https://ir.ymlib.yonsei.ac.kr/handle/22282913/168946 2026-04-20T10:35:47Z https://ir.ymlib.yonsei.ac.kr/handle/22282913/211479 Title: Association between instrumental activities of daily living and incidence of Parkinson's disease: a nationwide population-based cohort study Authors: Park, You Hyun; Lee, Hyo Jeong; Kim, Yong Wook; Lee, Sang Chul; Yoon, Seo Yeon Abstract: Several studies have investigated the prodromal factors for early diagnosis of Parkinson's disease (PD). Instrumental activities of daily living (IADL) involve both motor and non-motor functions, and has been used as a screening tool for dementia. This study aimed to examine the association between IADL dependency and PD incidence and identify specific IADL items linked to an increased likelihood of developing PD. This population-based cohort study used data from the Korean National Health Insurance Service database, that contains information on long-term care services. Individuals who underwent at least one health screening and completed the geriatric assessment sheet between 2009 and 2021 were included in this study. Information on IADL was extracted from the geriatric assessment sheet. The Fine-Gray subdistribution hazard model was used to assess the association between IADL dependency and PD incidence. During a mean follow-up period of 3.78 +/- 3.34 years, 308 of the 21,662 participants developed PD. The highest IADL dependency was significantly associated with an increased incidence of PD (adjusted hazard ratio [aHR] = 1.458, 95% confidence interval [CI] 1.037-2.050), particularly among women or >= 75 years. Among the 10 IADL items, dependency in financial management (aHR 1.420, 95% CI 1.057-1.909, p = 0.0201) or telephone use was significantly associated with an increased incidence of PD (aHR 1.536, 95% CI 1.204-1.961, p = 0.0006). Our results suggests that IADL dependency is a potential prodromal indicator of PD. Further research on other ethnicities that considers sociocultural differences is required to confirm this association. 2026-03-01T00:00:00Z https://ir.ymlib.yonsei.ac.kr/handle/22282913/211471 Title: Efficacy of Wearable Exoskeleton for Gait Recovery in Patients With Stroke: A Multicenter Randomized Controlled Trial Authors: Chang, Won Hyuk; Kim, Tae-Woo; Kim, Hyoung Seop; Hanapiah, Fazah Akhtar; Lee, Jong Weon; Han, Seung-Hyeon; Jia, Chai Wen; Kim, Dae Hyun; Kim, Deog Young Abstract: BACKGROUND:Robot-assisted gait training (RAGT) with wearable exoskeletons has the potential to enhance walking in patients with stroke; however, large-scale evidence is inconclusive. The aim of this study was to determine the effect of overground gait training using a torque-assisted exoskeleton in patients with subacute stroke on the recovery of ambulatory function.METHODS:This international, multicenter, randomized controlled trial enrolled 151 patients with subacute stroke who presented with severe gait impairment but relatively preserved trunk control. Participants were randomized to the RAGT group (30 minutes of conventional gait training plus 30 minutes of exoskeleton) or the control group (60 minutes of conventional gait training), 5 times per week for 4 weeks. The primary outcome was the change in ambulatory function, assessed by the Functional Ambulation Category (FAC) before and immediately after the 4-week intervention. Secondary outcomes included the lower limb strength, balance function. Independent ambulation was reassessed 3 months after the intervention.RESULTS:A total of 127 participants (56 female (44.1%), mean age, 60.1 +/- 13.6 years) completed the 4-week intervention. There were no serious adverse events related to the interventions, and dropout rates tended to be higher in the RAGT group without statistical significance. Both groups showed significant improvement in FAC after the intervention; however, no significant difference between groups (mean change (range), 3.0 (1-5) and 2.5 (1-4) in the RAGT and control group). Both groups exhibited significant gains in lower limb motor function; however, the RAGT group demonstrated a significantly greater improvement in lower limb strength (mean change, 15.9 +/- 14.2 and 11.1 +/- 11.2 in the RAGT and control group, P=0.034).CONCLUSIONS:Overground gait training using an exoskeleton was not superior to conventional rehabilitation for improving ambulatory function in subacute stroke patients; however, it could provide additional lower extremity motor improvement. These findings suggest that the overground gait training with an exoskeleton might be a potential intervention for patients with subacute stroke.REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT05157347. 2026-03-01T00:00:00Z https://ir.ymlib.yonsei.ac.kr/handle/22282913/211472 Title: Strategies to Increase Patients' Adherence to Digital Therapeutics for Musculoskeletal Diseases: A Narrative Review Authors: Bang, Myeonghwan; Park, Jung Hyun Abstract: Digital therapeutics (DTx) are a promising intervention for musculoskeletal diseases. However, real-world adherence remains low despite their established clinical efficacy and safety. This study analyzed the factors influencing patient adherence to DTx from four perspectives-DTx-related characteristics, patient-related factors, medical professional-related factors, and health system-related factors-and proposed an actionable strategic framework for each stakeholder group. A comprehensive literature search of PubMed and Google Scholar (January 2014 to December 2024) identified 45 eligible references on adherence to DTx for musculoskeletal diseases, including systematic reviews, randomized controlled trials, case-control studies, and other relevant publications. Key DTx features that affect adherence include demonstrated efficacy and safety, personalization, user-friendly interface design, gamification, reward systems, feedback mechanisms, and technical reliability. Patient-related factors included demographic characteristics, disease type and severity, and digital health literacy. Factors related to medical professionals included their perception of and preference for DTx as well as patient education and training efforts. Health system-related factors included regulatory frameworks, infrastructure, and accessibility. Based on these findings, we developed a strategic framework illustrating how developers, patients, physicians, and health system-level stakeholders can collaborate to improve adherence. These insights may serve as a valuable resource for promoting the adoption and widespread implementation of DTx. 2026-03-01T00:00:00Z https://ir.ymlib.yonsei.ac.kr/handle/22282913/211460 Title: Promoting Rehabilitation Using a Multimodal Internet of Things-Based Patient Monitoring System in a Smart Hospital Authors: Lee, Wonhee; Choi, Seung-Ick; Hong, Kyung Pyo; Kang, Yu Joo; Yang, Huiwoo; Park, Jin Young; Kim, Na Young Abstract: Objective: Continuous monitoring of patients' physical and psychological status using wearable sensors and Internet of Things platforms may enhance rehabilitation. We aimed to assess the feasibility of an Internet of Things-based smart hospital system integrating multi-source data to support individualized rehabilitation in patients with gait disturbances. Methods: We conducted a single-center feasibility study at Yongin Severance Hospital, Korea, including 15 inpatients with subacute central nervous system injuries (mean age, $60.9\pm 16.7$ years). The system integrated smart insoles, smart bands, real-time location system data, and mobile application data into the electronic medical record. Gait parameters, including step count, walking distance, gait speed, stride length, and symmetry, were measured during self-exercise. The app collected self-reported scores on pain, anxiety, depression, appetite, sleep, and general condition. Compliance, patient satisfaction, and nurses' qualitative feedback were analyzed descriptively. Results: Monitoring lasted 17.0 +/- 12.6 days. Patients averaged 7, 323 +/- 5,520 steps/day and walked 3,910 +/- 3,198 m/day; 87% showed reduced stride length and 27% had marked gait asymmetry. Application-based symptom monitoring enabled tailored interventions, including medication adjustments and referrals. Smart band data were sometimes incomplete owing to recording errors. Operational challenges included battery depletion, data transfer interruptions, and device registration errors. Overall satisfaction averaged 4.28/5; comfort rated the highest, durability the lowest. Nurses valued real-time condition detection and improved self-report honesty but noted increased workload. Conclusion: Implementing an Internet of Things-based system that integrates wearable and self-reported data into an electronic medical record is feasible in inpatient rehabilitation, facilitating individualized feedback and clinical decision-making while maintaining high patient adherence and satisfaction. Clinical Impact-This study shows the feasibility of an IoT-based smart hospital system integrating multisource data into EMRs, enabling personalized rehabilitation, improving clinical decision-making, and supporting scalable digital healthcare models. 2026-03-01T00:00:00Z