Physical Therapy最新文献

{"title":"Differences in Abdominal and Lumbar Muscle Thickness and Contractile Function Between Nulliparous, Primiparous, and Multiparous Women 6 Months Postpartum.","authors":"Laura Fuentes-Aparicio, Sofia Pérez-Alenda, Juan J Carrasco, Begoña Valls-Donderis, Lirios Dueñas, Mercè Balasch-Bernat","doi":"10.1093/ptj/pzae141","DOIUrl":"10.1093/ptj/pzae141","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to evaluate the differences between primiparous and multiparous women at 6 months postpartum and nulliparous women regarding the thickness (including thickness pattern) and contractile function of the abdominal and lumbar muscles.</p><p><strong>Methods: </strong>A cross-sectional observational study of 80 women, both primiparous (n = 29) and multiparous (n = 25), as well as including nulliparous as a comparison group (n = 26), was conducted. B-mode ultrasound imaging was used for the measurement of abdominal and lumbar muscle thickness in two conditions (resting and activation). Moreover, the contractile function of these muscles was determined by the thickness ratio.</p><p><strong>Results: </strong>Significant differences between groups were observed in abdominal muscle thickness. During activation, the obliques showed a lower thickness in both groups of postpartum women compared to nulliparous women, while lower values for the thickness for the transverse abdominis (TrA) were only observed in primiparous women. The thickness pattern observed in nulliparous women both in resting and in activation (internal oblique [IO] > external oblique [EO] > TrA) was also achieved among postpartum women, despite no statistical differences observed between IO and EO in these groups. No significant differences between groups were observed for contractile function, showing the TrA greater values, followed by IO and EO in both nulliparous and postpartum women.</p><p><strong>Conclusions: </strong>This study suggests that the thickness (and the thickness pattern) of the abdominal muscles in women at 6 months postpartum differs from nulliparous, while for the lumbar muscles, it is comparable to nulliparous. However, despite the obliques being thinner in postpartum women, the abdominal muscles are functionally competent.</p><p><strong>Impact: </strong>This is believed to be the first study to compare abdominal and lumbar muscles thickness and contractile function specifically between primiparous and multiparous women. Although at 6 months' postpartum abdominal thickness differs from nulliparous women, these muscles are functionally competent. These findings provide valuable insights for use in the development of postpartum interventions.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392467","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":"Factors Associated With Physical Activity and Sedentary Behavior in People With Parkinson Disease: A Systematic Review and Meta-Analysis.","authors":"Vitoria L Domingues, Marina P Makhoul, Tatiana B de Freitas, Janaine C Polese, Carla Silva-Batista, Fabio A Barbieri, Camila Torriani-Pasin","doi":"10.1093/ptj/pzae114","DOIUrl":"10.1093/ptj/pzae114","url":null,"abstract":"<p><strong>Objective: </strong>The goal of this review was to investigate factors associated with physical activity and sedentary behavior in people with Parkinson disease (PD). The magnitude of these associations was investigated in line with the International Classification of Functioning, Disability and Health components.</p><p><strong>Methods: </strong>A systematic literature review was conducted until February 2023, searching four databases (PubMed, EMBASE, Web of Science, and Scopus) for original articles investigating associations with physical activity or sedentary behavior in people with PD. Two independent researchers performed data extraction, and the risk of bias in the included studies was assessed using the Quality in Prognosis Studies tool. Meta-analyses were conducted to determine the magnitude of the associations, and significant regression models from the included studies were described.</p><p><strong>Results: </strong>Forty-two studies were included. Twenty-one factors associated with overall physical activity were identified. Higher levels of physical activity had a small association with cognition and body mass index and a fair association with 17 factors related to self-efficacy, physical function, mobility, quality of life, age, PD symptoms, and more. Better manual dexterity and functional gait had moderate to good associations with higher levels of physical activity. The regression model with the higher magnitude was composed mostly of contextual factors, except for the body max index. The magnitude of factors associated with physical activity intensity or sedentary behavior could not be identified.</p><p><strong>Conclusion: </strong>Functional gait and manual dexterity were the strongest factors related to physical activity in people with PD. Further investigation is needed to understand the factors associated with physical activity intensity and sedentary behavior.</p><p><strong>Impact: </strong>This study emphasizes the significance of considering contextual factors alongside body function and structure, activity and participation, and the health condition to enhance physical activity improvement during the rehabilitation process. By adopting such a holistic approach, rehabilitation professionals can optimize the overall health and well-being of individuals with Parkinson disease.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141913681","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":"Feasibility of a Multidomain Resiliency Assessment in Patients With Advanced Heart Failure Requiring Surgery: A Pilot Study.","authors":"Karlyn J Green, Rebecca North, Adam D DeVore, Samantha Green, Ashley K Poole","doi":"10.1093/ptj/pzae135","DOIUrl":"https://doi.org/10.1093/ptj/pzae135","url":null,"abstract":"<p><strong>Objective: </strong>The resiliency of patients who have advanced heart failure (HF) and undergo a physical stressor such as heart transplantation or left ventricular assist device implantation has yet to be studied in the physical, cognitive, and psychosocial domains. The primary aim of this pilot study was to assess the feasibility of a multidomain resiliency assessment in patients who have advanced HF and require surgery.</p><p><strong>Methods: </strong>A battery of assessments in each of the domains was completed at baseline before surgical intervention, after intensive care discharge, and 3 and 6 months after surgery. Feasibility was assessed through completion rates, time required to complete the assessments, and qualitative feedback from assessors.</p><p><strong>Results: </strong>Although various completion rates were noted at different time points, high completion rates were seen for grip strength, the modified Fried frailty phenotype, and the Montreal Cognitive Assessment. Additionally, when controlled for patients who were medically restricted from physical function, the Short Physical Performance Battery, gait speed, and the 30-second chair stand test also had high completion rates. A trend toward return to baseline status or an improvement in baseline status was observed in all physical and cognitive assessments and most psychosocial assessments at 3 and 6 months. Minimal change was noted in the Brief Resilience Scale questionnaire.</p><p><strong>Conclusion: </strong>This pilot study demonstrates that a multidomain assessment of resiliency is feasible in patients with advanced HF. Future studies are needed to help determine specific assessments or patient factors that would help predict positive postsurgical outcomes in this population.</p><p><strong>Impact: </strong>This study has implications for clinical practice on the most feasible assessments in multiple domains for patients who have advanced HF and are being evaluated for heart transplantation or left ventricular assist device.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":"104 12","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855054","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":"Validation of a Clinical Teaching Competency Framework for Physical Therapists: A Mixed-Methods Approach.","authors":"Amanda Sharp, Catherine Bilyeu, Carissa Wengrovius, Katherine Myers","doi":"10.1093/ptj/pzae138","DOIUrl":"10.1093/ptj/pzae138","url":null,"abstract":"<p><strong>Objective: </strong>A competency framework for clinical teaching in physical therapy was established in a recent study. Validation of competency frameworks requires multiple steps, including consideration of end-user perceptions of value and utility. The purpose of this study was to further validate the Clinical Teaching Competency Framework by gathering input specifically from clinical education faculty.</p><p><strong>Methods: </strong>This study used an explanatory sequential mixed-methods approach to seek input from clinical instructors (CIs) and site coordinators of clinical education (SCCE) from diverse practice areas and geographic regions. A survey invited participation from active clinical education faculty, and survey respondents were invited to participate in a focus group. Two focus groups were held via Zoom.</p><p><strong>Results: </strong>Survey responses from those holding roles of CI (59.3%), SCCE (11.3%), and CI/SCCE (29.4%) indicated support for the competency framework, including perceived value to their role (93.1%) and improvement in the quality of clinical education (94.1%). Concern regarding the ease of utilization of the framework was indicated by 24% of respondents. There were no statistically significant differences in responses based on role or credentials. The focus groups resulted in an overarching theme of collective impact, with 4 subthemes: assessment, CI development, implementation, and guidelines.</p><p><strong>Conclusion: </strong>Clinical education faculty perceive value and utility in the Clinical Teaching Competency Framework. Implementation of the framework should be collaborative and consistent across academic and clinical education programs.</p><p><strong>Impact: </strong>This study moves the profession one step closer to the use of a competency framework specifically targeted at clinical teaching in physical therapy. Clinical education faculty will be primary users of a competency framework, and buy-in from this user group is key to implementation. Continued efforts to validate this framework contribute to addressing the need for CI development and support in delivering excellence in clinical education.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142293189","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":"Type and Distribution of Gross Motor Activity During Physical Therapy in Young Children With Cerebral Palsy.","authors":"Laura A Prosser, Athylia C Paremski, Julie Skorup, Morgan Alcott, Samuel R Pierce","doi":"10.1093/ptj/pzae125","DOIUrl":"10.1093/ptj/pzae125","url":null,"abstract":"<p><strong>Objective: </strong>Physical therapists routinely deliver and prescribe motor practice to improve function. The ability to select optimal practice regimens is limited by a current lack of detail in the measurement of motor practice. The objective of this study was to quantify the type, amount, and timing of gross motor practice during physical therapist sessions.</p><p><strong>Methods: </strong>A secondary video coding analysis of physical therapist sessions from the iMOVE clinical trial (NCT02340026) in young children with cerebral palsy (CP) was conducted. The 37 children who completed the treatment phase were included (mean age = 22.1 months). Children could initiate pulling to stand but were unable to walk. Videos of randomly selected therapy sessions were coded for gross motor activity (422 videos total). The 10 gross motor activity codes included lying, sitting, four point, crawling, kneeling, knee walking, standing, walking, transitions between floor postures, and transitions to/from an upright posture. Twenty percent of each video was double coded for reliability. Time per session, number of bouts, and median time per bout were calculated for each gross motor activity and for 2 aggregate measures: movement time and upright time.</p><p><strong>Results: </strong>Participants spent more than half of therapy time in sitting and standing combined (60.3%). Transitions occurred more frequently than any other motor activity (49.3 total transitions per session). Movement time accounted for 16.3% of therapy time. Upright time accounted for 53.3% of therapy time.</p><p><strong>Conclusions: </strong>Critical practice time to gain motor skill is not equivalent to chronological time or time spent in therapy. Toddlers with CP spent a small amount of therapy time moving. Future work should explore the relations between motor practice and rehabilitation outcomes.</p><p><strong>Impact: </strong>Physical therapists are ideally suited to detail the content of motor practice and ultimately to prescribe optimal patterns of motor practice. We report the characteristics of gross motor practice during therapy in children with CP.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120443","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":"Cognitive Functional Therapy for Chronic Low Back Pain: A Systematic Review and Meta-Analysis.","authors":"Lena Thiveos, Peter Kent, Natasha C Pocovi, Peter O'Sullivan, Mark J Hancock","doi":"10.1093/ptj/pzae128","DOIUrl":"10.1093/ptj/pzae128","url":null,"abstract":"<p><strong>Objective: </strong>The objective was to investigate the effectiveness of cognitive functional therapy (CFT) in the management of people with chronic nonspecific low back pain (LBP) and explore the variability in available trials to understand the factors which may affect the effectiveness of the intervention.</p><p><strong>Methods: </strong>A systematic review with meta-analyses was conducted. Four databases were searched from inception to October 12, 2023. Randomized controlled trials investigating CFT compared with any control group in patients with nonspecific LBP were included. Mean difference and 95% CIs were calculated for pain, disability, and pain self-efficacy. Certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation approach.</p><p><strong>Results: </strong>Seven trials were included. Low to moderate certainty of evidence was found that CFT was effective for disability at short, medium, and long term time points compared with alternate treatments, including usual care. Low to moderate certainty of evidence was found that CFT is effective for pain in the short and medium terms and probably in the long term. There was high certainty evidence CFT was effective in increasing pain self-efficacy in the medium and long terms. A single study found CFT was cost-effective compared with usual care. Variability was found in the training and implementation of CFT across the included trials, which may contribute to some heterogeneity in the results.</p><p><strong>Conclusion: </strong>The results show promise in the use of CFT as an intervention likely to effectively manage disability, pain, and self-efficacy in people with chronic nonspecific LBP. The number of clinicians trained, their experience, and quality of training (including competency assessment) may be important in achieving optimal effectiveness.</p><p><strong>Impact: </strong>This is the most comprehensive review of CFT to date and included investigation of between-trial differences. CFT is a promising intervention for chronic LBP and high-quality synthesis of evidence of its effectiveness is important for its clinical application.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11649759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140792","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":"Progressive Multicomponent Intervention for Older Adults in Home Health Settings Following Hospitalization: Randomized Clinical Trial.","authors":"Alexander J Garbin, Jason R Falvey, Ethan Cumbler, Danielle Derlein, Deborah Currier, Amy Nordon-Craft, Robert Will, Maegan Olivos, Jeri E Forster, Kathleen K Mangione, Jennifer E Stevens-Lapsley","doi":"10.1093/ptj/pzae169","DOIUrl":"10.1093/ptj/pzae169","url":null,"abstract":"<p><strong>Objectives: </strong>Reduced physical function following hospitalization places older adults at risk of adverse health events. Many older adults receive home health physical therapy to reverse their deconditioning; however, optimal approaches to improve physical function are currently not known. This study aimed to evaluate the effectiveness of a home health care approach comprised of high-intensity exercise, enhanced care transition, and protein supplementation.</p><p><strong>Methods: </strong>Eligible participants included adults aged 65 years or older referred to home health care following hospitalization. Two hundred older adults who are medically complex were enrolled and were randomized 1:1 to (1) a high-intensity progressive, multi-component (PMC) intervention or (2) enhanced usual care (UC) comparison group. All participants received 12 visits over 60 days. The primary study outcome was change in the Short Physical Performance Battery (SPPB) from baseline to 60 days. Secondary outcomes included gait speed (usual, fast), modified Physical Performance Test, grip strength, Fatigue Severity Scale, Falls Efficacy Scale-International, physical activity (step count), and adverse events (falls, emergency department visits, hospitalizations). All outcomes were collected at baseline, then 30, 60, 90, and 180 days post baseline.</p><p><strong>Results: </strong>There was no difference in 60-day SPPB change between groups with both groups experiencing significant improvements (PMC = 1.53 [95% CI: 1.00-2.05]; enhanced UC = 1.39 [95% CI = 0.89-1.88]). Differences were also not observed in secondary measures or adverse events at any time point.</p><p><strong>Conclusion: </strong>An intervention consisting of high-intensity exercise, enhanced care transition, and protein supplementation was not associated with greater functional improvement at 60 days compared to enhanced UC in older adults receiving home health physical therapy.</p><p><strong>Impact: </strong>The findings of this study demonstrate that a high-intensity progressive, multi-component intervention results in similar physical functional changes as an enhanced UC intervention in older adults who are medically complex and receiving home health care following hospital-associated deconditioning.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":"104 12","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865086","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, December 2024.","authors":"","doi":"10.1093/ptj/pzae165","DOIUrl":"https://doi.org/10.1093/ptj/pzae165","url":null,"abstract":"","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":"104 12","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865066","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 Therapist Perspectives on the Use of Telehealth with First Nations Peoples in Canada: A Qualitative Study.","authors":"Débora Petry Moecke, Travis Holyk, Stacy Maddocks, Kristin L Campbell, Kendall Ho, Pat G Camp","doi":"10.1093/ptj/pzae175","DOIUrl":"https://doi.org/10.1093/ptj/pzae175","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to explore physical therapists' perspectives on providing physical therapy to First Nations peoples in Canada via telehealth, specifically to understand 1) their perspectives on the feasibility of telehealth as a medium for health care delivery and 2) their experiences building trusting therapeutic relationships via telehealth care.</p><p><strong>Methods: </strong>This study included 13 physical therapists who provided clinical care via telehealth for First Nations individuals in northern British Columbia in the past 3 years, and 7 master of physical therapy students undergoing or who completed their Indigenous Health clinical placement in the past 3 years and utilized telehealth. In-depth semi-structured interviews were conducted. Interview questions explored: telehealth usage and acceptance, experiences with telehealth, and overall recommendations for telehealth. Audio recordings were transcribed, and reflexive thematic analysis was conducted.</p><p><strong>Results: </strong>Three overarching themes were identified: \"Telehealth can make a huge difference, but it is widely underutilized;\" \"Telehealth is a little bit less personal and in-depth;\" and \"There is a time and place for telehealth.\"</p><p><strong>Conclusion: </strong>Telehealth shows promise in the delivery of physical therapist services to First Nations communities in Canada, enhancing accessibility, offering flexible scheduling options, and optimizing therapist time efficiency. However, successful implementation in these communities is contingent upon addressing several challenges, including building trusting therapeutic relationships. Technological glitches, the absence of physical interaction, and a history of trauma may hinder the development of the therapeutic relationship in telehealth encounters. To mitigate these challenges, cultural safety training, initial in-person appointments, community familiarity, and in-person support from a caregiver or other health care provider may play pivotal roles.</p><p><strong>Impact: </strong>This study not only sheds light on the underutilization of telehealth but also underscores its potential to significantly improve the accessibility and efficiency of physical therapist services to First Nations peoples in Canada. The findings emphasize the nuanced dynamics of therapeutic relationships in telehealth, offering critical insights for the integration of culturally sensitive practices. Addressing the challenges pinpointed can enhance the quality of telehealth care for First Nations individuals, promote more equitable healthcare delivery, and foster positive health outcomes.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824428","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":"Why This, Why Now? Author Response to Stilwell et al and Beneciuk et al.","authors":"David A Nicholls","doi":"10.1093/ptj/pzae174","DOIUrl":"https://doi.org/10.1093/ptj/pzae174","url":null,"abstract":"","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824429","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}