Francesca Gimigliano

Rehabilitation physicians worldwide have been called to take action to explore and implement the International Society of Physical and Rehabilitation Medicine’s Clinical Functioning Information Tool - ClinFIT. ClinFIT is an International Classification of Functioning, Disability and Health-based and clinician-administered tool that can be used to systematically assess and report functioning of different patient populations across the care continuum and support the monitoring of rehabilitation outcomes. One essential action step is getting familiar with ClinFIT. It is possible to create a ClinFIT version for your setting and purpose, either by tailoring an existing ClinFIT version or by developing a new version for a specific health condition or context. This paper describes how to create a ClinFIT that works for you. Specifically, it provides you with information about current ClinFIT versions and what to consider when creating the desired ClinFIT version and presents a step-by-step guide for either tailoring an existing ClinFIT version or for developing a new ClinFIT version. This paper also introduces reporting considerations to enhance clinical utility as well as emerging opportunities offered by artificial intelligence and other digital technologies. Lastly, the authors invite all PRM physicians worldwide to join the ClinFIT community as knowledge-brokers and as champions, actively disseminating information about ClinFIT and participating in ClinFIT research.

Cochrane Rehabilitation and the World Health Organization (WHO) Rehabilitation Programme have collaborated to produce four Cochrane overviews of systematic reviews synthesizing evidence from health policy and systems research (HPSR) in rehabilitation. Each overview focuses on one of the four HPSR pillars identified by the Cochrane Effective Practice and Organisation of Care (EPOC) taxonomy: delivery, financial, and governance arrangements; and implementation strategies. This overview addresses delivery arrangements, which Cochrane EPOC defines as how health services are organized and delivered, including who provides care, how care is coordinated and managed, and where services are provided. This overview aimed to synthesize current evidence on delivery arrangements in rehabilitation from an HPSR perspective. Our series of four overviews has the following overarching objectives. • To offer a broad synthesis of existing evidence on health policy and systems interventions' effects. • To direct end-users, including policymakers, towards systematic reviews that may address their health policy questions. • To identify current research gaps and set priorities for future primary HPSR. • To pinpoint needs and priorities for new evidence syntheses where no reliable, up-to-date systematic reviews currently exist. We searched Epistemonikos Health Systems Evidence databases and EPOC Group systematic reviews with no language limitations to identify reviews published between 2015 and 17 November 2024. We included Cochrane systematic reviews (CSRs) and non-CSRs of randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs) evaluating the effectiveness of health policy and systems interventions for rehabilitation in health systems, specifically related to delivery arrangements as defined in the EPOC taxonomy. All four overview teams screened reviews and extracted data. We used AMSTAR 2 to critically appraise the reviews, and we analyzed the results descriptively. We included 25 systematic reviews. Three overlapped, and for 17 the AMSTAR 2 rating was low or critically low confidence. Five systematic reviews (2 CSRs and 3 non-CSRs) contributed to our synthesis. Most outcomes focused on patients, caregivers, or service use (e.g. access to rehabilitation). Equity-related outcomes were absent, and quality of care, adverse events, and our important outcomes were rarely reported. Below, we report the results of three of the five reviews judged to have moderate to high confidence for our outcomes of interest, in which authors conducted meta-analysis and assessed the certainty of the evidence. Who provides care One review analyzed advanced practice physiotherapy (APP) models, which may result in little to no difference in health-related outcomes measured by the Pain Disability Index and EuroQol 5-Dimension questionnaire after the intervention, compared with usual care in adults with spinal pain (standardized mean difference [SMD] 0.05, 95% confidence interval [CI] -0.32 to 0.42; 2 studies, 225 participants; low certainty). Information and communication technology We included two reviews in this category. One compared telerehabilitation with usual care in older adults, finding that telerehabilitation may have little or no effect on quality of life after seven to 20 weeks (SMD -0.09, 95% CI -0.23 to 0.40; 3 studies, 179 participants; low certainty). There was very low-certainty evidence on mobility after seven to 26 weeks (SMD 0.63, 95% CI -0.25 to 1.51; 5 studies, 302 participants), strength after 12 and 26 weeks (SMD 0.73, 95% CI -0.10 to 1.56; 4 studies, 226 participants), and balance after seven to 26 weeks (SMD 0.40, 95% CI -0.35 to 1.15; 3 studies, 199 participants). Another review on stroke survivors living in the community found that telerehabilitation compared with usual care probably has little or no effect on independence in activities of daily living (ADL) after 24 weeks (SMD 0.00, 95% CI -0.15 to 0.15; 2 studies, 661 participants; moderate certainty), self-reported quality of life after six to 24 weeks (SMD 0.03, 95% CI -0.14 to 0.20; 3 studies, 569 participants; moderate certainty), and depression after six to 24 weeks (SMD -0.04, 95% CI -0.19 to 0.11; 6 studies, 1145 participants; moderate certainty); and may have little or no effect on upper limb function after 12 weeks (SMD 0.33, 95% CI -0.21 to 0.87; 2 studies, 54 participants; low certainty) and mobility after six weeks (mean difference 0.01, 95% CI -0.12 to 0.14; 1 study; 144 participants; low certainty). This review also compared telerehabilitation with in-person rehabilitation and found that there may be little to no difference in independence in ADL, measured with the Modified Barthel Index at four to 12 weeks (MD 0.59, 95% CI -5.50 to 6.68; 2 studies, 75 participants; low certainty); balance, measured with the Berg Balance Scale at four to 12 weeks (MD 0.48, 95% CI -1.36 to 2.32; 3 studies, 106 participants; low certainty); and upper limb function, evaluated with the Fugl-Meyer Assessment (Upper Extremity) four weeks after intervention (MD 1.23, 95% CI -2.17 to 4.64; 3 studies, 170 participants; low certainty). Current evidence on delivery arrangements in rehabilitation is limited, mostly of low certainty, and derived from high-income countries. Reviews covered five EPOC categories, but reliable evidence for our outcomes of interest was available for only two categories. Most evidence was on telerehabilitation. Compared with usual care, APP models may have little to no effect on health outcomes in adults with spinal pain. In people with stroke, telerehabilitation compared with usual care probably has little or no effect on independence in daily living, quality of life, and depression, and may have little to no effect on upper limb function and mobility. Compared with in-person care, telerehabilitation may have little to no effect on ADL, balance, and upper limb function. Further...

Background Cochrane Rehabilitation and the World Health Organization (WHO) Rehabilitation Programme have collaborated to produce four Cochrane overviews of systematic reviews that synthesize current available evidence from health policy and systems research (HPSR) in rehabilitation. Each overview focuses on one of the four pillars of HPSR as identified by the Cochrane Effective Practice and Organisation of Care (EPOC) taxonomy: delivery arrangements, financial arrangements, governance arrangements, and implementation strategies. This overview examined implementation strategies, defined by EPOC as interventions designed to bring about changes in healthcare organizations, the behavior of healthcare professionals, or the use of health services by healthcare recipients. Objectives This overview aimed to synthesize current evidence on implementation strategies in rehabilitation from a health policy and systems research (HPSR) perspective. Our series of four overviews have the following overarching objectives. • To offer a broad synthesis of the existing evidence on health policy and systems interventions' effects. • To direct end‐users, including policymakers, towards systematic reviews that may address their health policy questions. • To identify current research gaps and set priorities for future primary HPSR. • To pinpoint the needs and priorities for new evidence syntheses where no reliable, up‐to‐date systematic reviews currently exist. Methods We searched the Epistemonikos database, the Health Systems Evidence database, and EPOC Group systematic reviews to identify reviews published between 1 January 2015 and 17 November 2024. We applied no language limitations. We included Cochrane and non‐Cochrane systematic reviews of randomized controlled trials (RCTs) and non‐randomized studies of interventions (NRSIs) that evaluated the effectiveness of health policy and systems interventions for rehabilitation in health systems, specifically related to implementation strategies as defined in the EPOC taxonomy. All four overview teams collaborated to screen reviews and extract data. We used AMSTAR 2 to critically appraise the quality of the reviews. Results were analyzed descriptively and are based on reviews with ratings of high‐to‐moderate confidence, with low‐confidence reviews reported separately. Main results We identified 7882 systematic reviews, of which 15 met our inclusion criteria. Three reviews overlapped substantially with other reviews, and eight received low‐ or critically low‐confidence ratings. Ultimately, four moderate‐ to high‐confidence reviews contributed to the synthesis; two were Cochrane systematic reviews. Most primary studies were from high‐income countries; none were from low‐income countries. Most strategies targeting healthcare professionals (e.g. guideline dissemination, interactive workshops, opinion leaders, audit and feedback) or healthcare recipients (e.g. structured monitoring, telehealth support, counseling, motivational interviewing) included more than one component. Strategies targeting healthcare recipients' use of health services in cardiac rehabilitation may show small benefits in terms of participation (enrollment, adherence, completion), but effects on other outcomes are uncertain. The effects of strategies targeting older healthcare recipients via telehealth are uncertain. Strategies targeting healthcare professionals may have little to no effect on professional or patient and carer outcomes in stroke rehabilitation. For musculoskeletal conditions, there were no evidence‐certainty ratings, so intervention effects are unclear. We found no reviews of strategies targeting health service organizations or specific types of rehabilitation practice. The evidence certainty was generally low; evidence of adverse events was missing or uncertain; and reporting on organizational, implementation, economic, and equity outcomes was scarce. Authors' conclusions Current evidence on implementation strategies in rehabilitation is limited, mostly of low certainty, and derived from high‐income countries. Multicomponent, patient‐targeted strategies may modestly improve cardiac rehabilitation participation, but effects in other areas remain uncertain. Further high‐quality research using well‐defined frameworks is needed, especially in low‐ and middle‐income countries, to identify effective strategies and evaluate organizational, implementation, and equity outcomes. Future Cochrane overviews of reviews in HPSR should consider including a broader range of study designs, such as observational, qualitative, and mixed‐methods evidence, to better capture evidence on implementation strategies in rehabilitation. Funding This Cochrane review was funded by the Italian Ministry of Health (Ricerca Corrente). The funder played no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Registration The protocol was first published in the European Journal of Physical and Rehabilitation Medicine online on 27 January 2025. The manuscript was received on 11 November 2024 and was accepted on 26 November 2024. Protocol: DOI 10.23736/S1973‐9087.24.08833‐6.

Background/Objectives: Calcium and magnesium play a key role in musculoskeletal health and neuromuscular function. Mineral waters naturally rich in these elements provide a highly bioavailable dietary source. This study evaluated whether daily intake of naturally calcium and magnesium-rich mineral water compared with low-mineral water affects fall risk, muscle mass, and muscle function in adults aged ≥50 years, with or without osteosarcopenia. Methods: In this 12-month, randomized, double-blind, controlled trial, 98 participants (86.7% women, 13.3% men) were assigned to consume 1 L/day of either SG9 (mineral water with high calcium and magnesium content) or J66 (low-mineral water). Outcomes included incidence of falls (primary endpoint), appendicular skeletal muscle mass (ASMM), muscle strength, physical performance, biochemical markers, and patient-reported measures. Assessments were performed at baseline, 6 months, and 12 months following CONSORT guidelines. Results: Ninety-eight participants (mean age ~63 years) were randomized and completed the 12-month follow-up. At 6 months, the incidence of falls was significantly lower in the SG9 group compared with the J66 group (relative risk reduction 82%; RR = 0.18, 95% CI 0.04–0.88; p < 0.05), whereas no significant between-group difference was observed at 12 months. Appendicular skeletal muscle mass indexed to height (ASMM/h²) was significantly higher in the SG9 group at 12 months (p = 0.0002). In participants with osteosarcopenia, SG9 intake was associated with a consistent improvement in ASMM/h² at 6 and 12 months (p = 0.004 and p = 0.006, respectively). No significant between-group differences were detected in physical performance scores, biochemical markers, or quality-of-life measures. Conclusions: Daily consumption of calcium- and magnesium rich mineral water reduced fall risk and improved muscle mass in adults over 50 years, with or without osteosarcopenia. These findings support the role of calcium and magnesium-rich mineral water use as a complementary nutritional strategy for musculoskeletal health and fragility prevention.

Background/Objectives: Calcium and magnesium are essential minerals involved in neuromuscular function, bone metabolism, and fall prevention. Deficiency of these minerals contributes to musculoskeletal fragility, including osteoporosis, sarcopenia, and falls. While dairy products are the traditional source of dietary calcium, mineral waters naturally rich in calcium and magnesium offer a highly bioavailable alternative. This study evaluated the efficacy of daily intake of a naturally calcium‑ and magnesium‑rich mineral water compared with low-mineral water on fall risk, muscle mass, and muscle function in adults aged ≥50 years, with or without osteosarcopenia. Methods: In this 12‑month, randomized, double‑blind, controlled trial, 98 participants were assigned to consume 1 L/day of either SG9 (mineral water with high calcium and magnesium content) or J66 (low-mineral water). Outcomes included incidence of falls (primary endpoint), appendicular skeletal muscle mass (ASMM), muscle strength, physical performance, biochemical markers, and patient-reported measures. Assessments were performed at baseline, 6 months, and 12 months following CONSORT guidelines. Results: Ninety-eight participants (mean age ~63 years) were randomized and completed the 12-month follow-up. At 6 months, the incidence of falls was significantly lower in the SG9 group compared with the J66 group (relative risk reduction 82%; RR = 0.18, 95% CI 0.04–0.88; p < 0.05), whereas no significant between-group difference was observed at 12 months. Appendicular skeletal muscle mass indexed to height (ASMM/h²) was significantly higher in the SG9 group at 12 months (p = 0.005). In participants with osteosarcopenia, SG9 intake was associated with a consistent improvement in ASMM/h² at 6 and 12 months (p = 0.012 and p = 0.005, respectively). No significant between-group differences were detected in physical performance scores, biochemical markers, or quality-of-life measures. Conclusions: Daily consumption of calcium- and magnesium rich mineral water reduced fall risk and improved muscle mass in adults over 50 years, with or without osteosarcopenia. These findings support the role of calcium- and magnesium-rich mineral water as a complementary nutritional strategy for musculoskeletal health and fragility prevention.

Objective: This study aimed to develop Clinical Functioning Information Tool–musculoskeletal, an International Classification of Functioning, Disability and Health–based clinical tool for the assessment and reporting of the functioning and rehabilitation potential of patients with a musculoskeletal condition. Design: This multistep, mixed-methods tool development process encompassed developing an initial shortlist of International Classification of Functioning, Disability and Health categories (comprising the aggregation of the International Classification of Functioning, Disability and Health Core Sets for musculoskeletal conditions and a literature search), identifying the Clinical Functioning Information Tool–musculoskeletal items feasible for clinical use via a two-round Delphi survey, developing a simple description for each item and deciding on the rating scale through development working group consultations. These consultations were also instrumental at each step of tool development. Results: Based on a shortlist of 33 categories, the Delphi survey generated 17 items (7 body function and 10 activity and participation categories), which can be rated with a 0–4 scale (0 = no problem to 4 = complete problem) accompanied with rating specifications or with a 0–10 numeric rating scale without specification. Conclusions: Clinical Functioning Information Tool–musculoskeletal can be used by rehabilitation professionals to support individualized care and track functional outcomes. It can also be employed in research and public health. Psychometric testing and cross-cultural validation will be pursued to ensure Clinical Functioning Information Tool–musculoskeletal’s scientific robustness and applicability across diverse settings.

Rehabilitation is increasingly recognized as a key component of health systems worldwide. To meet the growing demand for rehabilitation services, it is essential to strengthen academic capacity in Physical and Rehabilitation Medicine within universities. Academic structures are critical for training future physicians and professionals, and for advancing research and innovation in rehabilitation. In response to this need, a new European organization has been established: the European Organization of University Physical and Rehabilitation Medicine. This organization aims to unite and support university-based educators and researchers in the field, fostering excellence in teaching, research, clinical care, and academic leadership. The initiative has been developed through collaboration with major European and international rehabilitation bodies and is grounded in the values of representativity, inclusiveness, and collaboration. The organization invites current and future university professors in Physical and Rehabilitation Medicine to join as founding members and contribute to shaping its mission, structure, and strategic direction. By building a strong academic network across Europe, this initiative seeks to reinforce the foundations of rehabilitation in health systems and promote the development of a skilled and innovative workforce. This commentary outlines the rationale, development, and goals of the new organization and calls for broad participation from the academic community.

Objective: to report on the development and global testing of the COVID-19 version of the International Classification of Functioning, Disability and Health-based Clinical Functioning Information Tool called “ClinFIT COVID-19” to collect functioning data of rehabilitation patients across the care continuum to establish an interval-scaled functioning score. Design: Multicentre, cross-sectional observational study. Subjects/Patients: Rehabilitation patients in acute, post-acute, and long-term settings. Methods: Three context-specific versions (13–16 ICF categories) of ClinFIT-COVID-19 were administered to collect information on patient functioning. Rasch analysis examined psychometric properties and generated conversion tables from ordinal raw scores to a 0–100 interval metric. Results: Twenty-six study centres in 17 countries across the globe collected data from 1,747 patients. Problems in exercise tolerance functions were most frequently reported in the acute and post-acute settings (74.2%; 87.6%), while long-term care patients most frequently reported pain as problematic (71.1%). With a testlets approach and item splitting, all 3 ClinFIT COVID-19 versions satisfied Rasch model expectations (item-trait χ² p > 0.05; PSI 0.742–0.812), making it feasible to develop respective transformation tables. Conclusion: This study found the psychometric properties of ClinFIT COVID-19 acceptable. Future studies are needed to validate the use of the transformation tables to monitor functioning and evaluate intervention impact.