Physical Therapy最新文献

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.

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.