Objectives: Motor imagery (MI) may enhance post-stroke recovery, but evidence of its benefit over conventional rehabilitation therapy (CRT) is inconsistent. This study evaluated the effect of MI combined with CRT on upper-limb recovery, accounting for methodological quality and publication bias. Methods: A systematic review and meta-analysis was conducted following PRISMA guidelines. Searches were performed in multiple databases up to July 2025. Methodological quality and risk of bias were assessed using the PEDro scale and Cochrane RoB 2 tool, respectively. Analyses included the calculation of effect sizes (ES), heterogeneity, sensitivity, publication bias, and GRADE-based certainty assessment. Results: From 4074 records, 10 randomized controlled trials (n = 255) were included. The initial pooled analysis showed a small-to-moderate effect of MI + CRT versus CRT alone (ES = 0.45; 95% CI: 0.16–0.74). However, the overall ES calculated with a robust variance estimator was −0.06 (95% CI: −0.21, 0.08). Most trials had methodological limitations (mean PEDro = 6.0; high risk of bias in 7/10 studies). The GRADE evaluation indicated a very low certainty of evidence. Conclusions: The initially observed positive effect of MI combined with CRT is not robust. When accounting for statistical dependencies and potential biases, the effect vanishes and is no different from zero. Current evidence does not support the use of MI as a standalone adjunct to CRT. Larger, high-quality RCTs with standardized protocols are required to establish any potential clinical relevance.

Background: The early detection of fall risk in older adults is crucial for prevention. This study assessed the 3-Meter Backward Walk Test (3m-BWT) as a predictor of falls. Methods: A retrospective observational case–control study was conducted with 483 community-dwelling participants (mean age 76.3 ± 6.5 years), including 101 individuals with a history of falls in the previous 12 months. A standardized battery of functional assessments was applied. Results: Significant differences were observed between fallers and non-fallers across all functional variables (p < 0.001), with fallers demonstrating slower performance on the 3m-BWT (6.8 ± 3.4 s vs. 5.1 ± 1.3 s). The 3m-BWT showed moderate correlations with Short Physical Performance Battery, 5-repetition Sit-to-Stand, gait speed, and 4-Square Step Test, and a moderate-to-strong correlation with Timed Up-and-Go (r = 0.632), even after adjusting for age, sex, and BMI. Although the 3m-BWT exhibited superior discriminative ability compared to other tests (AUC = 0.655), its predictive power in isolation remains limited. The optimal cut-off point was identified at 5.5 s (sensitivity: 59.5%; specificity: 68.6%), while a threshold of <3.5 s yielded high sensitivity (98%) but low specificity, supporting its use in fall risk screening. Conclusions: These findings support the integration of the 3m-BWT as a complementary tool within comprehensive geriatric assessments, particularly in contexts requiring high sensitivity. Given the multifactorial nature of falls, combining the 3m-BWT with other clinical evaluations and fall history is recommended to enhance risk stratification and inform preventive strategies.

Background: Motor imagery (MI) and mirror therapy (MT) are widely used neurorehabilitation strategies to enhance motor recovery after stroke and are commonly applied as adjuncts to conventional rehabilitation therapy (CRT). However, direct comparative evidence between these interventions remains limited. This systematic review compared the effects of MI and MT on motor function, functional performance, spasticity, and gait-related outcomes in adults after stroke. Methods: A systematic comparative review with narrative synthesis was conducted following PRISMA guidelines and registered in PROSPERO (CRD420251274308). PubMed, Cochrane Library, CINAHL, Scopus, Web of Science, and ScienceDirect were searched up to July 2025. Clinical trials directly comparing MI and MT in adults with stroke were included. Methodological quality was assessed using the PEDro scale, and risk of bias was evaluated with the Cochrane RoB 2 tool. Results: Six clinical trials involving 206 participants were included. Both MI and MT were associated with significant pre–post improvements across motor function, functional performance, spasticity, and gait-related outcomes. Between-group comparisons yielded heterogeneous findings, with no consistent evidence supporting the superiority of either intervention. Isolated advantages of MI were reported for specific upper-limb subdomains, but these effects were not consistently replicated. Overall methodological quality ranged from low to moderate, and all included studies were judged to be at high risk of bias according to the RoB 2 tool. Conclusions: MI and MT appear to provide comparable benefits for motor and functional recovery after stroke when used as adjuncts to CRT. Current evidence does not support the preferential use of one intervention, highlighting the need for well-designed trials with improved methodological rigor.

Background/Objectives: Chronic pain in older adults is a highly disabling epidemic, often overtreated with passive pharmacological approaches. Although clinical guidelines recommend active strategies combining multicomponent exercise and Pain Neuroscience Education (PNE), robust geriatric evidence remains scarce. Therefore, the central objective of this randomized controlled trial (RCT) is to evaluate the efficacy of combined PNE and exercise versus exercise alone. Crucially, this RCT addresses a major literature gap by investigating the long-term dose–response effect of PNE (an 8-week intensive vs. a 32-week maintenance program) to determine the optimal strategy for sustaining behavioral change and pain relief. Methods: A prospective, single-blind RCT (1:1:1 allocation) will recruit 90 older adults (≥65 years) with primary chronic musculoskeletal pain. The 32-week intervention comprises three arms: a control group (multicomponent exercise), Intervention Group 1 (exercise + 8 weeks of PNE), and Intervention Group 2 (exercise + 32 weeks of PNE). The primary outcome is pain intensity (assessed via the Numeric Rating Scale [NRS]). Secondary outcomes include kinesiophobia, pain catastrophizing, chronic pain grade and related disability, quality of life, physical performance, body composition and analgesic consumption. Data collected at baseline, 8, and 32 weeks will be analyzed using mixed-effects models for repeated measures. Results: As this is a study protocol, there are no results to report yet. Upon completion of the trial, data will be analyzed using mixed-effects models for repeated measures to evaluate intra- and intergroup changes over time, and the findings will be disseminated in future publications. Conclusions: By evaluating the long-term dose–response effect, this study will determine the optimal PNE dosage required for sustained pain relief and behavioral change in older adults. If our hypotheses are confirmed, the findings will generate high-quality evidence to support the integration of combined active interventions into community settings, promoting active aging and reducing the burden of chronic pain. Trial Registration: ClinicalTrials.gov Identifier: NCT07287501.

Background and Objectives: Although several meta-analyses have evaluated the effects of motor imagery (MI) on upper-limb recovery using the Fugl-Meyer Assessment for the Upper Extremity (FM-UE), evidence based on more specific (Action Research Arm Test, ARAT) and functional (Barthel Index, BI) outcomes remains scarce. This study examined the effect of MI combined with conventional rehabilitation therapy (CRT), which translates into meaningful improvements in upper-limb performance and functional independence after stroke, accounting for methodological quality and publication bias. Materials and Methods: A systematic review and meta-analysis were carried out in accordance with PRISMA recommendations, with prior registration in PROSPERO (CRD420251120044). Comprehensive searches were conducted across six electronic databases up to July 2025. The methodological rigor of the included studies was evaluated using the PEDro scale, and risk of bias was appraised with the Cochrane RoB 2 instrument. Random-effects models estimated pooled effect sizes (ESs) for the ARAT and BI, alongside analyses of heterogeneity, publication bias, and moderators. Results: Eleven RCTs (n = 425) were included. A small pooled improvement in ARAT was observed (ES = 0.25; 95% CI: 0.13–0.37; p < 0.001); however, this effect was rendered non-significant after correction for publication bias (ES = 0.08; 95% CI: −0.14–0.31). No significant differences were found for the BI (ES = 0.41; 95% CI: −0.35–1.18; p = 0.268), with substantial heterogeneity (I² = 96.6%). The mean PEDro score was 6.6, indicating moderate methodological quality. Conclusions: MI combined with CRT yields small and inconsistent effects on upper-limb recovery and no improvement in functional independence. Current evidence does not support its routine use in stroke rehabilitation. Well-designed, adequately powered randomized controlled trials employing standardized MI protocols are required to determine its true clinical relevance.

Introduction: Handgrip strength is essential for diagnosing sarcopenia and assessing muscle function in older adults. The Jamar hydraulic dynamometer, backed by strong clinical and epidemiological data, is widely used; however, weight and calibration requirements may limit use. Digital models such as InGrip offer stable calibration and ergonomic design. This study aimed to validate accuracy, reliability, and diagnostic performance of InGrip versus the Jamar. Methods: A cross-sectional, randomized, single-center study of 415 community-dwelling older adults (mean age: 75.3 ± 6.5 years). Handgrip strength was measured with both devices per the Southampton protocol. Correlation and agreement (Bland–Altman, ICC) between InGrip and the reference dynamometer (Jamar) were analyzed, and diagnostic capacity via ROC curves, estimating sensitivity, specificity, and predictive values for low handgrip strength per EWGSOP2 criteria. Results: The InGrip dynamometer showed strong correlation with the Jamar dynamometer (r = 0.95) and excellent agreement (ICC = 0.94), intra-observer (ICC = 0.96), and inter-observer (ICC = 0.96), with a mean bias of − 0.37 kg and limits of agreement from – 4.45 to 3.72 kg. Its diagnostic capacity was high (AUC women = 0.968; AUC men = 0.982). Optimal cutoffs were ≤ 18 kg for women (sensitivity = 92.6%, specificity = 90.5%) and ≤ 27.5 kg for men (sensitivity = 96%, specificity = 93%). Conclusion: The InGrip digital dynamometer showed excellent validity, reliability, and diagnostic accuracy compared to the Jamar in community-dwelling older adults, with sex-specific cutoffs aligned with EWGSOP2 criteria, supporting its use as a practical alternative for strength assessment in research and clinical practice. Trial registration: ClinicalTrials.gov NCT06623019.