Ethics and Study Limitations

The protocol identifies multicentre randomisation, a practical early recovery window, and a simple low-cost intervention as main strengths. Multicentre prospective validation will be required before broad clinical implementation. Single-centre retrospective validation provides only preliminary evidence and limits external validity. The trial cannot estimate dose-response effects because it includes only 12 intervention sessions. Selection bias is possible because participants may be older adults already motivated to join this type of research. Generalisability outside Japan is uncertain because the trial involves only Japanese older adults. The study's main strength is using pooled effect estimates with confidence intervals as an evidence-based framework for CRT response prediction. The main limitation is the absence of a traditional lecture-based control group. The inability to blind participants and care providers is a main limitation because it may introduce response bias. The study's confinement to tertiary hospitals in Dhaka limits generalisability to rural or lower-level facilities and similar LMIC settings. Conducting the study in China may limit generalisability to other r…