QUESTION: What are the relative effects of inspiratory muscle training (IMT) performed on an unstable or a stable seated surface and sham training on respiratory function, diaphragmatic thickness, balance/functional mobi...QUESTION: What are the relative effects of inspiratory muscle training (IMT) performed on an unstable or a stable seated surface and sham training on respiratory function, diaphragmatic thickness, balance/functional mobility, exercise capacity and quality of life in people after stroke? DESIGN: A randomised trial with concealed allocation, blinded assessors and intention-to-treat analysis. PARTICIPANTS: Eighty-eight adults after stroke. INTERVENTION: Participants were randomly allocated to three groups: IMT at 50% maximal inspiratory pressure (MIP) while seated on an unstable surface (unstable IMT), the same training on a stable surface (stable IMT), and IMT at 10% MIP on a stable surface (sham). All participants received conventional rehabilitation and their allocated IMT protocol for 4 weeks. OUTCOME MEASURES: Diaphragmatic thickness, forced expiratory volume in 1 second, forced vital capacity, MIP, Trunk Impairment Scale (TIS), Timed Up and Go (TUG), 6-minute walk distance and Stroke Impact Scale were assessed at weeks 0, 4 and 16. Postural sway using centre of pressure analysis during seated balance tasks was used to evaluate trunk balance at weeks 0 and 4. RESULTS: Compared with sham at week 4, stable IMT improved diaphragmatic thickness, respiratory function, TIS and TUG, whereas unstable IMT improved these same outcomes - typically with about 50% greater magnitude of benefit - and also improved 6-minute walk distance, Stroke Impact Scale and centre of pressure measures. Many of the benefits of stable IMT and most of the benefits of unstable IMT were maintained at week 16. CONCLUSION: As an adjunct to conventional rehabilitation, IMT at 50% MIP improves diaphragmatic thickness, respiratory function, TIS and TUG. Adding a postural challenge to the IMT increased the magnitude of these benefits and yielded additional benefits in exercise capacity, quality of life and dynamic sitting balance. We recommend IMT on an unstable surface as a complementary, synergistic adjunct to conventional post-stroke rehabilitation. REGISTRATION: NCT06640101.
INTRODUCTION: This paper highlights research relating to diagnosis and prognosis in low back pain (LBP) published between January 2020 and September 2025. METHODS: To identify studies for inclusion, we searched Medline,...INTRODUCTION: This paper highlights research relating to diagnosis and prognosis in low back pain (LBP) published between January 2020 and September 2025. METHODS: To identify studies for inclusion, we searched Medline, CINAHL and the Cochrane Database of Systematic Reviews. Search results were screened and relevant studies were grouped according to their topic area. From those results, we selected studies that were perceived to be of great clinical importance, particularly high quality and/or controversial. FINDINGS: This narrative review synthesised five key themes in LBP research. For Theme 1 (Serious pathologies presenting as LBP), we found that serious spinal conditions are rare, and clinicians should assess overall concern using a combination of alerting features rather than isolated red flags. In Theme 2 (Imaging in LBP management), we discussed the limited role of imaging, noting its continued overuse and frequent inappropriate application. In Theme 3 (Diagnostic uncertainty), we highlighted that LBP often lacks a clear anatomical cause and that embracing uncertainty while focusing on modifiable factors can help patients feel more supported and in control. Theme 4 (Clinical course and pain trajectories) showed that although recovery is common in recent onset LBP, recurrences are frequent; even long-lasting pain can improve. Traditional labels such as 'acute' and 'chronic' often fail to capture the fluctuating nature of LBP. Finally, in Theme 5 (Prognostic factors and prediction models), we presented patient characteristics related to delayed recovery but highlighted that current prediction models are not yet ready for clinical implementation. We provided direction for future research across all themes. The identified themes help clinicians make informed, evidence-based decisions and navigate current uncertainties in diagnosis and prognosis.
QUESTION: Is mirror therapy, using only the intact upper limb (unilateral), superior to the same amount and type of practice without the mirror at reducing upper limb impairments or activity limitations? Is mirror therap...QUESTION: Is mirror therapy, using only the intact upper limb (unilateral), superior to the same amount and type of practice without the mirror at reducing upper limb impairments or activity limitations? Is mirror therapy, using the intact and the affected upper limb (bilateral), superior to the same amount and type of practice without the mirror at reducing upper limb impairments or activity limitations? DESIGN: Systematic review of randomised trials with meta-analysis. PARTICIPANTS: Adults at any time after stroke of any severity. INTERVENTION: Supervised mirror therapy for the upper limb. OUTCOME MEASURES: Motor impairments and/or activities. RESULTS: A total of 19 trials, involving 618 participants, were included. The mean PEDro score of the trials was 6 (range 3 to 8). Low-level evidence indicates that unilateral mirror therapy may have a moderate effect on motor recovery (SMD 0.48, 95% CI 0.14 to 0.82) and moderate level evidence indicates that this is similar in terms of the Fugl-Meyer Assessment (MD 5 out of 66 points, 95% CI 0 to 10). Moderate-level evidence indicates that bilateral mirror therapy has little or no effect on motor recovery (SMD 0.15, 95% CI -0.07 to 0.38) and moderate level evidence indicates that this is similar in terms of the Fugl-Meyer Assessment (MD 2 out of 66 points, 95% CI -1 to 6). CONCLUSION: This systematic review suggests that unilateral mirror therapy may improve motor recovery after stroke. In contrast, bilateral mirror therapy appears to offer little benefit compared with practice without the mirror. REGISTRATION: PROSPERO (CRD420251038374).
QUESTION: What barriers and facilitators do physiotherapists and aged care facility staff perceive regarding the involvement of family caregivers in physiotherapy and exercise for residents with dementia? DESIGN: Reflexi...QUESTION: What barriers and facilitators do physiotherapists and aged care facility staff perceive regarding the involvement of family caregivers in physiotherapy and exercise for residents with dementia? DESIGN: Reflexive thematic analysis with semi-structured interviews to explore the subjective experiences of physiotherapists and aged care staff, grounded in a constructivist ontology. METHODS: We conducted 28 semi-structured interviews with 19 physiotherapists and 9 aged care facility staff members concerned with family participation. Participants were selected from Dutch aged care facilities providing care for residents with dementia. Interviews were recorded and transcribed and subsequently analysed using inductive thematic coding. RESULTS: The perceived barriers included the burden placed on family caregivers, particularly during the transition to an aged care facility, and the need for adequate information and guidance to ensure successful involvement. In addition, it was found that an unwelcoming environment fostered by physiotherapists and staff hinder family members' participation. Facilitators included a proactive approach of physiotherapists regarding the collaboration and information provision on practical aspects of exercise, particularly when supported by technology or exergaming. Other facilitators were the family caregivers' previous healthcare experience and cultural factors emphasising the importance of family support. CONCLUSION: The study identified barriers to family caregiver involvement, such as perceived caregiver burden and lack of role clarity, alongside facilitators such as previous caregiving experience, culturally rooted family values and strong social or religious networks. Physiotherapists and aged care facilities could improve collaboration by proactively discussing family caregiver roles, adopting flexible approaches, and using inclusive (digital) communication methods to support ongoing caregiver engagement.
QUESTION: How effective is a telerehabilitation program in reducing reports of pelvic floor dysfunction in women after gynaecological cancer treatment? DESIGN: Randomised controlled trial with blinded assessors, conceale...QUESTION: How effective is a telerehabilitation program in reducing reports of pelvic floor dysfunction in women after gynaecological cancer treatment? DESIGN: Randomised controlled trial with blinded assessors, concealed allocation and intention-to-treat analysis. PARTICIPANTS: Fifty-eight women reporting urinary incontinence (UI) after treatment for gynaecological cancer. INTERVENTIONS: Experimental group participants were allocated to undertake telerehabilitation sessions including pelvic floor muscle training once a week for 12 weeks. The control group received usual care. OUTCOME MEASURES: The primary outcome was the prevalence of UI on the International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI-SF). The secondary outcomes were: the impact of UI on quality of life (ICIQ-UI-SF), sexual function (Female Sexual Function Index), dyspareunia (numerical assessment scale), self-esteem (Rosenberg), pain (numerical assessment scale), faecal incontinence, stool consistency, vaginal stenosis, quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire) and level of physical activity. After 12 weeks, the telerehab group also responded about treatment satisfaction, adherence and system usability. RESULTS: After 12 weeks, the experimental group had better outcomes than the control group in several areas: prevalence of UI (RD -0.45, 95% CI -0.62 to -0.23); total ICIQ-UI-SF score (MD -9.5, 95% CI -11.8 to -7.1); pelvic pain (MD -3.1, 95% CI -4.7 to -1.4); self-esteem (MD 2.9, 95% CI 0.7 to 5.1); and measures of vaginal stenosis and quality of life. CONCLUSION: A 12-week telerehabilitation program was effective in reducing reports of UI, severity of UI, pelvic pain and dyspareunia in women after the treatment of gynaecological cancer. REGISTRATION: Brazilian Clinical Trials Registry (ReBEC) RBR-8ht5nqq.