Journal of Neurologic Physical Therapy最新文献

{"title":"Understanding Behavior Change in Clinical Practice Guideline Implementation: A Qualitative Study.","authors":"Julie K Tilson, Clarisa Martinez, Sharon Mickan, Linda J D'Silva, Robbin Howard, Sara MacDowell, Heidi R Roth, Karen M Skop, Elizabeth Dannenbaum, Lisa Farrell","doi":"10.1097/NPT.0000000000000498","DOIUrl":"10.1097/NPT.0000000000000498","url":null,"abstract":"<p><strong>Background and purpose: </strong>Growing numbers of clinical practice guidelines (CPGs) are available to neurologic physical therapists to guide and inform evidence-based patient care. Adherence to CPG recommendations often necessitates behavior change for therapists and patients. The purpose of this qualitative study was to gain insight into the experiences, perspectives, and drivers of behavioral change for therapists working to improve adherence to a CPG. We also sought to understand the perspectives of patients impacted by this work.</p><p><strong>Methods: </strong>Five sites participated in a 6-month implementation study integrating a CPG into local practice using the Knowledge to Action model. At the conclusion of the intervention, therapists and patients were recruited to participate in semi-structured interviews or focus groups. An inductive phenomenological approach was used for data analysis. Two authors coded data to generate primary themes. A secondary analysis used the Capability, Opportunity, Motivation, Behavior (COM-B) model to explain the drivers of behavior change for therapists and patients.</p><p><strong>Results: </strong>Perspectives from 16 therapists generated 6 themes around feedback/accountability, teamwork/belonging, complexity/adaptability, leadership/prioritization, engagement/benefit, and motivation/growth. Twelve patients' perspectives generated 2 themes around communication/personalization and support/recovery. Drivers for behavior change associated with the COM-B model are highlighted.</p><p><strong>Discussion and conclusions: </strong>Therapist adherence to CPG recommendations was supported by inclusive and goal-directed teams, regular quantitative audit and feedback, opportunities for learning, and a sense of accountability to their coworkers, patients, and themselves. Patients' engagement in rehabilitation was supported by personalized education, objective measures of progress, and a strong therapeutic relationship.</p><p><strong>Video abstract available: </strong>for more insights from the authors (see the video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A491).</p>","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":"49 1","pages":"13-23"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11594560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Correlation Between Fear Avoidance Beliefs and Physical Activity in Unilateral Vestibulopathies.","authors":"Lien Van Laer, Hanna M Koppelaar-van Eijsden, Ann Hallemans, Vincent Van Rompaey, Tjard R Schermer, Tjasse D Bruintjes, Luc Vereeck","doi":"10.1097/NPT.0000000000000499","DOIUrl":"10.1097/NPT.0000000000000499","url":null,"abstract":"<p><strong>Background and purpose: </strong>In individuals with unilateral vestibulopathy (UVP), physical activity (PA) is recommended to stimulate central vestibular compensation. However, the presence of fear avoidance beliefs might negatively influence PA. The objectives of this study were to investigate the relationship between fear avoidance beliefs and PA and to compare PA levels between individuals with UVP in an acute/subacute vs chronic phase.</p><p><strong>Methods: </strong>In this cross-sectional study, PA was measured using a triaxial accelerometer. Fear avoidance beliefs were quantified using the Vestibular Activities Avoidance Instrument. The correlation between fear avoidance beliefs and PA was evaluated using regression analyses, with other potential influencing factors also considered.</p><p><strong>Results: </strong>A total of 102 participants were included. The average age was 56.1 (SD 15.2) years, and 57.8% were male. Participants with chronic UVP presented with shorter sedentary time (4,591 vs 5129 min/wk; P = 0.004), longer standing time (1443 vs 1165 min/wk; P = 0.025), higher vigorous PA (187 vs 107 min/wk; P = 0.005), and higher total PA (773 vs 623 min/wk; P = 0.003) compared to participants with acute/subacute UVP. In participants with acute/subacute UVP, variability in total PA was explained up to 54.7% by fear avoidance beliefs, etiology of the UVP, and gender (R2 = 0.547, F4,45 = 13.6, P < 0.001). In participants with chronic UVP, fear avoidance beliefs explained 4.1% of the variability in total PA (R2 = 0.041, F1,49 = 2.086, P = 0.155).</p><p><strong>Discussion and conclusions: </strong>In acute/subacute UVP, assessing fear avoidance beliefs helps to understand physical inactivity. In chronic UVP, no significant association between fear avoidance beliefs and PA was observed.</p><p><strong>Video abstract available: </strong>for more insights from the authors (see the video, Supplemental Digital Content, available at: http://links.lww.com/JNPT/A488).</p>","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":"49 1","pages":"24-32"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11594542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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 Diabetes and Attentional Focus on Learning of a Novel Balance Task.","authors":"Szu-Ping Lee, Hui-Ting Shih, Fu-Lien Wu, Rebeca Armagnac, Yinny Lee, Alicia Letkiewicz, Mieko Mamauag, Andrew Hooyman, Carolee Winstein","doi":"10.1097/NPT.0000000000000501","DOIUrl":"10.1097/NPT.0000000000000501","url":null,"abstract":"<p><strong>Background and purpose: </strong>Chronic diabetes is a prevalent systemic disease that impairs neuromotor functioning and often leads to increased risk of falls. Adopting an external focus of attention during motor skill practice has been shown to improve learning outcomes; however, it has not been examined in this population. We examined how attentional focus instructions (internal vs external) affect balance performance and learning in older adults with and without diabetes.</p><p><strong>Methods: </strong>Fifty-three older adults (27 with diabetes, 63.7 ± 7.0 years) participated in the randomized, pre-post intervention study. The balance training involved 50 practice trials of a stabilometer task that was novel to all participants. Participants were randomized to receive either internal or external focus task instruction. Task performance was assessed at baseline, during training, and during a retention test. Primary outcomes were changes in balance task performance before and after training.</p><p><strong>Results: </strong>Participants who received external focus instruction showed a significantly greater increase in balance performance than individuals who received internal focus instruction (95% confidence interval, 0.02-4.05; P = 0.048). While participants with diabetes exhibited poorer baseline task performance (P = 0.02), both groups improved their relative task performance after training (95% confidence interval, 5.25-18.14; P < 0.0001).</p><p><strong>Discussion and conclusions: </strong>Adopting an external focus of attention benefits performance during short-term training of a novel balance task in older adults with and without diabetes. Participants with diabetes were capable of learning the challenging balance task with practice, at a relative rate similar to those without diabetes. This information may be useful for designing interventional strategies to improve physical function and mitigate fall risks in older adults with diabetes.</p>","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":"49 1","pages":"42-50"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reflections and Aspirations: Shaping the Future of Neurologic Physical Therapy.","authors":"Lori Quinn","doi":"10.1097/NPT.0000000000000503","DOIUrl":"10.1097/NPT.0000000000000503","url":null,"abstract":"","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":" ","pages":"1-3"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilization of Neurology and Allied Health Services by People With Parkinson's Disease in Israel: A Retrospective Observational Study.","authors":"Badera Naamneh-Abuelhija, Michal Kafri, Meir Kestenbaum, Efrat Shadmi, Igor Mintz, Sarit Shved, Shmuel Giveon, Sharon Kamah, Galit Yogev-Seligmann","doi":"10.1097/NPT.0000000000000502","DOIUrl":"10.1097/NPT.0000000000000502","url":null,"abstract":"<p><strong>Background: </strong>Sustainable utilization of neurology and allied health professions' services is pivotal for effective management of Parkinson disease (PD) and is correlated with positive health-related outcomes.</p><p><strong>Objectives: </strong>(1) To describe the utilization of neurology and allied health services by people with PD (PwP); (2) to explore the associations between demographic and structural variables and utilization; and (3) to test associations between utilization and unplanned hospitalizations.</p><p><strong>Methods: </strong>A retrospective observational cohort study of 1761 PwP in the years 2014-2019 was conducted. Utilization of neurology and allied health services was mapped. Regression models were examined to test associations between demographic and structural variables, utilization of neurology and physical therapy (PT), and unplanned hospitalizations.</p><p><strong>Results: </strong>Approximately 50% of the study population utilized neurology services. Utilization rate of allied health services ranged between 0% and 19%. The likelihood of utilizing neurology services increased for people with extended health insurance and people with more years since diagnosis and decreased for women and for people living at a great distance from a neurology service. The likelihood of utilizing PT increased for Jews and people with extended health insurance and decreased for people with more years since diagnosis and for people living at a great distance from a PT service. Among patients with fewer years since diagnosis (<5 years), those who utilized PT had a higher likelihood of unplanned hospitalization.</p><p><strong>Conclusions: </strong>Neurology and allied health services are underutilized by PwP, particularly by minorities and women. Policymakers should take proactive steps to increase utilization.</p><p><strong>Video abstract available: </strong>for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A496 ).</p>","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vagus Nerve Stimulation Paired With Rehabilitation for Chronic Stroke: Characterizing Responders.","authors":"Alexa Beovich, Jessica Boose, Rachana Patel, Steven L Wolf","doi":"10.1097/NPT.0000000000000488","DOIUrl":"10.1097/NPT.0000000000000488","url":null,"abstract":"<p><strong>Background and purpose: </strong>Implantable vagus nerve stimulation (VNS) paired with volitional upper extremity rehabilitation can improve impairment and function among moderately to severely impaired, chronic stroke survivors. This study is a retrospective analysis of the in-clinic rehabilitation phase of the blinded, placebo-controlled, randomized pivotal VNS-REHAB trial to determine whether dosing parameters during in-clinic paired VNS therapy were associated with responder status and whether covariates might impact that determination.</p><p><strong>Methods: </strong>Data were limited to 53 participants in the active VNS group who had received VNS implants prior to undergoing 6 weeks of in-clinic rehabilitation paired with VNS. Tasks were standardized across all participants. Dosing parameters included number of stimulations and task time. The primary outcome was the Fugl-Meyer Upper Extremity Assessment (FMA-UE), evaluated at the end of 6 weeks (Post-1). Participants were classified a priori as responders based on an improvement of ≥6 points on the FMA-UE from baseline to Post-1.</p><p><strong>Results: </strong>Dosing parameters were not associated with FMA-UE responder status at the end of 6 weeks. Covariates including age, gender, paretic hand, baseline severity, and chronicity of stroke were also not significant associations of response.</p><p><strong>Discussion and conclusions: </strong>While responders to VNS could be defined, therapy dosing and participant attributes did not provide greater specification for association of responder status. Limitations of this study include small sample size and non-linearity of the FMA-UE. Future studies will include reassessing responder categorization using more linear scales and examining stroke lesion characteristics to determine whether these measures are more sensitive to dosing parameters.</p><p><strong>Video abstract available: </strong>for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://www.w3.org/1999/xlink ).</p>","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":" ","pages":"217-223"},"PeriodicalIF":2.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141727932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Grateful for the Opportunity.","authors":"George Fulk","doi":"10.1097/NPT.0000000000000493","DOIUrl":"https://doi.org/10.1097/NPT.0000000000000493","url":null,"abstract":"","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":"48 4","pages":"177"},"PeriodicalIF":2.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142330679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of the Cervical Spine in Dizziness.","authors":"Julia Treleaven","doi":"10.1097/NPT.0000000000000491","DOIUrl":"10.1097/NPT.0000000000000491","url":null,"abstract":"<p><p>The neck can be implicated in dizziness via several, separate, discreet mechanisms. Proprioceptive cervicogenic dizziness (CGD) is the most common and reflects the cervical spine's important role, along with visual and vestibular input, for sensorimotor control. Impaired cervical proprioception can lead to symptoms such as dizziness, unsteadiness, visual disturbances, and altered sensorimotor control, and treatment directed toward cervical musculoskeletal and sensorimotor control is efficacious to improve this in individuals with cervical musculoskeletal disorders. Despite this, CGD is difficult to diagnose. Many people present with both neck pain and dizziness, and often the onset of both follows head and neck trauma, but neither necessarily implicate the neck as the cause of dizziness. Further, people often present with mixed forms of dizziness. Thus, rather than diagnosing CGD, it might be more important to consider the potential for the neck to have no (nil, co-morbid cervical condition) or some (minor, major, or compensatory) role in dizziness. Determining the precise role of the cervical spine role in dizziness requires a skilled interview and examination for cervical musculoskeletal and related sensorimotor impairments and relevant testing of other potential causes. A combination and cluster of test outcomes in addition to comparing responses to specific tests when the cervical afferents are stimulated and not stimulated will be important. Considering the role of the neck in dizziness will allow a balanced approach in assessment and management to allow timely, effective intervention to be provided to the large number of individuals presenting with neck pain and dizziness (Supplemental Digital Content, available at: http://links.lww.com/JNPT/A484 ).</p>","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":" ","pages":"1-10"},"PeriodicalIF":2.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"International Neurological Physical Therapy Association: Best Abstracts.","authors":"","doi":"10.1097/NPT.0000000000000492","DOIUrl":"https://doi.org/10.1097/NPT.0000000000000492","url":null,"abstract":"","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":"48 4","pages":"232-233"},"PeriodicalIF":2.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation and Clinical Outcomes of Blood Flow Restriction Training on Adults With Cerebral Palsy: A Case Series.","authors":"Christopher Joyce, Brendan Aylward, Nicholas Rolnick, Steven Lachowski","doi":"10.1097/NPT.0000000000000475","DOIUrl":"10.1097/NPT.0000000000000475","url":null,"abstract":"<p><strong>Background and purpose: </strong>Cerebral palsy (CP) is a congenital neurological disorder that causes musculoskeletal weakness and biomechanical dysfunctions. Strength training guidelines recommend at least 70% of 1-repetition maximum to increase muscle strength and mass. However, individuals with CP may not tolerate such high exercise intensity. Blood flow restriction (BFR) can induce similar gains in strength and muscle mass using loads as low as 20% to 30% 1-repetition maximum. This case series described the safety, feasibility, and acceptability of BFR in adults with CP and examined changes in muscle mass and strength.</p><p><strong>Case description: </strong>Three male participants with gross motor function classification system level 3 CP underwent strength training using a periodized 8-week BFR protocol. Outcomes included: Safety via blood pressure during and post-BFR exercises in addition to adverse event tracking; Feasibility via number of support people and time-duration of BFR exercises; Acceptability via rate of perceived discomfort (0-10) and qualitative interviews; Muscle Mass via ultrasonographic cross-sectional area of the quadriceps and hamstring; and Strength via (1) 3-repetition maximum in the leg press and knee extension, (2) isometric knee flexor and extensor muscle force measured with a hand-held dynamometer, and (3) 30-second sit-to-stand test.</p><p><strong>Intervention: </strong>Participants replaced 2 exercises from their current regimen with seated knee extension and leg press exercises using progressively higher limb occlusion pressure and exercise intensity. Limb occlusion pressure started at 60%, by week 4 progressed to 80%, and then remained constant. The exercise repetition scheme progressed from fixed nonfailure repetition sets to failure-based repetition sets.</p><p><strong>Outcomes: </strong>Blood pressure never exceeded safety threshold, and no adverse events were reported. The BFR training was time-consuming and resource-intensive, but well-tolerated by participants (rate of perceived discomfort with a mean value of 5.8, 100% protocol adherence). Strength, as measured by 3-repetition maximum testing and 30-second sit-to-stand test, increased, but isometric muscle force and muscle mass changes were inconsistent.</p><p><strong>Discussion: </strong>Blood flow restriction may be an effective means to increase strength in adults with CP who cannot tolerate high-intensity resistance training. Future research should compare BFR to traditional strength training and investigate mediators of strength changes in this population.</p><p><strong>Video abstract available: </strong>for more insights from the authors (see the Video, Supplemental Digital Content available at: http://links.lww.com/JNPT/A473 ).</p>","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":" ","pages":"224-231"},"PeriodicalIF":2.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140960465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}