Clinical Rehabilitation

Objective To develop and validate the Vellore Pain Impact Questionnaire to assess the impact of low back pain in the Indian context. Design A cross-sectional, quantitative study with two phases: development and validation of the Vellore Pain Impact Questionnaire. Content validity was ensured through a Delphi process involving five occupational therapists, while reliability and criterion validity were assessed. Setting The study was conducted at the Occupational Therapy outpatient unit of a tertiary care teaching hospital in South India. Participants Sixty-five patients aged 18 years and above with nonspecific low back pain persisting for at least 12 weeks were recruited through convenience sampling. Intervention Not applicable. Main Measures The Vellore Pain Impact Questionnaire underwent inter-rater and test-retest reliability using the intraclass correlation coefficient. Criterion validity was evaluated against the Oswestry disability index. Results The Vellore Pain Impact Questionnaire showed excellent content validity (content validity index: 0.96). It demonstrated high reliability, with inter-rater (intraclass correlation coefficient: 0.985) and test-retest (intraclass correlation coefficient: 0.973) scores. The receiver operating characteristic analysis indicated moderate criterion validity (area under the curve: 0.628) compared to the Oswestry disability index. The questionnaire's broader coverage of ICF categories, including psychological and environmental factors, highlights its ability to capture the multidimensional impact of low back pain. Conclusions The Vellore Pain Impact Questionnaire shows promise as a reliable and culturally relevant tool for assessing low back pain impact in India, addressing physical, psychological, and social factors. However, further studies are necessary to establish its validity across diverse populations and settings.

Objective To determine if the addition of cognitive retraining to rehabilitation following stroke results in better everyday living outcomes. Data sources Electronic databases MEDLINE, EMBASE, PsycINFO, CINAHL, OT Seeker and Cochrane Library were searched until January 2025. Review methods Randomised controlled trials were included if they measured change in function and investigated a cognitive retraining intervention aimed at restoration of impaired cognition in one or more specific cognitive domains in the adult stroke population. Papers were excluded if they exclusively provided interventions that were not restorative, such as compensatory approaches or direct task retraining. Two independent reviewers extracted data and assessed study quality. Results Twenty-one studies involving 1476 participants were included. There was very low-quality evidence that basic activity of daily living (ADL) was not improved by the addition of cognitive retraining (standardised mean difference (SMD) 0.48, 95% confidence interval (CI) −0.04 to 1.01). There was moderate quality evidence that cognitive retraining had no effect on Instrumental ADL (IADL) (SMD −0.19, 95% CI −0.65 to 0.27) or other measures of functional performance (SMD −0.03, 95% CI −0.31 to 0.24). Conclusions Cognitive retraining focusing on restoration of one or more cognitive domains after stroke did not show an impact in basic ADL performance, IADL performance, or other measures of functional performance. Results were complicated by low-quality evidence and methodological factors including variations in study populations, interventions provided and outcome measures. Further research that includes suitable measures of everyday living is needed to provide more robust evidence and guide clinical practice.

Background The well-known drawer tests to assess glenohumeral laxity and instability have shown appropriate reliability, although analysed mainly in healthy subjects. Objective To evaluate the intra- and inter-rater reliability of anterior and posterior drawer tests in subjects with symptoms of shoulder instability. Design Clinometric study of intra- and inter-rater reliability of drawer tests was carried out following COSMIN recommendations and GRRAS checklist. Setting Centres with equipped facilities for assessments. Participants There were 105 participants (69 male/36 female) aged 18 to 60 years with instability symptoms in at least one shoulder. Each participant underwent bilateral assessments. The sample consists of 210 shoulders, unstable and healthy. Intervention Anterior and posterior drawer tests. Main measures Humeral translations were assessed using drawer tests and graded with Hawkins scale, modified Hawkins and dichotomising (positive/negative). Two sessions were performed (seven to fourteen-day washout period): Each patient was evaluated by two examiners in the first session and by one of them in the second. Weighted Kappa analysed the reliability. Results The intra-rater reliability of the anterior and posterior drawer tests was excellent (weighted Kappa = 1) with the Hawkins scale. Inter-rater reliability was good for the anterior drawer: weighted Kappa = 0.76 (95%confidence interval: 0.67–0.85) with the Hawkins scale, weighted Kappa = 0.78 (95%confidence interval: 0.69–0.87) with modified Hawkins, and weighted Kappa = 0.80 (95%confidence interval: 0.71–0.89) dichotomising; and for the posterior drawer: weighted Kappa = 0.62 (95%confidence interval: 0.52–0.72), weighted Kappa = 0.67 (95%confidence interval: 0.57–0.78), and weighted Kappa = 0.70 (95%confidence interval: 0.59–0.80), respectively. Conclusion Drawer tests demonstrated excellent intra-rater and good inter-rater reliability in subjects with symptoms of shoulder instability.

Objective To investigate agreement in spasticity classification between the Modified Ashworth Scale (MAS) and the Modified Tardieu Scale (MTS) when performed on four lower limb muscles in adults following neurological injury. Design Observational trial. Setting Inpatient and outpatient neurological rehabilitation unit. Participants Ninety adults with lower limb spasticity. Main Measures Ninety participants underwent a spasticity assessment of their hamstrings at 40° and 90° of hip flexion, quadriceps, gastrocnemius and soleus using the MAS and MTS. Assessment findings were dichotomised into spastic (MAS ≥ 1 or MTS X ≥ 2) or not spastic (MAS = 0 or MTS X ≤ 1) categories. To evaluate agreement, 2 × 2 contingency tables were generated to calculate positive, negative and overall agreement. Statistical association was calculated using the Fisher's Exact Test. Results The MAS classified the presence of spasticity more frequently than the MTS. The proportion of trials with agreement in spasticity classifications according to both scales and their Fishers exact test were hamstrings at 90° hip flexion (17.6%; p = 0.009); hamstrings at 40° hip flexion (75.0%; p = 0.166); quadriceps (67.1%; p = 0.020); gastrocnemius (77.9%; p = 0.586); and soleus (67.8%; p = 0.113). Conclusion The MAS and MTS demonstrated a level of disparity in their classification of lower limb spasticity across all four muscles, particularly the more proximal muscle groups.

Objective To investigate changes in mobility in adults with recent major lower limb amputation participating in community-based rehabilitation. Second, to assess the impact of amputation level (transtibial versus transfemoral) on mobility changes. Design Cohort study. Setting Rehabilitation Centre in Copenhagen Municipality. Subjects A total of 265 individuals with recent major lower limb amputations were prospectively recruited into a cohort from 2008 to 2022 as part of routine practice. Methods Four physiotherapists collected data on age, sex, level of amputation (transtibial/transfemoral) and assessed mobility at start of walking out of parallel handrail (baseline) and at the end (follow-up) of rehabilitation. Mobility was assessed with the Timed-Up-and-Go test, 10-Meter Walk test, and 2-Minute Walk test. The impact of amputation level was analyzed using multivariable linear regression adjusted for age and sex. Results A total of 199 individuals (153 men) mean age of 64.9 (standard deviation 12.2) years had baseline and follow-up mobility data and were eligible for the study. Mobility significantly improved on all tests for individuals with both amputation levels after community rehabilitation. Multivariable analysis showed that individuals with transfemoral amputations on average improved with 17.9 seconds more (95% confidence interval: 12.7–23.1) than transtibial completing the Timed-Up-and-Go test. Contrary, transtibial walked 0.11 meter/second faster (95% confidence interval: 0.02–0.20) and 7.2 meters (95% confidence interval: −1.4 to 15.8) longer in the 10-Meter Walk test and 2-Minute Walk test respectively than transfemoral amputees. Conclusion Adults with lower limb amputations improved their mobility significantly from baseline to follow-up. Individuals with transfemoral amputations improved more than transtibial amputations on functional mobility.

Objective To assess the independent effect of pre-morbid frailty on stroke rehabilitation outcomes, including mortality, function, and discharge destination. Design Observational cohort study. Setting Inpatient stroke rehabilitation. Participants Two hundred consecutive stroke patients, 65 years or older, admitted during 2021. Main measures Logistic regression models analysed binary outcomes (mortality, discharge destination, and significant functional gain), and multiple linear regression models analysed normally distributed continuous outcomes (function, measured by Functional Independence Measure (FIM)). The confounders of age, stroke severity, and pre-morbid dementia/cognitive impairment, were accounted for. Clinical Frailty Scale was the predictor (considered as categorical and dichotomous) for these models. Results After accounting for the confounders, increased frailty was independently associated with lower discharge FIM (B = −11.32; 95% confidence interval (CI) −14.46−8.18, p < 0.001), smaller FIM change (B = −4.21; 95% CI −6.58−1.84, p < 0.001) and smaller FIM improvements over time (B = −2.36; 95% CI −3.40−1.32, p < 0.001). Frailer patients were less likely to return home (Odds Ratio 0.26; 95% CI 0.17–0.41, p < 0.001). Most patients improved function, at all levels of frailty. Stroke severity (Odds Ratio 1.13; 95% CI 1.06–1.20, p < 0.001), but not frailty, was independently associated with 6-month mortality. Conclusions Pre-morbid frailty was independently associated with lower functional improvement and lower likelihood of discharge back home after stroke rehabilitation, but not with mortality up to 6 months. Measuring both pre-morbid frailty and stroke severity may be useful to provide prognostic information and set realistic expectations.

Objective This study aims to explore how occupational therapists working in private practices in Canada use clinical indicators and tools to determine if clients require 24-hour attendant care. Design A qualitative research study. Setting The setting involved semi-structured, one-on-one interviews with occupational therapists in Canada. Participants Occupational therapists were selected through purposive sampling: (1) registered Canadian occupational therapists, (2) with over 10 years of private practice experience, and (3) who have assessed the need for 24-hour attendant care at least once before the study. Main measures The interviews were conducted, transcribed, coded, and thematically analyzed by two researchers using Braun and Clarke's protocol. The paper is also reported based on the consolidated criteria for reporting qualitative research guidance. Results The study involved nine occupational therapists (eight women and one man), with 14 to 24 years of private practice experience in Ontario. Three main themes in the decision-making process for 24-hour attendant care were identified: (1) Individualized and Holistic Assessments; (2) Clinical Expertise-Based Decision-making; and (3) Risk Assessment in Decision-Making. Conclusions This study provides a greater understanding of the decision-making process of occupational therapists working in Canada when recommending 24-hour attendant care. However, further research and development of guidelines are needed to support occupational therapists in this area.

Objective To describe the physiological and perceptual demand among physiotherapists delivering gait training interventions using usual care and overground robotic exoskeleton approaches for patients with neurological injuries during inpatient rehabilitation. Design Single-centre, prospective observational study. Setting Inpatient Rehabilitation Hospital. Participants Physiotherapists trained in neurorehabilitation. Intervention Physiotherapists conducted two gait training sessions (one usual care and one overground robotic exoskeleton) while physiological and perceptual demand was assessed. Main measures Physiological (oxygen consumption, metabolic equivalents and heart rate) and perceptual demand were measured using a wearable metabolic system and the National Aeronautics and Space Administration Task Load Index, respectively. Results Physiotherapists ( n = 4) were female, median (min–max) age = 35(34–44) years, non-Hispanic, 50% White, with 11(5–19) years of experience. Physiological demand was lower in overground robotic exoskeleton than usual care in oxygen consumption [13.5(11.3–15.3) versus 16.4(13.5–18.6) millilitres of oxygen/minute/kilogramme of body mass], metabolic equivalents [3.9(3.2–4.4) versus 4.7(3.8–5.3)], average heart rate [111(90–136) versus 119(103–145) beats per minute], peak heart rate [121(101–149) versus 149(116–162) beats per minute] and recovery heart rate [113(88–148) versus 123(105–161) beats per minute]. Perceptual demand was lower in overground robotic exoskeleton than usual care in mental [7(5–16) versus 12(6–17)], physical [10(8–12) versus 16.5(14–21)] and temporal demand [3.5(1–9) versus 12.5(2–16)], performance [5(3–16) versus 11(4–17)], effort [9(6–15) versus 16.5(13–17)] and frustration [3(1–7) versus 5.5(3–8)]. Conclusions Delivery of overground robotic exoskeleton gait training was associated with lower physiological and perceptual demand compared to usual care gait training in patients with neurological injuries during inpatient rehabilitation. Identifying modalities with low demand may reduce physiotherapist burnout and workplace injuries.

Objective To evaluate the effects of comprehensive perioperative nursing interventions on postoperative recovery in cardiac surgery patients with frailty, with a focus on physical activity, nutritional status, and cognitive function. Design A prospective, randomized, single-blind, parallel-group design with a 1:1 allocation ratio. Setting Cardiac surgery department in a tertiary care hospital. Participants This study included 300 patients with frailty after cardiac surgery. Using a computer-generated random number table, patients were randomly assigned to the experimental group (150 patients) and the control group (150 patients). The intervention group received preoperative psychological counseling, targeted nutritional support, skincare, and continuous hemodynamic monitoring; the control group received routine care, including postoperative vital sign monitoring, basic nutritional support, wound care, and standard cardiovascular assessments (e.g., heart rate and blood pressure). Primary outcomes Postoperative recovery was assessed through improvements in physical activity (Barthel Index), nutritional status (Mini Nutritional Assessment), cognitive function (Mini-Mental State Examination), biostatistical data and cardiopulmonary function indicators. Results The intervention group showed significant improvements: Barthel Index increased by 20 points (95% CI: 15–25, p < 0.01), Mini Nutritional Assessment scores by 3 points (95% CI: 1–5, p < 0.05), and Mini-Mental State Examination scores by 4 points (95% CI: 2–6, p < 0.05). Hospital stay was reduced by 5 days (95% CI: 3–7, p < 0.01), and the 6-month survival rate was 10% higher (95% CI: 5–15%, p < 0.05) compared to the control group. Conclusions Comprehensive perioperative nursing interventions significantly improve postoperative recovery, self-care ability, nutritional status, cognitive function, and short-term survival in cardiac surgery patients with frailty.

Objective To assess the feasibility of a multi-technology, group based, approach to increasing rehabilitation dose early after stroke. Methods Mixed methods design reporting recruitment, dropout, safety, dose and acceptability. Setting Acute Hospital Stroke Unit Participants Sixty stroke patients, 9.0 median (IQR 12.8) days after stroke, referred for rehabilitation, without contraindications to light exercise. Intervention Personalised rehabilitation delivered in supervised groups, using a multi-technology rehabilitation gym, in addition to usual care. Main measures Feasibility was based on achieving recruitment rates over 3.2 per month, dropout rates below 6%, absence of suspected unexpected serious adverse reactions and shoulder pain prevalence below 60%. Acceptability was derived from interviews with the clinical team. Dose (rehabilitation time) was recorded manually. Function was measured with the modified Rivermead Mobility Index and Therapy Outcome Measure. Results Feasibility was satisfactory with high recruitment rates (6 per month), low dropout (2%), no suspected unexpected serious adverse reactions and low prevalence (19%) of shoulder pain. Thematic analysis of interview data indicated the clinical team (n = 9) found the intervention acceptable and identified organisational constraints to higher doses. Participants attended an average of 9.1 (1–32) sessions during their hospital stay (23.0 days, SD 19.7), with sessions lasting 52 min (SD 15.7), on average. The modified Rivermead Mobility Index and Therapy Outcome Measure increased by 17.9 (SD 8.6) and 5.7 points (SD 2.4), respectively. Conclusions Strong feasibility findings support future trials of multi-technology, group-based rehabilitation. This novel approach is an encouraging step toward achieving recommended doses of rehabilitation after stroke but needs further investigation.

Objective To guide clinical practice by synthesising robust evidence concerning gluteal tendinopathy management. Data sources Five electronic databases were searched from inception to August 2024 for randomised controlled trials (RCTs) of medium or high quality, and low risk of bias, that measured pain and function in adults with clinically diagnosed gluteal tendinopathy. Review methods Systematic review reporting proof of efficacy. PEDro scale and Cochrane Risk of Bias Tool 2.0 were used to assess internal validity and risk of bias. Efficacy was determined by comparison to minimal intervention. Methodological heterogeneity prevented meta-analysis, but we calculated standardised mean differences (SMD) and 95% confidence intervals (95% CI) for individual study arms to facilitate comparison between interventions. Results Four interventions from four RCTs demonstrated efficacy. Exercise and education has moderate strength evidence of a medium effect on pain (SMD = 0.95; 95% CI [0.58, 1.33]) and function (SMD = 0.91; 95% CI [0.53, 1.28]) in the short term with small effects in the medium and long term. Corticosteroid injection has moderate strength evidence of a small effect on pain (SMD = 0.51; 95% CI [0.16, 0.86]) in the short term. Platelet-rich plasma injection was superior in the short term compared to corticosteroid injection for function (SMD = 0.46; 95% CI [0.00, 0.91]). For pain, focused shockwave therapy (f-ESWT) demonstrates superiority in the long term (SMD = 5.77; 95% CI [4.84, 6.71]) compared to corticosteroid injection. Conclusions Exercise and education can be cautiously recommended as the core approach for pain management and function, potentially supplemented by corticosteroid or f-ESWT, while definitive trials of promising interventions are needed to derive robust practice recommendations.

Objective To investigate the hypothesis that people with a prolonged disorder of consciousness experience nociceptive pain. Method A non-systematic literature review into the nature and neurophysiological basis of consciousness and pain likely function when someone has severe thalamocortical dysfunction; the behavioural manifestations of pain in people who cannot communicate; and how they relate to the experience. Findings Consciousness depends on thalamocortical integrity and is judged clinically by establishing the person's behaviour depends on extracting or using meaning. The experience of pain is also deduced from a person's behaviour, including increased purposeless motor movements, facial expressions, non-verbal vocal expressions and physiological (autonomic) changes such as tachycardia and tear production. Extensive brainstem and midbrain networks are activated by pain, including autonomic networks. Given their early evolution and location, they likely resist damage. The networks appear intrinsically resilient, functioning when damaged unless the damage is severe. Synthesis Someone with a prolonged disorder of consciousness usually has intransitive consciousness (arousal) that is not dependent on cortical cognitive processes and may have retained occurrent consciousness of mental states when aroused. Nociceptive stimuli elicit automatic but purposeless behaviours typically associated with pain. These behaviours are likely to be responses to this unpleasant mental state of occurrent consciousness that is limited to the time they show pain behaviours, with no memory of it. Conclusion The unconscious person with a prolonged disorder of consciousness exhibiting pain behaviours in response to nociceptive stimuli likely experiences pain without analysing its significance; they are unlikely to anticipate or remember it.

Objective To identify the optimal number of sessions and parameters of repetitive transcranial magnetic stimulation frequency, stimulation intensity, number of pulses per session/treatment that promotes a greater effect on post-stroke upper extremity function. Data sources MEDLINE (PubMed), Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database, Latin American and Caribbean Health Science Literature, Scientific Electronic Library Online, and Scopus up to November 2024. Review methods We conducted a meta-analysis on randomized controlled trials of repetitive transcranial magnetic stimulation combined with other therapies for post-stroke upper extremity function, assessed risk-of-bias using the Physiotherapy Evidence Database scale, calculated standard mean differences (SMD) with 95% confidence intervals (CI), and determined parameter cutoff points using a receiver operating characteristic curve. Results Thirty-five randomized clinical trials involving 897 patients were included. Compared to control groups, repetitive transcranial magnetic stimulation combined with other therapies improved upper extremity motor function with a higher effect size for: ≥ 15 sessions (SMD 0.72 95% CI, 0.37 to 1.08; p < 0.0001]), > 1 Hz frequencies (0.98 [95% CI, 0.48 to 1.48; p = 0001]), intensities of <100% of resting motor threshold (SMD 0.52 [95% CI, 0.29 to 0.75; p < 0.00001]), ≥ 1000 pulses per session (SMD 0.61 [95% CI, 0.40 to 0.82; p < 0.00001]), and ≥12,000 pulses per treatment (SMD 0.64 [95% CI, 0.36 to 0.93; p < 0.0001]). Conclusion To enhance post-stroke upper extremity function, the optimal repetitive transcranial magnetic stimulation protocol involves at least 15 sessions, frequencies above 1 Hz, intensities below 100% of resting motor threshold, at least 1000 pulses per session, and 12,000 pulses per treatment.

Objective To evaluate the criterion and construct validity of the 7-category Amputee Single Item Mobility Measure (AMPSIMM) in a large contemporary dysvascular lower limb amputation population and propose an abbreviated 4-category version (AMPSIMM-4) whose mobility categories parallel the Medicare Functional Classification Levels (K-levels). Design Cohort study retrospectively identifying persons with their first lower limb amputation then prospectively collecting their self-reported mobility. Setting National cohort identified through a large Veterans’ Administration dataset. Participants Six hundred and ninety-two participants aged 30 years and older, undergoing their first diabetes and/or peripheral artery disease-related amputation at the transmetatarsal, transtibial, or transfemoral level, with a subset of 60 consecutive participants with a self-reported K-level. Main measures AMPSIMM, Locomotor Capability Index-5 (LCI-5), K-levels, and PROMIS Global-10 Physical (PROMIS-P), at one year post amputation. Results The strength of the correlation between AMPSIMM and LCI-5 scores was large (Spearman's rho = .88; p < .0001). The correlation with PROMIS-P scores was 0.67 ( p < .0001). The strength of the correlation between the AMPSIMM-4 and self-reported K-levels was large (Spearman's rho = .82; p < .0001). Conclusions The AMPSIMM is a clinician-friendly single-item patient-reported measure that can capture a broad range of lower limb amputation mobility, from wheelchair to advanced community ambulation, with or without a prosthesis, and with or without ambulation aids. It demonstrates strong criterion and construct validity. The AMPSIMM-4 can be generated directly from the AMPSIMM with descriptors that are very similar to and are highly correlated with self-reported K-levels.

Objective To examine what delivery format had been used to facilitate rehabilitation services over recent years and to identify barriers and enablers to using telehealth in the future. Design Multiple method research approach. Setting: Outpatient rehabilitation service in a large regional hospital in Australia. Participants: Clinicians that deliver rehabilitation interventions including allied health professionals and nurses. Main measures First, a retrospective audit of data examining the rate of telehealth use. Second, semi-structured focus groups with clinical staff to identify barriers and enablers to using telehealth. Data were thematically analysed and mapped to a behaviour change framework. Results Pre-pandemic, 82% (n = 45,960) of rehabilitation services were delivered in-person; during peak restrictions, in-person delivery was 54% (n = 49,337). Following the ease of restrictions, 71% (n = 49,337) of the rehabilitation services were delivered in-person, 28% (n = 21,624) via phone and 1% (n = 493) via video. Telehealth use increased 11% from pre-pandemic to when restrictions were eased, driven by increased use of phone consultations. Six themes related to barriers and four themes related enablers to using telehealth were identified. Using the behaviour change framework, five interventions functions (education, training, environmental restructure, modelling and enablement) were recommended to facilitate telehealth use. Conclusions Telehealth-delivered rehabilitation rates increased post-pandemic, primarily via phone consultations. Reported barriers and enablers highlight the need for targeted strategies, with five intervention functions identified that may support increased telehealth adoption in rehabilitation settings. Future efforts should address clinician-raised barriers to optimise telehealth integration into service delivery.

Objective To explore how healthcare professionals facilitate nursing home residents’ involvement in food-related activities in two breakfast clubs based on a hospitality and reminiscences approach. Design Qualitative one-year intervention study Participants Nineteen residents and twelve healthcare professionals Method The data were based on observation and debriefing notes from 29 breakfast club events, including 20 ladies’ club events and 9 men's club events. Additionally, 13 interviews were conducted with residents, while 10 interviews were carried out with health care professionals. Data were subjected to thematic analysis and categorized into themes about how healthcare professionals can facilitate involvement in food-related activities. Results Five ways of facilitating involvement were identified. Recognizable meal routines and structure, combined with facilitating shifting host and guest roles, created a secure space for residents and formed the basis for involvement in food-related activities. Facilitating dialogues based on a reminiscence approach helped residents become authors of their own identities and facilitating co-creation supported mutual learning processes both for residents and healthcare professionals and allowed residents to negotiate their value as a club participant. Improvisation created opportunities for co-creating new social practices and new ways for residents to represent themselves. Conclusion Involving nursing home residents in food-related activities is a potential rehabilitation arena, but new competencies for healthcare professionals are needed. They include meal-preparation and hospitality competencies and the ability to support residents in transferring valuable past experiences into present and future intentions. In addition, rehabilitation can be considered as mutual learning processes with shared, negotiated goals.

Objective To evaluate the effectiveness of non-surgical interventions for knee stiffness or arthrofibrosis following knee replacement surgery. Data sources Ovid MEDLINE, Ovid Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL)were searched from database inception to October 2024. Review methods All studies of non-surgical interventions (versus any/no comparator) for adults who developed knee stiffness or a diagnosis of arthrofibrosis following knee replacement were included. Selection, quality appraisal and extraction were completed in duplicate. Results were synthesised narratively. The risk of bias was assessed, and GRADE criteria were used to evaluate evidence quality. Results Sixteen studies were included, comprising two randomised-controlled trials (n = 76), one non-randomised controlled trial (n = 35), seven cohort studies (n = 352) and six case studies (n = seven). Interventions varied widely including exercise, manual therapy, mechanical devices, and education. Improvements in knee range of movement were reported with some demonstrating functional gains >110° of knee flexion, but the evidence was of low quality. Limited reporting of intervention descriptions, patient-relevant outcomes including function and pain, and longer-term follow-up hindered comprehensive evaluation. Conclusion The review highlights the heterogeneity of interventions, emphasising the need for standardised reporting. While some studies showed promise, the lack of control groups, small sample sizes, and varied follow-up durations limit conclusive findings. There is insufficient evidence to support any specific non-surgical interventions for arthrofibrosis post-arthroplasty. Further research should be a priority.

Unlabelled: Objective The primary objective is to comprehensively examine the activity and participation limitations in adolescents with cleft lip and palate utilizing the ICF-CY (International Classification of Functioning, Disability and Health Children and Youth Version).DesignMixed designed study. Setting: Hacettepe University Plastic and Reconstructive Surgery Department. Participants: 264 adolescents with cleft lip and palate and 300 healthy adolescents. Main measures: The Mann-Whitney U test was used to compare occupational balance levels, and qualitative content analysis was used for analyzing interviews. Data were then coded according to the categories of the ICF-CY.ResultsThere was a statistically significant difference between temporality (P = .001), rest and sleep (P = .004), occupational variations and adaptations(P = .001), occupational meaning and value (P = .0001), and A-OBS (Adolescent Occupational Balance Scale) total scores. Participants expressed that they especially had problems in carrying out daily life activities and ensuring social participation. They further stressed that their families tended to provide an overly protective environment. Additionally, adolescents reported improved communication within virtual environments. Adolescents emphasized the impact of the ongoing surgical history on personal development.ConclusionsICF-CY provides an important perspective in examining the activity and participation limitations of children with cleft lip and palate, providing an opportunity to understand the effects of impairments in body structure and function, environmental barriers, and social impacts.

Objective To investigate the experience of people with shoulder osteoarthritis and their perception of non-surgical management in the U.K. National Health Service (NHS). Design Qualitative design, using semi-structured telephone interviews. Two authors (SL and MM) performed coding and theme development following principles of reflexive thematic analysis. Setting Physiotherapy services within three NHS trusts in England. Individual interviews were conducted with patients with a diagnosis of shoulder osteoarthritis. Participants Ten participants were recruited (age range 57–86 years; six females; five with bilateral shoulder osteoarthritis). Results Participants reported significant pain, functional limitations, and emotional distress. Non-surgical management experiences varied, with some finding relief from steroid injections, analgesia, and physiotherapy, while others reported limited perceived effectiveness. All participants expressed a desire for more information and support. There were divergent views on the need for surgery. Conclusion This is the first study to explore the experiences of people with symptomatic shoulder osteoarthritis who have received care within an NHS setting. It highlights the significant impact of shoulder osteoarthritis on daily life and the challenges faced in accessing appropriate care. Findings emphasise the need for patient-centred care, including education, support, information provision and consideration of psychosocial factors. Future research is required to develop an evidence-based guideline for non-surgical management of shoulder osteoarthritis.

Objective To systematically review the evidence and examine the effectiveness of group-based UL intervention versus individual therapy, in decreasing impairment and improving UL function post-stroke. Data Sources A comprehensive search of four key databases (CINAHL, Embase, Emcare, and MEDLINE) identified relevant studies published from inception through to November 2024. Review methods Two reviewers independently performed screening for inclusion according to selection criteria. Eligible studies provided dose-matched group and individual UL rehabilitation programs. Outcomes that measured UL impairment (Fugl-Meyer Upper Extremity Test) or function (Action Research Arm Test) were extracted for meta-analysis. Methodological quality was assessed using the PEDro scale. Results Of 3291 publications, eight studies were included ( n = 348) (seven randomised controlled trials and one controlled trial) of poor to good quality. A random effects meta-analysis model was conducted. Statistical significance was determined using analysis of covariance. No significant effects were shown in the meta-analyses on the effect of group versus individual therapy on UL impairment (mean difference 0.87, 95% CI: −0.87 to 2.62, p = .327) or function (mean difference 1.53, 95% CI: −0.23 to 3.29, p = .089). Results were limited by small sample sizes and substantial heterogeneity, with wide variation in intervention type, dosage and setting. Conclusion Meta-analyses suggest group-based UL intervention may be as effective as intervention delivered one-to-one, post-stroke. Additional studies of large sample size and rigorous methodology are necessary to substantiate these findings. Future research should investigate which types of UL intervention are most effective when provided in group-based settings across the different stages of stroke recovery.

Objective Physical activity levels of patients in hospital are low. The aim of this study was to explore the perceptions of physiotherapists, nurses, and physicians about physical activity of hospitalized patients. Design Qualitative focus group study using phenomenology. Setting University hospital. Participants Thirty healthcare professionals (physiotherapists, nurses, and physicians) participated in six focus groups. Main measures Semi-structured focus groups following an interview guide were conducted. Besides identification of influencing factors and development of ideas for associated interventions, participants should reflect on the roles of different professions. Content analysis of the transcriptions was performed in iterative cycles involving three researchers using inductive coding and redefining based on the literature. Consensus was reached through discussions in the research team. Results Three themes of influencing factors on physical activity of patients in hospital with seven codes emerged. In the theme “patient” physical and psychosocial factors were mentioned. The theme “organization” pooled all factors regarding facilities and processes. The third theme “health literacy” has an impact on the two other themes. In this theme self-efficacy, handling of health literacy/knowledge, and communication and cooperation became apparent as codes. Conclusions Health literacy plays an important role in the physical activity of patients in hospital. The developed model of influencing factors on physical activity highlights the importance of health literacy for all stakeholders, including patients, staff, and the organization and illustrates the connections to other influencing factors. This model can be helpful in conceptualizing interventions to promote physical activity.