Physical Therapy最新文献

{"title":"Descriptive Analysis of Supervised Falls Occurring During Physical Therapy Sessions in Adult Inpatient Rehabilitation.","authors":"Susan Camillieri, Cara Weiss, Michael Zervas, Branden Dennis","doi":"10.1093/ptj/pzaf096","DOIUrl":"https://doi.org/10.1093/ptj/pzaf096","url":null,"abstract":"<p><strong>Importance: </strong>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.</p><p><strong>Objective: </strong>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.</p><p><strong>Design: </strong>This was an observational study which included a retrospective analysis of medical records.</p><p><strong>Setting: </strong>This study examined falls occurring within 2 IR departments at a large hospital system located in an urban setting in the United States.</p><p><strong>Participants: </strong>This study involved patients receiving adult IR with diagnoses including, but not limited to, stroke, traumatic brain injury, and spinal cord injury.</p><p><strong>Exposures: </strong>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.</p><p><strong>Main outcomes and measures: </strong>Mann-Whitney U tests, chi square tests, and binomial logistic regression analyses were performed to compare characteristics of faller and non-faller groups.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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 fal","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Credentialism and Barriers to Entry: A Historical and Sociological Analysis of the CAPTE 50 Percent Requirement for Physical Therapy Faculty with Academic Doctorates.","authors":"Andrew J Hogan","doi":"10.1093/ptj/pzaf095","DOIUrl":"https://doi.org/10.1093/ptj/pzaf095","url":null,"abstract":"<p><p>This Perspective offers historical and sociological analysis 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 one 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.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying Directional Preference: A Scoping Review and Thematic Analysis of Variability and Application in Musculoskeletal Pain Research.","authors":"Joshua A Kidd, Joseph M Lorenzetti, Kenneth W Kirby, Jodi L Young, Joshua A Cleland, Ronald J Schenk","doi":"10.1093/ptj/pzaf094","DOIUrl":"https://doi.org/10.1093/ptj/pzaf094","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Data sources: </strong>A scoping review was conducted using 6 electronic databases (PubMed, CINAHL, Embase, SPORTDiscus, Web of Science, and Cochrane Library) from inception through May 2024.</p><p><strong>Study selection: </strong>Studies were included if they involved adults with musculoskeletal conditions and used the term \"directional preference\" in their methodology or reporting.</p><p><strong>Data extraction and synthesis: </strong>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 PRISMA-ScR guidelines.</p><p><strong>Main outcome(s) and measure(s): </strong>Primary outcomes included the number and type of directional preference definitions and expert perspectives on essential definitional elements.</p><p><strong>Results: </strong>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 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.</p><p><strong>Conclusions and relevance: </strong>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 consensus-driven efforts, such as Delphi studies, are needed to establish a clear and consistent definition to support improved research quality and clinical application.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations Between Fear-Avoidance or Pain Catastrophizing and Gait Quality in Chronic Low Back Pain: A Cross-Sectional Study.","authors":"Anna H Bailes, Gina P McKernan, Mark S Redfern, Rakié Cham, Carol M Greco, Jennifer S Brach, Sara R Piva, Nam Vo, Gwendolyn Sowa","doi":"10.1093/ptj/pzaf089","DOIUrl":"https://doi.org/10.1093/ptj/pzaf089","url":null,"abstract":"<p><strong>Importance: </strong>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.</p><p><strong>Objective: </strong>This study aimed to determine associations between fear-avoidance or pain catastrophizing and gait quality in cLBP.</p><p><strong>Design: </strong>This was a cross-sectional study.</p><p><strong>Setting: </strong>This study occurred at a university.</p><p><strong>Participants: </strong>There were 500 individuals (56.6 [SD = 16.5] years old.; 311 female) with cLBP.</p><p><strong>Interventions: </strong>Participants completed the Fear-Avoidance Beliefs Questionnaire - Physical Activity (FABQ-PA) and 6-item Pain Catastrophizing Scale (PCS-6). Participants were divided into high and low fear-avoidance subgroups based on an established FABQ-PA cutoff (>14).</p><p><strong>Main outcomes and measures: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p><p><strong>Relevance: </strong>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.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of PT-PENCIL: The Physical Therapy Frequency Clinical Decision Support Tool to Increase Hospital Discharge to Home.","authors":"Brittany Lapin, Sandra Passek, Andrew Schuster, Mary Stilphen, Kate Minick, Dave S Collingridge, Beth Hunt, Devyn Woodfield, Michael B Rothberg, Joshua K Johnson","doi":"10.1093/ptj/pzaf093","DOIUrl":"https://doi.org/10.1093/ptj/pzaf093","url":null,"abstract":"<p><strong>Importance: </strong>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.</p><p><strong>Objective: </strong>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.</p><p><strong>Design: </strong>A predictive model was developed using retrospective cohort data collected between April 2017 and August 2022, with external validation conducted in a separate sample.</p><p><strong>Setting: </strong>The setting was a large health system.</p><p><strong>Participants: </strong>Participants were adult patients who were hospitalized and received physical therapy.</p><p><strong>Main outcome and measures: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions and relevance: </strong>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.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144619695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trajectories of Physical Disabilities Over Six Months in Patients With Long COVID.","authors":"Imane Salmam, François Desmeules, Kadija Perreault, Imane Zahouani, Simon Beaulieu-Bonneau, Alexandre Campeau-Lecours, Jean-Sébastien Paquette, Simon Deslauriers, Jean Tittley, Gilles Drouin, Krista Best, Jean-Sébastien Roy","doi":"10.1093/ptj/pzaf091","DOIUrl":"https://doi.org/10.1093/ptj/pzaf091","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;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 strategies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The objective of this study was to compare physical capacity over time among adults without COVID-19 (control group), those who recovered from COVID without persistent symptoms (short COVID group), and those with long COVID (long COVID group [LCG]). A secondary objective was to identify baseline factors predicting HRQoL 6 months later in the LCG.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;This study was a prospective longitudinal cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Assessments were conducted at baseline, 3 months, and 6 months as part of in-laboratory evaluations performed either at the Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) in Quebec City or at the Orthopedic Clinical Research Unit of the Maisonneuve-Rosemont Hospital Research Center in Montreal.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;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 long COVID (symptoms persisting ≥12 weeks, LCG) participated in the study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Intervention/exposure: &lt;/strong&gt;Participants were categorized based on their COVID-19 history and symptom duration and no intervention or exposure was applied.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Self-reported outcomes measuring HRQoL, comorbidities, sleep quality, pain, and fatigue, along with objective performance measures such as grip strength, Short Physical Performance Battery, 6-minute walk test (6MWT), and perceived exertion (Modified Borg Scale) during the 6MWT, were collected at each time point. 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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Significant time × group interactions were observed for HRQoL, sleep quality, pain, fatigue, Short Physical Performance Battery, 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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;These findings highlight the persistent impairments in adults with long COVID and emphasize earl","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Care Cost Savings and Utilization Reductions Associated With Virtual Physical Therapy Care: A Propensity-Matched Claims Analysis.","authors":"Jenna M Napoleone, Susan M Devaraj, Madison Noble, Christina M Parrinello, Carolyn Bradner Jasik, Todd Norwood, Ian Livingstone, Sarah Linke","doi":"10.1093/ptj/pzaf084","DOIUrl":"https://doi.org/10.1093/ptj/pzaf084","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 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 musculoskeletal 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 musculoskeletal 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, musculoskeletal condition-related total services, and physical therapist services than patients in IP-PT at 6 and 12 months.</p><p><strong>Conclusions: </strong>V-PT care may be a meaningful driver of musculoskeletal condition-related cost savings by providing a cost-effective and accessible alternative to IP-PT care.</p><p><strong>Impact: </strong>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 musculoskeletal conditions.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144541887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Beliefs, Perceptions, and Experiences of Individuals With Tendinopathy: A Systematic Review and Meta-Ethnography of Qualitative Studies.","authors":"Mark S Mesiha, Steven J Obst, Samantha Randall, Amanda L Rebar, Cassandra K Dittman, Luke J Heales","doi":"10.1093/ptj/pzaf060","DOIUrl":"10.1093/ptj/pzaf060","url":null,"abstract":"<p><strong>Importance: </strong>This study systematically examines the effects of tendinopathy on patients' quality of life and investigates their experiences with rehabilitation.</p><p><strong>Objective: </strong>This study aimed to synthesize qualitative research exploring the beliefs, perceptions, and experiences of individuals living with tendinopathy by employing a systematic review with meta-ethnography.</p><p><strong>Data sources: </strong>Studies were identified from 4 databases (CINAHL, EMBASE, Scopus, and ProQuest One Academic).</p><p><strong>Study selection: </strong>Studies were included if they utilized qualitative methods to investigate beliefs, perceptions, and/or experiences of participants with clinically diagnosed tendinopathy.</p><p><strong>Data extraction and synthesis: </strong>Data synthesis was completed using the 7 phases of meta-ethnography and reported using the meta-ethnography reporting guidelines. Risk of bias was assessed using the Joanna Briggs Checklist for Qualitative Studies. Confidence in the findings was assessed using the Grading of Recommendations Assessment, Development, and Evaluation Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual).</p><p><strong>Main outcomes(s) and measure(s): </strong>Twenty-three studies were included (rotator cuff [n = 12]; Achilles [n = 6]; gluteal [n = 2]; lateral elbow [n = 2]; and mixed tendinopathies [n = 1]). Methodological quality of included studies varied. Moderate confidence in review findings 1 and 2 and high confidence in review finding 3.</p><p><strong>Results: </strong>Qualitative synthesis identified 3 themes: (1) I need to understand why my tendon hurts (participants wanted clarity regarding the cause of symptoms); (2) I want to fix my tendon, but I don't know how (participants had varied beliefs regarding optimal management and how to reduce their pain); and (3) I am uncertain whether my lifestyle will return to normal (participants felt frustrated with the negative impact that tendinopathy had on their life).</p><p><strong>Conclusion and relevance: </strong>This review provides insights into the lived experiences of individuals with tendinopathy. The review advocates for clearer communication and education regarding causes and optimal management of tendinopathy. Participants' varied beliefs and uncertainties about treatment efficacy suggest that health care providers consider individualized evidence-based guidance to improve patient outcomes.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12212419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying Potential Determinants That Can Impact the Implementation of a Physical Activity Pathway in Outpatient Physical Therapy: A Mixed Methods Study.","authors":"Mariana Wingood, Jennifer L Vincenzo, Justin B Moore, Jaime M Hughes","doi":"10.1093/ptj/pzaf088","DOIUrl":"https://doi.org/10.1093/ptj/pzaf088","url":null,"abstract":"<p><strong>Importance: </strong>Most physical therapists do not address older adults' inadequate physical activity (PA), resulting in increased risk of experiencing falls or frailty.</p><p><strong>Objective: </strong>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.</p><p><strong>Design: </strong>The design was a convergent parallel mixed-method design.</p><p><strong>Setting: </strong>The setting of this study was outpatient physical therapy.</p><p><strong>Intervention(s) or exposure(s): </strong>The intervention being examined is a PA pathway that provides guidance on assessing and addressing older adults' inadequate PA levels.</p><p><strong>Main outcome(s) and measures(s): </strong>The main outcome was determinants that can impact the implementation of the PA pathway.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion and relevance: </strong>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.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144541888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracorporeal Shock Wave Therapy for Chronic Adhesive Capsulitis in Type 2 Diabetics: A Systematic Review With Meta-Analysis.","authors":"Crystal Reno, Paul A Swinton, Lyndsay Alexander","doi":"10.1093/ptj/pzaf074","DOIUrl":"10.1093/ptj/pzaf074","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Design: </strong>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).</p><p><strong>Participants: </strong>This study included type 2 diabetic adults (>18 years) diagnosed with primary or secondary AC.</p><p><strong>Interventions: </strong>This review and meta-analysis included studies comparing ESWT with conservative management.</p><p><strong>Main outcomes: </strong>The primary outcome was pain. Secondary outcomes included range of movement (ROM) and disability.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p><p><strong>Relevance: </strong>Extracorporeal shock wave therapy may improve pain, ROM, and disability in type 2 diabetics with AC.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}