Perovskite-COF hybrid enables sequence-programmed, anti-correlated ECL/SERS readout of NF-κB p50.

Physical medicine and rehabilitation (PM&R) needs mechanism-anchored biomarkers that change early enough to guide exercise dosing and physiotherapy. Here we position NF-κB p50 as a PM&R biomarker-read out not by bulk abundance but by DNA-binding activity that reflects the inflammation-to-repair transition. We develop a dual-mode ratiometric sensor in which the same p50-κB recognition event yields opposite signals-electrochemiluminescence (ECL) increase and SERS decrease-combined as R=IECL/ISERS to self-normalize interface and matrix variability. The platform shows ultrasensitive detection (attomolar-level), wide working range, high specificity versus related nuclear proteins, and strong robustness across batches and complex matrices (cell lysate, spiked plasma) with ≤100 μL sample. By providing a pathway-activity readout, p50 complements routine clinical markers (e.g., CRP, IL-6, NT-proBNP) and links molecular response to functional recovery. We outline PM&R use cases-musculoskeletal repair, osteoarthritis rehabilitation, and neurorehabilitation-where serial R trajectories can inform progression/overload decisions and personalize therapy. This work frames p50 detection as a practical, translational biomarker for PM&R/physiotherapy, and offers a robust sensing architecture readily extendable to other rehabilitation-relevant transcriptional pathways.