Brazilian Journal of Physical Therapy最新文献

{"title":"Impact of femoral derotation osteotomy on gait in ambulatory children with cerebral palsy: A systematic review and meta-analysis","authors":"Orsolya Z Gresits ,&nbsp;Mátyás Vezér ,&nbsp;Marie A Engh ,&nbsp;Bence Szabó ,&nbsp;Zsolt Molnár ,&nbsp;Péter Hegyi ,&nbsp;Tamás Terebessy","doi":"10.1016/j.bjpt.2025.101257","DOIUrl":"10.1016/j.bjpt.2025.101257","url":null,"abstract":"<div><h3>Background</h3><div>Femoral derotation osteotomies (FDRO) are commonly performed in children with cerebral palsy who present with intoeing gait. However, the impact of FDRO on gait function and long-term results remains unclear.</div></div><div><h3>Objective</h3><div>This study aimed to quantify and qualify gait changes following gait-improving surgeries involving FDRO in ambulatory children with cerebral palsy and no associated hip pathologies, to support individualized decision-making regarding this invasive procedure.</div></div><div><h3>Methods</h3><div>A systematic search was conducted in May 2023 across six databases. Kinetic, kinematic, temporospatial parameters, and gait scores were extracted pre- and post-FDRO. A random-effects meta-analysis was performed.</div></div><div><h3>Results</h3><div>Forty-six articles, including 1144 patients, were analyzed. Significant improvements were observed in pelvic rotation (mean change: 6.6°, 95 % confidence interval [CI]: 2.2 to 11), hip rotation (mean change:14.4°, 95 % CI:16.7 to –12.1), foot progression angle (mean change:16.1°, 95 % CI:18.3 to –14), and gait scores (standardized mean difference [SMD]: 0.99, 95 % CI: 0.52 to 1.47). The estimated improvement in gait scores corresponded to a 10-point increase in the Gait Deviation Index in the short term and 6.9 points in the long term. No deterioration was found in any assessed parameter. Intoeing gait was corrected in 74 % of patients at one year and in 69 % at five years postoperatively. The recurrence rate was 13 %.</div></div><div><h3>Conclusion</h3><div>While evidence suggests that femoral derotation osteotomies in ambulatory children with cerebral palsy without hip pathology improve overall gait function, the quality of available data is low. Patient-reported outcomes, including quality of life and satisfaction, are lacking. Definitive surgical indication could not be established; factors to consider include femoral anteversion, hip rotation at gait analysis, patient age, and relevant functional impairments.</div></div>","PeriodicalId":49621,"journal":{"name":"Brazilian Journal of Physical Therapy","volume":"30 1","pages":"Article 101257"},"PeriodicalIF":3.2,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145223130","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":"Dry cupping therapy has no effect on pain, function, or quality of life in women with knee osteoarthritis: Randomized placebo-controlled trial","authors":"Racklayne Ramos Cavalcanti ,&nbsp;Hugo Jario de Almeida Silva ,&nbsp;André Pontes-Silva ,&nbsp;Mariana Arias Avila ,&nbsp;Clécio Gabriel de Souza ,&nbsp;Catarina de Oliveira Sousa ,&nbsp;Rodrigo Scattone Silva ,&nbsp;Germanna Medeiros Barbosa ,&nbsp;Marcelo Cardoso de Souza","doi":"10.1016/j.bjpt.2025.101259","DOIUrl":"10.1016/j.bjpt.2025.101259","url":null,"abstract":"<div><h3>Background</h3><div>Efficacy of cupping is known to be controversial, and the heterogeneity of the studies contributes to the uncertainty about its real benefits.</div></div><div><h3>Objective</h3><div>To evaluate the effects of dry cupping therapy on pain, disability, functional capacity, and quality of life compared to sham cupping in women with knee osteoarthritis (KOA).</div></div><div><h3>Methods</h3><div>This is a randomized placebo-controlled trial. Women with KOA aged 50–75 years were randomized into two groups: an experimental group, (receiving dry cupping therapy) and a control group (receiving sham cupping). Treatments consisted of 12 sessions, for 15 min, 2 × /week, for 6 consecutive weeks. Groups were evaluated at baseline (T0), 3 weeks after randomization (T3), at post-intervention or 6 weeks after randomization (T6), and 10 weeks after randomization (follow-up: T10). The primary outcome was pain intensity at rest or during movement, and secondary outcomes were the Global Perceived Effect (GPE), 30-seconds sit-to-stand test (STS-30), disability, 40-meter Fast-paced Walk Test (40mFPWT), and 8-step stair climb test (8-step SCT).</div></div><div><h3>Results</h3><div>A total of 62 women with KOA were recruited. We observed a significant within-group reduction for the primary outcome (i.e., pain intensity at rest and during movement) and for some secondary outcomes, there were no differences between groups for all variables in any of the timepoints.</div></div><div><h3>Conclusion</h3><div>Dry cupping therapy was not superior to sham cupping in improving pain, functional capacity, and quality of life, and in GPE in women with knee osteoarthritis.</div></div><div><h3>Trial registration</h3><div>NCT04331158</div></div>","PeriodicalId":49621,"journal":{"name":"Brazilian Journal of Physical Therapy","volume":"30 1","pages":"Article 101259"},"PeriodicalIF":3.2,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145223129","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":"Referral of people with low back pain to physical therapists in Brazilian primary healthcare: A challenge revealed","authors":"Tais Luciana Lacerda ,&nbsp;Pedro Lacerda Montes ,&nbsp;Luciana Gazzi Macedo ,&nbsp;Raymond Ostelo ,&nbsp;Henry Maia Peixoto ,&nbsp;Rodrigo Luiz Carregaro","doi":"10.1016/j.bjpt.2025.101538","DOIUrl":"10.1016/j.bjpt.2025.101538","url":null,"abstract":"<div><h3>Background</h3><div>Low back pain (LBP) is a disabling condition worldwide, and current evidence suggests low rates of referral to physical therapists and extensive use of low-value interventions such as pharmacological treatments and emergency visits.</div></div><div><h3>Objective</h3><div>To investigate the frequency of referrals and characterize people with LBP accessing primary care physical therapists, as well as characterize clinical and sociodemographic aspects and the use of health resources in Brazil.</div></div><div><h3>Method</h3><div>Observational study using nationwide data on 1,459,710 adults with LBP, stratified according to G1: medical care only, G2: medical care and referral to physical therapist, G3: physical therapist as first contact. Data were analyzed descriptively.</div></div><div><h3>Results</h3><div>1,405,145 people with LBP were included in G1, followed by G2 (N:14,079), and G3 (N:40,486). The majority was female (56.3 %), and the average age was 49 (±17) years for females and 48 (±17) for males. Less than 1 % (G2) were referred to physical therapists. Of these, 8085 (57.4 %) had an average duration of 17.4 days (±65.6) between referral and their clinical appointment, and 5994 (42.6 %) had a longer duration (261.1 ± 146.9 days). A total of 130,570 (8.9 %) participants were referred for imaging, totaling 152,150 exams. G1 had 105.65 exams/1000 people and 128 referrals to specialists/1000 people. G2 had 196.32 exams and 384.76 referrals to specialists/1000 people, and G3 had 22.87 exams and 64.89 referrals to specialists/1000 people.</div></div><div><h3>Conclusion</h3><div>We found a relatively low number of referrals of people with LBP to physical therapists in primary health care in Brazil, and a long period between the referral and the first contact with this professional. In addition, diagnostic imaging and referral to a specialist were frequently used.</div></div>","PeriodicalId":49621,"journal":{"name":"Brazilian Journal of Physical Therapy","volume":"30 1","pages":"Article 101538"},"PeriodicalIF":3.2,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207736","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":"Developmental coordination disorder and executive function deficits: Implications for emotional, mental, and overall well-being","authors":"Shahar Zaguri-Vittenberg,&nbsp;Naomi Weintraub ,&nbsp;Miri Tal-Saban","doi":"10.1016/j.bjpt.2025.101537","DOIUrl":"10.1016/j.bjpt.2025.101537","url":null,"abstract":"<div><h3>Background</h3><div>Developmental coordination disorder (DCD) has been found to be associated with executive function (EF) deficits, and to negatively impact emotional (self-esteem, self-efficacy), mental, and overall well-being. Previous research has largely focused on EF deficits in children with DCD, with limited examination of adults, particularly in relation to the effect of co-occurring EF deficits on various well-being aspects.</div></div><div><h3>Objectives</h3><div>To investigate (1) the frequency of EF deficits in adults with DCD, and (2) whether the co-occurrence of DCD and EF deficits contributes to emotional, mental, and overall well-being.</div></div><div><h3>Methods</h3><div>Fifty-five adults with DCD, without hyperactive attention deficit disorder (mean age = 27.57 years, 49.1 % male), underwent a test battery to assess fulfillment of the DSM-5 criteria for DCD. They completed norm-referenced measures of everyday EF-related difficulties, as well as self-report questionnaires measuring emotional, mental, and overall well-being.</div></div><div><h3>Results</h3><div>Almost 50 % of the adults with DCD exhibited EF deficits, manifested mostly by 'cold' (non-emotion-related) difficulties in task monitoring, planning, and organizing, and working memory. Compared to participants with DCD alone, participants with co-occurring DCD and EF deficits had significantly (<em>p</em> &lt; 0.05) lower emotional, mental, and overall well-being, manifested by lower self-esteem, general self-efficacy, and life satisfaction and higher psychological distress.</div></div><div><h3>Conclusions</h3><div>EF deficits, particularly in 'cold' domains, are highly prevalent among individuals with DCD, substantially affecting their emotional, mental, and overall well-being. The results highlight the need for a comprehensive evaluation of EF by healthcare professionals to ensure interventions address both motor and potential cognitive challenges, supporting improved well-being.</div></div>","PeriodicalId":49621,"journal":{"name":"Brazilian Journal of Physical Therapy","volume":"30 1","pages":"Article 101537"},"PeriodicalIF":3.2,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145160423","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":"“Improved not only the osteoarthritis but also general health”: A qualitative study on patient experiences with the peak-portuguese e-learning course for knee osteoarthritis self-management","authors":"Hugo Jario Almeida Silva ,&nbsp;Lívia Gaspar Fernandes ,&nbsp;Rana S. Hinman ,&nbsp;Julya Perea ,&nbsp;Karime Mescouto ,&nbsp;Angelica V. Ferrari ,&nbsp;Anderson Aparecido Fogaça ,&nbsp;Bruno T. Saragiotto ,&nbsp;Tania F. Salvini","doi":"10.1016/j.bjpt.2025.101528","DOIUrl":"10.1016/j.bjpt.2025.101528","url":null,"abstract":"<div><h3>Introduction</h3><div>Clinical practice guidelines for knee osteoarthritis (KOA) recommend that individuals receive education for self-management. Although education can be offered through different means, including websites, not all internet content is evidence-based. The Physiotherapy Exercise and Physical Activity for Knee Osteoarthritis - Portuguese (PEAK-PT) e-learning course provides updated and evidence-based information on KOA for physical therapists and may be useful for the education and self-management of individuals with KOA.</div></div><div><h3>Objective</h3><div>To assess the barriers and facilitators to engage with the PEAK-PT course from the perspectives of individuals with KOA and understand if the information provided by the course aligned with information about KOA they previously had.</div></div><div><h3>Methods</h3><div>A qualitative study was conducted with nine individuals with KOA who completed the PEAK-PT course. Semi-structured interviews explored facilitators, barriers, and prior knowledge. These three categories informed data analysis using content analysis.</div></div><div><h3>Results</h3><div>Facilitators of PEAK-PT included online accessibility, structured course modules, and downloadable materials. Barriers included technical issues and the need for cultural adaptation. Participants reported improved understanding and motivation for self-management, with some noting that the information provided confirmed what they already knew, while others identified difference between the new content and their prior beliefs.</div></div><div><h3>Conclusion</h3><div>This study's findings suggest that a program developed for clinicians may also be beneficial for individuals with KOA. However, education courses on health conditions for individuals with KOA should be culturally adapted.</div></div>","PeriodicalId":49621,"journal":{"name":"Brazilian Journal of Physical Therapy","volume":"29 6","pages":"Article 101528"},"PeriodicalIF":3.2,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145118212","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":"Five-repetition chair-stand test vs. handgrip strength: Which better predicts mortality risk? a follow-up study in 43,605 middle-aged and older adults","authors":"Rodrigo Núñez-Cortés ,&nbsp;Lars Louis Andersen ,&nbsp;Carlos Cruz-Montecinos ,&nbsp;Ana Polo-López ,&nbsp;Rubén López-Bueno ,&nbsp;Joaquín Calatayud","doi":"10.1016/j.bjpt.2025.101529","DOIUrl":"10.1016/j.bjpt.2025.101529","url":null,"abstract":"<div><h3>Background</h3><div>Ageing reduces muscle strength and function, increasing mortality risk. Identifying simple performance markers can guide interventions for healthy ageing.</div></div><div><h3>Objective</h3><div>To assess the prospective dose-response association of the 5-repetition Chair Stand Test (5-CST) and handgrip strength (HGS) with mortality in middle-aged and older adults.</div></div><div><h3>Methods</h3><div>This prospective study included community-dwelling participants aged 50 years or older from the SHARE study. HGS and 5-CST were assessed at baseline, with all-cause mortality tracked through follow-up interviews. Cox regression with restricted cubic splines was used, controlling for several confounders.</div></div><div><h3>Results</h3><div>43,605 participants (mean age (SD): 65.3 (9.1), 54 % women) were included. During a mean follow-up of 7.3 ± 2.2 years, there were 4154 deaths (9.5 %). Both 5-CST and HGS were curvilinearly associated with all-cause mortality. Using the median level of 5-CST as a reference (11 s), 10th percentile of 5-CST (7 s) showed a hazard ratio (HR) of 0.74 (95 %CI: 0.69, 0.80). The 90th percentile (18 s) of 5-CST showed a HR of 1.18 (95 %CI: 1.14, 1.22). Stratified analysis indicated 5-CST was most strongly associated with mortality in women. Regarding HGS, using the median level as a reference (33 kg), the 10th percentile of muscle strength (21 kg) showed a HR of 1.62 (95 %CI: 1.50, 1.75). The 90th percentile (51 kg) of muscle strength showed a HR of 0.58 (95 %CI: 0.52, 0.64).</div></div><div><h3>Conclusion</h3><div>Both tools provide valuable information, but HGS may be considered more relevant for identifying those at increased mortality risk, while 5-CST may be especially useful in women.</div></div>","PeriodicalId":49621,"journal":{"name":"Brazilian Journal of Physical Therapy","volume":"29 6","pages":"Article 101529"},"PeriodicalIF":3.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145118213","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":"Subjective Happiness Scale: Measurement properties of the online and paper-pen administrations in Nepali adults with musculoskeletal pain.","authors":"Ritu Basnet, Anupa Pathak, Mark P Jensen, Narendra Singh Thagunna, James H McAuley, Saurab Sharma","doi":"10.1016/j.bjpt.2025.101245","DOIUrl":"10.1016/j.bjpt.2025.101245","url":null,"abstract":"<p><strong>Background: </strong>Happiness is a positive psychological construct often described as subjective well-being. It is associated with a meaningful life, and better social support and coping with stress or trauma. Happiness may have a role in buffering the negative effects of musculoskeletal pain on quality of life. Validating measures that assess subjective happiness in individuals with musculoskeletal pain can help advance research and patient care in this emerging field.</p><p><strong>Objective: </strong>We sought to: (1) evaluate the measurement properties of the Subjective Happiness Scale (SHS) in a sample of Nepali adults with musculoskeletal pain; and (2) compare its measurement properties when administered using hard-copy and online methods.</p><p><strong>Methods: </strong>The Consensus-based Standards for the selection of health status Measurement Instruments (COSMIN) guidelines informed the conduct and reporting. A total of 180 (120 hard-copy and 60 online administrations) individuals with musculoskeletal pain were recruited in Nepal. Content validity, structural validity (exploratory factor analysis), internal consistency (Cronbach's alpha), construct validity (hypothesis testing), and test-retest reliability (Intraclass Correlation Coefficient, ICC_2,1), measurement error were assessed.</p><p><strong>Results: </strong>Single factor structure of the SHS was supported. The SHS showed good internal consistency for the combined, hard-copy, and online samples (Cronbach's alphas 0.857, 0.848, and 0.847, respectively). It evidenced moderate to good test-retest reliability [ICCs = 0.86 (95 % CI: 0.80, 0.93), 0.89 (95 % CI: 0.82, 0.93), and 0.66 (95 % CI: 0.32, 0.87), respectively]. The findings also supported the construct validity for both administration types.</p><p><strong>Conclusions: </strong>This study supports the validity of the SHS for assessing subjective happiness in adults with musculoskeletal pain, with moderate to good reliability.</p>","PeriodicalId":49621,"journal":{"name":"Brazilian Journal of Physical Therapy","volume":"29 5","pages":"101245"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12355072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812557","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":"Validity, reliability, and clinical usefulness of instruments for measuring thoracic kyphosis: a systematic review and meta-analysis.","authors":"Ana Paula Flôr Alves Nepomuceno, Ana Carolina Cury, Larissa Santos Pinto Pinheiro, George Schayer Sabino, Thales Rezende Souza, Sérgio Teixeira Fonseca, Juliana Melo Ocarino, Renan Alves Resende","doi":"10.1016/j.bjpt.2025.101246","DOIUrl":"10.1016/j.bjpt.2025.101246","url":null,"abstract":"<p><strong>Introduction: </strong>Thoracic hyperkyphosis is related to different health conditions, requiring precise evaluation in clinical settings. Several instruments have been proposed for assessing thoracic kyphosis, and previous studies have investigated their reliability and validity.</p><p><strong>Aims: </strong>Systematically review studies evaluating the validity and reliability of instruments designed to measure thoracic kyphosis and classify their clinical utility.</p><p><strong>Methods: </strong>MEDLINE and EMBASE (via Ovid) databases were used to search studies published until December 2023, and additional searches were conducted in Google Scholar and by hand search. Studies that analyzed the reliability and validity of noninvasive instruments for measuring thoracic kyphosis, regardless of population, study design, and language, were included. Two independent reviewers analyzed the titles, abstracts, and full text and assessed the methodological quality. Clinical utility was assessed using a 10-point scale.</p><p><strong>Results: </strong>Seventy-two studies were included, and 15 instruments had their measurement properties explored: seven were grouped in a meta-analysis for validity, seven for intra-rater reliability, and six for inter-rater reliability. Despite the heterogeneity of estimated data, they presented a strong to moderate correlation with the gold standard and excellent intra- and inter-rater reliability. The instruments most frequently studied were the Flexicurve Angle and the Analog Inclinometer.</p><p><strong>Conclusion: </strong>The meta-analysis demonstrated that the Analog Inclinometer, Flexicurve Angle and Index, Photogrammetry, Smartphone applications, and Spinal Mouse were valid and reliable for assessing thoracic kyphosis. Also, the utility analysis suggested that the Analog Inclinometer, Flexicurve Angle, and Smartphone applications are recommended for clinical settings.</p>","PeriodicalId":49621,"journal":{"name":"Brazilian Journal of Physical Therapy","volume":"29 5","pages":"101246"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12355107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805098","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":"Integrating interventions based on cognitive behavioural therapy for insomnia in physical therapist practice for individuals with chronic pain and insomnia: Identifying barriers and formulating implementation strategies","authors":"Marine Markaryan ,&nbsp;Céline Labie ,&nbsp;Sabine Verschueren ,&nbsp;Dieter Vanassche ,&nbsp;Jo Nijs ,&nbsp;Olivier Mairesse ,&nbsp;Anneleen Malfliet ,&nbsp;Kurt de Vlam ,&nbsp;Nils Runge ,&nbsp;Nele Caeyers ,&nbsp;Thomas Janssens ,&nbsp;Liesbet De Baets","doi":"10.1016/j.bjpt.2025.101243","DOIUrl":"10.1016/j.bjpt.2025.101243","url":null,"abstract":"<div><h3>Introduction</h3><div>Cognitive Behavioural Therapy for Insomnia (CBT-I) is the first-choice treatment for insomnia disorders. Although CBT-I is primarily provided by trained psychologists, evidence shows that other healthcare providers can also successfully apply interventions based on CBT-I principles in absence of complex psychiatric comorbidities. Because insomnia and chronic pain often co-occur, integrating CBT-I-based interventions into physical therapy is relevant.</div></div><div><h3>Objectives</h3><div>To identify implementation barriers for CBT-I in physical therapist practice and to formulate implementation strategies to address them.</div></div><div><h3>Methods</h3><div>16 stakeholders (8 physical therapists, 3 psychologists, 2 general practitioners, and 3 individuals with chronic pain and insomnia) were invited for 3 group-interviews and 1 online questionnaire. Implementation barriers were identified through thematic analysis according to the Consolidated Framework for Implementation Research (CFIR). Implementation strategies were matched to barriers and ranked based on evidence and stakeholder feedback.</div></div><div><h3>Results</h3><div>33 implementation barriers were identified across all CFIR domains, and 13 final strategies were formulated to address these barriers. Key strategies included education and training for physical therapists, structural changes, and raising awareness among general practitioners and the public. Secondary strategies focussed on adaptability of CBT-I, developing supporting tools, and multidisciplinary collaboration.</div></div><div><h3>Conclusion</h3><div>To overcome barriers for the implementation of CBT-I-based interventions in physical therapy practice, it is important to involve educational institutions, research bodies, policymakers, and patient representatives in crafting effective strategies. The study findings can guide strategy selection promoting the adoption of physical therapist-led CBT-I-based interventions for chronic pain and insomnia.</div></div>","PeriodicalId":49621,"journal":{"name":"Brazilian Journal of Physical Therapy","volume":"29 5","pages":"Article 101243"},"PeriodicalIF":3.2,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144917718","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":"Predictors of functional recovery in the first year after severe traumatic brain injury","authors":"Jessica Vaz Gonçalves ,&nbsp;Pedro Henrique Cassaro Lirio ,&nbsp;Carla Bernado Louzada ,&nbsp;Hanna Souza de Almeida ,&nbsp;Hellen Siler Vasconcellos ,&nbsp;Larissa Santos Ramos ,&nbsp;Thais da Silva Rodrigues ,&nbsp;Renato Campos Freire Júnior ,&nbsp;Lucas Rodrigues Nascimento ,&nbsp;Fernando Zanela da Silva Arêas","doi":"10.1016/j.bjpt.2025.101251","DOIUrl":"10.1016/j.bjpt.2025.101251","url":null,"abstract":"<div><h3>Introduction</h3><div>Traumatic Brain Injury (TBI) survivors often experience long-term impairments that might decrease their quality of life and functional independence.</div></div><div><h3>Objective</h3><div>This study aimed to identify predictors of functional recovery after severe TBI in Brazil.</div></div><div><h3>Methods</h3><div>A prospective observational cohort study was conducted at a trauma referral hospital between May 2021 and May 2022. Individuals with severe TBI (sTBI), defined as having a Glasgow Coma Scale (GCS) score of ≤8 at admission or within 72 h due to head trauma-related causes, were included. Functional recovery was assessed using the Glasgow Outcome Scale-Extended (GOSE) at discharge and 3, 6, and 12 months post-injury. Data on age, sex, cause of injury, GCS scores at admission, Injury Severity Score (ISS), pupillary alterations, decompressive craniectomy, days of mechanical ventilation support (MVS), and education level were extracted from electronic records. Of 172 patients, 145 completed follow-ups.</div></div><div><h3>Results</h3><div>Patients were mostly male (84.5 %), with low education levels (55.2 %) and an average age of 45. Male sex (OR=9.38, 95 %CI: 1.39, 62.97) and more days of MVS (OR=1.41, 95 %CI: 1.03, 1.48) predicted poor outcomes at discharge. At 3 months, ISS &gt;25 (OR=3.37, 95 %CI: 1.26, 9.03), decompressive craniectomy (OR=3.74, 95 %CI: 1.05, 13.33), more days of MVS (OR=1.18, 95 %CI: 1.07, 1.31), and low (OR=4.44, 95 %CI: 1.19, 16.57) or medium (OR=7.41, 95 %CI: 1.77, 31.02) education levels predicted poorer functional outcomes. At 6 months, decompressive craniectomy (OR=4.31, 95 %CI: 1.37, 13.58), more days of MVS (OR=1.13, 95 %CI: 1.05, 1.21), and a GOSE score ≤6 at discharge were associated with unfavorable functional outcome. At 12 months, age &gt;65 (OR=4.95, 95 %CI: 1.12, 21.84), more days of MVS (OR=1.08, 95 %CI: 1.03, 1.13), and low (OR=6.11, 95 %CI: 1.48, 25.16) or medium (OR=6.48, 95 %CI: 1.49, 28.21) education levels predicted poorer functional recovery.</div></div><div><h3>Conclusion</h3><div>Functional recovery after severe TBI in a low- to middle-income setting is influenced by clinical and sociodemographic factors.</div></div>","PeriodicalId":49621,"journal":{"name":"Brazilian Journal of Physical Therapy","volume":"29 6","pages":"Article 101251"},"PeriodicalIF":3.2,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144907893","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}