Sang Hun Kim

Background: Cardiopulmonary exercise testing is the reference standard for preoperative functional assessment before lung resection, but its use is limited by resource and practical constraints. This study developed and internally evaluated an interpretable machine learning model to estimate preoperative peak oxygen uptake from routine clinical assessments, quantify the contribution of individual predictors to model estimation, and evaluate classification performance at the clinically relevant threshold of 20 mL·kg⁻¹·min⁻¹. Methods: This single-centre retrospective study included 320 consecutive patients in South Korea who underwent preoperative treadmill cardiopulmonary exercise testing between April 2018 and March 2024. Thirty-three routinely available predictors, including demographic characteristics, anthropometric measures, pulmonary function results, and bioimpedance-derived indices, were used to train regression models. Model development employed 10 repeats of 5-fold nested cross-validation. The best-performing model was interpreted using Shapley additive explanations. Potential prioritisation performance was assessed by classifying patients with peak oxygen uptake below the prespecified threshold. Results: Random forest showed the best performance, with a root mean square error of 3.750±0.731, a mean absolute error of 2.901±0.599, and a coefficient of determination of 0.323±0.153, indicating moderate explanatory performance for continuous VO₂peak estimation. The most influential predictors were forced expiratory volume in 1 second, forced vital capacity, age, and bioimpedance-derived phase angle. At the threshold of 20 mL·kg⁻¹·min⁻¹, the model achieved an area under the receiver operating characteristic curve of 0.842±0.072. Conclusions: This model showed moderate performance for estimating peak oxygen uptake, identified clinically relevant contributors, and may support prioritisation for CPET and consideration of prehabilitation assessment when resources are limited.

Patient-reported data on long-term rehabilitation outcomes and support policies for individuals with spinal cord injury (SCI) in Korea are lacking. To assess real-world rehabilitation experiences among individuals with traumatic SCI in Korea, focusing on service utilization, satisfaction, barriers to access, unmet needs, and quality of life. Retrospective chart review and cross-sectional survey. Regional trauma center between 2016 and 2021. Survey data were collected between October 2023 and March 2024, ensuring a minimum of two years of follow-up after injury for all participants. Adults with traumatic SCI discharged from the regional trauma center. Variables measured with standardized instruments, including EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L) and World Health Organization Quality of Life Brief Version (WHOQOL-BREF). Of the 317 screened individuals, 72 completed the survey. After discharge, 72.2% received outpatient rehabilitation, 29.2% were employed, and 8.3% had returned to their pre-injury job. Employment was significantly associated with higher EQ-5D-5L index and WHOQOL-BREF scores. Greater neurological injury severity (motor complete vs. motor incomplete) and older age were associated with lower EQ-5D-5L and WHOQOL-BREF scores across multiple domains. Household income showed a consistent dose-response relationship with the WHOQOL-BREF Environment domain, indicating better perceived environmental and service-related quality of life with higher income. Major barriers included mobility limitations and transportation challenges. Unmet needs were frequent, with financial assistance (77.8%) and daily living support (37.5%) most requested. In this single-center survey, individuals with traumatic SCI reported persistent barriers to community reintegration and unmet rehabilitation needs. Quality of life was most consistently associated with injury severity, while household income showed the strongest association with the WHOQOL-BREF Environment domain. Community-based services should be strengthened. A national SCI registry should be established for long-term care planning.

Park TS, et al. J Korean Med Sci. 2026 Sep;41:e244. https://doi.org/10.3346/jkms.2026.41.e244

The management of chronic pulmonary disease (CPD) requires a holistic approach that extends beyond pharmacotherapy. This review examines the clinical evidence and strategic importance of self-management, patient education, and multidisciplinary care within the framework of pulmonary rehabilitation (PR). By reviewing recent international guidelines (Global Initiative for Chronic Obstructive Lung Disease [GOLD] 2023, American Thoracic Society [ATS] 2023) and relevant literature, this article analyzes key non-pharmacological interventions for optimizing CPD management. Current evidence suggests that effective self-management, increasingly supported by digital monitoring tools and written action plans, facilitates early recognition of exacerbations. Moreover, patient education strategies are shifting from simple information delivery to behavioral change, utilizing methods like "teach-back" to enhance self-efficacy, particularly in older adults with low health literacy. Additionally, a multidisciplinary team approach is identified as a key component to address complex conditions such as frailty, sarcopenia, and cardiovascular comorbidities through comprehensive assessment and individualized interventions. Ultimately, integrating selfmanagement, structured education, and multidisciplinary care is essential for improving quality of life and reducing healthcare utilization in CPD patients. Future management strategies should incorporate telerehabilitation and personalized PR to ensure sustainable, long-term health outcomes in this multimorbid population.

Purpose: To examine the effects of postoperative pulmonary telerehabilitation (PTR) in older adults with lung cancer using a popular mobile instant messenger. Methods: We conducted a randomized controlled trial in ambulatory patients (n = 64; aged ≥ 65 years) with lung cancer scheduled for video-assisted thoracoscopic surgery. Participants were randomly assigned to intervention (IG) or control (CG) groups. Four weeks after surgery, both groups received a one-time education session on standard home-based pulmonary rehabilitation at the rehabilitation center. The IG underwent a PTR program thrice weekly for 4 weeks using a mobile instant messenger or telephone. Both groups were instructed to maintain their exercise routine (at least 3 times a week) during the 4-week follow-up. Results: Compared with the CG, the IG showed significant improvements in peak oxygen uptake (VO _2peak ) and percent predicted VO _2peak of 3.3 mL/kg/min (95% CI, 1.9-4.8; P < .001) and 14% (95% CI, 7-21; P < .001), respectively, after PTR. These improvements persisted at the 4-week follow-up (VO _2peak = 3.8 mL/kg/min: 95% CI, 2.1-5.5; P < .001 and percent predicted VO _2peak = 13%: 95% CI, 6-20; P < .001). Compared with preoperative values, postoperative VO _2peak and percent predicted VO _2peak decreased significantly by 3.5 mL/kg/min (95% CI, 2.6-4.3; P < .001) and 15% (95% CI, 11-19; P < .001), respectively. Conclusions: A 4-week postoperative PTR program improved VO _2peak in older adults with lung cancer. Our findings suggest that PTR may be a feasible therapeutic strategy for lung cancer, even in older adults.

Using the first videofluoroscopic swallowing study (VFSS), we aimed to identify clinical predictors of dysphagia in patients with acute and subacute traumatic cervical spinal cord injury (TCSCI). This retrospective chart review included 143 adults, who were diagnosed with TCSCI and underwent their first VFSS between 2018 and 2021. Patients with alert mental status and no history of traumatic brain injury or preexisting conditions causing dysphagia were included. The neurological status was assessed using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). Dysphagia was evaluated using the penetration-aspiration scale and the pharyngeal residue severity rating scale. Cervical alignment was assessed by measuring the O-C2 and C2-C6 angles and the narrowest oropharyngeal diameter. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of dysphagia. Tracheostomy and age ≥ 65 years were identified as significant predictors of dysphagia. Tracheostomy was strongly associated with a higher risk of penetration-aspiration (odds ratio [OR] = 8.33, P = 0.001), whereas age ≥ 65 years was a significant predictor of pharyngeal residue (OR = 4.45, P < 0.001). Despite showing a trend toward significance in univariate analysis, increased cervical lordosis (C2-C6 angle) was not confirmed as an independent predictor in multivariate analysis. Tracheostomy and advanced age are significant early predictors of dysphagia in acute and subacute TCSCI. Early bedside screening, followed by timely instrumental assessment such as VFSS, is essential to detect dysphagia before initiating oral intake and to implement preventive strategies that may reduce aspiration-related complications.

Background/Objective : Maintaining physical and functional health is crucial for the independence of older adults. This study examined whether augmented reality (AR)-based exercise improves physical and cognitive function in community-dwelling older adults. Methods : A randomized controlled trial was conducted with 40 older adults (≥65 years), randomly assigned to an AR-based exercise group ( n = 20) or a control group ( n = 20). The intervention involved a 6-week AR-based movement and cognitive training program, performed three times per week for 30 min per session. Participants in the control group did not participate in the AR-based training program and were instructed to continue their usual daily activities. No specific restrictions were placed on their engagement in other physical activities during the study period. Primary outcomes included assessments of lower limb function, pulmonary capacity, body composition, and cognitive function. Results : The AR-exercise group showed significant improvements in Timed Up and Go ( p < .01), One-Minute Sit-to-Stand Test ( p < .05), maximal inspiratory pressure ( p < .01), and maximal expiratory pressure ( p < .01). No significant changes were observed in the Five Times Sit-to-Stand Test, pulmonary capacity, or cognitive function. The control group improved in maximal expiratory pressure ( p < .01) and the Five Times Sit-to-Stand Test ( p < .01), but leg muscle mass significantly decreased ( p < .05). Conclusion : AR-based exercise improves physical fitness, especially lower limb and respiratory muscle function, in older adults. These findings support its potential to promote functional health and mobility in aging populations. Significance/Implications : With growing demand for engaging rehabilitation strategies, AR-based exercise programs could support healthy aging and independent living in clinical and community settings.

Kim SH, et al. J Korean Med Sci. 2025 Apr;40:e150. https://doi.org/10.3346/jkms.2025.40.e150

To assess differences in autonomic function using heart rate variability (HRV) parameters between people with and without orthostatic hypotension (OH), and to determine symptoms of OH in people with spinal cord injury (SCI). R-R interval and blood pressure (BP) data were recorded using Finometer PRO^® in both the supine position and at a 60-degree tilt using a tilt table, each lasting for 6 minutes. R-R interval data were processed using the Kubios HRV analysis software to convert R-R interval into time and frequency domains for further analysis. Compared to the non-OH group, the SCI group with OH exhibited lower values for root mean square of the successive differences (RMSSD) and standard deviation of normal-to-normal interval (SDNN), along with an elevated heart rate during tilt-up. Participants with OH symptoms had a lower average heart rate in the supine and 60-degree positions compared to asymptomatic participants. Logistic regression analysis indicated that SDNN in the supine position correlated with the presence of OH, and that the mean heart rate in the 60-degree position was related to the presence of symptoms. Differences in HRV parameters were observed in people with SCI and OH, suggesting a reduced parasympathetic activity in the supine position, likely as a response to maintain homeostasis in BP regulation. Despite the presence or absence of OH symptoms, there was no difference in HRV parameters. This finding suggests that autonomic function may not be the primary determinant of these symptoms, with other factors likely being more influential.

Park TS, et al. World J Mens Health. 2024 Aug;42:e77. https://doi.org/10.5534/wjmh.240102