Physical Therapy最新文献

{"title":"Increasing Methodological Transparency and Openness in Rehabilitation-Related Health Services Research Using Claims Data: A Case Example.","authors":"Janet K Freburger, Elizabeth R Mormer, Kristin Ressel, Anna M Johnson, Amy M Pastva, Cheryl D Bushnell, Pamela W Duncan, Sara B Jones","doi":"10.1093/ptj/pzaf040","DOIUrl":"10.1093/ptj/pzaf040","url":null,"abstract":"<p><p>Health insurance claims are a rich source of information for health services researchers and can provide evidence to understand issues related to access, efficiency, and effectiveness of care. While numerous studies have examined rehabilitation utilization using Medicare, Medicaid, and/or private insurance claims data, these studies typically lack detail on approaches used to identify rehabilitation services. The primary objectives of this perspective are: (1) to raise awareness of the need for and importance of methodological transparency and openness in rehabilitation-related health services research using claims data and (2) to provide a case example by sharing the details of a method for identifying community-based physical therapy and occupational therapy in Medicare claims. General decisions made in claims-based analyses are discussed and then illustrated with the approach used for identifying community-based therapy claims within the context of a secondary analysis of data from a large, multicenter pragmatic clinical trial. Specific decisions made and challenges encountered are discussed, and recommendations are made for future work in this area. Sharing methodological details, data when possible, and metadata on approaches for conducting rehabilitation-related health services research can enhance its validity, rigor, and-ultimately-overall value. Rehabilitation health services researchers are encouraged to make greater efforts to share information on their methodological approaches using claims data and other data relevant to health services research.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721004","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":"Characteristics, Trends, and Implications of Hybrid Doctor of Physical Therapy Programs in the United States.","authors":"Kendra Gagnon, Teresa Bachman, Amy Garrigues","doi":"10.1093/ptj/pzaf043","DOIUrl":"10.1093/ptj/pzaf043","url":null,"abstract":"<p><strong>Importance: </strong>Hybrid Doctor of Physical Therapy (hDPT) programs, which combine online and in-person instruction, are becoming an increasingly common model for delivering physical therapist education. Understanding their characteristics, trends, and implications is critical to guiding their development and ensuring equitable and effective educational outcomes.</p><p><strong>Objective: </strong>The objective of this study was to examine characteristics and trends in hybrid education programs through a secondary analysis of publicly available data.</p><p><strong>Design: </strong>This study involved a secondary analysis of publicly available data on hDPT programs in the United States.</p><p><strong>Setting/participants/intervention: </strong>The study included accredited, candidate, and developing hDPT programs in the United States and involved descriptive analyses of program-level data.</p><p><strong>Main outcomes and measures: </strong>Key variables included institution type, institution and program characteristics, admissions and enrollment data, and program outcomes.</p><p><strong>Results: </strong>There are 33 hDPT programs at 25 unique institutions in the United States, located in 21 states. hDPT programs enroll a more racially and ethnically diverse body compared to national averages. Mean hDPT program cohort size was 32% larger than national average. Mean first-time pass rate for the National Physical Therapy Examination (NPTE) for hDPT graduates was reported at 71%, while ultimate pass rates, graduation rates, and employment rates ranged from 96% to 99%. Mean program duration and costs were consistent with national averages.</p><p><strong>Conclusion and relevance: </strong>hDPT programs demonstrate potential to broaden access and diversity in the physical therapy profession. Standardized data collection and further research are essential to exploring these challenges and supporting development of accessible, equitable, and high-quality hybrid education pathways in physical therapy.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754145","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":"Monitoring Treatment Fidelity in a Pragmatic Pediatric Rehabilitation Trial Comparing Two Physical Therapy Schedules: Analysis and Unexpected Findings.","authors":"Elizabeth Maus, Kimberley Scott, Rachel Ferrante, Sandy Antoszewski, Jill Heathcock","doi":"10.1093/ptj/pzaf004","DOIUrl":"10.1093/ptj/pzaf004","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to describe the monitoring of treatment fidelity in a pragmatic pediatric rehabilitation trial using the National Institutes of Health Behavior Change Consortium framework, and to identify child and therapist factors that influence treatment fidelity.</p><p><strong>Methods: </strong>Therapists (n = 28) were trained in the key ingredients (1-on-1, functional, goal-directed, motor learning intervention), and study protocol for a comparative effectiveness trial titled: \"A Comparison: High Intensity periodic vs Every week therapy in children with cerebral palsy (ACHIEVE)\" for children ages 2 to 8 years with cerebral palsy (CP). Therapists were instructed to record every tenth hour of treatment. A subset of recordings were used to monitor treatment fidelity so that each therapist was rated twice using the study-specific ACHIEVE Treatment Fidelity Checklist. Generalized linear mixed effects modeling and logistic regression were used to analyze child and therapist factors related to treatment fidelity.</p><p><strong>Results: </strong>Median treatment fidelity scores were high (>80%). With training, therapist's years of experience and specialty certification do not significantly impact treatment fidelity. There is a trend toward lower treatment fidelity scores for children with communication difficulties, particularly for therapist's use of multi-modal instructions to direct the child in the desired activity.</p><p><strong>Conclusion: </strong>Functional, goal-directed, motor learning intervention can be delivered with high fidelity for children with CP within a busy clinical setting. Motor learning principles may be implemented differently for children with communication difficulties. More research is needed to explore optimal motor learning strategies for these children.</p><p><strong>Impact: </strong>With training, physical therapists can deliver high-fidelity intervention to children with CP across all Gross Motor Function Classification System levels within a busy clinical setting. Therapists may use motor learning principles differently in children with communication delays.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009946","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 Therapists' 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":"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 therapy 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 therapy 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 health care delivery, and foster positive health outcomes.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11910163/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Additional or Standalone Corticosteroid Injections Compared to Physical Therapist Interventions in Rotator Cuff Tendinopathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Stefano Giuseppe Lazzarini, Riccardo Buraschi, Joel Pollet, Francesco Bettariga, Simone Pancera, Paolo Pedersini","doi":"10.1093/ptj/pzaf006","DOIUrl":"10.1093/ptj/pzaf006","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Rotator cuff tendinopathy represents the most prevalent cause of shoulder pain, the third most common musculoskeletal disorder after low back pain and knee pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The objective of this study was to determine the effectiveness of corticosteroid injection(s), alone or in combination with anesthetic injection or any other physical therapist interventions, compared to physical therapist interventions alone in adults with rotator cuff tendinopathy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;This study was a systematic review and meta-analysis of randomized controlled trials. PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and Physiotherapy Evidence Database were searched from inception to March 2023. Meta-analysis using a random-effects model was performed. Risk of bias and certainty of the evidence for the primary outcomes were assessed using the Cochrane risk-of-bias tool and the Grading of Recommendations, Assessment, Development and Evaluation approach, respectively. The protocol was registered in the International Prospective Register of Systematic Reviews (CRD42021240882).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;Participants were adults with rotator cuff tendinopathy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;Corticosteroid injection(s), alone or in combination with anesthetic injection or with any other physical therapist interventions, was compared to physical therapist interventions alone.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes: &lt;/strong&gt;Pain, function, quality of life, patient-rated overall improvement, and adverse events were the main outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Fifteen randomized controlled trials (1785 participants) met the inclusion criteria. At short term, corticosteroid injection coupled with physical therapist interventions and compared to the same interventions alone might have resulted in some small to moderate improvements in pain and function. Conversely, corticosteroid injection alone seemed not to be more effective than physical therapist interventions in improving pain and function in most of the studies included. At mid- and long-term follow-up assessments corticosteroid injection seemed not to be more effective than any physical therapist interventions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study highlights the potential effectiveness of corticosteroid injection(s) in rotator cuff tendinopathy for pain and function at short term at best, especially in combination with physical therapist interventions. However, the evidence is of moderate to mostly very low certainty. Additional high-quality research considering core outcomes, therefore, is needed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Relevance: &lt;/strong&gt;Corticosteroid injection(s) seems not to be superior to physical therapist interventions, other than resulting in some transient improvements at short term if provided together with other physical ther","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Memoriam.","authors":"","doi":"10.1093/ptj/pzaf027","DOIUrl":"https://doi.org/10.1093/ptj/pzaf027","url":null,"abstract":"","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":"105 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743384","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":"Current and Projected Future Supply and Demand for Physical Therapists From 2022 to 2037: A New Approach Using Microsimulation.","authors":"Patrick Zarek, Clark Ruttinger, David Armstrong, Ritashree Chakrabarti, Douglas R Hess, Tara Jo Manal, Timothy M Dall","doi":"10.1093/ptj/pzaf014","DOIUrl":"10.1093/ptj/pzaf014","url":null,"abstract":"<p><strong>Importance: </strong>Projections of physical therapist supply and demand provide critical insights into workforce trends, including factors that may influence possible shortages.</p><p><strong>Objective: </strong>This study evaluates the current and forecasted adequacy of the physical therapist workforce in the United States to meet the evolving health care needs of the population.</p><p><strong>Design: </strong>This is a cross-sectional study that combines survey data, analysis of administrative databases, and microsimulation modeling.</p><p><strong>Setting: </strong>The study evaluates future demand for physical therapists across all employment and care delivery settings. Projections of supply and demand are compared to assess workforce adequacy nationally and by state through 2037.</p><p><strong>Participants: </strong>Supply modeling incorporates a representative sample of physical therapists from each state, derived from the Federation of State Boards of Physical Therapy (FSBPT) counts and demographic data from the American Physical Therapy Association (APTA) member database. An online survey administered in April 2024 to APTA members (n = 1759 completed surveys, 18% response rate) collected data on demographics, practice characteristics, workload, hours worked, and retirement intentions.</p><p><strong>Intervention: </strong>The study examines key factors influencing the physical therapist workforce, including demographics, care delivery patterns, workload, hours worked, and provider retention.</p><p><strong>Main outcomes: </strong>The study forecasts annual full-time equivalent (FTE) physical therapist supply and demand through 2037, with state-level analysis and additional forecasts for alternative forecast scenarios.</p><p><strong>Results: </strong>In 2022, there were an estimated 233,890 FTE physical therapists in the workforce. A projected shortfall of 12,070 FTEs (5.2%) in 2022 was identified relative to population demand. Although projected supply growth from 2022 to 2037 (39,170 FTEs) exceeds demand growth (36,280 FTEs), a national shortfall remains in most forecast scenarios. By 2037, the physical therapist supply is expected to reach 273,070 FTEs, while demand will increase to 282,230 FTEs, resulting in a projected shortfall of 9120 FTEs (3.3%) in the main scenario.</p><p><strong>Conclusions: </strong>Unless measures are implemented to boost the number of physical therapists entering or re-entering the workforce, or policies are enacted to improve retention, the national shortfall is likely to persist, further exacerbating access to care challenges.</p><p><strong>Relevance: </strong>This study underscores the need for targeted policy interventions to address workforce shortages and additional research into health care workforce forecasting.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":"105 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557419","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":"Effects of Educational Interventions Designed to Develop Physical Therapist Learners' Clinical Reasoning: A Systematic Review.","authors":"Wing Fu, Tobi F Baldwin, Jacklyn H Brechter, Mark R Erickson, Kara Kobal, Vicki LaFay, Teresa M Miller, Jaclyn Morales","doi":"10.1093/ptj/pzae182","DOIUrl":"10.1093/ptj/pzae182","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this systematic review was to investigate the effects of educational interventions designed to develop physical therapist learners' clinical reasoning (CR) across the full continuum of professional development.</p><p><strong>Data sources: </strong>A systematic search was conducted of 6 databases, the entire Journal of Physical Therapy Education collection, and the reference lists of included articles through March 2022.</p><p><strong>Study selection: </strong>English-language primary relevant research studies of all research designs were included while grey literature was excluded.</p><p><strong>Data extraction and synthesis: </strong>Two reviewers independently extracted data from and determined risk of bias of each of the 40 included studies. Disagreements were resolved by consensus or use of a third reviewer. A narrative synthesis summarized and explained the quantitative data. Meta-analysis was not possible due to data heterogeneity. Qualitative data were synthesized using thematic analysis.</p><p><strong>Main outcome(s) and measure(s): </strong>Main outcomes were effects of the educational interventions per the Kirkpatrick model.</p><p><strong>Results: </strong>Forty articles met the inclusion criteria. Twenty-two of the 33 studies with quantitative data involving student or practicing physical therapists reported statistically significant positive outcomes. Three major themes emerged from thematic analysis of 23 studies: perceived educational gain, valued elements of educational interventions, and identified challenges to learning.</p><p><strong>Conclusions and relevance: </strong>Educational interventions that appeared to have a positive impact on learning outcomes were identified. However, the available research lacks rigor for the authors to develop evidence-based guidelines to support the development of CR in physical therapist learners. Given the importance of CR, high quality studies are warranted. This comprehensive systematic review appeared to be the first one in the profession to have investigated the effects of educational interventions designed to develop learners' CR across the entire professional development. Educators and researchers may benefit from the findings to develop educational interventions and future studies.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882521","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 Movement System and Diagnosis: Are We There Yet?","authors":"Philip McClure","doi":"10.1093/ptj/pzaf011","DOIUrl":"10.1093/ptj/pzaf011","url":null,"abstract":"<p><p>In the 29th Maley lecture, Phil McClure PT, PhD, FAPTA, shares a Perspective regarding the movement system and diagnosis. Despite declarations from the House of Delegates >10 years ago, the concept of a movement system has not been widely embraced in either education or practice. In this perspective, he offers critical analysis and 3 proposals that could potentially make the concept of a movement system more relevant and meaningful. The first is to operationally define the movement system, arguing that the current definition is too vague and not operational, and therefore not meaningful. The second is to intentionally separate the movement system from any specific diagnostic classification scheme which would allow the focus to remain on movement and movement analysis. He argues that diagnostic classification schemes require a biopsychosocial framework and that movement, while important, cannot be the only consideration. The third proposal is that diagnostic schemes must be developed by clinical scientists through appropriate research guided by sound theory, not by administrative or political process. He further argues that a greater focus on determining which patients are likely to be helped by physical therapists is necessary and offered the example of developing \"appropriateness criteria\" as a tool toward promoting value-based care. Achieving broad consensus around these proposals could unify our professional focus and assist toward the vision of optimizing movement to enhance the human experience.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399617","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":"Gait Speed Modifies Efficacy of Home-Based Exercise for Falls in Older Adults With a Previous Fall: Secondary Analysis of a Randomized Controlled Trial.","authors":"Jordyn Rice, Ryan S Falck, Jennifer C Davis, Chun L Hsu, Larry Dian, Kenneth Madden, Naaz Parmar, Wendy L Cook, Karim M Khan, Teresa Liu-Ambrose","doi":"10.1093/ptj/pzaf008","DOIUrl":"10.1093/ptj/pzaf008","url":null,"abstract":"<p><strong>Objective: </strong>Exercise is an evidence-based strategy for preventing falls. However, its efficacy may vary based on individual characteristics, like gait speed. This study examined whether baseline gait speed modified the effects of home-based exercise on subsequent falls among older adults.</p><p><strong>Methods: </strong>This is a secondary analysis of a 12-month, randomized controlled trial in community-dwelling adults who were ≥70 years old and who had fallen within the previous 12 months. Participants were randomized to either 12 months of home-based exercise (n = 172) or standard of care (n = 172). This study examined intervention effects on fall rates at 6 and 12 months stratified by baseline gait speed (slow [<0.80 m/s] or normal [≥0.80 m/s]) using negative binomial regressions. Baseline gait speed was investigated as a potential modifier of the intervention effects on mobility and cognitive function using linear mixed modeling.</p><p><strong>Results: </strong>At baseline, 134 participants had slow (exercise = 70; standard of care = 64) and 210 had normal (exercise = 102; standard of care = 108) gait speeds. For participants with slow gait speed, exercise reduced fall rates by 44% at 6 months (incidence rate ratio = 0.56; 95% CI [confidence interval] = 0.33-0.95) but not at 12 months (incidence rate ratio = 0.63; 95% CI = 0.38-1.03) compared with standard of care; for participants with normal gait speed, there was no significant effect of exercise on fall rates at 6 or 12 months. Gait speed modified intervention effects; in the exercise group, participants with slow gait showed significant improvements in the Timed \"Up & Go\" Test at 6 months (estimated mean difference = -4.05; 95% CI = -6.82 to -1.27) and the Digit Symbol Substitution Test at 12 months (estimated mean difference = 2.51; 95% CI = 0.81-4.21).</p><p><strong>Conclusion: </strong>Older adults with slow gait speed had a reduction in subsequent falls in response to exercise at 6 months. Gait speed modified the effects of exercise on mobility and cognition.</p><p><strong>Impact: </strong>Older adults with slow gait speed may be a target population for exercise-based fall prevention.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067299","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}