Journal of Modern Rehabilitation

Referral, Participation and Completion Rates in the Birjand Cardiac Rehabilitation Cohort after Coronary Revascularization

2026-09-07T15:36:19+0430

Introduction: Cardiac rehabilitation (CR) is a cornerstone of secondary prevention following coronary revascularization; however, its utilization remains suboptimal in underserved regions. This study aimed to evaluate referral, participation, and completion rates of CR and their associated factors in Birjand, Iran.
Materials and Methods: This retrospective cohort study included 758 consecutive patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) between April 2022 and May 2023. Data on demographics, insurance status, education level, and physician CR familiarity were collected using a structured checklist and phone follow-up. The CR program was defined as 36 supervised sessions. Multivariate logistic regression models were used to identify factors associated with referral, participation, and completion. All reported odds ratios were derived from fully adjusted models.
Results: Among 749 eligible patients, 19(26.3%) were referred to CR, 103(52.3% of referred) participated, and 69(67.0% of participants) completed the program. Multivariate analysis showed that higher education was the strongest predictor of referral (odds ratio [OR]=9.50, 95% confidence interval [CI], 4.9%, 18.27%, P<0.001), followed by male gender (OR=2.12, 95% CI, 1%, 4.49%, P=0.005). Furthermore, physicians familiar with CR had approximately a 3-fold higher referral rate compared to less-familiar colleagues. Insurance coverage was significantly associated with program completion (78% of insured vs 59% of uninsured completers; P=0.018).
Conclusion: Referral is the main systemic barrier to CR utilization in this underprivileged region. Participation and completion among referred patients reflect a selected group with adequate access, highlighting the need for system level interventions focused on physician referral practices—particularly for women and less educated patients—and improved insurance coverage to enhance equitable access to CR.

Effects of Reactive and Proactive Exercises on Ankle Spasticity in Patients with Chronic Stroke: A Randomized Clinical Trial

2026-09-07T15:45:58+0430

Introduction: Stroke is a leading cause of adult disability. Spasticity is a neurological condition that occurs secondary to stroke and affects the patient’s quality of life. This study aimed to compare the effects of reactive and proactive exercises on spasticity in people with stroke.
Materials and Methods: In this single-blind clinical trial, 30 individuals with stroke were randomly divided into three groups: Control, reactive, and proactive, of which 27 patients completed the study. These individuals were treated for 12 sessions for 4 weeks (three times a week). The control group received conventional exercises, the reactive group received conventional exercises plus reactive exercises, and the proactive group received conventional exercises plus proactive exercises. The outcomes were clinical measures of spasticity at baseline and neural properties, evaluated using the Modified Modified Ashworth Scale and H-reflex latency and Hmax/Mmax ratio. All statistical analyses were performed using SPSS software, version 20.
Results: No significant differences were observed between the groups in H-reflex latency (F=0.404, P=0.672, ηp²=0.033) and Hmax/Mmax ratio (F=0.878, P=0.429, ηp²=0.071).
Conclusion: Intergroup comparisons did not show a significant advantage of proactive and reactive exercises over conventional exercises alone in improving neural properties of spasticity.

The Postural Balance of Elderly Men Is Enhanced by Islamic Prayer

2026-09-07T15:49:33+0430

Introduction: Islamic prayer has several components that enhance physical and mental health. This study aimed to evaluate the impact of prayer on balance control.
Materials and Methods: Thirty healthy elderly men were divided into two groups in the study: One group (n=15) consisted of people who regularly prayed (WP). Another group (n=15) who did not pray (WOP) was matched on various factors with the praying group, such as demographics, lifestyle, physical and psychological abilities, cognitive abilities, and heart rate variability (HRV) indices. Biodex recorded the balance indexes under simple and dual-task conditions. Mann-Whitney and Pearson chi-square tests were used for non-parametric analyses, while t-test and analysis of covariance (ANCOVA) were used for parametric analyses and to balance variables. The tests were conducted from 9:00 to 13:00.
Results: ANCOVA showed that the overall, Ant-Post, and Med-Lat balance index values in simple and dual-task conditions were significantly lower in the WP group than in the WOP group (P<0.05). Age was considered a covariate. Other variables that influence balance control, such as demographics, lifestyle, psychological and physical health, cognitive abilities, and changes in HRV during tests, did not differ significantly between the groups.
Conclusion: Islamic prayer is associated with improved balance control in elderly men, independent of other effective factors. It can be used as a physiotherapy intervention for the elderly.

Scapular Stabilization Versus Elbow Strengthening in Athletes with Lateral Epicondylitis

2026-09-07T15:53:29+0430

Introduction: Lateral elbow tendinopathy is not merely a localized elbow condition and is often associated with proximal movement impairments, such as scapular dyskinesis, which may contribute to persistent pain and functional limitations in racket-sport athletes. This study aimed to compare the effects of scapular stabilization and elbow strengthening exercises on pain, disability, and functional performance in racket-sport athletes with lateral elbow tendinopathy accompanied by scapular dyskinesis.
Materials and Methods: In this single-blind randomized controlled trial with a pre-test–post-test control group design, 49 racket sport athletes aged 18–25 years and diagnosed with lateral elbow tendinopathy and scapular dyskinesis were randomly assigned to elbow strengthening exercises, combined training (elbow strengthening plus scapular stabilization), or a control group. Interventions were conducted over eight weeks, three sessions per week. Outcome measures included pain intensity, upper-limb disability, muscle strength, dynamic balance (YBT), upper-limb power, and functional movement performance.
Results: Both intervention groups showed reductions in pain and disability and improvements in functional performance, with greater and clinically meaningful improvements observed in the combined training group.
Conclusion: Incorporating scapular stabilization exercises into elbow strengthening programs leads to superior clinical and functional outcomes and supports a kinetic chain–based rehabilitation approach for racket sport athletes with lateral elbow tendinopathy.

A Review of the Digital Era of Cardiac Rehabilitation: From Centres to Screens

2026-06-10T15:11:51+0430

Introduction: Cardiac rehabilitation (CR) is a vital measure aimed at improving the quality of life (QoL) and preventing secondary complications and recurrence in individuals with a high cardiac risk profile. As an alternative to traditional CR, e-rehabilitation (e-rehab) using smartphones or web-based platforms is a modern solution for effective CR. This study aimed to identify its implementation and evaluate its effectiveness on functional capacity, adherence, and QoL.
Materials and Methods: A systematic search of randomized controlled trials (RCTs) was conducted in electronic databases, such as Medline, Embase, and Cochrane Central Register of Controlled Trials, between January 2015 and January 2025. The selected studies included e-rehab as an intervention, implemented through a hybrid model, among a heart disease population. A total of 210 studies were identified, of which 13 with higher-quality evidence were selected as appropriate to our scope.
Results: CR using the e-rehab protocol improved functional capacity and QoL. Participants’ follow-up rates and interest were noticeably lower in traditional CR compared to e-rehab.
Conclusion: Overall, e-rehab-based CR was effective, but when implemented alongside telemonitoring devices, it may reduce the risk of physical activity-induced adverse reactions. Such a model enhances patients’ willingness to enroll in exercise-based CR.