Physiotherapy Theory and Practice最新文献

Background: Class III obesity is associated with wide variability in early weight-loss response after metabolic and bariatric surgery (MBS), creating a need for simple preoperative measures that can help stratify risk for early nonresponse.

Objective: To determine whether preoperative physical functional capacity, assessed by the six-minute walk test (6MWT), predicts short-term weight loss outcomes following MBS.

Methods: In this retrospective study, a total of 164 adults (mean age = 43.1 ± 10.9 years) with class III obesity underwent MBS, predominantly laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy. Three 6MWT models using (1) absolute distance, (2) percentage of predicted distance, and (3) 6MWT/body mass index (BMI) were evaluated to predict nonresponse, defined as less than 45% excess BMI loss at six months. Patients were split into development and validation cohorts. Predictive performance was assessed with receiver operating characteristic curves, area under the curve (AUC), sensitivity, and specificity.

Results: Patients achieved a total body weight loss of 26.0 ± 6.9% and excess BMI loss of 57.3 ± 18.0% (76.6% follow-up). Model 3 showed the strongest predictive performance (development AUC = 0.74; validation AUC = 0.78). Model 1 demonstrated high sensitivity (0.83) but lower discrimination (validation AUC = 0.67).

Conclusions: Preoperative 6MWT performance provides promising prognostic information for early nonresponse to weight loss following MBS. The 6MWT/BMI ratio showed the strongest and most consistent predictive performance within our cohort, supporting its potential role as a valuable supplementary risk stratification tool. Absolute 6MWT distance may serve as a high-sensitivity screening tool. When used in conjunction with other clinical assessments, this two-step approach may help identify patients at risk for nonresponse and guide targeted perioperative interventions.

Background: Temporomandibular disorders (TMDs) are associatedwith orofacial pain and functional limitations. Although conventionalphysiotherapy is commonly used, the additional benefits ofproprioceptive neuromuscular facilitation (PNF) remain unclear. Thisstudy investigated the effects of adding PNF to conventional exercisetherapy in individuals with myogenous TMD.

Methods: A randomized controlled trial was conducted with 66participants aged 18-65 years diagnosed with myogenic TMD.Participants were divided into two groups for 4 weeks: a traditionalexercise group (CEG) or a traditional + PNF exercise group (PNFE).Pain intensity was assessed using the Numerical Pain Rating Scale(NPRS). Patient-reported mandibular function was evaluated using theMandibular Function Impairment Questionnaire (MFIQ). Mandibularmobility was assessed using jaw range of motion measures, includingactive range of motion (AROM) parameters (pain-free opening (PFO) andmaximum unassisted opening (MUO)) and assisted active range of motion(AAROM), measured as maximum mouth opening (MMO). Evaluations wereperformed at baseline (T0) and immediately after completion of the4-week intervention (T1).

Results: From T0 to T1, pain intensity decreased significantlyin both groups (p < .001), with a moderate effect size indicating a greater reduction in the PNFE group (ηp² = 0.110, p = .043).Patient-reported mandibular function(MFIQ), improved in both groupsover the 4-week intervention period (p < .001). The PNFE groupdemonstrated greater gains in jaw range of motion (MMO and MUO);however, these changes were small (ηp² = 0.021 and ηp² = 0.002).

Conclusion: PNF exercises, when combined with conventionalexercises, provided greater pain relief and improved ROM compared toconventional exercises alone, suggesting their potential value inTMDs rehabilitation. Further research is needed to assess long-termeffects.

Introduction: Exercise is used for maturing arteriovenous fistula (AVF) in patients with chronic kidney disease (CKD) to improve endothelial function and vessel adjustments for hemodialysis.

Objective: To evaluate the effects of a progressive exercise protocol to increase the diameter and distensibility of the cephalic vein prior to AVF creation.

Method: This is a case series study developed with nine patients with CKD (stages 4 and 5) aged between 35-75 years who participated in the training protocol distributed in two groups [non-progression group (NPG) and exercise progression group (EPG)], trained five days a week for four weeks. Patients were evaluated for diameter and distensibility of the cephalic vein (ultrasonography) at 2, 10 and 20 cm of the non-dominant limb and handgrip strength (HGS) before and after the protocol.

Results: Th patients who participated in the study all showed an increase in the diameter and distensibility of the cephalic vein. Younger and older patients showed better performance in terms of diameter and distensibility of the cephalic vein in the 2 cm (1.3 to 4.2 mm) and 20 cm segments (1.6 to 5.2 mm), respectively. All patients increased their HGS after applying the exercise protocol with a range of 30-68 kilogram-force (kgf) and 35 to 68 kgf for the NPG and EPG groups, respectively.

Conclusion: Exercises with and without load progression may indicate the onset of an increase in the diameter and distensibility of the cephalic vein in patients with CKD, notably in the group which performed the protocol without load adjustment.

Background: Assessment of movement capacity is fundamental in the field of physiotherapy to understand patient progress and the effectiveness of therapeutic interventions. The Movement Ability Measure (MAM) instrument is a self-reported questionnaire designed to assess self-perceived movement capacity.

Objective: To validate a Spanish version of the MAM instrument.

Methods: A two-part study was designed, based on guidelines for the cultural adaptation of patient-reported outcome measures: a phase for adaptation, involving 15 participants, and a phase for psychometric property analysis using Item Response Theory. The second phase included 205 subjects (49.9 ± 16.2 years, and 60.5% women). Structural validity was examined through the partial credit model. Reliability was estimated using the coefficient of reliability separation, test information function, and test-retest reliability (intraclass correlation coefficient) at one week. The association with the Physical Functioning Subscale was assessed using Spearman correlation coefficients. Movement capacity across different groups was compared using Wilcoxon - Mann - Whitney and Kruskal - Wallis tests.

Results: The Spanish version of the MAM instrument showed good fit indices, especially in the multidimensional model. The correlation with the Physical Functioning Subscale was 0.79 (p < .001), and the coefficient of reliability separation was 0.98. The intraclass correlation coefficient was 0.94 (95% CI 0.89-0.97). When analyzing differences between groups based on age, reported mobility issues, presence of chronic illness, and origin group, statistically significant differences were found according to prior hypotheses (p < .001).

Conclusion: The Spanish version of the MAM instrument is both reliable and valid for evaluating movement ability.

Introduction: Chronic low back pain is a common condition that often results in long-term disability and reduced quality of life.

Purpose: To assess the responsiveness and determine the Minimal Clinically Important Change (MCIC) of the Persian version of the Back Pain Functional Scale (BPFS) and Spine Functional Index (SFI) in patients with nonspecific chronic low back pain (LBP) following physiotherapy intervention.

Methods: Patients with nonspecific chronic LBP, recruited from outpatient clinics, completed the BPFS, SFI, Roland-Morris Disability Questionnaire (RMDQ), and Functional Rating Index (FRI) at pre-treatment. At post-treatment, these four questionnaires, along with the Global Rating of Change Scale (GRS), were administered. Responsiveness was evaluated using a criterion approach with the area under the receiver operating characteristic curve (AUC) and a construct approach by testing eight a priori hypotheses. The MCIC was determined as the optimal cutoff point on the ROC curve using GRS as an external anchor.

Results: A total of 100 patients with nonspecific chronic LBP participated in the study. The AUC was acceptable for both the BPFS (0.83) and the SFI (0.75). All predefined hypotheses were supported by both the BPFS and the SFI. The MCIC values were 9.5 for the BPFS and 13.5 for the SFI.

Conclusion: The Persian versions of the BPFS and SFI are responsive and clinically useful tools for evaluating functional changes in patients with nonspecific chronic LBP following physiotherapy. These tools can be effectively utilized in both clinical and research settings to monitor treatment outcomes.

Purpose: This study compared upper trapezius (UT) muscle stiffness between office workers with and without chronic neck pain using shear-wave elastography (SWE), and investigated the relationship between UT muscle stiffness, pain-related neck disability, fear-avoidance beliefs, and work ability.

Methods: Eighty-eight office workers (66 individuals with chronic neck pain and 22 healthy controls, mean age = 32.7 ± 8.3 years) participated in this study. UT muscle stiffness was measured using SWE. The Neck Disability Index (NDI), Fear-Avoidance Beliefs Questionnaire (FABQ), and Work Ability Index (WAI) were also assessed.

Results: Office workers with chronic neck pain exhibited significantly higher UT shear modulus compared to healthy controls (p < .001). UT shear modulus was positively correlated with NDI (r_s = 0.472, p < .001) and FABQ score (r_s = 0.350, p = .001), and negatively correlated with WAI (r_s = -0.330, p = .002).

Conclusion: Increased UT muscle stiffness is associated with greater neck disability, higher fear-avoidance beliefs, and reduced work ability. These findings highlight the importance of addressing both the mechanical properties of the UT muscle and psychosocial factors in the management of chronic neck pain, and this warrants further research and investigation. and warrant further research.

Background: Quadriceps strength assessment is widely used in rehabilitation; however, testing protocols often rely on empirical approaches.

Purpose: To identify the optimal contraction time and number of attempts needed to reliably measure muscle strength (maximal voluntary contraction, MVC) and how quickly force is generated (rate of force development, RFD) in older adults with cardiovascular disease (CVD).

Methods: We included 28 older outpatients undergoing cardiac rehabilitation (median age: 77 years). Quadriceps MVC and RFD at 0-50 ms (RFD₅₀) and 0-100 ms (RFD₁₀₀) were measured using isometric contractions. The tests examined how results varied based on 1) mean or maximum values, 2) dominant or both legs, and 3) the number of repetitions. Intra- (ICC_1,1) and inter-rater correlation coefficients (ICC_2,1) were evaluated across these patterns.

Results: Mean to peak force was 1.73 seconds; only 2.4% required ≥3 seconds. A single trial with dominant leg yielded excellent reliability for MVC (ICC_1,1 > 0.9; ICC_2,1 > 0.9). For RFD₅₀, moderate to good reliability was achieved with two repetitions of dominant leg or both sides (ICC_1,1: 0.76-0.79; ICC_2,1: 0.74-0.80), improving with three repetitions (ICC_1,1: 0.75-0.86; ICC_2,1: 0.79-0.84). For RFD₁₀₀, two trials using dominant leg provided excellent reliability (ICC_1,1: mean value 0.81, max value 0.89; ICC_2,1: mean value 0.83, max value 0.85). Three repetitions provided consistently excellent reliability (ICC_1,1: 0.88-0.93; ICC_2,1: 0.86-0.92).

Conclusion: Reliable MVC can be assessed with a single 3-second trial in older adults with CVD. For RFD, two repetitions, especially using the dominant leg and maximal value, provide excellent reliability.

Background: Mechanical traction (MT) is a noninvasive approach to unload the joint in knee osteoarthritis (KOA), however,its effects on co-contraction index (CCI) and balance remain unclear.

Purpose: To investigate whether combining MT with high intensity laser therapy (HILT) yields greater improvements in subjective and objective outcomes among patients with KOA compared to HILT alone.

Methods: Thirty-eight patients with KOA were randomly assigned to MT+HILT (n = 19) or HILT (n = 19) groups and received 10 treatment sessions over 2 weeks. Outcomes included pain (VAS), function (WOMAC), active knee flexion range of motion (AROM), CCI, and balance during curve tracking (CT) and sit-to-stand (STS) tasks. A two-way mixed-model ANOVA was used to assess the effects of treatment and time (pre - post).

Results: The MT+HILT showed significantly greater improvements than HILT in VAS (p < .001, η_p² = 0.27), WOMAC (p < .001, η_p² = 0.37), and AROM (p < .001, η_p² = 0.12). During CT, MT+HILT significantly reduced anteroposterior and mediolateral mean absolute errors (p = .00 and 0.03, η_p² = 0.10 and 0.15), and standard deviations of absolute errors (p = .02 and 0.04, η_p² = 0.82 and 0.15). Center of pressure area also decreased significantly in anteroposterior and mediolateral directions (p = .03 and 0.01; η_p² = 0.66 and 0.23).

Conclusion: These findings suggest that the combined application of MT+HILT may serve as an effective conservative strategy to improve pain management, functional capacity, AROM, and balance, potentially contributing to a reduced risk of falls in individuals with KOA.

Background: Functional constipation (FC) is a common condition that includes difficult, irregular bowel movements, abdominal pain, and bloating.

Purpose: To investigate the comparative effectiveness of connective tissue manipulation (CTM) and interferential currents (IFCs) over behavioral education and therapy (BET) on FC.

Methods: Fifty-four patients with FC were randomly assigned into four groups. The control group received only BET, the intervention groups received CTM, IFC_0-100, or IFC₁₀₀ additional to the BET, 3 days/week for 4 weeks. CTM was initially applied to the lumbosacral area; in subsequent sessions, the lower thoracic, scapular, interscapular, and cervical regions were also included, respectively. Bowel function (7-day-bowel diary), constipation severity (Constipation Severity Instrument), and QoL (Patient Assessment of Constipation Quality of Life) were assessed at baseline, after interventions, and at the end of the 1-month follow-up. Treatment satisfaction was assessed with visual analog scales.

Results: The defecation frequency increased and the defecation duration per attempt decreased in all groups (p < .05). In the CTM, IFC_0-100 and IFC₁₀₀ groups, defecation frequency increased more than in the control group (u = 23.500, u = 26.500, u = 15.500, respectively), (p < .001). The constipation severity decreased (p < .05), and this effect was maintained in all groups at the follow-up period (p > .05). QoL improved in all groups after the interventions, and was higher in the IFC_0-100 [95% CI=(-15.91-(-2.09)], and IFC₁₀₀ [95% CI=(-13.99-(-0.17)], (p < .05) groups than control group at follow-up, with no significant difference between control and CTM groups (p > .05). Treatment satisfaction was significantly higher in CTM [95% CI=(-1.3557-(-0.3443)], IFC_0-100 [95% CI=(-1.6911-(-0.6605)], and IFC₁₀₀ [95% CI=(-1.5450-(-0.5144)] groups than control group.

Conclusion: Additional CTM or IFCs to BET provide significant and long-lasting (at least 1 month) contributions to the bowel functions, QoL, and increase treatment satisfaction in patients with FC.

Background: Pharmacological treatments have been shown to improve physical and physiological functions in patients with axial spondyloarthritis (axSpA).

Purpose: This study aimed to compare core endurance, exercise capacity, cardiopulmonary responses during exercise testing, quality of life (QoL), and disease activity among patients with axSpA using biological and non-biological treatments, and healthy controls.

Methods: This cross-sectional study involved 52 patients on biological therapy, 57 on non-biological drugs, and 46 healthy controls. Core endurance (McGill tests), exercise capacity (six-minute stepper test), and disease activity indexes (The Bath Ankylosing Spondylitis Disease Indices; BASDAI, BASMI, BASFI, ASDAS-CRP, Leeds Enthesitis Index; LEI), spinal and hip radiographic scores (modified Stoke Ankylosing Spondylitis Spinal Score; mSASSS), Bath Ankylosing Spondylitis Radiology Hip Index; BASRI-hip), pain (Numeric Rating Scale), patient and physician global assessments, cardiopulmonary responses, quadriceps muscle fatigue and dyspnea (Modified Borg scale), laboratory markers (CRP, ESR), and QoL (Ankylosing Spondylitis QoL Scale; ASQoL) were measured.

Results: Step counts in the six-minute stepper test, trunk flexor, and lateral flexor muscle endurance values were significantly lower, while fatigue and quadriceps muscle fatigue during the six-minute stepper test were significantly higher in patients compared to healthy controls (p < .05). BASMI values were significantly lower in the non-biological treatment group compared to the biological group (p < .05). Step counts showed weak correlation with BASMI (r = -0.142; p = .167), moderate-strong correlation with BASDAI (r = -0.458; p < .001), ASQoL (r = -0.450; p < .001), ASDAS-CRP (r = -0.361; p < .001), trunk extensor and flexor muscle endurance (r = 0.489; p < .001, r = 0.485; p < .001), right and left trunk lateral flexor muscle endurance (r = 0.584; p < .001, r = 0.572; p < .001), and BASFI (r = -0.582; p < .001). Step count variance was explained by BASMI, BASDAI, BASFI, ASQoL, and trunk endurance, accounting for 34.1% of the total variance.

Conclusion: These findings may assist clinicians in planning personalized rehabilitation programs by considering not only functional limitations but also treatment history of the patients with axSpA. Understanding the effects of pharmacological treatment history on exercise capacity and core muscle endurance may guide the development of more effective physiotherapy approaches.