QUESTION: In patients with non-specific chronic low back pain, what is the effect of education to keep the abdomen relaxed versus contracted during Pilates exercises on pain intensity, disability, function and global per...QUESTION: In patients with non-specific chronic low back pain, what is the effect of education to keep the abdomen relaxed versus contracted during Pilates exercises on pain intensity, disability, function and global perceived effect? DESIGN: Two-group, parallel, randomised trial with concealed allocation and intention-to-treat-analysis. PARTICIPANTS: A total of 152 patients with non-specific chronic low back pain participated in the trial. INTERVENTION: All participants were randomised to one of two groups and treated with Pilates exercises for 12 weeks (twice a week for 60 minutes). The control group (n = 76) received guidance on the specific activation of the core muscle group-primarily the abdominals, pelvic floor, diaphragm and deep spinal muscles-while the experimental group (n = 76) received guidance to perform the exercises in a relaxed and smooth way. OUTCOME MEASURES: Primary outcomes were pain intensity and disability at 12 weeks. Secondary outcomes were patient-specific function and global improvement at 12 weeks. RESULTS: Compared with keeping the abdomen contracted during Pilates, education to keep it relaxed led to these adjusted mean differences: change on the 0-to-10 pain scale (-0.6, 95% CI -1.4 to 0.2), change on the 0-to-24 disability scale (-1.4, 95% CI -2.6 to -0.2), change on the 0-to-10 patient-specific function scale (0.3, 95% CI -0.3 to 0.9) and final score on the -5 to +5 global perceived effect (0.6, 95% CI -0.1 to 1.2). CONCLUSION: Education to relax the abdominal muscles during Pilates exercises resulted in slightly greater improvement in disability compared with Pilates with education to keep the abdomen contracted. For the other outcomes (pain, patient-specific function and global perceived effect), the effect of keeping the abdomen relaxed during Pilates was unclear, with confidence intervals ranging from roughly as good to mildly better than keeping the abdomen contracted. REGISTRATION: NCT05336500.
QUESTION: What experiences do people undergoing treatment for prostate cancer have with access to and participation in physiotherapy services in metropolitan and regional public and private settings? DESIGN: A phenomenol...QUESTION: What experiences do people undergoing treatment for prostate cancer have with access to and participation in physiotherapy services in metropolitan and regional public and private settings? DESIGN: A phenomenological qualitative approach was used to describe patient experiences with access to and participation in physiotherapy services in metropolitan and regional Australian public and private settings. We conducted 29 one-to-one interviews and reflexive thematic analysis was used to identify themes in the data. RESULTS: Four themes were identified. There was limited patient awareness that physiotherapy can provide symptomatic support. Participants stressed the importance of early implementation of pelvic floor muscle training. Transperineal, real-time ultrasound was valued as biofeedback. Regional locations and public health settings challenged access and impacted participation. CONCLUSION: This research identified that physiotherapy supportive care in prostate cancer should be established early and under the supervision of an appropriately trained clinician. Referral should be directed to specific providers and further exposure and education around physiotherapists' role in this space may be required. Different health service and geographical contexts influence access. Strategies to address systemic barriers need ongoing attention.
QUESTION: What are the effects of low-intensity extracorporeal shockwave therapy (Li-ESWT) and of pelvic floor muscle training (PFMT) on penile blood flow and erectile function in men with type 2 diabetes mellitus and er...QUESTION: What are the effects of low-intensity extracorporeal shockwave therapy (Li-ESWT) and of pelvic floor muscle training (PFMT) on penile blood flow and erectile function in men with type 2 diabetes mellitus and erectile dysfunction (ED)? DESIGN: Three-arm randomised trial with concealed allocation, assessor blinding and intention-to-treat analysis. PARTICIPANTS: Ninety subjects aged 35 to 55 years with type 2 diabetes mellitus and arteriogenic ED. INTERVENTIONS: All groups were on sildenafil treatment: 25 mg daily and 50 mg on demand. The Li-ESWT group received Li-ESWT with an energy flux intensity of 0.09 mJ/mm once per week for 6 weeks. The Li-ESWT was applied to six points bilaterally on the ventral aspect of the penile shaft (distal, middle and proximal) and the right and left penile crura. The PFMT group received home-based PFMT for 6 weeks. The control group received only the sildenafil treatment. OUTCOME MEASURES: The peak systolic velocity (PSV) of the right and left cavernosal arteries and the five-item version of the International Index of Erectile Function (IIEF-5, scored from 5 worst to 25 best) were assessed at baseline and after 6 weeks. RESULTS: Compared with control, Li-ESWT and PFMT each improved PSV of cavernosal arteries bilaterally and IIEF-5. Compared with PFMT, Li-ESWT improved PSV of cavernosal arteries bilaterally (difference in mean change 10 cm/sec, 95% CI 9 to 11) and IIEF-5 total score (difference in mean change 1.4, 95% CI 0.9 to 1.9). CONCLUSION: Combined with sildenafil treatment, Li-ESWT may induce a greater increase in penile blood flow and better erectile function than home-based PFMT in middle-aged men with type 2 diabetes mellitus and arteriogenic ED. Nevertheless, home-based PFMT combined with sildenafil treatment may yield greater improvements in these outcomes compared with sildenafil alone in this population. Patients should be informed of the potential benefits, discomforts and inconveniences associated with each treatment to facilitate informed decision-making. REGISTRATION: NCT06058832.
QUESTIONS: What is the effect of home-based, high-intensity, combined inspiratory and expiratory muscle training on maximal respiratory pressures, inspiratory muscle endurance, peak cough flow, dyspnoea, fatigue, exercis...QUESTIONS: What is the effect of home-based, high-intensity, combined inspiratory and expiratory muscle training on maximal respiratory pressures, inspiratory muscle endurance, peak cough flow, dyspnoea, fatigue, exercise capacity and quality of life in people with Parkinson's disease? DESIGN: A randomised controlled trial with concealed allocation, intention-to-treat analysis and blinding of participants, assessors and statisticians. PARTICIPANTS: People with Parkinson's disease. INTERVENTION: The experimental group received high-intensity combined inspiratory and expiratory muscle training at 60% of maximal inspiratory pressure (MIP) and 60% of maximal expiratory pressure (MEP). The control group received sham training using the same protocol, but without any resistive load. Both groups trained for 20 minutes, twice per day, 7 days/week for 8 weeks. OUTCOME MEASURES: The primary outcome was respiratory muscle strength (MIP and MEP). Secondary outcomes included inspiratory muscle endurance, peak cough flow, dyspnoea (0-to-4 Medical Research Council scale, where lower scores are better), fatigue (1-to-7 Fatigue Severity, where lower scores are better), exercise capacity (6-minute walk test) and quality of life (0-to-100 Parkinson's Disease Questionnaire-39, where lower scores are better). All outcomes were measured at 0, 8 and 12 weeks. RESULTS: Thirty-four participants were included. Compared with control, the experimental group had better MIP (MD 20 cmHO, 95% CI 10 to 30), MEP (MD 24 cmHO, 95% CI 10 to 39) and inspiratory muscle endurance (MD 1.2 minutes, 95%CI 0.4 to 2.0). The benefits in MIP and inspiratory muscle endurance were maintained at follow-up. Benefits also occurred in dyspnoea (MD -0.71, 95% CI -1.30 to -0.12) and exercise capacity (MD 24.9 m, 95% CI 0.2 to 49.7); however, the confidence intervals spanned worthwhile and trivial effects, indicating uncertainty about whether those effects are clinically worthwhile. CONCLUSION: High-intensity combined inspiratory and expiratory muscle training improved respiratory muscle strength, inspiratory muscle endurance, dyspnoea and exercise capacity in people with Parkinson's disease. REGISTRATION NUMBER: NCT05608941.
INTRODUCTION: This paper highlights research relating to the prevention and management of non-specific low back pain (LBP) published between January 2020 and December 2025. METHODS: To identify studies for inclusion, MED...INTRODUCTION: This paper highlights research relating to the prevention and management of non-specific low back pain (LBP) published between January 2020 and December 2025. METHODS: To identify studies for inclusion, MEDLINE, CINAHL and the Cochrane Database of Systematic Reviews were searched. Relevant studies were grouped according to topic area. From those results, studies that were perceived to be of great clinical importance and particularly high quality were selected. RESULTS: This narrative review synthesised five key themes in contemporary LBP management. Theme 1 (Prevention) demonstrated consistent evidence that exercise-based programs, particularly when combined with education, reduce the risk and impact of recurrent LBP. Theme 2 (Non-pharmacological management) showed that education, exercise, manual therapy, acupuncture and psychologically informed approaches generally produce small to moderate effects on average, with the strongest and most sustained benefits observed for exercise and psychologically informed approaches. In Theme 3 (Pharmacological management), it was found that commonly used medicines provide at best small benefits while carrying meaningful risks, reinforcing their limited and time-restricted role in care. Theme 4 (Invasive and surgical interventions) highlighted that most invasive procedures offer little to no meaningful benefit for LBP and expose patients to substantial harm and cost. Finally, Theme 5 (Special populations) showed that older adults, children, adolescents, and Indigenous and underserved communities remain under-represented in clinical trials and are more likely to receive non-guideline concordant care, emphasising the need for tailored, equity-oriented approaches. CONCLUSION: LBP care is most effective when it is active and person‑centred. Education, exercise and psychologically informed approaches should be prioritised, while medicines and invasive procedures offer little benefit and carry risk; care should be tailored to reduce persistent inequities across populations.