Clinical Rehabilitation

This systematic review and meta-analysis aimed to evaluate the effects of cervical lateral glide and median nerve neural mobilisation compared to no treatment and other physical therapy treatments on pain, function and disability in patients with nerve-related neck and arm pain.

Electronic searches were conducted in MEDLINE, Science Direct, Cochrane Library, PEDro and Google Scholar up to 30 June 2025.

Randomised controlled trials were included following PRISMA guidelines. Two authors independently selected relevant studies, extracted data, assessed risk of bias (RoB2 tool), and rated evidence quality. Meta-analysis was performed using random-effects models due to expected heterogeneity. The study was registered on PROSPERO (CRD42020216739).

Overall, 20 studies with 953 patients met the inclusion criteria. Cervical lateral glide reduced pain compared to no treatment (3 studies, MD −2.47; 95%CI: −3.41, −1.53; P < .001) and other physical therapy techniques (2 studies, MD −1.29; 95%CI: −2.54, −0.05; P = .04). Median nerve neural mobilisation also reduced pain compared to no treatment (4 studies, MD −3.07; 95%CI: −3.78, −2.37; P < .001). Both interventions had modest effects on disability (12 studies, SMD −0.50 to −1.22), with moderate-to-high heterogeneity in analyses. The certainty of evidence was low to very low.

Cervical lateral glide and median nerve neural mobilisation are clinically effective for reducing nerve-related neck and arm pain as part of multimodal management strategies. The quality of evidence remains low as the level of certainty. Targeting a population with a clear nociceptive, increased neural mechanosensitivity or neuropathic component should lead to better clinical outcomes.

This scoping review aimed to comprehensively map interventions for post-stroke apathy and their effects.

The literature search for this review was performed using PubMed, Cumulative Index to Nursing and Allied Health Literature, and Web of Science, targeting studies published until August 7, 2025.

This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. The population included patients with post-stroke apathy; the concept focused on post-stroke apathy assessment and interventions and their effects. The context covered both general and community healthcare settings. Controlled vocabulary (e.g., MeSH terms) such as “post-stroke apathy,” “intervention,” and “effect” was used to formulate the search strategy. The eligible studies were independently screened by three reviewers, and final inclusion was determined through discussion.

Of the 565 studies identified, 13 met the inclusion criteria (n = 13). The mapping revealed that pharmacological interventions not only improved and prevented post-stroke apathy symptoms but also alleviated emotional blunting, reduced loss of motivation and interest, and enhanced social behavior and participation. Non-pharmacological interventions were associated with symptom relief and recovery over time. Furthermore, combined pharmacological and non-pharmacological approaches contributed to improvements not only in post-stroke apathy but also in depression, language function, and behavioral aspects.

The findings suggest that appropriate treatment for post-stroke apathy may lead to symptom relief, improvement, and prevention while enhancing language function, behavior, and social participation. Future research should focus on systematic reviews and meta-analyses to establish evidence-based recommendations for post-stroke apathy treatment strategies and their optimal combinations.

Moderate to severe persistent pain can affect up to 25% of people after a knee replacement for osteoarthritis. The aim of the trial was to test the feasibility of implementing Kneed, a novel digital pain rehabilitation self-management programme.

Prospective, two group parallel randomised pilot study.

Online in Australia.

Adults with persistent pain rated as ≥4/10 in the operated knee more than 3 months post-knee replacement for osteoarthritis.

The Kneed group were provided with 8 weeks of access to a digital pain rehabilitation self-management programme and compared to usual care.

Recruitment, acceptability, usability and limited efficacy with descriptive statistics.

Sixty participants, mean age 68.7 years, 75% female, 66.7% retired and 43% living outside metropolitan areas, were recruited between 15 October and 19 December, 2024 via social media advertising with 418 online eligibility surveys performed. There were 190 (45.5%) deemed potentially eligible; 82 (19.6%) left contact details and 60 (14.4%) consented. At 8 weeks, there were 48 (80%) participants remaining in the trial (20 Kneed (64.5%), 28 usual care (96.6%)). A majority of the Kneed group found the Kneed programme acceptable, would use it again and found that it helped them effectively manage pain and function.

It is feasible to recruit and retain older Australians with moderate to severe knee pain post-knee replacement for a trial testing a digital pain rehabilitation self-management programme. A larger trial is indicated to further test the clinical effectiveness of Kneed to reduce pain and improve function.

Evaluate the internal consistency, inter-rater and test–retest reliability, convergent and divergent validity and clinical usability of the Cognition in Daily Life scale for patients with acquired brain injury.

Validation study.

A total of 75 patients with acquired brain injury (mostly male [n = 47, 68%]; mean age 67 years) were recruited from inpatient care facilities. Sixty participants (81%) had sustained a stroke.

Outcome measure: Cognition in Daily Life scale. Reference measures: Utrecht Scale for Rehabilitation-Cognition subscale, Montreal Cognitive Assessment, Barthel Index, Hospital Anxiety and Depression Scale and Fatigue Severity Scale.

After removing redundant items, all subscales of the Cognition in Daily Life scale demonstrated satisfactory internal consistency. Test–retest reliability was good (intraclass correlation coefficient [ICC] = 0.847), and inter-rater reliability was moderate (ICC = 0.615). Convergent validity was confirmed through moderately strong correlations between most subscales of the Cognition in Daily Life Scale and other measures of cognition. Cognition in Daily Life subscales generally did not correlate with the Hospital Anxiety and Depression Scale and Fatigue Severity Scale, indicating divergent validity. Moderate correlations with the Barthel Index suggested related, but distinct constructs. Clinicians found the Cognition in Daily Life scale easy to administer and relevant for practice, though time-consuming. They suggested layout improvements for greater usability.

The Cognition in Daily Life scale is adequately valid, reliable and clinically usable for assessing cognition in daily life in patients with acquired brain injury in a clinical setting. Future research needs to evaluate the scale's sensitivity to change and its performance in other settings and populations.

To explore the perspectives and experiences of patients with knee osteoarthritis regarding physiotherapy care management in Hong Kong.

Qualitative study using semi-structured, individual interviews.

Community.

Patients age 50 years or older with knee osteoarthritis, purposively recruited.

Face-to-face semi-structured interviews were conducted with patients who had completed a physiotherapy rehabilitation programme in the past six months.

A 21-question interview guide encouraged participants to discuss their physiotherapy management, experiences, and recommended interventions, covering all non-pharmacological treatments outlined in local clinical guidelines. Questions also explored factors influencing adherence to care during and after physiotherapy. Interviews were audio-recorded, transcribed verbatim, and analysed thematically.

Fourteen patients participated. Five key themes emerged: (a) navigating pain and management strategies; (b) adapting daily life and the impact of knee osteoarthritis on activities; (c) complexities of treatment and the need for personalised care; (d) the role of exercise and mobility; and (e) barriers to access and resources. While patients reported receiving various physiotherapy interventions, gaps were noted in aquatic therapy, neuromuscular training, weight management, and assistive devices. Barriers included limited access, financial constraints, and lack of home exercise equipment. Although participants valued physical activity, maintaining an exercise routine was challenging.

A comprehensive, patient-centred approach is essential for effective physiotherapy care for knee osteoarthritis in Hong Kong. Addressing practical barriers and integrating patient feedback can enhance the accessibility and impact of evidence-based interventions.

To adapt and modify the successful SIESTA (Sleep for Inpatients: Empowering Staff to Act) sleep-promoting hospital protocol to an acute stroke rehabilitation setting.

This study utilized a mixed methods design, involving qualitative surveys and interviews. Needs assessment and staff interviews informed the development of the adapted protocol, SIESTA-Rehab.

Inpatient unit treating persons with neurological injury, primarily stroke, in an acute rehabilitation hospital.

Nursing staff on the inpatient unit where SIESTA-Rehab was implemented.

After identifying needs, we adapted the SIESTA protocol with relevant modifications to SIESTA-Rehab. Protocol adaptations were guided by the Culture, Oversight, Systems Change, Training framework, with a focus on developing nursing education and sleep-enhancing tools. The protocol was implemented over a four-year period, sustained through periodic staff re-education, and nursing staff perceptions of the intervention were evaluated using fidelity interviews.

Qualitative assessments were conducted from a convenience sample of nurses to gauge understanding, recall, ease of implementation, and individual re-education needs for SIESTA-Rehab.

Initial staff feedback indicated limited awareness of sleep disorder screening and sleep optimization practices, highlighting the absence of sleep-based assessments during standard care. Initial unit-wide training was conducted on SIESTA-Rehab for nursing staff (N = 29), with ongoing education for new staff and periodic re-education for existing staff over 4 years of implementation. Fidelity interviews revealed high understanding, recall, and ease of implementing the intervention over survey periods.

SIESTA-Rehab can be successfully implemented in an acute rehabilitation setting, as indicated through positive staff responses.

To explore the attitudes and practice of allied health professionals working in stroke care in Ireland regarding recommended amounts of therapy set out in the National Clinical Guideline for Stroke (2023).

Qualitative descriptive study using one-to-one semi-structured interviews. Data were analysed using reflexive thematic analysis.

Five large acute teaching hospitals in Dublin, Ireland.

The 11 participants were allied health professionals working in acute and subacute stroke care in Dublin, and were recruited using a combination of purposive and snowball sampling.

Two main themes emerged: ‘Barriers and enablers to achieving guideline recommended therapy time’ and ‘Methods of increasing therapeutic time’. Patient factors and clinical resources impact on the provision of therapy post-stroke. Overall, participants felt positive about the recent guideline recommendation for increased therapeutic time. Various methods are employed to augment patient therapeutic time, including technology and semi-supervised practice. Participants perceived that Therapy Assistants play an important role in achieving greater amounts of therapy.

Allied health professionals view the new Stroke Guidelines recommendation for increased therapy intensity as challenging but are generally positive in trying to achieve it, citing the benefits of increased therapy time for patient outcomes. They utilise a wide range of methods to optimise therapeutic time for stroke survivors. The role of the therapy assistant in supporting the delivery of larger amounts of therapy time warrants further evaluation.

To evaluate the perceptions, knowledge, and attitudes of multidisciplinary clinicians within a healthcare organisation completing a stroke-integrated cardiac rehabilitation research programme in addition to usual care neurorehabilitation.

A qualitative study based on a phenomenological approach.

One-on-one, semi-structured, qualitative interview completed either face-to-face or over the telephone.

Fourteen multidisciplinary clinicians (e.g., physical therapists, occupational therapists, psychologists, speech therapists, cardiac nurses and a physician) working in usual care neuro- and cardiac-rehabilitation.

Two independent researchers completed line-by-line coding and thematic analysis and derived relevant themes and sub-themes addressing the research question. To enhance trustworthiness and transparency of findings, a third researcher reviewed final themes.

Three main themes emerged with 3–4 relevant sub-themes. The first theme was clinicians’ knowledge. Participants were aware of exercise recommendations within the clinical stroke guidelines, but their knowledge of the content of the recommendations, and the stroke-integrated cardiac rehabilitation programme, varied. The second theme was clinicians’ attitudes and beliefs towards the stroke-integrated cardiac rehabilitation programme. All participants described exercise as being important and believed the stroke-integrated cardiac rehabilitation programme was a good idea. However, clinicians highlighted numerous barriers and suggested programme adaptations (third theme) to the stroke-integrated cardiac rehabilitation programme. Increased awareness of the stroke-integrated cardiac rehabilitation programme, and a more flexible and adaptable programme, may enhance future implementation.

Clinicians believed the stroke-integrated cardiac rehabilitation programme was important and had clinical utility. Increased awareness of evidence-based recommendations, and a more flexible and adaptable programme may aid uptake and future implementation.

This study adopted a novel approach to exploring the content validity, safety, usability, and user experiences of different games for telerehabilitation purposes from the perspective of physiotherapists and stroke survivors.

A cross-sectional content validity and usability study.

Lab and online.

23 participants were recruited; 11 neuro-physiotherapists and 12 chronic stroke survivors.

Content validity and safety were assessed using a bespoke state evaluation questionnaire. The usability was evaluated using the system usability scale (SUS) and user experience questionnaire (UEQ). House of Quality analysis was conducted to identify the priority aspects for improvement.

Physiotherapists perceived the usability of the games as good to excellent for three games, median SUS = 80%, and poor for two games SUS < 68%. Three games had a mean average content validity index (CVI) > 0.8, and all games were safe to be administrated at home; mean CVI-safety item = 0.90. Stroke survivors with Fugl-Meyer Assessment of Upper Extremity function mean (SD) = 41(19.4), and mild to moderate spasticity perceived usability as very good to excellent for four games (median SUS = 85%). UEQ scale showed good to excellent acceptance among most of the games. House of Quality analysis revealed that clear instructions, avatar quality, motivational exercise scenarios, and clinical assessment tools are important criteria that should be considered throughout the development.

This study demonstrated the value of exploring patient and physiotherapist perspectives for better telerehabilitation interventions co-development. Clinical trials should be conducted after further refinement of the games to investigate their feasibility and potential efficacy as a telerehabilitation tool for arm and balance training.