Archives of physiotherapy最新文献

Introduction: Identifying factors associated with discharge destination after inpatient stroke rehabilitation is important for patients and healthcare professionals. It supports discharge planning and prevents delayed discharge.

Objective: To identify key variables from socio-demographic and clinical data associated with returning home after inpatient stroke rehabilitation, focusing on patients from three rehabilitation centers in Belgium and Switzerland.

Methods: This multicenter retrospective study, conducted in three centers, included 1475 adult patients with stroke admitted to an inpatient rehabilitation unit between December 2012 and June 2021. A logistic regression with backward selection was used to define the model for discharge destination. The dependent variable was the discharge destination (home vs other). The independent variables were selected from the socio-demographic, medical, neurological, care pathway, and functional data and included age, gender, living arrangement, type of stroke, previous stroke, cognitive impairments, independence in grooming, eating, and stair walking.

Results: The final model included three variables (independence in stair walking, living arrangement, and cognitive impairment). Stair walking had the strongest association with returning home. Patients who were partially (OR 5.83, 95% CI 3.67-9.26) or fully independent (OR 14.31, 95% CI 9.34-21.93) were more likely to return home than patients who were unable to walk the stairs. The results were similar for subgroups and for discharge and admission data.

Conclusion: The study showed that independence in walking stairs is strongly associated with discharge destination. Aligned with another study, these results should be confirmed in further research.

Measures of muscle performance, such as strength and the rate of force development (RFD), are important for function, rehabilitation, and successful aging. Clinicians seeking to use objective measurement methods of muscle performance in support of their assessments and rehabilitation programs have many affordable dynamometry options. However, substantive differences exist between devices on important characteristics such as sampling frequency, load capacity and determining force onset, which dramatically affect the ability to obtain accurate estimates of muscle performance. The assessment environment and setup also require careful consideration. Busy clinicians are often unaware of the extent to which methodological variability and inconsistencies in testing protocols can inflate measurement error and render tests insensitive to change. Where data inform treatment and return-to-play decisions (vs. motivational aid), ensuring validity and reliability is paramount, particularly given that clinicians typically assess individual, not group performance. This is because ascertaining change or difference in intra-individual performance demands a greater level of measurement precision compared to assessing performance between groups of people. This evidence-informed Masterclass will exemplify some of the critical technical and methodological factors that intrude on measurement accuracy. It will provide readers with the knowledge: how to critically evaluate the utility of dynamometers, answering the question, which to buy and why? How to construct assessment protocols to improve quality data collection, and how to understand what constitutes real change in performance beyond "differences" caused by measurement error.

[This corrects the article DOI: 10.33393/aop.2025.3381.].

Introduction: Guidelines often recommend patient education in the management of hip or knee replacement, despite evidence of its effectiveness is scarce. The aim of this study was to assess the effectiveness of postoperative patient education on pain, function, quality of life, and psychosocial issues.

Methods: We performed a systematic review and meta-analysis of RCTs investigating the effects of patient education (alone or in combination with other treatments) compared to usual care delivered after hip/knee replacement. Risk of bias was assessed using the Cochrane Risk of Bias 2.0. Certainty of evidence was established according to the GRADE approach.

Results: We included five trials. We found that patient education likely results in little to no effects compared to usual care in the medium-term on pain (SMD -0.09, 95% CI -0.41-0.22) and quality of life (MD 0.11, 95% CI 0.00-0.22). Similarly, it likely results in little to no effect on anxiety in both short- (MD 1.59, 95% CI -3.16 to -0.02) and medium-term (MD -1.51, 95% CI -3.07-0.05), as well as on depression in the short- (SMD -0.22, 95% CI -0.58-0.15) and medium-term (SMD -0.22, 95% CI -0.55-0.12). In contrast, usual care may improve long-term physical function (SMD 0.64, 95% CI -0.03-1.3).

Conclusion: Postoperative patient education provided no to small benefit on pain, physical function, quality of life or psychosocial issues compared to usual care. Its role may be more impactful when patient-tailored and integrated into multimodal rehabilitation strategies for people after hip/knee arthroplasty.

Introduction: Chronic non-specific low back pain is a leading cause of disability worldwide. While resistance training using external loads is common in rehabilitation, its added value over unloaded exercise remains uncertain, particularly across physical and psychological variables.

Method: This systematic review and meta-analysis, registered on PROSPERO (CRD42022366975), included randomized controlled trials comparing externally loaded resistance training to unloaded exercise in adults with chronic non-specific low back pain. Primary outcomes were pain intensity and disability. Secondary outcomes included back muscle endurance, maximal strength, fear-avoidance beliefs, and pain catastrophizing. Random-effects meta-analyses were conducted, stratified by follow-up duration.

Results: Thirteen randomized trials (778 participants) were included. At follow-up periods beyond seven weeks, externally loaded resistance training showed a small but statistically significant reduction in pain compared to unloaded exercise (mean difference = -0.52 on a 0-10 scale; 95% confidence interval [-0.92, -0.08]). No significant differences were found at short-term or post-washout follow-ups. Effects on disability were inconsistent and highly variable. Resistance training was associated with improvements in back muscle endurance and suggested a possible effect on long-term maximal strength, although wide prediction intervals prevent definitive conclusions. No meaningful differences were found for psychological variables, and pain catastrophizing was assessed in only one trial, limiting conclusions.

Conclusion: Externally loaded resistance training is safe and feasible for chronic non-specific low back pain, but its effects on pain, disability and psychosocial outcomes are comparable to unloaded exercise. In line with the multifactorial nature of chronic pain, improvements appear driven more by exposure, adherence and therapeutic context than by load intensity alone. Exercise prescription should therefore remain individualized and embedded within a biopsychosocial framework.

Introduction: Overweight and obesity management in primary care gained importance due to its global rise and association with cardiometabolic diseases and chronic musculoskeletal disorders (MSD). Physical therapists are well-positioned to incorporate weight management in their practice. This survey evaluates attitudes, barriers and clinical practices of physical therapists regarding weight management for individuals with chronic pain and comorbid overweight or obesity.

Methods: German-speaking physical therapists in Switzerland volunteered in an online survey. Descriptive statistics summarized physical therapists' attitudes, barriers and practices. Logistic regression analyses identified factors associated with recommending and implementing weight reduction interventions.

Results: Of the 581 respondents, 92.1% acknowledged the importance of educating patients on obesity-related health risks, and 81.6% recommended weight reduction. Two-thirds offered weight reduction interventions in physical therapy, although fewer (57.3%) received corresponding training during entry-level education. Most weight reduction interventions focused on movement, endurance, and strength, whilst a minority addressed nutrition, sleep or stress. The odds of offering weight reduction interventions were higher among those with entry-level education (OR: 2.1, 95% CI: 1.4-3.3), further education (OR: 1.9, 95% CI: 1.1-3.3), and for those who perceived weight reduction interventions (OR: 6.5, 95% CI: 3.5-12.3) and counseling on other lifestyle factors (OR: 2.9, 95% CI: 1.2-7.3) as within their professional scope.

Conclusions: While physical therapists showed positive attitudes toward weight reduction interventions for individuals with chronic pain and overweight or obesity, their education and implementation remain inconsistent, primarily focusing on improving physical activity. Clear competencies and structured training are needed to integrate evidence-based weight management into clinical practice.

Background: Rehabilitation after stroke often falls short of providing optimal benefits to patients due to challenges related to restricted access, financial burden, and lack of adherence. Video-based intervention may help to overcome these barriers.

Purpose: To develop and test the feasibility of video-based telerehabilitation (TR) exercises for facilitating upper extremity motor function among stroke survivors.

Method: The study was conducted in two phases: video development and feasibility testing. The research team developed the video. Feasibility was assessed using a single-group pre-test-post-test design, focusing on adherence, acceptability, satisfaction, and motor function. A total of 30 stroke survivors were purposively recruited. Each participant received a 3-minute-42-second video-based TR program to be performed three times weekly over four weeks. Adherence and acceptability were monitored through participant-maintained diaries. Satisfaction and motor function were measured using the Client Satisfaction Questionnaire-8 (CSQ-8) and the Wolf Motor Function Test (WMFT), respectively.

Results: Twenty-nine participants (15 males) completed the study. The participants showed a strong commitment to the intervention with a 97% adherence rate. They accepted and reported the intervention as satisfactory. A remarkable score of satisfaction corroborates this based on the CSQ-8 (Mean [SD] = 28.6 [4.90]). A significant improvement in the WMFT was observed (p < 0.001) with a large effect size (d = 1.14) post-intervention. The mean difference was 8.8, with a 95% confidence interval ranging from 4.75 to 12.9.

Conclusion: The video-based TR is feasible and can be deployed as a supplementary intervention. Future evaluation of the intervention is warranted to establish its effectiveness.

Objectives: The aim of this study is to assess the usability of the Myosuit within a chronic stroke survivors' rehabilitation program and to explore its therapeutic and assistive role on gait, stair negotiation, sit-to-stand transfers, and balance.

Methods: Ten chronic stroke survivors with gait impairments were enrolled. The System Usability Scale (SUS) was the primary outcome of the study; secondary outcomes were the Stroke Self-efficacy Questionnaire (SSEQ), the Short Physical Performance Battery, the 10-meter Walking Test (10mWT), the 2-minute Walking Test (2minWT), and the Stair Climbing Test. Tests were carried out before (T0) and after (T1) the training sessions, with and without the exoskeleton.

Results: The SUS rated poor-to-ok in 30% of the participants, good in 40%, and excellent to best imaginable in 30%. Comparing T1 vs T0, all the functional tests, except stair descending, showed statistically significant improvements without the exoskeleton, and SSEQ did not change significantly. T1 vs T0 comparisons with the exoskeleton showed improvements in all functional tasks, statistically significant for all, except for 2minWT and 10mWT.

Conclusions: This study confirmed the feasibility of a Myosuit-mediated treatment in a sample of chronic stroke survivors. Despite the usability of the wearable robot being generally positively perceived, it varied among users. Furthermore, the Myosuit exhibited both therapeutic and assistive potential in the sample.

Introduction: Spasticity is a common symptom after brain injury, often interfering with functional recovery and rehabilitation. The Tonic Stretch Reflex Threshold (TSRT) was proposed as an objective neurophysiological assessment of spasticity that could overcome the limitations of clinical scales. This systematic review aimed to appraise the current evidence on the metric properties of TSRT.

Methods: Electronic databases (MEDLINE, CINAHL, Scopus, Web of Science, and EMBASE) were screened from inception to June 30, 2025, for studies reporting data on reliability, validity, and/or responsiveness of TSRT in adults with stroke. Two reviewers independently selected the studies, assessed the methodological quality, and extracted relevant data. When possible, pooled estimates for each property were computed.

Results: Of the 9804 titles retrieved, 17 were eventually included, to which 2 articles from cross-references were added. We found insufficient values for both intra-rater (two studies, ICC = 0.548, 0.330-0.710) and inter-rater (three studies, ICC = 0.687, 0.511-0.808) reliability, with high measurement error. Data on validity were found in 14 articles, with conflicting results on the association of TSRT with clinical scales of spasticity and motricity, but good ability to discriminate among relevant groups. Only one study investigated responsiveness with an external anchor, finding that TSRT measurements failed to accurately detect improved participants.

Conclusion: Despite the potential of TSRT as a measure of spasticity, its metric properties, particularly reliability, are not fully supported. Future research should prioritize improving its reliability and investigating its validity and responsiveness with neurophysiological measures rather than relying solely on clinical scales.

Background and objective: Apart from mechanical dysfunction, low back pain (LBP) is also associated with underlying inflammatory and muscle-related biochemical changes. An increase in certain biomarkers, such as IL-10, a key anti-inflammatory cytokine, provides a positive objective indicator of underlying physiological responses to interventions in LBP beyond subjective clinical measures. This study assessed the effects of McKenzie Extension Protocol (MEP), Static Back Extension Endurance (SBEE), and Dynamic Back Extension Endurance (DBEE) on selected clinical outcomes and biomarkers of muscle status [creatine kinase (CK)] and inflammation (IL-4 and IL-10) in LBP.

Methods: A randomized controlled trial involving 76 patients with chronic LBP who were randomly assigned to MEP, SBEE, or DBEE groups was conducted. MEP involved a specific sequence of lumbosacral repeated movements in extension. SBEE involved five different back extensor muscle endurance protocols of increasing difficulty level. DBEE was a dynamic replica of the SBEE. Pain, CK, IL-4, and IL-10 were the primary outcomes. Functional disability and health-related quality of life were the secondary outcomes. Assessments were conducted at baseline, 3rd, and 6th week of the study.

Results: MEP and SBEE caused significant effects in all clinical and biochemical variables (p < 0.05) except IL-4 and IL-10 (p > 0.05). DBEE yielded no significant effects on IL-4 and IL-10 (p > 0.05). MEP had a significantly higher effect on pain (p < 0.05). SBEE had a greater impact on IL-4 (p < 0.05) and IL-10 (p < 0.05) at week 3. SBEE led to a higher impact on IL-4 (p < 0.05) and IL-10 (p < 0.05) at week 6. All interventions had comparable effects on other clinical parameters at week 6 (p > 0.05).

Conclusion: MEP reduced pain more, while SBEE led to higher changes in IL-4 and IL-10 inflammatory biomarker levels. Serum CK levels rose in all groups without indicating muscle damage. The results suggest that these exercises show potential benefits in modulating inflammation and enhancing muscle status, potentially supporting tissue repair and reducing chronic LBP, and therefore should be incorporated as part of strategies targeting underlying inflammatory processes in the management of chronic LBP.