Rehabilitation Outcomes Research Articles

Efficacy and safety of microsurgery in patients with Gustilo ⅢC open fractures

To analyze the clinical efficacy and safety of microsurgery in patients with Gustilo ⅢC open fractures. A total of 64 patients with Gustilo ⅢC open fractures who were admitted to the hospital bewteen September 2018 and March 2022 were included, and divided into the observation group and the control group, with 32 cases in each one. In the observation group, there were 24 males and 8 females, aged from 29 to 42 years with an average of (36.59±3.24) years. The tibial defect ranged from 2 to 5 cm with an average of (3.41±0.61) cm, and the soft tissue defect area ranged from 34 to 76 cm2 with an average of (58.50±9.44) cm2. This group received microsurgical treatment. In the control group, there were 25 males and 7 females, aged from 27 to 44 years with an average of (37.59±3.21) years. The tibial defect ranged from 2 to 6 cm with an average of (3.59±0.80) cm, and the soft tissue defect area ranged from 36 to 78 cm2 with an average of (59.09±9.53) cm2. This group received conventional staged surgery, with plaster or brace fixation after initial debridement and appropriate internal fixation at a later stage. The Anderson scores, motor ability Fugl-Meyer scale, perioperative indicators, rehabilitation outcomes, and complications were compared between the two groups. The patients were followed up for a duration from 2.5 to 5.5 months with an average of (3.15±1.11) months. In the observation group, 19 patients were rated as excellent, 12 patients as good, 1 patient as fair, and no patients as poor. In the control group, 11 patients were rated as excellent, 13 patients as good, 6 patients as fair, and 2 patients as poor. The difference in outcomes between the two groups was statistically significant (P<0.05). The operation time, the hospitalization time, and the hospitalization cost in the observation group(4.39±0.69) h, (30.22±4.58) d, and (23, 500±3, 300) yuan, respectively were significantly lower than those in the control group(5.01±0.75) h, (33.28±3.74) d, and(30, 200±5, 200) yuan, respectively (P<0.05). Revascularization time(134.25±14.76) h, wound healing time(11.34±1.56) d, and fracture healing time(3.09±0.42) months in the observation group were significantly shorter than those in the control group(P<0.05) which were (189.36±22.17) h, (13.22±2.03) d and (4.02±0.57) months respectively. The motor ability(42.91±5.51) points, sensory function(46.19±3.53) points, and total Fugl-Meyer score(89.09±6.08) in the observation group were significantly higher than those in the control group(P<0.05) which were(35.19±4.27), (34.03±3.79), (69.22±6.32) points respectivdy. In the observation group, there were 1 case of refractory wound and 3 cases of complete nerve injury, which were lower than those in the control group (8 cases and 10 cases, respectively, P<0.05). The number of complications in the observation group was lower than that in the control group (P<0.05). Microsurgical technique can effectively shorten the wound and fracture healing time in patients with Gustilo Ⅲ C open fracture, improve limb movement ability, and reduce the risk of poor prognosis and complications.

Gluteus medius contracture: A case report and review of the literature.

Bilateral gluteus medius contractures in adults are rare in clinical practice, with only a few cases reported. These contractures may result from repeated intramuscular injections during childhood. Understanding the clinical manifestations, diagnostic process, treatment, and outcomes can provide insights into effective management strategies. A 28-year-old female presented with an abnormal walking posture characterized by an out-toeing gait. She reported long-standing difficulties in walking and sought medical attention to improve her mobility and quality of life. The patient was diagnosed with bilateral gluteus medius contractures. The patient underwent open surgical release of the contractures on both sides, followed by a structured rehabilitation program to restore muscle function and improve gait. Postoperative exercise guidance was provided to ensure optimal recovery. At the 1-year follow-up, the patient demonstrated significant improvement in gait, functional abilities, and overall quality of life. She expressed high satisfaction with the surgical and rehabilitative outcomes. Once diagnosed with gluteus medius contracture, early surgical intervention is recommended. Through case reports and literature review, we have summarized the etiology, diagnostic methods, clinical characteristics, and existing treatment options for this condition.

Effect of baseline values on inpatient rehabilitation outcomes after total knee arthroplasty: a retrospective observational study.

To compare inpatient rehabilitation outcomes after total knee arthroplasty (TKA) between groups with different baseline scores. A retrospective observational study. Patients with knee osteoarthritis who have previously undergone unilateral TKA. Patients participated in 3-week inpatient rehabilitation following TKA and were assessed for patient-reported outcome measures (PROMs), which included the Numeric Pain Rating Scale (NPRS), the Health Assessment Questionnaire (HAQ), the European Quality of Life 5 Dimensions 5 Level Version (EQ-5D-5L), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Furthermore, mobility scores for the range of motion (ROM) and the Timed Up and Go (TUG) test were recorded at the beginning and the end of rehabilitation. Patients were divided into quartile groups based on their initial examination scores. 329 patients were enrolled in the study. The study population consisted mostly of female patients (63.8% vs 36.2%) with a mean age of 68.25 (SD 9.24) years. The personalized 21-day in rehabilitation programme was safe for all patients and had no dropouts. Patients with better PROMs scores at T1 did not have the same potential for improvement in PROMs but showed effective improvement in mobility (η² = 0.103 for changes in the WOMAC vs η²=0.502 for changes in the TUG test). Regardless of the baseline scores, all patients presented significant improvements in both subjective and objective measures. Age and baseline PROMs or mobility scores did not have a significant effect on score development.

Effectiveness of rehabilitation in hospitalized hemodialysis patients as compared with rehabilitation in hospitalized patientsnot on hemodialysis: a retrospective cohort study.

The effectiveness of rehabilitation aimed at improving the activities of daily living and physical functions may differ between hospitalized patients undergoing hemodialysis (HD) and not undergoing HD (non-HD). The aim of the present study was to compare the outcomes of rehabilitation between hospitalized HD and non-HD patients. This was a retrospective cohort study of inpatients who underwent rehabilitation. We measured the rehabilitation time (min/day), length of hospital stay (days), and the Barthel index (BI). In addition, at the time of admission and discharge, grip strength, isometric knee extension strength, 10m walking speed, timed up and go test, and short physical performance battery were examined. The outcomes were then compared between the HD and non-HD groups. This study was made up of 902 patients (non-HD group: 765, HD group: 137). Our analysis revealed a lower rehabilitation time [43.3 (0.6) vs. 38.8 (1.2) min/day] and longer hospital stay [48.5 (0.5) vs. 58.1 (2.3) days] in the HD group as compared with the non-HD group (p < 0.05). In addition, the 10m walking speed [0.75 (0.02) vs. 0.66 (0.03) m/s], timed up and go test [20.8 (0.7) vs. 24.3 (1.0) sec], and short physical performance battery [6.3 (0.6) vs. 4.7 (0.6) points] at discharge were also significantly lower in the HD group as compared with the non-HD group (p < 0.05). Rehabilitation efforts for HD patients need to be improved by securing more time for inpatient rehabilitation and promoting mobility function improvement for these patients.

Rehabilitation success and related costs following stroke in a regional hospital: a retrospective analysis based on the Australian National Subacute and Non-Acute Patient (AN-SNAP) classification

BackgroundEvidence is limited on the factors influencing successful stroke rehabilitation in regional contexts. Additionally, the relationship between rehabilitation costs following acute stroke, based on Australian National Subacute and Non-Acute Patient (AN-SNAP) casemix classification, and rehabilitation success remains unclear.ObjectiveThis retrospective cohort study investigated the factors contributing to improved functional outcomes following stroke rehabilitation in an Australian regional hospital, also evaluating the respective average daily and total payments.MethodsStroke patients’ admission records, during 2010–2020, were linked with rehabilitation registry data. Rehabilitation success was defined as relative functional gain (RFG) ≥ 0.5 and Functional Independence Measure (FIM) efficiency ≥ 1. Multivariate mixed effects logistical regressions modelled the sociodemographic and medical (i.e., comorbidities and stroke type) predictors of rehabilitation success, while logarithms of average daily and total rehabilitation payments were modelled using robust regressions.ResultsOf 582 included patients, 315 (54.1%) achieved RFG ≥ 0.5 and 258 (52.2%) achieved FIM efficiency ≥ 1. A longer delay in starting rehabilitation was associated with a lower likelihood of achieving RFG success [Odds Ratio (OR): 0.85, 95% confidence interval (CI): 0.78–0.93, P < 0.001] and FIM efficiency success (OR: 0.89, 95% CI: 0.82–0.97, P = 0.010). A higher FIM score at admission was associated with decreased odds of FIM efficiency success (OR: 0.35, 95% CI: 0.20–0.60, P < 0.001). The average daily and total rehabilitation payments for inpatients were $AU1,255 (median) [interquartile range (IQR): 1,040, 1,771] and $AU28,363 (median) (IQR: 18,822, 41,815), respectively. FIM efficiency success was positively associated with the average daily payment (Beta: 0.25, 95% CI: 0.20–0.30, P < 0.001), but negatively correlated with the total payment (Beta: -0.18, 95% CI: -0.24–0.13, P < 0.001). No significant associations were found between RFG success and these payments.ConclusionThis study identifies key factors affecting stroke rehabilitation outcomes in a regional Australian setting. Delays in starting rehabilitation were linked to lower success rates, underscoring the importance of timely intervention. While higher average daily costs were associated with better FIM efficiency, total costs did not correlate with relative functional gains. These findings may inform rehabilitation practices and may influence future funding strategies for rehabilitation services.

“I felt like I was missing ‘me’": Long-term experiences of intrapersonal loss, grief, and change in adults with an acquired brain injury

ABSTRACT Experiences of loss and change following acquired brain injury (ABI) are frequent and multi-contextual, yet the long-term experiences of people with ABI are not well understood. This study explored the experiences of intrapersonal loss, grief and change in people with ABI, a decade after their injury. Twelve adults with ABI were interviewed 10–13 years post-injury. Using interpretative phenomenological analysis, we identified four overarching themes: a dawning realization of the impact of injury; loss of personhood; loss and liminality; and learning to live with loss and grief. Our findings indicate that in the decade following ABI, people continue to develop awareness of the impact of their injury and experience oscillating acceptance towards enforced changes. Participants reported a diminished sense of agency and autonomy in how they were perceived by and interacted with following injury. Additionally, identity may be lost, suspended, and renegotiated. Findings suggest dynamic, active, and flexible coping strategies that continue to be present over the long term. Considering the persistent nature of the injury and the evolving needs of the individual, a longer term view of rehabilitation outcomes may be required, contextualised by relational and intrapersonal challenges that may present over the longer term.

Benefits and durability of an affordable prosthetic silicone cushion liner locally manufactured in a resource-limited environment: Enabling adoption of total surface bearing sockets and silicone cushion liners.

Prosthetic silicone liners improve comfort and skin protection and allow the use of total surface bearing (TSB) sockets, which provide enhanced proprioception and comfort. Unfortunately, silicone liners are cost-prohibitive in resource-limited environments (RLEs) where patellar tendon bearing (PTB) sockets with PE-lite liners remain standard, leading to patient discomfort and skin issues. This study evaluates the benefits and durability of an affordable silicone liner locally manufactured in an RLE to promote TSB socket adoption, aiming to enhance prosthetic care and patient outcomes. Ethical approval was granted by the Nepal Health Research Council. Twelve people with a unilateral transtibial amputation who were using a PTB socket with PE-lite participated in the study and received a new prosthesis (TSB socket with an affordable silicone liner). Participants performed mobility tests (2-Minute Walking Test, Timed Up and Go Test) and completed self-reported questionnaires for both prostheses. Liner durability was assessed. Participant mobility improved while wearing the TSB socket and silicone liner. The new prosthesis was found to be comfortable, and there were no major problems identified although excessive sweating, typical with silicone liners, was reported. Liners were replaced after 6.1 (±3.1) months. A locally manufactured liner provided increased mobility and high levels of satisfaction. This affordable liner may be suitable for use in RLEs, enabling adoption of TSB sockets and improving rehabilitation outcomes of people with a transtibial amputation. However, durability concerns and excessive sweating would suggest that improvements can still be made.

Development and validation of a dynamic nomogram to predict alexithymia in young and middle aged stroke patients

Alexithymia, characterized by difficulty in expressing and recognizing emotions, is prevalent among young and middle-aged stroke survivors and can significantly impact rehabilitation outcomes. This study aims to develop and validate a dynamic nomogram to predict the risk of alexithymia in this population. This cross-sectional study was conducted from November 2022 to August 2023 at two tertiary hospitals in Jinzhou City and Cangzhou City, enrolling 319 patients. Predictive factors for alexithymia, such as Activities of Daily Living (ADL) scores, social support levels, lesion location, educational background, and National Institutes of Health Stroke Scale (NIHSS) scores, were identified through univariate and multivariate analyses. These factors were integrated into a web-based dynamic nomogram. The model’s accuracy was evaluated using Receiver Operating Characteristic (ROC) curves and 1000 bootstrap resamples. In the training cohort, 47.8% of patients were diagnosed with alexithymia. The nomogram demonstrated excellent fit and reliability, with an Area Under the Curve (AUC) of 0.837 (95% CI: 0.787–0.889) in the training cohort and 0.847 (95% CI: 0.767–0.928) in the validation cohort, enabling reliable early detection of alexithymia. The dynamic nomogram provides healthcare professionals with an important tool for early detection and management of alexithymia in young and middle-aged stroke survivors. While the model shows high predictive accuracy, its applicability may be limited to similar clinical settings. Future studies should evaluate its utility across diverse healthcare systems. This tool has the potential to significantly improve rehabilitation outcomes by supporting personalized therapeutic strategies and interventions.

Integration of neuromuscular control for multidirectional horizontal planar reaching movements in a portable upper limb exoskeleton for enhanced stroke rehabilitation.

Globally, the prevalence of stroke is significant and increasing annually. This growth has led to a demand for rehabilitation services that far exceeds the supply, leaving many stroke survivors without adequate rehabilitative care. In response to this challenge, this study introduces a portable exoskeleton system that integrates neural control mechanisms governing human arm movements. This design leverages neuroplasticity principles to simulate natural movements, aiming to reactivate and strengthen neuromuscular connections and thus enhance rehabilitation outcomes. A tailored musculoskeletal model of the human arm and an associated cost function were developed to accurately replicate the planar motion trajectories of a healthy human arm across 32 directions. The application of a Proportional-Derivative (PD) controller enables precise tracking of these trajectories by the exoskeleton. Individual testing has demonstrated high consistency between the exoskeleton-driven motion paths and the simulated trajectories, especially in trajectory accuracy along the X and Y axes. These findings support the efficacy of integrating advanced neural control strategies with practical exoskeleton designs in stroke rehabilitation.

High-intensive physical rehabilitation approach in children and adolescents with acquired brain injury during subacute phase (REHABILITY): a feasibility study protocol

IntroductionWhile principles of neuroplasticity and motor learning emphasise the potential of high dosage of physical rehabilitation in children and adolescents with acquired brain injury (ABI) during the subacute phase, we...

Correlation between anxiety, depression, and social stress in young patients with thoracolumbar spine fractures.

Traumatic injuries, such as falling, car accidents, and crushing mostly cause spinal fractures in young and middle-aged people, and > 50% of them are thoracolumbar fractures. This kind of fracture is easily combined with serious injuries to peripheral nerves and soft tissues, which causes paralysis of the lower limbs if there is no timely rehabilitation treatment. Young patients with thoracolumbar fractures find it difficult to recover after the operation, and they are prone to depression, low self-esteem, and other negative emotions. To investigate the association between anxiety, depression, and social stress in young patients with thoracolumbar spine fractures and the effect on rehabilitation outcomes. This study retrospectively analyzed 100 patients admitted to the orthopedic department of Honghui Hospital, Xi'an Jiaotong University who underwent thoracolumbar spine fracture surgery from January 2022 to June 2023. The general data of the patients were assessed with the Hamilton anxiety scale (HAMA), Hamilton depression scale (HAMD), life events scale, and social support rating scale (SSRS) to identify the correlation between anxiety, depression scores, and social stress and social support. The Japanese Orthopedic Association (JOA) was utilized to evaluate the rehabilitation outcomes of the patients and to analyze the effects of anxiety and depression scores on rehabilitation. According to the scores of HAMD and HAMA in all patients, the prevalence of depression in patients was 39% (39/100), and the prevalence of anxiety was 49% (49/100). Patients were categorized into non-depression (n = 61) and depression (n = 39), non-anxiety (n = 51), and anxiety (n = 49) groups. Statistically significant differences in gender, occupation, Pittsburgh Sleep Quality Index (PSQI) score, and monthly family income were observed between the non-depression and depression groups (P < 0.05). A significant difference in occupation and PSQI score was found between the non-anxiety and anxiety groups. Both depression (r = 0.207, P = 0.038) and anxiety scores (r = 0.473, P < 0.001) were significantly and positively correlated with negative life events. The difference in negative life event scores as well as SSRS total and item scores was statistically significant between patients in the non-depression and depression groups (P < 0.05). The difference between the non-anxiety and anxiety groups was statistically significant (P < 0.05) in the negative life event scores as well as the total SSRS scores. Additionally, JOA scores were significantly lower in both anxious and depressed patients. Young patients with thoracolumbar fractures are prone to anxiety and depression. Patients' anxiety and depression are closely associated with social pressure, which reduces the life pressure of young patients with thoracolumbar fractures, enhances social support, and improves the psychology of anxiety and depression., which affects patients' recovery.

Tailored personas for self-management in home-based cardiac rehabilitation for patients with coronary heart disease: A qualitative study.

Self-management is a key factor determining recovery outcomes in home-based cardiac rehabilitation. However, the impact of individual differences on self-management in patients with coronary heart disease is particularly significant, and standardised approaches often fail to fully meet the needs of this heterogeneous group. This study aimed to explore the heterogeneity of self-management among patients with coronary heart disease undergoing home-based cardiac rehabilitation and construct patient personas to address the unique challenges and needs of diverse patient groups. A qualitative descriptive study was conducted at a cardiac rehabilitation centre in mainland China from April to July 2024. Purposive sampling was used to select patients with coronary heart disease. Semi-structured interviews were conducted to capture their self-management experiences during home-based cardiac rehabilitation. Content analysis was used to extract factual labels and construct dimensional models. Patient personas were developed by categorising patients based on these dimensions, and their self-management personas were visualised using labelled personas. A total of 28 eligible patients with coronary heart disease participated in the study. Three key dimensions were identified to construct the personas: descriptions, characteristics, and needs. Five distinct personas were developed based on individual attributes, highlighting the varying self-management behaviours and needs of patients with coronary heart disease. The personas were categorised as follows: patients who actively seek cooperation in health management, patients with limited knowledge and poor management behaviour, patients with management deficiencies under high work demands, patients with prominent symptoms but strong awareness, and patients with impaired motivation for self-management. Precise interventions based on patient personas are essential for enhancing self-management behaviours during home-based cardiac rehabilitation among patients with coronary heart disease. This study developed five patient personas for self-management in home-based cardiac rehabilitation, providing a basis for precise interventions to address the heterogeneous needs of this patient group.

Dental Rehabilitation After Microvascular Reconstruction of Segmental Jaw Defects: A Ten-Year Follow-Up.

Background/Objectives: Defects in maxillary and mandibular continuity are common in maxillofacial practice. They can occur after trauma, osteonecrosis, congenital jaw deformities, or surgical resection of benign or malignant tumours. Reconstruction with microvascular bone flaps and subsequent prosthetic rehabilitation is considered the contemporary first line treatment. This study assessed the extent to which the underlying disease influences the treatment course of microvascular segmental jaw reconstruction. Methods: A retrospective review of prospectively collected data from all patients who underwent microvascular segmental jaw reconstruction from January 2011 to December 2020 was completed. The course of treatment as well as the process of dental rehabilitation was assessed. Results: Two hundred patients were included in the study. A total of 15.5% of patients were fitted with a conventional removable prosthesis, and implant-supported prosthetic restoration could be realized in 53.5% of patients. However, dental rehabilitation was not possible in 31.0% of patients. The outcomes of prosthetic restoration showed a statistically significant difference between the different underlying diseases (p < 0.0001). About 50% of patients with malignant diseases and osteonecrosis remained without dental rehabilitation. In contrast, more than 90% of patients with jaw continuity defects, due to benign diseases or malformations, were able to receive an implant-supported prosthesis. Among the diagnostic groups, there was a significant difference regarding the number of implants placed (p < 0.0001). There was a significant correlation between increased incidence of complications and the size of the bone flaps. Conclusions: The underlying disease influenced significantly the treatment course and the outcome of dental rehabilitation after microvascular jaw reconstruction.

Mechanical Design and System Construction of Ankle Rehabilitation Robots

The ankle joint is the most heavily loaded joint in the human body and plays a crucial role in daily activities, making it susceptible to injuries. Currently, rehabilitation robots for the ankle joint facilitate the assessment of rehabilitation outcomes and the adjustment of rehabilitation programs, demonstrating significant practical value and application prospects. This paper reviews the mechanical structure design and control system construction of existing ankle rehabilitation robots. In this narrow review, we first analyze the characteristics and issues of current mechanical designs of ankle rehabilitation robots based on the analysis of physiological structure of the ankle joint. Subsequently, we examine design aspects aimed at enhancing precision based on the movement characteristics of the ankle joint, suggesting directions for further research. The control system is categorized into three types based on the driving method: passive, active, and assistive, with an explanation of their mechanisms of action. Finally, we summarize our findings and propose perspectives about the future development of ankle rehabilitation robots

Efficacy of virtual reality balance training on rehabilitation outcomes following anterior cruciate ligament reconstruction: A systematic review and meta-analysis.

The objective of this systematic review and meta-analysis is to clarify the rehabilitation efficacy of virtual reality (VR) balance training after anterior cruciate ligament reconstruction (ACLR). This meta-analysis was registered in PROSPERO with the registration number CRD42024520383. The electronic databases PubMed, Web of Science, Cochrane Library, MEDLINE, Embase, China National Knowledge Infrastructure, Chinese Biomedical Literature, China Science and Technology Journal Database, and Wanfang Digital Periodical database were systematically searched to identify eligible studies from their inception up to January 2024. The investigated outcomes included International Knee Documentation Committee (IKDC) score, visual analogue scale (VAS), Holden grading, Extensor peak torque (EPT), Flexor peak torque (FPT), knee reaction time, knee reproduction angle difference. The pooled mean difference (MD) and 95% confidence intervals (CIs) were calculated using the random-effects model. Six RCTs with a total of 464 patients after unilateral ACLR were included for 8-12 weeks of VR balance training intervention. Analysis of the results showed that compared with the conventional rehabilitation control group, the VR balance training group significantly improved the International Knee Documentation Committee (IKDC) score (MD = 3.88, 95%CI: 0.95~6.81), Holden grading (MD = 0.42, 95%CI: 0.33~0.51), Extensor peak torque (EPT) (MD = 12.03, 95%CI: 3.28~20.78)and Flexor peak torque (FPT) (MD = 14.57, 95%CI: 9.52~19.63) in postoperative ACLR patients, and significantly reduced knee reaction time (MD = -0.30, 95%CI: -0.35~-0.25), knee angle reproduction difference at 30° (MD = -0.88, 95%CI: -1.16~-0.61), knee angle reproduction difference at 60° (MD = -0.80, 95%CI: -1.09~-0.50), and VAS score (MD = -0.52, 95%CI: -0.65~-0.39). Since many of the included results are based on low-or very-low-quality evidence, although the results show a certain trend, the conclusion has great uncertainty. In the rehabilitation training following ACLR and lower-limb balance training, the application of VR might be advantageous for the recovery of patients' knee joint function, lower-limb muscle strength, proprioception, and pain management. The level of immersion may influence the rehabilitation outcome. Because of the limitations in data quality and heterogeneity as well as the small sample size, the strength of the conclusions is weakened. These findings should be verified in further large-scale prospective studies.

EFICÁCIA DAS INTERVENÇÕES FISIOTERAPÊUTICAS NA REABILITAÇÃO DE PACIENTES PÓS-AVC EM AMBIENTE HOSPITALAR: UMA REVISÃO DE PRÁTICAS E RESULTADOS

The Cerebrovascular Accident (CVA) is one of the leading causes of disability and mortality worldwide, affecting millions of people annually and generating significant economic and social costs. The sequelae of a stroke, such as the loss of motor, cognitive, and emotional skills, compromise the patient's quality of life and functional independence. In this context, physiotherapy plays a crucial role in recovery, with techniques such as muscle strengthening, stretching, gait training, and sensory stimulation being essential to restore motor function and prevent complications such as muscle atrophy, pain, fatigue, and falls. Furthermore, intensive physiotherapy contributes to neuroplasticity by promoting brain reorganization and the formation of new neuronal connections. The application of these specific interventions, based on scientific evidence, is essential for improving rehabilitation outcomes and aiding in the recovery of lost functions, providing greater autonomy, well-being, confidence, functionality, and quality of life for post-stroke patients.

Metaverse-Aided Rehabilitation: A Perspective Review of Successes and Pitfalls.

Background: The evolution of technology has continuously redefined the landscape of rehabilitation medicine. Researchers have long incorporated virtual reality (VR) as a promising intervention, providing immersive therapeutic environments for patients. The emergence of the metaverse has recently further expanded the potential applications of VR to augment the possibilities in rehabilitation. Rehabilitation is a crucial aspect of healthcare, and technological advancements have allowed new approaches to aid in this process. One such approach is the metaverse, a virtual world where users can interact with each other and their surroundings in a simulated environment. This comprehensive review aimed to analyze the scientific evidence using the term "metaverse" in rehabilitation and its potential patient benefits. Methods: We conducted a comprehensive literature search from the inception to September 2024 in PubMed, Scopus, Web of Science, and Cochrane Database to identify studies investigating the term "metaverse" and its role in rehabilitation. We then assessed these studies based on their methodology, patient population, technology used, and therapeutic outcomes. Results: Out of 81 articles, 55 remained after removing duplicates. After screening the title, abstract, and full text, we included five articles. Conclusions: Results from these studies suggested potential benefits in various rehabilitative areas, such as cerebral palsy, intellectual disabilities, pain management, and physical performance improvement among the elderly. The metaverse presents promising avenues for enhancing rehabilitation outcomes. While VR's effectiveness is well established, the metaverse, being a newer concept, necessitates further studies for a more comprehensive understanding.

Cognitive Assessment and Training in Extended Reality: Multimodal Systems, Clinical Utility, and Current Challenges

Extended reality (XR) technologies—encompassing virtual reality (VR), augmented reality (AR), and mixed reality (MR)—are transforming cognitive assessment and training by offering immersive, interactive environments that simulate real-world tasks. XR enhances ecological validity while enabling real-time, multimodal data collection through tools such as galvanic skin response (GSR), electroencephalography (EEG), eye tracking (ET), hand tracking, and body tracking. This allows for a more comprehensive understanding of cognitive and emotional processes, as well as adaptive, personalized interventions for users. Despite these advancements, current XR applications often underutilize the full potential of multimodal integration, relying primarily on visual and auditory inputs. Challenges such as cybersickness, usability concerns, and accessibility barriers further limit the widespread adoption of XR tools in cognitive science and clinical practice. This review examines XR-based cognitive assessment and training, focusing on its advantages over traditional methods, including ecological validity, engagement, and adaptability. It also explores unresolved challenges such as system usability, cost, and the need for multimodal feedback integration. The review concludes by identifying opportunities for optimizing XR tools to improve cognitive evaluation and rehabilitation outcomes, particularly for diverse populations, including older adults and individuals with cognitive impairments.

Evaluating for Health Equity in a Safety Net Hospital: Socioeconomic Status, Adherence, and Outcomes in Cardiac Rehabilitation.

Uncovering the racial/ethnic health disparities that exist within cardiovascular medicine offers potential to mitigate treatment gaps that might affect outcomes. Socioeconomic status (SES) may be a more appropriate underlying factor to assess these disparities. We aimed to evaluate whether adherence, attendance, and outcomes in cardiac rehabilitation are associated with SES in a safety net hospital. We analyzed 542 patients in a retrospective cohort study of the Cardiac Rehabilitation Program at Boston Medical Center from 2016 to 2019. Enrollees had a mean age of 59.4years, 34% were female, 42% Black, and 12% Hispanic. The zip codes of each enrollee were used to obtain their area deprivation index (ADI). The ADI reflects income, education, employment, and housing quality within a given zip code. Associations between ADI and adherence and attendance rate were evaluated while controlling for covariates. Secondary outcomes included associations of ADI with change in exercise capacity, low density lipoprotein cholesterol, weight, quality of life, nutrition, and depression scores. We applied logistic regression to examine the association between adherence and ADI with adjustment on the covariates. The attendance rate was analyzed with negative binomial regression with percent of sessions attended as prescribed as a dependent variable and adjusted on the same covariates. The primary outcome revealed no association for ADI with adherence to cardiac rehabilitation (OR=0.91: 95% CI, 0.74-1.12) or attendance rate (RR=0.91: 95% CI, 0.80-1.04). Utilizing multiple linear regression, secondary outcomes improved among patients regardless of ADI. We found equity in our cardiac rehabilitation program outcomes despite SES.

Comparison of bioabsorbable screw versus metallic screw fixation for tibial tubercle fractures in adolescents: a retrospective cohort study

BackgroundDisplaced tibial tubercle (TT) fractures in adolescents are typically treated with open reduction and internal fixation. While metallic screw (MS) fixation provides strong stability, it often results in a high incidence of postoperative screw head protrusion or irritation, leading to additional removal surgery. Bioabsorbable screw (BS) fixation presents an alternative that may avoid these issues, though its stability has not yet been extensively documented in the literature. This study aims to compare the efficacy of BS versus MS in the fixation of TT fractures.MethodsA retrospective analysis was conducted on adolescent patients with TT fractures who underwent surgical treatment from September 2015 to September 2023. Patients were divided into two groups based on the fixation method: The BS group and the MS group. Data collected included patient demographics, fracture details, treatment strategies, radiological and clinical rehabilitation outcomes, and postoperative complications. Knee joint function was evaluated using the Lysholm and Tegner scores. Statistical analysis was performed to identify differences between the variables of the two groups.ResultsA total of 30 patients with 32 fractures were included, with 15 fractures in the BS group and 17 in the MS group. The average follow-up period was 42.1 (range: 12.0-109.5) months. The demographic characteristics, fracture details, and treatment strategies were comparable between the two groups. No significant differences were observed between the groups in fracture healing time, time to return to pre-injury activities, or knee joint function as assessed by the Lysholm and Tegner scores at the final follow-up. However, compared with the MS group, the BS group showed a shorter time to regain full range of motion (ROM) in the knee joint and experienced lower rates of postoperative hardware irritation and joint stiffness.ConclusionsBoth BS and MS fixations are safe and effective for treating adolescent TT fractures. BS fixation has the advantages of avoiding hardware irritation, facilitating earlier recovery of knee joint ROM, reducing the incidence of joint stiffness, and eliminating the need for additional removal surgery.Clinical trial numberNot applicable.