Physiotherapy Theory and Practice最新文献

Introduction: This study aimed to evaluate responsiveness and minimal important changes (MICs) of a Persian version of the Lymphedema Life Impact Scale (LLIS), the Upper Limb Functional Index (ULFI), and the Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) in patients with breast cancer-related lymphedema (BCRL) following physiotherapy intervention.

Methods: The study included 90 participants with breast cancer-related lymphedema (BCRL) who received a physiotherapy intervention. Participants completed the LLIS, ULFI, and Quick DASH questionnaires at baseline and at a 3-week follow-up. A 7-point global rating of change (GRC) was also administered at the follow-up to serve as an external anchor for improvement. Responsiveness was assessed using correlation analysis and receiver operating characteristic (ROC) curve analysis with patients classified as improved or unimproved based on GRC scores. The ROC curve was utilized to identify the optimal cutoff value as MIC.

Results: All three instruments of the LLIS, ULFI, and Quick DASH demonstrated acceptable responsiveness with the area under the curve of 0.84 (95%CI: 0.76-0.92), 0.85 (95%CI: 0.77-0.93), and 0.90 (95%CI: 0.84-0.96), respectively. Correlation analysis showed relationship of the LLIS, ULFI, and Quick DASH with the external anchor fell within moderate to good range (Spearman = 0.55-0.69). The MIC values for the LLIS, ULFI, and Quick DASH were 10.85, 9.5, and 13.05 points, respectively.

Conclusions: The LLIS, ULFI, and Quick DASH demonstrated adequate responsiveness and effectively measured the change in lymphedema, upper limb function, and disability in BCRL patients undergoing physiotherapy intervention. The MIC values reflecting improvement identified for the LLIS, ULFI, and Quick DASH can help clinicians and researchers to detect meaningful change in an individual's clinical status, and to avoid the challenge of either over- or undervaluing treatment efficacy.

Background: Telerehabilitation has emerged as a promising approach in postoperative care following total knee arthroplasty(TKA);nevertheless,the relative effectiveness of different telerehabilitation modules is still under discussion, leaving room for alternative and multimodal program approaches.

Objectives: This study aimed to compare the effectiveness of a multimodal telerehabilitation(MTR) and voice call based telerehabilitation(VTR) in patients undergoing TKA.

Methods: A two-arm randomized controlled trial was conducted with 24 patients (68.42 ± 9.28y) in the MTR group and 21(71.19 ± 7.26y) in the VTR group. The MTR group received weekly digital booklets containing asynchronous exercise videos, one voice call, one video call,and text messages,for a total of three contacts per week. The VTR group received weekly printed booklets and voice calls three times a week(on alternate days) over the 8-week intervention period. Outcomes were assessed face to face at discharge, and at the 4th and 8th postoperative weeks. Measures included Visual Analog Scale(VAS), active and passive range of motion(ROM), Knee Osteoarthritis Outcome Score-Physical Function(KOOS-PS), Five Repetition Sit to Stand Test(5xSST), Brief Fear of Movement(BFoM) Scale, isometric Quadriceps muscle strength, Forgotten Joint Score-12(FJS-12),Exercise Adherence Rating Scale(EARS). The primary outcome was active knee flexion ROM. Statistical significance was set at p < .05; effect sizes (r, W) were reported for the Mann - Whitney U and Wilcoxon tests.

Results: After 8 weeks, a statistically significant difference in pain during activity was observed between the MTR and VTR groups (p < .001, r = 0.62). Both groups showed significant gains in active and passive knee flexion ROM, 5xSST, and KOOS-PS scores (all p < .001), while the MTR group also improved in rest pain, knee extension, and BFoM (all p < .001). At week 8, statistically significant differences were observed between the MTR and VTR groups across all outcome measures (all p < .001).

Conclusion: Both telerehabilitation approaches were effective in improving pain, ROM, and functional outcomes after TKA.Although this study did not compare outcomes with conventional in-person rehabilitation, MTR showed greater overall improvements than VTR. Nevertheless, VTR remains a reasonable alternative when MTR cannot be implemented.

Background: Ankle musculature serves as active dynamic stabilizers, yet conventional assessment focusing solely on peak torque fails to capture critical aspects of neuromuscular control. The ability to generate accurate, steady forces is paramount for functional joint stability. External supports may modulate sensorimotor function, potentially improving force control.

Objective: To compare the effectiveness of bracing and taping on the quantity and quality of evertor muscle force.

Methods: Sixty participants (18-40 years old) with chronic ankle instability, were randomly allocated to 3 groups: ankle orthosis, kinesio tape, and a control group. Evertor muscle strength, force sense, force steadiness, and kinesiophobia were evaluated at the baseline and at the end of week 4.

Results: The group × time interaction effects were significant for concentric evertor strength at both angular velocities of 60°/s and 120°/s. While orthosis group and kinesio tape group demonstrated significant within-group changes, there was no difference between the two intervention groups (p = .771; d_ppc2 = -0.17 at angular velocity of 60°/s, and at angular velocity of 120 °/s p = .930; d_ppc2 = 0.35), between orthosis group and control group (p = .883; d_ppc2 = 0.76 at angular velocity 60°/s, and p = .800; d_ppc2 = 0.71 at angular velocity 120°/s), or between kinesio tape group and control group (p = .975; d_ppc2 = 1.08, and p = .959; d_ppc2 = 0.39 at 60°/s, and 120°/s respectively). The group × time interaction effect was also significant for kinesiophobia, but there was no significant difference between the two intervention groups, between orthosis group and control group, and between kinesio tape group and control group. The main effects of time were significant for all variables, except for force sense.

Conclusion: Both ankle orthosis and kinesio tape application for four weeks significantly improved evertor muscle strength and reduced kinesiophobia, with notable trends toward improved force steadiness. These findings support their use as effective interventions for enhancing ankle neuromuscular function and mitigating fear of movement.

Introduction: Frozen shoulder (FS) is a disabling condition marked by pain and restricted mobility. The Spencer technique is a structured manual therapy protocol that has been used in clinical practice. However, evidence regarding its effectiveness remains inconsistent. This study systematically evaluated its effects on pain, disability, shoulder range of motion, and potential moderating factors.

Methods: Following PRISMA 2020 guidelines, a comprehensive search of PubMed, Physiotherapy Evidence Database (PEDro), and Medline-Ovid was conducted up to September 2025. Sixteen randomized controlled trials involving 659 participants were included. Outcomes assessed were pain, disability, and shoulder range of motion (external rotation [ER], abduction [ABD], internal rotation [IR]). Random-effects meta-analysis, subgroup, sensitivity, and meta-regression analyses were performed.

Results: The Spencer technique demonstrated positive effects compared with conventional physical therapies (CPTs) in reducing pain, improving disability, and range of motion, including ER, ABD, and IR. However, it did not show superiority over other manual therapies. Meta-regression identified the addition of muscle energy technique as a significant moderator associated with greater improvements in pain intensity (β =  -2.095, p = .012), disability (β =  -1.623, p = .001), and range of motion, including ER (β = 3.878, p < .001), ABD (β = 3.686, p < .001), and IR (β = 1.941, p = .009).

Conclusion: The Spencer technique provides clinical benefits compared with CPTs. However, it does not demonstrate significant superiority over other manual therapy approaches in patients with FS. Incorporation of muscle energy technique enhances its therapeutic effects. Future trials with long-term follow-up and stage-specific analyses are warranted to clarify treatment durability or optimize clinical application.

Introduction: Self-efficacy, one's confidence in performing specific tasks, is a theoretically grounded construct integral to learner motivation, engagement, and perceived readiness for clinical practice. As the prevalence of individuals with neurologic conditions increases, it is essential that physical therapy students develop the confidence and competence needed to meet the complex needs of this population.

Objective: The purpose of this study was to examine how participation in a structured experiential learning program with individuals with neurologic conditions influenced physical therapy students' self-efficacy for neurologic practice.

Methods: A sequential-explanatory mixed methods design was used across three academic semesters with second-year DPT students (n = 32). Quantitative data were first collected via the Physiotherapy Self-Efficacy neurologic subscale, and a 2 × 3 repeated measures ANOVA assessed changes over time and across semesters. Qualitative narrative reflections were then thematically analyzed using deductive and inductive coding to contextualize the quantitative findings.

Results: Twenty-eight students completed the study; three students did not complete all instruments, and one student withdrew from the program. Students' self-efficacy significantly improved over time (F(1, 27) = 131.14, p < .001), by semester (F(1, 38) = 71.60, p < .001), and with a time-by-semester interaction (F(1, 40) = 8.12, p = .003). Four themes helped explain these increases in self-efficacy: concrete experiences, developing confidence for practice, social modeling, and emerging professional identity.

Conclusion: Structured experiential learning with neurologic populations was associated with significant increases in physical therapy students' self-efficacy for neurologic clinical practice. Findings highlight its value in fostering student confidence, professional identity, and task-specific competence. Future research should examine these outcomes across diverse programs.

Background: Physical therapy (PT) has been associated with improved patient- and system- outcomes for hospitalized patients. However, significant variation exists in PT delivery to general medicine patients, and there has been little research exploring the utilization and effectiveness of PT in this population.

Purpose: The purpose of this study is to investigate the utilization and effectiveness of PT for acutely hospitalized general medicine patients, focusing on the relationship between PT minutes per day provided and patient functional improvement and discharge disposition.

Methods: This retrospective observational cohort study analyzed clinical data from 7693 patients admitted to an urban academic medical center between July 2021 and December 2023. Patients included were at least 18 years old, discharged alive, and received at least two PT visits. The primary predictor variable was minutes per day of PT provided. The primary outcome was functional improvement, measured by the Activity Measure for Post-Acute Care (AM-PAC) Basic Mobility "six-clicks" score. The secondary outcome was discharge to home. Multivariable logistic regression models were used to estimate adjusted odds ratios (aOR) for functional improvement and discharge disposition.

Results: Each 10-minute increase in PT minutes per day provided positively associated with functional improvement (aOR = 1.16 per 10-minute increase, 95% CI 1.07-1.25, p < .0001) and discharge to home (aOR = 1.22 per 10-minute increase, 95% CI 1.13-1.31, p < .0001). Higher daily PT thresholds showed increasing adjusted probabilities of functional improvement and discharge home, though gains in functional improvement plateaued beyond 30 minutes per day.

Conclusion: Increased daily PT was associated with greater functional improvement and higher likelihood of discharge to home. These results support more intentional PT resource allocation and suggest that identifying clinically meaningful treatment thresholds may help guide therapist decision-making.

Background: Severe burn injuries often lead to prolonged hospitalization, functional impairments, and painful necessary interventions such as physical and occupational therapy. Pharmacological pain management is often insufficient and associated with adverse effects, highlighting the need for integrative strategies that combine pain modulation with functional rehabilitation.

Objective: To evaluate the feasibility and impact of immersive virtual reality (VR) rehabilitation for pain modulation, functional recovery, and health economics in a severely burned patient.

Case description: A 24-year-old firefighter sustained burns over 60% of total body surface area resulting in refractory pain and requiring prolonged intensive care unit stay. A rehabilitation protocol combining immersive motor training with conventional therapy was implemented, consisting of 12 sessions using a VR system designed to modulate pain and enhance motor engagement. Outcomes included Numerical Rating Scale (NRS) for pain, VR experience, Functional Independence Measure (FIM), User Satisfaction Evaluation Questionnaire (USEQ), and medication costs.

Outcomes: Procedural pain decreased from severe (median NRS: 8/10) to moderate (4/10), with greater immersion correlating with lower pain intensity. Functionally, the patient progressed from full dependence (FIM: 13/91) to assisted ambulation (45/91), reaching improved independence by 8 months (59/91). The intervention was well tolerated (USEQ: 93.33%) with a reduced need for analgesic medication, resulting in a substantial cost savings (overall 59% reduction in total analgesic costs).

Conclusion: Immersive rehabilitation was a feasible, non-pharmacologic strategy that enhanced recovery, reduced pain, and decreased pharmacologic costs for a complex patient recovering from severe burns.

Background: Most current studies on Hereditary Spastic Paraplegia (HSP) focus on adolescents and adults. There is a lack of research on the effectiveness of structured, evidence-based developmental physiotherapy during early childhood. While early intervention strategies for children with motor development delays offer a useful framework, no specific guidelines have been developed for early physiotherapy in HSP. This report aimed to describe the effects of a home-based, evidence-based developmental physiotherapy approach in a child diagnosed with HSP Type 47 (SPG47).

Case description: A two-year-old child with SPG47 participated with parental consent. Before intervention, the child was unable to stand up using support or take more than a few side steps. Muscle tone, motor function, functional level, and trunk control were assessed using MAS, GMFCS, GMFM-66, and SATCo, respectively.

Interventions: A developmental physiotherapy program based on current evidence was implemented at home for 2 hours daily over 8 weeks, with daily home implementation by the family. The intervention was grounded in family-centered care principles and evidence-based early developmental physiotherapy, tailored to the child's clinical presentation.

Outcomes: After the program, GMFM-66 increased by 7.2%. The child gained the ability to stand independently and take more than five side steps. MAS scores improved, SATCo increased from level 6 to 7, and GMFCS improved from level III to II.

Conclusion: In this child with SPG47, an early structured developmental physiotherapy approach was associated with improved motor function and reduced spasticity, supported by motor learning, environmental adaptations, and family involvement. Integrating early intervention principles with HSP-specific considerations enabled targeted task progression and practical home implementation. These findings apply only to this child, and further research is needed to determine whether similar strategies may benefit children with AP4B1-related HSP.

Background: Clinical practice guidelines support healthcare professionals in making evidence-based decisions, yet guideline adherence among physical therapists remains inconsistent. To address this gap, a prototype digital knowledge translation tool powered by a large language model (LLM) was developed, with content based on two exemplary high-quality German national guidelines.

Objective: To (1) explore the experiences of German physical therapists using the tool, (2) assess their perspectives on its utilization in clinical practice, and (3) compare perceptions between outpatient and inpatient settings.

Methods: Six focus group interviews were conducted: three in a university hospital inpatient setting and three in outpatient physical therapy practices. Discussions were analyzed using qualitative content analysis with inductive and deductive coding.

Results: Twenty physical therapists (11 inpatient, 9 outpatient) participated. Overall experiences were positive, though prolonged response times were criticized. Utilization was thought to depend on time availability and workplace digitization. The tool's potential assisting with clinical questions was highlighted. No considerable differences in experiences across settings were noted. Inpatient therapists envisioned using the tool between sessions for personal knowledge enhancement, whereas outpatient therapists anticipated utilization during sessions for patient education.

Conclusion: LLM-based knowledge translation tools may contribute to improving guideline adherence among physical therapists. Successful implementation requires assessment of digital infrastructure, relevance to clinical needs, and users' digital literacy. Further research should evaluate the quality of LLM-generated summaries to ensure validity and trustworthiness, and optimize the tools' usability regarding speed and content. Development should also prompt ethical considerations about their role in clinical decision-making and patient care.

Background: Lumbosacral pain is a common musculoskeletal complaint that is typically mechanical in nature. However, rare conditions such as osteoblastoma can mimic benign spinal pain, leading to diagnostic delays and protracted care.

Case presentation: An 18-year-old male college student presented to physical therapy, via direct access, with persistent right-sided lumbosacral pain of 6 weeks. His pain worsened with general activity and lying supine. Clinical examination was pathognomonic of sacroiliac (SI) joint dysfunction, and clinical guidelines did not indicate a need for imaging. Four weeks of conservative management for presumed SI joint dysfunction was initiated and included mobilization, stabilization exercises, and use of an SI support belt. Despite adherence to an evidence-based plan of care, the patient failed to demonstrate clinically important improvement in pain and function based on previously established minimal clinically important difference thresholds. The patient ultimately, over the course of care, exhibited intermittent difficulty with bladder voiding and was referred to his family physician and ultimately a surgeon for further evaluation.

Diagnosis: Subsequent magnetic resonance imaging (MRI) and computed tomography (CT) revealed a lobulated, multi-cystic lesion involving the right sacrum extending into the S1 and S2 neural foramina. A CT-guided biopsy confirmed the diagnosis of osteoblastoma with secondary aneurysmal bone cyst features. Intervention: The patient underwent surgical excision of the tumor with decompression of the S1-S2 nerve roots. A multidisciplinary team including orthopedic and neurosurgical specialists performed the procedure without complication.

Outcomes: Postoperative recovery was uneventful, and follow-up MRI at 6 months and 1 year showed no evidence of recurrence. The patient, via telephone communication, reported resolution of symptoms and pre-morbid return to function at the 1-year post-operative period.

Conclusion: This case underscores the importance of considering red flags when patients are recalcitrant to standard interventions. A poor response to conservative care should prompt a referral for imaging.