Clinical Rehabilitation

To evaluate the impact of acquiring a power-assist device on participation.

Prospective multicenter cohort study.

Three physical medicine and rehabilitation outpatient centers.

Eighteen individuals with neurological impairments who primarily use manual wheelchairs for mobility.

Participants were followed throughout the process of acquiring a power-assisted mobility device, with assessments conducted at delivery, 3 months, and 6 months post-acquisition.

Participation (Wheelchair Outcome Measure), shoulder pain (Wheelchair User's Shoulder Pain Index), wheelchair skills (Wheelchair Skills Test Questionnaire), and satisfaction with the device (Quebec User Evaluation of Satisfaction with Assistive Technology). Evaluations were performed at baseline (pre-acquisition), delivery, and at 3 and 6 months.

Thirty-six participants were enrolled. Eighteen did not complete the study mostly due to funding difficulties and 18 completed the acquisition. Participation significantly increased, with WHOM scores rising from 19.33 ± 15.02 at baseline to 36.55 ± 17.06 at 3 months (p = 0.0001). WST-Q scores improved from 21.1 [19.9–23.7] at baseline to 25.2 [23.6–27.6] at 6 months (p = 0.0001). Although the overall WUSPI score did not change significantly, the mobility sub-score improved from 4.5 [0–9.2] at baseline to 0 [0–0] at 6 months (p = 0.03). Satisfaction with the device remained stable over time, with a consistent QUEST score of 3.3.

The acquisition of a power-assist device may enhance participation, wheelchair skills, and reduce mobility-related shoulder pain in manual wheelchair users. Further comparative studies are needed to confirm these findings.

Participation plays a pivotal role in rehabilitation for people with multiple sclerosis. In clinical practice, the International Classification of Functioning, Disability and Health serves as a basis for characterizing participation. However, this framework lacks the subjective perception of participation. This study examines the perceived participation of people with multiple sclerosis and gait impairment through a sense of connection, efficacy, and meaning.

Qualitative research design with focus group and individual interviews.

Participants were interviewed using an online conference tool.

Transcripts from four online focus group interviews with people with multiple sclerosis and gait impairment (4–6 participants each, totaling N = 19, aged 33 to 76, with 12 females) and from 12 individual interviews with participants from these focus groups were analyzed.

None.

Two researchers coded transcripts using qualitative content analysis by Kuckartz.

A sense of connection was about common activities, a sense of inclusion, sameness, familiarity, and contributing to a social system. Experiences of exclusion, otherness, and foreignness were reported. A sense of efficacy ranged from a sense of competence, influence, and independence to a sense of dependence, a lack of spontaneity, and helplessness, leading to refraining from activities. Meaningful activities, sensual experience, a sense of purpose, identity, and equality were related to a sense of meaning.

Perceived participation goes beyond the ability of being involved in life situations. Clinicians following a patient-centered approach can incorporate the presented perspective of people with multiple sclerosis and gait impairment on participation into their clinical action.

This scoping review maps evidence on sex and gender differences in technology-assisted stroke rehabilitation and identifies gaps to inform equitable approaches.

Searches were conducted in two rounds (up to March 2025 and April 2025–March 2026) on MEDLINE, CINAHL, Scopus, Web of Science, Cochrane Library, and Google Scholar.

Following PRISMA-ScR guidelines, we included primary studies reporting sex and gender outcomes in adults with stroke receiving technological interventions, guided by the PCC framework.

From 7071 records, 11 studies (1626 stroke survivors, 39.9% female) met inclusion criteria. Interventions included robotic exoskeletons, soft robotic gloves, virtual reality, exergaming, functional electrical stimulation, and biofeedback. Five studies found no significant sex differences. However, others reported female advantages in robotic gait training (p = 0.007), functional electrical stimulation (OR = 3.92), soft robotic glove hand function (3.43-fold greater improvement), and Virtual Reality-based balance recovery (p = 0.03). Younger women (<62 years) outperformed men in fine motor tasks, a pattern reversing with age.

Gender and sex disparities in rehabilitation outcomes vary by technology type, underscoring the need for inclusive device designs and improved female representation in trials. Future research must integrate biological and sociocultural perspectives and standardize outcome measures to optimize tailored rehabilitation for all stroke survivors.

The loss of manual dexterity significantly an impact is a key determinant directly influencing quality of life, social participation, and interaction in people with multiple sclerosis, making its assessment vital. This study aimed to determine the validity and reliability of the Minnesota Manual Dexterity Test in people with multiple sclerosis and the cut-off times that differentiate from healthy controls.

A cross-sectional study.

Outpatient clinic.

Sixty people with multiple sclerosis and thirty-five healthy controls. Forty PwMS performed the Minnesota Manual Dexterity Test on two occasions 1 week apart for reliability.

The Minnesota Manual Dexterity Test was administered along with the 9-Hole Peg Test, Jebsen Taylor Hand Function Test, ABILHAND questionnaire, and disability level.

The Minnesota Manual Dexterity Test demonstrated excellent test-retest reliability (Intraclass correlation coefficients = 0.91–0.99). The minimum detectable change values of subtests ranged from 3.66–19.97. The Minnesota Manual Dexterity Test showed a fair to excellent positive correlation with the 9-Hole Peg Test, Jebsen Taylor Hand Function Test, and disability level (ρ = 0.38-ρ = 0.76, p < 0.05), and fair to moderate negative correlations with the ABILHAND questionnaire (ρ = −0.29 to −0.59). Cut-off times were established ranging from 39.05 to 66.87 s depending on the subtest of Minnesota Manual Dexterity Test.

The Minnesota Manual Dexterity Test has advantages such as evaluating bilateral hand functions, hand-eye coordination, and gross motor skills that are not found in many other manual dexterity assessment tools. The test is adequately valid, reliable and clinically usable for assessing manual dexterity in people with multiple sclerosis.

Registration: ClinicalTrials.gov (NCT06704464)

To evaluate the effectiveness of non-pharmacological intervention studies on work outcomes in people with multiple sclerosis (MS).

We searched three electronic databases (MEDLINE, PsycINFO, and Web of Science: Conference Proceeding Citation Index) and included studies reporting on having/returning to paid employment, work productivity, or factors related to work ability.

The Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA extension for scoping reviews checklist were followed. All steps were conducted by two reviewers.

The search (inception-April 2026) yielded 10449 articles. Sixteen studies were included: four vocational, seven psychological, one exercise, and four combining these intervention types. Reported work outcomes included employment status, work difficulties, workplace accommodations, promotions, impact on work and education, work productivity and impairment, and work and social adjustment. Eight studies aimed to improve work outcomes. Five interventions demonstrated significant improvement: two targeting fatigue with cognitive behavioral therapy (β = −0.34, 95% CI: −0.66 to −0.03; β = −3.68, 95% CI: −5.82 to −1.537), one on conscientiousness (effect size not reported), one on information processing speed (f2 = 0.04, p = 0.044), and one on job seeking (career goals and appraisal of potential work difficulties (t = −2.68, p = 0.009), self-esteem (t = 2.47, p = 0.016), relations (t = 2.44, p = 0.017), finances (t = 2.14, p = 0.036)).

Few non-pharmacological interventions evaluate work outcomes. Cognitive behavioral therapy targeting MS-related fatigue shows promise for improving work outcomes. The heterogeneity of MS and variability in work contexts add challenges, indicating that personalized interventions may ultimately prove more effective than generic approaches.

To review the costs and cost-effectiveness of telerehabilitation training for upper limb function in people after stroke.

MEDLINE, EconLit, and EMBASE databases were searched for studies published between 2013 and 16 March 2026.

The review included studies of technology-based rehabilitation programmes for individuals after stroke that evaluated costs or cost-effectiveness. Titles and abstracts were screened, and data were independently extracted by two researchers. Study quality was appraised using the Critical Appraisal Skills Programme (CASP) checklist. Findings were synthesised narratively.

Fifteen studies including 963 participants were included. Two studies conducted cost-effectiveness analyses, eight reported cost analyses, and six reported the use of a preference-based measure recommended for cost-effectiveness studies (all used the EQ-5D), with some studies contributing to more than one category. Evidence on costs and cost-effectiveness was mixed, but several studies suggested potential cost savings. Reporting of EQ-5D outcomes was inconsistent across studies.

Evidence on the costs of telerehabilitation training for upper limb function primarily focused on therapist time and equipment costs. Few studies included costs associated with equipment maintenance, depreciation, or the need for internet-enabled devices. Reductions in therapist time could offset or exceed technology costs. Further research is needed to evaluate the longer-term costs and cost-effectiveness of telerehabilitation in this population.

This study aimed to evaluate the efficacy of immersive virtual reality-based naming therapy in individuals with chronic post-stroke aphasia.

Randomized, single-blind, parallel-group, and controlled trial.

Bolu Abant Izzet Baysal University Physical Medicine and Rehabilitation Hospital.

A total of 102 individuals with non-fluent aphasia (aged 40–80 years), randomly assigned to two groups (n = 51 each).

The virtual reality group received virtual reality-based self-managed naming therapy in an immersive environment, while the control group received conventional therapy. Both interventions were delivered 5 times per week over 8 weeks.

The primary outcome was language performance, measured by the Gulhane Aphasia Test. Secondary outcomes included Stroke and Aphasia Quality of Life Scale and enjoyment.

At baseline, groups were similar in demographics and clinical measures (p > 0.05). Both groups showed significant improvements in the Gulhane Aphasia Test and Stroke and Aphasia Quality of Life Scale scores (p < 0.05). The virtual reality group improved across all Gulhane Aphasia Test subscales (p < 0.05). In contrast, the control group did not show gains in listening comprehension and repetition. Stroke and Aphasia Quality of Life subscale improvements were broader in the virtual reality group. Between-group comparisons indicated significantly higher gains in the virtual reality group in oral motor (p = 0.005), naming (p = 0.001), and enjoyment (p = 0.002).

Therapy based on immersive virtual reality showed better results for naming, quality of life, and patient engagement. These findings suggest that virtual reality is an effective intervention for aphasia rehabilitation. Future studies are needed to investigate long-term effects and the potential for home-based applications.

A qualitative study using uni-professional focus groups, forming the first stage of a multi-phase co-design project to develop a model of care for early sling removal after conservatively managed proximal humerus fracture.

Focus groups were conducted online via Microsoft Teams with participants from a wide geographical spread across multiple United Kingdom National Health Service Trusts.

Healthcare professionals (n = 23), including orthopaedic surgeons, therapists (physio and occupational), and nurses, recruited through purposive sampling.

Three focus groups explored healthcare professionals’ perspectives on early sling removal in the non-operative management of proximal humerus fractures. Patient and public involvement and engagement work informed study design, identifying the need to first understand professionals’ viewpoints before engaging patients and progressing to consensus co-design.

Data were collected through focus groups supported by pre-session forms and analysed thematically following Braun and Clarke's framework using NVivo software.

Three overarching themes were identified: Navigating pain and fear, clinician confidence, and early engagement. Fear of patient harm and high pain levels in the early weeks were barriers to early sling removal. Confidence was influenced by experience, fracture severity and limited evidence, with hierarchical decision-making by surgeons. Participants considered enablers to be consistent messaging, early education, and reassurance to support both clinicians and patients.

Whilst healthcare professionals recognise benefits of earlier sling removal, implementation is limited by pain, uncertainty, and hierarchical decision-making. These findings highlight the need for multidisciplinary, co-designed pathways. There is a need next to explore patient perspectives to inform future co-designed pathways.

To compare upper extremity performance of ambulant children with Duchenne muscular dystrophy and typically developing peers under single- and dual-task conditions, and to examine its associations with mobility and balance.

Cross-sectional observational study.

Data were collected at the Pediatric Neurology Department and the Pediatric Rehabilitation Unit of the Faculty of Physical Therapy and Rehabilitation.

Twenty ambulant boys with Duchenne muscular dystrophy (6–12 years) and 19 age-matched typically developing peers.

Not applicable.

Upper extremity performance was assessed using the Nine-Hole Peg Test under single-task, motor dual-task, and cognitive dual-task conditions. Functional mobility and balance, as well as clinical scales, were also evaluated.

Children with Duchenne muscular dystrophy performed significantly slower than typically developing peers under cognitive dual-task conditions (p < 0.001) and under motor dual-task conditions for the left hand (p = 0.032). Slower dual-task performance was moderately associated with poorer balance and trunk control. Cognitive dual-task performance showed high diagnostic accuracy for identifying Duchenne muscular dystrophy (area under curve = 0.91–0.96).

Dual-task paradigms may reveal functional vulnerability in upper-limb performance in ambulant children with Duchenne muscular dystrophy that is not evident during single-task testing. Increased cognitive–motor demands appear to exacerbate functional difficulties beyond muscle weakness. These findings suggest that dual-task assessment may complement conventional clinical evaluations and provide additional insight for rehabilitation planning.

To explore, through reflective practice, physiotherapists’ perspectives on the meaning and establishment of the therapeutic relationship with patients.

The study formed part of a broader mixed-methods implementation study based on participatory action research and corresponded to the initial stages of recognition, analysis, action and observation, framed within a constructivist paradigm aimed at improving the therapeutic relationship. A qualitative study was conducted.

The study was carried out at the Rehabilitation Service of El Bierzo Hospital (Ponferrada, Spain).

All physiotherapists were invited to participate. Of the 19 physiotherapists and one physiotherapist manager invited, 18 consented to take part in the study.

Focus groups and self-observation through reflective diaries were undertaken. Focus groups were audio-recorded, and data from both methods were transcribed, coded, and thematically analysed.

Six key categories were identified that provide insight into how physiotherapists understand, construct, and experience the therapeutic relationship: (1) meaning of the therapeutic relationship, (2) importance of the therapeutic relationship, (3) purpose of the therapeutic relationship, (4) establishment of the therapeutic relationship, (5) bi-directionality in the therapeutic relationship, and (6) the environment of the therapeutic relationship.

This study highlights physiotherapists’ perceptions regarding the therapeutic relationship and how these are transferred to daily clinical practice. The therapeutic relationship is centred on accompaniment and trust. Participants emphasised the importance of initial patient contact, during which the therapeutic bond is established through a friendly and cordial approach. Subsequently, physiotherapists lack a structured process for the development of the therapeutic relationship.

To explore the experiences and perceptions of key stakeholders regarding social prescribing interventions.

Qualitative study incorporating focus groups and semi-structured interviews. Data was analysed thematically to identify themes and sub-themes. The Consolidated Criteria for Reporting Qualitative Research was used.

Urban communities in The Republic of Ireland.

Participants included people with long-term conditions (n = 12), link workers (n = 9), healthcare practitioners (n = 17), and community service representatives (n = 6).

Social prescribing interventions using community link workers

Face-to-face focus groups were conducted with individuals with long-term conditions and online focus groups with link workers, healthcare practitioners, and community service representatives. Online semi-structured interviews were conducted with General practitioner.

Transcripts were analysed using reflexive thematic analysis, using an inductive approach to develop codes, categories and themes. One overarching theme, three themes and six sub-themes were identified. The overarching theme ‘Between Promise and Precarity’ reflected the opportunities for growth, connection and sustainability alongside the challenges of implementing social prescribing. Theme 1 Promise had one sub-theme of empowerment and growth. Theme 2 was Fragmentation with two sub-themes of awareness and understanding. Theme 3 was Precarity with three sub-themes of workforce and resource insecurity, information gaps and evaluation shortfalls.

Social prescribing has the potential to improve health and well-being by empowering individuals to grow through social connection. However, poor stakeholder understanding and collaboration coupled with unclear link worker roles and resource constraints threaten its sustainability. Streamlined workflows, clear guidelines and robust stakeholder partnerships are required to ensure social prescribing succeeds.

To explore lived experience after young-onset stroke.

This embedded qualitative analysis formed part of a larger, ongoing observational follow-up study of young-onset stroke. Using an open-ended prompt at the end of a structured questionnaire, participants were invited to share further insights on their life after stroke. These responses formed the dataset for this qualitative analysis. Two authors developed codes and themes using reflexive thematic analysis, guided by the Biopsychosocial Model, and Coping and Adaptation Theory.

Telephone, electronic, or postal follow-up assessments were conducted between 13 September 2024 and 13 May 2025 with individuals who had been admitted to the University College London Hospitals Hyperacute Stroke Unit 5–8 years earlier with ischaemic stroke or intracerebral haemorrhage and were aged <55 at the time of stroke.

Of 127 eligible participants, 80 responded (age range: 20–54 years; 33 females; 65 with ischaemic stroke; 15 with intracerebral haemorrhage).

Four themes emerged: (1) persistent ‘hidden’ disabilities affecting daily life; (2) loss of sense of self and disruption of age-normative roles; (3) systemic gaps in stroke awareness and long-term support; and (4) emotional resilience developed in response to life disruption.

Young-onset stroke has profound and lasting effects, including ‘hidden’ disabilities that remain prevalent years later. Our findings emphasise the need for increased public awareness of young-onset stroke and call for a more holistic, long-term post-stroke care model that supports not only functional recovery but also the restoration of identity and life roles.

The comparative effectiveness of various mind-body exercises for chronic obstructive pulmonary disease remains unclear. This study aimed to compare and rank different mind-body interventions for improving objective and subjective outcomes in patients with chronic obstructive pulmonary disease.

We systematically searched PubMed, Web of Science, EMBASE, Cochrane Library, and Scopus.

Randomised controlled trials assessing mind-body exercises for chronic obstructive pulmonary disease were included. A network meta-analysis was performed using Stata 16.0. The protocol was registered with PROSPERO (CRD42024592835).

Thirty-seven studies involving 3179 participants and nine interventions were analysed. Regarding objective outcomes, Pilates plus pulmonary rehabilitation showed the largest improvement in exercise capacity. For pulmonary function, Pilates plus pulmonary rehabilitation significantly improved forced expiratory volume in the first second as a percentage of the predicted value and forced expiratory volume in the first second/forced vital capacity, while Yoga demonstrated superior effects on forced expiratory volume in the first second and forced vital capacity. Regarding subjective outcomes, Tai Chi, alone or combined with pulmonary rehabilitation, was superior in reducing dyspnea, while Tai Chi plus pulmonary rehabilitation and Qigong showed the greatest benefits for health-related quality of life.

Mind-body exercises are beneficial for chronic obstructive pulmonary disease management. Pilates plus pulmonary rehabilitation stands out for improving objective outcomes, particularly exercise capacity and pulmonary function, whereas Tai Chi, alone or combined with pulmonary rehabilitation, emerges as the most effective intervention for subjective outcomes, including dyspnea and health-related quality of life.

To explore the barriers and facilitators to leisure-time physical activity among community-dwelling adults with spinal cord injury in China, using the Capability, Opportunity, Motivation-Behaviour model as a theoretical framework.

A qualitative study employing semi-structured interviews.

Two rehabilitation centres in Guangzhou, China.

Twenty community-dwelling adults with spinal cord injury, purposively sampled for diversity in gender, age, injury level and severity.

The analysis identified multifaceted factors across the Capability, Opportunity and Motivation-Behaviour domains. Within the Capability domain, barriers included limited physical function and a pessimistic mindset, whereas facilitators encompassed strong psychological resilience, high self-efficacy and positive beliefs in rehabilitation. Opportunity was constrained by limited social resources, inadequate rehabilitation facilities and financial constraints, but was enhanced by diverse social support. Within the Motivation domain, engagement in leisure-time physical activity was hindered by low self-discipline, fear of physical activity and motivational conflict, while motivation was strengthened by reflection on the benefits of physical activity, a desire for social reintegration and return to work.

Promoting leisure-time physical activity among this population requires a theory-informed, multi-level intervention strategy. Interventions should simultaneously strengthen individual capability, expand opportunity and foster motivation. Crucially, such interventions must be contextually adapted to address China-specific socioeconomic constraints and cultural norms.

To establish the validity, reliability and fidelity of use of a screening tool for stroke survivors’ communication support needs during mental capacity assessments.

Cross-sectional psychometric study and multiple methods case series.

Participants’ homes and stroke units in north-west England.

Psychometrics: 47 community-dwelling stroke survivors; 10 speech and language therapists experienced in stroke. Fidelity: four nurses and one occupational therapist working in stroke; eight inpatients diagnosed with stroke.

Psychometrics: Stroke survivors were tested using the new communication screening tool and subtests from the Western Aphasia Battery Revised and Comprehensive Aphasia Test to measure convergent and discriminant validity, test-retest and interrater reliability. Data were analysed using Kendall's Tau, Goodman-Kruskal's Gamma and Cohen's Kappa.

The nurses and occupational therapist were videorecorded using the screening tool with inpatients. An observational checklist and semi-structured interviews were used to investigate adherence to predefined administration behaviours. Data were analysed using descriptive statistics and qualitative content analysis.

Psychometrics: Screening tool subtests demonstrated moderate-to-strong convergent validity (τ = 0.41–0.72) but poor discriminant validity (τ = 0.27–0.58). Criterion validity was strong (κ = 0.77, 95%CI 0.57–0.98). Test-retest reliability ranged from substantial to near-perfect (κ = 0.68–0.95). Interrater agreement ranged from substantial to perfect (κ = 0.65–1.00).

Participants adhered to a mean of 85.79% (SD = 10.33) administration behaviours. User errors related to task instruction delivery and scoring. All participants found the tool easy to use and useful.

This unique screening tool for stroke survivors’ communication support needs during mental capacity assessments is valid and reliable. Minor refinements to administration training will improve fidelity of use.

To determine the effect of falls-prevention exercise compared with nothing, sham or another exercise intervention on reducing falls after stroke. To also determine the effect of falls-prevention exercise on balance, mobility and quality of life.

Searches were conducted from inception to December 2025 on MEDLINE, EMBASE, Scopus and PEDro databases according to predefined search terms with details provided in supplementary materials.

Randomised trials were included if the intervention targeted falls and the primary outcome was the rate of falls or the number of people experiencing one or more falls. Other outcomes of interest were balance, mobility and quality of life. Methodological quality was rated with the PEDro scale. Two researchers independently extracted data, which was synthesised by meta-analysis.

Three trials (n = 677) were included in the review. Exercise trended towards a lower rate of falls compared to no/sham intervention (IRR 0.84, 95% CI 0.62 to 1.15, p = 0.29) with uncertainty in the estimate (confidence interval includes the possibility of no effect). Exercise did not reduce the number of individuals experiencing one or more falls (RR 0.98, 95% CI 0.81 to 1.18, p = 0.84). There was a trend towards improved balance (MD 0.49 steps in the Step Test, 95% CI −0.11 to 1.08, p = 0.11) and exercise did improve mobility a small amount (MD 0.04 m/s preferred walking speed, 95% CI 0.01 to 0.07, p < 0.01). No trials compared two exercise interventions.

There is a suggestion that exercise can reduce the rate of falls after stroke but does not affect the number of individuals falling.

PROSPERO CRD42024520272.

To initiate the development of an agreed core outcome set for post-stroke facial palsy, identifying which outcome domains should be measured in research and may inform clinical practice.

Two online e-Delphi rounds followed by an online consensus meeting.

International, multi-disciplinary.

Clinicians and researchers working in post-stroke facial palsy.

Delphi items were developed from existing literature, qualitative interviews with stroke survivors and patient/public involvement, then aligned with ICF levels. Participants completed two e-Delphi rounds rating outcome domains on a 1 to 9 GRADE scale: 7 to 9 ‘critical’; 1 to 3 ‘least important’. All domains were discussed at the consensus meeting and included in the final list if ≥70% of participants voted ‘yes’ to include the domain in the core outcome set.

In total, 156 Delphi questionnaires (round one, 101 participants from 16 countries; round two, 55 from 12 countries) were completed. Fifteen participants from 6 countries attended the consensus meeting. Three outcome domains were agreed for inclusion in the initial core outcome set: (1) facial movement and sensation, (2) everyday function, and (3) living with facial palsy.

We report the first internationally informed consensus between clinicians and researchers on ‘what’ outcome domains are important to measure for post-stroke facial palsy. We share these findings to encourage their measurement and to guide next steps. Our future work includes a separate consensus study, using a more inclusive methodology, on ‘what’ to measure with lived-experience stakeholders, and a systematic review on ‘how’ to measure these outcomes. COMET Initiative registration (December 2024): https://www.comet-initiative.org/Studies/Details/3295