Physical Therapy[JOURNAL]
Sun
200 papers
More Frequent Empathic Communication by Physical Therapists Is Associated With Improved Outcomes for Low-Impact Chronic Pain.
Chapman CR, Stone MD, Anthony J … +5 more , Patawaran M, Sinsay J, Solomon CR, Ungson S, Monroe KS
Phys Ther · 2026 Feb · PMID 41493287 · Full text
IMPORTANCE: Empathic communication is recommended in chronic pain management, yet few studies have examined the role of provider communication on treatment outcomes in pain rehabilitation. OBJECTIVE: The objective is to...
IMPORTANCE: Empathic communication is recommended in chronic pain management, yet few studies have examined the role of provider communication on treatment outcomes in pain rehabilitation. OBJECTIVE: The objective is to quantify associations between the frequency of empathic communication by physical therapists and patient-reported pain outcomes during routine clinical care for patients with chronic musculoskeletal pain. PARTICIPANTS AND DESIGN: Thirty-one physical therapist-patient dyads participated in a prospective cohort study in an outpatient physical therapy clinic. Evaluation and treatment sessions were audio-recorded over 6 weeks of routine physical therapy management of chronic musculoskeletal pain. MAIN OUTCOMES AND MEASURES: Empathic communication was quantified as a ratio of the frequency of empathic responses by physical therapists normalized to the frequency of empathic opportunities expressed by patients. Mixed-effects models assessed associations between physical therapist empathic communication and patient-reported pain intensity and interference over time. RESULTS: Across 99 recorded visits, physical therapists (n = 8) responded empathically 67% of the time. Empathic response rates for individual providers ranged from 27% to 84%. On average, more frequent empathic communication was associated with lower pain intensity (B = -1.29 [95% CI = -2.23 to -0.36) and pain interference (B = -1.07 [95% CI = -2.11 to -0.03]). More frequent empathic communication was also associated with a greater reduction in pain intensity over time (B = -0.78 [95% CI = -1.45 to -0.12]). CONCLUSIONS AND RELEVANCE: More frequent empathic communication is associated with lower patient-reported pain intensity and interference, along with larger and more rapid decreases in pain intensity over time. Future studies should investigate the efficacy of empathic communication skills training to improve outcomes of chronic pain management.
Defining and Categorizing Low-Value Physical Therapy Referral Waste in Acute Care: An Administrative Case Report.
Hull BL, Longnecker D
Phys Ther · 2026 Jan · PMID 41439590 · Publisher ↗
IMPORTANCE: Hospitals can follow the steps outlined in this administrative case report to identify and address potential overutilization waste. OBJECTIVE: Acute care physical therapist evaluation and intervention can ide...
IMPORTANCE: Hospitals can follow the steps outlined in this administrative case report to identify and address potential overutilization waste. OBJECTIVE: Acute care physical therapist evaluation and intervention can identify functional needs, safety needs, and develop treatment plans to optimize function, activity, safety, and the ability to discharge home safely. However, health care waste results when therapy referrals are utilized beyond these needs. This administrative case report aimed to define and categorize physical therapist overutilization to guide health care waste reduction. DESIGN: This administrative case report describes a 2-phase project to develop and implement a low-value referral (LVR) tracking system within a large health care system. During phase 1, the development phase, semi-structured group consensus meeting stakeholders identified 4 LVR categories and developed a data collection tool for a hospital-wide feasibility project. Phase 2 collected data on clinician-identified LVRs over a 2-year timeframe to identify LVR category, referring provider, and patient care unit from which the LVRs are located. SETTING: Baylor University Medical Center (BUMC) is a quaternary care academic medical center in Dallas, Texas, with 914 licensed acute care beds. PARTICIPANTS: All physical therapists evaluating and treating patients at BUMC during the project. RESULTS: Out of 40,815 total physical therapist referrals, 2263 were identified as LVRs. The authors found that 5.54% of hospital referrals were LVRs, with more than 75% of LVRs associated with patients currently at their baseline functional state and/or independent with activity/mobility. Furthermore, 27% of all LVRs came from just 20 referral sources (mean = 30.55; SD = 9.76), and 43.9% were located on 3 patient care units, making targeted and customized education and collaboration initiatives feasible. CONCLUSION AND RELEVANCE: This case report demonstrates that acute care hospital physical therapist overutilization can be easily defined by category, source, and location. This meaningful data can be used to divert potential health care waste toward evidence-informed patient care designed to improve outcomes.
The Relationship Between Postural Control and Fundamental Movement Skills in Children With Developmental Coordination Disorder, Mild Cerebral Palsy, and Typical Development.
Johnson C, Hallemans A, Meyns P … +4 more , Velghe S, Fransen E, Klingels K, Verbecque E
Phys Ther · 2026 Jan · PMID 41427869 · Publisher ↗
IMPORTANCE: Impaired fundamental movement skills are prevalent among children with developmental coordination disorder (DCD) and mild cerebral palsy (CP). Although postural control is a prerequisite for gross motor skill...
IMPORTANCE: Impaired fundamental movement skills are prevalent among children with developmental coordination disorder (DCD) and mild cerebral palsy (CP). Although postural control is a prerequisite for gross motor skills, its role in fundamental movement skills is understudied. OBJECTIVE: This study aims to determine the extent to which postural control contributes to fundamental movement skill performance in children with DCD, mild CP, and with typical development (TD). DESIGN: This was a case-control study. PARTICIPANTS: Participants were 127 children aged 5.0 to 10.9 years (DCD [N = 48], TD [N = 59)], mild spastic CP [N = 20]). Children with CP were classified as Gross Motor Function Classification System I (N = 11) or II (N = 9), and as having either unilateral (N = 11) or bilateral CP(N = 9). MAIN OUTCOMES AND MEASURES: The Test of Gross Motor Development-3 (TGMD-3) evaluated fundamental movement skills, and the Kids-Balance Evaluation Systems Test-2 (Kids-BESTest-2) assessed postural control. The domain and total scores of both tests were used for analysis. RESULTS: Children with TD significantly outperformed those with DCD and mild CP, while DCD and mild CP performed similarly. Across groups the Kids-BESTest-2 and TGMD-3 correlated significantly (r = 0.42-0.77). The total Kids-BESTest-2 score and group (TD-DCD-mild CP) explained 69% of locomotor skill variance but did not significantly explain ball skill performance (R2 = 0.40). Among postural control domains, only anticipatory postural adjustments contributed to fundamental movement skills. Group effects were larger (ηp2 = 0.15-0.31) than the effects of Kids-BESTest-2 scores (ηp2 = 0.01-0.12). CONCLUSIONS AND RELEVANCE: The findings suggest that postural control plays a role in locomotor performance but that unique group-specific factors influence this relationship. Further research should investigate the impact of postural control task-oriented training on fundamental movement skills, and should examine the influence of additional factors, such as body functions and environmental influences on fundamental movement skill development.
American Physical Therapy Association Clinical Practice Guideline Facilitated Shared Decision Making for Patients With Low Back Pain: Feasibility and Acceptability in Outpatient Physical Therapy.
Beneciuk JM, Bialosky JE, Harrison T … +3 more , Buzzanca-Fried KE, Rodgers LJ, Verstandig D
Phys Ther · 2026 Jan · PMID 41427851 · Publisher ↗
IMPORTANCE: The feasibility and acceptability of integrating shared decision making (SDM) for patients receiving physical therapy for low back pain (LBP) is unclear. OBJECTIVE: This study assessed feasibility and accepta...
IMPORTANCE: The feasibility and acceptability of integrating shared decision making (SDM) for patients receiving physical therapy for low back pain (LBP) is unclear. OBJECTIVE: This study assessed feasibility and acceptability of integrating SDM for intervention selection facilitated by American Physical Therapy Association clinical practice guidelines for patients with LBP. DESIGN: This was a non-randomized pilot feasibility study. SETTING: This study was conducted in outpatient physical therapy clinics. PARTICIPANTS: Physical therapists (n = 10) and patients receiving care for LBP (n = 40) participated. INTERVENTION: Physical therapists were non-randomly allocated to not receive (-SDM, n = 4) or receive (+SDM, n = 6) training to integrate SDM for patients with LBP. MAIN OUTCOMES AND MEASURES: Feasibility of study procedures was assessed through recruitment, enrollment, and retention rates. Acceptability was assessed with standard measures for treatment acceptability (Short Assessment of Patient Satisfaction, SAPS), credibility-expectancy (Credibility-Expectancy Questionnaire, CEQ), therapeutic alliance (Work Alliance Inventory Short-Revised, WAI-SR), SDM occurrence (collaborRATE, and 9-item Shared Decision Making Questionnaire, SDM-Q-9) at 4 weeks. Patient-reported outcomes were described for pain intensity and interference (Pain, Enjoyment, General Activity, PEG), pain self-efficacy (4-item Pain Self Efficacy Questionnaire, PSEQ-4), and LBP disability (Oswestry Disability Index, ODI). RESULTS: Of 68 patients that were eligible, 43 (63.2%) communicated with study coordinator, 40 (93.0%) were enrolled, and 24 (60.0%) completed 4-week follow-up. Patient acceptability outcome median scores for SAPS (-SDM = 24.0, +SDM = 24.0), CEQ-credibility (25.0, 26.0), CEQ-expectancy (21.0, 23.0), WAI-SR goal (20.0, 18.0), WAI-SR task (17.0, 18.0), and WAI-SR bond (16.0, 19.0) were observed. Top score rates for collaboRATE (-SDM = 53.8%, +SDM = 72.7%) and SDM-Q-9 (38.5%, 54.5%) were observed. Median within-participant change in PEG (-SDM = -0.7 points, +SDM = -2.0 points), PSEQ-4 (0.0, +2.0), and ODI (-4.0, -12.0) scores were observed with minimal important change rates for PEG (-SDM = 23.1%, +SDM = 54.5%), PSEQ-4 (30.8%, 63.7%), and ODI (38.5%, 63.6%) described. CONCLUSIONS: Feasibility findings will inform future efficacy study planning with respect to recruitment, enrollment, and retention procedures. Future studies should consider assessing SDM from both patient and physical therapist perspectives while also evaluating how clinical practice guidelines may be used as resources to facilitate SDM for people with LBP. RELEVANCE: These study findings have implications for SDM as a strategy to incorporate patient preferences into evidence-based clinical decision making for patients with LBP in outpatient physical therapy settings, however, larger scale studies are needed.
Trends in Rehabilitation Insurance Benefit Exhaustion Among Older Adults in the United States and Associations With Racial Identity.
Falvey JR, Sun N, Mathis LM … +2 more , Chou LN, Kumar A
Phys Ther · 2026 Jan · PMID 41427849 · Full text
IMPORTANCE: Rehabilitation supports independence for older adults with disability, but limitations in access to services and the amount of care received are ongoing concerns. One potential driver is insurance coverage. O...
IMPORTANCE: Rehabilitation supports independence for older adults with disability, but limitations in access to services and the amount of care received are ongoing concerns. One potential driver is insurance coverage. OBJECTIVE: This study characterized trends and racial disparities in rehabilitation insurance benefit exhaustion among older adults from 2015 to 2022. DESIGN: The study was a repeated cross-sectional analysis using data from the National Health and Aging Trends Study (NHATS). Models were clustered at the patient level to estimate changes in insurance exhaustion from 2015 to 2022, and an overall estimate of racial disparities over this time period was estimated using survey-weighted logistic regression. SETTING: Population-based survey of patients in rehabilitation facilities and clinics in the United States. PARTICIPANTS: The sample included 5653 rehabilitation user-years (weighted N = 38.3 million) contributed by 3386 community-dwelling Medicare beneficiaries aged 70+ who received rehabilitation services between 2015 and 2022. EXPOSURES: The primary exposure of interest was racial and ethnic identity, categorized as Non-Hispanic Black and Non-Hispanic White. MAIN OUTCOME AND MEASURES: The main outcome was patient-reported rehabilitation insurance benefit exhaustion, defined using NHATS survey responses. RESULTS: From 2015 to 2022, the overall rate of patient-reported rehabilitation insurance benefit exhaustion among older adults declined from 32.0% (95% CI = 28.1%-35.7%) to 27.9% (95% CI = 24.4%-31.3%). However, racial disparities persisted and widened over this period. In 2015, 39.2% (95% CI = 29.7%-48.8%) of Black older adults reported benefit exhaustion compared to 30.7% (95% CI = 26.3%-35.0%) of White older adults. By 2022, rates declined to 25.7% (95% CI = 21.6%-29.8%) among White adults and 38.5% (95% CI = 27.4%-49.5%) among Black adults. In adjusted analyses, the odds of patient-reported rehabilitation insurance benefit exhaustion were higher for Black versus White adults from 2015 to 2022 (OR = 1.50; 95% CI = 1.20-1.86). CONCLUSIONS: Although overall rates of patient-reported rehabilitation insurance benefit exhaustion declined modestly from 2015 to 2022, 1 in 4 still reported terminating their rehabilitation episodes because of self-reported insurance benefit exhaustion in 2022 with growing racial disparities over time. RELEVANCE: These findings highlight the need for Medicare reforms that expand and equitably enforce coverage to ensure all older adults-particularly those from marginalized groups-can complete the rehabilitation necessary to maintain independence.
40 Years of PTJ: The Lure of Blank Pages and Blue Screens.
Reynolds JP
Phys Ther · 2025 Nov · PMID 41424439 · Publisher ↗
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Letter by Gagnon and Blackinton on "Are There Speed Limits in Doctor of Physical Therapy Education? Future Research Directions." Davis SD. Phys Ther. 2025;105:pzaf079. https://doi.org/10.1093/ptj/pzaf079.
Gagnon K, Blackinton M
Phys Ther · 2026 Jan · PMID 41410380 · Publisher ↗
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Letter by Denninger, Hegedus, and Thigpen on "Are There Speed Limits in Doctor of Physical Therapy Education? Future Research Directions." Davis SD. Phys Ther. 2025;105:pzaf079. https://doi.org/10.1093/ptj/pzaf079.
Denninger TR, Hegedus EJ, Thigpen CA
Phys Ther · 2026 Jan · PMID 41400555 · Publisher ↗
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Response to Altenburger et al, Denninger et al, and Gagnon and Blackinton.
Davis DS
Phys Ther · 2026 Jan · PMID 41396060 · Publisher ↗
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Letter by Altenburger, Jette, Kosior, Pak, and Topp on "Are There Speed Limits in Doctor of Physical Therapy Education? Future Research Directions." Davis SD. Phys Ther. 2025;105:pzaf079. https://doi.org/10.1093/ptj/pzaf079.
Altenburger P, Jette DU, Kosior K … +2 more , Pak S, Topp K
Phys Ther · 2026 Jan · PMID 41396048 · Publisher ↗
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Understanding Patient and Care Partner Experiences With Rehabilitation After Hospitalization for Advanced Heart Failure: "I Was Thinking I'd Just Be Like I Was Before I Got This".
Stone S, Keeney T, Yildiz F … +8 more , Travis A, Coglianese E, Lewis GD, Greer JA, Steinhauser K, Pastva AM, Vranceanu AM, Ritchie CS
Phys Ther · 2026 Feb · PMID 41351874 · Publisher ↗
IMPORTANCE: Advanced heart failure (HF) is a life-limiting condition that frequently necessitates hospitalization and subsequent post-acute rehabilitation for older adults. Despite high rates of post-acute care utilizati...
IMPORTANCE: Advanced heart failure (HF) is a life-limiting condition that frequently necessitates hospitalization and subsequent post-acute rehabilitation for older adults. Despite high rates of post-acute care utilization, a notable gap exists in understanding the rehabilitation experiences of both patients and their care partners. OBJECTIVE: The objective was to conduct semi-structured interviews with older adults hospitalized with advanced HF and their care partners to explore their prior experiences with HF rehabilitation, including perceived benefits, unmet needs, and opportunities for improvement. DESIGN: Between 2021 and 2023, a qualitative descriptive approach was used to conduct semi-structured interviews with patients hospitalized at an urban academic medical center with advanced HF (n = 12) and care partners (n = 11). Human-centered design principles and the Framework Method were used to guide study design and analyze semi-structured interviews. SETTING: Qualitative interviews were conducted at bedside, in a quiet area in the hospital, or via Zoom after discharge. Interview location was guided by participant preferences and whether the patient had previously participated in HF rehabilitation prior to their current admission or was initiating rehabilitation for the first time following their hospitalization. PARTICIPANTS: Patients were eligible to participate if they were community-dwelling (non-institutionalized), aged 65 years and older, had New York Heart Association Class III to IV symptoms, able to speak and read English, and had a history of receiving rehabilitation for their HF in the past (in any setting) or would be initiating it upon discharge. Patients were excluded if they were undergoing advanced therapy (organ transplant or left ventricular assist device placement), had severe cognitive impairment (diagnosis of Alzheimer disease or related dementia, delirium, or altered mental status), or were enrolled in hospice during hospitalization or at hospital discharge. RESULTS: Three deductive domains were characterized: (1) patient and care partner rehabilitation experiences, (2) facilitators and barriers to participating in rehabilitation, and (3) recommendations for optimizing rehabilitation. In the recommendations domain, several inductive themes emerged, including: (1) enhance rehabilitation structure, (2) optimize communication between patients and therapists, (3) incorporate symptom management, and (4) provide structured activity recommendations and goals. RELEVANCE: Older adults with advanced HF are frequently hospitalized and require post-acute rehabilitation to address impairments in physical function. Our findings characterize patient and care partner experiences with post-acute rehabilitation and identify areas for improvement that may support the development of more effective post-acute rehabilitation interventions in advanced HF.
Effectiveness of a Physical Therapist-Administered Physical Activity Intervention After Total Knee Replacement: A Randomized Trial.
White DK, Jakiela J, Liles S … +7 more , Master H, Voinier D, Brunette M, Copson J, Bye T, Schmitt LA, Thoma LM
Phys Ther · 2026 Jan · PMID 41347910 · Full text
IMPORTANCE: While total knee replacement (TKR) is the definitive treatment for knee osteoarthritis, physical activity remains unchanged after surgery. OBJECTIVE: The objective of this trial was to examine the efficacy of...
IMPORTANCE: While total knee replacement (TKR) is the definitive treatment for knee osteoarthritis, physical activity remains unchanged after surgery. OBJECTIVE: The objective of this trial was to examine the efficacy of a physical therapist-administered physical activity intervention to increase moderate-to-vigorous physical activity (MVPA) over 6 months for adults after TKR. DESIGN: This was a randomized controlled trial. SETTING: The study took place in an outpatient physical therapist clinic. PARTICIPANTS: Included were 120 adults over the age of 45 years seeking outpatient physical therapy following a unilateral TKR. INTERVENTIONS: Participants received standardized physical therapy after TKR and a wearable activity tracking device, individualized step goals, and face-to-face feedback provided by a physical therapist (intervention), or standardized physical therapy alone (control). MAIN OUTCOME AND MEASURE: The primary outcome was change in MVPA recorded by a hip-worn Actigraph GT3X accelerometer from baseline to 6 months after discharge from physical therapy. RESULTS: Moderate-to-vigorous physical activity similarly increased from baseline to 6 months within the intervention (median = 6.0 minutes per day [semi-interquartile range = 11.9]) and control group (median = 5.9 minutes per day [semi-interquartile range = 14.3]). There was no between-group difference in MVPA change over time. CONCLUSION: A physical therapist-administered physical activity intervention resulted in a similar increase in MVPA over 6 months compared to standardized physical therapy for adults after TKR. RELEVANCE: Adding a wearable activity tracking device and individualized step goals may not increase physical activity for adults after TKR receiving outpatient physical therapy.
Association Between Timing of Out-of-Bed Mobilization and Functional Outcomes at Intensive Care Unit Discharge in Patients With COVID-19: An Analysis of Potential Clinical Reference Points.
Schujmann DS, Peso CN, Lunardi AC … +13 more , Pompeu JE, da Silveira LTY, Annoni R, Righetti RF, de Campos EC, Yamaguti WP, Lourenço Pt A, Aguera Pt SC, Miura MC, Dos Santos Pt CC, Francelin Pt H, Tanaka C, Fu C
Phys Ther · 2026 Jan · PMID 41324461 · Publisher ↗
IMPORTANCE: In patients who are critically ill, functional dependence and muscle weakness may be influenced by side effects related to the timing of out-of-bed mobilization, but there is a knowledge gap regarding the imp...
IMPORTANCE: In patients who are critically ill, functional dependence and muscle weakness may be influenced by side effects related to the timing of out-of-bed mobilization, but there is a knowledge gap regarding the impact of exercise prescriptions in specific intensive care unit (ICU) populations. OBJECTIVE: The objective of this study was to determine clinical reference values for the time to start out-of-bed mobilization of patients in the ICU to avoid functional dependence and muscle weakness at ICU discharge. DESIGN: This study was a secondary analysis of a prospective multicenter cohort. SETTING: The settings were the ICUs of 5 Brazilian hospitals. PARTICIPANTS: The participants were adult patients with COVID-19, an ICU stay of ≥4 days, and prior functional independence. EXPOSURE: Time for out-of-bed mobilization was the first day the patient was mobilized to higher postures, provided there were no contraindications. MAIN OUTCOMES AND MEASURES: Functional status (Barthel Index [BI]) and muscle strength (Medical Research Council Scale [MRC]) were assessed within 2 days of ICU discharge. Receiver operating characteristic analysis identified clinical thresholds for days to initiate out-of-bed mobilization in association with 2 levels of functional dependence and muscle weakness. Optimal cutoffs were based on sensitivity, specificity, and area under the curve (AUC). RESULTS: A total of 339 patients (58 years old [SD = 46-66 years old]; Simplified Acute Physiology Score III = 51.3 [SD = 16.5]; 36% women; 53% on mechanical ventilation) were analyzed. Days to start out-of-bed mobilization for each outcome were as follows: 3 days for a BI of <85 points (sensitivity = 67%, specificity = 65%, AUC = 0.68 [95% CI = 0.63-0.74]); 4 days for a BI of <60 points (sensitivity = 60%, specificity = 65%, AUC = 0.66 [95% CI = 0.59-0.73]); 5 days for an MRC score of <48 points (sensitivity = 54%, specificity = 73%, AUC = 0.66 [95% CI = 0.59-0.73]); and 5 days for an MRC score of <36 points (sensitivity = 69%, specificity = 67%, AUC = 0.67 [95% CI = 0.49-0.85]). CONCLUSIONS: Early out-of-bed mobilization, initiated within 3 to 5 days of physiological readiness, may differentiate patients who develop functional dependence or ICU-acquired weakness at ICU discharge from those who do not. However, since discrimination ranged from 66% to 68%, with a narrow margin for worse outcomes, this recommendation should be interpreted within context. RELEVANCE: Knowing clinical reference points for days to initiate out-of-bed exercises may help minimize poor physical outcomes at ICU discharge.
Physical Therapy Targeting Autonomic and Dura Mater Function: SPINEPASS Randomized Clinical Trial Protocol.
Treleaven J, Hammerle M, Swan A … +3 more , Marsh L, Bowles A, Thomas LC
Phys Ther · 2026 Jan · PMID 41324433 · Full text
IMPORTANCE: Persistent post-traumatic headache (PPTH) or concussion is a significant United States military problem, and pharmacological treatment is often ineffective. Headache is commonly migraine-like with associated...
IMPORTANCE: Persistent post-traumatic headache (PPTH) or concussion is a significant United States military problem, and pharmacological treatment is often ineffective. Headache is commonly migraine-like with associated autonomic nervous system (ANS) symptoms. Injury to the brain and neck likely co-occur during concussion, and recent research suggests resulting upper cervical hypermobility may trigger an ANS response and PPTH. A promising rehabilitation program (SPINE self-management techniques for Persistent headache After concuSSion [SPINEPASS]) has been developed, directed toward dysfunction of the upper cervical region, myodural bridges, and changes throughout the entire spine affecting the dura. OBJECTIVE: The aim of this trial is to explore (1) the efficacy of SPINEPASS physical therapy compared to standard physical therapy for PPTH and (2) patient experiences, and acceptability and feasibility of the program. DESIGN: The study will be a randomized controlled trial. SETTING: The trial will be conducted at a military hospital outpatient setting at the Brooke Army Medical Center, Brain Injury Rehabilitation Service, San Antonio, Texas. PARTICIPANTS: Participants will be active-duty military personnel (n = 120) with PPTH and ANS symptoms >1 month. INTERVENTIONS: Patients will receive up to 12, 1 hour, 1 on 1 physical therapist sessions of either SPINEPASS or standard physical therapy and a complete home exercise program. MAIN OUTCOMES AND MEASUREMENTS: The primary outcome measures are Aim 1 (headache disability) and Aim 2 (self-confidence to manage headache, acceptability, and feasibility immediately postintervention, and patient perspectives 3 months postintervention). Aim 1 secondary outcome measures: ANS symptoms, headache diary parameters, pain self-efficacy, quality of life, neck pain and disability, and pupillometry. Three- and 12-month follow-ups will also be performed. LIMITATIONS: Potential limitations include recruitment feasibility and lost to follow-up. CONCLUSIONS: The focus of the research will examine new non-pharmaceutical treatment of PPTH in military personnel. RELEVANCE: The study has potential to reduce ongoing pain, disability, and burden of PPTH and reduce dependence on pharmaceutical management.
Physical Therapist Interventions for People With Amyotrophic Lateral Sclerosis Across Disease Stages: A Systematic Review of Efficacy.
Macpherson CE, Wani DK, Li H … +4 more , Rana V, Blacutt M, Bello-Haas VD, Quinn L
Phys Ther · 2026 Jan · PMID 41307543 · Publisher ↗
IMPORTANCE: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease causing declines in muscular strength that affect respiratory function and functional independence. Although physical therapist i...
IMPORTANCE: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease causing declines in muscular strength that affect respiratory function and functional independence. Although physical therapist interventions have been studied in ALS, their efficacy and evidence quality have not been systematically assessed across disease stages. OBJECTIVE: The objective of this study was to examine the efficacy of physical therapist interventions on clinical outcomes across ALS disease stages. DESIGN: This study was a systematic review using Joanna Briggs Institute methodology. SETTING: Multiple settings were used. PARTICIPANTS: The participants were adults (>18 years old) with ALS or motor neuron disease. INTERVENTIONS: Physical therapist interventions within the professional scope of practice included therapeutic exercise, pulmonary training, manual therapy, and multimodal approaches. OUTCOME MEASURES: Outcome measures included effect sizes (ESs) and 95% CIs calculated for forced vital capacity (FVC) and the Amyotrophic Lateral Sclerosis Rating Scale (ALSFRS) or the ALSFRS revised (ALSFRS-R). RESULTS: Six databases were searched from inception to January 2025. Thirty-nine studies were included (25 experimental, 14 observational). Outcomes were heterogeneous, with 94 measures across studies: 23 included the ALSFRS or ALSFRS-R, and 16 included FVC. Most interventions targeted early-stage ALS (n = 27), limiting comparisons across stages. Multimodal training had moderate-quality evidence, with moderate effects on the ALSFRS-R (ES = 0.56 [95% CI = 0.09-1.03]), and low-quality evidence, with negligible effects on FVC (ES = -0.03 [95% CI = -1.47 to 1.41]). Pulmonary interventions had moderate-quality evidence, with small effects on FVC (ES = 0.40 [95% CI = -0.18 to 0.98]), and low-quality evidence, with negligible effects on the ALSFRS-R (ES = 0.04 [95% CI = -0.25 to 0.33]). CONCLUSIONS: A range of physical therapist interventions for ALS were assessed, although most were early phase or low quality. Multimodal and pulmonary interventions showed modest benefits in the ALSFRS-R and FVC, respectively. However, variability in outcome measures and limited research beyond early-stage disease highlight the need for stage-specific trials using consistent functional outcomes. RELEVANCE: This review highlights the breadth of studies of physical therapy in ALS and underscores the need for more rigorous, targeted research.
The Intensive Stroke Cycling for Optimal Recovery and Economic Value Trial: Protocol for a Randomized Clinical Trial.
Miller CR, Taylor D, Bethoux F … +11 more , Bischof-Bockbrader A, DeSilva TM, Streicher MC, Lapin B, Udeh BL, Singh T, Clark C, Kwasny L, O'Neill M, Harris D, Linder SM
Phys Ther · 2025 Nov · PMID 41288607 · Full text
IMPORTANCE: Current rehabilitative approaches for the recovery of upper extremity (UE) and lower extremity (LE) function following stroke involve costly time- and personnel-intensive 1-on-1 motor learning-based training....
IMPORTANCE: Current rehabilitative approaches for the recovery of upper extremity (UE) and lower extremity (LE) function following stroke involve costly time- and personnel-intensive 1-on-1 motor learning-based training. Preliminary data in chronic stroke indicate facilitated aerobic exercise (FE), where volitional LE movements are mechanically supplemented, enhances UE motor recovery associated with task-based practice. OBJECTIVE: The goals of the Intensive Stroke Cycling for Optimal Recovery and Economic Value trial are to determine effects of FE in facilitating UE and LE motor recovery post-subacute stroke, to elucidate neural and biochemical substrates of FE-induced motor recovery, and to evaluate cost-effectiveness of a FE-centered intervention. DESIGN: A prospective, single-center, parallel group, rater-blind, pragmatic randomized clinical trial will be conducted. SETTING: The setting will be a large academic medical institution. PARTICIPANTS: Individuals with hemiparesis due to subacute stroke (N = 66) will be enrolled. INTERVENTIONS: Participants will be randomized into FE followed by abbreviated sessions of physical and occupational therapy (FE + rehab) or usual care consisting of consecutive sessions of physical and occupational therapy (rehab). All participants will receive a comparable dose of contact time: 90 minutes, 2 times per week for 12 weeks. MAIN OUTCOMES: Motor outcomes will be collected at baseline, end of treatment (EOT) and EOT + 6 months. Electroencephalograms and blood biomarkers will be collected at baseline and EOT. Cost-effectiveness will be modeled over immediate and long-term horizons. RELEVANCE: The global effect of FE has the potential to enhance recovery in a growing population of stroke survivors in a cost-effective manner, thus accelerating its clinical acceptance. The mechanistic aim will explore the effects of each approach on substrates underlying neuroplasticity.
Evaluating the Effectiveness of Clinical Practice Guideline Adherence for Patellofemoral Pain (knEE-CAPP): Protocol for a Multisite, Parallel-Arm Randomized Clinical Trial in the Military Health System.
Beisheim-Ryan EH, Mauntel TC, Rhon DI … +8 more , Patterson CG, Parsons N, Paradise S, Roach MH, Pontillo M, Gorczynski SR, Emory A, Farrokhi S
Phys Ther · 2025 Nov · PMID 41273076 · Publisher ↗
IMPORTANCE: Patellofemoral pain (PFP) frequently affects military personnel, caused by the physical demands of duty-related training. Clinical practice guidelines (CPG) can guide PFP management, yet physical therapist pr...
IMPORTANCE: Patellofemoral pain (PFP) frequently affects military personnel, caused by the physical demands of duty-related training. Clinical practice guidelines (CPG) can guide PFP management, yet physical therapist practice patterns vary and often exclude CPG-recommended, evidence-based interventions. OBJECTIVE: The Evaluating the Effectiveness of Clinical practice guideline Adherence for Patellofemoral Pain (knEE-CAPP) trial assesses whether a CPG-adherent physical therapy approach more significantly reduces pain, disability, health care utilization, and analgesic medication prescription in Service members with PFP as compared to usual physical therapist care. DESIGN: This is a multisite, parallel arm randomized controlled trial. SETTING: The study will be conducted at 4 outpatient military physical therapist clinics. PARTICIPANTS: Male and female active-duty Service members (n = 440) ages 18 years or older with PFP will be included. INTERVENTION: Participants will be randomized to receive CPG-adherent or usual physical therapist care. CPG-adherent care includes a standardized examination and treatment protocol based on the 2019 American Physical Therapy Association's PFP CPG Decision Tree Model. This model subcategorizes impairments to guide targeted interventions. Usual care encompasses care delivered by outpatient physical therapist providers without research team directives. MAIN OUTCOMES AND MEASURES: Anterior Knee Pain Scale (a patient-reported measure of knee-specific function) and Numeric Pain Rating Scale (a patient-reported measure of knee pain intensity). RESULTS: Changes in Anterior Knee Pain Scale and Numeric Pain Rating Scale scores at 3-month follow-up will be compared between arms. Secondary outcomes (perceived duty- and deployment-related confidence, knee-related health care utilization, and analgesic medication prescription) will be compared up to 12-months post-randomization. CONCLUSIONS: This trial will determine the effectiveness of a standardized, CPG-adherent approach to PFP management for optimizing function, reducing long-term health care costs, and improving readiness for duty. RELEVANCE: A protocolized, CPG-adherent approach that can be implemented across health care settings is proposed.
Feasibility and Usability of an Omnidirectional Treadmill-Based Virtual Reality Rehabilitation Game: A Mixed-Methods Feasibility Study.
Quigley A, Pierson D, Jeong J … +10 more , Choi Y, Machuca MB, Pollock C, Lamontagne A, Neyedli HF, McDonald A, Dunlop M, Yip TH, Jones G, Eng JJ
Phys Ther · 2025 Nov · PMID 41263507 · Full text
IMPORTANCE: Virtual reality (VR) has been introduced to stroke rehabilitation along with omnidirectional (360°) treadmills to promote improvements in walking and balance. OBJECTIVE: The primary objective was to develop a...
IMPORTANCE: Virtual reality (VR) has been introduced to stroke rehabilitation along with omnidirectional (360°) treadmills to promote improvements in walking and balance. OBJECTIVE: The primary objective was to develop a rehabilitation omni-VR game and estimate the feasibility and usability of the game according to individuals with chronic stroke and physical therapists. The secondary objective was to generate preliminary walking characteristics and postural sway data among survivors of stroke. DESIGN: This was a mixed-methods feasibility study. SETTING: This study took place at a stroke research lab in Halifax, Canada. PARTICIPANTS: The participants were individuals with chronic stroke and stroke rehabilitation physical therapists. EXPOSURE: The research team developed a VR game involving 8 walking and balance tasks on an omnidirectional treadmill. Physical therapists and survivors of stroke tested the game in a single session and participated in a semi structured interview. MAIN OUTCOMES AND MEASURES: Main outcomes and measures were recruitment rate, user experiences, participant burden, technical issues, safety, and exercise dose. Descriptive statistics were calculated for feasibility outcomes and interview data were analyzed using reflexive thematic analysis. RESULTS: Eight survivors of stroke (4 female, 4 male) and 4 female physical therapists participated in the study. Feasibility and usability targets were met, except for user experience scores and technical issues. For survivors of stroke, the mean steps taken during the VR game was 693.0 (standard deviation, SD = 223.6), they reached 66.4% SD = 10.7 of predicted maximum heart rate, and the mean game testing time was 25.5 minutes SD = 13.5. Five qualitative themes emerged: benefits of the omni-VR system, difficulties & challenges with omni-VR, suggestions for improvements, application to rehabilitation, and safety of the system. CONCLUSIONS: There is preliminary evidence for the feasibility of omni-VR for stroke rehabilitation. RELEVANCE: The VR game appears to be of adequate intensity, provides a larger number of repetitions, and is of comparable duration to traditional rehabilitation sessions.
Does Treating Low Back Pain With Therapeutic Exercise Reduce the Risk of Subsequent Lower Extremity Injury? A Population-Level Cohort Analysis.
Foster K, Wang-Price S, Weber M … +4 more , Brizzolara K, Yuan X, Boeth R, Rhon DI
Phys Ther · 2025 Nov · PMID 41239979 · Publisher ↗
IMPORTANCE: The trunk and lower extremities are the most common locations for injury in the military, but they are managed as isolated regions. This study suggests these regions are connected, and utilization of therapeu...
IMPORTANCE: The trunk and lower extremities are the most common locations for injury in the military, but they are managed as isolated regions. This study suggests these regions are connected, and utilization of therapeutic exercise is protective of lower extremity injury following low-back-pain diagnosis. OBJECTIVE: The objective of this study was to determine whether therapeutic exercise for low back pain reduces risk of subsequent lower extremity injury. DESIGN: This study utilized a longitudinal cohort design based on routinely collected health information. SETTING: This study was conducted within the Military Health System. PARTICIPANTS: Patients aged 18 to 65 who sought care for low back pain between January 2015 and July 2019 were identified using diagnosis codes from electronic medical records and claims data. INTERVENTIONS: Participants were dichotomized based on whether they received therapeutic exercise. MAIN OUTCOMES AND MEASURES: Cox proportional hazards regression with hazard ratios (HRs) was used to model the relationship between therapeutic exercise use and dosing and risk of subsequent hip, knee, and ankle injury. RESULTS: Out of 452,668 patients (34.8% female; age 35.5 [12.3] years), 74,912 (16.5%) received at least 1 therapeutic exercise session, with a median (IQR) of 3 (1-6) sessions. Therapeutic exercise receipt significantly decreased subsequent lower extremity injury risk (hip: HR = 0.84, 95% CI = 0.825-0.852; knee: HR = 0.77, 95% CI = 0.756-0.777; and ankle/foot: HR = 0.80, 95% CI = 0.788-0.809), and that risk decreased further with each additional exercise session (hip: HR = 0.95, 95% CI = 0.942-0.948; knee: HR = 0.96, 95% CI = 0.956-0.963; and ankle/foot: HR = 0.96, 95% CI = 0.961-0.967). CONCLUSIONS: Patients with low back pain not treated with therapeutic exercise had an increased risk of subsequent lower extremity injury. For those who received therapeutic exercise, the risk for subsequent injury was reduced with additional sessions. RELEVANCE: Treating low-back-pain patients with therapeutic exercise may decrease the health-care burden.
Serendipity How? Data Insights During the Age of Artificial Intelligence.
George SZ
Phys Ther · 2025 Nov · PMID 41231389 · Publisher ↗
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