Physical Therapy最新文献

{"title":"Taking the Next Step in Neurologic Rehabilitation: Contributions of Intensity and Variability of Stepping Tasks during Locomotor Training.","authors":"T George Hornby, Jennifer Moore, Carey L Holleran, Christopher E Henderson","doi":"10.1093/ptj/pzaf005","DOIUrl":"10.1093/ptj/pzaf005","url":null,"abstract":"<p><p>Research over the past 20 years indicates the amount of task-specific walking practice provided to individuals with stroke, brain injury, or incomplete spinal cord injury can strongly influence walking recovery. However, more recent data suggest that attention towards 2 other training parameters, including the intensity and variability of walking practice, may maximize walking recovery and facilitate gains in non-walking outcomes. The combination of these training parameters represents a stark contrast from traditional strategies, and confusion regarding the potential benefits and perceived risks may limit their implementation in clinical practice. The purpose of this perspective is to delineate the evidence regarding the contributions of intensity and variability of locomotor training to improve mobility outcomes in individuals with acute-onset brain and spinal cord injury. The rationale and evidence supporting the utility of these training parameters in controlled laboratory settings is first described by integrating concepts in the field of neuroscience, motor learning, biomechanics, and exercise physiology into a rehabilitation intervention. Subsequently, the evidence supporting the efficacy of this paradigm is addressed, including discussions of some of the misconceptions regarding perceived negative consequences of these strategies in an effort to mitigate common clinical concerns. Finally, the utility of these strategies implemented during inpatient rehabilitation is delineated to facilitate a more comprehensive understanding of the feasibility and potential benefits early following neurologic injury. A greater understanding of how and why to integrate higher intensity, variable stepping practice will support therapists to take the next step to maximize mobility in the patients they serve.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Musculoskeletal Pain as a Risk Factor for Poor Dizziness Outcomes: A Longitudinal Study among Patients With Persistent Vestibular Dizziness.","authors":"Unni Moen, Roy Miodini Nilsen, Mari Kalland Knapstad, Kjersti Thulin Wilhelmsen, Stein Helge Glad Nordahl, Frederik Kragerud Goplen, Dara Meldrum, Liv Heide Magnussen","doi":"10.1093/ptj/pzaf001","DOIUrl":"https://doi.org/10.1093/ptj/pzaf001","url":null,"abstract":"<p><strong>Objective: </strong>Musculoskeletal pain and psychological distress are prevalent comorbidities in patients with persistent dizziness. Little is known about how comorbid pain influences the outcome of persistent dizziness. This study examined the impact of pain on dizziness outcomes and the potential modifying role of psychological distress.</p><p><strong>Methods: </strong>Longitudinal study of 150 patients with persistent dizziness. Vertigo Symptom Scale short form (VSS-SF), Dizziness Handicap Inventory (DHI), number of pain sites, pain intensity, and Hospital Anxiety and Depression Scale (HADS) were assessed at baseline, 6 months and 12 months. Linear mixed effects model for longitudinal data was used to explore the association between musculoskeletal pain and dizziness. Interaction analysis was used to assess whether psychological distress had a modifying effect on the association between pain and dizziness.</p><p><strong>Results: </strong>VSS-SF and DHI decreased during follow-up but not to a clinically relevant level for the patients. Patients reporting comorbid psychological distress reported higher scores on VSS-SF, DHI, more pain sites and higher pain intensity. A positive association was observed between the number of pain sites and VSS-SF and between pain intensity and VSS-SF, and these associations were stronger in patients reporting psychological distress. Similar associations were found for DHI. Patients reporting ≥4 pain sites or pain intensity of ≥4 out of 10 at baseline, still reported severe dizziness and moderate disability 12 months later.</p><p><strong>Conclusion: </strong>Musculoskeletal pain is a risk factor for poor dizziness outcomes, especially when comorbid psychological distress is present. Clinicians should be attentive to musculoskeletal pain when the number of pain sites exceeds 4 or pain intensity exceeds 4 on a numeric rating scale.</p><p><strong>Impact: </strong>A new understanding of the impact of musculoskeletal pain on persistent dizziness could be the key to successful recovery and the prevention of prolonged issues.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"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":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142688538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"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":"News From the Foundation for Physical Therapy Research, January 2025.","authors":"","doi":"10.1093/ptj/pzae181","DOIUrl":"https://doi.org/10.1093/ptj/pzae181","url":null,"abstract":"","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":"105 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971846","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":"On \"Effectiveness of Cognitive Functional Therapy Versus Core Exercises and Manual Therapy in Patients With Chronic Low Back Pain After Spinal Surgery: Randomized Controlled Trial.\" Avila L, da Silva M, Neves M, et al. Phys Ther. 2024;104:pzad105. https://doi.org/10.1093/ptj/pzad105.","authors":"Sourabh Kumar, Rubi Yadav, Sunanda Bhowmik, Kanu Goyal, Manu Goyal","doi":"10.1093/ptj/pzae161","DOIUrl":"10.1093/ptj/pzae161","url":null,"abstract":"","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":"142838568","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":"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":"Determinants of Longitudinal Changes in Exercise Capacity in Patients With Independent Functioning on Hemodialysis.","authors":"Naoto Usui, Junichiro Nakata, Akimi Uehata, Sho Kojima, Hideki Hisadome, Akihito Inatsu, Atsuhiro Tsubaki, Masakazu Saitoh, Shuji Ando, Tatsuro Kitayama, Kenta Maikusa, Yuki Nishiyama, Yusuke Suzuki","doi":"10.1093/ptj/pzae147","DOIUrl":"10.1093/ptj/pzae147","url":null,"abstract":"<p><strong>Objective: </strong>Patients with chronic kidney disease reportedly have decreased muscle oxygen utilization, which most substantially decreases exercise capacity, followed by cardiac reserve. However, determinants of longitudinal changes in exercise capacity in patients on hemodialysis (HD) and the effects of long-term exercise interventions (EI) are unknown. This study was conducted to clarify these concerns.</p><p><strong>Methods: </strong>This was a prospective cohort study. Patients on HD that were not hospitalized were followed from baseline up to 2 years, and cardiopulmonary exercise testing results, including peak oxygen uptake, peak work rate, heart rate reserve, and ventilatory equivalent for carbon dioxide slope, as well as implementation of EI were assessed. Based on the 2-year change in peak oxygen uptake, they were divided into improvement or declined groups.</p><p><strong>Results: </strong>Forty-five patients who were not hospitalized completed the follow-up were analyzed. In the improvement group, the variation was determined by an increase in peak work rate, which is a peripheral factor (partial regression coefficient 0.08 [95% CI = 0.01 to 0.16]), while in the decline group, the variation was determined by a decrease in the ventilatory equivalent for carbon dioxide slope, which is a cardiac factor (partial regression coefficient = -0.12; 95% CI = -0.21 to -0.03). Moreover, exercise intervention was associated with the change in peak oxygen uptake (partial regression coefficient = 3.09; 95% CI = 1.45 to 4.72).</p><p><strong>Conclusion: </strong>Exercise intolerance even in patients on HD that were not hospitalized and stable progressed over time with deterioration of cardiac reserve, whereas EI were associated with improved exercise capacity through enhanced peripheral function.</p><p><strong>Impact: </strong>The results support the early measurement of cardiopulmonary or skeletal muscle reserve through cardiopulmonary exercise testing and the implementation of long-term EI based on the measurement results to address the potential deterioration in exercise capacity associated with reduced cardiac reserve, even in patients on HD that are asymptomatic and stable.</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":"142472318","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}