Physiotherapy Theory and Practice最新文献

Background: New graduate physiotherapists play a vital role in meeting the increased demand for health services, and aligning graduate career aspirations with evolving workforce needs is crucial for the profession's future. However, little is known about the underlying motivating factors that influence early-career intentions for physiotherapy students preparing to enter the workforce.

Purpose: To explore the motivating factors influencing physiotherapy students preparing to enter the workforce and the impact of these factors on workplace and early-career intentions.

Methods: Semi-structured interviews were conducted with Australian entry-level physiotherapy students in their final six months of study (n = 13), recruited through a snowball sampling approach. Data were analyzed using reflexive thematic analysis. The Self Determination Theory was used to guide the interview framework, inform data analysis, and interpret participants' deeper motivations.

Results: Four major themes were developed and structured as statements made from the perspectives of participants: 1) I want my personal values to be fulfilled; 2) Supports I seek in my professional setting; 3) Relationships I hope to form within my career; and 4) Experiences that shape my early-career intentions.

Conclusion: The findings indicate that physiotherapy students are influenced by a combination of intrinsic and extrinsic motivations, alongside their placement experiences, when making decisions at the outset of their career. Consistent with Self Determination Theory, students seek to fulfill their innate psychological needs of competence, autonomy, and relatedness, and recognize the importance of aligning their values with prospective team environments and people in their early career.

Introduction: This study examined the distribution of board-certified and PhD/EdD faculty, as well as residency, fellowship, and PhD program offerings, across the top 25 physical therapy programs in the United States ranked by U.S. News & World Report, assessing their correlation with rankings and the impact of Research 1 (R1) designation on prestige.

Materials and methods: Data were sourced from program websites, the American Board of Physical Therapy Specialties (ABPTS), and the American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE), analyzing faculty specialization, terminal degrees, and post-professional offerings.

Results: Statistical analysis included Spearman's rho correlations and a Mann-Whitney U test. Results showed a predominance of full-time faculty in Orthopedics and Neurology, with no board-certified faculty in Oncology. Significant positive correlations were found between rankings and board-certified faculty (ρ = .455, p = .011), full-time PhD/EdD faculty (ρ = .467, p = .009), and total PhD/EdD faculty (ρ = .434, p = .015), while R1 institutions ranked higher than non-R1 programs (U = 26.000, Z = -2.305, p = .021). However, residency (p = .664) and fellowship (p = .286) programs did not influence rankings.

Discussion: A strong presence of PhD/EdD faculty drives higher rankings, with less impact from board-certified faculty, and that specialty gaps may reflect institutional priorities.

Conclusion: The study demonstrates that elevated proportions of PhD/EdD and board-certified faculty, alongside R1 designation, boost program rankings. The dominance of Orthopaedics and Neurology, alongside Oncology gaps, suggests targeted development opportunities, emphasizing research-intensive environments and terminal degrees in shaping future physical therapy education strategies.

Purpose: This study aimed to ascertain the validity of usual walking speed (UWS) as a postoperative recovery indicator and investigate the minimal clinically important difference (MCID) in UWS before to 1 week after radical surgery in patients with colorectal cancer (CRC).

Methods: To ascertain the concurrent validity (based on the hypothesis, test if there is a difference in the measured results in a population with a certain characteristic) of UWS as an indicator of postoperative recovery, the correlation coefficient between UWS and 6-minute walk distance (6MWD) changes was calculated. To assess the construct validity, the effect size (ES) was calculated for the difference between groups of UWS and 6MWD changes by comparing between patients with and without the following characteristics: older age, open surgery, postoperative complications, and delayed postoperative ambulation. To evaluate the responsiveness of UWS, ES and standardized response mean (SRM), for the difference within groups, were calculated. The MCID of UWS was calculated using the EuroQol 5-dimension 5 L questionnaire as an anchor.

Results: Seventy-two patients were included. UWS and 6MWD changes were moderately correlated (r = 0.628, p < .001), confirming the concurrent validity. Although the construct validity of UWS was somewhat low, it was judged to be comparable to that of 6MWD, which was used as an indicator of postoperative recovery. The ES and SRM of UWS were 0.56 and 0.73, respectively. The MCID of UWS was determined to be -0.18 m/s (area under the curve: 0.751 [95% confidence interval: 0.612 - 0.889]).

Conclusion: Regarding indicators of postoperative recovery, UWS, with low patient burden, short measurement time, and no need for a large space, may be a useful surrogate in settings and cases where 6MWD could not be evaluated, with an MCID of -0.18 m/s from before surgery to 1 week after in patients with CRC.

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.