Physical Therapy最新文献

Importance: Persistent post-traumatic headache (PPTH) or concussion is a significant United States military problem, and pharmacological treatment is often ineffective. Headache is commonly migraine-like with associated autonomic nervous system (ANS) symptoms. Injury to the brain and neck likely co-occur during concussion, and recent research suggests resulting upper cervical hypermobility may trigger an ANS response and PPTH. A promising rehabilitation program (SPINE self-management techniques for Persistent headache After concuSSion [SPINEPASS]) has been developed, directed toward dysfunction of the upper cervical region, myodural bridges, and changes throughout the entire spine affecting the dura.

Objective: The aim of this trial is to explore (1) the efficacy of SPINEPASS physical therapy compared to standard physical therapy for PPTH and (2) patient experiences, and acceptability and feasibility of the program.

Design: The study will be a randomized controlled trial.

Setting: The trial will be conducted at a military hospital outpatient setting at the Brooke Army Medical Center, Brain Injury Rehabilitation Service, San Antonio, Texas.

Participants: Participants will be active-duty military personnel (n = 120) with PPTH and ANS symptoms >1 month.

Interventions: Patients will receive up to 12, 1 hour, 1 on 1 physical therapist sessions of either SPINEPASS or standard physical therapy and a complete home exercise program.

Main outcomes and measurements: The primary outcome measures are Aim 1 (headache disability) and Aim 2 (self-confidence to manage headache, acceptability, and feasibility immediately postintervention, and patient perspectives 3 months postintervention). Aim 1 secondary outcome measures: ANS symptoms, headache diary parameters, pain self-efficacy, quality of life, neck pain and disability, and pupillometry. Three- and 12-month follow-ups will also be performed.

Limitations: Potential limitations include recruitment feasibility and lost to follow-up.

Conclusions: The focus of the research will examine new non-pharmaceutical treatment of PPTH in military personnel.

Relevance: The study has potential to reduce ongoing pain, disability, and burden of PPTH and reduce dependence on pharmaceutical management.

Importance: While total knee replacement (TKR) is the definitive treatment for knee osteoarthritis, physical activity remains unchanged after surgery.

Objective: The objective of this trial was to examine the efficacy of a physical therapist-administered physical activity intervention to increase moderate-to-vigorous physical activity (MVPA) over 6 months for adults after TKR.

Design: This was a randomized controlled trial.

Setting: The study took place in an outpatient physical therapist clinic.

Participants: Included were 120 adults over the age of 45 years seeking outpatient physical therapy following a unilateral TKR.

Interventions: Participants received standardized physical therapy after TKR and a wearable activity tracking device, individualized step goals, and face-to-face feedback provided by a physical therapist (intervention), or standardized physical therapy alone (control).

Main outcome and measure: The primary outcome was change in MVPA recorded by a hip-worn Actigraph GT3X accelerometer from baseline to 6 months after discharge from physical therapy.

Results: Moderate-to-vigorous physical activity similarly increased from baseline to 6 months within the intervention (median = 6.0 minutes per day [semi-interquartile range = 11.9]) and control group (median = 5.9 minutes per day [semi-interquartile range = 14.3]). There was no between-group difference in MVPA change over time.

Conclusion: A physical therapist-administered physical activity intervention resulted in a similar increase in MVPA over 6 months compared to standardized physical therapy for adults after TKR.

Relevance: Adding a wearable activity tracking device and individualized step goals may not increase physical activity for adults after TKR receiving outpatient physical therapy.

Importance: Comorbid depression in people with low back pain (LBP) is associated with poorer prognosis.

Objective: The objective was to understand the challenges faced by musculoskeletal (MSK) triage physical therapists when screening for depression in LBP populations, and to generate actionable recommendations for overcoming these challenges.

Design: This study adopted a pragmatic hybrid descriptive qualitative approach, integrating elements of ethnography and action research.

Setting: Interviews were conducted in the Republic of Ireland and used purposive sampling of physical therapists working in MSK triage roles.

Participants: To be included, participants were required to have managed at least 1 person with LBP each week in the 3 months prior to recruitment.

Intervention(s) or exposure(s): The context explored was MSK triage physical therapists' experience with depression screening in people with LBP.

Main outcomes and measure(s): The main outcomes were insights regarding challenges and potential solutions to depression screening. Semi-structured interviews were employed, with data analysis following a Reflexive Thematic Analysis framework.

Results: Fourteen MSK triage physical therapists participated. Challenges were organized into 3 themes: capacity (personal, professional, and system), culture (clinic, societal), and circuitous communication. Potential solutions were organized into 5 themes: training and education, standardized pathways, knowledge of and access to resources, screening tools, and normalizing depression screening in MSK triage equivalent to red flag screening.

Conclusion: The findings highlight capacity and cultural challenges that lead to circuitous communication. Addressing the potential solutions through implementation research could enhance depression screening practices by MSK triage physical therapists for people with LBP.

Relevance: This qualitative research offers novel insights into the challenges MSK triage physical therapists face when screening for depression in people with LBP. Importantly, it proposes actionable solutions with participants contributing as subject matter experts. Their pragmatic solutions can help facilitate consequential change and help normalize depression screening in MSK triage practice.

Importance: Rehabilitation supports independence for older adults with disability, but limitations in access to services and the amount of care received are ongoing concerns. One potential driver is insurance coverage.

Objective: This study characterized trends and racial disparities in rehabilitation insurance benefit exhaustion among older adults from 2015 to 2022.

Design: The study was a repeated cross-sectional analysis using data from the National Health and Aging Trends Study (NHATS). Models were clustered at the patient level to estimate changes in insurance exhaustion from 2015 to 2022, and an overall estimate of racial disparities over this time period was estimated using survey-weighted logistic regression.

Setting: Population-based survey of patients in rehabilitation facilities and clinics in the United States.

Participants: The sample included 5653 rehabilitation user-years (weighted N = 38.3 million) contributed by 3386 community-dwelling Medicare beneficiaries aged 70+ who received rehabilitation services between 2015 and 2022.

Exposures: The primary exposure of interest was racial and ethnic identity, categorized as Non-Hispanic Black and Non-Hispanic White.

Main outcome and measures: The main outcome was patient-reported rehabilitation insurance benefit exhaustion, defined using NHATS survey responses.

Results: From 2015 to 2022, the overall rate of patient-reported rehabilitation insurance benefit exhaustion among older adults declined from 32.0% (95% CI = 28.1%-35.7%) to 27.9% (95% CI = 24.4%-31.3%). However, racial disparities persisted and widened over this period. In 2015, 39.2% (95% CI = 29.7%-48.8%) of Black older adults reported benefit exhaustion compared to 30.7% (95% CI = 26.3%-35.0%) of White older adults. By 2022, rates declined to 25.7% (95% CI = 21.6%-29.8%) among White adults and 38.5% (95% CI = 27.4%-49.5%) among Black adults. In adjusted analyses, the odds of patient-reported rehabilitation insurance benefit exhaustion were higher for Black versus White adults from 2015 to 2022 (OR = 1.50; 95% CI = 1.20-1.86).

Conclusions: Although overall rates of patient-reported rehabilitation insurance benefit exhaustion declined modestly from 2015 to 2022, 1 in 4 still reported terminating their rehabilitation episodes because of self-reported insurance benefit exhaustion in 2022 with growing racial disparities over time.

Relevance: These findings highlight the need for Medicare reforms that expand and equitably enforce coverage to ensure all older adults-particularly those from marginalized groups-can complete the rehabilitation necessary to maintain independence.

Importance: Hospitals can follow the steps outlined in this administrative case report to identify and address potential overutilization waste.

Objective: Acute care physical therapist evaluation and intervention can identify functional needs, safety needs, and develop treatment plans to optimize function, activity, safety, and the ability to discharge home safely. However, health care waste results when therapy referrals are utilized beyond these needs. This administrative case report aimed to define and categorize physical therapist overutilization to guide health care waste reduction.

Design: This administrative case report describes a 2-phase project to develop and implement a low-value referral (LVR) tracking system within a large health care system. During phase 1, the development phase, semi-structured group consensus meeting stakeholders identified 4 LVR categories and developed a data collection tool for a hospital-wide feasibility project. Phase 2 collected data on clinician-identified LVRs over a 2-year timeframe to identify LVR category, referring provider, and patient care unit from which the LVRs are located.

Setting: Baylor University Medical Center (BUMC) is a quaternary care academic medical center in Dallas, Texas, with 914 licensed acute care beds.

Participants: All physical therapists evaluating and treating patients at BUMC during the project.

Results: Out of 40,815 total physical therapist referrals, 2263 were identified as LVRs. The authors found that 5.54% of hospital referrals were LVRs, with more than 75% of LVRs associated with patients currently at their baseline functional state and/or independent with activity/mobility. Furthermore, 27% of all LVRs came from just 20 referral sources (mean = 30.55; SD = 9.76), and 43.9% were located on 3 patient care units, making targeted and customized education and collaboration initiatives feasible.

Conclusion and relevance: This case report demonstrates that acute care hospital physical therapist overutilization can be easily defined by category, source, and location. This meaningful data can be used to divert potential health care waste toward evidence-informed patient care designed to improve outcomes.

Importance: Impaired fundamental movement skills are prevalent among children with developmental coordination disorder (DCD) and mild cerebral palsy (CP). Although postural control is a prerequisite for gross motor skills, its role in fundamental movement skills is understudied.

Objective: This study aims to determine the extent to which postural control contributes to fundamental movement skill performance in children with DCD, mild CP, and with typical development (TD).

Design: This was a case-control study.

Participants: Participants were 127 children aged 5.0 to 10.9 years (DCD [N = 48], TD [N = 59)], mild spastic CP [N = 20]). Children with CP were classified as Gross Motor Function Classification System I (N = 11) or II (N = 9), and as having either unilateral (N = 11) or bilateral CP(N = 9).

Main outcomes and measures: The Test of Gross Motor Development-3 (TGMD-3) evaluated fundamental movement skills, and the Kids-Balance Evaluation Systems Test-2 (Kids-BESTest-2) assessed postural control. The domain and total scores of both tests were used for analysis.

Results: Children with TD significantly outperformed those with DCD and mild CP, while DCD and mild CP performed similarly. Across groups the Kids-BESTest-2 and TGMD-3 correlated significantly (r = 0.42-0.77). The total Kids-BESTest-2 score and group (TD-DCD-mild CP) explained 69% of locomotor skill variance but did not significantly explain ball skill performance (R2 = 0.40). Among postural control domains, only anticipatory postural adjustments contributed to fundamental movement skills. Group effects were larger (ηp2 = 0.15-0.31) than the effects of Kids-BESTest-2 scores (ηp2 = 0.01-0.12).

Conclusions and relevance: The findings suggest that postural control plays a role in locomotor performance but that unique group-specific factors influence this relationship. Further research should investigate the impact of postural control task-oriented training on fundamental movement skills, and should examine the influence of additional factors, such as body functions and environmental influences on fundamental movement skill development.