Physiotherapy Theory and Practice最新文献

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.

Background: Hemorrhage can result in bilateral hypertrophic olivary degeneration (HOD) by damaging the dentato-rubral-olivary pathway, which may lead to tremor that is resistant to pharmacological management. In recent years, the cerebellum has emerged as a promising target for noninvasive brain stimulation in the treatment of post-stroke motor dysfunction. However, the effects of noninvasive brain stimulation on post-stroke tremor remain uncertain.

Purpose: To describe and evaluate the effects of theta-burst stimulation (TBS) on tremor induced by bilateral HOD.

Case description: A 50-year-old man with pontine hemorrhage was admitted to hospital because of unilateral tremor, dizziness, and ataxia. The intention tremor on the right side at a frequency of 2-3 Hz was pronounced. The Fahn-Tolosa-Marin tremor rating scale and Scale for Assessment and Rating of Ataxia were 61 and 25 points. Magnetic resonance imaging (MRI) performed 8 months after symptom onset revealed bilaterally enlarged inferior olivary nuclei. The patient underwent physical therapy for 4 months and pharmacological treatment for 2 months, but his right-sided tremor persisted. Consequently, in addition to personalized physiotherapy and medications, continuous TBS (cTBS) was applied to the right cerebellum, using 60% of the right hemisphere resting motor threshold (RMT) as the stimulation intensity.

Outcomes: After a two-week intervention, cTBS protocol led to worsened dizziness without any alleviation of the tremor.

Conclusion: Cerebellum-targeted TBS did not improve tremor induced by HOD. These findings highlight the need for a deeper understanding of the underlying pathophysiology of HOD-related tremor, which facilitates the development of more effective and targeted strategies in the future.

Background: Shoulder pain is one of the most common musculoskeletal complaints, increasing with age and affecting many functions.

Purpose: To compare the effects of synchronized telerehabilitation and face-to-face rehabilitation approaches in terms of pain, function, and muscle activation in patients with partial rotator-cuff (RC) tears.

Methods: 44 patients with partial RC tear were randomly separated into two groups (Group-1:Telerehabilitation; Group-2: Face-to-face rehabilitation). Pain levels were assessed using a Visual Analogue Scale (VAS), shoulder function using the Disabilities of the Arm, Shoulder, and Hand (DASH) scale, muscle activation levels using a superficial electromyogram (sEMG), and satisfaction levels using the Global Rating of Change (GRC) and the Telehealth Satisfaction Scale (TSS).

Results: The mean ages of the groups were 55.55 years (±7.01) and 57.00 years (±8.12), respectively. The VAS-rest score at Week 4 and the VAS-activity score at Weeks 4 and 8 showed a significant difference in favor of Group 2 (p < .001; p < .001; p = .01, respectively). Significant improvements were seen in DASH (p < .001,ES=.85; p < .001, ES = .89) scores and sEMG activation of the infraspinatus (p < .001, ES = .69; p < .001, ES = 81), upper trapezius (p < .001, ES = .28; p < .001, ES = .33, respectively), anterior deltoid(p < .001,ES=.92; p < .001, ES = .94), middle deltoid(p < .001, ES = .66; p < .001, ES = .68), and posterior deltoid (p = .002, ES = .92; p < .001, ES = .93) muscles, in both groups. No significant differences were found in GRC scores.

Conclusion: Face-to-face rehabilitation is more effective at relieving pain. Synchronized telerehabilitation is a feasible way to improve shoulder function, muscle activation, and patient satisfaction.Clinical Trial URL/Registration Number: https://clinicaltrials.gov/NCT05904249.

Background: The vascular endothelium regulates capillary permeability and inflammation; its function predicts cardiovascular risk and mortality. Low-intensity therapeutic ultrasound (LITUS) may influence endothelial function, but the effects remain uncertain.

Objective: This systematic review with meta-analysis of clinical trials aims to evaluate the effects of LITUS on endothelial function in humans.

Methods: Placebo-controlled randomized clinical trials evaluating the effects of LITUS on endothelial function in humans were included. The studies were registered on PROSPERO (CRD42024534383). Data were extracted from MEDLINE (PubMed), Cochrane CENTRAL, SCIELO, EBSCO, EMBASE, and Web of Science databases, with no restrictions on year of publication or language, up to February 6, 2025. Methodological risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. Meta-analyses were conducted using Review Manager version 5.3, and the certainty of evidence was evaluated by GRADE.

Results: Five randomized crossover clinical trials met the inclusion criteria, including data from 103 subjects (intervention and placebo). The methods used to evaluate endothelial function included flow-mediated dilation (in three studies), venous occlusion plethysmography, and laser Doppler flowmetry. The application of LITUS increased the endothelial function in pulsed (standard mean difference [SMD]: 0.88; CI 95%: 0.59 to 1.17; I²: 0%) and continuous (SMD: 1.09; CI 95%: 0.70 to 1.48; I²: 38%) waveforms. The certainty of the evidence was considered "moderate" for pulsed and continuous waveforms.

Conclusion: The pulsed and continuous waveforms of the LITUS improved endothelial function. These results indicates that the application of therapeutic ultrasound has benefits on vascular homeostasis.

Background: Contextual factors (CFs), such as clinician's words and patient's expectation, influence musculoskeletal pain outcomes through biopsychosocial processes. While physiotherapists' views on CFs have been studied elsewhere, no such research exists in Argentina.

Objective: This study examines Argentine physiotherapists' perspectives and their link to professional characteristics.

Methods: A cross-sectional online survey was distributed to 512 Argentine physiotherapists, members of a scientific society specializing in musculoskeletal care. It gathered demographic, professional data, two clinical vignettes on decision-making, and closed-ended questions on CF use, ethical and communication aspects, beliefs, use frequency, mechanisms of action, and perceived benefits. Associations between professional factors and both CF beliefs and use were analyzed using univariate and multivariate regression models.

Results: Response rate was 45.5%. The most influential CFs were therapeutic alliance, verbal communication, and positive attitudes and behavior; in contrast, professional reputation, patient's previous experience, and a patient-centered approach were rated less influential. While frequently used CFs generally matched perceived influence, some discrepancies emerged. Reading more than five scientific articles in the past three months was significantly associated with stronger CF beliefs (B = 0.178, 95% CI [0.055-0.301], p < .01) and higher CF use (B = 0.181, 95% CI [0.053-0.309], p < .01). Teaching activities were also linked to greater CF use (B = 0.178, 95% CI [0.027-0.329], p = .021).

Conclusion: Argentine physiotherapists recognize the importance of CFs, especially therapeutic alliance and communication. Discrepancies between beliefs and use, along with regression results, suggest that academic exposure and teaching play a key role in CF integration, underscoring the need to strengthen education and training in clinical practice.

Background: There is a clear need for physiotherapy in the care of patients receiving palliative care, especially in hospital-based settings.

Objective and methods: This study aimed to identify Swiss hospital-based physiotherapists' perceptions and experiences in palliative care, using an online qualitative survey design, and analyzing the data using reflexive thematic analysis.

Results: In total, 75 hospital-based physiotherapists participated in the study, of which 68% had palliative care experience. Three main themes were identified: 1) Recognizing the importance of palliative care, 2) the personal impact on physiotherapists, and 3) the search for individual solutions. Under the first theme were the positive perceptions toward palliative care, including wanting an earlier involvement of palliative care, as well as more acknowledgment of the key role that physiotherapists have in palliative care. The personal impact encompassed the way in which participants were affected by difficult patient situations, but also a recognition of the rewards of working in palliative care, including learning valuable lessons for life. The last theme encompassed participants' experiences of finding a sense of security in the team, their flexibility in setting adapted goals, and their own experience as a facilitator.

Conclusion: Physiotherapists seem to have a natural way of coping with difficult situations with support from their teams. In addition, hospital-based physiotherapists seem generally well equipped to treat patients in palliative situations and their involvement in the care of patients receiving palliative care should be promoted.

Background: Pulmonary involvement due to coronavirus disease 2019 (COVID-19) is common. Pulmonary involvement may affect pulmonary function. Moreover, structural alterations in the lungs may impair the extrapulmonary functions.

Purpose: This study compared respiratory functions, peripheral muscle strength, maximal exercise capacity, chronotropic incompetence (CI) (< 80% of maximal heart rate), physical activity level, and dyspnea in patients with post-COVID-19 who had lung involvement and healthy controls.

Methods: Forty-seven patients and 60 healthy controls were compared. Pulmonary function (spirometry), respiratory muscle strength (maximal inspiratory-expiratory pressures - MIP, MEP) and endurance, peripheral muscle strength (dynamometry), exercise capacity (cardiopulmonary exercise test - CPET), CI, physical activity(metabolic holter), and dyspnea (modified Borg Scale) were evaluated.

Results: Pulmonary function test parameters, MIP, MEP, respiratory muscle endurance, peripheral muscle strength, oxygen consumption, CI during CPET, total and active energy expenditures, daily physical activity duration, metabolic equivalents, and the number of steps were significantly lower in patients compared to controls (p < .001). In contrast, lying down duration (p = .027) and dyspnea on exertion (p < .001) were significantly higher in patients compared with controls. The diffusing capacity for carbon monoxide (DLCO) was 77.2% in patients, indicating mild diffusion impairment.

Conclusion: Respiratory functions, peripheral muscle strength, exercise capacity, and chronotropic response are considerably impaired in patients with post-COVID-19 with pulmonary involvement. The majority of patients demonstrate sedentary lifestyle and reported higher levels of dyspnea during daily living activities. Therefore, these outcomes need to be evaluated in patients with pulmonary involvement, and patients should be referred to comprehensive pulmonary rehabilitation to prevent long-term impairments.TRIAL REGISTRATION: NCT05381727 - Date: May 17, 2022.

Background: Persons living in rural areas face increased rates of multiple chronic health conditions and all-cause mortality. Physical therapy can positively impact disease prevention and wellness; however, a lack of rural providers limits access to physical therapy services and subsequent benefits in rural areas. This study aims to gain insights on physical therapists' experiences providing rural physical therapy services.

Methods: This qualitative study employed a phenomenological approach to capture the perspectives of physical therapists practicing in rural Alabama on providing healthcare services. Participants were recruited using convenience and snowball methods, and each participant completed a semi-structured telephone or Zoom interview. Interview data were coded independently by two separate members of the research team with subsequent group verification. Recruitment continued until saturation was achieved.

Results: Three themes emerged from 15 participants: 1) System-wide challenges in rural healthcare; 2) Personal considerations in providing rural healthcare; and 3) Proposed solutions to identified challenges.

Conclusion: Participants identified inadequate staffing, reduced access to specialty services, and financial concerns as system-wide challenges. Personal considerations included professional isolation, expansive caseloads, and aversion to rural living as challenges, while community pride and responsibility were identified as personal benefits to providing rural healthcare. Proposed solutions included financial incentives for providers, physical therapy student exposure to rural settings, and use of telehealth services. Interactions between themes and subthemes emerged, highlighting potential factors contributing to difficulty adequately staffing rural physical therapists.