Archives of physiotherapy最新文献

[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.

Background: Concussion management in youth sport relies on the experience of adults pitch-side as to injury recognition, removal, and management decisions. Little consensus exists on the consistency of pitch-side and medical pathway management approaches.

Objectives: A scoping review was completed to identify and synthesise primary research as to the management of the concussed youth athlete.

Methods: A systematic search was completed in Medline, CINAHL, PubMed, SPORTDiscus, OVID emcare, Web of Science, ScienceDirect, and Cochrane Library databases and Google Scholar from inception to 1st March 2025 according to PRISMA-ScR guidelines. Primary research studies that provided outcome data on management approaches for concussed youth athletes at all stages post-injury were included. Articles were synthesised and reported in themes.

Results: 36 studies were included and four themes identified: Exercise, activity, and neuromuscular training interventions (n = 14), Pitch-side, sub-acute management and monitoring (n = 6), Novel treatment interventions (n = 5), and individual management in specific populations (n = 11).

Conclusion: Published primary research for concussed youth athlete management approaches with outcome data supports early activity recommendations and sub-threshold exercise programmes. Few data exist for alternative management approaches. Case reports/ series saturated this review, with limited generalisable data reported on. Further transparency on concussion injury reporting and management, with outcome data, is warranted.

Introduction: Aging advancing decreases ankle-foot strength and mobility, affecting gait and balance control. The heel-rise (HR) task requires the ankle-foot to control different biomechanical demands. It is still unclear whether these demands during HR are associated with functional performance in older adults. The aim was to describe the association between HR biomechanical parameters and single-leg stability, functional mobility, and walking speed in community-dwelling older adults.

Methods: Sixty-nine older adults (73.0, SD 6.8 years) were tested on a force platform performing bilateral rapid HR in the rise and drop phases. The biomechanical parameters measured were peak force and time, impulse, root mean square and displacement of the center of pressure (CoP), as well as displacement and velocity of the center of mass (CoM), and vertical stiffness. Functional performance was assessed through balance using the single-leg stance test (SLS), functional mobility with the Timed Up & Go test (TUG), and walking speed (WS). Associations between functional tests and biomechanical parameters were determined using correlation tests.

Results: HR peak strength and time showed a medium to large association with TUG and WS but not SLS. CoP anteroposterior displacement showed a large association in the drop phase with all functional tests but not in the rise phase. CoM velocity and vertical stiffness were associated with all tests in both phases.

Conclusion: Older adults HR biomechanical parameters are more closely associated with functional mobility and walking speed tests (TUG and WS) than with static balance tests such as SLS.