Motor deficits caused by stroke are one of the significant contributors to long-term disability, which minimally improves independence and quality of life. Although rehabilitation in hospitals has shown to be effective, the lack of accessibility, cost, and compliance have also been identified as barriers to other forms of rehabilitation. Home-based rehabilitation is a feasible option; there is a lack of structured programs and evidence-based practice. This pilot was used to assess the viability, safety, and initial results of an organized 4-week home-based intervention involving rehabilitation. Ten participants with post-stroke between 45 and 70 years were involved in mobility, balance, and strength daily exercises, and the pre- and post-intervention tests were performed using both the Fugl-Meyer Assessment and the Timed Up and Go (TUG) test. There were no adverse events and high adherence to the program reported by all participants who report it to be easy to follow and help them in achieving their recovering aims. The clinical outcomes showed the improvement of motor skills and mobility, whereas subjective feedback showed the increase of confidence, motivation, and self-efficacy in carrying out daily activities independently. The results indicate that structured home-based rehabilitation is a viable, safe, and possibly effective addition to the hospital-based care and can facilitate physical recovery and patient engagement. Notably, the program enhanced more autonomy and motivation, which are crucial when it comes to rehabilitation success in the long run. Despite the small sample size and brief timeline, this study demonstrates some promising results that patient-based, adaptable rehabilitation plans can be extended to enhance access and compliance in post-stroke groups. These findings should be supported by bigger and more longitudinal studies to validate the findings and optimize program protocols, eventually increasing rehabilitation options to serve patient needs and maximize recovery outcomes.

Introduction:

Vitamin D plays a crucial role in calcium homeostasis and bone metabolism. Deficiency in vitamin D is linked to impaired bone mineralization, increased fracture risk, and osteoporosis. Despite growing global awareness, vitamin D insufficiency remains highly prevalent across different age groups, particularly in the elderly and postmenopausal women. This study aims to evaluate the impact of vitamin D levels on bone health outcomes, investigate the effectiveness of supplementation in at-risk populations, and highlight the importance of preventive strategies in clinical practice.

Methods:

A systematic review was conducted, including randomized controlled trials (RCTs) and observational studies published between 2015 and 2024. Databases searched included PubMed, Scopus, and Cochrane Library. Studies assessing serum 25-hydroxyvitamin D levels and outcomes such as bone mineral density (BMD), fracture incidence, or bone turnover markers were included. Data were extracted on participant demographics, intervention type, duration, baseline vitamin D status, and clinical outcomes. A qualitative synthesis was performed to identify trends and evaluate clinical significance.

Results:

Twenty-eight studies with a total of 15,342 participants were included. Low serum vitamin D (<20 ng/mL) was consistently associated with reduced BMD and a higher risk of osteoporotic fractures. Supplementation, particularly when combined with calcium, significantly improved BMD in postmenopausal women and elderly men. Fracture risk reduction ranged from 12% to 25%, especially in participants with baseline deficiency. Compliance, dosage, duration of supplementation, and initial vitamin D status were key determinants of efficacy.

Conclusion:

Maintaining adequate vitamin D status is essential for bone health, particularly in high-risk populations. Vitamin D supplementation effectively improves BMD and reduces fracture risk when appropriately administered. Early detection of deficiency and individualized supplementation strategies are recommended to optimize skeletal outcomes and support long-term musculoskeletal health.

Introduction: Autism is a neurodevelopmental disorder with a neurobiological basis. It is characterized by problems in communication, behavior and social interaction. The motor development of children with autism spectrum disorders is often delayed compared to neurotypical children. Both small and large motor skills can be impaired. This translates into problems with coordination and balance, communication, reluctance to engage in physical activity, and sometimes intellectual disability. Promptly undertaken, systematic rehabilitation has a positive impact on the functioning of people on the autism spectrum. Rehabilitation has a significant impact not only on motor development, but also on the child's cognitive, social, and emotional development.

The purpose of this study was to assess posture in children with autism spectrum disorder using a proprietary survey questionnaire completed by parents, and to determine what postural defects occur in children with autism spectrum disorder, what ailments the children struggle with, what therapeutic activities are carried out, and what type of physical activity the children engage in.

Methods: This study involved 140 parents of children aged 5-15. A proprietary survey questionnaire consisting of 36 questions was used, including questions about the child's attitude, activities undertaken, ailments accompanying the child, difficulties in daily functioning, and therapeutic activities.

Results: The survey showed that the majority of children do not have a diagnosed postural defect, and the most common among those who had one was flat and valgus feet. Most of the children do not have any complaints. The children receive help from a psychologist, speech therapist, Si therapist and various specialized clinics, most often psychiatric. Physical activity undertaken by the child is usually moderate, with children most likely to choose running and walking.

Conclusions: Systematic rehabilitation and prevention among children on the autism spectrum has a positive impact on improving quality of life and correcting posture.

Introduction

Regular physical activity is considered one of the most impactful lifestyle factors for promoting health and longevity. However, there remains a gap in evidence regarding the effectiveness of online and mobile rehabilitation interventions specifically designed for older adults. This study sought to systematically review and synthesize the literature on digital physical therapy interventions for aged adults, quantifying outcomes including lifestyle indicators (VO₂ max), biometrics, and clinical outcomes such as falls, hospital admissions, and functional index scores.

Methods

A systematic review and meta-analysis was conducted using predefined inclusion criteria and keyword combinations (“aged adults,” “mobile therapy,” “rehabilitation,” “non-acute”). Seventeen studies published between 2016 and 2025 were included, the majority of which were randomized controlled trials (RCTs, n = 13). Extracted data included participant demographics, intervention characteristics, outcome measures, and risk of bias. Pooled analyses were performed where outcomes were comparable across studies.

Results

A total of 17 studies (combined N ≈ 3,400 participants, mean study size 212, range 29–1628) were included. Interventions primarily utilized videoconferencing, app-based monitoring, and virtual reality platforms. Online physical therapy was associated with significant improvements in functional mobility scores (e.g., chair stand, Timed Up-and-Go), increased activity levels, and reduced falls compared with usual care. Meta-analysis of mobility outcomes (5 RCTs) demonstrated a moderate pooled effect size favoring intervention (SMD = 0.42, 95% CI 0.25–0.59, p < 0.001). Secondary outcomes showed gains in lean muscle mass and balance indices, while hospital admissions and mortality were less consistently reported. Risk of bias was generally low to moderate, with most trials using randomization and standardized protocols.

Conclusion

Online physical therapy interventions delivered through mobile health applications improve mobility, functional outcomes, and fall risk in older adults. Evidence supports integrating digital rehabilitation as a scalable strategy to enhance aged adult health. Future work should standardize outcome measures and assess long-term biomarkers related to aging.

Introduction: High-Intensity Interval Training (HIIT) emerges as a safe, effective, and time-efficient strategy for individuals with type 1 diabetes (T1D), with positive effects on glycemic control, cardiovascular function, and physical fitness. Studies suggest that HIIT reduces the risk of both acute and late-onset hypoglycemia compared to other exercise modalities, thus promoting adherence. Factors such as prandial state, insulin dosage, and time of day influence glycemic responses. However, there is no clear consensus on the optimal type, structure, or dosage of HIIT for people with type 1 diabetes. The wide variability in protocols, regarding intensity, interval duration, repetitions, rest periods, and weekly frequency, hampers study comparisons and the development of standardized recommendations.

Methods: This study aims to analyze and synthesize current scientific evidence, identifying key parameters for the safe and effective implementation of this approach. A total of 18 studies from MEDLINE and PubMed Central were reviewed and selected based on strict inclusion criteria. Priority was given to HIIT interventions in individuals with T1D, preferably using cycle ergometers, and reporting metabolic, physiological, or neurological outcomes. Data were organized into four main categories: population characteristics, HIIT protocol parameters, reported outcomes, and safety criteria.

Results: The evidence reveals considerable diversity in HIIT configuration. Although no single parameter explains the observed benefits, protocol adherence and individualization appear to be critical factors. Frequent glucose monitoring—ideally via continuous systems—and professional supervision, including virtual formats, are essential.

Conclusions: A preliminary framework is proposed to guide individualized HIIT programming for people with type 1 diabetes, considering intensity, interval duration, weekly frequency, glycemic control, and personal variables.

introduction: The latest guidelines from the World Health Organization suggest that all adults, including those with chronic conditions or disabilities, should engage in a minimum of 150 to 300 minutes of moderate-to-vigorous aerobic exercise each week. The health implications of physical inactivity are significant, and if global physical activity levels do not improve, the estimated cost associated with this inactivity could reach around USD 5.2 billion over an 11-year period from 2020 to 2030. This study investigates the impact of urinary incontinence (UI) on physical activity levels among women, highlighting that nearly two-thirds of women in the U.S. perceive UI as a barrier to exercise. Methods: Conducted in Spain during 2021 and 2022, this observational study involved 1,446 women, with 55.8% (807) experiencing UI and 25.7% (371) reporting low physical activity. The primary objective was to determine how UI influences physical activity patterns. Researchers measured physical activity levels using the International Physical Activity Questionnaire (IPAQ) and assessed UI's impact through the Urogenital Distress Inventory (UDI-6) scale. Various sociodemographic, health, lifestyle, and obstetric data were collected, followed by statistical analyses using binary logistic regression to establish adjusted odds ratios (aOR). Results: The findings revealed that mixed incontinence (aOR: 1.53) and a higher severity of urinary symptoms (UDI-6 score; aOR: 1.014) were significantly associated with lower physical activity levels. Other contributing factors included age, body mass index (BMI), pelvic pain, and income level, all linked to reduced physical activity (p < 0.001). Conclusion: This study indicates that women suffering from mixed-type UI are more likely to have low physical activity or inactivity. Furthermore, the severity of urinary symptoms correlates with an increased likelihood of reduced activity levels among women with UI. This highlights the need for awareness and potential interventions to address the physical activity barriers posed by UI, ultimately aiming to improve the quality of life of affected women.

Background: Sleep disruption is a prevalent yet under-recognised issue among stroke patients, with growing evidence suggesting its adverse impact on neurological recovery and rehabilitation. This study explores the causes of in-hospital sleep disturbances and evaluates post-discharge care-seeking behaviours in a stroke patient cohort.

Methods: A retrospective cohort study was conducted at Wrexham Maelor Hospital, North Wales, using data from the Sentinel Stroke National Audit Programme (SSNAP), the Welsh Clinical Portal, and EPOC from March 2024 to March 2025. A structured questionnaire was administered post-discharge to assess self-reported sleep quality across three time periods: pre-stroke, during hospitalisation, and after discharge. Contributing factors to sleep disturbance and patient interactions with healthcare providers regarding sleep concerns were also examined.

Results: Among 225 stroke patients, environmental factors were the most frequently reported causes of in-hospital sleep disruption, with noise (n=139) being the leading factor, followed by clinical interventions (n=82), lighting (n=36), anxiety/stress (n=23), pain (n=22), and disability (n=19). Despite widespread disturbances, only 13.3% of patients reported discussing sleep issues with their general practitioner post-discharge, and fewer than 10% received any formal management for sleep-related concerns.

Conclusion:

This study demonstrates that sleep disturbances are highly prevalent among hospitalised stroke patients with environmental factors, emerging as key disruptors. Sleep is a vital aspect of neurological recovery. The inconsistent acknowledgement and therefore inconsistent management of sleep disturbance reinforce the need for routine assessment, staff education on the importance of sleep, and environmental modifications to enhance rest and facilitate timely rehabilitation. In summary, sleep should be regarded not as an ancillary aspect of care but as a core component of stroke management. Embedding this perspective within stroke pathways offers a tangible means of improving recovery rates, reducing disability, and enhancing quality of life for stroke survivors.

Background: Sleep is essential for neurological recovery, yet it remains under-recognised in stroke care. Disrupted sleep is common among stroke patients and may hinder recovery or worsen cardiovascular risk.

Aim: This study explores how sleep duration and quality vary with age before, during, and after hospitalisation for stroke.

Methods: We conducted a retrospective cohort study at Wrexham Maelor Hospital using data from the Sentinel Stroke National Audit Programme (SSNAP), electronic health records from the Welsh Clinical Portal, and discharge summaries from the EPOC system between March 2024 and March 2025. Sleep was assessed through structured post-discharge questionnaires that captured self-reported sleep duration and perceived quality across three phases: prestroke, during hospital admission, and post-discharge. Participants were divided into three age groups: 18–49, 50–74, and 75+ years.

Results: Clear age-dependent differences in sleep duration and quality were evident prior to, during, and following hospitalisation for stroke. Patients aged 50–74 years reported the longest sleep durations before stroke, with a mean of 7.10 hours, while younger participants (18–49 years) had the most substantial post-discharge recovery at 7.30 hours. Older adults (75+ years) consistently had the shortest sleep durations throughout the study period; the mean values during prestroke, inpatient admission, and post-discharge were 6.96 hours, 5.72 hours, and 6.82 hours, respectively, with little improvement in sleep quality. All age groups experienced sleep declines during hospitalisation, with varying degrees of recovery afterward.

Conclusion: Sleep disruption is a widespread problem in stroke care, particularly among older patients who face persistent deficits. These findings emphasise the importance of routine sleep assessments and age-appropriate interventions. Integrating sleep health into comprehensive, patient-centred stroke rehabilitation may improve recovery and long-term well-being.

Background: Prolonged immobilization in children with severe disabling conditions carries a high risk of complications, including pressure ulcers and musculoskeletal deterioration. In line with the Italian Essential Levels of Care (LEA), the Local Health Authority (ASP) of the province of Catania provides specialized beds and mattresses free of charge to eligible paediatric patients with severe disorders. This study aimed to stratify all prescriptions of bedridden aids for individuals under 18 years, collected over 18 months (January 2024–July 2025), analyzing patterns by age, sex, diagnosis, healthcare district, and cost, within the ASP’s broader digitalization strategy (Oslo Project) and Internationalization Digit-aids plan.

Methods: An observational analysis was conducted on 27 paediatric prescriptions across the healthcare districts of Catania. Chi-squared tests (χ²) and contingency coefficients (C) were used to assess associations between demographic, clinical, and economic variables.

Results Most prescriptions involved males (70.4%), clustered in the 7–16 years age range, and concentrated in the Catania district (37%). Tetraparesis was the leading diagnosis (40.7%), followed by muscular dystrophy and cerebral palsy (both 11%). Statistically significant associations emerged between age and diagnosis (χ²=182.5, p<0.0001, C=0.933), with tetraparesis peaking at 14–16 years and cerebral palsy and muscular dystrophy at age 7. District and age were also associated (χ²=59.3, df=40, p=0.025), with younger cases concentrated in Adrano and older ones in the Catania district. District-level analysis (χ²=104.5, p=0.0001, C=0.891) revealed Adrano and Catania as hotspots for tetraparesis, while Paternò showed a distinct profile with cases of muscular dystrophy, pressure ulcers, and tetraparesis. No significant correlation was found between diagnosis and cost (p=0.472), reflecting that device reimbursement is standardized under LEA criteria rather than being disease-specific.

Conclusions: Prescription data revealed a non-uniform distribution, with strong diagnostic and age clustering. Digital stratification enables mapping of paediatric disability needs, supporting equitable allocation of resources and scalable international models for long-term care.

Introduction
Bipolar Disorder (BD) is one of the leading causes of disability worldwide and is frequently associated with persistent cognitive deficits that severely limit functional recovery. Cognitive remediation (CR) is a promising intervention, but traditional approaches face challenges in terms of adherence, patient engagement, and transferability of results to real-life functioning. Virtual reality (VR), through immersive and ecological scenarios, represents an innovative tool able to enhance CR effectiveness and integrate recovery-oriented pathways.

Methods:
In a randomized controlled feasibility trial, patients with BD participated in a VR-based CR program integrated with psychoeducational and recovery-oriented strategies. The intervention lasted 3 months (24 sessions), and cognitive outcomes were assessed post-treatment as well as at 6- and 12-month follow-ups.

Results:
Thirty-six patients completed the follow-ups. Cognitive functions remained stable or improved up to 12 months, with significant gains in language abilities. The intervention was well tolerated and highly acceptable, with low dropout rates. Additional analyses from the research group highlighted the following: (a) improvements in social rhythm regularity and emotional regulation; (b) age-related effects, with young adults benefiting more in complex domains (e.g., working memory) and older adults showing gains in structured functions (e.g., cognitive flexibility); and (c) positive impacts on depressive symptoms and quality of life.

Conclusions:
These findings confirm the feasibility and preliminary efficacy of VR-based CR for BD, with stable long-term outcomes and age-specific benefits. VR represents a paradigm shift in rehabilitation, enhancing engagement, promoting the generalization of cognitive skills to everyday life, and integrating recovery-oriented approaches. Beyond being a technological adjunct, VR emerges as a transformative opportunity in the clinical management of affective disorders. Future multicenter studies with larger samples and extended follow-up are needed to consolidate evidence and establish standardized protocols.