Public Health and Healthcare

Abstract: Background: The primary purpose of this feasibility-oriented investigation was to characterize wearable-derived median frequency (MF) responses during the standardized 30-second sit-to-stand (30-STS) assessment in medically stable adults aged 50–79 years using the Myontec MShorts 3 (Myontec Ltd., Kuopio, Finland) wearable monitoring platform and MBody Live application (Myontec Ltd., Kuopio, Finland). A secondary purpose was to examine associations among wearable-derived MF, age, biological sex, and self-reported physical activity. Methods: Twenty community-dwelling adults completed a standardized 30-STS assessment while wearable-derived physiological outputs were acquired using the Myontec MShorts 3 wearable monitoring platform. Participants were stratified into three age groups (50–59, 60–69, and 70–79 years), and habitual physical activity was assessed using the Rapid Assessment of Physical Activity (RAPA). Statistical outliers were identified using predefined standardized z-score criteria, resulting in a final analytical sample of sixteen participants. One-way analysis of variance examined age-group differences in wearable-derived MF, and multiple linear regression evaluated associations among wearable-derived MF, age, biological sex, and RAPA measures. Results: No statistically significant age-group differences in wearable-derived MF were observed (F(2,13) = 2.641, p = 0.109), although a moderate effect size was identified (η² = 0.289). Multiple linear regression did not identify significant associations among wearable-derived MF, age, biological sex, aerobic physical activity, or strength and flexibility activities (R² = 0.094, adjusted R² = -0.235). Wearable-derived physiological responses were successfully characterized during the standardized functional assessment, and substantial interindividual variability was observed across participants. Conclusions: Although statistically significant age-group differences and predictor relationships were not identified, the present investigation demonstrated the feasibility of integrating a commercially available wearable monitoring platform with a standardized functional assessment and a practical frequency-domain interpretive framework. The findings support continued investigation of wearable-derived physiological monitoring as a complementary approach for evaluating lower-extremity functional responses in exercise science, rehabilitation, and healthy aging.

Abstract: Background/Objectives: Early identification of disorders of consciousness (DoC) in acute care using standardized assessments may be linked to improved functional recovery, discharge disposition, and levels of consciousness (LoC) on the DoC spectrum. The impact of serial Coma Recovery Scale Revised (CRS-R) assessment and therapy exposure on improving LoC in acute care remains poorly understood. The objective of this study was to examine the association between serial CRS-R assessments, therapy exposure, discharge disposition and changes in LoC among patients with DoC. Methods: A retrospective cohort study included adult patients with severe acquired brain injury (sABI) evaluated and treated in an acute care setting between 2024 and 2026. Primary outcomes were changes in LoC category and discharge disposition. Results: Thirty-nine (39) individuals were included; most were in an unresponsive wakefulness state (UWS) at baseline (68%, n=25), male (74%, n=29), and with non-traumatic sABI diagnosis (72%, n=28). At discharge, 23% (n=9) patients emerged from minimally conscious states (eMCS). Therapy exposure was not significantly associated with changes in LoC. Increased time since therapy initiation was associated with higher odds of improving LOC (OR =4.95, p<0.05), while longer length of stay was associated with decreased odds (8% per day) of improvement (OR= 0.92, p<0.05). Final discharge recommendations were not significantly associated with age (p=0.5) or sex (p=0.7) however, etiology was significantly associated (p=0.046) with individuals with TBI etiologies more likely to have recommendations of inpatient rehabilitation. Discharge LoC (p=0.024) but not admission LoC (p=0.40) was associated with discharge disposition. Conclusions: Serial assessment in acute care for patients with DoC may provide important prognostic information to guide discharge planning.

Abstract: Whether physical activity can offset the health risks of a pro-inflammatory diet is a compelling question, but it becomes conceptually misleading when interpreted as simple behavioral compensation. This narrative review integrates evidence on dietary inflammatory potential, movement-related physiological capacity, and chronic disease vulnerability, with particular attention to the Dietary Inflammatory Index, biological translation pathways, and emerging joint diet–activity evidence. Pro-inflammatory dietary exposure may be translated into disease vulnerability through immune activation, oxidative stress, adipose tissue inflammation, metabolic dysfunction, endothelial impairment, and gut-related inflammatory signaling. Habitual movement and exercise training may influence many of these same pathways through skeletal muscle signaling, improved insulin sensitivity, reduced visceral adiposity, redox adaptation, vascular regulation, and higher cardiorespiratory fitness. Taken together, current human evidence is more consistent with partial buffering and joint risk stratification than with full compensation. We therefore propose an Inflammatory Resilience Framework in which physical activity, cardiorespiratory fitness, skeletal muscle function, adiposity, metabolic flexibility, vascular function, and baseline health status are positioned as modifiers of the biological translation from dietary inflammatory exposure to disease vulnerability. This framework shifts the research question from whether exercise cancels dietary risk to how movement-related physiological capacity modifies inflammatory risk expression across individuals, pathways, and outcomes.

Abstract: Background: Adolescent girls in Nigeria face multiple barriers to physical activity (PA), yet qualitative evidence on their lived experiences remains limited. Understanding these experiences is essential for developing culturally appropriate interventions to promote active lifestyles. This study explored the nature and patterns of PA participation, the enablers and barriers influencing engagement, and strategies for improving PA among adolescent girls in Enugu State, Nigeria. Methods: A qualitative descriptive study was conducted among 20 adolescent girls aged 10–19 years using semi-structured interviews. Data were analysed using reflexive thematic analysis, guided by the Socio-Ecological Model (SEM). The study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ). Results: Four themes were identified: (1) PA was predominantly unstructured and embedded within domestic chores and routine walking rather than intentional exercise; (2) participation was facilitated by parental support, teacher encouragement, peer influence, and access to school facilities; (3) barriers included academic demands, restrictive gender norms, school hierarchy, psychological factors, physical discomfort, and environmental constraints; and (4) participants recommended structured school-based programmes, equitable opportunities, improved facilities, and health education to promote PA. Conclusions: Physical activity participation among adolescent girls was shaped by interacting individual, interpersonal, organisational, and environmental factors. Beyond commonly reported barriers, this study identifies school hierarchy as an important organisational influence that may restrict opportunities for physical activity participation. These findings highlight the need for multilevel, gender-sensitive interventions that strengthen supportive school environments, address sociocultural and organisational barriers, and improve equitable access to safe opportunities for regular physical activity.

Abstract: Objective: Female athletes are a distinct high-risk population for Anorexia nervosa. Current clinical guidelines and psychological treatments are based predominantly on general population evidence, and review evidence is needed to support guideline development. The purpose of this review is to evaluate the psychological components of interventions for anorexia nervosa in adult female athletes, and to integrate quantitative effectiveness data with qualitative athlete experiences to identify factors that moderate treatment outcomes. Methods: This review was conducted as a convergent sequential mixed-methods systematic review in accordance with PRISMA 2020 and JBI guidelines (PROSPERO: CRD420251073240). Five databases were searched up to April 2026. Studies were eligible if they involved adult female athletes (≥18 years) with a clinical diagnosis of AN and included a psychological intervention component. The quantitative findings were synthesised narratively using the SWiM framework and certainty was assessed using GRADE. The qualitative findings underwent JBI meta-aggregation and certainty was assessed using CERQual. Results were then integrated. Results: Thirteen studies were included. A total population of 168 athletes were identified (137 female, 17 male, 12 unknown). Most of the studies were conducted in the USA and most utilised Cognitive Behavioural Therapy as a key component. From the quantitative results, the certainty was very low all outcome domains (eating disorder psychopathology, weight restoration, return to sport). Although the potential for meaningful recovery was identified. Although recovery was likely to be achieved when the environment, culture and support from the multi-disciplinary team was in place. Three themes from the qualitative synthesis provide insight to this. Conclusions: Standard psychological treatments may be insufficient for female athletes with AN without meaningful athlete-specific adaptation. Psychological interventions may be most effective when they incorporate sport-specific cultural competence, performance-framed cognitive restructuring, structured coach integration, and return-to-sport as an explicit therapeutic goal. This study has provided evidence that future research must prioritise athlete-adapted RCTs with sport-specific outcome measures to build the evidence base for this underserved population.

Abstract: Background: Shoulder injuries account for 15–30% of rugby injuries and are associated with recurrent instability, impaired performance, prolonged absence from sport, and long-term functional limitations. Physiotherapy rehabilitation is central to management; however, outcomes may be influenced by variability in rehabilitation approaches and insufficient consideration of psychological and neuromuscular recovery. This review evaluated evidence on physiotherapy rehabilitation following shoulder injuries in rugby players.Methods: This systematic review was prospectively registered with PROSPERO (CRD420261358218). PubMed, MEDLINE, CINAHL, EMBASE, EMCARE, Cochrane Library, HMIC, and Google Scholar were searched from inception to January 2026. Following screening and full-text assessment, five studies met the inclusion criteria. Methodological quality was assessed using the Mixed Methods Appraisal Tool and Oxford Centre for Evidence-Based Medicine Levels of Evidence. Findings were synthesized narratively.Results: Five studies comprising one randomized controlled trial, two observational studies, one cross-sectional study, and one qualitative study were included. Structured physiotherapy rehabilitation was associated with improvements in shoulder stability and upper-limb function. However, persistent proprioceptive deficits, reduced psychological readiness, and perceived shoulder dysfunction were reported despite return-to-play. Individualized rehabilitation, multidisciplinary support, and attention to psychological recovery were identified as important factors influencing outcomes.Conclusion: Physiotherapy rehabilitation may improve recovery following shoulder injury in rugby players. However, multidimensional approaches addressing physical, psychological, and neuromuscular recovery appear necessary to optimize return-to-play readiness.

Abstract: In accelerometer-based measurement, inclusion of upper extremity (UE) activity during walking can overestimate real-world functional UE use in people post-stroke. This study introduces a comprehensive, accelerometer-based approach to examine real-world UE use, including contribution of UE activity during walking, and compares UE use during walking versus ADL-based activities. People with subacute stroke wore bilateral wrist and ankle inertial measurement units (IMU) for one week (24 hrs/day). Agreement between UE-Total, UE-Continuous Walking, and UE-ADL measures were assessed using Bland–Altman analyses. Variables were modeled using linear regression to explore step count, mobility aid use and UE motor impairment as predictors of IMU measures of real-world UE use. Agreement between UE-Total and UE-ADL measures showed minimal bias. Differences between UE-Continuous Walking and UE-ADL varied by mobility aid. UE-Continuous Walking was associated with increased UE activity and relatively greater paretic arm use compared with UE-ADL. Across UE-Continuous Walking and UE-ADL, step count was the strongest predictor of real-world UE use. UE activity during continuous walking exhibits different use patterns as compared to ADL-based activity. Accordingly, separating continuous walking-related UE activity from ADL-based UE use may improve clinical interpretation of IMU measures of real-world UE use in individuals with subacute stroke.

Abstract: Background/Objectives: This study aimed to investigate the effects of different taping techniques commonly used in the management of hallux valgus (HV) on plantar pressure distribution under static and dynamic conditions. Methods: Thirty participants, including 15 individuals with HV and 15 healthy con-trols, were included. Individuals with mild–moderate HV were identified using the Manchester scale, while healthy participants were determined using the Foot Posture Index. Plantar pressure distribution was assessed using the Freemed Maxi pressure platform (Sensor Medica, Italy). Participants were first evaluated without taping. Rig-id taping and dynamic taping with mechanical correction techniques were then ap-plied in a randomized order with a 24-hour interval. Participants rested for 30 minutes after each taping application to evaluate the immediate effect. Static assessments in-cluded total pressure and forefoot and rearfoot loads, while dynamic analyses included forefoot load, rearfoot load, medial load, and lateral load. Conclusions: Data were analyzed using a repeated-measures General Linear Model in SPSS 21.0. No significant differences were observed between groups in static total pressure, forefoot load, or rearfoot load (p=0.965, p=0.928, and p=0.829, respectively). Significant effects were found for dynamic forefoot and rearfoot loads (p=0.036 for both variables). Dynamic medial and lateral loads showed no significant differences (p=0.338). Static forefoot and rearfoot pressure values in both taping conditions were closer to those of healthy individuals. However, dynamic taping resulted in lower forefoot and rearfoot loads during gait compared with healthy values, while dynamic medial and lateral loads approached healthy levels.

Abstract: Exercise training is frequently examined in relation to cognitive and brain health in aging populations. Yet many exercise-cognition studies remain difficult to interpret mechanistically because cognitive outcomes are often assessed without sufficient alignment with exercise dose, biological endpoints, and participant vulnerability. This mechanism-informed narrative review argues that future research in cognitive aging should move beyond outcome-based interpretation alone and more explicitly connect the exercise stimulus with cerebrovascular endpoints, supportive biological markers, baseline vulnerability, and cognitive or translational outcomes. The review treats cerebrovascular endpoints, including cerebral blood flow, cerebrovascular reactivity, endothelial function, vascular compliance, and neurovascular coupling, as primary mechanistic anchors because they are closely related to vascular cognitive vulnerability and are more proximal to biological adaptation than cognitive test scores alone. Immune-inflammatory markers, blood-brain barrier-related indicators, myokines, neurotrophic factors, and exercise-induced circulating factors are considered supportive endpoints because they may clarify broader biological responsiveness when selected according to a clear hypothesis. The review also considers how exercise modality, delivered dose, adherence, baseline fitness, vascular risk, cognitive status, sex, comorbidity, and recovery capacity may shape responder heterogeneity. Based on this synthesis, the review proposes a five-layer mechanism-informed endpoint framework to support future study design and interpretation. Rather than serving as a clinical prescription model or formal reporting guideline, the framework is intended to help align exercise exposure, participant characteristics, biological mechanisms, and cognitive outcomes in studies of cognitive aging.

Abstract: Burn injuries can have profound physical and psychological consequences, making holistic rehabilitation essential. This mixed methods service evaluation explored a peer-supported breakfast group delivered as part of routine occupational therapy practice for adult inpatient burn survivors with the aim of understanding acceptability, perceived benefits and feasibility. All English speaking inpatients aged >18 years who attended were invited (n=36; n=9 completed). A convergent design integrated open ended survey responses with PROMIS patient reported outcome items, analysed thematically and interpreted using the RE AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) and MMR RHS (Mixed Methods Reporting – Rehabilitation and Health Sciences) frameworks. Quantitative findings suggested high perceived physical function, strong emotional support, low anxiety and depression, low social isolation, and moderate pain interference. Reflexive thematic analysis generated four themes: fostering human connection and emotional wellbeing; restoring autonomy and confidence; preparing physically and psychologically for discharge; and the influence of the rehabilitation environment. Limitations include small sample size, low response rate, absence of baseline or control data and potential selection bias. While descriptive only, findings provide early insight into the acceptability and perceived value of peer supported group activity in inpatient burn care. Larger controlled studies with baseline measurement are needed to evaluate effectiveness and implementation feasibility.

Abstract:

Background: Inter-limb asymmetry has been widely studied as a potential determinant of physical performance in able-bodied athletes; however, its functional relevance in athletes with neurological impairments such as spastic hemiparesis remains unclear. This study aimed to examine the associations between lower-limb isometric strength, inter-limb asymmetry, physical performance, and match external-load variables in elite CP football players. Methods: Eleven male football players with spastic hemiparesis from the Spanish national team competing at the 2024 IFCPF World Cup participated in this observational cross-sectional study. Maximal isometric strength of the soleus, adductors, and hamstrings was assessed using a belt-stabilised dynamometer. Inter-limb asymmetry was calculated as a percentage difference between affected and non-affected limbs. Physical performance was evaluated using sprint, change-of-direction, dribbling, and intermittent endurance tests. Match external-load variables were collected during official competition using inertial measurement units. Associations were analysed using Spearman’s rank correlations, and between-group comparisons were conducted using a median split based on asymmetry magnitude. Results: Inter-limb asymmetry did not significantly differentiate physical performance outcomes across any field-based tests (p > .05). Isometric strength showed limited associations with performance variables, with a significant correlation between non-affected adductor strength and intermittent endurance (ρ = 0.63; p < .05). Soleus asymmetry was negatively associated with dribbling performance (ρ = −0.64; p < .05) and showed moderate-to-strong correlations with several match external-load variables, including mechanical work (ρ = −0.84; p < .01) and metabolic power (ρ = −0.83; p < .01). Conclusions: Inter-limb strength asymmetry did not appear to be a primary determinant of physical performance in CP football players with spastic hemiparesis. These findings suggest that asymmetry may represent a structural characteristic rather than a modifiable constraint, with athletes developing compensatory strategies to maintain performance. However, asymmetry in plantar flexor strength may influence match-specific physical demands, highlighting the importance of context-specific interpretation.

Abstract: Background: Injury rate is an important characteristic of any sport, with football occupying one of the leading positions in this indicator. Reducing injury frequency is a primary goal of sports medicine. Objective: To evaluate the impact of the "FIFA 11+" injury prevention program on the frequency and structure of injuries in amateur football players aged 15–17. Methods: A retrospective cohort study was conducted over two time intervals of 4 months each. In the first period warm-ups before training sessions and matches were performed arbitrarily. In the second period the "FIFA 11+" was used. The injury incidence rate (IR), severity, and location of injuries were evaluated. Results: The use of the "FIFA 11+" led to a significant decrease in the overall incidence rate (IR decreased from 31.9 to 17.1). At the same time, injuries decreased mainly due to moderate (p=0.003) and mild (p=0.02) injuries. Furthermore, the analysis of the injury structure within each study period revealed a significant change, showing a shift toward less severe injuries. Conclusion: The application of the "FIFA 11+" program in the training/match process of amateur football players aged 15–17 significantly reduces the incidence rate and lowers the proportion of severe and moderate injuries.

Abstract: Background: Injury prevention in situational sports remains a major challenge due to the dynamic, unpredictable, and multifactorial nature of competitive environments. Existing injury-risk assessment approaches are predominantly based on reductionist and linear models that evaluate isolated predictors and may not adequately reflect complex interactions among multiple risk factors. Methods: A conceptual non-linear framework for individualized injury-risk assessment was developed based on the dynamics of the logistic (sigmoid) function. The proposed model conceptualizes the athlete as a complex open biomechanical system and integrates physiological, technical, psychological, anthropometric, historical, recovery-related, and situational factors into a composite risk index (Z), which is transformed into a bounded injury probability scale (Pinjury ∈ [0,1]). Results: The framework describes three structural phases of injury-risk progression: (1) a latent risk phase characterized by compensatory mechanisms, (2) a non-linear acceleration phase driven by synergistic interactions among risk factors, and (3) a critical saturation phase in which injury probability approaches its upper limit. The concept of a “safety window” is introduced as a practical tool for individualized monitoring and training-load management. The model provides a unified theoretical structure for integrating heterogeneous injury-related factors within a single probabilistic framework. Conclusions: The proposed framework offers a novel conceptual basis for individualized injury-risk assessment in situational sports and may support the development of future decision-support systems for injury prevention. Although empirical validation and sport-specific calibration are required, the model establishes a theoretical foundation for future research and practical applications in sports science and sports medicine.

Abstract: Background/Objectives: Dementia and cognitive decline place increasing demands on healthcare systems, rehabilitation services, long-term care, and community-based prevention. Structured exercise training is a promising strategy for adults at risk of cognitive decline, but it remains unclear how intervention studies integrate cerebrovascular and cognitive outcomes in ways that can inform clinical translation, rehabilitation planning, and exercise prescription. Methods: This scoping review followed PRISMA-ScR guidance. PubMed/MEDLINE and Scopus were searched for peer-reviewed English-language studies published from January 2010 to 4 May 2026, supplemented by reference list checking and citation chasing. Eligible studies were human intervention studies involving structured exercise training and at least one cerebrovascular, vascular, brain-related, or cognitive outcome. Studies were mapped by exercise modality, population risk profile, grouped outcome domain, and outcome-integration category. Results: Fifty-four studies were included. Cognitive outcomes were assessed more frequently than cerebrovascular outcomes: 38 studies reported cognitive outcomes only, 9 reported cerebrovascular or vascular outcomes only, and 7 assessed both domains within the same intervention design. Aerobic training formed the most developed evidence cluster for direct cerebrovascular outcomes, whereas other modalities were more often represented in cognition-focused studies but less frequently included direct cerebrovascular measures. Conclusions: Current evidence shows a major vascular-cognitive integration gap. Most exercise intervention studies do not determine whether cerebrovascular adaptations correspond with cognitive outcomes in the same participants. Future trials should combine cerebrovascular assessment, domain-specific cognitive testing, dose reporting, adherence monitoring, safety reporting, feasibility evaluation, and mechanistic biomarkers to support more precise exercise prescription for dementia risk mitigation and cognitive health promotion.

Abstract: Background. Musculoskeletal pain (MSP) is highly prevalent among undergraduate students and may originate during early adulthood, increasing the risk of chronicity later in life. Modifiable factors such as reduced muscle flexibility and prolonged sedentary behavior have been proposed as contributors; however, longitudinal evidence among student populations remains scarce. This study aimed to prospectively examine changes in MSP prevalence and hip muscle length over one year and to identify independent predictors of MSP. Methods. A prospective longitudinal study was conducted among 62 first-year undergraduate students assessed at baseline and at one-year follow-up. MSP was evaluated using a modified Standardized Nordic Questionnaire, and demographic data including physical activity and sitting behavior were recorded. Hamstrings and the iliopsoas muscles' length were measured by passive straight-leg raise and modified Thomas tests, respectively. Changes over time were analyzed using paired t-tests and McNemar tests. Multivariable logistic regression was also performed to identify predictors of MSP at follow-up. Results. Most participants were female (79%, n = 49), with a mean age of 25.8 ± 6.0 years and body mass index of 23.6 ± 4.4 kg/m². Significant reductions in hamstrings (P < 0.001; d = −0.55 to −0.70) and iliopsoas muscles` length (P< 0.001; d = −1.32 to −1.46) were observed over one year. Health-science students manifested a significant decrease in hamstrings length over time compared to their counterparts in other programs (P ≤ 0.002). MSP prevalence increased across all body regions, particularly in the low back (46.8% to 71.0%) and cervical spine (46.8% to 61.3%). Baseline MSP was the only independent predictor of MSP at follow-up (upper quadrant: OR = 12.89, 95% CI: 2.38–69.65, P=0.003; lower quadrant: OR = 6.35, 95% CI: 1.39–28.90, P=0.018). Conclusions. MSP prevalence increased concurrently with significant reductions in hip muscles length over one year. While muscle shortening was not predictive of future MSP, baseline pain demonstrated strong prognostic value. These findings underscore the importance of early identification and targeted preventive strategies addressing modifiable behavioral risk factors in young adults.

Abstract: Background: Vertical jump performance is a key determinant of volleyball success. Prior evaluations of complex training in youth have relied largely on frequentist statistics, which are underpowered in the small, lean cohorts typical of elite youth sport. Objective: Apply Bayesian inference to evaluate vertical jump kinematics across short- and long-stretch-shortening-cycle modalities following a 9-week complex training program in adolescent female volleyball athletes. Methods: Eight athletes completed a periodized training protocol. Jump kinematics were assessed using a high-frequency force platform, and whole-body composition was assessed using bioelectrical impedance analysis. Data were analyzed using Bayesian inference. Results: Bayesian analysis indicated consistent improvements across jump modalities, with Block Volleyball Jump, Countermovement Jump, and Spike Jump heights increasing by 14.4%, 14.4%, and 13.9% (BF₁₀ = 24.3, 26.7, 38.4). Whole-body BIA detected no meaningful change in body mass (BF₁₀ = 0.37) or in muscle mass percentage (BF₁₀ = 1.67) over the intervention period. Conclusion: Complex training was associated with transferable neuromuscular improvements across the stretch-shortening cycle continuum. Bayesian inference provided an interpretable basis for evaluating training effects in a small elite cohort. The absence of a detectable change in whole-body composition is consistent with predominantly neural early-phase adaptation, although the single-arm design precludes causal attribution.

Abstract: Tele-exercise (TEF) is an option for maintaining the vitality of people who have difficulty exercising outside the home and in confinement situations. The aim of the present study was to determine the effect of TEF in Tai Chi (CT) compared to strength training (ST) on muscle mass and strength in older Mexican adults. The following groups were formed: (i) CT Group (CTG) n=42; (ii) ST Group (STG) n=41; (iii) Control Group (CG) n=40. Skeletal muscle mass index (SMMI), %FM (percentage of fat mass), handgrip strength (HF), and sit-stand test (SST) were assessed before and after the intervention. Both TEF groups showed an increase in SMMI, GTC (+0.73 ± 1 kg/m², p 0.009) and GEF (+0.45 ± 0.9 kg/m², p 0.03) in contrast to the GC (-0.49 ± 0.5, p 0.05). Likewise, both groups showed a significant decrease in %FM (GTC, -4.32 ± 6, p&lt;0.01; GEF, -4.24 ± 6, p&lt;0.01) compared to the GC (2.12 ± 7, p=0.04). An increase was also found in HS: TCG (+4 ± 7, p=0.08) and GEF (+5 ±3, p=0.08), along with a decrease in STST time in both groups (GTC, -2.19±3, p&lt;0.01; GEF, -3.48 ± 3, p&lt;0.001). The tele-exercise in tai chi or strength training has a similar positive effect on SMMI, %FM, HS, and STST, and an option for older adults in confinement situations.

Abstract: Dementia affects approximately 9.6% of Americans aged 65 or older with these numbers predicted to continue to rise, making it a significant growing public health concern that physical therapists may encounter. Dementia affects a large amount of the PT patient population, yet physical therapists report reduced confidence in treating this population due to the lack of education in academia and reduced exposure to dementia care in clinical practice. This experimental pre-post test study examined the implementation of the Leveraging Existing Abilities in Dementia™ training program on confidence levels handling various situations and the utilization of communication and treatment strategies discussed in the LEAD™ training program when treating individuals with dementia. Eight rehabilitation providers completed the 12-hour LEAD™ training program. Pre-program, post-program, and 3-month surveys were administered to capture confidence in communication, implementation strategies and dementia knowledge. Provider confidence significantly increased after LEAD™ training (49.3 → 67.4/70, p=0.003). At baseline, participants were unfamiliar with 5 of 10 validated dementia care practices, but by 3-month follow-up, 90% reported using these strategies at least weekly. Notable gains included intent-to-use the K.I.S.S. method (+73%) and Spaced Retrieval (+29%). Although dementia is highly prevalent, many rehabilitation providers lack confidence in dementia care due to limited training. The LEAD™ program shows potential to bridge this gap, but continued evaluation is needed to assess long-term effects on practice and patient outcomes.

Abstract: Background and Objectives: Evidence guiding rehabilitation outcomes among medically complex traumatic brain injury (TBI) populations remains limited, particularly in long-term acute care hospital (LTACH) settings. Most prior studies have focused on inpatient rehabilitation facilities, leaving a limited understanding of factors influencing recovery during LTACH rehabilitation. This study examined the association between mechanism of injury, time from injury to LTACH admission, and functional rehabilitation outcomes in adults with moderate-to-severe TBI. Materials and Methods: This cross-sectional observational study included adults with moderate-to-severe TBI who received multidisciplinary rehabilitation in an LTACH between January 2017 and December 2024. Of 272 eligible patients, 239 met the inclusion criteria after exclusions for short length of stay, incomplete evaluations, duplicate records, death during rehabilitation, or full independence at admission. Functional improvement in mobility and activities of daily living (ADLs) was measured using CMS Section GG assessments and dichotomized as improvement versus no improvement. Logistic regression analyses examined associations between predictors and outcomes while adjusting for demographic covariates. Results: Longer time from injury to LTACH admission was associated with lower odds of functional improvement. Compared with admission within 30 days, admission at 31–60 days (OR=0.53; 95% CI, 0.28-0.99; p=.045) and beyond 60 days (OR=0.26; 95% CI, 0.10-0.69; p=.006) was associated with reduced odds of improvement. Mechanism of injury was not significantly associated with outcomes. Male gender was associated with higher odds of improvement (OR=2.18; 95% CI, 1.05-4.51; p=.036). No significant interaction effects were identified. Conclusions: Delayed LTACH admission was associated with lower odds of functional improvement following TBI rehabilitation, independent of injury mechanism and demographic factors. These findings support the importance of timely access to postacute rehabilitation among medically complex TBI populations.

Abstract: Background: Rehabilitation assessment is increasingly integrated into medico legal practice to complement traditional impairment based evaluations with functional and multidimensional approaches. Wearable sensors offer objective measurements of joint range of motion, but their relationship with clinical outcome measures requires further investigation. Objective: To examine the construct validity of sensor based range of motion measurements by analyzing their association with commonly used rehabilitation outcome measures in a medico legal population. Methods: A cross sectional study was conducted on individuals with traumatic injuries. Joint range of motion of the shoulder, hip, knee, and ankle was assessed using XClinic wearable inertial sensors and expressed as a percentage of physiological reference values. Participants also completed validated outcome measures assessing balance, lower and upper limb function, fatigue, and kinesiophobia. Construct validity was evaluated through Pearson correlation analysis. Results: Sixty seven participants were included. Significant correlations were observed between sensor derived range of motion and multiple functional domains. Shoulder mobility was associated with work related disability, fatigue, and movement avoidance. Hip range of motion showed consistent associations with balance, lower limb function, and pain related activity limitations. Knee mobility demonstrated relationships with knee specific outcomes, balance, and lower extremity function, with additional links to fatigue and kinesiophobia in specific movements. Ankle range of motion showed more selective associations, particularly with balance, lower limb function, and specific psychological and fatigue related aspects. Conclusion: Sensor based range of motion assessment demonstrates meaningful relationships with functional and psychosocial outcomes, supporting its construct validity. These findings suggest its potential role as a complementary tool for multidimensional evaluation in rehabilitation and medico legal contexts.