Physical Therapy最新文献

Importance: New care models promoting early access to physical therapy by reducing or eliminating copays are emerging. Few studies have compared health care use in these programs to other care pathways across musculoskeletal conditions.

Objective: The objective of this study was to describe episode-level musculoskeletal health care use across different care pathway options, including a no-copay physical therapy program.

Design: This study was a descriptive retrospective analysis of claims data.

Setting and participants: This study included health care beneficiaries of a self-insured employer with ~52,000 covered lives.

Interventions or exposures: The study included musculoskeletal care episodes from October 2019 to September 2020 categorized as no copay physical therapy, traditional physical therapy, or other management.

Main outcomes: Rates of surgery/injection, imaging, inpatient services, physician services, emergency services, physical therapy, and other services by episode type, overall and stratified by body region: upper extremity, lower extremity, and spine.

Results: Of 9696 total episodes, 886 (9.1%) were no copay physical therapy, 1261 (13%) were traditional physical therapy, and 7549 (77.9%) were other management. No copay physical therapy episodes had lower imaging rates (38%) compared to traditional physical therapy (47%) and other management (45%) episodes. Inpatient services were similar for no copay (16%) and traditional (12%) physical therapy, both lower than other management episodes (23%). Physician services were higher in other management (100%) and traditional physical therapy (81%) episodes compared to no copay physical therapy episodes (43%). Surgery/injection rates were similar for no copay (11%) and traditional (8%) physical therapy, both lower than other management episodes (27%). Differences by pathway were more pronounced for extremity conditions than for spine conditions.

Conclusions: Rates of no copay program use were modest with those who used the program having lower rates of advanced imaging, injection, and surgery.

Relevance: Findings may be most relevant for employers, health systems, and payors planning resource allocation and benefit design for similar programs.

Importance: The rate of back pain in children is unclear.

Objective: This study evaluated the rate, intensity, disability, and characteristics of back pain across the pediatric age span in children referred with spinal concerns.

Design: This study used a retrospective design.

Setting: This was completed at a tertiary pediatric orthopedic institution in the United States.

Participants: Seventeen thousand nine hundred eleven children (6621 male and 11,280 female) ages 0 to 18.9 with any spinal condition from July 2018 to April 2022 were evaluated.

Main outcomes: All children/caregivers were asked yes/no, "Is back pain a significant concern at today's visit or the past 6 months?" Beginning in February 2020, children who reported back pain were assigned the 9-item Oswestry Disability Index (ODI-9). Beginning in April 2021, all children ages 5 and above were assigned 3 patient-reported outcomes measurement information system (PROMIS) pediatric measures: pain interference, mobility, and anxiety.

Results: Forty-two percent (7580/17,911) of all children with spinal concerns reported back pain which increased from about 20% at age 2 to about 30% by age 7 to 40% by age 13 to at least 55% by age 16. Back pain intensity averaged 2.0 out of 5. ODI-9 scores averaged minimal disability (18%). Female sex (odds ratio [OR] = 1.36), public insurance type (OR = 1.33), increased age (OR = 1.16), higher PROMIS pain interference scores (OR = 1.13), increased body mass index (BMI) percentile (OR = 1.01), and lower PROMIS mobility scores (OR = 0.98) were associated with the presence of back pain.

Conclusions: Four in 10 children referred with spinal concerns report back pain, which increases with female sex, public insurance type, age, BMI percentile, and worse PROMIS pain interference and mobility scores. Quantifying the functional, mental health, and socioeconomic burden of back pain can help prioritize multidisciplinary interventions.

Relevance: Clinicians need to pay attention to the likelihood of back pain in a younger demographic than traditionally thought.

Importance: While best practice guidelines recommend intensive rehabilitation for post-stroke walking recovery, knowledge of real-world implementation factors is limited.

Objective: The aim was to understand the implementation factors for intensive rehabilitation within real-world inpatient stroke rehabilitation settings.

Design: This was a cross-sectional, online survey study.

Setting: Twelve inpatient rehabilitation units (7 Canadian provinces) were included.

Participants: Eighty-five therapy staff who delivered an intensive rehabilitation protocol within the Walk 'n Watch implementation trial (NCT04238260) were invited.

Intervention: A structured intensive walking rehabilitation protocol was implemented as usual care (>2000 steps, 40%-60% heart rate reserve, >30 minutes/session). Step counters and heart rate monitors were provided.

Main outcomes and measures: An online survey was used, including close-ended and open-ended questions regarding the protocol practicalities, workplace structure, and training. Open-ended responses were thematically analyzed using the Consolidated Framework for Implementation Research (CFIR).

Results: Forty-seven participants (85% women) completed the survey. Most agreed they successfully delivered the protocol (87%) and found the step and heart rate targets helpful (72%). However, few participants agreed they had enough time to deliver the protocol (36%); 26% and 47% agreed they achieved the step count and heart rate targets, respectively. The major time-related factor was insufficient therapy time to accommodate the protocol and prescribed step targets (CFIR: Work Infrastructure); discharge planning often took priority. Most agreed to future protocol use (87%). However, only about half agreed to future use of the trial-assigned devices (49% step counters; 64% heart rate monitors), likely due to perceived device inaccuracies (CFIR: Materials and Equipment).

Conclusions: Therapy staff reported successfully delivering an intensive rehabilitation protocol as usual care under real-world conditions. Strategies to facilitate implementation included incorporating discharge planning considerations, system-level changes, and acquiring more accurate monitoring devices.

Relevance: This study enhanced the understanding of real-world implementation factors and potential strategies for future implementation.

Importance: Lower extremity amputation (LEA) is a worldwide public health problem leading to large disability burdens and health care costs. After LEA, prostheses improve functional mobility and quality-of-life. However, health care costs are high and prosthetic provision worldwide is unknown.

Objective: The objective was to map the worldwide evidence for prosthetic provision rates after major dysvascular LEA to identify evidence gaps.

Design: This scoping review followed best practices and PRISMA-Sc guidelines. Of 609 abstracts screened and 28 full texts reviewed, 18 articles were included.

Setting/exposures: Five databases were searched without language limits using Medical Subject Headings (MeSH) and keyword search terms. The Population-Concept-Context framework included people with major dysvascular LEA, prosthetic provision, and health care models.

Participants: Seventeen cohorts and 1 case-control study involved 31,982 people (7.7% female, 16.5% Americans from racial and ethnic minority groups), mean age 68.1 years, 85.0% after dysvascular LEA (61.4% transtibial).

Main outcomes: The outcome of interest was prosthetic provision rates.

Results: The overall prosthetic provision rate from 10 countries was 48.5%: 48.6% for high-income (16/18) and 39.2% for middle-income (2/18) countries. The 1 Bismarck not-for-profit universal health care model country had the highest provision rate (73.7%); 4 studies from 3 Beveridge/Bismarck model countries reported 59.3% provision. Most participants were from the hybrid US system, with 6 studies reporting 48.8% provision. Provision rate in 6 studies from 4 Beveridge government-financed care model countries was 41.2%, and 32% in the fee-for-service country. Lower prosthetic provision rates were observed for transfemoral compared with transtibial amputations, female compared with male sex, and Americans from racial and ethnic minority groups compared with White race.

Conclusions: Fewer than half receive prostheses after LEA worldwide. Differences among country health care models and income levels; lack of African, South American, and low-income country studies; and low prosthetic provision for people of female sex and Americans from racial and ethnic minority groups exposed evidence gaps for future research.

Relevance: Limited provision of prostheses that improve quality-of-life highlights the need to understand factors affecting prosthetic decisions and health care policies.

Importance: To this author's knowledge, this is the first study to examine the burden of rehabilitation-relevant conditions in Mexico, providing valuable evidence to inform public policy and enhance the delivery of rehabilitation services.

Objective: This study presents a national-level analysis estimating the number of people in Mexico who required rehabilitation at least once during the course of an illness or injury that caused a disability, based on data from the 2021 Global Burden of Disease Study.

Design: This was a cross-sectional analysis.

Setting and participants: This study is a secondary analysis using 2021 Global Burden of Disease Study estimates to quantify the burden of diseases and conditions considered amenable to rehabilitation. The use of these estimates provides a comprehensive and systematic approach to quantifying the magnitude of health loss in regional, national, and subnational locations using Bayesian methods.

Results: The findings suggest that the prevalence of persons with conditions that would benefit from rehabilitation was 43,488.0 (95% uncertainty interval [UI] = 39,240.1-47,930.6) per 100,000 persons, and the total estimated years lived with disability due to the same conditions were 3,610,038.9 (95% UI = 2,218,757.8-5,575,356.1). The total estimated number of people with musculoskeletal disorders who could benefit from rehabilitation services was 24,444,835 (95% UI = 21,061,024-27,876,368). In addition, an estimated 22,464,680 individuals (95% UI = 21,481,932-23,547,373) with hearing loss were also identified as likely to benefit from rehabilitation interventions.

Conclusions: The study provides a national-level analysis of the burden of diseases and conditions that are likely to require rehabilitation services in Mexico. The findings support the need for targeted preventive measures, strategic allocation of rehabilitation resources, and the development of multidisciplinary care models.

Relevance: The findings of the study provide key evidence for optimizing resource allocation, developing prevention strategies, and strengthening multidisciplinary care models. This research contributes to improving public policy planning and the quality of rehabilitation services.

Importance: Understanding how tendon structure relates to disability improvement during exercise interventions in rotator cuff tendinopathy is essential for optimizing individualized treatment strategies.

Objective: The objectives of this study were to characterize changes in supraspinatus tendon thickness and internal architecture over an 8-week resistive exercise intervention and evaluate the relationship between these changes and patient-reported shoulder disability.

Design: This was a prospective longitudinal observational study.

Setting: The settings were a university-based research laboratory and virtual supervision in participants' homes.

Participants: Forty-seven adults with unilateral rotator cuff tendinopathy were the study participants.

Intervention: The intervention was an 8-week progressive resistive exercise program, supervised twice weekly by a physical therapist.

Main outcomes and measures: Primary outcomes were the Pennsylvania Shoulder Score, supraspinatus tendon thickness, and internal tendon architecture assessed using the peak spatial frequency radius via ultrasound. Measurements were taken at baseline and at 2, 4, and 8 weeks. Linear mixed-effects models were used to assess changes and associations.

Results: Significant improvements from baseline were observed for the Pennsylvania Shoulder Score at 2, 4, and 8 weeks. Tendon thickness decreased significantly; changes in internal tendon architecture were not significant. A decrease in tendon thickness was associated with an improved Pennsylvania Shoulder Score at 2 weeks but not at 4 and 8 weeks.

Conclusions: Reductions in tendon thickness were associated with improved shoulder outcomes within the first 2 weeks of the intervention. Internal tendon architecture remained unchanged over the intervention. These findings suggest that tendon variables included in this study may be relevant only early in the intervention and that other factors should be investigated across different times of the intervention.

Importance: The Learning and Study Strategies Inventory (LASSI) is an instrument that measures self-regulated learning. However, it has not been validated for use in entry-level Doctor of Physical Therapy (DPT) learners.

Objective: The objective of this study was to investigate the validity and reliability of the LASSI in DPT learners.

Design: This was a retrospective observational cohort study.

Setting/participants/intervention: Demographic and LASSI data were retrospectively analyzed from 1541 learners enrolled in 5 entry-level DPT programs across the United States.

Main outcomes and measures: A confirmatory factor analysis (CFA) was conducted to evaluate whether the 60-item LASSI (3rd Edition) demonstrated a valid and reliable factor structure. An exploratory factor analysis (EFA) was used to identify a more succinct set of LASSI scales. Goodness-of-fit indices and reliability coefficients were computed to assess model fit and measurement consistency.

Results: CFA revealed that the 60-item LASSI accounted for 46.7% of total score variance. In contrast, EFA identified a revised 47-item version (termed LASSI-DPT) that accounted for 58.1%, indicating improved construct validity. χ2 goodness-of-fit supported the adequacy of the EFA model (χ2 = 3964.1). The revised 47-item LASSI demonstrated excellent internal consistency, with an overall Cronbach alpha of 0.92, compared to 0.78 for the 60-item version.

Conclusion: The revised 47-item LASSI-DPT provides a more reliable, concise, and valid assessment compared to the 60-item LASSI, tailored to learning strategies in physical therapist education programs.

Relevance: Factor analysis demonstrated improved construct validity and excellent reliability in a newly developed 47-item version of the LASSI tailored for DPT learners. This shorter instrument may result in decreased survey fatigue and improved measurement accuracy. With its enhanced psychometric properties, the LASSI-DPT may enable DPT programs to better identify learners who need additional support related to self-regulation of learning.

Importance: Determining the most effective intervention to improve respiratory function is complex.

Objective: This study aimed to determine the effectiveness of various cardiorespiratory physical therapist interventions to improve respiratory function in patients with stroke and to prioritize them.

Data sources: This network meta-analysis examined randomized controlled trials published between 2000 and 2023.

Study selection: Randomized controlled trials that enrolled patients with stroke and examined various cardiorespiratory physical therapist interventions were selected. The interventions included combined aerobic and breathing training, combined inspiratory and expiratory training (CIET), conventional training (CT), expiratory training, ground-based aerobic training (GBAT), inspiratory training (IT), and sham intervention (S).

Data extraction and synthesis: Data were independently extracted by 2 authors. The Comprehensive Meta-Analysis Software program was used to analyze the data and determine effect sizes.

Main outcomes and measures: Outcome variables were maximal expiratory pressure (MEP), maximal inspiratory pressure (MIP), and peak expiratory flow (PEF).

Results: Thirteen studies, involving 416 participants, were selected. CIET was more effective than CT in improving MEP, MIP, and PEF, with Hedges g (g) values of 0.890 (95% CI = 0.560-1.220), 0.948 (95% CI = 0.648-1.248), and 1.014 (95% CI = 0.636-1.391), respectively. IT was more effective than S for MEP (g = 0.582, 95% CI = 0.091-1.072) and more effective than CT for MIP (g = 0.934, 95% CI = 0.576-1.293). PEF analysis revealed that CIET was more effective than GBAT (g = -1.215, 95% CI = -2.035 to -0.395).

Conclusions and relevance: CIET or IT may improve respiratory function in patients with stroke more effectively than uniformly applied GBAT or CT. CIET and IT are effective regardless of age or intervention duration. Cardiopulmonary training is encouraged during the chronic phase of stroke to improve respiratory muscle strength, with at least 6 weeks of training recommended.