Search Results (305)

Obesity has emerged as one of the most complex and urgent public health challenges of the twenty-first century, driven by genetic, environmental, metabolic, and psychosocial determinants that collectively disturb energy homeostasis and systemic health. It is characterized by adipose tissue dysfunction, insulin resistance, chronic low-grade inflammation, and gut microbiota dysbiosis, all of which interact to perpetuate metabolic and cardiovascular diseases. Beyond the biological dimension, obesity profoundly affects mental health, being closely linked to depression, anxiety, body-image dissatisfaction, and stigma, which further reduce adherence to treatment. Current therapeutic strategies rely on a stepped-care approach, beginning with lifestyle interventions encompassing dietary modification, physical activity, and behavioral therapy. Pharmacologic treatments, particularly incretin-based agents such as semaglutide, liraglutide, and tirzepatide have transformed medical management through substantial and sustained weight loss, while bariatric surgery remains the most effective long-term option for severe obesity. Emerging approaches, including gene therapy, microbiome modulation, and nanomedicine, offer mechanistically targeted and potentially safer alternatives, though they remain largely experimental. Pharmacoeconomic analyses support the cost-effectiveness of combining behavioral, pharmacological, and surgical modalities, highlighting the economic advantage of integrated care models. Meanwhile, artificial intelligence and machine learning are redefining obesity research and management, enhancing cancer risk prediction, personalizing pharmacotherapy, optimizing resource allocation, and enabling precision medicine through multi-omics and imaging integration. Collectively, these insights support a shift toward a learning health-system paradigm that unites mechanistically anchored therapies with digital and AI-driven personalization to achieve sustainable weight reduction, reduce cardiometabolic and cancer burden, and improve global health outcomes. Full article

Objectives: The aim of this study is to summarize recent evidence of the effectiveness of rehabilitation interventions in managing symptoms related to endometriosis and adenomyosis. Methods: The review protocol was registered previously (CRD42022236516). A systematic search was conducted in the Medline, Web of Science, and Scopus databases for studies published up to 23 July 2025 that reported the effects of any rehabilitation intervention in women diagnosed with endometriosis or adenomyosis. Risk of bias was assessed, and meta-analyses were performed. Results: A total of 970 studies were identified, of which 19 reports from 17 trials met the inclusion criteria. Approximately one-third of the trials focused on electrophysical agents, another third on exercise programs, and the remaining studies included manual therapy-based interventions—such as pelvic floor physiotherapy (PFP), or Swedish massage—as well as other modalities. Most trials assessed changes in pain, quality of life (QoL), and mental health, showing consistent improvements following intervention. Additional outcomes evaluated included lumbopelvic impairments, sexual function, and bone mineral density. Meta-analyses of eleven studies on pain and five on QoL revealed significant effects, favoring the intervention groups. Conclusions: This review highlights promising benefits of physical rehabilitation, particularly in patients with endometriosis. A range of approaches—including therapeutic exercise, electrophysical agents, and PFP—may contribute to improvements in endometriosis-related clinical outcomes, especially pain and QoL. Full article

Background: Delayed Onset Muscle Soreness (DOMS) is a transient, exercise-induced condition characterized by muscle pain, stiffness, and functional impairment, particularly following eccentric or high-intensity physical activity. Recent advances in diagnostic imaging, neurophysiology, and therapeutic techniques have led to a reassessment of DOMS pathophysiology and management. Objective: This scoping review aims to critically evaluate non-pharmacological strategies for DOMS management, focusing on clinical studies published between 2020 and 2025. Emphasis is placed on physical, thermal, neurophysiological, and nutritional interventions in athletic populations. Methods: A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science. Included studies were randomized controlled trials, systematic reviews, meta-analyses, and high-quality scoping reviews. Methodological quality was assessed using PEDro, AMSTAR 2, and ROBIS tools. Key outcome measures included pain (VAS), functional recovery (ROM, performance), biochemical markers (CK, IL-6), and neuromuscular activation (iEMG). Results: Twenty-five studies met the inclusion criteria. Emerging strategies such as cryosauna, vibration therapy, percussive massage, and polyphenol supplementation demonstrated significant benefits in reducing DOMS-related symptoms and enhancing recovery. Evidence supports the integration of multimodal, personalized interventions over monotherapies. Imaging techniques (7T MRI, ultrasound) confirmed microstructural muscle changes consistent with DOMS, strengthening diagnostic precision. Conclusions: Non-pharmacological approaches to DOMS have evolved considerably, highlighting the importance of combining mechanical, thermal, and nutritional modalities. Personalized, multimodal recovery strategies appear most effective for symptom relief and performance restoration. Future studies should aim to standardize treatment protocols and outcome measures to improve clinical applicability. Full article

Homeostasis, which supports and maintains brain function, results from the continuous regulation of thermodynamics within tissue: the balance of heat production, redox oscillations, and vascular convection regulates coherent energy flow within the organ. Neuroinflammation disturbs this balance, creating measurable entropy gradients that precede structural damage to its tissue components. This paper proposes that a thermodynamic unity can be devised that incorporates nanoscale physics, energetic neurophysiology, and systems neuroscience, and can be used to understand and treat neuroinflammatory processes. Using multifactorial modalities such as quantum thermometry, nanoscale calorimetry, and redox oscillometry we define how local entropy production (s_t), relaxation time (τ^R), and coherence lengths (λc) allow quantification of the progressive loss of energetic symmetry within neural tissues. It is these variables that provide the basis for the etiology of thermodynamic biomarkers which on a molecular-redox-to-network scale characterize the transitions governing the onset of the neuroinflammatory process as well as the recovery potential of the organism. The entropic probing of systems (PEP) further allows the translation of these parameters into dynamic patient-specific trajectories that model the behavior of individuals by predicting recurrent bouts of instability through the application of machine learning algorithms to the vectors of entropy flux. The parallel development of the nanothermodynamic intervention, which includes thermoplasmonic heat rebalancing, catalytic redox nanoreacting systems, and adaptive field-oscillation synchronicity, shows by example how the corrections that can be applied to the entropy balance of the cell and system as a whole offer a feasible form of restoration of energy coherence. Such closed loop therapy would not function by the suppression of inflammatory signaling, but rather by the re-establishment of reversible energy relations between mitochondrial, glial, and vascular territories. The combination of these factors allows for correction of neuroinflammation, which can now be viewed from a fresh perspective as a dynamic phase disorder that is diagnosable, predictable, and curable through the physics of coherence rather than the molecular suppression of inflammatory signaling. The significance of this set of ideas is considerable as it introduces a feasible and verifiable structure to what must ultimately become the basis of a new branch of science: predictive energetic medicine. It is anticipated that entropy, as a measurable and modifiable variable in therapeutic “inscription”, will be found to be one of the most significant parameters determining the neurorestoration potential in future medical science. Full article

Objectives: Facial paralysis is a devastating yet frequent complication of skull base surgery, significantly impacting quality of life through functional impairments and psychosocial consequences. Management is complex and requires an individualized approach based on duration of paralysis, etiology and extent of nerve injury, overall prognosis, and rehabilitative goals. This review provides a comprehensive overview of current strategies for managing post-skull base surgery facial paralysis. Methods: A narrative review of the literature was performed, analyzing surgical reanimation techniques (nerve grafting, nerve transfers, regional and free muscle transfers), static procedures for facial symmetry and ocular protection, and non-surgical interventions such as physical therapy, botulinum toxin injections, and psychological support. Key criteria guiding treatment selection, including muscle viability and timing since injury, were examined. Results: Dynamic surgical approaches remain central to restoring movement. Nerve grafting and transfers are effective when viable musculature is present, whereas regional or free muscle transfers are required in long-standing paralysis with irreversible atrophy. Static procedures provide adjunctive improvements in resting symmetry and eye protection. Non-surgical strategies, including rehabilitation therapy and botulinum toxin, enhance functional outcomes and reduce synkinesis. Psychological counseling addresses the profound emotional burden associated with facial disfigurement. Across modalities, individualized treatment planning is crucial. Conclusions: Management of facial paralysis after skull base surgery demands a multidisciplinary, patient-centered approach. Combining surgical and non-surgical interventions optimizes functional and aesthetic outcomes, helping restore both facial movement and psychosocial well-being. Full article

Magnetic Particle Imaging (MPI) is a new type of tracer-based imaging that has great spatial and temporal resolution, does not require ionizing radiation, and can see deep into tissues by directly measuring the nonlinear magnetization response of superparamagnetic iron oxide nanoparticles (SPIONs). Unlike Magnetic Resonance Imaging (MRI) or Computed Tomography (CT), MPI has very high contrast and quantitative accuracy, which makes it perfect for use in dynamic cardiovascular applications. This study presents a full picture of the most recent changes in cardiac MPI, such as the physics behind Field-Free Point (FFP) and Field-Free Line (FFL) encoding, new ideas for tracer design, and important steps in the evolution of scanner hardware. We discuss the clinical relevance of cardiac MPI in visualizing myocardial perfusion, quantifying blood flow, and guiding real-time interventions. A hybrid imaging workflow, which improves anatomical detail and functional assessment, is utilized to explore the integration of MPI with complementary modalities, particularly MRI. By consolidating recent preclinical breakthroughs and highlighting the roadmap toward human-scale implementation, this article underscores the transformative potential of MPI in cardiac diagnostics and image-guided therapy. Full article

Background: Physiotherapy plays a crucial role in managing women’s health conditions, such as pelvic pain and postpartum recovery. However, its integration into standard care relies heavily on the awareness and referral practices of gynecologists and obstetricians, which may be suboptimal. Objective: To investigate the awareness, attitudes, and referral practices of gynecologists and obstetricians in Libya regarding the role of physiotherapy in women’s health. Methods: A cross-sectional study was conducted in public and private hospitals in Tripoli, Libya. A total of 100 practitioners were invited to participate. A self-administered questionnaire assessed demographics, awareness, attitudes, and practices. Results: The response rate was 67% (n = 67/100). The results revealed a key disparity: while the vast majority of respondents (94.1%) acknowledged the importance of physiotherapy in women’s health and 76.1% reported a willingness to refer patients, only 67.1% perceived physiotherapists as competent to manage these conditions. This indicates a significant gap in understanding specific physiotherapy techniques. Awareness percentage was significantly influenced by factors such as the type of hospital and prior exposure to physiotherapy education. Conclusions: A striking disparity was found between high general awareness (94.1%) and significantly lower perceived competence (67.1%) and knowledge of its role in specific conditions. This gap between general approval and specific understanding directly creates the critical barrier to referral. To improve interdisciplinary collaboration and patient access to care, enhanced educational initiatives for physicians, the development of clear clinical guidelines, and the establishment of dedicated women’s health physiotherapy clinics are strongly recommended. Full article

Background: Scoliosis, a three-dimensional spinal deformity, can impair posture, function, and quality of life. Conservative approaches such as structured physical therapy are widely used, but evidence from long-term, real-world settings remains limited. In this study, “structured” refers to a standardized, supervised program delivered three times per week, incorporating postural correction, Klapp-based positioning, core strengthening, flexibility training, and progressive intensity adjustments rather than ad hoc or unsupervised exercise. Methods: In this 12-month longitudinal study, 240 patients aged 15–19 years with idiopathic scoliosis (Cobb angle 15–25°) were enrolled; 222 completed the program and were included in analyses. All participants were near or beyond skeletal maturity, representing a population with low residual risk of curve progression. Spinal alignment was assessed by Cobb angle at baseline, 6 months, and 12 months, with monthly clinical evaluations to track progress. Outcomes were analyzed by baseline severity, age, sex, and skeletal maturity (Risser stage) using paired-samples t-tests, repeated-measures ANOVA, subgroup analyses, and multivariable regression. Clinically meaningful improvement was defined as a ≥20% reduction in Cobb angle from baseline. Results: Mean Cobb angle decreased from 18.59° at baseline to 14.85° at 12 months (Δ = −3.74°, 20.3% relative reduction; p < 0.001). The largest improvement occurred in the first 6 months (−3.04°, p < 0.001), followed by a smaller gain between months 6 and 12 (−0.70°, p = 0.012). Patients with milder baseline curves improved more than those with greater deviations (4.45° vs. 3.21°, p < 0.001). Monthly clinical follow-ups suggested gradual improvement between radiographic assessments, though detailed statistical analyses were limited to baseline, 6 months, and 12 months. In multivariable regression, baseline severity remained the only significant predictor of improvement (p < 0.001), while age, sex, and Risser stage were not significant (all p > 0.05). Overall, 24.3% of participants achieved clinically meaningful improvement. Conclusions: A structured 12-month physical therapy program produced significant, sustained improvements in spinal alignment across diverse patient groups. Early intervention in milder curves maximized benefit. These findings support physiotherapy exercise programs as an effective conservative option for scoliosis management. Full article

Background/Objectives: Activities of daily living (ADL) are critical for independence after stroke, yet many survivors remain functionally limited. Vibration therapy (VT), including whole-body and focal modalities, has been proposed as an adjunct to enhance recovery, but effects on ADL remain unclear. This study aimed to evaluate the overall effectiveness of VT on ADL and to identify moderating factors. Methods: A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. Thirteen controlled trials (12 RCTs, 1 nRCT) involving VT in stroke were included. Standardized mean differences (Hedges’ g) were synthesized using random-effects models. Meta-regression and subgroup analyses examined moderators such as session number, vibration parameters, stroke stage, and ADL subdomains. Risk of bias was assessed with RoB 2 and ROBINS-I. Results: VT produced a small but significant effect on ADL (Hedges’ g = 0.19; 95% CI: 0.06–0.33; p = 0.008), though significance was lost after adjustment for publication bias. Heterogeneity was moderate (I² = 34%). Session number was the only significant moderator (p = 0.045), explaining ~24% of variance, with the greatest benefit in the 13–24 session range (g = 0.34; 95% CI: 0.05–0.63). Subgroup analysis showed improvement in physical function/mobility (g = 0.32; p = 0.048), but not in self-care or quality-of-life outcomes. Other parameters were not significant moderators. Conclusions: VT confers modest benefits for ADL after stroke, particularly in mobility-related domains. Session number appears clinically important, with 13–24 sessions suggesting an optimal dose window. Full article

Equine gastric ulcer syndrome (EGUS) refers to mucosal gastric disease in horses, including equine squamous gastric disease (ESGD) and equine glandular gastric disease (EGGD), which present as two distinct disease entities differing in pathophysiology and approach to disease management. Both diseases are a source of pain in affected horses, partly explaining why EGUS continues to receive substantial attention in the equine medical, welfare and equitation research sectors. There is a complex interplay between EGUS and a variety of physical and psychological stressors. Horses with EGUS are often presented to veterinarians with a history of problem behaviors, some of which resolve following gastroprotectant therapy. However, problem behaviors persist in some cases, despite gastroscopic resolution of disease. Some of these horses have pain-related learnt, anticipatory behavior, even after the original source of pain has resolved. Such cases, as well as chronic or refractory EGUS cases, can benefit from a behavioral medicine approach. This includes the management of any underlying diseases, environmental modification, behavior modification, and, in select cases, behavior-modifying medication. This commentary, based on the authors’ clinical experiences and current literature, explores how behavioral medicine can be integrated with traditional pharmacologic, nutraceutical, and husbandry strategies for the multi-modal management of EGUS, with a focus on managing the horse’s experience to improve case outcome. Full article

Proper rehabilitation following rotator cuff repair (RCR) is necessary for successful postoperative outcomes, though the average course of physical therapy (PT) is lengthy and costly. The goals of this study were to (1) develop exercise programs for the CuffLink mHealth system and (2) evaluate early prototype efforts at meeting the needs of RCR clients. A panel of 24 clinicians participated in a Delphi study to identify consensus in rehabilitation, key informatic needs, and appropriate interface modalities for client usage. Utilizing the Delphi findings, the iA CuffLink mHealth system was developed, and a pilot evaluation assessed the feasibility and usability of CuffLink through the mHealth App Usability Questionnaire (MAUQ). During the pilot evaluation, the overall MAUQ score was 6.14. All participants (n = 18) viewed messaging the care team and a real time rep counter as “important” or “very important”. All participants either agreed or strongly agreed that quantifying progress would help motivate them to be compliant, and that the app helped them achieve their recovery outcomes compared to the shoulder device alone. Participants were generally pleased with the ease of use, information arrangement, and usefulness of CuffLink. These findings can advance our understanding of the informatics and usability needs in telerehabilitation systems. Full article

Optimal recovery supports health and enhances performance in soccer players, yet the empirical evidence on various recovery strategies in soccer is complex to interpret. This review aimed to summarize the literature on post-exercise recovery modalities in male and female soccer players of all ages and competition levels. Following PRISMA guidelines, PubMed, SPORTDiscuss, and Web of Science were systematically searched until 17 October 2023. Randomized controlled trials or within-subjects crossover design studies that examined the effects of post-exercise recovery interventions on physical, psychological, or performance outcomes in soccer players were included. A single reviewer extracted data and assessed study quality using the Physiotherapy Evidence Database (PEDro) scale. Overall, 41 studies were included in the final review. The recovery strategies represented in these studies were organized into the following categories: active recovery, blood flow restriction, cold water immersion, contrast water therapy, compression garments, active cool-down, cryotherapy, cold garments, sleep and daytime nap, pneumatic cooling, foam rolling, mindfulness interventions, nutritional intervention, and static stretching. The findings demonstrated that cold-water immersion consistently improved jump performance and perceptions of fatigue, soreness, and overall well-being. Other recovery strategies, such as active recovery, compression therapy, sleep interventions, and nutrition supplementation, also positively impacted recovery, albeit with varying levels of effectiveness and evidence. However, the studies exhibited heterogeneity in methods, outcome measures, and recovery intervention protocols, posing challenges for generalizability. This review summarizes recovery strategies for soccer players, emphasizing the need for practitioners, coaches, and athletes to individualize interventions based on athletes’ needs, preferences, and competition level. Full article

Background: Pain is a disabling issue in athletes, with significant impact on performance and career longevity. Many randomized clinical trials (RCTs) have explored interventions to reduce pain, leading to multiple systematic reviews with meta-analysis, but their methodological rigor and clinical applicability remain unclear. Objective: To provide an overview of systematic reviews with meta-analysis on interventions aimed at alleviating pain intensity in athletes, identifying knowledge gaps and appraising methodological quality. Methods: CINAHL, Embase, Epistemonikos, PubMed, Scopus, SPORTDiscus, and Cochrane Library were searched from inception to February 2025. Systematic reviews with meta-analysis of RCTs evaluating interventions to manage pain in athletes were considered. Athletes without restrictions in terms of sports, clinical, and sociodemographic characteristics were included. Overlap between reviews was calculated using the corrected covered area. Results: Twelve systematic reviews met inclusion criteria. Physical exercise modalities (e.g., gait retraining, hip strengthening), acupuncture, photo biomodulation, and topical medication showed potential benefits in reducing pain intensity. Other interventions, such as certain manual therapy techniques, platelet-rich plasma, or motor imagery, did not show consistent effects. All reviews focused solely on pain intensity, with minimal stratification by sport or clinical condition which may affect the extrapolation of meta-analyzed findings to the clinical practice. Methodological quality was often low, with flaws in reporting funding sources, lists of excluded studies, and certainty of evidence (was mostly rated as low/very low). Overlap was variable across the interventions. Conclusions: Given low/sparse certainty and minimal sport-specific analyses, no strong clinical recommendations can be made; preliminary signals favor proximal hip strengthening, gait retraining, photo biomodulation (acute soreness), and topical NSAIDs pending higher-quality syntheses. Future reviews should consider mandatory GRADE; pre-registered protocols; sport- and condition-specific analyses; and core outcome sets including multi-dimensional pain. Full article

Background: Breast cancer-related lymphedema (BCRL) is a common complication that impairs function and quality of life (QoL). The comparative effectiveness of physical therapy interventions (PTIs) remains unclear. This systematic review and network meta-analysis (NMA) was conducted to identify the most effective PTIs for BCRL management. Methods: A systematic search of Medline/PubMed, LILACS, CENTRAL, PEDro, and CINAHL was conducted up to July 2024. Eligible studies were randomized controlled trials (RCTs) involving women with BCRL, evaluating PTIs delivered alone or in combination. Primary outcomes were lymphedema volume, volume reduction, percentage reduction, QoL, and pain. Secondary outcomes included range of motion (ROM), grip strength, and adverse events. A frequentist NMA was performed, and certainty of evidence (CoE) was assessed using the GRADE approach. Results: Eighty-three RCTs were identified, of which twenty-six (1203 participants) were included in the NMA, assessing 23 PTIs. Based on moderate CoE, yoga was among the most effective interventions for improving QoL within 6 months compared to usual standard care (USC). The multimodal approach, with or without a home exercise program, showed intermediate benefits for external rotation and may also improve shoulder abduction (low to moderate CoE). No intervention demonstrated clear superiority over USC for other outcomes. Adverse events were reported with kinesiotaping and compression measures. Conclusions: The evidence supports yoga and multimodal programs as potential short-term strategies for improving QoL and shoulder mobility in women with BCRL. However, the predominance of low-to-very-low CoE underscores the need for individualized clinical decisions and future high-quality RCTs with standardized comparators, larger samples, and longer follow-up. The consistent use of standardized comparators will be crucial in improving network connectivity and enabling more robust and comprehensive comparisons across multiple interventions. Full article

Metabolic imaging is undergoing a fundamental transformation. Traditionally confined to static representations of metabolite distribution through modalities such as PET, MRS, and MSOT, imaging has offered only partial glimpses into the dynamic and systemic nature of metabolism. This Perspective envisions a shift toward dynamic metabolic intelligence—an integrated framework where real-time imaging is fused with physics-informed models, artificial intelligence, and wearable data to create adaptive, predictive representations of metabolic function. We explore how novel technologies like hyperpolarized MRI and time-resolved optoacoustics can serve as dynamic inputs into digital twin systems, enabling closed-loop feedback that not only visualizes but actively guides clinical decisions. From early detection of metabolic drift to in silico therapy simulation, we highlight translational pathways across oncology, cardiology, neurology, and space medicine. Finally, we call for a cross-disciplinary effort to standardize, validate, and ethically implement these systems, marking the emergence of a new paradigm: metabolism as a navigable, model-informed space of precision medicine. Full article