Shashank Ghai

Background: Chronic pain (CP) is a complex and prevalent public health condition that significantly impacts physical functioning, psychological well-being, and quality of life. Traditional biomedical treatments often provide limited relief, highlighting the need for integrative approaches. Biopsychosocial interventions, such as mindfulness-based stress reduction (MBSR), have shown promise in improving pain-related outcomes by targeting cognitive, emotional, and behavioral processes associated with CP. Objective: This pilot randomized controlled trial (RCT) evaluated the feasibility and preliminary effects of a virtual MBSR intervention for individuals with CP. Methods: We conducted a single-blinded, randomized, pilot trial of 61 participants with CP randomly assigned to either an 8-week virtual MBSR program or a no-intervention control group. Participants were aware of their allocation; the data analyst remained blinded throughout the study; and the outcome assessor was blinded at baseline, although blinding could not be reliably maintained at subsequent assessments. The primary outcome was feasibility, assessed through recruitment, retention, and adherence rates. Secondary outcomes, examined on an exploratory basis, included pain disability, CP acceptance, pain catastrophizing, pain self-efficacy, health-related quality of life (HRQoL; PROMIS-29 [Patient-Reported Outcomes Measurement Information System-29] and PROMIS-10 [Patient-Reported Outcomes Measurement Information System-10]), and global rating of change. Results: Recruitment (23.5%), retention (60.7%), and adherence (63.3%) rates were below the prespecified thresholds of 30%, 80%, and 80%, respectively, indicating that modifications to the current design are required before proceeding to a definitive trial. As this pilot trial was not powered to test intervention effectiveness, the following clinical outcomes are reported as exploratory and hypothesis-generating. A significant group-by-assessment period interaction was observed for pain disability, PROMIS-10 (physical health and global health), and PROMIS-29 (participation in social activities). No significant interactions were observed for pain catastrophizing, pain self-efficacy, or CP acceptance. On the Global Rating of Change scale, MBSR participants reported greater improvement in pain self-efficacy than the no-intervention control group. Conclusions: This pilot study did not meet its feasibility targets, highlighting the need to refine recruitment, retention, and intervention delivery procedures before conducting a future trial. Preliminary exploratory analyses suggested improvements in pain disability and several HRQoL subdomains in the MBSR group compared with the control group, but these findings should be interpreted cautiously given the underpowered sample and the exploratory nature of these analyses. These results provide guidance for optimizing study design and implementation of a future, adequately powered RCT evaluating virtual MBSR for adults with CP.

Background: Adults with major lower limb amputation (LLA) due to dysvascular etiology often experience diverse health outcomes. However, the absence of standardized outcome reporting limits the ability to synthesize evidence, evaluate care models, and develop consistent clinical pathways. This review updates a systematic review on outcome measures and indicators reported in this population. Methods: A systematic review update was conducted across six databases (MEDLINE, EMBASE, EBM Reviews, PsycINFO, Web of Science, and CINAHL) from 20 April 2017 to 1 December 2022. All study designs were eligible; however, the articles needed to report outcome measures and indicators on at least 50% of the adult population with major dysvascular LLAs. The extracted outcome measures and indicators were organized according to Dodd’s framework and then reclassified alongside those reported in the study by Ambler and colleagues. The pilot phase of data extraction was carried out independently by multiple reviewers, after which a single reviewer completed the data extraction. Results: Of the 12,557 articles, 160 studies reporting data on 228,116 individuals with major dysvascular LLA met the inclusion criteria. Combining these with the 440 studies from the previous review, 2,466 outcome measures and indicators were categorized in five core areas: life impact (25.7%), physiological/clinical (23.4%), death (18.7%), resource use (17.6%), and adverse events (14.6%). In terms of the outcome domains, mortality/survival was the most commonly reported domain, followed by physical functioning (e.g. prosthesis fit, use), skin (e.g., stump wound healing), nervous system outcomes (e.g., residual limb pain), need for further interventions (e.g., prescription of medications), hospital outcomes (e.g., duration of stay, discharge), and adverse events. Conclusion: This study builds on a previous review by identifying and categorizing outcome measures and indicators in adults with major dysvascular LLA, highlighting inconsistencies in outcome reporting across studies. The absence of a standardized set of outcome measures and indicators limits the ability to conduct meta-analyses or systematic reviews, evaluate the effectiveness of care models, and establish clinical pathways. Developing a core outcome set tailored to the needs of individuals with dysvascular LLA could help address these challenges by promoting consistency in outcome reporting and enabling meaningful comparisons across studies. Ultimately, this could contribute to improving the quality, efficiency, and person-centeredness of care. Trial registration: PROSPERO (CRD42023388570).

Falls remain the leading cause of injury-related death among older adults, with turning accident often producing the most severe consequences, such as hip fractures and a resulting decline in independence. Despite curved-path walking accounting for the majority of daily locomotion, most interventions insufficiently target the coordinated action of lower limb, pelvic and trunk muscles underlying safe turning. This leaves a large proportion of older adults and patients with motricity problems and movement disorders at heightened risk of life-altering injuries. Addressing this gap requires innovative strategies that proactively build on recent physiological research and improve turning strength and neuromuscular control of steering. Gait problems have often been addressed through the use of linear treadmills, which emphasise the symmetry and automaticity of walking but ignore the fact that more than half of daily locomotion involves deviations from the trajectory. In this perspective article, we review the differences between linear and curved walking. We also put forward the hypothesis that a turntable rotating parallel to the horizontal plane represents a potential solution. Such a device could allow individuals to step in place while the surface moves beneath them, simulating the natural rotation of legs, pelvis, and trunk involved in turning. The exercise is designed to train the muscle synergies and proprioceptive responses critical for turning, while minimising stress on vestibular systems, and enhancing task-specific neuroplasticity and proprioception.

Introduction: Falls constitute a significant public health burden across the adult lifespan, affecting both working-age and older populations and compromising functional independence and quality of life through physical and psychological consequences. Current interventions typically address these dimensions in isolation, emphasizing fall avoidance rather than equipping individuals to manage and recover from falls when they occur. Methods: This exploratory study evaluated the feasibility, acceptability, and safety of the Floor-Hugging Intervention (Floor-HI), a novel multicomponent program that combines controlled exposure to fall-risk environments with systematic training in post-fall recovery skills, including floor-to-standing transitions, fall imagination, and role-playing scenarios. Eight community-dwelling, middle-aged adults (3 males, 5 females; aged 31–55 years) completed a 3-week program. Outcomes including concern of falling, postural control, floor-rise ability, turning ability, and health-related quality of life were assessed at four time points (Weeks 0, 3, 6, and 9). Results: Recruitment, retention, and adherence rates were 100%, 89%, and 100%, respectively. Significant improvements over time were observed in postural stability (Mini-BESTest, p = .011), floor-rise ability (Sitting Rising Test, p = .011), and turning capacity (360° Turn Test duration, p = .012–.017). Concern of falling (Falls Efficacy Scale-International, p = .145) and health-related quality of life (RAND-36, p > .05) remained unchanged. Intervention acceptability was high across all domains of the Theoretical Framework of Acceptability questionnaire. Only a small number of mild, transient adverse events were reported, all resolving without medical intervention, and no serious adverse events occurred. Discussion: Despite being limited by the absence of a control group and a small sample size, this study demonstrates that Floor-HI is feasible, acceptable, and safe in community-dwelling middle-aged adults. These findings provide a foundation for future feasibility and controlled trials to establish efficacy and applicability in populations with elevated fall risk.

Background: Stroke is a prevalent neurological condition that frequently results in long-term disabilities and considerable societal costs. While existing rehabilitation approaches provide some benefits, residual motor impairments often persist and become permanent, leading to ongoing activity restrictions. Music-based intervention, such as the Ronnie Gardiner Method (RGM), adheres to best practice principles of stroke rehabilitation by simultaneously engaging motor, sensory, cognitive and emotional functions, potentially offering enhanced recovery outcomes. However, research examining its effectiveness in chronic stroke rehabilitation remains limited. Methods and analysis: This multicentre, randomised controlled trial will recruit 84 community-dwelling individuals with chronic stroke over a 2-year period across four sites in Sweden. Participants will be randomly assigned to either an intervention group receiving RGM training (n=42) or a passive waitlist control group (n=42). Only the investigators and outcome assessors will remain blinded to group allocation. RGM training consists of 60 min group sessions twice weekly for 12 consecutive weeks. The primary outcome is to evaluate the effectiveness of RGM training on balance performance using the Mini-Balance Evaluation Systems Test. Secondary outcomes include assessment of gait function (10-Metre Walk Test, 6 min Walk Test, Short Physical Performance Battery), upper limb function (9-Hole Peg Test, Observational Drinking Task Assessment), cognitive abilities (Victoria Stroop Test, Rey Complex Figure Test, Memory Test), fear of falling (Falls Efficacy Scale-International) and stroke-related functional impact (Stroke Impact Scale-16). Broader health-related quality of life will be assessed using the RAND 36-Item Health Survey, EuroQol 5-Dimension 5-Level, and depressive symptoms will be measured with the Montgomery-Åsberg Depression Rating Scale. All outcomes will be assessed at baseline, postintervention and at a 3-month follow-up. Additional assessments will include qualitative evaluations of participants’ and trainers’ subjective experiences, cognitive screening (Montreal Cognitive Assessment) and postintervention enjoyment assessment (Physical Activity Enjoyment Scale). Ethics and dissemination: Ethical approvals for the study have been obtained from the Swedish Ethical Review Authority (Dnr: 2025-01269-01 and Dnr: 2025-08232-02). The results will be disseminated via peer-reviewed journal publications, conference presentations and targeted communication with stakeholders and the media. Trial registration number: NCT06979050 .

Fall-compliant flooring represents a passive fall preventative approach that has emerged as an effective intervention for reducing fall-related injuries, yet its adoption remains limited due to insufficient understanding among end-users and key stakeholders. To address this knowledge gap, this perspective article provides a proof-of-concept for an interactive pedagogical tool designed to use gamification principles to improve understanding of the mechanical behavior of fall-compliant flooring. This two-part perspective article first establishes the scientific foundation through controlled ball drop experiments comparing energy dissipation between fall-compliant and standard flooring. Through video-based tracking analysis, the experiments quantified kinetic energy and force dissipation across spatial and temporal dimensions. Results revealed that fall-compliant flooring exhibits significantly superior spatiotemporal energy dissipation capabilities compared to standard flooring across both force and kinetic energy metrics. Building on these findings, the second part proposes a conceptual framework for a pedagogical tool that translates these experimental insights into an interactive learning experience that could, in future implementations, allow users to conduct hands-on ball drop activities supported by real-time scientific explanations. This approach transforms complex biomechanical concepts into accessible, engaging learning experiences. By combining experiential learning with gamified elements, this tool, termed “Fallville”, has the potential to increase fall-injury prevention awareness, deepen understanding of fall-compliant flooring mechanisms, and ultimately accelerate adoption of this proven safety intervention in healthcare and residential settings.

The global mental health crisis has escalated to unprecedented levels, with stress, anxiety, and depression posing major public health concerns. Conventional interventions have shown limited success in addressing these multifaceted issues, prompting researchers to explore alternative solutions. Yoga Nidra (YN), a meditative practice, has gained momentum over the past decade as a potential holistic approach to mental health care. Yet, its clinical effectiveness remains inadequately understood. This systematic review and meta‐analysis rigorously assessed YN's impact on stress, anxiety, and depression. A comprehensive search of seven databases and one trial database yielded 814 articles, of which 73 studies involving 5201 participants met the inclusion criteria. Between‐group meta‐analyses revealed significant benefits of YN for stress (Hedge's g : −0.80 with active comparator, −1.70 with no comparator), anxiety (active: −1.35, no comparator: −1.43), and depression (active: −0.69, no comparator: −0.92). Within‐group analyses supported these effects, reinforcing YN's therapeutic potential. However, given the low methodological quality and variability in intervention delivery, these moderate‐to‐large effects should be interpreted cautiously, as they likely reflect inflated estimates. Despite these limitations, YN shows potential in managing mental health symptoms, underscoring the need for high‐quality, standardized research to establish its efficacy as a viable clinical intervention.

Background: Pain, both acute and chronic, places a substantial burden on global healthcare systems. While conventional treatments may be limited in efficacy due to side effects, risk of dependency, or variable individual response, there is growing interest in mind-body complementary approaches. Yoga nidra (YGN) has emerged as a promising noninvasive intervention for pain management. However, a clear understanding of its efficacy remains limited. This systematic review and meta-analysis evaluated the effects of YGN on pain outcomes. Methods: A literature search was conducted across seven databases and one trial database. Eligible studies included quantitative designs assessing the effects of YGN on pain. Methodological quality was evaluated using the Cochrane Risk of Bias tool for randomized controlled trials and the modified Downs and Black checklist for non-randomized studies. Random-effects meta-analyses were performed to estimate pooled effect sizes. Results: Twelve studies, comprising 1,176 participants, were included. Between-group analyses revealed that YGN significantly reduced pain compared to passive comparators (Hedge’s g: −2.05, p = 0.01), while comparisons with active comparators (g: −0.31, p = 0.53) showed no statistically significant differences. Within-group analyses indicated significant pain reduction following YGN (g: −2.01, p < 0.001). Subgroup comparisons of single versus multiple training sessions, as well as meta-regression analyses, revealed no significant dose-response relationship across intervention durations. Conclusion: YGN shows potential in reducing pain intensity compared to passive control conditions, with notable within-group improvements following intervention. However, given the low methodological quality across the included studies, these effects should be interpreted cautiously, as the observed effects may represent inflated estimates. Despite these limitations, YGN demonstrates potential as a complementary approach for pain management, underscoring the need for high-quality, standardized research to establish its efficacy as a viable clinical intervention.

Taping is increasingly used to manage proprioceptive deficits, but existing reviews on its impact have shortcomings. To accurately assess the effects of taping, a separate meta-analyses for different population groups and tape types is needed. Therefore, both between- and within-group meta-analyses are needed to evaluate the influence of taping on proprioception. According to PRISMA guidelines, a literature search was conducted across seven databases (Web of Science, PEDro, Pubmed, EBSCO, Scopus, ERIC, SportDiscus, Psychinfo) and one register (CENTRAL) using the keywords “tape” and “proprioception”. Out of 1372 records, 91 studies, involving 2718 individuals, met the inclusion criteria outlined in the systematic review. The meta-analyses revealed a significant between and within-group reduction in repositioning errors with taping compared to no tape (Hedge’s g: -0.39, p < 0.001) and placebo taping (Hedge’s g: -1.20, p < 0.001). Subgroup and sensitivity analyses further confirmed the reliability of the overall between and within-group analyses. The between-group results further demonstrated that both elastic tape and rigid tape had similar efficacy to improve repositioning errors in both healthy and fatigued populations. Additional analyses on the threshold to detection of passive motion and active movement extent discrimination apparatus revealed no significant influence of taping. In conclusion, the findings highlight the potential of taping to enhance joint repositioning accuracy compared to no tape or placebo taping. Further research needs to uncover underlying mechanisms and refine the application of taping for diverse populations with proprioceptive deficits.