Archives of Physical Medicine and Rehabilitation

Objective To determine the comparative effectiveness of different digital health interventions for adults with low back pain. Design Systematic review and network meta-analysis of randomised controlled trials. Data sources PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, APA PsycINFO, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), from inception to 19 March 2026 (updated to 8 August 2026). Study selection Randomised controlled trials enrolling adults with low back pain. Interventions were classified as telemedicine, web-based applications (Web-App), mobile applications (Mobile-App), virtual reality (VR), exergaming, biofeedback devices, face-to-face care, and control. Paired reviewers independently screened records, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2 tool. Methods Frequentist random-effects network meta-analyses synthesised pain intensity and physical function (primary outcomes), and pain-related fear avoidance, health-related quality of life, self-efficacy, anxiety, and depression (secondary outcomes), assessed at post-intervention (from the end of treatment to < 2 months post-intervention), short-term ([&ge;]2 to <6 months), mid-term ([&ge;]6 to <12 months), and long-term ([&ge;]12 months) follow-up. Effects were reported as standardised mean differences with 95% confidence intervals. Transitivity was examined across potential effect modifiers, and Confidence in Network Meta-Analysis (CINeMA) informed confidence ratings. Results Ninety-two reports representing 84 trials involving 11 649 participants were included. At post-intervention, compared with control, VR showed the largest estimated reduction in pain intensity (SMD -1.43, 95% CI -1.87 to -0.98; moderate confidence) and improvement in physical function (-0.86, -1.45 to -0.26; very low confidence). VR was also associated with lower pain-related fear avoidance (-1.14, -1.68 to -0.61) and better health-related quality of life (0.97, 0.57 to 1.36) (both moderate confidence). Exergaming, Mobile-App, Web-App and telemedicine were also associated with lower pain intensity, while Mobile-App, Web-App, telemedicine, and biofeedback devices were associated with better physical function. For self-efficacy, exergaming (0.77, 0.05 to 1.49) showed favourable post-intervention effects, although confidence in this estimate was very low. No intervention showed a clear effect on anxiety, with confidence ranging from very low to moderate across comparisons, whereas telemedicine was associated with lower depression (-0.22, -0.44 to 0.00; low confidence). Networks became progressively sparse at later follow-up, and evidence of sustained effects was inconsistent across interventions and outcomes. Global inconsistency was detected in the post-intervention pain-intensity network, with local inconsistency identified for selected exergaming comparisons, and substantial heterogeneity was present in several networks. Conclusions Among adults with low back pain, VR showed the largest estimated post-intervention effects versus control for pain intensity, physical function, pain-related fear avoidance, and health-related quality of life, although comparative effects differed across outcomes. Self-efficacy showed favourable estimates for selected interventions, whereas evidence for anxiety and depression was limited. Evidence beyond treatment completion was increasingly sparse, and confidence in many network estimates was low or very low; firm comparative recommendations therefore remain premature. Systematic review registration PROSPERO CRD420261339841

Objective: To examine changes in function and pain interference among patients utilizing a digital exercise therapy application (DETA) for knee and shoulder pain. Methods: We conducted a retrospective analysis of data from patients utilizing a DETA for non-operative knee and shoulder pain. Primary outcomes for the study were 8-week changes in physical function, measured using the PROMIS-Physical Function (knee pain) and PROMIS-Upper Extremity Function (shoulder pain); and pain interference, measured using the PROMIS-Pain Interference. Data on patient characteristics was used to examine outcomes among specific patient subgroups. Results: We observed a 3.5 point (SD: 7.8) increase in function and a 3.9 point (SD: 7.5) decrease in pain interference overall (p<0.001), with changes in function and pain interference surpassing the minimal clinically important difference for patients with knee and shoulder pain. Patients with knee pain experienced greater improvements in function than those with shoulder pain (p=0.02), as did patients who report moderate-high levels of exertion during exercise compared to those reporting low levels of exertion (p=0.05). We saw greater reductions in pain interference among those with higher education (p=0.03), those with more acute symptoms (p=0.01) and those reporting moderate-high levels of exercise exertion (p=0.02). Conclusion: We observed a clinically meaningful improvement in pain interference and function among patients utilizing a DETA for knee and shoulder pain. Patients with knee pain, higher levels of education, more acute symptoms, and those who reported higher levels of exertion with exercise experienced the greatest changes in function and pain. Impact Statement: This study indicates that self-guided interventions, such as those delivered through a DETA, may be beneficial for patients with knee and shoulder pain. These results may also inform the development of patient profiles that can be used to identify patients most appropriate to receive care through a mobile application.

Periods of limb immobilization are common in clinical care and lead to rapid losses of muscle mass and strength. We therefore examined whether prehabilitative exercise improves outcomes after disuse by increasing pre-immobilization muscle reserve or by attenuating the biological response to immobilization. Here, we report the primary and muscle-focused secondary outcomes of the PRE-EX (PREhabilitative EXercise) randomized controlled trial (ClinicalTrials.gov: NCT06205784). Fifty-four healthy younger and older women completed four weeks of supervised resistance exercise or no training before eight days of unilateral limb immobilization, followed by four weeks of rehabilitation. From baseline to pre-immobilization, prehabilitation increased quadriceps cross-sectional area (CSA) by 6.7%, maximal voluntary contraction (MVC) by 15.2%, and muscle fiber CSA by 17.7%. Immobilization subsequently reduced quadriceps CSA by 3.2% over 5 days and MVC by ~20%, with similar relative losses in the Prehab and No-train groups. Consequently, quadriceps CSA, the studys primary outcome, remained greater in Prehab than in No-train after immobilization and following rehabilitation, while MVC was greater following rehabilitation. Prehabilitation did not preserve markers of neuromuscular innervation or produce a detectable post-immobilization transcriptomic signature. Instead, immobilization elicited an extensive transcriptional response comprising more than 7000 differentially expressed genes, characterized by activation of inflammatory, proteolytic, stress, and denervation-associated programs together with suppression of mitochondrial and muscle-structural pathways. Network analysis further linked these coordinated molecular programs to disuse-related changes in muscle size, strength, and morphology. The effects of prehabilitation and the subsequent response to immobilization were similar in younger and older women. These findings demonstrate that short-term prehabilitative exercise mitigates the consequences of limb immobilization by establishing greater muscle and strength reserve before disuse, rather than by attenuating the physiological or molecular response to immobilization.

Background: Excessive inflammation in early phases post-ischemic stroke is associated with poor long-term outcome and increased stroke recurrence. Interventions capable of downregulating persistent states of inflammation could improve recovery and prevent secondary stroke. Cardiovascular exercise (CE) has well-established anti-inflammatory effects but its capacity to attenuate the exaggerated inflammatory response triggered by ischemic stroke is unclear. Methods: We investigated the impact of eight weeks of CE on the serum concentration of inflammatory mediators in the early subacute phase post-stroke. Seventy-one patients with firstever ischemic stroke were randomly assigned to moderate-to-vigorous CE (n=45) or standard care (SC) (n=26). Concentrations of CRP, IL-6, IL-8, IL-10, TNF- and IL-1{beta} were measured at baseline and after the interventions. Differences between groups were analyzed with linear mixed models adjusted for age and sex. Results: Compared with the CE group, the SC group showed significant increases in IL-6 ({beta}=0.585, 95% CI=0.164-1.006, p=0.0073), IL-8 ({beta}=0.160, 95% CI=0.004-0.317, p=0.0447), and TNF- ({beta}=0.0845, 95% CI=0.0137-0.1553, p=0.0206). The SC group also showed greater increases in CRP ({beta}=0.250, 95% CI=-0.407, 0.906, p=0.4499) and IL-10 ({beta}=0.251, 95% CI=-0.024, 0.527, p=0.0729) but group differences were not significant. IL-1{beta} levels remained stable and differences between groups were not significant ({beta}=-0.008, 95% CI=-0.058, 0.042, p=0.7618). Conclusions: When introduced in the early subacute phase of stroke recovery, moderate-tovigorous CE mitigates increases in inflammation, but the effect differs across mediators. To what extent reducing the inflammatory response in the early stages post-stroke with CE can impact longterm recovery and stroke recurrence needs to be determined.

Background: Gait propulsion (anterior ground reaction force) is commonly impaired after stroke. Force plates and wearable sensors can quantify propulsion but are not routinely available in clinical settings. Walking speed alone does not adequately capture the heterogeneity of propulsion deficits. Objective: To determine whether standardized clinical measures can estimate post-stroke propulsion metrics and classify propulsion impairment. Methods: Forty individuals post-stroke participated: 33 for model development and cross-validation (11 with repeated observations for longitudinal validation) and 7 for independent-cohort validation. Clinical measures included the 6-Minute Walk Test (6MWT), comfortable walking speed (CWS), Functional Gait Assessment (FGA), Fugl-Meyer Assessment of the Lower Extremity (FMA-LE), Short Physical Performance Battery (SPPB), Timed Up and Go test (TUG), and stroke chronicity. Regression models were developed to estimate three propulsion metrics: paretic propulsion peak and impulse, and interlimb propulsion symmetry. Model performance was evaluated using R2 and RMSE. Propulsion impairment was classified from symmetry estimates using a prespecified cutoff of 31.5%, with classification accuracy reported. Results: Models using the 6MWT, SPPB, TUG, and chronicity estimated paretic propulsion peak (R2 = 0.77, RMSE = 3.00 %body weight) and impulse (R2 = 0.81, RMSE = 0.65 %body weight {middle dot} %stance phase). FMA-LE, SPPB, TUG, and chronicity estimated propulsion symmetry (R2 = 0.75, RMSE = 8.56%) and classified propulsion impairment with 84.8% accuracy. Classification accuracy was 91.7% in longitudinal validation and 85.7% in independent-cohort validation. Conclusions: A multidomain clinical assessment framework may support practical and accurate estimation and classification of post-stroke propulsion impairment in clinical settings where specialized instrumentation is unavailable.

Background: Large language models (LLMs) configured as virtual patients may expand structured practice of clinical reasoning in health professions education. Before testing effectiveness, it must be established whether students engage with them and whether the resulting scores are complete, reliable, and related to performance with real patients. Our earlier pilot randomized trial found very low engagement with a less structured LLM-based approach. Objective: This study aimed to assess the feasibility (adherence, acceptability, and data completeness) of a revised, structured LLM-based clinical reasoning laboratory (Laboratorio de Inteligencia Artificial [LIA]) in undergraduate physical therapy education and to explore its measurement properties, including its association with clinical judgment with a real patient assessed with the Lasater Clinical Judgment Rubric (LCJR). Methods: In this single-arm pilot feasibility study, 27 third-year physical therapy students at a Spanish university completed, in 2024-2025, 3 virtual patient cases (lumbar, cervical, and thoracic spine pain) simulated by ChatGPT (GPT-4) over 4 weeks, each twice. ChatGPT scored each attempt from 0 to 4 on the same 10 dimensions of the Lasater Clinical Judgment Rubric (LCJR; 0-40 points) that human assessors applied (1-4 per dimension; 10-40 points) during a real patient encounter. Feasibility outcomes were case completion, data completeness, and satisfaction (0-10). Measurement outcomes were internal consistency and convergent validity (Spearman correlations between model-generated and human LCJR scores). Variability estimates informed the sample size of a future trial. Results: All 27 students were assessed with the LCJR; 22 (81%) completed at least 1 LIA case. Both attempts of the lumbar, cervical, and thoracic cases were completed by 78%, 63%, and 74% of students, respectively. Satisfaction data were available for 15 students (56%; mean 6.0, SD 1.3), and missing secondary data clustered in the third rotation. Internal consistency was excellent for the LCJR (alpha=.96) and ranged from .43 to .90 for model-generated ratings. Model-generated LIA scores clustered near the maximum (mean 36.0, SD 1.4). Among completers, LIA scores correlated weakly with the LCJR (rho=0.25, 95% CI -0.20 to 0.61; rho=0.44, 95% CI 0.05-0.71, when noncompleted attempts were scored as 0). Grade point average correlated almost perfectly with the LCJR (rho=0.96; n=22); after adjustment for it, the LIA-LCJR association disappeared (partial rho=-0.10). A future trial would require approximately 39 students per group (80% power, conservative variance). Conclusions: Delivering the LIA within the curriculum was feasible, but clinical judgment ratings generated by ChatGPT did not reflect those of human assessors with a real patient: they clustered near the maximum and showed no convergent validity once noncompletion was separated from performance. LLM-generated ratings should not be used as outcome or assessment measures without validation against human raters. Case calibration, completion tracking, and clarification of the GPA-LCJR relationship are also needed before a definitive trial. Trial Registration: ClinicalTrials.gov NCT06809634; https://clinicaltrials.gov/study/NCT06809634

Background: Temporomandibular disorders (TMDs) are common conditions in the general population. Several therapeutic approaches are available, but there is no consensus on the most effective, particularly in physiotherapy. Objectives: To assess the efficacy of manual therapy (MT) and therapeutic exercise (TE) in reducing pain in patients with TMDs. Methods: Four databases (MEDLINE, PEDro, EMBASE, CINAHL) were searched up to March 2025. We included randomized controlled trials (RCTs) evaluating the effects of MT and/or TE in individuals with TMDs, compared to any other rehabilitation treatment, with pain intensity as the primary outcome. The methodological quality was assessed using the PEDro scale. A network meta-analysis was performed to compare the effectiveness of different rehabilitative approaches. Results: 25 RCTs for a total of 1,540 people were included. The main comparisons were: MT and/or TE vs no treatment or placebo, occlusal splint, and instrumental physiotherapy. In most studies, MT and TE were more effective than controls in reducing pain. However, the network meta-analysis indicated that multimodal treatments were the most effective. The methodological quality of the included studies ranged from 3 to 9 points. Conclusion: MT and TE are effective strategies for reducing pain in subjects with TMDs and should be used as first-line interventions before more invasive treatments; the combination of dry needling and manual therapy appears to be the most effective approach. Nonetheless, the variability in study quality suggests that further high-quality research is needed to confirm these findings.

Background: Task challenge is recognized as a core principle of neurorehabilitation and is frequently mentioned within stroke rehabilitation guidelines. However, guidance for operationalizing challenge in clinical practice remains limited. Examining how therapists and people with stroke currently use challenge in practice may help address this gap. Objective: To examine how challenge is operationalized in routine stroke rehabilitation practice. Methods: This study used focused video analysis to examine eight video-recorded stroke rehabilitation sessions across physiotherapy, occupational therapy, and speech-language therapy contexts. Video data were supplemented by observational memos. Analysis was conducted iteratively through four stages: immersion, detailed transcription, in-depth episode analysis, and comparative analysis. These stages enabled examination of material, embodied, social, and contextual aspects of challenge-related interactions as they unfolded during rehabilitation. Results: Twenty individuals, comprising four patient-therapist dyads and four triads participated. Challenge was operationalized through three intersecting practices: (i) Structuring challenge-related work through temporal phases determined when challenge was introduced, experienced, and consolidated across the session and within tasks; (ii) Establishing the macro-architecture of challenge guided what and how it was operationalized by constructing a challenge plan, shaping an optimal bandwidth by tailoring challenge to the persons abilities and/or experiences, and facilitating its transfer beyond the session; (iii) Modulating challenge through micro-calibrations involved moment-to-moment adjustments (e.g., adapting physical assistance, communication style, environmental setup) to modulate active practice, navigate differing perspectives, and cultivate an atmosphere conducive to engaging with challenge. These overarching practices were dynamically enacted through a range of explicit and implicit practices. Conclusion: Challenge in stroke rehabilitation is not merely a task parameter; it is operationalized through an interplay of explicit and implicit practices that structure and enable its responsive implementation. Considering challenge through these practices may help therapists and people with stroke co-construct meaningful experiences of challenge, both within and beyond formal stroke rehabilitation sessions.

Background: Post-stroke spasticity is commonly assessed using the Modified Ashworth Scale (MAS), despite its limited objectivity and variable reliability. This study introduces ScoreE, a novel isokinetic dynamometry-derived metric designed to quantify elbow and wrist flexor hyper-resistance by comparing patients torque-angle profiles with a healthy reference corridor. Methods: Thirty-five post-stroke patients and twenty-one healthy controls were included. Elbow and wrist hyper-resistance was assessed using the MAS and an isokinetic dynamometer in two testing conditions: seated on the dynamometer chair (ergo chair) and seated in the patient wheelchair. Two dynamometer-derived metrics were analyzed: ScoreE and peak torque (PeakT). Feasibility, inter-rater and test-retest reliability, and associations with MAS grades were assessed. Exploratory PRE-POST changes following a 10-min local vibration session were also described. Results: ScoreE showed good to excellent inter-rater and test-retest reliability across joints and testing conditions. Inter-rater ICCs ranged from 0.81 to 0.89, and test-retest ICCs from 0.76 to 0.93. PeakT showed moderate to good reliability. In contrast, MAS agreement was lower and more variable. ScoreE showed moderate associations with MAS grades, particularly at the elbow, with weaker and less consistent associations at the wrist. MAS assessment was faster, but all assessments were well tolerated, with median pain ratings of 0/10 in all testing conditions. PRE-POST vibration changes were small and heterogeneous, preventing formal assessment of responsiveness. Conclusion: ScoreE provides a reliable, objective, and visually interpretable quantification of post-stroke elbow and wrist flexor hyper-resistance. By comparing the full torque-angle profile with normative data, this approach preserves information on both the magnitude and angular span of abnormal resistance, supporting its potential for targeted longitudinal monitoring.

Background: School-based implementation of robot-assisted walking may support increased physical and social participation for children with physical disabilities, but evidence from an adequately powered trial is needed. This pilot study evaluated implementation strategies and study procedures to inform a future definitive trial. Methods: Participants were randomized to 12-weeks of robot-assisted walking or control, with subsequent crossover to the other condition. In the intervention arm, targeted dose was 75 minutes of robot-assisted walking, spread across three days/week. Implementation strategies for the child's classroom team included educational materials, centralized technical assistance, school champions, and on-going training. Implementation strategy evaluation focused on intervention protocol feasibility (i.e., weekly device use, troubleshooting) and fidelity (documentation of implementation strategy modifications). Preliminary estimates participation goal changes were obtained using the Canadian Occupational Performance Measure (COPM) 'Performance' scale (/10). Results: Eight children with neurodevelopmental physical disabilities participated (mean age 3.5, SD 0.5 years). Device use varied from 2.1 to 4.3 days/week (median 3.3) with a range of 48 to 96 minutes/week (median 80). Target use of >= 3 days/week was achieved for 66% of weeks and met the >=75-minute target for 33% of weeks. Troubleshooting occurred in 18.5% of sessions. Two implementation strategies were modified to improve feasibility. COPM mean change was 3.56 (SD 1.07) for robot-assisted walking and 2.11 (SD 2.41) for control (dz=0.74). Conclusions: This pilot study provided preliminary evidence regarding both the feasibility of robot-assisted walking implementation in schools and its potential effectiveness for children with physical disabilities. Findings support progression to a definitive trial.

Background: As musculoskeletal physiotherapy evolves toward advanced practice and direct access, evaluating high levels of clinical competence has become pressing. Quality indicators underpin large-scale audit systems, but indicators discriminating advanced competence remain insufficiently defined. Objective: To identify and characterize indicators capable of discriminating high levels of clinical competence in musculoskeletal physiotherapy. Methods: A modified Delphi comprised an exploratory pre-round and two consensus rounds. Experienced French-speaking musculoskeletal physiotherapists were recruited using an expertise scoring grid. Candidate indicators, generated from open-ended responses and existing quality indicators, were rated on 6-point Likert scales for relevance, formulation, and tool adequacy. Consensus was predefined as [&ge;]75% of ratings [&ge;]5. Results: Thirty-two experts completed the pre-round, 29 the first round, and 27 the second (84% retention), generating 49 candidate indicators. Thirteen reached consensus for relevance, and 10 also for formulation. Retained indicators primarily reflected advanced clinical reasoning: real-time adaptation, hypothesis prioritization, decision-making under uncertainty, and error management. Only one outcome indicator reached consensus: clinical performance weighted by case complexity. Conclusion: High levels of clinical competence in musculoskeletal physiotherapy appear characterized less by standardized outcome attainment than by managing complexity, uncertainty, and error through advanced clinical reasoning. These findings may inform competence-oriented audit and feedback systems. Trials registration: Not applicable.

IntroductionFalls are a major cause of injury-related morbidity, mortality, and healthcare utilisation among older adults, with the greatest burden occurring in those aged [&ge;]80 years. Multicomponent exercise programmes that include balance and resistance exercises reduce falls, whereas the effect of resistance training delivered as a standalone fall-prevention intervention remains uncertain. Existing resistance-training trials have generally been small, underpowered for fall outcomes, and have produced inconsistent findings, despite reduced muscle strength being an important modifiable risk factor in the oldest old. The resistance training prescription used in these studies has not always aligned with recommendations for optimal strength adaptations in terms of intensity or progressive overload, which may explain this uncertain efficacy. Therefore, this study aims to determine whether 12 months of high-intensity progressive resistance training reduces fall rates in community-dwelling adults aged [&ge;]80 years with reduced muscle strength. Methods and analysisThis single-centre, randomised controlled trial conducted in Trondheim, Norway, includes 241 community-dwelling adults aged [&ge;]80 years with reduced muscle strength. Participants are randomly assigned (1:1) to either standard care with written physical activity guidance or a twice-weekly high-intensity progressive resistance training intervention for 12 months. The primary outcome is the rate of falls over 12 months. Secondary outcomes include time to first fall, fall-related injuries, muscular function, physical performance, balance, body composition, cardiometabolic health, cognition, and participant-reported outcomes. Cost-effectiveness is assessed from a healthcare perspective over the 12-month intervention period using costs and quality-adjusted life years. Analyses follow the intention-to-treat principle, using negative binomial regression for the primary outcome. The first participant was included on 30 March 2023, and the last participant was included on 29 September 2025. The 12-month intervention period is expected to be completed by September 2026. Ethics and disseminationThe study has received approval from the Regional Committee for Medical and Health Research Ethics in Norway (REK; reference number 462261). All participants provided written informed consent before participating. Findings will be shared via peer-reviewed publications, conference presentations, and communication with stakeholders and the public. Trial registration numberClinicalTrials.gov (NCT05691166), registered 11 January 2023. Available at: https://clinicaltrials.gov/study/NCT05691166

Purpose: Stimulability testing involves the evaluation of multiple aspects of a patient's behavior, but the results are most frequently consolidated into a single domain (i.e., "stimulable"). The current study performs preliminary content, construct, concurrent, and predictive validation for the Multidimensional Stimulability Profile for Voice (MSP-V), a rating scale designed to measure multiple domains during stimulability testing (Degree of Change, Rapidity of Change, Generalization, Patient-rated Voice Quality, Patient-rated Voice Feel, and an overall rating of Stimulability Level). Methods: 78 patients with voice disorders (24 functional, 15 structural, 39 neurological) were administered the MSP-V by five speech-language pathologists (SLPs). Content validity was evaluated via the Content Validity Index (CVI) completed by nine voice-specialized SLPs. Construct validity was evaluated via exploratory factor analysis. Concurrent validity was assessed by determining whether MSP-V domains scaled in the expected direction compared to categorical stimulability ratings (e.g., "Highly stimulable" vs. "Stimulable"). Predictive validity was assessed by examining the relationship between MSP-V domains and voice disorder diagnosis, return to voice therapy, and patient-reported practice outside of therapy. Results: The CVI reached the critical value for clinician-rated and patient-rated domains. Two distinct factors were identified during EFA, one consisting of clinician-rated domains and the other of patient-rated domains. All MSP-V domains showed the expected directional relationships as categorical stimulability ratings. No domains differed significantly between disorder etiologies. The Rapidity of Change and Stimulability Level domains both significantly predicted return for voice therapy, where participants who rated lower on each domain were more likely to return to for voice therapy. No domains were predictive of patient-reported practice. Conclusions: The MSP-V is a clinically feasible tool with emerging content, construct, concurrent, and predictive validity that could be used to provide increased clarity and precision in stimulability testing documentation for research and practice.

Background: Safely walking through complex environments requires the use of visual information to plan and regulate steps, while managing competing cognitive demands. Age-related changes in visual control of gait and executive function may contribute to unsafe stepping behaviour, particularly under cognitive load. Route previewing may support visual motor planning, but its effects under dual task conditions in older adults are not well understood. Research Question: Does cognitive dual tasking influence gait and gaze behaviour during adaptive walking in older adults, and does previewing the walking route before gait initiation mitigate these effects? Methods: Thirty nine community dwelling older adults (Mage=73.4 years, SD=8.1; 14 male) completed four adaptive walking conditions, combining single and dual-task walking with and without previewing. Per condition, participants completed six trials across different 8-m long coloured walking routes. Gait characteristics were assessed using an instrumented walkway and video-analysis, while gaze behaviour was recorded using mobile eye tracking. Cognitive load was manipulated using a serial subtraction task. Gait and gaze outcomes were evaluated using linear mixed effects models. Results: Dual task performance significantly increased stepping errors, cross-steps, and double limb support, while reducing stride length (p < .001). It also significantly increased the number and duration of task irrelevant fixations (p < .001). After previewing, participants exhibited more efficient gaze behaviour, as evidenced by looking further ahead (larger forward gaze transitions) and fewer irrelevant gaze fixations (p < .002). Significant Task-by-Preview interactions revealed that previewing mitigated the negative effects of dual-tasking on stepping errors and cross steps (p < .001). Significance: Route previewing prior to gait initiation attenuates negative effects of cognitive load on adaptive gait in older adults, likely by supporting visual motor planning. These findings highlight the potential value of simple visual planning interventions for improving adaptive gait in older adults.

Current evidence supports resistance training for stroke recovery but autonomic dysregulation following stroke can lead to exaggerated fluctuations in blood pressure (BP) in response to exercise, thus challenging perceptions about safety and feasibility of resistance exercise. This study compared the post-exercise BP response following a single bout of leg-press exercise between people with and without stroke. Data from 11 individuals with chronic stroke (age 39-76 years, 5 female, 1-9 years post-stroke) and 19 recreationally active controls (age 18-33 years, 11 female) were included. Brachial artery BP was measured before exercise and immediately following a single set of leg-press (8 repetitions, target rating of perceived exertion 5-7/10). The difference between pre- and post-exercise BP was calculated and compared between groups using an independent t-test of equal variance. Additionally, a two-way analysis of covariance was used to examine potential cofounding effects of activity level and baseline BP on between group differences in BP response. No group differences were observed in post-exercise change in systolic (mean difference=3.61 mmHg, 95%CI:-8.36, 15.57, p=0.54); and diastolic (mean difference=5.38 mmHg, 95%CI:-6.11, 16.86, p=0.35) BP. Results were unchanged after controlling for baseline BP, and activity levels. Our work suggests that individuals with and without chronic stroke experience similar acute BP responses immediately following resistance exercise; however, work with more appropriately matched controls and greater sample sizes is needed to support these findings. Future studies may elucidate mechanisms related to the acute cardiovascular response to resistance exercise in individuals with stroke.

Frailty assessment is important while awaiting lung transplantation (LTx), as frailty is associated with disability and death before and after LTx. We assessed known risk factors and/or frailty indicators in frail, pre-frail, and non-frail patients according to the Short Physical Performance Battery (SPPB) and the Frailty Instrument for primary care of the Survey of Health, Ageing and Retirement in Europe (SHARE-FI), and evaluated the value of SHARE-FI as a proxy to detect frail patients. Frailty was assessed using SPPB and SHARE-FI in 82 patients on a waiting list for LTx. Demographic, anthropomorphic, and clinical variables were collected, and patients underwent respiratory/cardiorespiratory, biochemical, and quadriceps muscle performance assessments. The mean age was 57.3 {+/-} 9.4 years. Chronic obstructive pulmonary disease (COPD) (41.5%) and interstitial lung disease (ILD) (30.6%) were the most common indications for LTx. Four (4.9%), 13 (15.9%), and 65 (79.3%) patients were classified as frail, pre-frail, and non-frail by SPPB, respectively. These figures were 26 (31.7%), 41 (50%), and 15 (18.3%) with SHARE-FI. SPPB found differences between frail/pre-frail and non-frail patients in physical performance (6-minute walking distance) and muscular assessment, while SHARE-FI found differences in age, 6-minute walking distance, and oxygen saturation, and a trend in muscular strength. For COPD and ILD, frailty discrimination was better with SPPB. Concordance between the two measurements was weak, although all SPPB-frail ILD patients were detected by SHARE-FI. In patients awaiting LTx, SPPB showed better discrimination than SHARE-FI for COPD and ILD. SHARE-FI seems appropriate as a preliminary screening instrument for patients with ILD.

Background: Long COVID can result in persistent functional limitations, pain, and fatigue after acute COVID-19. Evidence describing these outcomes among survivors in Bangladesh remains limited. This study assessed functional impairment, pain, and fatigue and explored factors associated with these outcomes among long COVID survivors in Bangladesh. Methods: This multisite cross-sectional study included 240 adults with a history of COVID-19. Functional status was assessed using the Post-COVID-19 Functional Status Scale. Pain and fatigue were assessed using the Brief Pain Inventory and Brief Fatigue Inventory, respectively. Descriptive statistics, Spearman correlation, and regression analyses were used to examine functional impairment and factors associated with pain and fatigue outcomes. Results: Functional limitations were common, with moderate limitation particularly frequent in basic activities of daily living, while slight limitation predominated across several other domains. Pain and fatigue measures showed significant correlations. Older age was associated with greater impairment in basic activities of daily living. Booster vaccination was associated with lower pain and fatigue scores, although the booster subgroup was small (n = 17). Tobacco non-use was also associated with lower scores across several pain and fatigue domains. Physiotherapy-related variables showed associations with some functional and symptom outcomes; however, these findings may reflect confounding by indication because participants with greater impairment or more complex symptoms may have been more likely to receive rehabilitation. Conclusions: Long COVID survivors in Bangladesh experience substantial and multidimensional functional, pain, and fatigue burdens. The findings support a comprehensive assessment that considers functional status, pain, fatigue, and participation together. Longitudinal studies with larger samples and standardized rehabilitation protocols are needed to clarify symptom trajectories, identify potentially modifiable factors, and evaluate the effectiveness of individualized rehabilitation interventions.

Aims: Our primary aim was to determine the immediate effects of using a supported stepping device on the real-time locomotor behavior of pre-walking infants with Down syndrome (DS). Our secondary aim was to characterize the role of the caregiver in facilitating infant locomotor behavior by quantifying infant-initiated and caregiver-initiated walker movement, and to test whether walker movement encourages stepping behavior. Methods: Pre-walking infants with DS played with their caregiver in two conditions--with and without assistance from a wheeled suspension walker. To examine changes across development, we recorded infants across one to four sessions from 10 to 19 months of age. Results: Across developmental stages, we found that suspension walkers robustly increased infants' locomotor behavior: The walker increased upright time, percent time stepping, stepping rate, upright bout rate, percent time locomoting, and total bout rate. Most walker movement was initiated by caregivers, and infants stepped more while the walker was moving compared to stationary. Conclusions: Even without practice, pre-walking infants with DS were able to take advantage of the suspension walker to increase their locomotor behavior. Caregivers facilitated infants' activity by moving the walker. Future work will examine the potential of overground suspension walkers for home-based intervention.

Aim. To evaluate the accuracy, run-to-run consistency, and agreement of large language models on the Ukrainian Integrated Licensing Examination Krok 2 for the Specialty of Physical Therapy. Materials and Methods. Five cloud-based LLMs (ChatGPT-5.5, Claude 5 Sonnet, Gemini 3.5 Flash, Grok 4, DeepSeek-V3) were evaluated using 150 Ukrainian-language multiple-choice questions from the official Krok 2 database. Each model completed two independent runs with identical inputs. Accuracy (with 95% confidence intervals, Wilson method), run-to-run consistency, and agreement were assessed. Statistical analysis included Cohen's {kappa}, Cochran's Q and pairwise McNemar tests with Holm-Bonferroni correction. Results. All models achieved >80% accuracy in both runs, exceeding the passing threshold of [&ge;]64%. In the first run, accuracy ranged from 80.00% (DeepSeek-V3) to 93.33% (Gemini 3.5 Flash); in the second run, from 82.67% (Claude 5 Sonnet) to 88.67% (Gemini 3.5 Flash). In the first run significant differences were observed between Gemini 3.5 Flash and Grok 4 (93.33% vs 84.00%; p=0.0022) and DeepSeek-V3 (93.33% vs 80.00%; p=0.0001). There were no statistically significant differences between models in the second run. R2R consistency exceeded 90% for all models with the highest in ChatGPT-5.5 (98.67%) and lowest in DeepSeek-V3 (90.00%). Cohen's {kappa} ranged from 0.64 to 0.94, indicating substantial to almost perfect agreement. The stability of LLMs' response correctness across two runs ranged from 77.33% (DeepSeek-V3) to 88.00% (Gemini 3.5 Flash). Conclusions. All LLMs demonstrated high performance on Ukrainian-language Krok 2 examination tasks. Gemini 3.5 Flash showed the highest accuracy in both runs and response correctness stability while ChatGPT-5.5 exhibited the greatest response consistency and agreement. Although the accuracy and stability of LLM responses may be interrelated, they represent distinct aspects of model performance. This highlights the need for a comprehensive approach to evaluating LLMs. The findings indicate the potential of LLMs as an auxiliary tool in the professional practice of physical therapy specialists.

Background: System One Model is designed for structured decision-making and can provide probabilistic outputs, but their performance in domain-specific physical therapy tasks has not been established. Objective: To evaluate the performance and potential utility of Jev, a System One Model, for professional knowledge-based selection tasks in physical therapy by comparing it with GPT-4o. Methods: A total of 380 multiple-choice questions from the 2024 and 2025 Korean Physical Therapist Licensing Examinations were independently submitted to Jev and GPT-4o. The outcomes included answer accuracy, subgroup performance, output validity, API response latency, token usage, estimated API cost, and Jev's prediction uncertainty. A retrospective probability-based model-cascading simulation was also performed. Results: Jev correctly answered 282 questions (74.2%), whereas GPT-4o answered 326 (85.8%), a difference of -11.6 percentage points. Jev produced valid structured responses for all questions, whereas GPT-4o produced three invalid responses. Jev's selected-answer probabilities discriminated correct from incorrect answers (AUROC = 0.866), and accuracy reached 99.3% when probabilities were greater than or equal to 0.90. The median API response latency was 0.94 s for Jev and 1.06 s for GPT-4o, with estimated costs of US$0.008 and US$0.161, respectively. At a retrospective cascading threshold of 0.70, accuracy was 86.6% with 175 simulated GPT-4o calls. Conclusion: Jev showed lower overall accuracy than GPT-4o but provided reliable structured outputs, informative prediction probabilities, lower latency, and lower estimated cost. Its probabilistic outputs warrant further prospective evaluation for selective model escalation and decision-support workflows in physical therapy.