Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Frailty is a geriatric syndrome associated with increased risk of falls, hospitalization, and reduced quality of life. Traditional exercises may be unsuitable for frail older adults due to mobility issues and accessibility barriers. Virtual reality (VR) offers an engaging, home-based alternative by providing interactive training with real-time feedback. VR interventions have shown potential benefits for improving balance, strength, and mobility Objective: To systematically evaluate the effectiveness of VR-based home training programs in improving balance, strength, and mobility among frail and pre-frail older adults. Methods: A systematic search was conducted in PubMed, Scopus, and Web of Science from inception to November 1, 2023, using terms related to older adults, frailty, virtual reality, balance, mobility, and strength. Eligible studies included randomized and non-randomized trials involving frail or pre-frail adults aged ≥65 years who received home-based VR interventions aimed at improving balance, strength, or functional mobility. Comparator groups included no intervention, traditional exercise, or standard care. Studies involving participants with neurological or cognitive disorders were excluded. Study quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. A random-effects meta-analysis was performed to calculate pooled mean differences (MD) and 95% confidence intervals (CI) for three primary outcomes Berg Balance Scale (BBS), Timed Up and Go (TUG), and Chair Stand (CS). Results: A total of 1063 records were identified, with 1023 screened after duplicate removal. Six studies met the inclusion criteria, involving 407 participants (mean age 75.2 ± 6.4 years), of whom 198 were allocated to VR interventions and 159 to control groups. VR interventions lasted a mean of 13.3 ± 7.7 weeks, with an average of 39.6 ± 5.2 sessions lasting 25.3 ± 5 minutes. Methodological quality was high in five studies (mean PEDro score = 5.6 ± 1.3). Four studies were included in the meta-analysis. Significant improvements were observed in balance, as measured by the BBS (mean difference = 3.62; 95% CI 2.29–4.95; P < 0.001; I² = 0%). No significant effects were found for mobility (TUG: MD = -0.37; 95% CI -1.16 to 0.41; P = 0.35; I² = 0%) or strength (Chair Stand: MD = -0.20; 95% CI -1.70 to 1.29; P = 0.79; I² = 21%). Conclusions: VR-based training appears effective in improving balance in frail and pre-frail older adults, but its impact on strength and mobility remains inconclusive. These inconsistencies may be attributed to differences in intervention type, progression, and outcome measures. Future research should focus on optimizing VR program design and exploring long-term adherence and functional outcomes. Clinical Trial: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023478330

Objective: the aim of this systematic review and meta-analysis was to evaluate the effectiveness of photobiomodulation therapy (PBM) on perineal pain and wound healing following episiotomy. Methods: Electronic databases were searched for randomized controlled trials (RCTs) and non-RCTs investigating PBM after episiotomy. Risk of bias was assessed using RoB 2 for RCTs and ROBINS-I for non-RCTs. The certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Meta-analyses were performed using random-effects models. Results: Eight studies were included in the systematic review, and six studies were included in the meta-analysis. According to RoB 2, one trial was judged at low risk of bias, two trials raised some concerns, and three trials were at high risk of bias. ROBINS-I showed the serious risk of bias of two non-RCTs. GRADE for both pain and wound-healing outcomes was rated as very low. Meta-analysis of pain showed no significant difference between PBM and control groups (SMD = 0.04; 95% CI −0.60 to 0.68; p = 0.89), with considerable heterogeneity (I² = 91%). For wound-healing outcomes, meta-analysis showed no significant difference (MD = 0.94; 95% CI −0.69 to 2.56; p = 0.26), with substantial heterogeneity (I² = 94%). Conclusions: PBM therapy did not demonstrate a significant benefit for reducing perineal pain or improving wound healing after episiotomy compared with control interventions. Interpretation of these findings should be made cautiously due to small study numbers, substantial heterogeneity, and the inability to perform sensitivity or subgroup analyses, highlighting the need for high-quality RCT with standardized PBM protocols before clinical recommendations can be made.

Background: This study assessed the beliefs and knowledge of physical therapists in Saudi Arabia regarding the management of patellofemoral pain (PFP) and their alignment with current Clinical Practice Guidelines (CPGs). Methods: A cross-sectional survey was conducted, involving 111 licensed physical therapists actively treating PFP patients. The survey included questions about PFP risk factors, prognosis, diagnosis, and treatment, using a Likert scale to measure confidence and knowledge. Results: Readers have significantly greater confidence in the knowledge of managing patients with PFP following current CPGs (p < 0.01). No significant differences were observed between groups in the other items (p > 0.01). However, over 70% of respondents, irrespective of guideline familiarity, held beliefs about risk factors, prognosis, diagnosis, and treatment that were inconsistent with CPGs. Conclusions: These discrepancies highlight a significant knowledge gap that may affect patient care quality. Enhancing education and dissemination efforts regarding CPGs is essential to improve adherence to evidence-based practices among physical therapists in Saudi Arabia. To change practitioners’ preferences, attitudes, and beliefs, more targeted programs and interventions for knowledge dissemination and implementation should be provided.

Objectives: The aim of this systematic review was to evaluate the effectiveness of photobiomodulation (PBM) on pain and function in individuals with Patellofemoral Pain Syndrome (PFPS). Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Search was performed across PubMed/Midline, Scopus, Web of Science, EBSCO, ScienceDirect, Wiley Online Library, Springer, Cochrane CENTRAL, PEDro, ResearchGate, and Google Scholar from inception to January 2025. Randomized controlled trials (RCT) examining PBM in individuals with PFPS were included. Data extraction, risk-of-bias assessment (RoB 2), and quality of evidence evaluation (GRADE) were performed independently by multiple reviewers. Primary and secondary outcomes were pain and function, respectively. A random effect meta-analysis was performed to estimate the standardized mean difference (SMD) at 95% confidence interval (CI) and overall effect size. Results: Eight trials (340 participants) met the inclusion criteria. PBM significantly reduced pain compared with the control (SMD = −0.83; 95% CI −1.40 to −0.27). Functional outcomes demonstrated a significant improvement favoring PBM (SMD = 0.68; 95% CI 0.08 to 1.27), although substantial heterogeneity was present (I² = 83%). RoB2 showed five high-risk studies. GRADE showed a very low quality of evidence due to study limitations, imprecision, and inconsistency which limit the confidence to the effect estimate. Conclusions: PBM, combined with exercise, provides improvements in pain and knee function in individuals with PFPS. While findings support PBM as an effective adjunct modality, standardized dosing protocols and larger, high-quality RCTs are needed to strengthen future clinical recommendations.

Aim: To systematically review measurement properties of Arabic patient-reported outcome measures (PROMs) that assess activity and participation in children with and without health conditions. Method: Four databases were searched. Arabic PROMs with focus on activity and/or participation constructs were selected. Data on measurement properties were extracted and the methodological quality of the studies was assessed by COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) risk of bias checklist. Result: Of the total 149 articles screened, only 10 studies involving 10 measures that assessed activity and/or participation in children with or without health conditions were included. The focus of all PROMs is primarily on the activity of daily living at home and/or school, but dimensions of measurement differed across PROMs. None of the PROMs demonstrated sufficient properties for all psychometrics. The most studied psychometric property was internal consistency, whereas the least studied psychometric property was structural validity. Responsiveness was not investigated in any of the studies included. Conclusions: Despite the presence of Arabic PROMs on activity and participation for children, none of the reviewed measures satisfied all psychometric properties. Clinicians and researchers are encouraged to carefully select PROMs that are psychometrically sound and appropriate for the construct being measured.