Physiotherapy Theory and Practice最新文献

Background: The Upper Quarter Y Balance Test (YBT-UQ) assesses upper limb dynamic balance in able-bodied individuals but lacks a reliable version for those with disabilities.

Objective: This study aimed to introduce a modified YBT-UQ (mYBT-UQ) for physically impaired individuals (PI) and establish its validity and reliability.

Methods: The study involved 33 male athletes aged 18-55, divided into three equal groups: able-bodied, spinal cord injury with trunk control (SCI), and below-the-knee amputation (BKA). To ensure test validity, able-bodied athletes completed both tests. Test-retest reliability was evaluated by repeating the mYBT-UQ seven days after the first test by PI groups. The validity was assessed using the Pearson correlation and Bland-Altman plot. The intraclass correlation coefficient (ICC) (2,1), standard error of measurement (SEM), and the minimal detectable change with 95% confidence (MDC95%) were calculated to assess relative and absolute reliability.

Results: There were significant differences and excellent relationships between YBT-UQ and the mYBT-UQ. Also, the Bland-Altman plot showed minimal bias and an acceptable range of agreement. In athletes with BKA, the ICC (2,1) was above 0.90 for both limbs. The SEM ranged from 2.4%-2.7%, and MDC95% ranged from 6.7%-7.5%. In athletes with SCI, the ICC (2,1) ranged from 0.72-0.80. The SEM ranged from 3.1%-3.2% and MDC95% ranged from 8.6%-8.9%.

Conclusion: The results indicate that the mYBT-UQ is a reliable test to assess upper quarter dynamic balance in athletes with SCI and BKA. However, regarding the small sample size of the study, there is a need to conduct other research to establish the validity of the test.

Background: Restriction of shoulder movements in frozen shoulder may negatively affect individual's daily living activities. The effect of the virtual reality (VR)-based exercise program, which is an innovative application and has been used in the field of physiotherapy in recent years, is unknown on patients diagnosed with frozen shoulder.

Objective: This study was conducted to determine the effects of a VR-based exercise program provided to patients with frozen shoulder on their pain, joint motion, and quality of life.

Methods: In the randomized controlled study, patients were divided into two groups to receive treatment five times a week for four weeks:VR-based exercise (VR group, n = 18) and conventional treatment(control group, n = 18). The data were collected using the VisualAnalog Scale, the Shoulder Pain and Disability Index, and the ShortForm - 36 health Scale.

Results: In comparison to the pre-treatment measurements, improvements were observed in pain, joint range of motion, and quality of life in both groups after the treatment (p < .001). The improvement in pain observed in the VR group after the treatment was greater than that observed in the control group (U=-2.064, p= .030). After the treatment, the quality of life in the mental health dimension was better for patients in the VR group (U= -1.979, p= .048).

Conclusion: VR-based exercise was an effective method for reducing the pain levels and improving the mental health of patients diagnosed with frozen shoulder.

Background: Physiotherapy techniques applied in intensive care units (ICU) aim to counteract functional decline and manage acute respiratory conditions. Treatment strategies vary depending on factors such as diagnosis, disease severity, and costs. Staffing resources and workload impact the duration and frequency of interventions. Understanding the workload of procedures may enhance patient care quality.

Objective: To determine the frequency, duration, and workload of physiotherapy procedures applied to adult ICU patients. Secondarily, we analyzed the time spent per shift on teaching-related and non-procedure-related activities.

Methods: Longitudinal panel study conducted in a 12-bed university hospital. Physiotherapy sessions applied to adult ICU patients were included. The list of procedures was derived using the Delphi method. The investigator followed physiotherapists to measure the duration of procedures and calculate a workload index for each (determined as duration x frequency). Duration of teaching-related and non-procedure-related tasks was also recorded.

Results: A total of 339 physiotherapy sessions were analyzed across 79 shifts, involving 181 patients and 19 physiotherapists. Procedures with the highest workload index were: out-of-bed mobilization, patient positioning, passive limb mobilization, active exercises, artificial airway suctioning, and equipment management. Time distribution across the shifts was as follows: direct patient care 40% (SD 12%), non-procedure-related activities 20% (SD 6%), and teaching-related activities 10% (range: 4%-19%).

Conclusion: The procedures with the highest workload index were those directly related to rehabilitation, such as mobilization and exercises, and those not specific to patient condition, like positioning and equipment management. Physiotherapists spent most of their time in direct patient care, followed by indirect care activities and teaching.

Background and purpose: Adults living with Cerebral Palsy (CP) who are non-ambulatory are at increased risk for falls, contractures, reduced bone density, and pain. There is limited evidence for core strength training, anterior chain activation exercises, or high intensity gait training (HIGT) to improve gait function in adults with CP. The purpose of this case report is to describe the use of anterior chain muscle activation and HIGT to improve walking in a non-ambulatory adult male with quadriplegic CP.

Case description: The participant was a 26 y.o. male living with spastic quadriplegic CP with a goal to cross the finish line of an adaptive triathlon while ambulating. The outpatient physiotherapy protocol emphasized anterior chain activation exercises and HIGT to improve strength, gait, and mobility at a frequency of 1-2 times a week for 8 months.

Outcomes: The minimal detectable change of 19 points was achieved on the Function in Sitting Test (FIST). The original ambulation goal was exceeded to a maximum of 76 meters overground. The participant was able to walk across the finish line using a gait trainer while supervised at an adaptive triathlon.

Conclusions: Focusing on anterior chain exercises and HIGT was effective to minimize extensor spasticity by strengthening body flexors allowing improved mobility and gait.

Background: The interventions performed in most randomized controlled trials (RCTs) on neck pain patients are standardized, irrespective of the high heterogeneity of patients. However, clinicians tend to choose an intervention based on the patients' clinical characteristics, and thus match the treatment to the patient.

Objectives: To investigate the effectiveness of interventions matched to the clinical characteristics of patients with neck pain versus the same, but unmatched treatment for improving pain or disability.

Design: A systematic review and meta-analysis conducted following Cochrane guidelines.

Methods: Databases searches were performed from inception to September 2023. RCTs were included if the patients in the experimental group received a treatment matched to clinical presentation or to clinicians' assessment, if the patients in the control group received a similar but unmatched treatment, and if pain or disability were reported as outcome measures.

Results: The literature search produced 9516 records of which 27 met the inclusion criteria. Matched exercise therapy was superior to unmatched exercise for pain (SMD -0.57; 95% CI -0.95, -0.18) and for disability (SMD -0.69; 95% CI -1.14, -0.23) at short term, but not at intermediate-term follow-up. Matched manual treatment was not superior to unmatched manual therapy for pain or for disability at short or intermediate-term follow-up.

Conclusions: Results suggest that matching exercise to movement limitation, trapezius myalgia, or forward head position may lead to better outcomes in the short term, but not in the intermediate-term. Matched manual therapy was not superior to unmatched treatment either short or intermediate-term. Further research is warranted to verify if those criteria are potentially useful matching criteria.

Background: Post-stroke clinical changes not only affect extremities and trunk muscles but also the respiratory muscles.

Purpose: To determine the effect of robot-assisted arm training with conventional rehabilitation (CombT) on respiratory muscle strength, activities of daily living (ADL), and quality of life in patients with stroke and to compare the results with conventional rehabilitation (CR).

Methods: It was a two-arm, single-blinded, randomized controlled trial in which 66 patients were randomly allocated to either CombT or CR to receive 30 sessions (5/week) over 6 weeks. The respiratory muscle strength (maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP)), activities of daily life (ABILHAND questionnaire), and quality of life (Stroke Impact Scale (SIS)) were measured before and 6 weeks after training.

Results: The CombT group showed significantly better MIP, MEP, and performance in ADLs after 6 weeks of training compared to the CR group (p < .01). The effect size was large for MIP (d = 0.9) and MEP (d = 0.9), whereas medium for performance in ADLs (d = 0.62). Also, the SIS-arm strength (p < .01), hand function (p = .04), ADLs (p = .02), and recovery (p = .04) were significantly better in CombT group with a medium (d = 0.6, d = 0.5, d = 0.5, and d = 0.5, respectively) effect size compared with CR group.

Conclusions: Both CombT and CR groups improved respiratory muscle strength, performance in ADLs, and quality of life in patients with stroke. However, CombT appears to offer more comprehensive benefits, highlighting its valuable role in respiratory and functional recovery after stroke.

Introduction: Kartagener's syndrome (KS), consisting of bronchiectasis, situs inversus totalis, and sinusitis, is a subtype of primary ciliary dyskinesia (PCD). The presence of KS may affect respiratory and physical functions.

Purpose: This study aimed to compare respiratory functions, exercise capacity, muscle strength, and physical activity levels among children with PCD with/without KS and healthy peers.

Methods: Fifteen patients with KS, 23 with PCD without KS, and 27 controls were compared. Pulmonary function, functional exercise capacity (6-minute walk test - 6MWT), maximal inspiratory, expiratory (MIP, MEP), and skeletal muscle strength, inspiratory muscle endurance (IME), and physical activity level were evaluated.

Results: The forced expiratory volume in one second (FEV₁) % (p = .009), forced expiratory flow from 25%-75% (FEF_25-75%) % (p = .001), MIP (p = .034), MEP (p = .003), 6MWT distance (p = .001), and daily steps (p = .034) were significantly different among the groups. Quadriceps femoris (QF) muscle strength and IME were similar in groups (p ˃ .05). FEV₁% (p = .002), FEF_25-75% % (p = .001), MIP (p = .027), MEP (p = .001), and 6MWT distance (p = .003) in patients with KS; 6MWT distance (p = .003) in patients with PCD without KS was significantly lower than controls.

Conclusion: The presence of KS affects pulmonary function, respiratory muscle strength, and physical activity more. Exercise capacity and physical activity levels are decreased, inspiratory muscle endurance and QF muscle strength are preserved in patients with KS and PCD without KS. Kartagener's syndrome further impairs pulmonary and extrapulmonary outcomes; the reasons should be investigated, and the necessity of rehabilitation approaches that will prevent deterioration come to the fore.

Background: The effects of pelvic tilt control using visual biofeedback on gluteus maximus (GM), multifidus (MF), and hamstring (HAM) muscle activities during bridge exercises involving anterior pelvic tilt (APT), neutral pelvic tilt (NPT), and posterior pelvic tilt (PPT) were investigated.

Methods: Twenty-five healthy participants were included (mean age, 24.6 ± 1.9 years). Visual biofeedback was used for the participants to self-control pelvic tilt during the bridge exercises. Pelvic tilt controls were performed in a random order (APT vs. NPT vs. PPT) following 30 minutes education program. GM, MF, and HAM muscle activities were measured by surface electromyography. One-way repeated analysis of variance and Bonferroni post hoc test were used.

Result: GM and MF muscle activities significantly differed among the different pelvic tilting controls (APT vs. NPT vs. PPT) (p < .017). GM muscle activity during the exercise involving PPT was significantly higher than that involving APT and NPT (p < .017). In contrast, MF muscle activity during the exercise involving PPT was significantly lower than that involving APT (p < .017). In addition, the GM/Right MF, GM/Left MF, and GM/HAM muscle activity ratios during the exercise involving PPT were significantly greater than those involving APT and NPT (p < .017).

Conclusions: The bridge exercise involving PPT using visual biofeedback can be recommended as a home exercise to selectively improve the muscle activity of the GM and the muscle activity ratio of the GM/HAM and GM/MF. This information may be valuable for clinicians seeking exercise programs to target specific muscles effectively.

Background: Previous research has indicated significant concerns regarding attrition of early career physiotherapists in Australia. Despite the importance of retaining skilled and experienced professionals within the profession, the workplace and workforce intentions of early career physiotherapists remain relatively unexplored.

Purpose: The aim of this study was to investigate and explore factors influencing the workplace and workforce intentions of early career physiotherapists in Australia.

Methods: The Turnover Intention Theory was used to guide a whole-of-person qualitative exploration through semi-structured interviews with 14 participants. Transcribed interview data was subjected to reflexive thematic analysis.

Results: Four themes were generated, constructed as questions to represent participants' temporary holding of intentions: 1) What drives me?; 2) Do my expectations align?; 3) Do my values align?; and 4) What does the future hold?

Conclusion: Early career physiotherapists' perspectives encompass diverse and varied experiences that reflect an alignment, or in some cases a misalignment, of the expectations, values and resulting practices of becoming and being a physiotherapist. Early career physiotherapists experience a range of challenges within their workplaces, including significant experiences of stress, yet they express an underlying commitment to the wider profession.