Physiotherapy Theory and Practice最新文献

{"title":"Immediate effect of contactual hand-orientating response facilitation on wrist muscle activity in individuals with chronic stroke and severe motor deficits.","authors":"Pagamas Piriyaprasarth, Piyaporn Wichaidit, Komsak Sinsurin, Jim Richards","doi":"10.1080/09593985.2026.2621209","DOIUrl":"10.1080/09593985.2026.2621209","url":null,"abstract":"<p><strong>Purpose: </strong>Contactual hand-orientating response (CHOR) is a fundamental component of the Bobath concept which has been reported to promote hand function. This study aimed to assess activity and co-activation during CHOR facilitation of extensor digitorum (ED) which represented wrist extensors, and flexor digitorum superficialis (FDS) which represented wrist flexors.</p><p><strong>Method: </strong>CHOR facilitation of the paretic hand in 18 patients with chronic stroke with severe upper limb motor deficits, active contraction in the non-paretic hand and 18 healthy individuals wrist extensor and flexor muscles were compared using surface electromyography.</p><p><strong>Results: </strong>The co-contraction index of wrist extensors and flexors in the paretic hand in patients with chronic stroke was significantly greater during CHOR facilitation than in the healthy individuals (mean (SD) = 51.88 (6.02) and 46.75 (5.50), respectively), <i>p</i> = .012). Significantly greater wrist flexor and extensor muscle activity were seen in the paretic hand during CHOR facilitation compared with resting (median = 0.803 vs 0.133; median = 0.856 vs 0.225, respectively) (<i>p</i> < .001).</p><p><strong>Conclusion: </strong>CHOR facilitation appears to selectively enhance wrist extensor and wrist flexor activity in patients with stroke despite showing a greater co-activation. These findings support the immediate effect of movement facilitation to enhance muscle activity in patients with severe motor deficits post stroke.</p>","PeriodicalId":48699,"journal":{"name":"Physiotherapy Theory and Practice","volume":" ","pages":"1141-1151"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146068023","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":"Comparative effects of overground and treadmill gait training on post-stroke quality of life and walking performance.","authors":"Mashael A Al-Homayin, Matar A Alzahrani","doi":"10.1080/09593985.2026.2627991","DOIUrl":"10.1080/09593985.2026.2627991","url":null,"abstract":"<p><strong>Background: </strong>Post-stroke gait impairment significantly affects patients' functional independence and quality of life (QoL). Gait training strategies such as overground and treadmill-based interventions are frequently employed in stroke rehabilitation, yet the comparative effectiveness of these modalities remains inconclusive.</p><p><strong>Objective: </strong>To compare the effects of overground (OGT) and treadmill (TGT) gait training on post-stroke QoL and walking performance over a 4-week intervention period comprising 12 training sessions.</p><p><strong>Methods: </strong>An experimental pre-post intervention design was employed, involving 17 stroke survivors (<i>n</i> = 7 over ground, <i>n</i> = 10 on a treadmill). Participants underwent structured gait training and were assessed using the WHOQOL-BREF, walking speed (m/s), and 6-minute walk test (6MWT) for walking capacity. A multivariate repeated measures ANOVA examined effects of time, group, and interaction on QoL domains and performance metrics.</p><p><strong>Results: </strong>Significant within-group improvement was observed in overall QoL (Wilks' Λ = 0.501, F (1, 15) = 14.94, <i>p</i> = .002, partial η² = 0.499), irrespective of training modality, with no significant between-group differences (<i>p</i> = .712). Walking capacity demonstrated a statistically significant increase among all participants (F (1, 15) = 10.66, <i>p</i> = .005, partial η² = 0.415), with no significant between-group difference (<i>p</i> = .668). In contrast, changes in walking speed were not statistically significant (F (1, 15) = 1.96, <i>p</i> = .182), and no significant difference was observed between the OGT and TGT groups (<i>p</i> = .269).</p><p><strong>Conclusion: </strong>Both OGT and TGT significantly improved QoL and walking capacity among stroke survivors, with no superior effect observed between modalities. However, neither intervention significantly enhanced walking speed. These findings suggest that both training approaches are equally beneficial in improving endurance and overall well-being post-stroke, though additional strategies may be needed to target gait speed.77.</p>","PeriodicalId":48699,"journal":{"name":"Physiotherapy Theory and Practice","volume":" ","pages":"1203-1214"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146167643","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":"Predictive value of 6-minute walk test for weight loss after bariatric and metabolic surgery in individuals with class III obesity.","authors":"Sunghwan Choi, Eunse Park, Dilbar Abdurakhimova, Heidi C Bednarchuk, Joy M Macheel, Wootaek Lim","doi":"10.1080/09593985.2026.2627993","DOIUrl":"10.1080/09593985.2026.2627993","url":null,"abstract":"<p><strong>Background: </strong>Class III obesity is associated with wide variability in early weight-loss response after metabolic and bariatric surgery (MBS), creating a need for simple preoperative measures that can help stratify risk for early nonresponse.</p><p><strong>Objective: </strong>To determine whether preoperative physical functional capacity, assessed by the six-minute walk test (6MWT), predicts short-term weight loss outcomes following MBS.</p><p><strong>Methods: </strong>In this retrospective study, a total of 164 adults (mean age = 43.1 ± 10.9 years) with class III obesity underwent MBS, predominantly laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy. Three 6MWT models using (1) absolute distance, (2) percentage of predicted distance, and (3) 6MWT/body mass index (BMI) were evaluated to predict nonresponse, defined as less than 45% excess BMI loss at six months. Patients were split into development and validation cohorts. Predictive performance was assessed with receiver operating characteristic curves, area under the curve (AUC), sensitivity, and specificity.</p><p><strong>Results: </strong>Patients achieved a total body weight loss of 26.0 ± 6.9% and excess BMI loss of 57.3 ± 18.0% (76.6% follow-up). Model 3 showed the strongest predictive performance (development AUC = 0.74; validation AUC = 0.78). Model 1 demonstrated high sensitivity (0.83) but lower discrimination (validation AUC = 0.67).</p><p><strong>Conclusions: </strong>Preoperative 6MWT performance provides promising prognostic information for early nonresponse to weight loss following MBS. The 6MWT/BMI ratio showed the strongest and most consistent predictive performance within our cohort, supporting its potential role as a valuable supplementary risk stratification tool. Absolute 6MWT distance may serve as a high-sensitivity screening tool. When used in conjunction with other clinical assessments, this two-step approach may help identify patients at risk for nonresponse and guide targeted perioperative interventions.</p>","PeriodicalId":48699,"journal":{"name":"Physiotherapy Theory and Practice","volume":" ","pages":"1225-1233"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146144265","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":"Moving in the water: A randomized controlled trial on the effects of aquatic therapy on general movements and clinical outcomes in preterm newborns.","authors":"Andressa Lagoa Nascimento França, Natália Matos Tedesco, Olena Chorna, Geruza de Souza Mallmann, Mariane de Oliveira Nunes Reco, Priscila Rimoli de Almeida, Lucia Rocchitelli, Ginevra Costagli, Sabrina Del Secco, Andrea Guzzetta, Daniele Soares-Marangoni","doi":"10.1080/09593985.2026.2621956","DOIUrl":"10.1080/09593985.2026.2621956","url":null,"abstract":"<p><strong>Background: </strong>Bucket hydrokinesiotherapy, a supportive aquatic intervention for newborns, has been widely applied, although it lacks robust evidence regarding its clinical and neuromotor effects. While the General Movements Assessment (GMA) sensitively detects early neurological risk, the influence of therapeutic interventions on general movements (GMs) remains unclear.</p><p><strong>Objective: </strong>This study aimed to examine the effect of hydrokinesiotherapy on the GMs of hospitalized preterm infants and their clinical outcomes.</p><p><strong>Methods: </strong>Parallel-arm randomized controlled trial in which newborns were randomly assigned to two balanced groups and assessed at 34 (baseline), 36, 40-42, and 50-52 weeks postmenstrual age. Main inclusion criteria were: poor repertoire-GMs, admitted to a Neonatal Intermediate Care Unit, clinically stable. Assessors of main outcomes were blinded to group allocation. Interventions consisted of 10-minute bucket hydrokinesiotherapy followed by diaper change over 6 sessions on alternate days, or a diaper change only (control). Body weight and GMA were primary outcomes. Behavioral state was a secondary outcome; physiological parameters and respiratory distress were monitoring outcomes.</p><p><strong>Results: </strong>Thirty-four infants were included. Body weight (<i>p</i> = 0.43; d = 0.28) and global quality of GMs (p's > 0.25; d's < 0.39) were not affected by the intervention. Controls presented higher total (95%CI: 3.28-19.71; <i>p</i> < .001), upper (95%CI: 1.74-9.36; <i>p</i> < 0.001), and lower limb (95%CI: 0.79-8.14; <i>p</i> = 0.02) movement scores in the detailed GMA after the diaper changes protocol, at 36 weeks. The hydrokinesiotherapy group was more alert than controls after each session (p's < 0.01; V's > 0.53). Physiological parameters showed transient between-group differences within normal ranges (p's < 0.05). Adverse effects were not found.</p><p><strong>Conclusion: </strong>Bucket hydrokinesiotherapy was safe for the newborns. The technique was not effective in improving the global quality or detailed aspects of GMs after the two-week protocol. The intervention may be recommended to increase alertness, potentially supporting readiness for active feeding and engagement during care; however, caution is warranted given its acute effects on detailed aspects of GMs.</p><p><strong>Trial registrations: </strong>Trial registered in the Brazilian Clinical Trials Registry (ReBec). ReBec is a Primary Registry in the WHO Registry Network. Trial nº. RBR-5n82tv. https://ensaiosclinicos.gov.br/rg/RBR-5n82tv/.</p>","PeriodicalId":48699,"journal":{"name":"Physiotherapy Theory and Practice","volume":" ","pages":"1152-1170"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146087752","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":"Diagnostic accuracy of SARC-F and SARC-CalF as sarcopenia screening instruments in rheumatoid arthritis according to European Working Group on Sarcopenia in Older People.","authors":"Merve Karapınar, Zübeyde Uğurlu, Fatma Gür Hatip, Ferdi Başkurt, Mehmet Şahin, Atalay Doğru","doi":"10.1080/09593985.2026.2627992","DOIUrl":"10.1080/09593985.2026.2627992","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the diagnostic accuracy of SARC-F and SARC-CalF as screening tools for sarcopenia in patients with rheumatoid arthritis using the European Working Group on Sarcopenia in Older People 2 algorithm as the reference standard.</p><p><strong>Method: </strong>A cross-sectional study was conducted among 106 patients with rheumatoid arthritis diagnosed according to the 2010 ACR/EULAR criteria. Sarcopenia was assessed through handgrip strength, appendicular skeletal muscle mass (via bioelectrical impedance analysis), and gait speed, following the EWGSOP2 \"Find - Assess - Confirm - Severity\" (F-A-C-S) model. The diagnostic performance of SARC-F and SARC-CalF was evaluated using sensitivity, specificity, positive and negative predictive values (PPV, NPV), and receiver operating characteristic (ROC) curves.</p><p><strong>Results: </strong>Among the participants, 43.3% had probable sarcopenia (low muscle strength), 15% had confirmed sarcopenia (low muscle strength plus low muscle mass), and 11.3% had severe sarcopenia (low strength, low mass, and poor physical performance), according to EWGSOP2 criteria. SARC-F showed high sensitivity (86.2%) and NPV (91.3%) for probable sarcopenia but had low specificity (54.5%) and poor discrimination for confirmed (AUC: 0.43) and severe (AUC: 0.44) cases. In contrast, SARC-CalF demonstrated improved specificity (90.7%) and better AUC (0.63) for confirmed sarcopenia, although sensitivity remained low (32.3%). Both tools showed limited performance in detecting severe sarcopenia.</p><p><strong>Conclusion: </strong>SARC-F, with its high sensitivity, can serve as a first-line physiotherapy screening tool to identify patients with rheumatoid arthritis at risk of sarcopenia, enabling timely referral for muscle-strengthening interventions. SARC-CalF offers greater specificity for confirmed cases and supports individualized exercise planning. As neither tool alone detects severe sarcopenia, a two-step approach combining both questionnaires with confirmatory assessments is recommended to enhance early detection and optimize functional outcomes in physiotherapy practice.</p>","PeriodicalId":48699,"journal":{"name":"Physiotherapy Theory and Practice","volume":" ","pages":"1215-1224"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146183091","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 efficacy of adding proprioceptive neuromuscular facilitation to conventional treatments for myogenous temporomandibular disorders: a randomized controlled trial.","authors":"Gizem Ergezen Sahin, Erkin Ergezen, Sukru Can Akmansoy, Meltem Meran Caglar, Yasemin Ozkan","doi":"10.1080/09593985.2026.2624517","DOIUrl":"10.1080/09593985.2026.2624517","url":null,"abstract":"<p><strong>Background: </strong>Temporomandibular disorders (TMDs) are associatedwith orofacial pain and functional limitations. Although conventionalphysiotherapy is commonly used, the additional benefits ofproprioceptive neuromuscular facilitation (PNF) remain unclear. Thisstudy investigated the effects of adding PNF to conventional exercisetherapy in individuals with myogenous TMD.</p><p><strong>Methods: </strong>A randomized controlled trial was conducted with 66participants aged 18-65 years diagnosed with myogenic TMD.Participants were divided into two groups for 4 weeks: a traditionalexercise group (CEG) or a traditional + PNF exercise group (PNFE).Pain intensity was assessed using the Numerical Pain Rating Scale(NPRS). Patient-reported mandibular function was evaluated using theMandibular Function Impairment Questionnaire (MFIQ). Mandibularmobility was assessed using jaw range of motion measures, includingactive range of motion (AROM) parameters (pain-free opening (PFO) andmaximum unassisted opening (MUO)) and assisted active range of motion(AAROM), measured as maximum mouth opening (MMO). Evaluations wereperformed at baseline (T0) and immediately after completion of the4-week intervention (T1).</p><p><strong>Results: </strong>From T0 to T1, pain intensity decreased significantlyin both groups (<i>p</i> < .001), with a moderate effect size indicating a greater reduction in the PNFE group (ηp² = 0.110, <i>p</i> = .043).Patient-reported mandibular function(MFIQ), improved in both groupsover the 4-week intervention period (<i>p</i> < .001). The PNFE groupdemonstrated greater gains in jaw range of motion (MMO and MUO);however, these changes were small (ηp² = 0.021 and ηp² = 0.002).</p><p><strong>Conclusion: </strong>PNF exercises, when combined with conventionalexercises, provided greater pain relief and improved ROM compared toconventional exercises alone, suggesting their potential value inTMDs rehabilitation. Further research is needed to assess long-termeffects.</p>","PeriodicalId":48699,"journal":{"name":"Physiotherapy Theory and Practice","volume":" ","pages":"1181-1192"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146127253","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":"Clinical sensory tests in professional practice: a web-based survey on awareness and challenges among Italian physicians and physiotherapists.","authors":"Federico Rossi, Giuseppe Giovannico, Leonardo Pellicciari, Vincenzo Vinciguerra, Guido Argentieri, Germano Guerra, Matteo Cioeta","doi":"10.1080/09593985.2026.2723491","DOIUrl":"https://doi.org/10.1080/09593985.2026.2723491","url":null,"abstract":"<p><strong>Background: </strong>Clinical sensory testing comprises pragmatic, relatively low-cost bedside approaches for appraising somatosensory function. However, clinicians' perceptions of these approaches and the barriers they associate with their use in Italy are poorly characterized.</p><p><strong>Objective: </strong>To describe self-reported perceptions of clinical sensory testing, preferred approaches to the assessment of different sensory modalities, and perceived barriers among Italian physicians and physiotherapists.</p><p><strong>Methods: </strong>A cross-sectional web-based survey was conducted disseminating nationally through non-probability recruitment between January and August 2025. Eligible respondents self-identified as licensed physicians or physiotherapists practicing in Italy and reported at least partial involvement in assessment of musculoskeletal or neuromuscular conditions. Questionnaire comprised 18 mandatory closed-ended items covering professional characteristics, perceived barriers, conceptual/methodological perceptions, preferred sensory-assessment options, and perceived clinical applicability. Results were summarized separately by profession using frequencies and percentages.</p><p><strong>Results: </strong>Four hundred and ninety-six complete questionnaires were analyzed (105 physicians, 391 physiotherapists). Time constraints were the most frequently selected barrier among physicians (90/105, 85.7%) and physiotherapists (302/391, 77.2%). A low-cost screening approach for somatosensory alterations was selected as the preferred CST definition by 69 physicians (65.7%) and 280 physiotherapists (71.6%). Small-fiber assessment was rated as \"quite important\" by 67 physicians (63.8%) and 214 physiotherapists (54.7%). For tactile, thermal, nociceptive, and vibratory assessment, respondents most often selected cotton swabs, warm/cold coins, toothpicks, and tuning forks, respectively, although the response distributions differed between the two samples.</p><p><strong>Conclusions: </strong>Respondents generally perceived clinical sensory testing as a low-cost and potentially useful approach, and time was the most frequently selected barrier. The findings describe perceptions and preferred response options rather than objective knowledge, verified professional competence, or actual CST use. They should not be interpreted as nationally representative estimates. Future studies should evaluate the validity, reliability, feasibility, and implementation of brief standardized CST approaches using more representative recruitment and direct measures of clinical behavior.</p>","PeriodicalId":48699,"journal":{"name":"Physiotherapy Theory and Practice","volume":" ","pages":"1-11"},"PeriodicalIF":1.6,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860613","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":"Nutrition in Osteoarthritis care: expanding the physical therapist's role in multimodal management.","authors":"Brian Russ, Ovidio Olivencia","doi":"10.1080/09593985.2026.2722211","DOIUrl":"https://doi.org/10.1080/09593985.2026.2722211","url":null,"abstract":"<p><p>Osteoarthritis (OA) is one of the leading causes of pain, disability, and reduced quality of life worldwide and has traditionally been managed through exercise, physical activity, and symptom-focused rehabilitation. However, growing evidence suggests that OA is not solely a mechanical \"wear-and-tear\" condition but a multifactorial disease influenced by chronic low-grade inflammation, metabolic dysfunction, obesity, and lifestyle behaviors. This evolving understanding highlights nutrition as a potentially important, yet underutilized, component of comprehensive OA management. Physical therapists are well positioned to address lifestyle factors that affect musculoskeletal health. Practical strategies include screening for nutrition risk factors, incorporating nutrition-related discussions into patient education, promoting healthy dietary behaviors, and collaborating with registered dietitian nutritionist when individualized counseling is required. Barriers such as limited nutrition training and uncertainty regarding scope of practice remain challenges. The purpose of this commentary is to examine the emerging role of nutrition in OA care and discuss how physical therapists can incorporate evidence-based nutrition education within interdisciplinary practice.</p>","PeriodicalId":48699,"journal":{"name":"Physiotherapy Theory and Practice","volume":" ","pages":"1-5"},"PeriodicalIF":1.6,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833849","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 COMprehensive BSI Assessment and Treatment - Recovery (COMBAT-R) model: a biopsychosocial approach to addressing bone stress injuries in military training.","authors":"Garry F Dredge, Johanna M Hoch, Timothy M Benedict, Brian T Gregg, Jason L Judkins, Nicholas R Heebner","doi":"10.1080/09593985.2026.2720530","DOIUrl":"https://doi.org/10.1080/09593985.2026.2720530","url":null,"abstract":"<p><strong>Background: </strong>Bone stress injuries (BSIs) affect between 5% and 21% of military trainees and impose a significant financial burden on the U.S. military. Current management strategies for the prevention and rehabilitation of BSIs focus primarily on biological risk factors, often neglecting psychosocial elements (such as resilience, kinesiophobia, and recovery expectations) that significantly influence attrition and return to duty.</p><p><strong>Purpose: </strong>To propose the COMprehensive BSI Assessment and Treatment - Recovery (COMBAT-R) Model, a biopsychosocial framework designed to support longitudinal assessment and management of BSIs across the military training continuum.</p><p><strong>Methods: </strong>This theoretical article synthesizes evidence regarding the relevant biological risk factors for developing a BSI (e.g. sex and bone mineral density), as well as the psychosocial factors related to military attrition (e.g. depression and low hardiness). It integrates these findings into the \"cycle of decline,\" where psychological distress may trigger physiological stress responses, such as elevated cortisol, that could impair bone healing. The model organizes these factors into three phases: preventative resilience (prior to training), response resilience (during training), and recovery resilience (post-injury).</p><p><strong>Results: </strong>The COMBAT-R model advances whole-person care by proposing a psychosocial screening component composed of brief measures to inform future assessment and rehabilitation planning. COMBAT-R also provides a conceptual framework for considering targeted psychosocial interventions, such as Pain Neuroscience Education and Acceptance and Commitment Therapy, as adjuncts to standard physical rehabilitation for trainees diagnosed with a BSI during basic training.</p><p><strong>Conclusion: </strong>COMBAT-R offers a conceptual framework to guide whole-person BSI care, address the cycle of decline, and inform future efforts to reduce avoidable medical discharge from basic training.</p>","PeriodicalId":48699,"journal":{"name":"Physiotherapy Theory and Practice","volume":" ","pages":"1-22"},"PeriodicalIF":1.6,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820017","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":"A qualitative inquiry into the environmental barriers and facilitators to non-specific low back pain clinical practice guideline adherence among Canadian physiotherapists.","authors":"Shelley Sargent, Sandra Webber, François Desmeules, Cara L Brown","doi":"10.1080/09593985.2026.2716384","DOIUrl":"10.1080/09593985.2026.2716384","url":null,"abstract":"<p><strong>Background: </strong>Nonspecific low back pain (NSLBP) has profound adverse impacts at both the individual level, such as pain and dysfunction, as well as the health system level, including high care costs. Prior research suggests that physiotherapists adhere to some aspects of NSLBP clinical practice guidelines (CPGs) but deviate from others. Little is known about the environmental factors that influence clinician decision-making for this condition.</p><p><strong>Objective: </strong>To develop a deeper understanding of the environmental barriers and facilitators to NSLBP clinical practice guideline (CPG) use from the perspectives of physiotherapists across Canada, in the context of public and private sectors of settings.</p><p><strong>Methods: </strong>The Theoretical Domains Framework and the Ecological Systems Theory were used to inform data collection and analysis. Data collection included 12 in-depth, 1-on-1 semi-structured interviews with Canadian physiotherapists with experience treating patients with NSLBP. Transcripts were first deductively coded to the pre-determined domains of the Theoretical Domains Framework by two independent researchers. Then, the Ecological Systems Theory framed inductive analysis within a subset of data relating to the context of the environment. Dialogic engagement occurred throughout data collection and analysis.</p><p><strong>Results: </strong>Five overarching themes describe the environmental influences for NSLBP adherence and non-adherence: \"physical environment and resources,\" \"social influences,\" \"product marketing,\" \"legacy impact of education,\" and \"cultural views of physiotherapy.\"</p><p><strong>Conclusions: </strong>Physiotherapists' decision-making for those with NSLBP is complex and multifactorial, influenced by multiple intersecting environmental interfaces. Because broad systemic obstacles are difficult to modify, focusing on microsystem-level factors may help strengthen adherence to guideline recommendations for NSLBP. Clinical leaders can help drive change by promoting mentorship, creating learning opportunities, and ensuring access to evidence-based resources that support the use of CPGs.</p>","PeriodicalId":48699,"journal":{"name":"Physiotherapy Theory and Practice","volume":" ","pages":"1-18"},"PeriodicalIF":1.6,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148809238","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}