Physiotherapy Research International最新文献

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: 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/.

Background and purpose: Short Hamstring Syndrome (SHS) is described as a deficit of extensibility of this musculature. In contrast to Proprioceptive Neuromuscular Facilitation (PNF), which is widely used in these cases, the abdominal hypopressive technique (AHT) is presented as a possible method to improve flexibility. The primary aim of this trial was to assess the feasibility and acceptability of a single-session AHT program versus PNF stretching in adults with SHS, while the secondary, exploratory aim was to estimate their immediate effects on hamstring flexibility to inform the design and sample size of a future definitive trial.

Methods: A pilot randomized controlled trial of a single treatment session was designed, with a pre- and post-treatment evaluation to assess the effects of both techniques on flexibility. 19 subjects were randomized into an AHT group and a PNF stretching group. The Straight Leg Raise and Toe Touch tests assessed changes after treatment. Paired samples t-tests and independent samples t-tests were used to statistically analyze changes within and between groups, respectively.

Results: Significant improvements were observed in both groups on all tests pre- and post-intervention. However, no significant differences were found between the groups following the intervention.

Discussion: Both AHT and PNF techniques produced immediate improvements in hamstring flexibility in adults with shortened hamstring syndrome. However, these findings are exploratory, and, given the pilot nature of the trial, no conclusions can be drawn regarding the superiority of one method over the other.

Background and purpose: Balance impairments are among the most common motor impairments in patients with neurological disorders. Transcranial direct current stimulation (tDCS) and robotic-assisted gait training (RAGT) have recently been used in stroke rehabilitation. This review aims to investigate the effects of combined tDCS and RAGT on balance ability in patients with stroke.

Methods: Multiple databases, including PubMed, SCOPUS, Embase, Cochrane Library, REHABDATA, and Web of Science, were searched from inception to June 2025. The risk of bias across the included studies was assessed using the "Physiotherapy Evidence Database (PEDro)" scale. Statistical analysis was carried out using "Comprehensive Meta-Analysis Version 4 software".

Results: Five studies met the eligibility criteria. In total, 207 patients with stroke (mean age 60.73 years, 43% female) were included in this review. The median score on the PEDro scale is 9 with 95% range: 6-10 and IQR: 2. Based on three studies, the meta-analysis on combining tDCS with RAGT for balance in post-stroke patients showed a small, non-significant effect (Berg Balance Scale; SMD = 0.329, 95% CI: -0.622 to 1.279, p = 0.498). Heterogeneity was moderate (I² = 63%, Q = 5.347, p = 0.069) with a prediction interval of -1.233 to 1.892. IMPLICATIONS OF PHYSIOTHERAPY PRACTICE: tDCS combined with RAGT appears safe and well-tolerated, but its effectiveness on balance post-stroke remains inconclusive. The meta-analysis showed a small, non-significant effect with substantial heterogeneity. Although some studies reported significant improvements, variability across protocols and outcomes limits firm conclusions. Further high-quality research is needed to clarify the benefits.

Background and purpose: Sarcopenia can lead to negative outcomes for the functionality of individuals post-stroke. Therefore, understanding the prevalence of sarcopenia after a stroke is extremely important in order to plan specific interventions. To provide an up-to-date meta-analysis to investigate the prevalence of sarcopenia in individuals after stroke.

Methods: This systematic review was carried out in the MEDLINE, SCIELO, EMBASE, LILACS, PEDro, EBSCOHOST, AMED and gray literature databases, with no date or language restrictions.

Results: Of the 1142 articles found, 31 were included in the review, totaling 7357 post-stroke individuals. Of these, 74.1% were in an in-hospital setting and 38.7% were in the acute post-injury phase. Most of the studies were carried out in Asia (80.6%) and diagnosed sarcopenia according to the Asian Working Group of Sarcopenia consensus (58%). A low-quality screening prevalence of 42.4% (95% CI 13.0%-78.5%; I² = 99%) and 37.2% (95% CI 30.7%-44.2%; I² = 97%) of sarcopenia diagnoses with moderate-quality evidence were observed.

Discussion: High prevalence rates of post-stroke sarcopenia were observed, with high variability in relation to the form used for diagnosis and screening. It is important to highlight additional points observed such as a lack of consensus on definition and diagnostic criteria for sarcopenia, a variation of tools to measure body mass, a lack of consensus regarding the side of the assessment and a high heterogeneity of the samples analyzed, which can directly impact on the results found.