Physical Therapy[JOURNAL]
Sun
200 papers
Mostly Mothers, Many Others: Comparing Caregiver Attendance and Missed Treatment Hours in Pediatric Physical Therapy for Children With Cerebral Palsy.
Maus E, Sansuchat LA, Tripathi T … +1 more , Heathcock JC
Phys Ther · 2025 Nov · PMID 41206728 · Publisher ↗
IMPORTANCE: Cerebral palsy is a prevalent childhood motor disability which necessitates frequent outpatient physical therapy. Medical appointments can be time-consuming and burdensome for families and attendance rates fo...
IMPORTANCE: Cerebral palsy is a prevalent childhood motor disability which necessitates frequent outpatient physical therapy. Medical appointments can be time-consuming and burdensome for families and attendance rates for outpatient pediatric physical therapist visits are seldom reported. OBJECTIVE: This study investigates the number and types of caregivers that attend physical therapy sessions with the child and factors influencing attendance. DESIGN: The study is a secondary analysis of a randomized controlled pragmatic clinical trial. SETTING: Intervention occurred in an outpatient hospital-based pediatric clinic. PARTICIPANTS: The study included 90 children ages 2 to 8 years old with cerebral palsy enrolled in a randomized controlled pragmatic clinical trial (NCT02897024). INTERVENTION: The study compared 2 physical therapy schedules, weekly and intensive, both with a total dose of 40 treatment hours. The weekly group received one 1-hour visit per week for 40 weeks. The intensive group repeated two bouts of 2-hour visits, 5 days per week for 2 weeks (20 hours, 4-month break, 20 hours). Both groups received 40 hours of physical therapy. MAIN OUTCOMES AND MEASURES: The primary outcomes were (1) number of caregivers accompanying the child to visits throughout the 40-week episode of care; and (2) number of missed treatment hours. Clinic location and accompanying caregiver(s) were collected from the electronic medical record. Prior to treatment, parents self-reported home zip code and income as part of the Hollingshead Four-Factor Socioeconomic Status as well as concurrent school-based therapy. Travel distance was calculated using home zip code and clinic location. RESULTS: Forty combinations of caregivers accompanied n = 90 children to 1953 treatment sessions. The most common caregivers in attendance were the mother (70.5%) and father (15.0%). A non-parent attended 15.5% of sessions. The number of caregivers, travel distance, income, and concurrent school-based therapy were not significantly related to missed treatment hours. The intensive group missed significantly fewer treatment hours compared to the weekly group. CONCLUSIONS: The findings highlight the heterogeneity of caregivers attending physical therapist visits and that responsibility primarily falls to mothers. Treatment schedule influenced attendance patterns while number of caregivers involved, distance traveled, household income, and concurrent therapies did not. RELEVANCE: Attendance rates are an important metric for clinics and clinicians. Offering choices of treatment schedules may improve attendance rates. Future research could prospectively investigate caregiver scheduling preferences and their influence on attendance to outpatient pediatric physical therapy.
Long-Term Forgetting Rates Vary by Bloom's Taxonomy Levels but Not Initial Learning in DPT Education.
Ambler S, Holleran Mpt CL, Konrad JD … +2 more , Wally CM, McDaniel MA
Phys Ther · 2025 Nov · PMID 41206725 · Publisher ↗
IMPORTANCE: Health professions education programs emphasize learning specialized knowledge that will be needed by the health care provider long after the initial exposure. Most laboratory investigations into memory have...
IMPORTANCE: Health professions education programs emphasize learning specialized knowledge that will be needed by the health care provider long after the initial exposure. Most laboratory investigations into memory have little applicability to the material learned in health professions education, and evidence is mixed on which material is retained and for how long. OBJECTIVE: The objective was to describe the retention levels of health professions education material among Doctor of Physical Therapy (DPT) learners over an extended interval and determine if retention varies by the level of knowledge assessed or the performance level of the learner. DESIGN: Learners completed 6 multiple-choice examinations as part of their standard curriculum. Each exam was integrated to include content covered across all instructional areas. Seventy-two items were selected from these 6 exams and re-administered in 2 retention tests occurring at approximately 5 and 15 months. The retention test items were dichotomized into high-level and low-level according to Bloom's taxonomy. We also compared the forgetting rates between learners in the top and bottom quartile, based on their initial exam performance. SETTING: Learners were enrolled in a residential DPT training program. PARTICIPANTS: Ninety-four DPT learners participated. INTERVENTION(S) OR EXPOSURE(S): This was a retrospective analysis of standard curriculum assessments administered without any interventions. MAIN OUTCOME(S) AND MEASURE(S): The main outcome was the learners' level of retention at the retention tests. RESULTS: Overall, retention decreased at the 5 and 15-month intervals. Initial performance was significantly lower on high-level Bloom's items, however, these items showed less forgetting over time compared to low-level items. Learners forgot 9% of the high-level Bloom's items compared to 17.5% of the low-level items. The forgetting rates overall and for each Bloom's level did not significantly differ across top and bottom quartile learners. CONCLUSIONS: This study compared retention across levels of Bloom's taxonomy and compared high and low performing learners. An overall decrease in retention was found, that was attenuated by high-level Bloom's learning as compared to low-level learning. RELEVANCE: The attenuation of forgetting for high-level Bloom's questions and the stable rates of forgetting across high and low performers have implications for how programs might structure examinations to promote long-term retention. Future work should examine retention over extended intervals and investigate the effect of clinical experiences on the retention of material learned in the classroom.
Pain Catastrophizing Beliefs and Neuropathic Symptoms Are Associated With a Poorer Long-Term Recovery in Chronic Plantar Heel Pain: A Cohort Study.
Rogers J, Jones G, Wills K … +1 more , Winzenberg T
Phys Ther · 2025 Nov · PMID 41206644 · Full text
IMPORTANCE: Chronic plantar heel pain is common and often recalcitrant yet understanding of modifiable risk factors that influence its trajectory of recovery is limited. OBJECTIVE: The objective of this study was to desc...
IMPORTANCE: Chronic plantar heel pain is common and often recalcitrant yet understanding of modifiable risk factors that influence its trajectory of recovery is limited. OBJECTIVE: The objective of this study was to describe associations of changes in physical and psychological measures and symptom descriptors over 12 months with changes in pain, function, and quality of life in people with chronic plantar heel pain. DESIGN: A prospective cohort with longitudinal follow-up was used. SETTING: A community setting in southern Tasmania was used. PARTICIPANTS: The participants were 220 people with a clinical diagnosis of chronic plantar heel pain. EXPOSURES: The exposures were body mass index (kg/m2), waist circumference (centimeters), ankle plantarflexor strength (kilograms), ankle and first metatarsophalangeal joint dorsiflexion mobility (degrees), pain catastrophizing beliefs (Pain Catastrophizing Scale), depression (9-item Patient Health Questionnaire), multisite pain, morning stiffness, neuropathic symptoms (painDETECT), and physical activity (accelerometry). MAIN OUTCOMES AND MEASURES: The Foot Health Status Questionnaire pain and function domains and the 6-dimension Assessment of Quality of Life Scale were used. Outcomes and exposures were assessed at baseline and 12 months. Data were analyzed using linear mixed-effects models with exposure × time interactions. RESULTS: Increasing pain catastrophizing and neuropathic painDETECT scores over 12 months were associated with a poorer trajectory of pain recovery (pain catastrophizing interaction β = -.39 [95% CI = -0.01 to -0.77]; painDETECT interaction β = -.79 [95% CI = -0.10 to -1.48]). In full multivariable models, there were no other significant associations between any other variable and pain. The only associations with foot function and quality of life were weak negative associations of steps per day and sedentary time with function and quality of life, respectively. CONCLUSIONS AND RELEVANCE: Increasing pain catastrophizing and neuropathic symptoms were associated with poorer pain outcomes over 12 months in individuals with chronic plantar heel pain. These findings highlight the importance of pain beliefs and neurogenic factors in the prognosis of chronic plantar heel pain. Interventions targeting pain beliefs and neuropathic mechanisms may improve outcomes in subgroups with these characteristics.
Chest Binding and the Role of the Physical Therapist: A Commitment to Care.
Marengo J, Sutkowi-Hemstreet A, Condran C … +3 more , Goodman N, Offstein K, Nippins M
Phys Ther · 2025 Nov · PMID 41206500 · Publisher ↗
Transgender, nonbinary, and gender-diverse (TNBGD) individuals experience significant inequities in health, access to health care, and participation in physical activity for a myriad of reasons, including gender dysphori...
Transgender, nonbinary, and gender-diverse (TNBGD) individuals experience significant inequities in health, access to health care, and participation in physical activity for a myriad of reasons, including gender dysphoria and the physical effects of gender-affirming practices like chest binding. Physical therapists have the requisite clinical skills to evaluate and treat these individuals, potentially enhancing overall health and wellness while reducing barriers to physical activity. Binding is a common practice for many TNBGD individuals, often performed to achieve improved congruence between an outward physical appearance and one's gender identity. Given the typical frequency and duration of binding, negative binding-related symptoms such as thoracic or rib pain, shortness of breath, and postural changes may occur. Physical therapists can be the provider of choice in minimizing the symptom burden and adverse effects of binding, but as a profession, we must improve inclusive care practices, deepen our understanding of the physiologic impacts of binding, and implement culturally responsive care plans tailored to the needs of TNBGD patients. Increased access to inclusive physical rehabilitation may improve lifelong health, promote physical activity, and mitigate health inequities in this population. Clinicians can purposefully advertise their preparedness and willingness to serve lesbian, gay, bisexual, transgender, queer, intersex, asexual, and 2-spirit patients and work to understand and address disparities in health care access and quality. As a profession, we must continue to evolve to meet the needs of society, especially those who face systemic barriers and marginalization.
Loneliness and Disability: A Generational Health Challenge for Rehabilitation Therapists.
Falvey JR
Phys Ther · 2025 Oct · PMID 41139311 · Publisher ↗
Abstract loading — click title to view on PubMed.
Real-World Experiences of Therapy Staff Implementing an Intensive Rehabilitation Protocol in Canadian Stroke Inpatient Rehabilitation Settings: A Multi-Site Survey Study.
Hung SH, Ackerley S, Connell LA … +11 more , Bayley MT, Best KL, Donkers SJ, Dukelow SP, Ezeugwu VE, Milot MH, Peters S, Sakakibara BM, Sheehy L, Yao J, Eng JJ
Phys Ther · 2025 Oct · PMID 41139309 · Full text
IMPORTANCE: While best practice guidelines recommend intensive rehabilitation for post-stroke walking recovery, knowledge of real-world implementation factors is limited. OBJECTIVE: The aim was to understand the implemen...
IMPORTANCE: While best practice guidelines recommend intensive rehabilitation for post-stroke walking recovery, knowledge of real-world implementation factors is limited. OBJECTIVE: The aim was to understand the implementation factors for intensive rehabilitation within real-world inpatient stroke rehabilitation settings. DESIGN: This was a cross-sectional, online survey study. SETTING: Twelve inpatient rehabilitation units (7 Canadian provinces) were included. PARTICIPANTS: Eighty-five therapy staff who delivered an intensive rehabilitation protocol within the Walk 'n Watch implementation trial (NCT04238260) were invited. INTERVENTION: A structured intensive walking rehabilitation protocol was implemented as usual care (>2000 steps, 40%-60% heart rate reserve, >30 minutes/session). Step counters and heart rate monitors were provided. MAIN OUTCOMES AND MEASURES: An online survey was used, including close-ended and open-ended questions regarding the protocol practicalities, workplace structure, and training. Open-ended responses were thematically analyzed using the Consolidated Framework for Implementation Research (CFIR). RESULTS: Forty-seven participants (85% women) completed the survey. Most agreed they successfully delivered the protocol (87%) and found the step and heart rate targets helpful (72%). However, few participants agreed they had enough time to deliver the protocol (36%); 26% and 47% agreed they achieved the step count and heart rate targets, respectively. The major time-related factor was insufficient therapy time to accommodate the protocol and prescribed step targets (CFIR: Work Infrastructure); discharge planning often took priority. Most agreed to future protocol use (87%). However, only about half agreed to future use of the trial-assigned devices (49% step counters; 64% heart rate monitors), likely due to perceived device inaccuracies (CFIR: Materials and Equipment). CONCLUSIONS: Therapy staff reported successfully delivering an intensive rehabilitation protocol as usual care under real-world conditions. Strategies to facilitate implementation included incorporating discharge planning considerations, system-level changes, and acquiring more accurate monitoring devices. RELEVANCE: This study enhanced the understanding of real-world implementation factors and potential strategies for future implementation.
Episode of Care Characteristics Following Implementation of a No Copay Physical Therapy Program for Musculoskeletal Conditions.
Lentz TA, Lutz A, Ikeaba U … +4 more , Alhanti B, George SZ, Cook C, Thigpen C
Phys Ther · 2025 Nov · PMID 41134281 · Full text
IMPORTANCE: New care models promoting early access to physical therapy by reducing or eliminating copays are emerging. Few studies have compared health care use in these programs to other care pathways across musculoskel...
IMPORTANCE: New care models promoting early access to physical therapy by reducing or eliminating copays are emerging. Few studies have compared health care use in these programs to other care pathways across musculoskeletal conditions. OBJECTIVE: The objective of this study was to describe episode-level musculoskeletal health care use across different care pathway options, including a no-copay physical therapy program. DESIGN: This study was a descriptive retrospective analysis of claims data. SETTING AND PARTICIPANTS: This study included health care beneficiaries of a self-insured employer with ~52,000 covered lives. INTERVENTIONS OR EXPOSURES: The study included musculoskeletal care episodes from October 2019 to September 2020 categorized as no copay physical therapy, traditional physical therapy, or other management. MAIN OUTCOMES: Rates of surgery/injection, imaging, inpatient services, physician services, emergency services, physical therapy, and other services by episode type, overall and stratified by body region: upper extremity, lower extremity, and spine. RESULTS: Of 9696 total episodes, 886 (9.1%) were no copay physical therapy, 1261 (13%) were traditional physical therapy, and 7549 (77.9%) were other management. No copay physical therapy episodes had lower imaging rates (38%) compared to traditional physical therapy (47%) and other management (45%) episodes. Inpatient services were similar for no copay (16%) and traditional (12%) physical therapy, both lower than other management episodes (23%). Physician services were higher in other management (100%) and traditional physical therapy (81%) episodes compared to no copay physical therapy episodes (43%). Surgery/injection rates were similar for no copay (11%) and traditional (8%) physical therapy, both lower than other management episodes (27%). Differences by pathway were more pronounced for extremity conditions than for spine conditions. CONCLUSIONS: Rates of no copay program use were modest with those who used the program having lower rates of advanced imaging, injection, and surgery. RELEVANCE: Findings may be most relevant for employers, health systems, and payors planning resource allocation and benefit design for similar programs.
The Effects of Multimodal Exercise on Sleep Quality and Architecture, Motor Function, Cognition, Fatigue, and Systemic Inflammation in Corticobasal Syndrome: A Case Report.
Cristini J, Seo F, Bon A … +7 more , Rodrigues L, Sikorska K, Van Roy A, Dagher A, Carrier J, Paquette C, Roig M
Phys Ther · 2025 Nov · PMID 41128772 · Full text
IMPORTANCE: Corticobasal syndrome (CBS) is a rare tauopathy, with a complex pathophysiology that usually includes neuroinflammation. Parkinsonism, cognitive impairments, and sleep disturbances are common in CBS, although...
IMPORTANCE: Corticobasal syndrome (CBS) is a rare tauopathy, with a complex pathophysiology that usually includes neuroinflammation. Parkinsonism, cognitive impairments, and sleep disturbances are common in CBS, although alterations in sleep architecture remain poorly characterized. Regular exercise has been recommended in CBS to manage gait dysfunction, balance issues, and cognitive decline. However, the effects of regular exercise on sleep quality, sleep architecture, and systemic inflammation in CBS remain unclear. OBJECTIVE: The purpose of this study was to describe the effects of regular exercise in CBS. DESIGN: The design of this study was a case report. SETTINGS: This study was conducted in an academic laboratory. PARTICIPANTS: An individual with CBS participated in this case study. INTERVENTION: The participant completed a 12-week multimodal training program. MAIN OUTCOME(S) AND MEASURE(S): Cardiorespiratory fitness level was assessed with a symptom-limited cardiopulmonary exercise test and strength with a submaximal 1-repetition maximum test. Subjective and objective sleep quality were assessed using the Parkinson Disease (PD) Sleep Scale-2 and actigraphy, respectively. Sleep architecture was evaluated with polysomnography. Cognition and motor function were assessed with the Scale for Outcomes in PD-Cognition and Movement Disorder Society-Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS-III), respectively, functional mobility with the Time Up and Go (TUG), and fatigue with the PD Fatigue Scale. Concentrations of inflammatory markers, including interleukin (IL)-1β, IL-6, IL-10, tumor necrosis factor, and C-reactive protein, were measured from serum collected after a 12-hour fasting period. RESULTS: Following the training program (34 sessions; 25.35 hours), improvements in fitness, objective sleep quality and architecture, cognition, TUG, and a reduction in systemic inflammation were observed. Conversely, MDS-UPDRS-III scores deteriorated, and the participant reported diminished subjective sleep quality and increased fatigue. CONCLUSIONS: These results, which should be interpreted with caution, suggest that various clinical outcomes improved following multimodal training. Controlled studies are warranted to confirm these observations. RELEVANCE: This is the first case report describing the effects of a training program on sleep architecture and systemic inflammation in CBS.
Educating for Impact: The Imperative of Health Systems Science in Physical Therapy.
Hartley GW, Jensen G, Kirk-Sanchez N … +2 more , Landers MR, Skochelak S
Phys Ther · 2025 Nov · PMID 41099561 · Publisher ↗
While health systems science (HSS) is now recognized as a foundational pillar in medical education, the profession of physical therapy has yet to fully integrate this unifying framework into its educational models. Healt...
While health systems science (HSS) is now recognized as a foundational pillar in medical education, the profession of physical therapy has yet to fully integrate this unifying framework into its educational models. Health systems science offers a structured lens through which the profession can align its long-standing values such as patient-centered care, equity, and interprofessional collaboration, with the demands of a health care system that is complex, fragmented, and driven by accountability, data, and value. Without explicit incorporation of HSS into Doctor of Physical Therapy (DPT) curricula, the profession may have a diminished voice in critical conversations around health care equity, health system innovation, policy reform, and care redesign. This perspective presents an example from the University of Miami's DPT program, where HSS was systematically embedded across the curriculum using Kern's 6-step model for curriculum development. The process included comprehensive content mapping and intentional faculty development to promote a shared understanding of systems thinking and its relevance to physical therapist practice. As a result, DPT students are now engaged in learning that situates their clinical decision making within the broader structures, policies, and processes that shape patient outcomes at both individual and population levels. Health systems science enables physical therapists to move beyond implicit alignment with health system goals to active participation in advancing them. A physical therapist educated in HSS is positioned to contribute to population health by designing community-based interventions, participating in cross-sector partnerships, addressing social determinants of health, and applying data to reduce disparities in function and access. The framework also supports engagement in value-based care delivery, quality improvement initiatives, health informatics, and health policy development; areas central to the sustainability and evolution of health care. To remain relevant and impactful, this perspective offers a call to action for physical therapist educators to integrate HSS as a core component of professional formation and practice readiness.
Competency-Based Education: Development of the Entry-Level Pain Entrustable Professional Activities for Workplace-Based Assessment.
Helms J, Zimney K, Weaver P … +2 more , Courtney C, Wassinger C
Phys Ther · 2025 Nov · PMID 41099558 · Publisher ↗
IMPORTANCE: The physical therapy profession is being called to adopt a competency-based education (CBE) model, following the lead of other health professions. A key element of CBE is workplace-based assessment, in which...
IMPORTANCE: The physical therapy profession is being called to adopt a competency-based education (CBE) model, following the lead of other health professions. A key element of CBE is workplace-based assessment, in which clinicians evaluate learners' readiness to perform essential clinical tasks through entrustable professional activities (EPAs). Although a common set of EPAs exist for the profession, none currently guide assessment and learning in specialty areas like pain. OBJECTIVE: The objective of this study was to describe the development and initial validation of pain-specific entrustable professional activities (Pain EPAs) designed to assess physical therapist clinical competency in managing pain within a CBE framework. DESIGN: This was a developmental study following published recommendations for EPA creation, including preparation, drafting, quality control, and curriculum alignment. SETTING: The study was conducted across 4 American universities. PARTICIPANTS: Five American-based physical therapists collaborated on EPA development and gathered feedback from educators, clinicians, and an 8-person reactor panel. INTERVENTION: The intervention involved developing Pain EPAs through expert consensus and external review for alignment with competency frameworks. MAIN OUTCOME: The main outcome was a set of Pain EPAs reviewed for clarity, observability, and assessability using the EQual rubric, with external feedback guiding their categorization. RESULTS: Twenty-one Pain EPAs were developed and aligned with pain competency frameworks, with feedback organizing them into 4 levels of increasing complexity and autonomy: generalist, pain-specific entry-level, specialty clinic entry-level, and advanced practice. CONCLUSIONS: This study outlines a structured, replicable approach for developing EPAs aligned with CBE principles. The Pain EPAs provide an initial framework to assess readiness for autonomous pain management tasks. Further research is needed to establish their validity and support implementation in entry-level and post-professional training. RELEVANCE: The Pain EPAs support CBE workplace-based assessment in physical therapist education. This approach can be adapted for other specialty areas within physical therapist practice.
Adverse Events in the MASH Randomized Controlled Trial With Detailed Reporting of Musculoskeletal and Connective Tissue Disorders Events.
Sions JM, George SZ, Pugliese JM … +4 more , Patterson CG, Piva S, Simon CB, Hicks GE
Phys Ther · 2025 Nov · PMID 41081735 · Full text
IMPORTANCE: Older adults and those with low back pain (LBP) are at increased risk of research-related adverse events (AEs); yet, Cochrane reviews show AE under-reporting in rehabilitation trials. OBJECTIVE: To inform AE...
IMPORTANCE: Older adults and those with low back pain (LBP) are at increased risk of research-related adverse events (AEs); yet, Cochrane reviews show AE under-reporting in rehabilitation trials. OBJECTIVE: To inform AE practices in future rehabilitation trials, details are provided on novel AE surveillance and reporting practices used in the Manual Therapy and Strengthening for the Hip (MASH) trial. DESIGN: The study design was a secondary analysis of a multisite, single-masked, randomized controlled trial comparing 2 exercise-inclusive interventions. SETTING: The study was conducted at research-based physical therapist sites. PARTICIPANTS: Participants were older adults with moderate-intensity, chronic LBP with hip pain and muscle weakness. INTERVENTIONS OR EXPOSURES: Participants were randomly assigned to receive 16 sessions of hip-focused or spine-focused physical therapy over 8 weeks. Active AE monitoring was facilitated with standardized interviews during each treatment session and at 8-week, 3-, 4-, 5-, and 6-months. Common terminology criteria for AEs classification was used. AEs were adjudicated by a site investigator and reviewed at multisite meetings. MAIN OUTCOMES AND MEASURES: AE classification, relatedness, expectedness, severity, timing, recurrence, duration, and intervention impact were evaluated between interventions. RESULTS: Among 184 participants, there were 243 AEs (n = 128 hip-focused group, n = 115 spine-focused group) in 112 participants; 38.3% were unexpected, with 47 occurring in the hip-focused and 46 in the spine-focused group. AE relatedness, expectedness, and severity were similar between groups. Of the 243 AEs, 157 were mild, 71 were moderate, and 15 were severe/life threatening. Most AEs (80.2%) occurred early and were classified as musculoskeletal and connective tissue disorders (MSKCT), with shorter MSKCT AE duration in the hip-focused group. Within each group, 15 MSKCT AEs resulted in study modification. CONCLUSIONS AND RELEVANCE: This analysis describes a framework to improve upon active AE surveillance during rehabilitation trials to better inform risk-to-benefit analyses. Data can also be used to inform clinical decision-making related to risks from MASH trial interventions.
Effect of Telerehabilitation in Parkinson Disease: A Systematic Review and Meta-Analysis.
Darbandsari P, Pescatello LS, Piscitelli D … +3 more , Smith JM, Ugolini A, Colón-Semenza C
Phys Ther · 2025 Nov · PMID 41065729 · Publisher ↗
IMPORTANCE: Rehabilitation is a key in managing Parkinson disease (PD), but access barriers remain, and the benefits of telerehabilitation (TR) are still unclear. OBJECTIVE: The objective of this systematic review and me...
IMPORTANCE: Rehabilitation is a key in managing Parkinson disease (PD), but access barriers remain, and the benefits of telerehabilitation (TR) are still unclear. OBJECTIVE: The objective of this systematic review and meta-analysis was to examine the effect of TR in adults with PD through the International Classification of Functioning, Disability, and Health. DATA SOURCES: An electronic database search (PubMed, EMBASE, SCOPUS, PEDro, Cochrane) was performed for data published from inception to April 2025. DATA SELECTION: Inclusion criteria were randomized controlled trials involving adults with PD, assessing remotely delivered physical activity or physical rehabilitation interventions, compared to control groups not exposed to TR, and reporting outcomes of interest. Exclusion criteria included studies involving additional neurological disorders. DATA EXTRACTION AND SYNTHESIS: Data extraction was guided by the PRISMA guidelines. This review was registered with PROSPERO (CRD42023475545). A risk of bias assessment (RoB-2) and methodological quality assessment (PEDro) tools were used. Data were analyzed using random-effects models. MAIN OUTCOMES AND MEASURES: The outcomes of interest were balance, gait, functional mobility, physical activity, quality of life (QOL), and social support. RESULTS: Eighteen studies were included in the final analysis, involving 731 individuals with PD. The most common types of TR included remote-based exergaming and using video conferencing platforms. The results indicated no statistically significant difference between TR and control groups on balance (standardized mean difference [SMD] = 0.31, 95% CI = -0.02 to 0.65), gait speed (SMD = -0.07, 95% CI = -0.33 to 0.19), and functional mobility (SMD = 0.05, 95% CI = -0.27 to 0.37) outcomes. However, the results were statistically in favor of TR for improving QOL (SMD = 0.26, 95% CI = 0.05 to 0.47). CONCLUSIONS AND RELEVANCE: TR yielded similar or superior results compared to non-exposed control conditions across the 5 outcomes evaluated. Health care providers can decide which method of care delivery they prefer based on patients' preferences and resources.
Factors Related to the Prognosis of Chronic Low Back Pain in Older Adults.
Sakai Y, Watanabe T, Matsui H … +5 more , Osada N, Adachi Y, Takeichi Y, Katsumi A, Watanabe K
Phys Ther · 2025 Nov · PMID 41065721 · Publisher ↗
IMPORTANCE: Studies on the prognosis of chronic low back pain (CLBP) in older adults are lacking; hence, elucidating the pathophysiology of CLBP in older adults is necessary. OBJECTIVE: The objective of this study was to...
IMPORTANCE: Studies on the prognosis of chronic low back pain (CLBP) in older adults are lacking; hence, elucidating the pathophysiology of CLBP in older adults is necessary. OBJECTIVE: The objective of this study was to analyze the prognosis of CLBP and factors related to its intractability in older adults. DESIGN: The design was a prospective cohort study. SETTING: This study was conducted at a national center hospital, which was specialized in geriatric medicine and research. PARTICIPANTS: We included 361 patients aged ≥65 years with CLBP lasting for >3 months. INTERVENTION OR EXPOSURE: The nonimprovement group was defined as those who showed no improvement on a visual analog scale (VAS) of <3 for LBP after 12 months of exercise therapy. MAIN OUTCOMES AND MEASURES: Multivariate analyses of factors related to the intractability of CLBP in older adults, including body composition measured using whole-body dual-energy X-ray absorptiometry, cross-sectional area (CSA) of the paraspinal muscles measured using magnetic resonance imaging, and whole spinal alignment measured using X-rays, were conducted. RESULTS: Of the 361 patients, 152 (42.1%) had an improved VAS score of <3 within 1 year. In the nonimprovement group, the duration of the disease was significantly longer, VAS score before treatment and red blood cell distribution width (RDW) were higher, high-density lumbar spine volume and CSAs of the paravertebral muscles were significantly lower, and prevalence of disc degeneration was significantly higher. Age, disease duration, VAS score, RDW, and CSA of the lumbar multifidus (LM) at the L4/5 level were significant factors associated with CLBP. Changes in the CSA of the paraspinal muscle were significantly reduced at 12 months in the nonimprovement group compared with the improvement group. CONCLUSION: The factors affecting the intractability of CLBP were the intensity of pain, RDW, and atrophy of the LM muscles. RELEVANCE: Paravertebral muscle atrophy progresses over time in intractable LBP. Muscle training centered on the LM muscle of the lower lumbar spine is recommended.
Cost-Effectiveness of Physical Therapist Treatment in Addition to Usual Podiatry Management of Plantar Heel Pain: Economic Evaluation of a Randomized Clinical Trial.
McClinton SM, Heiderscheit BC, Flynn TW … +1 more , Pinto D
Phys Ther · 2025 Nov · PMID 41042252 · Full text
IMPORTANCE: Plantar heel pain (PHP) contributes to reduced quality of life and is costly to manage. Persons with PHP are infrequently referred to a physical therapist after presenting to primary care or podiatry. OBJECTI...
IMPORTANCE: Plantar heel pain (PHP) contributes to reduced quality of life and is costly to manage. Persons with PHP are infrequently referred to a physical therapist after presenting to primary care or podiatry. OBJECTIVE: The study objective was to compare the cost-effectiveness of usual podiatry care (uPOD) plus physical therapist treatment with that of uPOD alone in the management of PHP. DESIGN: A cost-effectiveness analysis from societal and health care sector perspectives and a 3-year time horizon was performed alongside a randomized clinical trial. Intention to treat was used as the base case, and sensitivity analyses were used to assess the impact of adherence to treatment (ie, per protocol) and PHP-specific costs. SETTING: The setting was a multidisciplinary outpatient clinic in the United States. PARTICIPANTS: Participants were 95 eligible patients with PHP. INTERVENTIONS: uPOD consisted of a stretching handout, medication, injections, and orthotics; uPOD plus physical therapist treatment also included physical therapist intervention consisting of manual therapy, exercise, foot taping, and iontophoresis. MAIN OUTCOMES AND MEASURES: Cost-effectiveness was determined by between-group differences in costs relative to quality-adjusted life-years (QALYs). Cost-effectiveness at different thresholds of decision maker willingness to pay was illustrated using the cost-effectiveness acceptability curve. RESULTS: uPOD plus physical therapist treatment reduced societal costs by $2708 (95% CI = -$294 to $5709) relative to uPOD and increased QALYs by 0.09 (95% CI = -0.01 to 0.18). The cost-effectiveness acceptability curve demonstrated 98%, 99%, and 97% probabilities of cost-effectiveness of uPOD plus physical therapist treatment in the base-case, per-protocol, and PHP-specific cost analyses using a willingness-to-pay threshold of $50,000 per QALY. CONCLUSIONS: Adding physical therapist treatment to uPOD lowered total costs and improved quality of life despite increased short-term health care utilization. Results were not altered when considering adherence to treatment or PHP-specific costs. RELEVANCE: This study informs shared decision-making between providers and patients with PHP about the costs and benefits of adding physical therapist treatment and provides support for the economic value of physical therapist treatment for PHP.
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 … +1 more , Boisgontier MP
Phys Ther · 2025 Nov · PMID 41042239 · Full text
IMPORTANCE: Arthritis is a chronic condition affecting hundreds of millions of people worldwide, often leading to pain and functional limitations. OBJECTIVE: This study aimed to investigate the direct and indirect effect...
IMPORTANCE: Arthritis is a chronic condition affecting hundreds of millions of people worldwide, often leading to pain and functional limitations. OBJECTIVE: This study aimed to investigate the direct and indirect effects of pain on functional dependence in individuals with arthritis. Depressive symptoms and physical activity were examined as potential mediators of this relationship. DESIGN: This study was a longitudinal cohort study. SETTING: The study setting included community-dwelling adults participating in the Canadian Longitudinal Study on Aging. PARTICIPANTS: This study sample consisted of 6972 participants with arthritis, including 4930 with osteoarthritis and 694 with rheumatoid arthritis. EXPOSURE: The exposure was the usual presence of pain or discomfort at baseline, with depressive symptoms (CESD-10) and physical activity (PASE) tested as mediators. MAIN OUTCOME AND MEASURE: The main outcome was functional dependence in basic activities of daily living (ADL) and instrumental activities of daily living (IADL) at follow-up, measured with a modified version of the Older Americans' Resources and Services Multidimensional Functional Assessment Questionnaire (OARS). RESULTS: Baseline pain was positively associated with depressive symptoms (b = 0.356 [95% CI = 0.310 to 0.402]) and negatively associated with physical activity (b = -0.083 [95% CI = -0.125 to -0.042]). Functional dependence at follow-up was significantly predicted by baseline pain (log OR = 0.607 [95% CI = 0.261 to 0.952]), depressive symptoms (log OR = 0.358 [95% CI = 0.184 to 0.533]), and physical activity (log OR = -0.598 [95% CI = -0.818 to -0.378]). Mediation analysis showed that 23.3% of the total effect of pain on functional dependence was accounted for by the indirect effect through depressive symptoms (16.2%), physical activity (6.3%), and their serial combination (0.8%). CONCLUSIONS: The presence of pain at baseline was associated with higher odds of functional dependence in basic and instrumental activities of daily living after a mean follow-up period of 6.3 years, with depressive symptoms and lower physical activity acting as mediators. RELEVANCE: The findings highlight the need for arthritis care to extend beyond pain management by incorporating strategies that address depressive symptoms and promote physical activity to preserve functional independence.
Author Response to Shoemaker et al.
Zarek P, Ruttinger C, Armstrong D … +4 more , Chakrabarti R, Hess DR, Manal TJ, Dall TM
Phys Ther · 2025 Oct · PMID 41001851 · Publisher ↗
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On "Current and Projected Future Supply and Demand for Physical Therapists From 2022 to 2037: A New Approach Using Microsimulation." Zarek P, Ruttinger C, Armstrong D, et al. Phys Ther. 2025;105(3):pzaf014. https://doi.org/10.1093/ptj/pzaf014.
Shoemaker MJ, Sander T, Arena S … +6 more , Blackwood J, Ferreira K, Heath AE, Reid K, Silkwood-Sherer D, Steele SL
Phys Ther · 2025 Oct · PMID 40985561 · Publisher ↗
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Behaviorally Informed Interventions to Promote Activity in the Home and Community for Adults With Neurological Disorders: A Systematic Review and Meta-Analysis.
LaMarca A, Karim R, Larsen G … +4 more , Tse I, Wechsler S, Gauthier LV, Keysor J
Phys Ther · 2025 Nov · PMID 40985556 · Publisher ↗
IMPORTANCE: Physical activity can improve clinical outcomes among people with neurological conditions; however, people with these conditions rarely engage in recommended levels of activity. Remote monitoring (RM) with th...
IMPORTANCE: Physical activity can improve clinical outcomes among people with neurological conditions; however, people with these conditions rarely engage in recommended levels of activity. Remote monitoring (RM) with the incorporation of behavior change strategies is purported to be an effective approach to promote increased physical activity in the home setting, however, its effectiveness in promoting activity for people with neurological conditions is unclear. OBJECTIVES: The objectives of this review were to examine the effectiveness of behaviorally informed RM interventions on physical activity in the home and community and to identify usage and impact of specific behavior change techniques (BCTs) implemented with RM interventions. DATA SOURCES: PubMed, PsycINFO, and CINAHL were searched in March 2024. STUDY SELECTION: This study included a selection of randomized controlled trials on behaviorally informed RM interventions that use wearable sensors or digital applications to target physical activity for patients with neurological diseases. DATA EXTRACTION AND SYNTHESIS: Data extraction was performed by 2 independent reviewers and data synthesis was performed with random effects meta-analysis. BCT were classified using Michie's behavior change technique taxonomy. Promising BCTs were identified by examining the proportion of statistically significant studies for each technique. Risk of bias was assessed with the risk of bias 2 tool. MAIN OUTCOMES AND MEASURES: The main outcomes and measures included physical activity measured by self-report and accelerometers. RESULTS: Fourteen studies were included with some concerns of bias, encompassing individuals with multiple sclerosis, stroke, Parkinson disease, and spinal cord injury. Behaviorally informed RM interventions resulted in statistically significant improvements in self-reported physical activity (SMD = 0.27, 95% CI = 0.06 to 49), but not accelerometry outcomes (SMD = 0.52, 95% CI = -0.07 to 1.11). Promising BCTs included self-monitoring, problem solving, goal setting, graded tasks, social support, and adding objects to the environment. CONCLUSIONS AND RELEVANCE: RM shows initial promise to increase physical activity of people living with neurological conditions when paired with behavior change consultation.
On "Seeing Past the Event Horizon: A Framework for Integrating Artificial Intelligence and Machine Learning Into Physical Therapy." Morelli N. Phys Ther. 2025;105;pzae137. https://doi.org/10.1093/ptj/pzae137.
Daley KN
Phys Ther · 2025 Oct · PMID 40985537 · Publisher ↗
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Loneliness Is Independently Associated With Functioning in the Oldest Old: A Cross-Sectional Study Using Data From the Survey of Health, Ageing and Retirement in Europe.
Bertoldi K, Haagsma AB, Bernardelli RS … +5 more , Karam LZ, Coll-Planas L, Frajacomo FTT, Jerez-Roig J, Baena CP
Phys Ther · 2025 Oct · PMID 40981664 · Publisher ↗
IMPORTANCE: Functionality is crucial for older adults' autonomy, and loneliness has emerged as a potential risk factor for chronic diseases. However, its role in functional limitations remains unclear. OBJECTIVE: The obj...
IMPORTANCE: Functionality is crucial for older adults' autonomy, and loneliness has emerged as a potential risk factor for chronic diseases. However, its role in functional limitations remains unclear. OBJECTIVE: The objective of this study was to analyze the association between loneliness and limitations in 1 or more basic activities of daily living (BADL) and instrumental activities of daily living (IADL) in individuals who were 80 years old or older. DESIGN: This was a cross-sectional study using data from wave 8 of the Survey of Health, Ageing and Retirement in Europe. SETTING: The study was conducted in 26 European countries. PARTICIPANTS: Participants were 7434 community-dwelling adults who were 80 years old or older. EXPOSURE: Loneliness was assessed using the 3-item loneliness scale, covering companionship, exclusion, and isolation. MAIN OUTCOME AND MEASURES: Functional limitations were defined as difficulty in 1 or more BADL (dressing, walking, bathing, eating, bed transfer, and toileting), IADL (map use, preparing a hot meal, shopping, phone use, medication management, housework, finances, transportation, and laundry), or in both types of activities (BADL and IADL). Sociodemographic and health-related variables were considered. Logistic regression and multivariate analyses were applied, using the odds ratio (OR) as the effect measure. RESULTS: The mean age was 84.4 (SD = 3.8) years; 58.2% of participants were women; and 52.5% had a low educational level. Loneliness affected 56% of participants, and 66% reported limitations in BADL/IADL. Loneliness was significantly associated with functional limitation in BADL/IADL in both univariate (OR = 2.18 [95% CI = 1.98-2.39]) and multivariate (OR = 1.50 [95% CI = 1.34-1.67]) models, even after adjustment for covariates, with an area under the receiver operating characteristic curve of 76%. CONCLUSIONS: Loneliness is significantly and independently associated with limitations in BADL/IADL among the oldest-old. RELEVANCE: These findings highlight the importance of assessing psychosocial factors, such as loneliness, when evaluating functional health in the oldest-old.
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