Physiotherapy Theory and Practice最新文献

Background: Further studies are necessary to sustain the efficacy of decompression interventions and to identify the optimal rehabilitation.

Aim: To compare pain activity patterns, disability, body awareness, proprioception, function in individuals post and pre-lumbar decompression surgery and to reveal intergroup relationships.

Methods: The present study was conducted with a total of 83 participants. Fifty participants were in the operated individuals' group (OI) and 33 participants were in the pre operativeindividuals' group (POI). Participants in OI and POI were assessed one time. The mean duration after surgery was 18.6 months in OI. Participants were evaluated with the Body Awareness Questionnaire (BAQ), the Patterns of Activity Measure-Pain (POAM-P), the Modified Oswestry Low Back Pain Disability Questionnaire (mOSW), lumbar joint proprioception, lower extremity stepping reaction time and the 3 Meter Backward Walking Test (3MBWT).

Results: Symptom duration was longer in OI (p < .05). Avoidance and pacing scores were higher in the OI (p₁ = 0.003, p₂ = 0.001). In the OI, proprioception and 3MBWT were moderately correlated with BAQ (r₁= -0.465, r₂= -0.297, p₁ = 0.0007, p₂ = 0.036). Avoidance and overdoing were weakly correlated with left lower extremity stepping reaction time (r₁ = 0.33, r₂= -0.321, p₁ = 0.019, p₂ = 0.023). Pacing had a weak correlation with the right lower extremity stepping reaction time (r = 0.324, p = .022). 3MBWT and left lower extremity stepping reaction time were moderately correlated with mOSW (r₁ = 0.413, r₂ = 0.43, p₁ = 0.003, p₂ = 0.002).

Conclusion: Avoidance and pacing behaviors were higher in the surgical group. Avoidance, overdoing, and pacing behaviors were associated with reaction time. Body awareness correlates with proprioception and function.

Background: The coexistence of pain and chronic obstructive pulmonary disease (COPD) is acknowledged, yet the pain prevalence and associated factors of the common pain area in the COPD population are unknown.

Objective: This study aims to examine the prevalence of pain in individuals with and without COPD and to explore the connections between common pain areas and related factors.

Methods: Data was gathered through spirometry tests and surveys, including demographics, pain characteristics, Shoulder Pain and DisabilityIndex (SPADI), Neck Disability Index (NDI), COPD assessment test, and dyspnea score.

Results: Comparing pain characteristics between 85 individuals with COPD and 85 age- and gender-matched non-COPD subjects, results showed significantly higher pain prevalence (75.3% versus 42.4%, p < .001), pain severity (3.9 ± 3.1 versus 2.1 ± 2.8, p < .001), pain locations (2 [IQR 0.5, 4.0] versus 0 [IQR 0.0, 2.0], p < .001), NDI (1.9 ± 5.3 versus 0.3 ± 1.7, p < .001), and SPADI (10.1 ± 17.4 versus 4.4 ± 10.6, p < .001) in individuals with COPD. The shoulder is the most common area of pain, followed by the thoracic region and the lower extremities. Notably, individuals with COPD with shoulder pain were more likely to have multiple pain locations (OR = 1.53 [95% CI 1.17, 2.01], p = .002), a high SPADI score (OR = 1.10 [95% CI 1.03, 1.16], p = .003), and a reduced % predicted of forced expiratory volume in the first second (%predicted FEV₁) (OR = 0.96[95% CI 0.92, 0.99], p = .018).

Conclusion: Individuals with COPD exhibit higher pain prevalence than those without, especially in the shoulder area. Multiple pain locations, SPADI score, and % predicted FEV₁may predict shoulder pain in individuals with COPD. The findings suggest further research on shoulder pain causes to develop better treatments for individuals with COPD.

Background: Amyotrophic Lateral Sclerosis (ALS) is a progressive motor neuron disease and presentation varies. There is limited description of this variability and how physical therapy (PT) specific movement system diagnoses (MSD) may impact care.

Purpose: The purpose of this case series is to describe the variability of ALS presentation longitudinally across early, middle, and late stages of ALS based on phenotype and MSD.

Methods: Four individuals were selected from an ALS clinic chart review representing a unique combination of phenotypes and MSDs (Case 1: bulbar onset force production deficit (FPD), Case 2: bulbar onset fractionated movement deficit (FMD), Case 3: limb onset FPD, Case 4: limb onset FMD). Descriptions of care over 9 years included outcomes of disability (ALS Functional Rating scale-revised), activity (10 Meter Walk Test, Five Times Sit to Stand Test, Trunk Impairment Scale-version 2), and impairment (strength and spasticity).

Results: Persons with ALS were seen every 3 to 6 months (10 to 19 visits total). Determination of MSD was hardest to complete in early stage bulbar onset ALS. Patterns of decline through stages varied by MSD and phenotype, most notably in length of time in middle stage. Limb onset FMD had the slowest progression. Falls and fall related injuries were most frequent in limb onset ALS but falls occurred in all cases.

Conclusion: The combination of MSD and phenotype enhanced variability description offers new insights into clinical decision-making in ALS care.

Introduction: Dementia is a leading cause of disability. Physiotherapists play a crucial role in caring for people with dementia. However, previous research has found that physiotherapists have low knowledge and confidence working with people with dementia.

Objective: To determine: 1) What are the components of effective physiotherapy care for people with dementia; and 2) What can be done to facilitate the provision of effective physiotherapy care.

Methods: This was a qualitative study using an interpretive description approach. Sixteen physiotherapists experienced in dementia care participated in semi-structured interviews. Researchers analyzed data using thematic analysis.

Results: Two themes were created for each research objective. The themes explaining the components of effective physiotherapy care were: 1) engaging the person with dementia (subthemes: knowing the person with dementia; using knowledge to adapt the approach to successfully deliver physiotherapy treatments; optimizing the physical environment) and 2) collaborative care (subthemes: working with care partners; working as an interdisciplinary team). The themes describing how to facilitate provision of effective care were: 1) Physiotherapists require "greater opportunity for mentoring and education on dementia care" and 2) Physiotherapists must "advocate for the role of physiotherapy in dementia care."

Conclusion: These findings provide important information regarding the components of effective dementia care for physiotherapists and will help guide clinical practice, inform future dementia education, research, and professional organization advocacy initiatives.

Background: Varus thrust (VT) is a frequently reported abnormal gait pattern in patients with medial knee osteoarthritis (KOA). VT is important to prevent KOA progression. However, there is no consensus on the relationship between VT and foot alignment and flexibility, although it has been reported that patients with KOA have pronated foot.

Objective: In this study, we examined the relationship between VT, foot alignment, and flexibility in patients with KOA.

Methods: Twenty patients with unilateral KOA were included in this study (mean age: 71.5 ± 4.7 years). KOA severity ranged from grade III (8 patients) to grade IV (12 patients) based on the Kellgren-Lawrence classification. Gait analysis using inertial sensors was performed to determine the difference between the VT of KOA side and the contralateral side without symptoms. The correlations between VT, foot alignment, and flexibility were also analyzed.

Results: VT was significantly greater on the side with KOA than on the contralateral side without KOA (d = 1.09, p = .002). VT was not significantly correlated with foot alignment but was significantly correlated with the arch stiffness index, which indicates foot flexibility (r = 0.642, p = .003).

Conclusion: This study suggests that foot flexibility may play a more significant role than foot alignment in addressing VT in patients with KOA. When performing physical therapy for VT, evaluating foot flexibility in addition to foot alignment may help reduce this condition. Further studies with larger sample sizes and more detailed statistical analyses are needed to validate these findings.

Background: Low back pain significantly impacts global health, particularly in low-income areas where primary care challenges are prevalent. Assessing both biophysical and psychological factors associated with low back pain-related disability is crucial for developing effective screening and management strategies.

Objectives: This study aimed to examine the association between fear of movement, trunk mobility, pain intensity, physical activity, and low back pain-related disability, and to identify key factors contributing to higher disability levels in patients with chronic low back pain.

Methods: This cross-sectional study analyzed data from 381 chronic low back pain patients aged over 18, collected at a primary care ambulatory between 2015 and 2019. Variables measured included pain intensity, fear of movement, physical activity, trunk mobility, and disability. A Classification and Regression Tree approach was used to model disability predictors.

Results: Fear of movement was the main driver of high disability (OR = 17.3, 95%CI 8.9-33.7). Two profiles were particularly prone to higher disability: patients with high fear of movement (>47.5) and pain intensity > 1.5; and those with lower fear of movement but poor trunk mobility (>36.5 cm). Patients with better trunk mobility and low pain intensity (≤3.5) showed significantly less disability (OR = 0.06, 95%CI 0.02-0.17).

Conclusions: The findings highlight the need for integrating better psychological and biophysical assessments in managing chronic low back pain. Understanding how fear of movement, trunk mobility, and pain interaction can improve screening accuracy and optimize care in resource-limited settings, using valid and feasible tools for these scenarios.

Background: Body lateropulsion (BL) is a phenomenon in which the body involuntarily falls to one side; however, its detailed postural control characteristics remain unclear.

Objective: This case report aimed to measure the surface electromyography (EMG) of the lower limbs while standing in a patient with severe BL on the affected side due to pontine infarction and to investigate the characteristics of postural control.

Case description: We evaluated a patient with severe BL due to pontine infarction at two-time points, 6 and 20 days after onset, to assess static standing balance under open and closed eye conditions and measure the center of pressure (COP) and lower extremity EMG during these tasks.

Outcomes: There were minimal changes in COP position and total locus length during the eyes closed condition compared to the eyes open condition. However, the head and trunk to the non-BL side of the tilt and bilateral medial hamstring muscle activity tended to be higher when the eyes were closed. At the final evaluation, head and trunk tilt and EMG changes were reduced during the eyes-closed condition compared to the eyes-open condition. The initial postural response was considered to reflect a compensatory postural strategy for BL, characterized by the body involuntarily tilting to one side.

Conclusion: The change in posture over time may indicate a reduction in the compensatory postural response as the condition improves. In this case, characteristic postural findings were identified through EMG measurements, suggesting the possibility of future studies involving multiple cases.

Introduction: Seated exercises can reduce the need for in-person assistance during remote-delivered programs, but its safety implications in stroke are unknown.

Objective: This case-report investigates the effect of a novel, remotely delivered 2-week seated exercise program on mobility in a person living with stroke.

Case description: A 68-year-old man living with a chronic stroke (>1-year post-stroke) and moderate disability (Modified Rankin Scale = 3) participated in a 2-week seated exercise program delivered remotely through videoconferencing (Zoom). Sessions were 60 min, 3 times per week. The participant worked on average at 37% of heart rate reserve (range: 21-53%).

Outcomes: No adverse events were reported during the 2-week intervention. After 2 weeks, Berg Balance Scale score improved by five points. Distance in the six-minute walk test increased from 218 m to 278 m and walking speed increased at self-selected walking (0.18 m/s) and fast-walking (0.28 m/s) pace. Sit-to-stands increased from 5 to 9 sit-to-stands in 30 s. Stroke Impact Scale improved in the following domains: hand function, activities of daily living, mobility, and participation.

Discussion: This novel case-report demonstrated the potential for a 2-week seated exercise program to transfer to meaningful improvements in balance and mobility in a person living with a chronic stroke and mobility impairment. Given the stable seated position, no in-person support was required, while the instructor safely delivered the intervention remotely.

Background: The Academy of Neurologic Physical Therapy's Intensity Matters campaign recommends the implementation of high-intensity locomotor training for all patients with neurologic dysfunction with goals to improve walking.

Objective: Retrospectively determine the effectiveness of a clinician-initiated implementation project on the adoption, reach, and fidelity of high-intensity locomotor training for patients with stroke during inpatient rehabilitation and, determine whether the project led to changes in patient outcomes.

Methods: Retrospective analysis of electronic medical records from 1 year before and after the project. Patients admitted with a stroke diagnosis were included. Demographic information, the number of high-intensity sessions, the percentage of time spent in the target heart rate zone, standardized assessment scores for motor function, functional mobility, balance, gait speed and endurance, and discharge destination were extracted for descriptive and linear mixed model analysis.

Results: Clinician reach was 75%, and adoption of high-intensity training varied between clinicians from 47.1% and 83.3%. Of eligible patients, 55% received the target intervention at least once, reflecting the patient reach. Implementation fidelity was 18.84%. Linear mixed effects modeling revealed a statistically significant effect of time (p < .001) but not group allocation or group × time interaction.

Conclusions: Although statistically significant differences in patient outcomes compared to pre-implementation were not found, results highlight the limitations associated with adopting high-intensity locomotor training for patients post-stroke in this setting .It remains unclear whether the implementation fidelity achieved was sufficient to impact patient outcomes. Further research is needed to establish fidelity targets and identify barriers to successful implementation projects by clinicians.

Objective: Perform a systematic critical appraisal of current clinical practice guidelines (CPGs) for frozen shoulder.

Literature survey: Systematic review of CPGs (PROSPERO number CRD42022368775). Inclusion criteria- CPGs written in English providing guidance on the evaluation and or treatment for frozen shoulder, traumatic injury and neurologic CPGs were excluded.Relevant studies were assessed for inclusion and selected studies were identified from PubMed, EMBASE, Scopus and CINAHL databases. The search strategy was developed by a biomedical librarian, performed on October 9, 2024.

Methodology: Data were extracted from the selected CPGs and underwent quality assessment using the Appraisal of Guidelines for Research and Evaluation (AGREE) II.

Synthesis: The search resulted in 38,428 studies and 2 CPGs were retained for appraisal. The mean overall AGREE II score was 75% (SD = 5.7). Lowest mean scores were found in the applicability (27% SD = 24.0) and editorial independence (48% SD = 14.1) domains. The highest domain scores were found in scope and purpose (92% SD = 7.8) and clarity and presentation (79% SD = 9.9). One CPG was rated as low quality based on a priori criteria and ultimately one higher quality CPG was recommended.

Conclusion: Given the advances in research that have developed over the last decade pertaining to the evaluation and treatment of frozen shoulder there is a critical need for an up to date, evidence informed, high quality CPG in order to identify gaps in our knowledge that the global research community should address.