Physiotherapy Theory and Practice最新文献

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.

Objective: This study examined the associations between urinary incontinence (UI), physical activity, and disease burden among women with multiple sclerosis (MS).

Methods: A cross-sectional study was conducted with 574 women with MS. Participants completed questionnaires including demographic data, as well as the International Physical Activity Questionnaire - Short Form (IPAQ-SF), Incontinence Impact Questionnaire-7 (IIQ-7), Urogenital Distress Inventory-6 (UDI-6), and Multiple Sclerosis Impact Scale-29 (MSIS-29).

Results: Mean age was 38.48 ± 10.10 years, mean body mass index 24.90 ± 4.86 kg/m², and median time since diagnosis 7 years. Median moderate and vigorous physical activity was 0.00 log-MET, while sitting and walking were 6.11 and 6.21 log-MET, respectively; total IPAQ-SF median was 7.20 log-MET. Correlations showed negligible associations between total IPAQ-SF and UI scores (IIQ-7: r = -0.036, p = .386; UDI-6: r = 0.010, p = .808) and significant positive correlations with MSIS-29 physical (r = 0.622, p < .001) and mental scores (r = 0.426, p < .001). Hierarchical regression indicated socio-demographic variables explained 2.3% of variance in physical activity (R² = 0.023, p = .020). Final model significant predictors were education (B = -0.106, β = -0.100, p = .030), MSIS-29 physical (B = -0.006, β = -0.151, p = .030), UDI-6 score (B = 0.031, β = 0.174, p = .024), childbirth status (B = 0.416, β = 0.293, p = .033), and birth weight of heaviest child (B = 0.000, β = -0.213, p = .047). Age, body mass index, marital status, living condition, chronic disease, and menopausal status were not significant. Full model explained 5.6% of variance (R² = 0.056).

Conclusion: Physical activity in women with MS is influenced by education, MS-related physical impact, UI, and reproductive factors, while moderate and vigorous activity levels remain particularly low. These findings highlight the need for tailored interventions addressing socio-demographic, clinical, and reproductive determinants to promote activity in this population.

Clinical trial: This study was conducted as a cross-sectional study, and thus no clinical trial registration was undertaken.

Background: Low back pain (LBP) is a leading cause of disability worldwide. Despite evidence in clinical practice guidelines (CPGs) emphasizing rehabilitation and self-management education as first-line interventions, uptake of successful self-management strategies is suboptimal. This study assesses a remotely-delivered method of personalized self-management education for patients with chronic LBP (cLBP) who are not actively receiving rehabilitation care.

Objective: This study evaluated feasibility and effectiveness of a remotely-delivered personalized patient education program, SmartBack, for individuals with cLBP. We hypothesized that the SmartBack program would demonstrate feasibility and lead to improvements in self-efficacy, pain, disability, or any combination of these outcomes in patients with cLBP.

Methods: This single-arm interventional pilot study continuously recruited participants from a local research registry until 30 eligible participants were enrolled. Participants received e-mail surveys every three days for three weeks. Personalized educational materials were distributed to each participant based on their baseline knowledge and beliefs regarding cLBP management and best evidence from nine recent CPGs. Outcome measures were the Pain Self-Efficacy Questionnaire (PSEQ, primary outcome), Numerical Pain Rating Scale (NPRS) and Oswestry Disability Index (ODI).

Results: Twenty-three participants completed the Smartback program. Most participants were female (78.3%), with a mean age of 46 years. Pain self-efficacy significantly improved post-intervention as measured by the PSEQ (p = .026, Cohen's d = 0.596). The mean PSEQ score increased from 29.84 (SD 16.36) to 34.68 (SD 16.75), suggesting that personalized education may positively influence patients' confidence in managing cLBP. Mean ODI and NPRS scores did not significantly change.

Conclusion: A remotely-delivered, personalized patient education program may be effective in improving self-efficacy among individuals with cLBP. Future research should examine the long-term effects in larger and more diverse populations and using randomized study designs including control groups.

Background: Respiratory muscle weakness causes inadequate respiration, ineffective coughing, impaired exercise capacity, and autonomic dysfunction. Inspiratory muscle strength training (IMST) may improve these functions; however, its effect in Parkinson's disease (PD) remains unknown.

Objective: To investigate the effects of IMST on upper and lower extremity exercise capacity, muscle oxygenation, autonomic function, cough strength, fatigue, and dyspnea in patients with PD.

Methods: A randomized, controlled, triple-blind study. Twenty patients with PD received IMST at 50% of maximal inspiratory pressure (MIP), and 20 received thoracic expansion exercises (control) for 7 days/8 weeks. The IMST group received one supervised session and six home sessions, while the control group received seven home sessions. Functional exercise capacity (6-minute walk test (6MWT) and 6-minute pegboard and ring test (6PBRT)), muscle oxygenation, autonomic function, cough strength, fatigue (Parkinson's Fatigue Scale (PFS)), and dyspnea (Modified Medical Research Council (MMRC) dyspnea scale) were evaluated.

Results: The 6MWT distance (Cohen's d = 2.02, p = .001), 6PBRT rings (Cohen's d = 1.20, p = .001) resting muscle oxygenation (Cohen's d = 0.81, p = .017), cough strength (Cohen's d = 1.46, p < .001), autonomic function (Cohen's d = 0.63, p = .058), PFS (Cohen's d = 1.20, p = .001), and MMRC (Cohen's d = 1.74, p < .001) scores of the IMST group improved significantly compared to the control. No improvement was prevalent between groups in muscle oxygenation during the 6MWT and 6PBRT (p > .05).

Conclusion: IMST improved upper and lower extremity exercise capacity, muscle oxygenation, cough strength, and autonomic function, while lowering fatigue and dyspnea in PD. Improved oxygenation may help patients tolerate higher workloads, aiding endurance and functional gains. These findings support the addition of IMST to rehabilitation programs for improved pulmonary, cardiac, and functional capacity. Increased cough strength may lower the risks of aspiration, pneumonia, and mortality - this requires further investigation. ClinicalTrials number: NCT06017336.

Background: Neck pain and headache are common among office workers and lead to a significant personal, societal and economic burden. Whether the area of pain or pain extent (PE) obtained from pain drawings by the office workers themselves can be explained and predicted by clinical outcomes such as pain intensity, frequency or disability is the aim of the current study.

Objectives: To examine whether clinical outcomes related to neck pain and headache can explain the PE in the head and neck region at baseline (cross-sectional analysis), and predict the PE at follow-up (longitudinal analysis) in office workers with neck pain and/or headache.

Methods: Secondary analysis of a cluster randomized controlled trial with 112 participants. The focus of this analysis was on the associations between neck pain variables (occurrence, average and maximal pain intensity ratings, and disability) and headache variables (occurrence, headache intensity, frequency and impact) with PE of the two regions. Data was analyzed using general linear models for both cross-sectional and longitudinal data.

Results: Headache occurrence and frequency explained 26% of the PE variance for the neck region at baseline. Further, baseline headache frequency, maximum neck pain intensity (p = .07). and age, could explain 21% of the variability in neck PE at follow-up: For the head region statistical assumptions for modeling data were not met.

Conclusion: Frequent headaches are closely related with PE in the neck region in symptomatic office workers. There is a strong need to additionally screen and assess for headache features in office workers with neck pain.

Clinical trial number: NCT04169646. Registered November 15, 2019.

Background and objectives: Temporomandibular joint (TMJ) dysfunction involves both myogenic and articular disc components, often arising from muscular hyperactivity, and impaired coordination of the lateral pterygoid muscle. Insufficient or unbalanced activation of this muscle can disrupt normal disc-condyle motion, contributing to pain, and functional limitation. While Muscle Energy Techniques (MET) have demonstrated efficacy in managing TMJ dysfunction, their specific application targeting the lateral pterygoid remains underexplored. The present trial investigates this targeted approach to determine its effectiveness in improving TMJ kinematics, and function.

Methods: Single Blinded Randomized Controlled Trial including 48 participants with symptomatic, and asymptomatic TMJ dysfunction were randomly allocated to two treatment groups with equal allocation in both groups based upon eligibility criteria. Group A received Lateral Pterygoid MET, along with conventional protocol while Group B received only conventional protocol for two weeks, with five sessions per week. The assessment for Maximal Mouth Opening (MMO), lateral deviation, and jaw function using JFLS-20 was conducted at day 0, day 14, and at day 21 follow-up. Ethical approval for the study was obtained from the Jamia Hamdard Institutional Ethics Committee (JHIEC) under Ethical Approval Number Ref. No. 13/24 (19/12/2024).

Results: Significant within-group improvements in MMO, lateral deviation, and jaw function (p < .001). Between-group differences were significant only for lateral deviation, favoring the experimental group (p < .001, Cohen's f = 0.55, partial η² = 0.23). The effect sizes were large for MMO (f = 0.64, partial η² = 0.29), and negligible for JFLS-20 (f = 0.06, partial η² = 0.004). Post hoc power analyses indicated sufficient power ( >0.95) for detecting between-group effects.

Conclusion: This trial demonstrates the effectiveness of lateral pterygoid MET in improving jaw kinematics, with particularly greater improvements observed in lateral deviation, while the intervention showed limited effects on JFLS-20 and MMO when between-group differences were analyzed. These findings highlight the importance of incorporating lateral pterygoid - specific MET into therapeutic interventions for temporomandibular joint dysfunction.

Purpose: Perform a systematic review to determine incidence and characteristics of vaccine administration of those developing frozen shoulder (FS) following COVID-19 vaccine administration.

Methodology: Systematic review of the literature (PROSPERO number CRD42024611140). Inclusion criteria; diagnosis of frozen shoulder, published or available in the English language and onset of frozen shoulder linked to COVID-19 vaccination. Studies were excluded if FS was linked to onset outside of vaccination and if data were not separated. Relevant studies were assessed for inclusion and selected studies were identified from PubMed, EMBASE, EBSCOhost, Cochrane Library, Web of Science and CINAHL databases. The search strategy was developed by a biomedical librarian run on August 4, 2025. Data were extracted from retained studies and underwent quality assessment using The Joanna Briggs Institute Critical Appraisal Checklist.

Results: The search resulted in 1,506 studies and 9 retained for appraisal. A total of 140 individuals were identified among the retained studies with past medical history being reported in 6 of these studies identifying diabetes and hypothyroidism among the most common. Vaccine manufacturer and symptom manifestation data were reported in all retained studies. Incidence could not be determined based on available data.

Conclusion: In addition to known risk factors associated with vaccinations, those with comorbidities associated with the etiology of FS may also be predisposed to developing FS following COVID-19 vaccination administration. Clinicians evaluating those with suspected FS should be aware of the link between vaccinations and the development of FS. Additionally, clinicians administering COVID-19 vaccinations and boosters need to be aware of potential risk factors that may predispose individuals to developing FS following as well as possible signs and symptoms to be aware of post-vaccination.

Background: Motor imagery training (MIT), a cognitive technique that involves mentally simulating movement, addresses the maladaptive neuroplastic changes associated with chronic pain.

Objective: The study aimed to investigate the effects of motor control exercises (MCE) combined with MIT on pain, pain-related beliefs, functional status, and neck awareness in women with chronic neck pain (CNP).

Methods: In this single-blind, randomized controlled trial, forty female participants with moderate CNP were allocated into two groups using stratified randomization: an experimental group (MCE, 30 min + MIT, 20 min; n = 20) and a control group (MCE, 30 min; n = 20). The researchers adapted the MIT procedure utilized in this study. Participants underwent training twice a week for eight weeks, with assessments conducted at pre-treatment, post-treatment, and a 12-week follow-up. Outcome measures included pain intensity, pain beliefs, muscle strength, endurance, functional status, neck awareness, and motor imagery ability.

Results: Both the experimental (mean age 51.50 ± 9.31 years) and control (mean age 55.00 ± 11.64 years) groups exhibited significant improvements in pain, pain-related beliefs, functional status, and neck awareness scores post-treatment (p < .05), and these improvements were maintained during the follow-up period. Furthermore, the experimental group demonstrated significantly greater improvements, with moderate-to-high effect sizes, in pain behavior (p = .01, η² = 0.08), functional status (p < .05, η² > 0.06), and neck awareness (p = .03, η² = 0.09) compared to the control group (p < .05, η² > 0.06).

Conclusions: The combination of MIT and MCE was more effective than MCE alone in improving pain-related parameters, functional status, and neck awareness in women with CNP.

Clinical trial number: NCT05999565.

Background and aim: Individuals with cerebral palsy exhibit poor movement coordination, reduced selective motor control, and balance dysfunction, all of which affect their overall behavior. This study aimed to examine whether music-driven movement therapy is beneficial for behavior and hand function in children and adolescents with cerebral palsy.

Methods: This one-group pretest-posttest pragmatic feasibility trial was conducted in special schools in Bangalore, India. Twenty-two children and adolescents with cerebral palsy aged 8-15 years, spastic and dyskinetic groups, with a Gross Motor Function Classification System level of I - IV, or a Manual Ability Classification System level of I - III were included in the study. They participated in non-directional goal-oriented movement sequences driven by playing joyful rhythmic beats on musical instruments. All of them practiced a one-hour session per day, 3 days a week, over a six-week duration. Behavioral function was measured using the Behavior Rating Inventory of Executive Function version 2.0 teacher form (BRIEF2), and hand function was assessed using the manual ability questionnaire - ABILHAND.

Results: Following music-driven movement practice, the Behavior Regulation Index, Emotion Regulation Index, Cognitive Regulation Index, and Global Executive Composite of the BRIEF2 and ABILHAND improved significantly (p < .001).

Conclusion: Music-driven movement therapy was beneficial for improving the behavior and hand function of children and adolescents with cerebral palsy.