Physiotherapy Theory and Practice最新文献

{"title":"Between the lines: a discursive analysis of the non-specific low back pain literature.","authors":"Clair Hebron, Morten Ekornsaeter, Karime Mescouto","doi":"10.1080/09593985.2024.2446530","DOIUrl":"10.1080/09593985.2024.2446530","url":null,"abstract":"<p><strong>Background: </strong>The term nonspecific low back pain (NSLBP) is often ambiguously defined and inconsistently used in scientific literature. Yet, there is limited discussion and reflection on the meaning of the term and how different meanings influence research and clinical practice.</p><p><strong>Aim: </strong>The aim of this study was to critically analyze the meaning of NSLBP in scientific literature and its consequent influence on research and clinical practice.</p><p><strong>Methodology and methods: </strong>Conducting a Foucauldian discourse analysis, we analyzed 24 articles that explicitly discussed the term's meaning. Relevant articles were retrieved through a systematic literature search of six databases, supplemented by snowballing and expert recommendations.</p><p><strong>Findings: </strong>Our analysis identified five distinct discourses analyzing NSLBP: \"Biomedical,\" \"Neurocentric,\" \"Rational-Multifactorial,\" \"Complex-Multifactorial,\" and \"NSLBP Otherwise.\"</p><p><strong>Conclusion: </strong>Each identified discourse was underpinned by unique assumptions that both enable and constrain certain ways of thinking about, researching, and managing NSLBP. Most discourses were individual-centric, guiding a search for causes and solutions within the individual. An exception was the \"NSLBP Otherwise Discourse,\" which enables a more society-centric perspective and encourages alternative views on NSLBP. Given the significant impact of NSLBP and the paucity of substantial breakthroughs in understanding and management, critical reflection on current discourses and their influence on clinical and research practices seem timely. Moreover, considering the present uncertainty surrounding NSLBP, embracing multiplicity could pave the way for a more expansive research agenda.</p>","PeriodicalId":48699,"journal":{"name":"Physiotherapy Theory and Practice","volume":" ","pages":"1647-1662"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957275","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":"Implementation and sustainment of a clinical practice guideline in a physical therapy student-run pro bono clinic: a case report.","authors":"Amy Yorke, Suzanne Trojanowski, Sean Hurlburt, Jessika Gehrke","doi":"10.1080/09593985.2025.2450612","DOIUrl":"10.1080/09593985.2025.2450612","url":null,"abstract":"<p><strong>Background: </strong>The development of evidence-based practitioners is an expectation of entry-level physical therapist education. Knowledge translation is a process to enhance the uptake of evidence into clinical practice. Student run pro bono clinics provide an authentic learning environment in which knowledge translation activities can be used to implement clinical practice guidelines (CPGs).</p><p><strong>Purpose: </strong>The purpose of this case report was to describe the implementation, evaluation, and sustainment process of incorporating a physical therapy neurologic outcome measure CPG in a physical therapy student run pro bono clinic.</p><p><strong>Methods: </strong>A mixed methods study, using the Knowledge to Action framework, was completed to standardize the outcome measures completed on patients with neurologic conditions who received services at a physical therapy student run pro bono clinic. The project was titled iKNOW (integrating KNOWledge translation) Super Six.</p><p><strong>Results: </strong>Chart audits, surveys, and focus groups revealed success in implementing a CPG promoting standardization of practice in a student run pro bono clinic. Students reported that environmental modifications and the availability of resources were strong facilitators of completing the measures. Differences existed between cohorts in perceived usefulness of peer support. To sustain use of the neurologic outcome measures as recommended by the CPG, efforts to enhance awareness, leverage peer support, maximize environmental facilitators, along with audit and feedback will continue.</p><p><strong>Conclusion: </strong>Student run pro bono clinics provide the environment for the implementation of CPGs. Students engaging in knowledge translation may develop the skills needed as an evidence-based practitioner.</p>","PeriodicalId":48699,"journal":{"name":"Physiotherapy Theory and Practice","volume":" ","pages":"1745-1753"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013638","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 association between screened psychological risk for disability and appropriateness of orthopedic surgery in patients with musculoskeletal disorders - data from a Swedish RCT in primary care 2009-2011.","authors":"Karin S Samsson, Susanne Bernhardsson, Maria Sandborgh, Maria E H Larsson","doi":"10.1080/09593985.2024.2448709","DOIUrl":"10.1080/09593985.2024.2448709","url":null,"abstract":"<p><strong>Introduction: </strong>To understand, diagnose and treat patients with musculoskeletal disorders, psychological risk factors should be assessed, and the association between psychological risk for disability and appropriateness of orthopedic surgery should be investigated.</p><p><strong>Purpose: </strong>To investigate the association between screened psychological risk for disability and appropriateness of orthopedic surgery, and to examine a physiotherapist's ability to assess risk for disability in patients referred for orthopedic consultation.</p><p><strong>Method: </strong>Patients (<i>n</i> = 192) were assessed by a physiotherapist or an orthopedic surgeon to determine the need for surgery. The Pain Belief Screening Instrument (PBSI) was used to screen for psychological risk. The physiotherapist assessed psychological risk for disability based on yellow flags. Association between PBSI risk profile and appropriateness of orthopedic surgery was analyzed using logistic regression. Sensitivity and specificity of the physiotherapist's assessment of risk was calculated using a binary classification model.</p><p><strong>Results: </strong>Orthopedic surgery was 2.28 times more likely to be considered an appropriate intervention for patients with a high PBSI risk profile (95% CI 1.09;4.78). The physiotherapist's risk assessment correctly identified 88% of those at low risk (specificity) and 32% of those at high risk for disability (sensitivity).</p><p><strong>Conclusion: </strong>The findings suggest that orthopedic surgery is likely to be considered appropriate for patients with a high PBSI risk profile. The high specificity of the physiotherapist's assessment implies good awareness of psychological factors. The low sensitivity suggests a need for using a screening tool such as the PBSI, to guide management decisions.<b>Trial registration</b>: Clinical Trials NCT02265172, retrospectively registered June 10, 2014.</p>","PeriodicalId":48699,"journal":{"name":"Physiotherapy Theory and Practice","volume":" ","pages":"1579-1586"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933192","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":"Long-term effect of CoDuSe program on balance, fall risk, and gait in patients with multiple sclerosis.","authors":"Waleed S Mahmoud, Marwa M Ibrahim, Nadia L Radwan","doi":"10.1080/09593985.2024.2447928","DOIUrl":"10.1080/09593985.2024.2447928","url":null,"abstract":"<p><strong>Background: </strong>Patients with Multiple Sclerosis (MS) frequently suffer from balance and gait difficulties.</p><p><strong>Objective: </strong>This study aims to investigate the long-term effects of a combined Core Stability, Dual-task, and Sensory Exercise (CoDuSe) program and standard exercise routine on balance, fall risk, and gait performance in patients with MS, compared to a standard exercise program alone.</p><p><strong>Methods: </strong>Thirty-nine patients with MS were randomized into a study group (<i>n</i> = 19) that received CoDuSe balance training in addition to a specified exercise program and a control group (<i>n</i> = 20) that received only the specified exercise program. Both groups of patients trained for 8 weeks at 60 min per session, 2 days a week. All patients were evaluated at pretreatment, week 9, week 16, and week 24 following the rehabilitation regimen. The Berg Balance Scale Test (BBST), the Biodex Balance System (BBS; specifically, the Overall Stability Index [OSI]), the timed 25-foot walk test (T25FW), and the 12-item MS walking scale (MSWS-12) were used to assess static and dynamic balance, the fall risk index test, gait speed, and walking ability, respectively.</p><p><strong>Results: </strong>The study group showed significant improvements compared to the control group in all outcome measures (<i>p</i> < .001). BBST scores improved the most in week 16 (ES = 0.66), while OSI and MSWS-12 improved significantly by week 9 (ES = 0.76, 0.34, respectively). T25FW demonstrated notable enhancements in weeks 9 and 16 (ES = 0.33). These findings highlight the sustained benefits of CoDuSe on balance, fall risk, and gait in patients with MS.</p><p><strong>Conclusion: </strong>The CODuSe program, when combined with a standard exercise routine, has a long-lasting effect on balance, fall risk (up to 24 weeks), and gait ability (up to 16 weeks) in patients with MS.</p><p><strong>Clinical trial registration: </strong>Iranian Trial Registration (IRCT20210909052421N4).</p>","PeriodicalId":48699,"journal":{"name":"Physiotherapy Theory and Practice","volume":"41 8","pages":"1564-1578"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762031","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":"Reliability, validity, responsiveness and minimal important changes of common clinical standing balance tests in individuals with knee osteoarthritis.","authors":"Neda Mostafaee, Nahid Pirayeh, Seyed Shahnam Moosavi","doi":"10.1080/09593985.2024.2445143","DOIUrl":"10.1080/09593985.2024.2445143","url":null,"abstract":"<p><strong>Introduction: </strong>Standing balance is essential for physical functioning. Therefore, improving balance control is a key priority in the management of knee osteoarthritis (OA), underscoring the importance of accurately assessing standing balance.</p><p><strong>Purpose: </strong>To assess reliability, construct validity and responsiveness of common clinical balance tests, including Step Test, Single-Leg Stance Test, and Functional Reach Test, in patients with knee OA.</p><p><strong>Methods: </strong>In the initial session, 100 participants underwent balance tests and completed Persian-version of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Timed Up and Go Test (TUG) as comparators for evaluating the construct validity of balance tests. For test-retest reliability, a subset of 70 participants repeated balance tests 1 week after initial assessment. To examine responsiveness, a subset of 90 participants underwent tests and completed WOMAC and TUG at baseline and after completing intervention. At post-intervention assessment, participants also completed global rating of change scale.</p><p><strong>Results: </strong>Three balance tests showed excellent test-retest reliability (intra-class correlation coefficient >0.75). All balance tests were considered valid and responsive because they confirmed 100% of priori hypotheses. Minimal detectable change (MDC) values were 2.71 steps for Step Test, 7.15 seconds for Single-Leg Stance Test, and 4.90 centimeters for Functional Reach Test. Minimal important change (MIC) values were 4.5 steps for Step Test, 13.10 seconds for Single-Leg Stance Test, and 5.5 centimeters for Functional Reach Test.</p><p><strong>Conclusion: </strong>Three tests are reliable, valid and responsive for measuring balance in patients with knee OA. The MIC values aid clinicians and researchers in assessing the clinical relevance of changes in balance for these patients.</p>","PeriodicalId":48699,"journal":{"name":"Physiotherapy Theory and Practice","volume":" ","pages":"1703-1711"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013965","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 kinesiotaping on proprioception, pain, disability, and quality of life in patients with cervical spondylosis: a randomized controlled trial.","authors":"Selin Aksungur, Tugba Ozsoy-Unubol, Gokcenur Yalcin, Serenay Vardar, Yeliz Bahar-Ozdemir, Muhammet Ali Yavuzdemir, Emre Ata","doi":"10.1080/09593985.2025.2449585","DOIUrl":"10.1080/09593985.2025.2449585","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to assess the effects of kinesiotaping (KT) adjunct to physical therapy (PT) on proprioception, cervical range of motion (ROM), pain, disability, anxiety, depression, and quality of life (QoL) in cervical spondylosis.</p><p><strong>Methods: </strong>Sixty-nine patients aged 50-70 years were randomized into three groups: PT, PT plus KT(PT+KT), PT plus sham-taping(PT+ST). All participants underwent standardized 15-session PT, 5 days/week. Additionally, group-II received KT, and group-III received ST 2 days/week for 3 weeks. Primary outcome was the cervical-joint-position-error-test (CJPET), with secondary outcomes active-cervical ROM, handgrip strength, Visual-Analogue-Scale (VAS), Douleur Neuropathique-4 Questions (DN4), Upper-Limb-Functional-Index (ULFI), Neck-Disability-Index (NDI), Hospital Anxiety and Depression Scale (HADS), and 36-Item Short Form Survey (SF-36).</p><p><strong>Results: </strong>CJPET for flexion improved in all groups (<i>p</i> < .05), with no significant intergroup differences (<i>p</i> > .05). ROM improved in all groups (<i>p</i> < .05), with significant intergroup differences in extension at both T1 (<i>p</i> = .006, eta squared = 0.125, medium effect size) and T2 (<i>p</i> = .022, eta squared = 0.086, medium effect size); revealing greater improvement for PT+KT and PT+ST compared to PT (<i>p</i> < .05).VAS, DN4, NDI, and SF-36 pain domain scores improved in all groups (<i>p</i> < .05). Handgrip strength increased in the nondominant hand in PT+KT and PT+ST (<i>p</i> = .021). No improvements were observed in HADS (<i>p</i> > .05). ULFI increased in PT (<i>p</i> = .043) and PT+ST (<i>p</i> = .005).</p><p><strong>Conclusion: </strong>KT adjunct to PT shows potential in improving proprioception, pain, and disability in cervical spondylosis. Further studies are needed to refine taping techniques and assess long-term effects.</p>","PeriodicalId":48699,"journal":{"name":"Physiotherapy Theory and Practice","volume":" ","pages":"1587-1601"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053974","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 effect of single-task versus dual-task assessment on muscle strength and performance in individuals with knee osteoarthritis.","authors":"Hazal Genç, Gamze Demircioğlu","doi":"10.1080/09593985.2024.2447488","DOIUrl":"10.1080/09593985.2024.2447488","url":null,"abstract":"<p><strong>Background: </strong>Dual-task activities, which involve performing two separate tasks simultaneously, often result in reduced motor function and daily activity performance among individuals with knee osteoarthritis (OA).</p><p><strong>Objective: </strong>This study aimed to investigate the impact of single- and dual-task conditions on muscle strength and performance in individuals with knee OA and examine how cognitive load influences physical task performance in this population.</p><p><strong>Methods: </strong>Sixty patients with knee OA were included. Baseline data included demographic characteristics, pain (Visual Analog Scale), and physical function (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)). Muscle strength and performance were assessed using isokinetic and sit-to-stand tests, initially under single-task conditions, and then under dual-task conditions three days later. Dual-tasking involved physical tasks with varying cognitive exercises (changed between sessions) and familiarization sessions to minimize learning effects.</p><p><strong>Results: </strong>The investigation revealed that individuals with knee OA showed reduced muscle strength and impaired sit-to-stand performance during dual-task activities, with lower peak torque (<i>p</i> = .0025), total work (<i>p</i> = .026), and longer time to peak torque (<i>p</i> = .011). Decreased muscle performance correlated with worse WOMAC scores (<i>p</i> ≤ .01, <i>r</i> = -0.506), particularly in dual-task conditions. Regression analysis identified extension total work and the sit-to-stand test as key predictors of dual-task performance, explaining 32.2% of the variance.</p><p><strong>Conclusion: </strong>Dual-task performance impairs muscle strength and physical function in individuals with knee OA, demonstrated by reduced peak torque, total work, and sit-to-stand performance. Extension total work and sit-to-stand test emerged as key predictors of dual-task performance, emphasizing the need to address cognitive load in rehabilitation strategies.</p>","PeriodicalId":48699,"journal":{"name":"Physiotherapy Theory and Practice","volume":" ","pages":"1555-1563"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886245","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":"Static and dynamic balance in physically active females with pronated feet.","authors":"Edyta Chemperek, Magdalena Zawadka, Raquel Fábrega-Cuadros, Agustín Aibar-Almazán, Fidel Hita-Contreras, Piotr Gawda","doi":"10.1080/09593985.2024.2447473","DOIUrl":"10.1080/09593985.2024.2447473","url":null,"abstract":"<p><strong>Background: </strong>Understanding and assessing static and dynamic balance and their relationship with the function of the medial longitudinal arch of the foot is crucial for people with pronated feet.</p><p><strong>Purpose: </strong>This study aimed to assess the medial longitudinal arch height and postural balance in physically active females with pronated feet.</p><p><strong>Methods: </strong>A case-control study. The participants were divided into two groups based on their Foot Posture Index (FPI) scores: females with bilateral foot pronation (<i>n</i> = 33) and the control group with normal feet (<i>n</i> = 30). A Navicular Drop Test (NDT) and Knee-to-Wall Test (KTW) were used to assess foot and ankle function. Static balance was assessed using the Stork Balance Test (SBT) and Tandem Stance (TS). Dynamic balance was assessed using the Y-Balance Test (Y-BT). Physical activity was assessed using the total score of the short version of the International Physical Activity Questionnaire.</p><p><strong>Results: </strong>There was a lack of differences in static balance between pronated and normal feet groups in SBT and TS. The Y-BT anterior reaching depends on foot posture in favor of a pronated foot (<i>p</i> = .04). Correlation also showed a significant relationship between Y-BT components and NDT (<i>r</i> = 0.33, <i>p</i> = .01) and between KTW and NDT (<i>r</i> = 0.30, <i>p</i> = .02).</p><p><strong>Conclusion: </strong>These results may suggest that foot pronation can be associated with dynamic balance in some directions. However, given that most comparisons did not show significant differences, the relationship between foot posture and functional assessment remains unclear.</p>","PeriodicalId":48699,"journal":{"name":"Physiotherapy Theory and Practice","volume":" ","pages":"1545-1554"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923437","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":"Exploring therapeutic alliance in spinal cord injury rehabilitation: Control, identity, and liminality.","authors":"Esha Lovrić, Niki Edwards, Julie King","doi":"10.1080/09593985.2024.2443028","DOIUrl":"10.1080/09593985.2024.2443028","url":null,"abstract":"<p><strong>Background: </strong>The therapeutic alliance (TA) has emerged as a key principle in enhancing the quality of health and rehabilitation services.</p><p><strong>Purpose: </strong>This study aimed to explore patient perspectives on the influence of TAs with practitioners during inpatient rehabilitation following spinal cord injury (SCI).</p><p><strong>Methods: </strong>Using a qualitative methodology, (<i>n</i> = 18) in-depth interviews were conducted with inpatient participants. Interviews were transcribed verbatim and analyzed using reflective thematic analysis. The study was grounded in a social constructionist epistemology, employing theories of liminality and psychotherapy as theoretical frameworks.</p><p><strong>Results: </strong>Patient narratives suggest TAs are central to the rehabilitation experience. Additionally, analysis of patient stories revealed that patients entered a state of liminality upon admission. The primary theme, \"Control as Enabling: Transition, the Marge,\" highlighted during rehabilitation, patients navigated an identity separation and transition phase central to liminal spaces. Where practitioners accommodated patients' identity journeys, meaningful TAs were established, enhancing rehabilitation. Conversely, when control was constrained, TAs weakened, increasing identity risks. TAs were found to be instrumental in protecting and preserving pre-SCI identity as well as facilitating movement through the liminal phase.</p><p><strong>Conclusion: </strong>This research underscores the significance of TAs in SCI rehabilitation, demonstrating their role in enabling patient control, safeguarding identity, and facilitating the potential exit from liminality. To address the unique needs of SCI patients, it is recommended that SCI practitioners receive specialized TA training and professional development.</p>","PeriodicalId":48699,"journal":{"name":"Physiotherapy Theory and Practice","volume":" ","pages":"1630-1646"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899503","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":"Using metabolic parameters to inform emergency care referral in a patient with a hyperglycemic induced acute kidney injury: a case report.","authors":"Juan P Gonzalez, Francesco Vendrame, Sabine Gempel, Kathryn E Roach, Neva Kirk-Sanchez, Marlon Wong","doi":"10.1080/09593985.2024.2449222","DOIUrl":"10.1080/09593985.2024.2449222","url":null,"abstract":"<p><strong>Objective: </strong>To describe the clinical reasoning and use of the American Diabetes Association (ADA) blood glucose and exercise guidelines in the face of an emerging acute glycemic crisis for a patient with type 2 diabetes mellitus receiving physical therapy for chronic ankle instability and fibromyalgia.</p><p><strong>Case description: </strong>Assessment of the patient's baseline blood glucose and ketone urinalysis revealed hyperglycemia and ketonuria, respectively. Shortly after testing, the patient became nauseous and vomited. This prompted assessment of her end-tidal carbon dioxide via nasal capnography to screen for diabetic keto-acidosis. Evidence of Kussmaul breathing, tachypnea, and hypocapnia in conjunction with hyperglycemia and ketonuria, as well as symptoms of nausea and signs of vomiting prompted a referral to the emergency department.</p><p><strong>Outcomes: </strong>The patient was admitted to the hospital for five days with a diagnosis of acute kidney injury. It was determined that the acute kidney injury was caused by hyperglycemia in combination with impaired kidney function and an exacerbation of her congestive heart failure, all of which are known risk factors for acute kidney injuries in patients with diabetes mellitus.</p><p><strong>Conclusions: </strong>Compliance with the ADA blood glucose exercise guidelines allowed for early recognition of metabolic dysfunction prior to the onset of symptoms. Failure to have complied with the ADA blood glucose exercise guidelines may have resulted in the physical therapist administering therapeutic exercise that likely would have contributed to a worse prognosis.</p>","PeriodicalId":48699,"journal":{"name":"Physiotherapy Theory and Practice","volume":" ","pages":"1729-1735"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014179","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}