A digital healthcare system based on augmented reality (AR) has promising uses for postoperative rehabilitation. We compare effectiveness of AR-based and conventional rehabilitation in patients after rotator cuff repair (RCR). This study randomly allocates 115 participants who underwent RCR to digital healthcare rehabilitation group (DR group) and conventional rehabilitation group (CR group). The DR group performs AR-based home exercises using UINCARE Home+, whereas the CR group performs brochure-based home exercises. The primary outcome is a change in the Simple Shoulder Test (SST) score between baseline and 12 weeks postoperatively. The secondary outcomes are the Disabilities of the Arm, Shoulder and Hand (DASH) score; Shoulder Pain And Disability Index (SPADI) score; EuroQoL 5-Dimension 5-Level (EQ5D5L) questionnaire score; pain; range of motion (ROM); muscle strength; and handgrip strength. The outcomes are measured at baseline, and at 6, 12, and 24 weeks postoperatively. The change in SST score between baseline and 12 weeks postoperatively is significantly greater in the DR group than in the CR group (p = 0.025). The SPADI, DASH, and EQ5D5L scores demonstrate group×time interactions (p = 0.001, = 0.04, and = 0.016, respectively). However, no significant differences over time are observed between the groups in terms of pain, ROM, muscle strength, and handgrip strength. The outcomes show significant improvement in both groups (all p < 0.001). No adverse events are reported during the interventions. AR-based rehabilitation shows better improvement in terms of shoulder function after RCR compared to conventional rehabilitation. Therefore, as an alternative to the conventional rehabilitation, the digital healthcare system is effective for postoperative rehabilitation.

To investigate duration of the treatment effect of extracorporeal shockwave therapy (ESWT) on spasticity levels measured with Modified Ashworth Scale (MAS) regardless of the patient group (stroke, multiple sclerosis, and cerebral palsy) and evaluate its spasticity-reducing effect depending on the number of shocks and site of application. PubMed, EMBASE, the Cochrane Library, and Scopus were searched from database inception to February 2018. Randomized controlled trials and cross-over trials were included. All participants had spasticity regardless of cause. ESWT was the main intervention and MAS score was the primary outcome. Among 122 screened articles, 9 trials met the inclusion criteria. The estimate of effect size showed statistically significant MAS grade reduction immediately after treatment (standardized mean difference [SMD]=-0.57; 95% confidence interval [CI], -1.00 to -0.13; p=0.012), 1 week after (SMD=-1.81; 95% CI, -3.07 to -0.55; p=0.005), 4 weeks after (SMD=-2.35; 95% CI, -3.66 to -1.05; p<0.001), and 12 weeks after (SMD=-1.07; 95% CI, -2.04 to -0.10; p=0.03). Meta-regression and subgroup analysis were performed for the 'immediately after ESWT application' group. The prediction equation obtained from metaregression was -1.0824+0.0002* (number of shocks), which was not statistically significant. Difference in MAS grade reduction depending on site of application was not statistically significant either in subgroup analysis (knee and ankle joints vs. elbow, wrist, and finger joints). ESWT effectively reduced spasticity levels measured with MAS regardless of patient group. Its effect maintained for 12 weeks. The number of shocks or site of application had no significant influence on the therapeutic effect of ESWT in reducing spasticity. Ongoing trials with ESWT are needed to address optimal parameters of shock wave to reduce spasticity regarding intensity, frequency, and numbers.

Background: Neutrophil-to-lymphocyte ratio (NLR), a systemic inflammatory biomarker, has been associated with poorer outcomes in acute ischemic stroke patients. The present study was designed to expand these findings by investigating the association between NLR and short-term functional outcomes in acute ischemic stroke patients. Methods: This retrospective study evaluated patients within 7 days after the onset of acute ischemic stroke. Stroke severity on admission was measured using the National Institutes of Health Stroke Scale (NIHSS). The functional outcomes were assessed using the Berg Balance Scale (BBS), Manual Function Test (MFT), the Korean version of the modified Barthel Index (K-MBI), and the Korean Mini-Mental State Examination (K-MMSE) within 2 weeks of stroke onset. The modified Rankin Scale (mRS) was evaluated at discharge. Results: This study included 201 patients, who were grouped into three NLR tertiles (2.71) on admission. A multivariate analysis showed that the top tertile group (NLR > 2.71) had significantly higher risks of unfavorable outcomes on the K-MBI (p = 0.010) and K-MMSE (p = 0.029) than the bottom tertile group (NLR < 1.84). Based on the optimal cut-off values from a receiver operating characteristic curve analysis, a higher NLR was significantly associated with higher NIHSS scores (p = 0.011) and unfavorable outcomes on the K-MBI (p = 0.002) and K-MMSE (p = 0.001). Conclusions: A higher NLR is associated with poorer short-term functional outcomes in acute ischemic stroke patients.

Background: Sarcopenia is commonly observed in patients with cardiovascular diseases. However, studies on the association between sarcopenia and atrial fibrillation and their causal relationships are limited. We performed cross‐sectional and longitudinal analyses to investigate the association between sarcopenia and atrial fibrillation among community‐dwelling older adults.Methods: A total of 2225 participants from the Korean Frailty and Aging Cohort Study (KFACS) from 2016 to 2017 were included in this cross‐sectional analysis. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 consensus. Atrial fibrillation was diagnosed on the basis of electrocardiographic findings. We investigated whether atrial fibrillation increased the risk of incident sarcopenia 2 years later and whether sarcopenia, in turn, increased the 2‐year risk of developing atrial fibrillation using KFACS data from 2018 to 2019.Results: Of the 2225 participants (54.2% women; mean age 76.0 ± 3.9 years), 509 (22.9%) had sarcopenia at baseline. In the cross‐sectional analysis, sarcopenia was associated with atrial fibrillation after multivariate adjustment [odd ratio (OR), 2.127; 95% confidence interval (CI), 1.240–3.648; P = 0.006]. Among the sarcopenia components, low physical performance was associated with atrial fibrillation (OR, 1.872; 95% CI, 1.123–3.120; P = 0.016). During the 2‐year follow‐up period, atrial fibrillation was not associated with new‐onset of sarcopenia (OR, 1.483; 95% CI, 0.597–3.685; P = 0.396), and sarcopenia also did not significantly increase the risk of incident atrial fibrillation (OR, 1.120; 95% CI, 0.384–3.264; P = 0.836).Conclusions: Although we found a significant association between sarcopenia and atrial fibrillation in a cross‐sectional analysis, we could not establish a causal relationship between the two based on 2 years of follow‐up. Further research with long‐term follow‐up is required to identify causal relationship between atrial fibrillation and sarcopenia.

Objective: Metabolic syndrome (MetS) and sarcopenia together pose significant health risks, increasing frailty, falls, and fractures in older adults. This study compared muscle mass measurements obtained using two different dual-energy X-ray absorptiometry (DXA) machines and bioelectrical impedance analysis (BIA), and evaluated the accuracy of these measurements in these older adults. Methods: In this prospective multicenter cohort study, patients aged ≥ 65 years with MetS had their muscle mass assessed using both BIA and DXA. Two DXA devices, Hologic Horizon and GE Lunar Prodigy, were used as clinical standards for sarcopenia diagnosis. Statistical analyses generated equations for transforming BIA results to match those from DXA, enhancing comparability. Results: Participants had a mean age of 73.2 ± 5.3 years. The mean appendicular skeletal muscle mass (ASM) measured by BIA and DXA was 19.7 ± 3.1 kg (BIA) and 18.1 ± 2.9 kg (DXA) for males, and 13.7 ± 2.2 kg (BIA) and 12.6 ± 1.8 kg (DXA) for females. Device-specific equations were developed to estimate DXA-measured ASM based on BIA results. These equations are presented for all participants and for each DXA device, highlighting significant differences in prediction models between the two DXA machines. Conclusion: The study developed device-specific equations for sarcopenia diagnosis in older adults with MetS, highlighting substantial differences between Hologic and GE Lunar devices. While BIA may offer a more accessible alternative to DXA, the variation in prediction formulas underscores the need for standardized equipment to ensure consistency in sarcopenia diagnosis.

Chon J, et al. Brain Neurorehabil. 2024 Nov;17(3):e23. https://doi.org/10.12786/bn.2024.17.e23