Physiotherapy Theory and Practice最新文献

Objective: This study investigated changes in ankle function in older adults with a history of falls and the influence of gender. It also explored the relationship between balance and ankle function in fallers.

Methods: A cross-sectional study of 78 nursing home residents [54 women (mean age: 75.54 ± 4.88), 24 men (mean age: 78.87 ± 5.50)] aged ≥65 years was conducted. Ankle dorsi-plantar flexion range of motion (ROM), tibialis anterior (TA) and gastrocnemius (GC) electromyography (EMG) activity during contraction/relaxation, and isometric TA/GC strength were measured. Fear of falling (FoF) and balance were assessed using the Falls Efficacy Scale (FES) and Berg Balance Scale (BBS), respectively.

Results: Rates of fallers (women %32, men %33) were similar between genders. Men with a history of falls showed higher GC EMG activity (p = .016) and greater FoF (p = .016) than women with fall history. Fallers versus non-fallers in men also exhibited higher GC EMG activity (p = .039) and FoF (p = .011). In men, fall number positively correlated with GC work average and FES. A strong negative correlation existed between BBS and FES in male fallers (r = -0.985, p = .015).

Conclusion: Ankle ROM and muscle function may be unaffected in women post-fall. However, men experiencing falls might have reduced ankle strength, potentially compensated by increased EMG activity. Men appear more significantly impacted by falls psychologically and functionally.

Background: Females have worse functional outcomes than males after a stroke including worse standing balance, slower gait speed, and higher fatigue levels. The current understanding of stroke recovery mechanisms has not yet been able to explain why females have worse outcomes compared to males. Functional Near Infrared Spectroscopy (fNIRS) amplitude offers information on the level of cognitive effort required to perform a task, as well as the impact of rehabilitation on brain function.

Objectives: The aim of this case series was to use fNIRS to provide detailed prefrontal cortex activation data on several functional lower extremity sensorimotor tasks in females admitted to a stroke inpatient rehabilitation unit.

Methods: Four female participants completed impairment, balance, gait, and fatigue measures as well as fNIRS assessments at admission and discharge from the inpatient stroke rehabilitation unit. fNIRS assessments included quiet and semi-tandem standing, and supine ankle sensorimotor tasks.

Results: All participants had a subcortical ischemic stroke with improvements in sensorimotor impairment (average 9-point increase on the Fugl-Meyer), balance (average 29-point increase on the Berg Balance Scale), and gait (average 0.25 m/s increase in gait speed, average 30 m increased distance on the 2-minute walk test) at discharge. Larger fNIRS amplitudes were observed at baseline which were reduced at discharge for the three supine tasks, and these changes were less evident for the two standing tasks. Two females had decreased fatigue at discharge with the other two females experiencing small increases (average 0.5-point decrease on the Fatigue Severity Scale).

Conclusions: For females admitted to an inpatient stroke unit, relationships may be present with improvements on clinical scores and decreased fNIRS amplitude during supine tasks, with standing tasks generating more diverse fNIRS responses. These findings suggest that fNIRS can provide prefrontal cortex activation data in females on an inpatient stroke unit and that a standard inpatient rehabilitation program appears to have an effect on fNIRS amplitudes.

Background: Canalith jam (CJ) is a rare variant of benign paroxysmal positional vertigo (BPPV), resulting from otoconial obstruction of endolymph flow. It causes persistent, direction-fixed nystagmus (DFN) and can mimic acute vestibular syndrome (AVS), including vestibular neuritis (VN) or stroke.

Objective: To describe the clinical and infrared video-Frenzel (IRVF) based diagnosis of horizontal semicircular canal (HSC) canalith jam (HSCCJ), a subtype of CJ, and to highlight the role of physiotherapy-guided bedside maneuvers in its successful management.

Case descriptions: Three patients (aged 50, 55, and 62) presented with positionally triggered acute vertigo. Patients 1 and 3 had sustained DFN consistent with AVS, whereas patient 2 developed persistent DFN during positional testing. The diagnosis of HSCCJ was established through positional tests [supine roll test (SRT), bow and lean test (BLT)] and assessment of DFN using IRVF goggles.

Intervention: All patients underwent a physiotherapist-administered head-shaking maneuver (HSM) in the yaw plane, performed with 30° of neck flexion. One patient also received the Gufoni maneuver (GM). Maneuvers were guided by real-time oculomotor responses recorded via videonystagmoscopy.

Outcomes: All patients experienced complete resolution of symptoms and nystagmus within 4 hours, confirmed by repeat testing at 4 and 24 hours. Transient nausea and vomiting were the only adverse effects observed.

Conclusion: Although the diagnosis of HSCCJ depends on clinical and oculographic evaluation, physiotherapy-guided HSM is a simple, safe, and effective bedside intervention. Incorporating this approach into vestibular rehabilitation (VR) protocols may enhance outcomes in atypical BPPV.

Introduction: Chronic ankle instability (CAI) is associated with altered gait mechanics and cognitive-motor deficits, while some individuals with a history of ankle sprain recover successfully as copers. Dual-tasking and fatigue represent common real-world challenges, but their combined effects on gait in CAI compared with copers remain unclear.

Purpose: To investigate the effects of motor fatigue on spatiotemporal gait parameters under single- and dual-task conditions in individuals with CAI compared with copers.

Methods: Thirty individuals with CAI (mean age 26.7 ± 7.2 years) and 30 age- and sex-matched copers, (mean age 24.48 ± 6.2 years) completed gait trials under single- and cognitive dual-task conditions, both before and after a fatiguing exercise protocol. Spatiotemporal gait parameters were recorded, and repeated-measures ANOVA with Bonferroni correction was used to examine main effects and interactions.

Results: Dual-tasking significantly altered gait in both groups, with increased step length (p = .005) and step time (p < .001) and reduced step width (p = .018) and step length variability compared with single-task walking (p = .036). Fatigue further modified spatiotemporal parameters. The individuals with CAI showed increased variability in step length, while copers demonstrated decreased variability in step time (p = .021). Cognitive performance remained stable across conditions.

Conclusion: Dual-tasking and fatigue interact to shape gait differently in CAI and coper groups. Rather than uniformly impairing gait, dual-tasking sometimes promoted more consistent walking, while fatigue destabilized gait, particularly in individuals with CAI. These findings highlight the importance of incorporating both cognitive and fatigue-related challenges into rehabilitation to better prepare individuals with CAI for real-world demands.

Introduction: Chronic kidney disease (CKD) is associated with muscular and respiratory complications, negatively affecting respiratory muscle strength, pulmonary capacity, peripheral muscle strength, and functional capacity in patients undergoing hemodialysis (HD). Understanding the extent of these impairments is essential to guide therapeutic strategies.

Objective: To evaluate the impact of CKD on respiratory muscle strength, pulmonary capacity, peripheral muscle strength, and functional capacity in patients undergoing dialysis.

Methods: This systematic review was conducted using PubMed/MEDLINE, LILACS, Embase, SciELO, and the Cochrane Library, with searches performed from July to August 2025. Cross-sectional observational studies evaluating respiratory muscle strength, pulmonary function, peripheral muscle strength, and functional capacity, compared with predicted values for sex and age, were included. Methodological quality was assessed using the Newcastle - Ottawa Scale. Results: A total of 1266 articles were identified, of which 22 met the inclusion criteria. Most studies presented satisfactory methodological quality (scores ≥6). Patients with CKD undergoing hemodialysis exhibited reduced respiratory muscle strength, with mean maximal inspiratory pressure of 53.7 ± 19.5% and maximal expiratory pressure of 49.5 ± 15.8% of predicted values. A moderate to strong correlation between maximal inspiratory pressure and functional capacity was observed (r = 0.38-0.79). Handgrip strength was also reduced compared with healthy individuals, with values approximately 40% below normal (28.18 ± 9.36 kgf; 114.00 ± 39.51% of predicted). Functional capacity was impaired, as indicated by a six-minute walk test distance corresponding to 66.33 ± 20.53% of predicted values. Pulmonary function findings were heterogeneous, with restrictive ventilatory pattern being the most frequently reported abnormality (66.7%). Conclusion: Patients with CKD undergoing hemodialysis present reduced respiratory and peripheral muscle strength, pulmonary capacity, and functional capacity.

Purpose: This study aimed to compare the short-term clinical and economic outcomes of physiotherapy, pharmacological therapy, and combined management in patients presenting to the emergency department (ED) with acute mechanical low back spasm.

Methods: A retrospective analysis was conducted on 150 adults aged 18 to 65 years who presented to the ED between January 2024 and January 2025. Patients were retrospectively stratified according to the treatment received during routine emergency care into physiotherapy, pharmacological therapy, or combined therapy groups (n = 50 each). Pain intensity and functional activity were assessed at baseline (pre-treatment) and post-treatment at ED discharge, and direct, short-term costs related to ED care were calculated.

Results: All treatment groups demonstrated significant reductions in pain intensity after intervention (within-group p < .001). The combined therapy group showed the greatest pain reduction (ΔVAS -5.80 ± 1.42), compared with physiotherapy (-3.80 ± 1.70) and pharmacological therapy (-3.30 ± 1.84) (between-group p < .001), with a large effect size (ε² = 0.31). Functional activity improved significantly in all groups (p < .001), with no significant difference between treatment modalities (p = .843). Patient-reported satisfaction scores differed significantly among groups and were highest in the combined therapy group (p < .001). Total treatment cost varied significantly between groups (p < .001), with pharmacological therapy being the least costly option.

Conclusion: Combined physiotherapy and pharmacological treatment was associated with superior short-term pain relief and higher patient-reported satisfaction compared with either approach alone in patients presenting to the ED with acute low back spasm. Despite higher immediate costs, these findings support the integration of physiotherapy into emergency care to improve short-term, patient-centered outcomes. Further prospective and cost-effectiveness studies are warranted.

Clinical trial registration: ClinicalTrials.gov Identifier: NCT06987656.

Background: Bucket hydrokinesiotherapy, a supportive aquatic intervention for newborns, has been widely applied, although it lacks robust evidence regarding its clinical and neuromotor effects. While the General Movements Assessment (GMA) sensitively detects early neurological risk, the influence of therapeutic interventions on general movements (GMs) remains unclear.

Objective: This study aimed to examine the effect of hydrokinesiotherapy on the GMs of hospitalized preterm infants and their clinical outcomes.

Methods: Parallel-arm randomized controlled trial in which newborns were randomly assigned to two balanced groups and assessed at 34 (baseline), 36, 40-42, and 50-52 weeks postmenstrual age. Main inclusion criteria were: poor repertoire-GMs, admitted to a Neonatal Intermediate Care Unit, clinically stable. Assessors of main outcomes were blinded to group allocation. Interventions consisted of 10-minute bucket hydrokinesiotherapy followed by diaper change over 6 sessions on alternate days, or a diaper change only (control). Body weight and GMA were primary outcomes. Behavioral state was a secondary outcome; physiological parameters and respiratory distress were monitoring outcomes.

Results: Thirty-four infants were included. Body weight (p = 0.43; d = 0.28) and global quality of GMs (p's > 0.25; d's < 0.39) were not affected by the intervention. Controls presented higher total (95%CI: 3.28-19.71; p < .001), upper (95%CI: 1.74-9.36; p < 0.001), and lower limb (95%CI: 0.79-8.14; p = 0.02) movement scores in the detailed GMA after the diaper changes protocol, at 36 weeks. The hydrokinesiotherapy group was more alert than controls after each session (p's < 0.01; V's > 0.53). Physiological parameters showed transient between-group differences within normal ranges (p's < 0.05). Adverse effects were not found.

Conclusion: Bucket hydrokinesiotherapy was safe for the newborns. The technique was not effective in improving the global quality or detailed aspects of GMs after the two-week protocol. The intervention may be recommended to increase alertness, potentially supporting readiness for active feeding and engagement during care; however, caution is warranted given its acute effects on detailed aspects of GMs.

Trial registrations: Trial registered in the Brazilian Clinical Trials Registry (ReBec). ReBec is a Primary Registry in the WHO Registry Network. Trial nº. RBR-5n82tv. https://ensaiosclinicos.gov.br/rg/RBR-5n82tv/.

Background: Sleep disorders and reduced functional status are common in individuals with chronic obstructive pulmonary disease (COPD) and negatively impact health outcomes. However, their association remains unclear. This systematic review aimed to synthesize evidence on the association between sleep disorders and functional status in individuals with COPD, and identify the instruments, variables, and diagnostic criteria used to assess these outcomes.

Methods: A comprehensive search was initially conducted in 2021 and updated twice, with the final search performed on July 11, 2025, in CINAHL, Cochrane Library, EMBASE, LILACS, MEDLINE, PEDro, SciVerse Scopus, and Web of Science. Reporting and methodological quality were assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist and the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

Results: Fifteen studies were included, totaling 2297 individuals with COPD. Sleep disorders were assessed using six diagnostic methods, and functional status was evaluated using three approaches. Twelve studies met 50-80% of STROBE criteria, and three met > 80%. Methodological quality was fair in 73%, good in 13% and poor in 13% of the studies. Sleep disorders were weakly to moderately associated with functional status, including field walking tests, maximal exercise capacity, and time spent in physical activity > 1.5 METs.

Conclusion: Moderate methodological quality suggests a weak-to-moderate association between sleep disorders and functional status in individuals with COPD. Further high-quality studies using validated instruments and study designs tailored to minimize bias are warranted to clarify this relationship and enhance its clinical applicability.

Background: Ambulation ability is among the most significantly compromised functions following lower-limb amputation, considerably impacting autonomy and quality of life.

Objective: To compare the spatiotemporal gait alterations between adults and older adults with lower-limb amputation in the pre-prosthetic phase and to identify the indicators of gait performance.

Methods: This observational, analytical, cross-sectional study enrolled 24 participants (13 adults aged 20-50 years and 11 older adults aged ≥60 years). Data collection included a demographic and clinical questionnaire, the Amputee Mobility Predictor without prosthesis (AMPnoPRO), the Functional Independence Measure (FIM), the Timed Up and Go (TUG) test, and gait analysis using an Inertial Measurement Unit with an accelerometer and gyroscope. Descriptive statistics were performed. Group comparisons were conducted using the Mann-Whitney U test. The Spearman correlation coefficient (p ≤ .05) was used to examine associations between gait parameters, age, anthropometric variables, and functional outcomes.

Results: Age, duration of physical therapy, and functional test performance (FIM, AMPnoPRO, TUG) were significantly associated with spatiotemporal gait parameters. Older adults demonstrated significantly lower cadence (-23.2 steps/min; p = .013) and longer step duration (+0.68 s; p = .022) compared to younger adults (20-59 years).

Conclusion: Age, duration of physical therapy, and performance on functional tests may serve as reliable indicators of gait performance, contributing to individualized rehabilitation strategies.