Parkinson’s disease (PD) is the second most common neurodegenerative disorder, its principal symptom being deterioration of motor function. Current treatment options are limited to symptom management but there is evidence that physical activity can provide motor benefits. More recently there is evidence to suggest that rhythmic auditory stimulation may improve gait and balance in PD. Sparky Samba is a community initiative in South Wales, UK, founded by a person living with PD. Sessions incorporate the following samba rhythms from a trained facilitator and are held weekly in a community setting.

The Sparky Samba trial is a multi-site, non-blinded, randomised controlled feasibility trial of Sparky Samba compared with activity as usual. A total of 60 people with PD will be randomised 1:1 to take part in a local Sparky Samba group for 12 weeks or continue their normal activities for the same length of time. The primary outcome is feasibility defined by recruitment, retention, data completeness and intervention adherence. Secondary outcomes relating to motor function, cognition, well-being and self-efficacy will also be assessed at baseline and at 12 weeks. Additionally, we will conduct a process evaluation to understand contextual mechanisms surrounding Sparky Samba. This will be achieved through qualitative interviews and structured participant questionnaires following individual trial completion and through structured questionnaires with intervention delivery staff, supplemented with qualitative interviews.

Feasibility outcomes will be assessed according to pre-defined criteria. For secondary outcomes, means and standard deviations (or medians and IQRs) will be calculated by arm, alongside 95% CIs for change from baseline to 12-week follow-up. Qualitative data will be subject to thematic analysis using NVivo software.

This study received a favourable ethical opinion from the North of Scotland Research Ethics Committee in April 2025 (REC reference 25/NS/0037). Study results will be disseminated through the peer-review literature, the ISRCTN registry and directly to participants, which will be facilitated by the study’s public and patient involvement steering group.

ISRCTN11861663

Younger female cancer survivors disproportionately suffer from treatment-related sexual dysfunction, yet evidence-based intervention for these prevalent and distressing side effects remains lacking. Previously, we developed and pilot-tested SHARE (Sexual Health and Rehabilitation), a single-session, in-person group educational intervention for younger female survivors with distressing sexual dysfunction. We recently adapted the intervention to be delivered via synchronous videoconference, now called SHAREonline. The aims of this optimisation trial are to (1) evaluate ‘proof-of-concept’, that is, clinically significant change in sexual function and psychological distress in younger female survivors, and (2) conduct pilot testing to assess feasibility of the intervention, including assessing the credibility of a control condition (ie, individual self-management (ISM)). Participant characteristics associated with clinically significant response to the intervention will also be explored to prepare for a larger efficacy trial.

This trial will enrol 84 female survivors, ages 19–49 with clinically significant treatment-related sexual dysfunction. Participants will be randomised to either the SHAREonline intervention or ISM. Sexual function and psychological distress are assessed at baseline, 8 and 16 weeks postintervention. Outcomes will be assessed by evaluating change in sexual function and psychological distress from baseline to 8 weeks (primary endpoint), and feasibility, including credibility and acceptability of the control condition, will be evaluated. Postintervention qualitative interviews will be conducted to further explore the experience of trial participants. If findings are positive, we will next evaluate the efficacy of SHAREonline in a fully powered efficacy trial.

This trial has been registered on ClinicalTrials.gov. Ethical approval has been granted by Dana-Farber Cancer Institute’s Institutional Review Board (4 January 2022) prior to data collection. Results will be published in peer-reviewed journals.

NCT06458049.

Improved survival from critical illness has led to an increase in patients with long-term physical and psychological morbidity. Postintensive care rehabilitation services are variable and it is recognised that there is a need for inclusive and accessible interventions to support recovery after critical illness. We engaged with people with lived experience of critical care admission to co-produce a virtual reality mediated intervention (ViRtual REality to AiD recoverY post intensive care unit (ICU) (VR READY).

Our primary objective was to determine the feasibility and acceptability of VR READY to improve the patient experience during recovery from critical illness. Secondary objectives included assessment of the feasibility and acceptability of selected outcome measures for use in future efficacy and cost-effectiveness studies for ICU recovery.

The co-developed intervention (VR READY) was evaluated in a single arm, non-randomised feasibility trial with embedded process evaluation in patients leaving critical care.

District General Hospital in Wales.

Adults who had been admitted to an ICU requiring organ support for more than 48 hours during their current hospital admission. Patients were approached at the point of stepping down from the ICU to a general ward (±48 hours). 87 patients were screened for eligibility, 37 were approached and 22 participants were recruited.

Participants were asked to use VR READY for at least 5 min per day for 14 days.

The primary outcome was feasibility defined by prespecified criteria. Secondary outcomes prioritised by patients and pertaining to recovery and well-being were assessed at baseline and 14 days. A qualitative interview was conducted 4–6 weeks later.

22 participants were recruited with 91% completion of baseline measures, 49.5% completion at 14-day follow-up and 27.3% completing the qualitative interview. Intervention adherence was poor (37.9%), however qualitative findings suggested that participants that engaged with the intervention considered VR READY beneficial to their recovery. While feasibility criteria were met for recruitment and data completion, criteria for retention and intervention adherence were not.

Critical illness is a traumatic experience. Our co-developed rehabilitation intervention VR READY was not feasible in its current format, potentially as a result of being offered too early in recovery when patients were struggling with fatigue, motivation and resilience. VR READY may be beneficial to recovery but further research is needed into optimal mode and timing.

ISRCTN88854487.

Approximately 96% of rifampicin resistance/multidrug-resistant tuberculosis (RR/MDR-TB) cases in Rwanda result from direct transmission rather than acquired resistance. However, the nationwide spatial distribution and transmission dynamics of RR/MDR-TB remain poorly characterised. This study aims to analyse spatial patterns of RR/MDR-TB in Rwanda and explore relationships between spatial proximity and RR/MDR-TB strains’ genetic relatedness.

We conducted a retrospective analysis of 249 confirmed RR-TB cases across Rwanda from 2017 to 2024, using the known geolocations of patients’ residences. Spatial and space-time clustering was assessed using Kulldorff’s scan statistics. Demographic and socioeconomic determinants were evaluated using multivariable regression. For 201 cases with whole-genome sequencing data, we performed transmission analysis using a 5-SNP threshold to define recent transmission clusters and investigated spatial relationships within genetically related strains.

Significant spatial clustering of RR/MDR-TB was identified in 21 sectors, mainly in Nyarugenge, southern Gasabo and western Kicukiro (relative risk: 10.06; p

RR/MDR-TB in Rwanda shows significant spatial clustering with transmission occurring through both localised and regional networks. Integrating genomic and spatial data reveals transmission patterns that extend beyond household contacts and administrative boundaries. These findings underscore the need to implement geographically targeted interventions that address community-level transmission to control RR/MDR-TB in Rwanda effectively.

To explore the outcomes among patients treated with TAVI (transcatheter aortic valve implantation) in the COMPARE-TAVI 1 trial by age groups and sex.

Cohort study.

Three Danish university hospitals.

Patients treated with TAVI in the COMPARE-TAVI 1 trial (N=1030), 60 (5.8%), 337 (32.7%), 592 (57.5%) and 41 (4.0%) were in the four age groups,

Transfemoral TAVI with balloon-expandable valves (Sapien or Myval) performed between June 2020 and November 2023.

Post hoc analyses of trial secondary outcomes that include end-point committee-adjudicated outcomes.

In the four age groups, 1-year mortality rates were 8.3%, 5.6%, 5.6% and 7.3% while it was 5.8% in both sexes. Across the four age groups, 1-year stroke rates were 6.7%, 1.8%, 3.2% and 4.9%, and 5.1% among females and 4.7% among males. In the four age groups, 1-year new pacemaker rates were 7.5%, 15%, 19% and 13% while it was 15% among females and 18% among males. Females had smaller annuli than males and their gradients were higher and the effective orifice area lower after TAVI but their frequency of prosthesis-patient mismatch was similar at 1 year.

While comorbidity levels varied between groups, clinical outcomes were similar across age groups and between sexes.

NCT04443023.

There is growing appreciation of the role of community engagement and involvement (CEI) in designing context-specific interventions for individuals with acquired brain and spinal injuries (ABSI). This realist review evaluates CEI strategies in ABSI research in both high-income (HICs) and low- and middle-income countries (LMICs).

A realist review.

Following RAMESES guidelines, a six-stage systematic search of the following databases: Medline, EMBASE, PsycINFO and Global Index Medicus was conducted from inception to March 2025.

Studies assessing CEI in ABSI research design and implementation were included. Neurodegenerative pathologies and studies focusing solely on perspectives or attitudes were excluded.

Data were extracted and synthesised using context-mechanism-outcome configurations to explain how CEI strategies were used to improve outcomes.

22 studies were included. Data showed three context-specific focus areas in HICs and LMICs. In HICs prominent contexts were (a) low self-efficacy, (b) untailored rehabilitation services and (c) poor digital literacy. These were addressed through (a) recognising volitional barriers, (b) creating modular programmes and (c) end-user-tested tele-education tools. Whereas in LMICs, the data showed high rates of (d) stigma, (e) poor workforce capacity for community care and (f) barriers to accessible community support. These were addressed through (d) involving community champions, (e) task-shifting addressing workforce gaps and (f) state-level policy changes. Most common CEI interventions in both HICs and LMICs were community advisory boards, Delphi method and integrated knowledge-translation approaches.

This study describes how different contextual factors affecting ABSI populations in HICs and LMICs interact with CEI strategies to trigger mechanisms that improve research engagement and patient outcomes. The study also highlights the dearth of CEI reported in neurosurgical trials. CEI should be embedded in experimental research to account for varying economic, social and infrastructural contexts, particularly in rural and LMIC settings.

To provide an updated systematic review of the effectiveness of workplace interventions for chronic musculoskeletal disorders, identify key intervention components and assess their impact on health and work-related outcomes.

Systematic review of randomised controlled trials.

MEDLINE, EMBASE, CINAHL, PsycINFO, Scopus and Web of Science were searched for studies published between 2018 and 2024. Grey literature sources were also consulted.

Randomised controlled trials and cluster-randomised trials evaluating workplace interventions targeting adults with chronic musculoskeletal disorders were included. Outcomes of interest included pain, functional outcomes, quality of life and work-related outcomes (eg, work ability, productivity, presenteeism and absenteeism).

Two reviewers independently screened studies, extracted data and assessed risk of bias using the Cochrane Risk of Bias 2 tool. Due to heterogeneity, only a narrative synthesis was conducted.

23 studies involving 2456 participants were included and classified into physical exercise, ergonomic and multicomponent interventions. Physical exercise interventions consistently improved pain and functional outcomes. Digital delivery of exercise interventions demonstrated comparable effectiveness to face-to-face or workplace-based approaches. Multicomponent interventions, combining exercise with ergonomic strategies, demonstrated the most consistent benefits across outcomes. Evidence for work-related outcomes was limited and inconsistent, and quality of life was assessed in only a small number of studies.

Workplace interventions, particularly multicomponent approaches combining exercise, ergonomics and education, can be effective in improving health outcomes in chronic musculoskeletal disorders. However, evidence on work-related outcomes remains limited and inconsistent.

CRD420261289218.

Digital health interventions (DHIs) show considerable promise in supporting hypertension self-management by promoting preventative care and self-monitoring. While their efficacy is increasingly evident, the long-term uptake, acceptance and sustained engagement with these tools are frequently challenged by issues such as usability, trust and varying user experiences. This review aims to synthesise qualitative evidence to identify barriers and facilitators and the key factors that impact the adoption, acceptance and engagement with DHIs for hypertension self-management.

Systematic review of qualitative literature using thematic analysis following Cochrane’s qualitative and implementation methods guidance.

PubMed, PsycInfo, Web of Science and the Cochrane Library were searched in February 2025.

The searches included relevant qualitative and mixed-methods studies on the use of digital devices for hypertension management, which described the barriers and facilitators associated with these tools. We included studies published from 2015 to 2025 to capture relevant evidence. Only studies published in English with a qualitative approach were included.

From an initial 10 943 identified publications, 15 met our inclusion criteria, primarily originating from Europe and the USA, exploring diverse racial and ethnic group experiences. Our thematic synthesis revealed 7 analytical and 22 descriptive themes detailing barriers and facilitators encountered by patients with hypertension, healthcare providers (HCPs) and caregivers. These themes covered technology utilisation, design components, linguistic and cultural relevance, healthcare factors, trust and credibility and interpersonal interactions.

Our analysis underscores that factors such as the usability, design and relevance of social support profoundly influence the uptake and acceptance of DHIs in hypertension self-management among patients, caregivers and HCPs.

CRD42023480389.

To evaluate the role of community pharmacy in the prevention of cardiovascular disease (CVD) among minority ethnic groups and to identify key barriers and facilitators influencing engagement with pharmacy-based CVD prevention services.

Systematic review using thematic synthesis to analyse both qualitative data and narratively synthesised quantitative data taking a convergent data synthesis approach. Searches were conducted from inception to 16 October 2024 across CINAHL Ultimate (EBSCOhost), EMBASE (Ovid), PubMed (NLM), Scopus (Elsevier) and Web of Science (Clarivate), supplemented by Google Scholar for grey literature and backward and forward citation tracking to identify additional studies.

Community pharmacy settings across multiple countries, including the UK and international contexts.

Minority ethnic groups accessing community pharmacy services and community pharmacy professionals involved in delivering CVD prevention interventions.

Community pharmacy-based CVD prevention interventions, specifically services addressing CVD risk factors.

Outcomes comprised qualitative insights, including barriers and facilitators to engagement with community pharmacy-led CVD prevention services.

Twenty-three studies met the eligibility criteria. Five overarching themes were identified: trust, systemic barriers, culturally tailored language, cultural and religious influences and family and social networks. Community pharmacies undertook varied CVD-related roles, most commonly CVD screening and diabetes management with additional contributions to smoking cessation, weight and lipid management, health promotion and medication adherence. Community pharmacies showed potential to support CVD prevention among minority ethnic groups. However, engagement was limited by language barriers, cultural beliefs, lack of trust in healthcare providers and organisational constraints such as time pressures and limited training. Facilitators included culturally tailored interventions, language concordance and strong pharmacist-patient relationships.

Evidence from the UK remains limited, highlighting a need for further research into the role of community pharmacy in reducing CVD disparities among minority ethnic groups. International evidence suggests significant potential for pharmacy-based interventions, but improved cultural competence, targeted service design and greater awareness of determinants of equitable healthcare are essential. Future research should focus on optimising culturally responsive pharmacy-led CVD prevention strategies.

CRD42024579766.

This qualitative study aims to explore the experiences and preferences of Hispanic men participating in the National Diabetes Prevention Program (NDPP), an intensive lifestyle change intervention that effectively reduces diabetes risk, considering Hispanic men experience diabetes disproportionately yet remain underrepresented in the NDPP.

Individual semi-structured interviews were conducted over the phone in English or Spanish between June 2023 and February 2024. Transcripts were analysed using a framework analysis.

17 Hispanic men engaged in the NDPP for ≥4 sessions. The majority were foreign-born (n=11) and self-identified as English proficient (n=11).

Through three major themes, Hispanic men reflected on their experiences: (1) Going into the NDPP: despite not knowing what to expect from the NDPP, their fear of diabetes motivated them to enrol in the programme; (2) During the NDPP: they felt relief from gaining critical knowledge about diet, exercise and diabetes prevention; and finally (3) Impressions of the NDPP: they appreciated the NDPP’s informational resources, personalised coaching, group format and acknowledgement of traditional cultural diets and found men-only groups often offered additional emotional safety but had mixed feelings about the programme’s virtual format.

Findings suggest that Hispanic men appreciate the knowledge and skills attained from the NDPP and value its resources, group format, culturally-tailored content and gender-tailored structure. Recruitment efforts may benefit from emphasising how the programme reduces uncertainty about prediabetes and from more clearly conveying the structure of the programme. Strategies to improve sustained engagement should consider how to feasibly offer delivery formats that accommodate diverse preferences.

Older patients admitted under surgical care have longer length of stay (LOS) and are at risk of functional decline, hospital-acquired complications and geriatric syndromes. Embedded specialist geriatrician models within surgical care teams can reduce length of stay and perioperative complications. Evidence gaps remain regarding the implementation of these models of care and their impact on patient outcomes. This study aims to measure hospital, patient and implementation outcomes of an embedded perioperative geriatric service in a large Australian tertiary referral hospital.

This hybrid type 1 effectiveness-implementation trial involves four services (emergency general, elective general, urology and vascular surgery), with a predicted reach of >2000 patients over 24 months. The intervention consists of a proactive geriatrician-led service providing a comprehensive geriatric assessment and ongoing review during the acute admission. Service evaluation will be via (1) traditional hospital outcomes (primary outcome LOS); (2) implementation outcomes; and (3) patient reported outcomes across three 6 month phases: (1) prior to service implementation; (2) during service implementation and (3) continued service but without active implementation. Data analysis will include descriptive statistics of patient demographics, clinical characteristics and implementation outcomes; cost-effectiveness; univariate and multivariate analysis of outcomes against demographic and clinical characteristics and thematic analysis of qualitative data.

This trial has been approved by the Hunter New England Research Ethics Committee (2024_ETH023259). The findings will be disseminated via peer-reviewed publications and conference presentations. The research team will facilitate adoption more broadly within the health service.

Australian New Zealand Clinical Trials Registry (ACTRN12625000404426)