Physical Therapy[JOURNAL]
Sun
200 papers
On "Effect of a 4-Week Telerehabilitation Program for People With Post-COVID Syndrome on Physical Function and Symptoms: Protocol for a Randomized Controlled Trial." Reeves JM, Spencer LM, Tsai LL, et al. Phys Ther. 2024;104(9):pzae080. https://doi.org/10.1093/ptj/pzae080.
Shukla MP, Chaudhary S
Phys Ther · 2025 Apr · PMID 40037302 · Publisher ↗
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The Mediating Role of Physical Therapists' Satisfaction With Helping Patients in the Relationship Between Work Support and Intention to Leave Their Current Employment.
Roitenberg N, Ben-Ami N
Phys Ther · 2025 May · PMID 40037291 · Publisher ↗
IMPORTANCE: The wellbeing of physical therapists is crucial for retaining them at work as skilled professionals and ensuring high-quality patient care. OBJECTIVE: The purpose of this study was to examine the effect of pe...
IMPORTANCE: The wellbeing of physical therapists is crucial for retaining them at work as skilled professionals and ensuring high-quality patient care. OBJECTIVE: The purpose of this study was to examine the effect of perceived organizational support and peer support on physical therapists' intention to leave their current employment, mediated by their satisfaction with helping patients (ie, compassion satisfaction). DESIGN: The design for this study was an online survey that included the short version of the Perceived Organizational Support scale, the Peer Support Scale, the Compassion Satisfaction Scale, and the Intent to Leave scale. The research used statistical analysis to explore the direct and indirect relationships between these variables. SETTING: The setting for this study was health care organizations and private practices. PARTICIPANTS: Israeli registered physical therapists volunteered to participate. MAIN OUTCOMES: Regression analysis indicated that greater perceived organizational support and peer support were associated with lower intention to leave the current employment. Compassion satisfaction levels mediated the relationships between physical therapists' perceived organizational support, peer support, and intention to leave their current employment. RESULTS: Two hundred ninety-three physical therapists completed the survey. Participants reported a medium level of perceived organizational support (mean = 2.86; range = 1-5); a high level of peer support (mean = 4.15; range = 1-5); a high level of compassion satisfaction (mean = 40.85; range = 10-50); and a low level of intention to leave their current employment (mean = 2.38; range = 1-5). CONCLUSIONS: The study shows the importance of fostering a supportive work environment and peer relationships to enhance physical therapists' satisfaction. The study attests to the contribution of the positive emotion physical therapists derive from helping patients as a protective factor against their intention to leave their current employment, contributing to the overall stability of the health care workforce. RELEVANCE: Understanding the relations between perceived organizational support, peer support, and intention to leave current employment, as well as the role of compassion satisfaction, can help health care organizations and policymakers retain physical therapists.
Physical Therapy for Mild Traumatic Brain Injury: Why Wait for a Faster Rate?
George SZ
Phys Ther · 2025 Feb · PMID 40036631 · Full text
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Author Response to Shukla and Chaudhary.
Reeves J, Spencer L, Tsai LL … +2 more , Baillie A, Alison J
Phys Ther · 2025 Apr · PMID 40036575 · Publisher ↗
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Federal Funding of Rehabilitation Research: Delayed and Disrupted.
George SZ, Jette AM
Phys Ther · 2025 Mar · PMID 40036362 · Publisher ↗
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Preventing Falls in Older Adults After Upper Limb Fractures: A Scoping Review.
Lobo BS, Amaral Alfonsi MD, Lima CA … +6 more , Felipe SGB, Kristensen MT, Beaupre LA, Sherrington C, Bruder AM, Perracini MR
Phys Ther · 2025 Apr · PMID 39982430 · Publisher ↗
OBJECTIVE: The objective was to identify and describe fall prevention strategies in upper limb fracture rehabilitation for older people using recent fall prevention guidelines as a standard. METHODS: A systematic search...
OBJECTIVE: The objective was to identify and describe fall prevention strategies in upper limb fracture rehabilitation for older people using recent fall prevention guidelines as a standard. METHODS: A systematic search was conducted in 9 electronic databases (PubMed/MEDLINE, EBSCOhost, Cochrane Library, Lilacs, SPORTDiscus, CINAHL, Web of Science, AgeLine, and SciELO), gray literature, and in bibliographic and citation searching of selected articles between May and December 2022 and updated between February and March 2024. Two independent reviewers screened citations for inclusion. Data extraction was performed by 1 reviewer and verified by a second reviewer. A frequency of strategies and content analysis syntheses were conducted. RESULTS: A broad search strategy was used, initially identifying 25,945 articles and including 6 randomized clinical trials. The gray literature search identified 18 records. Five studies included forearm fractures, 1 upper limb fracture, and no study exclusively on rehabilitation after humerus fractures. None of the studies provided comprehensive multifactorial fall risk assessments to guide tailored interventions. Assessments mainly focused on gait and balance. Exercise was the most offered intervention alone or in combination with education. Exercise programs were aligned with recommendations to include progressive balance and functional exercises overall. However, the frequency of ≥3 times weekly was less frequently offered. The gray literature showed a lack of fall prevention-specific information after upper limb fractures and mostly called attention to fall prevention after hip fractures. CONCLUSION: Upper limb fracture rehabilitation in older adults, considered at high risk of falling, did not include comprehensive and tailored multifactorial fall assessment and intervention. Unequivocally, exercise programs were overall aligned with recent recommendations and were the most frequent intervention. There is a crucial gap for humerus fractures. This study can help align the treatment of upper limb fractures with updated fall prevention recommendations and impact future research, guiding and influencing implementation in clinical practice. IMPACT: There is an urgent need to implement comprehensive and tailored multifactorial fall assessments and interventions in rehabilitation programs for older adults recovering from upper limb fractures. Guidelines should direct this work to enhance clinical practice.
Motor Impairment and Disuse Are Independent Predictors of Vascular Outcomes Poststroke.
Miller T, Ouyang H, Tsang CSL … +3 more , Calderón-Juárez M, Ying MTC, Pang MYC
Phys Ther · 2025 Mar · PMID 39982425 · Full text
IMPORTANCE: Cardiorespiratory fitness is reduced after stroke due to inactivity which may cause structural and functional changes to blood vessels in the extremities. Identifying clinical factors contributing to vascular...
IMPORTANCE: Cardiorespiratory fitness is reduced after stroke due to inactivity which may cause structural and functional changes to blood vessels in the extremities. Identifying clinical factors contributing to vascular function may be important for tailoring rehabilitation programs that reduce secondary disease risk and adverse events. OBJECTIVE: The study objective was to compare measures of arterial and intramuscular blood flow between the paretic and nonparetic upper limbs of individuals with stroke and healthy comparators. Associations between these parameters and stroke-related impairment were also examined. DESIGN: This was a cross-sectional study. SETTING: The setting was a university laboratory. PARTICIPANTS: Participants were individuals with stroke (n = 64; mean age = 60.8 [SD = 7.7] years) and matched controls (n = 64; mean age = 59.4 [SD = 7.8] years). MAIN OUTCOMES/MEASURES: Brachial artery blood flow volume (Vflow) and arterial diameter (AD) were measured using Doppler ultrasound. Intramuscular blood perfusion of the biceps brachii was estimated using the vascularity index (VI). Motor recovery and perceived use of paretic upper limbs were assessed with the Fugl-Meyer Assessment (FMA) and Motor Activity Log (MAL), respectively. RESULTS: Side × group interactions were observed for AD (F = 22.6) and VI (F = 4.00). Post hoc analyses showed lower AD and VI for paretic sides (stroke group), greater Vflow for dominant sides (comparators), and greater percent side-to-side differences (%SSDs) in AD and VI for the stroke group than for comparators. %SSDs in Vflow, AD, and VI demonstrated weak correlations with impairment (MAL, FMA; ρ = 0.253 to 0.347). MAL was an independent predictor of %SSD in Vflow (β = -0.286), and FMA was an independent predictor of %SSDs in AD (β = -0.307) and VI (β = 0.371). CONCLUSIONS/RELEVANCE: Relative to the nonparetic and bilateral limbs of comparators, arterial size and intramuscular blood flow in the paretic upper limbs of individuals with stroke were significantly reduced. Motor impairment and disuse emerged as independent predictors of all vascular outcomes and may be potential intervention targets for reducing cardiovascular disease risk after stroke.
Postural Sway Measurement Using a Body-Worn Movement Sensor in Clinical Stroke Rehabilitation: Exploring Sensitivity to Change and Responsiveness.
Geerars M, Wouda NC, Felius RAW … +3 more , Visser-Meily JMA, Pisters MF, Punt M
Phys Ther · 2025 Apr · PMID 39982424 · Full text
IMPORTANCE: During rehabilitation, the balance of a person with stroke is commonly monitored using the Berg Balance Scale and the Mini-Balance Evaluation Systems Test. These tests evaluate the ability to maintain balance...
IMPORTANCE: During rehabilitation, the balance of a person with stroke is commonly monitored using the Berg Balance Scale and the Mini-Balance Evaluation Systems Test. These tests evaluate the ability to maintain balance in an upright position while performing tasks. Currently, clinical practice lacks an adequate assessment of balance impairments like the increased postural sway poststroke. Integrating postural sway measurement with a body-worn inertial measurement unit could offer clinicians an objective and rapid measurement method. OBJECTIVE: Sensitivity to change and responsiveness of postural sway measurement during stroke rehabilitation were explored. DESIGN: A longitudinal study was conducted. SETTING: Data were collected in 5 rehabilitation centers. PARTICIPANTS: 94 people with stroke were included in the study. INTERVENTION: Sensitivity to change was evaluated by comparing the percentages of participants who exceeded the minimal detectable change for both the conventional and inertial measurement unit tests. Responsiveness was assessed through hypotheses testing, utilizing both a criterion approach (external criterion: a 5-point retrospective Global Rating of Change score) and a construct approach. RESULTS: At discharge, only 3.2% to 23.9% of the participants showed genuine improvement (ie, had a lower postural sway) on the inertial measurement unit test, compared to 33% to 60% on the conventional tests. In total, 67.4% of the hypotheses were rejected. CONCLUSIONS: The sensitivity to change and responsiveness of postural sway measurement in people with stroke are limited. Restoring balance to achieve functional independence is not necessarily dependent on, or associated with, the level of postural sway. At present, integrating postural sway measurement into clinical stroke rehabilitation seems to provide no added value for monitoring balance. RELEVANCE: A novel approach to balance assessment in clinical stroke rehabilitation was investigated. It was found that while most participants improved in terms of functionality and independence, only a small percentage exhibited a significant change in postural sway. Therefore, postural sway may not effectively serve as an indicator of improved movement quality. This insight is crucial for both researchers and clinicians involved in neurorehabilitation.
Health Care Professionals' Views of Barriers and Facilitators for Implementing a Fall Risk Screening Tool in Clinical and Public Health Settings.
Frisendahl N, Karlsson P, Sandlund C … +4 more , Ek S, Franzén E, Boström AM, Welmer AK
Phys Ther · 2025 Apr · PMID 39964354 · Full text
OBJECTIVE: The experiences of health care professionals using new screening tools in clinical and public health settings are crucial to the implementation process. However, further research is needed on their experiences...
OBJECTIVE: The experiences of health care professionals using new screening tools in clinical and public health settings are crucial to the implementation process. However, further research is needed on their experiences with fall risk screening. This study utilized the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to explore health care professionals' experiences with the First-time Injurious Falls (FIF) screening tool, aiming to identify barriers and facilitators for implementing the FIF tool in primary health care and public health settings. METHODS: A qualitative study with 4 focus group interviews and 7 individual interviews was carried out, using a semistructured interview guide. The interviews were recorded, transcribed verbatim, and analyzed with reflexive thematic analysis. The study included 20 participants (13 females and 7 males), with a mean age of 39 years (range 24 to 54). The participants were working in the primary health care setting (8 physical therapists, 3 occupational therapists, 3 managers, 2 registered nurses, and 1 dietician) and in a public health project (1 physical therapist and 2 health educators). RESULTS: The analysis resulted in 3 themes: "a valuable tool in clinical practice," "how to get everyone onboard when implementing fall risk screening," and "applicable in many areas of health services but not in all" with 4 related subthemes "quick and easy to use for all health care professionals," "simplifies assessment and creates a platform for discussion," "need for clear instructions and action list," and "should be incorporated into daily routines." CONCLUSION: The FIF tool was well-received by participants in practice as it was user-friendly and potentially effective in preventing falls. However, there is room for improvement, particularly in clarifying instructions to mitigate possible misinterpretations. The participants emphasized that implementation of a new screening tool requires favorable organizational conditions such as managerial support, that the tool is easily accessible, and the results are easy to document. IMPACT: The FIF tool seems to be a valuable screening tool for predicting first-time injurious falls in older adults, suitable for use by various health care professionals.
Metabolic Health Screening in Physical Therapy Private Practice in Australia: A Feasibility Study.
Mastwyk SE, Taylor NF, Lowe A … +2 more , Dalton CF, Peiris CL
Phys Ther · 2025 Apr · PMID 39961026 · Full text
IMPORTANCE: Noncommunicable diseases are the leading cause of morbidity and mortality globally. Physical therapists working in private practice have an opportunity to embed health screening in their practice to support c...
IMPORTANCE: Noncommunicable diseases are the leading cause of morbidity and mortality globally. Physical therapists working in private practice have an opportunity to embed health screening in their practice to support chronic disease prevention. However, it is not known if it is feasible to conduct health screenings in physical therapist private practice settings. OBJECTIVE: The aim of this study was to determine the feasibility of physical therapists conducting client health screening with point-of-care testing. DESIGN: This was a feasibility study, comprising of in-depth interviews and descriptive quantitative data. SETTING: The health screenings took place in physical therapy private practices in Australia. The 1-to-1 interviews were conducted via phone, video conference, or face-to-face, according to participant preference. PARTICIPANTS: Two hundred and thirty adult clients participated in a health screen at a physical therapy practice. Follow-up interviews were completed with 20 clients and 8 physical therapists. INTERVENTIONS: Clients had a 30-minute health screen that included collection of self-reported physical activity and dietary intake and physical examination of metabolic risk factors including waist circumference, blood pressure, and point-of-care testing of cholesterol and glucose. MAIN OUTCOMES AND MEASURES: Using interpretative description methods and inductive thematic analysis, themes were identified from the interviews and then mapped deductively onto feasibility domains of acceptability, demand, implementation, practicality, and integration. RESULTS: Three themes were identified. Clients perceived screening as convenient and comfortable; provided important health information; and could be part of usual physical therapy. Physical therapists saw health screening as a valuable add-on service and beneficial for client management but were uncertain about future integration. CONCLUSIONS AND RELEVANCE: Incorporating health screening into private practice physical therapy services is feasible and valued by clients but physical therapists were unsure how they could integrate this into their practice/business. Physical therapists working in private practice need additional training to incorporate health screening into their practice. Concurrently, funding models need to support this by prioritizing investment in health promotion and disease prevention.
Sitting Together and Reaching to Play Physical Therapy Affects Dyadic Emotional Availability in Children With Neuromotor Delay and Their Families.
Molinini RM, Stuyvenburg C, Koziol NA … +9 more , Harbourne RT, Hsu LY, Lobo MA, Willett SL, Bovaird JA, Chu VW, Price SK, Shall MS, Dusing SC
Phys Ther · 2025 Feb · PMID 39961025 · Full text
OBJECTIVE: Emotional availability (EA) describes caregiver-child emotional attunement and is critical to fostering adaptive development. Although early physical therapist interventions adopt a family centered approach, t...
OBJECTIVE: Emotional availability (EA) describes caregiver-child emotional attunement and is critical to fostering adaptive development. Although early physical therapist interventions adopt a family centered approach, the impact of interventions on families is often not quantified. This study compares EA in dyads receiving usual care-early intervention (UC-EI) versus sitting together and reaching to play (START-Play) in addition to UC-EI. METHODS: Data were drawn from 106 children with neuromotor delay who were 7 to 16 months old at baseline (mean = 10.5 months) and from their caregiver (91% were mothers). The EA Scale, Fourth Edition, was scored from 5-min videotaped interactions collected at baseline and at 3, 6, and 12 months after baseline. Piecewise multilevel modeling controlling for baseline age and motor delay estimated short- and long-term effects between treatment groups. Additionally, within-group change over time was analyzed to understand if groups differed in direction of EA trajectories. Analyses were run aggregated across all participants and stratified by baseline severity of motor delay or caregiver reported education. RESULTS: When comparing EA between groups, there were significant positive short- and long-term effects of START-Play on adult EA (gs > 0.38), sensitivity (gs > 0.26), structuring (gs > 0.43), and nonintrusiveness (gs > 0.36). For dyads with mild or significant motor delay or whose parent reported less than a bachelor's degree at baseline, positive effects of START-Play were observed. CONCLUSION: Results support important clinical implications for the positive effect of START-Play on EA. Similar child-level treatment effects highlight that the key difference between START-Play and UC-EI may lie in the way intervention affects caregivers. START-Play may be more beneficial to dyads with higher versus lower risks to EA. IMPACT: Early physical therapist interventions can have a significant impact on parents, children, and the parent-child relationship. Measuring the effect of these interventions on the relationship is critical to optimizing the delivery of family centered care.
Application of Algorithm-Based Treatment Approach to Low Back Pain in the Emergency Department.
Strickland KJ, Kim HS, Seitz AL
Phys Ther · 2025 Apr · PMID 39951510 · Full text
Low back pain accounts for nearly 4 million annual emergency department (ED) visits, and patient outcomes following an ED visit for low back pain are poor. Additionally, only a small portion of patients visiting the ED f...
Low back pain accounts for nearly 4 million annual emergency department (ED) visits, and patient outcomes following an ED visit for low back pain are poor. Additionally, only a small portion of patients visiting the ED for low back pain follow up with outpatient physical therapy within 3 months, despite established benefits of early versus delayed physical therapy referral such as improved patient outcomes, less opioid use, and reduced downstream health care utilization. Integrating a physical therapist directly into the ED care team can facilitate evidence-based guideline concordant care and improve patient outcomes, however, physical therapists who are staffed into this role from other settings may lack experience with evaluating and managing patients with acute low back pain. Additionally, there are several unique considerations of the ED care environment which may make existing treatment-based classification approaches difficult to apply in this setting, including physical constraints (eg, delivering care in stretchers and hallways), higher symptom severity and psychosocial stressors necessitating an emergency visit, and greater likelihood of alternative medical diagnoses (eg, kidney stone, aortic aneurysm) contributing to symptoms of low back pain. This perspective presents a modified ED treatment-based classification system (ED-TBC) for low back pain with 3 illustrative case examples. The ED-TBC for low back pain can be used to facilitate guideline concordant care, increase physical therapist confidence in evaluating low back pain in the ED, and reduce clinical practice variation.
Validation of the Revised American Physical Therapy Association Physical Therapist Clinical Performance Instrument 3.0.
Campbell DF, Alameri M, Macahilig-Rice F … +2 more , Witkin SE, Hellman NG
Phys Ther · 2025 Apr · PMID 39946243 · Publisher ↗
OBJECTIVE: Validation of the revised American Physical Therapy Association (APTA) Physical Therapist Clinical Performance Instrument (PT CPI 3.0) is essential to ensure that we are effectively assessing Doctor of Physica...
OBJECTIVE: Validation of the revised American Physical Therapy Association (APTA) Physical Therapist Clinical Performance Instrument (PT CPI 3.0) is essential to ensure that we are effectively assessing Doctor of Physical Therapy (DPT) students' clinical performance. The purpose was to validate the revised PT CPI 3.0 for use with DPT students as a measure of clinical performance. METHODS: A descriptive and exploratory combined cross-sectional retrospective and prospective cohort design was used. University DPT students' clinical education experiences were explored. Participants were selected using a convenience sample of 693 DPT students from 1 US multicampus DPT program(s) during Fall 2023 and Spring 2024 clinical education experiences. DPT students on (1) integrated (ICE) and (2) 2 terminal clinical education experiences (TCE I and TCE II) participated in the study. Clinical instructor PT CPI 3.0 item ratings of DPT students at midterm and final assessments during clinical education experiences were investigated. Descriptive and inferential statistics evaluated differences between clinical instructor PT CPI 3.0 item ratings of DPT students during clinical education experiences. RESULTS: The PT CPI 3.0 demonstrated good internal reliability, and factor analysis with a 1-factor solution explained 81.3% of variance. Construct validity was supported by significant differences in PT CPI item scores between DPT students on ICE and each of TCE I and TCE II. Construct and convergent validity were supported by significant score increases from midterm to final assessments for DPT students on ICE and TCEs and by moderate to large correlations between prior clinical experiences and remaining didactic coursework. CONCLUSION: Findings support validity of the revised PT CPI 3.0 as a measure of clinical performance. A limitation is that this study did not assess rater reliability. IMPACT: This study provides preliminary support for validation of the newly revised APTA PT CPI 3.0 as a measure to assess entry-level physical therapist student clinical performance.
The Movement System and Diagnosis: Are We There Yet?
McClure P
Phys Ther · 2025 Mar · PMID 39932786 · Publisher ↗
In the 29th Maley lecture, Phil McClure PT, PhD, FAPTA, shares a Perspective regarding the movement system and diagnosis. Despite declarations from the House of Delegates >10 years ago, the concept of a movement system h...
In the 29th Maley lecture, Phil McClure PT, PhD, FAPTA, shares a Perspective regarding the movement system and diagnosis. Despite declarations from the House of Delegates >10 years ago, the concept of a movement system has not been widely embraced in either education or practice. In this perspective, he offers critical analysis and 3 proposals that could potentially make the concept of a movement system more relevant and meaningful. The first is to operationally define the movement system, arguing that the current definition is too vague and not operational, and therefore not meaningful. The second is to intentionally separate the movement system from any specific diagnostic classification scheme which would allow the focus to remain on movement and movement analysis. He argues that diagnostic classification schemes require a biopsychosocial framework and that movement, while important, cannot be the only consideration. The third proposal is that diagnostic schemes must be developed by clinical scientists through appropriate research guided by sound theory, not by administrative or political process. He further argues that a greater focus on determining which patients are likely to be helped by physical therapists is necessary and offered the example of developing "appropriateness criteria" as a tool toward promoting value-based care. Achieving broad consensus around these proposals could unify our professional focus and assist toward the vision of optimizing movement to enhance the human experience.
Evaluating the Potential of Large Language Models for Vestibular Rehabilitation Education: A Comparison of ChatGPT, Google Gemini, and Clinicians.
Arbel Y, Gimmon Y, Shmueli L
Phys Ther · 2025 Apr · PMID 39932784 · Full text
OBJECTIVE: This study aimed to compare the performance of 2 large language models, ChatGPT (Generative Pre-trained Transformer) and Google Gemini, against experienced physical therapists and students in responding to mul...
OBJECTIVE: This study aimed to compare the performance of 2 large language models, ChatGPT (Generative Pre-trained Transformer) and Google Gemini, against experienced physical therapists and students in responding to multiple-choice questions related to vestibular rehabilitation. The study further aimed to assess the accuracy of ChatGPT's responses by board-certified otoneurologists. METHODS: This study was conducted among 30 physical therapist professionals experienced with vestibular rehabilitation and 30 physical therapist students. They were asked to complete a vestibular knowledge test (VKT) consisting of 20 multiple-choice questions that were divided into 3 categories: (1) Clinical Knowledge, (2) Basic Clinical Practice, and (3) Clinical Reasoning. ChatGPT and Google Gemini were tasked with answering the same 20 VKT questions. Three board-certified otoneurologists independently evaluated the accuracy of each response using a 4-level scale, ranging from comprehensive to completely incorrect. RESULTS: ChatGPT outperformed Google Gemini with a 70% score on the VKT test, while Gemini scored 60%. Both excelled in Clinical Knowledge scoring 100% but struggled in Clinical Reasoning with ChatGPT scoring 50% and Gemini scoring 25%. According to 3 otoneurologic experts, ChatGPT's accuracy was considered "comprehensive" in 45% of the 20 questions, while 25% were found to be completely incorrect. ChatGPT provided "comprehensive" responses in 50% of Clinical Knowledge and Basic Clinical Practice questions, but only 25% in Clinical Reasoning. CONCLUSION: Caution is advised when using ChatGPT and Google Gemini due to their limited accuracy in clinical reasoning. While they provide accurate responses concerning Clinical Knowledge, their reliance on web information may lead to inconsistencies. ChatGPT performed better than Gemini. Health care professionals should carefully formulate questions and be aware of the potential influence of the online prevalence of information on ChatGPT's and Google Gemini's responses. Combining clinical expertise and clinical guidelines with ChatGPT and Google Gemini can maximize benefits while mitigating limitations. The results are based on current models of ChatGPT3.5 and Google Gemini. Future iterations of these models are expected to offer improved accuracy as the underlying modeling and algorithms are further refined. IMPACT: This study highlights the potential utility of large language models like ChatGPT in supplementing clinical knowledge for physical therapists, while underscoring the need for caution in domains requiring complex clinical reasoning. The findings emphasize the importance of integrating technological tools carefully with human expertise to enhance patient care and rehabilitation outcomes.
Gait Speed Modifies Efficacy of Home-Based Exercise for Falls in Older Adults With a Previous Fall: Secondary Analysis of a Randomized Controlled Trial.
Rice J, Falck RS, Davis JC … +7 more , Hsu CL, Dian L, Madden K, Parmar N, Cook WL, Khan KM, Liu-Ambrose T
Phys Ther · 2025 Mar · PMID 39879229 · Full text
OBJECTIVE: Exercise is an evidence-based strategy for preventing falls. However, its efficacy may vary based on individual characteristics, like gait speed. This study examined whether baseline gait speed modified the ef...
OBJECTIVE: Exercise is an evidence-based strategy for preventing falls. However, its efficacy may vary based on individual characteristics, like gait speed. This study examined whether baseline gait speed modified the effects of home-based exercise on subsequent falls among older adults. METHODS: This is a secondary analysis of a 12-month, randomized controlled trial in community-dwelling adults who were ≥70 years old and who had fallen within the previous 12 months. Participants were randomized to either 12 months of home-based exercise (n = 172) or standard of care (n = 172). This study examined intervention effects on fall rates at 6 and 12 months stratified by baseline gait speed (slow [<0.80 m/s] or normal [≥0.80 m/s]) using negative binomial regressions. Baseline gait speed was investigated as a potential modifier of the intervention effects on mobility and cognitive function using linear mixed modeling. RESULTS: At baseline, 134 participants had slow (exercise = 70; standard of care = 64) and 210 had normal (exercise = 102; standard of care = 108) gait speeds. For participants with slow gait speed, exercise reduced fall rates by 44% at 6 months (incidence rate ratio = 0.56; 95% CI [confidence interval] = 0.33-0.95) but not at 12 months (incidence rate ratio = 0.63; 95% CI = 0.38-1.03) compared with standard of care; for participants with normal gait speed, there was no significant effect of exercise on fall rates at 6 or 12 months. Gait speed modified intervention effects; in the exercise group, participants with slow gait showed significant improvements in the Timed "Up & Go" Test at 6 months (estimated mean difference = -4.05; 95% CI = -6.82 to -1.27) and the Digit Symbol Substitution Test at 12 months (estimated mean difference = 2.51; 95% CI = 0.81-4.21). CONCLUSION: Older adults with slow gait speed had a reduction in subsequent falls in response to exercise at 6 months. Gait speed modified the effects of exercise on mobility and cognition. IMPACT: Older adults with slow gait speed may be a target population for exercise-based fall prevention.
Effectiveness of Additional or Standalone Corticosteroid Injections Compared to Physical Therapist Interventions in Rotator Cuff Tendinopathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Lazzarini SG, Buraschi R, Pollet J … +3 more , Bettariga F, Pancera S, Pedersini P
Phys Ther · 2025 Mar · PMID 39836429 · Publisher ↗
IMPORTANCE: Rotator cuff tendinopathy represents the most prevalent cause of shoulder pain, the third most common musculoskeletal disorder after low back pain and knee pain. OBJECTIVE: The objective of this study was to...
IMPORTANCE: Rotator cuff tendinopathy represents the most prevalent cause of shoulder pain, the third most common musculoskeletal disorder after low back pain and knee pain. OBJECTIVE: The objective of this study was to determine the effectiveness of corticosteroid injection(s), alone or in combination with anesthetic injection or any other physical therapist interventions, compared to physical therapist interventions alone in adults with rotator cuff tendinopathy. DESIGN: This study was a systematic review and meta-analysis of randomized controlled trials. PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and Physiotherapy Evidence Database were searched from inception to March 2023. Meta-analysis using a random-effects model was performed. Risk of bias and certainty of the evidence for the primary outcomes were assessed using the Cochrane risk-of-bias tool and the Grading of Recommendations, Assessment, Development and Evaluation approach, respectively. The protocol was registered in the International Prospective Register of Systematic Reviews (CRD42021240882). PARTICIPANTS: Participants were adults with rotator cuff tendinopathy. INTERVENTIONS: Corticosteroid injection(s), alone or in combination with anesthetic injection or with any other physical therapist interventions, was compared to physical therapist interventions alone. MAIN OUTCOMES: Pain, function, quality of life, patient-rated overall improvement, and adverse events were the main outcomes. RESULTS: Fifteen randomized controlled trials (1785 participants) met the inclusion criteria. At short term, corticosteroid injection coupled with physical therapist interventions and compared to the same interventions alone might have resulted in some small to moderate improvements in pain and function. Conversely, corticosteroid injection alone seemed not to be more effective than physical therapist interventions in improving pain and function in most of the studies included. At mid- and long-term follow-up assessments corticosteroid injection seemed not to be more effective than any physical therapist interventions. CONCLUSIONS: This study highlights the potential effectiveness of corticosteroid injection(s) in rotator cuff tendinopathy for pain and function at short term at best, especially in combination with physical therapist interventions. However, the evidence is of moderate to mostly very low certainty. Additional high-quality research considering core outcomes, therefore, is needed. RELEVANCE: Corticosteroid injection(s) seems not to be superior to physical therapist interventions, other than resulting in some transient improvements at short term if provided together with other physical therapist interventions, in adults with rotator cuff tendinopathy. Furthermore, considering the potential adverse events associated with the injections, physical therapist interventions may be an important stand-alone treatment option.
Association Between Physical Therapists' Attitudes and Beliefs and the Functional Outcomes of Patients With Low Back Pain: A Multilevel Analysis Study.
Nudelman Y, Pincus T, Ami NB
Phys Ther · 2025 Apr · PMID 39834020 · Full text
OBJECTIVE: This study aimed to investigate the association of physical therapists' attitudes and beliefs about low back pain (LBP) with treatment outcomes within a publicly funded health care system. METHODS: Data from a...
OBJECTIVE: This study aimed to investigate the association of physical therapists' attitudes and beliefs about low back pain (LBP) with treatment outcomes within a publicly funded health care system. METHODS: Data from a national outpatient physical therapy service provider were analyzed. Functional status data were collected at intake and discharge. The Attitudes to Back Pain Scale in Musculoskeletal Practitioners questionnaire was used to assess physical therapists' attitudes. Multilevel regression models were employed to examine the effects of physical therapists' attitudes while controlling for patient and physical therapist characteristics. RESULTS: The study included 68 physical therapists and 1043 patients. The physical therapist level explained a small portion of the variance in patients' function (4%-10%). A more biomedically oriented attitude was associated with a slightly lower patient function level (β = -.08), but patient characteristics largely influenced this effect. Other attitude factors were not significantly associated with function. Sensitivity analyses aligned with the main findings. CONCLUSIONS: The study suggests that physical therapists' attitudes have a limited impact on LBP treatment outcomes within a publicly funded health care system. While a more biomedically oriented attitude was associated with slight negative effects, the clinical relevance is questionable. Further research in diverse settings is needed to validate and contextualize these findings. The study underscores the importance of considering patient-level factors and health care system context in interpreting practitioner effects on treatment outcomes. IMPACT: Patient characteristics are more significant in explaining functional outcomes than physical therapists' characteristics and attitudes. A marginally small association was observed, indicating that a more biomedically oriented attitude among physical therapists was linked to slightly lower patient functioning. Despite the observed association, the clinical relevance of physical therapists' attitudes in LBP treatment outcomes remains modest.
Monitoring Treatment Fidelity in a Pragmatic Pediatric Rehabilitation Trial Comparing Two Physical Therapy Schedules: Analysis and Unexpected Findings.
Maus E, Scott K, Ferrante R … +2 more , Antoszewski S, Heathcock J
Phys Ther · 2025 Mar · PMID 39823290 · Publisher ↗
OBJECTIVE: This study aimed to describe the monitoring of treatment fidelity in a pragmatic pediatric rehabilitation trial using the National Institutes of Health Behavior Change Consortium framework, and to identify chi...
OBJECTIVE: This study aimed to describe the monitoring of treatment fidelity in a pragmatic pediatric rehabilitation trial using the National Institutes of Health Behavior Change Consortium framework, and to identify child and therapist factors that influence treatment fidelity. METHODS: Therapists (n = 28) were trained in the key ingredients (1-on-1, functional, goal-directed, motor learning intervention), and study protocol for a comparative effectiveness trial titled: "A Comparison: High Intensity periodic vs Every week therapy in children with cerebral palsy (ACHIEVE)" for children ages 2 to 8 years with cerebral palsy (CP). Therapists were instructed to record every tenth hour of treatment. A subset of recordings were used to monitor treatment fidelity so that each therapist was rated twice using the study-specific ACHIEVE Treatment Fidelity Checklist. Generalized linear mixed effects modeling and logistic regression were used to analyze child and therapist factors related to treatment fidelity. RESULTS: Median treatment fidelity scores were high (>80%). With training, therapist's years of experience and specialty certification do not significantly impact treatment fidelity. There is a trend toward lower treatment fidelity scores for children with communication difficulties, particularly for therapist's use of multi-modal instructions to direct the child in the desired activity. CONCLUSION: Functional, goal-directed, motor learning intervention can be delivered with high fidelity for children with CP within a busy clinical setting. Motor learning principles may be implemented differently for children with communication difficulties. More research is needed to explore optimal motor learning strategies for these children. IMPACT: With training, physical therapists can deliver high-fidelity intervention to children with CP across all Gross Motor Function Classification System levels within a busy clinical setting. Therapists may use motor learning principles differently in children with communication delays.
Taking the Next Step in Neurologic Rehabilitation: Contributions of Intensity and Variability of Stepping Tasks During Locomotor Training.
Hornby TG, Moore J, Holleran CL … +1 more , Henderson CE
Phys Ther · 2025 Mar · PMID 39823284 · Full text
Research over the past 20 years indicates the amount of task-specific walking practice provided to individuals with stroke, brain injury, or incomplete spinal cord injury can strongly influence walking recovery. However,...
Research over the past 20 years indicates the amount of task-specific walking practice provided to individuals with stroke, brain injury, or incomplete spinal cord injury can strongly influence walking recovery. However, more recent data suggest that attention toward 2 other training parameters, including the intensity and variability of walking practice, may maximize walking recovery and facilitate gains in non-walking outcomes. The combination of these training parameters represents a stark contrast from traditional strategies, and confusion regarding the potential benefits and perceived risks may limit their implementation in clinical practice. The purpose of this perspective is to delineate the evidence regarding the contributions of intensity and variability of locomotor training to improve mobility outcomes in individuals with acute-onset brain and spinal cord injury. The rationale and evidence supporting the utility of these training parameters in controlled laboratory settings is first described by integrating concepts in the field of neuroscience, motor learning, biomechanics, and exercise physiology into a rehabilitation intervention. Subsequently, the evidence supporting the efficacy of this paradigm is addressed, including discussions of some of the misconceptions regarding perceived negative consequences of these strategies in an effort to mitigate common clinical concerns. Finally, the utility of these strategies implemented during inpatient rehabilitation is delineated to facilitate a more comprehensive understanding of the feasibility and potential benefits early following neurologic injury. A greater understanding of how and why to integrate higher intensity, variable stepping practice will support therapists to take the next step to maximize mobility in the patients they serve.
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