BackgroundAcquired brain injury (ABI), which includes traumatic brain injury (TBI) and stroke, is a leading cause of disability. Evidence shows that sex may influence functional recovery post-acquired brain injury, potentially due to biological (e.g., hormones) and social factors (e.g., caregiver availability). Meanwhile, new neurorehabilitation technologies—such as virtual reality, robotic-assistance, and brain-computer interfaces—offer promising avenues for improving functional outcomes. Understanding how these technologies interact with sex differences could advance equitable and personalized healthcare.Research questionDoes evidence support a rationale for studying, developing, or employing neurorehabilitation technologies differently in males and females to improve functional outcomes post-ABI?MethodologyAn empirical integrative narrative review was conducted. Searches were performed in PubMed, Cochrane Library, and OVID, focusing on adult populations with ABI. Key terms encompassed “acquired brain injury,” “sex differences,” and “neurorehabilitation technologies.” Fifty-nine studies met inclusion criteria, spanning diverse methodologies, settings, and cultural contexts. Data were synthesized to compare functional outcomes impacted by sex and by neurorehabilitation technologies.ResultsFindings indicate that the effect of sex on neurorehabilitation outcomes is multifaceted. Studies using functional independence measures often reported no significant sex differences, whereas more specific measures (e.g., those measuring cognitive or social functions) identified notable sex effects. Neurorehabilitation technologies showed positive outcomes in various functional domains (e.g., upper extremity motor function, gait, cognition), but most studies focused on stroke.DiscussionCurrent research does not support the use of sex-differentiated technology interventions to target upper extremity motor function or global functional independence post-stroke. Sex-differentiated treatment may be relevant for other functional domains such as cognitive recovery, psychological well-being and social outcomes, but this requires further research, particularly for non-stroke ABI.ConclusionThese findings suggest that some neurorehabilitation technologies can be applied without sex-specific modification, whereas others may benefit from sex-specific considerations. Owing to methodological limitations and sparse data, especially for TBI, additional investigations are warranted. As novel neurorehabilitation technologies evolve, accounting for sex differences may enhance personalized care and optimize long-term outcomes.
Epistemic and ethical limits of large language models in evidence-based medicine: from knowledge to judgment
BackgroundThe rapid evolution of general large language models (LLMs) provides a promising framework for integrating artificial intelligence into medical practice. While these models are capable