Archives of physiotherapy最新文献

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.

Introduction: The modified shuttle test-15 (MST-15) is a valid alternative for assessing exercise capacity when a cardiopulmonary exercise testing is not feasible. This study aims to describe the percentage of healthy and cystic fibrosis (CF) children and adolescents reaching the MST-15 ceiling. Additionally, it examines associations between MST-15 distance and demographic, anthropometric, and lung function data.

Methods: This retrospective cross-sectional study involved 286 healthy volunteers (11.5 ± 3.3 years) and 70 CF patients (11.9 ± 4.4 years). Data on age, gender, weight, height, body mass index, lung function, and MST-15 were collected. The ceiling effect was determined by the absolute and relative number of participants reaching the 15th level. Univariate linear regression and correlation analyses were conducted to explore associations with MST-15 distance.

Results: A ceiling effect for the MST-15 was found in 19 healthy participants (6.6%) and 1 CF patient (1.4%). The ceiling effect was correlated with age (r = 0.777 for healthy; r = 0.538 for CF), with no cases under 10 years and reaching 25% in healthy participants aged 17-19. Regression analysis showed significant associations between age and MST-15 distance in healthy participants (β = 53.6) and CF patients (β = 32.1). Additionally, sex was significantly associated with MST-15 distance in healthy participants (β = 107.0), and FEV₁ with MST-15 distance in CF patients (β = 31.0).

Conclusions: The ceiling effect on the MST-15 is age-dependent, with no occurrences observed in children under 10 years and a gradual increase in incidence as participants age.

Introduction: Frozen shoulder (FS) is a musculoskeletal disorder affecting the glenohumeral joint. This condition leads to disability and a worsening in quality of life. Despite its considerable impact on patients and its economic burden, research on the psychological and social implications of FS-as well as patients' perspectives and needs-is limited. This study aims to explore the perspectives, perceptions, and expectations of individuals suffering from FS, providing a comprehensive understanding of their experiences and needs.

Methods: A cross-sectional observational study was conducted following STROBE guidelines. A 59-question survey was administered to Italian individuals diagnosed with FS from April 1 to July 1, 2023.

Results: All 110 participants completed the survey. Most preferred an experienced and empathetic physiotherapist (73.64%) and relied primarily on physiotherapy (49.09%) for FS management. Additionally, 45.45% were open to a multidisciplinary approach. Subjects reported reducing night pain (71.82%) and achieving full range of motion (ROM) recovery (70.91%) as their top priorities. Participants reported a notable shift in their mood from "pre" to "post" FS, with many experiencing fear and catastrophizing thoughts and perceiving a lack of social support. Furthermore, 27.27% were open to cortisone use, while 25.45% considered electrophysical agents beneficial for managing the painful phase of FS.

Conclusion: These results underscore a strong preference for empathetic physiotherapists and the value of a multidisciplinary approach. Addressing night pain and restoring ROM are crucial priorities-emphasizing the need for tailored and shared decision-making. Additionally, these findings highlight the importance of addressing psychological well-being alongside physical symptoms.

Introduction: We conducted a systematic review of clinical practice guidelines to identify red flags for serious pathologies in neck pain mentioned in clinical practice guidelines, to evaluate agreement in red flag recommendations across guidelines, and to investigate the level of evidence including what study type the recommendations are based on.

Methods: We searched for guidelines focusing on specific and nonspecific neck pain in MEDLINE, EMBASE, and PEDro up to June 9, 2023. Additionally, we searched for guidelines through citation tracking strategies, by consulting experts in the field, and by checking guideline organization databases.

Results: We included 29 guidelines, 12 of which provided a total of 114 red flags for fracture (n = 17), cancer (n = 21), spinal infection (n = 14), myelopathy (n = 15), injury to the spinal cord (n = 1), artery dissection (n = 7), intracranial pathology (n = 3), inflammatory arthritis (n = 2), other systemic disease (n = 6), or unrelated to a specific condition (n = 19). Overall, there is very little agreement (median Fleiss' kappa of 0) between guidelines on the red flags to screen for serious pathologies.

Conclusion: Red flags were mainly supported by expert opinions. We also observed a general lack of consensus among guidelines regarding which red flags to endorse. Considering the current limitations of the evidence, specific recommendations on which red flags to use cannot be provided, except for using the Canadian C-Spine rule for screening posttraumatic fractures.

Introduction: The Postural Assessment Scale for Stroke Patients (PASS) is commonly used by health professionals in Italy in several different translations. This study aimed to provide a validated version in Italian. The main focus is on the evaluator, to guarantee a uniform application and interpretation of the statements and scoring for each item in the Italian context.

Methods: A standardized protocol was used for the translation and cross-cultural adaptation. A pilot study conducted using the first draft of the scale led to a revised version, PASS-IT. A principal component analysis (PCA) was performed. The correlation with the Trunk Control Test (TCT) was examined for concurrent validity. In addition, the relationship with the Barthel Index (BI) and the Functional Ambulation Categories (FAC) was tested. Patients with recent stroke were tested for intra-rater (N = 49) and inter-rater agreement (N = 30). Cronbach's alpha, item-to-total correlation, corrected inter-item correlation, the intraclass correlation coefficient (ICC), and measurement error were used to evaluate internal consistency and intra-/inter-rater reliability.

Results: The PCA showed a two-dimensional structure, with high reliability in both subsections ("non-weight-bearing" α = 0.865; "weight-bearing" α = 0.949). A strong correlation (ρ > 0.80) was found with the TCT, the BI, and the FAC. The PASS-IT showed high internal consistency, intra-rater (ICC = 0.942) and inter-rater reliability (ICC = 0.940).

Conclusions: The PASS-IT is a recommended scale, suitable for clinical practice and research in the acute and subacute stage. The introduction of operating instructions resulted in the uniform application. A different order of the items allows faster administration, reducing changes of posture.

Introduction: The 10-Meter Walk Test (10MWT) and Timed Up and Go (TUG) are valid tools for gait performance and mobility assessment after total hip arthroplasty (THA). The study aimed to assess test-retest reliability of 10MWT and TUG in indoor and outdoor environments in patients in acute phase after THA and compare their indoor vs. outdoor performance during these tests.

Methods: Thirty-five inpatients performed 10MWT and TUG in indoor and outdoor settings on the second postoperative day. An additional evaluation session was performed after 1 hour under the supervision of the same operator. Test-retest reliability was assessed using Intraclass Correlation Coefficient (ICC: 2.1) and Minimal Detectable Change (MDC₉₅), while paired t-tests were used to compare indoor vs. outdoor performance.

Results: Indoor (ICC: 0.94, MDC₉₅: 0.13 m/s) and outdoor (ICC: 0.91, MDC₉₅: 0.16 m/s) 10MWT at maximum speed and indoor (ICC: 0.92, MDC₉₅: 2.5 s) and outdoor (ICC: 0.93, MDC₉₅: 2.4 s) TUG revealed excellent reliability. Indoor (ICC: 0.86, MDC₉₅: 0.16 m/s) and outdoor (ICC: 0.89, MDC₉₅: 0.16 m/s) 10MWT at spontaneous speed revealed good reliability. Spontaneous (mean difference [MD]: 0.05 m/s, 95% confidence interval [CI₉₅]: 0.03, 0.07, p < 0.001) and maximum (MD: 0.02 m/s, CI₉₅: 0.01, 0.04, p < 0.001) 10MWT revealed higher gait speed when performed outdoors compared to indoors.

Conclusions: Indoor and outdoor 10MWT and TUG are reliable tests in acute phase after THA. Higher gait speed during outdoor 10MWT may depend on test score variability, due to MDs being lower than MDC₉₅.

Introduction: Goniometric finger range of motion (ROM) is the most common outcome measure used for functional evaluation of finger joints, but its reliability is not well-evaluated. This study aimed to investigate intra- and inter-rater reliability of goniometric finger ROM using a written protocol for active, passive, and composite movements in healthy adults.

Methods: The design was a single-center, cross-sectional, reliability study. Participants were 20 healthy adults (mean ± standard deviation, 36.4 ± 10.9 years). ROM for active, passive, and composite movements of the fingers was assessed by three occupational therapists with at least 5 years clinical experience in the field of physical disabilities. To standardize the measurement method used, we developed a written protocol, stabilized the wrist position, and trained the evaluators. Intraclass correlation coefficient (ICC) values were used for the reliability analysis. ICC (1,1) was used for intra-rater reliability. ICC (2,1) was used for inter-rater reliability. Hand-shaped heatmaps were used to summarize the reliability data.

Results: Most of the results (88.7%) showed moderate to good intra-rater reliability (ICC ≥ 0.50), while inter-rater reliability showed less (69.0%). Both intra- and inter-rater reliability showed no trends between dominant and non-dominant hands, type of movement, finger, or joint.

Conclusions: Intra-rater reliability was relatively high and using a written protocol was beneficial. Inter-rater reliability tended to be lower, and differences in the physical structure of both raters and participants may have affected inter-rater reliability values.