Physical Therapy最新文献

Importance: Falls are commonly reported incidents that affect the safety of patients during inpatient hospitalization. Inpatient rehabilitation (IR) units report the highest fall rates when compared with other hospital units. Falls commonly result in patient injury and elevate episode costs. There is a dearth of information regarding characteristics of patients who fall during physical therapy sessions, which represents a unique subset of falls.

Objective: The aim of the study was to describe the nature of falls, characteristics of fallers, and characteristics of therapists who experienced patient falls, which occurred during physical therapy sessions in IR.

Design: This was an observational study which included a retrospective analysis of medical records.

Setting: This study examined falls occurring within 2 IR departments at a large hospital system located in an urban setting in the United States.

Participants: This study involved patients receiving adult IR with diagnoses including, but not limited to, stroke, traumatic brain injury, and spinal cord injury.

Exposures: This study examined characteristics of patients who fell as compared with patients who did not fall, quantified the conditions surrounding falls, and described physical therapists who experienced patient falls.

Main outcomes and measures: Mann-Whitney U tests, chi-square tests, and binomial logistic regression analyses were performed to compare characteristics of faller and non-faller groups.

Results: Among the 6238 unique patient admissions, a total of 40 falls were identified. The rate of falling was 0.43 falls per 1000 patient days. The majority of falls occurred because of buckling (47.5%) and during gait training (40.0%). Falls most often occurred close to discharge (mode = 6 days prior). Fallers were younger than nonfallers (exponential power of B, ie, Exp[B], = 1.02; 95% CI = 1.01-1.04). Diagnoses representing the largest proportion of fallers included brain dysfunction/stroke (30.0%) and spinal cord injury/peripheral nerve injury (30.0%). Fallers had comorbid diabetes mellitus type 2 (Exp[B] = 2.70; 95% CI = 1.45-5.04) and received renal dialysis (Exp[B] = 3.23; 95% CI = 1.14-9.17) in a higher proportion than nonfallers. Fallers were often high functioning, the majority receiving at most minimal assistance (72.5%). Falls most often occurred with therapists who had 1 to 2 years of experience (27.5% of falls).

Conclusions: The rate of falls during therapy was lower than the rate of falls previously reported in similar settings. Therapists should exercise caution when managing younger patients and patients with certain diagnoses. Therapists should screen for buckling risk when prescribing higher-risk activities. Therapists with various levels of experience should receive fal

Importance: Simulation-based education (SBE) is increasingly used in physical therapist training to address growing student numbers and clinical placement shortages. However, clinical educators' perspectives on the role of SBE in preparing students for practice remain unexplored.

Objective: The objective of this study was to explore physical therapy clinical educators' perspectives on academic-based SBE, particularly how it can equip students for clinical placement and whether it should contribute to practice education hours.

Design: Qualitative interpretive description methodology using semi-structured interviews was used.

Setting: Five hospital sites across the island of Ireland engaged in physical therapist practice education.

Participants: This study involved 8 physical therapist practice educators and tutors with 6 to 15 years of experience, supervising 2 to 50 students annually.

Intervention(s) or exposure(s): Individual semistructured interviews were conducted exploring participants' perspectives on SBE's role in clinical education, lasting 40 to 60 minutes each.

Main outcome(s) and measure(s): Thematic analysis identified patterns in clinical educators' perceptions of SBE's educational value and contribution to practice preparation.

Results: Simulation supported the transition to practice by: (1) priming for clinical environments, (2) enhancing feedback literacy in the workplace, and (3) tackling complexity of clinical practice. Specific clinical skills including documentation, basic safety, manual handling, subjective assessment, and understanding the multidisciplinary team's role were recognized as appropriate for instruction through SBE. Participants reported activities spent in SBE should count toward clinical hours and highlighted that processing feedback during SBE established a foundation for feedback practices in the workplace. Engaging simulated patients in scenarios informed by real patient experiences was proposed as a way of managing complex patient encounters.

Conclusions and relevance: SBE provides a means to scaffold the learning of essential clinical skills before practice placement and contributes to clinical education, though more research is needed to determine the proportion. Future research should examine simulated interventions to boost feedback literacy and readiness for clinical settings. Involving patients and the public in the design of SBE curricula is crucial for relevant and beneficial learning outcomes.

Objective: The objective of this review was to identify and describe the varying definitions and operational criteria used to characterize directional preference in musculoskeletal care research.

Data sources: A scoping review was conducted using 6 electronic databases (PubMed, CINAHL, Embase, SPORTDiscus, Web of Science, and Cochrane Library) from inception through May 2024.

Study selection: Studies were included if they involved adults with musculoskeletal conditions and used the term "directional preference" in their methodology or reporting.

Data extraction and synthesis: Data were extracted on terminology, definitions, and operational criteria. Definitions were thematically categorized. Expert consultation with 18 clinicians and researchers was also conducted to evaluate consensus on key components. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines.

Main outcome(s) and measure(s): Primary outcomes included the number and type of directional preference definitions and expert perspectives on essential definitional elements.

Results: Out of 15,390 records screened, 149 studies met the inclusion criteria. These studies exhibited considerable variability, with 111 unique definitions categorized into 8 distinct themes. Notably, 22% of the studies failed to define directional preference, and 15% incorrectly equated it with centralization. Expert consultation (n = 18) highlighted substantial variability in the perceived importance of different definition components, with "response to repeated and/or sustained movements" emerging as the most consistently prioritized criterion. Despite these insights, no consensus on a definition was reached, complicating research interpretation and clinical guideline formulation.

Conclusions and relevance: There is substantial inconsistency in the definition and operationalization of directional preference across the musculoskeletal literature, which impairs research synthesis and clinical translation. Symptom change in response to repeated or sustained movement may serve as a foundation for a standardized definition. Future effort sare needed to establish a clear and consistent definition to support improved research quality and clinical application.

Importance: This case report emphasizes the importance of recognizing and preventing adverse events, specifically pneumothorax related to dry needling (DN), particularly when using rib bracketing techniques in the intrascapular region. It highlights the need for greater clinician awareness to enhance patient safety and minimize the risk of complications during DN interventions.

Objective: The objective of this case report was to describe the clinical presentation, progression, and outcome of a patient who developed a pneumothorax following DN, and to propose alternative methods for safer needling in the intrascapular musculature.

Design: This case report presents a detailed account of a single patient's clinical experience-including the adverse event, its management, and outcome-supplemented by expert commentary from a clinician specializing in DN.

Setting: The setting of this case report was an outpatient physical therapy clinic.

Participants: A 24-year-old woman undergoing physical therapy for chronic neck and shoulder pain.

Intervention(s) or exposure(s): The physical therapist administered DN to the left intrascapular muscles using a rib bracketing technique to treat trigger points.

Main outcome(s) and measure(s): The primary outcome was the development of a pneumothorax, identified through clinical symptoms and confirmed by radiographic imaging. Outcomes included hospitalization, symptom resolution, and return to physical activity.

Results: The patient experienced an unusually sharp pain during needle insertion. Over the following 2 days, she developed dyspnea, thoracic pain, dry cough, and chest discomfort. A radiograph confirmed a moderate left-sided pneumothorax, which was treated with chest tube reinflation and one night of hospitalization. Post-discharge, the patient had residual symptoms for 2 weeks but achieved complete recovery by 1 month, returning to activities like hiking and skiing.

Conclusions: DN can result in serious complications such as pneumothorax. Early recognition and immediate treatment can lead to full recovery. This case raises concerns about the safety of the rib bracketing technique for DN in the thoracic intrascapular region.

Relevance: Physical therapists should exercise caution when performing DN, especially in high-risk anatomical areas. Safer techniques should be considered, and vigilance is crucial to detect and manage adverse events promptly. Enhancing practitioner awareness can improve patient outcomes and safety during rehabilitation interventions.

Objective: The objective of this study was to assess the effectiveness of extracorporeal shock wave therapy (ESWT) in the treatment of chronic adhesive capsulitis (AC) in the type 2 diabetes population.

Design: This study is a systematic review with meta-analysis. The search was conducted in MEDLINE, EMBASE, CINAHL, PEDro, Cochrane Database of Systematic Reviews, UK Clinical Trial Gateway and gray literature from 2012 to 2023. Two reviewers independently screened and extracted data through Covidence and the quality was evaluated using Cochrane risk-of-bias tool for randomized trials. Meta-analyses were conducted to quantify within-group change and comparative effectiveness. Five hundred and seventy-four studies were identified, and 7 studies included (n = 352 participants).

Participants: This study included type 2 diabetic adults (>18 years) diagnosed with primary or secondary AC.

Interventions: This review and meta-analysis included studies comparing ESWT with conservative management.

Main outcomes: The primary outcome was pain. Secondary outcomes included range of movement (ROM) and disability.

Results: Meta-analysis using Bayesian method of within group change showed consistent improvement for pain (-5.7 [95% credible interval (CrI) = -7 to -4.5] cm), ROM (2.6 [95% CrI = 1.4 - 3.8]), and disability (3.6 [95% CrI = 2.3-4.9]). Consistent evidence of improvements favoring ESWT over conservative management was identified for all outcomes. Study heterogeneity had limited influence on non-controlled effect sizes, whereas limited controlled effect sizes lowered the confidence for outcomes of ROM and disability. Limitations included low number of studies, poor methodological quality, and non-adherence to reporting guidelines.

Conclusions: Extracorporeal shock wave therapy for treatment of AC was shown to reduce pain and improve range of motion and disability in the type 2 diabetes population. These results should be interpreted with caution and high-quality randomized controlled studies are required to establish best-practice ESWT protocols regarding application position, dosage, and duration.

Relevance: Extracorporeal shock wave therapy may improve pain, ROM, and disability in type 2 diabetics with AC.

Importance: Low adherence rates to low back pain (LBP) clinical practice guidelines (CPGs) by physical therapists have been reported in the United States; however, no studies have explored barriers to their use.

Objective: The aim of this study was to explore perceived barriers physical therapists face for implementing the most recent LBP CPG from APTA Orthopedics academy.

Design: This was a convergent parallel mixed-methods design.

Setting: This was completed virtually.

Participants: A total of 173 United States outpatient physical therapists completed the survey, with 20 participating in focused interviews.

Intervention(s) or exposure(s): Participants completed an online survey and semi-structured virtual interviews.

Main outcome(s) and measure(s): The primary outcomes were the top barriers identified through survey data and thematic analysis of interviews. A thematic analysis was implemented for the qualitative analysis. A binary logistic regression was used to model relationships between demographic variables, barriers, and CPG use.

Results: Six themes related to barriers to CPG implementation were identified through interviews, including a lack of individualized care, a lack of skills/confidence, patient expectations/perceptions, previous experience, time limitations, and proper understanding of the guidelines. Participants who completed an orthopedic residency program were more likely to report the barrier of "difficulties with 1-on-1 care" (OR = 8.70, 95% CI = 2.12-39.22). Individuals practicing between 1 and 5 years (OR = 7.49, 95% CI = 1.39-52.75) compared to 20+ years, and those reporting regular use of the CPG (OR = 5.81, 95% CI = 1.99-21.51) were more likely to report the barrier of "concern for patient's response."

Conclusion: Novice clinicians and those who completed orthopedic residency reported specific barriers to CPG use. Six major themes related to barriers for implementing the CPG were identified, consistent with majority of the barriers reported in the survey, demonstrating the convergence of analyses. The most common barrier was the perception of sacrificing individualized care.

Impact: This study may help improve adoption and implementation of CPGs in real-world clinical practice settings.

Importance: This study systematically examines the effects of tendinopathy on patients' quality of life and investigates their experiences with rehabilitation.

Objective: This study aimed to synthesize qualitative research exploring the beliefs, perceptions, and experiences of individuals living with tendinopathy by employing a systematic review with meta-ethnography.

Data sources: Studies were identified from 4 databases (CINAHL, EMBASE, Scopus, and ProQuest One Academic).

Study selection: Studies were included if they utilized qualitative methods to investigate beliefs, perceptions, and/or experiences of participants with clinically diagnosed tendinopathy.

Data extraction and synthesis: Data synthesis was completed using the 7 phases of meta-ethnography and reported using the meta-ethnography reporting guidelines. Risk of bias was assessed using the Joanna Briggs Checklist for Qualitative Studies. Confidence in the findings was assessed using the Grading of Recommendations Assessment, Development, and Evaluation Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual).

Main outcomes(s) and measure(s): Twenty-three studies were included (rotator cuff [n = 12]; Achilles [n = 6]; gluteal [n = 2]; lateral elbow [n = 2]; and mixed tendinopathies [n = 1]). Methodological quality of included studies varied. Moderate confidence in review findings 1 and 2 and high confidence in review finding 3.

Results: Qualitative synthesis identified 3 themes: (1) I need to understand why my tendon hurts (participants wanted clarity regarding the cause of symptoms); (2) I want to fix my tendon, but I don't know how (participants had varied beliefs regarding optimal management and how to reduce their pain); and (3) I am uncertain whether my lifestyle will return to normal (participants felt frustrated with the negative impact that tendinopathy had on their life).

Conclusion and relevance: This review provides insights into the lived experiences of individuals with tendinopathy. The review advocates for clearer communication and education regarding causes and optimal management of tendinopathy. Participants' varied beliefs and uncertainties about treatment efficacy suggest that health care providers consider individualized evidence-based guidance to improve patient outcomes.

Importance: Task-specific balance deficits are common in people with neurological disorders (PwND), significantly affecting their activities of daily living (ADLs). However, the relationship between balance deficits and ADLs measured by patient-reported outcomes is poorly understood, thus limiting the selection of specific static and dynamic tasks to be used to train for a given activity.

Objective: The aim of the study was to provide a clinical framework linking ADLs, balance tasks, and balance resources to support clinicians' decision-making when planning task-oriented balance rehabilitation for PwND.

Design: This was an observational study with a cross-sectional design.

Setting: This study examined clinical contexts involving PwND.

Participants: This study involved people with Parkinson disease, stroke, or multiple sclerosis (MS).

Exposure: The study used the Activities-Specific Balance Confidence (ABC) Scale for patient-reported outcomes to assess perceived balance during ADLs, and the Berg Balance Scale (BBS) and Dynamic Gait Index (DGI) to evaluate static and dynamic balance.

Main outcomes and measures: Kendall tau correlations (τ) were used to identify meaningful associations between ABC and BBS-DGI items, matching ADLs with specific balance tasks.

Results: The study sample comprised 299 people with Parkinson disease (n = 94), stroke (n = 94), and MS (n = 111) with a median (interquartile range) age of 63 (52.0-71.5) years, all exhibiting moderate to severe balance impairments. Moderate correlations (τ ≥ 0.39) were found between dynamic and semi-dynamic challenging outdoor ADLs with static and dynamic tasks involving sensory orientation and the use of vestibular and proprioceptive systems. Moreover, stability limits-verticality, anticipatory postural adjustments, and stability in gait are the primary balance resources to consider when designing ad hoc rehabilitation interventions.

Conclusions: This study establishes associations between specific ADLs and balance tasks, offering a clinical framework to identify relevant balance resources for rehabilitation. It provides clinicians with a structured approach for planning task-oriented, needs-based balance rehabilitation for PwND, focusing on the training of specific balance resources to enhance ADLs.

Relevance: This study provides a clinical framework to help clinicians in planning task-oriented and needs-based balance rehabilitation for PwND, suggesting which balance resources should be trained to improve specific ADLs.

The lowest degree of disability acceptance has been found among people with a history of stroke. Disability acceptance involves adapting to disability-related changes and coming to terms with losses to redefine and live a meaningful new life. Across many movement-related disabilities and chronic conditions, disability acceptance has been positively associated with psychological well-being, social and physical functioning, and adjustment. Further, self-acceptance of disability is an important factor in rehabilitation and recovery. There is a growing need for physical therapy to engage with disability acceptance and understand the role of physical therapists and physical therapist assistants in facilitating disability acceptance after stroke. The purpose of this Perspective article is to critically evaluate the role of the physical therapy profession in disability acceptance for people with stroke. The article first reflects on ways in which the physical therapy profession has historically (and unintentionally) created obstructions to disability acceptance after stroke. The authors discuss assumptions implicitly underpinning physical therapist practices for stroke that are consistent with normalization tendencies, medicalized approaches to disability, and the mechanical body. The authors then present new and alternative approaches that can be applied in physical therapy to better facilitate disability acceptance after stroke, focusing on mindfulness-based interventions and a celebration of unique movement strategies of people with disability (ie, movement "improvisation"). The Perspective concludes with practical strategies for clinicians to employ in an effort to better foster disability acceptance poststroke. Impact The physical therapy profession may play an important and unique role in facilitating disability acceptance poststroke. supporting disability acceptance after stroke requires physical therapists and physical therapist assistants to critically reflect on ways in which the profession may unintentionally impede acceptance and consider new and alternative approaches to promote acceptance in clinical practice.