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Received β€” 13 April 2026 ⏭ Journal of Medical Internet Research

Large Language Model–Based Analysis of Statin Therapy Discussions and Sentiment on Social Media: Cross-Sectional Observational Study

Background: Statin therapy, despite proven cardiovascular benefits, remains underused. Social media platforms may capture patient perspectives that are less visible in clinical encounters. Objective: This study aimed to characterize themes, sentiment, and decision-making factors related to statin therapy through large language model (LLM)–based analysis of Reddit discussions. Methods: This cross-sectional observational study analyzed English-language Reddit posts and comments mentioning statins from January 2022 to May 2025, identified via keyword-based Reddit application programming interface searches (≀1000 posts per keyword). A total of 5328 retrieved discussions (n=1661, 31.2% posts and n=3667, 68.8% keyword-containing comments) from public subreddits were included. Themes, sentiments (positive, neutral, or negative), guideline-informed clinical relevance, information-seeking behavior, adverse effect mentions, decision factors, and adherence-related content were extracted using an LLM-based pipeline. Results: Among 5328 discussions, prominent topics included adverse effects (n=1697, 31.9%), decision-making references related to laboratory results and physician advice (n=2767, 51.9% and n=2034, 38.2%, respectively), and alternative approaches (n=2485, 46.6%). Overall sentiment was neutral in 34% (n=1812) of discussions, negative in 30.9% (n=1646), and positive in 16.9% (n=900); the remainder were mixed or unclear. Statin-directed sentiment was neutral in 44.1% (n=2350) of discussions, negative in 25.2% (n=1343), and positive in 12.5% (n=666); the remainder did not express statin-directed sentiment. High clinical relevance was identified in 12.6% (n=672) of discussions. Adherence-related issues were mentioned in 29.8% (n=1587) of discussions. Among adverse effect mentions, muscle pain (n=129, 7.6%) and fatigue (n=110, 6.5%) were common. Conclusions: LLM-enabled analysis of Reddit discourse highlights substantial negative sentiment, adherence-related concerns, and adverse effect narratives surrounding statin therapy. These findings suggest opportunities for patient-centered communication and shared decision-making strategies that address symptom attribution, uncertainty, and information needs in digital information environments.
Received β€” 26 March 2026 ⏭ Journal of Medical Internet Research

Robot-Assisted Therapy for Upper Limb Rehabilitation After Stroke: Umbrella Review

Background: Stroke is a leading cause of long-term upper limb disability, severely impacting patients’ independence and quality of life. Robot-assisted therapy (RAT) has emerged as a promising, high-intensity rehabilitation alternative. However, conclusions from existing systematic reviews on its efficacy are inconsistent and often lack a holistic framework, limiting their use for guiding personalized clinical decisions. Objective: This study aims to systematically synthesize recent evidence on RAT for upper limb rehabilitation after stroke. Guided by the International Classification of Functioning, Disability and Health framework, it moves beyond singular outcomes to provide a multidimensional evaluation across body function, activity, and participation levels. The review aims to provide stratified guidance for clinical decision-making based on patient- and intervention-specific characteristics, thereby supporting evidence-based practice and informing future research. Methods: This study included systematic reviews and meta-analyses published from January 1, 2019, to December 26, 2025, comparing RAT with conventional therapy for upper limb rehabilitation after stroke. Overall, 6 databases, including PubMed, Web of Science, and Embase, were searched. Two reviewers (XZ and LZ) independently performed study selection, data extraction, and quality assessment using the AMSTAR 2 tool. The synthesis integrated outcome measures and subgroup analyses derived from the included studies. Results: This umbrella review included 21 meta-analyses encompassing 535 randomized controlled trials and 27,598 patients across acute, subacute, and chronic stroke stages. According to AMSTAR 2, 17 reviews were high quality, 3 moderate, and 1 critically low. The synthesis demonstrated that RAT was superior in improving upper limb motor function, but no statistically significant advantages were observed in activities of daily living compared to conventional therapy. Subgroup analyses revealed that treatment effects were influenced by stroke stage, upper limb motor impairment level, and robot type. Conclusions: RAT is an effective intervention for improving upper limb motor function after stroke. However, its benefits are primarily observed at the level of body function, with limited evidence for long-term maintenance. The current evidence is constrained by significant outcome heterogeneity and methodological limitations inherent to umbrella reviews. Future research should validate these findings in broader clinical practice, focus on translating functional gains into sustained improvements in daily activities and participation, and include cost-effectiveness evaluations. Trial Registration: PROSPERO CRD42024497183; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024497183
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