JMIR Rehabilitation and Assistive Technologies最新文献

Background: Artificial intelligence (AI)-based gait analysis systems are increasingly applied in rehabilitation settings for objective and quantitative assessment of gait function. However, despite their potential, clinical adoption remains limited due to insufficient consideration of usability, user experience, and integration into actual clinical workflows.

Objective: This study aimed to conduct a formative evaluation of a prototype AI-based gait analysis system (MediStep M).

Methods: A mixed methods formative usability evaluation was conducted with 5 licensed physical therapists. Qualitative data were collected through focus group interviews, and quantitative usability was measured using the system usability scale (SUS). A scenario-based usability assessment was applied to identify user interface challenges, workflow issues, and potential design improvements.

Results: Participants identified major usability barriers, including limited accessibility of the power button, absence of battery status indicators, burdensome manual calibration, and insufficient clinical detail in the gait analysis reports. They also emphasized the need for wireless operation, improved portability, and integration with hospital electronic medical record systems. The mean SUS score was 57 (grade D), indicating suboptimal usability and the need for iterative design refinements.

Conclusions: Although AI-based gait analysis systems hold promise for enhancing rehabilitation outcomes, key usability challenges must be resolved before clinical implementation. Improvements in hardware portability, automated calibration, data management, and user interface design are essential to ensure safety, efficiency, and clinical applicability. These findings provide evidence-based insights to guide iterative development and promote user-centered innovation in AI-based rehabilitation technologies.

Background: The manufacture of load-bearing prosthetic lower limb sockets is traditionally reliant on skilled technicians working with qualified clinicians to create bespoke solutions. While this approach is effective and, in some situations, necessary, the appeal of a sustainable, efficient, and digitalized production solution cannot be ignored. The focus of additive manufacturing (AM) is typically on low-weight-bearing prostheses, which can be misleading for clinics attempting to adopt AM solutions for clientele with weight-bearing or activity-level needs.

Objective: This review aims to offer readers a way to approach AM for load-bearing requirements as opposed to non-load-bearing counterparts. The use cases of AM for the production of load-bearing transtibial prosthetic sockets and components are reviewed to highlight current trends, protocols, and standings.

Methods: By reviewing publications from the past 25 years, this state-of-the-art review highlights the key requirements and technologies relevant for load-bearing transtibial prosthetic sockets specifically.

Results: The most commonly used AM solutions for commercial use, such as selective laser sintering and binder jetting through Multi Jet Fusion, are outlined. As these solutions are most often paired with the structural testing standard International Organization for Standardization 10328, their relevance for evaluating the strength and durability of lower limb sockets is also discussed. Clinician and technician experiences of digitalized ways of working within the prosthetic industry for load-bearing applications are outlined.

Conclusions: Observations of adoption barriers of AM solutions are brought to light, focusing on clinician and technician education, skill set, exposure to innovative technologies, and trust in the regulation of digital processes in a clinical and technical environment.

Background: Postoperative rehabilitation is essential to improve quality of life (QoL), pain control, and upper limb function in women undergoing surgery for breast cancer (BC). Telerehabilitation has emerged as a promising alternative to conventional rehabilitation, especially in patients with limited access to care, but its comparative efficacy remains uncertain.

Objective: This study aimed to evaluate the effectiveness of telerehabilitation compared with standard care or no treatment in improving QoL, pain, handgrip strength, and upper limb function in women undergoing BC surgery.

Methods: We conducted a systematic review and meta-analysis following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. We included 11 randomized controlled trials, of which 5 were eligible for quantitative synthesis. Risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials version 2 (RoB2), and the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. Outcomes assessed included QoL, pain, grip strength, and upper limb function.

Results: Telerehabilitation significantly improved QoL (standardized mean difference [SMD] 0.59; 95% CI 0.24-0.95; moderate certainty) and grip strength (mean difference [MD] 2.93; 95% CI 0.82-5.04 kg; low certainty), and significantly reduced pain (SMD -0.50; 95% CI -0.79 to -0.22; low certainty). No significant difference was observed for upper limb function (SMD -0.86; 95% CI -2.02 to 0.31; low certainty).

Conclusions: Telerehabilitation is an effective and viable intervention for improving QoL, reducing pain, and enhancing grip strength in women following BC surgery. However, its impact on upper limb function remains inconclusive and requires further investigation.

Trial registration: PROSPERO CRD42024545075; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024545075.

Background: Impaired balance regulation after stroke puts patients and therapists at a heightened risk of injury during rehabilitation. Body weight support systems (BWSS) allow patients to safely conduct gait and balance training while minimizing risk and the fear of falling. Integrating perturbation-based balance training (PBT) modules with a BWSS may lead to further improvements.

Objective: This study aimed to evaluate the impact of a ceiling-track-mounted BWSS plus an integrated PBT (BWSS-P) module on the rehabilitation of stroke-related gait and balance impairments.

Methods: A multisite randomized active-comparator controlled trial was conducted. Inpatients with Berg Balance Scale (BBS) scores ≥21/56 were recruited from 4 sites. Participants completed 2-to-6 BWSS or BWSS-P study sessions. Both groups conducted the same balance and gait regimen, with the BWSS-P group also receiving 8 balance perturbations per session. BBS, Activities-Specific Balance Confidence, and 10 Meter Walk Test assessments were collected.

Results: A total of 126 patients were approached with 99 yielding sufficient data for analysis. With a corrected α level of .0054, both groups showed significant in-group changes over time for all outcomes evaluated (P≤.001). However, the primary outcome measure, the BBS, did not show evidence of a difference between BWSS and BWSS-P groups over time (F1,97=1.57; P=0.21) via linear mixed effects modeling with type III Wald F test with Kenward-Roger degrees of freedom. No significant between-group differences were noted for either secondary outcome measure, the Activities-Specific Balance Confidence scale (F1,94.99=0.36; P=.55), or 10 Meter Walk Test (F1,97=4.15; P=.04).

Conclusions: Although significant between-group differences were not observed, participants in both groups demonstrated similar improvements from before to after assessment. This novel PBT technology shows promise as an option for gait and balance recovery training, especially for individuals with impaired balance control or fear of falling. The BWSS-P intervention contributed positively to rehabilitation outcome overall and should be considered as a viable treatment modality when clinically appropriate.

Background: Anterior cervical discectomy and fusion (ACDF) is a common treatment for degenerative cervical spine disease, yet its frequent postoperative follow-up places substantial demands on both patients and health care systems. A digital program integrating computer-vision-guided exercise, wearable posture monitoring, and cognitive behavioral therapy (CBT) could provide remote monitoring and rehabilitation to alleviate this burden.

Objective: This study aims to evaluate the clinical effectiveness and compliance of a 12-week digital rehabilitation program after ACDF compared with conventional in-person therapy.

Methods: In this prospective cohort study, 336 postoperative patients self-selected either a 12-week mobile-based program incorporating computer-vision-guided exercises, wearable posture sensors, and cognitive behavioral therapy (n=270), or in-person rehabilitation group (IRG, n=66) involving weekly therapist-supervised sessions and paper-based home exercises. Digital users were stratified into a digital rehabilitation completion group (DCG, n=192) and a digital rehabilitation noncompletion group (DNG, n=78). All participants were recruited at a single tertiary hospital and returned to the clinic for outcome assessments at 0, 12, and 24 weeks postoperatively. Outcomes-primarily pain (visual analog scale [VAS]) and disability (neck disability index [NDI]), as well as 36-item short form survey mental component summary (SF-36 MCS), 3-plane cervical range of motion (ROM), muscle endurance, and patient satisfaction-were recorded at 0, 12, and 24 weeks postoperatively. All statistical analyses were performed using SPSS (version 29.0; IBM Corporation). Results were reported as means, SDs, and 95% CIs.

Results: Both the DCG (n=192, who completed all digital sessions) and IRG (who completed 12 weeks of weekly in-person sessions and home exercises) demonstrated significant improvements in pain and disability at weeks 12 and 24, with no significant differences between groups (P>.05). At Week 12, VAS decreased by -2.5 (95% CI -3.0 to -2.0) in the DCG and -2.8 (-3.7 to -1.9) in the IRG; NDI decreased by -6.8 (-10.3 to -3.3) and -8.1 (-14.3 to -1.9), respectively. At Week 24, VAS and NDI reductions reached -4.0 (-4.5 to -3.5) and -13.3 (-17.4 to -9.2) in the DCG, and -4.1 (-5.0 to -3.2) and -14.2 (-21.3 to -7.1) in the IRG. In contrast, the DNG showed minimal improvements: VAS changes were -0.8 (-1.6 to 0.0) at week 12 and -1.3 (-2.1 to -0.5) at week 24; NDI changes were -2.2 (-8.2 to 3.8) and -6.4 (-13.0 to 0.2), respectively (P<.05 compared to DCG and IRG).

Conclusions: The digital rehab program led to comparable improvements in pain, function, and mental health as conventional in-person rehab. Higher adherence was linked to better outcomes, supporting digital rehab as an effective, patient-centered approach after ACDF.

Background: There is a growing interest in the influence of variables that may negatively influence the reasoning of health care professionals, namely intolerance of uncertainty, defined as health care professionals' difficulty tolerating ambiguous situations that often trigger discomfort, overtesting, and suboptimal treatment choices, and resource consumption, defined as the ordering of unnecessary diagnostic tests that can waste resources and compromise decision-making.

Objective: Our purpose was to assess the influence of intolerance of uncertainty and resource consumption on the chosen therapeutic strategy.

Methods: A total of 127 physiotherapists were challenged to play a simulation game and choose a therapeutic strategy for 3 cases of low back pain of increasing difficulty (easy, medium, and difficult). Their intolerance of uncertainty level and their resource consumption were measured (ie, requests for test results for each case).

Results: Results showed that 87.4% (111/127) of participants chose the most appropriate strategy (ie, the one in line with the strategy recommended by experts) for the easy case, 46.5% (59/127) for the medium, and 29.1% (37/127) for the difficult. For the easy case, intolerance of uncertainty and resource consumption had a negative influence on the chosen therapeutic strategy, which was less appropriate (β=-4.03, t₁₂₁=-3.92, P<.001). Moreover, resource consumption among highly intolerant individuals had a more adverse influence on the chosen strategy (β=-3.42, t₁₂₁=-5.09, P<.001). Such results were not found for the medium and difficult cases.

Conclusions: Resource consumption may have a negative influence in some cases on the treatment strategies chosen by the physiotherapists who are most intolerant of uncertainty. Future research avenues are suggested to ensure the quality of patient care concerning physiotherapists' level of intolerance of uncertainty.

Background: The prevalence of upper limb impairment ranges from 40% to 50% in the chronic phase of stroke, presenting a significant public health challenge. Although traditional therapy effectively improves hand motor function, it often faces accessibility challenges. Telerehabilitation, particularly smart device-based therapy, provides a scalable and engaging alternative, although its effectiveness still requires further investigation.

Objective: This study aimed to identify smart device-based therapy interventions for improving hand motor function in stroke survivors during rehabilitation and to assess their effectiveness in hand motor function improvement in comparison with traditional therapy methods.

Methods: A scoping review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines to identify and evaluate smart device-based therapy interventions aimed at improving hand motor function in stroke survivors. A comprehensive literature search was performed across multiple databases, including Web of Science, PubMed (MEDLINE), EBSCO Complete, Google Scholar, Science Direct, ClinicalKey, and Scopus. Studies were screened based on predefined inclusion criteria, focusing on clinical trials that investigated the effectiveness of smart device-based rehabilitation approaches. Data extraction was carried out systematically, capturing key study characteristics, intervention types, and outcome measures. The effectiveness of these interventions was assessed and synthesized to provide a comprehensive overview of their impact on hand motor function recovery in stroke rehabilitation.

Results: A total of 958 studies were identified, of which 17 met the inclusion criteria. The studies encompassed various research designs, including randomized controlled trials (n=9), pilot feasibility studies (n=3), and a comparative nonrandomized trial (n=1). The interventions used diverse digital strategies, including gamified rehabilitation programs (n=14), virtual or mixed reality systems (n=7), Kinect camera or sensor-based approaches (n=6), Jintronix software platforms (n=4), robot-assisted devices (n=3), and tablet- or app-based rehabilitation systems (n=7). Overall, smart device-based therapies were associated with improvements in hand motor function, frequently reaching clinically meaningful thresholds, while also enhancing patient engagement and adherence.

Conclusions: The findings of this scoping study highlight the significant potential of smart device therapies for enhancing hand motor functions among stroke survivors. The development of smart devices is an evolving process, highlighting the need for future studies to assess their long-term effectiveness, optimize intervention designs, and explore their broader application in stroke rehabilitation.

Background: Action observation combined with motor imagery (AO+MI) training is considered a potentially effective approach for improving motor function in patients after stroke. Therefore, it is important to review and analyze the existing research evidence of its effectiveness.

Objective: This study aims to evaluate the effectiveness of AO+MI training on the limb motor function of patients with stroke.

Methods: A systematic search was conducted in PubMed, Cochrane Library, Web of Science, Embase, Proquest, Physiotherapy Evidence Database, ClinicalTrials.gov, and ChiCTR. The last search was performed in June 2025. Three reviewers independently screened the articles, and 2 reviewers extracted data. Quality assessments of randomized controlled trials were done using the Cochrane Risk-of-Bias Tool. The certainty of evidence was evaluated with GRADEpro GDT (Evidence Prime, Inc). A meta-analysis was performed using RevMan 5.3 (The Cochrane Collaboration) software and Stata software.

Results: A total of 13 articles were included with 399 patients with stroke. The results of the meta-analysis showed that compared with routine rehabilitation, AO+MI could improve the upper extremity function (standard mean difference [SMD]=1.02, 95% CI 0.28-1.75; P=.007) and the lower extremity function (SMD=6.31, 95% CI 4.75-7.87; P<.001) of patients with stroke. There was no significant difference between AO+MI and routine rehabilitation for improving activities of daily living (SMD=0.06, 95% Cl -0.35 to 0.47; P=.06). AO+MI could promote the recovery of upper extremity function in patients compared with MI independently (SMD=0.97, 95% Cl 0.13-1.80; P=.02). There was no significant difference between synchronous combination and asynchronous combination in upper extremity function rehabilitation of patients after stroke (SMD=-1.04, 95% Cl -2.56 to 0.48).

Conclusions: AO+MI can improve the motor function of limbs and can be considered an effective limb rehabilitation therapy for patients after a stroke.