Archives of physiotherapy最新文献

Introduction: Limited cervical range of motion (CROM) and pain are among the most common symptoms of cervical dystonia (CD), which are treated with botulinum neurotoxin (BoNT) injections. However, adjunctive interventions may offer additional benefit. Therefore, this study evaluated the immediate effects of peripheral stimulation comprising conventional transcutaneous electrical nerve stimulation (TENS), muscle stimulation (NMES), and muscle vibration on CROM and pain in patients with CD.

Methods: A single-case experiment design (SCED), alternating treatment design was conducted with 19 CD patients, recruited at the Antwerp University Hospital (UZA). Participants randomly received conventional TENS, NMES and muscle vibration on three different days. Main outcome measures were CROM, measured using a 3D-stereophotogrammetric scanning system (3dMD Inc., GA, USA) and pain, quantified by Visual Analog Scale (VAS).

Results: Mean age of participants was 59.87 ± 8.9 years. Baseline CROM for rotation ranged from 87^° to 137.6^° and from 79^° to 132.4^° for flexion/extension. Improvements in neck rotation were observed in 5 (33.3%) participants after conventional TENS, 8 (42.1%) after NMES, and 8 (42.1%) after muscle vibration. Similarly, improvement in flexion and extension was observed in 10 (55.6%) after conventional TENS, 8 (53.3%) after NMES, and 7 (46.7%) after muscle vibration. Significant reductions in pain shortly after the three interventions were observed in patients experiencing pain.

Conclusions: These findings suggest that peripheral stimulation may provide immediate symptomatic relief in CD, particularly for improving CROM and reducing pain. While promising, these results should be considered as exploratory and warrant further investigation in larger, controlled studies.

Introduction: Plantar fasciitis (PF) is a common musculoskeletal disorder characterized by heel pain that disrupts gait and daily function. This study examined relationships between clinical outcomes and gait biomechanics, determined whether these relationships differ between recent- and chronic-onset cases, and identified key clinical predictors of gait speed.

Methods: A cross-sectional study was conducted with 42 individuals with PF. Clinical outcomes included worst pain, normalized gastrocnemius and soleus muscle length, normalized lower limb muscle strength, and normalized dynamic balance. Gait biomechanics during barefoot walking were captured using a motion analysis system and force plates, focusing on spatiotemporal parameters and ground reaction forces (GRFs). Correlation coefficients were used to assess relationships across the overall cohort, as well as in recent- and chronic-onset PF, while multiple linear regression identified clinical predictors of gait speed.

Results: Clinical outcomes related differently to sptiotemporal parameters and GRFs depending on symptom duration, with the recent-onset PF showing widespread correlations and chronic-onset PF showing more selective links with ankle strength and dynamic balance. Regression analysis identified gastrocnemius muscle length and anterior reach distance on the Y-Balance Test (YBT) as significant predictors of gait speed, explaining 28.0% of the variance (p = 0.002).

Conclusion: Symptom duration influences gait biomechanics in PF, with recent onset showing broad adaptations and chronic onset exhibiting more specific strength- and balance-related changes. Gastrocnemius muscle length and dynamic balance in the anterior direction were identified as significant contributors to gait performance. Targeting these factors, with consideration of symptom duration, may improve gait in individuals with PF.

Introduction: Migraine is a leading cause of disability worldwide. Although effective, the use of pharmacological prophylaxis is low due to suboptimal efficacy and poor tolerability. This has led to a growing interest in non-pharmacological approaches such as manual therapy (MT), especially among patients with comorbid neck pain. While evidence for MT remains inconclusive, its adjunctive use is recommended. This study evaluated the effect of MT in patients with migraine and neck pain, compared to usual care provided by general practitioners (UC).

Methods: In this randomized controlled trial in primary care, participants with migraine and neck pain were allocated to MT (n = 36) or UC (n = 31). MT included mobilizations, exercises and myofascial techniques. Follow-up assessments were performed at 12-, 26-, and 52-weeks post-inclusion. The primary outcome was the number of migraine days. Secondary outcomes included migraine intensity, disability, medication use, neck pain intensity, neck muscle endurance, pressure pain thresholds, allodynia, and perceived recovery.

Results: There were no significant between-group differences in migraine days or most secondary outcomes. Compared with usual care, the MT group demonstrated significantly higher-pressure pain thresholds over the occipital muscles and reported greater perceived recovery at both 12 and 52 weeks. Use of prophylactic medication was higher in the UC group throughout follow-up.

Conclusion: MT, including postural and cranio-cervical exercises, was not superior to usual care in reducing migraine days and most secondary outcomes. Still, patient preference and treatment satisfaction for MT were high and may be considered in migraine management.

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.