Physiotherapy Theory and Practice最新文献

Background: Lateral Epicondylopathy (LE) is a common musculoskeletal condition characterized by pain over the lateral elbow.

Purpose: To examine the effects of eccentric stretching on pain, grip strength, and function in LE.

Methods: Forty participants with LE were randomized into study and control groups. The control group received cold application, deep friction massage, and a home exercise program (three times/week for four weeks). The study group additionally performed eccentric stretching(3 sets/15 repetitions, three times/week for four weeks). Outcomes included pain, grip strength, Patient-Rated Tennis Elbow Evaluation (PRTEE), viscoelastic muscle properties, Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH), and quality of life. Clinical relevance was assessed using the smallest worthwhile change (SWC).

Results: Significant Group×Time interactions were observed for grip strength (p < .001, ηp² = 0.426), lateral pinch strength (p = .014, ηp² = 0.150), and fingertip pinch strength (p = .014, ηp² = 0.149), indicating greater improvements in the study group. PRTEE-function (p < .001, ηp² = 0.443) and QuickDASH (p < .001, ηp² = 0.598) also demonstrated significant interaction effects favoring the intervention. Significant interactions were further observed for muscle tone, stiffness, and elasticity at rest (ηp² = 0.284-0.468) and for tone and stiffness during activity (ηp² = 0.151-0.257; all p ≤ .013), indicating superior viscoelastic adaptations in the intervention group. No significant interaction was found for elasticity during activity (p = .322, ηp² = 0.026). Pain outcomes showed no between-group differences (all p ≥ .512), although both groups demonstrated clinically meaningful reductions.

Conclusion: This study demonstrates for the first time that supervised eccentric stretching provides clinically meaningful improvements in strength, function, muscle viscoelastic properties, quality of life beyond conventional physiotherapy alone in chronic LE. These findings suggest that targeting passive tissue mechanics through controlled eccentric elongation may enhance functional recovery even when pain reduction is similar. Eccentric stretching may therefore represent a valuable adjunct strategy when functional restoration rather than pain relief alone is the primary therapeutic goal.

Background: The wiper exercise is an effective movement for selectively activating the infraspinatus (IsP) muscle. Weakness in this muscle may contribute to shoulder hypermobility and joint subluxation.

Methods: Thirty participants were recruited, and individuals with and without scapular dyskinesis (SD) were identified using the dynamic SD test. IsP muscle activity and strength were measured during the wiper exercise. A 2 × 3 mixed-measures ANOVA was conducted to examine differences in IsP activity and shoulder external rotation strength across three fixation conditions (no fixation, NF vs fixation on pelvis, FP vs fixations on pelvis and thorax, FPT) in individuals with and without SD.

Results: The FPT condition elicited significantly greater IsP muscle activity and external rotation strength compared to both the NF and FP conditions (p < .05), regardless of SD presence. No significant difference in muscle activity was observed between the NF and FP conditions (p > .05), although strength differed significantly (p < .05).

Conclusion: The FPT condition during the wiper exercise is recommended as a targeted intervention to improve IsP activity and external rotation strength in individuals both with and without SD.

Background: Persistent Postural Perceptual Dizziness (PPPD) is defined by chronic dizziness and impaired balance, often associated with disruptions in cortical activity and vestibular pathways.

Purpose: The primary objective of this report is to assess the effects of a six-week home-based vestibular rehabilitation regimen on dizziness, postural stability, cortical activation, and white matter microstructural integrity in a woman diagnosed with PPPD.

Case presentation: A 24-year-old female patient presenting with chronic dizziness, balance deficits, and frequent falls characteristic of PPPD participated in a six-week home-based vestibular rehabilitation intervention. Outcomes were measured using the Dizziness Handicap Inventory (DHI), Vertigo Symptom Scale (VSS), center of pressure (COP) analysis during static postural assessment, functional near infrared spectroscopy (fNIRS), and diffusion tensor imaging (DTI).

Outcomes: Following the intervention, the DHI score decreased from 28 to 18, but it failed to meet the minimal clinically important difference of 18 points. Furthermore, the VSS score dropped from 46 to 39 but remained above the mean score of 20.8 for patients with chronic dizziness, indicating limited improvement in subjective symptoms. In contrast, objective measures demonstrated robust recovery; COP parameters decreased by 27-72%, notably exceeding standard improvement thresholds of 15-25%. Furthermore, fNIRS revealed reduced cortical activation suggesting enhanced neural efficiency, and DTI showed a two- to four-fold volume increase in the lateral vestibulospinal tracts (VST), confirming structural plasticity.

Conclusion: In this case, while subjective symptom improvements were limited, home-based vestibular rehabilitation was associated with substantial objective postural recovery. These functional gains coincided with structural adaptations in the VST and enhanced cortical efficiency, highlighting the potential value of objective biomechanical and neuroimaging assessments in monitoring therapeutic responses in PPPD.

Background: The therapeutic alliance (TA) is fundamental to improving the quality of health and rehabilitation services.

Purpose: This study critically explored patient perspectives on the influence of TAs with practitioners while participating in inpatient rehabilitation after spinal cord injury (SCI).

Methods: A qualitative design involving (n = 18) in-depth interviews with inpatients was employed. The verbatim transcripts were subjected to an iterative, reflective thematic analysis (RTA), guided by a social constructionist epistemology and deductively informed by theories of power and psychotherapy.

Results: Patient accounts reinforce that TAs lie at the core of patient-centered rehabilitation. Significantly, narratives revealed that patients often struggled to find environmental conditions conducive to developing real and authentic working relationships. Narratives suggested that the institutional context and its associated responsibilities continuously introduced procedural complexities that shaped, ruptured, or obstructed the formation of effective working alliances, hindering therapeutic relationships. A primary theme that emerged, Control as disabling: Biopower and surveillance, highlighted that TAs could not develop with practitioners who constrained patient autonomy and control, thereby intensifying the experience of disability. Patients described an environment and behaviors characteristic of institutionalization, particularly when autonomy and agency were undermined.

Conclusion: Institutionalized practices reduce the likelihood of developing effective TAs. The findings highlight that TAs in SCI rehabilitation can potentially mitigate the effects of institutionalization, safeguard person-first identity, reduce identity risk, and support genuinely individualized person-centered care. To address the unique and complex needs of people with SCI, specialized TA training for rehabilitation practitioners, reinforced through ongoing professional development, is strongly recommended.

Background: Somatic tinnitus of cervicogenic and temporomandibular origin remains a therapeutic challenge, with limited evidence supporting manual interventions.

Objective: This study aimed to compare the efficacy of manual therapy combined with home-based exercises on tinnitus severity and outcomes in individuals with somatic tinnitus.

Methods: This single blinded randomized trial included 31 participants, allocated to manual therapy plus home exercises (n = 16) or home exercises alone (n = 15) for six weeks. All participants performed daily home exercises, with the manual therapy group receiving one weekly therapist session, totaling six. The primary outcome was tinnitus severity (visual analog scale, VAS). Secondary outcomes included cervical pain-VAS, Tinnitus Handicap Inventory (THI), Neck Disability Index (NDI), cervical range-of-motion (ROM), manual muscle testing, and Short Form-36 (SF-36) scores, assessed at baseline, week 3, and week 6.

Results: Significant interaction-effects favored the manual therapy group for tinnitus-VAS (p = .031, ηp² = 0.144), cervical pain-VAS (p = .031, ηp² = 0.219), THI (p = .038, ηp² = 0.136), and NDI (p = .020, ηp² = 0.164). Cervical ROM improved significantly in all directions, with group-effects in left lateral flexion (p = .012, ηp² = 0.199) and right rotation (p = .042, ηp² = 0.135). SF-36 improvements were noted in energy/fatigue (p = .005, ηp² = 0.246), general health (p = .012, ηp² = 0.198), and health change (p = .006, ηp² = 0.161).

Conclusion: Combining manual therapy with home exercises provided greater improvements in tinnitus severity, cervical symptoms, and quality of life in individuals with somatic tinnitus.Trial registration: ClinicalTrials.gov, NCT06433895.

Background: Previous studies have demonstrated alterations in skeletal muscle morphology and architecture in individuals with spastic cerebral palsy (CP). However, it remains unclear whether these morphological parameters vary across different mobility levels or how they relate to walking ability.

Purpose: This study aimed to examine morphological parameters of calf muscle across functional mobility levels in children and adolescents with spastic CP and their relationships with walking ability.

Methods: Children and adolescents with spastic CP, aged 5-17 years (mean age: 11.72 ± 4.6 years), were recruited in the study. Morphological parameters of the gastrocnemius medialis (GM), gastrocnemius lateralis (GL), and soleus muscle in the more severely affected lower limb were assessed using a B-mode ultrasound. Walking ability (i.e. mobility and locomotion activities) was evaluated using both the Gillette Functional Assessment Questionnaire-22 item skill set (FAQ-22) and ABILOCO-Kids.

Results: Analysis revealed a significant decrease in muscle thickness (p₁ = .013; p₂ = .032; p₃ < .001) and fascicle length (p₁ < .001; p₂ < .001) with declining mobility levels, except for GL fascicle length (p = .061). Conversely, pennation angle was significantly greater in children with severe motor involvement (p < .001 for all). Moderate to very strong correlations were found between calf muscle morphological parameters and walking ability (r = -0.41 to 0.89). Notably, muscle thickness demonstrated the strongest correlation coefficients with walking ability (r = 0.83-0.89).

Conclusion: The significant associations between GM and soleus muscle thickness and walking ability indicated that these muscles are important contributors to functional mobility in children and adolescents with CP. These findings also emphasized that musculoskeletal integrity remains a critical factor of mobility and locomotion activities, even within contemporary participation‑focused rehabilitation models.

Background: Subphrenic abscesses are infected structures that arise above or below the diaphragm and cause pulmonary problems such as dyspnea, pneumonia, and basal atelectasis. After medical treatment, persistent respiratory and functional impairments may remain, requiring additional interventions such as pulmonary rehabilitation.

Case description: A 16-year-old previously healthy male adolescent was diagnosed with a subphrenic abscess accompanied by pneumonia and pleural effusion after radiological and laboratory evaluation. Although appropriate medical treatment was completed and the patient was discharged, dyspnea and fatigue persisted during rest and physical activity. Therefore, pulmonary rehabilitation was initiated to improve persistent respiratory symptoms and functional limitations.

Outcomes: The patient's functional exercise capacity (69 meters), upper extremity exercise capacity, quadriceps femoris muscle oxygenation (muscle oxygen saturation increased from 16% to 20%), respiratory muscle strength (MIP: 31 cmH₂O, MEP: 28 cmH₂O), and upper and lower extremity peripheral muscle strength improved, and dyspnea and fatigue perception decreased.

Conclusion: This case report demonstrates the value of a timely and comprehensive pulmonary rehabilitation program in improving pulmonary and extrapulmonary symptoms for a patient with subphrenic abscess accompanied by pleural effusion and pneumonia.

Physiotherapy education in Canada, like many professional training programs, relies on categorization tools to determine who is most suitable for entry. One such tool is the Multiple Mini-Interview (MMI), an examination which is widely accepted as a fair, objective, and evidence-based method for assessing non-academic competencies. In this professional theoretical paper, we interrogate assumptions supporting its use through a Foucauldian reading of the MMI, examining it as an instantiation of disciplinary power. Rather than assessing whether the MMI "works" in predictive terms, we focus on the form of power underpinning yet concealed within it. By reading the MMI through a Foucauldian lens, we unsettle its taken-for-granted neutrality and call attention to the institutional logics that shape who gains access to the Canadian physiotherapy academy.We argue that, consistent with Foucault's theorization, the MMI encourages applicants to internalize and perform institutionally sanctioned norms of the "ideal" candidate, shaping admissions in ways that favor those with particular cultural and communicative skills who can anticipate and align with these expectations. These candidates are more likely to be perceived as "trainable" and therefore admissible. Thus, while framed as an equitable assessment, the MMI may reinforce Eurocentric and White institutional normativity, a recognized problem within Canadian physiotherapy programs. In this way, the MMI risks contributing to the profession's demographic homogeneity and perpetuating structural disadvantage for some applicants.