The World Health Organization (WHO) estimates that about one-third of people worldwide currently have a need for rehabilitation. This demand is expected to increase in the coming years due to changes in population health and characteristics. For example, with the intensification of global aging, the rehabilitation needs of patients with chronic diseases and disabilities, postoperative dysfunction, and cognitive impairment continue to grow, and emergencies such as conflicts, disasters, and epidemics may lead to a surge in rehabilitation needs. Early and sustained rehabilitation could reduce complications, improve function, and reduce disability in affected populations, but rehabilitation services are often underestimated due to underfunding and poor short-term outcomes. WHO sees rehabilitation as an essential part of achieving universal health coverage and the Sustainable Development Goals. With the development of China's economy and society and the trend of an aging population, the demand for rehabilitation therapists is growing rapidly. Since the development of rehabilitation education in China at the beginning of this century, great progress has been made in both the training mode and the number of people trained, especially in the construction of higher education of rehabilitation in related colleges and universities. Through descriptive qualitative analysis, this study collected information from national policy documents and official websites of colleges and universities on policies concerning degree systems, cultivating goals and ideas, courses, education internationalization, continuing education in practice, standardized training after graduation, the number of colleges and universities with rehabilitation therapy related majors in China, and summarizes the current situation of the development of rehabilitation personnel education in Chinese colleges and universities. Judging from the results, during the development of rehabilitation education, China has continuously improved in terms of policy support, educational goals and concepts, the number and quality of institutions, degree systems, and internationalization, while gradually adapting to China's development status. This also provides direction and feasible suggestions for China to improve the rehabilitation education development system and formulate a national rehabilitation education plan in the future to deal with the challenge of aging. With the increase in global life expectancy and changes in the health status of populations caused by disabilities, chronic diseases, postoperative dysfunction, cognitive impairments, etc., the demand for professional rehabilitation therapists in various countries has increased significantly. But in many countries, especially low- and middle-income countries, this growing demand for rehabilitation is largely unmet, with an average of fewer than 10 skilled practitioners per 1 million people  and the World Federation of Occupational Therapists (WFOT), many institutions have established a comprehensive high-level normative training system, including education, scientific research, and further education. The qualification examination is carried out according to the professional scope of the rehabilitation therapist. The employment of graduates of rehabilitation therapy-related majors is mainly for the rehabilitation departments, community rehabilitation institutions, nursing homes, fitness centers, sports clubs, and sports training equipment management institutions of hospitals at all levels, and there are also individual operators , 3. By dTo meet the rehabilitation needs of the population in the context of today's aging and population health, countries have taken various measures to improve the level of rehabilitation in their countries, with special attention to improving rehabilitation education, which is the fundamental way to develop rehabilitation therapists. For example, according to the needs of national social and economic development, the training of bachelor of rehabilitation in Japan highlights the acceptance of clinical internships in stages, and the internship institutions are not limited to medical rehabilitation institutions, but also include health and welfare institutions to enhance the comprehensive competence of talents in an all-round way . The AusAs a large country with a population of more than 1.4 billion and accounting for nearly one-third of the world , China fThis study aims to sort out the development status of mainland China rehabilitation therapy-related majors in the four education levels of professional–undergraduate–master's and doctoral degrees, including the development of colleges and universities, educational objectives, professional categories, etc. at each education level, which is of great significance for relevant scholars and public health policymakers to improve the high-level education concept of rehabilitation therapy in the field of aging health and healthcare, and to establish a rehabilitation therapy education development plan that is more in line with China's actual situation.The data sources of this study mainly include (1) Policy documents: Search for policy documents related to rehabilitation education, training, and career development on the official websites of the Ministry of Education of the People's Republic of China and the National Health Commission of the People's Republic of China. (2) Public information of relevant colleges and international organizations: The public information from the China Graduate Admissions Information Network, the World Physiotherapy Alliance, the World Occupational Therapy Alliance, and some colleges and universities in China has been collated, including rehabilitation therapy related professional training programs and curriculum settings, the rehabilitation therapy education of relevant colleges and universities meets international standards, and published literature: search for literature related to rehabilitation and education on CNKI, Wanfang Data Knowledge Service Platform, VIP, PubMed, Web of Science, and other domestic and foreign websites.This study used descriptive qualitative analysis, which mainly contained information on relevant colleges and majors in each training level of rehabilitation education in China. First of all, the educational objectives of rehabilitation therapy-related majors at different training levels were listed and their characteristics were summarized and analyzed, and then the number of institutions involved in each training level was counted, and finally, the level and category of relevant institutions, the regions they belong to, the types of degrees they open, the time of opening and the training years, etc. were analyzed to further analyze the development ideas, deficiencies, and countermeasures of China's rehabilitation education to lay the foundation.In 2013, the “Several Opinions of the State Council on Accelerating the Development of the Old-age Service Industry” and the “Several Opinions of the State Council on Promoting the Development of the Health Service Industry” proposed to scientifically set up professional and technical posts in old-age institutions, focus on training and introducing rehabilitation therapists and other professional and technical personnel with professional or vocational qualifications, increase the training and vocational training of health service personnel, and standardize and accelerate the training of practitioners including rehabilitation therapists. In 2015, the Guiding Opinions of the General Office of the State Council on Promoting the Construction of a Graded Diagnosis and therapy System once again emphasized the need to strengthen the training of professionals such as rehabilitation therapists in various ways, strengthen the construction of grass-roots medical and health personnel, and meet the multi-level and diversified health service needs of the people. In 2016, the “Several Opinions of the State Council on Accelerating the Development of the Rehabilitation Assistive Devices Industry” listed the teamwork of rehabilitation physicians, rehabilitation therapists, and rehabilitation assistive device configuration personnel as the focus of development. In 2017, to further meet the rehabilitation needs of the elderly, China focused on strengthening the training of rehabilitation therapists, rehabilitation physicians, and rehabilitation assistive devices in the “Notice of the State Council on Printing and Distributing the 13th Five-Year Plan for the Development of the National Aging Cause and the Construction of the Pension System,” and extensively carried out various types of rehabilitation training services for the elderly.Modern rehabilitation has been introduced to China in the 1980s and has only developed for a few decades. According to literature and relevant statistics, many Chinese colleges and universities have been carrying out research and education degree training in the field of rehabilitation therapy since the end of the 1980s. In 2004, the Rehabilitation Medicine Education Professional Committee of the Chinese Rehabilitation Medicine Association put forward the “Rehabilitation therapy Professional and Technical Personnel Access Standards” and “Undergraduate Rehabilitation Therapy Professional Education Setting Standards,” which clearly defined the concept of rehabilitation therapists, and made clear requirements for the professional skills they mastered. The personnel training targets of rehabilitation and therapy-related majors in Chinese educational levels are listed below .Rehabilitation education at the specialist  level emphasizes the mastery and proficiency of relevant skills. Currently, Chinese colleges and universities are gradually paying attention to physical therapy and sports therapy, while they are relatively weak in occupational therapy and speech therapy, and they also lack attention to traditional Chinese rehabilitation skills, such as TCM rehabilitation and Tuina. The undergraduate degree in rehabilitation therapy focuses more on translating theoretical knowledge into practical experience and cultivating application-oriented professionals who can engage in rehabilitation evaluation and rehabilitation therapy in medical and health units and rehabilitation institutions. Compared with the specialty, the undergraduate program has higher requirements for students' lifelong learning ability and sense of innovation. Postgraduate education requires students to go hand in hand with theoretical learning, operational exercises, and subject research so that they can continuously discover scientific problems in clinical practice and carry out creative scientific inquiries and scientific research activities.In addition, graduate education in rehabilitation can provide a clearer career framework for therapists. Obviously, vigorously developing postgraduate education in rehabilitation therapy is an important way to improve the overall level of rehabilitation therapy, and it is also the general trend in the development of rehabilitation education in China.In recent years, the number of colleges and universities officially approved by the Ministry of Education to open rehabilitation therapy majors has increased year by year, especially high-level colleges. As of 2022, the statistics of various education levels of rehabilitation therapy related majors in China are carried out, and the results are as follows ; from thFrom Most of the undergraduate education in rehabilitation therapy majors in mainland China is of 4 years, with a bachelor's degree in science, the 1st to 3rd year for theoretical courses, and the 4th academic year for the internship stage. After entering the clinic in the third academic year, most of them are divided into physical therapy (PT) and occupational therapy (OT) directions, and a few colleges and universities have also carried out speech therapy (ST) direction classes, focusing on strengthening the teaching of professional courses and clinical practice in their directions . There aMost period of rehabilitation therapy education is 4 years of undergraduate education, while postgraduate education is different. In the United States, the physical therapy major is a degree in education, but since 2014, the United States has phased out the master's degree in physical therapy, so the degree level is Doctor of Physical Therapy (DPT). Most students go through 4 years of undergraduate basic course study and clinical internship, and a few colleges and universities allow students who have completed 3 years of rehabilitation preparatory education to apply for 3 years of DPT study from higher institutions, the most common undergraduate majors are sports medicine, biomedicine, and sports science. In Japan, undergraduate rehabilitation therapy departments, such as Kyoto University and Capital University, mostly implement 4 year theoretical courses and annual internship courses, such as physical therapy and occupational therapy, and their master's and doctoral programs are implemented according to the credit system.Mainland China's rehabilitation education has gradually been in line with international standards in recent years, and the independent training of PT and OT with reference to WCPT and WFOT education standards is becoming the future trend of related professional education in the field of rehabilitation therapy in China. As the highest level and most authoritative organization in the field of PT and OT rehabilitation therapy in the world, WCPT and WFOT have promulgated the minimum education standards for physical/occupational therapists in the world to promote the development of physical/occupational therapists, and have absorbed the registration of many countries and their related colleges and universities. Since 2013, the PT and OT professional courses at Sichuan University, Shanghai University of Traditional Chinese Medicine, Capital Medical University, Kunming Medical University, Fujian University of Traditional Chinese Medicine, Tongji University, Guangzhou Medical University, Nanjing Medical University, and other eight institutions in China have successively passed the certification of WCPT and WFOT , 17 Tab, reflectIn recent years, China's emphasis on rehabilitation-related majors has also been reflected in the construction of rehabilitation professional colleges. In 2015, the China Disabled Persons' Federation proposed to build the world's first University of Health and Rehabilitation Sciences and positioned it as a high-level national applied research university with international characteristics based on research and application-oriented with Chinese characteristics. Since then, the construction of the University of Health and Rehabilitation Sciences has been included in the “Outline of the 13th Five-Year Plan for National Economic and Social Development of the People's Republic of China” and the “13th Five-Year Plan for the Development of National Education.” In 2019, the Ministry of Education officially approved the preparation and support for the establishment of the University of Health and Rehabilitation Sciences, sponsored by Shandong Province, and jointly built by the China Disabled Persons' Federation, the National Health Commission, and other departments. On June 11, 2019, the University of Health and Rehabilitation Sciences held an unveiling ceremony in Qingdao, Shandong Province, and the Boao Forum for Asia Global Health Forum Conference was held in Qingdao on the same day. As one of the sub-forums, the “Seminar on rebuilding a life for the disabled—Building the University of Health and Rehabilitation Sciences” invited experts from the World Health Organization, Japan, New Zealand, the United Kingdom, Canada, Sweden, Finland, Hong Kong, China, and relevant universities and research institutions in China to participate, and put forward valuable suggestions on the educational philosophy and discipline construction of the University of Health and Rehabilitation Sciences.Proper curriculum arrangement is the basis for building knowledge and ability. Many colleges and universities related to rehabilitation in mainland China have carried out more refined courses, basically meeting the health needs of the population. For example, the School of Rehabilitation Medicine of Weifang Medical University has set up geriatric, community rehabilitation, and other courses  concerniIt is concluded that in the education of rehabilitation related majors in China, many colleges and universities have strengthened the teaching of geriatrics, community rehabilitation, and other courses, and paid attention to the training and education related to elderly rehabilitation in practical training. In addition, many colleges and universities' enterprise cooperation between institutions and rehabilitation related institutions with a high proportion of elderly people has been strengthened, such as community rehabilitation centers and geriatric rehabilitation departments in general hospitals, which has laid a foundation for promoting students' practical courses .According to the research, the training of clinical ability of Chinese students majoring in rehabilitation therapy after graduation mainly depends on the clinical teaching level of medical institutions participating in an internship before graduation  and contThere are four main types of continuing education in practice that rehabilitation therapists participate in short-term continuing education project training, including national, provincial, and municipal short-term education projects, regular refresher education, 3 to 6 months of further learning in a superior hospital, participate in academic conferences and get continuing education credits, and online course learning. The above types of continuing education in practice have greatly promoted the profession of rehabilitation therapy. Taking Weifang People's Hospital as an example, the hospital strongly supported the continuing education in the practice of its rehabilitation therapists and provided sufficient funds and platform resources. The rehabilitation therapists of the hospital regularly go to the superior hospital for further study every year and regularly participate in training classes for various special rehabilitation therapists, each time for about 3 months or half a year, mainly for the training, teaching, exchange, and discussion of theory, operation technology, and actual cases. In addition, regular learning seminars are held within the department, and internal staff is organized to summarize and discuss recent cases to learn from experience. Finally, all employees will also take part in the online courses organized by the hospital. Online courses are not aimed at all sub-professional rehabilitation therapists but mainly focus on the comprehensive quality and medical ethics of staff. The credit system is usually implemented in online course learning, and the course can be concluded only after passing the corresponding online examination.Standardized training after graduation is an important means to further promote the comprehensive quality of Chinese rehabilitation therapists and improve their post-abilities, which has become the consensus of many experts in China . In receThe development of rehabilitation staff is a powerful measure to cope with aging and chronic diseases, disabilities, and postoperative rehabilitation. Currently, the problem of population aging cannot be ignored, in addition to various chronic diseases and physiological decline, etc. are increasing the demand for rehabilitation therapy. The establishment of China's rehabilitation higher education system and the University of Health and Rehabilitation Sciences as the basis for promoting the development of a rehabilitation therapy team can well promote the aging response and meet the rehabilitation therapy needs of the population.In recent years, China has issued a series of policies related to the health and pension system of the elderly, which has played a major role in promoting the development of China's health field, especially rehabilitation. In 2013, the introduction of policy documents such as “Several Opinions of the State Council on Accelerating the Development of the Old-age Service Industry” and “Several Opinions of the State Council on Promoting the Development of the Health Service Industry” has rapidly promoted the development of rehabilitation and therapy education in China. From Table 2, it can be seen that after 2013, a large number of rehabilitation therapy-related majors in Chinese colleges and universities emerged. In 2016, the introduction of the “Several Opinions of the State Council on Accelerating the Development of the Rehabilitation Assistive Device Industry” and the subsequent “Notice of the State Council on Printing and Distributing the “13th Five-Year Plan” National Aging Cause development and Pension System Construction Plan” once again promoted the overall rapid development of rehabilitation and therapy education in China.Currently, public health and healthcare policymakers and leaders should fully carry out rehabilitation medical research, clarify the existing rehabilitation therapy education development problems and weak links, and promote the continuous growth of rehabilitation therapy talents and the continuous improvement of disciplinary capabilities. Increase the training of rehabilitation therapy talents, improve the construction of rehabilitation universities, and increase the training and training of compound rehabilitation talents. At the same time, we will actively promote the construction of rehabilitation medical professional personnel training bases, promote the improvement of policies related to the access standards for rehabilitation therapists, actively set up rehabilitation therapy related majors and related secondary disciplines and interdisciplinary disciplines, and cultivate more high-quality rehabilitation therapy professionals.Public health and healthcare policymakers and leaders attach great importance to the development of physicians' practical ability, emphasizing that educational teaching concepts and training goals should be based on actual needs  while adReference can be made to the WHO International Classification of Functioning, Disability and Health (ICF)  theoriesThe overall training level of rehabilitation therapy talents in China still needs to be improved. With the continuous increase in people's demand for rehabilitation therapy services, the comprehensive quality requirements for rehabilitation therapy personnel are getting higher and higher, and it can be seen from We should actively respond to the national policy to cultivate high-level rehabilitation and therapy talents, and cultivate rehabilitation therapy masters and doctoral students in a targeted manner in combination with the national conditions of our country, and gradually improve the academic level of rehabilitation therapy talents. In addition, due to the limitations of undergraduate science degrees in rehabilitation therapy in China, the training direction of its graduates is limited to academic masters, and the training of clinical skills and practical operations is less, which to a certain extent leads to students failing to achieve a better combination of theory and practice. Therefore, relevant colleges and universities should improve the training program for master's degree students in rehabilitation therapy related majors, standardize the design of clinical courses for graduate students, and promote standardized training in related majors. For example, strengthen the supporting construction of laboratories , establiThe degree of standardization of rehabilitation-related professional education in China is not easy to be in line with international standards. The current mature international rehabilitation education model is to cultivate separately according to PT and OT and set up different professional types under them . There aWith the national “Healthy China 2030” policy orientation and the need for continuous precision in the rehabilitation therapy of the population, the reform of rehabilitation education, and the refinement of the teaching of rehabilitation therapy majors is the general trend. In addition, compared with the professional education certification standards required by WCPT and WFOT, there are still many problems in the current training programs and curriculum systems of China PT and OT that need to be revised and improved. We should keep up with the development trend of international higher education, based on the WCPT and WFOT international curriculum certification standards, carry out the revision of the core curriculum program of PT and OT majors and further optimization of the curriculum system, and at the same time give full play to the unique advantages of rehabilitation therapy in China, add traditional Chinese rehabilitation therapies such as acupuncture and Tuina to the curriculum, and explore the path suitable for rehabilitation therapy education in China on the basis of learning from international experience.Currently, the curriculum of rehabilitation therapy related specialties in China still has some limitations, such as the insufficient connection between the curriculum content and the necessary professional knowledge points of vocational technology, insufficient depth and breadth of knowledge, the structural lack of talent quality training, and the lack of targeted practice courses. With the support of the state and the efforts of talents from all sides, it is urgent to carry out the development and reform of the curriculum of rehabilitation therapeutics in full consideration of China's national conditions.With reference to Japan, where aging is very serious, some colleges and universities pay much more attention to elderly rehabilitation than other rehabilitation courses, accounting for more class hours, which indicates that Japanese curriculum content settings have a precise understanding of social applicability. Taking Japan International Welfare University as an example, it has set up teaching and practical courses in different stages for gerontology, geriatrics, geriatric physical therapy, occupational therapy for the elderly, occupational therapy for the elderly, and other disciplines . In the Currently, most medical colleges and universities in China have not jointly carried out standardized training for rehabilitation therapists after graduation with their affiliated hospitals, which is not conducive to the improvement of the individual professional abilities of rehabilitation therapists and the progress of rehabilitation therapy. In 2017, the expert group of the Rehabilitation therapy Professional Committee of the Chinese Rehabilitation Medical Association put forward the expert consensus on the standardization of Chinese rehabilitation therapists and believed that the standardized training of rehabilitation therapists was imperative. Standardized training after graduation should achieve the following points: First of all, it is necessary to define the training objectives. Second, we should formulate a sound system of teacher selection and qualification, teacher training and appointment, and teacher evaluation. Third, standardize the training time and management system of students. Finally, a post-competence examination shall be arranged after the training, and those who pass the examination shall be issued with corresponding post-competence certificates.As for the continuing education of rehabilitation therapists, the current education methods of short-term training and regular refresher education have been developed more maturely in China. The content of the existing training and refresher learning includes theoretical and technical explanations and case discussions of various types of rehabilitation therapy, greatly improving the theoretical and practical level of on-the-job rehabilitation therapists. However, due to such factors as funds and platforms, the popularity of short-term training and regular refresher education in grass-roots hospitals, community rehabilitation centers, and other places still needs to be improved. In the future, it can also be developed in the following aspects: First of all, the government should promote the construction of an academic exchange platform for the education and training of rehabilitation therapists including medical institutions at all levels, and promote that rehabilitation therapists in primary medical institutions can also continuously improve their professional knowledge and skills. Second, we should improve the professionalism and pertinence of the content of online training courses for rehabilitation therapists, and encourage rehabilitation therapists to actively participate in online education courses, such as Moo classes. Finally, enrich the training content, for example, regularly hold research and training classes for senior management talents of rehabilitation therapists to improve the quality of management cadres.This study had a few limitations. First of all, this study only introduces the professional education system related to mainland China rehabilitation therapy and lacks comparison with similar projects in Hong Kong, Macao, and Taiwan. Second, the development of master's and doctoral higher education in China's rehabilitation-related majors has only been 7 years, and experience and lessons coexist. Therefore, this study hopes to incorporate more recommendations and opinions to aid in the development of higher education in rehabilitation therapy.Rehabilitation education is essential to improve the overall quality of rehabilitation staff, which in turn directly affects the satisfaction of many health needs brought about by aging and chronic diseases, disabilities, and postoperative dysfunction. From the perspective of China's rehabilitation education system, this study uses daily data from Chinese and international rehabilitation therapy-related professional institutions to study the current development status of rehabilitation therapy education in China and summarizes the rehabilitation therapy education model with Chinese characteristics that are suitable for the development of rehabilitation therapy in China in comparison with international rehabilitation education. On the one hand, based on ICF, RCF, and other international rehabilitation-related classification concepts and method guidance, it can promote the goals and system settings of rehabilitation therapy education and training in China to continuously meet the current health needs of the population. On the other hand, based on national conditions, the basic theories and methods of traditional Chinese medicine with Chinese characteristics should be integrated into the training of disciplines related to rehabilitation and therapy. It is also necessary to accelerate the promotion of rehabilitation education in national policies, and at the same time further optimize the existing rehabilitation discipline majors and curriculum settings in accordance with the requirements of relevant international education majors and curriculum settings, and enhance the international recognition of Rehabilitation Therapy education training and personnel qualifications in China. Most of the previous research has focused on a certain level of rehabilitation education, and this article innovatively summarizes the professional education related to rehabilitation in China from the aspects of the full-time –undergraduate–master–Ph.D. high-level education system, providing a better reference for health policymakers, leaders, and scholars to formulate a more realistic rehabilitation therapy education Chinese program, and even the formulation of internationally recognized rehabilitation therapy education projects.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.SS conducted the study design, analysis, and basic writing. XL collected the data. XO conducted the analysis. WC, PG, ZL, LJ, QG, and ZD gave advice on the statistical analysis and data processing and offered comments to modify the manuscript. QJ and JZ contributed to the study design and supervised the process. All authors read and approved the final manuscript before submission.


Access to medical rehabilitation remains poor in Sub-Saharan Africa. This is partly due to inadequate service delivery emanating from ill-defined public health policies. Developed countries have adopted public-private partnership (PPP) agreements between the government and private sectors, thus presenting superior quality and access to rehabilitation services. To help develop a PPP model for physiotherapy service delivery in South Africa, this scoping review will map research linked to PPP for medical rehabilitation services delivery and outcomes in the global context.The Arksey and O’Malley (2005) framework  will be used to guide this review. Peer-reviewed literature will be searched in PubMed, EBSCOhost, Cochrane library, SCOPUS, and Google Scholar from 2000-2022 using a combination of keywords, Medical Subject Headings, and Boolean terms. Screening of the articles at all stages will be conducted independently by two reviewers using the eligibility criteria as a guide. The reference lists of retrieved articles will be manually searched for relevant studies. Emerging themes and sub-themes will be collated, summarized, and the results reported in the narrative form.We anticipate identifying literature gaps for future research to inform policy on PPP for rehabilitation services delivery in Sub-Saharan Africa and actual practice. The results of this review will contribute to building a model that will enable the provision of equitable rehabilitation services at the district health level using PPP. Of these, 19.2% are female, and 12.0% are male. The prevalence of disability in high-income countries is 11.8%. In comparison, that of low-income countries is 18% [The World Health Organization’s (WHO) The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) and other policy such as the National Rehabilitation Programme (NRP) stipulate that PLDs have a right to quality healthcare. However, health services to PLDs have been hampered by lack of human resources for health, dilapidated infrastructure, overburdened public health systems, and finite financial resources –7. In suThe PPP model has been identified as a key strategy to enhance public health systems and mitigate the rising costs of an already expensive and unsustainable private healthcare sector , 12. A PThere has been an increasing interest to implement PPPs among other Sub-Saharan countries in the effort to improve public health systems –18. In LPreferred Reporting Items for Systematic Reviews and Meta-Analyses guideline for Protocols (PRISMA-P) was followed to develop this protocol . This reThe primary research question for this review is “What research evidence linked to PPP and medical rehabilitation service delivery in SSA exist?” The population, concept, and context for this review question are defined in Table Relevant peer-reviewed articles and unpublished literature (grey literature) in the English language published in the last twenty years (from 2000 to 2022) will be sourced from electronic databases. The databases will include PubMed, EBSCOhost , Cochrane Library, SCOPUS, and Google Scholar. In consultation with an expert librarian, a search strategy will be developed using keywords, Boolean terms (AND/OR), and Medical Subject Heading terms. The keywords will include the following: “medical rehabilitation,” “physical therapy,” “physiotherapy,” “occupational therapy,” “speech therapy,” “public-private partnership,” “public-private mix,” “public-private cooperation,” “public-private coordination,” “public-private collaboration,” “contract out,” “contracting out,” “Private finance initiative contracts.” We will adequately document each search strategy as illustrated in Table This scoping review has a criterion to select most relevant studies to answer the research question(s). Thus, the inclusion and exclusion criteria are listed below.All articles that focus on medical rehabilitation services ,Articles that include PPP for medical rehabilitation service,Articles presenting evidence on access to medical rehabilitation services,Articles presenting evidence on referral pathways in medical rehabilitationArticles showing PPP models/frameworks for medical rehabilitation services,Primary study designs and frameworks/models,English language, andPublication from 2000 to 2022.Articles that exclude medical rehabilitation practitioners,Articles focusing on non-medical rehabilitation, such as drug rehabilitation.Studies that focus on access to other healthcare services,Scoping review, systematic reviews, and meta-analysis, literature reviews without PPP model/framework for medical rehabilitation, andArticles published before 2000.The EndNote library will be cleaned by identifying and removing all duplicate articles and shared with the review team. The screening tools will be piloted and tested by two reviewers independently and the necessary adjustments based on the feedback received to ensure the screening tools are accurate and reliable. Two reviewers will screen the titles and abstracts and the full-text articles independently. Based on the eligibility criteria, the two independent reviewers will sort the articles into either the “include” or “exclude” group. Any differences in the responses of the two independent reviewers at the abstract screening stage will be resolved through discussion among the review team, but a third reviewer will be engaged to resolve any discrepancies at the full-text screening phase. The University of KwaZulu-Natal library services to retrieve full-text articles that are closed access publications, but emails will also be sent to the original authors or corresponding author to request relevant full-text articles if needed. PRISMA flow diagram will be used to account for the articles Fig. .Fig. 1PRA data extraction form will be developed for the charting of relevant data from the included articles Table . Two revA narrative synthesis will be used to summarize all relevant data into themes and sub-themes to answer this study question. The findings will be categorized into four themes  and reported. Other relevant emerging themes or sub-themes will be reported. Tables and figures/maps will also be used to present the characteristics of the included studies, study results, and study findings that were appropriate.This scoping review will map existing models for PPP for medical rehabilitation in SSA and the availability, affordability, and human resource capacity for rehabilitation in SSA. Equitable access to quality medical rehabilitation requires improvement . A growi


Ophthalmic lens adaptation, particularly with progressive addition lenses, requires accurate measurements of the patient nasopupillary distance (NPD) and interpupillary distance (IPD), which are usually collected using the pupil centre as a reference. However, differences between the pupil centre and visual or foveal axis could induce some subsidiary effects of correcting lenses. This study aimed to assess the intrasession repeatability of a new prototype  that can measure the foveal fixation axis (FFA) distance and assess the agreement with the NPD measurements collected using a traditional method (frame ruler).The FFA at far and near distances was measured three consecutive times in 39 healthy volunteers to determine the intrasession repeatability according to the British Standards Institute and International Organization for Standardization. Additionally, the FFA and NPD (standard frame ruler) were measured in 71 healthy volunteers and compared using Bland–Altman analysis. Two blinded experienced practitioners conducted each FFA and NPD measurement.P < 0.001); LE: −0.61 ± 2.62, LoA = −5.75 to 4.53 mm (P = 0.052)) and near distances ; LE: −2.97 ± 3.97, LoA: −10.75 to 4.80 mm (P < 0.001)).The FFA measurements showed acceptable repeatability at far distances (right eye (RE): Sw = 1.16 ± 0.76 mm and coefficient of variation (CV) = 3.92 ± 2.51%; left eye (LE) Sw = 1.11 ± 0.79 mm and CV = 3.76 ± 2.51%) and at near distances . Additionally, agreement with the NPD showed large differences at far distances (RE: −2.15 ± 2.34, LoA = −6.73 to 2.43 mm (FFA measurements showed clinically acceptable repeatability at both far and near distances. Agreement with the NPD measured using a standard frame ruler showed significant differences, suggesting that both measurements are not interchangeable in clinical practice to prescribe and center ophthalmic lenses. Further research is necessary to assess the impact of FFA measurement in ophthalmic lens prescriptions. Refractive errors  affect most of the worldwide population (more than 2.3 billion people in the world) , and preOphthalmic lens prescription, particularly in high refractive errors or PAL, requires accurate measurements of some facial parameters of the patient  that areHowever, using the pupil centre as a lens centering reference implies a misconception because the pupil centre usually does not meet the visual axis. Although no consistent definition is available in the literature , the visPALs are one-piece spectacle design lenses with a progression of plus power across the lens surface from the distance prescription (the upper part of the lens) to the near prescription . Change in PALs power surface, induces lateral aberrations, as explained by the Minkwitz theorem . ConsequA new prototype  was developed to measure the foveal fixation axis distance (FFA) to improve ophthalmic lens prescription. The FFA is defined as the imaginary line that directly links the fixation point and fovea , and itsConsequently, this study aimed to describe the intrasession repeatability  of FFA dThis study involved 71 healthy subjects between the ages of 44 and 64 years with a visual acuity equal to or better than 20/30 to allow accurate fixation at far and near distances. Patients with severe systemic disease , advanced glaucoma or visual acuity under 20/30 were excluded from the study. Written informed consent was obtained from each subject after the Human Sciences Ethics Committee of Valladolid Area-Este Clinic Hospital  approved the study (PI 19-1194). All the subjects were treated in accordance with the Declaration of Helsinki.The nasopupillary distance and interpupillary distance were measured using a traditional frame ruler, and the FFA distance was also measured using the new Ergofocus device in all 71 subjects to conduct the agreement analysis. Both measurements were conducted in the same session by two blinded experienced practitioners. However, in only 39 patients, the FFA distance was measured three consecutive times to conduct the repeatability assessment.®; Lentitech Inc, Barakaldo, Spain)   Fig. 1)®; LentitThe patient wore the device on their head, fixed in place with rubber bands and resting on their nose. To measure the FFA distance in far vision, a fixation object was placed at 6 m. To measure the right eye FFA distance, the left eye was occluded, and right eye slits were manually moved by the examiner until the patient could see the fixation object centred in their visual field and vice versa for the left eye. When left eye measurement was completed, the examiner checked that the fixation point was centred binocularly. To measure the FFA distance in near vision, the process was the same as that for far distance except that the fixation point was placed at comfortable reading distance for the patient (measured by the device sensor).Frame ruler measurements were conducted following a standard procedure . To collP < 0.05 indicated that the data were not normally distributed). Data for the collected variables were presented as means, standard deviations (SDs) and ranges.Statistical analysis was performed using SPSS for Windows software . The nonparametric data distribution of variables was verified using the Kolmogorov–Smirnov test  . Exact 95% confidence intervals for the repeatability of the LoA were also calculated  . Linear lculated .t test or Wilcoxon nonparametric paired tests depending on the sample distribution .Comparisons between devices for each measured parameter were made using paired Seventy-one healthy subjects (37 women and 34 men) with an average age of 54.01 ± 4.50 years (44 to 64 years) and a spherical equivalent of −0.70 ± 2.52 D (−7.50 to +4.00 D) were enrolled in the study. Near distance was on average 33.14 ± 6.85 cm (ranged from 19.80 to 60.10 cm). All the subjects participated in the agreement study, but only 39 were also enrolled in the repeatability study , a spherical equivalent of −0.61 ± 2.52 (−7.50 to +4.00 D) and near distance of 32.66 ± 5.04 cm (19.80 to 42.00) cm).FFA measurements showed acceptable repeatability for clinical use in both right and left eyes with a CV lower than 5%, a Sw close 1 mm and an ICC higher than 0.89 at far and near distances .P < 0.001) in all assessed parameters except in left eye measurements at far distances   and Ergofocus FFA showed worse agreement (high differences with wide LoA) and statistically significant differences ( −1.941) .At far distances, the right eye showed a higher mean difference (close 2 mm with LoA larger ±4 mm) than the left eye (mean difference <1 mm), but the wide LoA ranged between approximately ±5 mm. In both eyes, the mean difference and LoA were slightly larger (mean difference close 3 mm and LoA close ±6 mm). However, agreement at near distances was worse than at far distances because both right and left eyes showed a mean difference close to 3 mm with a wider LoA (higher than ±10 mm) . The intCorrect centration of ophthalmic lenses  is necesPrevious reports have described the repeatability of different methods (standard and modified Viktorin’s method ) and devThe agreement of FFA measurement with the nasopupillary distance measured using a traditional frame ruler is low with higher differences in near vision than in far vision. This difference is expected because different measurement approaches are used by each technique, the frame ruler uses the pupil centre, the new prototype uses the visual axis, and the difference between both distances forms the kappa angle . PreviouThis low agreement  seems toDifferences between nasopupillary distance and FFA values could be relevant in different clinical scenarios. For example, undesired prismatic effects would occur that increase in high refractive errors  because,In summary, the mean difference between the nasopupillary distance and FFA found in this study would suggest a breach of ISO 21897:2017 rule with moderate and high prescriptions. Therefore, more studies assessing FFA, nasopupillary distance and kappa angle are necessary to assess the impact on spectacle wearers.A second major scenario could be presbyopia management with PAL because these lens prescriptions require correct and accurate facial measurements to minimize subjects’ adaptation process because of the reduced intermediate and near vision zones in these lenses explained by the Minkwitz theorem . TherefoThe main study limitation could be the sample size comprising Caucasian subjects aged between 40 and 65 years. However, this sample could be adequate to conduct the repeatability and agreement analysis in this study following previous recommendations , showingin vivo based on dual-depth whole-eye optical coherence tomography that is unavailable for clinical practice and does not measure distances between visual axes to prescribe ophthalmic lenses. However, the main interest of previous reports was assessing the repeatability of nasopupillary distance and/or interpupillary distance measurements collected using different methods or devices that use different measurement principles (mainly pupil centre) that could not be compared with the Ergofocus prototype that uses the FFA for measurements.Additionally, the absence of other published clinical methods to measure the visual axis made it challenging to compare these study results. Only one recent report  proposedFFA measurements showed clinically acceptable repeatability at both far and near distances with significant differences from the nasopupillary distance and interpupillary distance measured using a standard frame ruler, suggesting that both measurements are not interchangeable in clinical practice to prescribe and centre ophthalmic lenses. Further research to assess the use of FFA outcomes in clinical practice is required with special attention in PAL prescription to explore whether FFA measurements could improve user satisfaction, minimize the subject PAL adaptation process, and replace current nasopupillary distance and interpupillary distance use to centre this type of lens.10.7717/peerj.14942/supp-1Supplemental Information 1Click here for additional data file.10.7717/peerj.14942/supp-2Supplemental Information 2Click here for additional data file.


The lack of the rehabilitation professionals is a global issue and it is becoming more serious during COVID-19. An Augmented Reality Rehabilitation System (AR Rehab) was developed for virtual training delivery. The virtual training was integrated into the participants’ usual care to reduce the human trainers’ effort so that the manpower scarcity can be eased. This also resulted in the reduction of the contact rate in pandemics.To investigate the feasibility of the AR Rehab-based virtual training when integrated into the usual care in a real-world pandemic setting, by answering questions of whether the integrated trials can help fulfill the training goal and whether the trials can be delivered when resources are limited because of COVID-19.Chronic stroke participants were randomly assigned to either a centre-based group (AR-Centre) or a home-based group (AR-Home) for a trial consisting of 20 sessions delivered in a human–machine integrated intervention. The trial of the AR-Centre was human training intensive with 3/4 of each session delivered by human trainers (PTs/OTs/Assistants) and 1/4 delivered by the virtual trainer (AR Rehab). The trial of the AR-Home was virtual training intensive with 1/4 and 3/4 of each session delivered by human and virtual trainers, respectively. Functional assessments including Fugl-Meyer Assessment for Upper Extremity (FMA-UE) and Lower Extremity (FMA-LE), Functional Ambulation Category (FAC), Berg Balance Scale (BBS), Barthel Index (BI) of Activities of Daily Living (ADL), and Physical Component Summary (SF-12v2 PCS) and Mental Component Summary (SF-12v2 MCS) of the 12-Item Short Form Health Survey (SF-12v2), were conducted before and after the intervention. User experience (UX) using questionnaires were collected after the intervention. Time and human resources required to deliver the human and virtual training, respectively, and the proportion of participants with clinical significant improvement were also used as supplementary measures.p = 0.0022, AR-Home: p = 0.0043), FMA-LE , SF-12v2 PCS  were observed in both groups. Significant improvement in balance ability (BBS: p = 0.0438), and mental components (SF-12v2 MCS: p = 0.017) were found in AR-Centre group, while activities of daily living (BI: p = 0.0007) was found in AR-Home group. Contact rate was reduced by 30.75–72.30% within AR-All, 0.00–60.00% within AR-Centre, and 75.00–90.00% within AR-Home.There were 129 patients from 10 rehabilitation centres enrolled in the integrated program with 39 of them were selected for investigation. Significant functional improvement in FMA-UE (AR-Centre: The human–machine integrated mode was effective and efficient to reduce the human rehabilitation professionals’ effort while fulfilling the training goals. It eased the scarcity of manpower and reduced the contact rate during the pandemics. Stroke is the second commonest cause of death and one of the leading causes of disability –3. Reseaa et al.  in 2019.a et al. , 41–43, a et al. –37, 42, a et al. , 42, 43,a et al. , 23, 40,a et al. , 40, bala et al. , 28, 40,a et al. , 28. HowFirst of all, those studies focus on the specific aspects of the recovery for research purpose , while in a real clinical setting, the training needs to be designed as practical programs which are comprehensive enough to cover not only as many parts as necessary, but also the whole-body coordination and the quality of life. Furthermore, those systems may require complicated ad-hoc environmental setup which are not practical in rehabilitation centres or hospitals. For example, a precise camera calibration has to be done prior to the mirror training , 18–21. The purpose of this study is to investigate the feasibility of the AR rehabilitation system in a real-world setting, in which it is used as a part of an integrated training program of the usual care. The setting of the integrated mode rather than applying AR training alone (like in most of the previous studies) is due to a conclusion made by Kate et al. . Based oThe study was an assessor-blind, randomized controlled trial and was approved by the Joint Chinese University of Hong Kong—New Territories East Cluster Clinical Research Ethics Committee. Participants were recruited through 10 local public rehabilitation centres, which are distributed over 8 different districts of Hong Kong. Written informed consents were obtained from participants prior to the enrollment.Chronic stroke survivors were selected with inclusion criteria: (1) age between 18 to 90 years who are diagnosed with ischemic brain injury, intracerebral haemorrhage shown by magnetic resonance imaging, or computed tomography after the onset of stroke; (2) with motor impairment in upper-limb, lower-limb, and/or balance; (3) have no or mild spasticity on the lower-limb or upper-limb assessed by Modified Ashworth Scale  in consecutive 4–10 weeks. Each session consisted of 2–10 exercises selected by the trainer from a pool of 46 exercises. The selected exercises were tailored based on the participant’s condition and progress. The exercise pool was designed as much comprehensive as possible to cover the upper-limb (22 exercises) and lower-limb (7 exercises) motor functions, balance ability (11 exercises), or/and coordination (6 exercises). Each exercise was with a duration ranging from 3 to 23 min, and was determined by a set of parameters that can be adjusted to the individuals dynamically according to the participant’s performance.The training was delivered in an integrated manner of a human PT/OT/Assistant trainer  and a AR rehabilitation system .The two groups of AR-Centre and AR-Home were designed with different configurations of trainers to study the best way to integrate the AR training into usual care.AR-Centre group: The training was conducted at the rehabilitation centres following the same procedure as their regular usual care, with 3/4 of each session delivered by a human trainer and the rest of 1/4 delivered by a virtual trainer.AR-Home group: The training was conducted mainly at home (3/4 of each session) and delivered by the virtual trainers. However, at the beginning of each session, there was a short  in-centre/at-home training delivered by human trainers to make the participants familiar with the subjects and procedures. To this end, upon the recruitment, a human trainer was randomly assigned to a participant for tailoring her training plan according to the baseline assessment. While the participant was taking the training at home, the human trainer could monitor the training process remotely. Reports of the training were sent to the human trainer on a weekly basis. The human trainer could adjust the training plan based on the participant’s performance.As shown in Fig. The system is able to deliver the exercises following the same procedure as in the usual care. The exercises performed by therapists are prerecorded. Every exercise starts by a brief voice introduction followed by a video demonstration with detailed steps. The participant will then follow the steps to do the exercise. Her body movements will be sensed into 3D skeletons, on the basis of which parameters such as the centre of Mass-COM, body parts, joint angles, reaching distances, speed and directions of the motions, and trajectory are evaluated. At the end of exercise, immediate feedback will be given as a report with the performance details and compared with her early performance. In addition, the participant can review her performance through the skeleton videos recorded during the exercise to locate the exact steps which she needs to pay more attention for further improvement. The performance details with the skeleton videos are synchronized to the cloud so that the human trainer could review her performance and adjust her training plan accordingly.Participants received the pre-assessment within two weeks before the first training, and the post-assessment within two weeks after the last training. Assessments were conducted at centres for the AR-Centre group and at homes for the AR-Home group.The primary outcome measures focused on the motor function, balance, and functional ambulatory, which include (1) Fugl-Meyer Assessment with Upper Extremity and Lower Extremity (FMA-UE and FMA-LE); (2) Berg Balance Scale (BBS); (3) Functional Ambulation Category (FAC).The secondary outcome measures included the assessments of (1) Quality of life (QOL): physical and mental health using the 12-Item Short Form Health Survey (SF-12v2); (2) User experience (UX) using questionnaires (designed based on UEQ-S); and (3) Activities of Daily Living (ADL) using Barthel Index (BI).To evaluate the human effort required to deliver the training, the time of human training, the time of virtual training, the ratio of human training over the total training time, the number of human trainers required for each participant were calculated. The in-centre contact rate was calculated based on the numbers of PTs, OTs, training assistants, supporting staff, teammates the participant encountered at the centre. The numbers varied from centres and individuals. We used the numbers estimated by the PTs/OTs/Assistants and calculated the average across centres.In addition, to study the clinical significance, we identified participants who were with improvement exceeding the Minimal Clinically Important Difference (MCID) or Minimally Detectable Change (MDC), on the basis of which we used the proportion of participants with clinical performance improvement as a supplementary measure for the efficacy of the training. More specifically, MCIDs reported in –51 were ent}>=4) .t tests for numerical data with a normal distribution, and Mann-Whitney U tests for data with a skewed distribution. For categorical data, we used Pearson Chi-square tests or Fisher Exact tests. To assess the differences between pre- and post-assessments, Paired t-test was used for data with a normal distribution, and Wilcoxon Signed-Ranks tests were used for data with a skewed distribution.The normality of all demographic, clinical variables was tested by using the Kolmogorov-Smirnov method or Shapiro-Wilk method and histogram inspection. To assess the group differences on the baseline data, we used Independent Sample All outcomes measures were analyzed using both per-protocol analysis (PP) and intention-to-treat principle (ITT), and missing data were dealt with the last observation carried forward method. All outcomes aim to evaluate whether the results demonstrate feasibility of assistance with virtual rehabilitation when integrated into the usual care in a real-world pandemic setting. Statistical results were reported with the effect size in confidence interval of Participants were recruited from 10 centres across 8 districts of Hong Kong between September 2019 and August 2021. A total of 936 patients were screened, resulting in 129 from 10 centres. Eligible participants were randomly allocated to AR-Centre , balance (in BBS), and quality of life (in SF-12v2 PCS/MCS) are observed. The improvement is comprehensive when compared with those of the previous studies which focus on specific functions. This is also different from the conclusion made in  that theFirst of all, the training plans are tailored to the same extent of that of the usual care. The plans can thus dynamically address (and be adjusted to) the specific needs of the participants, and provide a comprehensive intervention by paying a balanced attention on the participants’ functions. Secondly, the integrated scheme draws a boundary between the training efforts on the teaching and practising. It makes the human trainers can focus more on the teaching and explaining of the trials. This part needs more perceptual intelligence that is still an open question for AR research. Meanwhile, the integrated scheme leaves the AR training mainly for the practising part, in which the key is the repetition of what being taught. The human trainers are thus released from this time-consuming part and their general availability to participants are maximized. The efficacy of the balanced efforts is evident in Table This leads to the reduction of contact rate as well. It makes the training possible even during the COVID-19 regulation from February 2020 to February 2021 in Hong Kong when the government imposed strict restriction on group gathering of more than 4 (sometimes 2) persons. The rehabilitation services of seven centres were suspended at that time because it was difficult to deliver the training with the conventional scheme . By contrast, 3 centres delivering our integrated program were still open for the services during that period. The AR-Home group was not affected because the training could be conducted at home by the participants with remote assistance of human trainers. Our records show that the average practice time of AR-Home group reached 2.64 hrs/week, which is 2.29 times longer than that of the less strict periods. Several participants reveal in our random interviews that their worries of missing the recovery period due to the regulation had drove them to conduct more self-training. The AR system installed at their homes made it happen.The feasibility of the integrated scheme also comes from its user acceptance. Despite the fact that the integrated scheme was one of a few possible solutions during the COVID-19, the results on the Table The BBS is a measure with inconsistent observations . This might be due to the human trainers’ concern of safety that it is dangerous for the participants to conduct the balance related training independently at home. Therefore, they intentionally reduced the amount of balance training for those in the AR-Home group, which may result in the less significant improvement. However, the statistical evidence in both PP and ITT do not support this hypothesis well, because there is no significant difference on BBS between the AR-Centre (with full training) and AR-Home (with reduced mobility training). The evidence is too weak to make the conclusion because the two groups are with different configurations of trainers. To answer this question, we need to conduct a specific experiment in the future by aligning the configurations.The SF-12v2 PCS is significant improved . However, the SF-12v2 MCS is with inconsistent observations . This is due to the fact that AR-Home users have less (face-to-face) communication with their PTs/OTs and friends than those of the AR-Centre, which is critical to how they feel about their quality of life (QOL) on mental well-being. In Fig. In this study, we include the comparison to MCID or MDC to investigate the clinical significance of the improvements. The method is indeed rarely used in AR rehabilitation for chronic stroke recovery .The reason might be that the chronic stroke recovery is a long-term, slow, and non-linear process –59 whichWhile encouraging results have been observed, there are several limitations. First of all, the attrition in this study is high. It is mainly due to the limited availability of on-site services at centres during the pandemic and the quarantine of participants. It reflects one of the nature of such studies when facing a force majeure like COVID-19 . One posFurthermore, we have seen that the human trainers reduced the balance training because of the safety concern. It reveals the limitation of AR rehabilitation for mobility-impaired individuals. In a more general sense, this is in fact an open question for most of the Tele-rehabilitation systems, but not sufficiently discussed because a majority of previous studies are conducted in a lab setting  became a mature technology.In addition, frequency of training of two groups are different from each other, although we have fixed the training to 20 sessions. This might contribute to the efficacy of training and needed to be further investigated in the future.We have conducted a feasibility study to investigate the efficacy of our rehabilitation programs which integrate the AR training into the participants’ usual care. The results showed that the integrated mode can significantly reduce the human (PTs/OTs/Assistants) trainers’ effort on the training as well as to reduce the contact rate during COVID-19 pandemics. The AR training system turns the time-consuming the monotonous practising part of the trials into an automated process which can be conducted by the participants independently. This also releases the human trainers so that they can focus more on the teaching and explaining part. We believe this is a practical rehabilitation mode with well-balanced human–machine coordination which is effective and efficient during the pandemics.


AR) gene which encodes a steroid receptor and is located on the Xq11-12 chromosome. The N-terminus of exon 1 of AR contains a polymorphic trinucleotide repeat (CAG)n region that encodes glutamine tract. There are some studies showing that shorter AR CAG repeats are significantly related to enhanced AR sensitivity.Polycystic ovary syndrome (PCOS) is a heterogeneous disorder, which affects about 15-20% of women of reproductive age. The most important etiopathogenesis factor in its incidence is hyperandrogenism; over 70 candidate genes are known to be associated with this syndrome, such as the androgen receptor n does not appear to be a major factor for PCOS in Iranian women. In contrast to some previous reports, the present data showed that the CAG length in PCOS cases did not significantly differ from that of controls. So, the  AR), gonadotropins, and sex hormones (9). The AR gene includes eight exons and seven introns and is located on the X chromosome (Xq11-q12 region). The first exon of AR is associated with a polymorphic CAG repeated region that encodes polyglutamine residues (10). Previously, it has been reported that CAG repeat expansions to more than 40 triplets in AR can be correlated with spinobulbar muscular atrophy (11). Similarly, some reports have shown that a shorter repeat of CAG tract elevates the sensitivity of AR, which subsequently leads to some hyperandrogenism-related disorders such as androgen-dependent prostate cancer, benign prostatic hyperplasia and juvenile rheumatoid arthritis (12). Correlations have also been found between CAG repeats in AR and infertility in males, increased risk of colon cancer and Alzheimer's disease in men (13). In the case of PCOS, despite some studies indicating an association between abnormal CAG repeats, some others have suggested that the relationship is not reasonable as it has been confirmed that even within the normal morphology, the range of CAG polymorphism is between 11 to 35 repeats .Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in young women. Polycystic refers to an excess of several hundred microcysts which are detected in an ultrasound on one or both of the ovaries (1). The syndrome commonly presents with hyperandrogenism and patients with PCOS suffer from irregular menstruation, unintentional weight gain and/or increased accumulation of fat around the abdominal area , androgenetic alopecia, excessive virilization and hirsutism (2). Moreover, the risk of developing cardiovascular diseases, infertility, diabetes mellitus type 2 and endometrial hyperplasia in PCOS patients is increased . The relationship between PCOS and breast cancer is also a controversial subject . Although the pathogenesis of the syndrome is largely unclear, there is evidence that both environmental and genetic factors influence the incidence of PCOS: studies on susceptible individuals have shown that healthy-weight women with PCOS present with higher insulin resistance (5). Furthermore, the chance of PCOS incidence in patients' sisters is about 50% (6). It has been shown that in the early stages of primate development, poor conditions such as prenatal androgenization, impaired nutrition, and an imbalanced steroidal environment can lead to the development of PCOS phenotype (7). By 2021, 70 candidate genes related to PCOS had been introduced; some of them are involved in biosynthesis and metabolism of steroids, cholesterol and lipids (8). Most of the PCOS-influencing genes are related to androgen biosynthesis and metabolism such as androgen receptor  and control (n = 80) groups. PCOS was diagnosed according to the Rotterdam criteria by presenting at least two of the following three clinical symptoms: oligomenorrhea or amenorrhea; clinical and/or laboratorial hyperandrogenism; and/or polycystic ovaries diagnosed by ultrasonography, as accepted by the National Institutes of Health (17). Women with other hyperandrogenism factors with similar phenotypes as PCOS such as Cushing's syndrome were excluded. Data on age, height, weight, menstrual characteristics, serum testosterone level, hirsutism and luteinizing hormone / follicle-stimulating hormone ratio were recorded for the two groups.AR. In the first round of PCR, 17 cycles using the 5'-GTGCGCGAAGTGATCCAGAA-3' and 5'-TCTGGGACGCAACCTCTCTC-3' sequences as forward and reverse primers were performed . The inside PCR was performed by the 5'-ACTCTCTTCACAG-CCGAAGAAGGC-3' and 5'ATCAGGTGCGGTGAAGTCGCTTTCC-3' primers. The final products were analyzed by electrophoresis on an agarose gel (2% agarose). For analysis of the exact nucleotide length, PCR products were confirmed using 5% denaturing polyacrylamide gels. Finally, to determine the exact CAG repeat number, the resulting fragments were sequenced after the second round of PCR.Vein blood samples (5 cc) were collected from each woman in both groups, were combined with EDTA as an anticoagulant agent and then stored at -20 C. The genomic DNA was extracted from each blood sample using a DNA purification kit . Using the previously reported primers (18), a nested polymerase chain reaction (PCR) was used to isolate the CAG repeat fragments in exon 1 of All women were willing to participate and signed a written consent form and the study proposal was approved by the Ethics Committee of Shahid Sadoughi University of Medical Sciences, Yazd, Iran (Code: 183154).Statistical analyses were performed using the Statistical Package for the Social Sciences software version 20.0 . The association between different alleles and the risk of PCOS was examined by the Chi-square test and odds ratios. The sample size was calculated based on the prevalence of CAG repeats in both groups with a confidence level of 95%, and accuracy of 5%, using the following formula:N = AR were considered as the independent variable and the other parameters, including serum testosterone level, hirsutism, luteinizing hormone / follicle-stimulating hormone ratio and irregular menstruation, were analyzed as dependent variables.The CAG repeats in Using two sets of primers in two separate reactions, the specificity of the PCR products was increased for the later sequencing process. PCR results were visualized on gel electrophoresis. The first round of PCR product was run on 2% agarose gel; as shown in figure 1, the product was placed between the 300 and 350 lanes of the ladder, representing the 324bp band and confirming the accuracy of the PCR process.At the second round of amplification, the PCR products of the first round were used for multiplication of a 230bp fragment which was confirmed on agarose and polyacrylamide gels. As shown in figure 2, the products were placed between the 200 and 250 bands of the ladder on 2% agarose gel, indicating the desired process of amplification. The CAG triplet length of the nested-PCR products was also analyzed on polyacrylamide gel electrophoresis containing 5% acrylamide. The resulting band around 230bp reconfirmed the PCR process .In order to determine the exact length of the CAG repeats, products of the second round of the nested-PCR process were sequenced; examples of the sequencing results are shown in figure 4.AR was 9-21 repeats and the smallest length of CAG repeats was 23-30 in both the control and PCOS groups. There was no significant difference in the length of CAG repeats between the control and PCOS groups (p = 0.52). The heterozygote and homozygote frequencies in both groups were evaluated by Chi-square test (Table I); the heterozygote population was larger than the homozygotes with no statistically significant difference between the number of heterozygotes and homozygotes. There were 13 and nine individuals with a homozygote natural allele (22 repeats) in the PCOS and control groups, respectively, and 14 and 15 women with heterozygote mutant alleles in the PCOS and control groups, respectively (Table I). There was no significant difference between heterozygotes and homozygotes (p = 0.61) in the PCOS and control groups, and also no significant difference between natural and mutant allele homozygotes (p = 0.44). The PCOS group had 22 CAG repeats and the control group had less than 22 CAG repeats , so there was no significant association between the CAG repeat frequency and incidence of PCOS.Based on the sequencing process, three alleles with different ranges of CAG repeat lengths were identified. As shown in table I, the largest CAG length of AR gene were associated with PCOS. To our knowledge, this is the first study comparing Iranian women with PCOS and healthy controls which evaluates the effect of CAG repeat polymorphisms on PCOS. Although the role of genetic factors in PCOS is strongly supported, there is no known direct genetic link to PCOS.In the present study we investigated whether the CAG repeat length polymorphisms in the AR and androgen function in these patients . There is some evidence showing that PCOS leads to conditions related to increased levels of androgens, such as oligo-anovulation, infertility, multifollicular ovary, hirsutism, inhibition of oocyte maturation, acne and androgenic alopecia .Some studies have shown a correlation between different polymorphisms of AR strongly affect the activity of the AR, for example, an increased number of CAG repeats leads to lower AR activity (21).Furthermore, increased androgen levels during fetal and childhood stages can cause abdominal obesity, amenorrhea and insulin resistance (20). It has been shown that increased androgen levels is a key factor in the pathology of PCOS (19). Several studies have indicated that special polymorphisms in exon 1 of AR is not a major determinant of PCOS (23). The number of heterozygotes in our study was larger than the homozygotes; however, this difference was not statistically significant. In this area, a study on Romanian populations showed that in homozygotes, the CAG repeat length in PCOS women was significantly shorter in comparison to healthy women (24). In the same way, a study on American women showed lower frequencies of CAG repeats in homozygotic PCOS women (15). It is of note that in some studies the results have been the opposite; in their study on Australian women, Hicky et al. reported a higher frequency of short (CAG)n alleles in PCOS patients in comparison with the controls (25). Some contradictory results were also obtained in evaluations of the direct correlation between increased androgen symptoms such as puberty and acne, and CAG repeat frequencies in PCOS patients. The data showed no correlation between the CAG frequencies and such clinical symptoms , which was in contrast to other studies that have presented a direct and meaningful relationship between lower CAG repeats and puberty and/or acne (27).Our results showed that there was no significant relationship between the frequency of CAG repeats in this exon and the incidence of PCOS. These results are in agreement with previous studies reported about Greek, Croatian and Finnish women , and other studies similarly reporting that AR is located on a highly conserved region of the X chromosome; therefore, given the variation in epigenetic factors including X inactivation (XCI), the phenotype of individuals cannot always be predicted from their genotype (27). In some situations XCI occurs non-randomly; it has been shown that this phenomenon can have a significant impact on the incidence of PCOS (15). Animal and human studies have shown that certain environmental conditions such as prenatal exposure to androgen excess can affect fetal programming and cause alterations in postnatal growth and metabolism, leading to a higher prevalence of PCOS (28). These findings indicate that fetal exposure to environmental stressors and abnormal conditions influence the DNA methylation pattern. It is hypothesized that factors affecting epigenetic changes such as DNA methylation and the XCI process have potential effects on AR and the incidence of PCOS (29). Varied results have been observed in the XCI pattern of PCOS: some studies have reported an association between CAG repeats and XCI in women with PCOS (23), while another study reported that there was no difference found in the XCI pattern of PCOS patients (15).When considering these paradoxical and varied results it should be noted that AR expression. Cell regulatory mechanisms and transcription factors affecting AR expression should be evaluated (10). In the functioning of AR, as a dynamic heterocomplex, a large number of co-activators and co-repressors have been identified as critical mediators for tissue-specific androgen effects (15).There are several possible reasons why the aforementioned studies have produced inconsistent and conflicting results. First, this may be due to the genetic variation of different nations. The normal range of CAG repeats in African-American and Asian people are longer than in European people (30). Second, the existing studies considered different sample sizes, ranging from 80 women in our study, to 300 women in the Shah et al. report (15). Third, results might vary across studies because of epigenetic and XCI effects on AR and PCOS in the Iranian population as a prognosis marker. The results of this study rejected the hypothesis that CAG repeat polymorphisms in AR can be a determinant of PCOS.In conclusion, we examined the association between CAG repeats of exon 1 of The authors declare that there is no conflict of interest.


Allergic rhinitis is a common chronic disease, and its high incidence has a great negative impact on the quality of life of many people, especially children. In this paper, through in-depth analysis of NOS2 gene polymorphism, the protective mechanism of NOS2 gene against AR was studied to provide theoretical and scientific basis for the diagnosis of children with AR. It was concluded that the concentration of Immunoglobulin E (IgE) in rs2297516 was 0.24 IU/mL compared with that in normal children. rs3794766 specific IgE concentration in the children group was increased by 0.36 IU/mL, which was higher than that in the healthy children group; the difference of rs7406657 specific IgE concentration between the children group and the healthy group was 0.03 IU/mL. The total serum IgE concentration in the healthy children group was lower than that in the infant group, and the change of Rs3794766 was the least, followed by rs2297516 and rs7406657. This means that rs7406657 is the highest, rs2297516 had general genetic correlation with AR patients, and rs3794766 had the least genetic correlation with AR patients. Among the three groups of SNP loci, the healthy children group was higher than the patient children group, indicating that AR reduces the gene frequency of the three loci, and the reduction of gene frequency will also increase the susceptibility of children to AR, because the frequency of gene occurrence will affect the gene sequence. In conclusion, smart medicine and gene SNPS can promote the detection and treatment of AR. Rhinitis is widely defined as inflammation of nasal mucosa, which is a common disease affecting about 40% of the population. AR is a common chronic rhinitis, accounting for 10%–20% of the world population. Severe AR may have more adverse effects on quality of life, sleep and work, because severe AR leads to respiratory obstruction in children. Intelligent medical treatment can improve the detection of influencing factors of AR, and detect AR related genes through intelligent devices, thus improving the detection accuracy. AR not only makes life difficult for adults, but also affects the quality of life of many children. Therefore, the study of AR has important clinical and social significance.AR can affect respiratory tract infection in children. Bousquet Jean put forward the first guide based on recommendation grading evaluation and development evaluation, integrating the application of supporting research in AR management. The purpose was to improve the accuracy of the diagnosis strategy and treatment plan in allergic rhinitis . Small PSNP is closely related to AR. Chen Min-Li studied the relationship between SNP and AR through meta-analysis of SNP and AR risk in interleukin-13 and differentiation 14 gene clusters . Falahi The treatment plan for AR can effectively relieve the symptoms of patients, which is usually safe and positive. However, it still cannot meet people’s expectations for the treatment of diseases, because the current treatment plan still cannot completely cure allergic rhinitis. Even after treatment, the quality of life of patients still suffers from some adverse effects. Intelligent medical treatment can improve the detection of influencing factors of AR, and detect AR related genes through intelligent devices, thus improving the detection accuracy. Therefore, in the aspect of AR treatment, it is necessary to discuss the treatment mechanism and pathogenesis in detail. By measuring the concentration of total IgE in patients’ serum, the degree of association between allergic factors and NOS2 gene polymorphism is analyzed.AR is a multifactorial disease caused by the interaction between gene and environment. Genetic research shows that AR is a complex genetic disease, in which environmental factors are mainly related to various allergens in the human environment . Many syThe treatment principle is to avoid contact with allergens, reasonably use antihistamines and glucocorticoids, and give special immunization to patients. In addition, IgE monoclonal antibody is very effective for severe AR, but it is expensive, because the preparation process of monoclonal antibody is complex. Active and effective AR treatment can prevent and reduce asthma attack. Although AR has not been completely cured, the standardization of combined treatment is helpful to optimize symptom control and significantly improve the quality of life of patients. The treatment of AR includes acute treatment, routine treatment and drug treatment, as shown in The current intelligent medical treatment can use ultrasound and radio frequency for AR treatment. In particular, ultrasound therapy is mainly used for focused ultrasound technology, rather than invasive technology. It allows the ultrasound generated outside the body to focus on specific human targets, and the focus area has high energy. The biological effect of ultrasound on nasal submucous tissue can reduce the sensitivity of nerves, blood vessels and clay glands. It can immediately change the structure and function of target tissues to reduce the hypersensitivity reaction of nasal mucosa, thus increasing the effective nasal respiratory area. By selectively destroying parasympathetic nerve fibers, AR can significantly improve nasal itching, sneezing, nasal mucus and other diseases, and improve the symptoms of patients . MoreoveAccording to AR diagnosis and treatment methods, 285 children with AR are selected from the otorhinolaryngology department of Hunan Children’s Hospital, P.R. China, from December 2020 to December 2021, including 167 boys and 118 girls, aged from 4 to 14 years. Then, 352 healthy children are searched again, including 157 boys and 195 girls, who are divided into two groups: the patient children group and the healthy children group. All children in the patient’s children group have many symptoms, such as nasal congestion, poor breathing, sneezing and nose itching. Allergen skin prick test (ASPT) is AR positive, and each patient has a history of allergy inheritance. All children in the healthy children group have no genetic history of allergy, and ASPT is AR negative. In addition, all children in this experiment have no other allergic diseases and allergic genetic history, and the accuracy of the experiment is improved by excluding other criteria.1) The ASPT experiment and grading are carried out according to the normal classification standard, and the ASPT grading of the patient group is ≥1.2) The patient’s serum IgE is detected using intelligent detection equipment system.3) All patients’ genomic DNA is extracted by elbow vein blood test and refrigerated with a unified anti coagulation test tube.4) There are three kinds of SNP site selection: rs2297516, rs3794766, rs7406657.5) The SNP classification uses an intelligent experimental platform for classification and detection. The chip with the sample is tested internally in the mass spectrometer, and the locus genotype of the gene sequence is detected with the support of intelligent equipment.2 Inspection. The degree of fit is used to test whether the gene distribution conforms to Hardy Weinberg equilibrium. x2 is used to test the correlation between allele frequency, haplotype, multilinear regression analysis SNP and total serum IgE, and modify according to age and sex to determine the main genetic model of A<0.05.Statistical analysis is carried out with data analysis software. The measurement data are expressed in the way of mean value. The gender difference between the two groups is compared with xFirst, the gender difference between the two groups of children in the genetic association analysis of NOS2 gene SNP and children’s AR is analyzed to determine whether the two groups of children met the test criteria. The specific differences are shown in 2of the patient children group is 0.251, and the x2of the healthy children group is 0.025. The difference between the two groups is 0.226. The A of the patient children group is 0.458, and the A of the healthy children group is 0.001. The difference between the two groups is 0.457. Through the analysis and comparison of x2and A, it can be known that the gender differences between the two groups meet the statistical standards. Then, the allele frequency difference of NOS2 between the two groups of children is analyzed, mainly using single locus analysis. The specific analysis is shown in According to the data described in According to the allele frequency difference of NOS2 between the two groups of children described in According to the data described in According to the comparative data in According to the comparative data in AR is a disease determined by genetic and environmental factors, which plays an important role in the occurrence of AR. Special immunotherapy is a method to treat allergic diseases and the only way to change the natural process of AR, which is to improve patients’ allergen resistance by changing the role of target cells. At present, AR is widely considered as a genetic and environmental disease caused by genetic and environmental factors. SNP is a common genetic factor that affects people’s susceptibility to disease. Studies have shown that the sensitivity of antiretroviral drugs and the effectiveness of drug therapy are related to multiple gene SNPs. The DNA differences of different races, groups and individuals found in the research of human genome observation system and their importance fundamentally change the diagnosis, treatment and prevention of diseases. NOS2 gene is located on chromosome 17, 37 KB long, with 26 exons. The second external element has the starting point of the converter, and the 26th external element has the final code. It runs a subspace area with many built-in factors required to activate the initializer. NOS2 genotype has multiple overlapping open reading frames, and the activation of subspace may affect the expression of INOS. The study found that the rs2297516 data of the healthy children group is 69% higher than that of the patient children group under the single point detection. The rs3794766 data of the healthy children group is 3% higher than that of the patient children group. The rs7406657 data of the healthy children group is 33% higher than that of the patient children group. The total serum IgE concentration of these three gene sequences is lower in the healthy children group than in the patient children group, and the change of rs3794766 is the smallest, followed by rs2297516, and finally rs7406657. This shows that rs7,406,657 has the highest genetic correlation with AR patients. The rs2,297,516 has the general genetic correlation with AR patients, and rs3,794,766 has the lowest genetic correlation with AR patients.In the research of human genome SNP observation system, the DNA differences have found in different races, groups and individuals and their important properties fundamentally have changed the diagnosis, treatment and prevention of AR diseases. The SNP of NOS2 gene may be related to children’s AR. The SNP genotype distribution of NOS2 gene analyzed in the experiment is very similar to the genetic sequence of allergic rhinitis. Intelligent medical treatment has improved the detection of influencing factors of AR, and AR related genes was detected through intelligent devices, thus improving the detection accuracy. In addition, NOS2 gene SNP has a certain correlation with the total serum IgE concentration. The potential role of NOS2 gene SNP in the formation and development of AR has required a large number of samples, multi regions and multi countries to conduct in-depth research, which has laid a theoretical foundation for developing new AR control direction. However, given the limited number of samples collected in this study, it is necessary to increase the number of samples to confirm the reliability of the results. The severity of these problems requires more sampling and comprehensive analysis in future research, and comprehensive analysis of gene diversity of different chromosomes should also be considered.


The activation of the androgen receptor (AR) pathway is crucial in the progression of human prostate cancer. Results of the present study indicated that the target protein xenopus kinesin-like protein (TPX2) enhanced the transcription activation of AR and promoted the proliferation of LNCaP (ligand-dependent prostate carcinoma) cells. The protein-protein interaction between AR and TPX2 was investigated using coimmunoprecipitation assays. Results of the present study further demonstrated that TPX2 enhanced the transcription factor activation of AR and enhanced the expression levels of the downstream gene prostate-specific antigen (PSA). TPX2 did this by promoting the accumulation of AR in the nucleus and also promoting the recruitment of AR to the androgen response element, located in the promoter region of the PSA gene. Overexpression of TPX2 enhanced both the in vitro and in vivo proliferation of LNCaP cells. By revealing a novel role of TPX2 in the AR signaling pathway, the present study indicated that TPX2 may be an activator of AR and thus exhibits potential as a novel target for prostate carcinoma treatment. Androgen receptor (AR), a member of the nucleus receptor protein family , plays a critical role in the transformation and proliferation of prostate carcinoma cells . Similarnd Hospital [nd hospital. The androgen (an agonist of AR), dihydrotestosterone , was purchased from the Selleck Corporation [A total of 30 paired clinical specimens (paired prostate carcinoma and nontumor tissues) were obtained by our lab from May 2017 to November 2018 via daily surgical resection. Written informed consent was obtained from all patients. The collection and use of these clinical specimens were approved by the Ethics Committee of Daping Hospital, Army Medical University, and all experiments were carried out following the Helsinki Declaration. LNCaP cells (a common human endocrine-dependent prostate carcinoma cell line) were gifted by Dr Fan Feng from Beijing 302Hospital . The plaporation . DHT wasporation , 14.LNCaP cells were transfected with empty vectors, TPX2 or siRNA targeting TPX2, cotransfected with the aforementioned luciferase reporters (PSA-Luc or ARE-Luc), and the cells were harvested for 24 h following transfection, for the subsequent luciferase assays. Luciferase experiments were performed using a kit purchased from the Promega Corporation, following the instructions provided by the manufacturer and the protocols provided by Cui et al. and Gao et al.  Moreover2. For the colony formation experiments, LNCaP cells were transfected with plasmids and harvested and seeded into the 6-well plates (Corning) at ~2,000 cells per well. After seeding the cells into the 6-well plates, cells were cultured in DMEM with 10% FBS. Cells in the plates were cultured for 3-4 weeks, and the colony formation assays were carried out following the methods described by Feng et al. [LNCaP cells were cultured in DMEM containing 10% FBS  at 37°C in 5% COg et al. LNCaP cells transfected with plasmids  or treated with the aforementioned agents were harvested for Western blot analysis . The comβ-actin was used as the control for the cytoplasm subfraction. western blotting images were quantitatively analyzed using the ImageJ software  [LNCaP cells were transfected with plasmids and treated with the solvent control or 10 nmol/L DHT for 30 min and harvested for the cellular subfractionation experiments following the methods described in the previous publication . The acc Health) .ChIP analysis was performed following a protocol provided by the ChIP kit  or Yang et al.  Briefly,LNCaP cells were transfected with plasmids and seeded into the subcutaneous position of male nude mice  to form tumor models . Tumor tP < 0.05 was considered to indicate a statistically significant difference.Statistical analyses were performed using the Bonferroni correction with two-way ANOVA, using the SPSS statistical software . The effects of TPX2 on the transcription factor activation of AR were examined. As displayed in Subsequently, the protein-interaction between AR and TPX2 in LNCaP cells was examined. As displayed in To further examine the effects of TPX2, both subcellular subfractionation and ChIP assays were performed in the present study. As demonstrated in P < 0.0001; Y = 10510∗X + 0.2356) and nontumor tissues  of AR. To further verify the effects of TPX2, the expression levels of endogenous PSA or TPX2 were examined in clinical specimens. As displayed in Figures The proliferation of LNCaP cells was examined using both in vitro and in vivo experiments. As shown in Prostate carcinoma is one of the most malignant types of cancer and poses a great threat to male health . As an eIt has previously been verified that the TPX2 gene, located at chromosome 20q11.2, is aberrantly expressed in several types of cancer, including prostate carcinoma . ResultsNumerous coregulators of AR have previously been identified, not only in regulating the activation of the AR pathway but also in regulating the proliferation of prostate carcinoma cells. These cofactors often function by directly modulating the transcription factor activation of AR, for example: (i) Modulating the interaction between AR and RNA polymerase II; (ii) modulating the interaction between AR and DNA; and (iii) modulating the widespread unfolding of chromosomes –35. The Moreover, as displayed in In conclusion, the present study revealed the interaction between TPX2 and AR in regulating the proliferation of prostate cancer cells. The results of the present study not only expand the current knowledge of TPX2 but also provide a novel theoretical basis for the development of prostate cancer treatments.