Physiotherapy Research International最新文献

Background: Peripheral nerve injuries of the upper limb frequently lead to severe motor and sensory impairment, surgery restores nerve continuity, and functional recovery often remains suboptimal without structured rehabilitation. This study evaluated the impact of Structured Physiotherapy on Post-Surgical Outcomes of Upper Limb PNI.

Methodology: A prospective comparative cohort design was implemented across tertiary hospitals. One hundred participants who underwent surgical repair for median, ulnar, or radial nerve injuries were consecutively recruited and followed for 6 months. Fifty patients received a structured physiotherapy program, while 50 received routine postoperative care. Functional (DASH, MHQ), motor (MRC grade), sensory (Semmes-Weinstein), pain (VAS), and work-return outcomes were evaluated at baseline, 6 weeks, 3 months, and 6 months. Data were analyzed using repeated-measures ANOVA and multivariable mixed-effects models with baseline adjustment.

Findings: Mean DASH scores improved from 65.2 ± 10.4 at baseline to 32.4 ± 11.2 at 6 months compared to 64.7 ± 11.1 to 44.7 ± 12.5 in controls (adjusted mean difference = -10.8; p < 0.001). Motor function (MRC ≥ 4.5: 37.5% vs. 16.7%; p = 0.03), sensory restoration (83.3% vs. 62.5%; p = 0.03), and pain reduction (VAS 2.9 ± 1.1 vs. 4.1 ± 1.3; p < 0.001) significantly favored physiotherapy. Return-to-work rates were higher (70.8% vs. 50%; p = 0.04).

Discussion: Structured physiotherapy accelerates neurofunctional recovery and bridges the persistent gap between surgical repair and real-world functionality. These findings suggest that even within resource-limited settings, the scientific application of structured rehabilitation can transform nerve repair outcomes from anatomical success to true functional independence.

Background and purpose: Hip fracture is a serious and common injury affecting older adults with significant psychosocial impacts. However, there is little information available on the assessment and treatment of psychosocial impacts of hip fracture during rehabilitation. Our aim was to determine the extent to which psychosocial factors are: (1) incorporated into goal setting; and (2) assessment and treatment during rehabilitation after hip fracture.

Methods: A retrospective data audit of patients admitted to a community rehabilitation program with a primary diagnosis of hip fracture from 30 June 2022 to 30 June 2023 in Melbourne, Australia. Data were extracted from the assessment and treatment notes of physiotherapists and occupational therapists.

Results: One-hundred included patients (59% female, mean age 81 (SD 7) years) were admitted to the community rehabilitation program an average of 41 days (SD 29) after hip fracture. All patients consulted a physiotherapist, 23 an occupational therapist, 6 a dietitian and 3 a social worker. Overall, 3 of 100 patients had a goal that focused on psychosocial functioning and 21 had a goal with a psychosocial element. A total of 96 patients had a mental health screening, but of 17 who were assessed as being 'at risk', 9 (53%) patients did not receive any documented psychosocial management, including 5 (29%) who declined referrals for mental health services. Apart from those patients screened as 'at risk' a number of patients with clinical notes indicating psychosocial concerns were recorded as receiving education (n = 16) and encouragement (n = 9).

Discussion: Psychosocial aspects of goals, assessment and treatment are rarely the focus of management in rehabilitation after hip fracture. More attention is needed to assess and treat psychosocial factors as part of a multidisciplinary, holistic approach to rehabilitation after hip fracture.

Background and purpose: It is unknown how Patient-Reported Outcomes Measures Information System Physical Function (PROMIS-PF) corresponds to physical abilities and common performance-based measures of function in patients with neurologic conditions/disorders in outpatient, ambulatory settings. The purpose of this study was to evaluate the association between PROMIS-PF and common performance-based measures of function in patients with neurologic conditions receiving outpatient physical therapy (PT).

Methods: A retrospective analysis of clinical data was conducted from 11 outpatient neurologic PT clinics within a large health care system between 12/2/2019 and 12/30/2022. Adult patients with neurologic conditions who had at least one performance-based functional measure [Timed up and go (TUG), 5 times sit to stand (5 × STS), and 10-m walk test (10 MWT)] and one PROMIS-PF score within 7 days were included. Pearson correlations and linear regression models were used to examine the relationships between the PROMIS-PF and performance-based measures.

Results: In our study of 1712 patients (average age 59 (SD 16) years, 44% male, 81% white race), there was a moderate relationship between PROMIS-PF and TUG and PROMIS-PF and 5 × STS (r = -0.31 and -0.38, respectively; p < 0.001). There was a strong association between PROMIS-PF and 10 MWT (r = 0.60; p < 0.001). In linear regression models, the variation in PROMIS-PF explained by the performance measures was the highest for 10 MWT (34.8%), followed by 5 × STS, and TUG (13.5% and 9%, respectively).

Discussion: Results demonstrated moderate associations between PROMIS-PF and performance-based measures. Both types of measures provide complementary clinical information for outpatients with neurological conditions.

Background and purpose: Immersive virtual reality (IVR)-based rehabilitation provides high-intensity, engaging, task-oriented training and motor exploration for upper limb (UL) recovery post-stroke. However, its feasibility and dose-response in acute and subacute stroke patients remain unclear. The purpose of this study was to evaluate the feasibility, safety and dose-response of IVR-based rehabilitation for post-stroke UL recovery.

Methods: A pilot trial included 12 acute and subacute stroke patients (mean age 59.8 ± 14.2 years) with upper limb impairment randomized into two groups: Group A (10 IVR sessions + conventional rehabilitation [CR]) and Group B (20 IVR sessions + CR). Feasibility outcomes included adherence, usability (User Satisfaction Evaluation Questionnaire [USEQ], System Usability Scale [SUS]), system operability, and adverse effects. Motor outcomes, categorized by the International Classification of Functioning, Disability, and Health (ICF), assessed UL impairment (Fugl-Meyer Assessment, Medical Research Council scale), activity (Box and Block Test), and participation (Motor Activity Log 30). Blinded therapists conducted assessments at baseline, post-intervention, and 4-week follow-up. Dose-response was analyzed using Probability of Superiority (PS).

Results: Feasibility was high, reporting 98% adherence, favorable usability scores (USEQ: 81.6 ± 15; SUS: 77.5 ± 7.4), efficient setup time (5.14 ± 1.57 min), system stability (77.86 ± 6.78%) and no severe adverse effects. Clinically meaningful motor improvements were observed across all ICF domains in both groups. Although the sample size was insufficient for inferential testing, descriptive trends and PS values above 75% suggested a potential dose-response trend favoring higher IVR exposure.

Discussion: IVR-based rehabilitation showed high feasibility, safety, and improvements in motor recovery, with a dose-response trend favoring higher doses. These findings align with evidence that IVR enhances neuroplasticity-driven recovery through high-intensity, engaging, exploratory, and task-oriented upper limb training. Despite the small sample and brief follow-up, this study provides key data to guide larger trials on efficacy and optimal dosing.

Trial registration: ClinicalTrials.gov, https://clinicaltrials.gov/study/NCT07086365, NCT07086365.

Background and purpose: Neuromuscular electrical stimulation (NMES) has shown promise as an adjunct or alternative to traditional training, but its optimal application in chronic kidney disease (CKD) population remains uncertain. This study aimed to compare the effects of the NMES intradialytic protocol combined with a traditional cycling on muscle strength and functional capacity in CKD patients.

Methods: Fourteen patients were randomly assigned to either the experimental group (cycling plus NMES) or the control group (cycling only). Treatments were administered twice weekly for 8 weeks. Primary outcomes included muscle strength (isometric manual dynamometry) and functional capacity (1-min sit-stand test). Secondary outcomes included neuromuscular excitability, respiratory muscle strength, and quality of life.

Results: After 8 weeks, repeated measures ANOVA showed no significant differences between the groups for any outcomes.

Discussion: This study demonstrated that NMES was not superior to the cycling protocol in terms of peripheral muscle strength, functional capacity, neuromuscular excitability, respiratory muscle strength, and quality of life.

Background and purpose: Pain and a progressive loss of glenohumeral (GH) joint mobility are the hallmarks of frozen shoulder (FS), which can seriously hinder daily activities. Limited GH mobility may be linked to increased neural mechanosensitivity, which could contribute to pain and functional limitations, though the precise mechanisms are still unclear. This study was established to compare the effectiveness of slider median nerve neural mobilization techniques (NMTs) versus the tensioner technique on pain intensity, functional disability and passive ROM of the GH joint in patients with FS.

Methods: Sixty-two patients with FS from both genders were randomly assigned to two equal groups. Group (A) received the slider technique of median nerve mobilization, whereas group (B) received the tensioner technique. All patients in both groups received GH joint mobilization and traditional physical therapy (three sessions per week for 6 weeks). Patients were evaluated for pain intensity by Visual Analog Scale (VAS), functional disability by Shoulder Pain and Disability Index (SPADI) and passive ROM of the GH joint by conventional goniometer at baseline and after the sixth week.

Results: Intergroup comparison revealed that there were statistically significant differences in the post-treatment measured outcomes: VAS (p = 0.003), SPADI (p < 0.001), passive abduction ROM (p < 0.001), passive external rotation ROM (p < 0.001), passive internal rotation ROM (p < 0.001).

Discussion: Both slider and tensioner median NMTs produce better improvements in pain alleviation, functional ability, and GH mobility in patients with FS, with slider approaches providing slightly greater, although incremental, benefits.

Trial registration: NCT06664437.

Background and purpose: Direct-access physiotherapy is often the first point of care for students with musculoskeletal pain, where early therapeutic alliances shape engagement and recovery. This commentary addresses an attribution gap in prior research by proposing a therapist-aware perspective that distinguishes student vulnerability from provider- and system-level influences.

Methods: Presents a conceptual and interpretive framework, integrating alliance theory and multilevel attribution principles to reconsider how first-visit alliance findings should be interpreted in student physiotherapy.

Results: Therapist-aware perspectives clarify that apparent alliance difficulties may reflect modifiable clinician behaviors or service structures rather than fixed student characteristics. One concise example of behaviorally anchored alliance measurement is presented.

Discussion: Repositioning alliance as a modifiable component of care supports fairer interpretation, targeted training, and scalable quality improvement without extending consultation time.

Background and purpose: Endurance of the deep neck extensor muscles is essential for cervical spine stability and function, yet population-specific normative reference values remain limited for middle-aged adults. This study aimed to establish age-, sex-, and activity-specific normative values for the Deep Neck Extensor Endurance Test (NEET) in asymptomatic adults.

Methods: In this observational study, 448 healthy adults (29-60 years) were assessed using the standardized NEET protocol. Endurance holding time was recorded, and participants were stratified by age decade, sex, and physical activity level using the International Physical Activity Questionnaire (IPAQ).

Results: The mean ± SD NEET time was 38.42 ± 24.04 s (median [IQR]: 35.82 [16.96] s). Endurance declined progressively with age. Males demonstrated slightly higher endurance than females, although the difference was small. Participants with higher physical activity levels demonstrated greater endurance compared with less active individuals (p < 0.05). While between-group differences were modest, values below the 25th percentile (≈26 s) may indicate clinically relevant reduced endurance.

Discussion: This study provides age-, sex-, and activity-specific normative NEET reference values for adults aged 29-60 years. These benchmarks can assist clinicians in identifying reduced cervical extensor endurance, setting rehabilitation targets, and objectively monitoring outcomes.

Trail registration: CTRI/2024/08/072963 (Registered on 23/08/2024) trial registered prospectively.

Background and purpose: Pusher Syndrome, or lateropulsion following hemispheric stroke magnifies disability and delays recovery. This postural control aberration has been linked to disruption of vestibular-mediated verticality perception and altered vestibulospinal activity. Modulating this activity by whole-body rotation could improve postural control in lateropulsion and expedite recovery. A randomised feasibility pilot study and kinematic reliability evaluation were conducted to determine the appropriateness of utilising and pursuing novel, rotatory vestibular stimulation targeting lateropulsion.

Methods: Acute stroke patients with lateropulsion at two stroke units in the United Kingdom (UK) were allocated to a vestibular intervention group or a conventional physiotherapy control group. Intervention group participants received 360° whole-body rotations plus routine physiotherapy. Measures of feasibility and postural control were collected over a 6-week period. Inferential analyses were conducted to crosscheck for adverse outcomes. Kinematic parameters of the vestibular intervention were investigated in a parallel study.

Results: Eight participants were recruited and six completed the trial. The novel intervention was readily administered during all planned treatment sessions with no adverse events reported. Gains in balance and trunk alignment were found in the intervention group only, but some of the postural measures used had questionable reliability. There was acceptable within-subject variability in the kinematic properties of the vestibular intervention.

Discussion: All feasibility and acceptability criteria were met supporting the progression to a larger scale pilot study, which should incorporate additional measures of postural control and a larger sample to further refine the methodology of an efficacy study.

Trial registration: Research Registry: researchregistry848 https://www.researchregistry.com/browse-the-registry#home/registrationdetails/5693d35a3f7235ec10988289/.