Physiotherapy Theory and Practice最新文献

Background: YouTube_®, one of the busiest video-sharing platforms, may lack sufficient or accurate information on health information and practices given the absence of a rigorous evaluation process.

Purpose: This study aims to evaluate the reliability of information and quality of exercise videos on YouTube_® for rheumatoid arthritis.

Methods: Video features and the source of the upload were sorted. Reliability of the information shared in the videos was evaluated using the mDISCERN too, and quality was assessed using the Global Quality Scale and JAMA scoring system. Videos were independently analyzed by two physiotherapists specialized in rheumatologic rehabilitation. Any bias was resolved by an independent third assessor.

Results: One hundred thirty-four exercise videos were included. A hundred and twenty-six (94%) of the 134 exercise videos were found to be useful, and 8 (6%) were misleading. The useful and misleading videos had similar numbers of views, likes, comments, and subscribers (p > .05), while video duration and time since upload were higher for useful videos (p < .05). Cohen's Kappa scores demonstrated that the level of agreement between the assessors were moderate (mDISCERN = 0.417, Global Quality Scale = 0.582, and JAMA = 0.555). There was a significant difference in JAMA scores (p = .013) between the sources of the videos. However, no significant difference was found in mDISCERN (p = .104) and Global Quality Scale (p = .128) scores.

Conclusion: YouTube_® exercise videos provide partially reliable and moderate-quality information for people with rheumatoid arthritis. However, patients should be cautious and not rely directly on YouTube_® exercise videos. Instead, they should consult a physician or physical therapist for exercises.

Introduction: The Measures Associated to PrognoStic (MAPS) tool is a standardized questionnaire that integrates validated prognostic tools to detect the presence of biopsychosocial prognostic factors in patients consulting for musculoskeletal disorders.

Purpose: The objectives were to assess the: 1) feasibility of implementation of the MAPS tool, 2) clinicians' acceptability of the dashboard, and 3) patients' acceptability of the MAPS tool.

Methods: Twenty physiotherapists and two occupational therapists from seven outpatient musculoskeletal clinics were recruited to implement the MAPS tool during a 3-month timeframe, where new patients completed the questionnaire upon initial assessment. The results were presented to the clinicians via a dashboard. Surveys and semi-structured interviews were conducted to measure feasibility and acceptability.

Results: Six out of 11 feasibility criteria (55%) and 21 out of 24 acceptability criteria (88%) reached the a priori threshold for success. The interviews allowed us to identify three main themes to facilitate implementation: 1) limiting the burden, 2) ensuring patients' understanding of the tool's purpose, and 3) integrating the dashboard as a clinical information tool.

Conclusion: Our quantitative and qualitative results support the feasibility of implementation and acceptability of the MAPS tool pending minor adjustments. Depicting the patients' prognostic profile has the potential to help clinicians optimize their interventions for patients presenting with musculoskeletal disorders.

Background: The increase in survival rates among women treated for cervical cancer (CC) requires greater attention to the side effects of treatment. Although a high prevalence of pelvic floor disorders (PFD) in this population is documented, there is a lack of consensus regarding physical therapy approaches.

Methods: Cross-sectional observational study with 56 physiotherapists who answered a questionnaire. The data were exported to Microsoft Excel® and analyzed descriptively.

Results: Most physiotherapists interviewed have postgraduate degrees in Women's Health (74.5%). The most common PFDs treated are sexual dysfunctions (26%), mixed urinary incontinence (23.9%), urge urinary incontinence (14,3%), pelvic organ prolapse (8,9%) and anal incontinence (4,1%). The PERFECT scale is the most used (20.2%) to assess the pelvic floor muscles. Female Sexual Function Index is the most used questionnaire for evaluation of sexual dysfunctions (46.7%) and vaginal desensitization (23.3%) for treatment of this condition. To assess urinary incontinence, 45.9% of the physiotherapists use voiding diary and the most cited intervention are pelvic floor muscle training (32.9%), bladder training and behavioral therapy (31.7%). Most of the physiotherapist intervieweddo not use specific instruments (65.4%) to assess pelvic organ prolapse and use pelvic floor muscle training (77.4%) for treatment. Anal incontinence is usually evaluated by Bristol Stool Scale (42.2%) and treated by Electrostimulation of the posterior tibial nerve (38.8%).

Conclusion: Most physiotherapists are qualified to manage PFDs. The variability in assessment methods and therapeutic approaches highlights the lack of consensus on managing PFD in women with cervical cancer, indicating the need for evidence-based guidelines.

Background: Previous studies suggest that cervical spine position sense declines with age, while the relationship between aging and cervical spine movement control remains unknown.

Objective: To investigate the relationship between age and cervical spine movement control in asymptomatic adults.

Methods: One hundred five asymptomatic adults (21-79 years old) were included. The Butterfly test (performed with an inertial measurement unit) was used to assess movement control of the cervical spine, in which participants tracked an unpredictable moving target with active head and neck movements at three different movement path difficulty levels (3 repetitions each). The determined parameters were amplitude accuracy (AA), time on target (ToT), undershoot (U) and overshoot (O). Spearman's rank correlation coefficient and simple linear regression analysis were used to assess the relationship between age and each parameter.

Results: A significant relationship was demonstrated between advancing age and the AA, ToT and U parameters for all three movement path difficulty levels (p ≤ .001), but not for the O parameter (p > .05). Advancing age explained 19.8-30.4%, 24.5-30.8% and 33.7-37.2% of the variance in the AA, ToT, and U parameters, respectively.

Conclusion: The results suggest that cervical spine movement control declines with aging in an asymptomatic population. Clinicians may need to monitor potential deficits in cervicocephalic kinesthesia in older asymptomatic adults, as these impairments may have a considerable impact on their functional abilities.

Objective: This study aimed to assess the effects of kinesiotaping (KT) adjunct to physical therapy (PT) on proprioception, cervical range of motion (ROM), pain, disability, anxiety, depression, and quality of life (QoL) in cervical spondylosis.

Methods: Sixty-nine patients aged 50-70 years were randomized into three groups: PT, PT plus KT(PT+KT), PT plus sham-taping(PT+ST). All participants underwent standardized 15-session PT, 5 days/week. Additionally, group-II received KT, and group-III received ST 2 days/week for 3 weeks. Primary outcome was the cervical-joint-position-error-test (CJPET), with secondary outcomes active-cervical ROM, handgrip strength, Visual-Analogue-Scale (VAS), Douleur Neuropathique-4 Questions (DN4), Upper-Limb-Functional-Index (ULFI), Neck-Disability-Index (NDI), Hospital Anxiety and Depression Scale (HADS), and 36-Item Short Form Survey (SF-36).

Results: CJPET for flexion improved in all groups (p < .05), with no significant intergroup differences (p > .05). ROM improved in all groups (p < .05), with significant intergroup differences in extension at both T1 (p = .006, eta squared = 0.125, medium effect size) and T2 (p = .022, eta squared = 0.086, medium effect size); revealing greater improvement for PT+KT and PT+ST compared to PT (p < .05).VAS, DN4, NDI, and SF-36 pain domain scores improved in all groups (p < .05). Handgrip strength increased in the nondominant hand in PT+KT and PT+ST (p = .021). No improvements were observed in HADS (p > .05). ULFI increased in PT (p = .043) and PT+ST (p = .005).

Conclusion: KT adjunct to PT shows potential in improving proprioception, pain, and disability in cervical spondylosis. Further studies are needed to refine taping techniques and assess long-term effects.

Purpose: The study aims to identify determinants of implementation behavior among physical therapists frequently promoting physical activity (PA) in cardiac and pulmonary rehabilitation.

Methods: A cross-sectional online survey incorporating the Determinants of Implementation Behavior Questionnaire (DIBQ) and anchored by the Theoretical Domains Framework (TDF) was sent to physical therapists working in cardiac and pulmonary rehabilitation practices in Australia and Singapore. All items on the DIBQ were scored on a 7-point Likert scale from "Strongly Disagree" to "Strongly Agree." Demographics and determinants were associated with frequency of PA promotion using logistic regression analysis with manual backward stepwise elimination. Differences between countries were measured using the Mann-Whitney U test.

Results: Thirty-four Australia and 32 Singapore physical therapists responded to the survey. Seventy-four percent of them correctly identified the PA guidelines and almost all (98%) agreed that PA promotion was the physical therapist's role. However, only 58% encouraged ≥ 10 patients monthly to be physically active. The logistic regression revealed that physical therapists with > 8 years of working experience (AOR = 8.08: 95% CI 1.69-38.67), currently measuring PA (AOR = 8.04: 95% CI 1.73-37.39) and who promote it automatically (Nature of Behaviors) (AOR = 8.57: 95% CI 0.66-111.55) were more likely to frequently promote PA. Similar determinants, except Belief about Consequences, were found between Australia and Singapore physical therapists.

Conclusion: Currently measuring PA, automaticity and working experience influence PA promotion frequency among physical therapists working in cardiac and pulmonary rehabilitation, regardless of PA guidelines knowledge, role awareness and countries they practice in.

Introduction: Individuals with neck pain (NP) often experience altered muscle mechanical properties (MMPs), such as increased tone and stiffness. Myotonometry has become a reliable, noninvasive tool for measuring MMPs. However, the effect of movement and rest on MMPs in acute neck pain (ANP) individuals remains insufficiently explored.

Objective: This study aimed to evaluate how sequential movement and short-term rest influence the MMPs of neck muscles in subjects with ANP.

Methods: A case-control study was conducted with 37 subjects with APN and 37 matched healthy controls. Muscle mechanical properties were assessed by myotonometry at baseline, post-movement (after a motion assessment sequence), and post-rest. The outcome measures of MMPs were frequency or tone, stiffness, decrement, which is the inverse of elasticity, relaxation, and creep.

Results: Subjects with ANP showed higher muscle tone, stiffness and decrement, and lower relaxation than controls, all with p < .05. In the ANP group, decrement was the only property that showed a significant change after movement and rest, both with p < .05. Reduced means values (m) with its standard deviation (SD) were observed post-movement (m = 1.35 Ø, SD = 0.03) and post-rest (m = 1.33 Ø, SD = 0.03) compared to baseline values (m = 1.43 Ø, SD = 0.04). The other MMPs remained stable across evaluation times (p > .05).

Conclusion: The evaluation of MMPs should be conducted prior to any mobility protocol to ensure that the results reflect the basal tissue characteristics in individuals with ANP, highlighting decrement as a sensitive marker of these changes.

Background: Low cardiorespiratory fitness predicts worse postoperative outcomes, exacerbated by age and frailty. Preoperative High-Intensity Interval Training (HIIT) improves cardiorespiratory fitness and postoperative outcomes but is challenging to implement in frailty due to perceived risks.

Purpose: The aim of this case report was to demonstrate feasibility of HIIT in a patient with frailty and multimorbidity.

Case presentation: An 83-year-old frail male with atrial fibrillation and limited mobility presenting with locally advanced rectal cancer was assessed as unfit for major surgery unless his cardiorespiratory fitness improved. Initial cardiopulmonary exercise testing demonstrated low cardiorespiratory fitness (peak oxygen consumption ($\dot{V}$O_2peak) of 11.45 mL·min^-1·kg^-1). He subsequently underwent 15 supervised HIIT sessions targeting a Rating of Perceived Exertion ≥ 15.

Outcomes: The patient demonstrated initial substantial improvements in his physical condition, increasing maximal work rate from 27.5 W to 55 W. However, there was no additional progress following session eight. At his post-exercise CPET he rapidly fatigued, resulting in a $\dot{V}$O_2peak of 7.4 mL·min^-1kg^-1. Clinical investigations revealed a worsening anemia with a hemoglobin of 92 g/L caused by an undiagnosed synchronous cecal tumor which was corrected preoperatively. Postoperatively, the patient recovered without complications and was successfully discharged home.

Conclusion: Personalized HIIT improved exercise duration and work rate and was associated with positive postoperative outcomes in this patient with frailty and multimorbidity. A unique feature of this case was the unexpected loss of training progress and $\dot{V}$O_2peak deterioration post-HIIT, which prompted further clinical investigations. These identified a worsening anemia and resulted in important changes in both the preoperative and intraoperative treatment.

Background: Persistent pain is increasingly recognized as a growing issue among adolescents worldwide, with an estimated prevalence of 10-30%. Physical therapy is a recommended treatment modality for managing this kind of pain. Yet, there is still limited knowledge regarding how physiotherapists experience, manage, and follow up this patient population.

Purpose: This qualitative study aimed to explore the experiences of physiotherapists in Norwegian primary healthcare working with adolescents experiencing persistent pain. The study examined the resources the therapists make use of, and the challenges they encounter.

Method: Four focus group interviews were conducted with a total of 13 Norwegian physiotherapists experienced in treating adolescents with persistent pain. The interviews explored the physiotherapists' experiences of working with adolescents with persistent pain. A reflexive thematic analysis was conducted to analyze the data.

Results: Three main themes were identified from the data analysis: (1) Relationship building as the foundation of the intervention. (2) Accompanying the adolescents into their everyday life. (3) Challenging cases that are also rewarding to work with.

Conclusion: This study sheds light on the importance of sufficient and multifaceted clinical competence among physiotherapists to enable them to work effectively with adolescents experiencing persistent pain, and their families. The experiences of physiotherapists show the importance of a strong therapeutic alliance and individualized treatment approaches, based on shared decision-making and age-appropriate communication and interventions. The therapists in our study emphasized the need to integrate interventions into the adolescents' everyday lives, tailoring treatments to the unique life of each individual. Physiotherapists must navigate the complexities of meeting individual patient needs and adapting to challenges beyond traditional practice. To support this patient group effectively, ongoing professional development is recommended, either through continued education or colleague guidance from other experienced physiotherapists.

Objective: To describe the clinical reasoning and use of the American Diabetes Association (ADA) blood glucose and exercise guidelines in the face of an emerging acute glycemic crisis for a patient with type 2 diabetes mellitus receiving physical therapy for chronic ankle instability and fibromyalgia.

Case description: Assessment of the patient's baseline blood glucose and ketone urinalysis revealed hyperglycemia and ketonuria, respectively. Shortly after testing, the patient became nauseous and vomited. This prompted assessment of her end-tidal carbon dioxide via nasal capnography to screen for diabetic keto-acidosis. Evidence of Kussmaul breathing, tachypnea, and hypocapnia in conjunction with hyperglycemia and ketonuria, as well as symptoms of nausea and signs of vomiting prompted a referral to the emergency department.

Outcomes: The patient was admitted to the hospital for five days with a diagnosis of acute kidney injury. It was determined that the acute kidney injury was caused by hyperglycemia in combination with impaired kidney function and an exacerbation of her congestive heart failure, all of which are known risk factors for acute kidney injuries in patients with diabetes mellitus.

Conclusions: Compliance with the ADA blood glucose exercise guidelines allowed for early recognition of metabolic dysfunction prior to the onset of symptoms. Failure to have complied with the ADA blood glucose exercise guidelines may have resulted in the physical therapist administering therapeutic exercise that likely would have contributed to a worse prognosis.