Physiotherapy Research International最新文献

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.

Background: Normal aging corresponds to neuroanatomical changes such as gray and white matter atrophy, particularly in the prefrontal cortex. These can lead to a decline in cognitive skills such as executive functions, processing speed, and working memory that leads to eventual challenges in performing activities of daily living and limits independent life. Dual-task training is known to be effective in these functions, but the evidence on the comparison between sequential and simultaneous dual-task training remains inconclusive.

Objectives: The main objectives of this randomized controlled trial (RCT) are to compare the effectiveness of sequential (SEQ-DTT) and simultaneous dual-task training (SIM-DTT) on executive functions and balance (static and dynamic) in older adults that combines balance training and computerized cognitive training.

Method: Forty-six older adults (60 years old or above) will be randomly allocated to one of the two groups: SEQ-DTT or SIM-DTT to carry out 60 min of balance training and cognitive intervention either sequentially or simultaneously, respectively, 3 times a week for 8 weeks. We will assess Event-related potential P300 (ERP P300), Trail Making Test (TMT), Stroop Colour and Word Test (SCWT), One Leg Standing Test (OLST), Timed Up and Go Test (TUG), 10 Meter Walk Test (10MWT) & 10 Meter Walk Test-Dual-Task (10MWT-DT). The comparison within the groups and between the groups at baseline and after 8 weeks of intervention will be done using independent t-test and one-way ANOVA, respectively.

Conclusion: The study will help understand the effectiveness of computer-based training in the elderly population for executive functions and the changes in the balance.

Trial registration: The study was registered in the Clinical Trial Registry-India (CTRI) with reference number CTRI/2023/12/060793 on 27/12/2023.

Early physiotherapy interventions in critically ill patients aim to mitigate muscle wasting and functional decline. Lorenzoni et al. examined the effects of early neuromuscular electrical stimulation (NMES) combined with passive in-bed cycling on quadriceps morphology. While ultrasound measurements suggested structural preservation, functional outcomes remained unchanged. From a physiotherapy perspective, preserved thickness does not necessarily indicate preserved function, especially when interventions lack voluntary activation. This Commentary discusses the physiological and methodological limitations of interpreting passive interventions as exercise and emphasizes the need for integrated approaches combining NMES with active participation and multimodal assessment to better align structural preservation with meaningful functional recovery.

Background and purpose: Musculoskeletal (MSK) pain is a common issue among higher education students and is often linked to poor physical function and a high psychosocial burden. In direct access physiotherapy, a patient-centered approach is essential for building a strong therapeutic relationship. While therapist attributes are known to influence this relationship, this study aimed to explore whether patient-specific factors, including psychosocial burden, physical function, and chronic pain, are associated with students' perception of the therapeutic relationship during their first physiotherapy visit.

Methods: This observational cross-sectional study included 326 higher education students with MSK pain (median age: 26 years) visiting direct access physiotherapy in Finnish Student Health Service (FSHS). The Experience of the Therapeutic Relationship questionnaire was used to assess the therapeutic relationship. Patient-specific factors included psychosocial burden and psychological distress, measured with the Short Form Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ-SF) and the Mental Health Index (MHI-5), respectively; physical function evaluated using the Patient-Specific Functional Scale (PSFS), and chronic pain derived from the ÖMPSQ-SF. Additional baseline data, including the level and field of study, FSHS region in Finland, and gender and age, were collected. Multiple linear regression analysis was performed to examine the associations between the therapeutic relationship and patient-specific factors.

Results: Psychological distress (ß = 0.30, 95% CI 0.03 to 0.58) and poorer self-rated physical function (ß = -0.13, 95% CI -0.24 to -0.02) were associated with a more negative perception of the therapeutic relationship. However, no significant associations were found for psychosocial burden (ÖMPSQ-SF moderate-risk ß = -0.19, 95% CI -0.50 to 0.12; high-risk ß = -0.02, 95% CI -0.34 to 0.30) or chronic pain (ß = 0.004, 95% CI -0.22 to 0.22).

Discussion: Psychological distress and impaired physical function appear to be negatively associated with students' perception of the therapeutic relationship. Integrating these factors into patient-centered care could potentially enhance therapeutic interactions.

Artificial intelligence (AI) has impacted numerous scientific and clinical disciplines including biomechanics. Here, this review highlights how AI can be applied to human movement, injury prevention, rehabilitation, sports performance and prosthetic control. Crucial AI methods, such as machine learning (ML), deep learning, and computer vision (CV), facilitate the automated, accurate, and real-time analysis of complex biomechanical data derived from wearable sensors, videos and other modalities These technological developments have expanded the use of biomechanical assessment beyond its traditional laboratory limits, fueling the development of markerless motion capture, personalized rehabilitation, and immersive virtual training environments. Despite advances, there are still challenges in the generalization of models, interpretation of predictions, privacy of data, and ethical issues. Upcoming future steps require both software and datasets to be standardized, explainable AI (XAI) strategies for AI-driven biomechanics, interdisciplinary collaboration to fulfill the promise of AI-driven biomechanics, responsibility and equitability of AI-driven biomechanics.

Background and purpose: To investigate the test-retest reliability, the standard error of measurement (SEM), and the smallest real difference (SRD) of the finger to nose test, as well as establish its reference values, according to sex, age, and dominant limb.

Methods: Individuals were requested to touch a 6 cm target, fixed in front of them, as quickly as possible for 20 s, first with the dominant limb and then with the non-dominant limb. In order to assess test-retest reliability, the test was administered two times, in 30 individuals, 5-7 days apart. In order to establish the Finger to Nose reference values, at least 30 individuals (15 women and 15 men) in each follow age group were collected: 20-29, 30-39, 40-49, 50-59 and over 60 years old. Test-retest reliability was assessed using the intraclass correlation coefficient (ICC). The SEM and SRD were calculated from the ICC.

Results: One hundred and sixty-five individuals were assessed. The test-retest reliability of the Finger to Nose showed good values, with an ICC of 0.92 for the dominant limb and 0.86 for the non-dominant limb. The SEM values were < 15%, being 9% for the dominant limb and 11% for the non-dominant limb, and were also considered adequate. Regarding the SRD, the values found were 7 points for the dominant limb and 8 points for the non-dominant limb. Finally, reference values were established based on sex, age and limb dominance.

Discussion: This study showed that the Finger to Nose test has good reliability for assessing upper limb motor coordination. In addition, changes of at least 7 points in the dominant limb and 8 in the non-dominant limb are necessary to be considered clinical changes in the patient. Finally, reference values were defined based on sex, age and dominance, offering support for future assessments and interventions.

Background and purpose: Low back pain (LBP) frequently co-occurs with other health conditions, but there is no clear consensus on which comorbidities are most prevalent. This limits understanding of the broader burden and challenges clinical practice.

Methods: Systematic searches were conducted in seven databases, including PubMed, Embase, CINAHL, PsycINFO, PEDro, Rehabilitation and Sports Medicine Source, and Cochrane Library. Observational studies on adults (≥ 16 years) with nonspecific LBP and at least three comorbidities were included. Data were extracted, tabulated, and quality assessed using CASP checklists and GRADE classifications.

Results: Nine peer-reviewed studies were included. The prevalence of at least one comorbidity ranged from 49% to 92%, with hypertension, osteoarthritis, and chronic pain elsewhere in the body being the most proportionally prevalent comorbidities in individual study populations. Across all studies, hypertension, diabetes, osteoarthritis, asthma, and depression were the most frequently reported comorbidities. Comorbidity assessment, population characteristics, and prevalence varied significantly. Certainty in the prevalence of comorbidities varied from "very low" to "moderate."

Discussion: Comorbidities are highly prevalent in adults with LBP. The included studies varied considerably in comorbidity assessment, reporting, and study populations, where sociodemographic factors like sex, age, marital status, education, and employment likely influenced comorbidity prevalence and types. Findings emphasize the need for standardized assessment methods and tailored physiotherapy approaches to address the diverse needs of this population.

Background and purpose: Chronic low back pain (CLBP) is the leading cause of years lived with disability worldwide. Several risk factors, such as psychosocial and body composition, are associated with CLBP. However, the isokinetic strength and trunk muscle quality index (MQI) have been poorly explored. Thus, this study aimed to compare clinical, body composition, and functional variables between healthy people and CLBP patients by sex and to determine the relationship between clinical and body composition variables according to sex.

Methods: Cross-sectional study. Twenty-eight healthy (22.0 ± 1.3 years, 72.5 ± 14.3 kg, and 1.70 ± 0.1 m) and 25 CLBP (24.1 ± 5.8 years, 72.1 ± 11.7 kg, and 1.67 ± 0.1 m) participants were evaluated for pain (Numeric Rating Scale), disability (Oswestry disability index), kinesiophobia (Tampa scale), body composition (DXA), isometric and isokinetic trunk strength, and trunk MQI.

Results: Pain, disability, and kinesiophobia were greater in the CLBP group, but no differences in body composition were found independent of sex. The CLBP group had less extensor and flexor relative strength, differences maintained in females, but higher rotator strength, a difference that is only maintained in males. Trunk MQI is lower in the CLBP group for flexors and extensors but higher for trunk rotators, a difference maintained only in males. No correlation between body composition and clinical variables was found; however, a significant large correlation between kinesiophobia and fat mass and distribution existed for males with CLBP.

Discussion: Compared to healthy people, CLBP patients have greater pain, disability, and kinesiophobia independent of sex, but they are not different in body composition. CLBP patients show fewer extensors and flexors strength and MQI; however, they have greater rotator strength and MQI, differences that are only maintained in males. Despite this, males present with pain and disability, so the role of trunk strength and MQI should be explored.