Physical Therapy最新文献

{"title":"Modeling Upper Limb Rehabilitation-Induced Recovery After Stroke: The Role of Attention as a Clinical Confounder.","authors":"Silvia Salvalaggio, Simone Gambazza, Martina Andò, Ilaria Parrotta, Francesca Burgio, Laura Danesin, Pierpaolo Busan, Sara Zago, Dante Mantini, Daniela D'Imperio, Marco Zorzi, Nicola Filippini, Andrea Turolla","doi":"10.1093/ptj/pzae148","DOIUrl":"10.1093/ptj/pzae148","url":null,"abstract":"<p><strong>Objective: </strong>People who have survived stroke may have motor and cognitive impairments. High dose of motor rehabilitation was found to provide clinically relevant improvement to upper limb (UL) motor function. Besides, mounting evidence suggests that clinical, neural, and neurophysiological features are associated with spontaneous recovery. However, the association between these features and rehabilitation-induced, rather than spontaneous, recovery has never been fully investigated. The objective was to explore the association between rehabilitation dose and UL motor outcome after stroke, as well as to identify which variables can be considered potential candidate predictors of motor recovery.</p><p><strong>Methods: </strong>People who survived stroke were assessed before and after a period of rehabilitation using motor, cognitive, neuroanatomical, and neurophysiological measures. We investigated the association between dose of rehabilitation and UL response (ie, Fugl-Meyer Assessment for upper extremity [FMA-UE]), using ordinary least squares regression as the primary analysis. To obtain unbiased estimates, adjusting covariates were selected using a directed acyclic graph.</p><p><strong>Results: </strong>Baseline FMA-UE was the only factor associated with motor recovery (b = 0.99; 95% CI = 0.83 to 1.15 points). Attention emerged as a confounder of the association between rehabilitation and final FMA-UE (b = 5.5; 95% CI = -0.8 to 11.9 points), influencing both rehabilitation and UL response.</p><p><strong>Conclusion: </strong>Preserved attention in people who have survived stroke might lead to greater UL motor recovery, albeit estimates have high levels of variability. Moreover, the increase in the dose of rehabilitation can lead to 5.5 points improvement on the FMA-UE, a nonsignificant but potentially meaningful finding. The approach described here discloses a new framework for investigating the effect of rehabilitation treatment as a potential driver of recovery.</p><p><strong>Impact: </strong>Attentional resources could play a key role in UL motor recovery. There is a potential association between amount of UL recovery and dose of rehabilitation delivered, needing further exploration. Preserved attention and rehabilitation dose are candidate predictors of UL motor recovery.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392470","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":"Sitting Together and Reaching to Play Physical Therapy Affects Dyadic Emotional Availability in Children With Neuromotor Delay and Their Families.","authors":"Rebecca M Molinini, Corri Stuyvenburg, Natalie A Koziol, Regina T Harbourne, Lin-Ya Hsu, Michele A Lobo, Sandra L Willett, James A Bovaird, Virginia W Chu, Sarah K Price, Mary S Shall, Stacey C Dusing","doi":"10.1093/ptj/pzae167","DOIUrl":"10.1093/ptj/pzae167","url":null,"abstract":"<p><strong>Objective: </strong>Emotional availability (EA) describes caregiver-child emotional attunement and is critical to fostering adaptive development. Although early physical therapist interventions adopt a family centered approach, the impact of interventions on families is often not quantified. This study compares EA in dyads receiving usual care-early intervention (UC-EI) versus sitting together and reaching to play (START-Play) in addition to UC-EI.</p><p><strong>Methods: </strong>Data were drawn from 106 children with neuromotor delay who were 7 to 16 months old at baseline (mean = 10.5 months) and from their caregiver (91% were mothers). The EA Scale, Fourth Edition, was scored from 5-min videotaped interactions collected at baseline and at 3, 6, and 12 months after baseline. Piecewise multilevel modeling controlling for baseline age and motor delay estimated short- and long-term effects between treatment groups. Additionally, within-group change over time was analyzed to understand if groups differed in direction of EA trajectories. Analyses were run aggregated across all participants and stratified by baseline severity of motor delay or caregiver reported education.</p><p><strong>Results: </strong>When comparing EA between groups, there were significant positive short- and long-term effects of START-Play on adult EA (gs > 0.38), sensitivity (gs > 0.26), structuring (gs > 0.43), and nonintrusiveness (gs > 0.36). For dyads with mild or significant motor delay or whose parent reported less than a bachelor's degree at baseline, positive effects of START-Play were observed.</p><p><strong>Conclusion: </strong>Results support important clinical implications for the positive effect of START-Play on EA. Similar child-level treatment effects highlight that the key difference between START-Play and UC-EI may lie in the way intervention affects caregivers. START-Play may be more beneficial to dyads with higher versus lower risks to EA.</p><p><strong>Impact: </strong>Early physical therapist interventions can have a significant impact on parents, children, and the parent-child relationship. Measuring the effect of these interventions on the relationship is critical to optimizing the delivery of family centered care.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441463","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":"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}

{"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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962593/pdf/","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":"OA","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":"Go With the Flow? Considerations for Blood Flow Restriction Training in People With Neurologic Conditions.","authors":"Mark M Mañago, Zachary Dunkle, Evan T Cohen, Michael Bade","doi":"10.1093/ptj/pzae159","DOIUrl":"10.1093/ptj/pzae159","url":null,"abstract":"<p><p>Blood flow restriction training (BFRT) with low intensity resistance or aerobic exercise can improve muscle strength and aerobic capacity, respectively. Furthermore, low intensity BFRT with resistance or aerobic exercise can be as effective as training at higher intensities without BFR in healthy adult populations. The clinical use of BFRT is therefore becoming increasingly common, particularly in otherwise healthy adults recovering from musculoskeletal injury or orthopedic surgery, for whom training at high intensities is not indicated. People with neurologic conditions may also benefit from training at lower intensities, as many individuals with neurologic conditions may not tolerate higher intensities for a variety of reasons, including advanced mobility restrictions, extreme weakness, severe fatigue, and/or pain. Indeed, more and more rehabilitation clinicians are beginning to use BFRT with their patients who have neurologic conditions even though there is very little evidence to support its safety, feasibility, or efficacy in those populations. In this perspective, we propose that BFRT can be an important alternative to conventional exercise training approaches for some individuals with neurologic conditions, and in the right circumstances can be delivered both safely and effectively. This perspective will also provide considerations and decision-making strategies that can help inform clinical decisions for rehabilitation practitioners considering the use of BFRT in their patients with neurologic conditions.</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":"142626225","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":"\"It's Just Really Important for Us All to Be on the Same Page\": Qualitative Evaluation of Factors That Influence Written Mobility Communication.","authors":"Sally Yin, Prue McRae, Julie Adsett, Alison Mudge","doi":"10.1093/ptj/pzae158","DOIUrl":"10.1093/ptj/pzae158","url":null,"abstract":"<p><strong>Objective: </strong>Poor interdisciplinary team communication is a known barrier to increasing inpatient mobility. Understanding why and how clinicians from different disciplines communicate about mobility would help inform communication improvements. This qualitative interview study aimed to describe and explore clinician perceptions about written mobility communication and perceived barriers and enablers to this communication.</p><p><strong>Methods: </strong>A rapid deductive qualitative approach was used to efficiently capture information for local improvement. Clinicians (physical therapists, nurses, physicians, and occupational therapists) working on 3 internal medicine wards in a metropolitan teaching hospital in Brisbane, Australia were purposefully sampled and invited to participate in individual interviews. Questions were based on the Consolidated Framework for Implementation Research. Interviews were recorded, transcribed, and analyzed using deductive and inductive thematic methods.</p><p><strong>Results: </strong>From 17 interviews, key themes identified that written communication about patient mobility is important and valued by clinicians; clinicians learn documentation on the job, often from physical therapists; clinicians are not aware of organizational responsibility for mobility communication; multiple purposes for written communication contribute to multiple locations and inconsistency; and clinicians perceive that improvement would require a multidisciplinary and multilevel approach. Suggestions for improvement included the use of a common language, consistent use of existing bedside communication tools, and clearer responsibility for written communication about mobility.</p><p><strong>Conclusion: </strong>Written communication about patient mobility was valued by clinicians, and a range of barriers to effective interdisciplinary communication was identified. Clear professional roles and responsibility for written mobility communication are important. Suggestions for improvement included an interdisciplinary language supported by multidisciplinary education and organizational governance.</p><p><strong>Impact: </strong>Written communication about patient mobility is recognized as critical to safe, high-quality hospital care. Our findings suggest that successful mobility communication improvements must involve multiple disciplines and include clear organizational governance to support staff training, clear role responsibilities, and quality monitoring.</p><p><strong>Lay summary: </strong>This study found that staff on a medical ward think writing about mobility is important for patient and staff safety. Having clear roles and responsibilities for writing about mobility is important and consistency may be improved through education and training.</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":"142591307","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 Effects of Ankle and Foot Exercises on Ankle Strength, Balance, and Falls in Older People: A Systematic Review and Meta-Analysis.","authors":"Sam Guoshi Liang, Joman Chung Man Chow, Nga Ming Leung, Yee Nok Mo, Thomas Ming Hin Ng, Christy Lok Ching Woo, Freddy Man Hin Lam","doi":"10.1093/ptj/pzae157","DOIUrl":"10.1093/ptj/pzae157","url":null,"abstract":"<p><strong>Objective: </strong>Ankle-foot control is essential to maintain balance and gait stability. However, there has been limited evidence on the effect of ankle-foot exercises on balance and falls in older people. This study aimed to summarize the effects of ankle-foot exercises on ankle flexibility and strength, balance, mobility, and falls in older people and to identify determining factors for ankle-foot exercises to improve balance and mobility.</p><p><strong>Methods: </strong>Cumulative Index to Nursing and Allied Health Literature, Embase, PubMed, and Physiotherapy Evidence Database (PEDro) were searched to identify randomized controlled trials that studied the effects of ankle-foot exercises on ankle control, balance, and falls in older people. The PEDro scale was used to evaluate the methodological quality of the studies. Meta-analyses were done for similar outcomes. The quality of evidence was rated by GRADE.</p><p><strong>Results: </strong>Sixteen papers (n = 651) were included. Meta-analyses showed that ankle-foot exercises significantly improved ankle plantarflexion strength (SMD = 0.35, 95% CI = 0.04 to 0.65, low-quality evidence), ankle flexibility (SMD = 0.48, 95% CI = -0.01 to 0.96, low-quality evidence), and balance in an eyes-open condition (SMD = 0.41, 95% CI = 0.19 to 0.70, low-quality evidence). There was no significant change in ankle dorsiflexion strength (SMD = 0.29, 95% CI = -0.24 to 0.82, very low-quality evidence), balance under eyes-closed condition (SMD = 0.41, 95% CI = -0.1 to 0.92, very low-quality evidence), and gait speed (SMD = 0.36, 95% CI = -0.24 to 0.96, very low-quality evidence). Two studies reported insignificant findings on fear of falling, fall incidence, and risk of falls.</p><p><strong>Conclusions: </strong>Very low- to low-quality evidence showed that ankle-foot exercises effectively improve ankle plantarflexion strength, flexibility, and balance with eyes open, whereas no effect on falls was found. Improvements in balance and gait tend to be associated with improvements in ankle strength and flexibility. Toe-strengthening exercise and training 3 times per week appear to be important for improving balance.</p><p><strong>Impact: </strong>This review suggested that ankle-foot exercises might improve balance in older people. Determining factors leading to improvement in balance and mobility were identified. It paves the ground for further research to study the effect of ankle-foot exercises on fall prevention.</p><p><strong>Lay summary: </strong>Ankle and foot exercises appear to be effective in improving ankle plantarflexion strength, flexibility, and balance performance in an eye-open condition. If you are an older adult who wants to improve your balance, your physical therapist may prescribe ankle and foot exercises as a supplemental component in a fall prevention program due to the observed improvements in balance and the safety and ease of the exercise.</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":"142829701","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":"Theory-Informed Development of a Multicomponent Intervention to Implement Clinical Practice Guideline Recommendations in the Management of Shoulder Pain.","authors":"Véronique Lowry, François Desmeules, Patrick Lavigne, Simon Décary, Yannick Tousignant-Laflamme, Marylie Martel, Jean-Sébastien Roy, Kadija Perreault, Marie-Claude Lefebvre, Kelley Kilpatrick, Anne Hudon, Diana Zidarov","doi":"10.1093/ptj/pzae160","DOIUrl":"10.1093/ptj/pzae160","url":null,"abstract":"<p><strong>Objective: </strong>Suboptimal primary health care management of shoulder pain has been reported in previous studies. Implementing clinical practice guidelines (CPGs) recommendations using a theoretical approach is recommended to improve shoulder pain management. This study aims to identify determinants of implementing recommendations from shoulder CPGs to help develop an intervention based on the identified determinants.</p><p><strong>Methods: </strong>Family physicians and physical therapists managing patients with shoulder pain in primary care were invited to participate in a qualitative study to identify determinants to implementing recommendations from shoulder CPGs. The Theoretical Domains Framework (TDF) was used to inform the creation of the semi-structured interview guide and for deductive coding of transcriptions. The determinants were mapped to intervention functions and behavior change techniques (BCT) using the Behavior Change Wheel method and strategies for implementing CPGs recommendations were identified.</p><p><strong>Results: </strong>Interviews were conducted with 16 family physicians and 19 physical therapists. We identified 12 barriers and 6 facilitators within 7 TDF domains: knowledge, skills, beliefs about capabilities, beliefs about consequences, intentions, environmental context and resources, and social influence. We identified 6 intervention functions and 12 BCT addressing the relevant determinants. The 11 implementation strategies identified include the development and distribution of educational material, interactive educational outreach visits, and audit and feedback. Other components to consider are the identification and preparation of champions in primary care clinical settings, revision of professional roles, and creation of interdisciplinary clinical teams.</p><p><strong>Conclusions: </strong>The identification of barriers and facilitators to implementing recommendations from shoulder CPGs allowed us to select implementation strategies at individual and organizational levels.</p><p><strong>Impact: </strong>The implementation strategies will be adapted to specific primary care contexts in consultation with stakeholders and operationalized into a multicomponent implementation intervention. Implementing the intervention has the potential to improve shoulder pain management in primary care and facilitate the use of evidence-based recommendations from CPGs.</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":"142818956","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":"Functional Recovery of Adults Following Acute COVID-19: A Systematic Review and Meta-Analysis.","authors":"Sophie Middleton, Christos V Chalitsios, Tanvi Mungale, Zeinab M Hassanein, Alex R Jenkins, Charlotte E Bolton, Tricia M McKeever","doi":"10.1093/ptj/pzae023","DOIUrl":"10.1093/ptj/pzae023","url":null,"abstract":"<p><strong>Objective: </strong>This systematic review and meta-analysis aimed to investigate the objective, functional recovery of patients more than 3 months after acute coronavirus disease 2019 (COVID-19) infection.</p><p><strong>Methods: </strong>Comprehensive database searches of EMBASE, PubMed/MEDLINE, Cochrane COVID-19 Study Register, CINAHL, and Google Scholar in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement were carried out until October 19, 2022. Data were extracted and agreed in duplicate. Data were narratively synthesized, and a series of meta-analyses were performed using the random-effects inverse variance method.</p><p><strong>Results: </strong>One-hundred six papers covering 20,063 patients, who were either hospitalized or not hospitalized with acute COVID-19 and were followed-up between 3 and 24 months, were included. Percentage predicted 6-minute walk distance at 3 months to <5 months was 84.3% (95% CI = 79.2-89.3; n = 21; I2 = 98.3%) and 92.5% (95% CI = 89.8-95.3; n = 9; I2 = 94.5%) at ≥11 months. Cardiopulmonary exercise testing revealed the percentage predicted peak oxygen consumption rate ($peakdot{mathsf{V}}{mathsf{o}}_{mathsf{2}}$) at 3 months to <5 months was 77.3% (95% CI = 71.0-83.7; n = 6; I2 = 92.3%) and 95.4% (95% CI = 87.1-103.6; n = 2; I2 = 77.3%) at ≥11 months. Mean handgrip strength was greatest at ≥11 months at 31.16 kg (95% CI = 19.89-42.43; n = 2; I2 = 98.3%) of all time points. All analyses showed marked heterogeneity.</p><p><strong>Conclusion: </strong>Patients have reduced physical function more than 3 months after COVID-19 infection. Better physical function in multiple physical domains is found after a longer recovery time.</p><p><strong>Impact: </strong>Physical function as measured by the 6-minute walk test, hand grip strength, and cardiopulmonary exercise testing is reduced at 3 months after COVID-19 infection and can remain over 11 months of follow-up. This protracted recovery following acute COVID-19 infection supports the need to assess physical function at any clinical follow-up, and further research into rehabilitation programs and intervention for patients who have not recovered.</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/PMC11738174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139932407","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}