Physical Therapy最新文献

Objective: The Virtual Arm Boot Camp program (V-ABC) was one of the first virtually delivered upper extremity exercise programs coupled with a novel wearable device that provided reach-to-grasp feedback for individuals with stroke. Understanding the experience of participants is critical to improving the implementation of rehabilitation interventions that embed biosensor technology within rehabilitation.

Design: A qualitative study embedded within a multi-center randomized controlled trial conducted on the CanStroke Recovery Trials Platform was used to investigate the experiences of participants post-stroke with the V-ABC program. A qualitative descriptive methodology was used to examine the acceptability of the program, factors influencing its effectiveness, and key elements for practical implementation. Semi-structured interviews were conducted via video conferencing with participants who had completed the program. Conventional content analysis was conducted to analyze the data. Strategies including triangulation, regular analytical meetings, peer examination, and reflexivity were used to increase the trustworthiness.

Setting: Interviews were conducted via videoconferencing using Zoom software.

Participants: Nineteen participants post-stroke (10 males/8 females, mean age = 60.2 [SD = 12.2] years; mean length of time since stroke = 217.0 [SD = 109.2] days) after completion of the program.

Intervention: The 3-week V-ABC program consisted of exercise, feedback from a wearable device on the use of the paretic upper extremity, and therapist support.

Results: Three themes describing the experiences of participants with the program were identified: (1) V-ABC provided motivating practice; (2) equipment and technology setup provided accessibility but posed challenges; and (3) increased use of the paretic hand can be integrated into daily life with varying degrees of success.

Conclusions: An intensive, virtually delivered upper extremity exercise program coupled with biosensing feedback on hand use from a wearable device was reported to be motivating, accessible, and facilitated use of paretic hands in daily life. The findings may help improve the future implementation of the V-ABC program and similar approaches involving telerehabilitation and wearable technology.

Importance: Chronic low back pain (cLBP) is associated with reduced gait speed and other gait quality impairments. Fear-avoidance and pain catastrophizing impact movement in cLBP, but their specific impact on gait quality is unknown.

Objective: This study aimed to determine associations between fear-avoidance or pain catastrophizing and gait quality in cLBP.

Design: This was a cross-sectional study.

Setting: This study occurred at a university.

Participants: There were 500 individuals (56.6 [SD = 16.5] years old; 311 female) with cLBP.

Interventions: Participants completed the Fear-Avoidance Beliefs Questionnaire - Physical Activity (FABQ-PA) and 6-item Pain Catastrophizing Scale. Participants were divided into high and low fear-avoidance subgroups based on an established FABQ-PA cutoff (>14).

Main outcomes and measures: Gait speed was measured during a 4-meter walk test, while step time average, step time variability, and symmetry were derived from a lumbar inertial measurement unit worn during a 2-minute walk test. Multiple linear regression models were used to determine relationships between fear-avoidance or pain catastrophizing and gait quality. T tests were used to determine gait quality differences between high versus low fear-avoidance subgroups.

Results: High fear-avoidance was associated with reduced gait speed (B = -0.0039), but pain catastrophizing was not. The high fear-avoidance subgroup had slower gait speed (mean difference = 0.05 m/s), longer step time (mean difference = 0.02 s), and higher step time variability (mean difference = 0.004 s) compared to the low fear-avoidance subgroup.

Conclusions: Fear-avoidance is associated with slower gait speeds, even after adjusting for demographics, pain, and disability. The established FABQ-PA cutoff is robust in detecting gait differences between high versus low fear-avoidance subgroups.

Relevance: It may be important to consider fear-avoidance in the delivery of multi-modal interventions to address gait impairments. Future studies are needed to determine the impact of addressing fear-avoidance alongside traditional gait interventions in cLBP.

This Perspective offers historical and sociological analyses of the Commission on Accreditation in Physical Therapy Education's (CAPTE) 2016 standard requiring that at least 50% of core faculty in all physical therapist education programs hold an academic doctorate, PhD, EdD, or ScD. The author associates this mandate's development with longstanding concerns among physical therapy leaders about their field's academic status and research productivity, as well as with changes in faculty training backgrounds following the adoption of the required entry-level Doctor of Physical Therapy (DPT) degree. This article draws on the sociological theory of credentialism to examine the origins of the 50% rule and its narrow focus on academic doctorates as the 1 best pathway to enhance faculty research productivity, to the exclusion of other important factors, including social and professional roles, institutional resources, and research mentorship. During the 2010s, when most new graduates held practice-focused DPTs, academic leaders in physical therapy raised concerns about research training among the next generation of faculty. Traditionally, aspiring faculty pursued post-professional training in research skills, but would DPT-holding practitioners be willing to pursue another formal degree? In response, the CAPTE 50% rule required that nearly half of new faculty obtain a second academic doctorate, after having already invested 6 to 7 years in postsecondary education and accruing over $150,000 in debt, on average. The author demonstrates that justifications for the 50% rule were rooted in professional biases and misleading evidence and suggests that this mandate is poorly suited to present academic trends. Importantly, the 50% rule is a significant barrier to entry for all aspiring faculty and an insurmountable 1 for those from less elite backgrounds. Its implementation is unlikely to improve research productivity and threatens the potential of physical therapy's parallel efforts to better represent diverse patient communities.

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.