Journal Of Physiotherapy[JOURNAL]

QUESTION: Are improvements in walking disability, measured with the walking component of the Oswestry Disability Index, mediated by walking confidence, capacity, fear avoidance, pain severity and/or physical performance?... QUESTION: Are improvements in walking disability, measured with the walking component of the Oswestry Disability Index, mediated by walking confidence, capacity, fear avoidance, pain severity and/or physical performance? PARTICIPANTS: Community-dwelling adults aged ≥ 65 years. DATA ANALYSIS: A causal mediation analysis was conducted. A directed acyclic graph identified potential pre-treatment confounders. Missing data were imputed, and intervention-mediator and mediator-outcome effects were estimated, along with the natural indirect effects (NIEs) through each mediator, the natural direct effect and the total intervention effect. RESULTS: The analysis included 435 participants. At 12 months, participants receiving the BOOST intervention had greater odds of walking more than one-quarter of a mile (and less than a mile) than those in the control arm (OR 1.38, 95% CI 0.85 to 2.16). The combined NIE via all mediators favoured the intervention (OR 0.71, 95% CI 0.56 to 0.91). The intervention improved walking disability in part by increasing walking confidence at 6 months (NIE OR 0.87, 95% CI 0.76 to 1.00) and reducing pain severity (NIE OR 0.90, 95% CI 0.79 to 1.02), which accounted for 41% and 32% of the combined indirect effect from all mediators, respectively. CONCLUSION: The BOOST intervention improved walking disability primarily through improving the walking confidence and pain severity of older adults with neurogenic claudication. Clinicians should prioritise interventions that build walking confidence (such as walking practice and dynamic balance exercises) and reduce pain severity, to optimise long-term mobility outcomes. TRIAL REGISTRATION: ISRCTN12698674.

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Critically appraised paper: Progressive resistance training was not superior to neuromuscular exercise in patients with hip osteoarthritis.

Østerås N

J Physiother · 2025 Jul · PMID 40544050 · Publisher ↗

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Critically appraised paper: Adding healthy lifestyle management to guideline-based care improves disability for low back pain.

Ross MH

J Physiother · 2025 Jul · PMID 40544049 · Publisher ↗

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Appraisal of Clinical Practice Guideline: Commonly used interventional procedures for non-cancer chronic spine pain.

Zadro JR

J Physiother · 2025 Jul · PMID 40544048 · Publisher ↗

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Physiotherapy for surgical patients.

White S, Elkins MR

J Physiother · 2025 Jul · PMID 40544047 · Publisher ↗

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Critically appraised papers: Manual therapy may improve passive cervical range of motion, symmetric head posture and reduce sternocleidomastoid tumour thickness in infants and young children with congenital muscular torticollis.

Milne N

J Physiother · 2025 Jul · PMID 40544046 · Publisher ↗

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Critically appraised paper: In adults with multiple sclerosis, improvements in physical capacity following aerobic or resistance training did not translate to improved physical function compared with usual care [commentary].

Learmonth YC

J Physiother · 2025 Jul · PMID 40544045 · Publisher ↗

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Critically appraised paper: In adults with multiple sclerosis, improvements in physical capacity following aerobic or resistance training did not translate to improved physical function compared with usual care.

Cavalheri V

J Physiother · 2025 Jul · PMID 40544044 · Publisher ↗

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Critically appraised papers: Manual therapy may improve passive cervical range of motion, symmetric head posture, and reduce sternocleidomastoid tumour thickness in infants and young children with congenital muscular torticollis [commentary].

Gross AR

J Physiother · 2025 Jul · PMID 40544043 · Publisher ↗

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Critically appraised paper: Adding healthy lifestyle management to guideline-based care improves disability for low back pain [commentary].

Sharma S

J Physiother · 2025 Jul · PMID 40544042 · Publisher ↗

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Physiotherapists prioritise compassionate and patient-centred care while navigating systemic constraints and ethical dilemmas in cancer rehabilitation: a mixed-methods study.

Bertoni G, Patuzzo Manzati S, Conti V … +2 more , Testa M, Battista S

J Physiother · 2025 Jul · PMID 40544041 · Publisher ↗

QUESTION: How do physiotherapists address bioethical issues in cancer rehabilitation? What drives physiotherapists' clinical actions regarding non-disclosure, patient autonomy, risk-benefit balance and treatment withdraw... QUESTION: How do physiotherapists address bioethical issues in cancer rehabilitation? What drives physiotherapists' clinical actions regarding non-disclosure, patient autonomy, risk-benefit balance and treatment withdrawal? DESIGN: A mixed-methods study with an explanatory sequential design. PARTICIPANTS: 681 Italian registered physiotherapists recruited via the National Federation of Physiotherapists' Registers. INTERVENTION: An online survey assessed physiotherapists' ethical responses, followed by focus groups with participants whose survey responses aligned with key bioethical principles: beneficence/non-maleficence, self-determination, justice/equity, defensive prudence and compassionate care. OUTCOME MEASURES: Quantitative data identified bioethical principles adherence patterns, while qualitative analysis explored the reasoning behind these ethical stances. RESULTS: Quantitative findings highlighted compassionate care as the most emphasised principle (29%), followed by self-determination (26%) and defensive prudence (23%). Beneficence/non-maleficence (16%) and justice and equity (6%) were less prioritised. Qualitative analysis identified five themes: functional recovery as dignity ('clinical good is the patient good'), patient autonomy ('patient knows better'), equity concerns ('everyone deserves care'), risk aversion ('it's better not to take risks') and the relational nature of care ('relationships can heal'). The mixed-methods integration showed how physiotherapists balance ethical ideals with systemic constraints, highlighting the importance of care equity, not underscored by the sole quantitative data. CONCLUSION: Physiotherapists working in cancer rehabilitation prioritise compassionate and patient-centred care while facing systemic constraints, risks and professional responsibilities. This study offers a framework for future research internationally and on other healthcare professionals.

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Critically appraised paper: Progressive resistance training was not superior to neuromuscular exercise in patients with hip osteoarthritis [commentary].

Battista S

J Physiother · 2025 Jul · PMID 40544040 · Publisher ↗

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Group-based exercise reduces pain and disability and improves other outcomes in older people with chronic non-specific low back pain: the ESCAPE randomised trial.

Silva HJ, Miranda JP, Silva WT … +4 more , Fonseca LS, Xavier DM, Oliveira MX, Oliveira VC

J Physiother · 2025 Apr · PMID 40175239 · Publisher ↗

QUESTION: In older people with chronic non-specific low back pain (CNSLBP), what is the effect of a group-based exercise protocol compared with a waitlist control on pain intensity, disability, global perceived effect, f... QUESTION: In older people with chronic non-specific low back pain (CNSLBP), what is the effect of a group-based exercise protocol compared with a waitlist control on pain intensity, disability, global perceived effect, frequency of falls, fear of falling and physical activity? DESIGN: Randomised trial with concealed allocation and intention-to-treat analysis. PARTICIPANTS: One hundred and twenty people aged ≥ 60 years with CNSLBP. INTERVENTIONS: Participants were allocated to undertake 1-hour group exercise sessions, three times per week for 8 weeks or to a waitlist control. OUTCOME MEASURES: The primary outcomes were pain intensity and disability. Secondary outcomes were the global perceived effect, frequency of falls, fear of falling and physical activity level. Data were collected at baseline, 8 weeks, 5 months and 12 months after randomisation. RESULTS: Compared with control, group-based exercise reduced pain intensity on a 0-to-10 scale (MD -2.0, 95% CI -2.8 to -1.3) and disability on the 0-to-24 Roland-Morris Disability Questionnaire (MD -3.4, 95% CI -4.7 to -2.1). Group-based exercise also led to higher ratings of global perceived effect sustained through to 12 months and higher levels of physical activity at week 8. The effect on fear of falling was clearly negligible. CONCLUSION: Group-based exercise has long-term benefits for pain intensity, disability and global perceived effect, with at least a short-term benefit for physical activity. Group-based exercise can be safely implemented in primary healthcare settings to manage CNSLBP in older people. REGISTRATION: RBR-9j5pqs.

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Critically appraised paper: In-bed cycle ergometry in mechanically ventilated patients is safe but does not improve physical function after intensive care discharge [commentary].

Boden I

J Physiother · 2025 Apr · PMID 40175238 · Publisher ↗

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Exercise adherence is associated with improvements in pain intensity and functional limitations in adults with chronic non-specific low back pain: a secondary analysis of a Cochrane review.

Jones MD, Hansford HJ, Bastianon A … +7 more , Gibbs MT, Gilanyi YL, Foster NE, Dean SG, Ogilvie R, Hayden JA, Wood L

J Physiother · 2025 Apr · PMID 40175237 · Publisher ↗

QUESTION: What is the association between exercise adherence and the effects of exercise on pain intensity and functional limitations in adults with chronic non-specific low back pain (CNSLBP)? DESIGN: Systematic review... QUESTION: What is the association between exercise adherence and the effects of exercise on pain intensity and functional limitations in adults with chronic non-specific low back pain (CNSLBP)? DESIGN: Systematic review with meta-analysis. PARTICIPANTS: Adults with CNSLBP. INTERVENTION: Randomised controlled trials of exercise compared with no exercise (eg, usual care, placebo/sham or another conservative treatment). Adherence to exercise must have been reported. OUTCOME MEASURES: Pain intensity and functional limitations. RESULTS: This study included 46 trials with 56 exercise groups. High exercise adherence (80 to 100%) was associated with reduced pain intensity (0 to 100 scale) (MD -14.32, 95% CI -18.61 to -10.03, low certainty) and functional limitations (0 to 100 scale) (MD -8.08, 95% CI -10.68 to -5.49, low certainty). Moderate exercise adherence (60 to 79%) was not associated with reduced pain intensity (MD -4.53, 95% CI -9.39 to 0.34, very low certainty) or functional limitations (MD -2.75, 95% CI -6.00 to 0.51, very low certainty). Low exercise adherence (< 59%) was associated with reduced pain intensity (MD -5.33, 95% CI -10.00 to -0.66, low certainty) and functional limitations (MD -4.43, 95% CI -7.14 to -1.72, moderate certainty). Compared with low adherence, additional differences in outcomes for moderate and high adherence were mostly negligible. CONCLUSION: Higher exercise adherence is associated with larger improvements in clinical outcomes in adults with CNSLBP, although overall differences are small compared with lower adherence. Other factors besides adherence between the trials and exercise programs could explain these results. Further research is needed to determine the causal effect of exercise adherence on outcomes in adults with CNSLBP. REGISTRATION: PROSPERO CRD42023447355 and Open Science Framework https://osf.io/7p6dw/.

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Research Note: Health economic modelling to inform the cost-effectiveness of physiotherapy interventions.

Killedar A, Hayes A

J Physiother · 2025 Apr · PMID 40175236 · Publisher ↗

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Journal Of Physiotherapy[JOURNAL]

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