Physical Therapy最新文献

{"title":"Neck or Shoulder? Establishing Consensus for Spine Screening in Patients With Shoulder Pain: An International Modified Delphi Study.","authors":"Néstor Requejo-Salinas, Rubén Fernández-Matías, Angela Cadogan, Rachel Chester, Jean-Sébastien Roy, Filip Struyf, Marcus Bateman, Simon Balster, Melina Nevoeiro Haik, Amee L Seitz, Leanne Bisset, Paula Rezende Camargo, Jean-Michel Brismée, Stephen May, Tom Walker, Craig Wassinger, Ross Lenssen, Jared K Powell, Karen McCreesh, Jo Gibson, Paula M Ludewig, Roy La Touche, Enrique Lluch-Girbés","doi":"10.1093/ptj/pzae133","DOIUrl":"10.1093/ptj/pzae133","url":null,"abstract":"<p><strong>Objective: </strong>There is no established consensus for screening the spine in patients with shoulder pain. The aim of this study was to explore the role of the spine in shoulder pain and generate a set of recommendations for assessing the potential involvement of the spine in patients with shoulder pain.</p><p><strong>Methods: </strong>A modified Delphi study was conducted through use of an international shoulder physical therapist's expert panel. Three domains (clinical reasoning, history, and physical examination) were evaluated using a Likert scale, with consensus defined as Aiken Validity Index ≥0.7.</p><p><strong>Results: </strong>Twenty-two physical therapists participated. Consensus was reached on a total of 30 items: clinical reasoning (n = 9), history (n = 13), and physical examination (n = 8). The statement that spinal and shoulder disorders can coexist, sometimes influencing each other and at other times remaining independent issues, along with the concept of radiating pain as an explanatory phenomenon for the spine contribution to shoulder pain, achieved the highest degree of consensus.</p><p><strong>Conclusion: </strong>International physical therapists shoulder experts reached consensus on key aspects when screening the spine in people with shoulder pain, including consideration of the distal location of symptoms relative to the shoulder, the presence or previous history of neck pain, the changes in symptoms related to neck movements, and the presence of neuropathic-like symptoms. They also acknowledged the importance of assessing active cervical or cervicothoracic movements and the usefulness of the Spurling test and symptom modification techniques applied to the spine.</p><p><strong>Impact: </strong>This consensus holds implications for both clinical practice and research. In research, applying these considerations may ensure more homogenous samples, thereby enhancing the investigation of outcomes in shoulder pain populations. In clinical practice, determining the need for spine screening and its potential impact on prognosis and management could significantly influence patient care.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140794","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 People With Subacute Mild Traumatic Brain Injury, Earlier Physical Therapy Improved Symptoms at a Faster Rate Than Later Physical Therapy: Randomized Controlled Trial.","authors":"Kody R Campbell, Prokopios Antonellis, Robert J Peterka, Jennifer L Wilhelm, Kathleen T Scanlan, Natalie C Pettigrew, Siting Chen, Lucy Parrington, Peter C Fino, James C Chesnutt, Fay B Horak, Timothy E Hullar, Laurie A King","doi":"10.1093/ptj/pzae180","DOIUrl":"10.1093/ptj/pzae180","url":null,"abstract":"<p><strong>Importance: </strong>There is unclear evidence on when to initiate physical therapy after mild traumatic brain injury (mTBI) in a non-athlete, adult population.</p><p><strong>Objective: </strong>The objective of this study was to investigate physical therapy timing after mTBI through changes in patient-reported and clinically-assessed tools and objective and mechanism measurements of sensorimotor balance control.</p><p><strong>Design: </strong>This study was an investigator-blinded randomized control trial (NCT03479541).</p><p><strong>Setting: </strong>The study took place at an academic research center.</p><p><strong>Participants: </strong>Two hundred and three participants were randomized to earlier physical therapy (n = 82) or to later physical therapy (n = 121).</p><p><strong>Intervention: </strong>After enrollment, the earlier physical therapy group started rehabilitation within 1 week and the later group started rehabilitation after a 6-week wait period. All participants received similar rehabilitation; 6-week program administered and progressed by licensed physical therapists.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the Dizziness Handicap Inventory (DHI). Secondary outcomes included common patient-reported/clinical assessments of mTBI and objective/mechanism measurements of balance, including novel measures of central sensorimotor integration. Differences between and within the groups on outcomes were examined with linear mixed-effect models, t tests, and effect sizes.</p><p><strong>Results: </strong>While both groups significantly improved and reached similar levels on patient-reported outcomes (DHI and secondary outcomes), the earlier physical therapy group had significantly larger and faster rates of improvement compared to later physical therapy. There were differential effects of physical therapy timing on the objective/mechanism-measured outcomes. Specifically, there were significant improvements in sensorimotor time delay for the earlier physical therapy group and no change in the later group. Further, the later group worsened in the motor activation components for balance control while there was no change in the early group.</p><p><strong>Conclusion and relevance: </strong>Earlier physical therapy after mTBI can improve symptoms at a faster rate relative to later physical therapy. Earlier physical therapy also showed improvements in sensorimotor aspects of balance control, not seen in the later group. There may be an important window to address central sensorimotor deficits after mTBI.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855035","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, February 2025.","authors":"","doi":"10.1093/ptj/pzaf003","DOIUrl":"https://doi.org/10.1093/ptj/pzaf003","url":null,"abstract":"","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":"105 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143492556","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 Therapy for Mild Traumatic Brain Injury: Why Wait for a Faster Rate?","authors":"Steven Z George","doi":"10.1093/ptj/pzaf009","DOIUrl":"https://doi.org/10.1093/ptj/pzaf009","url":null,"abstract":"","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":"105 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557414","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":"Chronic Underrepresentation of Females and Women in Stroke Research Adversely Impacts Clinical Care.","authors":"Julia S Dahlby, Lara A Boyd","doi":"10.1093/ptj/pzae155","DOIUrl":"10.1093/ptj/pzae155","url":null,"abstract":"<p><p>Unequal sex and gender sample sizes in rehabilitation studies have implications for the generalizability of the evidence and for the clinicians that utilize their recommendations. Physical therapists rely on evidence-based guidelines to tailor their assessments and interventions to optimize outcomes for patients. We currently know that females and women have worse stroke outcomes and prognoses than their counterparts, however, rehabilitation guidelines remain the same for all individuals. Notably, stroke prevention and acute care has recently shifted to include female- and women-oriented guidelines, however, rehabilitation guidelines have not yet caught up. This article summarizes the key differences that females and women with stroke experience, how they may impact recovery, and calls for researchers and rehabilitation professionals to consider sex and gender when working with patients who've had a stroke. Doing so will improve the lives for those with stroke and maximize treatment options and rehabilitation outcomes.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682252","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":"10.1093/ptj/pzae174","url":null,"abstract":"","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-02-06","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}

{"title":"Online Graded Motor Imagery Is Effective in Women Diagnosed With Pelvic Pain: A Randomized Controlled Trial.","authors":"Aida Lopez-Brull, Borja Perez-Dominguez, Maria Plaza-Carrasco, Cristina Blasco-Ortiz, Blanca Navarro-Ribera, Jose Casaña, Esther Diaz Mohedo, Irmina Nahon","doi":"10.1093/ptj/pzae164","DOIUrl":"10.1093/ptj/pzae164","url":null,"abstract":"<p><strong>Objective: </strong>Effective therapeutic strategies are crucial for managing genito-pelvic pain/penetration disorder (GPPPD), a condition presenting challenges for both patients and health care providers. This study aims to assess the effectiveness of an online graded motor imagery (GMI) program in alleviating pain intensity and improving sexual function in women diagnosed with GPPPD.</p><p><strong>Methods: </strong>Eighty-seven women were randomly assigned to either an online GMI group or a control group. The online GMI protocol involved engaging participants in 2-week segments of left/right judgment exercises, mental simulation of movements, and gradual exposure therapy. After 6 weeks, we assessed pain intensity and sexual function. The control group gained access to the program upon study completion.</p><p><strong>Results: </strong>The online GMI group demonstrated a significant reduction in pain intensity, coupled with improvements in sexual function. Notably, participants with enhanced movement imagery abilities experienced greater improvements, while those with negative beliefs and thoughts regarding vaginal penetration showed lower sexual function scores.</p><p><strong>Conclusion: </strong>An online GMI program is effective in alleviating the pain burden faced by women dealing with GPPPD.</p><p><strong>Impact: </strong>Effectively addressing pelvic pain in patients remains a daunting challenge for physical therapists. Therefore, implementing efficient and easily accessible strategies is crucial. The incorporation of GMI intervention proves to be an effective approach for improving both pain and sexual functioning in women with GPPPD.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142626228","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":"Optimizing the Accuracy and Precision of the Minimal Detectable Change Statistic: Secondary Analysis of Test-retest Data From the NIH Toolbox Study.","authors":"Jeremy Graber, Brian J Loyd, Thomas J Hoogeboom, Caitlin J Miller, Andrew J Kittelson","doi":"10.1093/ptj/pzae170","DOIUrl":"10.1093/ptj/pzae170","url":null,"abstract":"<p><strong>Objective: </strong>The minimal detectable change (MDC) statistic is often used by clinicians to monitor change in patients. However, the way in which the MDC is traditionally calculated might be suboptimal in terms of accuracy and precision, potentially resulting in erroneous clinical decisions. This study compared the performance of the MDC statistic as traditionally calculated to that of 2 regression-based alternatives.</p><p><strong>Methods: </strong>This analysis used test-retest data from adults who participated in usual walking speed (n = 169) or grip strength (n = 178) assessments as part of the NIH Toolbox Study. Three approaches for MDC calculation were compared: the traditional approach (MDCTrad), simple linear regression (MDCSLR), and generalized additive models for location, scale, and shape (MDCGAMLSS). These approaches were compared in terms of accuracy and precision across all levels of measurement and separately for initial test values above and below the median.</p><p><strong>Results: </strong>Each of the 3 approaches accurately modeled detectable change thresholds when performance was averaged across all test values. However, MDCTrad demonstrated inaccuracies when performance was considered separately for initial test values below or above the median. For walking speed, average precision improved by 12% with MDCSLR and 16% with MDCGAMLSS, compared to MDCTrad. For grip strength, average precision improved by 3% with MDCSLR and 21% with MDCGAMLSS, compared to MDCTrad.</p><p><strong>Conclusion: </strong>MDCSLR and MDCGAMLSS appeared to more accurately and precisely model detectable change thresholds, compared to MDCTRAD. In general, MDCGAMLSS demonstrated the best overall performance in this within-sample analysis.</p><p><strong>Impact: </strong>Improved precision and accuracy in detectable change thresholds for walking speed or grip strength might facilitate clinicians' ability to promptly detect a decline in function and intervene and to confidently detect improvements in function over time.</p><p><strong>Lay summary: </strong>This study compared the performance of the MDC statistic as traditionally calculated to 2 regression-based alternatives.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142688541","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":"Recommendations for Mobilization and Manipulation Treatment and Screening for Vascular Complications in Clinical Practice Guidelines for Neck Pain: A Systematic Review.","authors":"Renske Peters, Joannes Hallegraeff, Bart Koes, Emiel van Trijffel","doi":"10.1093/ptj/pzae179","DOIUrl":"10.1093/ptj/pzae179","url":null,"abstract":"<p><strong>Objective: </strong>This systematic review aimed to determine the methodological quality of international clinical practice guidelines (CPGs) and the clinical credibility and implementability of recommendations regarding manipulation or mobilization treatment recommendations proposed in CPGs for the management of people with neck pain. A secondary aim of this review was to provide an overview of recommendations for manipulation or mobilization in patients with neck pain. Manipulation or mobilization treatment of patients with neck pain is under debate for its potential risk of serious adverse events. Serious adverse events are rare, but it is the clinicians' responsibility to thoroughly screen patients at risk of vascular complications. A third aim of this review was to describe the extent to which the included guidelines inform clinical practice about screening for the risk of complications due to vascular pathology in the cervical spine.</p><p><strong>Methods: </strong>A systematic review of 13 electronic databases and 4 repositories was performed for potentially relevant guidelines published between January 1, 2000 and September 22, 2022. Two reviewers independently appraised eligible guidelines using Appraisal of Guidelines for Research and Evaluation II (AGREE II) and Appraisal of Guidelines for Research and Evaluation: Recommendation EXcellence (AGREE-REX) criteria. A best evidence synthesis was performed, and screening of risk factors was assessed.</p><p><strong>Results: </strong>A total of 19 CPGs were included, of which 5 were of high quality. All high-quality guidelines recommend the use of manipulation or mobilization, with or without exercise. Eight (42%) guidelines described the screening of risk factors for adverse events. Two (11%) guidelines met the a priori defined criteria for screening and scored present and complete.</p><p><strong>Conclusion: </strong>International CPGs consistently recommend the use of manipulations and mobilizations in the treatment of neck pain. There is a notable absence of recommendations regarding the identification of patients at risk for vascular complications.</p><p><strong>Impact: </strong>The findings of this study allow guideline developers to improve the quality of future neck pain guidelines and consider including vascular screening tools. Furthermore, it proposes recommendations to physical therapists interested in applying manipulations and mobilizations in the treatment of patients with neck pain.</p><p><strong>Lay summary: </strong>International clinical practice guidelines consistently recommend the use of manipulations and mobilizations in the treatment of neck pain. There is a notable absence of recommendations regarding identifying patients at risk for vascular complications.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952994","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":"Modeling Upper Limb Rehabilitation-Induced Recovery After Stroke: The Role of Attention as a Clinical Confounder.","authors":"Silvia Salvalaggio, Simone Gambazza, Martina Andò, Ilaria Parrotta, Francesca Burgio, Laura Danesin, Pierpaolo Busan, Sara Zago, Dante Mantini, Daniela D'Imperio, Marco Zorzi, Nicola Filippini, Andrea Turolla","doi":"10.1093/ptj/pzae148","DOIUrl":"10.1093/ptj/pzae148","url":null,"abstract":"<p><strong>Objective: </strong>People who have survived stroke may have motor and cognitive impairments. High dose of motor rehabilitation was found to provide clinically relevant improvement to upper limb (UL) motor function. Besides, mounting evidence suggests that clinical, neural, and neurophysiological features are associated with spontaneous recovery. However, the association between these features and rehabilitation-induced, rather than spontaneous, recovery has never been fully investigated. The objective was to explore the association between rehabilitation dose and UL motor outcome after stroke, as well as to identify which variables can be considered potential candidate predictors of motor recovery.</p><p><strong>Methods: </strong>People who survived stroke were assessed before and after a period of rehabilitation using motor, cognitive, neuroanatomical, and neurophysiological measures. We investigated the association between dose of rehabilitation and UL response (ie, Fugl-Meyer Assessment for upper extremity [FMA-UE]), using ordinary least squares regression as the primary analysis. To obtain unbiased estimates, adjusting covariates were selected using a directed acyclic graph.</p><p><strong>Results: </strong>Baseline FMA-UE was the only factor associated with motor recovery (b = 0.99; 95% CI = 0.83 to 1.15 points). Attention emerged as a confounder of the association between rehabilitation and final FMA-UE (b = 5.5; 95% CI = -0.8 to 11.9 points), influencing both rehabilitation and UL response.</p><p><strong>Conclusion: </strong>Preserved attention in people who have survived stroke might lead to greater UL motor recovery, albeit estimates have high levels of variability. Moreover, the increase in the dose of rehabilitation can lead to 5.5 points improvement on the FMA-UE, a nonsignificant but potentially meaningful finding. The approach described here discloses a new framework for investigating the effect of rehabilitation treatment as a potential driver of recovery.</p><p><strong>Impact: </strong>Attentional resources could play a key role in UL motor recovery. There is a potential association between amount of UL recovery and dose of rehabilitation delivered, needing further exploration. Preserved attention and rehabilitation dose are candidate predictors of UL motor recovery.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}