Physical Medicine

Wearable exoskeleton gait training does not outperform conventional therapy for ambulation after subacute stroke

In this multicenter RCT, 151 subacute stroke patients with severe gait impairment received either torque-assisted exoskeleton plus conventional gait training or conventional training alone for 4 weeks. Both groups showed significant Functional Ambulation Category improvements, with no between-group difference in ambulatory gains or independent ambulation at 3 months. The exoskeleton group had significantly greater lower-limb strength gains, with no serious device-related adverse events reported. These results support exoskeletons as optional strength adjuncts rather than replacements for conventional gait training when the goal is ambulation recovery. 1

High-intensity walking training enhances capacity and fitness in chronic incomplete SCI

Fifty-three ambulatory individuals more than 6 months post motor incomplete SCI were randomized to up to 30 sessions of high-intensity or low-intensity walking training. High-intensity training produced significantly greater improvements in peak treadmill speed than low-intensity training, despite similar numbers of completed sessions. Secondary outcomes, including 6-minute walk distance and combined measures of metabolic capacity and efficiency, also favored high-intensity training. Differences in fastest overground gait speed did not meet the adjusted significance threshold, but the overall pattern supports prescribing higher-intensity locomotor training when feasible. 2

Immersive VR hand therapy improves motion and engagement after traumatic hand injury

In this single-center RCT, 150 inpatients after traumatic hand injuries completed 12 sessions of either immersive StableHandVR or untargeted hand exercises with passive 360° VR. The StableHandVR group achieved significantly greater wrist range-of-motion gains and better thumb opposition than the active control group. Pain during movement decreased in both groups, but StableHandVR users voluntarily exceeded prescribed training volume by 63%. Participants using StableHandVR reported higher perceived effort, usefulness, and excellent usability, supporting VR integration to boost dose and functional recovery. 3

Protein plus vitamin D and multinutrition outperform drugs for sarcopenia outcomes in older adults

This network meta-analysis included 59 RCTs with 5543 older adults with sarcopenia receiving nutritional or pharmacologic interventions. Protein, protein plus vitamin D, and multinutrition probably improve quality of life versus usual care, with moderate-certainty evidence for most comparisons. Protein plus vitamin D, and possibly multinutrition, increased handgrip strength, whereas drug therapies did not clearly improve strength or timed up and go. Overall, combined protein and vitamin D and broader multinutritional strategies appear more effective than pharmacologic agents for clinically important sarcopenia outcomes. 4