INTRODUCTION: Improving motor functioning is a top priority for clinicians and people living with stroke. This review aimed to identify recent advances in motor recovery and rehabilitation research after stroke and to pr...INTRODUCTION: Improving motor functioning is a top priority for clinicians and people living with stroke. This review aimed to identify recent advances in motor recovery and rehabilitation research after stroke and to provide recommendations for future trials. METHODS: A systematic search of PubMed from 2020 was performed to identify randomised controlled trials (RCTs, n ≥ 100 participants), RCT protocols (projected sample of n ≥ 100) and systematic reviews of RCTs with meta-analysis of upper and/or lower limb motor training in adults with stroke. Together, 118 RCTs, protocols and systematic reviews with meta-analyses were identified. Additional eligible studies published after the systematic search were included from late-breaking trial presentations at 2025 international stroke conferences and authorship team knowledge. Identified evidence was synthesised to inform the development of four themes that were confirmed through multiple online meetings. Each theme was narratively discussed and recommendations to advance stroke recovery and rehabilitation were subsequently presented. FINDINGS: Four themes were established: motor training provides the foundation; mode is a tool to support the delivery of motor training; motor training may be improved with adjuvants; and motor trials need a defined measurement strategy. These themes highlight the integral role of high-quality motor training to stroke recovery and rehabilitation trial conduct. Five recommendations to drive continued advances in stroke motor recovery and rehabilitation were developed. It is recommended that researchers: deliver motor training that adheres to evidence-informed parameters of motor training; consider the use of delivery mode as a tool to support higher dose motor training; always pair an adjuvant with evidence-informed motor training; select or subgroup participants enrolled in trials according to potentially modifying characteristics such as severity and time since stroke; and match measurement strategies to the research question, main effect of interest, clinical trial phase, patient population tested and intervention delivered.
QUESTION: What are the measurement properties of the Chelsea Critical Care Physical Assessment tool (CPAx) for evaluating physical function and activity for rehabilitation of patients who are critically ill? METHODS: A s...QUESTION: What are the measurement properties of the Chelsea Critical Care Physical Assessment tool (CPAx) for evaluating physical function and activity for rehabilitation of patients who are critically ill? METHODS: A systematic search was conducted in five databases to 12 January 2026. Two reviewers independently screened studies, extracted data and assessed quality for each measurement property (COSMIN Risk of Bias checklist); quality of each available measurement property was independently evaluated by any two reviewers who judged the quality as very good, adequate, doubtful or inadequate. Data were synthesised according to COSMIN guidelines, with random-effects meta-analyses for intraclass correlation coefficients (ICCs). Pooled results were rated and the evidence graded as very low, low, moderate or high quality. RESULTS: 27 studies investigated 71 measurement properties (inadequate to very good). The CPAx was feasible, with small floor and ceiling effects across the trajectory of recovery. Content validity was high (pooled index 0.94; high-quality evidence). The CPAx demonstrated excellent inter-rater reliability (pooled ICC 0.99, 95% CI 0.98 to 1.00, six studies, high-quality evidence), intra-rater reliability (ICC 0.95, 95% CI 0.82 to 0.97, one study, low-quality evidence) and acceptable standard error of measurement (pooled SEM 1.36, five studies) corresponding to a smallest detectable change of 3.76 (sufficient rating, high-quality evidence). Construct validity was supported with 26 out of 34 predefined hypotheses accepted (76%, sufficient, 10 studies, moderate-quality evidence) and responsiveness with five out of six predefined hypotheses accepted (83%, sufficient, five studies, very low-quality evidence). CONCLUSION: Moderate- to high-quality evidence indicates that the CPAx is a valid and reliable instrument for evaluating physical function and activity of critically ill patients. Further research is needed to evaluate responsiveness. REGISTRATION: PROSPERO CRD420250655518.
QUESTIONS: What is the effect of group exercise-based telerehabilitation compared with a single session of in-person assessment and advice on health-related quality of life in cancer survivors? What are the effects on ac...QUESTIONS: What is the effect of group exercise-based telerehabilitation compared with a single session of in-person assessment and advice on health-related quality of life in cancer survivors? What are the effects on activity, function, safety and cost-effectiveness? DESIGN: An assessor-blinded, pragmatic randomised controlled trial with embedded cost analysis, concealed allocation and intention-to-treat analysis. PARTICIPANTS: Adult cancer survivors with any cancer diagnosis who were receiving treatment or within 12 months of treatment completion. INTERVENTION: The experimental group received an 8-week, twice-weekly, physiotherapist-led exercise group via videoconferencing, supplemented with support resources and a single in-person session of assessment and advice (TeleCaRe). The control group received a single in-person session of exercise assessment and advice. OUTCOME MEASURES: Assessments were completed at baseline, after the intervention (week 9) and at follow-up (week 26). The primary outcome was health-related quality of life, measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, at week 9. Secondary measures were walking capacity (6-minute walk test), physical activity (accelerometer), self-efficacy (Health Action Process Approach Questionnaire), adverse events, and health service and cost data. RESULTS: In total, 117 participants were recruited. Their mean age was 59 years, 82 (70%) were female, and 47 (40%) had breast cancer. Participants attended an average of seven out of 16 sessions (SD 6). There were no major adverse events. Intention-to-treat analysis found that TeleCaRe was not superior for improving quality of life (MD -5.3 units, 95% CI -13.3 to 2.6) or any secondary outcomes. TeleCaRe cost AU$363 per participant. CONCLUSION: Group exercise-based cancer telerehabilitation was safe but attendance was poor. The addition of telerehabilitation to assessment and advice was not superior to a single in-person physiotherapy session alone for improving quality of life. REGISTRATION: ACTRN12621001417875.
QUESTIONS: What are the perceived barriers and facilitators to physiotherapists adopting a prevention-based walking and education program (WalkBack) in routine practice for patients with recurrent low back pain? What ref...QUESTIONS: What are the perceived barriers and facilitators to physiotherapists adopting a prevention-based walking and education program (WalkBack) in routine practice for patients with recurrent low back pain? What refinements to the WalkBack program could enhance future implementation efforts? DESIGN: This was a qualitative study using individual, online, semi-structured interviews. PARTICIPANTS: Twenty registered physiotherapists practising in Australia, including 10 with previous experience delivering the WalkBack program and 10 without prior exposure. Purposive sampling was used to capture insights from physiotherapists across geographic settings, roles and experience levels. Interview questions were informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework and analysed using an inductive framework analysis. DATA ANALYSIS: Themes were iteratively developed through team-based discussions. RESULTS: Four themes were identified. First, the WalkBack program is relevant and acceptable to physiotherapists, aligning with the profession's shift towards prevention-based care and further supported by its endorsement by research and professional bodies. Second, the WalkBack training is important for effective delivery and implementation. Its flexible online and face-to-face format facilitated engagement, and forming communities of practice was viewed as critical for sustaining future implementation. Third, flexible delivery and structured resources were seen as critical to enabling scalable implementation. This included developing ready-to-use resources such as referral communication templates and advertising materials. Fourth, successful adoption hinges on system-level enablers, including supportive leadership, funding structures and alignment with service settings. CONCLUSION: Physiotherapists viewed WalkBack as relevant, acceptable and clinically valuable. Future implementation will need to address training needs, enhance resource provision and explore system-level support. Each clinic's unique service and funding structures may support or deter adoption of the WalkBack program. The findings offer transferable insights to inform implementation of similar clinician-delivered programs, particularly in contexts that share similar clinical and organisational characteristics. REGISTRATION: https://osf.io/t3xbc.
QUESTIONS: What is the estimated smallest worthwhile effect of anterior cruciate ligament (ACL) reconstruction followed by rehabilitation for improving knee function and return to sport compared with rehabilitation only?...QUESTIONS: What is the estimated smallest worthwhile effect of anterior cruciate ligament (ACL) reconstruction followed by rehabilitation for improving knee function and return to sport compared with rehabilitation only? What are the associations between participant characteristics (age, gender, health insurance status, sports participation level, preference for surgery versus non-surgical management, previous ACL rupture) and these smallest worthwhile effect estimates? DESIGN: Benefit-harm trade-off study conducted via an online survey. PARTICIPANTS: A total of 92 people engaged in recreational or competitive sport. DATA COLLECTION: Participants provided demographic information and answered two benefit-harm trade-off scenarios: a knee function scenario and a return to sport scenario. Participants indicated the minimum additional percentage improvement they would require for ACL reconstruction to be worthwhile compared with the anticipated percentage improvement with rehabilitation only. The expected benefits of rehabilitation only were based on published trial data. Associations between these smallest worthwhile effect estimates and participant characteristics were investigated using univariable regression models. RESULTS: The median smallest worthwhile effect was 12% (IQR 8 to 16) for knee function and 41% (IQR 35 to 47) for return to sport. Smallest worthwhile effects were slightly higher for those participating in competitive sport. Age was associated with smallest worthwhile effect for the knee function scenario (0.3% increase per year older, 95% CI 0.1 to 0.4), although the size of this effect may not be clinically relevant. None of the tested predictors were associated with the smallest worthwhile effect for the return to sport scenario. CONCLUSION: This study is the first to estimate the smallest worthwhile effect of ACL reconstruction. Participants require an additional 12% improvement in knee function or a 41% increase in the likelihood of returning to sport to justify undergoing ACL reconstruction. Therefore, the effects of surgery reported in many studies fall below what patients consider to be worthwhile. REGISTRATION: OSF; https://osf.io/2kn97/.