Physiotherapy Theory and Practice最新文献

Background: It appears that the therapeutic relationship in physiotherapy practice facilitates the success of patient health outcomes, although the process by which it is carried out has been poorly studied.

Objective: To explore the influence of the therapeutic relationship on any patient health outcomes in physical therapy settings.

Methods: PubMed, Web of Science, Scopus, CINAHL, LILACS and Dialnet databases were systematically searched following PRISMA guidelines. The searches were completed in August 2024. Qualitative and quantitative studies measuring the therapeutic relationship and assessing its influence on health outcomes of patients treated with physical therapy were included.

Results: The search yielded a total of 769 results. 13 studies ultimately retained for analysis. A total of 1555 individuals were studied who had suffered injuries such as low back pain; osteoarthritis; underwent cardiac surgery; hip fracture and elite athletes recovering from injuries. The results obtained were classified into three main themes: characteristics and skills of physical therapists (interpersonal, organizational, leadership and communication skills), therapeutic relationship factors (shared decision making, trusting relationships, motivating the patient and individualization of care) and patient health outcomes influenced by therapeutic relationship (functional outcomes, disability, pain intensity, outcome expectations, perceived global effect, adherence, self-efficacy, sports performance and lung function).

Conclusions: Through physical therapist's soft skills, therapeutic relationship factors are built under the paradigm of person-centered care and shared decision making, having a positive influence on certain patient health outcomes. Therefore, evidence support that therapeutic relationship contributes to improved patient health outcomes.

Introduction: A Physiotherapy-led Bike Fitting (PBF) intervention including a bike fit, education, and exercise prescription can be helpful among cyclists with knee pain.

Objective: To describe the PBF intervention and to assess knee-related pain and disability change among recreational cyclists exposed to the PBF intervention.

Methods: This is a single group prospective observational longitudinal study on a cohort of recreational road cyclists who consulted for cycling-related knee pain at a physiotherapy clinic specialized in cycling. The PBF included a comprehensive bike fit focusing on key measurements such as knee flexion and knee alignment relative to the pedal axis while cycling. Additionally, tailored education was provided on cycling cadence and training progression, along with exercise prescriptions. The primary outcome was the knee pain during cycling measured with the numerical pain rating scale (NPRS; 0-10). Linear models were used to assess within-group changes across time points at 4 and 12 weeks.

Results: Seventy-six recreational road cyclists with knee pain while cycling were included and all received the PBF intervention. In terms of evolution over time following the intervention, there were significant improvements over time in worst, least, and average knee pain while cycling (p < .001) with respective improvements of -2.52 (95% CI: -3.04; -2), -0.7 (95% CI: -1.02; -0.38) and -1.81 (95% CI: -2.27; -1.36) at 12 weeks.

Conclusions: Based on this single group observational study, recreational road cyclist exposed to a PBF intervention, including a bike fit, tailored education, and exercises prescriptions reported a reduction in cycling-related knee pain and disability.

Background: Transverse myelitis (TM) is a rare inflammatory disorder of the spinal cord resulting in neurological impairments that impact motor function and mobility. Blood flow restriction (BFR) training has emerged as a feasible intervention in neurologic populations to improve strength and functional performance. Recent studies suggest that combining BFR with neuromuscular electrical stimulation (NMES) may further enhance outcomes.

Objective: To evaluate the effects of an 8-week, low-intensity lower-extremity resistance training program incorporating BFR (2×/week for 4 weeks) followed by combined BFR+NMES (2×/week for 4 weeks) on functional performance in a patient with chronic TM. The patient was seen for a total of 17 visits.

Case description: A 31-year-old male with a 17-year history of TM presented with significant left lower extremity weakness, functional mobility limitations, and challenges navigating stairs and walking long distances. His primary goal was to improve his functional mobility.

Outcomes: Post-intervention assessments demonstrated improvement across multiple functional performance measures. The patient's gait speed with the 10-Meter Walk Test (10MWT) increased from 1.17 to 1.43 m/s (MDC 0.13 m/s), Timed Up and Go (TUG) time improved by 17.5% (MCID 10-15%), and his 30-Second Sit-to-Stand (30STS) performance increased by two repetitions (MDC 1.13). Improvements were also seen in the Patient-Specific Functional Scale (PSFS) and the SF-36.

Discussion: The findings suggest that BFR, alone or in combination with NMES, may improve function in chronic TM patients with lower extremity weakness. BFR appears to offer a promising approach for individuals with neurological conditions where traditional high-intensity resistance training is limited.

Background: The Subgroups for Targeted Treatment Back Screening Tool (SBST) is used to assess risk factors for chronic disability in non-specific low back pain (NSLBP). Patients are categorized into three subgroups (low, medium, and high risk) based on their SBST score.

Objectives: To evaluate the responsiveness and minimal important change (MIC) of Persian SBST in NSLBP.

Methods: Responsiveness of SBST over 4 weeks' physiotherapy was investigated (in all the patients, low-, medium-, and high-risk subgroups) by calculating the effect size (ES) of SBST change, correlation with a global rating of change, Roland-Morris Disability Questionnaire and Oswestry Disability Index changes, and receiver operating characteristics (ROC) curve analysis. Five priori hypotheses were formulated about the ES, correlation coefficients, and Area Under the ROC Curve. If 75% or more of the hypotheses were supported, the responsiveness of SBST was approved. The MIC of SBST was determined through coordinates of the ROC curve and Youden index.

Results: All (100%) of the hypotheses were accepted in all patients (200 patients). 40%, 80%, and all (100%) of the hypotheses were accepted in the low-, medium-, and high-risk subgroups, respectively. The MIC values of SBST in all patients, low-, medium-, and high-risk subgroups were 1.5, 0.5, 1.5, and 4.5 points, respectively.

Conclusion: The SBST accurately detects clinical changes when considering all the patients together. The SBST is responsive in the medium- and high-risk subgroups but not in the low-risk subgroup. A reduction of at least 1.5 points in the SBST score is required for clinically meaningful changes.

Background: The effectiveness of Kinesio Taping (KT) for mild-to-moderate Carpal Tunnel Syndrome (CTS) remains controversial.

Objective: To evaluate both the short-term and long-term efficacy of KT in the management of CTS.

Methods: Electronic searches were conducted in PubMed, EMBASE, The Cochrane Library, Web of Science and Scopus databases up to October 2024. Randomized controlled trials comparing KT with control (sham, no intervention, or basic treatment) or other conservative treatment were included. The revised Cochrane Risk of Bias tool (ROB-2) was used to assess the risk of bias across studies. Meta-analysis was performed to pool data from studies, calculating Mean Differences (MD) and 95% confidence intervals (CI) for continuous outcomes.

Results: Fourteen studies with 637 participants were included. Kinesio Taping (KT) significantly improved long-term pain relief compared to control (MD = -1.14, 95% CI: -1.69 to -0.59, p < .001). Additionally, KT led to significant improvements in symptoms and functional status. KT showed similar therapeutic outcomes to orthoses, and combining KT with orthoses provided greater short-term pain relief than orthoses alone (MD = -0.94, 95% CI: -1.76 to -0.11, p = .03).

Conclusion: Low to moderate quality evidence indicates that KT may effectively improve long-term pain relief and functional outcomes in patients with CTS. Additionally, low quality evidence suggests that the combination of KT and orthoses may provide greater short-term pain relief.PROSPERO registration number: CRD42024555320.

Background: Posterior cortical atrophy (PCA) is a neurodegenerative syndrome characterized by progressive damage to the brain's visual and association areas, resulting in impaired spatial awareness, visual processing, and functional independence.

Purpose: This report examines the effects of a 14-week treatment protocol consisting of translingual neuromodulation via a portable neuromodulation stimulator (PoNS_®¹) in conjunction with physical therapy on balance, gait, and functional mobility in an adult male with PCA.

Case description: Assessments included objective and subjective measures of balance and gait - the 10-Metre Walk Test, Functional Gait Assessment (FGA), Dynamic Gait Index (DGI), Community Balance and Mobility Scale (CB&M), Neuro-Quality of Life (Neuro-QoL), and Activities-specific Balance Confidence (ABC) Scale. These were performed at baseline and weeks 4, 8, and 14 to evaluate the protocol's efficacy in improving balance, stability, and gait.

Outcomes: Postural stability, balance, gait patterning, and gait speed improved, enhancing daily functioning abilities and self-confidence. Gait speed improved by 0.48 m/s (comfortable) and 0.46 m/s (fast), exceeding MDC thresholds. The participant's FGA score increased 21 points and DGI increased 17 points, both exceeding their respective MDC thresholds (6 points for FGA, 3.2 points for DGI), reflecting marked gait improvements. The CB&M score rose 24 points, exceeding the MDC of 9.6 points. Despite these gains, gait speed remained below age-related norms.

Conclusion: Given the largely positive response to the protocol, further investigation should be undertaken to continue to explore the efficacy of PoNS_® and physical therapy to determine its viability as a treatment for symptoms of PCA.

Introduction: Pulmonary involvement is prevalent in patients with coronavirus disease 2019 (COVID-19). Arterial hypoxemia may reduce oxygen transferred to the skeletal muscles, possibly leading to impaired exercise capacity. Oxygen uptake may vary depending on the increased oxygen demand of the muscles during submaximal and maximal exercise.

Objective: This study aimed to compare muscle oxygenation during submaximal and maximal exercise tests in patients with post-COVID-19 syndrome with pulmonary involvement.

Methods: Thirty-nine patients were included. Pulmonary function (spirometry), peripheral muscle strength (dynamometer), quadriceps femoris (QF) muscle oxygenation (Moxy® device), and submaximal exercise capacity (six-minute walk test (6-MWT)) were tested on the first day, maximal exercise capacity (cardiopulmonary exercise test (CPET)) was tested on the second day. Physical activity level was evaluated using an activity monitor worn for five consecutive days. Cardiopulmonary responses and muscle oxygenation were compared during 6-MWT and CPET.

Results: Patients' minimum and recovery muscle oxygen saturation were significantly decreased; maximum total hemoglobin increased, heart rate, blood pressure, breathing frequency, dyspnea, fatigue, and leg fatigue at the end-of-test and recovery increased in CPET compared to 6-MWT (p < .050). Peak oxygen consumption (VO_2peak) was 18.15 ± 4.75 ml/min/kg, VO_2peak; percent predicted < 80% was measured in 51.28% patients. Six-MWT distance and QF muscle strength were less than 80% predicted in 58.9% and 76.9% patients, respectively.

Conclusions: In patients with post-COVID-19 syndrome with pulmonary involvement, muscle deoxygenation of QF is greater during maximal exercise than during submaximal exercise. Specifically, patients with lung impairment should be evaluated for deoxygenation and should be taken into consideration during pulmonary rehabilitation.

Introduction: Excessive and insufficient physical exercise have both been associated with accelerated muscle function decline in boys with Duchenne Muscular Dystrophy (DMD), and optimal exercise remains unclear.

Objective: This study explored participants' experiences with a one-year training program.

Methods: Five semi-structured qualitative individual interviews and one focus group interview were conducted and analyzed using systematic text condensation.

Results: Participants included boys with DMD who participated in the intervention study (n = 10), their relatives and/or assistants (n = 7). Four main themes emerged: 1) the crucial role of motivation to maintain training routines, 2) benefiting from exercise, but with a need for balancing it, 3) time management challenges, and 4) the training as a social arena and meeting place. The participants emphasized the importance of experiencing progress, basic skills and enjoyable training. Parents were reassured knowing the appropriate exercise intensity and technique. The boys needed flexibility and support to find a balance between exercise and other activities and described benefits from sharing experiences with each other.

Conclusion: Clinical guidelines for physical exercise in DMD should encompass customization of exercise interventions supporting motivational factors, balance and social interaction, and identify competing commitments. Successful training programs may enhance quality of life and functionality for these boys.

Background: Proprioceptive impairment contributes to gait and balance impairments in patients with stroke. Diagnosis functional impairments and evaluation treatment efficacy require quantitative proprioception assessment. However, proprioception assessment has remained limited to ordinal scale measurement, with a lack of ratio scale measurements.

Purpose: This case report describes a physiotherapy management program focusing on proprioceptive impairment in patients with stroke using quantitative tests such as Threshold to Detect Passive Motion (TDPM) and Joint Position Sense (JPS).

Case description: A63-year-old male patient with an acute pontine lacunar infarction was admitted to our hospital. His muscle strength, selective movement, and trunk activity were preserved. However, the Berg Balance Scale (BBS) and Gait Assessment andIntervention Tool (GAIT) score were 42 and 9 points, observing balance impairment and the buckling knee pattern with hip ataxia during gait. Based on these, TDPM and JPS using image capture were performed. In physiotherapeuticdiagnosis, proprioceptive impairments in the hip and knee joints were the primary functional impairments related to balance and gait. To address these proprioceptive impairments, a 13-day treatment protocol incorporating transcutaneous electrical nerve stimulation (intensity: sensory threshold, frequency: 100 Hz) targeting the quadriceps femoris was performed.

Outcomes: The patient was discharged after achieving independent ambulation and improvement in BBS (56 points) and GAIT (2 points) scores, exceeding the minimum clinically important difference. Recovery of proprioceptive impairment corresponded withimproved balance and gait ability.

Conclusion: Quantitatively evaluating proprioceptive impairments may provide novel rehabilitation for patients with stroke who have proprioceptive impairments and contribute to clinical decision-making.

Background: There has been a recent rise in the use of technology for health promotional practices, which have begun to gain popularity among physiotherapists but not much research has been conducted to explore its many opportunities and challenges among older adults in developing countries.

Objectives: To explore Nigerian-based Physiotherapists' perspectives on how digital health technologies (DHT) can be utilized to promote physiotherapy home treatment programs among Nigerian older people.

Methods: This is a one-on-one semi-structured interview of 12 geriatric physiotherapists (7 Male, 5 female) virtually in the Teams Meeting platform. Data generated were analyzed thematically using the latest version of NVivo software.

Results: Three overarching themes were conceptualized including the usage of DHT in Nigeria, challenges to DHT application, and strategies to improve DHT usage. These described a low awareness and usage of DHT despite its recognized need and advantages for promoting home program. The forms of DHT commonly being used are mostly mobile-based through calls or texts, which could be due to barriers to the use of DHT including older people's declining cognition, poverty, and low interest in technology. Some external problems included the physiotherapists' attachment to hands-on practice and low commitment from the informal caregivers.

Conclusions: These findings suggested ways to utilize the DHT in promoting physiotherapy home treatment programs among older people by encouraging technological innovations and raising awareness among physiotherapists, while the physiotherapists need to patiently educate both the older people and involve their informal caregivers.