Physical Therapy最新文献

{"title":"Characterization and Related Factors of Postural Control in Adults With Late-Onset Pompe Disease: Cross-Sectional and Case Control Study.","authors":"Théo Maulet, Thomas Cattagni, Sofiane Mahmoudi, Thomas Gandois, Fabien Dubois, Pascal Laforet, Céline Bonnyaud","doi":"10.1093/ptj/pzaf073","DOIUrl":"10.1093/ptj/pzaf073","url":null,"abstract":"<p><strong>Importance: </strong>Adults with late-onset Pompe disease (LOPD) experience lower limb weakness, balance disorders, and recurrent falls. Mechanisms underlying postural control (stability, orientation) and falls in LOPD remain poorly understood. Investigating these aspects is critical to guide care and rehabilitation.</p><p><strong>Objective: </strong>This study compared postural control in participants with LOPD to controls, examining postural and muscular factors linked to falls and muscular contributions to postural alterations.</p><p><strong>Design: </strong>This study was a cross-sectional, case-control study. Postural stability and orientation during stationary standing were evaluated using force platforms and 3D motion analysis under two visual conditions, while maximal muscle strength was measured with an isokinetic dynamometer.</p><p><strong>Setting: </strong>This cross-sectional, case-control study was conducted at a teaching hospital, which was a reference center for neuromuscular disease.</p><p><strong>Participants: </strong>This study involved two cohorts: participants with LOPD and control participants.</p><p><strong>Main outcomes and measure: </strong>Postural stability (center of pressure [COP] displacements, lower limb joint range of motion) and orientation (COP mean position, weight distribution, joint positions) parameters were assessed, alongside falls reported over 3 months and maximal lower limb muscles strength.</p><p><strong>Results: </strong>Compared to 20 controls, 18 adults with LOPD showed impaired postural stability, especially medio-laterally with eyes closed (ES = 0.42-0.83), and an anterior shift of the COP without joint orientation changes. Falls were strongly associated with COP mean velocity (eyes open: ρ = 0.73; eyes closed: ρ = 0.74) and with hip abductor (ρ = - 0.77) and extensor strength (ρ = - 0.79). Hip extensor strength was most strongly associated with COP mean velocity (eyes closed: ρ = - 0.72; eyes open: ρ = - 0.69).</p><p><strong>Conclusions: </strong>Adults with LOPD demonstrate impaired postural stability, especially in the medio-lateral plane with eyes closed, and an anteriorized upright orientation.</p><p><strong>Relevance: </strong>Hip extensor and abductor strength, strongly linked to falls and stability, should be important to target in evaluations and rehabilitation and in studies on new therapies on LOPD.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094544","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":"Physical Function Differences by COVID-19 Status: A Cross-sectional Analysis From the RECOVER Adult Cohort.","authors":"Grace L Kulik, Tianyu Zheng, Sarah E Jolley, Hassan Ashktorab, Hassan Brim, Elen M Feuerriegel, John W Hafner, Rachel Hess, Benjamin D Horne, Mady Hornig, Brandon Johnson, C Kim, Adeyinka O Laiyemo, Grace A McComsey, Janko Ž Nikolich, Kayleigh Reid, John Scherry, Zaki A Sherif, Huong G Tran, Monica Verduzco-Gutierrez, Shelby West, Kristine M Erlandson","doi":"10.1093/ptj/pzaf063","DOIUrl":"10.1093/ptj/pzaf063","url":null,"abstract":"<p><strong>Importance: </strong>Many adults with prior SARS-CoV-2 infection have persistent limitations, but few studies have examined objective physical function impairment that persist longer than 3 months after infection.</p><p><strong>Objective: </strong>The objective was to characterize physical function impairment among adults with and without SARS-CoV-2 infection.</p><p><strong>Design: </strong>This study was a retrospective, cross-sectional analysis.</p><p><strong>Setting: </strong>Researching COVID to Enhance Recovery (RECOVER) initiative, a multi-site observational study in the United States (ClinicalTrials.gov: NCT05172024).</p><p><strong>Participants: </strong>Participants were adults ≥18 years old with and without SARS-CoV-2 infection.</p><p><strong>Exposures: </strong>Groups were defined based on COVID-19 status at enrollment: never diagnosed (control), diagnosed with COVID-19 ≤ 12 weeks (recent COVID-19), or > 12 weeks prior to enrollment (remote COVID-19). The RECOVER-Adult Long COVID Index was used to further characterize by Index ≥12 versus 0.</p><p><strong>Main outcomes/measures: </strong>Physical function (main outcome) was assessed by number of repetitions on a 30-second sit-to-stand test (30STS).</p><p><strong>Results: </strong>30STS assessments at enrollment were available from 11,578 participants. 30STS repetitions were lowest in the remote COVID-19 group (n = 4942) with 11.5 (SD = 4.2) repetitions compared to 12.5 (SD = 4.7) repetitions among controls (n = 1887) or 12.2 (SD = 4.5) in recent COVID-19 (n = 4698). Remote COVID-19, but not recent COVID-19, was associated with lower physical function in the adjusted model (-0.61 repetitions; SD = 0.21). Those with RECOVER Long COVID Research Index ≥12 performed 1.6 (SD = 0.2) fewer repetitions than those with an Index equal 0.</p><p><strong>Conclusions: </strong>Physical function impairment did not show clinically meaningful group differences between RECOVER Adult Cohort participants by COVID-19 status, or by Long COVID Index. Individual responses over time or in response to an intervention may be more clinically relevant.</p><p><strong>Relevance: </strong>In the RECOVER adult cohort, overall physical function differences by time since COVID-19 or by Long COVID Index were small. Individualized assessments are needed to determine functional impairment following COVID-19 diagnosis and subsequent steps for rehabilitation interventions.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12212418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975217","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":"Accuracy of Falls Screening Tools in Adult Patients With Cancer: A Systematic Review.","authors":"Kelli A Nielsen, Michael Foley, Earllaine Croarkin, Patricia Runde, Stephanie Prinster, Laura S Gilchrist","doi":"10.1093/ptj/pzaf068","DOIUrl":"10.1093/ptj/pzaf068","url":null,"abstract":"<p><strong>Importance: </strong>Patients with cancer experience increased falls risk secondary to oncological treatment and cancer-related sequelae.</p><p><strong>Objective: </strong>Identifying diagnostically and prognostically accurate screening tool(s) for falls risk in populations with cancer is an important issue.</p><p><strong>Data sources: </strong>Screening tests were identified in PubMed and CINAHL.</p><p><strong>Study selection: </strong>Two independent reviewers screened citations for inclusion.</p><p><strong>Data extraction and synthesis: </strong>Data extraction was performed by 1 reviewer and verified by a second. Tests were investigated for clinical utility, validity, diagnostic accuracy, and predictive capacity. Recommendations for screening measures were formulated using predetermined criteria.</p><p><strong>Measures: </strong>Falls risk screening tools were identified for populations with cancer.</p><p><strong>Results: </strong>Of 532 articles screened, 24 articles were included. Fifty-five variations of screening measures were identified, of which 47 had sufficient clinical utility. Twenty measures contained data on diagnostic accuracy or predictive capacity. No screening measure met all criteria to be highly recommended for both ruling in and ruling out falls risk currently (diagnostic accuracy) or in the future (predictive capacity). History of falls demonstrated good diagnostic accuracy for ruling in immediate falls risk (specificity 98.9%, positive predictive value 84.6%). A negative falls history was highly indicative of lower future falls risk status (negative predictive value 82.5% to 90.1%). Fear of falling demonstrated accuracy for ruling out immediate risk for falls (negative predictive value 87.0%, sensitivity 88.7%). Strong predictive capacity was demonstrated with the Timed \"Up & Go\" (TUG) Standard (sensitivity 93% at ≤7.8 s, specificity 95% at ≥11.35 s).</p><p><strong>Conclusions: </strong>Based on these results, a history of falls plus either the TUG Standard for those with a history of falls or subjective report of fear of falling for those without a history of falls is recommended for risk screening in populations with cancer.</p><p><strong>Relevance: </strong>Different screening tools are required for immediate versus future falls risk and are setting dependent.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033105","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":"Matching Clinical Profiles With Interventions to Optimize Daily Stepping in People With Stroke.","authors":"Kiersten M McCartney, Ryan T Pohlig, Allison E Miller, Elizabeth D Thompson, Darcy S Reisman","doi":"10.1093/ptj/pzaf070","DOIUrl":"10.1093/ptj/pzaf070","url":null,"abstract":"<p><strong>Importance: </strong>Individualizing interventions is imperative to optimize step-activity in people with chronic stroke.</p><p><strong>Objective: </strong>The objective was to group individuals with chronic stroke into clinical profiles based on baseline characteristics and examine if these profiles preferentially benefitted from a specific intervention to improve daily step-activity.</p><p><strong>Design: </strong>This is a secondary analysis of a randomized control trial.</p><p><strong>Setting: </strong>The parent study occurred at 4 outpatient rehabilitation clinics.</p><p><strong>Participants: </strong>Participants had strokes ≥6 months prior to enrollment, were 21 to 85 years old, had walking speeds of 0.3 to 1.0 meters per second, and took <8000 steps-per-day.</p><p><strong>Interventions: </strong>Participants were randomized to high-intensity treadmill training (FAST), a step-activity behavioral intervention (SAM), or a combined intervention (FAST+SAM).</p><p><strong>Main outcome(s): </strong>The primary outcome was the interaction of latent class (clinical profile) and intervention group (FAST, SAM, FAST+SAM) on a change in steps-per-day. Key clinical characteristics to identify the latent classes included walking speed, walking endurance, balance self-efficacy, cognition, and area deprivation.</p><p><strong>Results: </strong>Of the 190 participants with complete pre- and post-intervention data (mean [SD] age, 64 [12] years; 93 females [48.9%]), 3 distinct profiles of people with chronic stroke were identified. Class 1 had the lowest walking capacity (speed and endurance), lowest balance self-efficacy, and highest area deprivation, and the greatest change in step-activity when enrolled in SAM (mean = 1624, 95% CI = 426-2821) or FAST+SAM (mean = 1150, 95% CI = 723-1577]). Class 2 had walking capacity, baseline steps-per-day, and self-efficacy values between Class 1 and 3, and had the greatest change in step-activity when enrolled in SAM (mean = 2002, 95% CI = 1193-2811). Class 3 had the highest walking capacity, highest self-efficacy, and lowest area deprivation and the greatest change in step-activity when enrolled in FAST+SAM (mean = 1532, 95% CI = 915-2150).</p><p><strong>Conclusions: </strong>People with chronic stroke require different interventions to optimize changes in step-activity.</p><p><strong>Relevance: </strong>Clinicians can use clinically relevant measures to personalize intervention selection to augment step-activity in people with chronic stroke.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036990","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":"Author Response to Amalia et al.","authors":"Liv Heide Magnussen, Kjersti Wilhelmsen, Målfrid Råheim","doi":"10.1093/ptj/pzaf087","DOIUrl":"https://doi.org/10.1093/ptj/pzaf087","url":null,"abstract":"","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144485546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Quality of Physical Therapy in Patients With Hip or Knee Osteoarthritis in Germany: A Cross-Sectional, Vignette-Based Study.","authors":"Franziska Weber, Corelien Kloek, Max Bonk, Christian Grüneberg, Cindy Veenhof","doi":"10.1093/ptj/pzaf083","DOIUrl":"https://doi.org/10.1093/ptj/pzaf083","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Conservative, non-pharmacological interventions are the recommended first-line treatment for hip and knee osteoarthritis (OA). Clinical practice guidelines (CPGs), such as those from the Osteoarthritis Research Society International (OARSI), guide evidence-based care by physical therapists. However, no studies in Germany have examined physical therapists' treatment choices across patient cases and compared them with the latest evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The objective of this study was to investigate to what extent physical therapists meet the latest evidence when treating different type of people with hip or knee OA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design and setting: &lt;/strong&gt;A cross-sectional vignette-based online survey was conducted among physical therapists working in outpatient practices.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;Eligible participants had adequate German language skills, internet access, and recent experience treating patients with hip or knee OA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measures: &lt;/strong&gt;The survey included 4 case vignettes of hip or knee OA, with and without comorbidities, and a list of treatment modalities from the OARSI guideline. Correct selections matched high-evidence recommendations. Descriptive statistics analyzed demographics and treatment choices; linear regression assessed the influence of professional degree and work experience on meeting the latest evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 612 eligible therapists, 335 (54.7%) completed the survey (mean age 35.9 +/- 11.9 years; 60% female). Only 22% selected all recommended modalities across vignettes. Structured exercise (96%) and arthritis education (95%) were the most frequently chosen. However, many therapists also selected interventions with limited or conflicting evidence, such as massage and taping. Both professional degree and work experience significantly influenced the extent to which the latest evidence was met. Additionally, 49% were aware of at least 1 OA guideline.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;While many physical therapists aligned with evidence-based practices, inappropriate modality selection remained common. De-implementation is needed where evidence suggests a lack of benefit or potential safety concerns. Translating and implementing the OARSI guideline into various languages, specifically for physical therapists, is recommended to close knowledge gaps.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Impact statement: &lt;/strong&gt;The study's findings underscore the importance of understanding the treatment modalities used by physical therapists in managing hip or knee OA worldwide. This insight is crucial for addressing the evidence-to-practice gap and ensuring the effective implementation of high-quality physical therapy, a need that is equally relevant in other countries. Additionally, this knowledge is vital for developing targeted strategies, such as the creation and integration of (de-)implementation protocols into the education and o","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144507506","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 Heart of Movement: What's Love Got to Do with it?","authors":"Terrence M Nordstrom","doi":"10.1093/ptj/pzaf082","DOIUrl":"https://doi.org/10.1093/ptj/pzaf082","url":null,"abstract":"<p><p>Terrence M. Nordstrom, PT, EdD, FAPTA, the 56th McMillan Lecturer, is emeritus professor in the Department of Physical Therapy at Samuel Merritt University in Oakland, California, where he has served as a faculty member, director of clinical education, department chair, assistant academic vice president, and vice president of enrollment and student services. During his 24 years of clinical and leadership experience, his research and writing focused on professional education, professional formation and ethics, and academic leadership development. He received his bachelor's degree from the University of California, Santa Cruz; his master's degree in physical therapy from Stanford University; and his doctor of education from the University of San Francisco. His American Physical Therapy Association (APTA) recognitions include being the first vice president and second president of the American Council of Academic Physical Therapy. He currently serves as the finance officer for the California Physical Therapy Association. He has served on many APTA committees and task forces including the Ethics and Judicial Committee. He was a mentor in the APTA Fellowship in Higher Education Leadership from 2017 to 2023 and has been a mentor in the Grant Writing and Mentorship in Education Research program since its inception in 2018. He is a Catherine Worthingham Fellow of APTA and senior fellow and retired scholar of the National Academy of Practice. He was the APTA Academy of Education Pauline Cerasoli Lecturer in 2019.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286113","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":"Pneumothorax After Dry Needling of Intrascapular Muscles Using a Rib Bracketing Technique: Insights from the Clinician, Patient, and Clinical Expert.","authors":"Paul E Mintken, Blair Denman, Jan Dommerholt","doi":"10.1093/ptj/pzaf078","DOIUrl":"https://doi.org/10.1093/ptj/pzaf078","url":null,"abstract":"<p><strong>Importance: </strong>This case report emphasizes the importance of recognizing and preventing adverse events, specifically pneumothorax related to dry needling (DN), particularly when using rib bracketing techniques in the intrascapular region. It highlights the need for greater clinician awareness to enhance patient safety and minimize the risk of complications during DN interventions.</p><p><strong>Objective: </strong>The objective of this case report was to describe the clinical presentation, progression, and outcome of a patient who developed a pneumothorax following DN, and to propose alternative methods for safer needling in the intrascapular musculature.</p><p><strong>Design: </strong>This case report presents a detailed account of a single patient's clinical experience-including the adverse event, its management, and outcome-supplemented by expert commentary from a clinician specializing in dry needling.</p><p><strong>Setting: </strong>The setting of this case report was an outpatient physical therapy clinic.</p><p><strong>Participants: </strong>A 24-year-old woman undergoing physical therapy for chronic neck and shoulder pain.</p><p><strong>Intervention(s) or exposure(s): </strong>The physical therapist administered DN to the left intrascapular muscles using a rib bracketing technique to treat trigger points.</p><p><strong>Main outcome(s) and measure(s): </strong>The primary outcome was the development of a pneumothorax, identified through clinical symptoms and confirmed by radiographic imaging. Outcomes included hospitalization, symptom resolution, and return to physical activity.</p><p><strong>Results: </strong>The patient experienced an unusually sharp pain during needle insertion. Over the following 2 days, she developed dyspnea, thoracic pain, dry cough, and chest discomfort. A radiograph confirmed a moderate left-sided pneumothorax, which was treated with chest tube reinflation and 1 night of hospitalization. Post-discharge, the patient had residual symptoms for 2 weeks but achieved complete recovery by 1 month, returning to activities like hiking and skiing.</p><p><strong>Conclusions: </strong>DN can result in serious complications such as pneumothorax. Early recognition and immediate treatment can lead to full recovery. This case raises concerns about the safety of the rib bracketing technique for DN in the thoracic intrascapular region.</p><p><strong>Relevance: </strong>Physical therapists should exercise caution when performing DN, especially in high-risk anatomical areas. Safer techniques should be considered, and vigilance is crucial to detect and manage adverse events promptly. Enhancing practitioner awareness can significantly improve patient outcomes and safety during rehabilitation interventions.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226289","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":"An Improvement Science Framework to Advance Sense of Belonging for Physical Therapist Students From Minoritized Backgrounds.","authors":"Keshrie Naidoo, Camille Powell, Diane U Jette","doi":"10.1093/ptj/pzaf045","DOIUrl":"10.1093/ptj/pzaf045","url":null,"abstract":"<p><p>To better serve an increasingly racially and ethnically diverse United States population, the physical therapy profession has been focused on increasing the diversity of the physical therapy workforce and increasing recruitment of racially and ethnically minoritized (REM) students in Doctor of Physical Therapy (DPT) programs. In contributing to the goal of a diverse, equitable, and inclusive profession, DPT programs must admit, support, retain, and graduate individuals who represent diversity in its many aspects. However, factors such as a lack of REM mentors and decreased sense of belonging contribute to disparate academic outcomes for REM DPT students. Although educators must act to implement innovative strategies to support a sense of belonging among students who have been historically marginalized, a systematic approach to decision-making, action, and analysis is needed when dealing with a complex problem with multifaceted causes and multiple possible solutions. Improvement science is a continuous improvement approach that uses a series of data-informed processes and the expertise of multiple stakeholders to promote equity in education, offering a framework for seeing the problem from the perspective of REM DPT students. Plan-Do-Study-Act (PDSA) cycles offer the opportunity to introduce educational changes on a smaller scale to evaluate variation prior to applying it to a larger setting. This perspective highlights a series of PDSA cycles trialing interventions aimed at decreasing barriers to success and improving a sense of belonging for REM DPT students. Even in the face of structural and institutionalized barriers, leveraging an improvement science framework can help ensure that change is meaningful and lasting.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743373","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 home-based Rehabilitation on Activities of Daily Living in Patients With Stroke: Systematic Review and Meta-Analysis.","authors":"Yerim Do, Youngeun Lim, Shiyu Jin, Haneul Lee","doi":"10.1093/ptj/pzaf044","DOIUrl":"10.1093/ptj/pzaf044","url":null,"abstract":"<p><strong>Objective: </strong>This systematic review compared the effectiveness of home-based rehabilitation with that of hospital-based rehabilitation and usual care on activities of daily living (ADL) independence in patients with stroke.</p><p><strong>Methods: </strong>Ovid MEDLINE, Ovid EMBASE, and the Cochrane Library databases were searched for studies published between January 2000 and January 2024. This review was registered in the International Prospective Register of Systematic Reviews. Randomized controlled trials on home-based rehabilitation of patients with stroke were included. The included studies investigated ADL independence, upper limb function, mobility, balance, aerobic endurance, and quality of life. Two independent researchers extracted data using an extraction form and assessed the risk of bias and quality of evidence.</p><p><strong>Results: </strong>Forty-six studies were included in the qualitative synthesis, and 34 studies were included in the quantitative synthesis using Review Manager software 5.4. ADL independence was not significantly different between patients receiving home-based rehabilitation and hospital-based rehabilitation (standardized mean difference (SMD) = 0.17 [95% CI = 0.00 to 0.34], I2 = 29%). However, a significant difference was observed between home-based rehabilitation and usual care (SMD = 1.24 [95% CI = 0.69 to 1.79], I2 = 91%).</p><p><strong>Conclusion: </strong>Home-based rehabilitation is comparable to hospital-based rehabilitation and more effective than usual care and should be considered for patients with stroke after discharge to facilitate effective recovery. However, the high overall risk of bias requires cautious interpretation.</p><p><strong>Impact: </strong>Home-based rehabilitation can be an effective alternative method for improving ADL independence in patients with stroke by providing a familiar and convenient environment.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754146","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}