Physical Therapy最新文献

{"title":"Author response to Wang et al.","authors":"Kaitlyn Foster, Daniel I Rhon","doi":"10.1093/ptj/pzag045","DOIUrl":"10.1093/ptj/pzag045","url":null,"abstract":"","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147778573","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":"Complexities of shared decision-making in home-care physical therapy: a mixed methods study.","authors":"Cindy Lane Moore, J Scott Parrott, Kathryn M Sibley, Sandra L Kaplan","doi":"10.1093/ptj/pzag028","DOIUrl":"10.1093/ptj/pzag028","url":null,"abstract":"<p><strong>Importance: </strong>Shared decision-making (SDM) appears underutilized in physical therapy despite its potential benefits. Information regarding how SDM occurs in home-care physical therapy is limited.</p><p><strong>Objective: </strong>The objective was to describe SDM as experienced by physical therapists during in-home initial evaluation visits with older adults (age 65+) and to recommend SDM improvement strategies.</p><p><strong>Design: </strong>A convergent mixed methods design integrated findings from an anonymous survey and from volunteer interviews.</p><p><strong>Setting: </strong>The setting was United States home care.</p><p><strong>Participants: </strong>Surveys were completed by 220 home care therapists working in 44 states. Twenty therapists completed interviews.</p><p><strong>Intervention(s) or exposure(s): </strong>Participants' SDM-related experiences were examined.</p><p><strong>Main outcome and measure: </strong>The main outcomes were descriptions of SDM contained within 1 theme and practice dilemmas within a second theme.</p><p><strong>Results: </strong>The theme SDM as a Suite of Decisions emerged from 6 subthemes relating to goal setting, treatment planning, and service administration: discovering patients' goals, translating patients' goals into therapy goals, selecting the type of treatment, determining treatment frequency and duration, delineating delivery specifics, and SDM after the evaluation. The theme Balancing Patients', Therapists', and Employers' Needs emerged from 2 subthemes: patient advocacy versus organizational duty and coping with professional distress. Data described SDM actions and actors varying by decision type and therapy allotment decisions shifted from the patient-therapist dyad to include additional actors. Practice dilemmas surfaced related to reimbursement allocations, locus of authority to determine treatment frequency, and care continuity.</p><p><strong>Conclusions: </strong>Home-care physical therapy SDM is complex and affected by setting-specific contextual factors including competing loyalties that may cause ethical distress. Strategies for improving SDM are provided.</p><p><strong>Relevance: </strong>Knowledge of shared decision-making's complexities can inform strategies for improving its use, potentially increasing patient engagement and patient and therapist satisfaction.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147504894","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":"Effects of non-surgical interventions on standing posture and pain in children with flexible flatfoot: a network meta-analysis of randomized controlled trials.","authors":"Liang-Yu Lin, Ai-Chieh Lin, Pei-Chun Lai, Ching-Ju Fang, Yu-Kang Tu, Ming-Tung Huang, Po-Ting Wu, Wei-Ren Su, Chih-Kai Hong, Fa-Chuan Kuan, Kai-Lan Hsu, Chih-Wei Chang, Chii-Jeng Lin, Jou-Hua Wang, Zhao-Wei Liu, Su-Ying Lee, Chien-An Shih","doi":"10.1093/ptj/pzag033","DOIUrl":"10.1093/ptj/pzag033","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Pediatric flexible flatfoot (PFF) is a common condition affecting children's foot biomechanics. While various conservative treatments exist, their relative effectiveness remains unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The objective was to compare the effectiveness of non-surgical interventions-orthotic devices, active exercise-based interventions, and neuromuscular electrical stimulation (NMES)-for managing PFF.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;A systematic review and network meta-analysis of randomized controlled trials was conducted and registered in PROSPERO (CRD42024539990).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;Eleven trials encompassing 761 children with flexible flatfoot were included.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;Non-surgical interventions included orthotic devices (traditional insoles, talus control insoles, corrective shoes, heel cups) and active exercise-based physical therapist interventions (corrective exercises, core stabilization exercises, and NMES combined with corrective exercises).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Outcome measures included the Staheli index (static footprint measurement), barefoot radiological measures (anterior-posterior and lateral talocalcaneal angles, calcaneal pitch angle), pain scores, and treatment discontinuation rates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;NMES combined with corrective exercises demonstrated significant improvement in the Staheli index compared to no intervention (mean difference [MD] = -0.28, 95% CI = -0.35 to -0.22; certainty of evidence [CoE]: moderate). Talus control insoles showed significant improvements in radiological outcomes compared to conventional flat footwear, including lateral talocalcaneal angle (MD = -5.56°, 95% CI = -9.81 to -1.30; CoE: low) and calcaneal pitch angle (MD = 2.74°, 95% CI = 0.41 to 5.06; CoE: low). Traditional insoles effectively reduced pain scores compared to flat insoles (MD = -2.92 points, 95% CI = -3.73 to -2.11; CoE: very low). Pain outcomes were not assessed in exercise or NMES studies, preventing comparative effectiveness conclusions across intervention types. No significant differences in treatment discontinuation rates were observed among orthotic interventions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Both active exercise-based and orthotic interventions demonstrated beneficial effects. NMES with corrective exercises improved standing foot alignment by static footprint analysis, while orthotic interventions enhanced radiological alignment (talus control insoles) and pain relief (traditional insoles) compared to conventional footwear. Outcome measurement differences between intervention types limited direct comparisons. Ten studies measuring gait, functional, or developmental outcomes were excluded due to insufficient outcome overlap.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Relevance: &lt;/strong&gt;This network meta-analysis provides evidence-based guidance for selecting conservative PFF interventions based on primary treatment objectiv","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147593853","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 utilization among firearm injury survivors: an analysis of linked trauma database and medical claims data.","authors":"Heather M Barnett, Karen Segar, Qian Qiu, Rachel A Prusynski, Deepika Nehra, Ali Rowhani-Rahbar","doi":"10.1093/ptj/pzag034","DOIUrl":"10.1093/ptj/pzag034","url":null,"abstract":"<p><strong>Importance: </strong>Firearm injury in the United States disproportionately affects marginalized and disadvantaged communities and results in high rates of functional limitations, mobility impairments, and chronic pain. Despite the high rates of firearm injury and impact on function, few studies have examined access to rehabilitation care after firearm injury.</p><p><strong>Objective: </strong>This study analyzed the use of physical therapy after firearm injuries compared to other traumatic injuries.</p><p><strong>Design: </strong>A retrospective cohort study was performed using medical claims data from a statewide All Payer Claims Database (APCD) linked with an institutional trauma registry (2013-2022).</p><p><strong>Setting: </strong>The setting was a Level I trauma center.</p><p><strong>Participants: </strong>Patients were identified from our institution's trauma registry to obtain initial injury information, and trauma registry data were linked to the Washington State APCD to identify physical therapy service use.</p><p><strong>Exposure: </strong>The exposure was mechanism of injury (firearm vs other trauma).</p><p><strong>Main outcomes and measures: </strong>The main outcome was the use of physical therapy services in any setting in the year after hospital or emergency department discharge, and the secondary outcome was the total number of physical therapist visits. Covariates included sociodemographic factors (race, ethnicity, insurance, age, and gender) and clinical characteristics indicating the need for physical therapy (injury region, injury severity, and hospital length of stay). Multivariable Poisson regression with robust SEs was used to evaluate the effect of firearm mechanism on outcomes.</p><p><strong>Results: </strong>Among 25,404 patients, the overall rate of physical therapist service use was 37.2%. Firearm injury survivors were less likely to use physical therapy services than survivors of other trauma (21.3% vs 38.4%; adjusted relative risk = 0.79; 95% CI = 0.71-0.88). Firearm injury survivors had fewer total physical therapy visits (8.0 [SD = 11.4] vs 11.9 [SD = 13.8]; adjusted relative risk = 0.79; 95% CI = 0.76-0.82).</p><p><strong>Conclusions: </strong>Despite a high incidence of serious and disabling physical conditions after firearm injury, there was less use of physical therapy services after firearm injury than after other mechanisms of injury in this single-institution sample.</p><p><strong>Relevance: </strong>Insufficient use of physical therapy services after firearm injury may affect recovery and long-term outcomes among firearm injury survivors, and interventions are needed to support improved access to rehabilitation in this population.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147618444","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":"Missed opportunities: physical therapists and firearm injury recovery.","authors":"Jason R Falvey","doi":"10.1093/ptj/pzag043","DOIUrl":"10.1093/ptj/pzag043","url":null,"abstract":"","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":"106 5","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148034114","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":"Supporting family care partners during physical therapy care.","authors":"Gretchen Guttendorf Tucker, Jasmine K Cooper, Denise Orwig, Jason R Falvey","doi":"10.1093/ptj/pzag048","DOIUrl":"10.1093/ptj/pzag048","url":null,"abstract":"","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13216882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147778597","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":"Next generation trial design for intensive care unit rehabilitation.","authors":"Amy Nordon-Craft, Patricia J Ohtake, James M Smith, Heidi J Engel, John D Lowman, Marc Moss, Amy M Pastva","doi":"10.1093/ptj/pzag036","DOIUrl":"10.1093/ptj/pzag036","url":null,"abstract":"<p><p>The last 20 years have seen an explosion of research devoted to understanding the feasibility, safety, implementation, and patient and system outcomes of physical rehabilitation for patients who are critically ill in the intensive care unit (ICU). Multiple systematic reviews and meta-analyses have shown ICU physical rehabilitation to be feasible, safe, contribute to reduced ICU and hospital stays, reduce days on mechanical ventilation, and improve functional level outcomes at ICU and hospital discharge. These data demonstrate that ICU physical rehabilitation offers transformative potential for improving functional independence and quality of life in patients who are critically ill. However, significant barriers persist in translating evidence from randomized controlled trials into routine clinical practice. These barriers include patient heterogeneity, inconsistent intervention protocols and reporting, and systemic obstacles to implementation. This article provides perspective on these key challenges and proposes strategies for designing next-generation trials. Impact: Survivors of critical illness often face lasting physical, cognitive, and mental health challenges, and physical rehabilitation in the ICU can improve recovery. This article explores the importance of tailoring physical rehabilitation to individual needs and proposes new research methods to improve the design and outcomes of future ICU trials. By addressing challenges, the authors provide practical solutions to make ICU rehabilitation more accessible and effective. These insights aim to enhance recovery and quality of life for ICU survivors.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147662641","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, May 2026.","authors":"","doi":"10.1093/ptj/pzag037","DOIUrl":"https://doi.org/10.1093/ptj/pzag037","url":null,"abstract":"","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":"106 5","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841363","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 adaptability training for individuals with non-progressive neurological conditions: a scoping review of intervention characteristics and outcome measures.","authors":"Nicole Cesca, Matthew G Heffernan, Sydney Winokur, Katherine Chan, Clara Pujol-Fuentes, Kristin E Musselman","doi":"10.1093/ptj/pzag038","DOIUrl":"10.1093/ptj/pzag038","url":null,"abstract":"<p><strong>Importance: </strong>Gait adaptability is essential for safe walking. Impairments after non-progressive neurological conditions contribute to walking limitations and fall risk. Advances in virtual/augmented reality-based treadmills/walkways have increased interest in gait adaptability assessment and training, making a review timely.</p><p><strong>Objective: </strong>The objectives were as follows: (1) Explore the characteristics and outcomes of physical interventions used to improve gait adaptability for individuals with non-progressive neurological conditions; and (2) Identify the outcome measures and tasks used to track changes with interventions incorporating gait adaptability training.</p><p><strong>Data sources: </strong>A comprehensive search was conducted in 6 databases: CINAHL Complete, Embase, Emcare Nursing, Medline ALL, PEDro, and Web of Science Core Collection, from inception to September 8, 2025.</p><p><strong>Study selection: </strong>Studies that involved adults with non-progressive neurological conditions, incorporated walking with environmental/task changes, targeted gait adaptability, and included >2 training sessions were included.</p><p><strong>Data extraction and synthesis: </strong>Study/participant characteristics, interventions, and outcomes were extracted. Methodological quality was assessed using the Modified Downs and Black checklist. Interventions were categorized into 6 groups, and their alignment with 9 gait adaptability domains was evaluated. Outcome measures were identified and classified based on relevance to gait adaptability.</p><p><strong>Results: </strong>Twenty-nine studies (881 participants: 743 stroke, 132 spinal cord injury, 6 acquired brain injury) were included. The most common interventions were skilled overground/community walking and treadmill training with virtual/augmented reality. Obstacle negotiation was the most frequently targeted gait adaptability domain. Interventions that incorporated gait adaptability training led to improvements in walking outcomes such as speed and endurance. The most common outcome measures-10-Meter Walk Test, Timed Up and Go, and 6-Minute Walk Test-do not directly assess gait adaptability.</p><p><strong>Conclusions and relevance: </strong>Interventions that incorporated gait adaptability training included a broad range of overground and treadmill training approaches, and improved walking ability. Future trials should include measures that directly assess multiple domains of gait adaptability.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147675850","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":"Toward a shared framework for therapeutic pain education: a Delphi-based international consensus.","authors":"Silvia Di-Bonaventura, Francisco Gurdiel-Álvarez, Álvaro Reina-Varona, Ferran Cuenca-Martínez, Josué Fernández-Carnero, Mónica Grande-Alonso, Eva Huysmans, Roy La Touche, Federico Montero-Cuadrado, Rodrigo Nuñez-Cortes, Joaquín Pardo-Montero, Alba Paris-Alemany, Emilio L Puentedura, Felipe J J Reis, Giacomo Rossettini, Cormac G Ryan, Anabela G Silva, Luís Suso-Martí, Paul van Wilgen, Amarins Wijma, Kory Zimney, Raúl Ferrer-Peña","doi":"10.1093/ptj/pzag029","DOIUrl":"10.1093/ptj/pzag029","url":null,"abstract":"<p><strong>Importance: </strong>Persistent pain is a global cause of disability, affecting daily life and physical, psychological, and social functioning. While biomedical approaches may alleviate symptoms, they often overlook psychological, behavioral, and contextual contributors. Recently, therapeutic pain education has emerged as a key non-pharmacological strategy; however, consensus on its core content and implementation is still lacking.</p><p><strong>Objective: </strong>The objective was to reach an international expert consensus on the core components of therapeutic education programs for individuals with persistent pain.</p><p><strong>Design: </strong>The study consisted of a 3-round Delphi consensus study.</p><p><strong>Setting: </strong>An international, online Delphi modality was performed.</p><p><strong>Participants: </strong>Twenty-one multidisciplinary experts from 10 countries (high- to middle-income ratio: 19/2) were included in the present study.</p><p><strong>Intervention(s) or exposure(s): </strong>Participation consisted of a structured Delphi process of 1 open-ended round and 2 structured rounds using a 4-point Likert scale, organized across 8 predefined domains.</p><p><strong>Main outcome and measure(s): </strong>The main outcome was expert agreement on core components of therapeutic pain education, defined as an Aiken V value ≥0.7 with their 95% confidence interval exceeding this threshold. The process was organized around 8 domains: topic areas, patient/learner characteristics, materials and resources, activities, dosage and frequency, learning outcomes, context/environment, and adherence assessment.</p><p><strong>Results: </strong>The experts, with a mean of 20 years of clinical experience (SD = 9.6) and 15 years of research experience (SD = 6.4), reached agreement on 35 items. Experts highlighted core content such as neuroplasticity, pain-related beliefs, emotional regulation, and behavior change. They recommended assessing motivation, readiness to change, expectations, tailoring interventions to patient profiles, using explicit, evidence-based materials, including graded exposure and pacing, adjusting dosage according to engagement, ensuring a safe, welcoming, private environment, and assessing changes in beliefs, functioning, and lifestyle.</p><p><strong>Conclusion: </strong>This study provides an internationally validated framework for designing and implementing therapeutic education programs for individuals with persistent pain.</p><p><strong>Relevance: </strong>By translating expert consensus into practical components, it bridges the gap between theory and clinical practice, supporting consistent, patient-centered strategies and informing future implementation and research.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147499657","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}