Physical Therapy最新文献

Objective: There is no established consensus for screening the spine in patients with shoulder pain. The aim of this study was to explore the role of the spine in shoulder pain and generate a set of recommendations for assessing the potential involvement of the spine in patients with shoulder pain.

Methods: A modified Delphi study was conducted through use of an international shoulder physical therapist's expert panel. Three domains (clinical reasoning, history, physical examination) were evaluated using a Likert scale, with consensus defined as Aiken Validity Index ≥0.7.

Results: Twenty-two physical therapists participated. Consensus was reached on a total of 30 items: clinical reasoning (n = 9), history (n = 13), and physical examination (n = 8). The statement that spinal and shoulder disorders can coexist, sometimes influencing each other and at other times remaining independent issues, along with the concept of radiating pain as an explanatory phenomenon for the spine contribution to shoulder pain, achieved the highest degree of consensus.

Conclusion: International physical therapists shoulder experts reached consensus on key aspects when screening the spine in people with shoulder pain, including consideration of the distal location of symptoms relative to the shoulder, the presence or previous history of neck pain, the changes in symptoms related to neck movements, and the presence of neuropathic-like symptoms. They also acknowledged the importance of assessing active cervical or cervicothoracic movements and the usefulness of the Spurling test and symptom modification techniques applied to the spine.

Objective: This descriptive qualitative study aimed to gain insights into the expectations of individuals with chronic shoulder pain and to investigate how different levels of disability may influence their beliefs and expectations regarding improvement.

Methods: This qualitative study utilized the Common Sense Model (CSM) as its theoretical framework. Conducted within a public physical therapist clinic, individuals with chronic shoulder pain who were awaiting the initiation of the treatment were included. Participants, female and male [aged 30 to 69 years], were purposefully sampled. Thirty participants, categorized into 2 groups based on the Shoulder Pain and Disability Index (SPADI) scores, underwent semi-structured interviews. Group 1, lower SPADI scores (0 to 60), had 10 participants, and Group 2, higher SPADI scores (61 to 100), had 20 participants. Thematic analysis and inductive coding were employed to analyze the interviews.

Results: Common themes emerged in both groups: the use of medical terms for understanding the diagnosis and the multidimensional impact of pain. The last 2 themes differed between groups. Notable differences included Group 1's focus on resources for pain relief and positive expectations with physical therapy, while Group 2 emphasized rest, religion as a resource for pain relief, and God's role in improvement.

Conclusion: These findings highlight the complexity of beliefs and expectations among patients with chronic shoulder pain. Individuals with greater disability often incorporated religious beliefs into their coping strategies, but they held lower recovery expectations and reported negative treatment experiences. These insights have implications for tailoring patient-centered care approaches.

Impact: This study underscores the need for health care providers to consider the multidimensionality of recovery expectations, which can significantly influence patient outcomes. Clinicians can reflect on this knowledge to optimize treatment strategies and improve patient prognosis.

Objective: The objective was to investigate the effectiveness of cognitive functional therapy (CFT) in the management of people with chronic nonspecific low back pain (LBP) and explore the variability in available trials to understand the factors which may affect the effectiveness of the intervention.

Methods: A systematic review with meta-analyses was conducted. Four databases were searched from inception to October 12th 2023. Randomized controlled trials investigating CFT compared to any control group in patients with nonspecific LBP were included. Mean difference and 95% CIs were calculated for pain, disability, and pain self-efficacy. Certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Results: Seven trials were included. Low to moderate certainty of evidence was found that CFT was effective for disability at short, medium, and long term time points compared to alternate treatments, including usual care. Low to moderate certainty of evidence was found that CFT is effective for pain in the short and medium terms and probably in the long term. There was high certainty evidence CFT was effective in increasing pain self-efficacy in the medium and long terms. A single study found CFT was cost-effective compared to usual care. Variability was found in the training and implementation of CFT across the included trials, which may contribute to some heterogeneity in the results.

Conclusion: The results show promise in the use of CFT as an intervention likely to effectively manage disability, pain, and self-efficacy in people with chronic nonspecific LBP. The number of clinicians trained, their experience, and quality of training (including competency assessment) may be important in achieving optimal effectiveness.

Impact statement: This is the most comprehensive review of CFT to date and included investigation of between-trial differences. CFT is a promising intervention for chronic LBP and high-quality synthesis of evidence of its effectiveness is important for its clinical application.

Americans with disabilities represent the largest historically underserved and marginalized health disparity population in the United States. This perspective piece will raise the awareness of physical therapist faculty and clinicians on gaps in health care provider knowledge about disability and provide actionable strategies, frameworks, and resources available to improve disability competence to make changes in clinical education and practice. In this perspective piece, 3 contributions are made. First, health disparities experienced by Americans with disabilities as a result of health care providers' biased assumptions about disability and lack of disability competence are described through an in-depth illustration of lived experiences of people with disabilities. Second, a discussion of disability competence in physical therapist education is provided. Finally, critical and evidence-based insights and actionable frameworks and resources to address disability competence training gaps and to promote anti-ableist practice are provided.

Objective: COVID-19 has led to significant morbidity and mortality globally. Post-COVID sequelae can persist beyond the acute and subacute phases of infection, often termed post-COVID syndrome (PCS). There is limited evidence on the appropriate rehabilitation for people with PCS. The aim of this study is to evaluate the effect on exercise capacity, symptoms, cognition, anxiety, depression, health-related quality of life, and fatigue of a 4-week, twice-weekly supervised pulmonary telerehabilitation program compared with usual medical care for people with PCS with persistent respiratory symptoms.

Methods: The study will be a multi-site randomized controlled trial with assessor blinding. Participants with confirmed previous COVID-19 infection and persistent respiratory symptoms who attend a post-COVID respiratory clinic will be randomized 1:1 to either an intervention group of 4 weeks, twice-weekly pulmonary telerehabilitation or a control group of usual medical care. Participants in the control group will be invited to cross-over into the intervention group after the week 4 assessment. Primary outcome: exercise capacity measured by the 1-minute sit-to-stand test. Secondary outcomes: 5 repetition sit-to-stand test; Montreal Cognitive Assessment; COVID-19 Yorkshire Rehabilitation Scale; Chronic Obstructive Pulmonary Disease Assessment Test; 36-Item Short-Form Health Survey; Hospital Anxiety and Depression Scale; Fatigue Severity Scale; and the Kessler Psychological Distress Scale. Outcomes will be collected at baseline, after 4-weeks intervention or control period, after intervention in the cross-over group, and at 12-month follow-up.

Impact: Research into effective rehabilitation programs is crucial given the substantial morbidity associated with PCS and the lack of long-term data for COVID-19 recovery. A short-duration pulmonary telerehabilitation program, if effective compared with usual care, could inform practice guidelines and direct future clinical trials for the benefit of individuals with persistent respiratory symptoms post-COVID.

Objective: To optimize learning in physical therapist education, learners need opportunities to grow from their unique starting points. Traditional grading practices like A to F grades, zero grades, and grading on timeliness and professionalism hinder content mastery and accurate competency assessment. Grading should focus on mastery of skill and content, using summative assessments for final grades, a no-zero policy, and actionable feedback. Equitable grading supports learners from all backgrounds and identities and promotes academic success. This case study provides guidance and recommendations for implementing equitable grading practices in academic physical therapist programs.

Methods: Over a 2-year period, a doctor of physical therapy program began implementing 5 strategies to create more equitable grading practices: (1) eliminating zero grades, (2) allowing late assignment submissions without penalty, (3) using low-stakes formative assessments throughout the semester, (4) weighing end-of-course assessments more heavily than initial ones, and (5) offering a no-stakes anatomy prep course before matriculation.

Results: Outcomes from implementing equitable grading practices varied. Some learners felt increased stress from fewer points opportunities, while others appreciated the reduced anxiety from low-stakes assessments. Some saw multiple attempts for peers as unfair. Faculty faced higher workloads due to detailed feedback and remediation but believed it benefited learners. Median final grades improved in some courses, remained stable in others, and slightly decreased in one. Overall, the changes had minimal impact on most learners' grades but significantly improved outcomes and retention for struggling learners.

Conclusion: This case report documents the implementation of equitable grading practices in a Doctor of Physical Therapy program, offering valuable insights and recommendations for other institutions aiming to adopt similar practices.

Impact: Inequity in assessment widens the gap between learners entering professional programs. Equitable assessment practices level the playing field, enabling learners from diverse backgrounds and identities to succeed. Increased diversity benefits everyone, especially patients, by reducing health disparities for historically marginalized groups.

Objective: The demographic homogeneity of the physical therapist workforce and its educational pathway may undermine the profession's potential to improve the health of society. Building academic environments that support the development of all learners is fundamental to building a workforce to meet societal health care needs. The Benchmarking in Physical Therapy Education study uses the Physical Therapy Graduation Questionnaire to comprehensively assess learner perceptions of the physical therapist academic environment. The present report examined whether racial and ethnic minoritized (REM) physical therapist learners perceive their doctor of physical therapy education differently from their non-REM peers.

Methods: Five thousand and eighty graduating doctor of physical therapy learners in 89 institutions provided demographic data and perceptions of a range of learning environment domains. Analyses included REM versus non-REM comparisons as well as comparisons among individual race and ethnicity groups.

Results: Compared with their non-minoritized peers, REM respondents expressed less satisfaction with their education and lower confidence in their preparedness for entry-level practice. REM respondents observed more faculty professionalism disconnects and demonstrated less agreement that their program had fostered their overall psychological well-being. REM respondents experienced higher rates of mistreatment than their peers and reported higher rates of exhaustion and disengagement, the 2 axes of academic burnout. Black/African American and Hispanic/Latino/a/x (Hispanic, Latino, Latina, and/or Latinx) respondents incurred significantly more educational debt than Asian and White respondents. REM respondents reported greater empathy and greater interest in working in underserved communities.

Conclusion: REM respondents perceived the physical therapist learning environment more negatively than their non-minoritized peers but expressed strong interest in serving people from underserved communities. These national benchmarks offer academic institutions the opportunity to self-assess their own environment and to work to improve the quality of the educational experience for all learners.

Impact: In a nationwide benchmarking study, learners from minoritized race and ethnicity backgrounds reported more negative experiences and outcomes during physical therapist education than their non-minoritized peers. These same learners demonstrated high empathy and interest in serving people from underserved (under-resourced) communities. Learning environments that permit all individuals to thrive may be an essential avenue to improve the health of a rapidly diversifying society.

Objective: The purpose of this paper is to determine a claims-based definition of frontloaded home health physical therapy (HHPT) and examine the effect of frontloaded HHPT visits on all-cause 30-day hospital readmissions.

Methods: This study used a retrospective analysis of Medicare fee-for-service claims from older adults (≥65 years) in the National Health and Aging Trends Study (NHATS; 2011-2017) with ≥1 HHPT visit within 30 days of a hospitalization (n = 1344 hospitalizations; weighted n = 7,727,384). An exploratory analysis of home health claim distribution was conducted to determine definitions of frontloaded HHPT. Generalized linear models were then used to examine the relationship between hospital readmission and each definition of frontloading.

Results: Four definitions of frontloaded HHPT were identified: ≥2 HHPT visits in the first week after discharge; ≥3 visits in the first week; ≥4 visits in the first 2 weeks; and ≥ 5 visits in the first 2 weeks. The adjusted risk of readmission was lower for older adults receiving frontloaded HHPT in the first week: (risk ratio [RR] for ≥2 vs <2 visits = 0.57; 95% CI = 0.41-0.79; RR for ≥3 vs <3 visits = 0.39; 95% CI = 0.22-0.72). The reduction in risk of readmission was even greater for older adults receiving ≥4 versus <4 HHPT visits (RR = 0.32; 95% CI = 0.21-0.48) and ≥ 5 versus <5 HHPT visits (RR = 0.27; 95% CI = 0.14-0.50) within the first 2 weeks. The effect of HHPT frontloading was greater for patients hospitalized with surgical versus medical diagnoses and for patients with diagnoses targeted by the Hospital Readmissions Reduction Program.

Conclusion: Frontloaded HHPT reduces 30-day hospital readmissions among Medicare beneficiaries. Additional research is needed to determine the optimal number of visits and those most likely to benefit from frontloaded HHPT.

Impact: Frontloaded HHPT can be an effective approach for reducing 30-day hospital readmissions among Medicare beneficiaries.