Physiotherapy Theory and Practice最新文献

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.

Purpose: Contactual hand-orientating response (CHOR) is a fundamental component of the Bobath concept which has been reported to promote hand function. This study aimed to assess activity and co-activation during CHOR facilitation of extensor digitorum (ED) which represented wrist extensors, and flexor digitorum superficialis (FDS) which represented wrist flexors.

Method: CHOR facilitation of the paretic hand in 18 patients with chronic stroke with severe upper limb motor deficits, active contraction in the non-paretic hand and 18 healthy individuals wrist extensor and flexor muscles were compared using surface electromyography.

Results: The co-contraction index of wrist extensors and flexors in the paretic hand in patients with chronic stroke was significantly greater during CHOR facilitation than in the healthy individuals (mean (SD) = 51.88 (6.02) and 46.75 (5.50), respectively), p = .012). Significantly greater wrist flexor and extensor muscle activity were seen in the paretic hand during CHOR facilitation compared with resting (median = 0.803 vs 0.133; median = 0.856 vs 0.225, respectively) (p < .001).

Conclusion: CHOR facilitation appears to selectively enhance wrist extensor and wrist flexor activity in patients with stroke despite showing a greater co-activation. These findings support the immediate effect of movement facilitation to enhance muscle activity in patients with severe motor deficits post stroke.

Introduction: Individuals with autism spectrum disorder (ASD) have higher rates of obesity and exhibit more sedentary behaviors than neurotypical peers. Use of wearable devices (WD) to target insufficient physical activity (PA) in this population has increased over the past decade. However, standardized methods for assessing WD adherence remain limited among this understudied population.

Purpose: A prospective observational cohort design was used to compare two methods for determining WD adherence for monitoring PA in adolescents and adults with ASD.

Methods: Subjects were enrolled in an 8-week telehealth program aimed at improving PA among adolescents and adults with ASD. The Fitbit Inspire 3 WD was utilized for PA tracking and self-monitoring. Subject step activity and heart rate (HR) data were collected for an 8-week period via FITABASE management platform. Adherence was calculated using two methods. Method-A was defined as ≥10-hr daily wear-time based on HR monitoring; Method-B was defined as ≥ 500 steps/day. Observational data collected via researcher field notes documented participant-reported factors and/or behaviors that influenced WD adherence.

Results: Data from twenty-seven subjects (21 males, 6 females) ages 14 to 28 years (mean: 18.85 years) were analyzed. Adherence was significantly higher when calculated using Method B (mean = 40 days, 5.4 weeks) compared to Method A (mean = 24 days, 2.8 weeks; p  < .001). Observational data identified disability-related behaviors that negatively impacted Method A derived adherence.

Conclusions: Using HR-based measures of adherence may underestimate device use in individuals with ASD, potentially setting unrealistic expectations for continuous wear. Step-based metrics provides a more inclusive and pragmatic approach for assessing WD adherence in this population, with implications for future intervention design and evaluation. This study highlights the need to tailor WD adherence definitions to the behavioral and sensory profiles of neurodiverse populations. Further study is warranted.

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.