Pub Date : 2025-09-05DOI: 10.1016/j.physio.2025.101839
Joyce M.C.V. O’Riordan , Ruth McCullagh , Grainne Sheill , Helen P. French , Frances Horgan
<div><h3>Objective</h3><div>International guidelines recommend exercise-based rehabilitation in advanced cancer, however planning and implementation of rehabilitation is complex. Through engagement with people with metastatic breast cancer, clinical and academic physiotherapists, multidisciplinary team members and health service managers, we explored the intervention elements and the implementation planning of a primary care, exercise-based cancer rehabilitation intervention.</div></div><div><h3>Design setting and participants</h3><div>Using a World Café and interpretive description design, we held two workshops. In workshop one (<em>n</em> = 9), the Template for Intervention Description and Replication checklist was used to identify intervention components. In workshop two (<em>n</em> = 23), the Practical, Robust Implementation and Sustainability Model guided implementation planning. Written data were collected using whiteboards. Discussions were audio-recorded, transcribed and analysed by two authors.</div></div><div><h3>Results</h3><div>Workshop one highlighted the need for physiotherapists with oncology training to deliver individually-tailored, primary care-based interventions. Workshop two added that the role of physiotherapists with specialist oncology training would be to coordinate the delivery of adaptable interventions in an integrated manner, across care settings to respond to evolving needs of people with metastatic breast cancer, which include managing disease symptoms and treatment side-effects, and improving and maintaining quality of life and independence. Key implementation elements recommended include: evidence-based assessment and treatment; careful monitoring of patient and service outcomes; appropriate governance structures; service sustainability through ongoing training and supervision of physiotherapists, and oncologist support.</div></div><div><h3>Conclusions</h3><div>A primary care, exercise-based cancer rehabilitation intervention requires physiotherapists with specialist oncology training to coordinate and provide an adaptable, integrated interventions that respond to needs of people with metastatic breast cancer.</div></div><div><h3>Contribution of the Paper</h3><div><ul><li><span>•</span><span><div>We have described the essential intervention elements and implementation planning of a primary care exercise-based cancer rehabilitation intervention to decrease symptom burden and increase quality of life for people with metastatic breast cancer through engagement with a wide variety of relevant stakeholders.</div></span></li><li><span>•</span><span><div>Novel findings included support for physiotherapists with specialist oncology training to deliver and coordinate the delivery of adaptable interventions in an integrated manner across care settings to respond to the evolving needs of people with metastatic breast cancer. These should include the following implementation elements: evidence-based assessment and treatment;
{"title":"Co-designing a primary care physiotherapist-led cancer rehabilitation intervention for people with metastatic breast cancer using a World Café approach","authors":"Joyce M.C.V. O’Riordan , Ruth McCullagh , Grainne Sheill , Helen P. French , Frances Horgan","doi":"10.1016/j.physio.2025.101839","DOIUrl":"10.1016/j.physio.2025.101839","url":null,"abstract":"<div><h3>Objective</h3><div>International guidelines recommend exercise-based rehabilitation in advanced cancer, however planning and implementation of rehabilitation is complex. Through engagement with people with metastatic breast cancer, clinical and academic physiotherapists, multidisciplinary team members and health service managers, we explored the intervention elements and the implementation planning of a primary care, exercise-based cancer rehabilitation intervention.</div></div><div><h3>Design setting and participants</h3><div>Using a World Café and interpretive description design, we held two workshops. In workshop one (<em>n</em> = 9), the Template for Intervention Description and Replication checklist was used to identify intervention components. In workshop two (<em>n</em> = 23), the Practical, Robust Implementation and Sustainability Model guided implementation planning. Written data were collected using whiteboards. Discussions were audio-recorded, transcribed and analysed by two authors.</div></div><div><h3>Results</h3><div>Workshop one highlighted the need for physiotherapists with oncology training to deliver individually-tailored, primary care-based interventions. Workshop two added that the role of physiotherapists with specialist oncology training would be to coordinate the delivery of adaptable interventions in an integrated manner, across care settings to respond to evolving needs of people with metastatic breast cancer, which include managing disease symptoms and treatment side-effects, and improving and maintaining quality of life and independence. Key implementation elements recommended include: evidence-based assessment and treatment; careful monitoring of patient and service outcomes; appropriate governance structures; service sustainability through ongoing training and supervision of physiotherapists, and oncologist support.</div></div><div><h3>Conclusions</h3><div>A primary care, exercise-based cancer rehabilitation intervention requires physiotherapists with specialist oncology training to coordinate and provide an adaptable, integrated interventions that respond to needs of people with metastatic breast cancer.</div></div><div><h3>Contribution of the Paper</h3><div><ul><li><span>•</span><span><div>We have described the essential intervention elements and implementation planning of a primary care exercise-based cancer rehabilitation intervention to decrease symptom burden and increase quality of life for people with metastatic breast cancer through engagement with a wide variety of relevant stakeholders.</div></span></li><li><span>•</span><span><div>Novel findings included support for physiotherapists with specialist oncology training to deliver and coordinate the delivery of adaptable interventions in an integrated manner across care settings to respond to the evolving needs of people with metastatic breast cancer. These should include the following implementation elements: evidence-based assessment and treatment; ","PeriodicalId":54608,"journal":{"name":"Physiotherapy","volume":"130 ","pages":"Article 101839"},"PeriodicalIF":3.0,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-16DOI: 10.1016/j.physio.2025.101838
C. Bernal-Utrera , A. Bravo-Vázquez , F.J. Montero-Bancalero , A. Suárez-Vega , M.J. Casuso-Holgado , E. Anarte-Lazo
Objective
To assess the accuracy and reliability of an artificial intelligence (AI) chatbot (ChatGPT) in providing answers about exercise recommendations for breast cancer survivors.
Design
Cross-sectional study.
Methods
We extracted recommendations from recent systematic reviews of clinical practice guidelines (CPGs) on therapeutic physical exercise in breast cancer survivors. Clinical questions were developed and queried to ChatGPT-4. We evaluated the performance of ChatGPT-4 as a counseling tool by assessing the accuracy of responses (percentage of agreement with CPGs recommendations, weighted Cohen’s kappa and the percentage of text wording similarity) and the intra-rater and inter-rater reliability in grading ChatGPT answers (kappa value).
Results
We tested 15 clinical questions. The accuracy of the AI chatbot´s responses was considered unacceptable, with only 7% of responses being reasonably accurate (1/14), 64% of responses being partially accurate (9/14) and 29% being completely incorrect (4/14). It was observed a low Kappa coefficient (k = 0.244, CI: 0.089 to 0.577) and the similarity of responses was also considered unacceptable, with 27.2% of overlapping text wording. Intra and inter-rater reliability showed moderate to good values in all cases.
Conclusions
ChatGPT does not appear to be an accurate counselling tool for answering questions about exercise recommendations for breast cancer survivors. Compared to CPG´s recommendations, the accuracy of ChatGPT responses was considered poor, with moderate to good reliability. It is important to make patients know that they should not only base their decisions on information coming from ChatGPT.
Contribution of the Paper
•
ChatGPT is not an accurate tool for answering questions about exercise recommendations for breast cancer survivors.
•
Breast cancer survivors should not make decisions about exercise based on ChatGPT information alone.
•
The feasibility of therapeutic exercise in breast cancer survivors needs to be supported by expert advice.
{"title":"Evaluation of ChatGPT accuracy and reliability in answering questions about exercise recommendations for breast cancer survivors","authors":"C. Bernal-Utrera , A. Bravo-Vázquez , F.J. Montero-Bancalero , A. Suárez-Vega , M.J. Casuso-Holgado , E. Anarte-Lazo","doi":"10.1016/j.physio.2025.101838","DOIUrl":"10.1016/j.physio.2025.101838","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the accuracy and reliability of an artificial intelligence (AI) chatbot (ChatGPT) in providing answers about exercise recommendations for breast cancer survivors.</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Methods</h3><div>We extracted recommendations from recent systematic reviews of clinical practice guidelines (CPGs) on therapeutic physical exercise in breast cancer survivors. Clinical questions were developed and queried to ChatGPT-4. We evaluated the performance of ChatGPT-4 as a counseling tool by assessing the accuracy of responses (percentage of agreement with CPGs recommendations, weighted Cohen’s kappa and the percentage of text wording similarity) and the intra-rater and inter-rater reliability in grading ChatGPT answers (kappa value).</div></div><div><h3>Results</h3><div>We tested 15 clinical questions. The accuracy of the AI chatbot´s responses was considered unacceptable, with only 7% of responses being reasonably accurate (1/14), 64% of responses being partially accurate (9/14) and 29% being completely incorrect (4/14). It was observed a low Kappa coefficient (k = 0.244, CI: 0.089 to 0.577) and the similarity of responses was also considered unacceptable, with 27.2% of overlapping text wording. Intra and inter-rater reliability showed moderate to good values in all cases.</div></div><div><h3>Conclusions</h3><div>ChatGPT does not appear to be an accurate counselling tool for answering questions about exercise recommendations for breast cancer survivors. Compared to CPG´s recommendations, the accuracy of ChatGPT responses was considered poor, with moderate to good reliability. It is important to make patients know that they should not only base their decisions on information coming from ChatGPT.</div></div><div><h3>Contribution of the Paper</h3><div><ul><li><span>•</span><span><div>ChatGPT is not an accurate tool for answering questions about exercise recommendations for breast cancer survivors.</div></span></li><li><span>•</span><span><div>Breast cancer survivors should not make decisions about exercise based on ChatGPT information alone.</div></span></li><li><span>•</span><span><div>The feasibility of therapeutic exercise in breast cancer survivors needs to be supported by expert advice.</div></span></li></ul></div></div>","PeriodicalId":54608,"journal":{"name":"Physiotherapy","volume":"130 ","pages":"Article 101838"},"PeriodicalIF":3.0,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145571692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-16DOI: 10.1016/j.physio.2025.101837
Sally Mastwyk , Nicholas F. Taylor , Anna Lowe , Caroline Dalton , Casey L. Peiris
Background
Physiotherapists in primary care are well placed to provide health promotion interventions that target client metabolic risk factors.
Objective
To determine the effectiveness of health promotion interventions delivered by physiotherapists in primary care on metabolic outcomes for people with or at risk of metabolic syndrome.
Data sources
AMED, CINAHL, Cochrane, Medline, PEDro, PsycInfo, SPORTDiscus (searched up to February 2024).
Eligibility criteria
Studies evaluating physiotherapist-delivered health promotion interventions for adults with at least one metabolic risk factor (abdominal obesity, hypertension, elevated triglycerides, reduced HDL-C or elevated glucose) delivered in primary care settings were included.
Study appraisal and synthesis
Two reviewers extracted data, evaluated methodological quality using the Mixed Methods Appraisal Tool, and certainty of evidence using GRADE. Meta-analyses were conducted using a random effects model to calculate weighted mean differences (WMD) for outcomes on common scales, and standardised MD (SMD) for outcomes on different scales.
Results
Twenty-five studies (n = 3619 participants) were included. Moderate-high certainty evidence indicated that physiotherapist-delivered health promotion interventions reduced waist circumference (WMD −2.42 cm, 95%CI −4.31 to −0.53), diastolic blood pressure (WMD −2.34 mmHg, 95%CI −3.77 to −0.91), triglycerides (WMD −0.18 mmol/L, 95%CI −0.36 to 0.00) and fasting blood glucose (WMD −0.18 mmol/L, 95%CI −0.28 to −0.08), and increased physical activity (SMD 0.18, 95%CI 0.04 to 0.32) compared to usual care.
Conclusion
Physiotherapy-led health promotion interventions in primary care can improve metabolic risk factors and physical activity levels for people with or at risk of metabolic syndrome by small but clinically significant amounts.
Systematic Review Registration Number
Systematic Review Registration Number PROSPERO CRD42022352725.
Contribution of the Paper
•
This systematic review is the first to demonstrate that lifestyle interventions delivered by physiotherapists in primary care can improve metabolic risk factors for people with or at risk of metabolic syndrome.
•
Physiotherapy-led health promotion interventions likely improved waist circumference, diastolic blood pressure, triglycerides and blood sugar levels by a clinically significant amount.
•
Physiotherapists working in primary care settings should have confidence in their ability to provide health promotion interventions to target metabolic risk factors that may contribute to chronic disease prevention.
{"title":"Physiotherapist-led health promotion interventions in primary care can reduce metabolic risk factors for people with or at risk of metabolic syndrome: a systematic review","authors":"Sally Mastwyk , Nicholas F. Taylor , Anna Lowe , Caroline Dalton , Casey L. Peiris","doi":"10.1016/j.physio.2025.101837","DOIUrl":"10.1016/j.physio.2025.101837","url":null,"abstract":"<div><h3>Background</h3><div>Physiotherapists in primary care are well placed to provide health promotion interventions that target client metabolic risk factors.</div></div><div><h3>Objective</h3><div>To determine the effectiveness of health promotion interventions delivered by physiotherapists in primary care on metabolic outcomes for people with or at risk of metabolic syndrome.</div></div><div><h3>Data sources</h3><div>AMED, CINAHL, Cochrane, Medline, PEDro, PsycInfo, SPORTDiscus (searched up to February 2024).</div></div><div><h3>Eligibility criteria</h3><div>Studies evaluating physiotherapist-delivered health promotion interventions for adults with at least one metabolic risk factor (abdominal obesity, hypertension, elevated triglycerides, reduced HDL-C or elevated glucose) delivered in primary care settings were included.</div></div><div><h3>Study appraisal and synthesis</h3><div>Two reviewers extracted data, evaluated methodological quality using the Mixed Methods Appraisal Tool, and certainty of evidence using GRADE. Meta-analyses were conducted using a random effects model to calculate weighted mean differences (WMD) for outcomes on common scales, and standardised MD (SMD) for outcomes on different scales.</div></div><div><h3>Results</h3><div>Twenty-five studies (<em>n</em> = 3619 participants) were included. Moderate-high certainty evidence indicated that physiotherapist-delivered health promotion interventions reduced waist circumference (WMD −2.42 cm, 95%CI −4.31 to −0.53), diastolic blood pressure (WMD −2.34 mmHg, 95%CI −3.77 to −0.91), triglycerides (WMD −0.18 mmol/L, 95%CI −0.36 to 0.00) and fasting blood glucose (WMD −0.18 mmol/L, 95%CI −0.28 to −0.08), and increased physical activity (SMD 0.18, 95%CI 0.04 to 0.32) compared to usual care.</div></div><div><h3>Conclusion</h3><div>Physiotherapy-led health promotion interventions in primary care can improve metabolic risk factors and physical activity levels for people with or at risk of metabolic syndrome by small but clinically significant amounts.</div></div><div><h3>Systematic Review Registration Number</h3><div>Systematic Review Registration Number PROSPERO CRD42022352725.</div></div><div><h3>Contribution of the Paper</h3><div><ul><li><span>•</span><span><div>This systematic review is the first to demonstrate that lifestyle interventions delivered by physiotherapists in primary care can improve metabolic risk factors for people with or at risk of metabolic syndrome.</div></span></li><li><span>•</span><span><div>Physiotherapy-led health promotion interventions likely improved waist circumference, diastolic blood pressure, triglycerides and blood sugar levels by a clinically significant amount.</div></span></li><li><span>•</span><span><div>Physiotherapists working in primary care settings should have confidence in their ability to provide health promotion interventions to target metabolic risk factors that may contribute to chronic disease prevention.</div></span></li></ul></div><","PeriodicalId":54608,"journal":{"name":"Physiotherapy","volume":"130 ","pages":"Article 101837"},"PeriodicalIF":3.0,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145571629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-31DOI: 10.1016/j.physio.2025.101835
B. Caird , N. McGowan , J. Depiazzi , R. Marpole , N. Gibson
Objective
To describe the physiotherapy interventions provided to children with cerebral palsy (CP) at risk of respiratory illness and determine criteria for safe in-home treatment.
Design
Descriptive study of physiotherapy interventions received by children enrolled in the treatment arm of a 12-month feasibility randomised controlled trial between March 2022 and July 2023.
Setting
Tertiary hospital, community and in-home.
Participants
Ten children with CP aged 28 months to 12 years.
Interventions
All types of respiratory physiotherapy interventions.
Main outcome measures
Types of physiotherapy interventions, the number, location, and duration of occasion of service (OOS), patient symptoms at baseline and post intervention, stability of participant during treatment sessions.
Results
There were 159 physiotherapy intervention OOS, median (range) 15.5 (4 to 27). All 10 children had at least one new or worsened symptom at a follow up visit that was present before physiotherapy commenced and was not present at their initial baseline assessment on entry to the study. Nine children received individualised respiratory action plans, seven received airway clearance-based plans and two exercise-based plans. The most frequently used airway clearance techniques were manual techniques and positioning. Lung health education was delivered to all participants on every visit. No negative events related to physiotherapy interventions occurred. Criteria for children deemed unsuitable for respiratory physiotherapy interventions outside the hospital were developed.
Conclusion
Airway clearance, positioning and lung health education were the most frequently used respiratory physiotherapy interventions in the community. These were safe when children had clear action plans and were delivered by a skilled respiratory paediatric physiotherapist with tertiary experience.
Contribution of the Paper
•
Types of, and responses to respiratory physiotherapy interventions for children with cerebral palsy and respiratory illness, at risk of deterioration are described in detail.
•
Respiratory physiotherapy interventions are safe when guided by clear safety criteria and respiratory action plans.
•
Skilled paediatric physiotherapists with tertiary experience are vital to the safe delivery of these interventions.
{"title":"Unpacking the “black box” of safe respiratory physiotherapy interventions delivered in the home for children with cerebral palsy and medical complexity","authors":"B. Caird , N. McGowan , J. Depiazzi , R. Marpole , N. Gibson","doi":"10.1016/j.physio.2025.101835","DOIUrl":"10.1016/j.physio.2025.101835","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the physiotherapy interventions provided to children with cerebral palsy (CP) at risk of respiratory illness and determine criteria for safe in-home treatment.</div></div><div><h3>Design</h3><div>Descriptive study of physiotherapy interventions received by children enrolled in the treatment arm of a 12-month feasibility randomised controlled trial between March 2022 and July 2023.</div></div><div><h3>Setting</h3><div>Tertiary hospital, community and in-home.</div></div><div><h3>Participants</h3><div>Ten children with CP aged 28 months to 12 years.</div></div><div><h3>Interventions</h3><div>All types of respiratory physiotherapy interventions.</div></div><div><h3>Main outcome measures</h3><div>Types of physiotherapy interventions, the number, location, and duration of occasion of service (OOS), patient symptoms at baseline and post intervention, stability of participant during treatment sessions.</div></div><div><h3>Results</h3><div>There were 159 physiotherapy intervention OOS, median (range) 15.5 (4 to 27). All 10 children had at least one new or worsened symptom at a follow up visit that was present before physiotherapy commenced and was not present at their initial baseline assessment on entry to the study. Nine children received individualised respiratory action plans, seven received airway clearance-based plans and two exercise-based plans. The most frequently used airway clearance techniques were manual techniques and positioning. Lung health education was delivered to all participants on every visit. No negative events related to physiotherapy interventions occurred. Criteria for children deemed unsuitable for respiratory physiotherapy interventions outside the hospital were developed.</div></div><div><h3>Conclusion</h3><div>Airway clearance, positioning and lung health education were the most frequently used respiratory physiotherapy interventions in the community. These were safe when children had clear action plans and were delivered by a skilled respiratory paediatric physiotherapist with tertiary experience.</div></div><div><h3><strong>Contribution of the Paper</strong></h3><div><ul><li><span>•</span><span><div>Types of, and responses to respiratory physiotherapy interventions for children with cerebral palsy and respiratory illness, at risk of deterioration are described in detail.</div></span></li><li><span>•</span><span><div>Respiratory physiotherapy interventions are safe when guided by clear safety criteria and respiratory action plans.</div></span></li><li><span>•</span><span><div>Skilled paediatric physiotherapists with tertiary experience are vital to the safe delivery of these interventions.</div></span></li></ul></div></div>","PeriodicalId":54608,"journal":{"name":"Physiotherapy","volume":"130 ","pages":"Article 101835"},"PeriodicalIF":3.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145571697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Low back pain (LBP) is associated with a poorer prognosis when there is concomitant depression. Musculoskeletal (MSK) triage physiotherapists clinically assess a significant proportion of LBP referrals to public hospital outpatient waiting lists.
Objectives
To establish depression screening and referral practices of MSK triage physiotherapists, and to compare confidence in depression screening to red flag (e.g. cauda equina syndrome) and yellow flag (e.g. fear avoidance beliefs) screening.
Methods
Using a descriptive cross-sectional design, a bespoke e-survey was distributed to MSK triage physiotherapists in adult public hospital outpatient services in Ireland following ethical approval.
Results
Thirty-six surveys were completed and submitted (55% response rate). A minority of respondents (3/36, 8%) directly ask all patients with LBP about depression, while more than one third (13/36, 36%) never screened for depression. Reported barriers included lack of training or skill, time constraints, and absence of referral pathways. Confidence in screening for depression was lower than for red flags or yellow flags. There was some indication that a day or more of training improved depression screening confidence and practice.
Discussion
This study provides insight into current depression screening practices for people with LBP and the factors influencing decision-making among MSK triage physiotherapists working in advanced practice roles.
Conclusion
Few MSK triage physiotherapists in this sample directly screen for depression, and screening confidence was low. Understanding the current processes and determinants of practice, including the potential positive impact of targeted training, may support strategies to improve depression screening practices.
Contribution of the Paper
•
This is the first study, to the authors’ knowledge, that details depression screening practices in a cohort of LBP patients by MSK triage physiotherapists in advanced practice roles.
•
This study presents novel information on confidence in screening for depression compared to screening for red flags or yellow flags.
•
The findings from this niche group of clinicians are likely reflective of MSK triage physiotherapists worldwide. While the study focused on LBP populations, we hope that it encourages readers to reflect on their own confidence and practice when screening for depression, which may also be relevant to other patient groups.
{"title":"Depression among people with low back pain: a cross-sectional descriptive survey of Irish musculoskeletal triage physiotherapists’ screening and referral practices","authors":"Julie Sugrue , Sean McKenna , Siobhan MacHale , Kieran O’Sullivan","doi":"10.1016/j.physio.2025.101836","DOIUrl":"10.1016/j.physio.2025.101836","url":null,"abstract":"<div><h3>Background</h3><div>Low back pain (LBP) is associated with a poorer prognosis when there is concomitant depression. Musculoskeletal (MSK) triage physiotherapists clinically assess a significant proportion of LBP referrals to public hospital outpatient waiting lists.</div></div><div><h3>Objectives</h3><div>To establish depression screening and referral practices of MSK triage physiotherapists, and to compare confidence in depression screening to red flag (e.g. cauda equina syndrome) and yellow flag (e.g. fear avoidance beliefs) screening.</div></div><div><h3>Methods</h3><div>Using a descriptive cross-sectional design, a bespoke e-survey was distributed to MSK triage physiotherapists in adult public hospital outpatient services in Ireland following ethical approval.</div></div><div><h3>Results</h3><div>Thirty-six surveys were completed and submitted (55% response rate). A minority of respondents (3/36, 8%) directly ask all patients with LBP about depression, while more than one third (13/36, 36%) never screened for depression. Reported barriers included lack of training or skill, time constraints, and absence of referral pathways. Confidence in screening for depression was lower than for red flags or yellow flags. There was some indication that a day or more of training improved depression screening confidence and practice.</div></div><div><h3>Discussion</h3><div>This study provides insight into current depression screening practices for people with LBP and the factors influencing decision-making among MSK triage physiotherapists working in advanced practice roles.</div></div><div><h3>Conclusion</h3><div>Few MSK triage physiotherapists in this sample directly screen for depression, and screening confidence was low. Understanding the current processes and determinants of practice, including the potential positive impact of targeted training, may support strategies to improve depression screening practices.</div></div><div><h3>Contribution of the Paper</h3><div><ul><li><span>•</span><span><div>This is the first study, to the authors’ knowledge, that details depression screening practices in a cohort of LBP patients by MSK triage physiotherapists in advanced practice roles.</div></span></li><li><span>•</span><span><div>This study presents novel information on confidence in screening for depression compared to screening for red flags or yellow flags.</div></span></li><li><span>•</span><span><div>The findings from this niche group of clinicians are likely reflective of MSK triage physiotherapists worldwide. While the study focused on LBP populations, we hope that it encourages readers to reflect on their own confidence and practice when screening for depression, which may also be relevant to other patient groups.</div></span></li></ul></div></div>","PeriodicalId":54608,"journal":{"name":"Physiotherapy","volume":"129 ","pages":"Article 101836"},"PeriodicalIF":3.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144892751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-08DOI: 10.1016/j.physio.2025.101824
Rebecca Louise Rayner , Kelly Walker , John Stephenson , Geert Verheyden , Nicola J. Hancock , Joseph Anthony Hartley-Palmer
Background
Difficulties with sitting balance are common after stroke. The ability to sit unsupported is imperative for many daily tasks and correlated to more positive outcomes. There is limited research on “sitting balance” therapeutic interventions and their impact. This systematic review and meta-analysis aims to investigate the effectiveness of physiotherapy sitting balance treatments on sitting balance outcomes in people up to 3-months post-stroke.
Methods
The PRISMA checklist was followed and the review registered on PROSPERO. Seven electronic databases were searched to October 2023 (updated in January 2025) for studies comparing treatments focussing on sitting balance in adults who had suffered a cerebral stroke in the last three months. Studies were included if treatment was predominantly completed in sitting postures and reported sitting balance outcomes.
Studies were assessed for eligibility, and data extraction and risk of bias was completed by two independent reviewers.
Results
Data from 16 studies (623 participants) was synthesised narratively. Sitting balance interventions were classified into four main categories: weight shift and reaching; core stability exercises; environmental modifications; and task practice. A random effects meta-analysis conducted on eight studies (342 participants) revealed interventions to be beneficial for sitting balance (primary outcome: mean difference Trunk Impairment Scale 3.02; 95% confidence interval 2.19 to 3.86). Four studies demonstrated low risk of bias; and four showed some concerns.
Conclusions
The current sitting balance treatments offered to early sub-acute stroke patients show significant improvements in sitting balance primary outcome. Sitting balance treatments can be categorised into four sub-types, helping to standardise clinical application and ensure consistency in future research.
Systematic Review Registration Number
PROSPERO CRD42023444050.
Contribution of the Paper
•
Sitting balance impairment is significantly improved with therapy interventions completed in sitting.
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Four main categories of sitting balance treatments have been researched in the subacute stroke population.
{"title":"The effectiveness of physiotherapy sitting balance treatments on sitting balance outcomes in early sub-acute stroke. A systematic review and meta-analysis","authors":"Rebecca Louise Rayner , Kelly Walker , John Stephenson , Geert Verheyden , Nicola J. Hancock , Joseph Anthony Hartley-Palmer","doi":"10.1016/j.physio.2025.101824","DOIUrl":"10.1016/j.physio.2025.101824","url":null,"abstract":"<div><h3>Background</h3><div>Difficulties with sitting balance are common after stroke. The ability to sit unsupported is imperative for many daily tasks and correlated to more positive outcomes. There is limited research on “sitting balance” therapeutic interventions and their impact. This systematic review and meta-analysis aims to investigate the effectiveness of physiotherapy sitting balance treatments on sitting balance outcomes in people up to 3-months post-stroke.</div></div><div><h3>Methods</h3><div>The PRISMA checklist was followed and the review registered on PROSPERO. Seven electronic databases were searched to October 2023 (updated in January 2025) for studies comparing treatments focussing on sitting balance in adults who had suffered a cerebral stroke in the last three months. Studies were included if treatment was predominantly completed in sitting postures and reported sitting balance outcomes.</div><div>Studies were assessed for eligibility, and data extraction and risk of bias was completed by two independent reviewers.</div></div><div><h3>Results</h3><div>Data from 16 studies (623 participants) was synthesised narratively. Sitting balance interventions were classified into four main categories: weight shift and reaching; core stability exercises; environmental modifications; and task practice. A random effects meta-analysis conducted on eight studies (342 participants) revealed interventions to be beneficial for sitting balance (primary outcome: mean difference Trunk Impairment Scale 3.02; 95% confidence interval 2.19 to 3.86). Four studies demonstrated low risk of bias; and four showed some concerns.</div></div><div><h3>Conclusions</h3><div>The current sitting balance treatments offered to early sub-acute stroke patients show significant improvements in sitting balance primary outcome. Sitting balance treatments can be categorised into four sub-types, helping to standardise clinical application and ensure consistency in future research.</div></div><div><h3>Systematic Review Registration Number</h3><div>PROSPERO CRD42023444050.</div></div><div><h3>Contribution of the Paper</h3><div><ul><li><span>•</span><span><div>Sitting balance impairment is significantly improved with therapy interventions completed in sitting.</div></span></li><li><span>•</span><span><div>Four main categories of sitting balance treatments have been researched in the subacute stroke population.</div></span></li></ul></div></div>","PeriodicalId":54608,"journal":{"name":"Physiotherapy","volume":"130 ","pages":"Article 101824"},"PeriodicalIF":3.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145571698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-05DOI: 10.1016/j.physio.2025.101823
Yuhuan Sun , Xiaoyan Duan
{"title":"Comment on: a behaviour change intervention to reduce sedentary behaviour in chronic obstructive pulmonary disease: a qualitative study","authors":"Yuhuan Sun , Xiaoyan Duan","doi":"10.1016/j.physio.2025.101823","DOIUrl":"10.1016/j.physio.2025.101823","url":null,"abstract":"","PeriodicalId":54608,"journal":{"name":"Physiotherapy","volume":"130 ","pages":"Article 101823"},"PeriodicalIF":3.0,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145574923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-05DOI: 10.1016/j.physio.2025.101822
Sonia Wing Mei Cheng , Catherine Guan , Sarah Dennis , Jennifer Alison , Zoe McKeough
{"title":"Response to commentary on: a behaviour change intervention to reduce sedentary behaviour in chronic obstructive pulmonary disease: a qualitative study","authors":"Sonia Wing Mei Cheng , Catherine Guan , Sarah Dennis , Jennifer Alison , Zoe McKeough","doi":"10.1016/j.physio.2025.101822","DOIUrl":"10.1016/j.physio.2025.101822","url":null,"abstract":"","PeriodicalId":54608,"journal":{"name":"Physiotherapy","volume":"130 ","pages":"Article 101822"},"PeriodicalIF":3.0,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145574919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-02DOI: 10.1016/j.physio.2025.101819
Renske Annevelink , Sanneke Don , Jo Nijs , David Beckwée , Kelly Ickmans , Wilfried Cools , Lennard Voogt
{"title":"Reply to comment on “socio-cultural associates of pain, disability and health-related quality of life in 1350 primary care physiotherapy patients with non-specific musculoskeletal pain”","authors":"Renske Annevelink , Sanneke Don , Jo Nijs , David Beckwée , Kelly Ickmans , Wilfried Cools , Lennard Voogt","doi":"10.1016/j.physio.2025.101819","DOIUrl":"10.1016/j.physio.2025.101819","url":null,"abstract":"","PeriodicalId":54608,"journal":{"name":"Physiotherapy","volume":"130 ","pages":"Article 101819"},"PeriodicalIF":3.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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