Physical Therapy最新文献

Importance: Primary care providers (PCPs) manage musculoskeletal (MSK) pain and may prescribe opioids for their patients, presenting risk for opioid misuse. Physical therapists are well-positioned to collaborate with PCPs in identifying and mitigating opioid risk and misuse for patients that PCPs and physical therapists co-manage. How PCPs view such collaboration is unclear.

Objective: The objective of this study was to explore PCPs' attitudes regarding physical therapists' role in identifying and mitigating opioid risk and opioid misuse.

Design: This was a qualitative study using rapid content analysis and it was the first phase in a sequential exploratory mixed methods investigation.

Setting and participants: Semi-structured interviews were conducted with 22 PCPs in Utah. PCPs were invited to participate if they were listed by the Utah Division of Professional Licensure as having an active license to practice in Utah. PCPs were eligible to participate if they (1) referred a patient to outpatient physical therapy within the past 6 months and (2) prescribed an opioid within the past 6 months. Interviews were conducted between May 6, 2024, and August 9, 2024, and were audio recorded and transcribed.

Main outcome: The main outcomes were qualitative themes reported by the PCPs surrounding their attitudes toward collaborating with physical therapists on patients taking prescription opioid medication for pain.

Results: Twenty-two PCPs were interviewed, which included 7 (31.8%) physicians, 6 (27.3%) nurse practitioners, and 9 (40.9%) physician assistants. Mean years of clinical experience was 13.9 (SD = 9.1) with 12 (56.0%) participants identifying as female and 20 (90.1%) identifying as White. The themes identified were (1) physical therapist's involvement in opioid management can help patients, (2) communication between physical therapists and PCPs regarding opioids is important, (3) physical therapists should educate their patients about the risks of opioid use, and (4) physical therapists should refer their patients with suspected opioid misuse for further management.

Conclusion and relevance: PCPs favorably regarded Physical therapists' involvement in identifying and mitigating opioid risk and misuse among co-managed patients.

This paper explores the importance of fidelity in strengthening clinical translation and implementation of rehabilitation research interventions and in reducing unwarranted variation in practice patterns. Fidelity, or accurate and faithful delivery of an intervention, is critical for all aspects of the clinical translational research continuum. Fidelity intentionally defines and tracks the key or active ingredients of a research intervention, ensures adherence to and dose of these key ingredients across therapists and research sites, and clearly establishes what is new or different about an intervention as compared to usual or standard practice. Measurement and reporting standards for fidelity in rehabilitation research vary widely. Historically, rehabilitation researchers have not reported their fidelity process clearly, if at all. This reporting gap creates a multi-faceted conundrum for replication of research findings and eventual clinical implementation of rehabilitation interventions. Without clear fidelity metrics, researchers fail to establish what is novel or unique about an intervention and fail to differentiate a new intervention from other established approaches. Without seeking and applying fidelity metrics, clinicians have no way of replicating a new intervention or understanding which key ingredients replace or supersede old practice habits. Thus, failure of researchers to transparently communicate and of clinicians to understand and apply fidelity metrics widens unwarranted practice variations rather than improving our precision with rehabilitation interventions. Using 2 recent pediatric clinical trials as exemplars, we describe how the development and tracking of metrics defining fidelity for the Sitting Together and Reaching to Play (START-Play) intervention informed key ingredients and program differentiation as researchers moved from an efficacy to an effectiveness trial; and then propose how clinicians might use these same metrics to inform implementation of START-Play. This example will demonstrate how robust fidelity might serve as a common language for successful implementation of and improved precision with rehabilitation research interventions.

Importance: An improved understanding of the organizational influences on adult in-hospital mobility is essential to develop and sustain interventions to prevent functional decline.

Objective: The objective was to map contemporary evidence about organizational barriers and enablers of adult patient mobility in general acute hospital units, the participants reporting these barriers and enablers, and how mobility was defined.

Data sources: A systematic search was conducted in Embase, Emcare, EBSCO Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, Cochrane Library, Joanna Briggs Institute, MEDLINE, ProQuest (Health Research Premium Collection), PsycINFO, Scopus and Web of Science for studies published in English from January 2013 to October 2024 inclusive.

Study selection: Based on eligibility criteria, 2 reviewers independently screened title/abstracts and full texts.

Data extraction and synthesis: Two reviewers independently extracted study characteristics and mobility definitions. Organizational barriers and enablers of mobility were mapped to the Consolidated Framework for Implementation Research 2.0 outer (community and jurisdiction) and inner setting (hospital) domains.

Main outcomes: Fifty-one studies were included (45 primary studies and 6 reviews). Fourteen studies reported organizational barriers and enablers of mobility in the outer setting. All 51 studies reported inner setting mobility barriers and enablers, mostly related to infrastructure, culture and available resources. Most participants were patients or health professionals providing direct patient care. Few studies defined mobility, and definitions were inconsistent.

Conclusions and relevance: Studies reported many reported organizational barriers and enablers of mobility at the hospital level, with far fewer reported at the community and jurisdiction level. Few studies reported the perspectives of health service leadership, and investigating their perspective may provide greater insights to address these barriers. Consistent definitions of mobility could enable progress in research and practice.Greater insights into community and jurisdictional barriers and enablers of mobility from the perspective of health care leaders are required to address organizational barriers.

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: 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.