Physiotherapy Theory and Practice最新文献

Physiotherapy faces mounting challenges in an era of planetary crisis. This paper proposes a reorientation of physiotherapy through the philosophy of Gilles Deleuze and Félix Guattari, specifically their concept of ethology, which foregrounds affect, relation, and immanence. We argue that contemporary physiotherapy remains tethered to anthropocentric, essentialist, and representational assumptions that limit its capacity to respond to complex ecological entanglements. Drawing on ethology, we explore how bodies, human and non-human, can be understood not as stable entities but as dynamic assemblages defined by what they can do. We consider the implications of this approach for practice, education, and planetary health, suggesting that physiotherapy shift from its traditional forms of praxis toward a dynamic composition of capacities. In doing so, the profession might cultivate an ecologically attuned, affectively sensitive, and experimentally oriented practice capable of engaging in the world.

Background: Rounded shoulder posture (RSP) is a commonly observed abnormal alignment of the scapula. RSP is typically associated with shortening of the pectoralis muscle and weakness of the lower trapezius (LT). Changed muscle length of these muscles may result in different movement patterns compared to healthy subjects when performing exercises.

Purpose: We investigated to compare the muscle activity of the upper trapezius (UT), LT, and serratus anterior (SA) between healthy and RSP groups during Y-raise exercises with and without isometric adduction (IAD) using an elastic band.

Methods: A cross-sectional study with a single data collection session, participants were classified according to the criteria for RSP and assigned to either the healthy group (25.06 ± 1.24, n = 16) or the RSP group (24.88 ± 2.09, n = 16). Surface electromyography was used to measure muscle activity of the UT, LT, and SA during the exercises.

Results: UT and SA muscle activity significantly decreased during the Y-raise with IAD compared to the Y-raise without IAD in both groups (p < .025). Conversely, LT muscle activity significantly increased during the Y-raise with IAD compared to the Y-raise without IAD in the healthy group (p < .025), while LT activity significantly decreased in the RSP group (p < .025).

Conclusion: Applying IAD during the Y-raise exercise is effective for selectively increasing LT activity while decreasing UT and SA activity in the healthy group. However, structural improvement of scapular alignment may be required for subjects with RSP to perform the Y-raise with IAD effectively.

Introduction: Pain Neuroscience Education (PNE) is an intervention promoting patients' understanding of the chronic pain better and changes maladaptive thoughts that could limit recovery. Psychological risk factors are predictive of increased pain and disability in people after total knee arthroplasty (TKA).

Objective: The study aim was to investigate the efficacy of PNE on clinical outcomes compared to a standard physiotherapy program in patients after TKA.

Methods: A total of 34 participants were randomly assigned to either an experimental (standard physiotherapy program + PNE) or a control group (standard physiotherapy program only). After all participants had undergone routine post-operative care, the study intervention began 4-6 weeks post-surgery, at which point patients were assessed, and then followed for a 6-week treatment program. Outcomes assessed included pain severity, disability, function, pain catastrophizing, anxiety, depression, kinesiophobia, and quality of life.

Results: A statistically significant and clinically meaningful change from baseline was observed for kinesiophobia [p = .003, (pre-treatment: Mean Difference (MD): -2.05, 95%CI: -9.58, 5.46), (post-treatment: MD: 4.86, 95%CI: -2.33, 12.07)] and the mental component of quality-of-life [p = .006, (pre-treatment: MD: 1.45, 95%CI: -3.85, 6.76), (post-treatment: MD: -10.20, 95%CI: -15.69, -4.71)] in favor of the experimental group at the end of the treatment. No significant difference was found between groups for the remaining outcomes (p > .05).

Conclusion: The combination of PNE and a standard physiotherapy program effectively reduces kinesiophobia and improves the mental component of quality-of-life in patients after TKA. However, no significant clinical effects were observed in pain or physical function. These results suggest that PNE is a valuable adjunctive strategy to address psychological aspects, highlighting the value of combining educational and physical strategies to enhance post-operative rehabilitation outcomes.

Trial registration in clinicaltrials.gov: NCT05928351.

Introduction: Physical therapists (PTs) play established roles in emergency departments (EDs) internationally, yet their involvement in Saudi Arabia remains unexplored.

Objective: This study aimed to explore perceptions of physical therapists regarding their role in Saudi emergency departments.

Methods: A cross-sectional online survey was conducted among licensed PTs. The survey included sections on demographic and professional characteristics, ED exposure, perceptions of PT roles, educational background and ED-related competencies, and clinical scenarios suitable for PT involvement. Data were analyzed using descriptive statistics and regression models, with no formal response rate calculable.

Results: A total of 311 PTs completed the survey. Most respondents (69.5%) reported no dedicated PT services in their workplaces, and 71.7% had never evaluated or treated emergency department (ED) patients. Despite this, 69.8% agreed that PTs are valuable members of the ED team, and 63.7% agreed that integrating PTs into ED care is feasible within the Saudi healthcare system. Perceptions varied by gender, years of experience, and work setting. Male gender (β = 1.65, 95% CI: 0.75-2.55; p < .001) and employment in military hospitals (β = 1.80, 95% CI: 0.05-3.55; p = .045) were associated with higher perception scores, whereas 6-10 years of experience (vs. ≤5 years) was associated with lower scores (β = -1.93, 95% CI: -3.19 to -0.67; p = .003). Exposure to ED-related competencies was inconsistent, as respondents reported variable levels of curriculum and clinical experience across differential diagnosis, radiologic imaging, pharmacology, and laboratory interpretation. Musculoskeletal conditions, gait and balance training, neurological and vestibular conditions, and fall-risk assessment were identified as the most suitable areas for PT involvement.

Conclusion: The findings highlight professional readiness alongside system-level barriers, underscoring both the feasibility of PT integration to advance person-centered emergency care and the need for targeted education pathways and supportive policies for successful implementation within ED settings.

Objective: This study aimed to analyze the relationship between exercise barriers and benefits, kinesiophobia, balance confidence, fear of falling, and psychological status in individuals post-stroke.

Methods: A cross-sectional study was conducted with 102 participants, including 60 individuals post-stroke (mean duration since stroke: 32.09 ± 55.09 months) and 42 healthy controls. Disability levels were evaluated using the Modified Rankin Scale (mRS) by a clinical neurologist. The Exercise Benefits/Barriers Scale (EBBS), Tampa Scale of Kinesiophobia (TSK), International Fall Efficacy Scale (FES-I), Activity-Specific Balance Confidence Scale (ABC), and Hospital Anxiety and Depression Scale (HADS) were used to assess exercise perceptions, movement-related fear, balance confidence, and psychological status.

Results: Individuals post stroke showed significantly lower EBBS scores compared to controls (p < .05). Additionally, they had higher TSK and FES-I scores and lower ABC scores (p < .05). A positive correlation was observed between TSK and EBBS total, barriers, and benefits subscales (p < .001). Regression analysis indicated that EBBS scores were significantly associated with both TSK and mRS scores (p < .001), while HADS scores were not significant predictors.

Conclusion: Individuals post-stroke showed lower perceptions of exercise benefits/barriers and higher levels of kinesiophobia, fear of falling, and balance problems compared to healthy controls. Kinesiophobia was negatively correlated with exercise perceptions. Regression analysis indicated that TSK and mRS significantly affected EBBS scores, while depression and anxiety had no significant impact.

Background: There is no imaging gold standard for measuring segmental spinal motion that can serve as a criterion measure to compare with manual assessment or evaluate mechanical changes following spinal manipulative therapy (SMT).

Objective: This study aimed to determine intra-rater and inter-rater reliability, as well as the minimal detectable change (MDC), for measuring segmental lumbar spine flexion and extension in the sidelying position using ultrasound imaging.

Methods: Ultrasound images of the spinous processes of the lumbar spine and base of the sacrum were acquired from 30 asymptomatic subjects positioned in sidelying. Two independent examiners took two measurements of the interspinous distance at each lumbar segment using digital calipers during a single session.

Results: Inter-rater reliability using intraclass correlation coefficient (ICC_(2,1)) for lumbar flexion ranged from 0.87 to 0.97. The 95% limits of agreement (LOA) for flexion inter-rater reliability were -0.26 to 0.30 cm. For extension, ICC_(2,1) ranged from 0.81 to 0.96. Intra-rater reliability was higher, with ICC_(3,1) >0.90 for all segments in both directions. The 95% LOA for flexion intra-rater reliability was -0.17 to 0.17 cm. Standard error of measurement (SEM) ranged from 0.074 to 0.280 cm, and MDC at the 95% confidence level ranged from 0.204 to 0.498 cm, with flexion showing greater precision.

Conclusion: The results suggest ultrasound imaging is a reliable and precise method for assessing segmental lumbar motion in the sidelying position. Future research employing this ultrasound imaging method may inform debates on manual assessment of segmental spinal motion and the mechanical mechanism underlying SMT.

Background: Achilles tendon rupture (ATR) is a common injury that affects functional capacity and neuromuscular control of the lower limb. While exercise interventions after ATR are frequently prescribed, there is limited evidence regarding muscle activation demands during weight-bearing tasks on different balance surfaces in long-term post-operative individuals.

Objective: To compare lower leg muscle activation levels and co-contraction patterns during functional tasks performed on various balance platforms in individuals with a history of percutaneous ATR.

Methods: Nineteen recreationally active males (mean age 40.6 ± 7.2 years) who underwent unilateral percutaneous ATR approximately 5.0 ± 4.8 years prior to testing were recruited. Surface electromyography (%MVIC) was recorded from the peroneus longus (PL), tibialis anterior (TA), medial and lateral gastrocnemius (GM, GL), and soleus (SL) during Single-Leg Stance (SLS), single-leg squat (SLSQ), and forward lunge (FL) performed on flat ground, wobble board, stability trainer, and BOSU®. TA:GM and TA:SL co-contraction ratios were calculated. All subjects performed the functional tasks barefoot.

Results: The BOSU surface elicited the highest %MVIC in all muscles, particularly during SLS (e.g. PL: 44.8 ± 15.5; GM: 36.6 ± 12.7). FL and SLSQ on flat ground induced lower gastrocnemius activation. Co-contraction ratios were significantly higher in SLSQ and FL compared to SLS (p < .001), indicating more balanced dorsiflexor - plantarflexor engagement during dynamic tasks.

Conclusion: Muscle activation and co-contraction patterns vary by functional task type and surface. These findings may assist physiotherapists in prescribing functional progression exercises based on neuromuscular demand profiles after ATR.

Introduction: The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) are widely used to assess disease activity and function in patients with axial spondyloarthritis (axSpA). However, their reliability when administered via tele-assessment has not been investigated. This study aimed to evaluate the reliability of BASDAI and BASFI administered via tele-assessment in axSpA patients.

Methods: This study included patients with axSpA. BASDAI and BASFI were administered by phone at two separate times, 24 hours apart (test-retest). Internal consistency was assessed using Cronbach's alpha, and test-retest reliability was evaluated using intraclass correlation coefficients (ICC). Absolute reliability was assessed using the Bland-Altman method, standard error of measurement (SEM), and minimal detectable change (MDC₉₅).

Results: The study initially included 110 patients, with 102 completing the study. BASDAI showed adequate internal consistency (Cronbach's alpha = 0.769), and BASFI showed excellent consistency (Cronbach's alpha = 0.879). The test-retest reliability for BASDAI (ICC(3,1) = 0.864, 95% CI = 0.790-0.911) was good and for BASFI (ICC(3,1) = 0.949, 95% CI = 0.925-0.965) was excellent. SEM and MDC₉₅ values for BASDAI were 0.71 and 1.97, respectively, and for BASFI, 0.44 and 1.22. Bland-Altman plots indicated good agreement, with no significant proportional bias.

Conclusion: Both BASDAI and BASFI demonstrated good internal consistency and good to excellent test-retest reliability when administered via tele-assessment. These tools can be reliably used for remote monitoring of disease activity and functional status in patients with axSpA.

Trial registration: ClinicalTrials.gov, NCT06230952, https://clinicaltrials.gov/study/NCT06230952?cond = reliability%20BASDAI&rank = 1.

Introduction: Previous studies have examined the ability of balance tests to distinguish between individuals with chronic ankle instability (CAI) and healthy controls.

Purpose: To investigate accuracy and determine cutoff scores of balance tests in single- and dual-task conditions in discriminating between copers and individuals with CAI.

Methods: Seventy subjects (35 subjects in each group) participated in the study. Static and dynamic balance were evaluated using single-leg stance, side hop, figure-of-8 hop, and Y-balance test in single- and dual-task conditions. A cognitive task used in the study was backward counting by seven, starting from a random number, between 200 and 300. The accuracy of these tests was determined by calculation of sensitivity, specificity, area under receiver operating characteristic (ROC) curve (AUC), likelihood ratios (LRs) and predictive value (PV).

Results: The ROC curve showed, except for posterior-lateral direction of Y-balance test, all balance tests had good ability for discrimination between two groups of coper and CAI. Also, the highest sensitivity (0.97 (95% confidence interval (CI): 0.84-0.99)) and the lowest amount of negative LR (0.05 (95% CI: 0.00-0.35)) and negative PV (0.95 (95% CI: 0.73-0.99)) were related to single-leg stance. While the highest specificity (0.82-0.88) and greatest positive LR (5-5.75) and positive PV (0.83-0.85) were related to side hop test, single-leg stance, figure-of-8 hop, and the posterior-medial direction of Y-balance test in dual-task condition.

Conclusion: Investigating the static and dynamic balance under dual-task conditions could have added value to correctly identifying balance deficit in individuals with CAI.

Introduction: Many young adults seek psychomotor physiotherapy for long-term health disorders such as persistent pain. A patient-centered approach that integrates biological, psychological, and social perspectives of young patients' health disorders is encouraged. However, little is known about how these different perspectives are integrated when physiotherapists make sense of young adults' long-term health disorders.

Purpose: This study aims to generate novel insights into how psychomotor physiotherapists make sense of young adults' long-term health disorders and the clinical implications of their meaning-making.

Methods: We employed a narrative framework to analyze qualitative interviews with 10 Norwegian psychomotor physiotherapists in primary healthcare. Interviews followed clinical encounters with female patients aged 16-25 years.

Results: We highlight three intertwined storylines within the physiotherapists' narratives, emphasizing different patient needs and treatment directions: "bodies in need of adjustments," "'good girls' in need of adjustments," and "vulnerable individuals in need of shelter." These storylines were built from pieces of information emphasizing biological, psychological, and social factors, respectively. Furthermore, they emerged across and within each treatment narrative, indicating that each physiotherapist combined and alternated between these different interpretations when making sense of a young woman's health disorder.

Conclusion: Physiotherapists make sense of young women's long-term health disorders by piecing together a complex understanding of these patients' conditions. Different perspectives can guide the treatment in various directions, posing challenges in clinical practice. Furthermore, cultural notions risk overshadowing individual patient needs. Time, trust, and openness are important for physiotherapists to understand each young patient's situation and needs and thus provide patient-centered physiotherapy.