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Background Patellofemoral pain is a prevalent knee condition affecting up to 40% of individuals, especially females aged teens to 50 s. Standard treatments, including exercise therapy, often yield insufficient long-term results, partly due to low compliance and psychological factors like depression and catastrophizing of pain. A digital therapeutics “MORA Cure PFP,” which combines structured progressive exercise and cognitive behavioral therapy via an app, offers a solution to overcome the limitations of conventional treatment for patellofemoral pain patients. Methods To evaluate the safety and efficacy of MORA Cure PFP, a two-arm controlled trial will enroll 216 patients diagnosed with patellofemoral pain randomly assigned in a 1:1 ratio to treatment and control groups. The treatment group will use the app, while the control group will perform self-guided exercises using educational materials. This trial aims to determine if the treatment group shows greater reduction in usual pain intensity scores at 8 weeks compared to the control group. Additional assessments include worst pain, knee function, depression, and pain catastrophizing levels. Discussion Key design elements of the clinical trial, such as control group selection, inclusion/exclusion criteria, number of patients, and primary endpoint, were designed with consideration for not only medical perspectives but also regulatory aspects of software as a medical device, including device approval and health technology assessment. Trial registration ClinicalTrials.gov., NCT06260865, registered 15th February 2024.

Background and Objectives: Muscle atrophy caused by chronic ankle instability (CAI) can incur muscle weakness, altered movement patterns, and increased risk of injury. Previous studies have investigated the effects of rehabilitative exercises and neuromuscular electrical stimulation (NMES) on characteristics in CAI individuals, but few studies have examined their effects on foot and ankle muscle morphology. This study aimed to determine the effects of rehabilitative exercises and NMES on muscle morphology and dynamic balance in individuals with CAI. Materials and Methods: Participants with CAI (n = 47) were randomly divided into control (CG), rehabilitative exercise (REG), NMES (NG), and rehabilitative exercise and NMES combined (RNG) groups. The six-week intervention program consisting of rehabilitative exercises and NMES was applied to groups excluding CG. Muscle morphology and dynamic balance were evaluated using a portable wireless diagnostic ultrasound device and dynamic balance tests. For statistical analysis, an effect size with 95% confidence interval was calculated to assess mean differences according to intervention. Results: After six weeks, significant increases in morphology and dynamic balance were observed for all muscles except flexor hallucis longus (p > 0.05) in the intervention groups except for CG. However, no significant changes were observed in the CG (p > 0.05). Conclusions: These findings suggest that intervention programs may help prevent muscle atrophy and improve balance in CAI individuals.

Volumetric muscle loss (VML) is associated with irreversibly impaired muscle function due to traumatic injury. Experimental approaches to treat VML include the delivery of basic fibroblast growth factor (bFGF) or rehabilitative exercise. The objective of this study was to compare the effects of spatially nanopatterned collagen scaffold implants with either bFGF delivery or in conjunction with voluntary exercise. Aligned nanofibrillar collagen scaffold bundles were adsorbed with bFGF, and the bioactivity of bFGF-laden scaffolds was examined by skeletal myoblast or endothelial cell proliferation. The therapeutic efficacy of scaffold implants with either bFGF release or exercise was examined in a murine VML model. Our results show an initial burst release of bFGF from the scaffolds, followed by a slower release over 21 days. The released bFGF induced myoblast and endothelial cell proliferation in vitro. After 3 weeks of implantation in a mouse VML model, twitch force generation was significantly higher in mice treated with bFGF-laden scaffolds compared to bFGF-laden scaffolds with exercise. However, myofiber density was not significantly improved with bFGF scaffolds or voluntary exercise. In contrast, the scaffold implant with exercise induced more re-innervation than all other groups. These results highlight the differential effects of bFGF and exercise on muscle regeneration.

According to the characteristic of amputees of lower limbs, the scheme of research project apply the mode of seat-form training for amputees of below knee, and carry on exercise function recover training. Establish kinematics model and analyses electromyographic signal (EMG) of quadriceps when volunteers do rehabilitative exercises, and study pattern recognition and classification for the rehabilitative exercises system of lower residual limbs. Use threshold control, and make use of power spectrum coefficient of EMG acquire character value, establish the relation of the EMG character value and lower limbs in rehabilitative exercises, definite a method which can recognize rehabilitative exercises.

Background and Objectives: Pilates-based core stabilization training has garnered increasing attention for its potential to improve deep muscle activation and enhance spinal stability. This study aimed to investigate the effects of Pilates-based core stabilization training on deep stabilizing muscles using rehabilitative ultrasound imaging (RUSI). Materials and Methods: A total of 57 healthy adults aged 20 to 29 years were recruited and randomly allocated to either an experimental group (n = 29) or a control group (n = 28). Participants in the experimental group engaged in Pilates-based core stabilization training three times per week for six weeks, while the control group performed aerobic exercises. The pre- and post-intervention assessments included measurements of muscle thickness, contraction timing, and contraction ratios of the transverse abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles, evaluated using RUSI. Results: The experimental group demonstrated significant improvements in TrA and IO thickness (p < 0.05), contraction timing (p < 0.05), and contraction ratios (p < 0.05) compared to the control group. The EO muscle also showed significant, albeit less pronounced, enhancements in thickness and contraction ratios. Conclusions: Pilates-based core stabilization training significantly improves core muscle function, including muscle thickness, contraction timing, and contraction ratios. These findings support the inclusion of Pilates exercises in clinical protocols aimed at enhancing core stability.

In rehabilitation, physicians plan lower-limb exercises via linear guidance. Ensuring efficacy and safety, they design patient-specific paths, carefully plotting smooth trajectories to minimize jerks. Replicating their precision in robotics is a major challenge. This study introduces a linear rehabilitation motion planning method designed for physicians to use a multi-posture lower-limb rehabilitation robot, encompassing both path and trajectory planning. By subdividing the lower limb’s action space into four distinct training sections and classifying this space, we articulate the correlation between linear trajectories and key joint rehabilitation metrics. Building upon this foundation, a rehabilitative path generation system is developed, anchored in joint rehabilitation indicators. Subsequently, high-order polynomial curves are employed to mimic the smooth continuity of traditional rehabilitation trajectories and joint motions. Furthermore, trajectory planning is refined through the resolution of a constrained quadratic optimization problem, aiming to minimize the abrupt jerks in the trajectory. The optimized trajectories derived from our experiments are compared with randomly generated trajectories, demonstrating the suitability of trajectory optimization for real-time rehabilitation trajectory planning. Additionally, we compare trajectories generated based on the two groups of joint rehabilitation indicators, indicating that the proposed path generation system effectively assists clinicians in executing efficient and precise robot-assisted rehabilitation path planning.

Dysphagia leads to poor swallowing function and high risk of aspiration; swallowing rehabilitative therapies including jaw exercises, tongue exercises, chin tuck against resistance (CTAR), Shaker exercises, effortful swallow training (EST), traditional dysphagia therapy (TDT), and respiratory muscle training (RMT) including inspiratory muscle strength training (IMST) and expiratory muscle strength training (EMST) are a crucial part of dysphagia rehabilitation. However, limited evidence exists on the comparative efficacy of swallowing rehabilitative therapies in adults with dysphagia. This is the first network meta-analysis (NMA) to investigate the comparative efficacy of swallowing rehabilitative therapies for adults with dysphagia. Web of Science, Embase, CINAHL, Cochrane Library, and PubMed were comprehensively searched until September, 2024. The Frequentist NMA model was performed in R-Software presenting standardized mean differences with corresponding 95% confidence interval (95% CI) for swallowing function and aspiration. Cochrane Q , τ 2 , and I 2 statistics estimated heterogeneity and full design-by-treatment interaction random-effects and node-splitting models determined transitivity. Ranking of the swallowing rehabilitative therapies used the netrank function. The search yielded 7697 studies from which 25 randomized controlled trials with 1020 adults with dysphagia were included. The study findings revealed that CTAR + TDT (SMD = 3.44 [95% CI 2.42, 4.47]), EMST + TDT (SMD = 2.92 [95% CI 1.59, 4.25]), Shaker + TDT (SMD = 2.83 [95% CI 1.81, 3.84]), JE + TDT (SMD = 2.52 [95% CI 1.21, 3.83]), TE + TDT (SMD = 2.19 [95% CI 1.26, 3.12]), RMT + TDT (SMD = 2.14 [95% CI 1.36, 2.93]), and TDT (SMD = 1.92 [95% CI 1.42, 2.42]) showed very-large to huge effect in improving swallowing function. CTAR + TDT (0.93) demonstrated superior improvements for better swallowing function. Additionally, CTAR + TDT (SMD =  − 1.82 [95% CI − 2.89, − 0.75]), Shaker + TDT (SMD =  − 1.32 [95% CI − 2.36, − 0.27]), EMST (SMD =  − 1.23 [95% CI, − 2.01, − 0.45]), and EMST + TDT (SMD =  − 1.10 [95% CI − 2.15, − 0.04]) revealed very-large to large effect in preventing aspiration. CTAR + TDT (0.96) and Shaker + TDT (0.76) demonstrated superior improvements for reduced aspiration. The combination of swallowing rehabilitative therapies including CTAR + TDT and Shaker + TDT offers a more comprehensive approach for dysphagia management in adults. Study registration is PROSPERO: CRD42022321345.

Objective To evaluate the effectiveness of an integrated care programme, combining a patient directed and a workplace directed intervention, for patients with chronic low back pain.Design Population based randomised controlled trial.Setting Primary care (10 physiotherapy practices, one occupational health service, one occupational therapy practice) and secondary care (five hospitals).Participants 134 adults aged 18-65 sick listed for at least 12 weeks owing to low back pain.Intervention Patients were randomly assigned to usual care (n=68) or integrated care (n=66). Integrated care consisted of a workplace intervention based on participatory ergonomics, involving a supervisor, and a graded activity programme based on cognitive behavioural principles.Main outcome measures The primary outcome was the duration of time off work (work disability) due to low back pain until full sustainable return to work. Secondary outcome measures were intensity of pain and functional status.Results The median duration until sustainable return to work was 88 days in the integrated care group compared with 208 days in the usual care group (P=0.003). Integrated care was effective on return to work (hazard ratio 1.9, 95% confidence interval 1.2 to 2.8, P=0.004). After 12 months, patients in the integrated care group improved significantly more on functional status compared with patients in the usual care group (P=0.01). Improvement of pain between the groups did not differ significantly.Conclusion The integrated care programme substantially reduced disability due to chronic low back pain in private and working life.Trial registration Current Controlled Trials ISRCTN28478651.

Portable biofeedback technologies are increasingly used in rehabilitation; however, the validity of surface electromyography (sEMG) as a surrogate indicator of deep abdominal muscle function remains unclear. This study aimed to validate a portable sEMG-based visual biofeedback system by examining its relationship with ultrasound-derived measures of deep abdominal muscle activation. Twenty-nine healthy adults were randomly assigned to a Visual Biofeedback group (n = 14) or a Verbal Feedback group (n = 15). Both groups performed a standardized 2-week core stabilization program. Muscle activation of the deep abdominal muscle complex (transversus abdominis-internal oblique; TrA-IO) and external oblique (EO) was measured using sEMG (%MVIC), while ultrasound imaging was used to assess transversus abdominis thickness and contractile activity (ADIM-Rest index). Between-group differences and correlations between EMG and ultrasound variables were analyzed. The Visual Biofeedback group demonstrated significantly greater improvements in TrA-IO activation and in the preferential activation ratio (TrA-IO/EO) compared to the Verbal group ( = 0.004). Ultrasound analysis revealed significantly greater increases in TrA thickness and contractile activity in the Visual group ( < 0.001). A significant positive correlation was observed between changes in TrA-IO activation and TrA thickness (ρ = 0.51, < 0.001). Portable sEMG-based visual biofeedback demonstrated physiological relevance by reflecting ultrasound-derived changes in deep abdominal muscle function. These findings support the use of sEMG as a practical surrogate tool for monitoring deep core muscle activation and highlight the potential of portable biofeedback systems in scalable and accessible rehabilitation.

Purpose The symptoms of multiple sclerosis (MS) often cause physical and mental dysfunction, which interferes with a person's ability to participate in life's roles. Identification of the strength of the contributors to participation would help prioritize intervention approaches for its improvement. The objective of this study was to estimate the extent to which pain and other MS-related symptoms, physical function, psychological variables, and individual characteristics predict participation in people with MS. Methods This was a cross-sectional study. Study sample was a center-stratified random sample of 188 persons with MS. Subjects completed a battery of self-report and performance-based measures that assessed participation and domains affecting participation. To model the relationships among variables, a conceptual framework based on the Wilson and Cleary model was tested. Structural equation modeling aimed at identification of the predictors of participation within the hypothesized theoretical model. Results Fatigue (β = 0.63, p < 0.0001), physical function (β = 0.37, p < 0.0001), and psychological variables (β = 0.15, p = 0.04) were found to be as significant direct predictors of participation. Pain (β = 0.4, p < 0.0001) and age (β = 0.12, p < 0.0001) were significant indirect predictors through fatigue and physical function, respectively. Together these effects explained 88 % of the variance of participation, 35 % of the variance in psychological variables, and 29 % of the variance in physical function. Conclusion Fatigue, physical function, pain, and psychological variables were most important contributors for participation in persons with MS.