Physiotherapy
· 2026 Jan · PMID 41934736
·
Publisher ↗
OBJECTIVES: To explore the experiences of female physiotherapists facing workplace violence. DESIGN: A descriptive phenomenological approach. PARTICIPANTS AND SETTING: Twenty-two Spanish female physiotherapists from both...OBJECTIVES: To explore the experiences of female physiotherapists facing workplace violence. DESIGN: A descriptive phenomenological approach. PARTICIPANTS AND SETTING: Twenty-two Spanish female physiotherapists from both public and private practice settings were recruited using purposive and snowball sampling. METHODS: Data were collected through individualized semi-structured interviews. Interviews averaged 40 minutes, were audio-recorded, transcribed verbatim in Spanish, and analysed. Thematic analysis was used for data analysis with ATLAS.ti computer software. RESULTS: Four main themes were identified: (1) characterizing workplace violence against physiotherapists, which includes physical and verbal aggression, as well as sexual harassment, primarily perpetrated by patients, their relatives, and occasionally superiors; (2) socialization and reporting of workplace violence, where participants often refrained from sharing or reporting incidents due to shame, fear of retaliation, or perceived impunity; (3) coping styles and consequences of workplace violence, which ranged from minimisation and emotional distancing to significant psychological distress, professional devaluation, and, in some cases, resignation; and (4) prevention of workplace violence, highlighting the importance of setting clear boundaries, developing protocols, improving workplace safety measures, and providing training on violence prevention and labour rights. CONCLUSIONS: Physiotherapists experience physical, verbal, and sexual violence, mainly from patients and their relatives, causing significant emotional impact. Underreporting is driven by fear of retaliation and perceived impunity. Preventive strategies, training on violent behaviour, workplace protocols, and improved policies are essential to ensure their safety and protection. CONTRIBUTION OF PAPER.
Physiotherapy
· 2026 Jan · PMID 41934735
·
Publisher ↗
Rehabilitation of patients with and recovering from Critical Illness has been in the spotlight of Critical Care Research for over 2 decades. Yet little progress has been made in defining interventions that address the ph...Rehabilitation of patients with and recovering from Critical Illness has been in the spotlight of Critical Care Research for over 2 decades. Yet little progress has been made in defining interventions that address the physical sequalae of critical illness. There is a lack of knowledge describing which patients will benefit from rehabilitation, when to start, what to do or how to quantify the intervention. The lack of an underlying theoretical framework for why rehabilitation with exercise as part of that rehabilitation, should have an impact on patient outcomes, further hinders delineating interventions. If indeed exercise underpins improvements in Physical Function, what constitutes exercise in a patient with or recovering from critical illness?
Vancampfort D, Van Assche D, Brunner E
… +5 more, Dankaerts W, Stubbs B, Bervoets C, McGrath RL, Van Damme T
Physiotherapy
· 2026 Jan · PMID 41934734
·
Publisher ↗
OBJECTIVES: This study compares the accuracy of physiotherapists screening for symptoms of anxiety and depression in patients with osteoarthritis using the Patient Health Questionnaire-2 (PHQ-2) for depression and the Ge...OBJECTIVES: This study compares the accuracy of physiotherapists screening for symptoms of anxiety and depression in patients with osteoarthritis using the Patient Health Questionnaire-2 (PHQ-2) for depression and the Generalized Anxiety Disorder-2 (GAD-2) for anxiety versus Numeric Rating Scales (NRS). DESIGN: Observational cross-sectional study. SETTING: Private physiotherapy practices. PARTICIPANTS: Forty physiotherapists with a median age of 33 (interquartile range, IQR 27-49) years; 23 male; median of 9 (5-21) years of experience, assessed 146 newly referred patients with osteoarthritis with a median age 55 (47-67) years; 23 male; median illness duration 120 (30-240) months, after two weeks of treatment. MAIN OUTCOME MEASURES: Patients reported anxiety and depression levels using the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9), respectively. Physiotherapists screened for anxiety and depression using the GAD-2, PHQ-2, and NRS for anxiety and depression. Area under the curve (AUC) values, calculated using DeLong's method, were used to compare the accuracy of the screening tools. RESULTS: The prevalence of at least mild, at least moderate, and severe anxiety was 67%, 32%, and 3%, respectively, while the prevalence of at least mild, at least moderate, and severe depression was 69%, 37%, and 4%. The brief screening tools demonstrated higher accuracy than the NRS in all cases except for severe depression. CONCLUSIONS: Physiotherapists should incorporate brief anxiety and depression screening tools, rather than NRS, into routine mental health assessments for patients with osteoarthritis to facilitate timely interventions including referrals to specialists. CONTRIBUTION OF THE PAPER.
Li J, Zhang Y, Cai P
… +6 more, Tang W, Chen L, Chen X, Huang S, Chen L, Cai W
Physiotherapy
· 2026 Feb · PMID 41931880
·
Publisher ↗
OBJECTIVES: To compare the function of abdominal, diaphragm, and pelvic floor muscles during respiratory tasks among women with postpartum stress urinary incontinence (PPSUI), postpartum continent women, and healthy null...OBJECTIVES: To compare the function of abdominal, diaphragm, and pelvic floor muscles during respiratory tasks among women with postpartum stress urinary incontinence (PPSUI), postpartum continent women, and healthy nulliparous women. DESIGN: A cross-sectional study. SETTING: The Department of Obstetrics at a tertiary hospital in Shenzhen, China. PARTICIPANTS: A total of 162 women, including 54 women with PPSUI, 54 postpartum continent women, and 54 healthy nulliparous women. MAIN OUTCOME MEASURES: Pelvic floor muscle activity, diaphragm excursion and thickness, and abdominal muscle activity were assessed at rest, during maximum deep respiration and during maximum voluntary cough using transabdominal ultrasound. RESULTS: Women with PPSUI showed significantly smaller transversus abdominis thickness change at the end of maximum deep expiration [26 (17) %] compared to postpartum continent women [59 (19) %, P < 0.05] and healthy nulliparous women [62 (20) %, P < 0.05]. They also exhibited greater pelvic floor muscle activity at the end of maximum deep expiration [5.4 (2.0) mm] than postpartum continent [3.2 (1.5) mm, P < 0.05] and healthy nulliparous women [3.0 (1.4) mm, P < 0.05]. In addition, diaphragm excursion during maximum deep respiration was smaller in the PPSUI group [44.8 (8.0) mm] compared to the healthy nulliparous group [57.1 (6.9) mm, P < 0.05]. CONCLUSION: Women with PPSUI exhibited reduced thickness change of abdominal muscles, limited diaphragm excursion, and increased pelvic floor muscle activity during tasks that increase intra-abdominal pressure. These findings suggest that impaired core muscle coordination may contribute to postpartum stress urinary incontinence. CONTRIBUTION OF THE PAPER.
Physiotherapy
· 2026 Feb · PMID 41930794
·
Publisher ↗
BACKGROUND: The use of saline instillation (SI) before endotracheal suction (ETS) in mechanically ventilated patients remains contentious, with reasons for SI use/non-use varying amongst ICU clinicians. Methodological he...BACKGROUND: The use of saline instillation (SI) before endotracheal suction (ETS) in mechanically ventilated patients remains contentious, with reasons for SI use/non-use varying amongst ICU clinicians. Methodological heterogeneity in the existing literature makes drawing firm conclusions surrounding SI practice, informing evidenced based practice guidelines and clinical recommendations challenging. OBJECTIVE: To report the extent, scope and nature of the existing literature on the use of SI during ETS and to identify research gaps. DATA SOURCES: A systematic search was conducted of the following databases: 'EMBASE', 'MEDLINE', 'Pedro', 'Cochrane', 'EMCARE', 'PubMed' and 'CINAHL'. STUDY SELECTION: Inclusion criteria: primary research, reporting on SI use during ETS on critical care, published in English between January 2013 and October 2025. SYNTHESIS METHODS: A charting form was developed and piloted to extract: Author, study demographics and design; aim; sampling technique/sample size; population; eligibility criteria; control/intervention; outcome measures and results. RESULTS: Ten studies were included. Five were interventional, primarily focusing on the effects of SI on patient physiological outcomes; only one conducted sputum analysis. Five studies were observational and explored ICU clinicians' beliefs and perceptions surrounding SI use, most commonly justified in the context of managing thick or viscous secretions. LIMITATIONS: Non-English language, review articles and grey literature were excluded. CONCLUSIONS: There is limited contemporary research investigating the effects of SI during ETS. Literature remains heterogenous with a gap in primary research objectively looking at the efficacy of SI during ETS on secretion clearance i.e., secretion yield, the primary reason ICU clinicians utilise SI, highlighting a future research opportunity. CONTRIBUTION OF PAPER.
Brown TM, Eleryan N, Parker C
… +3 more, Shawcross P, Cook PA, Martin R
Physiotherapy
· 2026 Jan · PMID 41923676
·
Publisher ↗
OBJECTIVES: The Fit Note (FN) may help people return to work and avoid prolonged sickness absence. However, its utilisation by physiotherapists is not understood. This study explored physiotherapists' views and practices...OBJECTIVES: The Fit Note (FN) may help people return to work and avoid prolonged sickness absence. However, its utilisation by physiotherapists is not understood. This study explored physiotherapists' views and practices regarding work-focused health care and FN use. DESIGN: A mixed methods study involving an online survey followed by six online focus groups. PARTICIPANTS: United Kingdom (UK) physiotherapists (n = 401) working in a variety of settings responded to the survey. Sixteen also participated further in the focus groups. RESULTS: Participants (89%) viewed supporting patients to stay-in or return-to-work as part of their role, yet only 31% regularly issued FNs. Key themes were developed: physiotherapists recognise work as integral to care, and those issuing FNs do so in line with guidance, recommending strategies to help patients remain in or return to employment. Barriers included organisational, individual factors, such as limited recognition of physiotherapists' role and lack of confidence or knowledge, and perceived patient barriers including lack of awareness. Facilitators included training, organisational support, and a multidisciplinary approach to work-related issues. CONCLUSION: This study, the largest of its kind in the UK, indicates that physiotherapists regard work and health as integral to their professional responsibilities; however, FN implementation remains inconsistent. Qualitative findings reveal organisational, practitioner, and perceived patient barriers. Recommendations include improved mentorship and consistent digital FN access across all clinical settings. Further research should explore task-shifting consequences and patient perspectives. CONTRIBUTION OF THE PAPER.
Hough J, Gouveia M, Steele M
… +1 more, McAlinden B
Physiotherapy
· 2026 Mar · PMID 41916028
·
Publisher ↗
OBJECTIVE: Evaluate the impact of lung ultrasound (LUS) compared to current chest physiotherapy (CPT) outcome measures on clinical decision-making in the Neonatal Intensive Care Unit (NICU). DESIGN AND SETTING: Single-ce...OBJECTIVE: Evaluate the impact of lung ultrasound (LUS) compared to current chest physiotherapy (CPT) outcome measures on clinical decision-making in the Neonatal Intensive Care Unit (NICU). DESIGN AND SETTING: Single-centre prospective observational study at the NICU, Mater Mothers Hospital (MMH), Brisbane. PARTICIPANTS: Infants admitted to the NICU who had a chest x-ray (CXR) within the preceding 24 h. Infants were excluded if LUS was not possible, were expected to be discharged from MMH in less than 24 h or had a plan for redirection of care. INTERVENTIONS: Infants were assessed using CXR and auscultation by a physiotherapist, who recorded a diagnosis and intervention plan. An examiner blinded to the initial assessment then performed a LUS assessment. After receiving the LUS results, the initial physiotherapist recorded a re-evaluated intervention plan. MAIN OUTCOME MEASURES: The primary outcome was the net reclassification improvement (NRI), which quantified how frequently physiotherapy diagnosis and treatment was reclassified after LUS. Secondary outcomes included diagnostic concordance between CXR/auscultation and LUS, and physiotherapist confidence in diagnoses. RESULTS: From 30 included episodes, NRI was -41% (SE 0.38; 95% CI -116% to 33%), indicating that LUS did not significantly result in reclassification of physiotherapy diagnosis and treatment. Diagnostic concordance was moderate at 0.595 (p < 0.001) observed in 21 (70%) cases, resulting in treatment alteration in nine instances. After LUS, physiotherapy confidence in diagnosis increased by 1.16 on a 7-point Likert scale (p < 0.001). CONCLUSIONS: Although LUS did not result in significant reclassification of physiotherapy diagnosis and treatment, it did result in treatment alteration and improved physiotherapy confidence in diagnosis. ANZCTR REFERENCE NUMBER: ACTRN12624000290594. CONTRIBUTION OF THE PAPER.
Chance-Larsen K, Fenemor R, Mbada C
… +1 more, Walsh N
Physiotherapy
· 2026 Mar · PMID 41895244
·
Publisher ↗
In this debate article we draw on insights from a focused symposium at the World Physiotherapy Congress 2025, where we explored the embedding of physiotherapy in general practice and the role of First Contact Physiothera...In this debate article we draw on insights from a focused symposium at the World Physiotherapy Congress 2025, where we explored the embedding of physiotherapy in general practice and the role of First Contact Physiotherapy (FCP). We did this through the lens of four distinct national contexts: the UK, Norway, Nigeria, and New Zealand. We present country-specific experiences to show how historical, cultural, and systemic factors shape FCP implementation. Across these settings, we identify common challenges, including tensions around professional boundaries, patient expectations, workforce readiness, and funding mechanisms. We also highlight locally adapted solutions such as co-location, policy reform, competency development, and culturally responsive models that demonstrate the importance of tailoring FCP to local needs. Finally, we reflect on the strategic implications for global practice, advocating for flexible frameworks, international collaboration, and context-sensitive innovation to support equitable and sustainable development of FCP worldwide. CONTRIBUTION OF THE PAPER.
Physiotherapy
· 2026 Feb · PMID 41880815
·
Publisher ↗
OBJECTIVE: To investigate changes in mobility and factors affecting mobility over a 2-year period from childhood to adolescence in children with cerebral palsy. DESIGN AND SETTING: A multi-site, prospective, longitudinal...OBJECTIVE: To investigate changes in mobility and factors affecting mobility over a 2-year period from childhood to adolescence in children with cerebral palsy. DESIGN AND SETTING: A multi-site, prospective, longitudinal, cohort study was carried out. Data were collected in a single one-hour session at school or at home at baseline, and again one year and two years later. PARTICIPANTS: Seventy-five children with cerebral palsy aged 10.8 years (SD 1.1) at baseline participated. Participants were classified within Level I (33%), Level II (35%), Level III (12%) and Level IV (20%) of the Gross Motor Function Classification System (GMFCS). METHODS: Five impairments (loss of sensation, loss of strength, incoordination, spasticity and contracture) and three aspects of mobility (5-Times-Sit-To-Stand Test, 10-m Walk Test and 6-min Walk Test) were measured. All measurements were collected by one physiotherapist with 15 years of experience. Stepwise multiple regression analysis was conducted to examine the relationship between change in sensory and motor impairments with change in mobility. RESULTS: Overall, mobility, as well as coordination and strength increased, while spasticity, contracture, and sensation remained the same over the two years. In terms of the 6-min Walk Test, approximately 74% of participants improved, while 11% did not change and 15% deteriorated. Change in strength and coordination accounted for 20% of the variance in change in the 6-min Walk Test. CONCLUSIONS: Mobility increased over the two years of pre-adolescence and this was accompanied by an increase in muscle strength and coordination. CONTRIBUTION OF PAPER.
Physiotherapy
· 2026 Jun · PMID 41820130
·
Publisher ↗
OBJECTIVES: The aim of this study was to verify the efficacy of airway clearance technique on drug delivery by nebulization. DESIGN: Cross-over study. PARTICIPANTS: Stable patients with CF (PwCF) (n=8). INTERVENTIONS: Pa...OBJECTIVES: The aim of this study was to verify the efficacy of airway clearance technique on drug delivery by nebulization. DESIGN: Cross-over study. PARTICIPANTS: Stable patients with CF (PwCF) (n=8). INTERVENTIONS: Participants performed the airway clearance technique before or after the nebulization session. The Autogenic Drainage (AD) was the executed airway clearance techniques. The nebulization session was a delivery of 500 mg-amikacin with the AKITA®. MAIN OUTCOME MEASURES: The primary endpoint was the 24 h-urinary excretion of amikacin. RESULTS: PwCF were between 18 and 48 years old (FEV1: 43 to 92 %), all colonized by Pseudomonas aeruginosa, and all with bronchiectasis. Irrespective of the order of the nebulization and the physiotherapy sessions, the total amount of urinary amikacin excretion was similar (Median Difference (95%CI): 0 (-7 to 4)% of the nominal dose). The elimination constant rate for nebulization before (Median: 0.153 (IQR: 0.071 to 0.205)) and after the airway clearance technique (0.149 (0.041 to 0.182); p = 0.26) were similar (Median difference (95%CI): 0.02 (-0.004 to 0.023)). CONCLUSIONS: The lung delivery of nebulized medication in PwCF colonized with Pseudomonas aeruginosa was not improved by the order of the airway clearance and nebulization procedures. CONTRIBUTION OF THE PAPER.
Begg B, Powell R, Birkett ST
… +10 more, Griffiths TD, Drane AL, Davey H, Penn Z, Shave RE, Nicholls S, Lord RN, Cowie A, McGregor G, Ingle L
Physiotherapy
· 2026 Jun · PMID 41814106
·
Publisher ↗
OBJECTIVE: High intensity interval training (HIIT) is recognised within many international cardiac rehabilitation guidelines. In the United Kingdom, however, similar guidance does not exist; moderate intensity training r...OBJECTIVE: High intensity interval training (HIIT) is recognised within many international cardiac rehabilitation guidelines. In the United Kingdom, however, similar guidance does not exist; moderate intensity training regimens have traditionally been advocated. The aim is to provide a pragmatic technical report for practitioners working in CR to implement low-volume HIIT programmes for people with coronary artery disease (CAD). METHODS: We characterised the acute physiological response to low-volume HIIT and outlined patient inclusion and exclusion criteria, along with clinical and safety considerations. Additionally, we explored its practical implications to facilitate implementation in clinical practice. A detailed methodology for the 10 × 1-min low-volume HIIT model is provided, including exercise training progression criteria RESULTS: Key considerations for familiarisation, supervision, prescription, monitoring, recording, and reporting are discussed, underpinned by an overview of the acute physiological response to the training modality. CONCLUSIONS: We anticipate that this pragmatic evidence-based technical report will support practitioners in implementing low-volume HIIT in routine clinical practice, thus, allowing it to be offered as standard care alongside more traditional moderate intensity exercise training programmes.
Ford H, Lewis J, Tyros V
… +8 more, Low DC, Bateman WR, Lee Y, Sakadasariya R, Rex J, Oldfield M, Davare M, Shaheen AF
Physiotherapy
· 2026 Jun · PMID 41619345
·
Publisher ↗
OBJECTIVES: Introduce The ExtRA Capacity Test, a measure for assessing shoulder muscle performance. Assess its reliability, validity and present normative scores in a large sample of asymptomatic adults. DESIGN: Cross-se...OBJECTIVES: Introduce The ExtRA Capacity Test, a measure for assessing shoulder muscle performance. Assess its reliability, validity and present normative scores in a large sample of asymptomatic adults. DESIGN: Cross-sectional observational study with test-retest. SETTING: Community. PARTICIPANTS: Volunteers (n = 344, age 20-90 years). INTERVENTIONS: The ExtRA Capacity Test involves two capacity tests completed to a 30 beats per minute metronome: maximal scapular plane lateral raises to 90° abduction with 2.5 kg of external load, and maximal external rotations in unsupported prone lying with the shoulder at 90° abduction. Reliability was assessed in 30 asymptomatic participants, tested by two raters over two sessions, one week apart, using Bland-Altman analysis to determine mean bias and 95 % limits of agreement (LoA) as measures of error. Criterion validity was evaluated in 20 participants using Pearson correlation to examine the relationship between ExtRA and isokinetic dynamometry measures. A normative dataset was also established from 344 asymptomatic individuals across a range of ages, physical activity levels, and both sexes. RESULTS: The intra-rater and inter-rater agreement for the ExtRA Capacity Test was assessed in a sample of 30 participants. The 95 % LoA for abduction and external rotation measurements ranged from 2.9 to 13.1 repetitions. In a sample of 20 participants, the abduction test showed good/moderate correlation with muscle strength measures but not with the external rotation test. Older age, female sex and not achieving the WHO activity guidelines have a negative impact on ExtRA performance. CONCLUSIONS: Within the caveats discussed in this paper, ExtRA can be considered a reasonably reliable tool for assessing shoulder strength and control in a clinical setting. The normative database will help clinicians set rehabilitation or return-to-play targets based on sex, age, and physical activity level. CONTRIBUTIONS OF PAPER.
Physiotherapy
· 2025 Dec · PMID 41605724
·
Publisher ↗
BACKGROUND: Best management for the common, severe condition of Gluteal tendinopathy has not been determined, with exploration of expert clinical reasoning notably absent. We aimed to inform clinical care by exploring ho...BACKGROUND: Best management for the common, severe condition of Gluteal tendinopathy has not been determined, with exploration of expert clinical reasoning notably absent. We aimed to inform clinical care by exploring how experts manage GT. METHODS: An interview topic guide, iteratively developed with experts, was used alongside an online interview prompt with purposively sampled international inter-disciplinary experts during online, semi-structured interviews. Iterative framework and content analysis using a positivist stance was performed alongside recruitment until adequate information power was reached. RESULTS: Twenty participants including physiotherapists, physicians, and surgeons (14 males, 6 females) were interviewed for a mean (SD) of 52 (20) minutes yielding 5 main themes of: Therapeutic alliance: Developing a positive therapeutic alliance through emphatic engagement. "Give them a stack of reassurance and listen to their story";Service Delivery and multidisciplinary team involvement: "Patients get 45 min…they get a package (of care) …"; Clinical reasoning: "I usually use three things in a patient's specific context. So, it's going to be about the quality of sleep. Yeah, their ability to walk, and their ability to sit and get up from sitting…."; Exercise principles: "frontal plane control being priority for gluteal tendinopathy"; Specific interventions"You need to further that education as you go along. But patients can only take in so much at once." CONCLUSION: Expert reasoning prioritises personalised exercise and education as the core management approach in a reflexive therapeutic relationship incorporating individually staged interventions. Future work needs to focus on incorporating expert reasoning into clinical guidelines. CONTRIBUTION OF THE PAPER.
Hams A, Prudden C, Baque E
… +4 more, Collings T, Edwards S, Shepherd R, Jones T
Physiotherapy
· 2026 Jun · PMID 41534164
·
Publisher ↗
BACKGROUND: Musculoskeletal conditions contribute significantly to global health burden through impaired function and pain. Physiotherapy student-led services provide a model for addressing community healthcare needs whi...BACKGROUND: Musculoskeletal conditions contribute significantly to global health burden through impaired function and pain. Physiotherapy student-led services provide a model for addressing community healthcare needs while offering clinical training experiences. Despite their prevalence, description of patient demographics and clinical outcomes (function and pain) remains under-explored. OBJECTIVES: To evaluate changes in self-reported function and pain and describe patient demographics and presenting musculoskeletal conditions of patients accessing a student-led service. DESIGN SETTING AND PARTICIPANTS: Observational pre-post study at a student-led musculoskeletal physiotherapy service in Australia involving ninety-nine community-dwelling participants (Mdn age = 29 years, IQR = 22-40). METHODS: Final-year physiotherapy students managed patient care under senior physiotherapist supervision. Demographic and presenting condition data were collected at the initial appointment, while self-reported outcome measures of function (Patient Specific Functional Scale: PSFS) and pain (Numeric Pain Rating Scale: NPRS) were recorded at all appointments. RESULTS: A significant positive correlation was observed between appointment frequency and PSFS scores. At each appointment, the PSFS score increased by 0.8 units (95% CI 0.4 to 1.1, p < .001). There was a significant negative correlation between appointment frequency and NPRS scores, with each appointment associated with a 0.6 unit decrease in NPRS scores (95% CI: -0.8 to -0.4, p < 0.001). CONCLUSIONS: This study adds to growing evidence describing patient-reported outcomes within student-led physiotherapy services, showing that patients attending reported improvement in self-reported function and pain. Limitations of a pragmatic service evaluation are acknowledged; further multi-site longitudinal research is recommended. CONTRIBUTION OF THE PAPER.
Kiani S, Rezaei I, Ebrahimi N
… +2 more, Abasi S, Yazdani A
Physiotherapy
· 2026 Jun · PMID 41529319
·
Publisher ↗
INTRODUCTION: Exercise therapy is a commonly recommended intervention for managing musculoskeletal disorders. Utilizing virtual reality (VR) could prove effective in enhancing exercise therapy. Consequently, the objectiv...INTRODUCTION: Exercise therapy is a commonly recommended intervention for managing musculoskeletal disorders. Utilizing virtual reality (VR) could prove effective in enhancing exercise therapy. Consequently, the objective of this study is to design and develop a prototype of a VR-based therapeutic exercise game called Vitality, which is suitable for patients with lower limb musculoskeletal disorders. METHODS: This development-applied study was conducted in three phases, determining the identification and confirming requirements, development, and performance evaluation. In the first phase, functionality was extracted by the Delphi technique. In the second phase, the prototype was developed using the Unity 2018 reconstruction engine. Finally, the Vitality was evaluated using the ISO/IEC 25010:2011 product quality model. RESULTS: The implementation of the first phase led to the extraction of therapeutic practice and the selection of 54 information items during two Delphi rounds for the VR game. A game prototype was then developed, focusing on each of the 16-step therapy exercises in an avatar-based fashion. The evaluation results showed that the functional suitability of the Vitality was 88% and its usability was 94%. CONCLUSIONS: This research presents the VR game for the rehabilitation of different types of musculoskeletal disorders by considering more exercises and a customizable user interface that allows for game difficulty adjustment.
Occhetto B, Ballesio M, Mourad F
… +4 more, Trucco M, Maselli F, Chiarotto A, Feller D
Physiotherapy
· 2026 Jun · PMID 41529318
·
Publisher ↗
INTRODUCTION: Neck pain is a prevalent condition that can occasionally indicate serious underlying pathologies, such as tumours. Red flags are clinical indicators used to identify patients at risk of such conditions. Thi...INTRODUCTION: Neck pain is a prevalent condition that can occasionally indicate serious underlying pathologies, such as tumours. Red flags are clinical indicators used to identify patients at risk of such conditions. This scoping review systematically maps and summarizes the literature on red flags for tumours in patients presenting with neck pain in primary care, highlighting evidence gaps and priorities for future research. METHODS: A comprehensive search across four databases up to June 2025 targeted studies on patients of any age or gender presenting with neck pain as the primary complaint and a final diagnosis of a tumour. Only studies conducted in primary care were included, with no time or geographical restrictions. Data were synthesized quantitatively and thematically. RESULTS: From 10,211 initial records, 25 studies met the inclusion criteria, all being case reports. The most frequently reported red flags were severe neck pain, which may become progressive and constant, neurological signs and symptoms, and nocturnal neck pain. However, inconsistencies in reporting were observed: many commonly discussed red flags were absent from case reports, while some red flags highlighted in case reports are not extensively covered in the literature. CONCLUSION: Evidence on red flags for tumours in patients with neck pain in primary care remains fragmented. While certain red flags were frequently reported, their clinical utility is limited by inconsistent reporting and a lack of robust evidence. Further research is needed to standardize red flags and assess their diagnostic accuracy to improve early tumour detection in patients with neck pain. CONTRIBUTION OF PAPER.