This Week in Physical Medicine & Rehabilitation — Aug 20, 2026

Welcome to This Week in Physical Medicine and Rehabilitation. This week we're covering 10 notable papers spanning how and where we deliver rehabilitation, stroke recovery interventions and the limits of prognostication, and the medical complications and pain problems that fill our clinics. Let's dive in.

We start with delivery models, because the biggest trial of the week asks a question every department is wrestling with. In the Archives of Physical Medicine and Rehabilitation, Mehta and colleagues report the TEAMS pragmatic cluster randomised trial, which enrolled 759 adults with multiple sclerosis across 43 clinics in Alabama, Mississippi and Tennessee [1]. Everyone received the same twelve-week complementary exercise programme, but half of the clinics delivered it onsite with a therapist and half sent participants home with preloaded exercise videos to run themselves. Across fatigue, pain, physical and mental health summary scores and self-reported activity, there were no significant differences between the two arms at three, six or twelve months. On performance measures, the therapist-delivered arm was better on one outcome only, the Berg Balance Scale, by about two points at a year, with no difference in six-minute walk distance, sit-to-stand, or timed twenty-five foot walk. The authors are careful to note their hypothesis that home-based delivery would be superior was not supported — this is an equivalence story, not a win for telerehabilitation. But for a rural Deep South population with long travel times, comparable patient-reported outcomes from a home video programme is clinically meaningful, with the caveat that if balance is your target, supervised delivery still has an edge.

That finding sits interestingly beside two papers on how services are organised. In the Journal of Rehabilitation Medicine, Bērziņa and colleagues report SUSTAIN-EU, a survey of stroke rehabilitation services across 30 European countries with an eighty-one percent response rate [9]. Inpatient rehabilitation was available in every country and stroke unit rehabilitation in nine out of ten, but early supported discharge existed in only about half of countries, community-based rehabilitation in roughly six in ten, and telerehabilitation in under six in ten. Countries that joined the European society more recently had markedly lower availability of early supported discharge and community care. So the infrastructure gap is not in acute inpatient beds; it is in everything that happens after discharge — exactly the space the TEAMS trial suggests can be filled with lower-intensity home delivery. Complementing this, Clinical Rehabilitation publishes the REHABest Delphi study from Formigo-Couceiro and colleagues, which built a consensus framework of 50 quality indicators for neurorehabilitation units, split across structure, process and outcome domains, and validated it with 63 independent specialists [8]. External reviewers judged the indicators relevant and clear, though centres with fewer resources flagged implementation difficulties. If your unit is preparing for accreditation or building a dashboard, this is a ready-made starting point rather than reinventing metrics locally.

Turning to stroke recovery interventions, two papers in the American Journal of Physical Medicine and Rehabilitation push in the same direction with very different levels of confidence. Kim and colleagues randomised 40 patients with chronic stroke, average age around 59, to three months of daily individualised robot-assisted trunk and lower limb training on top of conventional rehabilitation, or conventional rehabilitation alone [2]. The robot group improved significantly on the Functional Ambulation Category, along with kinematic measures of lateral bending, forward bending and weight transfer, while the control group showed no significant change. That is encouraging for trunk-focused robotics in the chronic phase, where we often assume the plateau is fixed, but this is a single-centre trial of 40 patients with no blinding of the intervention and a large difference in contact time between arms — hypothesis-generating rather than practice-defining. In the same journal, Qian and colleagues report a systematic review and Bayesian network meta-analysis of 21 randomised trials comparing body acupuncture, electroacupuncture and auricular acupuncture after stroke [3]. All three improved Fugl-Meyer motor scores, activities of daily living and neurological impairment, with electroacupuncture ranking highest and auricular acupuncture lowest. I would read the ranking rather than the magnitude here: the pooled standardised effect sizes are implausibly large for a rehabilitation intervention, which usually signals heterogeneity, small-trial bias, or unblinded outcome assessment in the source literature. The authors themselves call for head-to-head trials.

Against that optimism, Clinical Rehabilitation delivers a useful corrective on prognosis. Levy and colleagues systematically reviewed early neuroimaging and neurophysiological biomarkers for predicting mobility after stroke, pooling 26 reports covering just under 2,700 participants, with biomarkers measured a median of about nine days after stroke [10]. They identified 109 separate biomarker analyses, but nearly nine in ten were simple association analyses, only one in ten attempted discrimination or classification, and just two percent involved validation. Corticospinal tract integrity metrics — the ones we tend to cite most confidently — mostly produced small or non-significant findings, and lesion location and size results were inconsistent. The conclusion is blunt: current evidence does not support using early imaging or neurophysiology to prognosticate mobility outcomes. When a family asks at day ten whether the scan tells us if he will walk, the honest answer remains that it does not.

On the medical complications side, two papers should change your surveillance and your antibiotic conversations in spinal cord injury. In Spinal Cord, Jin and colleagues pooled ten observational studies covering just over 76,000 individuals with spinal cord injury and found a pooled diabetes prevalence of about twelve percent, with spinal cord injury associated with roughly double the odds of diabetes compared with people without injury [5]. Within the injured population, male sex and Black race were associated with higher odds. The prevalence estimate is heterogeneous and the underlying studies are observational, but the direction is consistent enough to argue for systematic metabolic screening built into long-term follow-up rather than left to primary care. Then in the Journal of Spinal Cord Medicine, Kanner and colleagues describe 31 Veterans Affairs patients with culture-positive pressure injury associated pelvic osteomyelitis, median age 66 [6]. Cultures were polymicrobial in about four out of five patients and grew multidrug-resistant organisms in nearly two thirds. Six in ten patients underwent surgery, mostly debridement, and about a quarter met criteria for treatment failure, defined as relapse, need for chronic suppression, or death from the infection. Notably, patients who succeeded were more likely to have received a regimen that did not contain a beta-lactam, with no successful outcomes in that comparison among those on beta-lactam-only regimens. Median treatment duration was around two months in both groups. With 31 patients this is descriptive and cannot establish causation, but it argues strongly for early culture-directed, infectious-diseases-partnered therapy rather than empiric beta-lactam monotherapy.

Finally, two papers on pain. JAMA Internal Medicine publishes a review by Haas, Ibounig and Buchbinder on shoulder pain in primary care, the third most common musculoskeletal presentation [4]. Their central message is deflationary in the best sense: prefer the umbrella term subacromial pain over impingement, bursitis or rotator cuff tendinopathy, because those labels overlap and are inconsistently applied; skip early imaging unless there is significant trauma, fever, weight loss or malignancy history, since structural findings often do not correlate with symptoms and drive overtreatment; and start with education about the favourable natural history, symptom relief, activity modification and watchful waiting. They describe high-certainty evidence that subacromial pain does not benefit from surgery, and reserve referral for suspected serious pathology, significant functional or neurologic deficit, inflammatory features, or persistent worsening pain. At the other end of the intensity spectrum, Habibi and colleagues in the American Journal of Physical Medicine and Rehabilitation review ventral column spinal cord stimulation, which targets the spinothalamic tracts rather than the dorsal columns [7]. The supporting evidence is a small case series in visceral pain and a handful of case reports, including one showing relief sustained to twelve months. This is investigational — a reasonable option to discuss for patients refractory to conventional dorsal column stimulation, but patient selection and durability remain unanswered.

If you only have time for one paper this week, make it the TEAMS trial in the Archives of Physical Medicine and Rehabilitation [1]. It is the largest and most pragmatic test yet of whether a home-based programme can match clinic delivery in a real-world, underserved population, and its answer directly informs how you allocate scarce therapist time.

Here are the key takeaways from this week in Physical Medicine and Rehabilitation. Home-delivered exercise for multiple sclerosis matched clinic-delivered therapy on patient-reported outcomes over a year, with supervised delivery retaining an advantage only for balance. Access gaps across Europe are concentrated in community and post-discharge rehabilitation, not inpatient beds, and a new 50-item quality indicator framework gives neurorehabilitation units a way to measure themselves. Early imaging and neurophysiology are not yet ready to prognosticate walking recovery after stroke, so temper how confidently you use them in family conversations. Screen systematically for diabetes in spinal cord injury, where the odds are roughly doubled, and treat pressure injury related pelvic osteomyelitis as a polymicrobial, multidrug-resistant problem needing culture-directed therapy. And for most shoulder pain, education, time and restraint from imaging beat intervention.

That's your roundup for This Week in Physical Medicine and 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.

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