Physical Medicine

Post-stroke cognitive impairment independently worsens mobility, especially driving

Stroke survivors with cognitive impairment showed significantly worse balance, walking, and simulated driving than cognitively normal stroke survivors and healthy controls. Driving performance deteriorated the most, suggesting complex, cognitively loaded mobility is particularly vulnerable. These mobility deficits were independent of global disability level and motor strength, indicating a distinct cognitive contribution. Findings support routine post-stroke cognitive screening when assessing driving readiness and planning community mobility goals. 1

FES-assisted locomotor training adds little to walking speed or endurance in incomplete SCI

This systematic review and meta-analysis examined treadmill-based functional electrical stimulation–assisted locomotor training in motor incomplete SCI. Across three randomized trials, FES-assisted training did not significantly improve walking speed versus other locomotor training (Hedges g ≈ -0.01). Similarly, there was no significant added benefit for walking endurance compared with control locomotor interventions (small effect, confidence interval crossing zero). Overall evidence quality was limited, with substantial risk of bias and heterogeneity in training dose and stimulation parameters. Current data do not justify FES-assisted treadmill training solely to enhance speed or endurance, pending better-designed trials. 2

Structured physical activity improves lower-extremity performance in older cancer survivors

In this subgroup of the LIFE trial, 371 adults aged 70-89 years with prior cancer were randomized to physical activity or health education. The physical activity arm produced modest but significant Short Physical Performance Battery gains at 6, 12, and 24 months versus education. Walking speed over 400 m improved at 6 and 12 months but not sustained at 24 months. Moderate-to-vigorous activity volume partially mediated gains in performance measures, supporting dose–response effects. Results reinforce prescribing structured, ongoing physical activity in oncology follow-up to maintain lower-extremity function and delay mobility disability. 3

Lifting and bending transiently trigger low back pain flares but do not worsen one-year function

In this VA case-crossover cohort, 416 adults with low back pain completed nearly 10,000 daily surveys over one year. Each additional hour spent lifting more than 10 lb, bending, pushing or pulling, twisting, or squatting increased the short-term odds of a pain flare. More sitting time slightly reduced flare risk over the next 24 hours. However, average exposure to these activities over the first 8 weeks did not predict one-year functional limitations. Patients can be counseled that provocative activities may trigger temporary flares without clearly harming long-term function, supporting graded exposure strategies. 4