This Week in Physical Medicine & Rehabilitation — Oct 29, 2026
Generated Oct 29, 2026 · 10:30
The week's practice-changing Physical Medicine & Rehabilitation research, summarized for clinicians.
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Comparative effectiveness of three splints for rehabilitation after finger flexor tendon repair (FIRST): randomised controlled trial.
In 430 adults after zone 1 and 2 flexor tendon repair, long, short, and mini splints produced no significant difference in patient-rated hand function over one year.
BMJ · 2026 · PubMed
This week’s papers
- 01
Comparative effectiveness of three splints for rehabilitation after finger flexor tendon repair (FIRST): randomised controlled trial.
In 430 adults after zone 1 and 2 flexor tendon repair, long, short, and mini splints produced no significant difference in patient-rated hand function over one year.
Bamford E et al. · BMJ · 2026
From the briefingIn the BMJ, Bamford and colleagues report the FIRST trial, a pragmatic superiority study across 26 United Kingdom hospitals that randomised 430 adults after zone 1 and 2 flexor tendon repair to a long forearm-based splint, the Manchester short splint, or a relative motion flexion mini splint, each worn continuously for five weeks [1]. Patient-rated wrist and hand scores averaged over a full year were nearly identical across the three groups, with no statistically significant difference in any pairwise comparison, and serious adverse events ran at about one in ten participants in every arm. Adherence was somewhat higher with the long splint, at roughly four in five participants. Masking was impossible, but the trial's size, multicentre design, and year-long follow-up make this a firm negative result: for repairs in one or two fingers, the evidence now suggests splint design matters far less than tradition implied, which opens room for patient preference and hand therapy logistics to drive the choice.
If you only have time for one paper this week, make it the FIRST trial in the BMJ [1]. It is a large, multicentre randomised trial that settles a question hand therapists and rehabilitation physicians have debated for decades, showing that three very different splint designs produce equivalent outcomes after flexor tendon repair.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 02
Clinical Outcomes of Conventional Versus Lateral-Deployment RF Cannulas in Lumbar Medial Branch Radiofrequency Ablation: A Prospective Randomized Study.
Lateral-deployment cannulas roughly doubled six-month pain reduction versus conventional cannulas in lumbar medial branch ablation, though evidence comes from a single-centre completer analysis needing replication.
Kahraman E et al. · American Journal of Physical Medicine & Rehabilitation · 2026
From the briefingIn contrast, a single-centre trial from Kahraman and colleagues in the American Journal of Physical Medicine and Rehabilitation found a large difference between devices for lumbar medial branch radiofrequency ablation [2]. Among 90 participants with facet-mediated low back pain, the lateral-deployment cannula roughly doubled the pain reduction at six months compared with a conventional monopolar cannula, about five and a half points versus under three on a ten-point scale, and nearly three quarters of patients in the lateral-deployment group achieved at least halving of their pain, against under two fifths of the conventional group. Disability and physical health scores followed the same direction, with no major complications. The effect is striking, but this was a single centre, the analysis included only completers, and the authors themselves call for larger intention-to-treat trials before the finding can be considered settled.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 03
The fallibility of the T6 neurological level of injury for determining autonomic dysreflexia risk.
Autonomic dysreflexia occurred frequently in people with spinal cord injury below T6, with equal laboratory-provoked rates above and below, undermining T6 as a strict risk cutoff.
Solinsky R et al. · PM&R · 2026
From the briefingIn PM&R, Solinsky and colleagues tested the classic rule that only injuries at or above T6 carry autonomic dysreflexia risk [3]. In a cross-sectional study of 138 people with and without spinal cord injury, symptomatic dysreflexia was reported by about three quarters of participants injured at or above T6, but also by close to two fifths of those injured below it. In the autonomic laboratory, using controlled stimuli such as a foot cold pressor and bladder filling, 57 percent of participants in each group developed objective dysreflexia. The physiology pointed to heightened vascular responsiveness and blunted baroreflex sensitivity in lower injuries, which leaves little compensatory slowing of the heart. The laboratory subgroup was small, at 28 people with injury, but the authors conclude that the T6 cutoff should not be used as a strict boundary for risk, a direct challenge to resident and patient education materials.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 04
Early sacral reflexes and sensory recovery in complete cervical spinal cord injury: Unique predictive value of the anal wink.
In complete cervical spinal cord injury, an anal wink present within 72 hours independently predicted conversion to sensory incomplete status at three months in a retrospective cohort.
Murotani K et al. · Spinal Cord · 2026
From the briefingAlso in spinal cord injury, Murotani and colleagues in Spinal Cord looked for bedside predictors of sensory recovery in 70 patients with complete cervical injury who remained AIS A at 72 hours [4]. Just under a quarter of patients converted to sensory incomplete status by three months. Deep tendon reflexes predicted nothing, and the bulbocavernosus reflex lost significance after adjustment, but a present anal wink within 72 hours roughly quintupled the odds of recovery and was linked with larger gains in light touch and pinprick scores. This is a retrospective single-centre cohort with wide uncertainty around that estimate, so it is a promising prognostic signal for early family counselling rather than a validated tool.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 05
Prospective observational study of step-up dose treatment with onabotulinumtoxinA in patients with spasticity.
OnabotulinumtoxinA doses of 401 to 600 units for combined upper and lower limb spasticity showed no new safety concerns, with treatment-related adverse events in under five percent.
Abo M et al. · Journal of Rehabilitation Medicine · 2026
From the briefingRounding out the theme, Abo and colleagues in the Journal of Rehabilitation Medicine prospectively followed 109 patients receiving step-up onabotulinumtoxinA doses of 401 to 600 units for combined upper and lower limb spasticity [5]. Just under half of patients had any adverse event, mostly COVID-19 and nasopharyngitis, and only five patients had events attributed to the toxin or injection. Without a control arm, the effectiveness data are suggestive at best, but this adds prospective safety reassurance for doses above the conventional 400-unit ceiling in multifocal spasticity.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 06
Efficacy of Neuromuscular Electrical Stimulation (NMES) on Lower Limb Mobility and Activities of Daily Living in Post-Stroke Patients: A Systematic Review and Meta-Analysis.
Pooling ten trials, neuromuscular electrical stimulation improved lower limb motor function, balance, mobility, and daily living activities after stroke, supporting its role alongside standard rehabilitation.
Feng Y et al. · American Journal of Physical Medicine & Rehabilitation · 2026
From the briefingFeng and colleagues in the American Journal of Physical Medicine and Rehabilitation pooled ten randomised trials with 579 patients and found neuromuscular electrical stimulation improved lower limb Fugl-Meyer scores, ankle dorsiflexion range, balance, timed up-and-go, and activities of daily living, with roughly a thirteen-point gain on the modified Barthel Index [6]. The pool is modest, and the authors frame the modality as a complement to standard rehabilitation rather than a replacement.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 07
Comparative effectiveness of mirror therapy using different delivery media on motor recovery of the upper limb and hand in stroke patients: A systematic review and network meta-analysis.
All mirror therapy formats improved post-stroke upper limb function, with virtual reality ranking highest, but mostly indirect comparisons and very low certainty for hand outcomes limit conclusions.
Shi B et al. · Clinical Rehabilitation · 2026
From the briefingIn Clinical Rehabilitation, Shi and colleagues ran a Bayesian network meta-analysis of 30 trials comparing mirror therapy delivered traditionally, on a digital screen, or through virtual reality [7]. All three formats improved upper limb function versus control, and the virtual reality version ranked highest and outperformed traditional mirrors for hand function. However, the authors are explicit that most comparisons were indirect and certainty for hand outcomes was very low, so the ranking is exploratory until head-to-head trials appear.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 08
Dose-response relationship of exercise intervention on cognitive function in patients with stroke: a systematic review and meta-analysis.
Exercise produced small improvements in post-stroke global cognition across 19 trials, with an exploratory nonlinear model suggesting the largest effect near 465 MET-minutes per week.
Yang H et al. · Topics in Stroke Rehabilitation · 2026
From the briefingOn cognition, Yang and colleagues in Topics in Stroke Rehabilitation pooled 19 trials with over 1,300 patients and found exercise produced a small but statistically significant improvement in global cognitive function [8]. Exercise modality mattered, while frequency, session length, and time since stroke did not, and a nonlinear dose-response model suggested the largest predicted effect at around 465 MET-minutes per week, roughly a moderate effect. That dose estimate is labelled exploratory by the authors, but it offers a concrete target for future trials.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 09
Effect of bimodal signal biofeedback on the supraglottic swallowing maneuver in patients with post-stroke dysphagia: A randomised controlled trial.
Adding accelerometer and nasal airflow biofeedback to supraglottic swallow training improved oral intake and reduced severe aspiration in a small 30-patient post-stroke dysphagia trial.
Wang L et al. · Archives of Physical Medicine and Rehabilitation · 2026
From the briefingIn the Archives of Physical Medicine and Rehabilitation, Wang and colleagues randomised 30 patients with post-stroke dysphagia to conventional therapy including supraglottic swallow training, with or without bimodal biofeedback from a throat accelerometer and a nasal airflow sensor [9]. After two weeks, the biofeedback group had significantly better oral intake scores, maintained at one month, and fewer patients in that group showed deep penetration or aspiration on videofluoroscopy. The signal is consistent, but with only 15 patients per arm at one hospital, it is preliminary.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 10
Impact of age and frailty on the effect of a multimodal individualized long-term intervention after stroke: the last-long trial.
In a null trial of coordinator-led long-term stroke follow-up, participants aged 80 or older had fewer favourable functional outcomes with the intervention, while frailty did not modify effects.
Ihle-Hansen H et al. · Journal of Rehabilitation Medicine · 2026
From the briefingFinally, a sobering secondary analysis of the Norwegian LAST-long trial from Ihle-Hansen and colleagues, also in the Journal of Rehabilitation Medicine [10]. The parent trial of 18 months of monthly stroke-coordinator meetings had already shown no overall functional benefit. Here, age modified the effect: among participants aged 80 or older, a favourable modified Rankin outcome occurred in under a quarter of the intervention group versus over half of controls, while younger participants showed better executive function on Trail Making B. Frailty, interestingly, did not modify the response. This is a subgroup analysis of a null trial and should be read as hypothesis-generating, but it raises the possibility that intensive individualised follow-up may not suit, and could even disadvantage, the oldest stroke survivors.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
The full briefing
This AudioScholar briefing is generated by artificial intelligence for healthcare professionals and trainees. It is not medical advice.
Welcome to This Week in Physical Medicine & Rehabilitation. This week we're covering 10 notable papers spanning musculoskeletal and interventional procedures, spinal cord injury and spasticity, and the expanding evidence base for stroke rehabilitation. Let's dive in.
We start with two randomised trials that test the hardware we put on and into our patients. In the BMJ, Bamford and colleagues report the FIRST trial, a pragmatic superiority study across 26 United Kingdom hospitals that randomised 430 adults after zone 1 and 2 flexor tendon repair to a long forearm-based splint, the Manchester short splint, or a relative motion flexion mini splint, each worn continuously for five weeks [1]. Patient-rated wrist and hand scores averaged over a full year were nearly identical across the three groups, with no statistically significant difference in any pairwise comparison, and serious adverse events ran at about one in ten participants in every arm. Adherence was somewhat higher with the long splint, at roughly four in five participants. Masking was impossible, but the trial's size, multicentre design, and year-long follow-up make this a firm negative result: for repairs in one or two fingers, the evidence now suggests splint design matters far less than tradition implied, which opens room for patient preference and hand therapy logistics to drive the choice. In contrast, a single-centre trial from Kahraman and colleagues in the American Journal of Physical Medicine and Rehabilitation found a large difference between devices for lumbar medial branch radiofrequency ablation [2]. Among 90 participants with facet-mediated low back pain, the lateral-deployment cannula roughly doubled the pain reduction at six months compared with a conventional monopolar cannula, about five and a half points versus under three on a ten-point scale, and nearly three quarters of patients in the lateral-deployment group achieved at least halving of their pain, against under two fifths of the conventional group. Disability and physical health scores followed the same direction, with no major complications. The effect is striking, but this was a single centre, the analysis included only completers, and the authors themselves call for larger intention-to-treat trials before the finding can be considered settled.
Our second theme challenges some long-held teaching in spinal cord injury and spasticity care. In PM&R, Solinsky and colleagues tested the classic rule that only injuries at or above T6 carry autonomic dysreflexia risk [3]. In a cross-sectional study of 138 people with and without spinal cord injury, symptomatic dysreflexia was reported by about three quarters of participants injured at or above T6, but also by close to two fifths of those injured below it. In the autonomic laboratory, using controlled stimuli such as a foot cold pressor and bladder filling, 57 percent of participants in each group developed objective dysreflexia. The physiology pointed to heightened vascular responsiveness and blunted baroreflex sensitivity in lower injuries, which leaves little compensatory slowing of the heart. The laboratory subgroup was small, at 28 people with injury, but the authors conclude that the T6 cutoff should not be used as a strict boundary for risk, a direct challenge to resident and patient education materials. Also in spinal cord injury, Murotani and colleagues in Spinal Cord looked for bedside predictors of sensory recovery in 70 patients with complete cervical injury who remained AIS A at 72 hours [4]. Just under a quarter of patients converted to sensory incomplete status by three months. Deep tendon reflexes predicted nothing, and the bulbocavernosus reflex lost significance after adjustment, but a present anal wink within 72 hours roughly quintupled the odds of recovery and was linked with larger gains in light touch and pinprick scores. This is a retrospective single-centre cohort with wide uncertainty around that estimate, so it is a promising prognostic signal for early family counselling rather than a validated tool. Rounding out the theme, Abo and colleagues in the Journal of Rehabilitation Medicine prospectively followed 109 patients receiving step-up onabotulinumtoxinA doses of 401 to 600 units for combined upper and lower limb spasticity [5]. Just under half of patients had any adverse event, mostly COVID-19 and nasopharyngitis, and only five patients had events attributed to the toxin or injection. Without a control arm, the effectiveness data are suggestive at best, but this adds prospective safety reassurance for doses above the conventional 400-unit ceiling in multifocal spasticity.
The largest cluster this week addresses stroke recovery, starting with motor and cognitive outcomes from three meta-analyses. Feng and colleagues in the American Journal of Physical Medicine and Rehabilitation pooled ten randomised trials with 579 patients and found neuromuscular electrical stimulation improved lower limb Fugl-Meyer scores, ankle dorsiflexion range, balance, timed up-and-go, and activities of daily living, with roughly a thirteen-point gain on the modified Barthel Index [6]. The pool is modest, and the authors frame the modality as a complement to standard rehabilitation rather than a replacement. In Clinical Rehabilitation, Shi and colleagues ran a Bayesian network meta-analysis of 30 trials comparing mirror therapy delivered traditionally, on a digital screen, or through virtual reality [7]. All three formats improved upper limb function versus control, and the virtual reality version ranked highest and outperformed traditional mirrors for hand function. However, the authors are explicit that most comparisons were indirect and certainty for hand outcomes was very low, so the ranking is exploratory until head-to-head trials appear. On cognition, Yang and colleagues in Topics in Stroke Rehabilitation pooled 19 trials with over 1,300 patients and found exercise produced a small but statistically significant improvement in global cognitive function [8]. Exercise modality mattered, while frequency, session length, and time since stroke did not, and a nonlinear dose-response model suggested the largest predicted effect at around 465 MET-minutes per week, roughly a moderate effect. That dose estimate is labelled exploratory by the authors, but it offers a concrete target for future trials.
Two trials then address how stroke rehabilitation is delivered, one at the bedside and one in the community. In the Archives of Physical Medicine and Rehabilitation, Wang and colleagues randomised 30 patients with post-stroke dysphagia to conventional therapy including supraglottic swallow training, with or without bimodal biofeedback from a throat accelerometer and a nasal airflow sensor [9]. After two weeks, the biofeedback group had significantly better oral intake scores, maintained at one month, and fewer patients in that group showed deep penetration or aspiration on videofluoroscopy. The signal is consistent, but with only 15 patients per arm at one hospital, it is preliminary. Finally, a sobering secondary analysis of the Norwegian LAST-long trial from Ihle-Hansen and colleagues, also in the Journal of Rehabilitation Medicine [10]. The parent trial of 18 months of monthly stroke-coordinator meetings had already shown no overall functional benefit. Here, age modified the effect: among participants aged 80 or older, a favourable modified Rankin outcome occurred in under a quarter of the intervention group versus over half of controls, while younger participants showed better executive function on Trail Making B. Frailty, interestingly, did not modify the response. This is a subgroup analysis of a null trial and should be read as hypothesis-generating, but it raises the possibility that intensive individualised follow-up may not suit, and could even disadvantage, the oldest stroke survivors.
If you only have time for one paper this week, make it the FIRST trial in the BMJ [1]. It is a large, multicentre randomised trial that settles a question hand therapists and rehabilitation physicians have debated for decades, showing that three very different splint designs produce equivalent outcomes after flexor tendon repair.
Here is what this week's evidence adds up to in Physical Medicine & Rehabilitation. First, robust trial evidence now indicates that long, short, and mini splints perform equivalently after zone 1 and 2 flexor tendon repair, while a single-centre trial suggests lateral-deployment cannulas may substantially improve radiofrequency ablation outcomes, a finding that still needs replication. Second, the T6 rule for autonomic dysreflexia risk appears unreliable, with both symptomatic and laboratory-confirmed dysreflexia common below T6, though the physiology data come from a small cohort. Third, an early anal wink may flag sensory recovery potential in complete cervical injury, and step-up botulinum toxin doses above 400 units showed no new safety signal, both based on uncontrolled or retrospective data. Fourth, meta-analyses support electrical stimulation, mirror therapy, and exercise as adjuncts in stroke recovery, but rankings between formats and optimal exercise doses remain exploratory. And finally, biofeedback-enhanced swallowing training looks promising in a small trial, while the LAST-long analysis raises unresolved questions about long-term coordinator-led care in patients over 80.
That's your roundup for This Week in Physical Medicine & Rehabilitation. The full transcript and references are available on the episode page. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.
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