Archives of physiotherapy最新文献

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.

Introduction: Spine-related leg pain (SRLP), also commonly referred to as sciatica, is characterized by many unanswered questions. Nowadays, patients search for information online to find answers not provided by clinicians. Therefore, this work aimed to (i) collect the main questions and keywords searched by the Italian general population related to SRLP, (ii) analyze the content of the most clicked web pages, (iii) investigate its alignment with evidence-based recommendations, and (iv) assess their credibility and (v) readability.

Methods: SEMrush was used to collect questions, keywords, search volumes, and web pages. Credibility was assessed through the QUality Evaluation Scoring Tool (QUEST). Readability was evaluated by the Gulpease index. Thematic and content analyses were performed.

Results: Monthly search volumes ranged from 4,400 to 33,100. QUEST scores ranged from 1 to 14 out of 28. Readability scores ranged from 20 to 47 out of 100. Common themes highlighted the roles of medications and physiotherapy, the value of doing effortless activities, and the importance of sleep. Content analysis showed that 11 codes (41%) were aligned with, 7 (26%) were contradicted by, and 26 (96%) were entirely omitted from at least one web page.

Conclusion: The findings suggest that inaccurate, poorly credible, and difficult-to-read information on SRLP are common online, leading to plausible targets for the educational intervention of clinicians dealing with SRLP patients. Clinicians are now more aware of the questions that their patients could be asking to Google and the answers it provides about SRLP.

Background: Rehabilitation after Knee Replacement (KR) surgery often entails an extensive rehabilitation in primary care but evidence-based high-quality guidelines are lacking. There is also a knowledge gap regarding current rehabilitation modalities applied in primary care in Sweden. This study aimed to (I) describe rehabilitation in primary care after KR and (II) explore physiotherapists' perceptions of patients' challenges during the rehabilitation.

Methods: A cross-sectional, web-based survey was conducted among Swedish physiotherapists working in primary care. Questions were categorical or open-ended and related to current rehabilitation practices, treatment modalities, and physiotherapists' perceptions of patients' challenges in rehabilitation after KR. Data were described descriptively and open-ended answers were analyzed with quantitative and qualitative content analysis.

Results: In total, 202 physiotherapists answered the survey. Rehabilitation focused on home exercises with recurrent physiotherapy visits. Common treatment modalities were knee range of motion exercises, strength training, and stationary cycling. Key rehabilitation challenges included the following categories: Patients are unprepared, Challenging to find the optimal load, and Restoring function and trust in the knee.

Conclusion: Rehabilitation after KR in Swedish primary care seems to be in line with previously recommended international treatment modalities. According to the physiotherapists in this study, some of the key challenges that patients faced were not being prepared for the severe pain regaining function and trust in the knee, balancing load/recovery, and resuming physically demanding activities.

Background: Functional disorders appear early in the course of the disease and develop over time, impacting participation and quality of life. However, little is known about functional deterioration assessed by clinical and instrumented tools in longitudinal studies.

Methods: We included 63 PwMS with Expanded Disability Status Scale (EDSS) ≤2.5 points, disease duration ≤5 years, and age (Mean ± Standard Deviation) 38.7 ± 10.7 years. Participants were assessed at baseline and after 2 years with clinical and instrumented evaluations. Data on disability and functional disorders were collected using EDSS, Six-Minute Walk Test (6MWT), Multiple Sclerosis Walking Scale-12 (MSWS-12), Fatigue Severity Scale (FSS), and Symbol-digit modality test (SDMT), while instrumented data measuring complexity and intensity of balance disorders and gait symmetry-regularity-instability were extracted from wearable devices.

Results: Clinical scales (EDSS, 6MWT, FSS, MSWS-12, and SDMT) did not show a statistically significant deterioration when baseline and 2-year follow-up were compared: EDSS (Median and min-max) from 2 (0-2.5) to 1.5 (0-4.5)points, 6MWT from 566.2±٨٠.4 to 573.9 ± 94.7m, FSS from 2.89 (0.89-7) to 2.67(1-7)points, MSWS-12 from 25 (20-65) to 25 (20-78.3) points, and SDMT from 55.34 ± 14.7 to 61.4 ± 15.5 points. We observed similar results in instrumented variables: complexity from -0.15 ± 1.06 to -0.38 ± 1.08 [au], intensity from 0.00 ± 0.69 to -0.17 ± 0.78 [au], gait regularity from 0.87 ± 0.07 to 0.88 ± 0.08 [au], gait symmetry from 80.24 ± 20.24 to 83.0 ± 8.85 [au], and gait instability from 0.67 ± 0.11 to 0.70 ± 0.13 [au].

Conclusion: We hypothesized that subtle functional deteriorations would be detectable over two years. However, our data showed a functional stability of the disease at follow-up. This held even when an instrumented assessment was added to assess subtle functional disorders.

Introduction: The physiotherapeutic treatment of femoroacetabular impingement syndrome (FAIS) is a topic of growing interest in the literature. The aim of this study is to present all of the treatment modalities used in scientific research in order to analyze the extent to which the protocols are explicit.

Method: This is a scoping review. The literature search was performed using the Cochrane, Embase and PubMed databases. The data was collected in various tables and the protocols were assessed using the Template for Intervention Description and Replication (TIDieR) and the Consensus on Exercise Reporting Template (CERT) tools.

Results: Twenty-four studies were selected and 30 protocols were analyzed. The most frequently reported treatment modalities were strengthening (n = 25), manual therapy (n = 22) and stretching (n = 21). The average total score was 47% for studies evaluated by the TIDieR checklist and 40% for studies evaluated by the CERT checklist.

Discussion: The treatment modalities identified are similar to those used for other musculoskeletal conditions. Specific treatments were found and were generally consistent with the clinical characteristics of FAIS. The lack of precision in the reporting of interventions compromises their clinical use. The same lack of detail is noted for other physiotherapeutic interventions in the musculoskeletal field.

Conclusion: Numerous treatment methods are presented in the literature. However, the protocols lack in explicitness and the use of the TIDieR and CERT evaluation grids is not widespread.