Kant-Smits K, Bartels B, van Eijk RPA
… +5 more, Asselman FL, Veldhoen ES, van der Ent K, van der Pol WL, Hulzebos EHJ
Physiotherapy
· 2025 Dec · PMID 41075717
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OBJECTIVES: To investigate the efficacy and feasibility of respiratory muscle training (RMT) in patients with spinal muscular atrophy (SMA) and respiratory muscle weakness. DESIGN: A 4-month, single-blinded RCT, followed...OBJECTIVES: To investigate the efficacy and feasibility of respiratory muscle training (RMT) in patients with spinal muscular atrophy (SMA) and respiratory muscle weakness. DESIGN: A 4-month, single-blinded RCT, followed by an 8-month extension phase. SETTING: The outpatient clinic of the Neurology department and the Child Development and Exercise Center at the University Medical Center Utrecht, The Netherlands. PARTICIPANTS: 30 participants, ≥eight years, SMA type 1 to 4, and respiratory muscle weakness. INTERVENTIONS: The training group started RMT at 30% of their maximum inspiratory (PImax) and expiratory pressure (PEmax) and adjusted their training intensity based on perceived exertion. The control group started and continued RMT at 10% of PImax and PEmax. After four months, the control group received the same RMT as the training group. MAIN OUTCOME MEASURES: The primary outcome was the between-group difference in PImax after the RCT phase. Additionally, we explored the association between training volume (i.e., number of training sessions x training intensity) and increase in PImax over 1 year. RESULTS: 25 participants completed the study. Mean PImax after four months (corrected for baseline value) training group: 61.1 cmHO, control group: 54.3 cmHO, mean difference in PImax: 6.8 cmHO [95% CI: -2.0 to 15.6]. Despite the study being underpowered, we did find an association between training volume and increase in PImax (R = 0.531). CONCLUSION: There was a small between-group difference in PImax after the RCT phase. The training was safe, but the feasibility of the training needs further improvement. CLINICAL TRIAL REGISTRATION NUMBER: NL73280.041.20. CONTRIBUTION OF THE PAPER.
Crombie S, Sellers D, Kapur A
… +3 more, Baskerville J, Bremner S, Morris C
Physiotherapy
· 2025 Dec · PMID 40913932
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OBJECTIVES: Children and young people with complex neurodisability (CYPCN) are at high risk of respiratory illness, frequent hospital admissions and premature death. This study aimed to test the acceptability and feasibi...OBJECTIVES: Children and young people with complex neurodisability (CYPCN) are at high risk of respiratory illness, frequent hospital admissions and premature death. This study aimed to test the acceptability and feasibility of Breathe-Easy, a novel night-time postural intervention to improve respiratory health in CYPCN. DESIGN: Case series design incorporating a pre-post interventional study and qualitative study. SETTING: Intervention conducted at home by parents/carers. PARTICIPANTS: CYPCN aged 2 to 18 years, dependent on others to move, swallowing difficulties, gastrostomy/jejunostomy, and under care of a respiratory paediatrician. INTERVENTION: Breathe-Easy protocol included CYPCN lying on a flat bed, three-quarters prone or side-lying using existing night-time positioning equipment. A bile-bag was used to minimise reflux. CYPCN trialled intervention for 6 months. MAIN OUTCOME MEASURES: Measures of respiratory health and sleep were collected at baseline, three and six months. Semi-structured interviews were conducted with parents, CYPCN, and healthcare professionals post intervention. Data analysis comprised descriptive statistics and thematic analysis. RESULTS: Eleven CYPCN were recruited; eight completed the trial. We interviewed 5 CYPCN, 9 parents, 8 healthcare professionals, 6 carers and one teaching assistant. Positive views were expressed regarding sleep quality, breathing, secretion management and reduced hospitalisation. Overall improvement in respiratory health and sleep measures. All eight participants planned to continue with Breathe-Easy. CONCLUSION: Breathe-Easy appears acceptable and feasible. Further research will need to evaluate feasibility of implementation by other teams and families, and any impact on progressive musculoskeletal deformity, including addressing methodological challenges gathering key outcomes and adverse events. CONTRIBUTION OF THE PAPER.
Fini NA, Ramage E, Bernhardt J
… +10 more, Bicknell E, Tzefronis C, Fink P, Godecke E, Francis J, Wood R, Li N, Lin B, English C, Said CM
Physiotherapy
· 2025 Dec · PMID 40902427
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INTRODUCTION/ AIMS: Incorporating the perspectives of knowledge-users such as stroke survivors into intervention development processes can enhance their relevance and feasibility. The aims of this study were: i) to use c...INTRODUCTION/ AIMS: Incorporating the perspectives of knowledge-users such as stroke survivors into intervention development processes can enhance their relevance and feasibility. The aims of this study were: i) to use co-design to determine "active ingredients" and develop a personalised physical activity intervention for stroke survivors, and ii) to evaluate the co-design process. METHODS: A four-stage integrated knowledge translation approach (involving planning and workshops) was applied to co-design a post-stroke physical activity intervention. Knowledge-user participants (stroke survivors (n = 10), carers (n = 3) and clinicians (n = 12)) were recruited. Knowledge-user participants (n = 25) and the research team (n = 13) were invited to participate in a survey evaluation of the co-design process. Quantitative survey responses were analysed descriptively. Open-ended responses were grouped and summarised as key findings. RESULTS: Knowledge-users highlighted that flexibility in intervention delivery, consideration of personal preferences, aphasia-friendly resources and ongoing support were important intervention active ingredients. The developed physical activity intervention included a shared decision-making process, programme set-up, ongoing support and resources. High levels of trust, transparency and shared learning in the co-design process were reported by 81% of knowledge-users on project completion. Survey key findings included: 1) Co-design and the lived experience are highly valued by all involved. 2) Output that improves stroke care is important. 3) The co-design workshops provided a respectful atmosphere with opportunity for open discussion. 4) Participation in co-design can be personally beneficial. CONCLUSIONS: Using co-design, active ingredients were identified, and a comprehensive post-stroke physical activity intervention was developed. The co-design process was highly regarded by all and added valuable insights. CONTRIBUTION OF THE PAPER.
Sayner AM, Tang CY, Toohey K
… +2 more, Mendoza C, Nahon I
Physiotherapy
· 2025 Dec · PMID 40897107
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Physiotherapists play a crucial role in managing symptoms that can arise from treatments for prostate cancer. Despite the benefits, limited evidence exists on physiotherapists' self-perceived capabilities, enablers, and...Physiotherapists play a crucial role in managing symptoms that can arise from treatments for prostate cancer. Despite the benefits, limited evidence exists on physiotherapists' self-perceived capabilities, enablers, and barriers in service provision. This qualitative study employed a phenomenological approach to explore the experiences of physiotherapists providing supportive care to patients with prostate cancer in metropolitan and regional Victoria, Australia. Two online focus groups were conducted, one with metropolitan and the other with regional physiotherapists. Reflexive thematic analysis identified three key themes: 1) the need for accessible professional development, 2) the impact of public system operational constraints on service access, and 3) the importance of rapport building within the multidisciplinary team and with patients. Positive enablers included online learning opportunities and effective multidisciplinary collaboration. Recommendations highlight the importance of bolstering professional development opportunities, fostering mentorship programs, and dismantling systemic barriers to enhance access to physiotherapy services. This study identifies the necessity for targeted support for physiotherapists in delivering optimal care for patients with prostate cancer across different geographical contexts. CONTRIBUTION OF THE PAPER.
Mastromarchi P, May S, Ali N
… +2 more, McLean S, Peat GM
Physiotherapy
· 2025 Dec · PMID 40886684
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BACKGROUND: Exercise and manual therapy are recommended for managing non-specific neck pain (NSNP), but most randomised controlled trials (RCT) have not identified specific subgroups that might respond best to each inter...BACKGROUND: Exercise and manual therapy are recommended for managing non-specific neck pain (NSNP), but most randomised controlled trials (RCT) have not identified specific subgroups that might respond best to each intervention. Although matched exercise was found to be superior to unmatched interventions in the short term, high heterogeneity in effectiveness estimates and variable levels of intervention fidelity and quality of delivery may contribute to inconsistent findings on the effectiveness of matched or stratified care. OBJECTIVES: To assess the quality of intervention reporting and its relationship to treatment effect estimates in RCTs comparing matched versus unmatched exercise or manual therapy interventions for NSNP. DESIGN: Secondary analysis of a systematic review with meta-analysis. METHODS: For all included RCTs, independent reviewers rated the quality of intervention reporting using the TIDieR checklist. Meta-regression was used to assess the direction and magnitude of association between TIDieR scores and treatment effect estimates (standardised mean difference of change scores) for short-term pain and disability outcomes. RESULTS: The items related to intervention fidelity were not adequately reported. Materials used, intervention provider, location and modification were inconsistently reported. Poorer quality of intervention reporting was associated with larger treatment effect estimates in short-term pain and disability in favour of matched interventions. CONCLUSIONS: Trials with inadequate intervention reporting may overestimate the benefits of matched exercise or manual therapy treatments for NSNP. The lack of SUFFICIENT information to judge intervention fidelity in this field reinforces the need for better guidance on this specific aspect of study design, conduct, and reporting. CONTRIBUTION OF THE PAPER.
Minns Lowe CJ, Donovan M, Herbland A
… +1 more, Moulson A
Physiotherapy
· 2025 Dec · PMID 40858402
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OBJECTIVES: To explore and understand the replies to the quantitative findings (Part 1) from the work related well-being e-survey, provide greater depth information about the topic and identify new issues/areas from resp...OBJECTIVES: To explore and understand the replies to the quantitative findings (Part 1) from the work related well-being e-survey, provide greater depth information about the topic and identify new issues/areas from respondents in Part 2 of this two part paper. DESIGN: Cross-sectional, convenience, voluntary, open e-survey. SETTING: Online. PARTICIPANTS: UK physiotherapy workforce, including physiotherapists, students, support workers across all workplace settings and across the UK. METHODS: Following development, pre-testing and ethics approval, the e-survey was widely advertised and ran from 08/03/2023 to 30/04/2023 via Bristol Online Survey. The open comments question in the e-survey was: 'We are keen to hear your views, please type up to three key factors that you think impact most upon work-related well-being within physiotherapy'. ANALYSES: Open comments analyses using content analysis to interpret meaning from the content of text data. RESULTS: 612 respondents provided 1649 overall comments to. One overarching theme and three subthemes incorporating seventeen factors were developed from 138 initial codes. The overarching theme was moral distress and moral injury reducing work related well-being (WRWB) within the physiotherapy workforce. Subthemes were 1. Impact on me. 2. 'You aren't able to do your job properly'. 3. Management and support. Subthemes and factors fitted within the overarching theme. CONCLUSIONS: Moral distress and injury explained the quantitative findings (Part 1) regarding poor work-related well-being, burnout and stress within the physiotherapy workforce. Moral injury is the consequence of organisational processes and broken health care systems, strategies to improve WRWB across all UK physiotherapy settings are urgently required. CONTRIBUTION OF THE PAPER.
Sugrue J, McKenna S, MacHale S
… +1 more, O'Sullivan K
Physiotherapy
· 2025 Dec · PMID 40857779
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BACKGROUND: Low back pain (LBP) is associated with a poorer prognosis when there is concomitant depression. Musculoskeletal (MSK) triage physiotherapists clinically assess a significant proportion of LBP referrals to pub...BACKGROUND: Low back pain (LBP) is associated with a poorer prognosis when there is concomitant depression. Musculoskeletal (MSK) triage physiotherapists clinically assess a significant proportion of LBP referrals to public hospital outpatient waiting lists. OBJECTIVES: To establish depression screening and referral practices of MSK triage physiotherapists, and to compare confidence in depression screening to red flag (e.g. cauda equina syndrome) and yellow flag (e.g. fear avoidance beliefs) screening. METHODS: Using a descriptive cross-sectional design, a bespoke e-survey was distributed to MSK triage physiotherapists in adult public hospital outpatient services in Ireland following ethical approval. RESULTS: Thirty-six surveys were completed and submitted (55% response rate). A minority of respondents (3/36, 8%) directly ask all patients with LBP about depression, while more than one third (13/36, 36%) never screened for depression. Reported barriers included lack of training or skill, time constraints, and absence of referral pathways. Confidence in screening for depression was lower than for red flags or yellow flags. There was some indication that a day or more of training improved depression screening confidence and practice. DISCUSSION: This study provides insight into current depression screening practices for people with LBP and the factors influencing decision-making among MSK triage physiotherapists working in advanced practice roles. CONCLUSION: Few MSK triage physiotherapists in this sample directly screen for depression, and screening confidence was low. Understanding the current processes and determinants of practice, including the potential positive impact of targeted training, may support strategies to improve depression screening practices. CONTRIBUTION OF THE PAPER.
Physiotherapy
· 2025 Dec · PMID 40850243
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AIM: To explore physiotherapists' experiences, beliefs, and opinions about psychologically informed practice (PIP) in order to design a training programme for non-psychologist clinicians to enhance their PIP skills. DESI...AIM: To explore physiotherapists' experiences, beliefs, and opinions about psychologically informed practice (PIP) in order to design a training programme for non-psychologist clinicians to enhance their PIP skills. DESIGN: This study adopted an interpretive description qualitative methodology using focus groups and consistent with the aim of generating knowledge relevant to applied health and to inform the design of a training programme. PARTICIPANTS: Phase one included musculoskeletal physiotherapists (n=18) who were purposively sampled to take part in two focus groups. A third focus group consisted of pain specialist physiotherapists (n=6) recruited from a specialist network in the UK called the Physiotherapy Pain Association (PPA) to explore further topics identified in phase one and to inform training development. DATA ANALYSIS AND SYNTHESIS: Qualitative content analysis was used as a framework for data analysis and consisted of subjective interpretation of textual data through a systematic classification process of coding and identifying themes or patterns. RESULTS: Three interconnected themes that provide insights into the perceptions and experiences of physiotherapists concerning PIP were constructed: 1) Professional Roles and External Influences on PIP, 2) Interpersonal Aspects of PIP, and 3) Support Needs to Enhance PIP Application. CONCLUSION: The findings provide an understanding of the multifaceted nature of PIP and its impact within healthcare settings. They will inform development of training to address gaps and provide practical strategies for enhancing PIP for non-psychologists. CONTRIBUTION OF THE PAPER.
Craig B, Haas R, Buchbinder R
… +1 more, Ribeiro DC
Physiotherapy
· 2025 Dec · PMID 40850242
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BACKGROUND: Physiotherapists commonly manage patients with shoulder disorders. The primary aims of this study were to (1) determine current assessment and management of patients with shoulder disorders by physiotherapist...BACKGROUND: Physiotherapists commonly manage patients with shoulder disorders. The primary aims of this study were to (1) determine current assessment and management of patients with shoulder disorders by physiotherapists in New Zealand and compare it to evidence-based recommendations; and (2) assess their confidence in making a diagnosis. METHODS: We performed a cross-sectional online survey of New Zealand registered physiotherapists who self-report that they treat patients with shoulder disorders. The survey was distributed electronically via professional physiotherapy networks and social media. Physiotherapists were asked about four common shoulder disorders (rotator cuff tendinopathy, acute rotator cuff tear, early and later presentation of adhesive capsulitis) presented as vignettes. RESULTS: 234 physiotherapists completed the survey. Most (78%) work in private practice and 73% have a shoulder caseload of ≥5 patients per week. Participants commonly included physical examination of shoulder and cervical joints. Investigations and referral to other healthcare professionals varied between vignettes. Advice, education about exercise, manual therapy and activity/work modification were the most prevalent interventions. Electrotherapy was a common intervention for rotator cuff tendinopathy. Most physiotherapists were moderately or extremely confident in their diagnosis across all vignettes. There was no difference in correct diagnosis between physiotherapists with a high versus low shoulder caseload for 3 vignettes, with a slight difference favouring those with a high shoulder caseload for acute rotator cuff tear (90% vs 80%, Fisher's p = 0.047). CONCLUSIONS: Physiotherapists self-reported management of patients with shoulder disorders partially accord with evidence-based recommendations. They have confidence in their diagnoses which are mostly correct. CONTRIBUTION OF THE PAPER.
Physiotherapy
· 2025 Dec · PMID 40839984
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BACKGROUND: The Central Sensitization Inventory is a tool used to identify patients with central sensitization (CS) symptoms. The Central Sensitization Inventory has shown to be associated with psychosocial and cognitive...BACKGROUND: The Central Sensitization Inventory is a tool used to identify patients with central sensitization (CS) symptoms. The Central Sensitization Inventory has shown to be associated with psychosocial and cognitive factors commonly thought to contribute to and sustain the mechanism of central sensitization. Another potential factor that might play a role in central sensitization is beliefs about low back pain (LBP). OBJECTIVES: To investigate whether beliefs about LBP are associated with Central Sensitization Inventory in patients with chronic LBP. DESIGN: A cross-sectional study. PARTICIPANTS: 119 patients with nonspecific chronic LBP seeking physical therapy care in outpatient clinics. MAIN OUTCOME MEASURES: Demographic data and clinical characteristics such as pain intensity, disability, back pain beliefs (i.e., measured with Back Beliefs Questionnaire) and CS-related symptoms (i.e., measured with Central Sensitization Inventory) were collected. Multivariable linear regression analysis was used in the analysis. RESULTS: Most participants (60%) were classified as having subclinical or mild severity levels according to the Central Sensitization Inventory. Multivariable regression analysis showed that LBP beliefs not aligned with the current evidence were associated with higher scores of Central Sensitization Inventory, after controlling for sex, pain intensity and disability. CONCLUSIONS: Patients with LBP beliefs not aligned with the current evidence were more likely to present with higher scores on the Central Sensitization Inventory. CONTRIBUTION OF THE PAPER.
Minns Lowe CJ, Newman M, Herbland A
… +4 more, Heneghan N, Moulson A, Owusu N, Beeton K
Physiotherapy
· 2025 Dec · PMID 40835516
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OBJECTIVES: To explore burnout, professional fulfilment, work related stress, well-being and working patterns within the physiotherapy workforce. DESIGN: A cross-sectional, convenience, voluntary, open e-survey. SETTING:...OBJECTIVES: To explore burnout, professional fulfilment, work related stress, well-being and working patterns within the physiotherapy workforce. DESIGN: A cross-sectional, convenience, voluntary, open e-survey. SETTING: Online. PARTICIPANTS: UK physiotherapy workforce, including physiotherapists, students, support workers across all workplace settings and across the UK. INTERVENTION: Following development and pre-testing, the e-survey was widely advertised and ran from 08/03/2023 to 30/04/2023 via Bristol Online Survey. MAIN OUTCOME MEASURES: Stanford Professional Fulfilment Index (SPFI), a score for work related and private life related stress, work-life balance, WHO 5 well-being questionnaire and questions to capture working patterns, diversity and inclusivity questions and demographic data. RESULTS: Following data cleaning, 666/764 (87%) female and 92/764 (12%)male respondents. SPFI: burnout prevalence was 49%(376/764). 436/564 respondents (57%) reported feeling stressed "often" or "very often" (past month). WHO 5 scores had a median of 45 (IQR: 30-60) indicating many have score ≤50 indicating poor wellbeing. 45%(340/764) respondents reported their work-life balance over the previous 2 weeks as unbalanced/very unbalanced. 57%(435/764) reported that they worked full time and 43%(329/764) part-time. 78%(598/764) reported having one physiotherapy role, 18%(139/764) reported having two roles, 3%(23/764) having four roles and 1%(4/764) having five roles and unpaid hours were raised as problematic. 54% (411/764) reported being absent from work/study in the last year and 10%(76/764) reported adjusted work/study. 9%(72/764) reported additional non-physiotherapy roles/jobs. CONCLUSIONS: This e-survey obtained snapshot views from self-selecting participants. The positive workforce developments being experienced within the physiotherapy profession are threatened by poor work-related well-being, including burnout and stress. Action is required. CONTRIBUTION OF THE PAPER.
Annevelink R, Don S, Nijs J
… +4 more, Beckwée D, Ickmans K, Cools W, Voogt L
Physiotherapy
· 2026 Mar · PMID 40835515
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OBJECTIVES: To 1) describe the socio-cultural characteristics of people with non-specific musculoskeletal pain (NSMSP) visiting Dutch primary care physiotherapy, and 2) to determine associations between socio-cultural fa...OBJECTIVES: To 1) describe the socio-cultural characteristics of people with non-specific musculoskeletal pain (NSMSP) visiting Dutch primary care physiotherapy, and 2) to determine associations between socio-cultural factors and pain intensity, disability, and health-related quality of life (HRQoL) in people with NSMSP visiting Dutch primary care physiotherapy. DESIGN: Exploratory cross-sectional study. SETTING: 35 Dutch primary care physiotherapy facilities. PARTICIPANTS: 1350 patients with NSMSP. MAIN OUTCOME MEASURES: Participants completed self-reported questionnaires on socio-cultural (e.g., migration background, living situation, education level), demographic (e.g., sex, age), health-related (e.g., smoking, Body Mass Index (BMI)), and pain-related (e.g., analgesics) factors, along with standardized measures for outcomes pain intensity, disability, and HRQoL. RESULTS: After controlling for covariates (sex, age, smoking, BMI, The Mental Health Inventory (MHI-5), co-morbidity, analgesics, and chronic widespread pain), socio-cultural variable migration background was associated with on average higher pain intensity (ß = .447, p < .001), higher disability (ß = 3.997, p < .001), and poorer mental HRQoL (ß = -1.475, p < .001). Unemployment was associated with higher pain intensity (ß = .279, p .028) and lower physical HRQoL (ß = -1.709, p .004). Overall, higher education levels were associated with better outcomes, with on average lower pain intensity found for university (ß = -.731, p < .001) and higher professional education levels (ß = -.358, p .003) compared to no education. CONCLUSIONS: Migration background, unemployment and lower education levels were on average associated with poorer pain intensity, disability and HRQoL in people with NSMSP visiting Dutch primary care physiotherapy. Due to the cross-sectional nature of this study, findings should be interpreted with caution. CONTRIBUTION OF THE PAPER.