Physical Therapy最新文献

{"title":"Gait Speed Modifies Efficacy of Home-Based Exercise for Falls in Older Adults with a Previous Fall: Secondary Analysis of a Randomized Controlled Trial.","authors":"Jordyn Rice, Ryan S Falck, Jennifer C Davis, Chun Liang Hsu, Larry Dian, Kenneth Madden, Naaz Parmar, Wendy L Cook, Karim M Khan, Teresa Liu-Ambrose","doi":"10.1093/ptj/pzaf008","DOIUrl":"https://doi.org/10.1093/ptj/pzaf008","url":null,"abstract":"<p><strong>Objective: </strong>Exercise is an evidence-based strategy for preventing falls. However, its efficacy may vary based on individual characteristics, like gait speed. The study examined whether baseline gait speed modified the effects of home-based exercise on subsequent falls among older adults.</p><p><strong>Methods: </strong>This is a secondary analysis of a 12-month, randomized controlled trial in community-dwelling adults who were ≥ 70 years old and who had fallen within the previous 12 months. Participants were randomized to either 12 months of home-based exercise (n = 172) or standard of care (n = 172). This study examined intervention effects on fall rates at 6 and 12 months stratified by baseline gait speed (slow [<0.80 m/s] or normal [≥0.80 m/s]) using negative binomial regressions. Baseline gait speed was investigated as a potential modifier of the intervention effects on mobility and cognitive function using linear mixed modeling.</p><p><strong>Results: </strong>At baseline, 134 participants had slow (exercise = 70; standard of care = 64) and 210 had normal (exercise = 102; standard of care = 108) gait speeds. For participants with slow gait speed, exercise reduced fall rates by 44% at 6 months (incidence rate ratio = 0.56; 95% CI = 0.33 to 0.95) but not at 12 months (incidence rate ratio = 0.63; 95% CI = 0.38 to 1.03) compared with standard of care; for participants with normal gait speed, there was no significant effect of exercise on fall rates at 6 or 12 months. Gait speed modified intervention effects; in the exercise group, participants with slow gait showed significant improvements in the Timed \"Up & Go\" Test at 6 months (estimated mean difference = -4.05; 95% CI = -6.82 to -1.27) and the Digit Symbol Substitution Test at 12 months (estimated mean difference = 2.51; 95% CI = 0.81 to 4.21).</p><p><strong>Conclusion: </strong>Older adults with slow gait speed had a reduction in subsequent falls in response to exercise at 6 months. Gait speed modified the effects of exercise on mobility and cognition.</p><p><strong>Impact: </strong>Older adults with slow gait speed may be a target population for exercise-based fall prevention.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067299","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":"Effectiveness of Additional or Standalone Corticosteroid Injections Compared to Physical Therapist Interventions in Rotator Cuff Tendinopathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Stefano Giuseppe Lazzarini, Riccardo Buraschi, Joel Pollet, Francesco Bettariga, Simone Pancera, Paolo Pedersini","doi":"10.1093/ptj/pzaf006","DOIUrl":"https://doi.org/10.1093/ptj/pzaf006","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Rotator cuff tendinopathy represents the most prevalent cause of shoulder pain, the third most common musculoskeletal disorder after low back pain and knee pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The objective of this study was to determine the effectiveness of corticosteroid injection(s), alone or in combination with anesthetic injection or any other physical therapist interventions, compared to physical therapist interventions alone in adults with rotator cuff tendinopathy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;This study was a systematic review and meta-analysis of randomized controlled trials. PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, Web of Science, and Physiotherapy Evidence Database (PEDro) were searched from inception to March 2023. Meta-analysis using a random-effects model was performed. Risk of bias and certainty of the evidence for the primary outcomes were assessed using the Cochrane risk-of-bias tool and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, respectively. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42021240882).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;Participants were adults with rotator cuff tendinopathy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;Corticosteroid injection(s), alone or in combination with anesthetic injection or with any other physical therapist interventions, was compared to physical therapist interventions alone.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes: &lt;/strong&gt;Pain, function, quality of life, patient-rated overall improvement, and adverse events were the main outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Fifteen randomized controlled trials (1785 participants) met the inclusion criteria. At short term, corticosteroid injection coupled with physical therapist interventions and compared to the same interventions alone might have resulted in some small to moderate improvements in pain and function. Conversely, corticosteroid injection alone seemed not to be more effective than physical therapist interventions in improving pain and function in most of the studies included. At mid- and long-term follow-up assessments corticosteroid injection seemed not to be more effective than any physical therapist interventions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study highlights the potential effectiveness of corticosteroid injection(s) in rotator cuff tendinopathy for pain and function at short term at best, especially in combination with physical therapist interventions. However, the evidence is of moderate to mostly very low certainty. Additional high-quality research considering core outcomes is therefore needed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Relevance: &lt;/strong&gt;Corticosteroid injection(s) seems not to be superior to physical therapist interventions, other than resulting in some transient improvements at short term i","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009945","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":"Association between Physical Therapists' Attitudes and Beliefs and the Functional Outcomes of Patients with Low Back Pain: A Multilevel Analysis Study.","authors":"Yaniv Nudelman, Tamar Pincus, Noa Ben Ami","doi":"10.1093/ptj/pzaf007","DOIUrl":"https://doi.org/10.1093/ptj/pzaf007","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the association of physical therapists' attitudes and beliefs about low back pain treatment outcomes within a publicly funded health care system.</p><p><strong>Methods: </strong>Data from a national outpatient physical therapist service provider were analyzed. Functional status data were collected at intake and discharge. The Attitudes to Back Pain Scale in Musculoskeletal Practitioners Questionnaire was used to assess physical therapists' attitudes. Multilevel regression models were employed to examine the effects of physical therapists' attitudes while controlling for patient and physical therapist characteristics.</p><p><strong>Results: </strong>The study included 68 physical therapists and 1043 patients. The physical therapist level explained a small portion of the variance in patients' function (2%-4%). A more biomedically oriented attitude was associated with a slightly lower patient function level (β = -.08), but patient characteristics largely influenced this effect. Other attitude factors were not significantly associated with function. Sensitivity analyses aligned with the main findings.</p><p><strong>Conclusions: </strong>The study suggests that physical therapists' attitudes have a limited impact on low back pain treatment outcomes within a publicly funded health care system. While a more biomedically oriented attitude was associated with slight negative effects, the clinical relevance is questionable. Further research in diverse settings is needed to validate and contextualize these findings. The study underscores the importance of considering patient-level factors and health care system context in interpreting practitioner effects on treatment outcomes.</p><p><strong>Impact: </strong>Patient characteristics are more significant in explaining functional outcomes than physical therapists' characteristics and attitudes. A marginally small association was observed, indicating that a more biomedically oriented attitude among physical therapists was linked to slightly lower patient functioning. Despite the observed association, the clinical relevance of physical therapists' attitudes in low back pain treatment outcomes remains modest.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009944","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":"Monitoring Treatment Fidelity in a Pragmatic Pediatric Rehabilitation Trial Comparing Two Physical Therapy Schedules: Analysis and Unexpected Findings.","authors":"Elizabeth Maus, Kimberley Scott, Rachel Ferrante, Sandy Antoszewski, Jill Heathcock","doi":"10.1093/ptj/pzaf004","DOIUrl":"https://doi.org/10.1093/ptj/pzaf004","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to describe the monitoring of treatment fidelity in a pragmatic pediatric rehabilitation trial using the National Institutes of Health Behavior Change Consortium framework, and to identify child and therapist factors that influence treatment fidelity.</p><p><strong>Methods: </strong>Therapists (n = 28) were trained in the key ingredients (1-on-1, functional, goal-directed, motor learning intervention) and study protocol for a comparative effectiveness trial titled: A Comparison: High Intensity periodic vs. Every week therapy in children with cerebral palsy (ACHIEVE) for children ages 2 to 8 years with cerebral palsy. Therapists were instructed to record every tenth hour of treatment. A subset of recordings were used to monitor treatment fidelity so that each therapist was rated twice using the study- specific ACHIEVE Treatment Fidelity Checklist. Generalized linear mixed effects modeling and logistic regression were used to analyze child and therapist factors related to treatment fidelity.</p><p><strong>Results: </strong>Median treatment fidelity scores were high (>80%). With training, therapist's years of experience and specialty certification do not significantly impact treatment fidelity. There is a trend toward lower treatment fidelity scores for children with communication difficulties, particularly for therapist's use of multi-modal instructions to direct the child in the desired activity.</p><p><strong>Conclusion: </strong>Functional, goal-directed, motor learning intervention can be delivered with high fidelity for children with cerebral palsy within a busy clinical setting. Motor learning principles may be implemented differently for children with communication difficulties. More research is needed to explore optimal motor learning strategies for these children.</p><p><strong>Impact: </strong>With training, physical therapists can deliver high-fidelity intervention to children with cerebral palsy across all Gross Motor Function Classification System levels within a busy clinical setting. Therapists may use motor learning principles differently in children with communication delays.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009946","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":"Taking the Next Step in Neurologic Rehabilitation: Contributions of Intensity and Variability of Stepping Tasks during Locomotor Training.","authors":"T George Hornby, Jennifer Moore, Carey L Holleran, Christopher E Henderson","doi":"10.1093/ptj/pzaf005","DOIUrl":"https://doi.org/10.1093/ptj/pzaf005","url":null,"abstract":"<p><p>Research over the past 20 years indicates the amount of task-specific walking practice provided to individuals with stroke, brain injury, or incomplete spinal cord injury can strongly influence walking recovery. However, more recent data suggest that attention towards 2 other training parameters, including the intensity and variability of walking practice, may maximize walking recovery and facilitate gains in non-walking outcomes. The combination of these training parameters represents a stark contrast from traditional strategies, and confusion regarding the potential benefits and perceived risks may limit their implementation in clinical practice. The purpose of this perspective is to delineate the evidence regarding the contributions of intensity and variability of locomotor training to improve mobility outcomes in individuals with acute-onset brain and spinal cord injury. The rationale and evidence supporting the utility of these training parameters in controlled laboratory settings is first described by integrating concepts in the field of neuroscience, motor learning, biomechanics, and exercise physiology into a rehabilitation intervention. Subsequently, the evidence supporting the efficacy of this paradigm is addressed, including discussions of some of the misconceptions regarding perceived negative consequences of these strategies in an effort to mitigate common clinical concerns. Finally, the utility of these strategies implemented during inpatient rehabilitation is delineated to facilitate a more comprehensive understanding of the feasibility and potential benefits early following neurologic injury. A greater understanding of how and why to integrate higher intensity, variable stepping practice will support therapists to take the next step to maximize mobility in the patients they serve.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009947","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":"Musculoskeletal Pain as a Risk Factor for Poor Dizziness Outcomes: A Longitudinal Study among Patients With Persistent Vestibular Dizziness.","authors":"Unni Moen, Roy Miodini Nilsen, Mari Kalland Knapstad, Kjersti Thulin Wilhelmsen, Stein Helge Glad Nordahl, Frederik Kragerud Goplen, Dara Meldrum, Liv Heide Magnussen","doi":"10.1093/ptj/pzaf001","DOIUrl":"https://doi.org/10.1093/ptj/pzaf001","url":null,"abstract":"<p><strong>Objective: </strong>Musculoskeletal pain and psychological distress are prevalent comorbidities in patients with persistent dizziness. Little is known about how comorbid pain influences the outcome of persistent dizziness. This study examined the impact of pain on dizziness outcomes and the potential modifying role of psychological distress.</p><p><strong>Methods: </strong>Longitudinal study of 150 patients with persistent dizziness. Vertigo Symptom Scale short form (VSS-SF), Dizziness Handicap Inventory (DHI), number of pain sites, pain intensity, and Hospital Anxiety and Depression Scale (HADS) were assessed at baseline, 6 months and 12 months. Linear mixed effects model for longitudinal data was used to explore the association between musculoskeletal pain and dizziness. Interaction analysis was used to assess whether psychological distress had a modifying effect on the association between pain and dizziness.</p><p><strong>Results: </strong>VSS-SF and DHI decreased during follow-up but not to a clinically relevant level for the patients. Patients reporting comorbid psychological distress reported higher scores on VSS-SF, DHI, more pain sites and higher pain intensity. A positive association was observed between the number of pain sites and VSS-SF and between pain intensity and VSS-SF, and these associations were stronger in patients reporting psychological distress. Similar associations were found for DHI. Patients reporting ≥4 pain sites or pain intensity of ≥4 out of 10 at baseline, still reported severe dizziness and moderate disability 12 months later.</p><p><strong>Conclusion: </strong>Musculoskeletal pain is a risk factor for poor dizziness outcomes, especially when comorbid psychological distress is present. Clinicians should be attentive to musculoskeletal pain when the number of pain sites exceeds 4 or pain intensity exceeds 4 on a numeric rating scale.</p><p><strong>Impact: </strong>A new understanding of the impact of musculoskeletal pain on persistent dizziness could be the key to successful recovery and the prevention of prolonged issues.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971843","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":"Recommendations For Mobilization and Manipulation Treatment and Screening for Vascular Complications in Clinical Practice Guidelines for Neck Pain: A Systematic Review.","authors":"Renske Peters, Joannes Hallegraeff, Bart Koes, Emiel Van Trijffel","doi":"10.1093/ptj/pzae179","DOIUrl":"https://doi.org/10.1093/ptj/pzae179","url":null,"abstract":"<p><strong>Objective: </strong>This systematic review aimed to determine the methodological quality of international clinical practice guidelines and the clinical credibility and implementability of recommendations regarding manipulation or mobilization treatment recommendations proposed in clinical practice guidelines for the management of people with neck pain. A secondary aim of this review was to provide an overview of recommendations for manipulation or mobilization in patients with neck pain. Manipulation or mobilization treatment of patients with neck pain is under debate for its potential risk of serious adverse events. Serious adverse events are rare, but it is the clinicians' responsibility to thoroughly screen patients at risk of vascular complications. A third aim of this review was to describe the extent to which the included guidelines inform clinical practice about screening for the risk of complications due to vascular pathology in the cervical spine.</p><p><strong>Methods: </strong>A systematic review of 13 electronic databases and 4 repositories was performed for potentially relevant guidelines published between January 1, 2000 and September 22, 2022. Two reviewers independently appraised eligible guidelines using Appraisal of Guidelines for Research and Evaluation II (AGREE II) and Appraisal of Guidelines for Research and Evaluation: Recommendation EXcellence (AGREE-REX) criteria. A best evidence synthesis was performed and screening of risk factors was assessed.</p><p><strong>Results: </strong>A total of 19 clinical practice guidelines were included, of which 5 were of high quality. All high-quality guidelines recommend the use of manipulation or mobilization, with or without exercise. Eight (42%) guidelines described the screening of risk factors for adverse events. Two (11%) guidelines met the a priori defined criteria for screening and scored present and complete.</p><p><strong>Conclusion: </strong>International clinical practice guidelines consistently recommend the use of manipulations and mobilizations in the treatment of neck pain. There is a notable absence of recommendations regarding the identification of patients at risk for vascular complications.</p><p><strong>Impact: </strong>The findings of this study allow guideline developers to improve the quality of future neck pain guidelines, and to consider including vascular screening tools. Furthermore, it proposes recommendations to physical therapists interested in applying manipulations and mobilizations in the treatment of patients with neck pain.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952994","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":"Lower Extremity Osseointegration Postoperative Rehabilitation Protocols: A Scoping Review.","authors":"Matan Grunfeld, Taylor J Reif, S Robert Rozbruch, Jason S Hoellwarth","doi":"10.1093/ptj/pzae139","DOIUrl":"10.1093/ptj/pzae139","url":null,"abstract":"<p><strong>Objective: </strong>Lower-extremity transcutaneous osseointegration is a rehabilitation alternative to socket-suspended prostheses. The rehabilitation process, philosophies, and routines remain under-described. This review, primarily, identifies commonalities and differences among protocols. Secondarily, strategies are proposed to streamline future research of post-osseointegration surgery rehabilitation.</p><p><strong>Methods: </strong>Two differently-phrased queries of Google Scholar, Pubmed, Embase, and Web of Science were performed. First using either \"osseointegration\" or \"osseointegrated\" or \"bone anchored prosthesis\" AND [last name]. Second, replacing author name with \"physical therapy\" or \"rehabilitation\". Six hundred eighty-eight articles were identified describing lower-extremity rehabilitation following osseointegration. Following software-based deduplication, manual abstract and full-text review, article reference evaluation, and use of Google Scholar's \"Cited by\" feature, 35 studies were fully analyzed. First, a consolidated summary was made of protocols focusing on stages, timing, and other descriptions of postoperative rehabilitation. Subsequently, strengths and limitations of protocols were considered to propose potential strategies to investigate and optimize postoperative rehabilitation.</p><p><strong>Results: </strong>All articles describe rehabilitation having this same order of goal progression: from surgery to gradual weight bearing and final goal of independent ambulation. The most impactful difference influencing the stated final goal of independent ambulation was whether one or two surgical stages were performed. No articles reported patient success rate achieving proposed goals and timing, or challenges during rehabilitation. Therefore, the first research suggestion is to investigate actual success rates achieving proposed goals and timing. Second, to further explore rehabilitation of performance deficits, beyond unaided ambulation. Finally, to incorporate technology such as mobility trackers to more objectively understand prosthesis use and mobility.</p><p><strong>Conclusion: </strong>All lower-extremity osseointegration rehabilitation literature recommends identical goal progression order. No studies evaluate patient challenges or variation. Understanding and addressing such challenges may enhance postoperative rehabilitation.</p><p><strong>Impact: </strong>This article consolidates published rehabilitation protocols post-osseointegration surgery. Specific analysis and experimentation of the protocols may enhance the uniformity and potential of patient rehabilitation.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392469","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":"Diabetic Foot Ulcer Beyond Wound Closure: Clinical Practice Guideline.","authors":"Deborah M Wendland, Elizabeth A Altenburger, Shelley B Swen, Jaimee D Haan","doi":"10.1093/ptj/pzae171","DOIUrl":"10.1093/ptj/pzae171","url":null,"abstract":"<p><p>A total of 37.3 million Americans have diabetes, and 96 million more have prediabetes. Hyperglycemia, the hallmark of diabetes, increases the risk for diabetes-related complications, including skin breakdown and cardiovascular disease. Many clinical practice guidelines exist, but there are gaps regarding the best approaches to assess physical fitness and mobility in adults with diabetes; incorporate exercise into the care plan; and reload the diabetic foot after ulcer closure has occurred to avoid ulcer reoccurrence. The purpose of this clinical practice guideline was to review and assess previously published guidelines and address gaps within the guidelines specific to the following: best screening tools/tests and interventions to prevent a future reulceration, best screening tools and interventions to assess and address mobility impairments, best tools to measure and interventions to address reduced physical fitness and activity, best approach to reloading the foot after ulceration closure and, finally, whether improvement in physical fitness will positively change quality of life and health care costs. The Guidelines Development Group performed a systematic literature search and review of the literature. A total of 701 studies were identified. Following duplicate removal and exclusion for irrelevance, 125 studies underwent full-text review, and 38 studies were included. Recommendations were developed using a software assistant created specifically for guideline recommendation development. Recommendations resulted for physical fitness and activity inclusion and measurement for adults with diabetes and with or without foot ulceration. Exercise and physical activity should be prescribed according to the physiologic response of an adult with diabetes to exercise and preferences for optimizing long-term quality of life and reduce health care costs. Reloading following diabetic foot ulcer closure should include maximal offloading, especially during the first 3 months; loading should be titrated using a footwear schedule. Further research is necessary in the areas of exercise in the wound healing process and the assessment of methods to reload a newly reepithelialized ulcer to prevent recurrence.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142688538","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":"Essential Competencies for Oncology in Physical Therapist Professional Education Programs: Results of a Mixed Methods Modified Delphi Study.","authors":"Shana E Harrington, Christopher M Wilson, Margaret E Rinehart-Ayres, Frances Westlake, Lisa VanHoose","doi":"10.1093/ptj/pzae146","DOIUrl":"10.1093/ptj/pzae146","url":null,"abstract":"<p><strong>Objective: </strong>The objective was to establish consensus-based competencies for oncology within physical therapist professional education programs in the United States.</p><p><strong>Methods: </strong>A mixed-methods approach implementing a sequential exploratory design that included 3 phases was used to establish oncology competencies for physical therapist professional education programs. Participants in each phase were physical therapists representing diverse practice settings, experience levels, and geographical regions. Student physical therapists were included in phases 2 and 3. Three online focus groups were followed by an in-person group discussion to establish cancer-related themes, domains of practice, and competencies. Participants evaluated the competencies in a 3-round modified Delphi study for relevance and clarity. Each competency required 80% consensus using a Likert scale (1 = not at all relevant/clear, 5 = extremely relevant/clear). It was not accepted if a competency did not meet the 80% threshold by the end of round 3.</p><p><strong>Results: </strong>Six domains of practice and 28 competencies were developed and evaluated. Within the 6 domains, 21 competencies were accepted: general cancer concepts (n = 4), musculoskeletal system (n = 3), neurologic system (n = 5), integumentary system (n = 2), cardiovascular and pulmonary system (n = 5), and involvement of multiple systems across the lifespan (n = 2). Along with the 21 competencies, participants also recommended 11 overarching oncology themes to incorporate into physical therapist professional education programs. Delivering cancer content using a body systems approach was recommended.</p><p><strong>Conclusion: </strong>As the number of survivors of cancer continues to grow, integration of these essential competencies within physical therapist professional education programs will improve the profession's capacity to provide quality care to meet the societal need of persons living with and beyond cancer.</p><p><strong>Impact: </strong>Academic and clinical educators should integrate these competencies to ensure that physical therapist professional education programs appropriately prepare physical therapists for providing care for persons living with and beyond cancer across the lifespan.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392468","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}