Clinical Rehabilitation[JOURNAL]
Sun
200 papers
Effects of dual-task training on walking and balance in stroke patients: A systematic review and network meta-analysis.
Zhao Y, Guo C, Zhang D … +3 more , Wei X, Jiang X, Bi H
Clin Rehabil · 2026 Apr · PMID 41269895 · Publisher ↗
ObjectiveThis study aimed to compare the effects of different dual-task training modalities on walking and balance in stroke patients using network meta-analysis.Data sourcesRandomized controlled trials were searched in...
ObjectiveThis study aimed to compare the effects of different dual-task training modalities on walking and balance in stroke patients using network meta-analysis.Data sourcesRandomized controlled trials were searched in PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, and Chinese Biomedical Database from inception to September 2025.Review methodsMethodological quality was assessed using the Cochrane risk-of-bias tool. A frequentist approach was applied for network meta-analysis, and evidence quality was evaluated with confidence in the network meta-analysis framework.ResultsThirty-four trials covering 10 dual-task modalities were included. Network meta-analysis results showed that motor-walking dual-task training was the most effective in improving cadence (mean difference = 7.04, 95%: 1.95 to 12.12), walking speed (standardized mean difference = 0.67, 95%: 0.27 to 1.06), step length (standardized mean difference = 0.56, 95%: 0.20 to 0.92), stride (standardized mean difference = 0.76, 95%: 0.45 to 1.08), 10-Meter Walk Test (standardized mean difference = 0.73, 95%: 0.05 to 1.12) and berg balance scale (mean difference = 5.76, 95%: 1.38 to 10.14). Cognitive-balance dual-task training showed the greatest improvement in Timed Up and Go test (mean difference = -4.73, 95%: -10.24 to -0.78). The certainty of evidence for most outcomes, assessed using the Grading of Recommendations Assessment, Development and Evaluation framework, ranged from very low to high.ConclusionsMotor-walking dual-task training best improved cadence, walking speed, step length, stride, 10-Meter Walk Test, and Berg Balance Scale. Cognitive-balance dual-task training showed the greatest improvement in Timed Up and Go test. These results inform future guidelines and clinical decisions for stroke patients' walking and balance rehabilitation.
A patient-centred ICF-based comprehensive framework for rehabilitation in Austria: Development and implementation.
Honegger M, Skoumal M, Pertinatsch C … +4 more , Neubacher B, Kadane C, Lindner-Rabl S, Roller-Wirnsberger R
Clin Rehabil · 2026 Mar · PMID 41259261 · Publisher ↗
ObjectiveAustria's rehabilitation system lacked personalisation, alignment with the International Classification of Functioning, Disability, and Health (ICF), and measurable quality indicators. To address these gaps, a u...
ObjectiveAustria's rehabilitation system lacked personalisation, alignment with the International Classification of Functioning, Disability, and Health (ICF), and measurable quality indicators. To address these gaps, a unified change management approach aligned with international standards and the biopsychosocial model was developed. The resulting Comprehensive Framework for Rehabilitation Standards, Practices, and Services aimed to establish a patient-centred, evidence-informed model integrating policy, quality, and practice.Local contextRehabilitation in Austria is provided by social insurance institutions, including the Pension Insurance Austria, which defines medical and therapeutic specifications for rehabilitation services. Historically, these were disease-centred, heterogeneous, and lacked individualisation.MethodsThe development followed a co-creation process involving focus groups with interdisciplinary staff from rehabilitation centres. Implementation in 17 centres across Austria required process and information technology adaptations as well as capacity building. Thirteen key performance indicators were established for monitoring, evaluation, and benchmarking.ResultsAfter three quarters of implementation, all centres adhered to six key performance indicators, including staff and patient satisfaction, functional status assessment, quality of life screening, work-related rehabilitation needs, and follow-up rehabilitation referrals. Challenges included consistent ICF application, individual goal-setting, and therapy planning tailored to impairment severity. Implementation problems mirrored those reported internationally. Strong leadership, interdisciplinary collaboration, and early information technology engagement were key enablers.ConclusionThe framework operationalised international rehabilitation standards into a scalable national model. Its ICF-based design demonstrated that large-scale, patient-centred, participation-oriented rehabilitation is achievable through structured change management. Future evaluations should assess long-term outcomes and adaptability across health systems with varying digital maturity.
Impact of mobility dose levels on functional outcomes in individualised patients with critical illness: A multicentre prospective observational cohort study in Japan.
Watanabe S, Yamauchi K, Naito Y … +8 more , Shinohara A, Hirasawa J, Mizutani M, Kawamura M, Morita Y, Kozu R, Iida Y, from the RELIFE Network
Clin Rehabil · 2026 Mar · PMID 41252336 · Publisher ↗
ObjectiveTo investigate the association between individualised rehabilitation dose levels and functional outcomes across age- and frailty-specific cohorts of critically ill patients.DesignMulticentre prospective observat...
ObjectiveTo investigate the association between individualised rehabilitation dose levels and functional outcomes across age- and frailty-specific cohorts of critically ill patients.DesignMulticentre prospective observational cohort studySettingIntensive care units at 22 hospitals in Japan.ParticipantsOverall, 422 adult patients receiving mechanical ventilation for ≥48 h were categorised into old non-frail (age ≥65 years, clinical frailty scale: 1-4), old frail (age ≥65 years, clinical frailty scale: > 4) and middle-aged/young (age <65 years) cohorts.Main measuresThe primary outcome was independence in activity of daily living at hospital discharge, defined by a Barthel Index score of ≥90. Rehabilitation parameters dose, intensity, duration, frequency and timing were assessed. Multivariable logistic regression analysis was performed for each cohort.ResultsIn the old non-frail cohort, activity of daily living independence was associate with higher dose (odds ratio: 1.10, 95% confidence interval: [1.04-1.17]), higher intensity (odds ratio: 1.18 [1.02-1.37]) and shorter time to first mobilisation (odds ratio: 0.92 [0.86-0.98]), whereas, in the old frail cohort, it was higher dose (odds ratio: 1.07 [1.02-1.18]), longer duration (odds ratio: 1.05 [1.01-1.12]) and higher frequency (odds ratio: 1.82 [1.07-4.62]). In the middle-aged/young cohort, activity of daily living independence was associated with higher dose (odds ratio: 1.14 [1.05-1.28]) and higher intensity (1.30 [1.06-1.62]).ConclusionsThe impact of rehabilitation dose on functional recovery varies across age- and frailty-specific cohorts. These findings highlight the importance of tailoring rehabilitation dose to patient characteristics to optimise functional outcomes in critical illness. UMIN000036503.
A study of the reliability and validity of the Six-Spot Step Test Cognitive in ambulatory people with diabetic peripheral neuropathy.
Laugesen AK, Køhler E, Buhl CS … +1 more , Brincks JK
Clin Rehabil · 2026 Apr · PMID 41252317 · Publisher ↗
ObjectivesCognitive decline and impaired balance are well-documented in people with diabetic peripheral neuropathy; however, no ambulation assessments currently address the cognitive dual-task demands specific to this po...
ObjectivesCognitive decline and impaired balance are well-documented in people with diabetic peripheral neuropathy; however, no ambulation assessments currently address the cognitive dual-task demands specific to this population. The Six-Spot Step Test Cognitive is a brief, functional mobility test designed to equally emphasize cognitive and motor components. This study evaluated its construct validity and test-retest reliability in people with diabetic peripheral neuropathy.DesignCross-sectional study.SettingOutpatient clinics.ParticipantsFifty-five people with diabetic peripheral neuropathy.Main measuresThe Six-Spot Step Test Cognitive was completed twice within the same day and again three to seven days later. Additionally, the cognitive Timed "Up and Go" test and the Mini-BESTest were administered on the last day. Reliability and validity were estimated using Bland-Altman statistics, the minimal difference, Intraclass Correlation Coefficient, and Spearman's rank correlation coefficient.ResultsThe Six-Spot Step Test Cognitive was found reliable (Intraclass Correlation Coefficient: 0.88-0.92; minimal difference: 27.2%-31.4%) and showed moderate construct validity to the cognitive Timed "Up and Go" test (Spearman's rank correlation coefficient = 0.55, < .001). Weak correlations with the Mini-BESTest (Spearman's rank correlation coefficient = -0.26, < .06) indicated low construct validity. Significantly higher dual-task costs were observed when performing the Six-Spot Step Test Cognitive (58.7%) compared to the cognitive Timed "Up and Go" test (29.6%).ConclusionsIn people with diabetic peripheral neuropathy, the Six-Spot Step Test Cognitive demonstrated promising construct validity and acceptable to excellent reliability, making it a valid measure of functional mobility, including cognitive dual-tasking. Additionally, a higher dual-task cost indicated actual cognitive-motor interference while performing the test.
Overt Agitation in Patients With Prolonged Disorders of Consciousness: Prevalence, Clinical Characterization and Predictive Value.
Barra A, Magliacano A, Navarro MD … +3 more , Estraneo A, Noé E, Llorens R
Clin Rehabil · 2026 Mar · PMID 41248185 · Publisher ↗
BackgroundAgitation is frequently observed in patients with severe acquired brain injury and prolonged disorders of consciousness.ObjectivesTo evaluate the incidence of agitation and its diagnostic and predictive value,...
BackgroundAgitation is frequently observed in patients with severe acquired brain injury and prolonged disorders of consciousness.ObjectivesTo evaluate the incidence of agitation and its diagnostic and predictive value, in patients with disorders of consciousness.MethodsIn this retrospective observational cohort study, data from patients in unresponsive wakefulness state, minimally conscious state and emerged from the minimally conscious state was analyzed. Demographic and clinical information on agitation, disability, and neurobehavioral condition (i.e., Overt Agitation Severity Scale, Disability Rating Scale, and the Coma Recovery Scale-Revised Index) were collected at admission to a rehabilitation facility and long-term acute care hospital, and 24 months post admission.ResultsOne hundred and nineteen patients (unresponsive wakefulness state = 62, minimally conscious state = 57), of which 68.1% (unresponsive wakefulness state = 35, minimally conscious state = 46) exhibited signs of agitation with varying intensity. Patients in minimally conscious state showed significantly higher Overt Agitation Severity Scale scores in the upper and lower limb subscales, compared to patients in unresponsive wakefulness state ( < .001 and = .007, respectively). The Overt Agitation Severity Scale total score showed significant correlations with both the Coma Recovery Scale-Revised Index and the Disability Rating Scale total score. At 24 months after admission, 41 patients (11.3% unresponsive wakefulness state, 59.7% MCS) emerged from the minimally conscious state, whereas 78 patients were still in a disorder of consciousness. A logistic regression model found that traumatic etiology, higher Coma Recovery Scale-Revised Index and higher Overt Agitation Severity Scale total score increased the probability of emergence from the minimally conscious state at 24 months (accuracy = 80.7%).ConclusionsOur results provide the first evidence for agitation as a diagnostic and prognostic marker of recovery of consciousness.
Exploring staff views about implementing hospital-based Exergames to support older adults with frailty: A qualitative study.
Stanmore E, Fisher K, Birch C … +4 more , Hurst H, Chillala J, Dowding D, Briggs M
Clin Rehabil · 2026 Mar · PMID 41232087 · Publisher ↗
ObjectiveTo explore the views of staff in hospital rehabilitation wards about factors influencing implementation of Exergames for older adults with mild to moderate frailty.DesignQualitative descriptive study.SettingThre...
ObjectiveTo explore the views of staff in hospital rehabilitation wards about factors influencing implementation of Exergames for older adults with mild to moderate frailty.DesignQualitative descriptive study.SettingThree rehabilitation and frailty wards across two NHS hospital settings in the North West of England.ParticipantsA purposive sample of 22 healthcare professionals was recruited to take part in the study.InterventionTherapy staff were instructed on how to use the Exergames with patients. Trained therapists, and other healthcare professionals, took part in a focus group or semi-structured interview to share perceived constraints to Exergames implementation. The research physiotherapist also reflected on each ward's response to the intervention, and the Exergames training sessions. Pre-implementation actions in the Quality Implementation Framework informed the topic guide and analysis. Data was analysed using the Framework approach.ResultsThree face-to-face focus groups and seven interviews (in-person or online) were conducted, and the research physiotherapist recorded 25 h of observations. Themes represented factors impacting Exergames use in a hospital environment. These included: competing priorities for staff availability and time; buy-in from key stakeholders; the user-friendly integration of the Exergames system; flexible training sessions and development of a feasible and effective delivery framework.ConclusionsThe dynamic nature of hospital wards, such as changes of staff and ward focus, and complexity of interactions within and between individual, ward and organisational levels, means effective Exergames implementation requires coordinated efforts and ongoing adaptability.
The effect of blood flow restriction in chronic obstructive pulmonary disease: A systematic review and meta-analysis.
Alves IGN, Eufrasio AM, Gomes-Neto M … +3 more , Silva CMSE, Martinez BP, Jezler SFO
Clin Rehabil · 2026 Mar · PMID 41232084 · Publisher ↗
ObjectiveTo evaluate the efficacy and safety of blood flow restriction (BFR) training on exercise capacity, muscle strength, pulmonary function, and fatigue in individuals with chronic obstructive pulmonary disease (COPD...
ObjectiveTo evaluate the efficacy and safety of blood flow restriction (BFR) training on exercise capacity, muscle strength, pulmonary function, and fatigue in individuals with chronic obstructive pulmonary disease (COPD).MethodsA comprehensive search was conducted in six databases up to April 2025. Randomized controlled trials involving adults with COPD undergoing BFR training were included. Methodological quality was assessed using the Cochrane Risk of Bias 2 tool, and the certainty of evidence was graded according to Grading of Recommendations Assessment, Development and Evaluation guidelines.ResultsOf 573 records identified, three randomized clinical trials with a total of 127 participants met the inclusion criteria. Intervention durations ranged from 2 to 24 weeks with varying occlusion pressures and outcome measures. Meta-analysis showed no significant improvements in six-minute walk distance (mean difference: 20.83; 95% CI [-14.97 to 56.63]; very low certainty), or muscle strength (SMD: 0.78; 95% CI [-0.66 to 2.22]; very low certainty). A significant reduction in fatigue was observed (SMD: -0.48; 95% CI [-0.92 to -0.04]; very low certainty). Overall, the quality of evidence was rated very low.ConclusionCurrent evidence is insufficient to draw firm conclusions regarding the efficacy and safety of BFR training in COPD. Further high-quality, standardized RCTs are necessary to clarify its clinical utility and safety.
High-intensity interval training after stroke: A mixed-methods systematic review and meta-analysis of safety, feasibility and acceptability.
Blatgé H, Paul L, van Wijck F
Clin Rehabil · 2026 Mar · PMID 41232083 · Full text
ObjectiveTo synthesise evidence regarding the safety, feasibility and acceptability of high-intensity interval training in adults post-stroke.Data sourcesA systematic literature search using eight major databases from in...
ObjectiveTo synthesise evidence regarding the safety, feasibility and acceptability of high-intensity interval training in adults post-stroke.Data sourcesA systematic literature search using eight major databases from inception to January 2025.Review methodsStudies of any design, involving adults post-stroke, reporting on safety, feasibility and/or acceptability of any type of high-intensity interval training, were eligible. Methodological quality was assessed using the Effective Public Health Practice Project or the Mixed Methods Appraisal Tool, as appropriate. Meta-analyses of adverse events and dropouts were undertaken on data from randomised controlled trials. GRADE methodology was used to categorise the level of certainty of the evidence from each meta-analysis.ResultsTwenty studies plus one follow-up and a cost analysis, involving 658 participants, were included. Methodological quality varied. High-intensity interval training was mainly conducted individually and in supervised settings. There were no fatalities related to high-intensity interval training. There was low-moderate certainty of no difference in the risk of adverse events, whether these were intervention-related, non-intervention related or unclear. Average attendance at high-intensity interval training sessions was 94.4%. Reporting on acceptability of high-intensity interval training was scarce, but where reported participants' experiences were generally favourable.ConclusionThis systematic review found low-moderate certainty evidence that high-intensity interval training can be safe and feasible for carefully selected, generally younger, mildly affected, male stroke survivors in the chronic stage, supervised by trained professionals in controlled settings. Future studies should investigate experiences of high-intensity interval training and explore its use in a wider stroke population and range of settings.
Comparison of balance-confidence between glaucoma and age-related macular degeneration patients who live in a developing country.
Ottaiano-Poli PA, Germano-Morrel CS, Tomishige KS … +2 more , Macchione RM, Kasahara N
Clin Rehabil · 2026 Mar · PMID 41223116 · Publisher ↗
ObjectiveTo compare balance-confidence among patients with primary open-angle glaucoma, age-related macular degeneration, and controls in Brazil.DesignCase-control study.SettingCharity hospital in São Paulo, Brazil.Parti...
ObjectiveTo compare balance-confidence among patients with primary open-angle glaucoma, age-related macular degeneration, and controls in Brazil.DesignCase-control study.SettingCharity hospital in São Paulo, Brazil.ParticipantsPatients with glaucoma, age-related macular degeneration, and controls without eye diseases.Main outcomes measuresActivities-specific Balance Confidence (ABC) Scale scores.ResultsThe sample consisted of 64 patients with glaucoma, 60 with age-related macular degeneration, and 60 controls. All groups were matched by age, gender, ethnic distribution, and comorbidities. The ABC Scale score was 63.1 (25.9) in the glaucoma group, 69.5 (16.4) in the age-related macular degeneration group, and 95.3 (9.1) for the controls ( < 0.001; Hedges' -1.65 and -1.93, large effect size); glaucoma patients score did not differ from age-related macular degeneration patients ( = 0.132; Hedges' 0.30, small effect size).ConclusionBoth glaucoma and age-related macular degeneration patients reported lower balance-confidence in performing daily activities without losing balance as compared to controls.
Exploring the role of patient activity in the clinical decision-making processes of health care practitioners working in hospital care: A qualitative study.
de Miguel Llorente C, Van Der Velde M, Scheffers I … +2 more , Veenhof C, Valkenet K
Clin Rehabil · 2026 Feb · PMID 41223070 · Full text
ObjectiveThis study aims to explore the role of patient activity in the clinical decision-making processes of various health care practitioners working in hospital care.DesignQualitative research study.SettingThe study w...
ObjectiveThis study aims to explore the role of patient activity in the clinical decision-making processes of various health care practitioners working in hospital care.DesignQualitative research study.SettingThe study was conducted in the hospital care setting of UMC Utrecht, the Netherlands.ParticipantsHealth Care Practitioners working in the hospital setting were selected through purposive sampling. Doctors, nurses, and physiotherapists were included if their professional activity centered on inpatient care, they had worked in the hospital for over four weeks and were not students in the department.Main measuresData were collected through observations and interviews. Interview recordings were transcribed, and both the interview transcripts and observation fieldnotes were coded and analyzed using reflexive thematic analysis, following Braun and Clarke's approach. Themes were iteratively reviewed and refined, leading to the development of core themes, which were constructed by synthesizing subthemes and examining their interrelationships.ResultsThe study involved forty-two participants working at UMC Utrecht. Four core themes were identified: 1) Patient activity influences clinical decision-making, 2) clinical decision-making influences patient activity, 3) multidisciplinary dynamics influence how patient activity is valued in clinical decisions, and 4) limited use of objective measurements influences how patient activity informs clinical decisions.ConclusionThis study explores the complex interaction between clinical decision-making and patient activity and how patient activity is integrated from a multidisciplinary perspective in the hospital setting. The results highlight the importance of interdisciplinary communication, barriers and facilitators for improved decision-making and examines both implicit and explicit processes involved.
State-of-the-art applications of driving simulators in neurorehabilitation: A scoping review.
Trost W, Wellauer ZH, Küst J … +2 more , Hackenfort M, Bujan B
Clin Rehabil · 2026 Jan · PMID 41223061 · Publisher ↗
ObjectiveThis scoping review evaluates the current use of driving simulators in neurorehabilitation, focusing on diagnostic assessment and therapeutic training in neurological populations.Data SourcesWe searched nine maj...
ObjectiveThis scoping review evaluates the current use of driving simulators in neurorehabilitation, focusing on diagnostic assessment and therapeutic training in neurological populations.Data SourcesWe searched nine major databases for studies published through September 2025, using broad terms related to simulated driving and neurorehabilitation.Review MethodsFollowing PRISMA-ScR guidelines, we used ASReview software with active learning to identify relevant studies. Articles were grouped into diagnostic, therapeutic, review, and special interest categories, with data charted manually by two reviewers.ResultsOf 224 included articles, 124 addressed diagnostic use and 25 examined therapeutic interventions. Simulated driving was often evaluated for its predictive value in determining fitness-to-drive. Combined with neuropsychological tests, simulator outcomes reliably identified key cognitive predictors such as attention and executive function. Twenty-eight studies included on-road driving comparisons, supporting simulator validity. Simulator-based interventions showed benefits for patients with stroke, traumatic brain injury, or Parkinson's disease, particularly for improving tactical driving skills and awareness. Benefits were more pronounced in individuals with mild to moderate impairments. Simulators were generally well-accepted across patient populations.ConclusionDespite the heterogeneity of the literature, there is evidence to support the use of driving simulators as a promising tool for evaluating and improving fitness to drive in neurorehabilitation.
Performance-based tests in individuals with Parkinson's disease: Outcome scores and reliability.
Soares CLA, Ribeiro IL, Benfica PDAY … +3 more , Casado PV, Swarowsky A, Faria CDCM
Clin Rehabil · 2026 Feb · PMID 41217837 · Publisher ↗
ObjectiveTo compare the outcome scores and reliability of performance-based tests (Timed "Up and Go," 10-Meter Walk Test at comfortable and maximal speeds, and Five Times Sit-to-Stand Test) in individuals with Parkinson'...
ObjectiveTo compare the outcome scores and reliability of performance-based tests (Timed "Up and Go," 10-Meter Walk Test at comfortable and maximal speeds, and Five Times Sit-to-Stand Test) in individuals with Parkinson's disease, considering one repetition and the mean of two and three repetitions.DesignReliability study.SettingResearch laboratory.Participants52 individuals with Parkinson's disease were included and assessed for inter-rater reliability (66.9 ± 6.2 years; 61.5% men) and 50 for test-retest reliability (67.1 ± 6.8 years; 62.5% men).Main measuresAssessments were conducted in two sessions, seven to 14 days apart, by two independent raters. Four performance-based tests were applied. ANOVA and intraclass correlation coefficient (ICC) were used (α=5%).ResultsFor all tests, the results were similar among the different outcome scores (0.269 ≤ F ≤ 0.046; 0.995 ≤ p ≤ 0.764), with high to very high test-retest reliability (0.73 ≤ ICC ≤ 0.96; p ≤ 0.001) and high to very high of inter-rater (0.84≤ ICC ≤ 0.96; ≤ 0.001) reliabilities, except for Five Times Sit-to-Stand Test at one repetition, which inter-rater reliability was classified as moderate (ICC = 0.68; ≤ 0.001).ConclusionFor all investigated tests, only one repetition, after familiarization, was necessary to provide consistent and reliable results for mobility assessment in individuals with Parkinson's disease.
Relationship between level of amputation and compensatory gait strategy.
Nikoumanesh N, Sudhir S, Hannigan LS
Clin Rehabil · 2026 Feb · PMID 41217820 · Publisher ↗
ObjectiveGait biomechanics changes after lower limb amputation. This study aims to determine how amputation level may impact gait biomechanics and compensatory behaviour in people with unilateral amputation.Study designO...
ObjectiveGait biomechanics changes after lower limb amputation. This study aims to determine how amputation level may impact gait biomechanics and compensatory behaviour in people with unilateral amputation.Study designObservational study.SettingLaboratory.ParticipantsThis study included eight participants with unilateral transtibial amputation, 10 individuals with unilateral transfemoral amputation, and 11 older persons with no history of amputation.Main outcome metricsGait kinetics and kinematics.ResultsThe transfemoral group significantly walked slower compared to the older persons (p-value = 0.005). Knee adduction moment on intact side was greater during midstance in the transfemoral group compared to the transtibial (0.16 ± 0.16 Nm/kg). The older persons showed greater hip adduction moment on the amputated side during initial midstance compared to those in the transfemoral (0.28 ± 0.18 Nm/kg) and transtibial (0.21 ± 0.16 Nm/kg) groups. The transtibial group demonstrated greater lateral trunk flexion towards the intact side during initial contact (4.08 ± 4.05°) and swing phase (4.36 ± 3.66°) compared to older persons. The transfemoral group also had greater lateral flexion towards the intact side during early swing (2.78 ± 2.70°) compared to older persons.ConclusionsBoth groups of transtibial and transfemoral used trunk lateral flexion toward their intact side as a compensatory behaviour to enhance stability and minimize activation of the hip abductors, which can contribute to lower back pain. The increased knee adduction moment in the transfemoral group indicates a higher risk of knee osteoarthritis. Rehabilitation and physical therapy may prove beneficial in improving muscle strength, which can lead to better gait mechanics.
Development and validation of self-management education module of ChestCare app: Empowering healthy behaviours in chronic obstructive pulmonary disease.
Ghaben SJ, Mat Ludin AF, Singh DKA … +1 more , Mohamad Ali N
Clin Rehabil · 2026 Mar · PMID 41190998 · Publisher ↗
ObjectiveIn this mixed-methods study, we aimed to develop a self-management education module within the ChestCare mHealth app, thus enabling patients with chronic obstructive pulmonary disease to self-manage their condit...
ObjectiveIn this mixed-methods study, we aimed to develop a self-management education module within the ChestCare mHealth app, thus enabling patients with chronic obstructive pulmonary disease to self-manage their condition and empower healthy behaviours.DesignWe integrated the results of sequential focus group discussions and content validity evaluation to decide the topics. We then utilized the multimedia learning theory, the Lung Foundation Australia Guidelines, and consolidated theories of mHealth development to design the education module. Consequently, we used artificial intelligence-augmented platforms to develop the multimedia educational tools.SettingOutpatient physiotherapy department in a Malaysian public hospital.ParticipantsPhysiotherapists and patients with chronic obstructive pulmonary disease engaged in sequential focus group discussions to share their perspectives on the proposed educational topics. Then, nine experts, three in physiotherapy, clinical psychology, and dietetics, evaluated the content validity of the education module.InterventionSelf-management education module to empower patients with chronic obstructive pulmonary disease.Main measuresthe development of a validated self-management education module that aims to improve treatment outcomes and address rehabilitation challenges.ResultsThe sequential discussions resulted in modifications and refinements of the proposed topics, ultimately identifying 12 education topics. The content validity calculations for the three educational clusters resulted in a score of 1. We developed flipbooks, education cards, and videos, along with auditory recitation, using theoretical design and creative development.ConclusionsWe created 12 flipbooks, education cards, and videos that serve as self-management education embedded in mHealth, with the next step to evaluate their usability and feasibility in clinical practice.
Post-stroke facial palsy: Prevalence, recovery patterns within the first 7 days, risk factors, and effect of hyperacute treatments.
Lu Z, Eroglu HS, Naess H … +5 more , Gittins M, Kishore AK, Smith CJ, Vail A, Mitchell C
Clin Rehabil · 2026 Mar · PMID 41186499 · Full text
ObjectiveThis study estimated the prevalence of facial palsy after stroke and identified risk factors; examined recovery patterns; and evaluated the effect of hyperacute treatments on its recovery.Design and settingThis...
ObjectiveThis study estimated the prevalence of facial palsy after stroke and identified risk factors; examined recovery patterns; and evaluated the effect of hyperacute treatments on its recovery.Design and settingThis was a secondary analysis of data prospectively collected in the first 7 days of stroke admission for the Bergen NORSTROKE study.ParticipantsOf 5987 patients, a subgroup of 2293 with facial palsy were analysed for recovery, including 1954 with ischaemic stroke assessed for treatment effect.Main measurementsFacial palsy was assessed repeatedly at irregular intervals from admission using the National Institute of Health Stroke Scale.AnalysisPrevalence was summarised descriptively, and multifactorial logistic regression identified risk factors. The recovery was analysed with Kaplan-Meier curves and Cox models.ResultsFacial palsy was observed in 2578 patients (43%), including 2406 (40%) with minor or partial paralysis and 172 (3%) with complete paralysis. Facial palsy was more common in haemorrhagic (360, 54%) than ischaemic stroke (2218, 42%), reflecting greater motor impairment. Among patients without motor impairment, prevalence was lower in haemorrhagic strokes (15, 10%) than in ischaemic strokes (284, 14%). Risk factors included sex, age, and the degree of motor and sensory deficit. By day 2, 573 patients (25%) had fully recovered, while 1434 (63%) still had symptoms by day 7. Worse recovery was associated with more severe motor and sensory impairments. Intravenous thrombolysis was associated with better recovery.ConclusionsOur study provides a comprehensive analysis of post-stroke facial palsy, highlighting recovery patterns and the need for ongoing monitoring and rehabilitation.
Experiences of implementation and perceived impacts of dyad-focused strategy training: Perspectives from stroke survivors, caregivers, and therapists.
Lin YN, Mauludina YS, Fields BE … +4 more , Wu YH, Liu YT, Kang JH, Chang FH
Clin Rehabil · 2026 Feb · PMID 41182915 · Publisher ↗
ObjectiveTo explore stroke survivors', caregivers', and therapists' experiences of the implementation and perceived impacts of the Dyad-Focused Strategy Training program.DesignA qualitative descriptive study using semi-s...
ObjectiveTo explore stroke survivors', caregivers', and therapists' experiences of the implementation and perceived impacts of the Dyad-Focused Strategy Training program.DesignA qualitative descriptive study using semi-structured interviews and thematic analysis.SettingSix academic medical centers in Taiwan.ParticipantsForty-one stroke survivor-caregiver dyads and 10 occupational therapists who completed the Dyad-Focused Strategy Training intervention.InterventionThe Dyad-Focused Strategy Training program is a therapist-guided, dyadic intervention focused on shared goal setting, problem-solving, and strategy development to improve stroke rehabilitation outcomes.Main Outcome MeasuresThematic analysis identified key themes related to therapists' roles, benefits for dyads, implementation challenges, and therapists' professional reflections.ResultsTwo overarching themes emerged: (1) Experiences with Dyad-Focused Strategy Training Implementation-participants emphasized the essential role of therapists, the emotional benefits of personalized strategies, and the complexity of balancing differing goals, fluctuating motivation, and emotional challenges within dyads; (2) Perceived Impact of Dyad-Focused Strategy Training on Individual, Dyadic, and Professional Outcomes-survivors reported improved independence and participation, caregivers noted reduced stress and clearer caregiving strategies, dyads described strengthened emotional bonds and communication, and therapists experienced professional growth and deeper insight into dyadic dynamics.ConclusionsDyad-Focused Strategy Training fostered meaningful improvements in participation of stroke survivors and caregivers, survivor independence, and caregiver well-being, while contributing to therapist development. Addressing emotional and motivational challenges and providing structural support to therapists are key for successful and sustainable implementation in clinical practice.
Cross-cultural adaptation and psychometric properties of the Stroke Social Network Scale in a Chinese population.
Ho LY, Lai CK, Ng SS
Clin Rehabil · 2026 Feb · PMID 41182831 · Publisher ↗
ObjectivesScientific evidence showed that social networks and support are important for stroke rehabilitation. The Stroke Social Network Scale was developed for people with stroke but is not available in Cantonese. This...
ObjectivesScientific evidence showed that social networks and support are important for stroke rehabilitation. The Stroke Social Network Scale was developed for people with stroke but is not available in Cantonese. This study aimed to test the psychometric properties of the Cantonese scale (C-SSNS).DesignA validation study.SettingCommunity settings.SubjectsOne hundred people with stroke with a mean post-stroke duration of 6.76 years.Main measuresParticipants completed the C-SSNS, Multidimensional Scale of Perceived Social Support, Fugl-Meyer Assessment, Geriatric Depression Scale, Fatigue Assessment Scale, and Community Integration Measure. The psychometric properties of the C-SSNS were evaluated.ResultsThe C-SSNS had a Cronbach's α of 0.67-0.82 and ICC of 0.78-0.97. The standard error of measurement was 3.65-7.16. The minimal detectable change was 10.11-19.85. Floor effects were only found in the 'relatives' and 'groups' subscales. The item- and scale-level content validity indices were 1.0. In assessing construct validity, all subscores correlated with the overall score ( = 0.44-0.75). Confirmatory factor analysis supported a 5-factor model. For concurrent validity, the overall score correlated with perceived social support ( = 0.42, < 0.001). Social network correlated with motor impairment ( = 0.32, = 0.001), depressive symptoms ( = -0.37, < 0.001), fatigue ( = -0.24, = 0.015), and community integration ( = 0.38, < 0.001). Known group differences were demonstrated between stroke participants with moderate-to-severe impairment and those with no-to-mild impairment, and those with and without depressive symptoms.ConclusionsThese findings revealed that the C-SSNS can capture meaningful data concerning social networks for evaluating interventions. This study supports its applicability in research and clinical practice.
Tracking bimanual recovery after stroke: Grasp function and stroke severity predict 1-year performance.
Van Gils A, Zou Y, Meyer S … +6 more , Michielsen M, Lafosse C, Beyens H, Schillebeeckx F, Kos D, Verheyden G
Clin Rehabil · 2026 Jul · PMID 41171992 · Publisher ↗
ObjectiveTo characterize the trajectory and identify early predictors of bimanual performance at 6 and 12 months post-stroke.DesignProspective longitudinal study with assessments at admission, 6, and 12 months post-strok...
ObjectiveTo characterize the trajectory and identify early predictors of bimanual performance at 6 and 12 months post-stroke.DesignProspective longitudinal study with assessments at admission, 6, and 12 months post-stroke.SettingInpatient rehabilitation centre.ParticipantsFirst-ever stroke survivors with unilateral upper limb motor impairment.Main MeasuresBimanual performance was assessed using the Adult Assisting Hand Assessment Stroke. Potential predictors were collected at admission through comprehensive clinical and functional assessments. We used multivariate linear regression to identify key predictors and a Chi-square Automatic Interaction Detection analysis to derive a clinical decision tree.ResultsNinety-two participants (mean age 67 ± 12 years; 22 ± 8 days post-stroke) participated. Bimanual performance improved over time ( < 0.001), with median scores increasing from 8 (interquartile range 0-52) at admission to 48 (8-70) at 6 months, and 48 (8-75) at 12 months. At 6 months, admission grasp function and stroke severity (64% and 9%) jointly explained 73% of the variance in bimanual performance scores. At 12 months, admission stroke severity, grasp function, and Barthel Index (66%, 10%, and 2%) accounted for 78% of the variance. Decision tree analysis confirmed stroke severity and grasp function as the primary predictors and generated a clinically interpretable model.ConclusionBimanual performance improves most within the first 6 months post-stroke. Grasp function and stroke severity at admission strongly predict long-term bimanual outcomes. The decision tree derived from the Chi-square Automatic Interaction Detection analysis may support stratified rehabilitation and realistic goal-setting for daily bimanual use.
Utilisation of cardiopulmonary exercise testing for tailored pulmonary rehabilitation in people with interstitial lung diseases: A systematic review.
Bowhay B, Williams CA, Goodrum S … +4 more , Lacy-Kerr T, Gibbons MA, Scotton CJ, Tomlinson OW
Clin Rehabil · 2026 Feb · PMID 41168676 · Full text
ObjectiveTo systematically evaluate the effects of cardiopulmonary exercise test-derived, tailored pulmonary rehabilitation on cardiopulmonary outcomes in individuals with interstitial lung diseases.Data sourcesMEDLINE,...
ObjectiveTo systematically evaluate the effects of cardiopulmonary exercise test-derived, tailored pulmonary rehabilitation on cardiopulmonary outcomes in individuals with interstitial lung diseases.Data sourcesMEDLINE, Embase, CINAHL Ultimate, SPORTDiscus, CENTRAL, and the Cochrane Library were searched from inception up to 4th September 2025. Reference lists of the included studies were hand-searched for additional sources.Review methodsReporting followed PRISMA 2020 guidelines. Studies of any design published in English and involving participants with interstitial lung disease were eligible. Due to intervention heterogeneity, meta-analysis was not conducted.ResultsEleven studies comprising 321 participants were included, with sample sizes ranging from 1 to 52. Designs encompassed single-cohort interventions ( = 4), comparative interventional studies ( = 3), randomised controlled trials ( = 3), and one case report. Pulmonary rehabilitation interventions included aerobic, interval, and resistance training, delivered over study durations ranging from 4 weeks to 4.5 years. Cardiopulmonary exercise testing outcomes included peak oxygen uptake; peak work rate; peak minute ventilation; maximum heart rate, and rate of perceived exertion. All studies assessing peak oxygen uptake and peak work rate reported improvements. Peak minute ventilation improvements were reported in six of seven studies. No serious adverse events were reported.ConclusionTailored pulmonary rehabilitation via cardiopulmonary exercise test metrics appears to enhance peak oxygen uptake and peak work rate in individuals with interstitial lung disease. Findings support its potential efficacy; however, future research should prioritise standardised methods, consistent reporting, and longer follow-up durations to inform clinical practice.
Is rehabilitation's unifying expertise its holistic scope and cognitive approach to the patient's problems? An exploration.
Wade DT
Clin Rehabil · 2026 Feb · PMID 41137512 · Publisher ↗
ObjectiveTo propose three areas of cognitive expertise as the foundation of rehabilitation, uniting the many varieties of rehabilitation.Five issuesThe following matters require an explanation: (i) Does only providing a...
ObjectiveTo propose three areas of cognitive expertise as the foundation of rehabilitation, uniting the many varieties of rehabilitation.Five issuesThe following matters require an explanation: (i) Does only providing assistive technology constitute rehabilitation?(ii) What explains the dramatic success of spinal cord injury rehabilitation?(iii) How did stroke rehabilitation units reduce mortality and morbidity?(iv) How does rehabilitation improve outcomes in progressive conditions?(v) How does rehabilitation benefit people born with a disabling condition?FoundationsPeople naturally adapt to illness, and rehabilitation facilitates this adaptation within the holistic biopsychosocial framework.Three featuresThree cognitive characteristics of rehabilitation practice are identified: (i) Recognising that the person's adaptation to any limitations imposed by a health condition is the fundamental process underlying change, and that rehabilitation expertise enhances and facilitates it.(ii) Being person-centred, considering the patient's situation using the holistic biopsychosocial model of illness, paying particular attention to the potential long-term social outcomes, including living arrangements.(iii) Using systematic and evidence-based clinical reasoning to achieve a holistic formulation focused on functional problems, collaborating with other professions and services in the interventions.HealthcareRehabilitation is one of many specialities using a biopsychosocial healthcare approach, focused on these principles, which contrasts with a biomedical approach focused on disease.ConclusionRehabilitation expertise has a broader scope than biomedical practice, emerging from rehabilitation thinking, which combines three key features: enhancing the person's adaptation, being person-centred, and employing a systematic approach to clinical reasoning. These differences resolve the five issues.
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