Patient activation, broadly defined as the ability of individuals to manage their health and navigate the healthcare system effectively, is crucial for achieving positive health outcomes. The Patient Activation Measure (PAM), a popularly used tool, was developed to assess this vital component of health care. This review is the first to systematically examine the validity of the PAM, as well as study its reliability, factor structure, and validity across various populations. Following the PRISMA and COSMIN guidelines, a search was conducted in MEDLINE, EMBASE, and Cochrane Library, from inception to 1 October 2023, using combinations of keywords related to patient activation and the PAM. The inclusion criteria were original quantitative or mixed methods studies focusing on PAM-13 or its translated versions and containing data on psychometric properties. Out of 3007 abstracts retrieved, 39 studies were included in the final review. The PAM has been extensively studied across diverse populations and geographical regions, including the United States, Europe, Asia, and Australia. Most studies looked at populations with chronic conditions. Only two studies applied the PAM to community-dwelling individuals and found support for its use. Studies predominantly showed a high internal consistency (Cronbach’s alpha > 0.80) for the PAM. Most studies supported a unidimensional construct of patient activation, although cultural differences influenced the factor structure in some cases. Construct validity was established through correlations with health behaviors and outcomes. Despite its strengths, there is a need for further research, particularly in exploring content validity and differential item functioning. Expanding the PAM’s application to more diverse demographic groups and community-dwelling individuals could enhance our understanding of patient activation and its impact on health outcomes.

Objective. Invasive brain-computer interfaces (iBCIs) have evolved significantly since the first neurotrophic electrode was implanted in a human subject three decades ago. Since then, both hardware and software advances have increased the iBCI performance to enable tasks such as decoding conversations in real-time and manipulating external limb prostheses with haptic feedback. In this systematic review, we aim to evaluate the advances in iBCI hardware, software and functionality and describe challenges and opportunities in the iBCI field. Approach. Medline, EMBASE, PubMed and Cochrane databases were searched from inception until 13 April 2024. Primary studies reporting the use of iBCI in human subjects to restore function were included. Endpoints extracted include iBCI electrode type, iBCI implantation, decoder algorithm, iBCI effector, testing and training methodology and functional outcomes. Narrative synthesis of outcomes was done with a focus on hardware and software development trends over time. Individual patient data (IPD) was also collected and an IPD meta-analysis was done to identify factors significant to iBCI performance. Main results. 93 studies involving 214 patients were included in this systematic review. The median task performance accuracy for cursor control tasks was 76.00% (Interquartile range [IQR] = 21.2), for motor tasks was 80.00% (IQR = 23.3), and for communication tasks was 93.27% (IQR = 15.3). Current advances in iBCI software include use of recurrent neural network architectures as decoders, while hardware advances such as intravascular stentrodes provide a less invasive alternative for neural recording. Challenges include the lack of standardized testing paradigms for specific functional outcomes and issues with portability and chronicity limiting iBCI usage to laboratory settings. Significance. Our systematic review demonstrated the exponential rate at which iBCIs have evolved over the past two decades. Yet, more work is needed for widespread clinical adoption and translation to long-term home-use.

Background: Sarcopenia is associated with adverse surgical outcomes. Recent literature suggested that pre-surgery prehabilitation, nutrition and β-Hydroxy β-methylbutyric acid (HMB) supplementation improve myological and functional outcomes. However, long-term outcomes remain uncertain. Thus, we aimed to analyse findings from the long-term follow-up of surgical patients undergoing oral supplementation and prehabilitation. Methods: A prospective single-centre pilot cohort study was conducted to evaluate the effects of multimodal prehabilitation using high-protein oral nutritional supplementation (HP-ONS) with HMB. Sarcopenic patients between 40 and 90 years old and undergoing gastrointestinal surgery were included from June 2022 to January 2024. Patients were followed up from two to four weeks pre-operatively to six months post-operatively. Paired Wilcoxon signed-rank tests were conducted to evaluate outcomes between time points. Results: 36 patients were included with a median age of 71.5 years (IQR: 55–90), and 50% were male. 12 (33.3%) patients were sarcopenic, while 24 (66.7%) were severely sarcopenic. No significant difference in IMAT% was observed at post-operative six months. Number of chair rise repetitions (Median:15 vs. 11, p < 0.001) and six-min walk test (Median: 387 m vs. 349 m, p = 0.020), mid-arm muscle circumference (Median: 23.7 cm vs. 22.5 cm, p = 0.013), mid-arm muscle area (Median: 44.8 cm² vs. 39.3 cm², p = 0.005), weight (Median: 51.6 kg vs. 50.8 kg, p = 0.023) and BMI (Median: 23.2 kg/m² vs. 21.8 kg/m², p = 0.025) increased significantly at six-months post-operatively from surgery. Conclusions: Our findings suggest that improvements in anthropometric and functional outcomes from prehabilitation may persist beyond the acute recovery period. If supported by future works, multimodal prehabilitation has the potential to optimise postoperative recovery amongst sarcopenic older adult surgical patients.