Physical Therapy[JOURNAL]
Sun
200 papers
Clinical Efficacy of Respiratory Exercise for Respiratory Function in Stroke Rehabilitation: A Network Meta-Analysis.
Kim SH, Cho SH
Phys Ther · 2025 Oct · PMID 40973170 · Publisher ↗
IMPORTANCE: Determining the most effective intervention to improve respiratory function is complex. OBJECTIVE: This study aimed to determine the effectiveness of various cardiorespiratory physical therapist interventions...
IMPORTANCE: Determining the most effective intervention to improve respiratory function is complex. OBJECTIVE: This study aimed to determine the effectiveness of various cardiorespiratory physical therapist interventions to improve respiratory function in patients with stroke and to prioritize them. DATA SOURCES: This network meta-analysis examined randomized controlled trials published between 2000 and 2023. STUDY SELECTION: Randomized controlled trials that enrolled patients with stroke and examined various cardiorespiratory physical therapist interventions were selected. The interventions included combined aerobic and breathing training, combined inspiratory and expiratory training (CIET), conventional training (CT), expiratory training, ground-based aerobic training (GBAT), inspiratory training (IT), and sham intervention (S). DATA EXTRACTION AND SYNTHESIS: Data were independently extracted by 2 authors. The Comprehensive Meta-Analysis Software program was used to analyze the data and determine effect sizes. MAIN OUTCOMES AND MEASURES: Outcome variables were maximal expiratory pressure (MEP), maximal inspiratory pressure (MIP), and peak expiratory flow (PEF). RESULTS: Thirteen studies, involving 416 participants, were selected. CIET was more effective than CT in improving MEP, MIP, and PEF, with Hedges g (g) values of 0.890 (95% CI = 0.560-1.220), 0.948 (95% CI = 0.648-1.248), and 1.014 (95% CI = 0.636-1.391), respectively. IT was more effective than S for MEP (g = 0.582, 95% CI = 0.091-1.072) and more effective than CT for MIP (g = 0.934, 95% CI = 0.576-1.293). PEF analysis revealed that CIET was more effective than GBAT (g = -1.215, 95% CI = -2.035 to -0.395). CONCLUSIONS AND RELEVANCE: CIET or IT may improve respiratory function in patients with stroke more effectively than uniformly applied GBAT or CT. CIET and IT are effective regardless of age or intervention duration. Cardiopulmonary training is encouraged during the chronic phase of stroke to improve respiratory muscle strength, with at least 6 weeks of training recommended.
Development and Validation of PT-PENCIL: A Tour de Force for Prediction Studies.
George SZ
Phys Ther · 2025 Aug · PMID 40928814 · Publisher ↗
Abstract loading — click title to view on PubMed.
Burden of Rehabilitation-Relevant Diseases in Mexico: Findings From the Global Burden of Disease Study 2021.
Martinez B, Gonzalez-Rocha A, Rios-Blancas MJ … +1 more , Denova-Gutiérrez E
Phys Ther · 2025 Oct · PMID 40928157 · Publisher ↗
IMPORTANCE: To this author's knowledge, this is the first study to examine the burden of rehabilitation-relevant conditions in Mexico, providing valuable evidence to inform public policy and enhance the delivery of rehab...
IMPORTANCE: To this author's knowledge, this is the first study to examine the burden of rehabilitation-relevant conditions in Mexico, providing valuable evidence to inform public policy and enhance the delivery of rehabilitation services. OBJECTIVE: This study presents a national-level analysis estimating the number of people in Mexico who required rehabilitation at least once during the course of an illness or injury that caused a disability, based on data from the 2021 Global Burden of Disease Study. DESIGN: This was a cross-sectional analysis. SETTING AND PARTICIPANTS: This study is a secondary analysis using 2021 Global Burden of Disease Study estimates to quantify the burden of diseases and conditions considered amenable to rehabilitation. The use of these estimates provides a comprehensive and systematic approach to quantifying the magnitude of health loss in regional, national, and subnational locations using Bayesian methods. RESULTS: The findings suggest that the prevalence of persons with conditions that would benefit from rehabilitation was 43,488.0 (95% uncertainty interval [UI] = 39,240.1-47,930.6) per 100,000 persons, and the total estimated years lived with disability due to the same conditions were 3,610,038.9 (95% UI = 2,218,757.8-5,575,356.1). The total estimated number of people with musculoskeletal disorders who could benefit from rehabilitation services was 24,444,835 (95% UI = 21,061,024-27,876,368). In addition, an estimated 22,464,680 individuals (95% UI = 21,481,932-23,547,373) with hearing loss were also identified as likely to benefit from rehabilitation interventions. CONCLUSIONS: The study provides a national-level analysis of the burden of diseases and conditions that are likely to require rehabilitation services in Mexico. The findings support the need for targeted preventive measures, strategic allocation of rehabilitation resources, and the development of multidisciplinary care models. RELEVANCE: The findings of the study provide key evidence for optimizing resource allocation, developing prevention strategies, and strengthening multidisciplinary care models. This research contributes to improving public policy planning and the quality of rehabilitation services.
Validation of the Learning and Study Strategies Inventory (LASSI) in Doctor of Physical Therapy Learners: A Retrospective Observational Study.
Feda JT, Pucillo EM, Wenger LE … +5 more , Scales MH, Adams KR, Minahan CA, Martin JG, Smith NS
Phys Ther · 2025 Oct · PMID 40899704 · Publisher ↗
IMPORTANCE: The Learning and Study Strategies Inventory (LASSI) is an instrument that measures self-regulated learning. However, it has not been validated for use in entry-level Doctor of Physical Therapy (DPT) learners....
IMPORTANCE: The Learning and Study Strategies Inventory (LASSI) is an instrument that measures self-regulated learning. However, it has not been validated for use in entry-level Doctor of Physical Therapy (DPT) learners. OBJECTIVE: The objective of this study was to investigate the validity and reliability of the LASSI in DPT learners. DESIGN: This was a retrospective observational cohort study. SETTING/PARTICIPANTS/INTERVENTION: Demographic and LASSI data were retrospectively analyzed from 1541 learners enrolled in 5 entry-level DPT programs across the United States. MAIN OUTCOMES AND MEASURES: A confirmatory factor analysis (CFA) was conducted to evaluate whether the 60-item LASSI (3rd Edition) demonstrated a valid and reliable factor structure. An exploratory factor analysis (EFA) was used to identify a more succinct set of LASSI scales. Goodness-of-fit indices and reliability coefficients were computed to assess model fit and measurement consistency. RESULTS: CFA revealed that the 60-item LASSI accounted for 46.7% of total score variance. In contrast, EFA identified a revised 47-item version (termed LASSI-DPT) that accounted for 58.1%, indicating improved construct validity. χ2 goodness-of-fit supported the adequacy of the EFA model (χ2 = 3964.1). The revised 47-item LASSI demonstrated excellent internal consistency, with an overall Cronbach alpha of 0.92, compared to 0.78 for the 60-item version. CONCLUSION: The revised 47-item LASSI-DPT provides a more reliable, concise, and valid assessment compared to the 60-item LASSI, tailored to learning strategies in physical therapist education programs. RELEVANCE: Factor analysis demonstrated improved construct validity and excellent reliability in a newly developed 47-item version of the LASSI tailored for DPT learners. This shorter instrument may result in decreased survey fatigue and improved measurement accuracy. With its enhanced psychometric properties, the LASSI-DPT may enable DPT programs to better identify learners who need additional support related to self-regulation of learning.
Global Prosthetic Provision Rate After Major Lower Extremity Amputation for Dysvascular Populations From Four Continents: A Scoping Review.
Wong CK, Shimoda C, Steel E … +2 more , Janums A, Beckley AA
Phys Ther · 2025 Oct · PMID 40879185 · Publisher ↗
IMPORTANCE: Lower extremity amputation (LEA) is a worldwide public health problem leading to large disability burdens and health care costs. After LEA, prostheses improve functional mobility and quality-of-life. However,...
IMPORTANCE: Lower extremity amputation (LEA) is a worldwide public health problem leading to large disability burdens and health care costs. After LEA, prostheses improve functional mobility and quality-of-life. However, health care costs are high and prosthetic provision worldwide is unknown. OBJECTIVE: The objective was to map the worldwide evidence for prosthetic provision rates after major dysvascular LEA to identify evidence gaps. DESIGN: This scoping review followed best practices and PRISMA-Sc guidelines. Of 609 abstracts screened and 28 full texts reviewed, 18 articles were included. SETTING/EXPOSURES: Five databases were searched without language limits using Medical Subject Headings (MeSH) and keyword search terms. The Population-Concept-Context framework included people with major dysvascular LEA, prosthetic provision, and health care models. PARTICIPANTS: Seventeen cohorts and 1 case-control study involved 31,982 people (7.7% female, 16.5% Americans from racial and ethnic minority groups), mean age 68.1 years, 85.0% after dysvascular LEA (61.4% transtibial). MAIN OUTCOMES: The outcome of interest was prosthetic provision rates. RESULTS: The overall prosthetic provision rate from 10 countries was 48.5%: 48.6% for high-income (16/18) and 39.2% for middle-income (2/18) countries. The 1 Bismarck not-for-profit universal health care model country had the highest provision rate (73.7%); 4 studies from 3 Beveridge/Bismarck model countries reported 59.3% provision. Most participants were from the hybrid US system, with 6 studies reporting 48.8% provision. Provision rate in 6 studies from 4 Beveridge government-financed care model countries was 41.2%, and 32% in the fee-for-service country. Lower prosthetic provision rates were observed for transfemoral compared with transtibial amputations, female compared with male sex, and Americans from racial and ethnic minority groups compared with White race. CONCLUSIONS: Fewer than half receive prostheses after LEA worldwide. Differences among country health care models and income levels; lack of African, South American, and low-income country studies; and low prosthetic provision for people of female sex and Americans from racial and ethnic minority groups exposed evidence gaps for future research. RELEVANCE: Limited provision of prostheses that improve quality-of-life highlights the need to understand factors affecting prosthetic decisions and health care policies.
Rate, Intensity, Disability, and Characteristics of Back Pain in Children 0 to 18 Years Old Referred to Pediatric Orthopedics for Spinal Concerns.
Zapata KA, Ramo BA, Jo CH … +1 more , Petrasic JR
Phys Ther · 2025 Oct · PMID 40879180 · Publisher ↗
IMPORTANCE: The rate of back pain in children is unclear. OBJECTIVE: This study evaluated the rate, intensity, disability, and characteristics of back pain across the pediatric age span in children referred with spinal c...
IMPORTANCE: The rate of back pain in children is unclear. OBJECTIVE: This study evaluated the rate, intensity, disability, and characteristics of back pain across the pediatric age span in children referred with spinal concerns. DESIGN: This study used a retrospective design. SETTING: This was completed at a tertiary pediatric orthopedic institution in the United States. PARTICIPANTS: Seventeen thousand nine hundred eleven children (6621 male and 11,280 female) ages 0 to 18.9 with any spinal condition from July 2018 to April 2022 were evaluated. MAIN OUTCOMES: All children/caregivers were asked yes/no, "Is back pain a significant concern at today's visit or the past 6 months?" Beginning in February 2020, children who reported back pain were assigned the 9-item Oswestry Disability Index (ODI-9). Beginning in April 2021, all children ages 5 and above were assigned 3 patient-reported outcomes measurement information system (PROMIS) pediatric measures: pain interference, mobility, and anxiety. RESULTS: Forty-two percent (7580/17,911) of all children with spinal concerns reported back pain which increased from about 20% at age 2 to about 30% by age 7 to 40% by age 13 to at least 55% by age 16. Back pain intensity averaged 2.0 out of 5. ODI-9 scores averaged minimal disability (18%). Female sex (odds ratio [OR] = 1.36), public insurance type (OR = 1.33), increased age (OR = 1.16), higher PROMIS pain interference scores (OR = 1.13), increased body mass index (BMI) percentile (OR = 1.01), and lower PROMIS mobility scores (OR = 0.98) were associated with the presence of back pain. CONCLUSIONS: Four in 10 children referred with spinal concerns report back pain, which increases with female sex, public insurance type, age, BMI percentile, and worse PROMIS pain interference and mobility scores. Quantifying the functional, mental health, and socioeconomic burden of back pain can help prioritize multidisciplinary interventions. RELEVANCE: Clinicians need to pay attention to the likelihood of back pain in a younger demographic than traditionally thought.
Relationship Between Tendon Tissue and Shoulder Disability Change During an 8-Week Exercise Intervention for Rotator Cuff Tendinopathy: An Observational Study.
Vila-Dieguez O, Heindel MD, Zipser MC … +5 more , Mortazavi K, Kulig K, Bashford G, Mack W, Michener LA
Phys Ther · 2025 Oct · PMID 40879175 · Full text
IMPORTANCE: Understanding how tendon structure relates to disability improvement during exercise interventions in rotator cuff tendinopathy is essential for optimizing individualized treatment strategies. OBJECTIVE: The...
IMPORTANCE: Understanding how tendon structure relates to disability improvement during exercise interventions in rotator cuff tendinopathy is essential for optimizing individualized treatment strategies. OBJECTIVE: The objectives of this study were to characterize changes in supraspinatus tendon thickness and internal architecture over an 8-week resistive exercise intervention and evaluate the relationship between these changes and patient-reported shoulder disability. DESIGN: This was a prospective longitudinal observational study. SETTING: The settings were a university-based research laboratory and virtual supervision in participants' homes. PARTICIPANTS: Forty-seven adults with unilateral rotator cuff tendinopathy were the study participants. INTERVENTION: The intervention was an 8-week progressive resistive exercise program, supervised twice weekly by a physical therapist. MAIN OUTCOMES AND MEASURES: Primary outcomes were the Pennsylvania Shoulder Score, supraspinatus tendon thickness, and internal tendon architecture assessed using the peak spatial frequency radius via ultrasound. Measurements were taken at baseline and at 2, 4, and 8 weeks. Linear mixed-effects models were used to assess changes and associations. RESULTS: Significant improvements from baseline were observed for the Pennsylvania Shoulder Score at 2, 4, and 8 weeks. Tendon thickness decreased significantly; changes in internal tendon architecture were not significant. A decrease in tendon thickness was associated with an improved Pennsylvania Shoulder Score at 2 weeks but not at 4 and 8 weeks. CONCLUSIONS: Reductions in tendon thickness were associated with improved shoulder outcomes within the first 2 weeks of the intervention. Internal tendon architecture remained unchanged over the intervention. These findings suggest that tendon variables included in this study may be relevant only early in the intervention and that other factors should be investigated across different times of the intervention.
Do Patients With Shoulder Pain Exhaust Nonoperative Care Prior to Undergoing Subacromial Decompression Surgery? Results From a Large Retrospective Observational Study of US Service Members.
Hando BR, Rhon DI, Greenlee TA … +2 more , Cleland JA, Snodgrass SJ
Phys Ther · 2025 Aug · PMID 40847786 · Publisher ↗
IMPORTANCE: Clinical practice guidelines recommend individuals with subacromial pain syndrome (SAPS) exhaust conservative care, with an emphasis on therapeutic exercise, prior to undergoing subacromial decompression (SAD...
IMPORTANCE: Clinical practice guidelines recommend individuals with subacromial pain syndrome (SAPS) exhaust conservative care, with an emphasis on therapeutic exercise, prior to undergoing subacromial decompression (SAD) surgery. To date, there are no studies that describe the care individuals with SAPS receive prior to undergoing SAD in a large health care system. OBJECTIVE: The objective of this study was to characterize care received by patients undergoing SAD in the year before surgery with a focus on shoulder exercise visits. DESIGN: This was a retrospective, longitudinal database study. SETTING: This study included records from the Military Health System. PARTICIPANTS: Participants were United States active-duty service members (n = 5917). EXPOSURE: This study included patients who underwent SAD in a military treatment facility between 2015 through 2019. MAIN OUTCOMES AND MEASURES: Medical imaging, shoulder injections, medications, and rehabilitation encounters were categorized using Current Procedural Terminology codes. Rehabilitation encounters were further categorized as exercise, manual therapy, and/or passive therapy visits. A multivariable negative binomial regression model was performed to identify factors associated with the number of exercise visits attended in the year preceding surgery. RESULTS: Overall, 2171 (36.7%) service members did not attend any exercise visits in the year before surgery. Significant predictors of attending more exercise visits included undergoing at least 1 magnetic resonance imaging study, receiving a shoulder injection, and younger age (<25 years). Most patients (94.6%) underwent at least 1 shoulder-related imaging procedure. The most common therapeutic class of medication prescribed was nonsteroidal anti-inflammatory drugs (NSAIDs; 81.0%), followed by muscle relaxers (29.3%), opioids (27.3%), and analgesics that were not NSAIDs (24.4%). CONCLUSIONS: Therapeutic exercise was underutilized in our cohort, which may contribute to the overutilization of SAD in individuals with SAPS. Before considering SAD, providers should ensure patients with SAPS complete a course of evidence-based nonoperative care, to include supervised therapeutic exercise. RELEVANCE: Increasing awareness of care patterns prior to SAD may help improve care pathways for individuals with SAPS.
Use of Virtual Reality in Upper Extremity Rehabilitation of Adults After Stroke and Its Effect on Functionality: Systematic Review and Meta-Analysis.
Enríquez-Canto Y, Pizarro-Mena R, Ludueña-Hernández K … +3 more , Alexandre-Vergara K, Riveros-Basoalto G, Dresdner-Figueroa A
Phys Ther · 2025 Aug · PMID 40827691 · Publisher ↗
IMPORTANCE: Virtual reality (VR) is increasingly used in patients after stroke upper limb rehabilitation, but the comparative effectiveness of VR-Only versus hybrid VR combined with conventional therapy (CT) remains uncl...
IMPORTANCE: Virtual reality (VR) is increasingly used in patients after stroke upper limb rehabilitation, but the comparative effectiveness of VR-Only versus hybrid VR combined with conventional therapy (CT) remains unclear. OBJECTIVE: The objective of this review was to systematically review and meta-analyze the effectiveness of 2 distinct VR intervention approaches for patients undergoing hemiparetic upper limb rehabilitation after stroke: VR-Only versus CT, and hybrid interventions combining VR with CT versus CT alone. DATA SOURCES: A PROSPERO protocol (CRD 42022349259) for a comprehensive search was conducted across 7 databases, focusing on studies published in English and Spanish. STUDY SELECTION: Randomized controlled trials (RCTs) comparing VR-Only or hybrid VR interventions to CT were included. DATA EXTRACTION AND SYNTHESIS: Study characteristics, participant demographics, intervention specifics, and outcome measures were extracted. The risk of bias was assessed using the Risk of Bias 2 (RoB 2) tool. Meta-analyses used a random-effects model to estimate standardized mean differences (SMDs) with 95% confidence intervals. MAIN OUTCOME(S) AND MEASURE(S): Primary outcomes included motor function, motor capacity, hand dexterity, and functional capacity, measured by validated instruments such as the Fugl-Meyer Assessment and Box and Block Test. RESULTS: Twenty-seven RCTs (1156 participants) were included. Hybrid VR + CT interventions significantly improved motor function (SMD = 0.44) and manual dexterity (SMD = 0.33) compared to CT alone. VR-Only interventions showed positive trends but were not statistically significant. Hybrid interventions maintained benefits at follow-up (SMD = 0.63, 95% CI = 0.11-1.15). Optimal improvements were observed with hybrid sessions of 31 to 59 minutes daily. CONCLUSIONS: Hybrid VR + CT interventions are more effective than CT alone, improving motor function and manual dexterity after stroke, with sustained benefits over time. VR-Only interventions showed less consistent effects. RELEVANCE: These results suggest that integrating VR into CT enhances rehabilitation outcomes of stroke survivors. Future research should focus on optimizing hybrid protocols and exploring long-term outcomes.
"It's Still Exposure Just in a Slightly Different Way"-Understanding the Contribution of Simulation to Developing Physical Therapist Skills in Ireland: An Interpretive Description Study.
Mulhall CM, Eppich W, Schulmann K … +3 more , Condron C, McDonough S, O'Shea O
Phys Ther · 2025 Aug · PMID 40815831 · Full text
IMPORTANCE: Simulation-based education (SBE) is increasingly used in physical therapist training to address growing student numbers and clinical placement shortages. However, clinical educators' perspectives on the role...
IMPORTANCE: Simulation-based education (SBE) is increasingly used in physical therapist training to address growing student numbers and clinical placement shortages. However, clinical educators' perspectives on the role of SBE in preparing students for practice remain unexplored. OBJECTIVE: The objective of this study was to explore physical therapy clinical educators' perspectives on academic-based SBE, particularly how it can equip students for clinical placement and whether it should contribute to practice education hours. DESIGN: Qualitative interpretive description methodology using semi-structured interviews was used. SETTING: Five hospital sites across the island of Ireland engaged in physical therapist practice education. PARTICIPANTS: This study involved 8 physical therapist practice educators and tutors with 6 to 15 years of experience, supervising 2 to 50 students annually. INTERVENTION(S) OR EXPOSURE(S): Individual semistructured interviews were conducted exploring participants' perspectives on SBE's role in clinical education, lasting 40 to 60 minutes each. MAIN OUTCOME(S) AND MEASURE(S): Thematic analysis identified patterns in clinical educators' perceptions of SBE's educational value and contribution to practice preparation. RESULTS: Simulation supported the transition to practice by: (1) priming for clinical environments, (2) enhancing feedback literacy in the workplace, and (3) tackling complexity of clinical practice. Specific clinical skills including documentation, basic safety, manual handling, subjective assessment, and understanding the multidisciplinary team's role were recognized as appropriate for instruction through SBE. Participants reported activities spent in SBE should count toward clinical hours and highlighted that processing feedback during SBE established a foundation for feedback practices in the workplace. Engaging simulated patients in scenarios informed by real patient experiences was proposed as a way of managing complex patient encounters. CONCLUSIONS AND RELEVANCE: SBE provides a means to scaffold the learning of essential clinical skills before practice placement and contributes to clinical education, though more research is needed to determine the proportion. Future research should examine simulated interventions to boost feedback literacy and readiness for clinical settings. Involving patients and the public in the design of SBE curricula is crucial for relevant and beneficial learning outcomes.
An Intensive Upper Extremity Program Coupled With a Wearable Device for Poststroke Rehabilitation: A Qualitative Study of the Perspectives of People With Stroke.
Yang CL, Simpson LA, Jang S … +14 more , Barclay R, Bayley MT, Dukelow SP, MacIntosh BJ, MacKay-Lyons M, Menon C, Mortenson WB, Peng TH, Pollock CL, Pooyania S, Silverberg ND, Teasell R, Yao J, Eng JJ
Phys Ther · 2025 Aug · PMID 40810494 · Full text
OBJECTIVE: The Virtual Arm Boot Camp program (V-ABC) was one of the first virtually delivered upper extremity exercise programs coupled with a novel wearable device that provided reach-to-grasp feedback for individuals w...
OBJECTIVE: The Virtual Arm Boot Camp program (V-ABC) was one of the first virtually delivered upper extremity exercise programs coupled with a novel wearable device that provided reach-to-grasp feedback for individuals with stroke. Understanding the experience of participants is critical to improving the implementation of rehabilitation interventions that embed biosensor technology within rehabilitation. DESIGN: A qualitative study embedded within a multi-center randomized controlled trial conducted on the CanStroke Recovery Trials Platform was used to investigate the experiences of participants post-stroke with the V-ABC program. A qualitative descriptive methodology was used to examine the acceptability of the program, factors influencing its effectiveness, and key elements for practical implementation. Semi-structured interviews were conducted via video conferencing with participants who had completed the program. Conventional content analysis was conducted to analyze the data. Strategies including triangulation, regular analytical meetings, peer examination, and reflexivity were used to increase the trustworthiness. SETTING: Interviews were conducted via videoconferencing using Zoom software. PARTICIPANTS: Nineteen participants post-stroke (10 males/8 females, mean age = 60.2 [SD = 12.2] years; mean length of time since stroke = 217.0 [SD = 109.2] days) after completion of the program. INTERVENTION: The 3-week V-ABC program consisted of exercise, feedback from a wearable device on the use of the paretic upper extremity, and therapist support. RESULTS: Three themes describing the experiences of participants with the program were identified: (1) V-ABC provided motivating practice; (2) equipment and technology setup provided accessibility but posed challenges; and (3) increased use of the paretic hand can be integrated into daily life with varying degrees of success. CONCLUSIONS: An intensive, virtually delivered upper extremity exercise program coupled with biosensing feedback on hand use from a wearable device was reported to be motivating, accessible, and facilitated use of paretic hands in daily life. The findings may help improve the future implementation of the V-ABC program and similar approaches involving telerehabilitation and wearable technology.
Lifestyle Intervention in People With Overweight and Obesity and Chronic Low Back Pain: Study Protocol for an International Multicenter Randomized Controlled Trial.
Liechti M, Schurz AP, Quiroz Marnef A … +10 more , Taeymans J, Clijsen R, Baur H, Lutz N, Deliens T, Clarys P, Nijs J, Vanroose M, Van Bogaert W, Malfliet A
Phys Ther · 2025 Aug · PMID 40801269 · Full text
IMPORTANCE: Chronic low back pain (CLBP) is a global health problem with significant clinical, social, and economic challenges. Over 80% of CLBP cases are non-specific (CNLBP), causing the highest number of years lived w...
IMPORTANCE: Chronic low back pain (CLBP) is a global health problem with significant clinical, social, and economic challenges. Over 80% of CLBP cases are non-specific (CNLBP), causing the highest number of years lived with disability. People with CNLBP often have comorbidities such as overweight or obesity, which negatively impact symptoms and treatment outcomes. OBJECTIVE: The objective is to evaluate whether a lifestyle intervention combining diet, physical activity, and evidence-based physical therapy can reduce pain in individuals with CNLBP and comorbid overweight or obesity. DESIGN: This is an international multicenter triple-blinded randomized controlled trial (RCT). SETTING: The trial will be conducted in Belgium and Switzerland, with interventions delivered in hospitals (ambulatory care) and outpatient private practices. PARTICIPANTS: In total, 252 adults will be included and randomly assigned to 1 of 2 treatment arms. INTERVENTIONS: The control intervention includes Pain Neuroscience Education and Cognition-Targeted Exercise Therapy. The experimental group receives the same intervention supplemented with a Behavioral Weight Reduction Program. MAIN OUTCOMES AND MEASURES: The primary outcome is pain intensity (assessed using the Brief Pain Inventory). Secondary outcomes include other pain-related outcomes, body composition measures, energy balance related behavior, medical consumption, indirect health-related costs, and quality of life. Assessments will occur at baseline, post-intervention, and at 3-, 6-, 9-, and 12-months follow-up. CONCLUSION: This study is the first international multicenter RCT integrating a lifestyle approach into evidence-based physical therapy for people with CNLBP and comorbid overweight or obesity. It will assess whether addressing comorbid overweight or obesity enhances pain reduction and other health outcomes in this population. RELEVANCE: The results will push the field forward, leading to new knowledge about the (cost-)effectiveness of this approach, which will provide key insights for different stakeholders, help optimizing therapy guidelines and individualized care for people with CNLBP and comorbid overweight or obesity.
Descriptive Analysis of Supervised Falls Occurring During Physical Therapy Sessions in Adult Inpatient Rehabilitation.
Camillieri S, Weiss C, Zervas M … +1 more , Dennis B
Phys Ther · 2025 Aug · PMID 40693732 · Publisher ↗
IMPORTANCE: Falls are commonly reported incidents that affect the safety of patients during inpatient hospitalization. Inpatient rehabilitation (IR) units report the highest fall rates when compared with other hospital u...
IMPORTANCE: Falls are commonly reported incidents that affect the safety of patients during inpatient hospitalization. Inpatient rehabilitation (IR) units report the highest fall rates when compared with other hospital units. Falls commonly result in patient injury and elevate episode costs. There is a dearth of information regarding characteristics of patients who fall during physical therapy sessions, which represents a unique subset of falls. OBJECTIVE: The aim of the study was to describe the nature of falls, characteristics of fallers, and characteristics of therapists who experienced patient falls, which occurred during physical therapy sessions in IR. DESIGN: This was an observational study which included a retrospective analysis of medical records. SETTING: This study examined falls occurring within 2 IR departments at a large hospital system located in an urban setting in the United States. PARTICIPANTS: This study involved patients receiving adult IR with diagnoses including, but not limited to, stroke, traumatic brain injury, and spinal cord injury. EXPOSURES: This study examined characteristics of patients who fell as compared with patients who did not fall, quantified the conditions surrounding falls, and described physical therapists who experienced patient falls. MAIN OUTCOMES AND MEASURES: Mann-Whitney U tests, chi-square tests, and binomial logistic regression analyses were performed to compare characteristics of faller and non-faller groups. RESULTS: Among the 6238 unique patient admissions, a total of 40 falls were identified. The rate of falling was 0.43 falls per 1000 patient days. The majority of falls occurred because of buckling (47.5%) and during gait training (40.0%). Falls most often occurred close to discharge (mode = 6 days prior). Fallers were younger than nonfallers (exponential power of B, ie, Exp[B], = 1.02; 95% CI = 1.01-1.04). Diagnoses representing the largest proportion of fallers included brain dysfunction/stroke (30.0%) and spinal cord injury/peripheral nerve injury (30.0%). Fallers had comorbid diabetes mellitus type 2 (Exp[B] = 2.70; 95% CI = 1.45-5.04) and received renal dialysis (Exp[B] = 3.23; 95% CI = 1.14-9.17) in a higher proportion than nonfallers. Fallers were often high functioning, the majority receiving at most minimal assistance (72.5%). Falls most often occurred with therapists who had 1 to 2 years of experience (27.5% of falls). CONCLUSIONS: The rate of falls during therapy was lower than the rate of falls previously reported in similar settings. Therapists should exercise caution when managing younger patients and patients with certain diagnoses. Therapists should screen for buckling risk when prescribing higher-risk activities. Therapists with various levels of experience should receive fall prevention training. CLINICAL RELEVANCE: Therapists can use frequently occurring patient characteristics to screen for falling and use additional precautionary measures, particularly for patients with specific diagnoses, at higher risk for knee buckling, and of a younger age.
Credentialism and Barriers to Entry: A Historical and Sociological Analysis of the CAPTE 50 Percent Requirement for Physical Therapy Faculty With Academic Doctorates.
Hogan AJ
Phys Ther · 2025 Aug · PMID 40679435 · Publisher ↗
This Perspective offers historical and sociological analyses of the Commission on Accreditation in Physical Therapy Education's (CAPTE) 2016 standard requiring that at least 50% of core faculty in all physical therapist...
This Perspective offers historical and sociological analyses of the Commission on Accreditation in Physical Therapy Education's (CAPTE) 2016 standard requiring that at least 50% of core faculty in all physical therapist education programs hold an academic doctorate, PhD, EdD, or ScD. The author associates this mandate's development with longstanding concerns among physical therapy leaders about their field's academic status and research productivity, as well as with changes in faculty training backgrounds following the adoption of the required entry-level Doctor of Physical Therapy (DPT) degree. This article draws on the sociological theory of credentialism to examine the origins of the 50% rule and its narrow focus on academic doctorates as the 1 best pathway to enhance faculty research productivity, to the exclusion of other important factors, including social and professional roles, institutional resources, and research mentorship. During the 2010s, when most new graduates held practice-focused DPTs, academic leaders in physical therapy raised concerns about research training among the next generation of faculty. Traditionally, aspiring faculty pursued post-professional training in research skills, but would DPT-holding practitioners be willing to pursue another formal degree? In response, the CAPTE 50% rule required that nearly half of new faculty obtain a second academic doctorate, after having already invested 6 to 7 years in postsecondary education and accruing over $150,000 in debt, on average. The author demonstrates that justifications for the 50% rule were rooted in professional biases and misleading evidence and suggests that this mandate is poorly suited to present academic trends. Importantly, the 50% rule is a significant barrier to entry for all aspiring faculty and an insurmountable 1 for those from less elite backgrounds. Its implementation is unlikely to improve research productivity and threatens the potential of physical therapy's parallel efforts to better represent diverse patient communities.
Correction to: Gait Speed Modifies Efficacy of Home-Based Exercise for Falls in Older Adults With a Previous Fall: Secondary Analysis of a Randomized Controlled Trial.
Phys Ther · 2025 Jul · PMID 40674125 · Full text
Abstract loading — click title to view on PubMed.
Identifying Directional Preference: A Scoping Review and Thematic Analysis of Variability and Application in Musculoskeletal Pain Research.
Kidd JA, Lorenzetti JM, Kirby KW … +3 more , Young JL, Cleland JA, Schenk RJ
Phys Ther · 2025 Aug · PMID 40673823 · Publisher ↗
OBJECTIVE: The objective of this review was to identify and describe the varying definitions and operational criteria used to characterize directional preference in musculoskeletal care research. DATA SOURCES: A scoping...
OBJECTIVE: The objective of this review was to identify and describe the varying definitions and operational criteria used to characterize directional preference in musculoskeletal care research. DATA SOURCES: A scoping review was conducted using 6 electronic databases (PubMed, CINAHL, Embase, SPORTDiscus, Web of Science, and Cochrane Library) from inception through May 2024. STUDY SELECTION: Studies were included if they involved adults with musculoskeletal conditions and used the term "directional preference" in their methodology or reporting. DATA EXTRACTION AND SYNTHESIS: Data were extracted on terminology, definitions, and operational criteria. Definitions were thematically categorized. Expert consultation with 18 clinicians and researchers was also conducted to evaluate consensus on key components. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. MAIN OUTCOME(S) AND MEASURE(S): Primary outcomes included the number and type of directional preference definitions and expert perspectives on essential definitional elements. RESULTS: Out of 15,390 records screened, 149 studies met the inclusion criteria. These studies exhibited considerable variability, with 111 unique definitions categorized into 8 distinct themes. Notably, 22% of the studies failed to define directional preference, and 15% incorrectly equated it with centralization. Expert consultation (n = 18) highlighted substantial variability in the perceived importance of different definition components, with "response to repeated and/or sustained movements" emerging as the most consistently prioritized criterion. Despite these insights, no consensus on a definition was reached, complicating research interpretation and clinical guideline formulation. CONCLUSIONS AND RELEVANCE: There is substantial inconsistency in the definition and operationalization of directional preference across the musculoskeletal literature, which impairs research synthesis and clinical translation. Symptom change in response to repeated or sustained movement may serve as a foundation for a standardized definition. Future effort sare needed to establish a clear and consistent definition to support improved research quality and clinical application.
Associations Between Fear-Avoidance or Pain Catastrophizing and Gait Quality in Chronic Low Back Pain: A Cross-Sectional Study.
Bailes AH, McKernan GP, Redfern MS … +6 more , Cham R, Greco CM, Brach JS, Piva SR, Vo N, Sowa G
Phys Ther · 2025 Aug · PMID 40662641 · Full text
IMPORTANCE: Chronic low back pain (cLBP) is associated with reduced gait speed and other gait quality impairments. Fear-avoidance and pain catastrophizing impact movement in cLBP, but their specific impact on gait qualit...
IMPORTANCE: Chronic low back pain (cLBP) is associated with reduced gait speed and other gait quality impairments. Fear-avoidance and pain catastrophizing impact movement in cLBP, but their specific impact on gait quality is unknown. OBJECTIVE: This study aimed to determine associations between fear-avoidance or pain catastrophizing and gait quality in cLBP. DESIGN: This was a cross-sectional study. SETTING: This study occurred at a university. PARTICIPANTS: There were 500 individuals (56.6 [SD = 16.5] years old; 311 female) with cLBP. INTERVENTIONS: Participants completed the Fear-Avoidance Beliefs Questionnaire - Physical Activity (FABQ-PA) and 6-item Pain Catastrophizing Scale. Participants were divided into high and low fear-avoidance subgroups based on an established FABQ-PA cutoff (>14). MAIN OUTCOMES AND MEASURES: Gait speed was measured during a 4-meter walk test, while step time average, step time variability, and symmetry were derived from a lumbar inertial measurement unit worn during a 2-minute walk test. Multiple linear regression models were used to determine relationships between fear-avoidance or pain catastrophizing and gait quality. T tests were used to determine gait quality differences between high versus low fear-avoidance subgroups. RESULTS: High fear-avoidance was associated with reduced gait speed (B = -0.0039), but pain catastrophizing was not. The high fear-avoidance subgroup had slower gait speed (mean difference = 0.05 m/s), longer step time (mean difference = 0.02 s), and higher step time variability (mean difference = 0.004 s) compared to the low fear-avoidance subgroup. CONCLUSIONS: Fear-avoidance is associated with slower gait speeds, even after adjusting for demographics, pain, and disability. The established FABQ-PA cutoff is robust in detecting gait differences between high versus low fear-avoidance subgroups. RELEVANCE: It may be important to consider fear-avoidance in the delivery of multi-modal interventions to address gait impairments. Future studies are needed to determine the impact of addressing fear-avoidance alongside traditional gait interventions in cLBP.
Development and Validation of PT-PENCIL: The Physical Therapy Frequency Clinical Decision Support Tool to Increase Hospital Discharge to Home.
Lapin B, Passek S, Schuster A … +7 more , Stilphen M, Minick K, Collingridge DS, Hunt B, Woodfield D, Rothberg MB, Johnson JK
Phys Ther · 2025 Aug · PMID 40652311 · Publisher ↗
IMPORTANCE: Identifying patients most likely to benefit from physical therapy in the hospital could aid physical therapists in optimizing treatment allocation for the purpose of increasing discharge to home. OBJECTIVE: T...
IMPORTANCE: Identifying patients most likely to benefit from physical therapy in the hospital could aid physical therapists in optimizing treatment allocation for the purpose of increasing discharge to home. OBJECTIVE: The aims of this study were to develop and externally validate a predictive model for discharge to home on the basis of physical therapy frequency for patients who were hospitalized. DESIGN: A predictive model was developed using retrospective cohort data collected between April 2017 and August 2022, with external validation conducted in a separate sample. SETTING: The setting was a large health system. PARTICIPANTS: Participants were adult patients who were hospitalized and received physical therapy. MAIN OUTCOME AND MEASURES: Predictors were extracted from the electronic health record and included demographics, clinical characteristics, and therapist-entered variables such as home set-up and prehospital level of function. Physical therapy frequency was quantified as once daily, defined as ≥5 times per week. The outcome was discharge to home. Variables were included in the final multivariable logistic regression model on the basis of associations with physical therapy frequency and/or outcome and clinical relevance. Calibration and discrimination of the models were assessed. RESULTS: The development sample included 205,659 adult patient (average age = 72.2 [SD = 14.3] years; 55.3% female) hospitalizations, with 52.5% of patients receiving physical therapy daily and an overall proportion of 67.1% being discharged to home. The final multivariable model included 8 variables, with good calibration and discrimination. Internal validity was established with an optimism-corrected concordance statistic of 0.874 (95% CI = 0.872-0.875). The external sample included 102,311 patient (average age = 67.7 [SD = 16.5] years; 50.9% female) admissions, with 64.5% of patients receiving physical therapy daily and 77.8% being discharged to home. Predictive performance was high (calibration slope = 0.908), and discrimination was good (concordance statistic = 0.851). CONCLUSIONS AND RELEVANCE: This study developed and externally validated the underlying prediction model for a clinical decision support tool, termed Physical Therapy Frequency Clinical Decision Support Tool (PT-PENCIL), to identify patients most likely to benefit from daily physical therapy to discharge to home. Future work will evaluate the implementation of PT-PENCIL to determine its effect on patient-centered outcomes.
Trajectories of Physical Disabilities Over 6 Months in Patients With Long COVID.
Salmam I, Desmeules F, Perreault K … +9 more , Zahouani I, Beaulieu-Bonneau S, Campeau-Lecours A, Paquette JS, Deslauriers S, Tittley J, Drouin G, Best K, Roy JS
Phys Ther · 2025 Aug · PMID 40622013 · Full text
IMPORTANCE: Understanding the long-term impact of long COVID on physical function and health-related quality of life (HRQoL) is essential to guide clinical care and rehabilitation. OBJECTIVE: The objective of this study...
IMPORTANCE: Understanding the long-term impact of long COVID on physical function and health-related quality of life (HRQoL) is essential to guide clinical care and rehabilitation. OBJECTIVE: The objective of this study was to compare physical capacity over time among adults in 3 groups: those without COVID-19 (control group [CG]), those who recovered from COVID without persistent symptoms (short COVID group [SCG]), and those with long COVID (long COVID group [LCG]). A secondary objective was to identify baseline predictors of 6-month HRQoL in the LCG. DESIGN: This study was a prospective longitudinal cohort study. SETTING: In-laboratory assessments were conducted at baseline, 3 months, and 6 months, at either the Center for Interdisciplinary Research in Rehabilitation and Social Integration (Quebec City) or the Orthopedic Clinical Research Unit (Montreal). PARTICIPANTS: A total of 360 age- and sex-matched adults (n = 120 per group), including individuals without a history of COVID-19 (CG), those with short COVID (symptom resolution within 4 weeks, SCG), and those with persistent symptoms ≥12 weeks (LCG) participated in the study. INTERVENTION/EXPOSURE: Participants were categorized based on their COVID-19 history and symptom duration and no intervention or exposure was applied. MAIN OUTCOMES AND MEASURES: Self-reported outcomes measuring HRQoL, comorbidities, sleep quality, pain, and fatigue, along with objective measures such as grip strength, Short Physical Performance Battery (SPPB), 6-min walk test (6MWT), and perceived exertion (Modified Borg Scale) during the 6MWT, were collected. Daily averages for resting heart rate, step count, and minutes of intensive activity were recorded over 7 days using a fitness tracker watch. Generalized estimating equations were used for longitudinal comparisons, and recursive partitioning analysis for predicting HRQoL factors. RESULTS: Significant time × group interactions were observed for HRQoL, sleep quality, pain, fatigue, SPPB, and 6MWT. Although the LCG showed significant improvements across these outcomes, only the reduction in fatigue reached a clinically meaningful level, whereas the other groups remained stable. A group effect was detected for all outcomes, except for heart rate and minutes of intensive activity, with the LCG consistently showing lower scores across all follow-ups. Recursive partitioning analysis identified 2 baseline predictors of HRQoL at 6 months in the LCG: self-reported fatigue and daily step count. CONCLUSIONS AND RELEVANCE: These findings highlight the persistent impairments in adults with long COVID and emphasize early HRQoL predictor identification to anticipate long-term needs and adjust treatment plans accordingly.
Health Care Cost Savings and Utilization Reductions Associated With Virtual Physical Therapy Care: A Propensity-Matched Claims Analysis.
Napoleone JM, Devaraj SM, Noble M … +5 more , Parrinello CM, Jasik CB, Norwood T, Livingstone I, Linke S
Phys Ther · 2025 Aug · PMID 40600643 · Publisher ↗
OBJECTIVE: The objectives of this study were to evaluate the differences in medical costs and health care utilization between patients receiving virtual physical therapy (V-PT) care and patients receiving in-person physi...
OBJECTIVE: The objectives of this study were to evaluate the differences in medical costs and health care utilization between patients receiving virtual physical therapy (V-PT) care and patients receiving in-person physical therapy (IP-PT) care (controls) over 6 and 12 months. METHODS: This study used claims data from July 2019 to May 2023. The index date was defined as the initial video (V-PT) or in-person (IP-PT) (controls) physical therapist evaluation date. Patients receiving V-PT (n = 342) were 1:3 propensity score matched to controls receiving IP-PT (n = 1026). Median difference-in-difference per-member-per-month (PMPM) estimates, differences in median postindex costs between groups, and return on investment at 6 and 12 months were estimated. Utilization was evaluated as the postindex mean difference in encounter counts. RESULTS: There were significant gross PMPM savings among patients in V-PT versus those in IP-PT at 6 and 12 months in total costs (-$104.70 vs - $64.10) and musculoskeletal (MSK) condition-related total costs (-$99.56 vs - $49.80). After inclusion of the cost of virtual care, patients receiving V-PT experienced significant net PMPM savings in 6-month MSK condition-related total costs (-$21.20) and 6- and 12-month physical therapy costs (-$25.05 vs - $8.22). These patients experienced significantly lower 6- and 12-month gross MSK condition-related postindex costs than patients receiving IP-PT (-$1059 vs - $1049) which translates to a 1.8-times return on investment at both time points. Patients in V-PT utilized significantly fewer total health care services, MSK condition-related total services, and physical therapist services than patients in IP-PT at 6 and 12 months. CONCLUSIONS: V-PT care may be a meaningful driver of MSK condition-related cost savings by providing a cost-effective and accessible alternative to IP-PT care. IMPACT: V-PT care provides an accessible platform for clinically appropriate patients to engage in physical therapy in a cost-effective way. Increasing awareness and utilization of V-PT care may reduce medical costs related to MSK conditions. LAY SUMMARY: To the author's knowledge, this is the first real-world health care claims analysis to evaluate costs and utilization of V-PT care compared to IP-PT care in treating musculoskeletal conditions. This study suggested that V-PT care was associated with cost savings and lower utilization for total medical care and musculoskeletal condition-specific care compared to IP-PT, with reductions driven by physical therapy costs and encounters.
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