Physical Therapy[JOURNAL]
Sun
200 papers
Identifying Potential Determinants That Can Impact the Implementation of a Physical Activity Pathway in Outpatient Physical Therapy: A Mixed Methods Study.
Wingood M, Vincenzo JL, Moore JB … +1 more , Hughes JM
Phys Ther · 2025 Aug · PMID 40590492 · Full text
IMPORTANCE: Most physical therapists do not address older adults' inadequate physical activity (PA), resulting in increased risk of experiencing falls or frailty. OBJECTIVE: The objective was to identify determinants tha...
IMPORTANCE: Most physical therapists do not address older adults' inadequate physical activity (PA), resulting in increased risk of experiencing falls or frailty. OBJECTIVE: The objective was to identify determinants that can impact the implementation of a PA pathway that provides physical therapists with step-by-step guidance on assessing and addressing older adults' inadequate PA levels. DESIGN: The design was a convergent parallel mixed-method design. SETTING: The setting of this study was outpatient physical therapy. INTERVENTION(S) OR EXPOSURE(S): The intervention being examined is a PA pathway that provides guidance on assessing and addressing older adults' inadequate PA levels. MAIN OUTCOME(S) AND MEASURES(S): The main outcome was determinants that can impact the implementation of the PA pathway. METHODS: Our quantitative surveys examined current practice, knowledge, and barriers related to assessing and addressing inadequate PA levels, and perceptions about the pathway's feasibility, acceptability, and appropriateness. The semi-structured interviews examined determinants that may impact the decision to use the PA pathway. The study included outpatient physical therapists who treated patients aged 65 years and older, with 51 completing the survey and 16 completing the interview. RESULTS: Over 88% perceived the PA pathway as an acceptable, appropriate, and feasible innovation that can guide physical therapists through the recommended PA assessments and behavior change techniques. Barriers identified in the quantitative and qualitative data were lack of knowledge, skills, and confidence in assessing and addressing PA, patient's preference of not doing PA, and lack of time. Two additional barriers identified via the qualitative data were lack of information on how to use behavior change techniques and lack of electronic health record infrastructure. Reimbursement's impact on implementing the PA pathway was mixed. CONCLUSION AND RELEVANCE: The gap in assessing or addressing older adults' PA levels could be resolved through the step-by-step guidance provided by the PA pathway. The successful adoption of the pathway can be enhanced via a plan that addresses the potential barriers identified in this study.
Clinical Practice Guidelines: Present, Past, and Future.
van der Wees PJ
Phys Ther · 2025 Jun · PMID 40583770 · Publisher ↗
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Exploring the Quality of Physical Therapy in Patients With Hip or Knee Osteoarthritis in Germany: A Cross-Sectional, Vignette-Based Study.
Weber F, Kloek C, Bonk M … +2 more , Grüneberg C, Veenhof C
Phys Ther · 2025 Aug · PMID 40576964 · Full text
IMPORTANCE: Conservative, non-pharmacological interventions are the recommended first-line treatment for hip and knee osteoarthritis (OA). Clinical practice guidelines (CPGs), such as those from the Osteoarthritis Resear...
IMPORTANCE: Conservative, non-pharmacological interventions are the recommended first-line treatment for hip and knee osteoarthritis (OA). Clinical practice guidelines (CPGs), such as those from the Osteoarthritis Research Society International (OARSI), guide evidence-based care by physical therapists. However, no studies in Germany have examined physical therapists' treatment choices across patient cases and compared them with the latest evidence. OBJECTIVE: The objective of this study was to investigate to what extent physical therapists meet the latest evidence when treating different types of people with hip or knee OA. DESIGN AND SETTING: A cross-sectional vignette-based online survey was conducted among physical therapists working in outpatient practices. PARTICIPANTS: Eligible participants had adequate German language skills, internet access, and recent experience treating patients with hip or knee OA. MEASURES: The survey included 4 case vignettes of hip or knee OA, with and without comorbidities, and a list of treatment modalities from the OARSI guideline. Correct selections matched high-evidence recommendations. Descriptive statistics analyzed demographics and treatment choices; linear regression assessed the influence of professional degree and work experience on meeting the latest evidence. RESULTS: Of 612 eligible therapists, 335 (54.7%) completed the survey (mean age 35.9+/-11.9 years; 60% female). Only 22% selected all recommended modalities across vignettes. Structured exercise (96%) and arthritis education (95%) were the most frequently chosen. However, many therapists also selected interventions with limited or conflicting evidence, such as massage and taping. Both professional degree and work experience significantly influenced the extent to which the latest evidence was met. Additionally, 49% were aware of at least 1 OA guideline. CONCLUSIONS AND RELEVANCE: While many physical therapists aligned with evidence-based practices, inappropriate modality selection remained common. De-implementation is needed where evidence suggests a lack of benefit or potential safety concerns. Translating and implementing the OARSI guideline into various languages, specifically for physical therapists, is recommended to close knowledge gaps. IMPACT: The study's findings underscore the importance of understanding the treatment modalities used by physical therapists in managing hip or knee OA worldwide. This insight is crucial for addressing the evidence-to-practice gap and ensuring the effective implementation of high-quality physical therapy, a need that is equally relevant in other countries. Additionally, this knowledge is vital for developing targeted strategies, such as the creation and integration of (de-)implementation protocols into the education and ongoing professional development of physical therapists globally.
On "Patient Experiences of a Group Intervention Integrating Vestibular Rehabilitation, Body Awareness, and Cognitive Behavioral Therapy for Long-Lasting Dizziness: A Focus Group Study." Magnussen LH, Wilhelmsen KT, Råheim M. Phys Ther. 2025;105:pzaf062. https://doi.org/10.1093/ptj/pzaf062.
Amalia R, Indreswari H, Aditya RS … +1 more , Noviandari H
Phys Ther · 2025 Aug · PMID 40576325 · Publisher ↗
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On "Treatment Decision-Making for Anterior Cruciate Ligament Rupture From the Perspective of Physical Therapists in Australia: A Mixed Methods Study." Filbay SR, Rooney J, Hoffmann T, et al. Phys Ther. 2025;105(5):pzaf030. https://doi.org/10.1093/ptj/pzaf030.
Saputra R, Lidyawati Y
Phys Ther · 2025 Aug · PMID 40557908 · Publisher ↗
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Author Response to Amalia et al.
Magnussen LH, Wilhelmsen K, Råheim M
Phys Ther · 2025 Aug · PMID 40557903 · Publisher ↗
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The Heart of Movement: What's Love Got to Do With it?
Nordstrom TM
Phys Ther · 2025 Jul · PMID 40511865 · Publisher ↗
Terrence M. Nordstrom, PT, EdD, FAPTA, the 56th McMillan Lecturer, is emeritus professor in the Department of Physical Therapy at Samuel Merritt University in Oakland, California, where he has served as a faculty member,...
Terrence M. Nordstrom, PT, EdD, FAPTA, the 56th McMillan Lecturer, is emeritus professor in the Department of Physical Therapy at Samuel Merritt University in Oakland, California, where he has served as a faculty member, director of clinical education, department chair, assistant academic vice president, and vice president of enrollment and student services. During his 24 years of clinical and leadership experience, his research and writing focused on professional education, professional formation and ethics, and academic leadership development. He received his bachelor's degree from the University of California, Santa Cruz; his master's degree in physical therapy from Stanford University; and his doctor of education from the University of San Francisco. His American Physical Therapy Association (APTA) recognitions include being the first vice president and second president of the American Council of Academic Physical Therapy. He currently serves as the finance officer for the California Physical Therapy Association. He has served on many APTA committees and task forces including the Ethics and Judicial Committee. He was a mentor in the APTA Fellowship in Higher Education Leadership from 2017 to 2023 and has been a mentor in the Grant Writing and Mentorship in Education Research program since its inception in 2018. He is a Catherine Worthingham Fellow of APTA and senior fellow and retired scholar of the National Academy of Practice. He was the APTA Academy of Education Pauline Cerasoli Lecturer in 2019.
First-Contact Physical Therapy Compared to Usual Primary Care for Musculoskeletal Disorders: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Abuhl B, Ehrmantraut D, Wolden M
Phys Ther · 2025 Aug · PMID 40511847 · Publisher ↗
IMPORTANCE: This study aims to enhance the care provided for patients with musculoskeletal disorders (MSKDs). OBJECTIVE: The objective of this study is to compare first-contact physical therapy (FCPT) and usual primary c...
IMPORTANCE: This study aims to enhance the care provided for patients with musculoskeletal disorders (MSKDs). OBJECTIVE: The objective of this study is to compare first-contact physical therapy (FCPT) and usual primary care (UPC) for societal and clinical outcomes of patients with MSKDs. DESIGN: The design was a systematic review and meta-analysis of randomized controlled trials. SETTING: The study took a global perspective on FCPT compared to UPC for societal and clinical outcomes of patients with MSKDs. PARTICIPANTS: The study included patients presenting with MSKDs. INTERVENTION(S) OR EXPOSURE(S): FCPT was compared to UPC for patients with MSKDs. MAIN OUTCOMES AND MEASURES: Societal outcomes including clinical imaging rates, prescription medication rates, cost, and clinical outcomes including pain, disability, and health-related quality of life (HRQoL) were assessed. RESULTS: Ten randomized controlled trials were included with a sample size of 2081 patients. Very low to moderate quality of evidence showed patients achieved similar to superior societal and clinical outcomes with FCPT compared to UPC. Lower clinical imaging rates (risk ratio [RR] = 0.55; 95% CI, 0.45-0.68) and prescription medication rates (RR = 0.29; 95% CI, 0.16-0.53) were associated with FCPT. All effects favored FCPT, including a small effect for cost (mean difference = -309.79; 95% CI, -678.69 to 59.12), a medium effect for pain (standardized mean difference [SMD] = -0.75; 95% CI, -1.57 to 0.06), and negligible effects for disability (SMD = -0.15; 95% CI, -0.32 to 0.03) and HRQoL (SMD = -0.03; 95% CI, -0.17 to 0.11). CONCLUSIONS: When compared to UPC, FCPT is likely to reduce clinical imaging rates and may result in a reduction of prescription medication rates. FCPT may result in little to no difference in disability and HRQoL. Evidence is very uncertain about the effect of FCPT on pain and cost. All conclusions can be interpreted for the medium term. RELEVANCE: Health care organizations treating patients with MSKDs should consider integrating FCPTs to support primary care.
Are There Speed Limits in Doctor of Physical Therapy Education? Future Research Directions.
Davis DS
Phys Ther · 2025 Aug · PMID 40492726 · Publisher ↗
The increasing prevalence of accelerated Doctor of Physical Therapy (DPT) programs, which condense the conventional 3-year curriculum into a 2-year format, has emerged with limited national discussion and debate and with...
The increasing prevalence of accelerated Doctor of Physical Therapy (DPT) programs, which condense the conventional 3-year curriculum into a 2-year format, has emerged with limited national discussion and debate and without substantive educational research support. This novel approach challenges the traditional 3-year DPT educational framework. This perspective draws historical parallels between the challenges and unintended consequences that arose from the acceleration of anterior cruciate ligament reconstruction rehabilitation protocols with early return-to-play and the current shift toward accelerated DPT education. While advocates argue that accelerated programs offer advantages over traditional 3-year DPT curricula, there is insufficient evidence to support these claims or to determine whether these benefits outweigh potential drawbacks. Using Rogers' Diffusion of Innovation framework, this perspective explores key questions and potential concerns regarding accelerated DPT programs. This perspective critically examines the potential impact of reducing the duration of DPT education on program and graduate outcomes, including National Physical Therapy Exam pass rates, clinical readiness, and broader educational experiences. It also raises questions about the potential effects on student well-being and mental health. The perspective emphasizes the need for rigorous, data-driven educational inquiry and recommends comprehensive data collection to evaluate the effects of accelerated DPT programs on a wide range of important variables. This perspective emphasizes the importance of prioritizing student learning and development by exploring potential unforeseen risks associated with accelerated DPT curricula. It advocates for a student-centered approach to educational research, ensuring that any changes to program length support both the depth and quality of learning. Through systematic investigation, the profession can determine whether safeguards are necessary to maintain the integrity of DPT education, ensuring that students receive the comprehensive training they need without compromising educational excellence in the pursuit of speed.
Pneumothorax After Dry Needling of Intrascapular Muscles Using a Rib Bracketing Technique: Insights From the Clinician, Patient, and Clinical Expert.
Mintken PE, Denman B, Dommerholt J
Phys Ther · 2025 Aug · PMID 40470852 · Publisher ↗
IMPORTANCE: This case report emphasizes the importance of recognizing and preventing adverse events, specifically pneumothorax related to dry needling (DN), particularly when using rib bracketing techniques in the intras...
IMPORTANCE: This case report emphasizes the importance of recognizing and preventing adverse events, specifically pneumothorax related to dry needling (DN), particularly when using rib bracketing techniques in the intrascapular region. It highlights the need for greater clinician awareness to enhance patient safety and minimize the risk of complications during DN interventions. OBJECTIVE: The objective of this case report was to describe the clinical presentation, progression, and outcome of a patient who developed a pneumothorax following DN, and to propose alternative methods for safer needling in the intrascapular musculature. DESIGN: This case report presents a detailed account of a single patient's clinical experience-including the adverse event, its management, and outcome-supplemented by expert commentary from a clinician specializing in DN. SETTING: The setting of this case report was an outpatient physical therapy clinic. PARTICIPANTS: A 24-year-old woman undergoing physical therapy for chronic neck and shoulder pain. INTERVENTION(S) OR EXPOSURE(S): The physical therapist administered DN to the left intrascapular muscles using a rib bracketing technique to treat trigger points. MAIN OUTCOME(S) AND MEASURE(S): The primary outcome was the development of a pneumothorax, identified through clinical symptoms and confirmed by radiographic imaging. Outcomes included hospitalization, symptom resolution, and return to physical activity. RESULTS: The patient experienced an unusually sharp pain during needle insertion. Over the following 2 days, she developed dyspnea, thoracic pain, dry cough, and chest discomfort. A radiograph confirmed a moderate left-sided pneumothorax, which was treated with chest tube reinflation and one night of hospitalization. Post-discharge, the patient had residual symptoms for 2 weeks but achieved complete recovery by 1 month, returning to activities like hiking and skiing. CONCLUSIONS: DN can result in serious complications such as pneumothorax. Early recognition and immediate treatment can lead to full recovery. This case raises concerns about the safety of the rib bracketing technique for DN in the thoracic intrascapular region. RELEVANCE: Physical therapists should exercise caution when performing DN, especially in high-risk anatomical areas. Safer techniques should be considered, and vigilance is crucial to detect and manage adverse events promptly. Enhancing practitioner awareness can improve patient outcomes and safety during rehabilitation interventions.
Using a Discrete Choice Experiment to Elicit Patient Preferences for Physical Therapist Services After Surgery for Breast Cancer.
McTaggart-Cowan H, Zadravec K, Rafn BS … +3 more , Raymakers AJN, Regier DA, Campbell KL
Phys Ther · 2025 Jul · PMID 40439292 · Publisher ↗
IMPORTANCE: Patients often experience challenges accessing physical therapy for breast cancer-related impairments. Eliciting patient preferences for physical therapy can inform design of patient-centered, breast cancer-f...
IMPORTANCE: Patients often experience challenges accessing physical therapy for breast cancer-related impairments. Eliciting patient preferences for physical therapy can inform design of patient-centered, breast cancer-focused physical therapy programming. OBJECTIVE: A discrete choice experiment (DCE) was used to elicit patient preferences for physical therapy after breast cancer surgery. DESIGN: Sequential mixed methods identified 7 attributes of physical therapy: education timing; referral method; first appointment timing; physical therapist expertise level; treatment format; treatment frequency; and annual out-of-pocket cost. Respondents chose between 2 physical therapy programs and an opt-out option. SETTINGS: The DCE was administered online. PARTICIPANTS: Participants were adults with breast cancer in Canada. MAIN OUTCOMES AND MEASURES: Responses were analyzed using a mixed logit model. Willingness-to-pay estimates were calculated as the marginal rate of substitution between each attribute level with respect to cost. RESULTS: The DCE was completed by 148 respondents (completion rate: 77.5%). Most were within 3 years post-diagnosis (54.1%), had completed post-secondary education (70.9%), and had annual family incomes over $40,000 (76.5%). Nearly half were referred to physical therapy (48.5%). Respondents preferred to be seen by a physical therapist with expertise in breast cancer (β = .368, SD = 0.091) and to receive more frequent appointments (β = -.011, SD = 0.025). CONCLUSION: The DCE was capable of eliciting patient preferences for physical therapy after breast cancer surgery. Respondents exhibited preferences for physical therapist expertise level and treatment frequency. Findings from this study will be the first step in informing development of accessible physical therapy programming that is responsive to the needs and preferences of patients with breast cancer. RELEVANCE: This work can inform design of accessible, patient-centered physical therapist services for patients with breast cancer. Receiving timely physical therapy can improve patients' physical function, quality of life, and ability to engage in life roles and activities.
Investigating Balance Perception and Balance Performance in Neurological Disorders for Targeted Rehabilitation Strategies.
Cardini R, Torchio A, Aprile I … +3 more , Turolla A, Cattaneo D, Gervasoni E
Phys Ther · 2025 Jul · PMID 40433842 · Full text
IMPORTANCE: Task-specific balance deficits are common in people with neurological disorders (PwND), significantly affecting their activities of daily living (ADLs). However, the relationship between balance deficits and...
IMPORTANCE: Task-specific balance deficits are common in people with neurological disorders (PwND), significantly affecting their activities of daily living (ADLs). However, the relationship between balance deficits and ADLs measured by patient-reported outcomes is poorly understood, thus limiting the selection of specific static and dynamic tasks to be used to train for a given activity. OBJECTIVE: The aim of the study was to provide a clinical framework linking ADLs, balance tasks, and balance resources to support clinicians' decision-making when planning task-oriented balance rehabilitation for PwND. DESIGN: This was an observational study with a cross-sectional design. SETTING: This study examined clinical contexts involving PwND. PARTICIPANTS: This study involved people with Parkinson disease, stroke, or multiple sclerosis (MS). EXPOSURE: The study used the Activities-Specific Balance Confidence (ABC) Scale for patient-reported outcomes to assess perceived balance during ADLs, and the Berg Balance Scale (BBS) and Dynamic Gait Index (DGI) to evaluate static and dynamic balance. MAIN OUTCOMES AND MEASURES: Kendall tau correlations (τ) were used to identify meaningful associations between ABC and BBS-DGI items, matching ADLs with specific balance tasks. RESULTS: The study sample comprised 299 people with Parkinson disease (n = 94), stroke (n = 94), and MS (n = 111) with a median (interquartile range) age of 63 (52.0-71.5) years, all exhibiting moderate to severe balance impairments. Moderate correlations (τ ≥ 0.39) were found between dynamic and semi-dynamic challenging outdoor ADLs with static and dynamic tasks involving sensory orientation and the use of vestibular and proprioceptive systems. Moreover, stability limits-verticality, anticipatory postural adjustments, and stability in gait are the primary balance resources to consider when designing ad hoc rehabilitation interventions. CONCLUSIONS: This study establishes associations between specific ADLs and balance tasks, offering a clinical framework to identify relevant balance resources for rehabilitation. It provides clinicians with a structured approach for planning task-oriented, needs-based balance rehabilitation for PwND, focusing on the training of specific balance resources to enhance ADLs. RELEVANCE: This study provides a clinical framework to help clinicians in planning task-oriented and needs-based balance rehabilitation for PwND, suggesting which balance resources should be trained to improve specific ADLs.
A Core Set of Outcome Measures to Assess Physical Function for Adults Participating in Physical Therapist Treatment in the Hospital: A Clinical Practice Guideline.
Mayer KP, Johnson AM, Smith DJ … +8 more , Crandall CM, Johnson MD, Fresenko LE, Robinson CM, Robinson LE, Kaplan SL, Kumble S, Norris TL
Phys Ther · 2025 Jun · PMID 40403754 · Full text
IMPORTANCE: Outcome measures (OMs) are an integral part of physical therapist practice and implementation can have a multifaceted effect on care delivery. OBJECTIVE: The objective of this project was to identify a core s...
IMPORTANCE: Outcome measures (OMs) are an integral part of physical therapist practice and implementation can have a multifaceted effect on care delivery. OBJECTIVE: The objective of this project was to identify a core set of OMs for adults requiring acute care hospitalization in the setting of acute care physical therapist practice. DESIGN AND SETTING: This Clinical Practice Guideline (CPG) focuses on the assessment of physical function within the "activity" domain of the International Classification of Functioning, Disability and Health. MAIN OUTCOMES AND MEASURES: The CPG scope was developed with input from interested parties at multiple levels, including Academy of Acute Care Physical Therapy leadership, the CPG Working Group, and consumers of acute care physical therapist practice. A systematic review assessed psychometric data on physical function OMs that included the constructs of bed mobility, transfer ability, and ambulation. The modified Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN-M) was used to examine methodological quality and psychometric strength for each OM. Recommended OMs in the core set met 3 criteria: addressed the established constructs, had strong psychometric properties and methodological quality, and had high clinical utility, defined as minimal time (<20 minutes), low to no cost, and minimal training required for use in clinical practice. RESULTS: Thirty-four OMs were initially identified in the systematic review. Fourteen OMs were considered for the final CPG. In the end, action statements 1 to 3 supported 3 OMs that comprised the acute care core outcome measure set (COMS), and action statements 4 to 8 were recommendations for supplemental OMs that may be performed as additions to augment the COMS. All action statements considered the published evidence, clinical utility, and acute care expertise from the Guideline Development Group. Research recommendations follow each summary of the evidence. CONCLUSIONS AND RELEVANCE: The CPG provides recommendations for COMS to assess physical function in acute care physical therapist practice.
Extracorporeal Shock Wave Therapy for Chronic Adhesive Capsulitis in Type 2 Diabetics: A Systematic Review With Meta-Analysis.
Reno C, Swinton PA, Alexander L
Phys Ther · 2025 Jul · PMID 40401517 · Publisher ↗
OBJECTIVE: The objective of this study was to assess the effectiveness of extracorporeal shock wave therapy (ESWT) in the treatment of chronic adhesive capsulitis (AC) in the type 2 diabetes population. DESIGN: This stud...
OBJECTIVE: The objective of this study was to assess the effectiveness of extracorporeal shock wave therapy (ESWT) in the treatment of chronic adhesive capsulitis (AC) in the type 2 diabetes population. DESIGN: This study is a systematic review with meta-analysis. The search was conducted in MEDLINE, EMBASE, CINAHL, PEDro, Cochrane Database of Systematic Reviews, UK Clinical Trial Gateway and gray literature from 2012 to 2023. Two reviewers independently screened and extracted data through Covidence and the quality was evaluated using Cochrane risk-of-bias tool for randomized trials. Meta-analyses were conducted to quantify within-group change and comparative effectiveness. Five hundred and seventy-four studies were identified, and 7 studies included (n = 352 participants). PARTICIPANTS: This study included type 2 diabetic adults (>18 years) diagnosed with primary or secondary AC. INTERVENTIONS: This review and meta-analysis included studies comparing ESWT with conservative management. MAIN OUTCOMES: The primary outcome was pain. Secondary outcomes included range of movement (ROM) and disability. RESULTS: Meta-analysis using Bayesian method of within group change showed consistent improvement for pain (-5.7 [95% credible interval (CrI) = -7 to -4.5] cm), ROM (2.6 [95% CrI = 1.4 - 3.8]), and disability (3.6 [95% CrI = 2.3-4.9]). Consistent evidence of improvements favoring ESWT over conservative management was identified for all outcomes. Study heterogeneity had limited influence on non-controlled effect sizes, whereas limited controlled effect sizes lowered the confidence for outcomes of ROM and disability. Limitations included low number of studies, poor methodological quality, and non-adherence to reporting guidelines. CONCLUSIONS: Extracorporeal shock wave therapy for treatment of AC was shown to reduce pain and improve range of motion and disability in the type 2 diabetes population. These results should be interpreted with caution and high-quality randomized controlled studies are required to establish best-practice ESWT protocols regarding application position, dosage, and duration. RELEVANCE: Extracorporeal shock wave therapy may improve pain, ROM, and disability in type 2 diabetics with AC.
Characterization and Related Factors of Postural Control in Adults With Late-Onset Pompe Disease: Cross-Sectional and Case Control Study.
Maulet T, Cattagni T, Mahmoudi S … +4 more , Gandois T, Dubois F, Laforet P, Bonnyaud C
Phys Ther · 2025 Jul · PMID 40384280 · Publisher ↗
IMPORTANCE: Adults with late-onset Pompe disease (LOPD) experience lower limb weakness, balance disorders, and recurrent falls. Mechanisms underlying postural control (stability, orientation) and falls in LOPD remain poo...
IMPORTANCE: Adults with late-onset Pompe disease (LOPD) experience lower limb weakness, balance disorders, and recurrent falls. Mechanisms underlying postural control (stability, orientation) and falls in LOPD remain poorly understood. Investigating these aspects is critical to guide care and rehabilitation. OBJECTIVE: This study compared postural control in participants with LOPD to controls, examining postural and muscular factors linked to falls and muscular contributions to postural alterations. DESIGN: This study was a cross-sectional, case-control study. Postural stability and orientation during stationary standing were evaluated using force platforms and 3D motion analysis under two visual conditions, while maximal muscle strength was measured with an isokinetic dynamometer. SETTING: This cross-sectional, case-control study was conducted at a teaching hospital, which was a reference center for neuromuscular disease. PARTICIPANTS: This study involved two cohorts: participants with LOPD and control participants. MAIN OUTCOMES AND MEASURE: Postural stability (center of pressure [COP] displacements, lower limb joint range of motion) and orientation (COP mean position, weight distribution, joint positions) parameters were assessed, alongside falls reported over 3 months and maximal lower limb muscles strength. RESULTS: Compared to 20 controls, 18 adults with LOPD showed impaired postural stability, especially medio-laterally with eyes closed (ES = 0.42-0.83), and an anterior shift of the COP without joint orientation changes. Falls were strongly associated with COP mean velocity (eyes open: ρ = 0.73; eyes closed: ρ = 0.74) and with hip abductor (ρ = - 0.77) and extensor strength (ρ = - 0.79). Hip extensor strength was most strongly associated with COP mean velocity (eyes closed: ρ = - 0.72; eyes open: ρ = - 0.69). CONCLUSIONS: Adults with LOPD demonstrate impaired postural stability, especially in the medio-lateral plane with eyes closed, and an anteriorized upright orientation. RELEVANCE: Hip extensor and abductor strength, strongly linked to falls and stability, should be important to target in evaluations and rehabilitation and in studies on new therapies on LOPD.
The Continuing Trials of Physical Therapy and Rehabilitation Clinical Trials.
George SZ
Phys Ther · 2025 May · PMID 40381215 · Publisher ↗
Abstract loading — click title to view on PubMed.
Matching Clinical Profiles With Interventions to Optimize Daily Stepping in People With Stroke.
McCartney KM, Pohlig RT, Miller AE … +2 more , Thompson ED, Reisman DS
Phys Ther · 2025 Jul · PMID 40360175 · Full text
IMPORTANCE: Individualizing interventions is imperative to optimize step-activity in people with chronic stroke. OBJECTIVE: The objective was to group individuals with chronic stroke into clinical profiles based on basel...
IMPORTANCE: Individualizing interventions is imperative to optimize step-activity in people with chronic stroke. OBJECTIVE: The objective was to group individuals with chronic stroke into clinical profiles based on baseline characteristics and examine if these profiles preferentially benefitted from a specific intervention to improve daily step-activity. DESIGN: This is a secondary analysis of a randomized control trial. SETTING: The parent study occurred at 4 outpatient rehabilitation clinics. PARTICIPANTS: Participants had strokes ≥6 months prior to enrollment, were 21 to 85 years old, had walking speeds of 0.3 to 1.0 meters per second, and took <8000 steps-per-day. INTERVENTIONS: Participants were randomized to high-intensity treadmill training (FAST), a step-activity behavioral intervention (SAM), or a combined intervention (FAST+SAM). MAIN OUTCOME(S): The primary outcome was the interaction of latent class (clinical profile) and intervention group (FAST, SAM, FAST+SAM) on a change in steps-per-day. Key clinical characteristics to identify the latent classes included walking speed, walking endurance, balance self-efficacy, cognition, and area deprivation. RESULTS: Of the 190 participants with complete pre- and post-intervention data (mean [SD] age, 64 [12] years; 93 females [48.9%]), 3 distinct profiles of people with chronic stroke were identified. Class 1 had the lowest walking capacity (speed and endurance), lowest balance self-efficacy, and highest area deprivation, and the greatest change in step-activity when enrolled in SAM (mean = 1624, 95% CI = 426-2821) or FAST+SAM (mean = 1150, 95% CI = 723-1577]). Class 2 had walking capacity, baseline steps-per-day, and self-efficacy values between Class 1 and 3, and had the greatest change in step-activity when enrolled in SAM (mean = 2002, 95% CI = 1193-2811). Class 3 had the highest walking capacity, highest self-efficacy, and lowest area deprivation and the greatest change in step-activity when enrolled in FAST+SAM (mean = 1532, 95% CI = 915-2150). CONCLUSIONS: People with chronic stroke require different interventions to optimize changes in step-activity. RELEVANCE: Clinicians can use clinically relevant measures to personalize intervention selection to augment step-activity in people with chronic stroke.
The Longitudinal Course of Physical Activity Behavior Poststroke and Its Variation Across Subgroups: The Norwegian Cognitive Impairment After Stroke Study.
Luzum G, Allore H, Han L … +5 more , Saltvedt I, Tan X, Thingstad P, Håberg A, Askim T
Phys Ther · 2025 Jul · PMID 40360170 · Full text
IMPORTANCE: Despite its importance as a modifiable target poststroke, the longitudinal course of physical activity (PA) is not fully understood. OBJECTIVE: This study aimed to describe the course of poststroke PA behavio...
IMPORTANCE: Despite its importance as a modifiable target poststroke, the longitudinal course of physical activity (PA) is not fully understood. OBJECTIVE: This study aimed to describe the course of poststroke PA behavior from 3 to 36 months and identify subgroups with different PA patterns using multi-trajectory modeling. DESIGN: A prospective multicenter cohort study design was used. SETTING: Follow-up at 3, 18, and 36 months poststroke was community-based. PARTICIPANTS: In total, 277 individuals (age = 70.1 [SD = 10.9]; 116 [41.9%] female) with primarily mild strokes were included. Participants provided at least 2 follow-up periods with accelerometer data each lasting at least 3 consecutive days. MAIN OUTCOMES AND MEASURES: At each follow-up, daily estimates of upright time, time spent in light physical activity (LPA), time spent in moderate physical activity (MPA), step count, and the number of sit-to-stand transitions were measured. RESULTS: Average daily upright time declined by -7.4 min (95% CI = -10.09 to 4.64), and average daily step count declined by -132 steps (95% CI = -176 to -88) each year. Four distinct groups of individuals with different characteristics were identified, following a similar developmental course across PA dimensions over time: one-fourth of the participants (25.6%) were characterized by stable low PA estimates and a tendency to decline over time. Two groups, making up 32.4% and 20.8% of the sample, were characterized by intermediate levels of LPA and MPA, with differing levels of sit-to-stand transitions; and 1 group (21.2% of participants) was characterized by stable high PA duration estimates over time. CONCLUSIONS: The overall course of PA poststroke was characterized by a modest decrease over 3 years. Differing PA trajectory groups characterized by different demographic and clinical features highlight the diverse needs for supporting people living with stroke in becoming more active. RELEVANCE: Findings may help clinicians identify subgroups of people with stroke who need extended professional follow-up in long-term rehabilitation.
Accuracy of Falls Screening Tools in Adult Patients With Cancer: A Systematic Review.
Nielsen KA, Foley M, Croarkin E … +3 more , Runde P, Prinster S, Gilchrist LS
Phys Ther · 2025 Jul · PMID 40353566 · Publisher ↗
IMPORTANCE: Patients with cancer experience increased falls risk secondary to oncological treatment and cancer-related sequelae. OBJECTIVE: Identifying diagnostically and prognostically accurate screening tool(s) for fal...
IMPORTANCE: Patients with cancer experience increased falls risk secondary to oncological treatment and cancer-related sequelae. OBJECTIVE: Identifying diagnostically and prognostically accurate screening tool(s) for falls risk in populations with cancer is an important issue. DATA SOURCES: Screening tests were identified in PubMed and CINAHL. STUDY SELECTION: Two independent reviewers screened citations for inclusion. DATA EXTRACTION AND SYNTHESIS: Data extraction was performed by 1 reviewer and verified by a second. Tests were investigated for clinical utility, validity, diagnostic accuracy, and predictive capacity. Recommendations for screening measures were formulated using predetermined criteria. MEASURES: Falls risk screening tools were identified for populations with cancer. RESULTS: Of 532 articles screened, 24 articles were included. Fifty-five variations of screening measures were identified, of which 47 had sufficient clinical utility. Twenty measures contained data on diagnostic accuracy or predictive capacity. No screening measure met all criteria to be highly recommended for both ruling in and ruling out falls risk currently (diagnostic accuracy) or in the future (predictive capacity). History of falls demonstrated good diagnostic accuracy for ruling in immediate falls risk (specificity 98.9%, positive predictive value 84.6%). A negative falls history was highly indicative of lower future falls risk status (negative predictive value 82.5% to 90.1%). Fear of falling demonstrated accuracy for ruling out immediate risk for falls (negative predictive value 87.0%, sensitivity 88.7%). Strong predictive capacity was demonstrated with the Timed "Up & Go" (TUG) Standard (sensitivity 93% at ≤7.8 s, specificity 95% at ≥11.35 s). CONCLUSIONS: Based on these results, a history of falls plus either the TUG Standard for those with a history of falls or subjective report of fear of falling for those without a history of falls is recommended for risk screening in populations with cancer. RELEVANCE: Different screening tools are required for immediate versus future falls risk and are setting dependent.
Primary Care Physical Therapy and Exercise Therapy for People With Persistent Complaints After a SARS-CoV-2 Infection: Secondary Analysis of the ParaCov Prospective Cohort Study.
Gerards MHG, Verburg AC, Slotegraaf AI … +6 more , van Heerde R, de Bie RA, van der Wees PJ, Lenssen AF, Hoogeboom TJ, Dutch Consortium Allied Healthcare COVID-19
Phys Ther · 2025 Jun · PMID 40344651 · Full text
IMPORTANCE: Current insight into recovery and real-world treatment of people with persistent complaints after SARS-CoV-2 infection is limited. OBJECTIVE: The objective of this study was to describe the content, duration,...
IMPORTANCE: Current insight into recovery and real-world treatment of people with persistent complaints after SARS-CoV-2 infection is limited. OBJECTIVE: The objective of this study was to describe the content, duration, and reasons for initiating and terminating physical therapist interventions and (factors contributing to) changes in outcomes before and after treatment. DESIGN: This was a prospective cohort study in Dutch primary care allied health care. PARTICIPANTS: Participants were patients receiving allied health care treatment after SARS-CoV-2 infection. INTERVENTION: The intervention was primary care physical therapy. MAIN OUTCOMES AND MEASURES: Self-reported functioning (patient-specific functional scale [PSFS]), 6-min walk test (6MWT), sit-to-stand performance (5 times sit-to-stand [5TSTS]), grip strength, and treatment characteristics were measured pre- and post-treatment. Associations between baseline characteristics, pre-treatment scores, and clinically important improvement on PSFS were calculated. RESULTS: Nine hundred ninety-two patients (mean age 50 years [SD = 13]) were included. Median treatment duration was 24 weeks (IQR = 17-26) and 31 sessions (19-43). Most selected treatment goals were to improve endurance (74%) and physical functioning (72%). In 59% of treatment episodes, therapists reported that patients had achieved the main treatment goal. Mean change scores (95% CIs) were -4.1 points (-4.4 to -3.8) on the PSFS, 70 m (61-78) on the 6MWT, -3.0 s (-3.4 to -2.5) on the 5TSTS, and 3.0 kg (2.1-3.9) on grip strength. Females and participants with worse baseline scores on PSFS had greater odds of reporting a clinically important improvement on the PSFS. Patients with longer 5TSTS times had lower odds. CONCLUSION: Most patients achieved their treatment goals and demonstrated clinically important improvements on PSFS and 6MWT. This study provides information on the most important therapeutic goals and provides estimates for realistic treatment episodes. RELEVANCE: This article provides insight into real-world physical therapy in patients experiencing persistent complaints after SARS-CoV-2 infection. Additionally, insight into their recovery is provided, showing that patients improve significantly and clinically important on self-reported functioning, 6-min walk test, and sit-to-stand performance.
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