Search Results (96)

Background: The pediatric population with chronic suppurative lung diseases (CSLDs) presents with a clinical profile of persistent productive cough and impaired airway clearance, which leads to reduced exercise capacity and physical activity (PA). The main objective of this research is to evaluate the effect of a 12-week intervention that combines airway clearance techniques (ACTs) and exercise training delivered through synchronous (videoconferencing) and asynchronous implementation at home, supported by an informative, specially designed website and supervised by a physiotherapist on exercise capacity. The secondary objective is to assess adherence to the ACT performance. The hypothesis of the study is that this hybrid tele-rehabilitation program will improve functional and exercise capacity, as well as compliance with ACTs, compared to the usual care. Methods: Thirty-two children with CSLDs (other than cystic fibrosis) will be randomly assigned to either the intervention group (home-based, synchronous, and asynchronous ACTs and exercise training) or the control group (usual care). An assessor blind to group allocation will measure the modified shuttle walk test, 6-minute walking test, Chester step test, respiratory muscle strength, handgrip, pulmonary function, PA, sedentary behavior, and quality of life at baseline, at the end of the intervention (3 months), and 6 months after completion. Discussion: This study introduces a hybrid (synchronous and asynchronous) tele-rehabilitation program, aiming to improve physical capacity and adherence to physiotherapy management for pediatric CSLD populations. Full article

Telerehabilitation—the remote delivery of rehabilitation services—is undergoing a paradigm shift with the convergence of immersive virtual reality (VR) and wearable biosensor technologies. This perspective article outlines a vision for home-based motor and cognitive rehabilitation that is engaging, personalized, and data-driven. We describe how immersive VR environments (for example, simulations of home settings or supermarkets) coupled with wearable sensors can address current challenges in rehabilitation by increasing patient motivation, enabling real-time biofeedback, and supporting remote clinician supervision. Gamification mechanisms and rich sensory feedback in VR are highlighted as key strategies to enhance user engagement and adherence to therapy. We discuss conceptual innovations such as multi-sensor data integration, dynamic difficulty adaptation, and AI-driven personalization of exercises, derived from recent research and our development experience, and consider their potential benefits for patients with neuro-cognitive-motor impairments (e.g., stroke, Parkinson’s disease, and multiple sclerosis). Implementation scenarios for home-based therapy are presented, emphasizing scalability, standardized digital metrics for monitoring progress, and seamless involvement of clinicians via telehealth platforms. We also critically examine the current limitations of VR and telehealth rehabilitation and how an integrative model could overcome these barriers. More specifically, this perspective defines the engineering requirements of a closed-loop VR-based telerehabilitation framework, including multimodal data synchronization, calibration, signal-quality management, interpretable adaptive control, digital biomarker validation, and practical strategies to improve accessibility, privacy, and scalability in home-based neurological rehabilitation. Full article

Background: Frailty is highly prevalent among older adults with cardiovascular disease (CVD) and strongly predicts disability and mortality after cardiac events. Although cardiac rehabilitation (CR) improves prognosis, frail older patients often face barriers to participating in in-person programs. eHealth-based, home-delivered CR programs incorporating tele-rehabilitation and remote monitoring may improve accessibility, yet evidence regarding their effectiveness on frailty status remains limited. Methods: We designed a multicenter, randomized, parallel-group trial enrolling people ≥65 years recently hospitalized for acute heart failure (AHF) and/or acute coronary syndrome (ACS). Participants were randomized 1:1 to an eHealth home-based tele-rehabilitation program or the usual care. The primary endpoint is frailty prevalence at follow-up, defined by an Essential Frailty Toolset (EFT) score ≥3, with co-primary outcomes being between-group differences in the mean levels of EFT and Short Physical Performance Battery (SPPB) scores after 3–6 months. Secondary endpoints include mortality and hospitalization, among others. Results: The full protocol and study procedures are reported. Between May 2024 and December 2025, 589 patients were screened at the two Italian centers involved; 442 met eligibility criteria and 209 were enrolled and randomized. Baseline characteristics were largely comparable between groups. The mean age was 77 ± 9 years, 70% were male, and 55% had ACS. Lower-than-expected enrollment was mainly attributable to refusal related to difficulties in using digital devices. Conclusions: This randomized trial will evaluate whether a multidomain, eHealth-based CR intervention can reduce the prevalence or degree of frailty in older people after AHF or ACS. We report the study protocol and baseline characteristics of the enrolled cohort, highlighting the challenge of digital illiteracy in contemporary older populations. Full article

Background/Objectives: Primary dysmenorrhea is a common menstrual condition that significantly affects women’s daily functioning and quality of life. Although physiotherapy has been shown to reduce menstrual pain, the awareness of these methods in Saudi Arabia remains unclear. This study aimed to assess women’s awareness and experiences of physiotherapy methods for managing primary dysmenorrhea in Saudi Arabia. Methods: A cross-sectional online survey was conducted among women living in SA between 16 and 28 February 2024. The questionnaire collected information on six sections including on sociodemographic characteristics, menstrual history and pain severity, work-related impact, pain-management practices, healthcare utilisation, and awareness and use of physiotherapy modalities. Convenience sampling was employed, and participation was voluntary and anonymous. Descriptive data analysis was performed using SPSS software. Results: A total of 431 women participated; most were Saudis (91.9%) and aged 18–24 years (43.2%). Primary dysmenorrhea was reported by 86.5% of participants. More than half (58%) had used at least one physiotherapy-related method, mainly heat, massage, or exercise, and 55.2% considered these methods effective. However, most relied on basic home strategies rather than structured physiotherapy interventions. Additionally, 60.8% expressed willingness to use physiotherapy in the future. Conclusions: Despite the frequent use of simple home-based methods, structured physiotherapy interventions remain underutilised. Increasing public education, improving access to physiotherapy services, and integrating self-management guidance and telerehabilitation into women’s health programmes may enhance menstrual pain management and overall quality of life. Full article

Home based telerehabilitation has expanded after COVID-19, but delivering timely guidance and monitoring exercise performance outside the clinic remains difficult. Traditional physiotherapy often relies on repeated execution of simple routines, yet clinicians have limited visibility into adherence and movement quality during unsupervised sessions. From a systems perspective, many telerehabilitation approaches also face constraints in accessibility, bandwidth, and computational cost that can limit practical deployment. This paper presents a modular telerehabilitation framework and prototype that captures and records rehabilitation exercise sessions for asynchronous clinician review in a 3D visualisation environment. The system integrates skeletal motion capture with plantar pressure sensing, and stores sessions as portable artefacts to support replay, inspection, and downstream analysis. A connector-based architecture enables extension to additional sensors without redesigning the core application, and the design aims to support deployment under constrained home computing and networking conditions. The manuscript contributes an implementation blueprint and reference architecture for multimodal capture and replay. Clinical effectiveness, usability outcomes, and quantitative sensor accuracy benchmarking are outside the scope of this work and are identified as necessary future evaluation. Full article

Background/Objective: Post-COVID survivors present significant respiratory deficiency that has been associated with ongoing shortness of breath and impaired lung function. Inspiratory muscle training (IMT) is increasingly used in survivors of COVID-19 rehabilitational programs as a means to facilitate recovery of the respiratory system. Yet, its home-based effectiveness across clinically relevant outcomes remains unclear. This systematic review aimed to present current evidence on home- or tele-delivered IMT in the post-COVID-19 population. Methods: PubMed, Scopus, Cochrane library and Science Direct were systematically searched for studies evaluating home-based (or telerehabilitation) IMT, alone or as part of a respiratory muscle training program, in adults with post-COVID-19 symptoms. The primary outcome was inspiratory muscle strength. Secondary outcomes included dyspnea, pulmonary function, exercise capacity and health-related quality of life. The methodological quality of the included studies was assessed via the PEDro scale. Owing to clinical and methodological heterogeneity, we performed only a qualitative synthesis. Results: Eight studies met the inclusion criteria. Two included both inspiratory and expiratory muscles training and three included physical training as well. The methodological quality was found to be good. IMT consistently increased inspiratory muscle strength across trials. Respiratory muscle training (RMT) programs that combined inspiratory and expiratory training also improved maximal expiratory pressure. IMT reduced dyspnea versus control/sham or baseline and several studies reported improvements in exercise capacity and physical function. Spirometry/DLCO changes were small or null in most cohorts. HRQoL gains were domain-specific in anxiety and depression. Adherence was generally good. No serious adverse events attributable to IMT were reported. Conclusions: Home-based IMT for adults with post-COVID-19 conditions is safe and seems to improve inspiratory muscle strength and dyspnea, with signs of benefit for exercise capacity, physical function, and selected HRQoL domains. Effects on ventilatory efficiency and conventional lung function appear limited. Future multicenter, sham-controlled RCTs should further explore the characteristics of IMT, employ core outcome sets, include longer follow-up, and predefine phenotype-based subgroups. Full article

Background: Cardiac rehabilitation (CR) is a key component of secondary prevention after acute coronary events, coronary and valve interventions, and device implantation, yet participation and long-term adherence remain suboptimal. Digital technologies offer the potential to extend CR beyond the centre-based model and to support more flexible, patient-centred care. Methods: This narrative “review on a systematic backbone” synthesizes original clinical studies published between 2005 and 2025 that evaluated the use of digital technologies as an integral part of CR in adults after myocardial infarction, revascularization, valve procedures or implantation of cardiac devices. Interventions were grouped into four categories: mobile health (mHealth) and tele-rehabilitation, virtual reality (VR) and exergaming, virtual education platforms, and other multi-component digital CR solutions. Only original studies with clinical, functional, or patient-reported outcomes were included. Results: Twenty-one studies on the categories mentioned above met the eligibility criteria. mHealth-enabled home-based or hybrid CR programs consistently achieved improvements in functional capacity and physical activity that were broadly comparable to centre-based CR, with generally high adherence. VR and exergaming interventions were feasible and safe, produced at least similar functional gains, and showed more consistent benefits as far as anxiety levels and engagement levels. Virtual education platforms delivered knowledge and produced behaviour change similar to traditional education and, in some studies, supported better control of blood pressure and lipids. Comprehensive digital CR platforms improved risk-factor profiles and quality of life to a degree comparable with face-to-face CR. Conclusions: Digital technologies can credibly support core objectives of CR in high-risk patients and expand access, but must be implemented as a complement to, rather than a replacement for, multidisciplinary, patient-centred rehabilitation. Full article

Background/Objectives: Despite the known benefits of cardiac rehabilitation, it remains underutilized among women. In particular, little is known about the effectiveness of hybrid comprehensive telerehabilitation (HCTR) in women with heart failure (HF). The purpose of this study was to assess effectiveness and safety of HCTR in women with HF. Methods: This analysis formed part of the TELEREH-HF multicenter, randomized trial that enrolled 850 HF patients (NYHA I-III, LVEF ≤ 40%). Patients were randomized 1:1 to HCTR plus usual care (UC) or UC alone. Patients underwent either HCTR (1 week in hospital and 8 weeks at home, five times weekly) or UC with observation. The effectiveness of HCTR was assessed by changes in peak oxygen consumption (VO₂peak), workload duration (t) in cardiopulmonary exercise test and quality of life (QoL) based on Medical Outcome Survey Short Form 36 Questionnaire (SF-36). Measurements were taken before and after intervention/observation. Results: Women constituted 11.5% of the TELEREH-HF study population. Forty women in the HCTR group and 44 women in the UC group completed program and observation, respectively. HCTR resulted in a significant improvement in VO₂peak (13.4 ± 4.3 vs. 14.3 ± 4.6; 95%CI 0.91 [0.05; 1.77], p = 0.038), workload duration (301 ± 162.3 vs. 334 ± 156.6; 95%CI 33 [5; 60], p = 0.022) and SF-36 overall score (85.9 ± 13.6 vs. 89.9 ± 13.5; 95%CI 4.0 [0.6; 7.4], p = 0.024). These favorable results were not observed in the UC group VO₂peak (14.2 ± 4.8 vs. 14.2 ± 4.8; 95%CI 0.02 [−1.20; 1.24], p = 0.971) and SF-36 overall score (89.1 ± 17.4 vs. 89.5 ± 15.8; 95%CI 4.0 [−2.1; 2.8], p = 0.796), except for an increase workload duration (268 ± 138.4 vs. 300 ± 130.1; 95%CI 32 [2; 62], p = 0.036). The HCTR group showed a significantly greater improvement in the physical component of QoL than the UC group. In neither group were there deaths nor major adverse events related to exercise training. Conclusions: Among women with heart failure, hybrid comprehensive telerehabilitation appears safe and leads to statistically significant although moderate improvements in physical capacity and quality of life. However, due to the small sample size, further studies in larger female populations are needed to confirm these findings. Full article

Experiencing weakness or paralysis on one side of the body is a common consequence of stroke, with approximately 8 out of 10 patients experiencing some degree of Hemiparesis. Rehabilitation through physiotherapy and occupational therapy is one of the primary methods used to alleviate these conditions. However, physiotherapy, provided by a therapist, is not always readily available. Rehabilitation robots have been studied as alternatives and supplements to conventional therapy. These robots, based on their interaction with the user, can be categorized as end-effector and exoskeleton-based robots. This work aims to examine end-effector rehabilitation robots targeting hemiplegic arm’s proximal joints (shoulder and elbow) for post-stroke recovery. Additionally, we analyze their mechanical design, training modes, user interfaces, and clinical outcomes, highlighting trends and gaps in these systems. Furthermore, we suggest design considerations for home-based therapy and future integration with tele-rehabilitation, based on our findings. This review uniquely focuses on end-effector robots for proximal joints, synthesizing design trends and clinical evidence to guide future development. Full article

Background/Objectives: Telerehabilitation is intended for remote treatment, but studies on group training after stroke performed in the patient’s home have not yet been conducted. The purpose of this study was to evaluate adherence rates, safety, usability and enjoyment and preliminary clinical effects of home-based remote group training for balance and mobility in chronic stage after stroke. Methods: Community-dwelling patients in chronic stage after stroke who walked independently and had mild balance deficits participated. Over a 6-week period, they completed 60-min sessions of balance and mobility training twice a week in a group from their home. Adherence rates, adverse events and technical problems were recorded. Participants’ satisfaction was assessed using Modified Physical Activity Enjoyment Scale. The primary outcomes were Mini-Balance Evaluation Systems Test (mini-BESTest), 5TSTS and 10MWT and secondary outcomes were limits of stability, weight-bearing symmetry and Activities-Specific Balance Confidence Scale (ABC Scale), measured before, immediately after and six weeks after remote group training. Results: Participants expressed a very high level of satisfaction with training. There were no adverse events and dropouts, but some minor technical challenges. Results showed significant improvements in primary outcomes (mini-BESTest, 10MWT fast walking speed, 5TSTS; all p < 0.001), however there were no significant improvements in secondary outcomes (weight-bearing symmetry, limits of stability and ABC Scale). All improvements persisted six weeks after training. Conclusions: Remote group training at home is feasible, safe and efficient to improve balance and mobility in patients in the chronic phase after stroke. Full article

Background and Objectives: Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity that affects postural alignment, function, and quality of life. Telerehabilitation has emerged as a promising approach to enhance accessibility and continuity of exercise-based treatment in AIS. This study aimed to compare the effects of telerehabilitation-supported home exercise programs with standard home exercises on posture, pain, body image, and quality of life in adolescents with mild AIS. Materials and Methods: Forty adolescents aged 10–18 years with mild AIS (Cobb angle 10–25°, Risser 0–3) were randomly assigned to two groups: study (n = 20) and control (n = 20). Both groups performed an 8-week home-based exercise program. The study group additionally received weekly online supervision by a physiotherapist. Outcomes included pain severity (VAS), posture (New York Posture Assessment Scale), body image (Walter Reed Visual Assessment Scale), and quality of life (SRS-22 questionnaire). Statistical analyses were performed using non-parametric tests, with a significance level of p < 0.05. Results: Twenty-nine participants completed the study (15 in the study group, 14 in the control group). Significant improvements were observed in the study group in SRS-22 total, pain, and function subscores, as well as posture scores (p < 0.05). In the control group, only the satisfaction subscore improved significantly (p < 0.05). No significant changes were detected in body image (WRVAS) in either group. Between-group comparisons showed greater overall clinical gains in the study group despite similar exercise adherence rates. Conclusions: Supervised telerehabilitation enhances the effectiveness of home-based exercise programs in adolescents with mild AIS by improving postural alignment, reducing pain, and increasing functional capacity and quality of life. Telerehabilitation represents an accessible and efficient complementary strategy for managing AIS when in-person supervision is limited. Full article

Background: Knee osteoarthritis (OA) is a leading cause of disability globally. Conventional physiotherapy, while effective, faces barriers including accessibility and adherence. Telerehabilitation augmented by wearable sensor technology and AI-driven feedback offers a scalable alternative. Objective: This pilot randomized controlled trial compared the feasibility, safety, and preliminary clinical effectiveness of a sensor-based telerehabilitation protocol using the KneE-PAD patient monitoring approach which was also combined with an avatar-guided visual feedback add-on tool. Although this approach is capable of AI-driven postural error detection, this feature was not enabled during the current study, and feedback was provided solely through visual cues. Methods: Twenty adults with radiographically confirmed Kellgren–Lawrence grade 1 to 3 knee OA were randomized into two groups (Control/Intervention groups, n = 10 in each). The control group received in-person physiotherapy, while the intervention group engaged in remote rehabilitation supported by wearable sEMG and IMU sensors. The 8-week program included supervised and home-based sessions. Primary outcomes were WOMAC scores (Functionality/Pain), quadriceps strength, and sEMG-derived neuromuscular activation. Secondary outcomes included Timed Up and Go test (TUG), psychological measures (HADS, TSK), and self-efficacy measure (ASES). Analyses employed both parametric and non-parametric statistics including an effect size estimation. Results: Both groups demonstrated significant improvements in WOMAC total scores (Intervention: −11.8 points; Control: −6.4 points), exceeding the minimal clinically important difference (MCID) for knee OA. Strength and mobility also improved significantly in both groups, with the Intervention group showing superior gains in sEMG measures (RMS: p = 0.0077; Peak-to-Peak: p < 0.005), indicating enhanced neuromuscular adaptation. TUG performance improved more in the intervention group (–3.17 s vs. –2.57 s, p = 0.037). Psychological outcomes favored the control group, particularly in depression scores (HADS-D, t(18) = 2.37, p = 0.03). Adherence was high (94.8%), with zero attrition and no adverse events. Conclusions: The KneE-PAD monitoring approach offers a feasible and clinically effective alternative to conventional physiotherapy, enhancing neuromuscular outcomes through real-time sensor feedback. These findings support the viability of intelligent telerehabilitation for scalable OA care and inform the design of future large-scale trials. Full article

Background: Alzheimer’s Disease (AD) is the most common form of dementia and is characterized by progressive cognitive decline and neurodegeneration. In Italy, AD represents a major public health and socio-economic challenge. This review aims to summarize current Italian research on pharmacological and non-pharmacological interventions, including preclinical studies, clinical trials, rehabilitative approaches, and emerging neuromodulation techniques, highlighting contributions and future directions. Methods: A narrative review of the literature was conducted, focusing on Italian preclinical and clinical studies, observational and real-world evidence, cognitive and physical interventions, music therapy, non-invasive brain stimulation (rTMS, tDCS, tACS), and digital or home-based rehabilitation programs. Results: Italian research has explored different pharmacological strategies, including multitarget compounds, eptastigmine, rotigotine, and combinatorial therapies (donepezil-memantine, citicoline addition). Non-pharmacological interventions, such as cognitive stimulation, motor rehabilitation, music therapy, and multidimensional programs, demonstrated benefits on cognition, behavior, daily functioning, and caregiver well-being. Non-invasive neuromodulation techniques, targeting the dorsolateral prefrontal cortex and precuneus, showed promising effects on memory, attention, and executive functions, especially when combined with cognitive training. Digital health technologies, including telerehabilitation and home-based brain stimulation programs, further enhanced accessibility and adherence. Challenges remain due to fragmented research, small sample sizes, and limited standardization. Conclusions: Italian research on AD reflects a growing emphasis on integrated, multidimensional, and technologically advanced approaches. Strengthening preclinical studies, promoting multicenter collaborations, and combining pharmacological, cognitive, and neuromodulatory strategies may enhance therapeutic efficacy and patient quality of life. Continued investment in innovation and multidisciplinary research positions Italy to contribute meaningfully to global AD management and prevention. Full article

Foot drop, a form of paralysis affecting ankle and foot control, impairs walking and increases the risk of falls. Effective rehabilitation requires monitoring gait to guide personalized interventions. This study presents a proof-of-concept smart foot–ankle brace integrating low-cost sensors, including gyroscopes, accelerometers, and a Fiber Bragg Grating (FBG) array, with an Arduino-based processing platform. The system captures, in real time, the key locomotion parameters, namely, angular rotation, acceleration, and sole deformation. Experiments using a 3D-printed insole demonstrated that the device detects foot-drop-related gait deviations, with toe acceleration approximately twice that of normal walking. It also precisely detects foot deformation through FBG sensing. These results demonstrate the feasibility of the proposed system for monitoring gait abnormalities. Unlike commercial gait analysis devices, this work focuses on proof-of-concept development, providing a foundation for future improvements, including wireless integration, AI-based gait classification, and mobile application support for home-based or tele-rehabilitation applications. Full article

Recently, telerehabilitation has taken on a significant role in rehabilitation programs, with benefits in improving balance. Many neurological diseases are associated with an increased fall risk and, considering the impact of falls on quality of life, the aim of this study is to evaluate the ability of the Silver Index (via the hunova^® robotic platform) to identify the fall risk and the effect of a telerehabilitation intervention (by ARC Intellicare) on fall risk in patients with neurological disorders. This is an ancillary study of a single-center, randomized controlled trial. Ninety patients with stroke, Multiple Sclerosis (MS), and Parkinson’s Disease (PD) participated, and were randomized into an ARC Intellicare group (experimental group) and a paper-based group (control group). Each group performed home treatment for 60 min a day, 3 days a week, for 8 weeks. Fall risk was assessed with clinical scales and hunova^®. Data analysis showed a correlation between clinical scales and the Silver Index. Furthermore, only the MS patients in the experimental group showed a significant decrease in fall risk (p = 0.015). This study suggested that the Silver Index is a valid tool for assessing fall risk in neurological disorders. It also confirmed that ARC Intellicare is a useful tool for remote rehabilitation at home. Full article