Disability and Rehabilitation

Purpose To explore patient and caregiver perspectives on factors influencing mobility during hospitalization after hip fracture surgery, and how these are experienced and negotiated in everyday hospital practice. Materials and methods A qualitative interview study informed by a hermeneutic-phenomenological perspective was conducted in a hospital setting in Denmark. Using purposive sampling with maximum variation, ten patients and nine caregivers were interviewed during hospitalization. Data were analyzed using reflexive thematic analysis following Braun and Clarke. Results Five interrelated themes were identified; (1) Body and mind in transition; (2) Communication as a prerequisite for safety and mobility; (3) Structural barriers and ambiguities in responsibility; (4) The physical environment and ward culture; and (5) Mobility as preparation for life after discharge. Across themes, mobility emerged as a socially shaped and negotiated practice through everyday interactions, communication, organizational routines, and situational support during hospitalization. Conclusions Mobility during hospitalization after hip fracture surgery emerged as a context-dependent and socially shaped practice rather than a purely physical task. These findings suggest that rehabilitation during hospitalization may need to attend not only to mobility prescription, but also to relational, communicative, and contextual aspects of everyday ward routines that shape patients' confidence and participation.

Background The incidence of post-operative periprosthetic femoral fractures (POPFFs) is increasing. However, specific clinical guidance relating to patient management does not exist, resulting in variations in care and outcomes. This study aimed to elicit and synthesise expert knowledge in POPFF service delivery and explore views on variations in service provision and the factors influencing these. Methods Semi-structured interviews were undertaken with healthcare professionals with expertise in POPFF care from England and Wales to explore current practices, challenges, service variations and perceived future opportunities. Participants were identified through specialist research and clinical networks for POPFF and hip fracture care, authors of key publications on the subject, national leads for POPFF/hip fracture networks, and research team contacts. Interviews were analysed using thematic analysis. Results Ten interviews were undertaken with experts in POPFF services across a range of professional roles. Four themes were identified: conceptualisation of POPFF (by different professional groups and in different service settings) and understanding of POPFF patient needs; sources of variation in management and care of POPFF patients; service model rationales, advantages and disadvantages; and potential strategies to improve POPFF care. Conclusion When designing POPFF services, we suggest that four key areas need consideration: the extent to which POPFF patients are a distinct group with particular care needs; the necessity for and consequences of patient transfer between wards and hospitals; the resourcing of extensive multidisciplinary support for POPFF patients; and the need for national initiatives to encourage service developments. These findings should form the basis of future clinical guidance. Sensitivity to contextual factors driving variation in services is needed to ultimately improve care for POPFF patients.

Background Gait training incorporating visual feedback or rhythmic auditory cueing has shown promising results in neurological conditions but has rarely been investigated in clinical rehabilitation for persons with Multiple Sclerosis (pwMS). Objective To evaluate the feasibility of treadmill training (TT) with visual feedback (VF) and TT with visual feedback plus rhythmic auditory cueing (VF+RAC) during clinical rehabilitation and explore its effects on gait parameters. Methods PwMS were randomly allocated 1:1 to perform ten 30-minute training sessions of TT with VF or VF+RAC during inpatient rehabilitation. The primary outcome was feasibility (adherence, compliance, safety, and acceptability). Secondary outcomes were session-by-session developments in spatiotemporal and qualitative gait parameters. Results Sixty of 68 randomized participants completed the intervention (VF: n=29; VF+RAC: n=31). Adherence and compliance rates were 93% and 86%, respectively, with no differences between groups. The most common adverse event in both groups was (leg) pain (21/38 total adverse events). One fall occurred in 629 sessions. Both interventions were greatly accepted and perceived as fun, motivating and helpful to achieve rehabilitation goals. Both groups increased in distance, gait speed, and average step length. Step length variability did not change in the VF-group, while the VF+RAC-group slightly improved. Step length difference was constantly low in the VF+RAC-group, while the VF-group differences were elevated. Conclusions VF and VF+RAC are feasible training options for pwMS in a rehabilitation setting and are greatly accepted by participants. Qualitative gait parameters should be investigated in studies powered to detect clinically relevant differences in the future.

Background: Post-stroke motor impairment is the leading contributor to long-term disability. Despite evidence that high dose, high intensity (HDHI) and virtual reality (VR) interventions are effective in reducing post-stroke motor impairment, access to such interventions is limited, especially in community-based models. The purpose of this study was to explore the effect of one community-based HDHI VR intervention, Next-Generation NeuroAnimation Therapy (NG-NAT), on motor impairment for community-dwelling stroke survivors. Methods: The study employed a retrospective pre-test post-test design of de-identified data sets of one cohort of stroke survivors who participated in an HDHI NG-NAT intervention at a community-based center from March to December 2025. The intervention consisted of three hours of daily therapy, five days a week, for three weeks. Two hours were allocated for NG-NAT gameplay, while one hour focused on non-VR activity. The NG-NAT was provided in a small studio with a large screen monitor and 12 motion caption cameras mapping client movements to play the game. The upper extremity Fugl Meyer Assessment was used to measure motor impairment at pre- and post-testing. Linear regressions were run to determine the relational strength between pre- and post-UEFMA scores. Wilcoxon Signed Rank Tests were run to calculate median differences in pre- and post-UEFMA scores and account for non-parametric data distributions at baseline and the small sample size. Effect size was explored using the Rank Biserial Correlation. Frequency of minimally clinically important differences (MCID), minimal detectable changes (MDC), recovery stage transition were calculated. Content analysis and co-review of documentation contextualized statistical findings. Results: Nineteen participants completed three weeks of intensive NG-NAT. All experienced positive UEFMA score improvements from pre- to post-testing with a median difference of 8 points. Fifteen achieved MDC and MCID; one experienced a ceiling effect. Eight participants transitioned into better recovery stages. There was a highly significant, positive relationship with narrow confidence intervals and pre-score predicted post-score (e.g., those with mild/moderate impairment improved better than those with severe impairment). Conclusion: This study provides evidence supporting the efficacy of NG-NAT as a community-based intervention to reduce motor impairment for individuals with stroke. Given its ability to deliver intense and engaging therapy, NG-NAT offers a promising adjunctive strategy to expand access for stroke survivors to improve clinically relevant health outcomes. These findings underscore the need for pragmatic trials evaluating effectiveness, implementation, and cost-effectiveness.

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: 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 and Purpose: Walking after stroke is often characterized by persistent biomechanical impairments and reduced walking capacity. While visual biofeedback can improve gait mechanics and fast walking can enhance capacity, it is unclear whether individuals post-stroke can effectively use biofeedback at higher walking speeds to address both deficits simultaneously. This study examined the effects of walking speed on the ability of participants with chronic stroke to reduce step length (SL) errors using visual biofeedback. Methods: Sixteen individuals with chronic stroke walked on a treadmill at slow, self-selected, and fast speeds with and without visual SL biofeedback. Absolute SL error relative to individualized targets was calculated for paretic and non-paretic limbs. Linear mixed-effects models with piecewise linear splines assessed the effects of speed, limb, and feedback condition. Post hoc comparisons were performed for significant interactions. Results: At lower speeds, increasing speed reduced SL error in both limbs (p < 0.001). At higher speeds, the effects of speed were dependent on limb and condition (p < 0.001). Paretic SL error increased with speed without feedback but remained stable with feedback (p < 0.001). Non-paretic SL error decreased with speed regardless of condition. SL error was greater in the paretic limb overall (p < 0.001). Discussion and Conclusions: Fast walking alone did not reduce paretic SL errors. Participants with chronic stroke can effectively use visual biofeedback to reduce paretic SL errors at higher speeds, supporting its integration into high-intensity gait training to simultaneously treat biomechanical impairments and walking capacity deficits after stroke.

Objectives: Explore feasibility and acceptability of upskilling a workforce to deliver a co-developed intervention, based on Acceptance and Commitment Therapy (ACT), to support psychological adjustment post-stroke targeting underserved groups. Design: Multi-site, single-arm feasibility study with embedded mixed-methods process evaluation (ISRCTN17628580). Setting: Four NHS community stroke services across England. Participants: 1. Stroke survivors [&ge;]18 years of age, [&ge;]4 months post-stroke, reporting psychological difficulties adjusting to stroke, able to consent and access remote group sessions in English; 2. Group facilitators from NHS stroke services, not ACT specialists. Intervention: WAterS-2: an eight-session, remotely-delivered ACT-informed group intervention. Outcome measures: Recruitment, fidelity, safety, acceptability and perceived value were assessed using fidelity checklists, post-intervention surveys and semi-structured interviews with stroke survivors and facilitators. Clinical outcomes including mood (HADS), wellbeing (ONS4), psychological flexibility (AAQ-ABI), measured post-group and three-months later. Results: Nineteen stroke survivors recruited (mean 9.6 months post-stroke; n=5 (26%) minoritised ethnicities; n=10 (52%) with aphasia). Thirteen facilitators - including two peer support workers - delivered the intervention with fidelity following structured training across four services. Drop-out was low (2/19; 11%); with 15 (79%) attending [&ge;]5/8 sessions. Remote data collection was feasible (79% follow-up completion), with no adverse events recorded. Acceptability was high: survivors valued peer connection, grounding and mindfulness practices. ACT metaphors were helpful for some but challenging for others, including some with aphasia. Online delivery was suitable but limited informal connection. Facilitators reported increased capability, incorporating ACT skills into routine care. NHS workforce pressures and geographically-constrained referral pathways limited recruitment reach. Conclusions: WAterS-2 is feasible, safe, acceptable and inclusive. A mixed workforce, including NHS peer support workers, can be upskilled to deliver with fidelity. Inclusion of underserved groups is achievable but requires active strategies beyond standard NHS referral routes. Findings inform a provisional logic model and a future pragmatic trial.

Background: A subset of uveal melanomas can be treated using either enucleation or proton beam therapy (PBT), which offer similar oncological outcomes. The most appropriate treatment depends on a patient's preference. To allow patients to genuinely determine their preference, it is recommended to describe options as neutrally as possible. This study assesses to what extent ocular oncologists use and perceive non-neutral framing behaviour, and if it is related to patient satisfaction with decision-making. Methods: Consultations of ocular oncologists with patients newly-diagnosed with uveal melanoma were audio recorded, transcribed verbatim, and coded for ocular oncologists' explicit and implicit non-neutral framing behaviours. Explicit non-neutral framing was defined as: explicitly mentioning a preferred option at least once, without relating it to the patient. Implicit non-neutral framing was defined as: describing an option (un)favourably, without providing a medically substantive clarification alongside. Results: 110 patients provided consent for the audio recordings. Non-neutral framing was found in 84% (n=92/110) of consultations. We found explicit behaviour in 38% (42/110) and implicit behaviour in 76% (84/110, median=1, range, 0-4) of consultations. The most frequent implicit framing was presenting options by positively or negatively emphasizing one option. Non-neutral framing behaviours were not significantly related to patient satisfaction with decision-making. Conclusion: This study shows that in most consultations some non-neutral framing was present, which did not impact patients' satisfaction with decision-making. Nonetheless, ocular oncologists should be aware that how they describe options may influence preferences in ways that do not align with the patient's values.

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 ([&ge;] 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.

Abstract Background: Non-specific chronic low back pain (NSCLBP) is a major cause of disability worldwide and is associated with low-grade systemic inflammation. This study investigated the effects of aerobic exercise on inflammatory biomarkers, pain intensity, and quality of life among individuals with NSCLBP. Methods: In this parallel-group randomized controlled trial, 41 participants with NSCLBP were allocated to either an aerobic exercise plus health education group (n=21) or a health education-only control group (n=20). Participants in the intervention group completed supervised aerobic cycling three times weekly for 12 weeks. Outcome assessors and laboratory personnel were blinded to group allocation. Outcomes were measured at baseline, Week 8, and Week 12. Results: Interaction effects were observed for TNF- (p=0.046), IL-6 (p<0.001), hs-CRP (p<0.001), and pain intensity (p<0.001). Significant improvements were also observed across all WHOQOL-BREF quality-of-life domains (all p<0.05). After adjustment for baseline values and age, participants in the intervention group had significantly lower Week 12 IL-6 (p=0.013), hs-CRP (p<0.001), and pain intensity (p<0.001) than controls. No serious adverse events were reported. Conclusions: Aerobic exercise combined with health education produced greater improvements in inflammatory biomarkers, pain intensity, and quality of life than health education alone among individuals with NSCLBP. These findings support the integration of structured aerobic exercise into rehabilitation programmes for chronic low back pain. Keywords: Non-specific chronic low back pain; aerobic exercise; inflammation; IL-6; hs-CRP; pain intensity; quality of life; randomized controlled trial.

Sensorimotor adaptation is a motor learning process that contributes to movement flexibility and is thought to arise from the interaction of fast and slow adaptive processes. Evidence suggests that declarative memory contributes to adaptation through its influence on the fast process. Although adaptation deficits are common following stroke, the mechanisms underlying these deficits remain unclear. This study investigated differences in locomotor adaptation rate and forgetting between individuals with chronic stroke and age-matched controls and examined how these measures were associated with immediate declarative memory performance. Individuals with chronic stroke (n = 23) and age- and education-matched controls (n = 21) completed four 4-minute bouts of split-belt treadmill adaptation separated by rest breaks. Adaptation rate, adaptation magnitude, and forgetting were quantified from exponential fits to normalized step-length asymmetry data. Immediate declarative memory was quantified using the Repeatable Battery for the Assessment of Neuropsychological Status, and associations between adaptation measures and immediate declarative memory were evaluated using robust linear regression. Participants with stroke adapted less (p = 0.001) and more slowly (p = 0.039) than controls during early adaptation and forgot less of the adapted behavior during the first rest break (p = 0.024). Notably, poorer immediate declarative memory performance was associated with reduced forgetting during the initial rest break, irrespective of group assignment (p = 0.035). This relationship supports the hypothesis that declarative memory contributes to adaptation through a cognitively mediated fast process. These findings suggest that cognitive impairment contributes to altered adaptation following stroke and highlight the importance of considering cognitive factors when investigating motor learning mechanisms and rehabilitation outcomes in neurological populations.

Anterior cruciate ligament (ACL) injuries are associated with physical, psychological and social consequences, yet diagnosis is often delayed. Existing research has focused on clinical and organisational contributors to delayed diagnosis, with limited attention on patient lived experiences of the diagnostic process. This study aimed to explore patient perspectives on the contributors to and impact of delayed ACL injury diagnosis. A qualitative study was conducted, informed by a critical realist perspective, using semi-structured interviews with ten UK-based adults who experienced a diagnostic delay exceeding three months following ACL injury. Data were analysed using codebook thematic analysis. Three interrelated themes were generated: understanding and interpreting the injury experience; navigating healthcare pathways and professional interactions; and the impact of delay, recovery and life disruption. Participants described early uncertainty, symptom normalisation and attempts to self-manage the injury, often influenced by competing work, study or family commitments. Delayed diagnosis was shaped by fragmented healthcare pathways, inconsistent advice, repeated consultations without progression and perceived dismissal of patient concerns. MRI and specialist consultations were commonly viewed as pivotal moments that validated the injury and diagnosis. Delayed diagnosis had substantial consequences extending beyond physical symptoms, including disrupted sport participation, altered occupational and parenting roles, psychological distress, and a perceived loss of time and opportunity. Diagnostic delay following ACL injury appears to arise through the interaction of patient decision making, clinical encounters and healthcare system constraints. Improving timely diagnosis may therefore require person-centred approaches that strengthen public awareness, support clearer communication and improve continuity and access within healthcare pathways.

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.

Background. A recent meta-analysis by Dang et al. [1] concluded that enteral supplementation with docosahexaenoic acid (DHA), with or without arachidonic acid (ARA) did not significantly affect retinopathy of prematurity (ROP) outcomes in preterm infants. Of four eligible trials that supplemented both DHA and ARA, only two contributed to each ROP outcome analyzed, and severe ROP was not assessed. Methods. We replicated the eligibility criteria and search strategy of Dang et al., restricted to trials that supplemented both DHA and ARA, and reanalyzed three ROP endpoints (any ROP, ROP requiring treatment, and severe ROP [stage 3 and/or treated]) using complete outcome records from all eligible trials. Crude risk ratios (RR) were pooled by Mantel-Haenszel fixed-effect meta-analysis. Gestational age-adjusted odds ratios (adjOR) were pooled on the log scale by inverse-variance random-effects meta-analysis with restricted maximum likelihood (REML) estimation of between-study variance and Hartung-Knapp confidence intervals. Results. Five trials were included; one trial was identified in our replicated search but was excluded by Dang et al. without a stated rationale. The pooled estimate for any ROP was consistent with Dang et al. (RR 0.87 [95% CI 0.71-1.08]; adjOR 0.70 [0.46-1.08]). For ROP requiring treatment, the crude RR suggested a lower risk but did not reach statistical significance (RR 0.60 [0.35-1.04]), whereas the gestational age-adjusted estimate indicated lower odds (adjOR 0.47 [0.23-0.94]). For severe ROP, DHA+ARA supplementation produced a significant protective effect in both unadjusted and adjusted models (RR 0.56 [0.36-0.86]; adjOR 0.42 [0.19-0.96]). Conclusions. When all eligible trials contribute to each endpoint and severe ROP is included as an outcome, enteral DHA+ARA supplementation reduces severe ROP and is associated with lower odds of ROP requiring treatment after adjustment for gestational age. These findings differ from the conclusions of Dang et al. and support reconsideration of DHA+ARA supplementation as a strategy to reduce sight-threatening ROP in preterm infants.

Background Annually, nearly 2 million hip, knee, and spinal inpatient surgeries are performed in Canada and the US for osteoarthritis (OA), costing over $37 billion in hospital expenditures. However, 15-30% of patients experience limited or no improvement, resulting in poor value for money. This study evaluated the one-year cost-utility of joint and spine procedures for OA by comparing non-responders to responders, considering various responder definitions. Methods Individual micro-costing data were collected for 1,175 elective hip, knee, and spine patients enrolled in the Longitudinal Evaluation in the Arthritis Program - Osteoarthritis (LEAP-OA) between 2014 and 2018. Quality-adjusted life years (QALYs) were derived using the SF-6D utility index. One-year incremental cost-utility ratios (ICURs) were calculated from the hospital perspective. Results Responder rates varied by definition, ranging from 78%-94% for hip replacements, 64%-90% for knee replacements, 60%-64% for spine fusions, and 50%-68% for spine decompressions. Corresponding ICURs were: $45,956-$51,773/QALY for responders versus $108,593-$485,762/QALY for non-responders for hip replacements; $54,831-$71,151/QALY for responders versus $200,486-$1,203,596/QALY for non-responders for knee replacements; $65,980-$74,422/QALY for responders versus $262,039-$729,686/QALY for non-responders for spine fusions; and $29,947-$42,168/QALY for responders versus $63,195-$662,586/QALY for non-responders for spine decompressions. Conclusions While surgical response rates were highly dependent on the responder definition, ICURs for non-responders were significantly higher than those for responders across all definitions. Beyond the negative impact on patients, there is a compelling economic argument for investment in improved pre-operative identification of patients at risk of surgical non-response. Such efforts could enable more personalized, value-based care pathways and reduce the provision of low-value surgical interventions.

Purpose: To investigate corneal subbasal nerve plexus alterations using in vivo corneal confocal microscopy (IVCM) in patients with Autosomal Recessive Spastic Ataxia of Charlevoix-Saguenay (ARSACS) and Spastic Paraplegia Type 7 (SPG7). Methods: This cross-sectional pilot study included eight ARSACS patients, five SPG7 patients, and twenty age- and sex-matched healthy controls. All participants underwent neurological and ophthalmological examination followed by central corneal imaging using IVCM. Quantitative corneal nerve parameters were analyzed with automated software, and correlations with clinical severity scales were assessed. Results: The mean age was 34.2 +/- 3.4 years in controls, 34.5 +/- 0.7 years in the ARSACS group, and 38.2 +/- 3.5 years in the SPG7 group. Corneal nerve branch density (CNBD) and corneal nerve total branch density (CTBD) were significantly lower in ARSACS and SPG7 patients compared with healthy controls. CNFD, CNFL, CNFA, CNFW, and CNFrD were lower in ARSACS and SPG7 patients compared with healthy controls; however, these differences did not reach statistical significance. No statistically significant differences in IVCM parameters were detected between ARSACS and SPG7 patients. Spearman correlation analysis did not show significant correlations between corneal nerve parameters and FARS, SARA, ADL scores, or disease duration. Conclusion: IVCM revealed reduced corneal nerve branching parameters in patients with ARSACS and SPG7. These findings indicate involvement of the corneal subbasal nerve plexus and support the potential role of corneal confocal microscopy as a non-invasive ocular imaging modality for evaluating peripheral neural alterations in hereditary spastic ataxias.

Post-stroke depression affects approximately 30% of patients after stroke and is associated with delayed recovery in activities of daily living, reduced rehabilitation effectiveness, and poorer quality of life. Attentional bias modification may provide a low-burden, nonpharmacological approach for patients in the acute phase of stroke. However, before such an intervention can be implemented in clinical practice, it is necessary to clarify whether attentional bias is present in patients with acute stroke and depressive symptoms, whether cognitive function influences the manifestation of this bias, and which task and stimulus formats are most appropriate for assessment. This multicenter, cross-sectional observational study will enroll patients with acute stroke between 7-30 days after stroke onset. Depressive symptoms will be assessed using the depression subscale of the Hospital Anxiety and Depression Scale. Attentional bias will be measured under four task conditions based on the dot-probe task and the cue-target task, using face and word stimuli. Secondary assessments will include cognitive function, anxiety symptoms, activities of daily living, health-related quality of life, and clinical background variables. The aims of this study are to investigate the association between depressive symptoms and attentional bias in patients with acute stroke, compare attentional bias characteristics across task and stimulus types, and examine the potential influence of cognitive function on this association. The findings are expected to provide an empirical basis for designing future attentional bias modification protocols targeting post-stroke depression in the acute phase. This study has been registered with the UMIN Clinical Trials Registry (UMIN000059166).

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.

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.