Physiotherapy Theory and Practice最新文献

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.

Background: Chronic ankle instability (CAI) is often treated with strength and balance training, but pain and fear of re-injury can limit tolerance to high-intensity exercise. Blood flow restriction training (BFRT) allows strength gains under low loads and may serve as an alternative for these patients. However, current research lacks a systematic evaluation of BFRT in individuals with CAI, particularly comparing different training modalities.

Objective: To systematically evaluate the effects of BFRT on individuals with CAI through meta-analysis.

Methods: Relevant randomized controlled trials were identified by searching eight databases (CNKI, VIP, Wanfang, PubMed, Embase, Web of Science, Cochrane Library, and PEDro) from their inception to October 17, 2025. Methodological quality was evaluated using the Cochrane Risk of Bias tool. Publication bias was assessed with Egger's test.

Results: A total of 3206 records were identified, and 11 studies were included. Compared with control groups, BFRT improved anterior Y balance score [MD = 2.08, 95%CI (0.37 to 3.79), p < .05], posterolateral Y balance score [MD = 2.88, 95%CI (0.64 to 5.11), p < .05], and CAIT score [MD = 2.39, 95%CI (1.28 to 3.51), p < .05]. There was no statistical difference between the BFRT and control groups in overall Y balance score [MD = 1.48, 95%CI (-0.18 to 3.13), p > .05] and posteromedial balance score [MD = 0.30, 95%CI (-1.85 to 2.44), p > .05]. Subgroup analysis was conducted based on pressure type. BFRT of relative pressure improved CAIT scores and most balance measures except posteromedial. BFRT of absolute pressure significantly improved CAIT scores but showed no effects on Y-balance in any direction or overall score. The probability ranking indicated that relative pressure BFRT was superior to absolute pressure BFRT.

Conclusion: Training under blood flow restriction can improve ankle balance and stability in individuals with CAI through neuromuscular adaptations. Relative pressure is more effective than absolute pressure, emphasizing the need for individualized training. Further high-quality studies are required to confirm long-term effects and refine protocols.

Background: Knee osteoarthritis (OA) causes pain and diminishes quality of life. Backward walking exercise (BWE) has been shown to improve lower muscle strength and reduce knee adduction moment, making it a recommended intervention for knee OA rehabilitation. This study aims to evaluate the effectiveness of BWE combined with conventional rehabilitation programs on pain intensity and disability among individuals with knee OA.

Material and methods: Following the PRISMA guidelines, we systematically searched for studies from the inception to June 2025, prioritizing pain intensity as the primary outcome and disability as the secondary outcome, standardized by Hedges' g. A random-effects model was utilized for data pooling. Subgroup analyses focused on different walking speeds, surfaces, and control group characteristics.

Results: Based on the final inclusion of 13 randomized controlled trials, combining BWE with conventional rehabilitation programs was found to significantly reduce pain intensity (Hedges' g = -0.997, 95% CI = -1.373 to -0.620) and improve disability (Hedges' g = -1.015, 95% CI = -1.326 to -0.703). Subgroup analyses revealed larger effect sizes for comfortable walking speed, and treadmill walking. Significant differences were observed across all control group comparisons (p < .05).

Conclusion: BWE combined with rehabilitation showed moderate-to-large effect sizes in reducing pain and disability in knee OA. Future research should assess its standalone efficacy, long-term impact, and certainty of the evidence.

Objective: To compare the immediate effects of two manual therapy techniques - Compressive Myofascial Release (CMR) and Talocrural Joint Mobilization (TJM) - on passive mechanical properties, ankle mobility, and functional performance in individuals following Achilles tendon repair.

Methods: Twenty participants with surgically repaired Achilles tendons received a single session of either CMR or TJM. Passive mechanical properties (tone, elasticity, stiffness) of the medial/lateral gastrocnemius and Achilles tendon were assessed via handheld myotonometer. Functional outcomes included the Weight-Bearing Lunge Test (WBLT), Achilles Tendon Resting Angle (ATRA), and heel-rise height. Patient-reported outcomes were the Achilles Tendon Total Rupture Score (ATRS) and Foot and Ankle Outcome Score (FAOS).

Results: Demographic variables were similar between groups (p > .05). The mean time since surgery was 12.8 ± 10.3 months in the TJM group and 16.8 ± 13.25 months in the CMR group. CMR led to significantly greater improvements in MG stiffness (p = .007, r = 0.85), MG tone (p = .032, r = 0.68), and LG stiffness (p = .005, r = 0.89), with changes exceeding minimal detectable change (MDC) values. Although Achilles tendon stiffness also decreased significantly (p = .037, r = 0.66), this change did not exceed its MDC. Both groups showed statistically and clinically meaningful gains in ATRA, heel-rise height, and WBLT (all p < .01, r > 0.85). ATRS and FAOS indicated high functional recovery.

Conclusion: CMR yielded greater short-term improvements in clinically relevant muscle-tendon mechanical properties than TJM and may be a valuable therapeutic option following Achilles tendon repair.

Level of evidence: Level II.

Background: There is limited evidence regarding somatosensory impairments and their impact on mobility outcomes among ambulatory individuals with stroke, particularly within the context of developing countries.

Objectives: To report the proportion of somatosensory impairments and compare mobility necessary for independence and safety among ambulatory individuals with stroke, with and without somatosensory deficits.

Methods: Eighty ambulatory individuals with stroke (average age of 60 years old) were recruited from medical records at a provincial hospital in a developing country. Participants were assessed for their sensorimotor functions, and mobility using the 10-meter walk test (10MWT), timed up-and-go test (TUG), five times sit-to-stand test (FTSST), and six-minute walk test (6MWT). The findings between the groups with and without somatosensory impairments were compared using the Mann-Whitney U test.

Results: Nearly 60% of participants who mostly walked without a walking device (68.8%) experienced somatosensory impairments, mostly in the proprioception (91.5%) of the lower extremity (85.1%). Their mobility outcomes (10MWT = 0.46 m/s, TUG = 21.1s, FTSST = 14.4s, and 6MWT = 175.2 m) were significantly poorer than those with intact sensations (10MWT = 0.79 m/s, TUG = 12.9s, FTSST = 11.3s, and 6MWT = 302 m, p < .001).

Conclusion: A large proportion of ambulatory individuals with stroke experienced somatosensory impairments, particularly in lower extremity proprioception, which affects their mobility. Therefore, in addition to motor functions, rehabilitation strategies should also focus on improving somatosensory function to promote safe community participation for these individuals.

Background: Stroke-related balance impairments reduce independence, making accurate assessment vital for rehabilitation. However, research on the minimal clinically important difference for the Kansas University Standing Balance Scale (KUSBS) is limited.

Objectives: This study determined the minimal clinically important difference for the KUSBS based on reduced assistance in walking and daily living activities for inpatients with acute-to-subacute stroke.

Methods: This retrospective study included 407 inpatients diagnosed with acute-to-subacute stroke who were referred to the rehabilitation department between 2016 and 2022. Clinical outcomes - including the Kansas University Standing Balance Scale (KUSBS), Berg Balance Scale (BBS), Functional Ambulation Category (FAC), and Modified Barthel Index (MBI) - were assessed at both admission and discharge. The minimal clinically important difference was determined using anchor-based methods, including receiver operating characteristic curve analysis.

Results: The minimal clinically important difference for the KUSBS was 0.5 for both anchors; for the BBS, it ranged from 5.5 to 9.5. Subgroup analysis demonstrated statistical significance for patients requiring assistance with activities. Multivariate analysis indicated that functional improvements varied according to the initial functional levels.

Conclusion: The minimal clinically important difference for the KUSBS was 0.5 for patients requiring walking assistance and 1.5 for those needing maximal assistance with daily activities. Alternative balance assessment tools may be more suitable for patients who do not require assistance. Our study findings emphasize the importance of incorporating qualitative balance assessment tools, such as the KUSBS, alongside traditional quantitative measures, such as the BBS, to provide a more comprehensive evaluation of post-stroke balance function.