Archives of physiotherapy最新文献

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.

Background: Reproduction and resolution of head pain with sustained upper cervical mobilization has been proposed as a diagnostic indicator of Cervicogenic Headache (CGH). However, there has been little focus on describing head pain response during the application of these maneuvers. The purpose of this study was to describe the head pain response during the performance of sustained upper cervical spine mobilization in people with probable CGH.

Methods: In this case series of 20 individuals with probable CGH as defined under the International Headache Society criteria, were assessed by one experienced physiotherapist who administered five sustained upper cervical spine mobilization techniques to each participant. Reproduction of head pain during mobilization was noted. At the start, during, and end of each mobilization technique, change in head pain intensity and time taken to achieve head pain resolution was recorded.

Results: Sixteen of the 20 participants experienced reproduction and resolution of head pain within 90 seconds of sustained upper cervical mobilization. This phenomenon occurred no more frequently with the mobilization of C2 than with C1. Eight patients reported this on the dominant head pain side only, 6 patients experienced this bilaterally. Neck pain was present in 13 of the 20 participants.

Conclusion: From this case series, it seems that neither the duration (measured in seconds) nor the magnitude of reduction in head pain intensity was markedly different across dominant compared to non-dominant head pain sides or across cervical levels, indicating reproduction and resolution behavior is irregular. The presence of CGH without neck pain is possible.

Background: The Neuromuscular Cranio-Cervical Device (NOD) was originally designed to evaluate Cranio-Cervical Flexion Test performance but can also be used as a handheld dynamometer for testing other muscle groups, including neck muscle strength. It offers a potential alternative to the Multi-Cervical Unit (MCU), a fixed dynamometer, more closely aligned with isokinetic dynamometry, the gold standard. However, its validity and reliability need to be established. This study aimed to evaluate concurrent validity compared to the MCU and inter- and intra-rater reliability of the NOD for measuring neck flexion and extension muscle strength.

Methods: Twenty participants were assessed for neck flexion/extension strength whilst in a seated position, with the measurements repeated over three sessions. Concurrent validity was assessed by comparing NOD measurements to the MCU using Pearson correlation coefficients, and reliability was determined using Intraclass Correlation Coefficients (ICCs).

Results: Concurrent validity was strong for extension (r = 0.954) but lower for flexion (r = 0.705), indicating some variability in flexion measurements. Inter-rater reliability was good to excellent for both flexion (ICC = 0.931) and extension (ICC = 0.896). Intra-rater reliability for extension was good to excellent (ICC = 0.893), while flexion ranged from moderate to excellent (ICC = 0.844).

Conclusions: The NOD is a valid tool, particularly for extension measurements, although further refinement of testing is needed to improve the accuracy for flexion strength measurements. It is also reliable for both extension and flexion, showing promise as a practical, affordable, portable tool with real-time feedback for the assessment of neck muscle strength in clinical settings.

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.