Archives of physiotherapy最新文献

Introduction: Exercise is known to be beneficial for individuals with Parkinson's disease (PD). Rock climbing contains exercise characteristics highlighted in published clinical guidelines for PD (e.g., aerobic, resistance, balance training, cued-movements, community-based) and also has unique somatosensory and visuospatial experiences that may facilitate motor learning. The purpose of this study was to investigate the effects of a climbing program on the physical function of individuals with PD.

Methods: This quasi-experimental observational pilot study used pre-to-post-test comparisons to assess participants with mild to moderate PD (Hoehn and Yahr 1-3) who walked independently. The intervention was 12 weeks of community-based, twice weekly top-rope climbing sessions under one-on-one supervision and tailored to skill level. Wall angles, hand/foot holds, and routes varied from climb to climb and became progressively more difficult as skills increased. The primary outcome measure was the Community Balance & Mobility Scale (CBMS); secondary measures were the Agility T-Test (ATT), 9-Hole Peg Test (9HPT), upper extremity reaction time using BlazePods (UE-React), and grip strength (GS).

Results: 28 participants completed the study: 8 women/20 men; mean age = 66.1 (sd = 7.4) years; average disease duration = 4.0 (sd = 3.6) years. Paired t-tests comparing pre- and post-test scores and effect sizes (ES) with 95% confidence intervals (CI) were calculated for statistically significant results using Hedge's g. Findings were: CBMS (p < 0.001; ES = 0.573, 95% CI = 0.178-0.960), ATT (p < 0.001; ES = 0.462, 95% CI = 0.078-0.838), 9HPT (p < 0.001; ES = 0.480, 95% CI = 0.094-0.858), UE-React (p <0.001; ES = 0.329, 95% CI = -0.045-0.696); GS changes were non-significant.

Conclusions: Rock climbing demonstrated medium-size effects on mobility/balance and small-size effects on agility and dexterity that could impact functioning in everyday activities.

Introduction: The presence of altered central pain processing and modulation, as well as negative psychological factors, have been suggested to impede recovery in chronic low back pain (CLBP). Psychologically-informed physiotherapy (PiP) aims to specifically address the latter factors-in addition to physical factors-to improve treatment effects. This study aims to determine if the effect of PiP is superior to usual physiotherapy (UP) on pain sensitivity and modulation in participants with CLBP and if changes in these variables were associated with changes in clinical outcomes.

Methods: Forty participants with CLBP were randomly allocated to PiP or UP. Seven physiotherapy sessions over 6 weeks plus a booster session at an 11-week follow-up were delivered. Pressure pain threshold (PPT), temporal summation of pain (TSP), and exercise-induced hypoalgesia were assessed on lumbar, upper, and lower limb sites at baseline and after 6 weeks. Linear mixed models tested if PiP was superior to UP on pain sensitivity/modulation. Linear regressions tested if pain sensitivity/modulation changes were associated with changes in clinical outcomes (pain intensity, physical functioning, symptoms of central sensitization).

Results: PiP was not superior to UP to modulate pain sensitivity/modulation variables. All PPTs increased after 6 weeks regardless of the approach. Lumbar PPT and lumbar and lower limb TSP changes were associated with physical functioning changes.

Conclusion: Although our study suggests that neither approach has a superiority to impact on pain sensitivity, both approaches elicited widespread hypoalgesia. Future powered trials should verify if pain sensitivity can be a mediator of physical functioning improvement, as suggested by our results.

Introduction: Literature on bioethics in physiotherapy, particularly in cancer management, is limited. This study explores the perceived bioethical issues in cancer rehabilitation by Italian physiotherapists.

Participants: Thirty-one physiotherapists (Age: 42 ± 10.5 years; 20 women, 11 men) with expertise in cancer rehabilitation were purposefully selected.

Data collection: Six online focus groups were conducted, guided by a focus group guide based on existing literature and refined by experts in cancer rehabilitation and bioethics.

Data analysis: Sessions were recorded, transcribed, and analyzed using Braun and Clarke's 'Reflexive Thematic Analysis'.

Results: Four primary themes emerged: 1) Challenges of (Non)-Disclosure in Diagnosis and Prognosis - ethical difficulties around withholding diagnosis or prognosis information; 2) Balancing Hope and Realism in Patient and Caregiver Expectations - navigating hope versus realistic rehabilitation goals; 3) Weighing Efficacy and Safety in Cancer Rehabilitation - balancing -treatment outcomes with patient safety; 4) Decisions on Withdrawing Treatment - ethical considerations in discontinuing treatment.

Discussion: These themes highlight common ethical dilemmas faced by physiotherapists in cancer rehabilitation, mirroring broader healthcare challenges. Addressing them requires a nuanced understanding of ethical principles within the cancer rehabilitation context.

Conclusions: The study provides insights into the bioethical issues in cancer rehabilitation, stressing the need for a patient-centered approach to navigate these challenges effectively.

Introduction: Gait impairments are common in People with Multiple Sclerosis (PwMS). Several studies have examined the clinometric properties of Inertial Measurement Units (IMUs), with LDLJa identified as a robust metric for gait smoothness. However, its responsiveness and interpretability have not been explored.

Methods: This cross-sectional study at IRCCS Santa Lucia Hospital enrolled 44 PwMS (age: 28-71; EDSS: 0-6) and 43 age- and gait-speed-matched healthy participants (HP). Two physiotherapists conducted assessments with five synchronized IMUs during a 10-meter walk at participants' preferred speed. Data were collected at baseline (T0) and after 4 weeks of training (T1).

Results: Significant differences in log dimensionless jerk (LDLJa) were found between PwMS and HP in the AP (p < 0.001, d = 0.63), ML (p < 0.001, d = 1.08), and CC (p = 0.03, d = 0.68) directions. PwMS had lower LDLJaAP values (< -4.88) and LDLJaML values (< -5.40) with probabilities of 63% and 76%, respectively. ΔLDLJaML demonstrated good responsiveness to rehabilitation (AUC ~0.80), with improvements >4.02% representing the optimal MCID for clinical improvement in MiniBesTest.

Conclusion: Lower LDLJa values in the AP and ML directions characterize gait smoothness impairment in PwMS. LDLJa in the ML direction is responsive to balance-focused rehabilitation, highlighting its potential for tracking gait disorders and rehabilitation progress.

Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic presents a substantial global health challenge. While the disease is known to impact multiple systems, leading to long-term consequences that require monitoring and rehabilitation, its effects on the pelvic floor remain unclear.This study aims to explore COVID-19-related signs and symptoms affecting pelvic floor functions through a scoping review.

Methods: We conducted a scoping review following the Arksey and O'Malley framework. A systematic search was performed in PubMed, CINAHL, and Embase databases up to March 19, 2024, to identify studies examining pelvic floor-related signs and symptoms in COVID-19 patients. Two independent reviewers extracted the study and participant characteristics, areas involved (e.g., anorectal, sexual, urogenital), and signs and symptoms using an ad-hoc data extraction form. Signs and symptoms were classified as direct (e.g., directly impacting the pelvic floor) or indirect (e.g., indirectly affecting the pelvic floor with potential long-term consequences).

Results: We included 104 studies, primarily a systematic review (N = 40; 38.46%) and focused on adult populations (N = 80; 76.92%), investigating 140 signs and symptoms from various regions worldwide. Most (N = 124; 88.57%) were indirect signs and symptoms, while the minority were direct (N = 16; 11.43%). The most prevalent indirect symptom was diarrhea (n = 81; 70,43%) in the anorectal bowel area (n = 115). The most prevalent direct were lower urinary tract symptoms (LUTS) (n = 16; 84.21%) in the urogenital area (n = 19).

Conclusion: This study highlights the significant prevalence of both direct and indirect pelvic floor symptoms in COVID-19 patients. Clinicians should be aware of the potential link between COVID-19 and pelvic floor dysfunction.

This masterclass explores the increasing recognition of spirituality as a vital aspect of patient care, alongside other Social Determinants of Health (SDH) such as economic stability and education. The distinction between spirituality and religion is clarified, with spirituality described as a broader, more personal experience that can exist both within and outside of religious contexts. Research demonstrates that spirituality influences health in mostly positive ways, particularly in areas like mental health, resilience, and coping, making it a critical component of holistic, patient-centered care. In physical therapy, incorporating a patient's spirituality into their plan of care can enhance cultural competence and foster a more holistic care approach. However, many Physical Therapists (PTs) express uncertainty in addressing spiritual concerns, often due to limited training or unclear role expectations. The authors suggest that integrating tools like the Inclusive Spiritual Connection Scale (ISCS), Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp), Spiritual Well-Being Questionnaire (SWBQ), the Spiritual Health and Life-Orientation Measure (SHALOM), or the Spiritual Transcendence Scale (STS), along with enhanced education, could help therapists incorporate spirituality into practice more seamlessly. Integration of spirituality enables PTs to deliver more complete, personalized care that addresses the whole person. Ultimately, the authors advocate for recognizing spirituality as a key determinant of health and an important component of healthcare to ensure more inclusive treatment.

Objective: The treatment of irritable bowel syndrome (IBS) is challenging, calling for therapeutic strategies other than pharmacological treatment. Therefore, this study aimed to investigate the effects of Pilates exercises on IBS symptoms and severity, frequency of complete spontaneous bowel movements, fatigue, anxiety, depression, and body weight in women with IBS.

Methods: Sixty women with IBS, aged 20-45, completed this study. They were randomly assigned to two equal groups: a study group (n = 30) and a control group (n = 30). The study group received an 8-week Pilates exercise program (2 sessions per week) in addition to dietary advice, while the control group received dietary advice only. Inclusion criteria were women, IBS diagnosed based on Rome IV Diagnostic criteria, constipation-predominant IBS, and moderate to severe IBS. The outcome measures were the IBS severity scoring system (IBS-SSS), the frequency of complete spontaneous bowel movements, the modified fatigue impact scale (MFIS), hospital anxiety and depression (HADS) scale, and body weight (BW).

Results: The study group showed more significant improvements than the control group in total IBS-SSS score (Cohen d = 0.73, p < 0.001), frequency of complete spontaneous bowel movements (Cohen d = 0.50, p < 0.001), total MFIS score (Cohen d = 0.74, p < 0.001), anxiety (Cohen d = 0.56, p < 0.001), and depression (Cohen d = 0.64, p < 0.001). The study group also showed a significant reduction in body weight compared to baseline (p < 0.05). The control group showed significant improvements in all outcomes, except body weight, compared to baseline (p < 0.05).

Conclusion: Pilates exercises, used in addition to dietary advice, may significantly improve IBS symptoms and severity, frequency of complete spontaneous bowel movements, and alleviate fatigue, anxiety, and depression moderately more than dietary advice alone in women with constipation-predominant IBS. Nevertheless, dietary advice alone may also significantly improve these outcomes in this cohort.

Objective: Virtual reality (VR) therapies have increasingly been adopted across medical fields, including neurorehabilitation for stroke recovery. Evidence from several systematic reviews (SRs) was explored, covering different aspects. We aim to explore overlaps, gaps, and trends of SRs focusing on VR stroke rehabilitation providing a foundation for improving the field and addressing current limitations.

Materials and methods: We moved from a recent overview of reviews, searching multiple databases for all published SRs and the international database of prospectively registered SRs (PROSPERO) for ongoing SRs. Data extraction of study characteristics and methodological quality of SRs using AMSTAR 2 were obtained from a recent overview of reviews. Two independent reviewers conducted data analysis and visualization by the trend over time of published SRs with their included primary studies and ongoing SRs, methodological quality and other SR characteristics.

Results: The data set consisted of 58 SRs, including 345 primary studies and 45 ongoing SRs, published between 2007 and 2022. The number of published and ongoing SRs significantly increased over time (R² = 0.8654; R² = 0.747, respectively). In the last three years, Asia accounts for the majority of publications (31%). Overall, the main outcome assessed over time was upper extremity function and activity in 67.2% of SRs. Most of the published SRs were judged "critically low" (77.6%). The number of included studies increased over time reaching a median of 17 studies with a median of 493 participants.

Conclusions: In stroke rehabilitation, the published and ongoing SRs on VR have risen over time in terms of the number of publications, with some concerns about methodological quality and representation of countries around the world.

Introduction: Physiotherapists exhibit different degrees of adherence to clinical guidelines for low back pain (LBP). The preferences and expectations of their patients significantly influence physiotherapists' adherence to these guidelines. Therefore, it is crucial to have a comprehensive analysis of the patients' perspectives, which can identify the factors that prevent the implementation of an active approach.

Methods: We conducted semi-structured interviews with patients suffering from non-specific chronic LBP (CLBP). We transcribed the semi-structured interviews verbatim and conducted an inductive thematic analysis to uncover themes related to the participants' expectations and experiences of consultations with physiotherapists for CLBP.

Results: In total, we interviewed thirty-three individuals, with 14 women and 19 men (mean age 53 + 12 years). Our thematic analysis discovered six overarching themes that are relevant to patients' expectations and experiences. We identified several sub-themes under the "physiotherapist-related factors" and "patient-related factors" themes. Additional themes recognized were guideline-related factors, institution-related factors, healthcare-related factors, and health information. A significant number of participants expressed dissatisfaction with the short timeframe allocated by the physiotherapist.

Conclusions: Multiple participants expressed dissatisfaction with their experience, particularly about the quality of explanations and the nature of the exercises provided. This emphasizes the importance of patient education, and physiotherapists should consider suggesting active interventions that the family, society, and culture can more easily accept. Accordingly, the formulation of future guidelines for nations like India should take into account these patient expectations and perspectives.

Introduction: While adverse events related to physiotherapy are possible, the type of adverse event and the area of physiotherapy practice in which they occur are not well understood. The purpose of this scoping review was to establish adverse events related to physiotherapy practice and understand the nature of these events and the circumstances in which they occurred.

Methods: Relevant literature from January 2014 to February 2024 was gathered from five electronic databases. Studies reporting adverse events within any physiotherapy practice (intervention or assessment) were eligible. Two reviewers independently assessed title and abstract, and full texts. Findings were synthesised by clinical streams.

Results: A total of 58 studies met the inclusion criteria. Common adverse events described in musculoskeletal physiotherapy involving manual therapy, exercise and electrotherapy were increased pain and stiffness. Cardiorespiratory physiotherapy interventions involving early mobilisation, exercise and airway clearance therapy reported desaturation and haemodynamic instability. Neurological physiotherapy studies reported falls and fatigue during gait and balance training and exercise. Oncology and aged care interventions involving exercise, balance training and lymphoedema management reported increased pain and muscle strain while studies including pelvic floor muscle training reported the adverse event of vaginal discomfort.

Conclusion: This review identified adverse events occurring during physiotherapy interventions or assessment procedures. Increased monitoring and proactive safety measures may be necessary to ensure patient safety during these treatments.