Physiotherapy Theory and Practice最新文献

Background: Deep venous insufficiency (DVI) affects 30% of individuals with superficial venous insufficiency (SVI). It is caused by valvular incompetence or obstruction, leading to venous hypertension. While conservative treatment is compression therapy, there is evidence supporting the efficacy of complex decongestive therapy (CDT), although it has not been studied in patients with DVI without ulcerations.

Objective: We present a program for the evaluation and treatment of CDT in patients with DVI.

Case description: The patient was a 49-year-old woman with bilateral DVI classified as C3 according to the Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification. She experienced pain, heaviness, mild edema, decreased quality of life (QoL), and retrograde reflux > 0.5 seconds in the deep venous system of both extremities (femoral, common femoral, and popliteal veins). The patient was evaluated using ultrasound, impedance measurement, circumferential measurements, and the Venous Clinical Severity Score (VCSS) and Chronic Venous InsufficiencyQualityofLifeQuestionnaire (CIVIQ-20). She underwent CDT (manual lymphatic drainage, pressotherapy, and bandaging) twice a week for 4 weeks, with follow-up assessments conducted after treatment and at 6 weeks.

Outcomes: The patient reported a decrease in pain and heaviness (VCSS), along with an increase in QoL (CIVIQ-20) (60.8% T1, 67.1% T2), flow velocity in the deep veins, and decreased reflux. While there was no improvement in edema, the fat mass in the extremities was reduced.

Conclusion: CDT was effective in improving severity and symptoms in this patient with DVI. Randomized controlled studies are necessary to further demonstrate the efficacy of this treatment in patients with DVI.

Introduction: A large decrease in physical activity (PA) is typically observed among people with spinal cord injury (SCI) upon discharge from in-hospital rehabilitation. Physiotherapists and SCI peers are well-positioned to intervene at this critical timepoint; however,the implementation of coordinated PA interventions between these two groups have yet to be studied.

Purpose: To identify barriers and facilitators that affect the implementation of coordinated PA counseling among physiotherapists and SCI peers during the transition from in-hospital rehabilitation to the community.

Methods: Semi-structured interviews were conducted with nine physiotherapists and two SCI peer coaches, using an interview guide informed by the Theoretical Domains Framework (TDF). Interviews were transcribed and coded deductively onto the TDF with themes and subthemes generated by inductive content analysis.

Results: The most salient TDF domains were social influences, environmental context and resources, and skills. Specifically, participants identified challenges such as addressing patient barriers and continual staff onboarding. Facilitators included the availability of peer coaches with lived experience, support from champions of the PA counseling intervention, group training sessions for physiotherapists and SCI peer coaches, and an adaptable PA counseling form as a conversation guide.

Conclusion: Successful coordination of services provided during the transition from in-hospital rehabilitation to the community may be strengthened by 1) providing resources and training that guide both content and delivery of PA counseling and 2) a referral system that leverages the strengths of both physiotherapists and peer support.

Introduction: In Norway, as elsewhere, young people may experience psychological distress and long-lasting pain. Such health disorders can be complex, leading some young people to seek psychomotor physiotherapy treatment. Thus far, however, there has been little qualitative investigation of their experiences.

Objective: The purpose of this study was to gain new knowledge about the illness experiences of young people with long-term health disorders engaging psychomotor physiotherapy.

Method: Qualitative interviews with ten Norwegian women aged 16-24 in psychomotor physiotherapy were analyzed within a narrative framework.

Findings: The participants' treatment experiences take place in the context of a long history of pain, distress, and lack of understanding and support. Their stories tell of being threatened by illness and other difficult life events, and of being placed under further stress by a prolonged and disruptive quest for help within the healthcare system. For participants, psychomotor physiotherapy represents a breathing space where their illness experiences are acknowledged, enabling them to find rest and explore their bodily reactions and habits.

Conclusion: Long-term health disorders represent significant disruptions to the daily lives and relationships of young women. It is important to acknowledge the illness experiences of these young women and establish trustful therapeutic relationships. Psychomotor physiotherapy may offer significant potential as a means to help young people explore and make sense of their illness experiences.

Introduction: Recent literature in physical therapy education suggests learners' non-cognitive skills, such as grit and reflection, may be predictors of success. Little is known about the relationship of these constructs to each other or success during the first year of entry level physical therapist education.

Objective: The purpose of this study was to assess the relationship between Reflection-In- Learning Scale (RLS), grit, and grade point average (GPA) of entry-level physical therapy students during the first year of didactic instruction.

Methods: One hundred and fourteen entry-level doctor of physical therapy students enrolled in a private university completed the original 12-item Grit Scale (Grit 1) and the RLS (RLS 1) during the first term and again at the end of the third trimester (Grit 2 and RLS 2).

Results: The relationship between Grit 1 and RLS 1 demonstrated a fair, positive, significant correlation (r = .380, p < .001). No relationship was found between Grit 1 and GPA (r = .066, p = .485), or Grit 2 and GPA (r = .064, p = .500), or between RLS 1 and GPA (r = .017, p = .857), or RLS 2 and GPA (r = .171, p = .069). Fifty-three percent of students demonstrated a decrease in grit and 56% decreased RLS scores at the end of the first year of the program.

Conclusion: The fair correlation between these variables indicates they may measure different constructs. Findings suggest that doctor of physical therapy programs should be cautious when using these non-cognitive factors in making admission decisions. Future research should explore changes in grit and RLS throughout the curricula and impact on student success.

Purpose: To develop a clinical prediction model (CPM) to predict independence in activities of daily living (ADLs) in patients with heart failure.

Subjects and methods: We collected the data of the individuals who were admitted and rehabilitated for heart failure from January 2017 to June 2022 from Japan's Diagnosis Procedure Combination database. We assessed the subjects' ADLs at discharge using the Barthel Index and classified them into independence, partial-independence, and total-dependence groups based on their ADLs at discharge. Two CPMs (an independence model and a partial-independence model) were developed by a binomial logistic regression analysis. The predictors included subject characteristics, treatment, and post-hospitalization disease onset. The CPMs' accuracy was validated by the area under the curve (AUC). Internal validation was performed using the bootstrap method. The final CPM is presented in a nomogram.

Results: We included 96,753 patients whose ADLs could be traced at discharge. The independence model had a 0.73 mean AUC and a 1.0 slope at bootstrapping. We thus developed a simplified model using nomograms, which also showed adequate predictive accuracy in the independence model. The partial-independence model had a 0.65 AUC and inadequate predictive accuracy.

Conclusions: The independence model of ADLs in patients with heart failure is a useful CPM.

Background: Transcranial Direct Current Stimulation (tDCS) emerges as a promising therapeutic intervention for knee osteoarthritis (KOA), yet its impact on physical function remains insufficiently explored.

Objectives: To evaluate the relative effects of tDCS for physical function in patients with KOA.

Methods: Pubmed, Web of Science, Scopus and Cochrane Database were explored as of August 2023 to identify studies to be included in the current systematic review and metaanalysis. Randomized controlled trials in patients with KOA comparing tDCS with placebo were included. The outcomes defined were measures of physical function (questionnaires, gait, or physical performance). The Risk of Bias tool was used to assess bias in the randomized controlled trials, whereas the PEDro scale was applied for methodological quality, and the certainty of evidence for each outcome was assessed through GRADE. Results for each outcome were synthesized using meta-analysis (random-effects model, I²-test for heterogeneity) and a subgroup analysis was performed to improve the sensitivity of the results and to explore potential moderating factors of the effect sizes.

Results: Ten studies with good to excellent quality were included, analyzing a total of 628 participants. Regarding physical function, tDCS showed a favorable effect (ES: -0.58; 95%CI -0.82, -0.33; I²: 52.1%) with a low risk of bias and low to moderate certainty of evidence. The concurrent application of physiotherapy interventions and tDCS improved the effects on pain and function. Applying physiotherapy interventions, as well as adding peripheral currents, increased the effect sizes (ES: -0.95, k = 3, p = .018; ES: -0.95, k = 4 p = .001, respectively). The pattern of application of the tDCS, either daily or in alternate days, did not moderate the effect size (p = .619). Meta-regression revealed that the number of tDCS sessions did not moderate the effect size either (p = .242).

Conclusion: The tDCS might be a promising therapeutic approach to enhance physical function in subjects affected with KOA. However, further systematic reviews with meta-analyses should be performed with standardized and proven-efficacy physiotherapy programs, as well as with long-term results, to ascertain whether the improvement may be sustained over time. This study provides valuable insights into optimizing tDCS interventions for enhanced outcomes in the management of KOA.Protocol available via PROSPERO [CRD42023440676].

Background: It has been two decades since the World Health Organization's endorsement of the International Classification of Functioning, Disability and Health (ICF). It is timely to undertake a rigorous search that analyzes the discourses around the ICF's conceptual framework within physiotherapy, the kinds of enquiry to date and the professional areas where this is happening and how.

Purpose: The aim of this research is to synthesize the literature related to how the physiotherapy profession (practice, research and education) thinks about and puts to use the WHO ICF.

Results: A final sample of 37 papers was agreed. Five overarching third-order interpretations were derived: (i) A way of thinking and practicing, (ii) Endorsed but not embedded, (iii) Striking a balance, (iv) Power of participation and (v) Moving forward. Together, these themes illustrate the evolving role of the ICF in physiotherapy over the previous two decades. They highlight the ICF's potential for shaping the future of physiotherapy practice, education and research.

Conclusions: Work is needed to connect existing literature about the ICF and related models and embed the ICF, its language and philosophy across physiotherapy education and practice. Re-representation of the model might help address misinterpretation of the ICF, but fundamentally, embedding the ICF in entry-level curriculum is likely to be the most significant driver of change in practice.

Background: Whole body vibration (WBV) exercise is a therapy used for individuals with low tolerance to conventional exercises, such as patients with chronic obstructive pulmonary disease (COPD). This study aimed to assess the impact of WBV exercise on the functional capacity, muscle strength, and health-related quality of life (HRQoL) in severe COPD patients.

Methods: Studies published until March 2024 were reviewed, encompassing randomized clinical trials (RCTs) without temporal or linguistic constraints, comparing WBV exercise with other interventions. The PubMed/MEDLINE, Scopus, Cochrane Airways Trials Register, and CINAHL databases were queried. The Revised Cochrane risk-of-bias tool for randomized trials 2.0A was employed for quality assessment.

Results: Among 351 screened studies, 7 met the criteria, totaling 356 participants (WBV group, n = 182; control group, n = 174). Meta-analysis revealed a significant mean difference of 41.36 m [95%CI (13.28-69.44); p = .004] in the 6-minute walk test distance favoring the WBV group for functional capacity. Lower limb muscle strength improved in 57.14% of included studies. HRQoL meta-analysis demonstrated a 1.13-point difference [95%CI -1.24-3.51; p = .35] favoring WBV, although group differences were not significant. A mean difference of 2.31 points favored the control group in health condition [95%CI (-1.32-5.94); p = .021].

Conclusion: WBV exercise is recognized as a promising therapeutic modality for severe COPD patients, notably enhancing functional capacity. Although heterogeneous study protocols weaken the evidence for clinically relevant outcomes, improvements in lower limb muscle strength and HRQoL were also observed, differences between groups were not significant.

Background: High-quality evidence shows that exercise helps people with Parkinson's disease improve functional abilities including balance. However, few studies have investigated whether the setting and format through which balance-focused exercise programs are provided matters. This systematic review investigated group exercise compared to individual exercise, and to no-exercise control (CTL), on clinical measures of balance for people with Parkinson's disease.

Methods: MEDLINE, EMBASE, CINAHL and Cochrane CENTRAL databases were searched through March 24, 2024, on terms for Parkinson's disease; exercise or physical activity; community-based or group classes; balance or postural control. Citations, abstracts and full-text articles were independently reviewed, and included studies were rated on risk of bias by two authors.

Results: Twenty-seven randomized controlled trials (30 reports) with 1200 participants met criteria. Meta-analysis using mean difference (MD) compared group exercise to CTL on seven clinical measures of balance. Three yielded significant differences favoring group exercise: Timed Up and Go = -2.29 (MD), -3.56 to -1.02 (95% Confidence interval) (95% CI); Mini-BEST = 2.72 (MD), 1.88 to 3.57 (95% CI); Berg Balance Scale = 4.31 (MD), 1.33 to 7.29 (95% CI). Meta-analyses were also conducted on six clinical measures of balance, comparing group exercise to individual exercise, yielding no significant differences.

Conclusions: For people with Parkinson's disease, group exercise may be more effective than CTL on some clinical measures of balance and it yields similar results to individual exercise. People with Parkinson's disease are encouraged to participate regularly in group or individual exercise based on preference and accessibility.

Background: Improvement of activity and participation for the disabled and chronically ill is an important aim of rehabilitation. Cervical dystonia is a neurological movement disorder characterized by involuntary contractions of the neck muscles. Until now, research has identified factors contributing to disability rather than factors which may make it easier to be active and participate in the community.

Objective: Explore and describe perceived experiences of activity and participation in daily life as experienced by persons with cervical dystonia.

Methods: Sixteen informants participated in this semi-structured interview study. Inductive qualitative content analysis was performed to understand and interpret experiences shared by the informants.

Results: Results from the analysis generated two themes "An active life" and "A challenging life" and six sub-themes: Using helpful coping strategies, Accepting a new life situation, Adhering to BT treatment, Facing the negative impact of stress, Experiencing a negative self-image and Suffering from pain and fatigue.

Conclusions: Our results support the importance of actions using a rehabilitation approach that consider both motor and non-motor symptoms. Future studies should compare the effects of physiotherapy taking into account wishes and challenges in patients' everyday life versus traditional physiotherapy addressing mostly the motor disorder.