effective method in controlling pain, improving walking speed, and enhancing functionality in patients undergoing lower extremity surgery. https://clinicaltrials.gov/study/NCT06072261.

We aimed to evaluate the effectiveness of combining low-frequency (1 Hz) rTMS (LF-rTMS) over the unaffected hemisphere or intermittent theta burst stimulation (iTBS) over the affected hemisphere with conventional rehabilitation (CR) on lower extremity motor function, balance, and gait. This single-center, randomized, sham-controlled study included patients with chronic stroke (>6mo) and unilateral hemiplegia (Brunnstrom stages 3 to 5), who were assigned to LF-rTMS+CR (n=21), iTBS+CR (n=21), or sham rTMS+CR (n=21) for 10 sessions using a figure-of-eight coil. All active participants completed treatment, and 18 sham participants were analyzed. The Fugl-Meyer Assessment, Berg Balance Scale (BBS), Timed-Up and Go (TUG) test, Functional Independence Measure, and 36-item Short-Form Health Survey (SF-36) were performed during pretreatment, post-treatment, and 6-week follow-up, alongside assessments of the Hmax/Mmax amplitude at baseline and 6-week follow-up. Both real rTMS groups showed greater improvements in balance and mobility (BBS and TUG) versus sham group. In addition, intragroup evaluation revealed that improvements in mental function and general health (SF-36) were more pronounced in the real rTMS groups. The combination of rTMS, including LF-rTMS or iTBS, with CR may serve as an effective neurorehabilitation strategy to improve balance and mobility in individuals with chronic stroke.

The optimal endovascular treatment strategy for medium and distal vessel occlusions remains undefined given the anatomical challenges of distal vessels. Stent retriever-assisted intra-arterial lysis (SAIL) is a pharmacomechanical technique designed to facilitate clot dissolution while minimizing mechanical stress on fragile distal vessels. We performed a retrospective single-center analysis of consecutive patients with acute ischemic stroke due to distal vessel occlusions treated with SAIL between November 2022 and January 2026. Distal occlusions included M2-M3, A2-A3, and P1-P2 segments, and were classified as primary or secondary. SAIL consisted of temporary stent retriever deployment across the thrombus to restore flow, followed by intra-arterial tirofiban infusion through a distal access catheter and subsequent device resheathing. Primary outcomes were feasibility and safety; secondary outcomes included angiographic reperfusion and clinical outcomes. 24 patients were included (mean age 74±14.6 years; median baseline National Institutes of Health Stroke Scale (NIHSS) 16). Most occlusions involved the middle cerebral artery territory (79.2%). SAIL was predominantly used after unsuccessful mechanical thrombectomy (70.8%), with a median of two prior device passes. Successful reperfusion (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2b) was achieved in 87.5% of patients, including near-complete or complete reperfusion (mTICI 2c-3) in 62.5%. Any intracranial hemorrhage occurred in 25.0% of patients and symptomatic intracranial hemorrhage in 4.2%. At 90 days, functional independence (modified Rankin Scale 0-2) was observed in 6 of 12 patients (50%) with available follow-up. SAIL was feasible and achieved high reperfusion rates with a low rate of symptomatic intracranial hemorrhage despite frequent use as rescue therapy after failed thrombectomy. These findings support further evaluation of pharmacomechanical strategies for distal vessel occlusions.

Greater mobility independence after spinal cord injury is thought to lead to better long-term outcomes. However, evidence is inconclusive for ambulation compared with wheelchair dependency. This study aimed to describe and compare long-term outcomes across mobility levels in individuals with spinal cord injury. Cross-sectional survey. Community-dwelling individuals with spinal cord injury in the Netherlands. Data were collected via the Dutch arm of the International Spinal Cord Injury (InSCI-NL) Survey (2018). Mobility level was assessed using the modified Spinal Cord Independence Measure-Self-Report. Long-term outcomes were compared across mobility levels, using generalised linear models. 253 participants were included with a mean (standard deviation) age of 58.7 (13.6) years and median [interquartile range] time since injury of 10 [5.0-22.0] years. Electric wheelchair users reported lower functional independence, and more participation problems and secondary health conditions compared with manual wheelchair users (p < 0.001). Ambulatory individuals using walking aids reported no better outcomes than manual wheelchair users, except for functional independence (p < 0.001). Ambulatory individuals without walking aids reported more paid work than those with walking aids (62.7% vs 34.3%, p < 0.001). In general, electric wheelchair users reported the least favourable long-term outcomes. Remarkably, ambulatory individuals using walking aids generally did not report better outcomes than manual wheelchair users.

Neuropathic pain and pain catastrophizing are common after stroke and may be associated with poorer rehabilitation outcomes. However, their independent associations with functional recovery remain insufficiently explored. This study aimed to determine the frequency of neuropathic pain and pain catastrophizing in patients with stroke and to examine their associations with post-treatment rehabilitation outcomes. In this prospective observational study, patients with post-stroke hemiplegia undergoing inpatient rehabilitation were evaluated at baseline and after a 4-week rehabilitation program. Functional status was assessed using the Barthel Index, Brunnstrom Staging, Modified Ashworth Scale, and Functional Ambulation Classification. Quality of life was assessed using the SF-12. Neuropathic pain and pain catastrophizing were assessed using the painDETECT questionnaire and Pain Catastrophizing Scale. Baseline-adjusted linear regression models examined whether baseline painDETECT and Pain Catastrophizing Scale scores were independently associated with post-treatment outcomes. Eighty patients were included. At baseline, 10 patients (12.5%) had possible neuropathic pain, 17 (21.3%) had definite neuropathic pain, and 15 (18.8%) had clinically significant pain catastrophizing. After rehabilitation, possible and definite neuropathic pain were observed in 5 (6.3%) and 8 patients (10.0%), respectively, and clinically significant pain catastrophizing in 9 patients (11.3%). Functional and pain-related outcomes improved after rehabilitation. In adjusted models, higher baseline Pain Catastrophizing Scale scores were independently associated with lower post-treatment Barthel Index and Functional Ambulation Classification scores. Baseline painDETECT scores were not independently associated with post-treatment outcomes. Pain catastrophizing, but not painDETECT score, was independently associated with poorer post-treatment functional independence and ambulation.

Poststroke spasticity is a common and debilitating condition that limits functions, is associated with pain, and impairs independence. Medications are often costly, temporary or insufficient to manage this condition. We aimed to compare the efficacy and safety of hyperselective peripheral neurectomy with best medical therapy in patients of poststroke spasticity. This trial was a prospective, randomized controlled study performed on adults with poststroke spasticity [modified Ashworth scale (MAS) score of 3-4] refractory to maximal tolerated baclofen. Patients were randomized (1:1) to undergo surgery plus rehabilitation or to continue medical therapy with rehabilitation. The primary outcome was change in MAS score at 12 months from baseline. Fifty patients were randomized equally into the 2 groups. At 12 months, the surgical group had significantly greater reduction in spasticity with a between-group difference of 1.36 points (95% CI 0.97-1.74; P < .001). The surgical group also had clinically meaningful ≥1-grade improvement in MAS score in 96% of patients compared with only 8% in the medical group (number needed to treat 1.14). Functional independence improved only within the surgical group, with no significant between-group difference. No differences were observed in power or sensory outcomes. Transient neuropathic pain was observed in 5 patients in the surgical group (resolved with medicines in 2-3 months). The hyperselective peripheral neurectomy is associated with substantial and sustained reduction in spasticity in carefully selected patients. CTRI/2023/11/060191.

Hospital-induced immobility contributes to functional decline and delirium in older adults. This pilot study evaluated the preliminary efficacy of a multicomponent intervention - Help, Optimise and Mobilise Elders (H.O.M.E) in improving functional mobility among older adults in acute care. A quasi-experimental study evaluated the H.O.M.E intervention in older inpatients. The intervention group (n=42) received pre-mobilisation assessments, regular mobilisation, and weekly group physiotherapy and art activities, while the control group (n=39) received usual care. Functional mobility and independence were assessed at baseline and discharge (maximum walking distance, gait speed and the Modified Barthel Index). Secondary outcomes included delirium incidence and hospital length of stay. Linear regression showed the intervention group had significantly greater improvement in Modified Barthel Index scores than controls (B=4.2, 95% CI, 0.60-7.79, p=0.02), with no significant differences in gait speed, maximum walking distance, hospital stay or costs. Unadjusted logistic regression indicated that the intervention group had 65% lower odds of self-reported functional decline at 30 days post-discharge (odds ratio=0.35, 95% CI, 0.12-0.99, p=0.047). The H.O.M.E intervention improved functional independence during hospitalisation and may reduce medium-term functional decline, although limited post-discharge benefits highlight the need for continued care beyond hospitalisation.

Prognostic Value of Frailty in Aortic Surgery: A Systematic Review and Meta-Analysis Comparing Frailty Assessment Tools.

It remains unclear which patient subgroups benefit most from intensive rehabilitation therapy. This study aimed to examine the heterogeneity in the effects of intensive postacute rehabilitation after hip fracture surgery on activities of daily living and to identify its potential sources. A retrospective observational study. Patients aged 50 years or older who underwent hip fracture surgery within 2 days of admission and were transferred to a rehabilitation ward between 7 and 30 days after surgery. Exposure was defined as the average daily rehabilitation time within 30 days posttransfer, dichotomized as ≥120 versus <120 minutes/day. The outcome was the motor domain score of the Functional Independence Measure (FIM) at 60 days posttransfer. Heterogeneity of treatment effects was assessed using conditional average treatment effects (CATEs) estimated through the causal forest approach. The models were adjusted for relevant covariates, including age, sex, and FIM score at the time of transfer to the rehabilitation ward. The causal forest approach revealed heterogeneous effects-the estimated CATE for the top 20% high-benefit subgroup was 3.89 (95% CI: 2.32-5.46). The high-benefit subgroup was older and had lower FIM scores for the self-care, mobility, transfers, and excretion control domains at the time of transfer, compared with the low-benefit subgroup (the bottom 20% of the estimated CATEs). Heterogeneity exists in the association between intensive in-hospital rehabilitation therapy and functional status among older patients undergoing early hip fracture surgery during the postacute rehabilitation phase.

Which is the association between patient-related variables and type of hospital discharge in geriatric surgical patients? Findings from a retrospective study.