Physical therapists are considered movement experts, yet many physical therapists lack the knowledge, training, and confidence to incorporate bioenergetic considerations when prescribing aerobic exercise and resistance t...Physical therapists are considered movement experts, yet many physical therapists lack the knowledge, training, and confidence to incorporate bioenergetic considerations when prescribing aerobic exercise and resistance training interventions. Additionally, clinical practice guidelines omit bioenergetic considerations reflecting a fundamental gap in how the profession conceptualizes rehabilitation, one that individual clinicians cannot be expected to bridge when clinical practice guidelines themselves exclude the bioenergetic dimensions of health conditions. As this perspective outlines, bioenergetics are essential for propelling human movement and should inform physical therapist interventions. A bioenergetically informed approach to physical therapist interventions empowers physical therapists to design interventions that integrate physiologic systems critical to bioenergetic capacities more fully, optimizing both the mechanical components and fuel systems that power movement. This perspective uses recovery as a model framework to emphasize the benefits of a bioenergetically informed approach, and importantly, it serves as a component of rehabilitation that can be immediately acted on by clinicians, recognizing that optimal therapeutic outcomes require adequate bioenergetic capacity to support the intended applications. While physical therapists have traditionally excelled as biomechanical practitioners who address the structural and mechanical aspects of human movement, the integration of comprehensive bioenergetic principles represents a transformative opportunity to elevate clinical practice by understanding not only the machinery, but also the metabolic systems that fuel optimal performance.
IMPORTANCE: Although the Trunk Impairment Scale (TIS) is widely used in stroke rehabilitation, the quality and certainty of evidence regarding its measurement properties have been unclear. OBJECTIVE: The objective was to...IMPORTANCE: Although the Trunk Impairment Scale (TIS) is widely used in stroke rehabilitation, the quality and certainty of evidence regarding its measurement properties have been unclear. OBJECTIVE: The objective was to systematically evaluate the measurement properties of the TIS in individuals with stroke, using the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) methodology. DATA SOURCES: Five electronic databases (PubMed, EBSCOhost, CINAHL, MEDLINE, and ICHUSHI) were searched from their inception dates to January 14, 2025. STUDY SELECTION: Studies assessing the psychometric properties of the TIS in individuals with stroke were included. DATA EXTRACTION AND SYNTHESIS: The studies' methodological quality was evaluated using the COSMIN Risk of Bias checklist. The certainty of evidence was rated using a modified GRADE approach, and meta-analyses were conducted when appropriate. MAIN OUTCOMES AND MEASURES: The measurement properties evaluated were content validity, structural validity, cross-cultural validity, internal consistency, reliability, measurement error, criterion validity, construct validity, and responsiveness. RESULTS: Thirteen studies from 7 countries met the inclusion criteria, with sample sizes of 28 to 201 participants. Based on the modified GRADE approach, internal consistency showed "low" certainty of evidence, whereas all other measurement properties were rated as "very low" certainty due to methodological limitations, including lack of unidimensionality testing, insufficient hypothesis formulation, and poor reporting. A meta-analysis indicated acceptable pooled Cronbach α-values (mean α = .88) and high intra and interrater reliability (mean intraclass correlation coefficient [ICC] = 0.98), although heterogeneity and risk of bias reduced confidence in these findings. CONCLUSIONS AND RELEVANCE: Despite its widespread use, the TIS lacks high-quality psychometric evidence. Further validation studies using COSMIN-aligned methodology are needed to establish its reliability and validity in diverse stroke populations.
IMPORTANCE: Rural communities face poor health outcomes due to limited health care access and provider shortages. Physical therapists are increasingly recognized as potential contributors to primary care delivery, yet li...IMPORTANCE: Rural communities face poor health outcomes due to limited health care access and provider shortages. Physical therapists are increasingly recognized as potential contributors to primary care delivery, yet little is known about their actual roles in rural settings. OBJECTIVE: The objective of this study was to explore the unique professional experiences of physical therapists in the rural Upper Midwest. DESIGN: A qualitative, exploratory case study design was used. Data was collected through semi-structured interviews and field observations. Analysis included inductive, in-vivo coding methods and thematic analysis guided by the Culturally Sustaining Pedagogy theoretical framework. SETTING: This study was situated in 5 communities in a rural, Upper Midwest state. PARTICIPANTS: Five physical therapists with over 4.5 years of rural clinical experience were included in this study. RESULTS: Four key themes and associated subthemes were derived regarding the role of rural physical therapists: (1) operating as a primary care provider: physical therapists filled primary care roles through rurality-imposed autonomy, health care coordination, and health education; (2) employing a wide breadth of practice: therapists required broad generalist knowledge across practice settings; (3) patient-centeredness: patient-centered care involved fostering cultural norms and decentering of the therapist's own values; and (4) Community integration: Community engagement beyond their role as a physical therapist and understanding local culture were crucial for community acceptance and providing appropriate care. CONCLUSIONS: Physical therapists in rural communities in an Upper Midwest state are fulfilling expanded primary care roles to address health care shortages, while deeply integrating within communities to provide appropriate and acceptable care. Their experiences highlight the complexity of rural health care delivery and potential for physical therapists to help alleviate provider shortages. RELEVANCE: As health care shortages persist in rural areas and the understanding the role of the primary care physical therapist continues to grow, this study shows that physical therapists are uniquely positioned to support primary care delivery.
IMPORTANCE: Anterior cruciate ligament (ACL) injury is a common sports injury with substantial physical and psychological consequences. Qualitative studies have explored patient experiences, but most use cross-sectional...IMPORTANCE: Anterior cruciate ligament (ACL) injury is a common sports injury with substantial physical and psychological consequences. Qualitative studies have explored patient experiences, but most use cross-sectional designs, limiting insight into how experiences evolve throughout rehabilitation. OBJECTIVE: The purpose of this study was to explore patients' experiences of ACL injury and recovery using a prospective, narrative approach, from injury to achievement of self-defined rehabilitation goals. DESIGN: This was a longitudinal qualitative study with narrative analysis. SETTING: The study was conducted at an outpatient sports rehabilitation clinic in Sweden. PARTICIPANTS: Four adults (ages 20 to 29 years; 2 male, 2 female) undergoing ACL reconstruction were included using consecutive sampling. INTERVENTION(S) OR EXPOSURE(S): Serial one-to-one semi-structured interviews were conducted around injury, pre-surgery, early post-surgery, and every 2 months until each participant achieved a rehabilitation goal defined at study entry. Interviews were analyzed using Narrative Oriented Inquiry with attention to story structure, tone, positioning, and context. MAIN OUTCOME(S) AND MEASURE(S): The main outcome were the evolving narratives of participants' recovery experiences, expressed through first-person interpretative stories. RESULTS: The longitudinal narratives revealed shifting identities, emotions, and meanings attached to rehabilitation milestones. One participant described moving from helplessness to renewed athletic identity; another portrayed a pragmatic recovery marked by monotony and team reintegration; a third experienced progress until a second ACL injury reframed priorities; and the fourth navigated prolonged knee pain, missed timelines, and gradual acceptance. Across cases, rehabilitation was experienced not as a linear sequence but as an ongoing negotiation of trust, belonging, and confidence. CONCLUSIONS AND RELEVANCE: Prospective narrative inquiry illuminated how recovery after ACL reconstruction is lived as a personal, evolving story. For physical therapists, recognizing the temporal dynamics of identity, trust, and confidence may support more individualized rehabilitation, complementing standardized protocols. These findings highlight the importance of attending to both physical and narrative dimensions of ACL recovery in clinical practice.
IMPORTANCE: Evidence-based practice (EBP) is a core competency in physical therapy. In 2015, France implemented a major reform of physical therapist education, extending training from 3 to 5 years and embedding EBP throu...IMPORTANCE: Evidence-based practice (EBP) is a core competency in physical therapy. In 2015, France implemented a major reform of physical therapist education, extending training from 3 to 5 years and embedding EBP throughout the curriculum. However, whether this reform translates into improved EBP competencies remains unclear. OBJECTIVE: This study aimed to determine the impact of evidence-informed curriculum changes on EBP competencies among physical therapist graduates. DESIGN: This study was a national cross-sectional survey. SETTING: This study was conducted in France. PARTICIPANTS: The participants were French physical therapists trained under the pre-reform (1989 to 2015) and post-reform (2015 to present) curricula. INTERVENTION(S) OR EXPOSURE(S): The exposures included the 2015 reform of entry-level physical therapist education and participation in continuing education related to EBP. MAIN OUTCOME(S) AND MEASURE(S): EBP competencies were assessed using the Evidence-Based Practice Profile questionnaire (EBP2) and the Knowledge of Research Evidence Competencies test (K-REC). The EBP2 evaluates self-reported attitudes, confidence, EBP use, and understanding of research terminology. The K-REC measures applied knowledge of research evidence using a clinical scenario. RESULTS: A total of 168 physical therapists participated. Compared with pre-reform graduates, post-reform graduates had higher scores across most EBP domains, with the largest improvement in the "Knowledge" domain (effect size = 0.50). Moderate gains were observed in "Terminology" and smaller but significant improvements in "Confidence" and attitudes toward EBP. Despite these gains, only 35.1% of respondents achieved a passing score on the knowledge test, and self-reported EBP practice remained limited. Continuing education and curriculum reform exerted independent and additive effects. CONCLUSIONS AND RELEVANCE: The curriculum reform was associated with meaningful improvements in EBP competencies, particularly knowledge. However, important gaps remain between knowledge acquisition and routine clinical application, indicating that entry-level reform alone is insufficient to ensure sustained EBP implementation. These findings suggest that lifelong learning and supportive clinical environments remain necessary to achieve durable integration of evidence-based physical therapy.
IMPORTANCE: Standardized outcome measure batteries are important for tracking functional progress, enhancing communication among providers, and evaluating intervention effectiveness in physical therapy. However, implemen...IMPORTANCE: Standardized outcome measure batteries are important for tracking functional progress, enhancing communication among providers, and evaluating intervention effectiveness in physical therapy. However, implementation of standardized batteries is challenging due to time constraints, documentation requirements, and limited resources. OBJECTIVE: The objective was to evaluate the implementation of a standardized gait and balance outcome measure battery by physical therapists for patients with stroke, brain injury, and spinal cord injury in the inpatient rehabilitation facility (IRF) setting. DESIGN: This study used a retrospective cohort study of 773 episodes of care at the IRF, and a quantitative survey for 22 staff physical therapists at the IRF. SETTING: This study was conducted at a 50-bed IRF in the United States. INTERVENTIONS: A standardized outcome measure battery with 5 measures (10 Meter Walk Test, 6 Minute Walk Test, Berg Balance Scale, Functional Gait Assessment, and 5 Times Sit to Stand) was implemented by all physical therapist teams at the IRF. MAIN OUTCOMES AND MEASURES: The main outcome measures were Penetration and Sustainability, assessed with retrospective cohort data, and Acceptability and Feasibility, assessed with the quantitative survey of physical therapists. RESULTS: There was a significant improvement in the completion rates of all 5 outcome measures, with most measures exceeding a 70% completion rate threshold 1 year after implementation. Completion rates of the entire battery did not reach 70%. Physical therapists indicated that implementation of the battery resulted in positive practice changes, and that barriers to completion were patients' functional levels and the time required for completion. CONCLUSIONS: Implementation of a standardized outcome measure battery is feasible in the IRF setting. However, outcome measure completion rates may improve with a more condensed battery and with integration into clinical workflows. RELEVANCE: This study provides a practical model for IRFs to adopt and evaluate standardized outcome measure batteries that improve physical therapists' ability to assess physical function across health systems and settings.
OBJECTIVE: This study aimed to compare the effects of 7 physical therapy interventions delivered with Home Exercise Program (HEP) versus HEP alone on pain and function in plantar fasciitis (PF). DATA SOURCES: Studies wer...OBJECTIVE: This study aimed to compare the effects of 7 physical therapy interventions delivered with Home Exercise Program (HEP) versus HEP alone on pain and function in plantar fasciitis (PF). DATA SOURCES: Studies were identified through PubMed, Embase, the Cochrane Library, Web of Science, and Scopus from database inception to January 2026. STUDY SELECTION: Randomized controlled trials (RCTs) comparing physical therapy interventions delivered with HEP versus HEP alone in individuals with PF were included. DATA EXTRACTION AND SYNTHESIS: A frequentist random-effects network meta-analysis was conducted.Outcomes were assessed at short-term (≤6 weeks), medium-term (6-12 weeks), and long-term (≥12 weeks) follow-up periods. Eight treatment nodes were analyzed: extracorporeal shock wave therapy, ultrasound therapy, manual therapy, taping, low-level laser therapy, orthoses, and dry needling, all delivered with HEP, and HEP alone as the control. Risk of bias was assessed using the Cochrane Risk-of-Bias tool, and the certainty of evidence was evaluated with the Confidence in Network Meta-Analysis framework. MAIN OUTCOMES AND MEASURES: Pain and functional outcomes were evaluated using standardized mean differences (SMDs) with 95% CIs. RESULTS: Twenty-four RCTs (1240 participants) were included. For pain outcomes, dry needling (DN) (SMD = -1.26, 95% CI = -2.25 to -0.28), low-level laser therapy (-1.54, -2.82 to -0.27), and manual therapy (MT) (-1.02, -1.82 to -0.21), delivered with HEP, resulted in clinically significant improvements in short-term pain (moderate-quality evidence). The pain-relieving effects of DN delivered with HEP were sustained in the medium term (-1.14, -1.62 to -0.66; high-quality evidence). For functional outcomes, DN (0.66, 0.13 to 1.19) and taping (0.84, 0.27 to 1.40), delivered with HEP, resulted in clinically significant improvements in short-term function (moderate-quality evidence). Additionally, DN with HEP sustained significant clinical improvements in medium-term function (1.06, 0.24 to 1.87; moderate-quality evidence). CONCLUSIONS AND RELEVANCE: When delivered with HEP, DN, low-level laser therapy, and MT provided clinically significant short-term improvements in pain compared to HEP alone, with DN and taping improving short-term functional outcomes. Dry needling further sustained its benefits in both pain and function into the medium term.
IMPORTANCE: The representation of students with disabilities (SWD) in physical therapist education programs is lower than in other health care education programs. Technical standards (TS), the non-academic requirements f...IMPORTANCE: The representation of students with disabilities (SWD) in physical therapist education programs is lower than in other health care education programs. Technical standards (TS), the non-academic requirements for admission to health care education programs, may impact access to education for SWD. However, the availability and language of TS has not been comprehensively assessed. OBJECTIVE: The objective of this study was to describe the availability and language of TS in physical therapist education programs. DESIGN: This study was conducted as a mixed methods online exploratory study. Phase 1 collected TS and described the availability and ease of locating TS. Phase 2 analyzed TS compliance and inclusivity using a Critical Disability Studies framework. SETTING: The study setting was online, with physical therapist education program websites reviewed as a part of the data collection. PARTICIPANTS: Websites from United States Commission on Accreditation of Physical Therapy accredited physical therapist education programs as of March 2023 (n = 260) were included in the study. MAIN OUTCOME(S) AND MEASURE(S): Phase 1: Analyzed TS for availability and ease of locating. Phase 2: Analyzed available TS for willingness to provide accommodations, nature of compliance with legal obligations and locus of responsibility for providing accommodations. RESULTS: Phase 1: 75% of programs had TS available and 77.9% of TS were easy to locate. Phase 2: 45% of TS were equivocal in willingness to accommodate. Most TS were compliant (83%). No programs identified the student as responsible for providing accommodations and 13 (7.6%) described a shared process between the school and the student. CONCLUSIONS: Findings show some movement towards disability inclusion and offer areas to address TS. More research is needed to understand the impact of TS on SWD applying to physical therapist education programs. RELEVANCE: Including SWD in physical therapist education programs may transform the workforce to meet the need for more physical therapists as well as potentially mitigate health disparities.
IMPORTANCE: Falls among older adults are a major public health concern, but evidence on Thai boxing dance (TBD) interventions for prevention remains inconclusive. OBJECTIVE: This study aimed to evaluate the effectiveness...IMPORTANCE: Falls among older adults are a major public health concern, but evidence on Thai boxing dance (TBD) interventions for prevention remains inconclusive. OBJECTIVE: This study aimed to evaluate the effectiveness of a 6-month TBD program in reducing fall incidence and improving physical performance, fear of falling, and cognitive function among community-dwelling older adults at risk of falling. DESIGN: This study was a 3-arm parallel-group, assessor-blinded randomized controlled trial. SETTING: The study was conducted at 3 primary health care centers in Chiang Rai, Thailand. PARTICIPANTS: Among the 123 participants enrolled, 115 older adults aged ≥60 years were identified as being at risk of falling and completed the study. INTERVENTIONS: Participants were randomly allocated to 1 of 3 groups: TBD, conventional balance exercise (CBE), or a control group (CG). All groups participated in biweekly sessions over a 24-week period. MAIN OUTCOMES AND MEASURES: Falls were monitored over a 180-day period, whereas physical performance, fear of falling, and cognitive function were assessed at baseline and at the 6-month intervention period. RESULTS: Of the 123 participants, 115 completed the trial. Incident rates of falls in the TBD and CBE group (0.18 and 0.17 per person-month, respectively) were lower than the rate of 0.62 in the CG. The TBD group showed a 76% reduction in the fall rate compared to CG. TBD also led to significantly greater improvements in physical performance, including postural sway, gait parameters, and lower-limb strength, compared with the CG after the 6-month intervention. The CBE group showed greater improvements in gait parameters only. No significant between-group differences were observed in fear of falling or cognitive function. CONCLUSIONS AND RELEVANCE: A 6-month TBD and CBE program reduced falls. TBD improved physical performance more broadly, whereas CBE yielded targeted gait improvements in community-dwelling older adults at risk of falling.
IMPORTANCE: The changing landscape of health care calls for recalibration of educating the next generation of physical therapists. Physical therapist education programs rely on external clinical entities to prepare stude...IMPORTANCE: The changing landscape of health care calls for recalibration of educating the next generation of physical therapists. Physical therapist education programs rely on external clinical entities to prepare students for practice. Descriptions of relationships between academic and clinical entities are scarce despite a national call to explore this concept. OBJECTIVE: The objective of this study is to describe existing relationships from the perspectives of the multiple key decision makers within Doctor of Physical Therapy clinical education (CE). DESIGN: This study used a qualitative investigation using a multi-site descriptive case study design. SETTING & PARTICIPANTS: A national call for participants was made to Commission on Accreditation of Physical Therapist Education (CAPTE) accredited programs, serving as case, followed by purposeful recruitment to achieve maximum variation. Programs varied by categories such as size, public/private institutions and residential/hybrid programs. Cases included academic and clinical participants associated with a single institution in varied academic and clinical roles as well as students. Participants completed a demographic survey and engaged in an individual virtual semi-structured interview or a focus group. Thematic analysis both within-cases and cross-cases was followed. MAIN OUTCOMES: Qualitative themes were reported by participants surrounding their perceptions about the different types of relationships that exist in CE. RESULTS: A total of 10 cases with 88 interview/focus group transcripts were analyzed. Seven themes emerged identifying and describing different relationships in physical therapist CE. Relationship types included: One and Done, Transactional, Collaborative and Trusting, Systems Relationship, Go-to Site, Existing Relationship, and Strained Relationship. CONCLUSIONS: A variety of relationships are valuable in professional level CE. Flexibility andcustomization of relationships are essential to accommodate changing demands of health care, education, and student needs. Further research is needed to optimize communication and efficiency, to ensure the sustainability of relationships and, consequently, the profession. RELEVANCE: This study provides insight into the nature of clinical-academic relationships,contributing to the development of models that may enhance quality and sustainability of CE in physical therapist education.
IMPORTANCE: Persistent postconcussion symptoms (PCS) following mild traumatic brain injury (mTBI) are common and are often associated with exercise intolerance. The effects of aerobic exercise on PCS in adolescent athlet...IMPORTANCE: Persistent postconcussion symptoms (PCS) following mild traumatic brain injury (mTBI) are common and are often associated with exercise intolerance. The effects of aerobic exercise on PCS in adolescent athletes have been promising. However, randomized controlled trials targeting persistent PCS in the adult population are needed. OBJECTIVE: The objective of this study was to evaluate the effects of sub-symptom threshold aerobic exercise (SSTAE) on symptom burden and exercise intolerance in adults with persistent PCS. DESIGN: This was a randomized (1:1) controlled single-blind, parallel-group trial with follow-up at 12 weeks and 6 months. SETTING: The setting was a TBI outpatient clinic at Oslo University Hospital, Norway. PARTICIPANTS: The participants were 81 adults who were 18 to 59 years old and had PCS and exercise intolerance 3 to 24 months after mTBI. INTERVENTIONS: The interventions were treatment-as-usual plus SSTAE versus treatment-as-usual including only general exercise information and advice. MAIN OUTCOMES AND MEASURES: The primary outcome was symptom burden, measured with the Rivermead Post-Concussion Symptoms Questionnaire. The secondary outcome was exercise intolerance, measured as the symptom threshold and minutes to stop on the Buffalo Concussion Treadmill Test. Tertiary outcomes were measurements of health-related quality of life, depression, anxiety, fatigue, and level of physical activity. RESULTS: No between-group differences were observed in the Rivermead Post-Concussion Symptoms Questionnaire at 12 weeks or 6 months. sub-symptom threshold aerobic exercise significantly improved the Buffalo Concussion Treadmill Test symptom threshold at 12 weeks, with effects sustained at 6 months. Additionally, the SSTAE group was superior to the control group in minutes to stop at 12 weeks but not at 6 months. No adverse events occurred. No statistically significant treatment effects were observed for the tertiary outcomes. CONCLUSIONS: The added benefit of SSTAE to treatment-as-usual did not lead to greater reduction in symptom burden compared to the control group. However, SSTAE significantly improved exercise intolerance and was safe and well tolerated. Both groups improved over time in symptom burden, health-related quality of life, depression, anxiety, and fatigue. RELEVANCE: Symptom restricted aerobic exercise intervention, provided by physical therapist, improves exercise intolerance in patients with persistent postconcussion symptoms after mTBI.
OBJECTIVE: Physical therapists have served in primary care roles in the United States military, but the model has yet to be widely adopted in US private, non-governmental health care settings. This review aims to map exi...OBJECTIVE: Physical therapists have served in primary care roles in the United States military, but the model has yet to be widely adopted in US private, non-governmental health care settings. This review aims to map existing literature regarding the implementation and variations of primary care physical therapy (PCPT) models, assessing health care utilization and patient outcomes. DATA SOURCES, STUDY SELECTION, DATA EXTRACTION, AND SYNTHESIS: We searched 3 electronic databases (PubMed, CINAHL, and Scopus) for studies published from 2014 to 2023 in English language. Studies that evaluated health care utilization/costs or patient outcomes while comparing PCPT with the traditional medical primary care model were included. MAIN OUTCOMES AND MEASURES: Main outcomes included study characteristics (population, setting, and model of PCPT), and reported outcomes relevant to health care utilization/costs and patient outcomes. RESULTS: Of the 3565 publications identified, 39 were included in the scoping review. Seventeen studies contained sufficient detail to describe the integration of physical therapists into primary care, and included approaches such as team-based care, co-location of physical therapists in a primary care clinic, and the use of a formalized triage system at the primary care clinic that directed patients to schedule with a physical therapist first. PCPT models have been described in multiple countries internationally. In the United States, PCPT is largely described in unique payor systems including the military, Veterans Affairs, and employee health settings. PCPT may be associated with lower health care costs and utilization compared to traditional medical primary care, particularly in terms of reduced imaging (17 out of 19 studies) and medication use (11 out of 17 studies), including opioid use (5 out of 5 studies). Patient outcomes appeared similar between PCPT and medical primary care pathway, but less robust evidence is available on the topic. CONCLUSIONS AND RELEVANCE: This scoping review found a variety of PCPT models used in governmental, including military, and civilian settings in the United States and internationally, with evidence suggesting that integrating physical therapists in primary care may result in reduced health care utilization with non-inferior patient outcomes.