Physical Therapy最新文献

{"title":"Impact of Virtual Reality Training on Quality of Life, Diaphragmatic Excursion, Pulmonary Function, and Respiratory Muscle Strength After Upper Abdominal Surgeries: A Randomized Controlled Study.","authors":"Nesma M Allam, Nabil Mahmoud Abdel-Aal, Alshaymaa S Abd El-Azeim, Hadaya Mosaad Eladl","doi":"10.1093/ptj/pzag106","DOIUrl":"https://doi.org/10.1093/ptj/pzag106","url":null,"abstract":"<p><strong>Importance: </strong>Adding virtual reality exercise (VRE) to conventional physical therapy (CPT) may reduce upper abdominal surgery complications.</p><p><strong>Objective: </strong>The objective of the study was to evaluate the effects of VRE on quality of life (QoL), diaphragmatic excursion, pulmonary function, respiratory muscle strength, and functional capacity after upper abdominal surgeries.</p><p><strong>Design: </strong>This was a randomized controlled trial.</p><p><strong>Setting: </strong>The setting was a physical therapy outpatient clinic.</p><p><strong>Participants: </strong>Participants were 120 patients (20-65 years old) with upper abdominal surgeries. They were randomly assigned to a VRE group or a control group.</p><p><strong>Interventions: </strong>The VRE group received 5 interactive games plus CPT; the control group received CPT alone, with supervised sessions 5 times weekly for 8 weeks.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was QoL. Secondary outcomes included diaphragmatic excursion, forced vital capacity, forced expiratory volume in 1 second, peak expiratory flow, maximum inspiratory and expiratory pressures, and functional capacity, measured at baseline and after intervention. Following trial registration and prior to data analysis, the primary outcome was revised from pulmonary function to QoL to better reflect the multidimensional objectives of the intervention; all originally registered outcomes were retained and reported as secondary outcomes.</p><p><strong>Results: </strong>After intervention, the results revealed statistically significant differences between groups in QoL domains, with more favor to the VRE group. Mean differences and 95% CIs between the groups were 20.28 (95% CI = 18.09 to 22.48) for physical health, 23.8 (95% CI = 21.9 to 25.7) for psychological health, 22.98 (95% CI = 20.92 to 25.05) for social relationships, and 21.77 (95% CI = 19.8 to 23.73) for environmental health.</p><p><strong>Conclusions: </strong>Integrating VRE with CPT produced clinically meaningful short-term improvements in QoL, pulmonary function, respiratory muscle strength, diaphragmatic excursion, and functional capacity compared with CPT alone following upper abdominal surgery.</p><p><strong>Relevance: </strong>These findings support the use of VRE as an effective adjunct to postoperative rehabilitation. However, the results should be interpreted with caution due to the short follow-up period and the inability to blind participants to group allocation.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196159","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":"Long-Term Clinical Outcomes and Factors Associated With Response in Older Adults With Massive Irreparable Rotator Cuff Tears: A Four-Year Prospective Cohort Study.","authors":"Héctor Gutiérrez-Espinoza, Mario Ríos-Riquelme, Juan Valenzuela-Fuenzalida, Felipe Araya-Quintanilla, Eoin Ó Conaire, Robinson Ramírez-Vélez","doi":"10.1093/ptj/pzag113","DOIUrl":"https://doi.org/10.1093/ptj/pzag113","url":null,"abstract":"<p><strong>Importance: </strong>Few studies that have reported long-term trajectories of a standardized nonoperative management in patients with massive irreparable rotator cuff tears (MIRCTs).</p><p><strong>Objective: </strong>The aims of this study were to describe the long-term clinical outcomes of nonoperative treatment and to analyze sociodemographic and comorbidity baseline factors associated with functional outcomes trajectories in older adults with atraumatic MIRCTs.</p><p><strong>Design: </strong>A prospective cohort study was performed.</p><p><strong>Setting: </strong>The setting was a single tertiary health care hospital.</p><p><strong>Participants: </strong>Patients aged ≥60 years with atraumatic MIRCTs were recruited.</p><p><strong>Interventions: </strong>All patients were treated with Nonsteroidal anti-inflammatory drugs, a 12-week physical therapist program, home exercises, and, when required, a corticosteroid injection.</p><p><strong>Main outcomes and measures: </strong>The Constant-Murley (CM) questionnaire was used to assess shoulder function, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire for upper limb function, and the Visual Analog Scale (VAS) for pain intensity. Four evaluations were performed, at baseline, at 3 months, 1 year, and 4 years. Because outcomes were measured repeatedly in the same participants, linear mixed-effects models with random intercepts were used to account for within-subject correlation.</p><p><strong>Results: </strong>The majority of patients (76/92) showed clinically important improvements in 3 months that persisted until 4 years. Of the patients that did not improve at 1-year, 16 underwent surgery (17%). In patients treated nonoperatively, in CM, DASH, and VAS, the minimal clinically important difference (MCID) was reached between 95% to 97% of patients at 3 months, 89% to 97% at 1 year, and all patients at 4 years (100%). In the prespecified adjusted models, longer symptoms duration (β = -1.3; 95% CI = -1.7 to -0.8) and smoking (β = -8.8; 95% CI = -13.2 to -4.4) were associated with worse shoulder function. Diabetes mellitus was associated with higher pain intensity (β = 0.3; 95% CI = 0.1 to 0.5).</p><p><strong>Conclusions: </strong>In the long term, the majority of older patients with atraumatic MIRCTs in this cohort responded well to nonoperative treatment. Moreover, some sociodemographic and comorbidity baseline factors were associated with functional recovery trajectories in these patients. However, further research is needed to confirm these findings.</p><p><strong>Relevance: </strong>Findings showed that functional recovery trajectories are significantly influenced not only by biomechanical or related to rotator cuff tear factors but by modifiable sociodemographic and comorbidity factors which should be addressed in these patients.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196218","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":"Implementation of a Guideline-Based Preference Elicitation Tool to Enhance Shared Decision-Making in Supervised Exercise Therapy for Patients With Intermittent Claudication: A Multi-Methods Cluster Randomized Trial.","authors":"Laura H M Marcellis, Steffie Spruijt, Katrien M Rutgers, Mitchell C M van Doormaal, Joep A W Teijink, Philip J van der Wees, Thomas J Hoogeboom","doi":"10.1093/ptj/pzag103","DOIUrl":"https://doi.org/10.1093/ptj/pzag103","url":null,"abstract":"<p><strong>Importance: </strong>Shared decision-making is not yet common practice in physical therapy, emphasizing the need for effective decision aids. A preference elicitation tool (PE-tool) was designed to complement supervised exercise therapy (SET) in intermittent claudication treatment.</p><p><strong>Objective: </strong>Primarily, to assess the impact of implementing the PE-tool on patients' functional walking distance (FWD), maximal walking distance (MWD) and health-related quality of life (HRQoL) after 3 and 6 months. Secondarily, to assess the tool's impact on shared decision-making and person-centeredness.</p><p><strong>Design: </strong>Nationwide pragmatic cluster randomized trial.</p><p><strong>Setting: </strong>Primary care physical therapy practices in the Netherlands.</p><p><strong>Participants: </strong>Primary care physical therapists and patients with intermittent claudication receiving SET.</p><p><strong>Exposure(s): </strong>Therapists assigned to the intervention group had access to the PE-tool to complement SET, whereas therapists in the control group delivered SET.</p><p><strong>Main outcome(s) and measure(s): </strong>Group differences in FWD, MWD, and HRQoL at 3- and 6-month follow-ups were assessed using routinely collected clinical data. Audio-recorded consultations between therapists and patients in the intervention (n = 72) and control group (n = 74) were assessed using the OPTION-5 instrument to assess shared decision-making. Participating patients completed a questionnaire afterwards to assess person-centeredness.</p><p><strong>Results: </strong>Intention-to-treat analyses indicated no statistically significant differences between intervention (n = 1199 patients) and control (n = 915 patients) groups at both follow-ups for FWD and MWD. For HRQoL, a statistically significant difference favoring the control group was found at 3-month follow-up (MD = -0.3 points), but not at 6-month (MD = -0.3 points). Statistically significant effects favoring the intervention group were found for shared decision-making (MD = +39.0 points) and person-centeredness (MD = +2.0 points).</p><p><strong>Conclusions: </strong>Use of the PE-tool in intermittent claudication treatment did not improve patient-level outcomes compared to SET alone, but positively impacted levels of shared decision-making and person-centeredness.</p><p><strong>Relevance: </strong>Although achieving health improvements through decision aids remains complex, the novel tool could support therapists in adopting a more collaborative and person-centered approach.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196279","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":"A Single-Number Value Metric Integrating Quality and Cost in Outpatient Physical Therapy.","authors":"Bryan Bourcier, Thomas Ruediger, Christine Walck, Sean M Kennedy","doi":"10.1093/ptj/pzag109","DOIUrl":"https://doi.org/10.1093/ptj/pzag109","url":null,"abstract":"<p><strong>Importance: </strong>As health care transitions toward value-based care, outpatient physical therapy lacks a practical metric that objectively integrates quality of care and cost into a single measure of clinical value.</p><p><strong>Objective: </strong>The objective was to develop a single-number value metric (VM) integrating clinical effectiveness, patient experience, and cost efficiency in outpatient physical therapy and to determine its concordance with blinded manager assessments of therapist value.</p><p><strong>Design: </strong>This was a retrospective observational cohort study.</p><p><strong>Setting: </strong>The study was conducted at 8 outpatient physical therapy clinics within a single health care system, including freestanding ambulatory clinics and hospital-based outpatient departments.</p><p><strong>Participants: </strong>The study included twelve licensed physical therapists and 2400 outpatient episodes of care.</p><p><strong>Intervention(s) or exposure(s): </strong>Therapist-level patient-reported outcome measure (PROM) improvement, clinic-level Net Promoter Score (NPS), and financial data were combined to calculate a single-number VM. Blinded clinical managers independently ranked therapists according to perceived value.</p><p><strong>Main outcome(s) and measure(s): </strong>VM scores were calculated for each therapist. Concordance between VM rankings and blinded manager rankings was assessed using Spearman rank correlation coefficient.</p><p><strong>Results: </strong>VM scores ranged from 1.39 to 4.76 (median = 2.39; interquartile range = 1.99-3.13). Across 2400 episodes of care, 72.8% of PROM changes met or exceeded published minimal clinically important difference thresholds. Among ambulatory therapists, VM rankings demonstrated a strong inverse correlation with manager rankings (Spearman ρ = -0.82). Among hospital-based therapists, VM rankings demonstrated perfect inverse agreement with manager rankings (Spearman ρ = -1.00).</p><p><strong>Conclusions: </strong>The proposed VM integrates clinical effectiveness, patient experience, and cost efficiency into a feasible, single-number measure of value in outpatient physical therapy. VM scores were strongly aligned with blinded managerial assessments of therapist value.</p><p><strong>Relevance: </strong>The VM offers a potential framework for evaluating clinical value in outpatient physical therapy and supporting the transition from volume-based to value-based care.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183560","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":"Impact of social determinants of health on physical therapy utilization in home health and outpatient settings: a retrospective cohort study.","authors":"Michael Markee, Hyunkyu Ko, Brook I Martin, Amit Kumar","doi":"10.1093/ptj/pzag090","DOIUrl":"10.1093/ptj/pzag090","url":null,"abstract":"<p><strong>Importance: </strong>Home health and outpatient physical therapy are important for recovery after lower extremity joint replacement (LEJR); yet, their use may be influenced by social determinants of health (SDOH).</p><p><strong>Objective: </strong>The objective of this study was to identify SDOH factors at the patient-, hospital-, and regional-levels that are associated with the use of home health and outpatient physical therapy after LEJR.</p><p><strong>Design: </strong>This cross-sectional study used 100% Medicare fee-for-service claims. Hierarchical regression models assessed associations of patient-, hospital-, and regional-level SDOH with home health and outpatient physical therapy utilization.</p><p><strong>Setting: </strong>Not applicable.</p><p><strong>Participants: </strong>Medicare beneficiaries who were 66 years old and older in 2018 and who were eligible for participation in the Comprehensive Care for Joint Replacement (CJR) program.</p><p><strong>Exposure(s): </strong>SDOH at the patient level (race, dual eligibility status), hospital level (percentage of Disproportionate Share Hospital patients), and regional level (themes from the Social Vulnerability Index).</p><p><strong>Main outcome and measure(s): </strong>Number of physical therapy visits in home health and outpatient settings within 90 days after discharge following an LEJR surgery, stratified by hip replacement and knee replacement.</p><p><strong>Results: </strong>This study included 74,937 patients undergoing joint replacement from January 1 to September 30, 2018. At the patient level, Black patients had more home health and outpatient physical therapy visits than White patients following both knee and hip replacement. Dual-eligibility status was associated with more home health visits but fewer outpatient physical therapy visits. At the regional level, greater socioeconomic vulnerability was associated with more home health visits and outpatient physical therapy visits. Greater vulnerability in housing type and transportation was associated with more home health visits but fewer outpatient physical therapy visits.</p><p><strong>Conclusions: </strong>SDOH were associated with greater home health and outpatient physical therapy utilization following hospital discharge after joint replacement.</p><p><strong>Relevance: </strong>Incorporating SDOH into discharge planning may promote equitable access to community-based rehabilitation following LEJR.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857566","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":"Open for business: why mechanistic and basic science still matter for physical therapy practice.","authors":"Chiao-Nan Chen","doi":"10.1093/ptj/pzag101","DOIUrl":"https://doi.org/10.1093/ptj/pzag101","url":null,"abstract":"","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":"106 10","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224663","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":"The role of physical activity in oral cancer recovery: a systematic review.","authors":"Lina Van Lint, Manon Lefever, Yolinne Meert, Lynn Christiaens, Robin Willaert, Kaat Alaerts, Jeroen Van Dessel","doi":"10.1093/ptj/pzag088","DOIUrl":"10.1093/ptj/pzag088","url":null,"abstract":"<p><strong>Importance: </strong>Physical activity (PA) is a cornerstone in cancer rehabilitation, yet evidence in oral cancer remains limited and heterogeneous, despite the significant functional impairments and morbidity associated with treatment.</p><p><strong>Objective: </strong>This systematic review synthesizes evidence on PA in people living with or beyond oral cancer (PLWBOC), focusing on its association with recovery-related outcomes across the cancer care continuum.</p><p><strong>Data sources: </strong>A comprehensive systematic search was conducted in 9 databases (PubMed, Embase, CENTRAL, CINAHL, Web of Science, Scopus, PEDro, ClinicalTrials.gov, and the International Clinical Trials Registry Platform [ICTRP]) on October 26, 2024. The review followed PRISMA 2020 and SwiM guidelines and was registered with PROSPERO (CRD42024591662).</p><p><strong>Study selection: </strong>Eligible studies included randomized controlled trials (RCTs), quasi-experimental designs, and observational studies examining the associations between postoperative PA and recovery-related outcomes in PLWBOC.</p><p><strong>Data extraction and synthesis: </strong>Two reviewers independently extracted data on PA characteristics, outcomes, and study quality using a standardized form. Risk of bias was assessed using the Revised Cochrane Risk of Bias tool for randomized trials (RoB 2) for RCTs and Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) for non-randomized studies, visualized with Risk-Of-Bias VISualization tool (ROBVIS). Twenty-four studies met the inclusion criteria, which encompassed RCTs, pilot trials, and cohort studies.</p><p><strong>Main outcomes and measures: </strong>Primary outcomes include physical function, fatigue, health-related quality of life (HRQoL), and treatment-related morbidity.</p><p><strong>Results: </strong>Physical activity consisted of resistance training, aerobic exercise, and multimodal programs combining PA with education or behavioral support. PA was associated with improved functional performance, reduced fatigue, and moderate HRQoL gains. Resistance training increased lean body mass and strength. Early-phase and 12- to 24-week programs showed prominent effects. Supervised, individualized programs yielded higher adherence rates and better functional outcomes. Nonetheless, heterogeneity in protocols, outcome measures, and study quality limited comparability and precluded meta-analysis.</p><p><strong>Conclusions and relevance: </strong>Physical activity-supervised, multimodal, and early-initiated-offers promising benefits for PLWBOC. Future research should prioritize RCTs, standardized outcome measures, extended follow-up, and digital outreach to establish tailored exercise guidelines for this population.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796921","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":"Synergistic effects of constraint-induced movement therapy and mirror therapy on neuroplasticity and functional recovery in rats with hemiplegic cerebral palsy.","authors":"Xiuying Zhao, Xin Wei, Liru Liu, Hongmei Tang, Jie Luo, Xiaolin Guo, Lu He, Kaishou Xu","doi":"10.1093/ptj/pzag097","DOIUrl":"10.1093/ptj/pzag097","url":null,"abstract":"<p><strong>Importance: </strong>The mechanisms underlying the combined effects of constraint-induced movement therapy (CIMT) and mirror therapy (MT) on neuroplasticity in hemiplegic cerebral palsy (HCP) remain unclear.</p><p><strong>Objective: </strong>This study investigated whether combined CIMT and MT improves functional recovery more than either therapy alone and examined accompanying motor cortical neuroplastic changes.</p><p><strong>Design: </strong>HCP rats were randomly assigned to HCP, HCP + CIMT, HCP + MT, and HCP + CIMT + MT groups (n = 13 per group), with a separate control group.</p><p><strong>Setting: </strong>The study was conducted at the Experimental Animal Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.</p><p><strong>Participants: </strong>The final sample comprised 52 rats with HCP and 13 controls.</p><p><strong>Interventions: </strong>Intervention groups received CIMT, MT, or both.</p><p><strong>Main outcomes and measures: </strong>Rotarod, forelimb suspension, and Y-maze tests assessed motor and cognitive functions. Golgi staining, immunofluorescence, Western blotting, and transmission electron microscopy evaluated dendritic spine density, neuronal survival (neuronal nuclear protein [NeuN]), synaptic proteins (synaptophysin [SY38], postsynaptic density protein 95 [PSD95]), and myelin integrity (myelin basic protein) in the motor cortex.</p><p><strong>Results: </strong>The HCP + CIMT + MT group showed greater improvement in rotarod performance than the HCP + CIMT (31.21 s [95% CI = 7.27 to 55.15]) and HCP + MT (26.59 s [95% CI = 1.50 to 51.67]) groups. Longer forelimb suspension times were observed mainly in the MT-containing groups. The HCP + CIMT + MT group showed better Y-maze performance than the HCP and single-therapy groups. Compared with these groups, the combined group showed higher expression of NeuN, SY38, PSD95, and myelin basic protein and improved myelin ultrastructure in the motor cortex.</p><p><strong>Conclusions: </strong>Combined CIMT and MT may promote the recovery of motor coordination and balance, support forelimb suspension performance, and improve spatial working memory in rats with HCP. These functional improvements were accompanied by enhanced motor cortical neuroplasticity involving neuronal survival, synaptic remodeling, dendritic spine density, and myelin integrity.</p><p><strong>Relevance: </strong>This study provides preclinical evidence on the functional and neuroplastic effects of combined CIMT and MT in HCP.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983220","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":"Biomechanical contributions to alterations in peak metabolic capacity and efficiency following locomotor training in individuals after stroke.","authors":"T George Hornby, Abbey Plawecki, Jennifer K Lotter, Emily G Lucas, Devan Parrott, Christopher E Henderson","doi":"10.1093/ptj/pzag092","DOIUrl":"10.1093/ptj/pzag092","url":null,"abstract":"<p><strong>Importance: </strong>Changes in peak metabolic capacity (Vo2peak) and gait efficiency at matched speeds (Vo2match) are often observed in individuals after stroke following locomotor training, although it is uncertain how those changes are achieved.</p><p><strong>Objective: </strong>The objective of this study was to evaluate the effects of locomotor training on changes in Vo2peak and Vo2match in individuals after stroke and their associations with changes in locomotor kinematics and kinetics.</p><p><strong>Design: </strong>This study was a secondary analysis of a randomized trial.</p><p><strong>Setting: </strong>The setting was an outpatient clinic/laboratory.</p><p><strong>Participants: </strong>Participants were individuals >6 months after stroke with self-selected walking speeds of <1.0 m/s with assistive devices and ankle-foot orthoses as needed.</p><p><strong>Interventions: </strong>Participants were randomized to receive ≤30 sessions of locomotor training at higher intensities (>70% of heart rate reserve) either in variable contexts (multiple tasks/environments) or during forward walking (treadmill/overground) or at lower intensities (<40% of heart rate reserve) in variable contexts.</p><p><strong>Main outcomes and measures: </strong>As changes in Vo2match masked gains in Vo2peak, both measures were evaluated during graded exercise tests and their difference calculated (Vo2gain), with subsequent determination of associations with changes in locomotor kinematics and kinetics. Between-group differences in changes in metabolic and biomechanical outcomes were evaluated using 1-way analyses of variance, with subsequent correlation and stepwise regression analyses.</p><p><strong>Results: </strong>Data from 45 participants with baseline and posttraining data indicated no between-group differences in changes in Vo2peak or Vo2match. However, larger changes in Vo2gain were observed following either higher-intensity paradigm, consistent with faster treadmill speeds. Correlation and regression analyses revealed limited associations with changes in Vo2peak, with greater associations between Vo2gain and selected spatiotemporal parameters, joint kinematics, and nonparetic joint powers. Conversely, changes in Vo2match were associated primarily with paretic ankle powers.</p><p><strong>Conclusions: </strong>High-intensity training resulted in significant improvements in Vo2gain, which were related to improvements in multiple biomechanical variables at higher treadmill speeds, while gains in gait efficiency were related to improved paretic limb power.</p><p><strong>Relevance: </strong>Alterations in peak metabolic capacity and efficiency are associated with distinct biomechanical changes.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888355","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":"My View of PTJ: Giving Thanks to Peer Reviewers.","authors":"Steven Z George","doi":"10.1093/ptj/pzag105","DOIUrl":"https://doi.org/10.1093/ptj/pzag105","url":null,"abstract":"","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128310","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}