This Week in Physical Medicine & Rehabilitation — Jun 11, 2026

Welcome to This Week in Physical Medicine & Rehabilitation. This week we're covering 10 notable papers spanning the multifaceted management of spinal cord injury, innovations in fall prevention and mobility, and new insights into refining clinical practice for specific patient populations. Let's dive in.

We begin this week with a deep dive into spinal cord injury, with four papers from The Journal of Spinal Cord Medicine that cover the continuum from broad societal participation to specific clinical interventions. A systematic review and meta-analysis identified key factors associated with post-SCI employment [6]. The analysis of 52 articles, mostly from high-income countries, found that higher education, being married, and the ability to drive were all strongly associated with being employed. Conversely, factors like older age at injury and needing to use a wheelchair were associated with lower employment odds. Notably, the authors highlight a major gap in the literature, with very little evidence on employment factors in low and middle-income countries, underscoring a need for more global research. Shifting from employment to daily health management, two studies explored dietary patterns in individuals with SCI. One national cross-sectional survey of United States veterans and civilians found that both knowledge of and adherence to the Dietary Guidelines for Americans were low [7]. Across various food groups, knowledge of the recommendations ranged from just 24 to 44 percent, and fewer than a third of participants adhered to the guidelines. Interestingly, the belief that the guidelines were even applicable to people with SCI was also low, though those who did believe in their applicability showed better adherence. This suggests a critical need to clarify dietary guidelines for this population and address these knowledge gaps. A second study looked at a more specific dietary pattern: eating windows [9]. In a single-site study of 45 veterans with chronic SCI and obesity, the median eating window was 10.8 hours. In multivariable analysis, the only factor significantly associated with a shorter eating window was not being employed. This work begins to quantify daily eating patterns, which may be a future target for interventions aimed at addressing the high rates of cardiometabolic dysfunction in this population. Finally, for a specific and challenging SCI complication, a case report highlights the utility of ultrasound-guided Botulinum toxin A for intractable abdominal spasms [8]. The report details a 43-year-old male with C4 tetraplegia whose severe, painful rectus abdominis spasms were refractory to oral baclofen. A targeted injection under ultrasound guidance led to a significant reduction in spasm frequency and severity, improving his sitting comfort and quality of life. This presents a viable alternative to more invasive options like intrathecal baclofen for patients with focal abdominal spasticity.

Next, we turn to innovations in mobility and fall prevention. A study in the Archives of Physical Medicine and Rehabilitation introduces a novel tool called the ReacStick for assessing fall risk in older adults [4]. In a cross-sectional study of 90 community-dwelling older adults, researchers compared recurrent fallers to non-fallers. They found that parameters measured by the ReacStick, which assesses simple reaction time and inhibitory control, were significantly worse in fallers. In fact, a combined measure of inhibitory control and processing speed was the best predictor of faller status, with an adjusted odds ratio of over 12, far outperforming non-significant trends seen with the Timed Up and Go and Berg Balance Scale. The study suggests that diminished short-latency inhibitory control is a key factor in fall risk, and that tools like ReacStick, combined with strength assessment, could significantly improve the accuracy of our fall risk classifications. Looking toward future technologies for balance augmentation, a paper in the Journal of Neuroengineering and Rehabilitation proposes a new, generalizable control approach for wearable robots [3]. Inspired by the nervous system, the controller uses delayed feedback on the body's center of mass to modulate multi-joint reactive torques. Researchers tested this in healthy adults during various standing perturbations. The model, trained on a single condition, generalized with high fidelity to predict joint torques across different perturbation directions and magnitudes during standing. However, its ability to generalize from standing to a cyclical, walking-like movement was limited, working well for the hip and knee but not the ankle. This suggests that a center-of-mass feedback controller could robustly drive a hip or knee exoskeleton to assist with balance, but more work is needed to apply it to the ankle during dynamic movement.

Our final theme this week focuses on refining clinical protocols and deepening our understanding of diverse patient populations. A systematic review in Disability and Rehabilitation addresses a common question in orthopedic rehab: the timing of rehabilitation after reverse total shoulder arthroplasty [1]. By analyzing seven studies including over 1,600 shoulders, the review compared early motion, started within two weeks, to delayed programs starting at four weeks or later. The findings suggest that an early protocol modestly accelerates the recovery of forward flexion at six weeks post-op. Importantly, dislocation rates and overall complications were low and comparable between groups. By the 6-to-12-month mark, functional outcomes were equivalent. This provides low-to-moderate certainty evidence that starting passive or active motion early is safe and may offer a short-term benefit, allowing for more individualized rehabilitation plans. From post-operative protocols, we move to the complex issue of unexplained myofascial pain. A study in the Archives of Physical Medicine and Rehabilitation conducted a multidimensional analysis of 84 adults with and without neck and shoulder pain [5]. Participants were categorized into an "active" group with spontaneous pain, a "latent" group with pain only on provocation, and a pain-free group. The study found that the overall symptom burden—including factors like pain catastrophizing, physical function, sleep disturbance, and anxiety—explained 75% of the variance in pain intensity and interference. Specifically, poor physical function and high pain catastrophizing were key predictors. This work moves beyond a purely regional pain model, emphasizing the need for multidisciplinary approaches that manage the whole patient. In a similar vein, a study in PM&R explored the factors associated with independence in managing a bowel program among youth and young adults with spina bifida [10]. In a sample of 79 individuals, researchers found that after adjusting for age and ambulation, higher full-scale IQ was significantly associated with greater independence, with an odds ratio of 1.32. While academic functioning was also associated, IQ remained the only significant predictor in a multivariable model. This highlights the importance of considering general intellectual ability when designing treatment plans to promote self-management in this population. Finally, a scoping review in Disability and Rehabilitation encourages us to look critically at our own research practices, specifically regarding virtual exercise programs for adults with mobility limitations [2]. The review of 36 studies found that nearly all applied exclusion criteria that disproportionately affected underrepresented groups, such as those with specific health conditions or lack of digital access. As a result, study participants were predominantly white older women. The authors call for proactive inclusion strategies—like providing technological assistance or flexible scheduling—to ensure that virtual exercise interventions are developed for and accessible to the diverse communities they are meant to serve.

If you only have time for one paper this week, make it the systematic review on early versus conventional rehabilitation after reverse total shoulder arthroplasty in Disability and Rehabilitation [1]. It addresses a frequent and practical clinical dilemma with the reassuring finding that initiating motion within two weeks is safe and can accelerate early gains, providing evidence to support more individualized and potentially faster-paced rehab protocols.

Here are the key takeaways from this week in Physical Medicine & Rehabilitation. First, for uncomplicated reverse total shoulder arthroplasty, starting motion within two weeks appears safe, accelerates early range of motion recovery, and does not increase complications, though long-term outcomes are similar to delayed protocols [1]. Second, when assessing fall risk in older adults, consider that measures of reaction time and inhibitory control may be more sensitive predictors of faller status than traditional functional tests like the TUG or Berg Balance Scale [4]. Third, in spinal cord injury care, a holistic approach is crucial. Societal factors like education and driving ability are strongly linked to employment [6], while patient-level factors like low knowledge of dietary guidelines hinder self-management [7]. For specific refractory symptoms like abdominal spasms, targeted interventions like ultrasound-guided botulinum toxin injections can be highly effective [8]. And finally, for complex conditions like myofascial pain and spina bifida, look beyond the primary complaint. The overall symptom burden, particularly physical function and pain catastrophizing, explains much of the pain variability in myofascial pain [5], while general intellectual functioning is a key predictor of bowel program independence in spina bifida, informing how we should tailor patient education [10].

That's your roundup for This Week in Physical Medicine & Rehabilitation. The full transcript and references are available on the episode page in your AudioScholar library. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.

This is an automated summary generated by artificial intelligence, which can make mistakes. Always review the original source materials.