Physical Therapy最新文献

Objective: Physical therapists routinely deliver and prescribe motor practice to improve function. The ability to select optimal practice regimens is limited by a current lack of detail in the measurement of motor practice. The objective of this study was to quantify the type, amount, and timing of gross motor practice during physical therapist sessions.

Methods: A secondary video coding analysis of physical therapist sessions from the iMOVE clinical trial (NCT02340026) in young children with cerebral palsy (CP) was conducted. The 37 children who completed the treatment phase were included (mean age = 22.1 months). Children could initiate pulling to stand but were unable to walk. Videos of randomly selected therapy sessions were coded for gross motor activity (422 videos total). The 10 gross motor activity codes included lying, sitting, four point, crawling, kneeling, knee walking, standing, walking, transitions between floor postures, and transitions to/from an upright posture. Twenty percent of each video was double coded for reliability. Time per session, number of bouts, and median time per bout were calculated for each gross motor activity and for 2 aggregate measures: movement time and upright time.

Results: Participants spent more than half of therapy time in sitting and standing combined (60.3%). Transitions occurred more frequently than any other motor activity (49.3 total transitions per session). Movement time accounted for 16.3% of therapy time. Upright time accounted for 53.3% of therapy time.

Conclusions: Critical practice time to gain motor skill is not equivalent to chronological time or time spent in therapy. Toddlers with CP spent a small amount of therapy time moving. Future work should explore the relations between motor practice and rehabilitation outcomes.

Impact: Physical therapists are ideally suited to detail the content of motor practice and ultimately to prescribe optimal patterns of motor practice. We report the characteristics of gross motor practice during therapy in children with CP.

Objective: The goal of this review was to investigate factors associated with physical activity and sedentary behavior in people with Parkinson disease (PD). The magnitude of these associations were investigated in line with the International Classification of Functioning, Disability and Health components.

Methods: A systematic literature review was conducted until February 2023, searching 4 databases (PubMed, EMBASE, Web of Science, and Scopus) for original articles investigating associations with physical activity or sedentary behavior in people with PD. Two independent researchers performed data extraction, and the risk of bias in the included studies was assessed using the Quality in Prognosis Studies tool. Meta-analyses were conducted to determine the magnitude of the associations, and significant regression models from the included studies were described.

Results: Forty-two studies were included. Twenty-one factors associated with overall physical activity were identified. Higher levels of physical activity had small association with cognition and body mass index, and fair association with 17 factors related to self-efficacy, physical function, mobility, quality of life, age, PD symptoms, and more. Better manual dexterity and functional gait had moderate to good association with higher levels of physical activity. The regression model with the higher magnitude was composed mostly of contextual factors, except for the body max index. The magnitude of factors associated with physical activity intensity or sedentary behavior could not be identified.

Conclusion: Functional gait and manual dexterity were the strongest factors related to physical activity in people with PD. Further investigation is needed to understand the factors associated with physical activity intensity and sedentary behavior.

Impact: This study emphasizes the significance of considering contextual factors alongside body function and structure, activity and participation, and the health condition to enhance physical activity improvement during the rehabilitation process. By adopting such holistic approach, rehabilitation professionals can optimize the overall health and wellbeing of individuals with Parkinson disease.

Objective: The objective was to determine the validity of the Targeted Motor Control (TMC) screening tool with the Neurosensory Motor Developmental Assessment (NSMDA) in 4-year-old children.

Methods: In this single cohort observational study, children (3 years 9 months to 4 years 5 months) completed the TMC and the NSMDA in a randomized order 5 to 14 days apart.

Results: Seventy-six children (mean age = 4 years 2 months; standard deviation = 2.5 months; n = 35 male) completed both assessments. Forty-two children performed within the normal range on the NSMDA. There were significant and positive moderate correlations between the item totals overall and for each area on the NSMDA and the TMC (r = 0.40-0.61), and between the NSMDA functional grade for each area and the corresponding TMC areas (r = 0.47-0.67). However, the correlation between the NSMDA sensorimotor functional grade and the TMC sensory score was significant but low and positive (r = 0.35). The optimal cut-off score for detecting children at risk of atypical development on the TMC was a score of <9 (n = 42) (sensitivity = 82.4%; specificity = 66.7%), with a positive likelihood ratio of 2.47 (95% confidence interval [CI] = 1.57-3.89) and a negative likelihood ratio of 0.26 (95% CI = 0.12-0.56).

Conclusion: The TMC is a valid screening tool to identify 4-year-old children at risk of motor delay.

Impact: Early identification of developmental concerns using a validated screening tool is recommended. The TMC is a valid performance-based screening tool that can be used to identify children at risk of atypical motor development who would benefit from further developmental assessment so that, if indicated, timely intervention can be implemented.

Objective: Long-term follow-ups of prehabilitation programs for lumbar spine surgery are lacking, and more comprehensive evaluations are needed. In the current study, we evaluated the long-term effects of a prehabilitation program compared with conventional care in relation to lumbar fusion surgery in patients with degenerative disc disease.

Methods: Patients (n = 118) receiving lumbar fusion surgery were included in a multicenter randomized controlled trial, involving 1 university hospital and 2 spine clinics. The intervention was a person-centered prehabilitation program based on cognitive-behavioral physical therapy that targeted psychological presurgical risk factors, physical activity, and overall health. The control group received conventional preoperative care. Patient-reported outcome measures (PROMs) included assessments at 8 time-points: low back disability (primary outcome), back pain intensity, leg pain intensity, pain catastrophizing, fear of movement, anxiety and depressive mood, health-related quality of life, and patient-specific functioning. Physical activity and physical capacity were assessed at 5 time points. Linear mixed models were used to analyze the effects of the intervention.

Results: There were no significant differences between groups at the 12- and 24-month follow-ups for any outcome, except for the One Leg Stand test 1 year following surgery, in favor of the control group. There were significant improvements for both groups, from baseline to the 12- and 24-month follow-ups for all physical capacity test and patient-reported outcome measures, except for leg pain and self-efficacy for exercise.

Conclusion: No long-term effects were found for the prehabilitation program compared to conventional care. Physical activity did not improve over time, despite significantly improved self-reported functioning and physical capacity measurements.

Impact: These findings have implications for the current understanding of the long-term effects of prehabilitation and suggest that future research should focus on programs promoting physical activity both before and after lumbar spine surgery to decrease the risk of long-term adverse health outcomes.

People living with chronic primary or secondary musculoskeletal pain conditions such as low back pain, fibromyalgia, and inflammatory arthritis typically experience wide-ranging impacts on their physical function, activity participation, and psychosocial wellbeing. These can extend to negative impacts on a person's sexual function and their intimate relationships. While sexual function is an important component of wellbeing, it is often not considered within musculoskeletal pain care. Without awareness or targeted training, physical therapists may lack the confidence and skills to screen, assess, and manage the impacts that pain may be having on a person's sexual function and can miss the opportunity to tailor their care and optimize wellbeing. This article seeks to raise awareness among physical therapists of how living with chronic musculoskeletal pain can impact a person's sexual function and intimate relationships, and provide guidance on how to consider these issues within a person-centered approach to care. It describes why considering sexual function and intimate relationship issues as part of a person's lived musculoskeletal pain experience may be relevant, outlines the use of validated patient-reported outcome measures to assess sexual dysfunction, and suggests practical strategies for sensitively raising sexual function in consultations. Management approaches and possible referral pathways are also presented, to assist physical therapists in understanding available care options. This article seeks to support holistic care by improving physical therapists' knowledge and understanding of sexual dysfunction and its management in people living with chronic musculoskeletal pain.

Impact: Considering sexual function as a valued functional activity, together with other activities of daily living, will assist physical therapists to provide more holistic and person-centered care. This article covers the main considerations for raising sexual function and intimate relationship issues with people living with chronic musculoskeletal pain, as well as management options and potential referral pathways. Physical therapists are encouraged to seek targeted training to improve their confidence and skills in this area, and to use inclusive, respectful language for discussions around sexual function and intimate relationships.