Physical Therapy最新文献

Importance: Low adherence rates to low back pain (LBP) clinical practice guidelines (CPGs) by physical therapists have been reported in the United States; however, no studies have explored barriers to their use.

Objective: The aim of this study was to explore perceived barriers physical therapists face for implementing the most recent LBP CPG from APTA Orthopedics academy.

Design: This was a convergent parallel mixed-methods design.

Setting: This was completed virtually.

Participants: A total of 173 United States outpatient physical therapists completed the survey, with 20 participating in focused interviews.

Intervention(s) or exposure(s): Participants completed an online survey and semi-structured virtual interviews.

Main outcome(s) and measure(s): The primary outcomes were the top barriers identified through survey data and thematic analysis of interviews. A thematic analysis was implemented for the qualitative analysis. A binary logistic regression was used to model relationships between demographic variables, barriers, and CPG use.

Results: Six themes related to barriers to CPG implementation were identified through interviews, including a lack of individualized care, a lack of skills/confidence, patient expectations/perceptions, previous experience, time limitations, and proper understanding of the guidelines. Participants who completed an orthopedic residency program were more likely to report the barrier of "difficulties with 1-on-1 care" (OR = 8.70, 95% CI = 2.12-39.22). Individuals practicing between 1 and 5 years (OR = 7.49, 95% CI = 1.39-52.75) compared to 20+ years, and those reporting regular use of the CPG (OR = 5.81, 95% CI = 1.99-21.51) were more likely to report the barrier of "concern for patient's response."

Conclusion: Novice clinicians and those who completed orthopedic residency reported specific barriers to CPG use. Six major themes related to barriers for implementing the CPG were identified, consistent with majority of the barriers reported in the survey, demonstrating the convergence of analyses. The most common barrier was the perception of sacrificing individualized care.

Impact: This study may help improve adoption and implementation of CPGs in real-world clinical practice settings.

Importance: This study systematically examines the effects of tendinopathy on patients' quality of life and investigates their experiences with rehabilitation.

Objective: This study aimed to synthesize qualitative research exploring the beliefs, perceptions, and experiences of individuals living with tendinopathy by employing a systematic review with meta-ethnography.

Data sources: Studies were identified from 4 databases (CINAHL, EMBASE, Scopus, and ProQuest One Academic).

Study selection: Studies were included if they utilized qualitative methods to investigate beliefs, perceptions, and/or experiences of participants with clinically diagnosed tendinopathy.

Data extraction and synthesis: Data synthesis was completed using the 7 phases of meta-ethnography and reported using the meta-ethnography reporting guidelines. Risk of bias was assessed using the Joanna Briggs Checklist for Qualitative Studies. Confidence in the findings was assessed using the Grading of Recommendations Assessment, Development, and Evaluation Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual).

Main outcomes(s) and measure(s): Twenty-three studies were included (rotator cuff [n = 12]; Achilles [n = 6]; gluteal [n = 2]; lateral elbow [n = 2]; and mixed tendinopathies [n = 1]). Methodological quality of included studies varied. Moderate confidence in review findings 1 and 2 and high confidence in review finding 3.

Results: Qualitative synthesis identified 3 themes: (1) I need to understand why my tendon hurts (participants wanted clarity regarding the cause of symptoms); (2) I want to fix my tendon, but I don't know how (participants had varied beliefs regarding optimal management and how to reduce their pain); and (3) I am uncertain whether my lifestyle will return to normal (participants felt frustrated with the negative impact that tendinopathy had on their life).

Conclusion and relevance: This review provides insights into the lived experiences of individuals with tendinopathy. The review advocates for clearer communication and education regarding causes and optimal management of tendinopathy. Participants' varied beliefs and uncertainties about treatment efficacy suggest that health care providers consider individualized evidence-based guidance to improve patient outcomes.

Importance: Task-specific balance deficits are common in people with neurological disorders (PwND), significantly affecting their activities of daily living (ADLs). However, the relationship between balance deficits and ADLs measured by patient-reported outcomes is poorly understood, thus limiting the selection of specific static and dynamic tasks to be used to train for a given activity.

Objective: The aim of the study was to provide a clinical framework linking ADLs, balance tasks, and balance resources to support clinicians' decision-making when planning task-oriented balance rehabilitation for PwND.

Design: This was an observational study with a cross-sectional design.

Setting: This study examined clinical contexts involving PwND.

Participants: This study involved people with Parkinson disease, stroke, or multiple sclerosis (MS).

Exposure: The study used the Activities-Specific Balance Confidence (ABC) Scale for patient-reported outcomes to assess perceived balance during ADLs, and the Berg Balance Scale (BBS) and Dynamic Gait Index (DGI) to evaluate static and dynamic balance.

Main outcomes and measures: Kendall tau correlations (τ) were used to identify meaningful associations between ABC and BBS-DGI items, matching ADLs with specific balance tasks.

Results: The study sample comprised 299 people with Parkinson disease (n = 94), stroke (n = 94), and MS (n = 111) with a median (interquartile range) age of 63 (52.0-71.5) years, all exhibiting moderate to severe balance impairments. Moderate correlations (τ ≥ 0.39) were found between dynamic and semi-dynamic challenging outdoor ADLs with static and dynamic tasks involving sensory orientation and the use of vestibular and proprioceptive systems. Moreover, stability limits-verticality, anticipatory postural adjustments, and stability in gait are the primary balance resources to consider when designing ad hoc rehabilitation interventions.

Conclusions: This study establishes associations between specific ADLs and balance tasks, offering a clinical framework to identify relevant balance resources for rehabilitation. It provides clinicians with a structured approach for planning task-oriented, needs-based balance rehabilitation for PwND, focusing on the training of specific balance resources to enhance ADLs.

Relevance: This study provides a clinical framework to help clinicians in planning task-oriented and needs-based balance rehabilitation for PwND, suggesting which balance resources should be trained to improve specific ADLs.

The lowest degree of disability acceptance has been found among people with a history of stroke. Disability acceptance involves adapting to disability-related changes and coming to terms with losses to redefine and live a meaningful new life. Across many movement-related disabilities and chronic conditions, disability acceptance has been positively associated with psychological well-being, social and physical functioning, and adjustment. Further, self-acceptance of disability is an important factor in rehabilitation and recovery. There is a growing need for physical therapy to engage with disability acceptance and understand the role of physical therapists and physical therapist assistants in facilitating disability acceptance after stroke. The purpose of this Perspective article is to critically evaluate the role of the physical therapy profession in disability acceptance for people with stroke. The article first reflects on ways in which the physical therapy profession has historically (and unintentionally) created obstructions to disability acceptance after stroke. The authors discuss assumptions implicitly underpinning physical therapist practices for stroke that are consistent with normalization tendencies, medicalized approaches to disability, and the mechanical body. The authors then present new and alternative approaches that can be applied in physical therapy to better facilitate disability acceptance after stroke, focusing on mindfulness-based interventions and a celebration of unique movement strategies of people with disability (ie, movement "improvisation"). The Perspective concludes with practical strategies for clinicians to employ in an effort to better foster disability acceptance poststroke. Impact The physical therapy profession may play an important and unique role in facilitating disability acceptance poststroke. supporting disability acceptance after stroke requires physical therapists and physical therapist assistants to critically reflect on ways in which the profession may unintentionally impede acceptance and consider new and alternative approaches to promote acceptance in clinical practice.

Objective: Long-lasting dizziness is a distressing and disabling condition frequently accompanied by psychological and physical discomfort, and if untreated, could evolve into a complex, self-perpetuating condition challenging treatment. A treatment approach addressing psychological, physical, and social ailments in connection with long-term dizziness has been developed. The objective of this study was to explore experiences and perceptions of participants with long-lasting dizziness who have engaged in a group-based intervention approach that combines principles from vestibular rehabilitation (VR), body awareness therapy (BA), and cognitive behavioral therapy (CBT) in primary care.

Methods: The study is rooted in an interpretative approach. Fifteen participants, 10 women and 5 men, aged 38 to 71 years, were interviewed in 3 focus groups. Data were analyzed by systematic text condensation, a 4-step thematic cross-case strategy suitable for exploratory investigations.

Results: Four main themes emerged from the analyses: (1) to share and feel understood when struggling with dizziness; (2) the exercises: body perceptions and challenging one's own limits to control dizziness; (3) increased self-knowledge helps to process anxiety and challenge avoidance behavior; (4) changing habits is hard work, but necessary to recover from dizziness.

Conclusions: This novel group-based VR-BA-CBT treatment for individuals with long-lasting dizziness offered valuable peer support, shared learning, and learning in action providing new understanding. The VR-BA-CBT treatment includes a comprehensive and holistic approach addressing physical, psychological, and social challenges.

Impact: Through knowledge about dizziness triggers, participants learn new strategies to confront previously avoided activities. The approach holds promise to be implemented in primary care physical therapy settings.

Importance: Adults with late-onset Pompe disease (LOPD) experience lower limb weakness, balance disorders, and recurrent falls. Mechanisms underlying postural control (stability, orientation) and falls in LOPD remain poorly understood. Investigating these aspects is critical to guide care and rehabilitation.

Objective: This study compared postural control in participants with LOPD to controls, examining postural and muscular factors linked to falls and muscular contributions to postural alterations.

Design: This study was a cross-sectional, case-control study. Postural stability and orientation during stationary standing were evaluated using force platforms and 3D motion analysis under two visual conditions, while maximal muscle strength was measured with an isokinetic dynamometer.

Setting: This cross-sectional, case-control study was conducted at a teaching hospital, which was a reference center for neuromuscular disease.

Participants: This study involved two cohorts: participants with LOPD and control participants.

Main outcomes and measure: Postural stability (center of pressure [COP] displacements, lower limb joint range of motion) and orientation (COP mean position, weight distribution, joint positions) parameters were assessed, alongside falls reported over 3 months and maximal lower limb muscles strength.

Results: Compared to 20 controls, 18 adults with LOPD showed impaired postural stability, especially medio-laterally with eyes closed (ES = 0.42-0.83), and an anterior shift of the COP without joint orientation changes. Falls were strongly associated with COP mean velocity (eyes open: ρ = 0.73; eyes closed: ρ = 0.74) and with hip abductor (ρ = - 0.77) and extensor strength (ρ = - 0.79). Hip extensor strength was most strongly associated with COP mean velocity (eyes closed: ρ = - 0.72; eyes open: ρ = - 0.69).

Conclusions: Adults with LOPD demonstrate impaired postural stability, especially in the medio-lateral plane with eyes closed, and an anteriorized upright orientation.

Relevance: Hip extensor and abductor strength, strongly linked to falls and stability, should be important to target in evaluations and rehabilitation and in studies on new therapies on LOPD.

Importance: Individualizing interventions is imperative to optimize step-activity in people with chronic stroke.

Objective: The objective was to group individuals with chronic stroke into clinical profiles based on baseline characteristics and examine if these profiles preferentially benefitted from a specific intervention to improve daily step-activity.

Design: This is a secondary analysis of a randomized control trial.

Setting: The parent study occurred at 4 outpatient rehabilitation clinics.

Participants: Participants had strokes ≥6 months prior to enrollment, were 21 to 85 years old, had walking speeds of 0.3 to 1.0 meters per second, and took <8000 steps-per-day.

Interventions: Participants were randomized to high-intensity treadmill training (FAST), a step-activity behavioral intervention (SAM), or a combined intervention (FAST+SAM).

Main outcome(s): The primary outcome was the interaction of latent class (clinical profile) and intervention group (FAST, SAM, FAST+SAM) on a change in steps-per-day. Key clinical characteristics to identify the latent classes included walking speed, walking endurance, balance self-efficacy, cognition, and area deprivation.

Results: Of the 190 participants with complete pre- and post-intervention data (mean [SD] age, 64 [12] years; 93 females [48.9%]), 3 distinct profiles of people with chronic stroke were identified. Class 1 had the lowest walking capacity (speed and endurance), lowest balance self-efficacy, and highest area deprivation, and the greatest change in step-activity when enrolled in SAM (mean = 1624, 95% CI = 426-2821) or FAST+SAM (mean = 1150, 95% CI = 723-1577]). Class 2 had walking capacity, baseline steps-per-day, and self-efficacy values between Class 1 and 3, and had the greatest change in step-activity when enrolled in SAM (mean = 2002, 95% CI = 1193-2811). Class 3 had the highest walking capacity, highest self-efficacy, and lowest area deprivation and the greatest change in step-activity when enrolled in FAST+SAM (mean = 1532, 95% CI = 915-2150).

Conclusions: People with chronic stroke require different interventions to optimize changes in step-activity.

Relevance: Clinicians can use clinically relevant measures to personalize intervention selection to augment step-activity in people with chronic stroke.

Importance: Patients with cancer experience increased falls risk secondary to oncological treatment and cancer-related sequelae.

Objective: Identifying diagnostically and prognostically accurate screening tool(s) for falls risk in populations with cancer is an important issue.

Data sources: Screening tests were identified in PubMed and CINAHL.

Study selection: Two independent reviewers screened citations for inclusion.

Data extraction and synthesis: Data extraction was performed by 1 reviewer and verified by a second. Tests were investigated for clinical utility, validity, diagnostic accuracy, and predictive capacity. Recommendations for screening measures were formulated using predetermined criteria.

Measures: Falls risk screening tools were identified for populations with cancer.

Results: Of 532 articles screened, 24 articles were included. Fifty-five variations of screening measures were identified, of which 47 had sufficient clinical utility. Twenty measures contained data on diagnostic accuracy or predictive capacity. No screening measure met all criteria to be highly recommended for both ruling in and ruling out falls risk currently (diagnostic accuracy) or in the future (predictive capacity). History of falls demonstrated good diagnostic accuracy for ruling in immediate falls risk (specificity 98.9%, positive predictive value 84.6%). A negative falls history was highly indicative of lower future falls risk status (negative predictive value 82.5% to 90.1%). Fear of falling demonstrated accuracy for ruling out immediate risk for falls (negative predictive value 87.0%, sensitivity 88.7%). Strong predictive capacity was demonstrated with the Timed "Up & Go" (TUG) Standard (sensitivity 93% at ≤7.8 s, specificity 95% at ≥11.35 s).

Conclusions: Based on these results, a history of falls plus either the TUG Standard for those with a history of falls or subjective report of fear of falling for those without a history of falls is recommended for risk screening in populations with cancer.

Relevance: Different screening tools are required for immediate versus future falls risk and are setting dependent.