Physiotherapy Theory and Practice最新文献

Background: Individuals in the Hispanic and Latino community have the lowest levels of post-stroke function compared to other races and ethnicities and are poorly represented in stroke rehabilitation research studies.

Objective: To understand the Hispanic and Latino perspective on stroke and rehabilitation research in the midwestern United States.

Methods: An academic-community partnership was formed between stroke rehabilitation researchers and community experts. Over a 9-month period, we developed and administered a survey and conducted focus group discussions aimed at understanding Hispanic and Latino perspectives on stroke and rehabilitation research. Themes from focus group discussions were abstracted using inductive thematic analysis.

Results: The survey identified that there are concerns which may limit research participation in general and that family comfort with the research team is valued. Three themes emerged from focus group discussions: (1) Research Engagement and Information; (2) Stroke Knowledge; and (3) Community Contextualization and Cultural Congruence. While generally interested in research and motivated to attain additional information, participants were widely unaware of stroke and rehabilitation research opportunities and reported limited stroke knowledge. Participants noted language differences as a critical concern, and there was a strong desire to understand the community impact of research.

Conclusion: Limited information exchange and limited understanding of stroke are concerns among the Hispanic and Latino community in the midwestern United States. It is necessary for stroke and rehabilitation research teams to engage in productive information sharing and enhance relationships with community partners.

Introduction: Lateral ankle sprain (LAS) is a common injury with long-term consequences, including joint degeneration and behavioral adaptations.

Objective: This study compares talar cartilage measures, physical activity, and injury-related fear between young and middle-aged adults with and without a history of LAS.

Methods: Forty adults were categorized into four groups: young ankle sprain (YAS), young control (YC), middle-aged ankle sprain (MAS), and middle-aged control (MC). Talar cartilage cross-sectional area (CSA), echointensity (EI), and echogenicity (EG) were measured using ultrasound. Physical activity was assessed via accelerometry and the Godin Questionnaire. The Tampa Scale of Kinesiophobia-11 (TSK-11), the Fear-Avoidance Beliefs Questionnaire (FABQ), and the Foot and Ankle Disability Index (FADI) were used to evaluate injury-related fear and ankle function.

Results: Significant age × LAS interactions for lateral EI (p = .016, d = -0.88) and medial EI (p = .007, d = -0.91) indicated compositional decline in MAS vs. YAS. Medial EI was higher in YAS than MAS (p = .007, d = 0.91), reflecting better cartilage composition in younger LAS participants. LAS history was associated with increased lateral CSA (p = .008, d = 0.62) and medial CSA (p = .017, d = 1.50). LAS participants also had reduced lateral EG (p = .009, d = 0.78), FADI-ADL (p = .001, d = 1.21), FADI-S (p = .019, d = 0.79), and very vigorous physical activity (p = .023, d = 0.74) compared to controls. No significant differences were observed for TSK-11 (p = .054) or FABQ (p = .102).

Conclusion: Adults with prior LAS exhibited early signs of talar cartilage morphology, evidenced by thickening and a more hypoechoic appearance on ultrasound. These changes occurred with selfreported functional deficits, but without significant increases in fear of movement or exercise avoidance.

Background: Multi-canal benign paroxysmal positional vertigo (MC-BPPV) is a rare form of BPPV characterized by the simultaneous involvement of multiple semicircular canals, often resulting in complex diagnostic and therapeutic challenges. While MC-BPPV most commonly affects the posterior and horizontal semicircular canals, tri-canal involvement - especially with bilateral asymmetry - is exceedingly rare.

Purpose: To describe a unique case of tri-canal BPPV involving right posterior and horizontal semicircular cupulolithiasis and left horizontal semicircular canalolithiasis, successfully managed with a structured, sequential protocol of repositioning maneuvers including a novel Bascule maneuver.

Case description: A 43-year-old woman presented with vertigo triggered by positional changes. Detailed positional testing identified cupulolithiasis in the right posterior and horizontal canals and canalolithiasis in the left horizontal canal. Sequential diagnostic maneuvers, including half Dix-Hallpike, inversion, and supine roll tests, revealed complex nystagmus patterns indicating multicanal involvement. Treatment began with mastoid oscillations and the Bascule maneuver targeting the right posterior canal, followed by the Zuma and Gufoni maneuvers for horizontal canal involvement.

Outcomes: Right posterior canal cupulolithiasis resolved within 24 hours. On day 2, transformation of horizontal nystagmus patterns enabled identification and successful treatment of right horizontal canal cupulolithiasis. On day 3, the left horizontal canalolithiasis was confirmed and treated. Complete symptom resolution and negative positional testing were achieved within 72 hours.

Conclusion: This case highlights the importance of comprehensive positional testing and a sequential, canal-specific therapeutic approach in managing complex MC-BPPV. The Bascule maneuver, combined with tailored repositioning techniques, proved highly effective in resolving tri-canal involvement rapidly and completely.

Objectives: To investigate predictive features of passive hip adduction flexibility impairment measured during modified Ober's test on chronicity of pain in runners with Iliotibial Band Syndrome (ITBS).

Methods: Twenty male runners with ITBS were evaluated for self-reported pain characteristics and passive hip adduction angle using a digital inclinometer during the modified Ober test. The receiver operating characteristics (ROC) analysis identified the cutoff value for hip adduction angle that predicts ITBS chronicity, and linear regression determined the relationship between these two variables.

Results: The average passive hip adduction measured with the modified Ober test was 7.48°±3.03°. The ROC analysis determined an optimal cutoff value of 6.35° passive hip adduction as a potential indicator of ITBS chronicity (AUC = 0.740; p = .034; SE 0.113, 95% CI 0.518 to 0.962) with good sensitivity (80%), moderate specificity (60%) in runners with ITBS (p = .034). A significant positive association existed between greater passive hip adduction and increased ITBS chronicity (R² = 0.226; β = 0.475; p = .034).

Conclusion: The preliminary findings of this study suggest that passive hip adduction impairment identified during the modified Ober test may be a potential indicator of pain chronicity in male runners with ITBS, hinting at its potential benefit in treatment. While hip adduction flexibility impairment in ITBS appears to be a protective feature, it may reflect maladaptive mechanical pain sensitivity linked to changes in ITB stiffness during running. Given this is a pilot study, caution should be considered when interpreting and generalizing the identified hip adduction flexibility impairment cutoff value for clinical application.

Background: Pediatric pain is complex due to physiological, psychological, and social factors. Evidence suggests that untreated childhood pain might have long-term physical and mental effects. While physiotherapists are key in pediatric care, research from India remains scarce. In the Indian context, children's pain is frequently underestimated due to cultural norms, limited pain education in physiotherapy curricula, and inconsistent access to resources. Maharashtra, as a diverse and populous state, presents specific challenges where physiotherapists' knowledge and attitudes directly influence pediatric care.

Objective: Examining the knowledge and attitudes of physiotherapists in Maharashtra with relation to the management of pediatric pain was the primary goal of this research.

Methods: Using the Pediatric Healthcare Provider's Knowledge and Attitudes Survey Regarding Pain, 152 physiotherapists completed a descriptive, online cross-sectional survey. A convenience sample was used to recruit participants from a range of clinical settings in Maharashtra. Using SPSS version 25.0, we examined the data and found significant relationships between variables using chi-square tests.

Results: A total of 124 therapists responded (81.6%) from which most participants (59.7%) demonstrated average knowledge, while 39.5% had good knowledge. Educational qualification (p = .002) and clinical experience (p = .023) were significantly associated with higher knowledge levels. Gender and age showed no significant impact. Gaps were observed in pharmacological knowledge, infant pain perception, and cultural sensitivity. Although a majority supported proactive pain management, inconsistencies were noted in opioid use and pain assessment.

Conclusion: Physiotherapists in Maharashtra show a foundational understanding of pediatric pain, yet notable gaps remain. Continued education, standardized protocols, and culturally competent training are essential for improving care.

Background: The Impella 5.5® device is a temporary ventricular assist device that improves the cardiac output in patients with cardiogenic shock. These patients are critically ill and are often placed on bed rest, which can result in a functional decline. Early mobility programs have helped mitigate some of the negative consequences of immobility while also reducing the incidence of hospital-related complications.

Objective: To describe the characteristics of patients with the Impella 5.5® device and to compare the initial mobility status of patients discharged home versus a post-acute facility.

Methods: This retrospective cohort study examined 77 patients supported with the Impella 5.5® device in 2022. Data on demographic characteristics, medical interventions and functional outcomes were collected. The functional outcomes included the Activity Measure of Post-Acute Care Basic Mobility Short Form, the Functional Status Score for the Intensive Care Unit (ICU), the ICU Mobility Scale and the maximum ambulation distance.

Results: The mean age was 58.7 years, with 74.2% of participants being male. Sixty-two patients received referrals for physical therapy, and 61/62 (98.4%) were able to be mobilized out of bed, with 74% (46/62) being able to ambulate while on the Impella 5.5®. Significant improvements were observed in all functional outcome measures by hospital discharge (p < .001). Patients discharged home were able to mobilize out of bed earlier (p < .001) and had higher functional outcomes scores compared to those discharged to a post-acute facility (p < .001).

Conclusions: Early mobilization is associated with improved function and a higher likelihood of being discharged home compared to a post-acute facility. The results of this study may help physical therapists working in the acute care setting be aware of the functional characteristics and progression of mobility in this patient population, which may assist therapists in developing a plan of care and determining discharge needs.

Background: Despite widespread dissemination of clinical practice guidelines (CPGs), physical therapists (PTs) often use ineffective interventions for low back pain (LBP), suggesting a lack of knowledge translation. The transition from awareness to adherence is a complex process and not well understood.

Objective: To evaluate outpatient PTs' progression from awareness to adherence to LBP CPGs using Pathman's model of clinical behavior change.

Methods: A cross-sectional survey was conducted in 18 outpatient physical therapy clinics across eight health systems. Seventy-three PTs who routinely manage patients with LBP were invited to participate. The survey assessed awareness, agreement, adoption, and adherence to CPG-recommended interventions and included three clinical vignettes representing distinct LBP subgroups. Proportions of PTs meeting successive adherence steps were calculated. Spearman's rank correlations examined associations among awareness, agreement, adoption, and adherence. Differences across subgroups were analyzed to identify variation in guideline uptake.

Results: Sixty PTs completed the survey. Awareness was 78.3%, agreement 85%, adoption 65% and adherence 10%. Among those who agreed with the CPGs, 80% were aware. Of those who adopted the guidelines, 69% were aware and 84% agreed. All adherent PTs met criteria for awareness, agreement, and adoption. Awareness (r_s = 0.379, P = .001), agreement (r_s = 0.395, P < .001), and adoption (r_s = 0.284, P = .030) were significantly correlated with mean adherence. While adoption did not differ significantly across vignettes (P = .879), the mean adherence for LBP with associated affective disorder was 26% lower (P < .001).

Conclusion: Adherence to LBP CPGs among PTs remains low despite high awareness and agreement. While strengthening earlier stages of guideline uptake is critical, persistent gaps in adoption and adherence indicate this alone is insufficient. Targeted strategies are urgently needed, particularly for patients with affective disorders, where adherence is notably poor.

Background: Medial tibial stress syndrome (MTSS) affects up to 35% of military recruits during basic training, yet no validated patient-reported outcome measure (PROM) exists to assess this condition in Hebrew-speaking populations. The MTSS score is a validated PROM for assessing symptom severity; however, it requires linguistic adaptation for use among Hebrew-speaking individuals.

Objective: To translate and assess psychometric properties of the Hebrew version of the Medial Tibial Stress Syndrome score (MTSS-He) among active-duty servicemembers.

Methods: Following Beaton's guidelines, the MTSS score was translated into Hebrew and culturally adapted. A total of 133 participants were recruited. A cross-sectional validation study was conducted with 72 active-duty servicemembers diagnosed with MTSS (mean age 19.32 ± 0.8 years, 63.9% male). Psychometric properties, including internal consistency (Cronbach's Alpha (α) and McDonald's Omega (ω)), test-retest reliability (ICC3,1), concurrent validity (Spearman correlations with Short Form 12 and numerical pain rating scales), and discriminative validity were assessed.

Results: The MTSS-He demonstrated acceptable internal consistency (α = 0.66, ω = 0.68), good test-retest reliability (ICC3,1 = 0.75), and significant correlations with pain measures (rho = 0.32-0.61, p < .01). The instrument significantly discriminated between patients with MTSS and asymptomatic controls (p < .001), with median MTSS-He scores of 3 (IQR: 2-4).

Conclusions: The MTSS-He is a reliable and valid instrument for assessing MTSS in Hebrew-speaking active-duty servicemembers, addressing a critical gap in Hebrew-language assessment tools. It enables standardized symptom quantification and outcome comparison, with potential for broader application in clinical and research settings. Future studies should investigate structural validity based on internal consistency test results and extend validation to civilian and athletic populations.

Introduction: Limited research exists on ethical landscapes in physiotherapy in South America, Spain, and Portugal.

Objective: The study aimed to explore the diversity and contextuality of preexisting ethical situations and to identify novel ethical situations encountered by physiotherapists in these regions.

Methods: A cross-sectional online survey incorporating one optional open-ended question was conducted, adapted from the ESPI-study and translated into Spanish and Portuguese. Participants were asked to describe ethical situations they experienced. Qualitative data were analyzed deductively and inductively and novel ethical situations categorized thematically.

Results: Participants included 98 physiotherapists from 11 countries. The qualitative analysis revealed 94 ethical situations, with 78 relating to predefined survey items, and 44 ethical situations concentrating on seven survey items. Reported situations included professional misconduct in educational settings, conflicts with other health professionals and patients, lack of professional recognition and knowledge about physiotherapy scope, inadequate regulatory infrastructure and economic pressures. Sixteen novel ethical situations formed four new themes: (1) inadequate compensation and devaluation of physiotherapy services, (2) work exploitation and labor rights violations, (3) managing interpersonal violence and neglect within patients' environments, and (4) gender-based professional disrespect.

Discussion: Findings highlight how structural hierarchies, cultural norms, and gender biases shape ethical challenges of physiotherapists. The study underscores the need for targeted ethics education, stronger professional advocacy, and systemic reforms to address labor rights and gender equity.

Conclusion: The study reveals complex ethical realities faced by physiotherapists in South America, Spain, and Portugal, and calls for context-sensitive strategies to enhance professional autonomy, equity, and ethical preparedness.

Introduction: First-line treatment for subacromial pain syndrome (SAPS) includes non-surgical interventions with surgery as a secondary option. The relationship between outcome of first line treatment and long-term outcomes remains unclear. We aimed to investigate the relationship between symptom improvement and symptom status 4 months after diagnosis and the probability of subsequent surgery and acceptable symptom status after 1 year.

Methods: This is a population-based prospective cohort-study of patients with SAPS from Danish outpatient hospital clinics. The patients completed online questionnaires 4 months and 1 year after diagnosis, including data on symptom improvement (Global Impression of Change) and symptom status (Patient Acceptable Symptom State) at 4-month follow-up, symptom status at 1-year follow-up and information on surgery (yes/no) between 4-month and 1-year follow-up. We used logistic regression analyses, adjusted for potential confounders.

Results: In total, 2244 patients completed a 1-year follow-up. Those who did not undergo surgery (n = 1406), those who had surgery before 4-month follow-up (n = 510), and those who had surgery between 4-month and 1-year follow-up (n = 223) had a 64%, 70% and 48% probability of reaching acceptable symptom status at 1-year follow-up, respectively. Symptom improvement or acceptable symptom status at 4-month follow-up significantly reduced the probability of surgery between 4-month and 1-year follow-up (OR 0.32 (95%CI: 0.23-0.46) and 0.26 (95%CI: 0.17-0.42)) and significantly increased the probability of acceptable symptom status at 1-year follow-up for patients not undergoing surgery (OR 1.46 (95%CI: 1.12-1.90) and 4.10 (95%CI: 3.14-5.36), respectively).

Conclusion: Symptom improvement and acceptable symptom status after 4-month follow-up relate to a lower probability of surgery and a higher probability of acceptable symptom status.