Physical Therapy[JOURNAL]
Sun
200 papers
Correction to: Revisiting the concept of minimal detectable change for patient-reported outcome measures.
Phys Ther · 2026 Feb · PMID 41766486 · Publisher ↗
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Primary care provider attitudes regarding physical therapists addressing opioid use and opioid misuse: a qualitative study.
Magel JS, Siantz E, Incze MA … +9 more , Beneciuk JM, Fritz JM, Kelley AT, Cochran G, Blosser P, Hartman P, Tyszko M, Kertesz S, Gordon AJ
Phys Ther · 2026 Apr · PMID 41761771 · Full text
IMPORTANCE: Primary care providers (PCPs) manage musculoskeletal pain and may prescribe opioids for their patients, presenting risk for opioid misuse. Physical therapists are well-positioned to collaborate with PCPs in i...
IMPORTANCE: Primary care providers (PCPs) manage musculoskeletal pain and may prescribe opioids for their patients, presenting risk for opioid misuse. Physical therapists are well-positioned to collaborate with PCPs in identifying and mitigating opioid risk and misuse for patients that PCPs and physical therapists co-manage. How PCPs view such collaboration is unclear. OBJECTIVE: The objective of this study was to explore PCPs' attitudes regarding physical therapists' role in identifying and mitigating opioid risk and opioid misuse. DESIGN: This was a qualitative study using rapid content analysis and it was the first phase in a sequential exploratory mixed-methods investigation. SETTING AND PARTICIPANTS: Semi-structured interviews were conducted with 22 PCPs in Utah. PCPs were invited to participate if they were listed by the Utah Division of Professional Licensure as having an active license to practice in Utah. PCPs were eligible to participate if they (1) referred a patient to outpatient physical therapy within the past 6 months and (2) prescribed an opioid within the past 6 months. Interviews were conducted between May 6, 2024, and August 9, 2024, and were audio recorded and transcribed. MAIN OUTCOME: The main outcomes were qualitative themes reported by the PCPs surrounding their attitudes toward collaborating with physical therapists on patients taking prescription opioid medication for pain. RESULTS: Twenty-two PCPs were interviewed, which included 7 (31.8%) physicians, 6 (27.3%) nurse practitioners, and 9 (40.9%) physician assistants. Mean years of clinical experience was 13.9 (SD = 9.1) with 12 (56.0%) participants identifying as female and 20 (90.1%) identifying as White. The themes identified were (1) physical therapist's involvement in opioid management can help patients, (2) communication between physical therapists and PCPs regarding opioids is important, (3) physical therapists should educate their patients about the risks of opioid use, and (4) physical therapists should refer their patients with suspected opioid misuse for further management. CONCLUSION AND RELEVANCE: PCPs favorably regarded physical therapists' involvement in identifying and mitigating opioid risk and misuse among co-managed patients.
On "Depressive Symptoms and Physical Activity Mediate the Adverse Effect of Pain on Functional Dependence in Patients With Arthritis: Evidence From the Canadian Longitudinal Study on Aging." Goubran M, van Allen ZM, Bilodeau M, Boisgontier MP. Phys Ther. 2025;105(11):pzaf120. https://doi.org/10.1093/ptj/pzaf120.
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Phys Ther · 2026 Mar · PMID 41761766 · Publisher ↗
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Intervention fidelity: a common language for clinicians and researchers.
Willett SL, Cunha AB, Hsu LY … +3 more , Brown ED, Harbourne RT, Dusing S
Phys Ther · 2026 Mar · PMID 41738301 · Publisher ↗
This paper explores the importance of fidelity in strengthening clinical translation and implementation of rehabilitation research interventions and in reducing unwarranted variation in practice patterns. Fidelity, or ac...
This paper explores the importance of fidelity in strengthening clinical translation and implementation of rehabilitation research interventions and in reducing unwarranted variation in practice patterns. Fidelity, or accurate and faithful delivery of an intervention, is critical for all aspects of the clinical translational research continuum. Fidelity intentionally defines and tracks the key or active ingredients of a research intervention, ensures adherence to and dose of these key ingredients across therapists and research sites, and clearly establishes what is new or different about an intervention as compared to usual or standard practice. Measurement and reporting standards for fidelity in rehabilitation research vary widely. Historically, rehabilitation researchers have not reported their fidelity process clearly, if at all. This reporting gap creates a multi-faceted conundrum for replication of research findings and eventual clinical implementation of rehabilitation interventions. Without clear fidelity metrics, researchers fail to establish what is novel or unique about an intervention and fail to differentiate a new intervention from other established approaches. Without seeking and applying fidelity metrics, clinicians have no way of replicating a new intervention or understanding which key ingredients replace or supersede old practice habits. Thus, failure of researchers to transparently communicate and of clinicians to understand and apply fidelity metrics widens unwarranted practice variations rather than improving our precision with rehabilitation interventions. Using 2 recent pediatric clinical trials as exemplars, we describe how the development and tracking of metrics defining fidelity for the Sitting Together and Reaching to Play (START-Play) intervention informed key ingredients and program differentiation as researchers moved from an efficacy to an effectiveness trial; and then propose how clinicians might use these same metrics to inform implementation of START-Play. This example will demonstrate how robust fidelity might serve as a common language for successful implementation of and improved precision with rehabilitation research interventions.
Organizational barriers and enablers of adult mobility in general acute hospital units: a scoping review.
Nolan J, Conroy T, Ross A … +3 more , Baker N, van den Berg M, Mudge A
Phys Ther · 2026 Apr · PMID 41725382 · Full text
IMPORTANCE: An improved understanding of the organizational influences on adult in-hospital mobility is essential to develop and sustain interventions to prevent functional decline. OBJECTIVE: The objective was to map co...
IMPORTANCE: An improved understanding of the organizational influences on adult in-hospital mobility is essential to develop and sustain interventions to prevent functional decline. OBJECTIVE: The objective was to map contemporary evidence about organizational barriers and enablers of adult patient mobility in general acute hospital units, the participants reporting these barriers and enablers, and how mobility was defined. DATA SOURCES: A systematic search was conducted in Embase, Emcare, EBSCO Cumulative Index to Nursing and Allied Health Literature Complete, Cochrane Library, Joanna Briggs Institute, MEDLINE, ProQuest (Health Research Premium Collection), PsycINFO, Scopus and Web of Science for studies published in English from January 2013 to October 2024 inclusive. STUDY SELECTION: Based on eligibility criteria, 2 reviewers independently screened title/abstracts and full texts. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently extracted study characteristics and mobility definitions. Organizational barriers and enablers of mobility were mapped to the Consolidated Framework for Implementation Research 2.0 outer (community and jurisdiction) and inner setting (hospital) domains. MAIN OUTCOMES: Fifty-one studies were included (45 primary studies and 6 reviews). Fourteen studies reported organizational barriers and enablers of mobility in the outer setting. All 51 studies reported inner setting mobility barriers and enablers, mostly related to infrastructure, culture, and available resources. Most participants were patients or health professionals providing direct patient care. Few studies defined mobility, and definitions were inconsistent. CONCLUSIONS AND RELEVANCE: Studies reported many organizational barriers and enablers of mobility at the hospital level, with far fewer reported at the community and jurisdiction level. Few studies reported the perspectives of health service leadership, and investigating their perspective may provide greater insights to address these barriers. Consistent definitions of mobility could enable progress in research and practice.Greater insights into community and jurisdictional barriers and enablers of mobility from the perspective of health care leaders are required to address organizational barriers.
Functional classification of hemiparetic gait based on paretic leg extension angle and gastrocnemius muscle activity.
Tsushima Y, Fujita K, Saiki Y … +2 more , Hayashi K, Kobayashi Y
Phys Ther · 2026 Mar · PMID 41700786 · Publisher ↗
IMPORTANCE: Hemiparetic gait after stroke shows substantial individual variability, and understanding its biomechanical determinants is essential for developing targeted rehabilitation strategies. OBJECTIVE: The objectiv...
IMPORTANCE: Hemiparetic gait after stroke shows substantial individual variability, and understanding its biomechanical determinants is essential for developing targeted rehabilitation strategies. OBJECTIVE: The objective of this study was to classify hemiparetic gait into subgroups based on paretic leg extension angle and gastrocnemius muscle (GM) activity during stance and to examine differences in walking ability among these subgroups. DESIGN: This study used a cross-sectional observational design with hierarchical cluster analysis. SETTING: Data were collected in a hospital rehabilitation department. PARTICIPANTS: Eighty-three individuals with chronic stroke who could walk independently participated. EXPOSURE: Leg extension angle and GM activity during stance were assessed using a video-based markerless motion analysis system and surface electromyography. MEASURES: Spatiotemporal gait parameters, gait asymmetry, peak knee flexion angle during swing, and clinical assessments of motor paresis and spasticity were compared among the identified clusters. RESULTS: Hierarchical cluster analysis identified 4 gait patterns based on paretic leg extension angle and gastrocnemius activity during stance: Cluster 1 (large leg extension angle with moderate gastrocnemius activity) showed walking speed comparable to Cluster 3 but with reduced knee flexion during swing; Cluster 2 (moderate leg extension angle with moderate gastrocnemius activity) demonstrated intermediate walking speed that was slower than that of Cluster 1; Cluster 3 (large leg extension angle with the greatest gastrocnemius activity) exhibited faster walking speed and the greatest peak knee flexion during swing; and Cluster 4 (small leg extension angle with reduced gastrocnemius activity) showed the slowest walking speed, significant gait asymmetry, and severe motor paresis. CONCLUSIONS: Hemiparetic gait was classified into 4 patterns based on leg extension angle and gastrocnemius activity, and these patterns were associated with differences in walking ability. RELEVANCE: This functional classification framework may help clinicians identify key biomechanical targets and support the design of individualized rehabilitation strategies after stroke.
Geographic disparities in rehabilitation provider availability and community demographics in Texas: a cross-sectional geographic information systems study.
Ratoza M, Patel RM, Brewer W … +2 more , Mitchell K, Chevan J
Phys Ther · 2026 Mar · PMID 41697017 · Publisher ↗
IMPORTANCE: Availability of rehabilitation providers is a critical component of access to care, yet little is known about how workforce supply relates to community demographic characteristics within urban and rural regio...
IMPORTANCE: Availability of rehabilitation providers is a critical component of access to care, yet little is known about how workforce supply relates to community demographic characteristics within urban and rural regions. OBJECTIVE: The objective of this study was to examine geographic variability in the availability of licensed physical and occupational therapy providers in Texas and evaluate the relationship between provider supply and community-level characteristics including race and ethnicity, disability, and poverty. DESIGN: The study used a descriptive, cross-sectional observational study design. SETTING: The setting was all 6896 census tracts across the state of Texas. PARTICIPANTS: Participants included all physical therapists, physical therapy assistants, occupational therapists, and occupational therapy assistants who held a license in 2022 and resided in Texas. INTERVENTIONS/EXPOSURES: Provider workforce supply was derived from state licensure records and linked to population-level demographic and socioeconomic data from the American Community Survey using geospatial analysis. MAIN OUTCOMES AND MEASURES: The population-to-provider ratio for physical therapy and occupational therapy providers per census tract and its relationship to community demographics was the main outcome measure. RESULTS: Among 45,114 licensed physical therapy and occupational therapy providers, provider availability varied widely across Texas census tracts, with population-to-provider ratios ranging from 4 to 11,147 individuals per provider. Bivariate mapping showed that census tracts with fewer providers often overlapped with areas of higher disability prevalence, larger proportions of Hispanic or non-White residents, and higher poverty rates, particularly along southern and border regions and within parts of urban centers like southern Dallas and eastern Houston. Statistical comparisons revealed significant differences in racial composition between areas with the highest and lowest provider availability (χ26 = 1,561,831; Cramér V = 0.36) and in ethnic composition (χ2₁ = 1,012,990; Cramér V = 0.29). Differences in poverty (χ2₁ = 38,746; Cramér V = 0.06) and disability prevalence (χ2₁ = 5175.9; Cramér V = 0.02) were also significant but had smaller effect sizes. CONCLUSIONS: Substantial geographic variability exists in rehabilitation provider supply across census tracts in Texas, with lower availability in areas where populations may have higher needs. These findings highlight opportunities for workforce planning and targeted resource allocation to improve access to rehabilitation services in underserved regions. RELEVANCE: Understanding provider shortages at the census tract level combined with specific community demographics can inform workforce policy development, and initiatives to strengthen the rehabilitation workforce to meet population health needs. Addressing workforce diversity could improve access, patient-provider relationships, and culturally relevant care.
Addressing loneliness through movement and connection in physical therapy practice.
Vancampfort D, McGrath RL, Stubbs B
Phys Ther · 2026 Mar · PMID 41665273 · Publisher ↗
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Cueing-assisted gamified augmented-reality home rehabilitation for gait and balance in people with Parkinson disease: feasibility and effectiveness in the clinical pathway.
Hoogendoorn EM, Geerse DJ, van Dam AT … +6 more , van Hall SJ, van Doorn PF, Hardeman LES, Hoozemans MJM, Stins JF, Roerdink M
Phys Ther · 2026 Mar · PMID 41665260 · Full text
IMPORTANCE: Physical therapy is moving toward digitally supported, independent, home-based care to improve therapy accessibility and adherence. OBJECTIVE: This trial evaluated the clinical feasibility and potential effec...
IMPORTANCE: Physical therapy is moving toward digitally supported, independent, home-based care to improve therapy accessibility and adherence. OBJECTIVE: This trial evaluated the clinical feasibility and potential effectiveness of Strolll, an augmented reality (AR) neurorehabilitation platform offering gamified gait-and-balance exercises with optional assistive AR cueing for individuals with Parkinson disease, implemented in real-world clinical practice. DESIGN AND SETTING: In this pragmatic clinical trial, 15 Dutch health care practices were onboarded, 28 therapists trained, and 100 individuals with Parkinson disease (Hoehn and Yahr stages 1-3) included. All participants followed the T0-usual-care-control-T1-Strolll-intervention-T2 procedure. INTERVENTION: The Strolll intervention consisted of 2-week supervised in-clinic training followed by 6 weeks, 5 sessions per week of 30 active minutes each, independent home-based training. RESULTS: No serious adverse events occurred; only 2 non-injurious falls were reported in >60.000 exercise minutes. Adherence was high (96% session adherence, 91% active minutes/session adherence). Therapists prescribed the program progressively, with significantly higher game-play levels over time. Participants' exercise performance increased over time. Participants and therapists rated user experience and technology acceptance positively. Timed "Up & Go" test and 10-meter walk test (10MWT) (fast speed) scores improved significantly after the intervention period only. Five times sit-to-stand test, 10MWT (comfortable speed), and Mini Balance Evaluation Systems Test scores improved after both usual-care and intervention periods. Falls Efficacy Scale-International scores showed no significant improvements. AR cueing was deemed beneficial for a subset of participants. CONCLUSIONS: Strolll is a safe, adherable, progressive, usable, and well-accepted therapist-managed, home-based intervention for people with Parkinson disease, with the potential to improve gait, balance, and fall-risk indicators. Findings on the integration of AR cueing highlight the importance of an individualized approach. RELEVANCE: Implementing AR rehabilitation technologies like Strolll in the clinical pathway is feasible, offering a safe and scalable way for individuals to train independently, potentially improving accessibility of care and broadening its use to physical activity promotion. CLINICAL TRIAL REGISTRATION: This study was registered at ClinicalTrials.gov (NCT06590987).
Ethical and bioethical issues in physical therapy: A systematic scoping review.
Bertoni G, Patuzzo Manzati S, Pagani F … +2 more , Testa M, Battista S
Phys Ther · 2026 Mar · PMID 41626749 · Full text
IMPORTANCE: Ethical and bioethical issues are central to the identity and practice of physical therapy. A comprehensive overview of how these issues are addressed in the literature is essential for advancing education, c...
IMPORTANCE: Ethical and bioethical issues are central to the identity and practice of physical therapy. A comprehensive overview of how these issues are addressed in the literature is essential for advancing education, clinical practice, and professional reflection. OBJECTIVE: The objective was to systematically map ethical and bioethical issues in the physical therapy literature, describe the methodologies employed, and identify key gaps to inform education, practice, and policy. DATA SOURCES: Medline (via PubMed), Embase, Cochrane Central, CINAHL, PsycINFO, PEDro, grey literature sources, and academic library resources were searched from inception to October 2024. The review protocol was prospectively published on medRxiv. STUDY SELECTION: Studies addressing ethical or bioethical issues in physical therapy were included, encompassing both normative and descriptive (empirical) approaches. After screening titles, abstracts, and full texts, 108 studies met the inclusion criteria. DATA EXTRACTION AND SYNTHESIS: Data were extracted using a modified Joanna Briggs Institute standardized form. A narrative synthesis was conducted to map ethical themes and characterize methodological approaches across studies. MAIN OUTCOMES AND MEASURES: Identification and mapping of ethical and bioethical themes and characterization of research methodologies applied. RESULTS: A total of 15,464 records were identified; 3223 duplicates were removed. Of 12,241 titles and abstracts screened, 385 full texts were assessed, and 108 studies were included. Major themes included ethical reasoning (n = 33), ethical reasoning and education (n = 19), ethical theories (n = 12), care relationships (n = 15), justice and equity (n = 8), perception of ethical issues (n = 13), and codes of ethics (n = 8). Key challenges involved physical touch, informed consent, professional boundaries, and moral distress. Structural barriers, cultural contexts, and disparities in ethics education were recurring concerns. Ethical reasoning was often situational and intuitive, whereas formal codes were frequently perceived as disconnected from clinical practice. CONCLUSIONS AND RELEVANCE: Ethical complexities in physical therapy arise from its embodied, relational, and context-sensitive nature. The literature reveals variability in how ethics is taught and applied across settings and highlights underexplored areas, including oncology, end-of-life care, digital health and artificial intelligence, and equity, diversity, and inclusion. Findings emphasize the need to strengthen ethics education, reinforce the application of existing codes of ethics, and provide organizational support for ethical deliberation. This synthesis provides a foundation for future research and can inform curricular development, clinical practice, and policy initiatives in physical therapy ethics.
Psychological mediators in chronic spinal pain after fully remote digital rehabilitation: a real-world, large-sample study.
Janela D, Tong X, Pires D … +2 more , Fonseca H, Costa F
Phys Ther · 2026 Mar · PMID 41626740 · Full text
IMPORTANCE: Psychological factors are associated with chronic spinal pain, yet their mediating role in postrehabilitation recovery remains poorly understood, particularly in fully remote digital care. Most research has f...
IMPORTANCE: Psychological factors are associated with chronic spinal pain, yet their mediating role in postrehabilitation recovery remains poorly understood, particularly in fully remote digital care. Most research has focused on baseline predictors, with few studies evaluating psychological mediators and moderators. OBJECTIVE: The objective of this study was to investigate whether changes in fear avoidance beliefs, depression, and anxiety mediate pain outcome following a digital care program (DCP) for chronic spinal conditions and whether these effects vary by Body Mass Index (BMI), self-reported gender, and socioeconomic status. DESIGN: This was an ad hoc analysis of a real-world registry of patients undergoing a DCP. SETTING: The setting was a fully remote DCP delivered across the United States. PARTICIPANTS: The participants were adults who had chronic spinal musculoskeletal pain (N = 14,818) and who accessed the DCP via employer-sponsored health plans. INTERVENTION: The DCP consisted of exercise, education, and behavior change, managed asynchronously by physical therapists. MAIN OUTCOMES AND MEASURES: The final pain score (11-point numeric pain rating scale) was the primary outcome. Candidate mediators were changes in fear avoidance beliefs, depression, and anxiety. Confounding was mitigated through demographic and clinical covariates. Moderation was tested for BMI, self-reported gender, and socioeconomic deprivation. Structural equation modeling was used. RESULTS: Improvements in fear avoidance beliefs (β = -0.10, SE = 0.00), depression (β = -0.05, SE = 0.01), and anxiety (β = -0.04, SE = 0.01) significantly mediated lower final pain scores after adjustment for confounding. The mediating effect of fear avoidance was especially pronounced among patients with severe obesity. Self-reported gender and socioeconomic status did not show moderating effects. The model's explained variance was 30%. CONCLUSIONS AND RELEVANCE: Changes in fear avoidance beliefs, depression, and anxiety play a central role in pain recovery following digital rehabilitation. Fear avoidance mediation was particularly strong in individuals with severe obesity, highlighting the need for targeted psychological support in this subgroup. The findings emphasize the pertinence of systematically screening, monitoring, and addressing psychological factors in remote care, contributing to understanding how digital rehabilitation promotes recovery.
A physical therapy mobility checkup is feasible with annual wellness visits in primary care.
Lieberz D, Lundberg S, McDonald M … +3 more , Tiede C, Karow C, Taran A
Phys Ther · 2026 Feb · PMID 41609116 · Publisher ↗
IMPORTANCE: Screening older adults for mobility disability and preclinical mobility limitation does not routinely occur. OBJECTIVE: This study aimed to: (1) determine the feasibility of implementing a preventive physical...
IMPORTANCE: Screening older adults for mobility disability and preclinical mobility limitation does not routinely occur. OBJECTIVE: This study aimed to: (1) determine the feasibility of implementing a preventive physical therapy mobility checkup in primary care and (2) determine if 1 mobility checkup shifts the self-efficacy of older adults for meeting activity recommendations. DESIGN/SETTING: A cross-sectional study with a convenience sample was conducted at 1 primary care clinic. PARTICIPANTS: Participants (N = 80) were, on average, 73.4 years (range 65-92) and 61.3% female. INTERVENTIONS: A 15-min mobility checkup consisted of (1) self-reported activity and mobility, (2) testing with the Short Physical Performance Battery, including gait speed and the 5 Times Sit to Stand Test; (3) education about results; and (4) recommendations. MAIN OUTCOMES AND MEASURES: Twelve feasibility criteria were established a priori and evaluated after study completion. The feasibility criteria evaluated acceptability, adoption, appropriateness, and feasibility of the mobility checkup. Shifts in the retrospective pre-post self-efficacy for exercise (SEE) surveys were evaluated descriptively. RESULTS: Ten of 12 feasibility criteria were met. The total mean retrospective pre-SEE survey score was 6.39 (SD = 2.54) and the total mean post-SEE survey score was 7.61 (SD = 1.97). There were 62 positive shifts, 3 negative, and 14 unchanged with the retrospective pre-post SEE survey. CONCLUSIONS: A mobility checkup in primary care is feasible and may increase the self-efficacy of older adults for meeting activity guidelines. RELEVANCE: Routine physical therapy mobility checkups in primary care offer a promising strategy to optimize health outcomes for older adults.
My View of PTJ: Updates From the Home Office.
George SZ
Phys Ther · 2026 Jan · PMID 41592111 · Publisher ↗
Abstract loading — click title to view on PubMed.
Author Response to Perme et al.
Mayer KP, Johnson AM, Kumble S … +1 more , Norris TL
Phys Ther · 2026 Feb · PMID 41575225 · Publisher ↗
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From theory to practice: A mixed-method evaluation of a program to implement high-intensity rehabilitation in skilled nursing facilities.
Hinrichs-Kinney LA, Pontiff M, Butera KA … +3 more , Beisheim-Ryan EH, Magnusson DM, Stevens-Lapsley JE
Phys Ther · 2026 Feb · PMID 41575205 · Publisher ↗
IMPORTANCE: Implementing evidence-based dosing of rehabilitation in skilled nursing facilities (SNFs) is essential to improve functional outcomes in a medically complex population. OBJECTIVE: The objective was to evaluat...
IMPORTANCE: Implementing evidence-based dosing of rehabilitation in skilled nursing facilities (SNFs) is essential to improve functional outcomes in a medically complex population. OBJECTIVE: The objective was to evaluate an implementation program promoting high-intensity resistance rehabilitation (HIR) in SNFs by (1) measuring proximal (clinician knowledge, self-efficacy, and HIR perspective) and distal (HIR adoption and implementation) outcomes; (2) exploring how the program influenced distal outcomes (program processes); and (3) investigating clinician factors influencing HIR implementation. DESIGN: The design was a prospective convergent mixed-methods, theory-driven program evaluation. SETTING: This study was conducted across 8 rural Department of Veterans Affairs SNFs. PARTICIPANTS: Rehabilitation clinicians (n = 38) and leaders (n = 16) were included. INTERVENTIONS OR EXPOSURES: All sites received a multicomponent implementation program promoting HIR. MAIN OUTCOMES AND MEASURES: Validated questionnaires assessed HIR perspective (Perceived Characteristics of Intervention Scale) and adoption (Commitment to Change Scale). Study-specific questionnaires measured clinician HIR knowledge, self-efficacy, and implementation. Interviews and focus groups explored program processes and clinician factors. RESULTS: The program improved clinician HIR knowledge, self-efficacy, and perspective, leading to acceptable adoption rates. Implementation was marginally affected. Only the clinician perspective correlated with adoption (P = .47). Qualitatively, the program supported distal outcomes by keeping HIR at the forefront of clinicians' mind, fostering positive outcome expectations, and enhancing team cohesion and accountability. Clinician creativity, adaptability, resilience, professional discipline, and previous experience influenced implementation. CONCLUSION: The program influenced HIR adoption primarily by enhancing clinicians' positive perspectives of HIR. Future efforts could strengthen implementation by fostering team cohesion, accountability, and clinician creativity while also assessing environmental factors. RELEVANCE: Effective HIR implementation can optimize patient outcomes. Strategies that enhance clinician perspective and creativity, keep HIR at the forefront, and foster team cohesion and accountability may improve adoption. Additionally, assessing and addressing environmental factors may further support sustainable integration of HIR into clinical practice.
On "A Core Set of Outcome Measures to Assess Physical Function for Adults Participating in Physical Therapist Treatment in the Hospital: A Clinical Practice Guideline." Mayer KP, Johnson AM, Smith DJ, et al. Phys Ther. 2025;105(6):pzaf076. https://doi.org/10.1093/ptj/pzaf076.
Perme CS, Damasceno MS, Wilches-Luna EC … +1 more , Nawa RK
Phys Ther · 2026 Feb · PMID 41575178 · Publisher ↗
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Predictors of Functional Recovery in Individuals Exposed to Late-Stage Exercise Programs After Total Knee Replacement: A Secondary Analysis of a Randomized Controlled Trial.
Carlesso CR, Smith C, Patterson CG … +2 more , Bove AM, Piva SR
Phys Ther · 2026 Feb · PMID 41568780 · Full text
IMPORTANCE: Total knee replacement (TKR) is common for advanced cartilage degeneration. Often, functional limitations persist, and late-stage exercise (2-4 months after TKR) may improve recovery. OBJECTIVE: The objective...
IMPORTANCE: Total knee replacement (TKR) is common for advanced cartilage degeneration. Often, functional limitations persist, and late-stage exercise (2-4 months after TKR) may improve recovery. OBJECTIVE: The objective of this study was to identify predictors of late-stage functional recovery after TKR and their variations by exercise program. DESIGN: This study was a secondary analysis of a randomized controlled trial. SETTING: The settings were 1 physical therapy clinic and 4 community centers in Allegheny County, Pennsylvania. PARTICIPANTS: The study included 199 individuals (mean age = 70 years; body mass index = 31 kg/m2; 60% women). INTERVENTIONS: Interventions were physical therapy exercises, community-based exercises, and usual care. MAIN OUTCOME AND MEASURES: The main outcome was functional recovery at 6 months after intervention. Functional recovery was defined as ≥50% improvement on the Western Ontario and McMaster Universities Osteoarthritis Index physical function subscale, at least somewhat better on the Global Rating of Change, and ≥ 20% improvement on ≥2 performance-based tests. Predictors were identified using logistic regression. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported. RESULTS: In the entire cohort, 33% of participants achieved functional recovery, including 42% in the physical therapy group and 38% in the community group. Overall, better baseline health (odds ratio [OR] = 2.70 [95% CI = 1.34-5.47]), discharge to home (OR = 6.24 [95% CI = 1.94-20.09]), and higher Western Ontario and McMaster Universities Osteoarthritis Index pain subscale scores (OR = 1.22 [95% CI = 1.07-1.40]) predicted functional recovery. In the physical therapy group (n = 83), positive predictors were better health (OR = 4.40 [95% CI = 1.20-16.06]), discharge to home (OR = 11.67 [95% CI = 2.01-67.76]), regular use of nonsteroidal anti-inflammatory drugs (OR = 3.76 [95% CI = 1.11-12.78]), and as-needed use of analgesics (OR = 10.53 [95% CI = 1.75-63.48]). Negative predictors, associated with a lower likelihood of recovery, were regular use of salicylates (OR = 0.22 [95% CI = 0.07-0.74]) and greater use of pain-coping strategies (OR = 0.51 [95% CI = 0.29-0.89]). No predictors were identified in the community group (n = 76). CONCLUSIONS: Better baseline health, discharge to home after TKR, and higher pain levels predicted functional recovery. Physical therapy provided additional benefits for a subset of participants. RELEVANCE: This evidence helps clinicians set realistic functional recovery expectations and strategies to facilitate function late after TKR.
Physical Therapy and Occupational Therapy in Acute Care: Association of Timing and Frequency With 30-Day Readmission After Ischemic Stroke.
Edelstein J, Hoffman A, Luby DM … +3 more , Rosenthal J, Deutsch A, Graham JE
Phys Ther · 2026 Feb · PMID 41562579 · Publisher ↗
IMPORTANCE: Reducing 30-day hospital readmission rates after ischemic stroke is a national priority, yet optimal rehabilitation service delivery strategies in acute care are unclear. Physical therapy and occupational the...
IMPORTANCE: Reducing 30-day hospital readmission rates after ischemic stroke is a national priority, yet optimal rehabilitation service delivery strategies in acute care are unclear. Physical therapy and occupational therapy are essential for functional recovery, discharge planning, and readmission prevention, but the association between service delivery factors and readmission risk remains uncertain. OBJECTIVE: The objective was to evaluate the relationship between the timing and frequency of physical therapy and occupational therapy in acute care and 30-day readmission rates among patients with ischemic stroke. DESIGN: This was an observational cross-sectional study using electronic medical records from January 2018 to December 2021. SETTING: The study was conducted within a 13-hospital health system in Colorado. PARTICIPANTS: Patients with a primary diagnosis of ischemic stroke (N = 1545) were included. Inclusion required receiving physical therapist or occupational therapist treatment, while exclusions included evaluation-only visits, discharge to hospice, leaving against medical advice, interhospital transfers, or death within 30 days. Final samples included 979 physical therapy and 713 occupational therapy patients, stratified by discharge destination (home vs postacute rehabilitation). EXPOSURES: Rehabilitation service delivery factors were: (1) time to evaluation: days from admission to first therapy evaluation; (2) time to treatment: days from evaluation to first therapy session; and (3) therapy frequency: total number of therapy sessions (1-2, 3-4, or ≥ 5). Separate analyses were conducted for physical therapist and occupational therapist services. MAIN OUTCOMES: The primary outcome was 30-day hospital readmission. RESULTS: Among patients discharged home, fewer days between physical therapist evaluation and treatment were associated with reduced odds of readmission (OR = 1.105, 95% CI = 1.003-1.217). Higher occupational therapy session frequency was linked to lower readmission odds (≥5 sessions: OR = 0.17, 95% CI = 0.029-0.994). After adjustment for length of stay, the association between occupational therapy frequency and readmission was attenuated, whereas the association between time to physical therapy evaluation and readmission remained significant. No significant associations were found in patients discharged to postacute rehabilitation facilities. CONCLUSIONS AND RELEVANCE: Early physical therapist treatment and frequent occupational therapy sessions were associated with reduced 30-day readmission risk for patients discharged home. Optimizing acute care rehabilitation service delivery is essential to improving postdischarge outcomes.
Perspective From the APTA Academy of Geriatric Physical Therapy: The Need for Annual Mobility Assessment for Aging Adults.
Criss MG, Dring J, Eckert S … +1 more , Puthoff M
Phys Ther · 2026 Feb · PMID 41504372 · Publisher ↗
During the 2023 Carole B. Lewis Lecture, Michelle Lusardi, PT, DPT, PhD, FAPTA, issued a call to action for the American Physical Therapy Association's Academy of Geriatric Physical Therapy (APTA Geriatrics): to embrace,...
During the 2023 Carole B. Lewis Lecture, Michelle Lusardi, PT, DPT, PhD, FAPTA, issued a call to action for the American Physical Therapy Association's Academy of Geriatric Physical Therapy (APTA Geriatrics): to embrace, enact, and evaluate the effectiveness of an annual mobility screen for aging adults. This call highlighted the need to quickly identify preclinical mobility limitations that indicate those at risk for functional decline, falls, and other adverse health outcomes. By moving to a true primary prevention model aimed at identifying preclinical issues, physical therapists can share findings, provide education about the importance of physical activity, and initiate referrals and/or interventions when needed. In response, APTA Geriatrics assembled an Annual Mobility Assessment Task Force to assess this issue and make recommendations. This Perspective Paper summarizes APTA Geriatrics' position on this issue, the Task Force findings, and actions to date. APTA Geriatrics believes that primary prevention efforts to identify risk for avoidable mobility limitations are essential for the physical therapy profession to embrace its mission to transform society by optimizing movement.
"It's an Uncomfortable Subject"-a Qualitative Exploration of the Challenges and Potential Solutions to Depression Screening in Low Back Pain.
Sugrue J, McKenna S, MacHale S … +1 more , O'Sullivan K
Phys Ther · 2026 Jan · PMID 41499156 · Full text
IMPORTANCE: Comorbid depression in people with low back pain (LBP) is associated with poorer prognosis. OBJECTIVE: The objective was to understand the challenges faced by musculoskeletal (MSK) triage physical therapists...
IMPORTANCE: Comorbid depression in people with low back pain (LBP) is associated with poorer prognosis. OBJECTIVE: The objective was to understand the challenges faced by musculoskeletal (MSK) triage physical therapists when screening for depression in LBP populations, and to generate actionable recommendations for overcoming these challenges. DESIGN: This study adopted a pragmatic hybrid descriptive qualitative approach, integrating elements of ethnography and action research. SETTING: Interviews were conducted in the Republic of Ireland and used purposive sampling of physical therapists working in MSK triage roles. PARTICIPANTS: To be included, participants were required to have managed at least 1 person with LBP each week in the 3 months prior to recruitment. INTERVENTION(S) OR EXPOSURE(S): The context explored was MSK triage physical therapists' experience with depression screening in people with LBP. MAIN OUTCOMES AND MEASURE(S): The main outcomes were insights regarding challenges and potential solutions to depression screening. Semi-structured interviews were employed, with data analysis following a Reflexive Thematic Analysis framework. RESULTS: Fourteen MSK triage physical therapists participated. Challenges were organized into 3 themes: capacity (personal, professional, and system), culture (clinic, societal), and circuitous communication. Potential solutions were organized into 5 themes: training and education, standardized pathways, knowledge of and access to resources, screening tools, and normalizing depression screening in MSK triage equivalent to red flag screening. CONCLUSION: The findings highlight capacity and cultural challenges that lead to circuitous communication. Addressing the potential solutions through implementation research could enhance depression screening practices by MSK triage physical therapists for people with LBP. RELEVANCE: This qualitative research offers novel insights into the challenges MSK triage physical therapists face when screening for depression in people with LBP. Importantly, it proposes actionable solutions with participants contributing as subject matter experts. Their pragmatic solutions can help facilitate consequential change and help normalize depression screening in MSK triage practice.
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