Archives of Physical Medicine and Rehabilitation

Background: Mobility recovery after stroke is highly variable, yet is typically described using average patterns that obscure meaningful differences between individuals. Identifying distinct recovery trajectories may improve prognostication and guide rehabilitation strategies. Methods: We conducted a retrospective cohort study of adults admitted for stroke to a large health system between 2016 and 2024. Mobility was assessed using Activity Measure for Post-Acute Care (AM-PAC) Basic Mobility, which was collected during routine clinical care. Growth mixture modeling was used to identify subgroups with distinct mobility recovery trajectories during the first 180 days after stroke. Subgroups were then characterized with baseline personal and clinical characteristics. Results: Seven hundred and fifty individuals contributed 3,389 mobility observations (median 4 per person). A five-class solution was selected based on model fit and classification quality. Distinct trajectories were identified: low stable (n=127), low rapidly improving (n=29), mid declining (n=169), mid improving (n=365), and high stable (n=60). Subgroups differed in both baseline mobility and patterns of change over time, with some demonstrating improvement, others remaining stable, and one declining. Individuals in improving subgroups were generally younger, more likely to be independent before stroke, received physical therapy on a greater proportion of hospital days, and were more frequently discharged to inpatient rehabilitation. In contrast, those in low or declining trajectories had lower baseline function, longer hospital stays, and were more likely to be discharged to skilled nursing facilities. Conclusions: The distinct mobility recovery trajectories identified in this work reflect the heterogeneity present in routine clinical practice. Subgroups differed in both recovery patterns and characteristics. Early identification of trajectory membership may improve prognostication and inform more targeted rehabilitation strategies.

Background & Objective. Cardiac rehabilitation is an existing guideline-concordant intervention for heart failure that provides benefits but is grossly underutilized by both physicians and patients. We aimed to identify patient-reported barriers and facilitators of participation in cardiac rehabilitation. Design, participants, approach: Qualitative theory-guided in-depth interviews were conducted with adults with heart failure, recruited from ambulatory settings with oversampling of those with heart failure with preserved ejection fraction. Thematic analysis was applied to interview data. Depressive symptoms and perceived stress were assessed by Patient Health Questionnaire (PHQ-8) and Perceived Stress Scale (PSS), respectively. Key results: Twenty-two adults with heart failure, aged 27-85, completed the study; of them 59.1% were women, 68.2% - African American, 4.5% - Hispanic; 77.3% had public insurance or were self-pay; 68.2% had heart failure with preserved ejection fraction. Mean PHQ-8 score was 11.4 (SD= 2.9) and mean PSS score - 20.4 (SD=4.5). Patient-reported barriers to cardiac rehabilitation included unawareness of cardiac rehabilitation and its benefits, perceived inability to exercise, depression, and weight gain, specifically for heart failure with preserved ejection fraction. Perceived inability to exercise stemmed from uncontrolled heart failure symptom burden and exercise intolerance, medication side effects, non-cardiac pain, fear of exercise, and low motivation for exercise. Facilitators of participation included intrinsic and extrinsic motivating factors and specific features of programs, such as individualized and supervised interventions with moderate level of exercise. Conclusion: Participants reported multiple barriers to cardiac rehabilitation; some of them can be modified by providing counselling and referral to cardiac rehabilitation from primary care physicians and simultaneously addressing heart failure symptom burden, pain, stress and depression. Combining cardiac rehabilitation and weight management can benefit adults with heart failure with preserved ejection fraction specifically. Increasing insurance coverage for cardiac rehabilitation for heart failure is warranted.

BACKGROUND: Older adults with cancer often struggle to achieve recommended levels of physical activity and dietary intake. Ecological momentary assessment combined with accelerometry can provide insights into the temporal dynamics of psychological and behavioral processes at the individual level, such as motivation towards health behaviors. OBJECTIVE: This N-of-1 study aims to improve physical activity and nutritional behaviors among older patients with cancer using an mHealth behavioral intervention. METHODS: A single-subject ABA' design will be employed among older patients with cancer ([≥] 70 years). A 2-week baseline phase (A) will be followed by an 8-week intervention phase (B) and a two-week withdrawal phase (A'). Throughout all these phases, participants will complete a daily data collection protocol combining ecological momentary assessment questionnaires and an ActiGraph wGT3X-BT accelerometer worn on the waist to measure physical activity. Ecological momentary assessment questionnaires will be delivered via a digital application to collect information on nutritional behavior, fatigue, and motivational constructs based on the Theory of Planned Behavior. The intervention (B) will consist of an mHealth intervention based on behavior change techniques, delivered via weekly calls, personalized messages, and a digital application. Data will be analyzed using piecewise and segmented regression models. In addition, a semi-structured interview will be conducted to assess patient experience. These qualitative data will help identify contextual factors, such as treatment-related side effects or variations in health status, that may have influenced behavior change and participation in data collection. CONCLUSION: This N-of-1 study explores intra-individual behavioral dynamics using intensive longitudinal data rather than testing a strictly reversible intervention effect. The mHealth intervention is based on behavior change techniques and tailored to each patient, with adjustments made based on repeated daily assessments in a real-world setting using a wGT3X-BT accelerometer and ecological momentary assessment questionnaires. The results will contribute to the evidence base for mHealth interventions designed to promote sustained physical activity and dietary intake among older adults with cancer.

Background: Cognitive rehabilitation (CR) is an established behavioral intervention that improves daily functioning for individuals with mild cognitive impairment (MCI) and early-stage dementia. Traditional models of in-person delivery limit access, particularly for individuals living in rural areas. This study evaluated the efficacy of a novel telephone-based virtual CR model combining speech-language pathologist (SLP)-led sessions with cognitive exercises delivered by an automated voice agent between visits. Methods: We conducted a retrospective observational analysis of 141 older adults who completed treatment to discharge (58% female; mean age 71.2, standard deviation 10.8 years; MCI diagnosis rate 61.7%, dementia diagnosis rate 29.1%; Montreal Cognitive Assessment mean score 20.8, standard deviation 4.3). Changes in four outcome measures from initiation of treatment to discharge were evaluated for statistical significance. The four outcomes studied were patient-reported quality of life and three therapist-rated Functional Communication Measures (FCMs): overall cognition, spoken language, and language comprehension. Changes were compared to FCM averages from the American Speech-Language-Hearing Association National Outcomes Measurement System (ASHA NOMS). Models were developed to predict changes in outcome measures based on patient demographics, clinical status, program engagement and treating therapist. Results: All four outcomes improved significantly over the course of treatment (p<0.05), with medium to very large effect sizes. Mean changes in the three FCM outcomes exceeded ASHA NOMS benchmarks for in-person outpatient care. A majority of patients saw an improvement in each clinical outcome measure. Models with meaningful predictive power were identified for changes in all outcome measures except the FCM for language comprehension. Baseline cognitive function was the most influential and negatively correlated predictor of an improvement in overall cognitive abilities and language expression. Baseline quality of life was the dominant and negatively correlated predictor of improvement in quality of life. Conclusions: Telephone-based virtual CR led by SLPs with automated exercises delivered by a voice agent produced clinically meaningful functional and quality of life gains relative to external benchmarks for in-person clinical practice. These results support the use of virtual CR within post-diagnostic care for older adults experiencing cognitive impairment, particularly for rural and underserved communities.

Spinal cord injury (SCI) causes rapid and severe bone loss in the paralysed lower limbs, particularly at the distal femur and proximal tibia, where fragility fracture risk is high. In vitro nanoscale vibration at 1 kHz has been shown to promote osteogenic differentiation and inhibit osteoclastogenesis, suggesting potential as a targeted mechanical intervention. This study aimed to develop and evaluate a wearable device for delivering and monitoring localised nanovibration at the distal femur in individuals with SCI. The device delivered continuous sinusoidal nanoscale stimulation at 1 kHz via a bone-conduction transducer, with an opposing accelerometer used to monitor transmitted vibration in real time. Design and target-site selection were refined through two healthy-volunteer investigations comparing the distal femur, proximal tibia, and distal tibia. Bovine femur experiments characterised vibration transmission under controlled benchtop conditions. Preliminary repeated-use feasibility was assessed in one individual with motor-complete SCI. Healthy volunteer testing showed that although the ankle initially produced the highest transmitted amplitudes, these were highly variable, and positioning was inconsistent. Within the knee region, the distal femur provided the most practical and repeatable site for a wearable application. In bovine femur experiments, scanning laser vibrometry demonstrated measurable vibration on the condylar surface opposite the transducer, and depth-resolved measurements confirmed that nanoscale vibration remained detectable within bone. A gel interface layer reduced the transmitted amplitude. In the feasibility evaluation, 61 sessions were completed over 14 weeks, with logged accelerometry confirming repeated nanoscale vibration transmission. These findings establish feasibility and support further device optimisation and translational studies.

Quantitative gait analysis could enhance personalized treatment for many movement-related conditions; however, it is not routinely integrated into clinical care. Advances in mobile sensing, such as smartphone-based motion capture, enable rapid clinical gait assessment, but extracting actionable insights remains challenging. Although machine learning models can support clinical decisions from gait data, they typically require costly task- and condition-specific datasets, which limits progress across various gait-related conditions. Here we present a generative foundation model of walking kinematics that enables various downstream clinical tasks across diverse patient populations using clinically accessible smartphone video-based gait analysis. We aggregated eight gait datasets comprising 657 individuals across seven unique pathologies. Using weakly-supervised learning, we trained a variational autoencoder to distill high-dimensional gait kinematics into a 16-dimensional learned latent representation. We demonstrate generalizability across four downstream clinical tasks spanning pathologies both seen and unseen during training, with and without model fine-tuning, including: 1) classification of neuromuscular disorders unseen during training, 2) predicting clinical severity scores for individuals with Parkinson's disease, 3) tracking of subacute recovery post-stroke, and 4) generating patient-specific kinematic changes following total hip arthroplasty. Our model also computes a deviation from mean unimpaired (DMU) score, an interpretable scalar metric that captures an individual's deviation from typical unimpaired gait, providing rapid, holistic quantification of impairment. This generalizable model provides a foundation for clinically actionable tools that translate mobile sensing-derived gait data into precise biomechanical insights for clinical research and decision-making. The open-source model is deployed in the cloud for automated smartphone video-based gait analysis on our freely available OpenCap platform.

Background: Chronic pain is a multidimensional condition that often persists despite conventional treatment and adversely affects multiple domains of daily life. Music listening has emerged as a promising non-pharmacological intervention, with accumulating evidence supporting its beneficial effects on pain and associated psychological outcomes. However, despite growing evidence of efficacy, the translation of music listening into routine clinical practice remains limited, partly because intervention reporting has received comparatively little attention. Objective: To evaluate the effectiveness of music listening interventions for chronic pain and systematically assess the methodological quality and completeness of intervention reporting to identify barriers to reproducibility and clinical implementation. Methods: Systematic searches were conducted in PubMed, Cochrane Library, CINAHL, and Web of Science through June 2025, with no date restrictions on publication. Randomized controlled trials involving adults with chronic pain receiving music listening interventions were included. Two independent reviewers screened studies, extracted data, and assessed risk of bias. Intervention reporting was evaluated using the TIDieR checklist, and a random-effects meta-analysis was performed for pain intensity outcomes. Results: Ten RCTs involving 538 participants were included. Music listening interventions varied substantially in delivery, duration, and music selection procedures, reflecting considerable heterogeneity in intervention design. Most studies reported significant improvements in pain and psychological outcomes. Meta-analysis of eight trials (10 effect estimates), demonstrated a moderate reduction in pain intensity (SMD = -0.53, 95% CI: -0.96 to -0.11, p = 0.014; I2 = 76.2%). Although intervention rationale and procedures were generally well described, reporting of intervention modifications, treatment fidelity, and adherence was frequently incomplete. These reporting deficiencies may compromise reproducibility and limit translation into clinical practice. Conclusions: Music listening appears to be a safe, accessible, and scalable non-pharmacological intervention for chronic pain management, with benefits extending beyond pain reduction to psychological wellbeing, quality of life, and functioning. However, incomplete reporting of key intervention components may limit reproducibility and hinder clinical implementation. Future trials should adopt standardized and transparent reporting standards to facilitate implementation into clinical practice.

Background: Transition timing to post-acute rehabilitation after ischemic stroke is heavily influenced by non-clinical factors, introducing potential systemic disparities in care access. We evaluated the association between insurance payor status and acute hospital length of stay (LOS) prior to inpatient rehabilitation discharge among critically ill stroke patients. Methods: Using the MIMIC-IV database, we identified ICU-admitted adults with ischemic stroke discharged to inpatient rehabilitation (n=1,285). The primary outcome was hospital LOS prior to rehab transfer. Multivariable log-transformed linear regression evaluated the association with insurance payor (Medicare, private, other/unknown; reference: Medicaid), adjusting for demographics, diagnostic-code counts (medical complexity), and ICU LOS (acute illness severity). Results: Median hospital LOS before rehab discharge was longest for Medicaid patients (13.2 days) compared with private insurance (11.0 days) and Medicare (9.5 days). In the adjusted model, Medicare insurance was associated with a significantly shorter transition time to inpatient rehabilitation, corresponding to a 13.5% shorter acute hospital stay (adjusted LOS ratio 0.87; 95% CI: 0.79-0.96; p=0.005) relative to Medicaid. Private insurance demonstrated a descriptive trend toward shorter LOS that did not achieve statistical significance (adjusted LOS ratio 0.93; 95% CI: 0.84-1.02; p=0.122). Other and unknown payor categories showed no significant differences. Conclusions: Insurance payor status serves as an independent predictor of acute care transition timing for stroke patients requiring inpatient rehabilitation. The prolonged acute stays observed among Medicaid beneficiaries suggest significant non-clinical, administrative bottlenecks in post-acute placement, underscoring the critical need for standardized, streamlined insurance approval pathways to ensure equitable neurological recovery.

Myofascial pain syndrome (MPS) is a major cause of chronic neck pain, with tissue ischemia implicated as a contributing factor. This prospective, single-arm interventional study evaluated the analgesic effect of ultrasound-guided fascia hydrorelease (US-FHR) performed around arteries supplying the neck in patients with chronic neck MPS. Thirteen adults (median age 53.0 years; 38.5% female) underwent US-FHR targeting the perivascular fascia of either the transverse cervical or dorsal scapular artery using 2 mL of normal saline. Pain intensity was assessed by visual analog scale (VAS) at rest and during movement; disability by the 5-item Pain Disability Index, Japanese version (PDI-5-J); and arterial blood flow volume before and after the procedure. The primary outcome, pain VAS during movement, decreased from 49.0 mm (interquartile range [IQR], 44.5-64.0) at baseline to 22.0 mm (IQR, 14.5-31.5) at 15 min and 22.0 mm (IQR, 14.0-34.0) at 1 week (Hodges&-Lehmann median difference, 30.5 mm [95% CI, 24.5 to 36.5] and 28.5 mm [95% CI, 18.5 to 37.0]; both P < 0.001). Pain VAS at rest improved from 21.0 mm (IQR, 13.0-43.5) to 8.0 mm at 15 min and 1 week (median difference, 14.5 mm [95% CI, 9.0 to 24.0; P = 0.001] and 13.5 mm [95% CI, 6.0 to 21.0; P = 0.007]). PDI-5-J decreased from 17.0 (IQR, 10.5-23.0) to 13.0 (IQR, 4.0-17.5) at 1 week (median difference, 5 [95% CI, 2 to 8; P = 0.004]). Blood flow volume increased from 11.2 mL/min (IQR, 4.5-14.4) to 17.2 mL/min (IQR, 6.1-23.7) immediately after US-FHR (median difference, +4.1 mL/min [95% CI, +2.5 to +8.9; P = 0.001]), although transient. One patient experienced transient bleeding that was promptly controlled. In this single-arm feasibility study, US-FHR around the target artery was simple and safe to perform and was associated with reduced neck pain. Because the study lacked a control group, these preliminary findings should be regarded as hypothesis-generating and require confirmation in controlled trials; they may also inform the future evaluation of MPS in other anatomical regions. Trial registration: UMIN Clinical Trials Registry, UMIN000053612.

Background/Objectives: This systematic review examines how different mechanisms of Traumatic Brain Injury (TBI) influence post-injury functional independence and aims to clarify whether recovery patterns vary by injury type. A total of 105 studies (n = 59,621) involving adults with TBI were synthesized. These findings can guide clinicians and researchers in predicting outcomes and effectively customizing rehabilitation plans. Methods: A review following PRISMA standards analyzed English-language studies published from 1975 to 2025, assessed functional outcomes using the Functional Independence Measure (FIM) or the Glasgow Outcome Scale-Extended (GOSE), converted them to z-scores, and aggregated them via a random-effects model with inverse-variance weighting to demonstrate their relevance. Results: Recreational TBIs show the highest functional independence (z = +1.77), followed by MVAs (z = +1.56), with falls (z = +0.70) and assault-related TBIs (z = -0.12) showing moderate outcomes, and TBIs with penetrating trauma (z = -1.15) indicating the most adverse results. Conclusions: TBI mechanisms appear to meaningfully influence long-term post-injury functional independence. Highlighting this can inspire clinicians and researchers to trust these insights to improve prognosis and rehabilitation strategies, underscoring their crucial role in advancing patient care.

Objective To analyze the associations between cardiorespiratory fitness (CRF) indicators and cardiovascular health, assessed through the Life's Essential 8 (LE8) score, in individuals with coronary artery disease (CAD). Patients and methods This cross-sectional study included individuals (aged 50-75 years) with stable CAD were enrolled in the Heart-Brain randomized controlled trial (NCT06214624) from April 2022 to June 2024. Participants underwent a cardiopulmonary exercise test until volitional exhaustion. CRF indicators included peak oxygen consumption (VO2peak), time to exhaustion (TTE), ventilatory anaerobic threshold (VAT), peak oxygen pulse, 60-s heart rate recovery (HRrec) and oxygen uptake efficiency slope (OUES). LE8 score (range 0-100) was calculated as the unweighted average of 8 variables: physical activity, sleep, diet, nicotine exposure, glucose, lipids, body mass index, and blood pressure, as defined by the American Heart Association. We used linear regression models adjusted for sex, age, and education. Results 102 individuals were included (21 females). VO2peak ({beta}std=0.67, P<.001) and TTE ({beta}std=0.64, P<.001) showed strong positive associations with LE8 total score, followed by VAT ({beta}std=0.43, P<.001) and HRrec ({beta}std=0.26, P=.01). No associations were found for OUES ({beta}std=-0.08, P=.54) and peak oxygen pulse ({beta}std=-0.05, P=.72). Conclusion Maximal and submaximal indicators of CRF were positively associated with LE8 in individuals with CAD, yet maximal indicators showed the strongest associations. Notably, TTE demonstrated a similar strength of association with LE8 as VO2peak. These findings have important clinical and research implications as they support TTE as a simpler (than the gold-standard VO2peak), yet informative, marker of cardiovascular health in individuals with CAD.

Background Falls are a leading cause of injury-related hospital admissions among older adults with substantial burden on health and social care systems. Digital exercise programmes may improve physical function at scale and complement traditional services. Keep-On-Keep-Up (KOKU) is an NHS-approved digital programme offering progressive, evidence-based exercises and education on fall prevention. We aimed to evaluate the effectiveness and cost-effectiveness of KOKU for improving balance, physical function and reducing fall risk among community-dwelling older adults. Methods A two-arm, parallel group randomised controlled trial was conducted with community-dwelling older adults (>=60 years). Participants were randomised (1:1) to receive KOKU alongside standard care (strength and balance exercise advice and a falls prevention leaflet) or standard care alone. The primary outcome was balance function at 12 weeks (Berg Balance Score). Secondary outcomes included lower limb strength, concerns about falling, falls, mood, pain, fatigue, healthcare utilisation, health-related quality of life and usability. A modified intention-to-treat approach was used to analyse effectiveness and cost effectiveness. Results A total of 202 older adults (mean age 76.8 years, 72.8% female) were enrolled (102 intervention; 100 control). Retention at 12-weeks was 89.1% (91 intervention; 89 control). Compared with standard care, KOKU significantly improved balance function at 12 weeks after adjusting for baseline scores (mean difference: 6.35, 95% CI: 4.48, 8.22). KOKU was associated with lower mean falls related costs (incremental cost (GBP): -62.98, 95% CI -218.54 to 40.22) and a QALY gain of 0.020 (95% CI 0.003 to 0.035). Conclusion The KOKU programme improves balance with preliminary evidence of cost-effectiveness among community-dwelling older adults.

Background/Objectives: Traumatic Brain Injuries (TBIs) often cause profound functional impairments, yet the influence of TBI mechanisms on stair-climbing functional independence over extended timelines remains poorly understood. This study assesses whether Rasch-transformed FIM Stairs scores varied by TBI mechanism over follow-ups spanning 10 years or more. Methods: Data from the TBI Model Systems database were analyzed. The original 30,768 data entries were reduced to 6,226, corresponding to individuals with at least 10 years of data. Functional Independence Measure Stairs data were transformed to logit units via Rasch analysis before being evaluated with a linear mixed-effects regression, incorporating TBI mechanisms, age, follow-up time, and their interactions, with random effects accounting for the participant ID and pre-injury residence location. Results: TBI mechanisms meaningfully shape very long-term stair-climbing. Gunshot wounds and pedestrian-related accidents are associated with poorer performances, whereas motorcycles, bicycles, unclassified vehicular accidents, winter sports, other sports, and fall-related TBIs demonstrated relatively better function. Age, follow-up time, and their interaction also reached significance. Conclusions: Stair-climbing recovery trajectories over extended time significantly vary by TBI mechanism, with individuals with TBIs from gunshots and pedestrian-related accidents showing the most unfavorable recoveries. These findings support the development of mechanism-specific prognostic guidance and individualized rehabilitation strategies, thereby encouraging tailored approaches to improve outcomes.

Background/Objectives: Traumatic Brain Injuries (TBIs) affect more than 50 million individuals worldwide each year. Approximately 90% of individuals survive and experience persistent motor, cognitive, and emotional deficits, substantially contributing to a reduced quality of life and a global economic burden. TBI mechanisms are a foundational determinant of long-term recovery. The objective of this study was to examine long-term trends in functional locomotion ability over extended follow-up durations (>10 years) across distinct TBI mechanisms. The researchers hypothesized that TBIs caused by falls or violent mechanisms would be associated with poorer functional locomotor abilities and, subsequently, lower item scores than those sustained through automotive or recreational activities. Methods: Data were obtained from the Traumatic Brain Injury Model Systems (TBIMS) database at Craig Hospital in Englewood, Colorado, the largest longitudinal TBI data repository in the world. Functional locomotion was assessed using the Functional Independence Measure (FIM) Locomotion item as the primary outcome measure. To enhance measurement precision and ensure interval-level scaling, raw FIM scores were converted into logit-based estimates of latent functional ability using Rasch modeling. Longitudinal changes of these Rasch-transformed scores were analyzed using linear mixed-effects regression, accounting for individual-level variability and unbalanced follow-up data. Results: The findings demonstrated a clinically meaningful decline in functional ability among individuals with TBIs from violent mechanisms, particularly assault-related injuries and gunshot wounds, which were associated with chronic medical complications and limited functional independence. Conversely, TBIs from bicycling, unclassified vehicular incidents, and winter sports showed significant positive estimates, possibly reflecting higher premorbid physical fitness. Motor vehicle, motorcycle, pedestrian, and fall-related TBIs demonstrated steep early gains, followed by a period of recovery stabilization and plateau. In contrast, violence-related mechanisms were characterized by consistently low median scores, with minimal long-term improvement. Falls, gymnastics, track & field, and water sports did not exhibit meaningful changes in the context of the primary hypothesis. Conclusions: TBI mechanisms play a vital role in shaping long-term functional locomotion outcomes, with violence-related TBIs associated with poorer long-term functional independence. The results have clinically important implications, supporting earlier identification of high-risk populations and the development of targeted rehabilitation strategies during periods of heightened neuroplasticity. Rasch analysis integrated with linear mixed-effects modeling yields a robust analytic framework that uncovers subtle but meaningful differences in recovery trajectories across TBI mechanisms.

Objectives: Given the high injury burden in football and the documented limitations of strength-based screening, novel approaches are warranted. Adaptive Force (AF)being closer to injury-prone movements than pushing/pulling strength--offers an alternative. This study examined the association between AF-based muscle stability and musculoskeletal complaints in football players and compared AF-derived and conventional strength parameters in their discriminative capacity, complemented by a preliminary prospective follow-up. Methods: AF and maximal voluntary isometric contraction (MVIC) were measured in 23 male football players across five bilateral muscle groups (knee extensors/flexors; hip flexors/adductors/abductors). AF parameters (maximal isometric AF, maximal AF, AF-Ratio), MVIC and hamstrings-to-quadriceps (H:Q) ratio were compared between players with and without complaints assessed via questionnaire at baseline and six-month follow-up (n=13). Results: Stability deficits were strongly associated with complaints (OR=54.0, 82% side concordance). AF-Ratio discriminated clearly between players with and without complaints (d=-1.47), with hip abductors showing the strongest effect (d=-1.64). Players with subsequent complaints showed lower baseline AF-Ratio (d=-1.45) and more stability deficits (d=1.67). MVIC and H:Q ratio did not discriminate (p>0.430). Conclusion: The findings suggest that muscle stability assessment outperforms conventional strength parameters in discriminating players with and without complaints, with preliminary follow-up data providing tentative support for predictive value. The concept of functional instability syndrome (FIS) provides a mechanistic framework for non-contact injuries and musculoskeletal complaints. AF assessment offers potential for screening, including return-to-sport decisions. Further studies are needed to verify the results, investigate predictive value, and evaluate whether personalised stability-based interventions can reduce injury incidence.

DREAM is a randomised, superiority, parallel-group, placebo-controlled, participant, clinician, and assessor blinded trial with an adaptive group sequential design that allows early stopping for efficacy or futility. The purpose is to investigate whether taking 60 mg of duloxetine daily for 12 weeks in addition to guideline-recommended advice, compared with placebo in addition to guideline-recommended advice, can reduce leg pain intensity in individuals with chronic sciatica. The primary outcome is leg pain intensity measured on a 0-10 numerical pain rating scale. It will be analysed using a repeated-measures linear mixed model. This statistical analysis plan pre-specifies the methods of analysis to be used in the interim analysis and the final analysis for the outcomes and key variables collected in the trial. It includes planned sensitivity analyses for the final analysis, including covariate adjustments and subgroup analyses, as well as the health economics analysis plan.

Pedalling cadence during an acute eccentric cycling exercise altered physiological and perceptual responses. We examined the influence of cycling cadence on neuromuscular adaptation induced by a 6-week eccentric cycling training period. Eighteen participants performed training (eighteen sessions) at a cadence of 30 or 60 rpm over six weeks. Power output was the same between the two groups. Perceived effort and heart rate were recorded at each training session. Muscle pain and fatigue were reported the day after each session. Maximal voluntary contractions torque, as well as concentric and eccentric cycling efficiency, were assessed before and after training. Additionally, the loss of maximal voluntary isometric torque was assessed after the first and last training sessions. Heart rate and perceived effort increased in the second week of training and then plateaued, with no difference between groups. Muscle pain and fatigue remained low throughout the training, with no difference between groups. Isometric (+28%) and eccentric (+13%) maximal voluntary torque of knee extensor muscles increased regardless of training cadence. Concentric maximal voluntary torque increased for the group pedalling at 60 rpm only (+21%). Cycling efficiency was improved in eccentric mode only (+43%), with no difference between the two training groups. Finally, the voluntary isometric torque loss induced by the first and last sessions were similar. While six weeks of eccentric cycling training improved neuromuscular and functional capacities, cadence had no observable effect. This finding suggest that patients could choose their preferred cadence to obtain better adherence to the rehabilitation program without altering the adaptations.

Older adults face an increased risk of falls that may have severe consequences for their well-being. Routine, accessible clinical screening may help mitigate fall risk through early detection of balance impairments. Portable force plates offer a convenient and practical solution for balance assessment in clinical settings. A new force-plate-based balance measure, the intersection-point-height, has shown particularly promising results in its ability to distinguish between healthy and impaired balance behaviors. However, the intersection-point-height measure requires measurement of shear force during standing, which exhibits magnitudes of less than 0.2% of normal forces (body weight), taxing the dynamic range of most sensor technologies. The ability of existing force plates to measure such low-magnitude shear forces observed during quiet standing is currently unknown. This study presents a force-plate performance assessment method to evaluate shear-force measurement errors and quantify the uncertainty of the intersection-point-height measure. The method was applied to test a commonly used laboratory-grade portable force plate. While the device successfully captured sagittal-plane intersection-point-height at the lowest frequencies, low signal strength prevented precise readings in the frontal plane. Thus, the tested device only marginally met the precision required for quiet-standing analysis, underscoring the critical need for systematic performance validation of portable force plates prior to clinical use. Future efforts should focus on evaluating alternative portable force plates and exploring economical design improvements to enhance shear-force measurement precision.

Background: Demoralization, a syndrome of helplessness, hopelessness, and loss of meaning and chronic pain are common sources of distress in early palliative care. Psilocybin-assisted therapy (PAT) is an emerging intervention with preliminary data suggesting improvements in pain and demoralization. To date, PAT has not been studied among people living with both demoralization and chronic pain nor has it been studied as part of routine multidisciplinary outpatient palliative care. Objectives: We conducted an open-label pilot study assessing the safety, feasibility, and acceptability of PAT delivered with multidisciplinary palliative care support in cancer patients across the illness trajectory living with demoralization and chronic pain. Methods: Participants received a single 25 mg oral dose of psilocybin with preparation, monitoring, and integration provided by a mental health clinician and spiritual health clinician, alongside multidisciplinary palliative care support. Outcomes included safety, feasibility, acceptability, and exploratory self-report measures assessing for demoralization and pain intensity pre- and post-dosing. Results: Eleven participants were enrolled, ten of whom received psilocybin. The intervention was safe and feasible, with no serious adverse events and complete study visit retention among dosed participants. All 10 dosed participants reported the intervention as highly acceptable. Among dosed participants, 70% rated the experience among the five most meaningful and educational of their lives, and 60% among their five most spiritually significant experiences. By study endpoint, 90% no longer met criteria for clinically-significant demoralization syndrome and had pain scores below the trial enrollment threshold. Conclusions: PAT delivered with multidisciplinary palliative care support was safe, feasible, and acceptable in demoralized cancer patients with chronic pain. Key Message: Psilocybin-assisted therapy delivered within multidisciplinary outpatient palliative care was safe, feasible, and acceptable among demoralized cancer patients with chronic pain.

Background: Alzheimer's disease (AD) involves complex molecular alterations in the cerebrospinal fluid (CSF) proteome, yet the links between these protein changes and hallmark AD pathology remain incompletely defined. We investigated the relationship between the CSF proteome with CSF biomarkers of Alzheimer's disease (AD). Methods: CSF was collected in 500 individuals of non-Hispanic white, African Americans, and Caribbean Hispanic individuals. CSF biomarkers of AD were measured including P-tau181, A{beta}40, A{beta}42, total-tau, neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP). CSF was depleted of abundant proteins followed by precipitation, cysteine reduction/alkylation, and proteolytic cleavage by trypsin. Peptides were measured using a Q-Exactive HF mass spectrometer (Thermo Scientific). Association of individual and co-abundant modules of proteins were tested using elevated CSF P-tau181 and reduced A{beta}42/A{beta}40 to confirm the diagnosis of AD. We validated results in CSF from 397 participants in the Accelerated Medicine Partnership-Alzheimer's Disease cohort. Associated proteins were functionally validated in postmortem human brains and zebrafish. Results: We detected 1030 proteins, yielding an overall data completeness value of 97%. CSF levels of 75 (7.3%) proteins were significantly associated with CSF P-tau181 levels after multiple testing correction. Notably phospholipase D3 (PLD3, p=2.41E-09), apoE (p=4.25e-08) and osteopontin (OPN p=1.4E-16) were increased and autotaxin (ATX/ENPP2, p= 8.39E-09) and ceruloplasmin (CP) (p=2.72E-07) were lower among individuals with high P-tau181 levels. These proteins were also associated with CSF A{beta}42/A{beta}40 ratio and total tau levels but not with NfL. OPN was also associated with CSF levels of GFAP (p=1.32e-05). Among proteins associated with P-tau181 levels, pathways related to axon development (p=2.4E-12), axonogenesis (p=1.45E-11) and regulation of axonogenesis (p=5.1E-09) were enriched. Immunostaining on postmortem human and zebrafish brain found that ENPP2 expression, the gene encoding ATX, was significantly reduced in AD brain and in the amyloidosis model in zebrafish. Reduced ENPP2 expression was consistent with reduced lysophosphatidic acid (LPA) levels in the CSF of individuals with AD. LPA administration into zebrafish CSF reduced the pathological changes in synapses and vasculature due to A{beta}42. Conclusion: Unbiased profiling of circulating CSF proteins among individuals with antemortem diagnosis of AD, identified key proteins PLD3, apoE, OPN, ATX, and ceruloplasmin. Validation in postmortem human brains and zebrafish models support potential roles in endosomal sorting and APP processing, inflammation, angiogenesis, lipid transport, and oxidative stress.