Physical Therapy最新文献

{"title":"On \"Depressive Symptoms and Physical Activity Mediate the Adverse Effect of Pain on Functional Dependence in Patients With Arthritis: Evidence From the Canadian Longitudinal Study on Aging.\" Goubran M, van Allen ZM, Bilodeau M, Boisgontier MP. Phys Ther. 2025;105(11):pzaf120. https://doi.org/10.1093/ptj/pzaf120.","authors":"Anas","doi":"10.1093/ptj/pzag023","DOIUrl":"10.1093/ptj/pzag023","url":null,"abstract":"","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147317957","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 classification of hemiparetic gait based on paretic leg extension angle and gastrocnemius muscle activity.","authors":"Yuichi Tsushima, Kazuki Fujita, Yoshitomo Saiki, Koji Hayashi, Yasutaka Kobayashi","doi":"10.1093/ptj/pzag015","DOIUrl":"10.1093/ptj/pzag015","url":null,"abstract":"<p><strong>Importance: </strong>Hemiparetic gait after stroke shows substantial individual variability, and understanding its biomechanical determinants is essential for developing targeted rehabilitation strategies.</p><p><strong>Objective: </strong>The objective of this study was to classify hemiparetic gait into subgroups based on paretic leg extension angle and gastrocnemius muscle (GM) activity during stance and to examine differences in walking ability among these subgroups.</p><p><strong>Design: </strong>This study used a cross-sectional observational design with hierarchical cluster analysis.</p><p><strong>Setting: </strong>Data were collected in a hospital rehabilitation department.</p><p><strong>Participants: </strong>Eighty-three individuals with chronic stroke who could walk independently participated.</p><p><strong>Exposure: </strong>Leg extension angle and GM activity during stance were assessed using a video-based markerless motion analysis system and surface electromyography.</p><p><strong>Measures: </strong>Spatiotemporal gait parameters, gait asymmetry, peak knee flexion angle during swing, and clinical assessments of motor paresis and spasticity were compared among the identified clusters.</p><p><strong>Results: </strong>Hierarchical cluster analysis identified 4 gait patterns based on paretic leg extension angle and gastrocnemius activity during stance: Cluster 1 (large leg extension angle with moderate gastrocnemius activity) showed walking speed comparable to Cluster 3 but with reduced knee flexion during swing; Cluster 2 (moderate leg extension angle with moderate gastrocnemius activity) demonstrated intermediate walking speed that was slower than that of Cluster 1; Cluster 3 (large leg extension angle with the greatest gastrocnemius activity) exhibited faster walking speed and the greatest peak knee flexion during swing; and Cluster 4 (small leg extension angle with reduced gastrocnemius activity) showed the slowest walking speed, significant gait asymmetry, and severe motor paresis.</p><p><strong>Conclusions: </strong>Hemiparetic gait was classified into 4 patterns based on leg extension angle and gastrocnemius activity, and these patterns were associated with differences in walking ability.</p><p><strong>Relevance: </strong>This functional classification framework may help clinicians identify key biomechanical targets and support the design of individualized rehabilitation strategies after stroke.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146213907","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":"Geographic disparities in rehabilitation provider availability and community demographics in Texas: a cross-sectional geographic information systems study.","authors":"Madeline Ratoza, Rupal M Patel, Wayne Brewer, Katy Mitchell, Julia Chevan","doi":"10.1093/ptj/pzag014","DOIUrl":"10.1093/ptj/pzag014","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Availability of rehabilitation providers is a critical component of access to care, yet little is known about how workforce supply relates to community demographic characteristics within urban and rural regions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The objective of this study was to examine geographic variability in the availability of licensed physical and occupational therapy providers in Texas and evaluate the relationship between provider supply and community-level characteristics including race and ethnicity, disability, and poverty.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;The study used a descriptive, cross-sectional observational study design.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;The setting was all 6896 census tracts across the state of Texas.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;Participants included all physical therapists, physical therapy assistants, occupational therapists, and occupational therapy assistants who held a license in 2022 and resided in Texas.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions/exposures: &lt;/strong&gt;Provider workforce supply was derived from state licensure records and linked to population-level demographic and socioeconomic data from the American Community Survey using geospatial analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The population-to-provider ratio for physical therapy and occupational therapy providers per census tract and its relationship to community demographics was the main outcome measure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 45,114 licensed physical therapy and occupational therapy providers, provider availability varied widely across Texas census tracts, with population-to-provider ratios ranging from 4 to 11,147 individuals per provider. Bivariate mapping showed that census tracts with fewer providers often overlapped with areas of higher disability prevalence, larger proportions of Hispanic or non-White residents, and higher poverty rates, particularly along southern and border regions and within parts of urban centers like southern Dallas and eastern Houston. Statistical comparisons revealed significant differences in racial composition between areas with the highest and lowest provider availability (χ26 = 1,561,831; Cramér V = 0.36) and in ethnic composition (χ2₁ = 1,012,990; Cramér V = 0.29). Differences in poverty (χ2₁ = 38,746; Cramér V = 0.06) and disability prevalence (χ2₁ = 5175.9; Cramér V = 0.02) were also significant but had smaller effect sizes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Substantial geographic variability exists in rehabilitation provider supply across census tracts in Texas, with lower availability in areas where populations may have higher needs. These findings highlight opportunities for workforce planning and targeted resource allocation to improve access to rehabilitation services in underserved regions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Relevance: &lt;/strong&gt;Understanding provider shortages at the census tract level combined with specific community demographics can inform ","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202496","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":"News From the Foundation for Physical Therapy Research, March 2026.","authors":"","doi":"10.1093/ptj/pzag022","DOIUrl":"https://doi.org/10.1093/ptj/pzag022","url":null,"abstract":"","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":"106 3","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147469063","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":"In Memoriam.","authors":"","doi":"10.1093/ptj/pzag024","DOIUrl":"https://doi.org/10.1093/ptj/pzag024","url":null,"abstract":"","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":"106 3","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147513108","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":"Psychological mediators in chronic spinal pain after fully remote digital rehabilitation: a real-world, large-sample study.","authors":"Dora Janela, Xin Tong, Diogo Pires, Hélder Fonseca, Fabíola Costa","doi":"10.1093/ptj/pzag010","DOIUrl":"10.1093/ptj/pzag010","url":null,"abstract":"<p><strong>Importance: </strong>Psychological factors are associated with chronic spinal pain, yet their mediating role in postrehabilitation recovery remains poorly understood, particularly in fully remote digital care. Most research has focused on baseline predictors, with few studies evaluating psychological mediators and moderators.</p><p><strong>Objective: </strong>The objective of this study was to investigate whether changes in fear avoidance beliefs, depression, and anxiety mediate pain outcome following a digital care program (DCP) for chronic spinal conditions and whether these effects vary by Body Mass Index (BMI), self-reported gender, and socioeconomic status.</p><p><strong>Design: </strong>This was an ad hoc analysis of a real-world registry of patients undergoing a DCP.</p><p><strong>Setting: </strong>The setting was a fully remote DCP delivered across the United States.</p><p><strong>Participants: </strong>The participants were adults who had chronic spinal musculoskeletal pain (N = 14,818) and who accessed the DCP via employer-sponsored health plans.</p><p><strong>Intervention: </strong>The DCP consisted of exercise, education, and behavior change, managed asynchronously by physical therapists.</p><p><strong>Main outcomes and measures: </strong>The final pain score (11-point numeric pain rating scale) was the primary outcome. Candidate mediators were changes in fear avoidance beliefs, depression, and anxiety. Confounding was mitigated through demographic and clinical covariates. Moderation was tested for BMI, self-reported gender, and socioeconomic deprivation. Structural equation modeling was used.</p><p><strong>Results: </strong>Improvements in fear avoidance beliefs (β = -0.10, SE = 0.00), depression (β = -0.05, SE = 0.01), and anxiety (β = -0.04, SE = 0.01) significantly mediated lower final pain scores after adjustment for confounding. The mediating effect of fear avoidance was especially pronounced among patients with severe obesity. Self-reported gender and socioeconomic status did not show moderating effects. The model's explained variance was 30%.</p><p><strong>Conclusions and relevance: </strong>Changes in fear avoidance beliefs, depression, and anxiety play a central role in pain recovery following digital rehabilitation. Fear avoidance mediation was particularly strong in individuals with severe obesity, highlighting the need for targeted psychological support in this subgroup. The findings emphasize the pertinence of systematically screening, monitoring, and addressing psychological factors in remote care, contributing to understanding how digital rehabilitation promotes recovery.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13016882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146106753","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":"Addressing loneliness through movement and connection in physical therapy practice.","authors":"Davy Vancampfort, Ryan L McGrath, Brendon Stubbs","doi":"10.1093/ptj/pzag013","DOIUrl":"10.1093/ptj/pzag013","url":null,"abstract":"","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146150224","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":"Intervention fidelity: a common language for clinicians and researchers.","authors":"Sandra L Willett, Andrea B Cunha, Lin-Ya Hsu, Elena D Brown, Regina T Harbourne, Stacey Dusing","doi":"10.1093/ptj/pzag018","DOIUrl":"10.1093/ptj/pzag018","url":null,"abstract":"<p><p>This paper explores the importance of fidelity in strengthening clinical translation and implementation of rehabilitation research interventions and in reducing unwarranted variation in practice patterns. Fidelity, or accurate and faithful delivery of an intervention, is critical for all aspects of the clinical translational research continuum. Fidelity intentionally defines and tracks the key or active ingredients of a research intervention, ensures adherence to and dose of these key ingredients across therapists and research sites, and clearly establishes what is new or different about an intervention as compared to usual or standard practice. Measurement and reporting standards for fidelity in rehabilitation research vary widely. Historically, rehabilitation researchers have not reported their fidelity process clearly, if at all. This reporting gap creates a multi-faceted conundrum for replication of research findings and eventual clinical implementation of rehabilitation interventions. Without clear fidelity metrics, researchers fail to establish what is novel or unique about an intervention and fail to differentiate a new intervention from other established approaches. Without seeking and applying fidelity metrics, clinicians have no way of replicating a new intervention or understanding which key ingredients replace or supersede old practice habits. Thus, failure of researchers to transparently communicate and of clinicians to understand and apply fidelity metrics widens unwarranted practice variations rather than improving our precision with rehabilitation interventions. Using 2 recent pediatric clinical trials as exemplars, we describe how the development and tracking of metrics defining fidelity for the Sitting Together and Reaching to Play (START-Play) intervention informed key ingredients and program differentiation as researchers moved from an efficacy to an effectiveness trial; and then propose how clinicians might use these same metrics to inform implementation of START-Play. This example will demonstrate how robust fidelity might serve as a common language for successful implementation of and improved precision with rehabilitation research interventions.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147284771","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":"Ethical and bioethical issues in physical therapy: A systematic scoping review.","authors":"Gianluca Bertoni, Sara Patuzzo Manzati, Federica Pagani, Marco Testa, Simone Battista","doi":"10.1093/ptj/pzag011","DOIUrl":"10.1093/ptj/pzag011","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Ethical and bioethical issues are central to the identity and practice of physical therapy. A comprehensive overview of how these issues are addressed in the literature is essential for advancing education, clinical practice, and professional reflection.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The objective was to systematically map ethical and bioethical issues in the physical therapy literature, describe the methodologies employed, and identify key gaps to inform education, practice, and policy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data sources: &lt;/strong&gt;Medline (via PubMed), Embase, Cochrane Central, CINAHL, PsycINFO, PEDro, grey literature sources, and academic library resources were searched from inception to October 2024. The review protocol was prospectively published on medRxiv.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study selection: &lt;/strong&gt;Studies addressing ethical or bioethical issues in physical therapy were included, encompassing both normative and descriptive (empirical) approaches. After screening titles, abstracts, and full texts, 108 studies met the inclusion criteria.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data extraction and synthesis: &lt;/strong&gt;Data were extracted using a modified Joanna Briggs Institute standardized form. A narrative synthesis was conducted to map ethical themes and characterize methodological approaches across studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Identification and mapping of ethical and bioethical themes and characterization of research methodologies applied.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 15,464 records were identified; 3223 duplicates were removed. Of 12,241 titles and abstracts screened, 385 full texts were assessed, and 108 studies were included. Major themes included ethical reasoning (n = 33), ethical reasoning and education (n = 19), ethical theories (n = 12), care relationships (n = 15), justice and equity (n = 8), perception of ethical issues (n = 13), and codes of ethics (n = 8). Key challenges involved physical touch, informed consent, professional boundaries, and moral distress. Structural barriers, cultural contexts, and disparities in ethics education were recurring concerns. Ethical reasoning was often situational and intuitive, whereas formal codes were frequently perceived as disconnected from clinical practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;Ethical complexities in physical therapy arise from its embodied, relational, and context-sensitive nature. The literature reveals variability in how ethics is taught and applied across settings and highlights underexplored areas, including oncology, end-of-life care, digital health and artificial intelligence, and equity, diversity, and inclusion. Findings emphasize the need to strengthen ethics education, reinforce the application of existing codes of ethics, and provide organizational support for ethical deliberation. This synthesis provides a foundation for future research and can inform curricular development, clinical practice, and policy","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13017120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146106773","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":"Does the disappearance of .400 batting average have relevance for health care?","authors":"Steven Z George","doi":"10.1093/ptj/pzag019","DOIUrl":"https://doi.org/10.1093/ptj/pzag019","url":null,"abstract":"","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":"106 3","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147581987","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}