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.

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

Objectives: Mental wellbeing is lower in people with vision impairment (VI) but the mechanisms for this are not completely understood. Here we examined factors that limit and benefit wellbeing in children and young people with VI. Design: Qualitative semi-structured interviews with children and young people with vision impairment and parents/carers of young people with VI. Interviews were recorded, transcribed and analysed by two researchers, working independently, using reflexive thematic analysis. Setting: Low vision and genetic eye disease clinics in a tertiary eye hospital in London, England. Participants: Young people aged 13-18 years with vision impairment (VI) caused by inherited macular disease and parents of young people with VI caused by inherited macular disease. Results: Four overarching themes were developed: (1) Living in the aftermath of diagnosis, capturing participants' internal experience of living with vision impairment from the time of diagnosis onward, including the psychological impact of negotiating the loss of vision and the challenge of accepting VI; (2) Fighting the system, reflecting how parents and CYP navigate both formal and informal support systems, highlighting the barriers they face; (3) Being seen and being misunderstood, encapsulating how VI influences the way that participants experience relationships, develop a sense of self and navigate their place within society; and (4) Building a life with vision impairment, centring on how participants function in everyday contexts whilst living with VI, alongside their aspirations for building their lives and living well in adulthood. Conclusions: Vision impairment has emotional, social, and systemic consequences. Factors linking VI to reduced mental well-being included low acceptance of vision loss, low functional adaptation, reduced self-efficacy, effects of social stigma and discrimination.

Purpose: To co-design a community-based walking program that incorporates social connection to improve physical activity post-stroke. Methods: A four-stage Integrated Knowledge Translation approach was used. Stage 1: research team (2 stroke survivors, 8 professionals) defined research questions, scope and plan. Stage 2: workshops held with stroke survivors, carers, and health and design professionals to identify important program principles. Stage 3: research team used a Nominal Group Technique to make key decisions and develop the program. Stage 4: program presented to participants; feedback gathered and adaptations made. Workshop findings were iteratively analysed and summarised during sessions. Results: Twenty-six participants were recruited across stages 2 and 4 (12 stroke survivors, 2 carers, 12 professionals). Key program principles identified in Stage 2 were social support, inclusive environment, motivational support, co-ordination and administrative support. The Supportive Strides program was co-designed to incorporate these principles. Program elements included accessible outdoor walking routes, pre-walk coffee and social connection, peer-support, online group chat, milestone celebrations, and a safety checklist. Following Stage 4 participant feedback, adaptations were incorporated e.g., simpler screening process, include more walking route information. Conclusions: The co-designed Supportive Strides community-based walking program is ready for testing to improve physical activity and social connection after stroke.

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.

Background and objective: Children with cerebral palsy (CP) generally experience more sedentary lifestyles than neurotypical peers. Powered overground exoskeletons offer stable and assisted stepping that have been shown to lead to functional and exercise-linked participation opportunities. Our aim was to explore physiotherapy team experiences, perceived benefits and challenges when using an overground lower-limb exoskeleton in physiotherapy sessions with minimally ambulatory children with CP. Methods: Qualitative descriptive study within a pre/post feasibility trial involving 10 children with CP (GMFCS Level IV, 4 to 6 years) who received lower limb exoskeleton-based physiotherapy twice weekly over six weeks in school or outpatient setting. Physiotherapist (PT, n=5) and physiotherapy assistant (PTA, n=4) intervention team dyads were interviewed following completion of the exoskeleton intervention with their assigned child. Semi-structured interviews were conducted over Zoom. Coding of interview transcripts was followed by inductive thematic analysis. Results: There were 10 PT/PTA dyad interviews linked specifically to 10 children's intervention experiences in the exoskeleton study. Three themes were developed: 1) exoskeleton-based sessions provided additional exercise/gross motor options and may be a valuable adjunct to conventional therapy; 2) exoskeleton-based sessions were enjoyable, supporting enhanced inclusion and autonomy; 3) exoskeleton-based physiotherapy requires new clinical skills, added resources and individualized goal-based thinking. Therapists described exoskeleton-based therapy as a complement to, rather than a replacement for, conventional physiotherapy, since it addresses only a subset of motor goals. Therapists identified staffing, training, environmental accessibility, and equitable resource allocation as important considerations for clinical implementation. This study provides PT/PTA perspectives on their first use of an overground exoskeleton across school and outpatient settings with children with CP. Findings highlight the perceived value and logistical considerations of lower-limb exoskeleton use within physiotherapy sessions with minimally ambulatory children with CP. The findings were mapped onto the seven facets of the Theoretical Framework of Acceptability for new interventions and may inform implementation planning. Transferability to other settings should be considered in light of differences in resources, funding structures, and organizational contexts. Future research exploring ethical considerations, service delivery models, and clinical protocols is needed to support responsible integration into therapy settings across diverse clinical contexts.

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.

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

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

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

Stroke is a leading cause of mortality and long-term disability worldwide, with low- and middle-income countries carrying the greatest burden. Impaired trunk control and balance are common after stroke, severely limiting mobility and independence and increasing the risk of falls. Conventional balance training is widely used to improve stability, but it primarily targets static postural control and may not sufficiently activate trunk muscles during dynamic tasks. Swiss ball balance training, which uses an unstable surface to engage core musculature and enhance sensorimotor integration, has shown promising results in improving trunk control and functional mobility. However, research comparing Swiss ball balance training with conventional balance training is limited, particularly in Sub-Saharan Africa. This study aims to compare the effects of Swiss ball training and conventional balance training on trunk control, balance, and mobility in individuals with subacute stroke. A randomized, assessor-blinded, two-period, two-sequence crossover trial will be conducted. Participants will be randomly assigned to Swiss Ball Balance Training or Conventional Balance Training, each administered for 45 minutes per session, three days per week, over six weeks, with a one-week washout period between phases. Standardized clinical outcome measures will assess trunk control, postural stability, and functional mobility at baseline and after each intervention phase. Data will be analyzed using paired t-tests and Wilcoxon rank-sum tests in Stata v17 (p < 0.05). It is expected that Swiss ball exercises will yield greater improvements in trunk control, balance performance, and functional mobility than conventional methods. The results are expected to help design context-specific rehabilitation programs.

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

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

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

Introduction: Approximately 40-80% of individuals post-stroke fail to use their paretic arm despite sufficient capacity, a phenomenon known as arm nonuse. This behavior arises from an interaction between cognitive and motor factors, necessitating evaluation approaches that capture the impact of complex task demands on arm nonuse. However, existing measures require specialized equipment, extensive setup, or prolonged monitoring, limiting their clinical feasibility. To address this gap, this study evaluated the reliability, validity, and usability of a novel virtual reality-based arm nonuse (VR-NonUse) tool designed to measure arm nonuse during naturalistic reaching under varying cognitive and motor demands. Methods: Fifty-one individuals with stroke and 23 controls completed the VR-NonUse assessment across three conditions varying in cognitive and motor demand. Usability and tolerability were evaluated. Concurrent validity was examined by assessing associations between paretic arm nonuse on the VR-NonUse tool and established nonuse assessments. Discriminant validity was evaluated by comparing these associations with a motor impairment measure. Construct validity was examined by determining the effects of cognitive and motor demand on arm use. Results: The VR-NonUse tool was usable and well-tolerated. Paretic arm nonuse on the VR-NonUse tool was associated with established nonuse measures, and more strongly related to nonuse than to motor impairment, supporting concurrent and discriminant validity. Higher cognitive demand reduced paretic arm use, supporting construct validity. A brief cognitively demanding condition yielded a robust index of nonuse. Discussion: The VR-NonUse tool is a reliable, valid, and practical assessment of arm nonuse in chronic stroke.

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.