Search Results (331)

The purpose of this narrative review is to critically appraise recent advances in sports injury rehabilitation—primarily focusing on biopsychosocial (BPS) approaches alongside emerging technological innovations—and identify current gaps and future directions. A literature search was conducted in PubMed, Scopus, and Web of Science for the years 2018–2024. Eligible records were English-language, human studies comprising systematic reviews, clinical trials, and translational investigations on wearable sensors, artificial intelligence (AI), virtual reality (VR), regenerative therapies (platelet-rich plasma [PRP], bone marrow aspirate concentrate [BMAC], stem cells, and prolotherapy), and BPS rehabilitation models; single-patient case reports, editorials, and non-scholarly sources were excluded. The synthesis yielded four themes: (1) BPS implementation remains underutilised owing to a lack of validated tools, variable provider readiness, and system-level barriers; (2) wearables and AI can enhance real-time monitoring and risk stratification but are limited by data heterogeneity, non-standardised pipelines, and sparse external validation; (3) VR/gamification improves engagement and task-specific practice, but evidence is dominated by pilot or laboratory studies with scarce longitudinal follow-up data; and (4) regenerative interventions show mechanistic promise, but conclusions are constrained by methodological variability and regulatory hurdles. Conclusions: BPS perspectives and emerging technologies have genuine potential to improve outcomes, but translation to practice hinges on (1) pragmatic or hybrid effectiveness–implementation trials, (2) standardisation of data and intervention protocols (including core outcome sets and effect-size reporting), and (3) integration of psychological and social assessment into routine pathways supported by provider training and interoperable digital capture. Full article

Background and Objectives: Osteoarthritis (OA) is a chronic, degenerative joint disease. The main symptoms include pain that can cause loss of function and stiffness, as well as swelling, reduced range of motion, crepitus, joint deformity, and muscle weakness. It leads to irreversible structural changes, that in advanced stages can require surgical interventions. The aim of this review was to summarize the current literature about the role of virtual reality (VR), exergames and digital technologies in patients with knee osteoarthritis before or after total knee arthroplasty, to understand if it is possible to prevent and reduce the symptoms and if these new technologies are more effective than conventional rehabilitation therapies. Materials and Methods: We conducted a systematic search of PubMed, Cochrane Library, Scopus, and PEDro from inception to November 2024. The review adhered to the PRISMA 2020 guidelines, and the protocol was prospectively registered in PROSPERO (registration number: CRD42024541890). We included randomized controlled trials (RCTs) enrolling participants aged 60 years or older, in which VR or telerehabilitation programs were compared with conventional rehabilitation approaches. Eligible studies had to report at least one of the following outcomes: pain, functionality, stability, or adherence. Two independent reviewers screened titles and abstracts, assessed full-text eligibility, extracted data, and evaluated the risk of bias using the Cochrane Risk of Bias 2 (RoB 2) tool. Results: Fourteen randomized controlled trails (RCTs) (1123 participants; mean age 68.2 years) were included. VR and telerehabilitation generally outperformed conventional rehabilitation for pain (8/13 studies, −0.9 to −2.3 VAS points) and functionality (7/13 studies, WOMAC improvement 8–15%, TUG −1.2 to −2.8 s). Compliance was higher in most technology-assisted programs (6/7 studies, 70–100% adherence). Stability outcomes were less consistent, with only 1/4 studies showing clear benefit. One study favored conventional rehabilitation for functionality. Overall risk of bias was low-to-moderate, with heterogeneity mainly driven by intervention duration, platform type, and supervision level. Conclusions: Structured telerehabilitation, non-immersive VR, and interactive online exercise programs, especially those offering real-time feedback, show comparable or superior benefits to conventional rehabilitation in older adults with knee OA or after TKA, particularly for pain reduction, functional gains, and adherence. These approaches enhance accessibility and home-based care, supporting their integration into clinical practice when in-person therapy is limited. Full article

Background: As means of addressing ongoing challenges in accessing publicly funded specialist care, new models of care have been trialled. One such approach is using physiotherapists in advance practice roles, who in collaboration with other health professionals, act as an initial orthopedic point of contact and coordinate care. This research investigated the impact of a model of care, the Spinal Virtual Clinic Model, implemented for the first time in South Australia, using advanced practice physiotherapists in a large metropolitan hospital in South Australia. Although formally named the “Spinal Virtual Clinic” by the health service, this model does not involve direct patient contact and differs from traditional virtual or telehealth clinics. Instead, it is best understood as a physiotherapy-led referral triage and management service. Methods: This research was conducted in two stages. Stage 1 was a retrospective clinical audit of sequential patients triaged to the Spinal Virtual Clinic, as well as a follow up audit to capture any subsequent engagement with the Orthopaedic Spinal Service following the initial Spinal Virtual Clinic correspondence. Data were descriptively analysed. In Stage 2, semi-structured interviews were conducted with patients from the Spinal Virtual Clinic to explore their perspectives on this model of care. The interviews were transcribed verbatim and independently analysed using thematic analysis. The sequential use of quantitative and qualitative approaches enabled us to both describe engagement with this model of care and better understand the underlying perspectives. Results: Three hundred and nine referrals were triaged to the physiotherapy-led spinal virtual clinic over a six-month period from 1 January 2021 to 30 June 2021. Majority of referrals were triaged as low acuity did not need formal spinal specialist review and could be managed safely in primary care. Therapist-led active management strategies (80.8%), trial of neuropathic medication (35.6%) closely followed by advice regarding targeted spinal injections (foraminal and epidural), were the most common conservative management strategies recommended. Only a small proportion needed surgical review. Interviews with eleven patients revealed that while many valued the convenience, timely advice, and reassurance offered by the service, others expressed confusion about the referral process and disappointment at not seeing a specialist. A key recommendation identified was improved communication, including providing patients with direct feedback alongside general practitioner correspondence. Conclusions: This research, underpinned by quantitative and qualitative research, has showcased the potential of this model of care, the spinal virtual clinic, to have a positive impact on improving access and reducing the burden on the health system for low acuity patients. As historical models of care become unsustainable and obsolete, alternative models of care can be implemented in health care settings where outpatient demand significantly exceeds capacity. Full article

Background/Objectives: Motor decline in older adults can hinder cognitive assessments. To address this, we developed a brain–computer interface (BCI) using electroencephalography (EEG) and event-related potentials (ERPs) as a motor-independent EEG Switch. ERPs reflect attention-related neural activity and may serve as biomarkers for cognitive function. This study evaluated the feasibility of using ERP-based task success rates as indicators of cognitive abilities. The main goal of this article is the development and baseline evaluation of the Neurodetector system (incorporating the EEG Switch) as a motor-independent tool for cognitive assessment in healthy adults. Methods: We created a system called Neurodetector, which measures cognitive function through the ability to perform tasks using a virtual one-button EEG Switch. EEG data were collected from 40 healthy adults, mainly under 60 years of age, during three cognitive tasks of increasing difficulty. Results: The participants controlled the EEG Switch above chance level across all tasks. Success rates correlated with task difficulty and showed individual differences, suggesting that cognitive ability influences performance. In addition, we compared the pattern-matching method for ERP decoding with the conventional peak-based approaches. The pattern-matching method yielded a consistently higher accuracy and was more sensitive to task complexity and individual variability. Conclusions: These results support the potential of the EEG Switch as a reliable, non-motor-dependent cognitive assessment tool. The system is especially useful for populations with limited motor control, such as the elderly or individuals with physical disabilities. While Mild Cognitive Impairment (MCI) is an important future target for application, the present study involved only healthy adult participants. Future research should examine the sources of individual differences and validate EEG switches in clinical contexts, including clinical trials involving MCI and dementia patients. Our findings lay the groundwork for a novel and accessible approach for cognitive evaluation using neurophysiological data. Full article

Background/Objective: The use of immersive virtual reality (VR) for cognitive training in older adults has shown promising results in recent years. However, the number of well-designed studies remains limited, and variability in methodologies makes it difficult to draw generalizable conclusions. This systematic review aims to examine the effects of VR-based cognitive training in older adults, describe the technological characteristics of these interventions, identify current gaps in the literature, and suggest future research directions. Methods: Following PRISMA guidelines, a search was conducted across major databases (PubMed, PsycINFO, Scopus, ProQuest, ACM, and Web of Science) from 2018 to 2025. The database search identified 156 studies, of which 12 met the inclusion criteria after screening and eligibility assessment. Across these studies, a total of 3202 older adult participants (aged 60 years or older) were included. Interventions varied in duration from 4 to 36 sessions, targeting domains such as memory, executive function, attention, and global cognition. Most interventions were based on cognitive training, with a few employing cognitive stimulation or cognitive rehabilitation approaches. Quality was assessed using the Effective Public Health Practice Project tool. Results: Most studies reported positive effects of VR interventions on cognitive domains such as attention, executive functions, and global cognition. Fewer studies showed improvements in memory. The majority used head-mounted displays connected to computers and custom-built software, often without public access. Sample sizes were generally small, and blinding procedures were often unclear. The average methodological quality was moderate. Conclusions: Immersive VR has potential as an effective tool for cognitive training in older adults. Future research should include larger randomized controlled trials, long-term follow-up, standardized intervention protocols, and the development of accessible software to enable replication and broader application in clinical and community settings. Full article

A revolutionary non-invasive method for the thorough evaluation of coronary artery disease (CAD) is fractional flow reserve (FFR) obtained from coronary computed tomography angiography (CCTA). Computed tomography-derived FFR (FFR_CT) assesses both the anatomical and functional significance of coronary lesions simultaneously by utilizing sophisticated computational models, including computational fluid dynamics, machine learning (ML), and Artificial Intelligence (AI) methods. The technological development, validation research, clinical uses, and real-world constraints of FFR_CT are compiled in this review. Large multicenter trials and registries consistently show that FFR_CT is a reliable gatekeeper to invasive coronary angiography (ICA) and increases diagnostic accuracy significantly when compared to coronary Computed Tomography Angiography (CTA) alone, especially in patients with intermediate-risk anatomy. Additionally, FFR_CT has demonstrated benefits in populations with in-stent restenosis (ISR) and in virtual procedural planning. Notwithstanding its advantages, the technique still requires high-quality imaging, and its practical application is constrained by expenses, processing requirements, and image distortions. Continuous developments in automation and deep learning should improve accessibility, effectiveness, and workflow integration in clinical settings. FFR_CT is expected to become more and more important in the individualized treatment of CAD by minimizing unnecessary invasive procedures and improving patient selection for revascularization. Full article

Clinical trials in nephrology have historically been hindered by significant challenges, including slow disease progression, patient heterogeneity, and recruitment difficulties. While recent therapeutic breakthroughs have transformed care, they have also created a ‘paradox of success’ by lowering baseline event rates, further complicating traditional trial designs. We hypothesize that integrating innovative trial methodologies with advanced computational tools is essential for overcoming these hurdles and accelerating therapeutic development in kidney disease. This narrative review synthesizes the literature on persistent challenges in nephrology trials and explores methodological innovations. It investigates the transformative impact of computational tools, specifically Artificial Intelligence (AI), techniques like Augmented Reality (AR) and Conditional Tabular Generative Adversarial Networks (CTGANs), in silico clinical trials (ISCTs) and Digital Health Technologies across the research lifecycle. Key methodological innovations include adaptive designs, pragmatic trials, real-world evidence, and validated surrogate endpoints. AI offers transformative potential in optimizing trial design, accelerating patient stratification, and enabling complex data analysis, while AR can improve procedural accuracy, and CTGANs can augment scarce datasets. ISCTs provide complementary capabilities for simulating drug effects and optimizing designs using virtual patient cohorts. The future of clinical research in nephrology lies in the synergistic convergence of methodological and computational innovation. This integrated approach offers a pathway for conducting more efficient, precise, and patient-centric trials, provided that critical barriers related to data quality, model validation, regulatory acceptance, and ethical implementation are addressed. Full article

Background/Objectives: Beyond the core characteristics of the condition, autistic individuals often significantly struggle with postural balance. This pilot study aimed to investigate the effects of an immersive virtual reality-based training administered with Gait Real-time Analysis Interactive Lab (GRAIL) on postural balance of autistic children. Methods: A total of 20 autistic participants aged 6 to 13 were enrolled in a 5-week randomized, parallel-group, open-label, controlled trial, and received either balance training with the GRAIL system or no training. The trial was registered at ClinicalTrials.gov (identifier: NCT04276571). The primary outcome measures were the change in center of pressure (CoP) metrics during GRAIL balance assessments and the change in motor skills as assessed with Movement Assessment Battery for Children-2. Secondary outcome measures included parent-report Developmental Coordination Disorder Questionnaire, center of mass metrics, and gait parameters evaluated with GRAIL. ANCOVA tests were performed for all outcomes, with time (T0 and T1) as within-subjects factor, the group (training and control groups) as between-subjects factor, and considering age as covariate. Results: Slight but significant time by group interactions were found in some CoP metrics (i.e., sway path length, velocity in the antero-posterior direction, and the jerk). Conclusions: These findings preliminarily suggest that a virtual reality-based training may induce slight modifications in postural balance strategies, which can be enhanced with longer or more intensive training. Full article

(1) Virtual reality (VR) technologies have shown significant potential for diagnosing and treating vision-related impairments. This rapid review evaluates and characterizes the existing literature on VR technologies for diagnosing and treating vision-based diseases. (2) Methods: A systematic search was conducted across Ovid MEDLINE, Ovid Embase, the Cochrane Database of Systematic Reviews (Ovid), and the Cochrane Central Register of Controlled Trials (Ovid). Abstracts were screened using Rayyan QCRI, followed by full-text screening and data extraction. Eligible studies were published in peer-reviewed journals, written in English, focused on human participants, used immersive and portable VR devices as the primary intervention, and reported on the clinical effectiveness of VR for therapeutic, diagnostic, or screening purposes for vision or auditory–visual impairments. Various study characteristics, including design and participant details, were extracted, and the MMAT assessment tool was used to evaluate study quality. (3) Results: Seventy-six studies met the inclusion criteria. Among these, sixty-four (84.2%) were non-randomized studies exploring VR’s effectiveness, while twenty-two (15.8%) were randomized-controlled trials. Of the included studies, 38.2% focused on diagnosing, 21.0% on screening, and 38.2% on treating vision impairments. Glaucoma and amblyopia were the most commonly studied visual impairments. (4) Conclusions: The use of standalone, remotely controlled VR headsets for screening and diagnosing visual diseases represents a promising advancement in ophthalmology. With ongoing technological developments, VR has the potential to revolutionize eye care by improving accessibility, efficiency, and personalization. Continued research and innovation in VR applications for vision care are expected to further enhance patient outcomes. Full article

Background: Reverse total shoulder arthroplasty (RTSA) is increasingly used for managing cuff tear arthropathy, osteoarthritis, complex fractures, and revision procedures. As the demand for surgical precision and reproducibility grows, immersive technologies such as virtual reality (VR), augmented reality (AR), and metaverse-based platforms are being explored for surgical training, intraoperative guidance, and rehabilitation. While early data suggest potential benefits, a focused synthesis specific to RTSA is lacking. Methods: This systematic review was conducted in accordance with PRISMA 2020 guidelines. A comprehensive search of PubMed, Scopus, and Cochrane Library databases was performed through 30 May 2025. Eligible studies included those evaluating immersive technologies in the context of RTSA for skill acquisition or intraoperative guidance. Only peer-reviewed articles published in English were included. Data were synthesized narratively due to heterogeneity in study design and outcome metrics. Results: Out of 628 records screened, 21 studies met the inclusion criteria. Five studies evaluated immersive VR for surgical training: four randomized controlled trials and one retrospective case series. VR training improved procedural efficiency and showed non-inferiority to cadaveric training. Sixteen studies investigated intraoperative navigation or AR guidance. Clinical and cadaveric studies consistently reported improved accuracy in glenoid baseplate positioning with reduced angular and linear deviations in postoperative controls as compared to preoperative planning. Conclusions: Immersive technologies show promise in enhancing training, intraoperative accuracy, and procedural consistency in RTSA. VR and AR platforms may support standardized surgical education and precision-based practice, but their broad clinical impact remains limited by small sample sizes, heterogeneous methodologies, and limited long-term outcomes. Further multicenter trials with standardized endpoints and cost-effectiveness analyses are warranted. Postoperative rehabilitation using immersive technologies in RTSA remains underexplored and presents an opportunity for future research. Full article

Background/Objectives: Historically, echocardiographic imaging of the right heart has been challenging because its abnormal geometry is not conducive to reproducible anatomical and functional assessment. With the development of advanced echocardiographic techniques, it is now possible to complete an integrated assessment of the right heart that has fewer assumptions, resulting in increased accuracy and precision. Echocardiography continues to be the first-line imaging modality for diagnostic analysis and the management of acute and chronic right heart failure because of its portability, versatility, and affordability compared to cardiac computed tomography, magnetic resonance imaging, nuclear scintigraphy, and positron emission tomography. Virtually all echocardiographic parameters have been well-validated and have demonstrated prognostic significance. The goal of this narrative review of the echocardiographic parameters of the right heart chambers and hemodynamic alterations associated with right ventricular dysfunction is to present information that must be acquired during each examination to deliver a comprehensive assessment of the right heart and to discuss their clinical significance in right heart failure. Methods: Using a literature search in the PubMed database from 1985 to 2025 and the Cochrane database, which included but was not limited to terminology that are descriptive of right heart anatomy and function, disease states involving acute and chronic right heart failure and pulmonary hypertension, and the application of conventional and advanced echocardiographic modalities that strive to elucidate the pathophysiology of right heart failure, we reviewed randomized control trials, observational retrospective and prospective cohort studies, societal guidelines, and systematic review articles. Conclusions: In addition to the conventional 2-dimensional echocardiography and color, spectral, and tissue Doppler measurements, a contemporary echocardiographic assessment of a patient with suspected or proven right heart failure must include 3-dimensional echocardiographic-derived measurements, speckle-tracking echocardiography strain analysis, and hemodynamics parameters to not only characterize the right heart anatomy but to also determine the underlying pathophysiology of right heart failure. Complete and point-of-care echocardiography is available in virtually all clinical settings for routine care, but this imaging tool is particularly indispensable in the emergency department, intensive care units, and operating room, where it can provide an immediate assessment of right ventricular function and associated hemodynamic changes to assist with real-time management decisions. Full article

Person-centered navigation (PCN) in healthcare refers to a proactive collaboration among professionals, researchers, patients, and their families to guide individuals toward timely access to screening, treatment, follow-up, and psychosocial support. PCN—which includes professional, peer, and virtual guidance, is particularly crucial for rare cancers, where affected individuals face uncertainty, limited support, financial strain, and difficulties accessing relevant information, testing, and other services. The Canadian Cholangiocarcinoma Collaborative (C3) prioritizes PCN implementation to address these challenges in the context of Biliary Tract Cancers (BTCs). C3 uses a virtual PCN model and staffs a “C3 Research Navigator” who provides clinical and research navigation such as personalized guidance and support, facilitating access to molecular testing, clinical trials, and case reviews through national multidisciplinary rounds. C3 also supports a national network of BTC experts, a patient research registry, and advocacy activities. C3’s implementation strategies include co-design, timely delivery of support, and optimal outcomes across its many initiatives. Future priorities include expanding the C3 network, enhancing user engagement, and further integrating its innovative approach into routine care. Full article

Background: Perioperative care is an integral part of the procedure of a surgical operation, with strictly defined rules. The need to upgrade and improve some individual long-term processes aims at optimal patient care and the provision of high-level health services. Therefore, preoperative care is drawn up with new data resulting from the evolution of technology to upgrade the procedures that need improvement. According to the international literature, a factor considered to be of major importance is high preoperative anxiety and its effects on the patient’s postoperative course. High preoperative anxiety is postoperatively responsible for prolonged hospital stays, increased postoperative pain, decreased effect of anesthetic agents, increased amounts of analgesics, delayed healing of surgical wounds, and increased risk of infections. The use of Virtual Reality technology appears as a new method of managing preoperative anxiety. Objective: This study investigates the effect and effectiveness of Virtual Reality (VR) technology in managing preoperative anxiety in adult patients. Methods: A literature review was performed on 193 articles, published between 2017 and 2024, sourced from the scientific databases PubMed and Cochrane, as well as the trial registry ClinicalTrials, with a screening and exclusion process to meet the criterion of investigating VR technology’s effectiveness in managing preoperative anxiety in adult patients. This systematic review was conducted under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Results: Out of the 193 articles, 29 were selected. All articles examined the efficacy of VR in adult patients (≥18) undergoing various types of surgery. The studies represent a total of 2.354 participants from 15 countries. There are two types of VR applications: distraction therapy and patient education. From the studies, 14 (48%) used the distraction VR intervention, 14 (48%) used the training VR intervention, and 1 (4%) used both VR interventions, using a range of validated anxiety scales such as the STAI, VAS-A, APAIS, and HADS. Among the 29 studies reviewed, 25 (86%) demonstrated statistically significant reductions in preoperative anxiety levels following the implementation of VR interventions. VR technology appears to manage preoperative anxiety effectively. It is a non-invasive and non-pharmacological intervention with minimal side effects. Conclusions: Based on the review, the management of preoperative anxiety with VR technology shows good levels of effectiveness. Further investigation of the efficacy by more studies and randomized controlled trials, with a larger patient population, is recommended to establish and universally apply VR technology in the preoperative care process as an effective method of managing preoperative anxiety. Full article

Background: Current methods of postural control assessments and interventions to improve postural stability and thereby prevent falls often fail to incorporate the hazardous perturbation situations that frequently accompany falls. Virtual environments can safely incorporate these hazards. The purpose of the study was to identify if virtual slip and trip perturbations can be used as an exposure paradigm in place of real slip and trip perturbations to improve postural control. Methods: Fifteen healthy young adults were included in this study. Two paradigms, real gait exposure (real) and virtual environment gait exposure (virtual), consisting of real and virtual slip and trip trials, were performed by each participant in a counterbalanced order to avoid order effects. At baseline and following real and virtual paradigms, the modified clinical test for sensory integration and balance (mCTSIB), limits of stability (LOS), and single-leg stance (SLS) using BTracks balance plate were administered. Separate one-way (baseline vs. Real vs. Virtual) repeated measures analysis of variance were conducted on response variables. Results: In the posterior left quadrant of the LOS, significant differences were found after the real paradigm compared to baseline (p = 0.04). For the anterior left quadrant and total LOS, significant differences post real paradigm (p = 0.002 and p < 0.001) and virtual paradigm (p = 0.007 and p < 0.001) compared to baseline were observed. For the SLS, the left-leg significant differences were observed post real paradigm (p = 0.019) and virtual paradigm (p = 0.009) compared to BL in path length, while significant main effects were found for mean sway velocity for the left leg only (p = 0.004). For the right leg, significant differences were only observed after the virtual paradigm (p = 0.01) compared to BL. Conclusions: Both virtual and real paradigms were identified to improve postural control. The virtual paradigm led to increased postural control in the right-leg SLS condition, while the real paradigm did not, without any adverse effects. Findings suggest virtual reality perturbation exposure acutely improves postural control ability compared to baseline among healthy young adults. Full article

Background. Digital dentistry continues to evolve, offering improved accuracy, efficiency, and patient experience across various prosthodontic procedures. Many previous reviews have focused on digital applications in prosthodontics. But the use of a fully digital workflow for full-arch implant-supported prostheses in edentulous patients remains an emerging and underexplored area in the literature. Objective. This article presents a comprehensive methodological review of the digital workflow in full-arch implant-supported rehabilitation. It follows a structured literature exploration and synthesizes relevant technological processes from patient assessment to prosthetic delivery. Methods. The relevant literature was retrieved from the PubMed database on 20 June 2024, to identify the most recent and relevant studies. A total of 22 articles met the eligibility criteria and were included in the review. The majority included case and technical reports. Results. The review illustrates the integration and application of digital tools in implant dentistry, including cone-beam computed tomography (CBCT) exposure, intraoral scanning, digital smile design, virtual patients, guided surgery, and digital scanning. The key findings demonstrate multiple advantages of a fully digital workflow, such as reduced treatment time and cost, increased patient satisfaction, and improved interdisciplinary communication. Conclusions. Despite these benefits, limitations persist due to the low level of evidence, technological challenges, and the lack of standardized protocols. Further randomized controlled trials and long-term clinical evaluations are essential to validate the effectiveness and feasibility of a fully digital workflow for full-arch implant-supported rehabilitation. Full article