Disability and Rehabilitation

Background: Aerobic exercise is recommended during stroke rehabilitation to improve cardiorespiratory fitness and support recovery; however, participation rates remain low. While institutional and system-level barriers have been widely examined, less is known about how individual patient factors influence engagement in aerobic exercise during rehabilitation. Objectives: We aimed to determine whether depressive symptoms, apathy, self-efficacy and outcome expectations for exercise, perceived barriers, or past exercise history were associated with aerobic exercise participation in stroke rehabilitation. Methods: In this prospective cohort sub-study, adults admitted to in- or out-patient stroke rehabilitation at three urban hospitals completed validated questionnaires assessing depressive symptoms, apathy, exercise self-efficacy, outcome expectations for exercise, perceived barriers to being active, and premorbid exercise history. Participants were separated into two groups for analysis: those who completed aerobic exercise during rehabilitation and those who did not. Equivalence testing and between-group comparisons were performed. Results: Sixty-two participants were enrolled; 16 participated in aerobic exercise and 46 did not. Groups were not equivalent on any individual-level factors. Compared to non-participants, those who performed aerobic exercise had significantly higher depressive symptom scores (p=0.0025) and lower self-efficacy for exercise (p=0.0087). Non-participants demonstrated significantly higher apathy (p=0.0007). No significant differences were found for outcome expectations, perceived barriers, or exercise history. Conclusion: Depressive symptoms and lower self-efficacy did not impede aerobic exercise participation during rehabilitation. Increased apathy, however, was associated with non-participation. Findings highlight the need for individually tailored aerobic exercise prescriptions that consider motivational and affective factors to optimize engagement during stroke rehabilitation.

Objective: To identify patient, clinician, therapist and service priorities for a health-literacy intervention combining patient education with patient-reported outcome measure (PROM) feedback in routine hand surgery and hand therapy. Methods: A qualitative co-design study was undertaken across public and private hand-care contexts in New South Wales, Australia. Twelve stakeholders participated: five consumers, three hand surgeons, one hand therapist and three administrative/managerial staff. Individual interviews plus a clinician group discussion were conducted. Data were collected in March 2026, audio-recorded, transcribed verbatim and de-identified. General inductive thematic analysis was undertaken in NVivo by one researcher, with final themes reviewed by co-investigators. Results: Four themes guided intervention design: (1) providing information is not enough, it must be understood, retained and reinforced; (2) patients need a practical roadmap of diagnosis, treatment, recovery and rehabilitation; (3) education should be multimodal, reusable and adaptable to individual needs; and (4) PROMs should improve the clinical conversation rather than become another burden. Participants supported brief, accessible PROMs and visual feedback over time, but views differed on comparison with other patients because benchmarking could either reassure or create anxiety and unrealistic expectations. Conclusion: Health-literate hand care requires more than readable leaflets. It requires repeated, practical and adaptable communication across the care pathway, with PROM feedback embedded in patient-clinician conversations. Practice implications: Hand services should pair standardized core education with flexible delivery and use brief PROMs as conversation tools. Longitudinal displays may support monitoring and shared decisions, while group comparisons should be optional and carefully explained.

Visual wayfinding is essential for safe navigation but remains poorly characterized in people with ultra-low vision (ULV). Because assessing complex environments in the real world carries safety risks, this study utilized a calibrated virtual reality (VR) platform to safely quantify navigation. Participants with ULV, normal vision (NV), and simulated ULV (sULV) completed tasks across three environments (street crossing, cafeteria, and metro station) of increasing complexity to determine which metrics best capture task difficulty. Navigation metrics included motion onset latency, walking speed, path efficiency, and turn deviation derived from head position data. Participants with ULV showed longer onset latency, slower walking speed, reduced path efficiency, and greater turn deviation compared with NV, while sULV showed intermediate performance. These metrics successfully reflected increasing task difficulty across environments, with the metro station posing the greatest challenge. Path efficiency consistently detected differences between environments across groups, whereas turn deviation provided insight into complex tasks. Findings indicate that diverse virtual environments capture distinct aspects of navigation that cannot be safely studied in the real world, and trajectory-based metrics capture navigation behavior more effectively than conventional measures. VR-based assessment offers a useful approach for evaluating functional navigation and guiding rehabilitation strategies in profound vision loss.

Objective: The Brief-cope questionnaire explore coping behavior. However, the underlying factor structure remains a subject of ongoing debate. Exploratory factor analyses (EFA) conducted across different populations have identified factor solutions ranging from two to fourteen factors. As of yet, the underlying factor structure of the Brief-cope has not been investigated in patients with seropositive rheumatoid arthritis (RA). Therefore, the aim of this study was to explore the underlying factor structure of the Brief-cope in a German population of seropositive RA. Methods: 216 outpatients with seropositive RA completed the Brief-cope. An EFA with principal axis factoring and Promax rotation was conducted. Results: EFA indicated a five-factor solution. The five-factor solution explained 51.95% of variance. The identified factors were: (1) problem-focused coping (Cronbach's = .851), (2) emotion-focused coping ( = .754), (3) maladaptive coping ( = .747), (4) religious coping ( = .851), and (5) substance-use coping ( = .869). Conclusion: A five-factor solution provided the most appropriate representation of the underlying factor structure of the Brief-cope in patients with seropositive RA. This factor structure may serve as a suitable basis for future analyses of Brief-cope data in comparable RA populations.

Purpose: Lower-limb prosthesis use involves interacting physical, psychosocial, and device-related outcomes that may not be fully captured by conventional clinical assessment. This study aimed to develop and evaluate a stakeholder-informed framework of outcome domains relevant to meaningful everyday prosthesis use. Materials and Methods: A mixed-methods participatory design comprised a structured synthesis of selected clinically relevant content from five established patient-reported outcome measures; semi-structured interviews and importance and actionability ratings with 18 contributors (12 prosthesis users, four clinicians, and two industrial partners); and integration of the synthesis, qualitative, and rating findings. Interview records were analysed using reflexive thematic analysis, and ratings were analysed descriptively. Results: The resulting framework comprised four interrelated domains: Mobility, Physical Function, Psychosocial Wellbeing, and Prosthesis Experience. Mobility showed the clearest convergence across stakeholder perspectives. Prosthesis users showed the largest importance actionability gap for Prosthesis Experience (4.5 vs 3.0), whereas clinicians showed the largest gap for Psychosocial Wellbeing (5.0 vs 3.0). Interviews highlighted day-to-day variability in prosthesis use and the influence of confidence, fatigue, comfort, environmental conditions, social context, and device usability. Conclusions: Meaningful outcome assessment in prosthetic rehabilitation should extend beyond mobility alone to consider physical function, psychosocial wellbeing, and prosthesis experience within everyday contexts. The proposed framework provides a stakeholder-informed foundation for multidimensional outcome assessment in prosthetic rehabilitation.

Abstract Introduction: Cardiac rehabilitation (CR) is key for secondary prevention; however, participation remains low due to persistent barriers. Identifying strategies used by high-performing programs may inform approaches to improve patient engagement and outcomes. Purpose: To identify strategies associated with improved participation and adherence in CR programs from the perspective of leaders in high-performing sites. Methods: Semi-structured interviews were conducted with 10 CR leaders from urban, suburban, and rural programs ranked in the top 10% on at least two objective performance measures (e.g., participation and adherence rates) but moderate or low on others. Data were analyzed using thematic analysis to identify strategies associated with high performance. Results: Programs with high participation and adherence rates consistently implemented proactive, patient-centered strategies to address barriers. Individualized care approaches tailored to language, culture, health literacy, and age were commonly used to improve engagement among Hispanic, Black, and older adult populations. High-performing programs addressed structural barriers such as insurance and transportation through flexible scheduling, community partnerships, and targeted outreach. Strong coordination with referring providers and effective transitions from inpatient to outpatient care were associated with higher enrollment and sustained participation. Additional strategies included staff development through ongoing education, use of digital tools for patient tracking, and implementation of virtual and hybrid CR models. Integration of psychological support further enhanced patient engagement. Conclusion: High-performing CR programs employ coordinated, patient-centered, and system-level strategies associated with improved participation and adherence. These findings provide actionable approaches to enhance accessibility and improve programs and patients outcomes in CR across diverse settings. Keywords: Cardiac rehabilitation; participation; adherence; health disparities; implementation strategies

Structural musculoskeletal pain, defined as pain associated with musculoskeletal conditions of the spine and peripheral joints, afflicts persons widely, independent of demographic, and continues to contribute substantially to disability on a global scale. Osteopathic manipulative treatment (OMT) is a non-invasive therapy performed by osteopathic physicians, encompassing a wide variety of techniques meant to heal the dysfunctions manifesting structural musculoskeletal pain. However, the efficacy of OMT in relieving pain symptomatology remains subject to debate. This meta-analysis examines the effect OMT serves to manage structural musculoskeletal pain, measured on a Visual Analog Scale. Three randomized control studies (RCTs) were included, with a total of 231 participants, 117 of which received OMT as part of pain management treatment, the other 114 receiving other treatment modalities. Using the random effects model, the mean difference between OMT and non-OMT treated groups was -1.80 (-7.31; 3.78). Although this mean difference favors OMT with regard to greater reduction in pain, the finding is not statistically significant. Heterogeneity was found to be extraordinarily high (I2 = 96%) and statistically significant (p = <0.0001), albeit attributed to one of the papers, deemed an outlier. With its removal, heterogeneity was still moderate (I2 = 54.4%). Given these findings, the efficacy of OMT in reducing structural musculoskeletal pain cannot be proven. A significant limitation of this study was a low sample size, consisting of 3 RCTs, reducing statistical power. In addition, there was high heterogeneity between studies. More high-quality RCTs with larger sample sizes, standardized methods, and an examination of a broader set of structural musculoskeletal conditions are necessitated to better evaluate the contribution of OMT in pain reduction. Key Words: Pain Management, Osteopathic Manipulative Medicine, Osteopathic Manipulative Treatment, Structural Pain, Orthopaedics, Knee Arthritis, Shoulder Pain, Cervical Spondylosis

Background Given the close anatomical proximity of the eye and its adnexae to the cranium, ocular injury frequently coexists with head trauma. However, specific factors predisposing patients with head injury to ocular involvement in Uganda remain poorly defined. Objective This study aimed to determine the factors associated with ocular injury among patients with head injury at Mulago National Referral Hospital (MNRH), a tertiary referral facility in Kampala, Uganda. Methods We conducted a cross-sectional study among 383 adult patients admitted with head injury to the Accidents and Emergency Department of MNRH from 15/05/2025 to 30/07/2025. All participants underwent a standardized ophthalmic evaluation. Bivariable and multivariable Poisson regression analyses were used to identify factors associated with ocular injury, reported as adjusted prevalence ratios (APR). Results Ocular injury was identified in 268 of 383 patients (70.0%; 95% CI: 65.1-74.5). On multivariable analysis, age 26-44 years (APR 1.18; 95% CI: 1.11-1.43; p=0.013), commercial motorcyclist (boda-boda rider) occupation (APR 1.25; 95% CI: 1.06-1.47; p=0.007), road traffic accident mechanism of injury (APR 1.19; 95% CI: 1.02-1.38; p=0.03), severe head injury (APR 1.70; 95% CI: 1.44-2.01; p<0.0001), and the presence of facial fractures (APR 1.61; 95% CI: 1.44-1.81; p<0.0001) significantly increased the likelihood of ocular injury. Conversely, intracranial hemorrhagic lesions were inversely associated with ocular injury (APR 0.80; 95% CI: 0.68-0.93; p=0.004). Conclusion Ocular injuries are common among patients with head injury. Patients aged 26 to 44 years, commercial motorcyclist occupation, road traffic injury, severe head injury, and facial fractures have a higher risk of ocular injury. We recommend prioritizing ophthalmic evaluation of for patients admitted with head injury to minimize preventable visual impairment.

Abstract Objective HYROX is a rapidly growing hybrid fitness competition combining running with functional exercise stations. Our objective was to describe the 12-month prevalence, characteristics and severity of self-reported HYROX-related injuries. Methods We conducted an international cross-sectional online survey of 418 HYROX athletes. The primary outcome was the self-reported 12-month period prevalence of at least one HYROX-related injury; secondary outcomes included an exposure-adjusted lower-bound rate per 1000 hours of total training exposure and the profile and severity of the most significant injury. Associated factors were examined by multivariable logistic regression. Results Overall, 208 of 418 participants (49.8%, 95% CI 45.0 to 54.5) reported at least one HYROX-related injury. The exposure-adjusted lower-bound rate was 1.65 reported injuries per 1000 hours of total training exposure. Injuries mainly affected the lower extremity, most commonly the knee (20.8%); tendon-related complaints were the leading type (41.6%) and most were of gradual onset. Among participants with severity data, 20.3% reported more than 28 days of training interruption or no return to their previous performance level. Higher HYROX-specific training frequency was the only factor independently associated with injury reporting (adjusted OR 1.61, 95% CI 1.20 to 2.16; p = 0.001). Conclusion Approximately half of respondents reported at least one HYROX-related injury during the preceding 12 months, predominantly involving gradual-onset lower-extremity complaints. Higher HYROX-specific training frequency was associated with injury reporting, although the cross-sectional design precludes causal interpretation. Prospective, exposure-based surveillance is needed to quantify HYROX-specific injury incidence and burden and examine whether training frequency, load distribution and recovery contribute to injury risk.

Background. Guidelines recommend surgery for moderate and severe cervical spondylotic myelopathy (CSM) but support either surgery or nonoperative care for mild disease. How patients weigh the adverse events associated with each pathway is not well characterized. Methods. We conducted a three-arm randomized vignette experiment among United States adults aged 40 years and older recruited through an online research panel. All participants read an identical description of mild CSM and were randomized to one of three scenarios: surgery that improved symptoms, surgery that halted progression without improvement, or nonoperative management with symptom progression. Participants in the surgical scenarios rated 12 possible complications and those in the nonoperative scenario rated 8 progression outcomes. For each item, participants rated how strongly it would influence their decision (0-10) and whether they would still choose the same treatment. Items for which participants would no longer choose the same treatment were termed dominant decision factors. Results. Of 276 respondents, 263 (95.2%) were analyzed. Dominant factor rates ranged from 13.5% to 87.8% across complications. Complications described as persisting at one year produced substantially higher rates than the same complications described as resolving by three months. Adverse events more frequently constituted dominant factors when surgery was framed as offering less benefit, although differences between scenarios were not statistically significant. In the nonoperative scenario, worsening bladder control (56.6%) and neck pain interfering with sleep (53.0%) were the strongest influences, exceeding needing a cane to walk (32.1%). Conclusions. Treatment decisions for mild CSM are driven primarily by the expected permanence of adverse events and their anticipated impact on daily quality of life, rather than by conventional neurological metrics or surgical benefit framing.

Background Cervical spondylotic myelopathy (CSM) is the most common cause of nontraumatic spinal cord dysfunction in adults. For mild disease, guidelines recommend shared decision-making between surgery and structured rehabilitation on the basis of clinical equipoise, yet no comparative effectiveness study has reported outcomes in this population. Whether a randomized trial is feasible is unknown. Methods We conducted two cross-sectional surveys between December 2025 and July 2026: one of patients with surgeon-confirmed CSM recruited from academic outpatient spine clinics, and one of practicing neurosurgical and orthopedic spine surgeons. Respondents rated willingness to participate in (1) a randomized trial of early surgery versus observation and (2) a prospective observational study in which treatment was patient-selected. Responses of likely or very likely were classified as willing. Groups were compared using Fisher exact tests, designs within respondents using exact McNemar tests, and predictors using univariable logistic regression. Results Fifty-four patients and 52 surgeons completed the surveys. Patients were markedly less willing than surgeons to accept randomization (15 of 54, 27.8% versus 44 of 52, 84.6%; p < 0.001). Both groups accepted the observational design (39 of 54, 72.2% versus 51 of 52, 98.1%; p < 0.001), and 26 of 39 patients unwilling to be randomized were willing to enroll in an observational study (p < 0.001). Willingness to be randomized did not differ across mJOA severity (mild 30.4%, moderate 25.0%, severe 27.3%; p = 0.93). Among patients declining randomization, 85.2% cited a wish to retain control over treatment, whereas fear of surgery was cited by one respondent. Forty-five surgeons (86.5%) considered both surgery and observation reasonable, and preference was divided (46.2% favoring early surgery, 48.1% favoring initial observation). Conclusions Surgeons report equipoise and high willingness to randomize, but most patients would decline random allocation, citing a wish to retain treatment choice rather than fear or distrust. A prospective observational study appears the more feasible route to comparative evidence in mild CSM. Feasibility assessments restricted to clinicians may substantially overestimate attainable accrual.

Importance: There are very few interventions designed for individuals with the most severe mobility impairments. Robotic walking may be an effective way to facilitate exercise in this population. Objective: To examine how robot-assisted walkers physical parameters and user characteristics moderate the exercise intensity achieved by individuals with neuromotor disorders causing mobility impairments. Design: A prospective study. Intervention: A single-session intervention involving an overground robot-assisted walker that can be used in an endurance mode requiring no voluntary movement or a strength mode during which voluntary movement could impact the gait pattern. Participants: Individuals with pediatric-onset mobility impairments Main Outcome Measures: Participants were characterized based on their age, sex, diagnosis, and Gilette Functional Assessment Questionnaire (FAQ) levels. Heart rate during the final minute of four 5-minute walking conditions: strength mode at fast speed, strength mode at slow speed, endurance mode at fast speed and endurance mode at slow speed was expressed as a percentage of each participant heart rate reserve (%HRR). Linear mixed-effects models were used to evaluate the impact of speed, device mode and user characteristics on the level of exercise achieved. Results: 29 individuals (aged 2-26 years) with mobility impairments (FAQ levels 1-6) completed this study. Fast speeds were associated with a higher %HRR (beta= 2.11, SE = 1.03, p = 0.044). Participants in FAQ class 1 exhibited significantly higher %HRR compared with those in FAQ classes 2 and 3 (beta=18.6, SE=7.31, p=0.017; beta= 16.9, SE = 8.13, p = 0.047, respectively). No other device or participant characteristics were associated with exercise intensity. Conclusions: To facilitate higher exercise levels, users of robot-assisted walkers can increase their speed. Individuals who cannot take steps due to their neuromotor impairments experience the highest levels of exercise. Relevance: The findings in this study highlight the promise of robot-assisted walkers to improve health, particularly in those who often face the greatest barriers to exercise.

[Purpose] By pairing repeated peripheral muscle fatigue induction with a functional and ADL-based assessment, this study tests whether hand muscle fatigue alone is sufficient to im pair fine motor performance in healthy adults performing ADL-inspired tasks. [Participants and Methods] Thirty healthy male and female university students performed 11 tasks twice, once in the pre-fatigue condition and once in the post-fatigue condition. The performance of each task was graded on a 0-4 scale. The score and the time to finish the task (TTFT) were recorded twice, for both the pre- and post-fatigue phases. Maximum force gen eration (MFG) of each participant's grip was recorded prior to the tasks in the pre-fatigue phase and again in the fatigue condition after performing the fatigue protocol. [Results] Muscle fatigue did not have a significant effect on the fine motor performance of the thirty participants, neither (TTFT) nor the scores of each task (p > 0.05) (r=0.08). In contrast, hand muscle fatigue led to a significant decrease in the mean (MFG) for both males and females (p<0.01). [Conclusion] Hand muscle fatigue led to a significant decrease in the mean grip MFG for both sexes. However, this reduction did not translate into impaired fine motor performance during ADL-like tasks. Consequently, under muscle fatigue, hand grip changes during fine tasks tested are rare and have minor to no impact on hand performance. This study suggests that acute peripheral muscle fatigue can coexist with preserved fine motor performance in healthy populations.

Background Ocular injuries concomitantly occur among patients with head trauma because of the close anatomical relationship between the cranium and the orbit. Unfortunately, they are often overlooked during acute trauma care and may result in preventable visual loss. There is a dearth of data describing the burden and spectrum of ocular injury among head injury patients in sub-Saharan Africa. We conducted a hospital-based cross-sectional study to determine the prevalence and describe the patterns of ocular injury among adults admitted with head injury at the Accidents and Emergency Unit of Mulago National Referral Hospital, Uganda, from 1st May 2025 to 30th July 2025. Methods Consecutive patients aged 18 years and above with a confirmed head injury diagnosis underwent a structured ophthalmic evaluation comprising visual acuity testing, tonometry, slit-lamp and dilated fundus examination, pupillary and ocular motility assessment, confrontation visual fields, and review of craniofacial computed tomography. Ocular injuries were classified by anatomical site and injury type, and the prevalence was reported with a 95% confidence interval. Results Of 383 patients evaluated (mean age 32.7 {+/-} 12.3 years; 89.3% male), road traffic accidents were the leading mechanism of injury (68.9%) and most patients had mild head injury (72.3%). Overall, 268 patients (70.0%; 95% CI 65.1-74.5) sustained at least one ocular injury. Adnexal injuries were most frequent (64.0%), dominated by periorbital oedema (45.2%), subconjunctival haemorrhage (42.3%) and eyelid ecchymosis (33.2%); orbital fractures occurred in 27.4%. Closed and open globe injuries were present in 13.8% and 0.8% of patients, respectively, and abnormal confrontation visual fields in 28.2%. Conclusion Ocular injury is highly prevalent among patients admitted with head injury in this setting, with adnexal and orbital structures most commonly affected. Routine ophthalmic assessment should be integrated into the initial evaluation of all head injury patients to reduce missed injuries and prevent avoidable visual morbidity.

Background: Acute osteoporotic vertebral fractures (OVFs) may be difficult to detect on conventional radiographs, particularly before substantial vertebral collapse occurs. Comparing supine and sitting lateral radiographs may reveal load-dependent vertebral mobility. This preliminary study evaluated the diagnostic accuracy of supine to sitting dynamic radiography for detecting MRI confirmed acute OVFs. Methods: This retrospective, single center diagnostic accuracy study included consecutive patients who underwent paired supine and sitting lateral radiography and MRI of the same spinal region between April 2024 and July 2026. Dynamic radiographs were interpreted by a board certified orthopedic and spine surgeon who was blinded to the MRI findings. MRI was independently interpreted by a second board certified orthopedic surgeon and served as the reference standard. The primary outcome was patient-level sensitivity and specificity. Vertebra level diagnostic accuracy was evaluated secondarily, with patient cluster bootstrap confidence intervals used to account for within patient correlation. Results: Sixty three patients (mean age, 80.6 years; 51 women [81.0%]) and 490 evaluable vertebrae were analyzed. MRI identified acute OVFs in 34 patients and 36 vertebrae. At the patient level, dynamic radiography yielded 31 true positive, no false-positive, three false negative, and 29 true negative results. Sensitivity was 91.2% (95% confidence interval [CI], 76.3%-98.1%), specificity was 100.0% (95% CI, 88.1%-100.0%), positive predictive value was 100.0%, negative predictive value was 90.6%, and overall accuracy was 95.2%. At the vertebral level, sensitivity was 91.7% (33/36; patient cluster bootstrap 95% CI, 81.3%-100.0%) and specificity was 100.0% (454/454). The three missed fractures involved T9, L2, and L3. No false-positive vertebrae were observed. Conclusions: Supine to sitting dynamic radiography demonstrated high patient level sensitivity and no observed false positive findings for MRI confirmed acute OVFs. It may provide a practical complementary diagnostic option when MRI is not immediately available. However, a negative dynamic radiographic examination does not exclude an acute fracture, and the apparent perfect specificity requires validation in larger, prospective multi-reader studies.

Abstract Objective: Glaucoma is a chronic disorder that impairs ocular health and may exacerbate ocular surface disease leading to tear film instability, dry eye symptoms and decreased quality of life. This study compared changes in tear quantity among glaucoma subjects living with and without diabetes mellitus, attending an eye clinic in Nigeria. Methods: A comparative cross sectional research design was used. 157 subjects which comprised 74 glaucoma subjects living with diabetes mellitus and 83 glaucoma subjects living without diabetes mellitus participated in the study. Tear quantity assessment included the Schirmer I test and tear meniscus height (TMH) measurement. Descriptive statistics, independent samples t-test and Chi-square test were used to examine the data at 0.05 level of significance. Results: Glaucoma subjects living with diabetes mellitus showed substantially decreased tear production (11.4 +/- 6.8 mm) compared with glaucoma subjects living without diabetes mellitus (19.6 +/- 9.6 mm; p < 0.001). Tear meniscus height in glaucoma subjects living with diabetes mellitus (0.8 +/- 0.3 mm) was significantly greater than in subjects living without diabetes mellitus (0.7 +/- 0.3 mm; p = 0.034). Conclusion: Diabetes mellitus dramatically deteriorates the ocular surface function in glaucoma subjects by decreasing tear production, altering the tear meniscus height and increasing the severity of ocular surface symptoms. Routine glaucoma care, especially in patients with diabetes mellitus, should include a full ocular surface evaluation including Schirmer I test, TBUT, TMH, and OSDI assessment to allow early detection and management of ocular surface disease, better treatment adherence, and improved visual outcomes. Keywords: Glaucoma, Diabetes Mellitus, Tear production, Tear Meniscus Height, Ocular Surface Disease.

Rationale: Dislocation is the leading reason for early revision surgery. To address the problem of dislocation, the dual-mobility (DM) cup was developed in France in the 1970s. This cup should provide more stability and biomechanically reduce the risk of dislocation. In the Netherlands, most DM cups are placed in specific patients, e.g. with cognitive impairment and for revisions due to recurrent dislocations. Despite the increased and, in some countries, broad use of DM cups, high quality evidence of their (cost)effectiveness is lacking. This study aims to perform a trial to fill this gap in knowledge. Much of the information needed to judge the effectiveness of DM cups is already incorporated in the Dutch Arthroplasty Register (LROI). This register lends itself perfectly for a nested RCT towards this aim. Objective: The primary objective is to investigate whether there is a difference in the number of hip dislocations following primary total hip arthroplasty (THA), using the posterolateral approach, with a DM cup compared to a unipolar cup in elderly patients 1 year after surgery. The secondary objectives are: to investigate whether there is a difference in the number of revisions; to investigate what the cost-effectiveness and cost-utility is of a DM cup compared to a unipolar cup at 1 year follow-up; to investigate whether there is a difference in the number of hip dislocations and revisions between a DM cup and a unipolar cup 2 years after surgery; to investigate whether there is a difference in patient reported outcomes between a DM cup compared to a unipolar cup 1 and 2 years after surgery; to compare the number of hip dislocations, revisions and PROM data between patients in the randomized DM group and patients in an observational cohort DM group. Finally, long-term survival of DM and unipolar cups will be evaluated based on revision and mortality data registered in the LROI. Study design: Prospective multi-center international wide within the European Union (EU), single blinded RCT, nested in the national registry. Study population: Patients [&ge;] 70 years old, undergoing an elective primary THA. Intervention (if applicable): The intervention group receives a THA with a dual mobility cup, the control group receives a THA with a unipolar cup. Main study parameters/endpoints: Primary: The number of dislocations. Secondary: costs, patient reported outcomes and implant survival.

Background: An estimated 826 million people have avoidable near vision impairment (NVI) due to lack of access to near vision glasses for presbyopia. Glasses use, uptake and replacement is essential to sustained NVI correction. Here we explore the uptake of second and subsequent pairs of near vision glasses and the willingness to pay. Methods: In this cross-sectional survey, 276 individuals who received near vision glasses through eye health screening programs in Punjab province, Pakistan from 2020 to 2022, were surveyed between February and July 2025, i.e. 3-5 years later. Results: 92.0% (n=254) of respondents were still using near vision glasses: a purchased replacement (41.3%, n=114), a free replacement (30.8%, n=85), or the original pair (19.9%, n=55). Male gender, higher age, and personal income were strongly associated with purchasing additional pairs, while women and those economically dependent on others relied more on free provision (all p values <0.05). Accessibility, indicated by shorter travel times and awareness of supply sources, also played a significant role in sustained replacement. Over 98% of participants expected to obtain (purchase or receive) a new pair of glasses in the future, and over 94% of participants expected to purchase their next pair. The mean willingness-to-pay (WTP) was 353 PKR (95% CI: 327-379) // 1.25 USD (95% CI: 1.16-1.34), while the average reported price paid was 416.67 PKR // 1.47 USD (95% CI: 351.39-481.94)). Conclusion: Sustained use of near vision glasses remained high 3-5 years after initial provision. Many recipients had purchased replacements, and willingness and ability to pay were high among participants, suggesting potential for sustained demand beyond initial subsidized distribution.

Background and purpose: Patellofemoral pain syndrome (PFPS) is a multifaceted condition where proximal, local, and distal factors may contribute to symptoms and limitations. How these factors collectively contribute to PFPS remains poorly understood. Therefore, this study compared proximal, local, and distal mechanical characteristics between individuals with and without PFPS and investigated their association with pain intensity and functional disability. Methods: Eighty participants were included: 40 individuals with unilateral or bilateral PFPS, 40 healthy controls. Isometric muscle strength of hip, trunk, and ankle was assessed using a handheld dynamometer. Joint alignment (Q-angle, rearfoot angle, pelvic tilt) and muscle flexibility (iliotibial band, hamstrings, quadriceps, gastrocnemius, and soleus) were measured using standard clinical techniques. Pain severity was assessed using a visual analog scale (VAS), and functional disability was evaluated using the Kujala score. Results: Individuals with PFPS showed reduced iliotibial band flexibility, decreased hamstring and soleus length, lower hip abductor strength, and greater anterior and lateral pelvic tilt (all p < 0.02). Multivariate analysis identified reduced iliotibial band flexibility (OR = 7.48) and greater anterior pelvic tilt (OR = 11.75) as independent associates of PFPS. Anterior pelvic tilt predicted pain severity, while anterior trunk muscle strength and Q-angle predicted disability. Discussion: Reduced iliotibial band flexibility and increased anterior pelvic tilt were independently associated with PFPS, while anterior pelvic tilt predicted pain severity and anterior trunk muscle strength and Q-angle predicted functional disability. Clinical assessment and rehabilitation of PFPS should therefore extend beyond the knee to include iliotibial band flexibility, pelvic alignment, and trunk muscle strength.

Frontline healthcare workers (HCWs) during the COVID-19 pandemic in Malawi included physiotherapists. This study explored the experiences of those physiotherapists to help prepare workforce support plans in the future in the advent of a new disease outbreak. This phenomenological qualitative study was conducted between 2 May and 15 June 2024 at two tertiary hospitals in Southern Malawi namely, Queen Elizabeth Central Hospital (QECH) and Zomba Central Hospital (ZCH). Participants were purposely sampled and included physiotherapists who had been involved in caring for patients with COVID-19 at the two hospitals. Data was collected from 11 participants (9 from QECH and 3 from ZCH) using physical in-depth interviews. The recorded interviews were transcribed verbatim and transcripts analyzed using a deductive thematic approach. Themes were broadly categorized into positive and negative experiences. Among positive experiences, participants reported that physiotherapy interventions facilitated quick recovery of patients. In some instances where oxygen cylinders were not enough or had run out of oxygen, physiotherapy interventions were lifesaving. Additionally, the COVID-19 pandemic raised awareness of physiotherapy's role in COVID-19 management and resulted in permanent employment for several physiotherapists. Under the theme of negative experiences, participants faced challenges with team recognition, communication, staff shortages, inadequate equipment, and no local physiotherapy guidelines. The findings suggest Malawis healthcare system needs better pandemic preparedness and stronger interdisciplinary care.