Eleni A. Kortianou

Aim: To determine the level of agreement between remote and in-person assessment for the Timed Up and Go test (TUG), the Lateral Step-Up test (LSU), the Five-Times-Sit-To-Stand test (FTSTS), and the Pediatric Balance Scale (PBS) in children with cerebral palsy (CP). Methods: Fifteen children diagnosed with unilateral and bilateral spastic CP and Gross Motor Function Classification System levels I–II underwent these four tests in two distinct environments. These assessments were conducted 24 to 48 hours apart, first in person at the physiotherapy clinic and then remotely at home via the VSee platform. Before the remote assessment, all parents attended a preliminary training session that covered technical proficiency with VSee, the proper setup of home equipment, and essential safety protocols. Results: Children had a median age of 7 (IQR = 6–10) years old. All children successfully finished all four tests in both the home and clinic settings without any reported safety issues. The agreement was good for the time of repetitions in the FTSTS: ICC = 0.884 (95% CI: 0.654 to 0.961; MD = –1.26 seconds, 95% CI: –2.81 to 0.28, p = 0.102), and excellent for the total time of the TUG: ICC = 0.998 (95% CI: 0.990 to 0.999; MD = –0.42 seconds, 95% CI: –0.76 to –0.08, p = 0.017), the total score in the PBS: ICC = 0.998 (95% CI: 0.992 to 0.999; MD = 0.26 units, 95% CI: 0.01 to 0.52, p = 0.041), and the total number of steps in the LSU: ICC = 0.988 (95% CI: 0.965 to 0.996; MD = 0.53 steps, 95% CI: –0.68 to 1.75, p = 0.364). Conclusions: Remote evaluation of the FTSTS, TUG, LSU, and PBS demonstrates good-to-excellent agreement with in-person assessment. However, wide limits of agreement indicated individual variability.

Inspiratory muscle training (ΙμΤ) with high loads, an adjuvant exercise modality in cardiac rehabilitation programs, seems beneficial for patients with heart failure (HF). This systematic review and meta-analysis aims to investigate the effects of combined high ΙμΤ (H-IMT) and aerobic exercise (AE) training in patients with HF. A systematic search of randomized controlled trials (RCTs) was conducted across Medline (via EBSCOhost), PEDro, PubMed, Scopus, Web of Science up to 15 July 2025, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The revised Cochrane Risk of Bias tool for randomized trials (RoB2) and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach were used to assess the methodological quality and overall evidence quality, respectively. A narrative synthesis of findings was completed, and meta-analysis was conducted on clinical outcomes when data were available from at least two studies. Seven RCTs were included, with female participants comprising 33% of the total sample. Interventions lasted from 6 to 16 weeks in hospital or home settings. Adding H-IMT elicits extra benefits in maximum inspiratory pressure (MIP) (MD = 15.24 cm H2O, 95% CI 7.30 to 23.17, P = 0.0002), quality of life (QoL) (MD = -6.96 units, 95% CI -11.33 to -2.59, P = 0.002) compared with AE training. No extra benefit was reported in pulmonary indices, left ventricular ejection fraction, aerobic and functional capacity. Still, most studies (4 out of 7) had a considerable risk of bias. Combined H-IMT and AE training may improve MIP and QoL in patients with HF. However, these findings are preliminary and based on very low-quality evidence. Larger, high-quality trials are needed to confirm benefits before broad clinical implementation. PROSPERO registration number is CRD42024568200.

Background: Preschool wheezing is common, but distinguishing transient wheezing from early persistent asthma remains difficult. Oscillometric techniques, including impulse oscillometry (IOS), may provide objective prognostic information. Objective: To systematically review longitudinal studies assessing whether oscillometric measurements obtained at preschool age are associated with later asthma-related outcomes or lung function impairment. Methods: PubMed, Scopus, and MEDLINE (via EBSCOhost) were searched from inception to 28 February 2026. Eligible studies included preschool-aged children or closely related early-childhood populations assessed with IOS or forced oscillation technique (FOT), longitudinal follow-up, and later asthma-related or spirometric outcomes. Two reviewers independently screened studies, extracted data, and assessed risk of bias with QUIPS. Owing to substantial heterogeneity, findings were synthesized qualitatively. Results: Seven longitudinal cohort studies, encompassing 1077 children, met the eligibility criteria; baseline oscillometry was performed between ages 2 and 7 years, and follow-up ranged from 1 to 10 years. Short-term classification and longer-term prognostic studies were interpreted separately. Resistance-based indices, particularly R5, showed the most consistent associations with later asthma-related outcomes and lower subsequent spirometric indices, including FEV₁ and FEV_1/FVC. Most studies were at moderate risk of bias, and some reports came from related cohorts. Conclusions: Preschool oscillometry may provide complementary physiological information to assess asthma risk in symptomatic or high-risk preschool-aged children, particularly through resistance-based measures. However, evidence remains limited, heterogeneous, and insufficient to support a single validated cutoff, routine screening of apparently healthy children, or routine stand-alone prognostic use.

Heart failure (HF) is a heterogeneous clinical syndrome with increasing prevalence among adults worldwide. It is characterized by complex central and peripheral alterations that contribute to exercise intolerance, fatigue, dyspnea, and reduced quality of life. Inspiratory muscle weakness (IMW) plays a key role in this vicious cycle by exacerbating symptoms and further limiting functional capacity. Inspiratory muscle training (IMT) has emerged as a potential adjuvant in comprehensive HF management and is a physiologically grounded and promising tool in the contemporary HF therapeutic toolkit. Its integration into multimodal rehabilitation programs may mitigate the cycle of dyspnea and deconditioning in patients with HF. On this basis, we provide an overview of the pathophysiological mechanisms underlying IMW and present the practical characteristics of IMT programs, synthesizing current evidence regarding its clinical efficacy and implementation challenges.

Background: The pediatric population with chronic suppurative lung diseases (CSLDs) presents with a clinical profile of persistent productive cough and impaired airway clearance, which leads to reduced exercise capacity and physical activity (PA). The main objective of this research is to evaluate the effect of a 12-week intervention that combines airway clearance techniques (ACTs) and exercise training delivered through synchronous (videoconferencing) and asynchronous implementation at home, supported by an informative, specially designed website and supervised by a physiotherapist on exercise capacity. The secondary objective is to assess adherence to the ACT performance. The hypothesis of the study is that this hybrid tele-rehabilitation program will improve functional and exercise capacity, as well as compliance with ACTs, compared to the usual care. Methods: Thirty-two children with CSLDs (other than cystic fibrosis) will be randomly assigned to either the intervention group (home-based, synchronous, and asynchronous ACTs and exercise training) or the control group (usual care). An assessor blind to group allocation will measure the modified shuttle walk test, 6-minute walking test, Chester step test, respiratory muscle strength, handgrip, pulmonary function, PA, sedentary behavior, and quality of life at baseline, at the end of the intervention (3 months), and 6 months after completion. Discussion: This study introduces a hybrid (synchronous and asynchronous) tele-rehabilitation program, aiming to improve physical capacity and adherence to physiotherapy management for pediatric CSLD populations.

Background: Regular aerobic exercise during childhood promotes critical physiological adaptations in the cardiovascular and respiratory system. Finswimming, a unique aquatic sport, requires high-intensity demands and specific breathing patterns. The present study aimed to compare respiratory function and cardiorespiratory responses between young male finswimmers and sedentary age-matched non-athletes. Methods: Thirty-two boys aged 8 to 12 years old were stratified into the finswimmers group (FSG, n = 16) and the non-athletes group (NAG, n = 16). Assessments included pulmonary function (spirometry) and respiratory muscle strength (Maximum Inspiratory Pressure, MIP/Maximum Expiratory Pressure, MEP). Exercise capacity was evaluated using the modified shuttle walk test (MSWT). Results: The FSG exhibited significantly higher pulmonary function (Forced Vital Capacity, Forced Expiratory Volume in 1 s, Maximum Voluntary Ventilation; p < 0.05) and superior MIP compared to the NAG (105.3 ± 24.8 versus 87.3 ± 24.7 cmH₂O; p = 0.022). During the MSWT, FSG covered substantially greater distances (746.6 ± 97.2 versus 591.1 ± 86.4 m; p < 0.001) with lower levels of leg fatigue (Borg 0–10) (0.53 ± 0.39 versus 2.13 ± 1.93; p = 0.004) and demonstrated lower heart rate recovery time (4.47 ± 0.68 versus 5.75 ± 0.68 min; p < 0.001) compared to NAG. At the iso-level (8th level of MSWT), FSG scored lower levels of leg fatigue (0.13 ± 0.12 versus 2.02 ± 2.0; p = 0.001) compared to NAG, indicating better peripheral oxygen % saturation (100 ± 0.0 versus 98.14 ± 1.16; p < 0.001). Conclusions: Systematic exercise training enhances profound cardiorespiratory and peripheral muscle adaptations in children. Enhanced cardiorespiratory function allows young athletes to achieve higher workloads and recover faster than sedentary peers, highlighting the sport’s role in establishing a robust cardiorespiratory fitness.

Objective: The objective of this study is to conduct a systematic review of the evidence on the use of remotely administered walking tests (RaWTs) in patients with chronic pulmonary diseases (CPDs) and heart failure (HF), focusing on agreement, reliability, feasibility, and clinical utility as outcomes. Methods: This study followed the Preferred Reporting Items for Systematic Reviews and was registered on the International Prospective Register of Systematic Reviews platform (ID: CRD420251180996). The PubMed, Web of Science, CENTRAL, Scopus, and ACM databases were comprehensively searched from inception up to October 2025. Observational, randomized and non-randomized control studies assessing the agreement, reliability, feasibility, and clinical utility of RaWTs in people with CPDs and HF and reporting quantitative outcomes were eligible. Two reviewers independently conducted study selection, data extraction, and risk of bias assessment using the COSMIN Risk of Bias tool for the reliability studies, the Risk of Bias in Non-Randomized Studies—of Interventions (ROBINS-I) tool for non-randomized studies, and the Quality in Prognosis Studies (QUIPS) tool for the prognostic studies. Results: Eleven studies met the inclusion criteria. Five studies included patients with HF, five with pulmonary hypertension (PH), and one study included candidates for lung transplantation due to advanced CPD. All studies used the 6 min walk test (6MWT); one also included the incremental shuttle walk test. Agreement with face-to-face in-clinic testing (in five studies) is setting-dependent and influenced by the testing setup. Reliability (in eight studies), derived from variable statistical indices in both patient populations, showed that RaWTs are reliable. Adherence and safety were used as the main feasibility indicators. Eight studies concluded that remote assessment is feasible, acceptable, and safe. Clinical utility was examined in only one HF study, showing that remotely administered 6MWT can predict all-cause mortality and HF hospitalization. According to COSMIN, the overall methodological quality of nine studies ranged from very good to inadequate. One study was rated as having a serious risk of bias according to ROBINS-I, and one study as having a high risk of bias according to QUIPS. Conclusions: Although the evidence is limited and heterogeneous, RaWTs demonstrate robust reliability across repeated measurements while agreement with in-clinic testing is context-dependent and strongly influenced by test setup and environmental conditions. RaWTs appear to be acceptable to patients; however, further high-quality studies are needed to confirm these findings and determine the clinical utility of RaWTs on specific clinical outcomes in these populations.

Beyond respiration, the diaphragm contributes to trunk stability and posture. Rehabilitative Ultrasound Imaging (RUSI) assesses Diaphragm Thickness (DT) and Excursion (DE), but evidence on reliability across novice examiners is limited. This study investigated intra- and inter-tester reliability of diaphragmatic RUSI across novice examiners in healthy women and compared DT and DE between parous and nulliparous participants. Healthy parous and nulliparous women participated. Exclusion criteria included pregnancy, chronic conditions, and BMI > 30 kg/m2. Two physiotherapists, novices in RUSI, measured DT during full inspiration and expiration and DE during quiet breathing. An independent examiner calculated the Thickening Fraction (TF). Three within-session measurements were taken for intra-tester reliability, whereas, for inter-tester reliability, agreement between mean measurements was analyzed via Intraclass Correlation Coefficients (ICC) and 95% Confidence Intervals (CIs). Independent samples t-tests assessed DT and DE differences between groups. Twenty women (33±14.3 years, BMI: 23.4±3.3) participated. Intra-tester reliability was moderate to good for DT (ICC:0.511-0.691) and very good for DE (ICC:0.700-0.756). Inter-tester reliability was very good for DE (ICC=0.748), and moderate for DT (ICC: 0.573-0.706). TF reliability was poor. Only one tester found higher inspiratory DT in parous women (p<0.01). Novice examiners can reliably measure DT and DE using RUSI, supporting its use in rehabilitation. Further standardization is required to enhance RUSI practices and additional research to clarify parity-related diaphragm changes.

Objective: To synthesize the available evidence on field tests used to assess functional capacity in children with CLDs other than asthma, such as cystic fibrosis (CF), and non-CF bronchiectasis (NCFB). Still, the application and reliability of the field tests in non-asthmatic pediatric CLDs populations is scarce. Methods: Three databases (PubMed, Medline via EBSCOhost, and Web of Science) were searched from inception to 20 May 2025. Two researchers independently screened the retrieved articles and rated the methodological quality using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Information was extracted about study design, field test used, outcomes measured, and methodological quality. Results: Out of 784 records, 8 studies met the inclusion criteria. Most studies focused on CF. Five different field tests were identified: six-minute walk test (6MWT), modified shuttle walk test (mSWT), one-minute sit-to-stand test (1mSTS), three-minute step test (3mST), and TGlittre-P test. The 6MWT (n = 3) and mSWT (n = 2) were the most frequently used and demonstrated good reliability and clinical applicability. Reported outcomes included distance walked, total steps, task’ repetitions, and cardiopulmonary parameters, such as heart rate and perceived exertion of dyspnea/leg fatigue. Conclusions: Field exercise tests appear to be feasible in children with CLDs other than asthma, with most data available in CF. They can be used to monitor functional capacity over time, to assess the effectiveness of rehabilitation programs, and to complement symptom assessment with tools such as the Borg scale. Evidence in NCFB and PCD is still limited, and additional pediatric studies are needed.

Prematurity, defined as a birth before 37 weeks of gestation, affects approximately 15 million infants worldwide yearly. Beyond the Neonatal Intensive Care Unit and the possibility of long-term developmental challenges affecting children’s quality of life, prematurity influences family dynamics, including parental mental health, financial stability, employment, and daily life. On a broader scale, research highlights the significant socioeconomic consequences of preterm birth that influence public healthcare policies, healthcare systems, and long-term costs. Addressing these challenges requires a multidisciplinary approach, beginning in the NICUs, with parental inclusion as a key component. The shift toward parental inclusion in the NICU may represent a fundamental transition from a medical to a social model of prematurity. The concept of a social model of prematurity parallels the social model of disability, from disability studies, focusing on premature babies, strengthening their abilities and nurturing early caregiver—infant relationships. It highlights how societal structures, such as accessibility and support systems, shape developmental outcomes and inclusion of premature infants, rather than framing prematurity solely in terms of survival and treatment.