Physical Therapy最新文献

Importance: Physical therapy is moving toward digitally supported, independent, home-based care to improve therapy accessibility and adherence.

Objective: This trial evaluated the clinical feasibility and potential effectiveness of Strolll, an augmented reality (AR) neurorehabilitation platform offering gamified gait-and-balance exercises with optional assistive AR cueing for individuals with Parkinson disease, implemented in real-world clinical practice.

Design and setting: In this pragmatic clinical trial, 15 Dutch health care practices were onboarded, 28 therapists trained, and 100 individuals with Parkinson disease (Hoehn & Yahr stages 1-3) included. All participants followed the T0-usual-care-control-T1-Strolll-intervention-T2 procedure.

Intervention: The Strolll intervention consisted of 2-week supervised in-clinic training followed by 6 weeks, 5 sessions per week of 30 active minutes each, independent home-based training.

Results: No serious adverse events occurred; only 2 non-injurious falls were reported in >60.000 exercise minutes. Adherence was high (96% session adherence, 91% active minutes/session adherence). Therapists prescribed the program progressively, with significantly higher game-play levels over time. Participants' exercise performance increased over time. Participants and therapists rated user experience and technology acceptance positively. Timed-Up-and-Go and 10-Meter Walk Test (fast speed) scores improved significantly after the intervention period only. Five Times Sit-to-Stand Test, 10-Meter Walk Test (comfortable speed), and Mini Balance Evaluation Systems Test scores improved after both usual-care and intervention periods. Falls Efficacy Scale International scores showed no significant improvements. AR cueing was deemed beneficial for a subset of participants.

Conclusions: Strolll is a safe, adherable, progressive, usable, and well-accepted therapist-managed, home-based intervention for people with Parkinson disease, with the potential to improve gait, balance, and fall-risk indicators. Findings on the integration of AR cueing highlight the importance of an individualized approach.

Relevance: Implementing AR rehabilitation technologies like Strolll in the clinical pathway is feasible, offering a safe and scalable way for individuals to train independently, potentially improving accessibility of care and broadening its use to physical activity promotion.

Importance: Psychological factors are associated with chronic spinal pain, yet their mediating role in postrehabilitation recovery remains poorly understood, particularly in fully remote digital care. Most research has focused on baseline predictors, with few studies evaluating psychological mediators and moderators.

Objective: The objective of this study was to investigate whether changes in fear avoidance beliefs, depression, and anxiety mediate pain outcome following a digital care program (DCP) for chronic spinal conditions and whether these effects vary by body mass index, self-reported gender, and socioeconomic status.

Design: This was an ad hoc analysis of a real-world registry of patients undergoing a DCP.

Setting: The setting was a fully remote DCP delivered across the United States.

Participants: The participants were adults who had chronic spinal musculoskeletal pain (N = 14,818) and who accessed the DCP via employer-sponsored health plans.

Intervention: The DCP consisted of exercise, education, and behavior change, managed asynchronously by physical therapists.

Main outcomes and measures: The final pain score (11-point numeric pain rating scale) was the primary outcome. Candidate mediators were changes in fear avoidance beliefs, depression, and anxiety. Confounding was mitigated through demographic and clinical covariates. Moderation was tested for body mass index, self-reported gender, and socioeconomic deprivation. Structural equation modeling was used.

Results: Improvements in fear avoidance beliefs (β = -0.10, SE = 0.00), depression (β = -0.05, SE = 0.01), and anxiety (β = -0.04, SE = 0.01) significantly mediated lower final pain scores after adjustment for confounding. The mediating effect of fear avoidance was especially pronounced among patients with severe obesity. Self-reported gender and socioeconomic status did not show moderating effects. The model's explained variance was 30%.

Conclusions: Changes in fear avoidance beliefs, depression, and anxiety play a central role in pain recovery following digital rehabilitation. Fear avoidance mediation was particularly strong in individuals with severe obesity, highlighting the need for targeted psychological support in this subgroup.

Relevance: The findings emphasize the pertinence of systematically screening, monitoring, and addressing psychological factors in remote care, contributing to understanding how digital rehabilitation promotes recovery.

Importance: Empathic communication is recommended in chronic pain management, yet few studies have examined the role of provider communication on treatment outcomes in pain rehabilitation.

Objective: The objective is to quantify associations between the frequency of empathic communication by physical therapists and patient-reported pain outcomes during routine clinical care for patients with chronic musculoskeletal pain.

Participants and design: Thirty-one physical therapist-patient dyads participated in a prospective cohort study in an outpatient physical therapy clinic. Evaluation and treatment sessions were audio-recorded over 6 weeks of routine physical therapy management of chronic musculoskeletal pain.

Main outcomes and measures: Empathic communication was quantified as a ratio of the frequency of empathic responses by physical therapists normalized to the frequency of empathic opportunities expressed by patients. Mixed-effects models assessed associations between physical therapist empathic communication and patient-reported pain intensity and interference over time.

Results: Across 99 recorded visits, physical therapists (n = 8) responded empathically 67% of the time. Empathic response rates for individual providers ranged from 27% to 84%. On average, more frequent empathic communication was associated with lower pain intensity (B = -1.29 [95% CI = -2.23 to -0.36) and pain interference (B = -1.07 [95% CI = -2.11 to -0.03]). More frequent empathic communication was also associated with a greater reduction in pain intensity over time (B = -0.78 [95% CI = -1.45 to -0.12]).

Conclusions and relevance: More frequent empathic communication is associated with lower patient-reported pain intensity and interference, along with larger and more rapid decreases in pain intensity over time. Future studies should investigate the efficacy of empathic communication skills training to improve outcomes of chronic pain management.

Importance: Screening older adults for mobility disability and preclinical mobility limitation (PCML) does not routinely occur.

Objective: This study aimed to: (1) determine the feasibility of implementing a preventive physical therapy mobility checkup in primary care and (2) determine if 1 mobility checkup shifts the self-efficacy of older adults for meeting activity recommendations.

Design/setting: A cross-sectional study with a convenience sample was conducted at 1 primary care clinic.

Participants: Participants (N = 80) were, on average, 73.4 years (range 65-92) and 61.3% female.

Interventions: A 15-minute mobility checkup consisted of (1) self-reported activity and mobility, (2) testing with the Short Physical Performance Battery, including gait speed and the 5 Times Sit to Stand Test; (3) education about results; and (4) recommendations.

Main outcomes & measures: Twelve feasibility criteria were established a priori and evaluated after study completion. The feasibility criteria evaluated acceptability, adoption, appropriateness, and feasibility of the mobility checkup. Shifts in the retrospective pre-post Self-Efficacy for Exercise (SEE) surveys were evaluated descriptively.

Results: Ten of 12 feasibility criteria were met. The total mean retrospective-pre SEE survey score was 6.39 (SD = 2.54) and the total mean post-SEE survey score was 7.61 (SD = 1.97). There were 62 positive shifts, 3 negative, and 14 unchanged with the retrospective pre-post SEE survey.

Conclusions: A mobility checkup in primary care is feasible and may increase the self-efficacy of older adults for meeting activity guidelines.

Relevance: Routine physical therapy mobility checkups in primary care offer a promising strategy to optimize health outcomes for older adults.

Importance: Implementing evidence-based dosing of rehabilitation in skilled nursing facilities (SNFs) is essential to improve functional outcomes in a medically-complex population.

Objective: The objective was to evaluate an implementation program promoting high-intensity resistance rehabilitation (HIR) in SNFs by (1) measuring proximal (clinician knowledge, self-efficacy, and HIR perspective) and distal (HIR adoption and implementation) outcomes; (2) exploring how the program influenced distal outcomes (program processes); and (3) investigating clinician factors influencing HIR implementation.

Design: The design was a prospective convergent mixed-methods, theory-driven program evaluation.

Setting: This study was conducted across 8 rural Department of Veterans Affairs SNFs.

Participants: Rehabilitation clinicians (n = 38) and leaders (n = 16) were included.

Interventions or exposures: All sites received a multicomponent implementation program promoting HIR.

Main outcomes and measures: Validated questionnaires assessed HIR perspective (Perceived Characteristics of Intervention Scale) and adoption (Commitment to Change Scale). Study-specific questionnaires measured clinician HIR knowledge, self-efficacy, and implementation. Interviews and focus groups explored program processes and clinician factors.

Results: The program improved clinician HIR knowledge, self-efficacy, and perspective, leading to acceptable adoption rates. Implementation was marginally affected. Only clinician perspective correlated with adoption (ρ = 0.47). Qualitatively, the program supported distal outcomes by keeping HIR at the forefront of clinicians' mind, fostering positive outcome expectations, and enhancing team cohesion and accountability. Clinician creativity, adaptability, resilience, professional discipline, and previous experience influenced implementation.

Conclusion: The program influenced HIR adoption primarily by enhancing clinicians' positive perspectives of HIR. Future efforts could strengthen implementation by fostering team cohesion, accountability, and clinician creativity while also assessing environmental factors.

Relevance: Effective HIR implementation can optimize patient outcomes. Strategies that enhance clinician perspective and creativity, keep HIR at the forefront, and foster team cohesion and accountability may improve adoption. Additionally, assessing and addressing environmental factors may further support sustainable integration of HIR into clinical practice.