Physical therapy research最新文献

Objectives: In stroke rehabilitation, the Fugl-Meyer Assessment Lower Extremity (FMA-LE) motor scale is widely used to assess consecutive recovery steps from motor paralysis and predict prognosis after stroke. However, there has been limited opportunity to refer to the useful yet few studies that evaluated the minimal important change (MIC) and the minimal detectable change (MDC) of the FMA-LE motor scale. The aims of this review were to: (1) identify studies that have estimated the MIC and MDC, (2) identify the calculated MIC and MDC values and disease phases in previous studies, and (3) assess the methodological quality of the MIC and MDC studies of the FMA-LE motor scale.

Methods: A scoping review was undertaken following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) recommendations. 3 databases (PubMed, CINAHL, and Web of Science) were used for the literature search. Reports of the MIC and MDC of the FMA-LE motor scale in patients with stroke were selected.

Results: 6 studies were included after confirming their eligibility. In the acute phase, inter-rater MDC was 3.23 points. In the early subacute phase, intra-rater MDC was 1.24 points. In the chronic phase, intra-rater MDC was 3.80, 4.87, and 7.98 points, inter-rater MDC was 3.57 and 5.96 points, and MIC was 6.00 points.

Conclusion: No late subacute threshold was identified for the MDC, and no acute or subacute threshold was identified for the MIC. Compared with the quality of the MIC study, there is room for improvement in the quality of the MDC studies with respect to study design.

Objectives: This study aimed to systematically review exercise-based cardiac rehabilitation (CR) programs implemented in South Korea since their inclusion in the National Health Insurance System in 2017.

Methods: A systematic literature search was conducted using international and Korean databases for studies published after January 2017. The inclusion criterion was exercise-based CR intervention in patients with cardiac disease in South Korea. The methodological quality of each study was assessed using the Physiotherapy Evidence Database scale.

Results: A total of 11 studies met our inclusion criteria. Most CR programs are hospital-based, whereas some incorporate home-based, aquatic, or forest environments. The exercise prescriptions followed the FITT (frequency, intensity, time, and type) principle and often included aerobic and high-intensity interval training. The reported outcomes included improvements in cardiopulmonary fitness, physical activity, and psychological well-being. Despite their clinical effectiveness, participation in CR programs remains low in Korea owing to accessibility and institutional limitations.

Conclusions: Exercise-based CR programs in Korea demonstrated clinical benefits and diversified delivery models. Further efforts are required to enhance accessibility and promote wider adoption through policy and infrastructure development.

Objectives: This study aimed to determine whether neuromuscular electrical stimulation (NMES) of the quadriceps muscle early after total knee arthroplasty (TKA) is effective in improving muscle strength.

Methods: This was a single-center, non-blinded, randomized controlled trial involving 37 patients (60 knees) who underwent TKA. Patients were randomly assigned to either the intervention group (19 patients, 30 knees) or the control group (18 patients, 30 knees). Both groups received standard rehabilitation starting on postoperative day 1. Additionally, the intervention group received NMES therapy starting on postoperative day 2. NMES was administered at the highest tolerable intensity for 15 min per session (10-s stimulation and 10-s rest) twice daily for 4 weeks. Outcome measures included voluntary isometric quadriceps strength, knee joint range of motion (ROM), visual analog scale (VAS), and the Timed Up and Go (TUG) test, which were assessed preoperatively and at 4, 8, and 12 weeks postoperatively. The outcomes were compared between the two groups.

Results: Both groups showed improvements in all outcomes over time. However, no significant differences were observed between the two groups (muscle strength: p = 0.412, flexion ROM: p = 0.668, extension ROM: p = 1.000, VAS score: p = 0.192, TUG test score: p = 0.296) (p-values are main effects of group factors in the split-plot analysis of variance).

Conclusions: NMES in the early postoperative period after TKA did not provide significant additional functional recovery benefits compared with standard rehabilitation.

Objectives: Physical activity is a relevant factor for the locomotive syndrome (LS); however, the association between intensity of physical activity and LS is unclear. This study aimed to investigate the associations among different intensities of physical activity (vigorous, moderate, and light), sedentary time, and LS.

Methods: A cross-sectional analysis of records from 2890 Japanese community residents (mean age: 57.5 years) was conducted. LS was assessed using the stand-up test, two-step test, and 25-question Geriatric Locomotive Function Scale. Physical activity and sedentary time were assessed by self-administered questionnaires. The associations among physical activity, sedentary time, and LS were examined by logistic regression analysis stratified by age (<65 years and ≥65 years) and sex.

Results: Vigorous physical activity in men aged ≥65 years, and moderate and vigorous physical activities in women aged <65 years were significantly associated with lower odds of LS. By contrast, no significant association was found between physical activity and LS in men <65 years and women ≥65 years of age. No association between light physical activity and the LS was found in either group. The association between sedentary time and LS was observed in women aged <65 years.

Conclusions: Physical activity and sedentary time were associated with the LS but in an age- and sex-dependent manner. This study highlights the importance of engaging individuals in high-intensity physical activity to prevent or address LS.

Objectives: The 6-minute walk test (6MWT) is generally used to evaluate endurance in interstitial lung disease (ILD). In ILD, treatment efficacy differs between patients with idiopathic pulmonary fibrosis (IPF) and those with non-idiopathic pulmonary fibrosis (non-IPF), and the clinical profile varies according to disease severity. This study compared 6MWT parameters by severity of illness in patients with IPF and non-IPF.

Methods: The participants were hospitalized patients with ILD and either IPF (n = 20) or non-IPF (n = 25). To compare IPF and non-IPF by severity, patients were classified using the gender-age-physiology (GAP) index as having GAP stage I (i.e., mild) or GAP stage II/III (i.e., moderate to severe). The evaluation parameters were the 6-minute walk distance (6MWD), minimum percutaneous oxygen saturation (SpO₂), heart rate recovery at 1 minute (HRR1) after the 6MWT, and modified Borg scale rating of perceived exertion.

Results: The minimum SpO₂ value during exertion was significantly lower in the IPF group than in the non-IPF group (p < 0.05). Furthermore, when comparing by severity, patients with IPF and GAP stage I had a significantly lower 6MWD, HRR1, and SpO₂ value. In patients with GAP stage II/III, there were no significant differences in 6MWD, SpO₂ values, or dyspnea.

Conclusions: Patients with mild IPF were more prone to hypoxemia, while in moderate-to-severe cases, we observed no significant hypoxemia- or endurance-related differences between IPF and non-IPF patients. This study highlights the importance of severity-based evaluation, particularly in guiding individualized rehabilitation and risk management for patients with IPF.

Objective: The movement of the diaphragm plays an important role in respiration. In this study, we proposed and validated a new method for estimating the volume of a single ventilation (representing the tidal volume [VT]) from the vertical distance of diaphragmatic movement and thoracic circumference.

Method: Diaphragm excursion (DE) was measured in healthy adult subjects via ultrasound, and the thoracic cavity volume change was estimated based on DE and thoracic circumference. Moreover, we measured the VT obtained by an expiratory gas analyzer and examined the relationships between DE and thoracic volume change (TVC) and between DE and VT.

Results: The results showed that a correlation (ρ = 0.609) existed between DE and VT, and an even higher correlation existed between TVC and VT. TVC correlated better with the product of thoracic circumference squared and DE (ρ = 0.839) than with the product of thoracic circumference and DE as an alternative index (ρ = 0.746).

Conclusion: Our findings demonstrate that, taking into account body size in addition to DE, changes in thoracic cavity volume are useful predictors of VT and provide an alternative measure for assessing the respiratory function, which will improve clinical and research practice in respiratory care.

Objective: The relationship between pre-stroke frailty and clinical outcomes remains unclear. This systematic review aimed to examine the association of pre-stroke frailty with mortality, length of stay (LOS), and functional outcomes in people with stroke.

Methods: We used several databases, including PubMed, EMBASE, and CENTRAL. We searched for studies investigating the association between pre-stroke frailty and clinical outcomes. The Quality in Prognosis Studies tool was used to assess the risk of bias in the included studies. Meta-analyses were performed using the random effects model. The certainty of evidence was assessed with the Grading of Recommendations, Assessment, Development, and Evaluation.

Results: Fourteen studies (participants: 11583) were included in this review. Pre-stroke frailty is associated with higher mortality (odds ratio: 1.11; 95% confidence intervals [CI]: 1.0-1.23), longer LOS (mean difference: 0.75; 95% CI: -0.29 to 1.78), and poorer functional outcomes (standardized mean difference: 0.79; 95% CI: 0.48-1.1). The certainty of evidence is low due to risk of bias, inconsistency, and imprecision.

Conclusions: These results suggest that frailty before stroke onset may be associated with higher mortality, increased LOS, and poorer functional outcomes.

Objectives: We investigated the association between locomotive syndrome (LS), cortical bone thickness, and trabecular bone density in community-dwelling postmenopausal women.

Methods: In total, 1405 postmenopausal women aged ≥50 years were analyzed from the Japan Multi-Institutional Collaborative Cohort (J-MICC) Study. LS was assessed using the stand-up test, 2-step test, and the 25-question Geriatric Locomotive Function Scale. The cortical bone thickness and trabecular bone density at the radius were assessed using a quantitative ultrasound device capable of distinguishing between the cortical and trabecular components. Demographic and bone-related variables were compared between participants with and without LS using the t-test and chi-squared test. Multivariate linear regression analyses were performed with cortical bone thickness or trabecular bone density as the dependent variable and LS status as the independent variable, after adjusting for age and lifestyle factors.

Results: Of all participants, 892 (63.5%) had LS. Multiple linear regression analysis showed that LS was independently associated with reduced cortical bone thickness (β = -0.076, p = 0.001) and trabecular bone density (β = -0.109, p <0.001). This association was statistically significant in both age groups (<65 and ≥65 years).

Conclusions: In postmenopausal women, LS was independently associated with cortical bone thinning and trabecular bone loss. Our findings suggest that bone quality may play an important role in the prevention and management of LS, indicating that future strategies should consider both bone density and bone quality.

Objectives: Chronic fracture pain (CFP) is a significant issue in patients with osteoporotic fractures (OFs) in convalescent rehabilitation wards (CRWs). This study aimed to examine the association between CFP and the Japanese short-form Central Sensitization Inventory (CSI-9) and verify the predictive validity of CSI-9 in patients with OF admitted to a CRW.

Methods: This single-center retrospective study included 71 patients with OF (median age: 85.3 years, 54 females). CFP was defined as pain of Numerical Rating Scale (NRS) score ≥4 persisting at discharge, despite >3 months post-fracture. Multiple logistic regression and receiver operating characteristic curve analyses were performed to assess the association and predictive validity of the CSI-9 for CFP.

Results: The incidence of CFP was 38.0%. CSI-9 was independently associated with CFP at admission (odds ratio = 1.12, 95% confidence interval [CI]: 1.01-1.24) and discharge (odds ratio = 1.15, 95% CI: 1.03-1.29). The area under the curve for the CSI-9 was 0.727 (95% CI: 0.605-0.850) at admission and 0.752 (95% CI: 0.637-0.867) at discharge, indicating fair predictive accuracy. The optimal cutoff values for the CSI-9 were 8 points at admission and 6 points at discharge.

Conclusions: CSI-9 was independently associated with CFP and demonstrated moderate predictive accuracy in patients with OF in CRWs. Assessing central sensitization-related symptoms using the CSI-9 may be useful for evaluating and preventing CFP in this population. Further validation using large-scale prospective studies is required.

Motion analysis is essential for physical therapists and athletic trainers to understand the motor function of their patients or athletes. Although marker-based motion analysis systems have been widely utilized in research, they are expensive and demand significant time and effort for measurement and analysis, which can complicate their application in clinical practice. In recent years, markerless motion analysis technologies have emerged as affordable and portable alternatives. These technologies include inertial measurement unit (IMU) sensors, depth cameras, manual digitization, and posture-tracking algorithms. IMU sensors detect motion using accelerometers and gyro sensors and can be worn on body parts. Depth cameras use infrared or laser technology to capture three-dimensional (3D) motion without requiring markers. Manual digitization enables semiautomatic identification of joint positions from images, allowing joint angle measurement without using specific cameras or markers. Posture-tracking algorithms use artificial intelligence to approximate joint positions from standard camera images, enabling automated motion analysis. Despite the enhanced accessibility of these technologies, limitations remain, particularly in analyzing detailed joint movements or individuals with structural abnormalities, and their accuracy depends on the environment and motion task. However, with further development, these technologies are expected to become increasingly reliable and provide physical therapists and athletic trainers with valuable, cost-effective, and easy-to-use tools for assessing movement in clinical and sports settings.