Indonesian Journal of Physical Medicine and Rehabilitation

Secretome as an Alternative Therapy for Pain Intervention in Musculoskeletal Disorders

Evi Rachmawati Nur Hidayati — 2026-07-24

Pain is one of the factors that may impair a person’s quality of life, and persistent pain is difficult to manage. Recently, pain management that focuses solely on symptom relief has been shown to potentially lead to chronic pain. Nowadays, clinicians face several potential approaches that may help prevent or break the cycle of pain. One of these potential approaches is stem cell therapy. Although the evidence base supporting this approach is still limited, preliminary studies—such as in vitro, in vivo, and translational studies—show positive and encouraging effects on tissue regeneration in cases of degenerative tissue damage.

The secretome is one modality of stem cell therapy that offers several advantages, including a lower risk of allergic reactions and the ability to stimulate the tissue-healing process. Secretome-based, cell-free therapy has moved from a peripheral topic in regenerative medicine to a mainstream translational strategy for musculoskeletal disorders, including osteoarthritis, ligament and tendon injury, sarcopenia, and peripheral nerve entrapment syndromes such as carpal tunnel syndrome. This reflects a broader shift toward a present-and-future translational framing of stem cell secretome across tissue repair applications (Da Silva et al., 2025). This shift deserves attention because the field is at an inflection point: preclinical data are accumulating faster than standardized clinical protocols, and manuscripts submitted for review vary widely in how they define, characterize, and dose “secretome.” These notes are intended to guide editorial assessment of submissions in this area and to outline where future-oriented, design-driven research is most needed.

Influence of Robotic Hand Gloves on Hand Function in Stroke Survivors

Arun Balasubramaniam — 2026-07-24

Introduction: Stroke is one of the leading causes of long-term disability worldwide and frequently results in impaired upper limb and hand functions. Recent advances in rehabilitation technology have introduced wearable robotic devices to enhance repetitive, task-oriented training and promote neuroplasticity. The present study aimed to evaluate the effectiveness of robotic hand glove therapy integrated with task-oriented training on hand motor function among stroke survivors.

Method: A quasi-experimental design with forty-two individuals with subacute stroke survivors were recruited from Thulir physiotherapy & rehabilitation center. Erode. Participants were allocated into two groups: a robotic glove group receiving task-oriented training combined with robotic-glove exercises, and another group receiving task-specific exercises along with sham robotic glove. The intervention was conducted for eight weeks under supervised conditions. Outcome measures included the Action Research Arm Test (ARAT), Nine-Hole Peg Test (NHPT), and Stroke Impact Scale (SIS), assessed at baseline, mid-intervention, and post-intervention to evaluate changes in dexterity, functional performance, and perceived recovery.

Result: Statistical analysis with repeated measures ANOVA showed significant time effects across outcomes (p < 0.001), and Bonferroni analysis confirmed progressive differences between all intervals. In the robotic hand group, mean ARAT improved from 16.33 to 23.52 and 34.38, whereas TOG improved from 16.38 to 20.33 and 25.57. NHPT time decreased in RHG from 85.86 to 65.48 and 49.67, while TOG reduced from 85.10 to 72.91 and 63.24. SIS scores increased in RHG from 29.14 to 51.48 and 61.43, compared to TOG improvement from 29.33 to 38.24 and 47.29.

Conclusion: This study concluded as robotic-gloves along with task-oriented rehabilitation offers excellent hand recovery in stroke survivors.

Effect of Retrowalking Exercise as Adjunctive Therapy on Functional Disability in Patients with Knee Osteoarthritis: A Randomized Controlled Trial

Nelfidayani — 2026-07-24

Background: Osteoarthritis (OA) is a degenerative joint disease and one of the major health problems caused functional disability that inhibits the performance of daily activities. Previous studies reported the beneficial effect of retrowalking in patients with knee osteoarthritis. The current study aims to find the effectiveness of retrowalking exercise as an adjunct to conventional therapy on functional disability in patients with knee osteoarthritis.

Methods: A randomized control trial design was conducted at outpatient Medical Rehabilitation Department in December 2018 to March 2019. Thirty-eight patients with knee OA participated in this study, which were randomly into 2 groups: experimental and control groups. The subjects from both groups received conventional therapy and only the experimental group received retrowalking exercise, 3x/week for 4 weeks. WOMAC Index was used to measure functional disabilitybefore and after intervention. Data were analysed using SPSS version 20.

Results: Per-protocol analysis showed a statistically significant change in the WOMAC index score in patients who received retrowalking exercises compared to the control group (p= 0.027) after 4 weeks of intervention. Only the pain subscale of the WOMAC index showed a statistically significant difference between the experimental and control groups (p= 0.043).

Conclusions: The 4 weeks retrowalking exercise as an adjunctive therapy in patients with knee osteoarthritis is more effective to reduce functional disability compared to conventional therapy alone.

Keywords: Exercise Training, Adjunctive Therapy, Retrowalking, Disability Evaluation, Osteoarthritis of Knee

Effect of Additional Extracorporeal Shockwave Therapy on Knee Functional Score: A Study in Patients with Knee Osteoarthritis Receiving Quadriceps Set Exercises

Mustika Ngada Lasiga — 2026-07-24

Background: Osteoarthritis (OA) is the most common degenerative joint disease worldwide and a major cause of disability. Extracorporeal shockwave therapy (ESWT) is a novel treatment that promotes regeneration in musculoskeletal diseases. ESWT can trigger subchondral bone changes, inhibit cartilage degeneration, stimulate neovascularization, increase chondrocyte proliferation, and enhance angiogenesis, leading to improved knee function.

Objective: The goal of this study was to investigate the effect of adding ESWT on knee functional scores in patients with knee OA who perform quadriceps exercise sets.

Method: We performed a randomized controlled trial with total 28 individuals divided equally into the control (CG) and intervention groups (IG). Both groups received quadriceps exercise sets on daily basis for 4 weeks; the treatment group also received ESWT once a week for 4 weeks. We used Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) to assess knee function both before and after the 4 weeks treatment program.

Results: There was a significant increase in WOMAC score in both the intervention group (p = 0.001) and the control group (p = 0.001). There was a significant difference WOMAC post treatment with p 0.019 and the p value for WOMAC comparation between group was 0.377 so it could be concluded that there was no significant difference.

Conclusion: Both groups showed significant results, with IG demonstrating a greater improvement than CG. However, no significant difference was found between the groups. In conclusion, ESWT benefits patients with OA.

Keywords: Extracorporeal Shockwave Therapy, Osteoarthritis, Quadriceps Set Exercises.

Beyond the Injury Level: Functional Outcome Variability in Cervical Spinal Cord Injury: A Case Series

Hafidz Mumtaz — 2026-07-26

Introduction: Spinal cord injury (SCI) is damage to the spinal cord that causes motor, sensory, and autonomic dysfunction. Global incidence ranges from 13 to 220 cases per one million people. Many complications are irreversible.

Objective: To describe and compare three patients with SCI at different injury levels and examine variations in rehabilitation outcomes using the ADL scale and ASIA Impairment Scale.

Methods: This descriptive observational study included three hospitalized male patients with SCI. Collected data consisted of age, etiology, time to admission, comorbidities, neurological status, autonomic dysfunction, ADL level, ASIA classification, and rehabilitation interventions.

Results: The cases showed different neurological and functional outcomes. Case 1 (T10 to L1, ASIA A) had complete motor loss in the lower limbs, impaired proprioception, and total dependence in ADL. Case 2 (C3 to C7, ASIA B) showed severe motor deficits with incomplete sensory preservation and remained fully dependent. Case 3 (C5 to C6, ASIA B) demonstrated better recovery potential, including improved upper limb strength and partial sensory preservation. All patients experienced urinary and bowel dysfunction. Differences in age, injury level, completeness, comorbidities, and early surgical care contributed to outcome variation. Based on the ICF framework, these differences reflect variations in body functions, activities, and participation. Community-based rehabilitation may support long-term independence.

Conclusion: SCI outcomes depend on lesion level, completeness of injury, age, comorbidities, and early multidisciplinary management. Incomplete injuries, especially ASIA B, show better potential for neurological and functional recovery. The use of ICF principles can guide rehabilitation goals and improve functional independence.

Comparative Effectiveness of AI-Assisted Telerehabilitation Versus Conventional Rehabilitation for Upper Limb Recovery After Stroke: A Systematic Review and Meta-Analysis

Fianirazha Primesa Caesarani — 2026-07-24

ABSTRACT

Background: Stroke is a leading cause of long-term disability, with upper limb motor deficits limiting functional independence and quality of life. Advances in artificial intelligence (AI) have enabled AI-assisted telerehabilitation platforms that deliver intensive, task-specific, individualized therapy remotely, yet their comparative effectiveness remains uncertain.

Methods: PubMed, Embase, Scopus, Cochrane CENTRAL, and Web of Science were searched to June 2025. Randomized controlled trials and quasi-experimental studies enrolling adults with stroke-related upper limb impairment were eligible. Studies compared AI-assisted telerehabilitation with conventional therapist-led or standard remote therapy and reported validated outcomes, including the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) and Motor Activity Log (MAL). Risk of bias was assessed using the Cochrane tool, and pooled mean differences were calculated using random-effects models.

Result: Five studies including 339 participants met inclusion criteria. Meta-analysis demonstrated no statistically significant difference between AI-assisted telerehabilitation and conventional therapy. The pooled mean difference for FMA-UE was 0.55 (95% CI: -0.60 to 1.08; p=0.38; I²=89%), and for MAL was 0.36 (95% CI: -0.45 to 1.17; p=0.39). Both groups achieved clinically meaningful improvements, with no serious adverse events reported.

Conclusion: AI-assisted telerehabilitation is an alternative to conventional post-stroke upper limb rehabilitation.

Keywords: artificial intelligence, motor recovery, stroke, telerehabilitation, upper limb

ABSTRAK

Latar Belakang: Stroke merupakan salah satu penyebab disabilitas jangka panjang, dengan gangguan fungsi motorik ekstremitas atas membatasi kemandirian fungsional serta kualitas hidup. Telerehabilitasi berbasis AI sebagai alternatif layanan rehabilitasi memungkinkan pemberian terapi secara intensif, spesifik terhadap tugas, dan terindividualisasi dari rumah. Namun, bukti mengenai efektivitas telerehabilitasi berbasis AI masih terbatas.

Metode: Pencarian literatur dilakukan pada PubMed, Embase, Scopus, Cochrane CENTRAL, dan Web of Science hingga Juni 2025. Studi uji acak terkontrol dan kuasi-eksperimental yang melibatkan pasien dewasa pascastroke dengan gangguan ekstremitas atas disertakan. Studi membandingkan telerehabilitasi berbasis AI dengan terapi konvensional yang dipandu terapis atau terapi jarak jauh standar, disertai luaran tervalidasi seperti Fugl-Meyer Assessment untuk Ekstremitas Atas (FMA-UE) dan Motor Activity Log (MAL). Penilaian risiko bias dilakukan menggunakan alat Cochrane, dan analisis meta dilakukan dengan model efek acak.

Hasil: Lima studi dengan total 339 partisipan memenuhi kriteria inklusi. Hasil meta-analisis menunjukkan tidak terdapat perbedaan bermakna secara statistik antara kelompok telerehabilitasi berbasis AI dan terapi konvensional. Perbedaan rerata gabungan FMA-UE adalah 0.55 (95% CI: -0.60 to 1.08; p=0.38; I²=89%), sedangkan untuk MAL sebesar 0.36 (95% CI: -0.45 to 1.17; p=0.39). Kedua kelompok menunjukkan perbaikan klinis bermakna, tanpa kejadian efek samping serius.

Kesimpulan: Telerehabilitasi berbasis AI merupakan alternatif yang layak untuk pemulihan fungsi ekstremitas atas pascastroke.

Kata kunci: kecerdasan buatan, pemulihan motorik, stroke, telerehabilitasi, ekstremitas atas

Functional Outcomes and Health-Related Quality of Life in Traumatic Brain Injury Patients with Rehabilitative Program: A Literature Review Using GOSE and HRQoL Measures

Nathalia Gabriella — 2026-07-26

Abstract

Background: Traumatic brain injury (TBI) resulting in long-term physical and neurobehavioral impairments leads to functional disabilities and remains a major public health challenge worldwide. Rehabilitation is the key intervention in improving functional outcomes and quality of life. Objectives:Disparities in rehabilitation access, underrepresentation of cognitive and psychological outcomes, and inconsistent use of functional assessment tools persist. Aim:To synthesize recent evidence regarding short and long-term impact of various method of rehabilitation in functional outcome and quality of life in patients with TBI, also identify gaps in rehabilitation service and differences in the special population. Methods:This literature review integrates evidence from ten peer-reviewed publications between 2019 and 2024, selected through targeted searches from PubMed, ScienceDirect, and Google Scholar using keywords including “traumatic brain injury,” “rehabilitation,” “functional outcome,” “GOSE,” and “neurorehabilitation.”. Results:Rehabilitation for TBI patients is proven to enhance functional outcome and quality of life across age groups and injury levels. Improvements are not restricted to the early phases, but can continue over several months or years, particularly with structured and multidisciplinary care. Pediatric, older adult patient and complicated TBI require tailored rehabilitation strategies considering cognitive development and comorbidities. Conclusions:Rehabilitation for TBI should be initiated early and continued after acute stage. Tailored personalized program integrating physical, cognitive and psychological therapy are needed.

Keywords: functional outcome, quality of life, rehabilitation, traumatic brain injury.

Return to Sports in Patients with Coronary Artery Disease: A Narrative Review

Arnengsih Nazir — 2026-07-26

Introduction: Coronary artery disease (CAD) is a leading cause of mortality and morbidity, often limiting physical activity due to myocardial ischemia and ventricular dysfunction. Cardiac rehabilitation (CR) reduces cardiovascular risk, improves functional capacity, and enhances quality of life. While CR supports a safe return to sports (RTS), determining appropriate exercise intensity and type remains challenging. Guidelines from cardiology associations recommend risk assessment before RTS, often using cardiopulmonary exercise testing, but implementation varies, and research on RTS after CR in CAD patients is limited. This review explored physical activity and CR in facilitating safe RTS, addressing benefits, risks, screening, assessment, and exercise recommendations.

Methods: A literature search was conducted using PubMed, ScienceDirect, and CINAHL with keywords like â€œreturn to sportâ€ and â€œcoronary artery disease.â€ Inclusion criteria encompassed original research on RTS in CAD patients, available in full text, and focused on adults. A multi-step screening process included title, abstract, and full-text evaluations.

Results: Seventeen articles addressed the risks and benefits of physical activity in CAD patients, eleven focused on pre-participation screening and assessments, and four examined RTS recommendations. Findings were synthesized into a narrative review with tables for clarity.

Conclusion: Physical activity benefits CAD patients by improving endothelial function, autonomic balance, and plaque stability, reducing cardiovascular risk. However, high-intensity exercise may trigger acute events, necessitating pre-participation screening. Risk stratification guides safe RTS, with tailored exercise programs optimizing benefits while minimizing risks. Individualized prescriptions and periodic evaluations ensure long-term safety.

Can Pilates Straighten the Curve? A Systematic Review of Pilates in Scoliosis Therapy

Varalisa Rahmawati — 2026-07-26

Background: Scoliosis is a three-dimensional spinal and trunk deformity affecting 0.93% to 12% of the global population. As a progressive musculoskeletal condition, it impairs mobility and reduces quality of life. Objectives: Recent studies suggest that Pilates, which is increasingly popular amongst a wide range of people, may improve postural control, spinal flexibility, muscular balance, and pain levels in individuals with scoliosis. However, the evidence remains scattered across studies with varying designs, populations, outcome measures, and intervention protocols. As interest in integrating Pilates into clinical rehabilitation grows, a comprehensive synthesis of the current evidence is needed to assess its effectiveness, limitations, and clinical applicability. Aim: This study aimed to systematically review the current literature to determine the efficacy of Pilates as a therapeutic intervention for scoliosis. Methods: Following PRISMA guidelines and being registered in PROSPERO, a systematic search was conducted in Scopus, PubMed, Cochrane, and Springer databases to search for published articles from 2005 to 2025 to identify articles that met the inclusion criteria. Keywords were determined as “scoliosis” and “pilates.” Risk of bias and study quality was evaluated with the PEDro Scale. Results: A total of 6 randomized controlled trials studies involving 201 participants with idiopathic or functional scoliosis were included. Most studies reported improvements in Cobb angle and angle of trunk rotation after Pilates-based interventions ranging from 8 to 12 weeks. Functional outcomes such as pain reduction were also noticed, though long-term effects remain under-researched. Conclusions: Pilates appears to offer potential benefits as a conservative intervention for scoliosis by improving posture and pain. However, current evidence is limited by heterogeneity in intervention protocols and outcome measures. Further high-quality, large-scale studies are warranted to confirm the therapeutic value of Pilates in scoliosis management and to establish standardized intervention guidelines.