Physical Therapy最新文献

Importance: Functionality is crucial for older adults' autonomy, and loneliness has emerged as a potential risk factor for chronic diseases. However, its role in functional limitations remains unclear.

Objective: The objective of this study was to analyze the association between loneliness and limitations in 1 or more basic activities of daily living (BADL) and instrumental activities of daily living (IADL) in individuals who were 80 years old or older.

Design: This was a cross-sectional study using data from wave 8 of the Survey of Health, Ageing and Retirement in Europe.

Setting: The study was conducted in 26 European countries.

Participants: Participants were 7434 community-dwelling adults who were 80 years old or older.

Exposure: Loneliness was assessed using the 3-item loneliness scale, covering companionship, exclusion, and isolation.

Main outcome and measures: Functional limitations were defined as difficulty in 1 or more BADL (dressing, walking, bathing, eating, bed transfer, and toileting), IADL (map use, preparing a hot meal, shopping, phone use, medication management, housework, finances, transportation, and laundry), or in both types of activities (BADL and IADL). Sociodemographic and health-related variables were considered. Logistic regression and multivariate analyses were applied, using the odds ratio (OR) as the effect measure.

Results: The mean age was 84.4 (SD = 3.8) years; 58.2% of participants were women; and 52.5% had a low educational level. Loneliness affected 56% of participants, and 66% reported limitations in BADL/IADL. Loneliness was significantly associated with functional limitation in BADL/IADL in both univariate (OR = 2.18 [95% CI = 1.98-2.39]) and multivariate (OR = 1.50 [95% CI = 1.34-1.67]) models, even after adjustment for covariates, with an area under the receiver operating characteristic curve of 76%.

Conclusions: Loneliness is significantly and independently associated with limitations in BADL/IADL among the oldest-old.

Relevance: These findings highlight the importance of assessing psychosocial factors, such as loneliness, when evaluating functional health in the oldest-old.

Importance: Virtual reality (VR) is increasingly used in patients after stroke upper limb rehabilitation, but the comparative effectiveness of VR-Only versus hybrid VR combined with conventional therapy (CT) remains unclear.

Objective: The objective of this review was to systematically review and meta-analyze the effectiveness of 2 distinct VR intervention approaches for patients undergoing hemiparetic upper limb rehabilitation after stroke: VR-Only versus CT, and hybrid interventions combining VR with CT versus CT alone.

Data sources: A PROSPERO protocol (CRD 42022349259) for a comprehensive search was conducted across 7 databases, focusing on studies published in English and Spanish.

Study selection: Randomized controlled trials (RCTs) comparing VR-Only or hybrid VR interventions to CT were included.

Data extraction and synthesis: Study characteristics, participant demographics, intervention specifics, and outcome measures were extracted. The risk of bias was assessed using the Risk of Bias 2 (RoB 2) tool. Meta-analyses used a random-effects model to estimate standardized mean differences (SMDs) with 95% confidence intervals.

Main outcome(s) and measure(s): Primary outcomes included motor function, motor capacity, hand dexterity, and functional capacity, measured by validated instruments such as the Fugl-Meyer Assessment and Box and Block Test.

Results: Twenty-seven RCTs (1156 participants) were included. Hybrid VR + CT interventions significantly improved motor function (SMD = 0.44) and manual dexterity (SMD = 0.33) compared to CT alone. VR-Only interventions showed positive trends but were not statistically significant. Hybrid interventions maintained benefits at follow-up (SMD = 0.63, 95% CI = 0.11-1.15). Optimal improvements were observed with hybrid sessions of 31 to 59 minutes daily.

Conclusions: Hybrid VR + CT interventions are more effective than CT alone, improving motor function and manual dexterity after stroke, with sustained benefits over time. VR-Only interventions showed less consistent effects.

Relevance: These results suggest that integrating VR into CT enhances rehabilitation outcomes of stroke survivors. Future research should focus on optimizing hybrid protocols and exploring long-term outcomes.

Importance: Most physical therapists do not address older adults' inadequate physical activity (PA), resulting in increased risk of experiencing falls or frailty.

Objective: The objective was to identify determinants that can impact the implementation of a PA pathway that provides physical therapists with step-by-step guidance on assessing and addressing older adults' inadequate PA levels.

Design: The design was a convergent parallel mixed-method design.

Setting: The setting of this study was outpatient physical therapy.

Intervention(s) or exposure(s): The intervention being examined is a PA pathway that provides guidance on assessing and addressing older adults' inadequate PA levels.

Main outcome(s) and measures(s): The main outcome was determinants that can impact the implementation of the PA pathway.

Methods: Our quantitative surveys examined current practice, knowledge, and barriers related to assessing and addressing inadequate PA levels, and perceptions about the pathway's feasibility, acceptability, and appropriateness. The semi-structured interviews examined determinants that may impact the decision to use the PA pathway. The study included outpatient physical therapists who treated patients aged 65 years and older, with 51 completing the survey and 16 completing the interview.

Results: Over 88% perceived the PA pathway as an acceptable, appropriate, and feasible innovation that can guide physical therapists through the recommended PA assessments and behavior change techniques. Barriers identified in the quantitative and qualitative data were lack of knowledge, skills, and confidence in assessing and addressing PA, patient's preference of not doing PA, and lack of time. Two additional barriers identified via the qualitative data were lack of information on how to use behavior change techniques and lack of electronic health record infrastructure. Reimbursement's impact on implementing the PA pathway was mixed.

Conclusion and relevance: The gap in assessing or addressing older adults' PA levels could be resolved through the step-by-step guidance provided by the PA pathway. The successful adoption of the pathway can be enhanced via a plan that addresses the potential barriers identified in this study.

The increasing prevalence of accelerated Doctor of Physical Therapy (DPT) programs, which condense the conventional 3-year curriculum into a 2-year format, has emerged with limited national discussion and debate and without substantive educational research support. This novel approach challenges the traditional 3-year DPT educational framework. This perspective draws historical parallels between the challenges and unintended consequences that arose from the acceleration of anterior cruciate ligament reconstruction rehabilitation protocols with early return-to-play and the current shift toward accelerated DPT education. While advocates argue that accelerated programs offer advantages over traditional 3-year DPT curricula, there is insufficient evidence to support these claims or to determine whether these benefits outweigh potential drawbacks. Using Rogers' Diffusion of Innovation framework, this perspective explores key questions and potential concerns regarding accelerated DPT programs. This perspective critically examines the potential impact of reducing the duration of DPT education on program and graduate outcomes, including National Physical Therapy Exam pass rates, clinical readiness, and broader educational experiences. It also raises questions about the potential effects on student well-being and mental health. The perspective emphasizes the need for rigorous, data-driven educational inquiry and recommends comprehensive data collection to evaluate the effects of accelerated DPT programs on a wide range of important variables. This perspective emphasizes the importance of prioritizing student learning and development by exploring potential unforeseen risks associated with accelerated DPT curricula. It advocates for a student-centered approach to educational research, ensuring that any changes to program length support both the depth and quality of learning. Through systematic investigation, the profession can determine whether safeguards are necessary to maintain the integrity of DPT education, ensuring that students receive the comprehensive training they need without compromising educational excellence in the pursuit of speed.