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In recent years, we have faced challenges in managing coronavirus disease 2019 (COVID-19), especially in older adults. We have witnessed a crisis in geriatric care services, mining the possibility for older adults to maintain their capacities and abilities during the pandemic. Disruption of the routine management of chronic diseases, physical inactivity, deteriorating physical function and quality of life, malnutrition, and mental disorders have been suggested as major threats to the health of older adults.1 To address these problems and plan the reactivation of normal care activities, this article summarizes the contents of a webinar held by the Annals of Geriatric Medicine and Research (AGMR) regarding the future directions of geriatric medicine and research in the post-COVID-19 era.

Objective: Study the effect of the coronavirus disease (COVID-19) pandemic on emergency room (ER) utilization for musculoskeletal (MSK) complaints. Methods: Data from ER encounters in a teaching hospital for years 2019 and 2020 were extracted from an electronic database. The ICD-10-CM codes were used to assign the primary diagnosis. Joinpoint regression was applied to a time-series to detect changes in daily encounters (all-cause and MSK). Total number and median daily encounters were calculated by year, sex, age groups, and diagnostic codes for each year. Results: Overlapping intervals within March 2020 showed drops of 8.1 all-cause encounters per day (95% CI: 4.8-11.5), and 1.2 MSK encounters per day (95% CI: 0.8-1.7), resulting in net losses for the year of 33.2% for all-cause and 35.8% for MSK encounters. Reductions were observed for both sexes and all age groups. MSK codes with largest declines were low back pain, joint pain, and limb pain. Conclusion: The COVID-19 pandemic resulted in major reductions in all-cause and MSK encounters in the ER of an academic hospital probably due to governmental restrictions and a change in patients behaviors. Persistence of the observed reduction suggests that patients requiring ER services delayed seeking care for MSK and other health conditions.

Sarcopenia, generally described as "aging-related loss of skeletal muscle mass and function", can occur secondary to a systemic disease.This project aimed to study the prevalence of sarcopenia in chronic ambulatory stroke survivors and its associated risk factors using the two most recent diagnostic criteria.A cross-sectional observational study.A scientific laboratory.Chronic stroke.Twenty-eight ambulatory chronic stroke survivors (12 females; mean age=57.8±11.8 years; time after stroke=76±45 months), hand-grip strength, gait speed, and appendicular skeletal muscle mass (ASM) were measured to define sarcopenia. Risk factors, including motor impairment and spasticity, were identified using regression analysis.The prevalence of sarcopenia varied between 18% and 25% depending on the diagnostic criteria used. A significant difference was seen in the prevalence of low hand grip strength on the affected side (96%) when compared to the contralateral side (25%). The prevalence of slow gait speed was 86% while low ASM was present in 89% of the subjects. Low ASM was marginally negatively correlated with time since stroke and gait speed, but no correlation was observed with age, motor impairment, or spasticity. ASM loss, bone loss and fat deposition were significantly greater in the affected upper limb than in the affected lower limb. Regression analyses showed that time since stroke was a factor associated with bone and muscle loss in the affected upper limb, spasticity had a protective role for muscle loss in the affected lower limb, and walking had a protective role for bone loss in the lower limb.The prevalence of sarcopenia in stroke survivors is high and is a multifactorial process that is not age-related. Different risk factors contribute to muscle loss in the upper and lower limbs after stroke.Clinicians need to be aware of high prevalence of sarcopenia in chronic stroke survivors. Sarcopenia is more evident in the upper than lower limbs. Clinicians also need to understand potential protective roles of some factors, such as spasticity and walking for the muscles in the lower limb.

Ulnar-sided wrist injuries are common in sports that require repeated pronosupination, wrist radial/ulnar deviation, axial loading, and gripping equipment. Common anatomic structures affected include the triangular fibrocartilage complex, extensor carpi ulnaris tendon, distal radioulnar and ulnocarpal joints, and hamate bone. Presenting symptoms include pain with activity, swelling, possible snapping or clicking, and reproduction of symptoms with provocative maneuvers. Imaging may confirm or rule out pathologies, but abnormal findings also may present in asymptomatic athletes. Initial treatment is usually nonoperative with splinting, load management, activity modification, strengthening the components of the kinetic chain of the particular sport, and pain management. Surgery is usually indicated in ulnar-wrist pain pathology such as hook of hamate fractures and required in associated instability. Future research should address specific treatment and rehabilitation protocols, emphasizing the complete kinetic chain along with the injured wrist.

The 20th and 21st centuries have witnessed a substantial increase in human life expectancy and in the number of men and women aged 60 years and older. Aging is associated with a large number of health conditions, including sarcopenia, which has been the subject of important research in the past 30 years. Sarcopenia is characterized by an age-related loss of muscle mass, weakness, and impaired physical performance. The condition can be diagnosed with a combination of measurements of these three elements. The precise definition of sarcopenia and the selection of optimal assessment methods have changed significantly in the past 20 years; nonetheless, the prevalence of sarcopenia in the general older population is in the range of 5-15%. Molecular and cellular events at the muscle cell level impact the size and quality of muscles (force adjusted for size). The active and passive mechanical properties of single muscle fibers are altered by changes in the structure and function of various cellular elements. Systemic factors such as inflammation, loss of hormonal influence, and deleterious lifestyle choices also contribute to sarcopenia. The consequences of sarcopenia include many adverse effects such as impairments in activities of daily living, falls, loss of independence, and increased mortality. Several rehabilitative interventions have been tested, and the safest and most effective is the use of progressive resistance exercise. An increase in dietary protein intake has synergistic effects. Future research should focus on a consensus definition of sarcopenia, identification of the best assessment methods, understanding of biological mechanisms, and testing of innovative interventions.

The "relevance" of research to stakeholders is an important factor in influencing the uptake of new knowledge into practice; however, this concept is neither well defined nor routinely incorporated in clinical rehabilitation research. Developing a uniform definition, measurement standards, stakeholder engagement strategies, and guiding frameworks that bolster relevance may help incorporate the concept as a key element in research planning and design. This article presents a conceptual argument for why relevance matters, proposes a working definition, and suggests strategies for operationalizing the construct in the context of clinical rehabilitation research. We place special emphasis on the importance of promoting relevance to patients, caregivers, and clinicians and provide preliminary frameworks and innovative study designs that can assist clinical rehabilitation researchers in doing so. We argue that researchers who include a direct statement regarding why and to whom a study is relevant and who incorporate considerations of relevance throughout all phases of study design produce more useful research for patients, caregivers, and clinicians, increasing its chance of uptake into practice. Consistent consideration of relevance, particularly to nonacademic audiences, during the conceptualization, study design, presentation, and dissemination of clinical rehabilitation research may promote the uptake of findings by patients, caregivers, and providers.

Objective Our objective was to investigate whether women, people 65 yrs and older, or individuals who identify with racial and/or ethnic minority groups, were underrepresented among participants in rehabilitation clinical trials. Design This is a cross-sectional study of completed rehabilitation clinical trials investigating the number and percentage of women, older adults, and racial and/or ethnic minorities enrolled in rehabilitation clinical trials between January 1, 2011, and January 1, 2020. Secondary outcome measures were inclusion by diagnostic group, as well as International Classification of Functioning, Disability and Health category, and intervention by diagnostic group. Results Of the 108 studies meeting inclusion criteria, a majority (69%) were based in the United States. Stroke was the most frequent diagnostic group, followed by musculoskeletal conditions. Ninety-six percent of the United States-based trials included at least one female participant in their study, but among specific diagnostic groups, this ranged from 5% to 73%. Age information was reported inconsistently; however, of the trials reporting age, 100% of cardiac trials included older adults, whereas no spinal cord injury (SCI) trials included them. Among trials based in the United States reporting race, 70% of participants were White, followed by 20% Black or African American and 1% Asian. Among trials based in the United States reporting ethnicity, Hispanic or Latino participants were underrepresented overall and among each diagnostic group. Conclusions In this study, we found that among participants of rehabilitation clinical trials women, older individuals, and racial/ethnic minorities were generally underrepresented. In contrast, Black or African American participants were overrepresented with the exception of cardiac trials. An important finding was that many trials did not report age and/or race/ethnicity. Investigators should aim to include underrepresented populations and improve reporting.

Background: The Coronavirus Disease 2019 (COVID-19) pandemic has adversely impacted the Physical and Rehabilitation Medicine (PRM) residency training program in many countries. Aims and Objectives: To describe and analyse the issues and challenges faced by PRM trainees in Asia, Eastern Mediterranean and Oceania, and to discuss strategies to encounter the training and educational challenges amidst the pandemic. Materials and Methods: A cross-sectional survey was completed by Country Ambassadors of the International Society of Physical and Rehabilitation Medicine (ISPRM) World Youth Forum Task Force, to assess the COVID-19 impact on PRM trainees across Asia, Eastern Mediterranean, and Oceania. Results: Participants reported issues including training program disruption, limited practical skills training, examination postponement, negative psychological consequences, PRM service delivery restructuring, and deployment to acute services. Conclusion: The COVID-19 pandemic has variably impacted PRM residency training programs in the countries. The role of National Societies, training programs, and ISPRM is crucial to support trainees during the pandemic.

Introduction: Coronavirus disease 2019 (COVID-19) pandemic has affected the physical and rehabilitation medicine (PRM) specialty globally. The effects of this pandemic on PRM residents in 14 countries of the Americas are described in this study. Materials and Methods: This study is based on the international survey done by the World Youth Forum of the International Society of Physical and Rehabilitation Medicine. The cross-sectional data obtained were analyzed for a point-of-view study (August 2020). Results: PRM residents reported multiple challenges in their training program including mental health issues during the pandemic. In all the countries, there was either complete or partial closure of services provided by PRM specialists at the height of the crisis. In some areas, there was a necessity to temporarily transform the rehabilitation service into a COVID-19 unit and to assign residents to medical and intensive care units. Residency programs in 13 countries introduced virtual lectures and examinations. The duration of residency will probably increase in three countries, may not be affected in another six, and is still undetermined in five. The specialty licensing examination was temporally suspended/postponed in four countries, administered in a modified way in one, and has not been affected yet in four. Conclusion: COVID-19 pandemic adversely affected the training of PRM residents in the Americas. Despite the efforts to overcome this, the residents need more support including well-being programs. Every country and training program should continue to evolve to adapt to the crisis and anticipate additional challenges in the near future.

The International Society of Physical and Rehabilitation Medicine (ISPRM) has recently started an educational initiative named “ISPRM Webinar Series,” broadcasting a series of live interactive online webinar sessions over 3 months. The objectives of the webinars were to connect rehabilitation professionals worldwide, share experiences/expertise, and create teaching-learning activities during the coronavirus disease 2019 (COVID-19) pandemic. The pandemic has been adversely affecting the lives of people including being a big challenge to the medical community. The specialty of physical and rehabilitation medicine is facing challenges and simultaneously having unique opportunities to contribute to the care of COVID-19 survivors. This article describes the purpose, educational structure, and overall experiences during the ISPRM Webinar Series. Distinguished speakers/panelists from around the world delivered their message, expertise, and experience in several topics with a special emphasis on the COVID-19 pandemic. A historical moment for ISPRM was when the Honorable Director General of the World Health Organization, Dr. Tedros Adhanom Ghebreyesus, sent a special message to ISPRM and its global audience. The audience for the various webinars has included colleagues from 101 countries and territories, with an average number of 365 participants per live session and a high prevalence of youth. In conclusion, based on the feedback of the participants, the ISPRM Webinar Series proved to be a timely and effective educational initiative with wide-spread global reach during the COVID-19 pandemic.

The Association of Academic Physiatrists convened a Women's Task Force in 2016, under the leadership of then Association of Academic Physiatrists President Gerard Francisco, MD, to evaluate data and metrics pertaining to the representation and inclusion of female physiatrists in the society. An initial published report focused on a retrospective analysis of data in categories such as leadership, conference presentations, and recognition awards. The findings, which highlighted areas in which the Association of Academic Physiatrists had been successful in supporting gender equity as well as areas in which female physiatrists were underrepresented, provided a base from which to strategically focus on closing gaps in representation. The task force developed an action plan that was approved by the Board of Trustees and included strategies aimed at closing gaps and collecting data to determine corresponding effectiveness. Because most of the categories fell under the supervision of various Association of Academic Physiatrists committees, an appointee from each committee ("diversity steward") liaised with the Women's Task Force. The diversity stewards reviewed the plan with their respective committees and collected data within their committee's purview. This task force follow-up report documents recent progress, consistent with the Association of Academic Physiatrists Board of Trustees commitment to transparency and gender equity.

The rupture and reconstruction of the anterior cruciate ligament (ACL) of the knee are associated with an increased risk of functional instability, a reduction in sports performance, and a higher risk of future additional injuries. Competitive athletes who participate in sports that require pivoting, cutting, and jumping are at particularly high risk for ACL rupture. The return to sport progression continuum after surgery includes sports-specific rehabilitation, evaluation of strength and function, gradual participation in exercise training with progressively challenging activities in the field of play, participation in sports at a lower level, and finally a return to preinjury-level sports competition. This narrative review evaluates the evidence that supports the use of quadriceps and hamstrings isokinetic strength testing and sports-specific functional skills assessments to evaluate progress with rehabilitation after ACL surgery. Strength evaluations, hop tests, agility tests, and the limb symmetry index are described, as well as the associations of quadriceps and hamstrings muscle strength and functional test results with successful return to sports and the risk of ACL graft rupture and contralateral knee injuries. Suggestions for future research directions are presented including the importance of presurgery testing, standardization of test batteries, and comparison of test results with normative data.

BACKGROUND Low cardiorespiratory fitness (CRF) is usually observed in people living with HIV. The effect of a low-volume high-intensity interval training (LV-HIIT) on CRF in HIV+ and HIV- Hispanic women was evaluated in this study. SETTING A nonrandomized clinical trial with pre-test and post-test using a LV-HIIT intervention was conducted in the AIDS Clinical Trials Unit and the Puerto Rico Clinical and Translational Research Consortium at the University of Puerto Rico Medical Sciences Campus. METHODS Twenty-nine HIV+ and 13 HIV- Hispanic women recruited from community-based programs and clinics, and able to engage in daily physical activities, volunteered to participate. Of these, 20 HIV+ (69%) and 11 HIV- (85%) completed the study and were included in the analyses. LV-HIIT consisted of 6-week, 3 d/wk, 8-10 high-intensity and low-intensity intervals on a cycle ergometer at 80%-90% of heart rate reserve. Main outcome measures were CRF (defined as VO2peak), peak workload, and time to peak exercise. RESULTS Average peak workload and time to peak exercise increased after training (P < 0.05) in both groups. However, average CRF was significantly higher after training only in the HIV- group. Gains in CRF were observed in 100% of HIV- and 50% of HIV+ women. This was not influenced by exercise testing, habitual physical activity, or anthropometric variables. CONCLUSIONS Given the lack of change in CRF observed in the HIV+ group after LV-HIIT intervention, it is important to focus on variations that may occur within groups.

Objective: To correlate ultrasound characteristics of spastic muscles with clinical and functional measurements in chronic stroke survivors.Methods: Ultrasound assessment and clinical and functional assessments were performed in 28 ambulatory stroke survivors (12 females, mean age 57.8 ± 11.8 years, 76 ± 45 months after stroke).Results: Muscle thickness in the affected side was decreased compared with the contralateral side (p < 0.001). The decrease was more evident in the upper limb muscles. On the affected side, the modified Heckmatt scale score was lowest (closer to normal) in the rectus femoris (RF) muscle compared with other muscles (biceps brachii (BB), flexor carpi ulnaris (FCU) and medial gastrocnemius (MG)). Muscle thickness and echogenicity of spastic muscles did not correlate with spasticity, as measured with the modified Ashworth scale (MAS), Fugl-Meyer motor assessment scores, age, or time since stroke. There was a significant negative correlation between grip strength and percentage decrease in muscle thickness for the spastic FCU muscle (r = –0.49, p = 0.008). RF muscle thickness correlatedwith ambulatory function (Timed Up and Go test (r = 0.44, p = 0.021) and 6-metre walk test (r = 0.41, p = 0.032)). There was no significant correlation between echogenicity and functional assessments Conclusion: Ambulatory chronic stroke survivors had function-dependent changes in muscle thickness on the affected side. Muscle thickness and echogenicity of spastic muscles did not correlate with spasticity, Fugl-Meyer motor assessment scores, age, or time since stroke. LAY ABSTRACTMuscle changes occur secondary to various factors after stroke. In this study, ultrasound characteristics of spastic muscles and clinical and functional assessment were performed in 28 ambulatory chronic stroke survivors. Muscle thickness in the affected side was decreased compared with the contralateral side. The decrease was more evident in the upper limb muscles. The percentage decrease in the flexor carpi ulnaris muscle thickness correlated negatively with grip strength, while the rectus femoris muscle thickness correlated with ambulatory function. Echogenicity was lowest in the rectus femoris compared with other muscles. Muscle thickness and echogenicity of spastic muscles did not correlate with spasticity, Fugl-Meyer motor assessment scores, age, or time since stroke. These function-dependent changes in muscles on the affected side suggest an important role of voluntary muscle activation in preserving muscle mass after stroke. Stroke motor rehabilitation programmes should focus on active use of muscles on the affected side for strengthening and preserving muscle mass.

BACKGROUND: One of the goals of Cochrane Rehabilitation is to strengthen methodology relevant to evidence-based clinical practice. Toward this goal, several research activities have been performed in rehabilitation literature: a scoping review listed the methodological issues in research, a study showed the low clinical replicability of randomized controlled trials, two systematic reviews showed the relevant items in reporting guidelines, and a series of articles discussed main methodological issues as a result of the first Cochrane Rehabilitation Methodological Meeting (Paris 2018). The need to improve the quality of conduct and reporting of research studies in rehabilitation emerged as a relevant task. The aim of this article is to present the Randomized Controlled Trial Rehabilitation Checklists (RCTRACK) project to produce a specific reporting guideline in rehabilitation. METHODS: The project followed a combination of the CONsolidated Standards of Reporting Trials and EQUATOR Network methodologies. The project includes five phases. The first is kick-off, first consensus meeting and executive and advisory committee identification. The second is literature search and synthesis, where eight working groups will produce knowledge synthesis products (systematic or scoping reviews) to compile items relevant to reporting of randomized controlled trials in rehabilitation. The topics will be as follows: patient selection; blinding; treatment group; control group and co-interventions; attrition, follow-up, and protocol deviation; outcomes; statistical analysis and appropriate randomization; and research questions. The third is guidelines development, which means drafting of a document with the guidelines through a consensus meeting. The fourth is Delphi process consensus, a Delphi study involving all the rehabilitation research and methodological community. The fifth is final consensus meeting and publication. CONCLUSIONS: The RCTRACK will be an important contribution to the rehabilitation field and will impact several groups of rehabilitation stakeholders worldwide. The main goal is to improve the quality of the evidence produced in rehabilitation research. The RCTRACK also wants to improve the recognition and understanding of rehabilitation within Cochrane and the scientific and medical community at large. ispartof: AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION vol:99 issue:3 pages:210-215 ispartof: location:United States status: published

Skeletal muscle strength, mass, and function should be carefully monitored for signs of decline with advanced adult age. An understanding of the pathophysiology and severity of sarcopenia can be improved with the exploration of changes in muscle fiber properties. Furthermore, although functional decline with increase age is a well-known phenomenon, the mechanisms underlying this decline, and the features that characterize it, are complex and variable. The age-related decline of muscle function is a result of not only a decrease of muscle mass but also a decline in the intrinsic properties of muscle fibers that are independent of size. We believe it is important to understand changes in muscle quality (force adjusted for size), and not to focus solely on muscle mass, because muscle quality is closely related to measurements of function and could potentially predict clinical outcomes such as morbidity, disability, and mortality. Neurological and metabolic mechanisms contribute to muscle quality, but the intrinsic properties of muscle cells are central to the maintenance of force-generating capacity. Muscle quality can be evaluated with the assessment of morphological, physiological, and mechanical properties in single permeabilized or skinned fibers. This approach excludes the influence of the nervous system, tendons, and the extracellular matrix. In this review, we summarized the changes in active and passive mechanical properties at the single muscle cell level in older skeletal muscles. We argue that intrinsic mechanical changes in human single muscle fibers are useful biomarkers and indicators of muscle quality.

Sarcopenia is an important public health problem, characterized by age-related loss of muscle mass and muscle function. It is a precursor of physical frailty, mobility limitation, and premature death. Muscle loss is mainly due to the loss of type II muscle fibres, and progressive loss of motor neurones is thought to be the primary underlying factor. Anterior thigh muscles undergo atrophy earlier, and the loss of anterior thigh muscle function may therefore be an antecedent finding. The aim of this review is to provide an in-depth (and holistic) neuromusculoskeletal approach to sarcopenia. In addition, under the umbrella of the International Society of Physical and Rehabilitation Medicine (ISPRM), a novel diagnostic algorithm is proposed, developed with the consensus of experts in the special interest group on sarcopenia (ISarcoPRM). The advantages of this algorithm over the others are: special caution concerning disorders related to the renin-angiotensin system at the case finding stage; emphasis on anterior thigh muscle mass and function loss; incorporation of ultrasound for the first time to measure the anterior thigh muscle; and addition of a chair stand test as a power/performance test to assess anterior thigh muscle function. Refining and testing the algorithm remains a priority for future research.

Changes in stiffness or extensibility of the muscle or muscle–tendon unit with aging could lead to impaired function and an increased vulnerability to injury. We aimed to investigate the passive force and viscoelastic properties of single muscle fibers in older adults. Seven older adults (mean age 79.0 ± 3.8 years) and 10 young control (mean age 25.6 ± 4.5 years) were recruited. Biopsy specimens were obtained percutaneously from m. vastus lateralis and skinned single fibers were used for the experiments. Slack tests were performed to determine maximal force and maximal unloaded shortening velocity. Passive force was measured in pCa 9.0 solution using a stepwise stretch technique with increment of sarcomere length from 2.4 to 4.2 µm. Myosin heavy chain (MHC) isoform was determined by sodium dodecyl sulfate–polyacrylamide gel electrophoresis. Specific force was calculated as maximal force divided by cross-sectional area. Passive force, peak passive force, time to half stress relaxation (T1/2) and force decay index (a force time integral under a stress relaxation curve) were measured. No difference between the groups were found in specific force and shortening velocity. Passive force and peak passive force were greater in both MHC I and IIa fibers of older adults (p

Background: Few studies have examined the use of ergogenic supplements (ESs) by young athletes residing in a sports specialized school. Methods: In this cross-sectional study, 120 students from a sports specialized school (ages 12–19) completed a questionnaire to assess the prevalence of use of ES according to sex, sport, type of supplement, reasons for use, knowledge of supplements, and sources of information. Results: Most athletes were males (55%) and participated in track and field (32%). Mean age was 14.7 ± 1.6 years. Approximately 98% of athletes indicated using one or more supplements. Sport beverages (95.0%), proteins/amino acids (57%), and vitamins (54%) were the most commonly used. Athletes practicing racquet sports were more likely to consume proteins/amino acids every day than those in any other type of sport (P < 0.05). The adjusted odds of using vitamins were 14% (95% confidence interval [CI]: 0.22–3.30) and 71% (95% CI: 0.09–0.96) lower among athletes practicing explosive sports and high intensity, respectively, as compared to those practicing endurance-intensive sports. On the other hand, the odds of using proteins/amino acids was higher for those practicing explosive (adjusted odds ratio [AOR]: 3.48, 95% CI: 1.02–11.86) and high-intensity (AOR: 2.88, 95% CI: 1.00–8.26) sports. Approximately 62% of athletes used supplements to improve performance. Only 8% of athletes were willing to use a prohibited substance to achieve participation in the Olympics. Conclusion: There was a very high prevalence of use of ES in a sports specialized school. Education regarding supplement use is warranted for athletes, coaches, and family.

This article is meant as an update on the previous articles published about the International Society of Physical and Rehabilitation Medicine (ISPRM). It reflects the current organizational structure and describes its core activities. Strengths, weaknesses, opportunities, and threats of the society are analyzed to define a strategic plan for the future of ISPRM. Key activities like ISPRM World Congresses, the foundation of the Journal of ISPRM and the creation of a certification project are described. The article reports also about the external relationship of ISPRM with different organizations and in particular with the World Health Organization and with the United Nations.

Our objective was to investigate whether women, people 65 yrs and older, or individuals who identify with racial and/or ethnic minority groups, were underrepresented among participants in rehabilitation clinical trials.This is a cross-sectional study of completed rehabilitation clinical trials investigating the number and percentage of women, older adults, and racial and/or ethnic minorities enrolled in rehabilitation clinical trials between January 1, 2011, and January 1, 2020. Secondary outcome measures were inclusion by diagnostic group, as well as International Classification of Functioning, Disability and Health category, and intervention by diagnostic group.Of the 108 studies meeting inclusion criteria, a majority (69%) were based in the United States. Stroke was the most frequent diagnostic group, followed by musculoskeletal conditions. Ninety-six percent of the United States-based trials included at least one female participant in their study, but among specific diagnostic groups, this ranged from 5% to 73%. Age information was reported inconsistently; however, of the trials reporting age, 100% of cardiac trials included older adults, whereas no spinal cord injury (SCI) trials included them. Among trials based in the United States reporting race, 70% of participants were White, followed by 20% Black or African American and 1% Asian. Among trials based in the United States reporting ethnicity, Hispanic or Latino participants were underrepresented overall and among each diagnostic group.In this study, we found that among participants of rehabilitation clinical trials women, older individuals, and racial/ethnic minorities were generally underrepresented. In contrast, Black or African American participants were overrepresented with the exception of cardiac trials. An important finding was that many trials did not report age and/or race/ethnicity. Investigators should aim to include underrepresented populations and improve reporting.

PURPOSE OF REVIEW: to evaluate recent scientific research studies related to the changes in skeletal muscle after stroke and the presence of sarcopenia in stroke survivors to establish its incidence and effects on function. RECENT FINDINGS: Recently published findings on stroke-related sarcopenia are limited. This might be due to changes in the consensus definition of sarcopenia. Sarcopenia in stroke patients is estimated at 14 to 54%. The presence of sarcopenia at the time of a stroke can lead to worse recovery and functional outcomes. SUMMARY: Presence of sarcopenia prior to a stroke may be more common than suspected and can lead to worse functional recovery. Clinicians should be aware of this to better identify and treat stroke-related sarcopenia. Future research should focus on larger population studies to more accurately establish correlation between stroke and sarcopenia.

This cross-sectional study examines whether racial and/or ethnic minority, female, and older adults are underrepresented in vaccine clinical trials compared with the US population., Key Points Question Do vaccine clinical trials equitably represent individuals who identify as members of underrepresented racial/ethnic groups, are women, and are people aged 65 years or older? Findings In this cross-sectional study of 230 US-based clinical trials with 219 555 participants, Black or African American, American Indian or Alaska Native, Hispanic or Latino, and older adults were underrepresented and women were overrepresented compared with the US population. Meaning The findings suggest that diversity enrollment targets are needed for vaccine trials in the US., Importance Medical research has not equitably included members of racial/ethnic minority groups or female and older individuals. There are limited data on participant demographic characteristics in vaccine trials despite the importance of these data to current trials aimed at preventing coronavirus disease 2019. Objective To investigate whether racial/ethnic minority groups and female and older adults are underrepresented among participants in vaccine clinical trials. Design, Setting, and Participants This cross-sectional study examined data from completed US-based vaccine trials registered on ClinicalTrials.gov from July 1, 2011, through June 30, 2020. The terms vaccine, vaccination, immunization, and inoculation were used to identify trials. Only those addressing vaccine immunogenicity or efficacy of preventative vaccines were included. Main Outcomes and Measures The numbers and percentages of racial/ethnic minority, female, and older individuals compared with US census data from 2011 and 2018. Secondary outcome measures were inclusion by trial phase and year of completion. Results A total of 230 US-based trials with 219 555 participants were included in the study. Most trials were randomized (180 [78.3%]), included viral vaccinations (159 [69.1%]), and represented all trial phases. Every trial reported age and sex; 134 (58.3%) reported race and 79 (34.3%) reported ethnicity. Overall, among adult study participants, White individuals were overrepresented (77.9%; 95% CI, 77.4%-78.4%), and Black or African American individuals (10.6%; 95% CI, 10.2%-11.0%) and American Indian or Alaska Native individuals (0.4%; 95% CI, 0.3%-0.5%) were underrepresented compared with US census data; enrollment of Asian individuals was similar (5.7%; 95% CI, 5.5%-6.0%). Enrollment of Hispanic or Latino individuals (11.6%; 95% CI, 11.1%-12.0%) was also low even among the limited number of adult trials reporting ethnicity. Adult trials were composed of more female participants (75 325 [56.0%]), but among those reporting age as a percentage, enrollment of participants who were aged 65 years or older was low (12.1%; 95% CI, 12.0%-12.3%). Black or African American participants (10.1%; 95% CI, 9.7%-10.6%) and Hispanic or Latino participants (22.5%; 95% CI, 21.6%-23.4%) were also underrepresented in pediatric trials. Among trials reporting race/ethnicity, 65 (48.5%) did not include American Indian or Alaska Native participants and 81 (60.4%) did not include Hawaiian or Pacific Islander participants. Conclusions and Relevance This cross-sectional study found that among US-based vaccine clinical trials, members of racial/ethnic minority groups and older adults were underrepresented, whereas female adults were overrepresented. These findings suggest that diversity enrollment targets should be included for all vaccine trials targeting epidemiologically important infections.