Frontiers in rehabilitation sciences最新文献

Background: Public Health Rehabilitation Programs (PHRPs) are essential to achieving universal health coverage and disability-inclusive health systems. Despite their importance, sustainability is threatened by demographic pressures, funding variability, and weak system integration. Systems Thinking (ST) provides a structured paradigm to address complexity, identify key leverage points, and embed adaptive capabilities for longer-term program survival. Our aim was to summarise global applications of ST in PHRPs and identify mechanisms that most effectively contribute to sustainability.

Methods: We conducted a rapid review of peer-reviewed literature and global case studies published between 2010 and 2025. The short timeframe was intentionally selected to provide timely, policy-relevant insights while laying the groundwork for more extensive future reviews. Searches in PubMed, Scopus, and WHO repositories identified studies applying ST to sustain PHRPs. Data were thematically synthesized using the WHO 10-step ST framework and the Systems Thinking for Health (ST4H) model.

Results: Six studies from six countries were included. Three mechanisms emerged: (1) Feedback Loops & Adaptive Learning, (2) Stakeholder Engagement & Systems Mapping, and (3) Strategic Leverage Points. Examples from diverse contexts, especially low- and middle-income countries such as Brazil, India, South Africa, and Jordan, demonstrated improved service integration, resilience, and reach.

Conclusion: ST offers a robust framework for addressing persistent sustainability challenges in PHRPs. Embedding ST early in program design, supported by cross-sector engagement, systems literacy, and strong governance, enhances adaptability, equity, and efficiency. This rapid review provides actionable evidence for policymakers and practitioners, while also underscoring the need for context-specific sustainability metrics and broader scoping or systematic reviews to deepen and expand the evidence base.

Background: Chronic headaches (CH) affect approximately 1 billion people globally, with women having three to five times higher prevalence. The estimated cost in Europe is €173 billion. Recent studies suggest a strong link between chronic headaches and temporomandibular disorders (TMD), which are characterized by orofacial pain, temporomandibular joint symptoms, and limited mandibular movement. Physiotherapy for these disorders often involves addressing muscle spasms through massage, trigger point therapy, and active stretching.

Objective: This systematic review aimed to assess the effectiveness of temporomandibular joint (TMJ) physiotherapy for patients with chronic headaches (CH) and temporomandibular disorders (TMD).

Methods: A systematic literature search was performed in January 2025 using the PICOS framework and relevant MeSH terms across the PubMed, PEDro, and Cochrane databases. Two reviewers independently screened studies, with a third reviewer resolving disagreements. Five randomized controlled trials (RCTs) met the inclusion criteria. Data extraction and study characteristics were analyzed, and the risk of bias was assessed using the Cochrane RoB2 tool.

Results: The review identified five studies, suggesting that physiotherapy may benefit these patients. Three studies showed significant improvements in headache intensity and frequency following TMJ or orofacial physiotherapy. One study favored the control group, and one showed no significant difference. However, variability in study quality, therapist roles, and poorly reported interventions limited comparability and prevented meta-analysis. The findings point to potential benefits of physiotherapy for managing chronic headaches and TMD but underscore the need for more standardized research.

Conclusion: This review highlights the potential of multidisciplinary treatments for patients with chronic headaches and temporomandibular disorders. However, due to the variability in treatment protocols and outcome measures, further research is needed to confirm these findings and standardize protocols for more reliable and consistent results.

Background: Musculoskeletal disorders (MSDs) are a leading cause of disability among industrial workers worldwide, often resulting from excessive physical and mental workload. This study aimed to determine the prevalence of MSDs and their correlation with workload including physical and mental dimensions among industrial workers in the cleaning and ballasting division of a Peruvian shipyard.

Methods: A cross-sectional, correlational study was conducted in 2023 among 100 workers selected from a population of 134. Workload was assessed using a validated questionnaire covering physical and mental dimensions, while MSDs were evaluated with the standardized Nordic Musculoskeletal Questionnaire. Descriptive statistics summarized the prevalence of workload and MSDs, and the relationship between variables was analyzed using Spearman's correlation coefficient, considering a significance threshold of p < 0.05.

Results: High workload was identified in 85% of workers, with both physical and mental workload dimensions reaching high levels in the same proportion. The prevalence of severe MSDs was 88%, affecting primarily the wrist/hand, neck, shoulder, lumbar region, and elbow/forearm. A strong and statistically significant positive correlation was found between overall workload and MSDs (Spearman's rho = 0.896, p < 0.001). Similar correlations were observed for the physical (rho = 0.834) and mental (rho = 0.896) workload dimensions.

Conclusion: Severe musculoskeletal disorders are highly prevalent among industrial workers exposed to substantial physical and mental workload. The strong correlations observed highlight the need for comprehensive occupational health strategies that address both ergonomic and psychosocial risk factors to reduce the burden of MSDs in industrial settings.

Objective: In this review we aimed to understand better frequent experiences accompanying phantom limb issues from patients' perspective and accordingly to generate recommendations for clinical practice.

Methods: A systematic literature review approach was utilized and articles meeting the eligibility criteria were critically appraised using the Critical Appraisal Skills Program (CASP). Additionally, a meta-synthesis approach was adopted to combine and analyze the data.

Results: Ten relevant studies were critiqued, key themes were: 1) early Information Provision about phantom Limb Pain (PLP) and Participants' Satisfaction; 2) the PLP's described characteristics; 3) different Emotions and Psychosocial Issues with PLP; 4) the Impact of the PLP on Performing Daily Activities; and 5) the experienced strategies to address the PLP.

Conclusion: The experience of phantom limb varies among individuals with lower limb amputation (LLA); however, for many, PLP significantly affects both physical and psychological well-being, adding an additional burden to the overall experience of amputation. Addressing these challenges should begin with early education, followed by a rehabilitation process that considers individual differences in coping mechanisms. Moreover, patients' preferences should be prioritized when selecting prosthetic devices and determining the most appropriate treatment strategies for managing PLP.

Design aim and method: To explore in patients with postcovid-19 condition the influence of various factors on return to work in the year following diagnosis. The study had an explorative quantitative and qualitative design based on interviews with 41 hospitalized (HC) and 63 primary care (PC) COVID-19 patients. RTW was described at 3 and 12 months, and differences between groups, changes over time and possible factors explaining RTW were analysed statistically. Qualitative analyses with content analysis of interviews were performed to describe obstacles to work.

Result: The obstacles for RTW were persistent symptoms such as fatigue, cognitive dysfunction and breathlessness with the consequences for work as lack of energy, decreased physical capability, decreased mental stamina, reduced cognitive ability, increased sensitivity to stress and general reduced capacity. At 12 months, 50% and 70% of patients in the PC and HC groups, respectively, had returned to full-time work, while 20% of patients in both groups had not RTW at all. To function at work, many patients expressed that they required adaptations. RTW was not dependent on the initial severity of COVID-19 or type of work. The likelihood of RTW was higher in males with COVID-19 onset during the second wave.

Conclusion: RTW may be limited after COVID-19 infection, regardless of its initial severity. Women with persistent covid had greater difficulty than men in returning to work. Limitations were due to a general reduced capacity mainly caused by physical and mental fatigue, and cognitive dysfunction. However, the support from employers and the environment also has an impact on the RTW. If necessary, appropriate rehabilitation measures should be offered and adaptations of work content and the organization of the work at the workplace are of great importance.

Background: Exertion-intolerant symptoms common in post-COVID-19 syndrome (PCS), often resembling myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), challenge conventional rehabilitation and highlight the need for research into the poorly understood relationship between PCS symptoms and physical activity.

Objectives: We aimed to investigate the longitudinal associations between PCS symptoms and physical activity (same and following day), while accounting for the presence of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) symptoms. Additionally, to compare the characteristics and outcomes of PCS patients with and without ME/CFS symptoms.

Methods: Adults with PCS participated in an in-person evaluation that included assessment of dyspnea (Borg scale), fatigue (Fatigue Severity Scale), ME/CFS symptoms screening (DePaul Symptom Questionnaire), and functional capacity. Participants were also instructed to complete a daily PCS symptoms survey and wear a smartwatch for a week to track daily physical activity (step count).

Results: Eighteen individuals with PCS (78% females, 51 ± 11 years) participated in the study, averaging 4,067 steps per day (95%CI 3,638-4,497) over 117 days of valid data. Individuals with ME/CFS symptoms (n = 11) reported more severe PCS symptoms and had lower functional capacity than those without ME/CFS symptoms. After adjusting for ME/CFS symptoms, greater dizziness was associated with fewer steps on the same [OR 0.94 (95%CI 0.88-0.99), p = 0.026] and following day [OR 0.91 (95%CI 0.84-0.98), p = 0.016]. Lower levels of fatigue [OR 0.69 (95%CI 0.49-0.99), p = 0.043] and chest pain [OR 0.76 (95%CI 0.57-0.99), p = 0.048] were associated with walking ≥5,000 steps on the previous day.

Conclusion: Regardless of the presence of ME/CFS symptoms, dizziness was negatively associated with physical activity on both the same and following day in PCS individuals. Additionally, lower levels of fatigue and chest pain were linked to walking 5,000 steps or more the previous day.

Impact: These results provide insights into the relationships between symptoms and daily physical activity in PCS, which can help tailor interventions and improve the management of this condition. This research also highlights the value of using wearable devices and smartphone apps to collect data for monitoring individuals with PCS over time.

Background: Despite the critical role of assistive technologies (AT) in supporting individuals with functional impairments, there is limited information on AT needs and barriers across India's diverse regions. To fill this gap, we have designed a detailed survey protocol to gather nationally representative data on AT need, unmet need and satisfaction.

Methods: A cross-sectional survey of 180,000 individuals (30,000 per region) across six regions i.e., North, South, East, West, Central, and North-East India will be conduct. Districts will be purposively selected to capture geographic diversity and institutional capacity; within each selected district, villages and urban wards will be chosen with probability proportional to size and households will then be selected by systematic random sampling. All members of each sampled household will be interviewed with the digital WHO Rapid Assistive Technology Assessment (rATA) tool, after staff complete standard training program; data quality will be ensured through real-time database checks, supervisory cross-checks, and monthly audits by the ICMR coordinating team.

Analysis: We will estimate prevalence of AT need, unmet need, and satisfaction with 95 percent confidence intervals using univariate and multivariate logistic regression to identify associated factors. Sampling weights and sensitivity analyses will adjust and compare estimates.

Discussion: This protocol describes the largest AT needs survey ever conducted in South-East Asia. The data generated will provide crucial evidence to guide India's national AT strategy. By sharing our detailed methodology, we aim to offer a practical framework that other low and middle-income countries can adapt to assess and enhance their own AT services.

Purpose: To investigate how perceived recovery influences perspectives on successful community reintegration, from the point of view of persons with spinal cord injury (PWS) and their support persons (SP).

Methods: Our mixed methods approach included qualitative interviews conducted with civilians and Veterans with spinal cord injury (SCI) and their designated SP at three time points across the first year after SCI: during inpatient rehabilitation, 6 months, and 12 months. Participants with SCI completed measures of independence [Spinal Cord Injury Independence Measure III (SCIM-III)] and self-efficacy (Moorong Self-Efficacy Scale) during inpatient rehabilitation and at 12 months postinjury. Data analysis was informed by the Transformative Framework and International Classification of Functioning, Disability, and Health (ICF).

Results: Regarding perceptions of how recovery influences community reintegration, PWS most often reported themes related to slow recovery whereas SPs expressed concerns about psychological impacts on PWS. While some participants were equally satisfied with rate of recovery and rate of community reintegration, several deviated from that expected trajectory. Associations between satisfaction with community reintegration and independence or self-efficacy were variable.

Conclusions: Successful community reintegration cannot be predicted solely on clinical measures. Inclusion of perspectives of PWS and their support systems is critical to inform successful societal participation after SCI.

The growing demand for healthcare services and development of healthcare present an opportunity for expanding physical therapy roles into internal medicine. This perspective discusses the potential benefits and limitations of establishing a formal internal medicine specialization for physical therapists (PTs). While PTs already contribute significantly to chronic disease prevention and treatment, their current scope of practice lacks structured training in internal medicine domains such as metabolic, autoimmune, renal, and systemic inflammatory disorders. Integrating internal medicine into PT education and clinical practice could enhance early identification of red flags, embrace interdisciplinary collaboration, and improve non-pharmacological interventions for various internal medicine-related diseases. Nevertheless, this expansion must be approached with caution, ensuring clear scope definitions, adequate training, and collaborative implementation to mitigate risks such as role ambiguity or misdiagnosis. Drawing on global experiences from advanced practice models and emerging literature, this paper calls for a discussion on the feasibility, safety, and value of internal medicine specialization in physical therapy practice. The goal of this perspective is not to replace medical professionals but to augment chronic disease management through targeted evidence-based rehabilitation strategies and preventative approaches.