Physiotherapy
· 2026 Mar · PMID 41308270
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OBJECTIVES: Behaviour change interventions may support physical activity behaviour in people with chronic respiratory disease. The most effective interventions for long-term physical activity behaviour change in this coh...OBJECTIVES: Behaviour change interventions may support physical activity behaviour in people with chronic respiratory disease. The most effective interventions for long-term physical activity behaviour change in this cohort remains unclear. This aim of this study was to explore the use and perceptions of behaviour change interventions by both providers of physical activity programmes for people with chronic respiratory disease and by people living with chronic obstructive pulmonary disease (COPD) in The Republic of Ireland. DESIGN: Two anonymous online and paper-copy cross-sectional surveys, piloted and mapped to the COM-B model of behaviour change, were distributed via social media and relevant gate-keepers (e.g Irish Society of Chartered Physiotherapists, COPD Support Ireland) between November 2023 and April 2024. Findings were summarised using descriptive statistics including frequencies, percentages, means and medians. Relationships between variables were investigated using Chi (p = 0.05). RESULTS: The response rate to the provider survey was 71% (107/150), and 112 participants responded to the COPD cohort survey. Providers perceived encouragement, pertaining to theoretical constructs such as self-confidence, optimism and reinforcement to be the most effective techniques influencing physical activity behaviour. People with COPD perceived social support, pertaining to theoretical constructs such as interpersonal skills and social identity, to be the most effective interventions influencing their physical activity behaviour. Motivation was frequently identified as a common COM-B component, suggesting important links to this mechanism of action in influencing behaviour. CONCLUSIONS: Interventions with motivational components are perceived as effective influencers of physical activity behaviour by providers of physical activity programmes and by those living with chronic respiratory disease. CONTRIBUTION OF THE PAPER.
Aygun-Polat E, Polat Y, Ozbilen YE
… +3 more, Altun A, Acaroz S, Cirakli A
Physiotherapy
· 2026 Mar · PMID 41289866
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OBJECTIVES: To assess the validity and reliability of the Six-Spot Step Test (SSST) in total hip arthroplasty (THA) patients. DESIGN: Cross-sectional cohort study. SETTING: Outpatient clinic. PARTICIPANTS: Sixty-one pati...OBJECTIVES: To assess the validity and reliability of the Six-Spot Step Test (SSST) in total hip arthroplasty (THA) patients. DESIGN: Cross-sectional cohort study. SETTING: Outpatient clinic. PARTICIPANTS: Sixty-one patients at least six months post-primary THA. MAIN OUTCOME MEASURES: The SSST was performed twice on the same day by Rater 1, along with the Timed Up and Go (TUG), Four-Square Step Test (FSST), and Berg Balance Scale (BBS). It was repeated 5-7 days later by Raters 1 and 2. Reliability was assessed using intraclass correlation coefficients (ICC) and Bland-Altman analysis; validity with Spearman's correlation. A fall-risk cut-off was identified via receiver operating characteristic (ROC) analysis. RESULTS: Participants' mean (SD) age was 64 (7) years, with an Oxford Hip Score of 37 (8). As defined by the Bland-Altman analysis, the agreement intervals, within which 95% of the differences of the second measurement, compared to the first one, fall were: within day -1.7 to 2.3 seconds (s), -2.3 to 2.0 seconds between day and -2.0 to 1.9 between raters. Reliability was excellent within-day (ICC: 0.95), between-day (ICC: 0.94), and inter-rater (ICC: 0.95). The SSST correlated strongly with the TUG (ρ = 0.70) and FSST (ρ = 0.81), and moderately with the BBS (ρ = -0.62). A cut-off of 10.7 seconds indicated fall risk (sensitivity: 75%; specificity: 73%; AUC = 0.82, 95% CI: 0.71-0.94, p < 0.001). CONCLUSION: The SSST is a reliable and valid tool for assessing mobility in THA patients. It effectively identified fall risk in this sample, supporting its clinical use. However, further validation in different samples is required. CLINICAL TRIAL REGISTRATION NUMBER: NCT06704217 CONTRIBUTION OF PAPER.
Physiotherapy
· 2026 Mar · PMID 41275724
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BACKGROUND: Single camera markerless motion capture technology offers a potential means of assessing joint function in patients with musculoskeletal disorders/diseases. The aim of this study was to determine the validity...BACKGROUND: Single camera markerless motion capture technology offers a potential means of assessing joint function in patients with musculoskeletal disorders/diseases. The aim of this study was to determine the validity and within-session reliability of sagittal plane knee joint kinematics quantified using the Deep Vision platform in patients with knee osteoarthritis. METHODS: Sagittal plane knee joint kinematics were quantified using a 3D motion capture system, the msk.ai Deep Vision platform and Kinovea in fifteen patients with knee osteoarthritis. Bland Altman plots with 95 % limits of agreement were used to assess validity and within-session reliability, with mean differences and limits of agreement explored relative to ± 5° and 10° clinically meaningful thresholds, respectively. This is based on the assumption that changes in joint angles greater than 5° are clinically meaningful. RESULTS: Mean differences and 95 % limits of agreement were within the clinically meaningful thresholds when using the Deep Vision platform to quantify peak knee flexion and extension, and range of motion. Mean differences were within the clinically meaningful threshold for Kinovea based assessments, but 95 % limits of agreement exceeded the ± 10° clinically meaningful threshold for peak flexion and range of motion. All assessment methods displayed mean differences and 95 % confidence intervals within the clinically meaningful thresholds on average when comparing across repetitions to quantify within-session reliability. CONCLUSION: The findings of the study demonstrate that the msk.ai Deep Vision platform provides a valid and reliable means of quantifying peak knee flexion, extension and range of motion. CONTRIBUTION OF THE PAPER.
Physiotherapy
· 2026 Mar · PMID 41275723
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BACKGROUND: Difficulties with sitting balance are common after stroke. The ability to sit unsupported is imperative for many daily tasks and correlated to more positive outcomes. There is limited research on "sitting bal...BACKGROUND: Difficulties with sitting balance are common after stroke. The ability to sit unsupported is imperative for many daily tasks and correlated to more positive outcomes. There is limited research on "sitting balance" therapeutic interventions and their impact. This systematic review and meta-analysis aims to investigate the effectiveness of physiotherapy sitting balance treatments on sitting balance outcomes in people up to 3-months post-stroke. METHODS: The PRISMA checklist was followed and the review registered on PROSPERO. Seven electronic databases were searched to October 2023 (updated in January 2025) for studies comparing treatments focussing on sitting balance in adults who had suffered a cerebral stroke in the last three months. Studies were included if treatment was predominantly completed in sitting postures and reported sitting balance outcomes. Studies were assessed for eligibility, and data extraction and risk of bias was completed by two independent reviewers. RESULTS: Data from 16 studies (623 participants) was synthesised narratively. Sitting balance interventions were classified into four main categories: weight shift and reaching; core stability exercises; environmental modifications; and task practice. A random effects meta-analysis conducted on eight studies (342 participants) revealed interventions to be beneficial for sitting balance (primary outcome: mean difference Trunk Impairment Scale 3.02; 95% confidence interval 2.19 to 3.86). Four studies demonstrated low risk of bias; and four showed some concerns. CONCLUSIONS: The current sitting balance treatments offered to early sub-acute stroke patients show significant improvements in sitting balance primary outcome. Sitting balance treatments can be categorised into four sub-types, helping to standardise clinical application and ensure consistency in future research. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42023444050. CONTRIBUTION OF THE PAPER.
Moffatt F, Narayanasamy M, Smith B
… +4 more, Stocks J, Sheehan K, Sackley C, Hall M
Physiotherapy
· 2026 Mar · PMID 41273943
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PURPOSE: Arthrofibrosis following total knee arthroplasty (TKA) is a recognised complication resulting in severe stiffness with limited options for treatment. To date, little is known about the lived experiences of those...PURPOSE: Arthrofibrosis following total knee arthroplasty (TKA) is a recognised complication resulting in severe stiffness with limited options for treatment. To date, little is known about the lived experiences of those affected. This study aimed to understand the perceived impact of arthrofibrosis, the experience of the treatment pathway, and perceptions of barriers to optimal care. METHODS: Participants who had undergone elective TKA with postoperative arthrofibrosis, were recruited from three NHS orthopaedic units. All interviews were conducted using a semi-structured interview schedule, digitally recorded, and transcribed verbatim. Data were analysed using thematic analysis. RESULTS: Fourteen patients were recruited. Four themes were developed from the data: Adjusting to Loss: Erosion of Function and Identity - the impact on function was overwhelming and significantly impaired social functioning. This resulted in self-reported adverse mental health outcomes. Seeking Clarity and Compassion: Navigating Communication with Healthcare Professionals - many participants described inconsistency in advice given post-TKA, particularly concerning exercise. Many felt that they had unmet needs related to their rehabilitation. Making Sense of a Stalled Recovery: The Quest for Answers, Solutions and Hope - significant emotional labour was invested in understanding what was happening to their knee. Commitment and Constraint: Navigating Rehabilitation in Everyday Life - participants described a commitment to post-operative exercise regimes; all had integrated exercises into daily activities but continued to face challenges. CONCLUSIONS: The experience of arthrofibrosis after TKA is disruptive, distressing and frustrating. Future development of interventions and clinical pathways should ensure person-centred approaches that offer consistency and clarity of advice, particularly regarding exercise. CONTRIBUTION OF PAPER:STUDY REGISTRATION NUMBER: NCT05459259.
Caird B, McGowan N, Depiazzi J
… +2 more, Marpole R, Gibson N
Physiotherapy
· 2026 Mar · PMID 41273942
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OBJECTIVE: To describe the physiotherapy interventions provided to children with cerebral palsy (CP) at risk of respiratory illness and determine criteria for safe in-home treatment. DESIGN: Descriptive study of physioth...OBJECTIVE: To describe the physiotherapy interventions provided to children with cerebral palsy (CP) at risk of respiratory illness and determine criteria for safe in-home treatment. DESIGN: Descriptive study of physiotherapy interventions received by children enrolled in the treatment arm of a 12-month feasibility randomised controlled trial between March 2022 and July 2023. SETTING: Tertiary hospital, community and in-home. PARTICIPANTS: Ten children with CP aged 28 months to 12 years. INTERVENTIONS: All types of respiratory physiotherapy interventions. MAIN OUTCOME MEASURES: Types of physiotherapy interventions, the number, location, and duration of occasion of service (OOS), patient symptoms at baseline and post intervention, stability of participant during treatment sessions. RESULTS: There were 159 physiotherapy intervention OOS, median (range) 15.5 (4 to 27). All 10 children had at least one new or worsened symptom at a follow up visit that was present before physiotherapy commenced and was not present at their initial baseline assessment on entry to the study. Nine children received individualised respiratory action plans, seven received airway clearance-based plans and two exercise-based plans. The most frequently used airway clearance techniques were manual techniques and positioning. Lung health education was delivered to all participants on every visit. No negative events related to physiotherapy interventions occurred. Criteria for children deemed unsuitable for respiratory physiotherapy interventions outside the hospital were developed. CONCLUSION: Airway clearance, positioning and lung health education were the most frequently used respiratory physiotherapy interventions in the community. These were safe when children had clear action plans and were delivered by a skilled respiratory paediatric physiotherapist with tertiary experience. CONTRIBUTION OF THE PAPER.
Sampford J, Myers-Ingram R, Jones GD
… +1 more, Cork S
Physiotherapy
· 2026 Mar · PMID 41273939
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Obesity is a global health concern requiring multidisciplinary approaches for effective management. Incretin-based pharmacotherapies, such as glucagon-like peptide 1 receptor agonists and dual GLP-1 and glucose-dependent...Obesity is a global health concern requiring multidisciplinary approaches for effective management. Incretin-based pharmacotherapies, such as glucagon-like peptide 1 receptor agonists and dual GLP-1 and glucose-dependent insulinotropic polypeptide receptor agonists, have demonstrated significant weight loss outcomes, yet their impact on body composition remains underexplored. Evidence indicates that weight loss with these medications may lead to disproportionate fat-free mass loss, heightening risks of sarcopenia and sarcopenic obesity, which are associated with frailty, comorbidities, and reduced functionality. Exercise, particularly resistance training, has proven effective in preserving fat-free mass and optimising long-term weight maintenance. Physiotherapists are uniquely positioned, as one of the largest professions within the Allied Healthcare Professional workforce, their expertise in exercise prescription, rehabilitation, and behaviour change, has the potential to address these challenges. However, concerningly, much of the guidance around the prescription of incretin-based therapies for weight loss fails to mention the inclusion of physiotherapists in the patient management team, and the impact that they can have on clinical outcomes. This debate article argues for the inclusion of physiotherapy within interdisciplinary teams managing patients on incretin-based pharmacotherapy to optimise their efficacy and promote healthier weight loss. CONTRIBUTION OF THE PAPER.
Mastwyk S, Taylor NF, Lowe A
… +2 more, Dalton C, Peiris CL
Physiotherapy
· 2026 Mar · PMID 41273938
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BACKGROUND: Physiotherapists in primary care are well placed to provide health promotion interventions that target client metabolic risk factors. OBJECTIVE: To determine the effectiveness of health promotion intervention...BACKGROUND: Physiotherapists in primary care are well placed to provide health promotion interventions that target client metabolic risk factors. OBJECTIVE: To determine the effectiveness of health promotion interventions delivered by physiotherapists in primary care on metabolic outcomes for people with or at risk of metabolic syndrome. DATA SOURCES: AMED, CINAHL, Cochrane, Medline, PEDro, PsycInfo, SPORTDiscus (searched up to February 2024). ELIGIBILITY CRITERIA: Studies evaluating physiotherapist-delivered health promotion interventions for adults with at least one metabolic risk factor (abdominal obesity, hypertension, elevated triglycerides, reduced HDL-C or elevated glucose) delivered in primary care settings were included. STUDY APPRAISAL AND SYNTHESIS: Two reviewers extracted data, evaluated methodological quality using the Mixed Methods Appraisal Tool, and certainty of evidence using GRADE. Meta-analyses were conducted using a random effects model to calculate weighted mean differences (WMD) for outcomes on common scales, and standardised MD (SMD) for outcomes on different scales. RESULTS: Twenty-five studies (n = 3619 participants) were included. Moderate-high certainty evidence indicated that physiotherapist-delivered health promotion interventions reduced waist circumference (WMD -2.42 cm, 95%CI -4.31 to -0.53), diastolic blood pressure (WMD -2.34 mmHg, 95%CI -3.77 to -0.91), triglycerides (WMD -0.18 mmol/L, 95%CI -0.36 to 0.00) and fasting blood glucose (WMD -0.18 mmol/L, 95%CI -0.28 to -0.08), and increased physical activity (SMD 0.18, 95%CI 0.04 to 0.32) compared to usual care. CONCLUSION: Physiotherapy-led health promotion interventions in primary care can improve metabolic risk factors and physical activity levels for people with or at risk of metabolic syndrome by small but clinically significant amounts. SYSTEMATIC REVIEW REGISTRATION NUMBER: Systematic Review Registration Number PROSPERO CRD42022352725. CONTRIBUTION OF THE PAPER.
Physiotherapy
· 2026 Mar · PMID 41273936
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OBJECTIVES: To map the extent of advanced practice physiotherapy (APP) integration in Danish hospitals and explore the roles and characteristics of these models of care. DESIGN: Cross-sectional survey. SETTING: All hospi...OBJECTIVES: To map the extent of advanced practice physiotherapy (APP) integration in Danish hospitals and explore the roles and characteristics of these models of care. DESIGN: Cross-sectional survey. SETTING: All hospitals in Denmark (secondary care). PARTICIPANTS: Representatives from all 36 Danish hospitals were contacted; 31 responded (86 % response rate). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Prevalence and duration of APP models, departmental placement, scope of responsibilities, and any required education or competencies. RESULTS: Seventeen of the 31 respondent hospitals (55 %) reported having APP roles. The mean duration of APP integration was 9.7 years. Most APP models were located in orthopaedic departments, although they were also present in rheumatology, internal medicine, and acute medical units. Common APP functions included initial patient examination, triage, ordering diagnostic imaging, establishing medical diagnoses, and, in some settings, performing injections or fracture repositioning. Less frequently reported functions included ultrasound examinations and cast application. All respondents noted continuous access to physician consultation. Considerable regional variation was observed in both the departmental integration of APP and the range of responsibilities undertaken by APP clinicians. CONCLUSIONS: Approximately half of Danish hospitals reported established APP roles, indicating broader uptake than previously captured by global surveys. The observed variability across regions and departments underscores the need for standardized guidelines, further research on clinical effectiveness, and clarification of required competencies. Understanding these factors may help optimize APP implementation and improve patient access to timely and effective musculoskeletal and general healthcare.
Bernal-Utrera C, Bravo-Vázquez A, Montero-Bancalero FJ
… +3 more, Suárez-Vega A, Casuso-Holgado MJ, Anarte-Lazo E
Physiotherapy
· 2026 Mar · PMID 41270301
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OBJECTIVE: To assess the accuracy and reliability of an artificial intelligence (AI) chatbot (ChatGPT) in providing answers about exercise recommendations for breast cancer survivors. DESIGN: Cross-sectional study. METHO...OBJECTIVE: To assess the accuracy and reliability of an artificial intelligence (AI) chatbot (ChatGPT) in providing answers about exercise recommendations for breast cancer survivors. DESIGN: Cross-sectional study. METHODS: We extracted recommendations from recent systematic reviews of clinical practice guidelines (CPGs) on therapeutic physical exercise in breast cancer survivors. Clinical questions were developed and queried to ChatGPT-4. We evaluated the performance of ChatGPT-4 as a counseling tool by assessing the accuracy of responses (percentage of agreement with CPGs recommendations, weighted Cohen's kappa and the percentage of text wording similarity) and the intra-rater and inter-rater reliability in grading ChatGPT answers (kappa value). RESULTS: We tested 15 clinical questions. The accuracy of the AI chatbot´s responses was considered unacceptable, with only 7% of responses being reasonably accurate (1/14), 64% of responses being partially accurate (9/14) and 29% being completely incorrect (4/14). It was observed a low Kappa coefficient (k = 0.244, CI: 0.089 to 0.577) and the similarity of responses was also considered unacceptable, with 27.2% of overlapping text wording. Intra and inter-rater reliability showed moderate to good values in all cases. CONCLUSIONS: ChatGPT does not appear to be an accurate counselling tool for answering questions about exercise recommendations for breast cancer survivors. Compared to CPG´s recommendations, the accuracy of ChatGPT responses was considered poor, with moderate to good reliability. It is important to make patients know that they should not only base their decisions on information coming from ChatGPT. CONTRIBUTION OF THE PAPER.
O'Riordan JMCV, McCullagh R, Sheill G
… +2 more, French HP, Horgan F
Physiotherapy
· 2026 Mar · PMID 41167023
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OBJECTIVE: International guidelines recommend exercise-based rehabilitation in advanced cancer, however planning and implementation of rehabilitation is complex. Through engagement with people with metastatic breast canc...OBJECTIVE: International guidelines recommend exercise-based rehabilitation in advanced cancer, however planning and implementation of rehabilitation is complex. Through engagement with people with metastatic breast cancer, clinical and academic physiotherapists, multidisciplinary team members and health service managers, we explored the intervention elements and the implementation planning of a primary care, exercise-based cancer rehabilitation intervention. DESIGN SETTING AND PARTICIPANTS: Using a World Café and interpretive description design, we held two workshops. In workshop one (n = 9), the Template for Intervention Description and Replication checklist was used to identify intervention components. In workshop two (n = 23), the Practical, Robust Implementation and Sustainability Model guided implementation planning. Written data were collected using whiteboards. Discussions were audio-recorded, transcribed and analysed by two authors. RESULTS: Workshop one highlighted the need for physiotherapists with oncology training to deliver individually-tailored, primary care-based interventions. Workshop two added that the role of physiotherapists with specialist oncology training would be to coordinate the delivery of adaptable interventions in an integrated manner, across care settings to respond to evolving needs of people with metastatic breast cancer, which include managing disease symptoms and treatment side-effects, and improving and maintaining quality of life and independence. Key implementation elements recommended include: evidence-based assessment and treatment; careful monitoring of patient and service outcomes; appropriate governance structures; service sustainability through ongoing training and supervision of physiotherapists, and oncologist support. CONCLUSIONS: A primary care, exercise-based cancer rehabilitation intervention requires physiotherapists with specialist oncology training to coordinate and provide an adaptable, integrated interventions that respond to needs of people with metastatic breast cancer. CONTRIBUTION OF THE PAPER.
O'Riordan JMCV, McCullagh R, Sheill G
… +2 more, French HP, Horgan F
Physiotherapy
· 2026 Jun · PMID 41130824
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OBJECTIVE: Cancer rehabilitation interventions can improve quality of life (QOL) in people with metastatic breast cancer (PwMBC), but little is known on how to tailor cancer rehabilitation strategies in a primary care (p...OBJECTIVE: Cancer rehabilitation interventions can improve quality of life (QOL) in people with metastatic breast cancer (PwMBC), but little is known on how to tailor cancer rehabilitation strategies in a primary care (primary care) setting. Using Focus Group Discussion (FGDs) including PwMBC and physiotherapists, this qualitative study aimed to explore the desired elements, potential benefits, barriers and facilitators of a proposed physiotherapy-led, exercise-based cancer rehabilitation service in a primary care setting to improve the QOL of PwMBC. METHODS: We used a World Café approach guided by interpretative description qualitative methodology and the Braun and Clarke process. We included PwMBC and physiotherapists working in primary care, national and local acute oncology and palliative care services in three FGDs. All FGDs were transcribed and analysed inductively. The COnsolidated criteria for REporting Qualitative research checklist was used. RESULTS: FGD1 (N = 13) comprised of physiotherapists working in primary care and national acute oncology care settings. FGD2 included PwMBC (N = 4). FGD3 (N = 4) included physiotherapists working in palliative and local acute care settings. Three themes were identified. 1. 'Empowerment' highlighted potential benefits and facilitators including the maintenance of overall health, a self-management approach, symptom management and maintaining independence. 2. 'Social safety' outlined elements of the proposed intervention including primary care setting, multi-disciplinary approach, appropriate resources and access to information. 3. 'Trust' suggested barriers including lack of: suitably trained therapists to provide intervention, bidirectional communication, shared care management and the importance of causing no harm. CONCLUSIONS: PwMBC are underrepresented in cancer rehabilitation and this research provides evidence supporting strategies and interventions to optimise rehabilitation of PwMBC. CONTRIBUTION OF THE PAPER.