Physical Medicine

Supervised, diagnosis-specific shoulder rehab beats generic home exercise for subacromial impingement

Adults with stage II subacromial impingement randomized to 12 weeks of specific supervised exercise had substantially better outcomes than those doing a general home program. Between-group Constant-Murley differences at 12 weeks and 1 year clearly exceeded minimal clinically important thresholds, favoring supervised exercise. DASH, pain (VAS), kinesiophobia, and irritability all improved more with supervised exercise, also surpassing clinically important differences. Responder rates at 12 weeks were higher with supervised therapy, and benefits persisted to 1 year, supporting ongoing clinic-based, diagnosis-specific programs. 1

Levodopa does not enhance routine stroke rehabilitation outcomes

This systematic review and meta-analysis pooled seven randomized trials of levodopa-based therapy added to stroke rehabilitation in adults. Levodopa had no significant effect on motor recovery versus placebo, with standardized mean difference essentially zero and narrow confidence intervals. Mood and cognitive outcomes were also unchanged, with pooled effects close to null and minimal heterogeneity. The authors conclude levodopa-based augmentation should not be used routinely in stroke rehab outside mechanistic or biomarker-stratified trials. 2

High-intensity respiratory muscle training improves breathing and walking in Parkinson disease

This randomized, sham-controlled trial tested 8 weeks of home-based inspiratory and expiratory muscle training at 60% MIP and MEP in Parkinson disease. Compared with sham, active training produced meaningful gains in maximal inspiratory and expiratory pressures and inspiratory muscle endurance, maintained at follow-up. Dyspnea scores and 6-minute walk distance also favored active training, though confidence intervals included both trivial and worthwhile effects. Data support prescribing structured, high-intensity respiratory muscle training in PD, with some uncertainty about the size of functional benefits. 3

BCI-based rehab yields additional upper-limb recovery in early stroke

This systematic review and meta-analysis included nine randomized trials of brain-computer interface-based upper-limb rehabilitation within 3 months of stroke. BCI-based interventions produced statistically significant improvements in upper-limb function compared with control therapy, with a mean difference around 5 points on motor scales. Activities of daily living showed potential improvement, but findings were highly heterogeneous and not robust in sensitivity analyses. No major safety concerns were reported, suggesting BCI-based rehab is a promising adjunct for upper-limb recovery in early stroke. 4