Physiotherapy Theory and Practice最新文献

Introduction: One explanation for inconsistent adherence to evidence-based recommendations in the management of spinal pain may be related to the physical therapist's philosophical approach, which is likely initiated during their entry-level education. A significant gap exists in the systematic study of physical therapist education, prompting recent calls for meaningful reform within the field. The aims of this study were to identify the unique number of orthopedic philosophical approaches to teaching musculoskeletal spine content across DPT curricula and to explore the beliefs of faculty members regarding musculoskeletal spine education.

Methods: This was a mixed methods research study with an electronic survey including both quantitative and qualitative questions, followed by an optional semi-structured virtual interview. Faculty members teaching musculoskeletal spine content in CAPTE-accredited DPT programs (n = 252) were invited to participate. Survey questions included demographics, orthopedic philosophical approaches, and methods of curricular design for teaching musculoskeletal spine content. The semi-structured interview explored themes in curricular design and approach to musculoskeletal spine education. Quantitative data was analyzed using descriptive statistics. Qualitative data was analyzed using grounded theory procedures to explore themes. A convergent design with a merging approach was used for data integration.

Results: Fifty-four faculty completed the survey, with 12 interviewed. A variety of orthopedic philosophical approaches were used, with all identified approaches implemented to some degree across DPT programs. Participants indicated that they do not implement one primary approach. Three overarching themes were revealed: Pragmatic Teaching and Learning Effectiveness, Curricular Integration for Adaptive Practice, and Clinical Applicability.

Conclusion: Findings reveal underlying themes that may explain the variability in how musculoskeletal spine content is taught in DPT programs. Insights into the current educational atmosphere have the potential to inform curricular refinement to ensure entry-level education upholds its obligation to produce competent practitioners prepared to meet the needs of society.

Background: While stroke survivors with persistent pain consider mind-body therapies useful, physiotherapists have reported that consumers may not see mind-body therapies as within their role.

Objective: To explore the perceptions and experiences of stroke survivors with pain regarding physiotherapists' provision of mind-body therapies.

Methods: Fifteen Australian stroke survivors with pain (11 women/4 men, aged 28-84 years, 5 months to 84 years post-stroke) participated in qualitative semi-structured interviews using a study-specific interview guide comprising eight primary questions regarding their demographics, perceptions and experiences of stroke, pain, mind-body therapies and physiotherapists providing mind-body therapies. Data were analyzed using reflexive thematic analysis and the COREQ guidelines informed the reporting of the study.

Results: We generated five themes to describe participants' perceptions and experiences of physiotherapists' use of mind-body therapies. Theme 1 detailed support for physiotherapists providing or referring for mind-body therapies. Theme 2 described that physiotherapists being trusted health professionals would increase consumers' use of mind-body therapies. Theme 3 collated perceptions that physiotherapists' low use of mind-body therapies may be related to limited skills/knowledge regarding the mind-body connection. Theme 4 summarized perceptions about physiotherapists' training needs. Finally, Theme 5 presented responses regarding the perceived scope of practice for physiotherapists regarding mind-body therapies.

Conclusion: Stroke survivors with pain see physiotherapists as trusted health professionals and would like them to provide, recommend, or refer for mind-body therapies as guided by scientific literature or past patient experience. Increased training for physiotherapists, including experiential practice and content on psychological aspects of persistent pain and the mind-body connection, could improve physiotherapists' current low use of mind-body therapies. While many mind-body therapies may be within physiotherapists' scope of practice, this requires further exploration.

Introduction: Video-based physiotherapy consultations are increasingly implemented within primary care, yet insight about patients' subjective experiences remains limited. Prior research has primarily examined the reliability and validity of video-based physical assessments. However, a qualitative approach is useful while studying patients' experiences of physiotherapy.

Objective: To explore and contrast patients' experiences of initial physiotherapy consultations for individuals presenting with knee-related symptoms delivered via video or in-person in a primary care context.

Methods: A comparative qualitative study was conducted using individual, semi-structured interviews with 15 participants (8 in-person, 7 video-based). Data were analyzed using inductive qualitative content analysis. Separate analyses were conducted for each group, followed by a comparative thematic synthesis to identify converging and diverging experiences across consultation formats.

Results: Participants with various knee-conditions were recruited from primary health care in both rural and urban areas. The analysis resulted in 5 categories and 19 subcategories. The categories were: Practical circumstances regarding the consultation, The need for communication and clear instructions, Video-based physiotherapy places new demands on the patient, Building a partnership, and Establishing confidence in the physiotherapy consultation.

Conclusion: In both in-person and digital settings, it is essential that physiotherapy is delivered in a way that fosters trust. Limited nonverbal communication in video-based consultations may hinder the development of trust and therapeutic alliance, shifting its foundation from interpersonal connection to perceived professional competence. Both consultation formats revealed a shared desire for more thorough examination, despite existing evidence supporting the adequacy of physiotherapy assessments. These findings suggest that video-based consultations are still perceived as a novel and evolving format, requiring time, experience, and clear communication to achieve broader acceptance.

Background: Chronic musculoskeletal pain is best addressed from a biopsychosocial perspective. Despite physiotherapists' awareness of this approach, translating it into practice remains a challenge. A three-month post-graduate course was designed to facilitate Dutch physiotherapists in private practice to implement the biopsychosocial approach through experiential learning, workplace facilitation, and home assignments. This study evaluates the perceived feasibility of the course regarding its contextual alignment with, and practical applicability in, clinical settings.

Methods: We conducted a qualitative study, using semi-structured interviews with all thirteen participants who completed the course, and applied a qualitative analysis to investigate perceived feasibility.

Results: Three interrelated concepts emerged: 1) the individual process; 2) the course as an intervention; 3) social and professional context. Although each participant had their own journey, they all experienced a change in attitude and confidence, as well as feeling more comfortable in using communication strategies and psychology informed movement interventions focusing on valued daily activities and social participation. Learning with and from peers and experiential learning were seen as important facilitators. Social and material factors were mentioned as influencing the implementation of learned knowledge and skills.

Conclusions: Findings from this study show promise in using a course that contains experiential learning, workplace facilitation, and home assignments, to train physiotherapists working in private practice to implement a biopsychosocial approach. Valuable insights into key barriers and facilitators show potential in informing the refinement of course design, and support understanding of the use of educational strategies for promoting new practice behaviors.

Background: The Functional Symmetry Observation Scale (FSOS-V2) is a video-based instrument that measures symmetry in spontaneous movement and posture in infants with congenital muscular torticollis. It has established content and construct validity and acceptable intrarater reliability. However, its interrater reliability is poor to moderate, which precludes the scale use by several therapists assessing symmetry in the same child. While the FSOS-V2 scores should be independent of the infants' age and motor development, visual inspection of reliability data obtained in previous research indicated a potential scoring bias. Younger infants received lower scores from at least one rater, with potential implications for discriminant validity of the scale. Additionally, excessive scoring time and discrepancies in score interpretation among raters likely contributed to lower-than-expected interrater reliability, leading to a recommendation to develop a shorter form of the FSOS-V2.

Purpose: The purposes of the current study were to evaluate the discriminant validity of the FSOS-V2, perform individual item analyses using the existing reliability data, and develop recommendations for scale modifications into a short form.

Methods: Secondary analyses of FSOS-V2 reliability data obtained by four raters from 50 infants with CMT were performed. Participants' videos were examined for the number of achieved major gross motor milestones. Correlations between the FSOS-V2 scores and participants' age, between the FSOS-V2 scores and the number of achieved milestones, and between the age and the number of achieved milestones were calculated. Individual item analysis was performed using descriptive statistics and item response theory (IRT) modeling.

Results: One rater's scores correlated significantly with participants' age and number of achieved milestones. IRT modeling yielded recommendations for scale modifications and removal of several items.

Conclusion: Scoring bias affected the discriminant validity and interrater reliability of the FSOS-V2. Current results corroborate scale revisions into short forms and modifications to scoring guidelines.

Introduction: Fibromyalgia Syndrome (FMS) is a complex disease characterized by widespread pain, fatigue, emotional disturbances, and autonomic dysfunction. Transcutaneous Auricular Vagus Nerve Stimulation (taVNS) has emerged as a potential noninvasive approach to modulate FMS-related symptoms.

Purpose: To compare the effects of left and bilateral taVNS on pain, mood, functionality, and autonomic nervous system (ANS) activity in individuals with FMS.

Methods: Forty female individuals with FMS were assigned to either a left (n = 20) or a bilateral (n = 20) taVNS group. Both received 11 sessions of taVNS targeting the tragus and concha regions (30 minutes each, 25 Hz, 300 µs) over nonconsecutive days, excluding weekends and menstrual periods. Visual Analog Scale (VAS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Fibromyalgia Impact Questionnaire (FIQ) were assessed. ANS activity was evaluated via heart rate variability (HRV). After 11 sessions of taVNS, a 2-week follow-up was performed.

Results: No significant differences were observed between groups except for FIQ and BAI on day 28 (p = .002-0.008). Both groups showed significant within-group improvements in VAS (r = 0.87-0.94; p < .001), BDI (r = 0.46-0.71; p < .001), FIQ (r = 0.95-0.99; p < .001), and BAI (r = 0.69-0.94; p < .001) scores. Parasympathetic Nervous System (PNS) (p = .365-0.776) and Sympathetic Nervous System (SNS) (p = .598-0.880) indices, which are the subparameters of HRV, showed no significant between-group differences, with small effect sizes (r < 0.15).

Conclusion: Both stimulation protocols effectively reduced pain and improved mood and functionality in fibromyalgia, indicating a safe, noninvasive adjunctive treatment option.

Clinicaltrials.gov: (Identifier: NCT06871306).

Background: Excessive patellofemoral joint (PFJ) loading is considered a primary stimulus for patellofemoral pain (PFP) development. However, little is known about how changes in PFJ loading influence PFP in active females, who are affected more frequently than males.

Purpose: Examine if changes in the patellofemoral joint reaction force (PFJRF) caused by forward trunk lean are associated with changes in self-reported PFP and hip and knee kinematics during single limb landing. Examine if and to what extent PFJRF reductions are related to changes in self-reported PFP.

Methods: Twenty-six active females (age: 23.4 ± 4.1 years) with PFP performed five single limb landing trials (0.25 m) using self-selected and forward trunk lean strategies. For each trial, kinematics, kinetics, and self-reported PFP were recorded. Dependent variables included pain, peak PFJRF, and PFJRF at varying knee flexion angles. Paired t-tests and Wilcoxon signed rank tests were calculated to examine the forward trunk lean effects on dependent variables. Spearman's rho was calculated to examine relationships between changes in PFJRF and self-reported PFP.

Results: Forward trunk lean led to increased peak PFJRF (mean difference (MD) = 16.15 N/kg; p < .05) and decreased PFJRF at knee flexion angles of 20 (MD = -5.73 N/kg; p < .001), 25 (MD = -7.67 N/kg; p < .001), and 30 degrees (MD = -6.86 N/kg; p < .001), but not 35 degrees (p > .05). The forward trunk lean also led to a 3-point median decrease in PFP (p < .05) and abolished pain in 18 of 26 participants, despite increased peak PFJRF. The PFJRF change at 25 degrees of knee flexion was significantly and positively related to changes in self-reported PFP (ρ = .44; p = .026).

Conclusions: For active females, increased forward trunk lean during single limb landing can improve PFP and reduce PFJRFs at small knee flexion angles, despite increased peak PFJRF. Additionally, greater decreases in the submaximal PFJRF at 25 degrees of knee flexion were associated with greater decreases in self-reported PFP during single limb landing.

Background: Students from culturally and linguistically diverse (CALD) backgrounds face more challenges during clinical placements than those who are non-CALD. However, strategies used to navigate these challenges are relatively unknown, especially in physiotherapy. As students have insight into helpful strategies for placements, it is important to explore these in physiotherapy settings for future cohorts from CALD backgrounds to benefit from these perspectives.

Purpose: To investigate helpful strategies identified by student physiotherapists from CALD backgrounds during clinical placements in Australian settings, and to understand these in relation to the challenges they experience.

Methods: The Cognitive Load Theory (CLT) was used as an interpretive framework for an experiential qualitative investigation of 13 students of CALD background and Asian heritage via semi-structured interviews. Interview data underwent inductive, reflexive thematic analysis.

Results: Coded data were developed into three key themes: (1) Gaining cognitive control, (2) Clarity is king: "Things we don't know, we don't know.," and (3) Jumping in the deep end with others.

Conclusion: Student physiotherapists from CALD backgrounds identify a variety of strategies during clinical placements. These strategies can be conceptualized as optimizing cognitive load to enhance learning and performance. Strategies include working together with clinical educators to gain clarity through explicit learning expectations, frequent feedback, and open communication. Cognitive enhancement strategies utilized scripting and targeted planning and practice. Students adopted acculturation strategies such as shadowing, communication exposure and simplification, and mind-set training, which optimize cognitive load. Some strategies utilized in this study were influenced by students' Asian heritage.

Background: Home-based exercise programs (HEPs) are critical for maintaining patient functionality after hospital discharge, yet a consensus on the most effective instruction method is lacking.

Purpose: This study aims to examine the feasibility and patient adherence to different HEPs in adult and pediatric patients.

Methods: This multicenter, randomized controlled study included 237 adult and 60 pediatric patients. The adult group was given HEPs primarily consisting of strengthening exercises, while the pediatric group focused on stretching. Patients were randomized into one of three groups: verbal instruction only, verbal instruction together with a brochure, and verbal instruction together with a video. Participants and caregivers were evaluated using standardized tools such as the Functional Independence Measure (FIM) or Functional Independence Measure for Children (WeeFIM), the Fatigue Severity Scale (FSS), the State-Trait Anxiety Inventory (STAI), the Visual Analog Scale (VAS), and the Gross Motor Function Classification System (GMFCS). Exercise adherence was measured by the level of confidence in performing the exercises, and exercise feasibility was measured by the number of days exercised and exercise completion percentage.

Results: The mean age was 41.50 ± 16.84 years for adults and 12.87 ± 3.92 years for children. No significant difference was observed among the exercise learning types in the adult group (exercise confidence level: p = .936, η² = 0.001; number of days exercised: p = .987, η² = 0.001; exercise completion: p = .942, Cramer's V = 0.108). Similarly, no significant difference was found in the pediatric group (exercise confidence level: p = .536, η² = 0.200; number of days exercised: p = .266, η² = 0.045; exercise completion: p = .342, Cramer's V = 0.194). Furthermore, no significant difference in adherence was found between the age groups.

Conclusion: This study suggests that the method of providing HEPs does not significantly impact adherence in either adult or pediatric patient populations. This finding indicates that video-based instruction is not superior to traditional methods like verbal instruction or brochures in improving exercise adherence.

Background: Isolated gastrocnemius tightness (IGT) limits ankle dorsiflexion with the knee extended. This study evaluated a 12-week physiotherapy program's effects on lower extremity function and gait in children with IGT.

Materials and methods: A single-group pre-post interventional design was used, including 30 children aged 6-12 years with bilateral IGT. Active and passive ankle dorsiflexion and lower extremity flexibility were measured. IGT was accepted based on passive dorsiflexion as < 10° with the knee extended and an increase of ≥ 10° with the knee flexed, according to the Silfverskiold test. The physiotherapy program involved stretching, strengthening, and functional exercises targeting the foot and ankle. Outcomes were assessed using the Navicular Drop Test (NDT), Foot Posture Index-6 (FPI-6), the Lower Extremity Functional Scale (LEFS), the Sit-to-Stand Test (SST). Gait was recorded on video, analyzed using Kinovea® software, and deviations were scored using the Edinburgh Visual Gait Score (EVGS).

Results: Bilateral improvements were observed in dorsiflexion with knee extension (ηp2 = 0.888-0.956), dorsiflexion with knee flexion (ηp2 = 0.445-0.749), inversion (ηp2 = 0.300-0.362), and eversion (ηp2 = 0.202-0.280). Foot posture improved on both sides in NDT (ηp2 = 0.363) and FPI-6 (ηp2 = 0.357-0.642). Functional outcomes showed significant changes in SST (ηp2 = 0.336), LEFS (ηp2 = 0.649), and EVGS (ηp2 = 0.548).

Conclusion: This study highlights the clinical value of physiotherapy in improving foot posture, lower extremity function, and gait in children with IGT. The findings support including targeted physiotherapy to address musculoskeletal impairments from gastrocnemius tightness.ClinicalTrials.gov ID: NCT06678139, registration date: April 11, 2024.