Tobias Braun, Maxime Hermanns, Vanessa Haug, Jessica Nau, Bettina Scheffler, Gudrun Diermayr, Gregory W. Hartley, Keith G. Avin, Susanne Saal
Osteoporosis is one of the major causes of fractures in individuals over the age of 50 years worldwide and an increasing public health problem. Trustworthy evidence indicates that physical exercise can reduce the risk of fall-related fractures in people with osteoporosis. Patients with suspected or confirmed osteoporosis are frequently referred to physiotherapy to address fall risk, bone health, pain, range of motion, and physical functioning. In Germany, there was no specific guidance on physiotherapeutic management for patients with osteoporosis. Thus, we aimed to identify, translate and adapt the most appropriate international physiotherapy guideline for the management of patients with osteoporosis. The guideline adaptation process was informed by internationally accepted methodological frameworks and included six modules. We conducted a systematic review of the literature to identify relevant guideline(s) for adaptation (module 1), assessed guideline quality with AGREE-II (module 2), decided on one source guideline according to prespecified criteria (module 3), translated this guideline into German (module 4), reviewed and revised several guideline drafts by means of an expert committee, 3 physiotherapists and 2 older individuals with osteoporosis and adapted the guideline to the German healthcare context (module 5), and initiated implementation and dissemination of the final German guideline version (module 6). In total, we screened 873 records from databases and via other methods, and finally selected the “APTA Geriatrics’ (Academy of Geriatric Physical Therapy, American Physical Therapy Association, USA) guideline published in 2022. Expert, end-user, and patient feedback (module 5) was used to make minor adaptations to the guideline (e.g., adding a glossary). We did not change any recommendation concerning physiotherapy management. A final German version of the guideline was approved by the whole research team and the developers of the source guideline and is now available open access (https://osf.io/yav94/files/s357b). The APTA Geriatrics osteoporosis guideline was translated and adapted for German-speaking countries through a structured, participatory process. The guideline can serve as the basis for evidence-based physiotherapy in German-speaking countries. The study protocol was published prospectively (https://doi.org/10.17605/OSF.IO/TYXGF).
This case report investigates the feasibility and potential value of an individualized precision rehabilitation protocol for large-area stroke, integrating multimodal neuromodulation under the guidance of a multidisciplinary team (MDT) and dynamic assessment. A 38-year-old male with right hemiplegia and global aphasia following large left hemispheric infarction underwent an 8-month MDT-managed program. A closed-loop “assess-decide-intervene-re-assess” framework was implemented, featuring periodic multimodal evaluations (clinical scales, DTI, fMRI, EEG, 3D gait analysis). The intervention dynamically combined conventional therapy with staged neuromodulation: repetitive Transcranial Magnetic Stimulation (rTMS) for aphasia and intermittent Theta Burst Stimulation (iTBS) for motor disorder, Brain-Computer Interface (BCI)-robotic training and task-oriented Virtual Reality (VR) for upper limb function, and biomechanical correction with custom insoles based on gait analysis. Notable functional improvements were observed: LOTCA increased by 16 points, CRRCAE subscale improved by 60%–90%, FMA increased from 20 to 56, FMA-B reached 12, and MBI improved from 40 to 91. Neuroimaging revealed increased fractional anisotropy (FA) in the corpus callosum and right corticospinal tract, and elevated ALFF/ReHo in right frontal-temporal areas. Event-related desynchronization (ERD) decreased during BCI training, and gait parameters improved. In this patient with large-area stroke who showed limited response to conventional rehabilitation, an MDT-guided, dynamically adjusted multimodal intervention was temporally associated with concurrent recovery across cognitive, language, motor, and daily living domains. The concomitant neural changes suggest possible trans-hemispheric network reorganization. These observations are hypothesis-generating and, while limited by the single-case design, provide a preliminary rationale for future investigations into precision neurorehabilitation approaches in similar complex cases. ChiCTR2300069203.
Emily K. Phillips, Jacqueline L. Hay, April Gregora, Kathy Smith, Anna M. Chudyk, Carly Shaski, Sarah Gilchrist, Andrew Fagan, Maureen C. Ashe, Annette S. H. Schultz, Rakesh C. Arora, Todd A. Duhamel, Sheila O’Keefe-McCarthy
New or worsening cognitive, mental, and/or physical health after a stay in an intensive care unit (ICU) defines post-intensive care syndrome (PICS). PICS is prevalent post-cardiac surgery (CS), and interventions are needed for prevention. Early mobility shows potential to prevent PICS but is not optimally integrated into CSICU clinical care. This may relate to the absence of engagement of people with lived experience (PWLE) in CSICU early mobility research. PWLE of the CSICU were engaged to meet three objectives: 1) co-create a definition of early mobility, 2) identify barriers and facilitators to early mobility, and 3) prioritize outcome and experience measures for use in future intervention research. Engagement occurred through two virtual consultation workshops involving group discussions, consensus building, and prioritization using the nominal group technique. Eight patients and two care partners participated. The co-created definition of early mobility was a progression of functional life activities that begins as soon as the patient can participate (typically within six hours post-surgery), where the patient uses their muscle strength intentionally. The top barrier to early mobility was brain “fuzziness/fogginess”. The top facilitator was a “positive attitude”. The top physical outcome was “Do you feel lightheaded/dizzy?”. The top cognitive outcome was “Do you feel fuzzy/foggy”. The top mental outcome was “Are you focusing on the positives in your life right now?”. The top experience measure was “Do you feel your doctors gave you the care and attention you needed?”. This important contribution of the lived experience with early mobility in the CSICU advances the literature and will empower future research to align with the perspectives and priorities of people undergoing CS. This contribution may advance the integration of early mobility into CSICU clinical care and reduce the prevalence of adverse cognitive, mental, and/or physical health outcomes that are seen in PICS.
Emily K. Phillips, Jacqueline L. Hay, April Gregora, Kathy Smith, Anna M. Chudyk, Carly Shaski, Sarah Gilchrist, Andrew Fagan, Maureen C. Ashe, Annette S. H. Schultz, Rakesh C. Arora, Todd A. Duhamel, Sheila O’Keefe-McCarthy
Using arts-based research methods to engage people with lived experience (PWLE) supports the exploration of embodied knowledge, including senses, expressions, and emotions. Understanding embodied experiences may support closing the know-do gap by reducing the disconnect between research production and its translation into clinical care. Most research focuses on medical perspectives and less on patient experiences with early mobility after cardiac surgery (CS). No research explores patient experiences using arts-based research methods, which limits the depth of the exploration of their experiences. This article describes the findings of a qualitative, arts-based research method study. Body mapping was used to explore the embodied knowledge of early mobility in the CS intensive care unit (ICU). Body mapping involves participants creating a life-size tracing of a body in a position of their choice. The tracing is then filled with various art media, reflecting participants' lived experiences in response to the questions posed by the researchers. Three workshop sessions were held during which 1) the project, team, and body mapping process were introduced; 2) participants created body maps; and 3) body maps and the participants' experiences were discussed and co-analyzed by participants and researchers using compositional interpretation. Video recordings of the discussions were further analyzed using narrative inquiry and participant observation to build on the initial analysis. Eight patients and two care partners participated. Five themes were generated that described the significant emotional and mental impact of mobility on patients following CS: Making Meaning of Movement, the Paradox of Movement, Moving Through the Emotions, Person-First, and Attitude. These embodied experiences can inform novel interventions or approaches to enhance clinical care and research, thereby supporting successful mobilization and potentially improving patient health outcomes.
Robotic-assisted therapy (RAT) has emerged as a promising intervention for post-stroke recovery; however, its implementation in developing countries such as Indonesia remains limited by economic, technical, and systemic barriers. This structured narrative review summarizes clinical effect reported by systematics review and meta-analyses and examines implementation consideration and potential economic feasibility within the Indonesian healthcare context. A structured review of systematic reviews and meta-analyses (2015–2025) was conducted using PubMed, Scopus, PEDro, and Cochrane Library. Studies involving adult with stroke were included. Findings were synthesized narratively because of heterogeneity. Implementation barriers were analyzed, and a scenario-based economic model was developed to assess feasibility of RAT in Indonesia. QALY-equivalent outcomes (QEOs) were estimated using ratio-based value-transfer approach that scaled published reference values according to observed functional effects. Evidence from 22 systematic reviews indicated that RAT improved functional outcomes compared with conventional therapy, particularly gait and upper-limb function (effect sizes: 0.02–0.52). Key implementation barriers included limited device availability, inadequate workforce training, and regulatory constraints. Modelled ICERs ranged from US$236.23–752.31 per QEO for upper-limb rehabilitation and US$558.86–4,890 per QEO for gait-related rehabilitation. Most estimates remained below the Indonesian willingness-to-pay threshold (<US$5,030), suggesting a favourable economic profile under model assumptions, particularly in higher-resource provinces, while lower-income regions may face affordability constraints. RAT shows potential clinical benefits, but implementation in Indonesia should consider clinical effectiveness, economic feasibility, infrastructure, workforce, technology acceptance, and reimbursement. A phased approach in suitable tertiary-care settings may support wider adoption based on local evidence.
