Physiotherapy Theory and Practice最新文献

Background: Falls cause significant morbidity/mortality in older adults. Current scales assess fear of falling and proactive balance confidence but neglect confidence in reactive balance recovery (regaining stability after perturbations). The Balance Recovery Confidence Scale (BRCS) fills this gap, requiring cultural adaptation for Turkish populations.

Objective: To translate, culturally adapt, and validate the BRCS in community-dwelling Turkish older adults.

Methods: Following Beaton's guidelines, BRCS underwent forward-backward translation, expert review (n = 10), and pilot testing (n = 30). Psychometric validation included 76 adults ≥65 years. Content validity used Content Validity Index (CVI) and Ratio (CVR). Construct validity employed Exploratory/Confirmatory Factor Analysis (EFA/CFA). Reliability was assessed via Cronbach's α and Intraclass Correlation Coefficient (ICC₃,₁; 7-day retest). Convergent validity examined Spearman correlations between Turkish BRCS and Falls Efficacy Scale-International (FES-I), Activities-specific Balance Confidence Scale (ABC), Tinetti Balance & Gait Test (TBT&TGT), Timed Up and Go Test (TUG), 30-Second Chair Stand Test (30s-CST), and Handgrip Strength Test (HGST).

Results: Content validity was excellent (mean CVI = 0.92, CVR = 0.70-1.00). EFA/CFA confirmed a one-factor structure with excellent fit (CFI = 0.96, RMSEA = 0.045). Internal consistency (α = 0.94) and test-retest reliability (ICC₃,₁ = 0.94) were excellent. Turkish BRCS correlated strongly negatively with FES-I (-0.68), strongly positively with ABC (0.74), and moderately with physical performance tests (all p < .05). Standard Error of Measurement (SEM) = 6.91; Minimal Detectable Change at the 95% confidence level (MDC₉₅) = 19.16.

Conclusion: The Turkish BRCS is a valid, reliable tool for assessing reactive balance recovery confidence in older adults, suitable for clinical and research applications.

Introduction: The course of low back pain (LBP) may be influenced by comorbidities, including lower urinary tract symptoms (LUTS). This study aimed to explore the impact of the coexistence of LBP and LUTS on physical functioning, quality of life, sleep quality, comorbidities and symptoms of depression, anxiety, and stress in men.

Methods: Men aged 40 years and older were invited by their health care professional or social media and websites to participate in a cross-sectional survey. LUTS severity and bother (ICIQ-MLUTS), physical functioning (PROMIS-PF-10), physical and mental health (PROMIS-GH-10), symptoms of depression, anxiety, and stress (DASS-21-R), presence of comorbidities, and sleep quality (PSQI) were evaluated.

Results: Sixty-three men entered the survey, with 57 respondents (mean age = 58 years, sd = 12) completing the LBP and LUTS questionnaires and 49 the entire survey. LBP was present in 52 respondents, and severity of LUTS was mild (n = 41), moderate (n = 13), or severe (n = 3). The models revealed that physical functioning was better explained by including both LUTS severity (R² = 0.31) and LBP, rather than LBP (R² = 0.23) or LUTS severity alone (R² = 0.18). Bother due to LUTS and LBP was also associated with reduced physical functioning (R² = 0.29) and health (R² = 0.31).

Conclusion: Physical limitations are affected by the coexistence of LBP and LUTS. Mental health, depression, anxiety, stress, sleep quality, and other comorbidities were not. Health care professionals should assess LUTS when treating men with LBP, and LBP when treating men with LUTS.

Background: It is estimated that 6% to 12% of Australian emergency department (ED) presentations are due to musculoskeletal (MSK) conditions. In response, primary contact physiotherapy roles have developed in many Australian EDs. A further innovation is a diversion pathway for people with MSK conditions to move from the ED to a primary contact physiotherapy outpatient clinic.

Objective: To explore the perceptions of people with MSK conditions and hospital staff on diverting patients from the emergency department (ED) to receive care from primary contact physiotherapists in the outpatient setting.

Methods: A qualitative descriptive study with thematic analysis.

Results: Fourteen patient and 18 staff participants with experience of the diversion pathway were interviewed. There were four main themes combining staff and patient participant perspectives. The three combined themes were: (i) appropriateness of physiotherapists diverting patients from ED; (ii) communication; and (iii) impact of diverting patients from the ED. The unique staff theme was "staff perceptions of the diversion pathway." All patients felt diversion from the ED to see a physiotherapist in the outpatient clinic was appropriate, even if this was not their initial expectation of receiving care in the ED. Staff also perceived the diversion process as safe and valued addition to the ED. Both patient and staff participants described positive communication experiences from the physiotherapists in the diversion pathway. Several staff participants suggested improvements to the diversion pathway.

Conclusion: Patient and staff participants perceived the diversion pathway as a safe, appropriate and effective addition to the public general hospital ED processes.

Background: The role of carpal tunnel syndrome (CTS) in activity and participation is critical for improving rehabilitation outcomes, but there is a gap in the literature on this subject. This study presents an innovative application of Structural Equation Modelling (SEM) within the framework of the International Classification of Functioning, Disability and Health (ICF) for CTS patients.

Purpose: The aim of this study was to examine the effects of symptoms, proprioception, electrodiagnostic findings, and activity/participation in idiopathic CTS.

Methods: This cross-sectional study included 81 patients with mild to moderate idiopathic CTS. For the assessment of body structure/function, symptoms were measured by Visual Analogue Scale, Leeds Assessment of Neuropathic Symptoms and Signs, and Boston Carpal Tunnel Questionnaire - Symptom Severity Scale; proprioception by the force reproduction tests; and electrodiagnostic findings. Activity/participation were assessed using the Boston Carpal Tunnel Questionnaire - Functional Status Scale and the Quick Disability of the Arm, Shoulder, and Hand. SEM was used to examine the effect of body structure/function on activity/participation.

Results: This study revealed that symptoms (standardized coefficient = 0.858, p < .001) and proprioception (0.207, p = .032) had a significant effect on activity/participation. Conversely, the model results indicated no significant effect of sensory nerve conduction findings (-0.031, p = .673) and motor nerve conduction findings (0.195, p = .170) on activity/participation.

Conclusion: Relying solely on electrodiagnostic findings may contribute to the underestimation or misinterpretation of activity/participation limitations in patients with CTS. The findings of this study suggest that reducing symptoms may enhance activity/participation. Incorporating proprioception into the management of CTS patients may offer promising benefits.

Background: Physiotherapy clinical educators report that supervising students who are underperforming, struggling and/or challenging is one of the most difficult aspects of their role. These situations impact the individual educator and may also have negative effects on other students, staff, and the workplace.

Objective: The aim of this project was to explore the attitudes and opinions of physiotherapy clinical educators and departmental managers regarding the impact of supervising challenging students and document their needs for support/training.

Methods: This study was a cross-sectional design employing qualitative and quantitative methods of data analysis. Participants were Australian physiotherapy clinical educators and departmental managers.

Results: There were 209 completed surveys returned (educators n = 166, managers n = 43), Overall response rate was 60%. Most respondents indicated that they had supervised (87% of educators) or worked with (93% of managers), a student they perceived to be challenging. Supervising challenging students often had a negative impact on physiotherapy clinical educators and their workplaces. It was perceived by both educators and departmental managers that these difficult situations resulted in an increased workload, additional stress, and often adversely influenced willingness to engage in further student clinical education. A need for more training and face-to-face support to assist in the management of challenging student situations was widely reported and particularly highlighted by novice educators.

Conclusion: Challenging students have a considerable impact on physiotherapy clinical educators and their workplace. Better pre-placement student preparation and improved support and training are vital to enhance educator job satisfaction, contribute to a positive workplace culture around student supervision and maintain capacity to provide high-quality physiotherapy clinical placements.

Introduction: Assessing the state of functioning and disability post-stroke is essential for managing treatment and allocating appropriate resources.

Purpose: To explore the minimal important change (MIC) of the World Health Disability Assessment Schedule 2.0 (WHODAS 2.0) in individuals with chronic stroke using different statistical approaches.

Methods: WHODAS 2.0 was administered at baseline and after six months. MIC was estimated through distribution-based methods, anchor-based approaches, and ROC curve analysis using the Youden's index. A logistic regression model was also applied to estimate a predictive MIC (MIC_pred). Positive and negative predictive values (PPV and NPV) were estimated for three MIC thresholds.

Results: Fifty participants with chronic stroke were included (48% male; mean age approximately 60 years). Most (78%) had mild disability, and 80% showed functional improvement after six months. MIC estimates varied: 1.6 points (standard error of measurement), 5.28 points (0.33 × SD), and 8 points (0.5 × SD). ROC analysis yielded an AUC of 0.67, Youden's index of 0.35, sensitivity of 75%, specificity of 60%, and MIC ≤ 1.89 points. MIC_pred was 10.3 points (Nagelkerke R² = 0.078). The threshold of 5.28 points showed the best PPV (90.67%) and modest NPV (26.32%).

Conclusion: MIC values for WHODAS 2.0 in chronic stroke differ by method. The 5.28-point threshold offered the most balanced predictive value but should be interpreted cautiously. The findings support using multiple methods and emphasize the need for patient-centered assessment and methodological consistency in MIC determination.

Objectives: The physical therapy workforce lacks racial and ethnic diversity, with Black, Indigenous, People of Color (BIPOC) overwhelmingly underrepresented in the profession. This study explored the lived experiences of BIPOC physical therapists who have navigated the academic and social challenges of entrance into the profession. The research question was What are the facilitators, barriers, and challenges encountered by participants throughout their studies in a Doctor of Physical Therapy (DPT) program, while applying for their first job as a physical therapist, and subsequent adjustment to their work environment?

Methods: A descriptive phenomenological design with semi-structured interviews was used. Participants included six physical therapists who met the inclusion criteria for the study. A set of open-ended interview questions derived from the study's purpose encouraged participants to reflect on their lived experiences as a student and subsequently on entering the profession. The interviews were recorded and transcribed verbatim from a video-conferencing platform. Analysis included open coding, theming, and horizontalization.

Results: Six themes emerged: representation, biases/microaggressions, favoritism, identity/recognition, role models, and language barriers.

Conclusions: The six themes identified in the study were supported by previous studies. The findings of this study demonstrated an overall negative experience for BIPOC individuals in physical therapy education and practice. Recommendations to improve the BIPOC experience included changes at the social/cultural, institutional, programmatic, and clinical levels.

Background: Patients with idiopathic pulmonary fibrosis (IPF) often experience a decline in activities of daily living (ADL) due to progressive lung impairment. Therefore, it is essential to evaluate ADL performance in a way that reflects real-life challenges.

Purpose: This study aims to investigate the metric properties of the Londrina ADL Protocol in patients with IPF.

Methods: Thirty-three patients (66.7% men, age: 66.7 ± 5.2 years) participated in this observational metric analysis study. We evaluated the protocol's validity, reliability, standard error of measurement (SEM), and minimal detectable change with 95% confidence (MDC₉₅). To assess validity, we calculated correlation coefficients between the Londrina-ADL protocol and the Glittre Test (TGlittre), the 6-Minute Walk Test (6MWT), the London Chest-ADL (LCADL) Scale, hand grip strength, knee extension strength, and respiratory functions. Intra-rater reliability was analyzed using the intraclass correlation coefficient (ICC), paired sample t-test, SEM, MDC₉₅, and the learning effect.

Results: The Londrina-ADL protocol showed significant correlations with the TGlittre, the 6MWT, the LCADL, hand grip strength, knee extension strength, and respiratory functions (r = 0.742, r = -0.619, r = 0.665, r = -0.601, r = -0.587, p < .001, respectively.). The protocol demonstrated excellent intra-rater reliability (ICC = 0.939). Test durations differed significantly between tests (p < .001). The SEM and MDC₉₅ values were 8.69 seconds and 24.01 seconds, respectively, with a learning effect of 4.7% observed between the first and second tests.

Conclusion: Given its strong metric properties, the Londrina-ADL protocol may serve as a practical and sensitive tool for evaluating daily functional capacity and guiding individualized rehabilitation strategies in patients with IPF.

Background: Blood flow restriction treatment for lateral epicondylitis has little empirical evidence to support its use.

Objectives: To identify whether a blood flow restriction physical therapy (BFRPT) program is superior to a standard physical therapy (SPT) program when treating lateral epicondylitis.

Methods: A randomized controlled trial comparing a BFRPT program to an SPT program over six weekly visits was performed. The primary outcome was the change in the patient rated tennis elbow evaluation (PRTEE) score at 12 months. Secondary outcomes included the numeric pain rating scale (NPRS) and change in grip strength.

Results: Forty-one patients were enrolled and included in the intention to treat analysis. The PRTEE was analyzed with linear mixed effect model and revealed statistically significant improvements in both the SPT group -26.22 (95%CI: -37.35, -15.09, p < .001), and the BFRPT group -30.54 (95%CI: -42.44, -18.63, p < .001). BFRPT showed non-statistically significant improvement at 12 months compared to SPT, -4.32 (95% CI: -9.17,17.81, p = .53). Secondary outcomes also showed non-statistically significant differences: NPRS at 12 months, favoring SPT with a between group difference of -0.23 (95% CI:-2.56, 2.1, p = .85); pain-free grip strength favoring SPT -14.05 kg (95%CI: -41.28,11.59, p = .25), and maximum grip strength also favoring SPT -4.95 kg (95%CI:-28.61, 18.71, p = .66) at the completion of therapy.

Conclusion: This real-world trial suggests the addition of once weekly BFRPT is no better than simply performing a standard once weekly heavy load SPT protocol with prescribed HEP.

Background: We investigated the relationships among the 5 m walk test (5mWT), walking speed during the first 5 m of the 10 m walk test (5'10mWT), 10 m walk test (10mWT), and 6 min walk test (6MWT).

Objective: To validate whether the 5mWT and 5'10mWT can predict the walking speed in 10mWT and distance covered in 6MWT.

Methods: A total of 21 stroke participants underwent functional assessments using the Modified Ashworth Scale (MAS), Berg Balance Scale (BBS), and Fugl - Meyer Assessment for the lower extremity (FMA-L/E). Walking speed was measured using the 5mWT, 5'10mWT, and 10mWT, and walking distance was assessed using the 6MWT.

Results: The mean speeds for the 5mWT (0.77 ± 0.43 m/s), 5'10mWT (0.73 ± 0.38 m/s), and 10mWT (0.77 ± 0.42 m/s) did not significantly differ (p = .084). The 5mWT strongly correlated with 5'10mWT, 10mWT, and 6MWT (r = .945-.997, p < .001), and 10mWT closely correlated with 5'10mWT and 6MWT (r = .946-.994, p < .001) Regression analysis showed that the explanatory power of 5mWT and 5'10mWT in predicting 10mWT walking speed was 99% (p < .001) and 97% (p < .001), respectively, whereas that for 6MWT walking distance was 86% (p < .001) and 88% (p < .001), respectively.

Conclusion: Both 5mWT and 5'10mWT reliably predicted walking speed (10mWT) and distance (6MWT), in individuals with stroke, enabling quick and valid assessments of speed and endurance with limited space and serving as potential alternatives to both 10mWT and 6MWT. High correlations among the tests suggest interchangeability, reinforcing the clinical utility of the 5mWT and 5'10mWT for stroke populations in spatially and temporally constrained settings.