Shoulder pain is one of the most common musculoskeletal conditions, and for people over 40 years old, it represents the musculoskeletal pain with the greatest impact on quality of life. Psychological factors, such as fear-avoidance beliefs, are associated with musculoskeletal pain, and several studies suggest that they can influence various treatment outcomes. Our objective was to explore the cross-sectional association between fear-avoidance beliefs and shoulder pain intensity and disability in subjects with chronic shoulder pain. A cross-sectional study was conducted, and 208 participants with chronic unilateral subacromial shoulder pain were recruited. The shoulder pain and disability index assessed pain intensity and disability. The Spanish fear-avoidance components scale assessed the presence of fear-avoidance beliefs. The association between fear-avoidance beliefs and pain intensity and disability was analyzed by means of multiple linear regression models and proportional odds models, reporting odds ratios and 95% confidence intervals. Shoulder and pain disability scores were significantly associated with fear-avoidance beliefs (p < 0.0001, adjusted R-square 0.93, multiple linear regression). There was no evidence of an association between sex and age in this study. The regression coefficient for shoulder pain intensity and disability score was 0.67446. The proportional odds model showed an odds ratio of 1.39 (1.29–1.50) for shoulder pain intensity and disability total score. This study suggests that greater levels of fear-avoidance beliefs are associated with greater levels of shoulder pain and disability in adults with chronic shoulder pain.

Knee osteoarthritis (KOA) is a prevalent condition globally, leading to significant pain and disability, particularly in individuals over the age of 40. While exercise has been shown to reduce symptoms and improve physical function and quality of life in patients with KOA, long-term adherence to exercise programs remains a challenge due to the lack of ongoing support. To address this, a chatbot was developed using large language models (LLMs) to provide evidence-based guidance and promote adherence to treatment. A systematic review conducted under the PRISMA framework identified relevant clinical guidelines that served as the foundational knowledge base for the chatbot. The Mistral 7B model, optimized with Parameter-Efficient Fine-Tuning (PEFT) and Mixture-of-Experts (MoE) techniques, was integrated to ensure computational efficiency and mitigate hallucinations, a critical concern in medical applications. Additionally, the chatbot employs Self-Reflective Retrieval-Augmented Generation (SELF-RAG) combined with Chain of Thought (CoT) reasoning, enabling dynamic query reformulation and the generation of accurate, evidence-based responses tailored to patient needs. The chatbot was evaluated by comparing pre- and post-improvement versions and against a reference model (ChatGPT), using metrics of accuracy, relevance, and consistency. The results demonstrated significant improvements in response quality and conversational coherence, emphasizing the potential of integrating advanced LLMs with retrieval and reasoning methods to address critical challenges in healthcare. This approach not only enhances treatment adherence but also strengthens patient–provider interactions in managing chronic conditions like KOA.

Introducción: Los factores psicológicos son esenciales para comprender y mejorar el rendimiento del pádel, ya que influyen en la forma en que los jugadores afrontan las exigencias físicas y emocionales de este deporte. Objetivo: Esta revisión sistemática pretende identificar y analizar las principales variables psicológicas estudiadas en relación con el pádel, incluyendo la frustración, la ansiedad, el estrés, la autoconfianza y la fatiga mental. Metodología: La revisión siguió las directrices de PRIS-MA e implicó una búsqueda exhaustiva en cuatro bases de datos principales: PubMed, Web of Science, Scopus y SPORTDiscus, hasta agosto de 2024. Tras aplicar criterios de inclusión y exclusión, se seleccionaron 12 estudios de un total de 1.384, con 1.021 participantes. La mayoría de los estudios fueron descriptivos, transversales y comparativos, y sólo uno adoptó un diseño experimental. Resultados: La revisión reveló que las variables psicológicas más investigadas en el pádel son la ansiedad, la autoconfianza y la fatiga mental inducida por el estrés. Un hallazgo consistente en todos los estudios fue que los jugadores a menudo experimentan altos niveles de ansiedad y estrés antes de las competiciones, mientras que también mantienen niveles elevados de confianza en sí mismos. Además, los jugadores con mayor experiencia y niveles competitivos más altos tienden a gestionar las demandas psicológicas de manera más eficaz que sus compañeros con menos experiencia. Discusión: Estos resultados sugieren que la preparación psicológica y el entrenamiento mental pueden ser cruciales para mejorar el rendimiento en el pádel. Conclusión: Esta revisión destaca la importancia de la preparación psicológica y el entrenamiento mental para mejorar el rendimiento en el pádel.

Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory disorder that poses significant challenges in treatment adherence. This systematic review evaluates the effectiveness of mobile health (mHealth) interventions compared to conventional therapy in improving treatment adherence among COPD patients. A total of 13 randomized controlled trials and comparative cohort studies published up to July 2023 were included, analyzing interventions such as medication reminders and remote monitoring in adult COPD patients. Studies involving participants under 18 years of age or with severe comorbidities were excluded. This review identified 4688 records from MEDLINE, WEB OF SCIENCE, and SCOPUS. Of these, 13 studies met the inclusion criteria. The selection process was conducted by two independent reviewers, with discrepancies resolved by consensus with a third reviewer. The results showed that mHealth interventions improved treatment adherence in some studies, particularly in exercise and symptom monitoring; however, the evidence was inconsistent, and results varied across studies. This review concludes that mHealth interventions have the potential to improve adherence but higher-quality studies and more robust designs are needed to confirm these findings and support their clinical implementation.

Introduction Musculoskeletal disorders (MSDs) represent a significant global health burden that leads to substantial disability with socioeconomic impact. With the rise of artificial intelligence (AI), particularly large language model-driven conversational agents (chatbots), there is potential to enhance the management of MSDs. However, the application of AI-powered chatbots in this population has not been comprehensively synthesised. Therefore, this scoping review aims to explore the current and potential use of AI-powered chatbots in managing MSDs. The review will map out the targeted diseases, the purposes of chatbot interventions, the clinical tools or frameworks used in training these systems and the evaluated outcomes in clinical settings. Methods and analysis This scoping review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines, with a comprehensive search across multiple databases, including Medline (Ovid Medline), Embase (Ovid), ISI Web of Science (Clarivate) and ClinicalTrials.gov. We will include studies involving adults with MSDs, regardless of publication status, language or year. The scoping review will exclude studies using non-AI chatbots or human health coaches. Data extraction and synthesis will focus on demographic characteristics, chatbot methods, outcomes and thematic analysis. Ethics and dissemination Formal ethical approval is not required as this study involves neither human participants nor unpublished secondary data. The findings of this scoping review will be disseminated through professional networks, conference presentations and publication in a scientific journal.

Background: Neurodevelopmental disorders such as attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and Down syndrome (DS) are associated with cognitive, behavioral, motor, and functional impairments that may negatively affect daily functioning and quality of life. Aquatic exercise has emerged as a potential complementary intervention due to its unique physical and sensory characteristics. Objective: To analyze the available evidence regarding aquatic exercise as a complementary intervention for individuals with ADHD, ASD, and DS, considering its potential effects on cognitive, behavioral, motor, and functional outcomes. Methods: A narrative review was conducted using studies identified in PubMed, Scopus, and Web of Science between November 2025 and February 2026. Experimental and quasi-experimental designs, including case studies, evaluating aquatic exercise interventions in individuals with ADHD, ASD, or DS were included. Results: Twenty-two studies were analyzed (ADHD = 7, ASD = 10, DS = 5). In ADHD, aquatic exercise was associated with improvements in inhibitory control, attention, cognitive flexibility, behavioral regulation, academic performance, and cardiorespiratory fitness. In ASD, the main benefits included improvements in balance, motor coordination, aquatic skills, social interaction, communication, adaptive behavior, and behavioral regulation, particularly in Halliwick-based interventions. In DS, positive effects were mainly observed in aerobic capacity, muscular strength, body composition, balance, functional physical fitness, and motor autonomy. Across studies, interventions commonly involved 2–3 weekly sessions lasting 30–90 min over 6–36 weeks. Conclusions: Aquatic exercise appears to be a promising complementary intervention for individuals with ADHD, ASD, and DS, with potential benefits across cognitive, behavioral, motor, and functional domains. Although the available evidence is heterogeneous and methodological limitations remain, aquatic exercise may represent a valuable component of interdisciplinary intervention and adapted physical activity programs.