Physical Medicine

PT vs CBT Sequencing for Chronic Low Back Pain in a SMART Trial

In adults with chronic low back pain, 8 weeks of PT produced slightly greater 10-week functional improvement than CBT on the Oswestry Disability Index. The adjusted ODI difference (2.8 points) favored PT but did not reach the minimum important difference threshold of 6 points. Pain intensity did not differ between PT and CBT at 10 weeks, and group differences in function disappeared by 26 and 52 weeks. Among nonresponders, switching to mindfulness or to the alternative treatment produced similar long-term pain and function outcomes. 1

Network Meta-analysis of Nonpharmacologic Strategies for Post-Stroke Social Participation

This network meta-analysis pooled 92 RCTs (7724 stroke survivors) comparing 15 nonpharmacologic interventions for social participation. Psychological interventions ranked highest for improving participation, but supporting evidence was low certainty and vulnerable to risk-of-bias issues. Complex interventions, exercise-based programs, and occupational therapy plus cognitive therapy also improved participation with generally moderate certainty for complex and exercise-based approaches. Benefits of complex and exercise-based interventions remained robust in sensitivity analyses excluding high-risk-of-bias trials and younger or very-early stroke populations. 2

Mobility, Verticalization, and Resistance Training During ECMO Are Feasible and Safe

This prospective pilot enrolled 20 predominantly venovenous ECMO patients into a standardized daily mobility, verticalization, and resistance-training program. Patients averaged 21 minutes of PT/OT and 30 minutes of resistance exercise daily, with a combined median of 35 minutes of activity. Only two minor adverse events occurred, both resolving immediately, supporting the safety of early structured exercise on ECMO. Day-28 survival was 95%, in-hospital survival 85%, and over half of survivors were discharged home, though there was no control group. 3

Economic Evaluations Favor Community and Home Stroke Rehabilitation Models

This PRISMA-guided review synthesized 27 full economic evaluations of outpatient stroke rehabilitation conducted across multiple countries. Community-based, home-based, and early supported discharge models frequently showed favorable cost-effectiveness compared with inpatient or clinic-based outpatient rehabilitation. Most economic evaluations focused on health-related quality of life, functional recovery, or process measures as primary outcomes. Methodologic quality was generally moderate, with serious risk of bias in many nonrandomized studies and some reporting concerns in RCTs. 4