Physical therapy research最新文献

Parkinson's disease (PD) is now the world's fastest-growing neurological disorder with rapidly rising prevalence and increasing demand for effective health services. Recent research has focused on the importance of early diagnosis and proactive management of physical function. Accumulating evidence indicates that reduced physical activity levels and mild pre-clinical disability are present in many people prior to a clinical diagnosis, perhaps developing over years. Early referral to a physiotherapist at the time of diagnosis is now recommended in global guidelines. Multiple forms of exercise have been found to have benefits in early and mid-stage disease across a range of motor and non-motor symptoms. Evidence from longitudinal studies confirms that disability is delayed when regular exercise is sustained over long periods. Exercise is now recognized as an essential component of treatment, in combination with medical therapies. Contemporary physiotherapy interventions now combine health behavior change techniques with physical exercise to promote the development of long-term exercise adherence. Advances in technology and digital health have progressed quickly and now offer opportunities for remote assessment and monitoring, remote exercise supervision, and support adherence through feedback and motivational strategies. Recent biomedical discoveries forecast improved earlier and more accurate diagnosis of PD, allowing opportunities for earlier interventions. Current research in progress will provide important insights into the dose and intensity of aerobic exercise in PD. Physiotherapists have important roles in advocacy and education in conjunction with care delivery to support access to evidence-based care for all people with PD.

Objectives: Previous studies indicated that early ambulation following lung resection can prevent postoperative pulmonary complications (PPCs). However, some patients fail to achieve early ambulation owing to factors such as postoperative nausea, vomiting, or pain, particularly on postoperative day 1. This study aimed to address the critical clinical question: Is ambulation for ≥10 m during initial pulmonary rehabilitation necessary after lung resection surgery?

Methods: This retrospective observational cohort study included 407 patients who underwent lung resection surgery for lung cancer between January 2021 and December 2022. Twelve patients with a performance status of ≥2 and 21 patients lacking pulmonary rehabilitation prescriptions were excluded. Patients were categorized into the "early ambulation" group, which included individuals ambulating ≥10 m during rehabilitation on the first postoperative day, and the "delayed ambulation" group. The primary outcome was PPC incidence, with secondary outcomes encompassing pleural drain duration, hospital length of stay, and Δ6-minute walk distance (Δ6MWD: postoperative 6MWD minus preoperative 6MWD).

Results: The early and delayed ambulation groups comprised 315 and 59 patients, respectively. Significant disparities were noted in the length of hospital stay (7 [6-9] days vs. 8 [6-11] days, P = 0.01), pleural drainage duration (4 [3-5] days vs. 4 [3-6] days, P = 0.02), and Δ6MWD (-70 m vs. -100 m, P = 0.04). However, no significant difference was observed in PPC incidence (20.6% vs. 32.2%, P = 0.06).

Conclusions: Ambulation for ≥10 m during initial pulmonary rehabilitation after lung resection surgery may yield short-term benefits as evidenced by improvements in various outcomes. However, it may not significantly affect the PPC incidence.

Objective: To investigate the impact of multidisciplinary team (MDT) intervention for early mobilization (EM) of patients with aneurysmal subarachnoid hemorrhage (aSAH) in the intensive care unit (ICU).

Methods: A retrospective uncontrolled before-after observational study was conducted to assess patient outcomes before and after introducing MDT in the stroke care unit (SCU). Participants admitted to the SCU from April 2017 to September 2023 were categorized into conventional (April 2017 to June 2020) and MDT (July 2020 to September 2023) groups. The measured primary outcome was the days until sitting, standing, and walking commenced.

Results: A total of 131 patients were screened, with 115 included in the analysis. The MDT group comprised 56 individuals (48.7%), whereas the conventional group consisted of 59 patients (51.3%). The MDT group exhibited a significantly shorter duration until sitting (4 [3-7] vs. 7 [5-17], p <0.001), standing (5 [3-7] vs. 10 [5-17], p <0.001), and walking (7 [5-10] vs. 16 [7-23], p <0.001) commenced. Furthermore, the MDT group showed a significantly higher ICU mobility scale (IMS) (8 [5-8] vs. 5 [3-8], p <0.001) at SCU discharge, shorter length of SCU stay (16 [15-17] vs. 17 [15-24], p = 0.048), and hospital stay (34 [25-48] vs. 48 [33-80], p = 0.006).

Conclusion: This study suggests that MDT played a facilitative role in promoting the EM of patients with aSAH. Their involvement streamlined the mobilization process, shortening the days until the initiation of mobilization.

Patient Background: A 75-year-old man had difficulty moving around at home because of loss of appetite and neglect of medication for several days. He was brought to the emergency room and admitted on the same day with a diagnosis of dehydration and diabetic ketoacidosis. He started physical therapy (PT), had frequent fainting and presyncope due to hypotension, and had difficulty leaving bed. The patient was transferred to our hospital to continue PT. Test results on admission were as follows: short physical performance battery (SPPB) [points], 1/12 points; chair stand 5 times (CS5) [sec], not possible; functional independent measure (FIM) [points], 66/126; standing test: blood pressure (BP) [mmHg], 130/60/HR [beats per minute], 76 in supine, 90/56/79 in sitting, 70/-/79 in standing.

Process: After transfer, BP continued to fall markedly and he frequently fainted and required assistance with nearly all activities of daily living (ADL). Neuromuscular electrical stimulation (NMES) of the thigh and lower leg was performed five times a week for 30 min. After approximately 3 days of NMES, BP decreased slowly, presyncopic symptoms disappeared, and he could leave bed more frequently and for longer periods. The patient became independent in ADL and was discharged on Day 142. Results at discharge were as follows: SPPB, 11/12; CS5, 13.5; FIM, 114/126.

Discussion: Although NMES is not effective for orthostatic hypotension (OH) associated with diabetic autonomic neuropathy (DAN), stabilization of BP early after the introduction of NMES may have been due to its peripheral sympathetic nerve-stimulating effect.

Conclusion: The combination of exercise therapy and NMES for OH caused by DAN can alleviate hypotension.

Objective: Interstitial lung disease (ILD) is classified into several disease groups. Among them, idiopathic pulmonary fibrosis (IPF) has higher incidence and poor prognosis; therefore, it is important to characterize specific IPF symptoms. Exercise desaturation is a strong factor related to mortality in patients with ILD. Thus, the purpose of this study was to compare the degree of oxygen desaturation between IPF and other ILD (non-IPF ILD) patients during exercise, using the 6-minute walk test (6MWT).

Methods: This retrospective study included 126 stable patients with ILD who underwent 6MWT in our outpatient department. The 6MWT was used to assess desaturation during exercise, 6-minute walk distance (6MWD), and dyspnea at the end of exercise. In addition, patient characteristics and pulmonary function test results were recorded.

Results: Study subjects were divided into 51 IPF patients and 75 non-IPF ILD patients. The IPF group had significantly lower nadir oxygen saturation determined by pulse oximetry (SpO₂) during 6MWT than the non-IPF ILD group (IPF, 86.5 ± 4.6%; non-IPF ILD, 88.7 ± 5.3%; p = 0.02). The significant association between the nadir SpO₂ and IPF or non-IPF ILD grouping remained even after adjusting for gender, age, body mass index, lung function, 6MWD, and dyspnea (β = -1.62; p <0.05).

Conclusion: Even after adjusting for confounding factors, IPF patients had lower nadir SpO₂ during 6MWT. Early assessment of exercise desaturation using the 6MWT may be more important in patients with IPF compared with patients with other ILDs.

We perform physical therapy combined with repetitive transcranial magnetic stimulation (rTMS) in stroke patients with hemiplegia in the maintenance phase with the intent of improving the support of paralyzed leg. In gait evaluation in patients with hemiplegia, it is important to assess elements related to coordination carefully. rTMS therapy is effective in alleviating the tension of upper limbs. As rTMS helps upper-limb swing to become evident during gait, it makes trunk rotation necessary for left-right coordination appear more easily. As a result, rTMS has potential for improved upper-limb swing or trunk rotation. Post-rTMS therapy may prepare for the environment suitable for hip extending the stance phase of the paralyzed side. In physical therapy, it is advisable to practice standing up, maintaining standing posture or walking by making good use of these effects. We conduct practices in combination with the following: standing up focusing on load evenly distributed on both sides, standing on slant-board training, which enables forward shift of center of mass, walking by fixating upper limbs to the back of the body with the intent of extending the stance phase of the paralyzed side, and increasing trunk rotation. It is also necessary to discuss the combination with injection with botulinum toxin, which suppresses spasticity of ankle plantar flexors with the physician. Gait is associated with a variety of factors and has significant intrapatient and interpatient variations. In this regard, physiotherapists are required to develop a treatment program based on a quantitative evaluation, especially, in patients with hemiplegia.

Heart failure (HF) is a complex clinical syndrome caused by structural and/or functional abnormalities that results in significant disease burdens not only to the patients and their families but also to the society. Common symptoms/signs of HF include dyspnea, fatigue, and exercise intolerance, which significantly reduce the quality of life of individuals. Since the coronavirus disease 2019 (COVID-19) pandemic in 2019, it has been found that individuals with cardiovascular disease are more vulnerable to COVID-19-related cardiac sequelae including HF. In this article, we review the updated diagnosis, classifications, and interventional guidelines of HF. We also discuss the link between COVID-19 and HF. The latest evidence about physical therapy for patients with HF in both the stable chronic phase and acute cardiac decompensation phase is reviewed. Physical therapy for HF patients with circulatory support devices is also described.

Many studies on frailty have primarily focused on individual-level risk factors such as demographics and lifestyle. While guidelines for frailty management recommend modifications to an individual's lifestyle, their lifestyle behaviors are significantly influenced by their surroundings. Recently, the association between frailty and environmental attributes has drawn attention as a result of the increase in evidence that multiple factors affect health conditions and behaviors associated with frailty. These findings can be organized based on an ecological model involving five nested levels that influence an individual's behaviors, namely, an intrapersonal/individual core (age, education, and attitude), an interpersonal level (persons and groups), an organizational/institutional level (organization and workplace), a community level (natural, built, and social environments), and a system/public policy level (public policies from local to national). This study reviewed possible factors associated with frailty from the onset and its progression at each level of the ecological model and their implications regarding frailty prevention. Additionally, we introduce a policy-level approach for frailty prevention in Japan-which encourages residents to engage in the local society by participating in community places or groups that are referred to as "Kayoi-no-ba"-and aggregate its status from a government report. This perspective on community building is consistent with the concept of an ecological model. However, few studies have verified the effects of policy- or system-level approaches on disability and frailty prevention. Further studies from an ecological perspective are needed to fulfill multilevel interventions for frailty prevention.

Objective: The purpose of this study was to investigate if leg cycling could reduce lower extremity spasticity in patients with cerebral palsy (CP). In addition, we investigated whether the intervention could cause changes in the modulation of presynaptic inhibition.

Methods: This study was a quasi-experimental study, with pretest-posttest for 1 group. Participants in this experiment were eight adult patients with CP with lower extremity spasticity. Spasticity parameters assessed were the amplitude of soleus maximum Hoffmann's reflex (H_max) and maximum angular velocity (MAV) of knee flexion measured using the pendulum test. D1 inhibition, which seems to be related to the presynaptic inhibition, was recorded by measuring soleus Hoffmann's reflex (H-reflex) with conditioned electric stimuli to the common peroneal nerve.

Results: D1 inhibition was significantly enhanced immediately by the cycling intervention. The amplitude of the soleus H_max was significantly depressed, and there was significant difference in H_max/maximum M-wave. The MAV was increased due to inhibition of the stretch reflex.

Conclusion: Leg cycling suppressed stretch reflex and H-reflex, and caused plasticity of inhibitory circuits in patients with CP with lower extremity spasticity. These findings strongly suggest that lower extremity spasticity can be improved by cycling movements.

Objective: This study aimed to understand the long-term transition of exercise tolerance in patients on phase III cardiac rehabilitation (CR) and clarify the characteristics of patients with a high risk of declined exercise tolerance during the first emergency declaration.

Methods: Patients who participated in phase III outpatient CR before the first emergency declaration and those who performed cardiopulmonary exercise testing were at ≥2-time points: before and at 3 or 12 months post-emergency declaration. Exercise tolerance transition at 3-time points was analyzed, and whether different social background factors affected the peak oxygen uptake (V̇O₂) transition method remains to be examined.

Results: A total of 101 (median age 74.0 years, 69% men), and both peak V̇O₂ and anaerobic threshold (AT) significantly declined from pre-declaration to 3 months post-declaration but recovered to levels likely similar from pre-declaration at 12 months (peak V̇O₂: from 17.3 to 16.7 to 18.7 mL/min/kg; AT: from 11.8 to 11.2 to 11.6 mL/min/kg). Further, patients with multiple comorbidities at pre-declaration had a significantly lower peak V̇O₂ at 3 months (-1.0 mL/min/kg, p = 0.025) and it remained significantly low in those with a slower gait speed at 12 months after lifting the emergency declaration (-2.5 mL/min/kg, p = 0.009).

Conclusion: The emergency declaration declined the exercise tolerance in patients on phase III CR but improved to pre- declaration levels over time, but more likely declined in patients with multiple comorbidities during pre-declaration and those with low-gait speeds were less likely to improve their declined exercise tolerance.