Physiotherapy Theory and Practice最新文献

Background: Non-specific low back pain (LBP) is a major health concern associated with a sedentary lifestyle. Understanding the multifactorial risk factors is essential for developing effective management and prevention strategies.

Purpose: This study aims to evaluate how posture, muscle activity and strength imbalances, pain levels, and emotional awareness collectively contribute to the subjective functional status of young office workers with chronic nonspecific LBP, in order to assess the need for a holistic, biopsychosocial approach to managing this condition.

Methods: A cross-sectional study, involving 102 office workers, including 64 females and 38 males, both healthy and suffering from chronic nonspecific LBP, was conducted. The average age of subjects was 31 years (standard deviation = 6.6). The study combined objective assessments, such as posture evaluation, muscle electrical activity, and strength imbalances with patient-reported outcomes (PRO) to investigate their correlations with subjective functional status.

Results: Significant correlations and subsequent inclusion in the multivariate linear regression model identified vertebral rotation, muscle activity and strength disparities as key predictors. PRO, including pain levels and emotional awareness also significantly influenced the Spine Functional Index. Collectively, these factors explained 46.8% of the variance in the subjective functional status among subjects.

Conclusion: This study underscores the importance of a holistic approach in understanding nonspecific LBP, integrating objective measures with PRO to reveal the intricate relationship between functional status and diverse influencing factors. Our findings advocate for the adoption of the biopsychosocial model, demonstrating how the interplay of health conditions, body structures, and social factors impacts chronic nonspecific LBP.

Background: Inconsistent findings concerning the effects of music therapy on patients with chronic obstructive pulmonary disease (COPD) have been reported.

Objective: To systematically evaluate the effects of music therapy on patients with COPD.

Methods: Database search was conducted in Cochrane Library, Web of Science, PubMed, Embase, CINAHL, CNKI, CBM, WanFang Data, and VIP databases, from database inception to June 2024. Two researchers independently reviewed and assessed the methodological quality of the included studies using the Version 2 of the Cochrane tool. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the overall quality. Review Manager (v 5.4) software was used for the meta-analysis.

Results: Eleven studies with 947 patients were included. Standardized mean differences (SMD) and 95% confidence intervals (CI) were observed in favor of music therapy for quality of life (SMD = 0.92, 95% CI [0.39, 1.46]) and exercise endurance (SMD = 0.77, 95% CI [0.05, 1.49]). Meanwhile, the results of subgroup analyses indicated that passive music therapy had significant effects on quality of life (SMD = -0.83, 95% CI [-1.23, -0.44]), anxiety (SMD = -0.67, 95% CI [-1.11, -0.24]) and exercise endurance (SMD = 1.54, 95% CI [0.55, 2.54]). When intervention duration was more than 3 months, music therapy could significantly improve quality of life (SMD = -1.32, 95% CI [-2.17, -0.47]), reduce depression (SMD = -3.94, 95% CI [-5.20, -2.67]) and increase exercise endurance (SMD = 0.96, 95% CI [0.41, 1.51]).

Conclusion: Music therapy is effective for quality of life and exercise endurance of patients with COPD; however, its impact on dyspnea, anxiety, and depression is still uncertain. More high-quality randomized control trials are warranted to confirm these conclusions.

Purpose: We investigate and compare responsiveness of the physical function subscales of patient-reported measures of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Oxford Knee Score (OKS), and performance-based measures of the timed up-and-go test and 6-min walk test and determine the minimal clinically important change (MCIC) values in knee osteoarthritis (OA) patients following physiotherapy intervention.

Methods: One hundred patients were asked to complete the WOMAC and OKS and to perform the timed up-and-go test and 6-min walk test once pre-intervention and again after 4-week physiotherapy intervention (post-intervention). Responsiveness was determined by correlation analysis and receiver operating characteristics (ROC) curve.

Results: The WOMAC-physical function subscale (WOMAC-PF), OKS-functional component score (OKS-FCS), timed up-and-go test, and 6-min walk test showed moderate-to-good relationships with the patients' global rating scale (Spearman correlation ranges = 0.51-0.56). All outcome measures of physical function showed the area under the curve (AUC) >0.70 (AUC ranges = 0.78-0.82). The MCIC values were 12.5 points for WOMAC-PF, 17.5 points for OKS-FCS, 2.82 s for timed up-and-go test, 61 m for 6-min walk test.

Conclusions: All outcome measures have adequate responsiveness to detect clinical improvements over time in functional status following the physiotherapy intervention in patients with knee OA. The MCIC values can help clinicians and researchers to make a decision based on the clinical significance of improvements in patients' functional status.

In this professional theoretical article, the authors argue that patient care should be centered on connection and that authentically turning toward suffering necessitates an approach to care that transcends medicine's traditional focus on cure and physical restoration and differentiates between pathology and disability. The meaning of illness and suffering for those who have experienced life-changing injuries or illness is explored. Strategies for approaching the lifeworld of these individuals are discussed using the concepts of phenomenology and embodiment, rooted in the work of philosophers from the phenomenological tradition. The authors also propose an approach to patient care offering a case-based example based on postmodernist concepts that elevate connection, relationship, and interdependency above the traditional focus of restoring normality and physical independence for individuals with disabilities. Traditional assumptions about quality of life, illness, and disability are called into question by focusing on the fluidity of being and disability identity, which serves to destabilize static, binary conceptions of individuals as either healthy or ill, disabled, or able-bodied. A postmodern lens invites healthcare practitioners to envision themselves as part of an assemblage that may promote a more expansive view of the relationship between patient and healthcare practitioner.

In health sciences, including physical therapy, communication techniques are a critical part of the success in the therapeutic process. Managing the patient's beliefs, perceptions, and the narrative of their problems, becomes an essential part of the therapeutic process. This is the key to achieving real changes regarding how the patient copes with pain, illness, dysfunction, as well as the ability to develop adequate resources for facing them. We call this "Therapeutic expectancy" a new concept that originates from the well-known Therapeutic alliance and incorporates practices from the field of Motivational interviewing and Strategic dialogue. The Therapeutic expectancy starts from the first interaction with the patient and continues throughout the different stages of the therapeutic process. This article describes the structure of the relationship with the patient and some verbal communication techniques to generate an effective physical therapist-patient interaction, building Therapeutic expectancy, through a "centered on the patient's narrative" strategy. Expectancy constitutes a desirable goal in any patient and in any pathological condition as it pursues a change in an individual's perception of their state of health, thereby enhancing the desire for healing and empowerment.

Objective: This study aimed to measure the functional exercise capacity of patients with ankylosing spondylitis (AS) with the incremental shuttle walk test (ISWT), and to determine the factors associated with this test.

Methods: This cross-sectional study included 54 patients with AS (29 males, 25 females). The ISWT was performed to determine functional exercise capacity. The number of completed shuttles was recorded, and the total incremental shuttle walk distance (ISWD) was calculated. Disease activity was assessed with the Bath AS Disease Activity Index (BASDAI), physical functioning was assessed with the Bath AS Functional Index (BASFI), and spinal mobility was assessed with the Bath AS Mobility Index (BASMI). Upper body and core endurance were assessed by sit-up and push-up tests. Tests were performed in a single session in the order listed.

Results: The mean ISWD of the patients was 462.41 ± 97.96 m, and the subjects reached 50.48% of the predicted ISWD. The ISWD of male subjects was significantly higher than that of females (p < .05). At the end of the test, male subjects reached 60.87% of the age-predicted maximal heart rate, and female subjects reached 55.25%. There was a significant positive moderate correlation between ISWD and height (r = 0.535, p < .01), sit-up test (r = 0.617, p < .01), and push-up test (r = 0.495, p < .01), while there was a negative weak correlation between BASFI (r = -0.344, p = .011) and BASMI (r = -0.280, p = .040).

Conclusion: The study showed that functional exercise capacity as assessed by the ISWT decreased in patients with AS. ISWT performance was associated with sex, height, functionality, spinal mobility, and muscular endurance.

Background: Poststroke shoulder pain (PSSP) is a common poststroke complication. Even though it is a common phenomenon, it is unclear how it impacts the patient's life.

Objective: To investigate the differences in upper extremity function, sleep quality, and functional independence between patients with and without PSSP.

Methods: This cross-sectional study included 63 participants with stroke (32 patients with PSSP and 31 patients without PSSP). Shoulder pain was evaluated with a Visual Analog Scale and the participants were divided into two groups as those with and without PSSP. The upper extremity function was assessed with the Disabilities of the Arm, Shoulder, and Hand Questionnaire, the Arm Motor Ability Test, and the Nine Hole Peg Test. Sleep quality was assessed with Pittsburgh Sleep Quality Index and the functional independence was assessed with the Functional Independence Measure. All data were analyzed using the program IBM SPSS Statistics 22.0. The Mann-Whitney U test was used to compare the non-normally distributed parameters, and the Chi-square test was used to compare the ordinal variables. The Spearman correlation test was used for the relationship and a linear regression test was used for regression.

Results: Upper extremity function decreased (p < .05), only the sleep disturbance sub-parameter of sleep quality increased (p = .01), and functional independence increased in patients with PSSP (p < .001). There was a moderate relationship between pain and upper extremity function and a fair relationship between pain and sleep quality (use of sleep medications, daytime dysfunction sub-parameters) (p < .05).

Conclusions: PSSP impairs upper extremity functions, which play an important role in activities of daily living, and reduces functional independence. These results suggest that it is important to evaluate shoulder pain and examine the factors affecting pain in the rehabilitation of patients with stroke.

Background: The "gold standard" marker for freezing of gait severity is percentage of time spent with freezing observed through video analysis.

Objective: This study examined inter- and intra-rater reliability and variability of physiotherapists rating freezing of gait severity through video analysis and explored the effects of experience.

Methods: Thirty physiotherapists rated 14 videos of Timed Up and Go performance by people with Parkinson's and gait freezing. Ten videos were unique, while four were repeated. Freezing frequency, total duration, and percentage of time spent with freezing were computed. Reliability and variability were estimated using ICC (2,1) and mean absolute differences. Between-group differences were calculated with the one-way ANOVA.

Results: Inter- and intra-rater reliability ranged from moderate to good (ICC: inter-rater frequency = 0.63, duration = 0.78, percentage = 0.50; intra-rater frequency = 0.84, duration = 0.89, percentage = 0.50). Variability for freezing frequency was two episodes. Inter- and intra-rater variability for total freezing duration was 18.8 and 12.3  seconds, respectively. For percentage of time spent with freezing, this was 15.2% and 13.5%. Physiotherapy experience had no effect.

Conclusion: Physiotherapists demonstrated sufficient reliability, but variability was large enough to cause changes in severity classifications on existing rating scales. Percentage of time spent with freezing was the least reliable marker, supporting the use of freezing frequency or total duration instead.

Background: Functional assessments easy to administer within the clinic to identify non-ambulatory individuals with spinal cord injury at risk of recurrent falls are needed.

Purpose: To examine the ability of functional balance and transfer quality to predict recurrent falls.

Methods: This 6-month prospective study examined remote assessments of transfer quality using the Transfer Assessment Instrument and functional sitting balance with the Function in Sitting Test and the Trunk Control Test. Then, participants prospectively monitored their falls for 6-month using fall diaries. Frequency of falls was categorized as infrequent fallers (≤2 falls) and recurrent fallers (>2 falls). A multivariable logistic regression analysis was conducted. A Receiver Operating Characteristic curve was performed to determine the area under the curve, the sensitivity, and the specificity of the model.

Results: Eighteen non-ambulatory individuals (mean age = 44 ± 16 years, mean time since injury = 7.8 ± 32.6 years) participated in the study. Poor balance (lower Function in Sitting Test score) was associated with higher odds of future recurrent falls (Odds Ratio = 0.70, 95% CI, 0.48 to 1.00, p = 0.05), area under the receiving operating curve = 0.87, sensitivity = 88%, and specificity = 70%.

Conclusions: A comprehensive sitting balance assessment that includes the static, proactive, and reactive components of balance with the integration of sensorial functions as evaluated within the Function in Sitting Test may be useful for predicting recurrent falls among non-ambulatory individuals with spinal cord injury. Replication of the findings in a larger sample is warranted.

Background: The efficacy of various supervision methods for stabilization exercises in patients with chronic low back pain (CLBP) remains uncertain.

Objective: To evaluate the impact of supervised and unsupervised stabilization exercises in patients with CLBP.

Methods: Sixty-six participants were assigned to the in-person-supervised, tele-supervised, or unsupervised groups. All participants received a 20-30-minute exercise program three times a week for 4 weeks. We assessed functionality (Oswestry Disability Index), pain intensity (Numeric Rating Scale), and kinesiophobia (Tampa Scale of Kinesiophobia) before and after the 4 weeks. The outcomes were analyzed using effect size, minimum clinically important difference (MCID), minimal detectable change (MDC), Wilcoxon test, and post hoc analyses.

Results: While the unsupervised group improved in all measures (p < .05) both the tele-supervised (p = .001) and in-person-supervised (p < .001) groups achieved superior functionality exceeding MDC. The in-person-supervised group demonstrated greater functionality (p < .001) than the tele-supervised group, exceeding MCID. Pain intensity decreased in the tele-supervised (p = .011) and in-person-supervised groups (p < .001) compared to the unsupervised group, exceeding MCID and MDC. No significant difference was found in post-treatment NRS score changes between the supervised groups (p = .071). The in-person-supervised group displayed a greater reduction in kinesiophobia than the tele-supervised (p < .001) and unsupervised groups (p < .001) but not exceeding MCID or MDC. Effect sizes were large within and between groups except for a small effect size between the tele-supervised and unsupervised groups in kinesiophobia.

Conclusion: While tele-supervised stabilization exercises alleviate pain and enhance functionality, in-person-supervised exercises may be more effective in improving functionality and reducing kinesiophobia in patients with CLBP.