Archives of physiotherapy最新文献

Introduction: The craniocervical flexion test (CCFT) has been proposed to assess muscular stabilization using deep neck flexors. Reliability of the CCFT using a pressure biofeedback unit has been regarded as doubtful, and the level of evidence is reportedly low.The aim of the current study is to pilot test an alternative measurement protocol by using a new digital device during the staged CCFT when compared to surface electromyography (sEMG) of neck flexor muscles in participants with bruxism.

Methods: Cross-sectional pilot study including five participants with bruxism and five controls. Measuring five incremental stages (20-100%), from a maximum force of 17 N for the CCFT and parallel to sEMG measurements of bilateral sternocleidomastoideus (SCM) and masseter muscles. SEMG data were normalized to their activity during maximal voluntary contraction. Performance during the staged CCFT was fed back via a smartphone screen.

Results: A two-way repeated measures ANOVA found a significant stage (F = 32.56, df = 4, p = 0.001) but not group (0.30, df = 1, p = 0.65) main effect for SCM activity, with both groups demonstrating higher normalized sEMG activity for incremental stages of the CCFT. Neither group nor stage effects were found for normalized masseter activity during the staged CCFT.

Conclusion: A new measurement protocol and test device for the CCFT were examined in participants with and without bruxism. In parallel, sEMG used showed differences in SCM activity for incremental test stages. Group differences could not be found.

Objectives: To verify the feasibility of the Virtual Eggs Test (VET) and establish the ranges of fragilities of the Virtual Eggs (VEs) for assessing dexterity of stroke subjects and to collect feedback to improve its usability.

Methods: An observational non-profit study, with a pre-market medical device. It was conducted at a hospital neurorehabilitation unit. Nine subjects with chronic stroke (5 males; mean age 55.8 ± 18.9) performed the pilot with their paretic arm. Time to complete the test (TT), the number of failures for each VE, the threshold (T), and participants' self-reported comfort in performing the test were measured.

Results: The T varied among participants from 1.70 to 4.88 N/N. The average TT was 20.1 ± 6.5 minutes (range 11-33). Only one subject found the test uncomfortable.

Conclusions: The study found that the VET, with minor modifications, is feasible in stroke subjects. It might be useful for assessing sensorimotor impairment in both the affected and the less affected arm. Its metric properties and normative values in the healthy population will be determined in a study currently underway.

Introduction: Recent randomized clinical trials (RCTs) provide evidence on the effects of robot-assisted training (RAT) for upper limb impairments in stroke subjects; however, evidence on the clinical relevance of these differences is lacking. This study aimed to perform a systematic review with meta-analyses of RCTs on clinical relevance, expressed as minimal clinically important difference (MCID), of RAT to improve independence in activities of daily living, arm function, and impairments in patients with stroke.

Methods: Four databases were searched. RCTs investigating RAT aimed at recovering motor and functional skills of the upper limb in adult post-stroke patients were included. MCID values were retrieved from specific databases. Two independent reviewers performed screening, data extraction, and assessment of methodological quality. Meta-analyses for both statistical significance and clinical relevance were performed. Clinical relevance was expressed as a standardized MCID overall score (SMOS) for each outcome measure, calculated as the difference between mean outcome measures in experimental and control groups divided by corresponding MCID, when available.

Results: Eighty-five studies were included. Conventional meta-analyses showed that RAT, compared to control, had significant effects in the domains of activities of daily living, dexterity, arm function, and strength, but not on pain. Meta-analyses for clinical relevance reported non-clinically relevant differences between groups for all domains.

Conclusion: RAT produces some significant improvements for the upper limb, but these differences are not clinically relevant when compared to other therapies. Improvements in using the RAT in clinical practice may not be more clinically relevant than other therapies for stroke patients.

Introduction: The literature investigating the factors associated with functional recovery after stroke suggests that, in the early subacute phase, time is the factor that most significantly drives the recovery. However, it is unclear whether the dose of physiotherapy (PT) delivered is equally associated with recovery of motor function and independence.

Methods: A multivariable modeling of data from a multicenter longitudinal prospective cohort study investigating the contents of neurological PT interventions in Italy was developed, with the aim to estimate the association between the dose of PT received in the early subacute phase after stroke and recovery of walking, motor function, and independence.

Results: A total of 96 patients were included in the analyses. PT dose seems associated with recovery of manual dexterity, measured by the Box and Block test (BBT), but not with the level of independence nor walking function. The probability of achieving a score higher than 31 at the BBT is 46% (95%CI: 18-76) after 10 hours and 76% (95%CI: 42-93) after 20 hours of PT, respectively.

Conclusions: In the early subacute phase after stroke, the higher the dose of PT provided, the better the probability of significant recovery of upper limb (UL) dexterity should be.

Introduction: The cervical spine's role in shoulder pain remains unclear, particularly regarding its influence on shoulder pain severity and functional limitations. This study aimed to compare neck mobility, pain sensitivity, and strength between patients with rotator cuff-related shoulder pain (RCRSP) and asymptomatic controls and to explore associations between neck active range of motion (AROM) and shoulder outcomes.

Methods: A cross-sectional study was conducted with 50 patients with RCRSP and 50 asymptomatic controls. Neck AROM was measured with a CROM device, pressure pain thresholds (PPTs) with a digital algometer, and isometric neck strength with a handheld dynamometer. Shoulder pain and disability were assessed using the Visual Analog Scale (VAS) and the Shoulder Pain and Disability Index (SPADI).

Results: Compared to controls, patients with RCRSP exhibited reduced neck rotation toward the affected shoulder (mean difference: -5.19°; 95% CI: -8.84 to -1.38) and lower PPTs bilaterally (affected side: -1.49 kg/cm²; 95% CI: -1.99 to -1.00; unaffected side: -1.42 kg/cm²; 95% CI: -1.98 to -0.91). No differences were found in neck strength. Regression analysis showed that greater neck flexion, lateral flexion toward the affected side, and reduced protraction were associated with higher SPADI scores. Additionally, neck lateral flexion and rotation toward the affected side were negatively associated with shoulder pain intensity over the last week.

Conclusion: These findings suggest a potential interaction between the cervical spine and shoulder in RCRSP, underscoring the importance of a comprehensive assessment of both cervical and shoulder impairments in this condition.

The introduction of generative AI into scientific publishing presents both opportunities and risks for the research ecosystem. While AI could enhance knowledge creation and streamline research processes, it may also amplify existing problems within the system. In this viewpoint article, I suggest that generative AI is likely to reinforce harmful processes unless scientific journals and editors use these technologies to transform themselves into vibrant knowledge communities that facilitate meaningful discourse and collaborative learning. I describe how AI could support this transformation by surfacing connections between researchers' work, making peer review more dialogic, enhancing post-publication discourse, and enabling multimodal knowledge translation. However, implementing this vision faces significant challenges, deeply rooted in the entrenched incentives of the current academic publishing system. Universities evaluate faculty based largely on publication counts, funding bodies rely on traditional metrics for grant decisions, and publishers benefit from maintaining existing models. Making meaningful change, therefore, requires coordinated action across multiple stakeholders who must be willing to accept short-term costs for long-term systemic benefits. The key to success lies in consistently returning to journals' core purpose: advancing scientific knowledge through thoughtful research and professional dialogue. By reimagining journals as AI-supported communities rather than metrics-driven repositories, we can better serve both the scientific community and the broader society it aims to benefit.

Introduction: To address the health needs of the aging population, it is necessary to map entry-level curricula for health professionals. This survey investigated geriatric-related content in entry-level physical therapist (PT) curricula offered by Italian universities.

Methods: A cross-sectional observational study was conducted using the CROSS checklist. A 66 questions survey was developed and sent via e-mail to all entry-level PT program directors of the Italian universities.

Results: A total of 34 physical therapist undergraduate course directors out of 62 completed the survey, yielding a 54.8% response rate. These results highlight the need for greater emphasis on health promotion and prevention. Although essential competencies such as the promotion of an active lifestyle and fall prevention appear to be well covered, other aspects remain underrepresented. Relevant gaps were also noted in the care and rehabilitation of some common chronic conditions (e.g., constipation, depression, and diabetes), as well as in therapeutic education. Greater attention to these topics could help align training with the emerging needs of the healthcare system. However, 11.76% of Italian PT programs do not include specific modules or courses dedicated to geriatric rehabilitation. Overall, there is considerable variability in teaching hours, topic coverage, and depth.

Conclusions: This study provides meaningful insights for updating the current PT curricula in geriatric care. This survey could represent a tool for future longitudinal research on mapping curricula over time in response to the aging population.

Introduction: Various physical therapy interventions for coccydynia have been evaluated, but their effectiveness has not yet been comprehensively synthesized. This systematic review aims to evaluate the effectiveness of physical therapy interventions in adults with coccydynia.

Methods: A systematic search of relevant randomized controlled trials (RCTs) was conducted in PubMed/MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Physiotherapy Evidence Database (PEDro). Outcomes of interest included pain, function, mobility, and patient satisfaction. Due to the heterogeneity of the included studies, a narrative synthesis was performed.

Results: A total of 515 adults with coccydynia across 10 studies were included in the review. Physical therapy interventions, including extracorporeal shock wave therapy, kinesiotaping plus exercise, levator anus stretching or massage, manipulation alone or manipulation plus electrotherapy or exercise, and muscle energy technique, showed significant improvements in pain and function in the short term. Additionally, kinesiotaping plus exercise showed significant short-term improvement in trunk mobility. In the intermediate term, manipulation alone and levator anus stretching or massage were effective at reducing pain, whereas manipulation alone was effective at improving function. In the long term, levator anus stretching or massage showed sustained improvement in pain.

Conclusions: Overall, physical therapy interventions led to short-term improvements in pain and function for adults with coccydynia. However, there is a need for high-quality studies with long-term follow-ups to compare the efficacy of various physical therapy interventions, both in isolation and in combination.

Introduction: The motor impairment evidenced post-stroke results in limitations to performing activities of daily living (ADL), especially when it involves locomotion. The Serious Games (SG) are an interesting therapeutic option, as they allow the performance of exercises according to stroke treatment guidelines. However, there is little research exploring the evaluation potential of SG. This study aimed to evaluate the possible metric properties of the mim-pong SG in addition to the therapeutic effects.

Methods: Twenty-four hemiparetic stroke patients were divided into two non-randomized groups: the experimental group (EG) (n = 16) and the control group (CG) (n = 8). Participants were evaluated in terms of motor impairment (lower limb), muscle strength (MS), motor control, and functional mobility.

Results: The significant correlations observed between the score generated by the SG and clinical variables in both groups are highlighted, especially with MS (rho = 0.62-0.66; p = 0.000, and rho = 0.67-0.71; p = 0.002-0.005, for the experimental and CGs, respectively) and motor function of the lower limb for the EG (rho = 0.41, p = 0.018). In addition, the results indicated improvements in all variables in the EG, with superiority over the CG.

Conclusions: This study showed that the mim-pong serious game could be considered a potential resource for the assessment and treatment of hemiparetic stroke patients.

Background: Previous studies demonstrated that digital tools can be effectively integrated into physiotherapy higher education. However, their adoption remains limited. This study aimed to 1) evaluate the perceived knowledge, confidence, and frequency of digital technology use among Italian lecturers and 2) explore lecturers' experiences with digital technology in higher education.

Methods: We performed a convergent mixed-method study using an online survey instrument for Italian physiotherapy lectures. We employed a 5-point Likert to evaluate perceived knowledge, confidence, and frequency of digital technology use, with consensus defined as an agreement of ≥70% on a statement. An optional qualitative section explored lecturers' experiences with technology, which we analyzed using Reflexive Thematic Analysis.

Results: Between June and September 2023, 118 lecturers (mean age: 45 ± 11; 69% female, n = 81) completed the survey. Participants expressed confidence in utilizing digital tools such as videoconferencing (95%), online repositories (88%), and communication apps (78%). On average, 32% reported using technologies "often" or "always." In the qualitative section, completed by 77 participants, we generated three themes: 1) "Technology can promote a constructive educational approach"; 2) "Action of technologies on students' learning process," with mixed results on their impact; and 3) "Technology is not within everyone's reach," due to barriers to its implementation in didactics. Qualitative and quantitative findings confirmed one another, allowing for a deeper understanding of digital technologies among Italian physiotherapy lecturers.

Conclusions: Our findings indicate that digital tools are still underutilized among Italian physiotherapy lecturers. The main barriers include inadequate infrastructure and a lack of digital competencies.