Brazilian Journal of Physical Therapy最新文献

{"title":"Association between pitching velocity and elbow varus torque","authors":"Scott Peters ,&nbsp;Garrett S. Bullock ,&nbsp;Kristen F. Nicholson","doi":"10.1016/j.bjpt.2025.101222","DOIUrl":"10.1016/j.bjpt.2025.101222","url":null,"abstract":"<div><h3>Background</h3><div>While there has been an increase in the number of biomechanical studies and usage across baseball, there often remains a dichotomy between performance enhancement and injury reduction.</div></div><div><h3>Objective</h3><div>To identify which variables have the highest influence on elbow varus torque while controlling for pitch velocity. The secondary purpose was to evaluate a minimal data set prediction model derived from the identified biomechanical variables.</div></div><div><h3>Method</h3><div>A retrospective review was performed on baseball pitchers who underwent biomechanical evaluation. Analysis of covariance and prediction modeling for varus torque and fastball velocity were utilized.</div></div><div><h3>Results</h3><div>298 pitchers were included. Small associations were identified between the log of hip shoulder separation (0.12 (95 % CI: 0.01, 0.23), R²=0.10), maximum trunk rotation velocity (0.42 (0.15, 0.70), R²=0.12), trunk flexion at ball release (-0.11 (-0.20, -0.02), R²=0.10), and shoulder abduction at late cocking (-0.29 (-0.52, -0.06), R²=0.10) in relation to the log of elbow varus torque. The clinical prediction model for elbow varus torque resulted in poor prediction performance, calibration, and large error using minimal predictor variables (RMSE=1.15, R²=0.10, Calibration=0.78 (0.41, 1.15)).</div></div><div><h3>Conclusion</h3><div>Optimizing pitching efficiency by improving small aspects throughout the pitching delivery has potential to accomplish an improvement in velocity while maintaining lower levels of varus torque.</div></div>","PeriodicalId":49621,"journal":{"name":"Brazilian Journal of Physical Therapy","volume":"29 5","pages":"Article 101222"},"PeriodicalIF":3.1,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144125142","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":"Technology for healthcare professionals' education about the early detection of cerebral palsy","authors":"Adriana Neves dos Santos ,&nbsp;Melissa Gladstone ,&nbsp;Alessandra Lemos de Carvalho ,&nbsp;Liliane dos Santos Machado ,&nbsp;Egmar Longo","doi":"10.1016/j.bjpt.2025.101214","DOIUrl":"10.1016/j.bjpt.2025.101214","url":null,"abstract":"","PeriodicalId":49621,"journal":{"name":"Brazilian Journal of Physical Therapy","volume":"29 4","pages":"Article 101214"},"PeriodicalIF":3.1,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144105727","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":"Interdisciplinary expert agreement on group and definitions for compensatory protective step strategies to prevent falls: A e-Delphi method study","authors":"Maria Melo-Alonso ,&nbsp;Juan Luis Leon-Llamas ,&nbsp;Santos Villafaina ,&nbsp;Mari Carmen Gomez-Alvaro ,&nbsp;Pedro R. Olivares ,&nbsp;Carmen Padilla-Moledo ,&nbsp;Narcís Gusi","doi":"10.1016/j.bjpt.2025.101227","DOIUrl":"10.1016/j.bjpt.2025.101227","url":null,"abstract":"<div><h3>Background</h3><div>Older adults have a high probability of experiencing falls during activities of daily living, which can lead to fear of falling, alterations in gait patterns, decreased mobility, reduced social interactions, and limited ability to perform various tasks. Previous studies examining gait in the presence of perturbations have identified and analyzed several protective gait strategies aimed at preventing falls. However, there is a lack of standardized terminology and definitions for these strategies, hindering comparison and collaborative progress among researchers and professionals.</div></div><div><h3>Objective</h3><div>To unify definitions of compensatory protective step strategies and establish a standardized terminology.</div></div><div><h3>Methods</h3><div>This study adapted the Conducting and Reporting of Delphi Studies (CREDES) guidelines and followed a chronological sequence: 1) Preliminary phase: A literature review and both quantitative (three dimensions: relevance, wording, and identification, assessed using a Likert-type scale (1 to 5) and qualitative (an open-ended question) assessment were conducted; 2) Exploratory phase: Expert panel selection (<em>n</em> = 14) and the e-Delphi study were conducted; and 3) Final phase: Expert opinions were collected and analyzed. Content validity was assessed using Aiken’s V coefficient.</div></div><div><h3>Results</h3><div>The results demonstrated high levels of validity (<em>V</em> ≥ 0.68) for all definitions, with none being eliminated based on Aiken's V critical value.</div></div><div><h3>Conclusion</h3><div>A precise definition was developed for each of the 14 compensatory protective step strategies (13 identified in the scoping review and one added by the expert panel). In total, the number of definitions was reduced from 61 to 14, with one definition for each of the compensatory protective step strategies identified.</div></div>","PeriodicalId":49621,"journal":{"name":"Brazilian Journal of Physical Therapy","volume":"29 4","pages":"Article 101227"},"PeriodicalIF":3.1,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144099712","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 prevalence of sarcopenia and its associations with weekly energy expenditure and physical activity levels in female patients with breast cancer at the time of diagnosis","authors":"Noemi Trajano de França da Silva ,&nbsp;Daniele Medeiros Torres ,&nbsp;Marcos Vinicius dos Santos Corrêa ,&nbsp;Rejane Medeiros Costa ,&nbsp;Erica Alves Nogueira Fabro ,&nbsp;Suzana Sales Aguiar ,&nbsp;Simone Abrantes Saraiva ,&nbsp;Anke Bergmann","doi":"10.1016/j.bjpt.2025.101224","DOIUrl":"10.1016/j.bjpt.2025.101224","url":null,"abstract":"<div><h3>Background</h3><div>Early breast cancer diagnoses have enabled better therapeutic responses and better patient prognoses. However, sarcopenia, may develop as a result of this oncological disease, through the release of inflammatory cytokines.</div></div><div><h3>Objectives</h3><div>Determine the prevalence of sarcopenia and associations with weekly energy expenditure and physical activity (PA) levels in female patients with breast cancer at the time of diagnosis in a reference oncology hospital.</div></div><div><h3>Methods</h3><div>Cross-sectional <strong>s</strong>tudy of patients with breast cancer stages IA to IIIC between June 2021 and June 2022. Sarcopenia was classified as “probable” when patients had low muscle strength, “confirmed” when both low strength and low muscle mass were detected, and “severe” when these two factors were associated with low physical performance. Muscle strength was assessed using dynamometry, muscle mass through calf circumference and physical performance using the Timed Up and Go test. PA level was determined by the International Physical Activity Questionnaire. Binary logistic regressions were performed between sarcopenia and PA levels, while linear regressions were performed for weekly energy expenditure.</div></div><div><h3>Results</h3><div>Ninety-two women were evaluated. Sarcopenia prevalence was determined as probable in 5.4 % and confirmed in 14.1 % of participants. It was observed that women classified as having probable or confirmed sarcopenia were older than those who were not sarcopenic. No significant differences concerning weekly energy expenditure and PA levels between groups were observed.</div></div><div><h3>Conclusion</h3><div>Less than a quarter of the assessed patients were diagnosed with probable or confirmed sarcopenia, and none were diagnosed with severe sarcopenia. No associations were observed between sarcopenia, weekly energy expenditure or PA levels.</div></div>","PeriodicalId":49621,"journal":{"name":"Brazilian Journal of Physical Therapy","volume":"29 4","pages":"Article 101224"},"PeriodicalIF":3.1,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144099711","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":"Psychometric properties of the sit-to-stand test for patients with pulmonary hypertension: A systematic review","authors":"Natália L. Cardoso ,&nbsp;Joceline F. de Sá ,&nbsp;Larissa F.E. do Nascimento ,&nbsp;Luciana A. Mendes ,&nbsp;Selma Bruno ,&nbsp;Rodrigo Torres-Castro ,&nbsp;Isabel Blanco ,&nbsp;Guilherme A.F. Fregonezi ,&nbsp;Vanessa R. Resqueti","doi":"10.1016/j.bjpt.2025.101223","DOIUrl":"10.1016/j.bjpt.2025.101223","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary hypertension (PH) is defined as an increase in mean pulmonary arterial pressure, often accompanied by indicators such as dyspnea on exertion, exercise intolerance, and systemic muscle dysfunction. Various protocols exist that can indirectly assess these indicators through the sit-to-stand test (STST).</div></div><div><h3>Objective</h3><div>Assess the psychometric properties of different STST protocols in patients with PH.</div></div><div><h3>Methods</h3><div>This study is a systematic review. We searched the PubMed, EMBASE, SciELO, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science databases. The risk of bias was assessed using the COSMIN tool and the certainty of evidence using the modified Recommendations, Assessment, Development, and Evaluation (GRADE) classification. Two investigators evaluated independently, and a third evaluator was consulted as needed.</div></div><div><h3>Results</h3><div>Out of a total of 7933 articles identified, only 5 articles met the criteria for inclusion in the analysis. Four psychometric properties were assessed across the five protocols used. The 1-STST protocol provided high-quality evidence for both convergent validity and responsiveness. The 30-STST protocol showed moderate-quality evidence for convergent validity and responsiveness, while the 5-STST also demonstrated moderate-quality evidence for responsiveness. The between-groups validity and reliability of the 30-STST protocol were considered to be low and very low, respectively.</div></div><div><h3>Conclusion</h3><div>Despite the limited number of studies, we can infer that the most commonly used protocol is the 1-STST, which has a high degree of convergent validity and responsiveness when compared to other assessment tools.</div></div>","PeriodicalId":49621,"journal":{"name":"Brazilian Journal of Physical Therapy","volume":"29 4","pages":"Article 101223"},"PeriodicalIF":3.1,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143924271","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":"Achilles tendinopathy physical impairments evaluated through clinician-friendly measures: a systematic review with meta-analysis and GRADE recommendations","authors":"Victor M.L.M. Ferreira ,&nbsp;Rafael Z.A. Pinto ,&nbsp;Guy Simoneau ,&nbsp;Lívia S. Pogetti ,&nbsp;Renan A. Resende ,&nbsp;Juliana M. Ocarino","doi":"10.1016/j.bjpt.2025.101212","DOIUrl":"10.1016/j.bjpt.2025.101212","url":null,"abstract":"<div><h3>Background</h3><div>Clinician-friendly tests, defined as affordable, portable, and readily available, can facilitate assessing and treating Achilles tendinopathy.</div></div><div><h3>Objective</h3><div>To identify physical impairments in individuals with Achilles tendinopathy using clinician-friendly tests.</div></div><div><h3>Methods</h3><div>Searches were performed in Medline, CINAHL, EMBASE, Web of Science, and Sportdiscus for studies comparing physical function between individuals with Achilles tendinopathy and controls using clinician-friendly measures. Study quality was assessed using the Downs and Black scale, and evidence certainty using GRADE approach. When possible, data were pooled through meta-analysis.</div></div><div><h3>Results</h3><div>Seventeen studies were included with 12 contributing to quantitative synthesis. Meta-analyses showed individuals with Achilles tendinopathy when compared with an asymptomatic group had: lower ankle dorsiflexion in a non-weight bearing position with knee bent (mean difference [MD] = 5.22, 95 % CI: 2.16, 8.28), lower ankle plantar flexion endurance on heel raises (MD = 10.47 repetitions, 95 % CI: 7.17, 13.76), and lower hip extension isometric strength (Effect Size= 0.49, 95 % CI: 0.12, 2.59). In those with Achilles tendinopathy, effect size analysis showed a greater Achilles tendon angle and tibia varus compared to an asymptomatic group, greater first ray and midfoot abduction laxity than the asymptomatic limb, and impaired jump performance compared to asymptomatic individuals and limb.</div></div><div><h3>Conclusion</h3><div>Low to moderate certainty evidence suggests those with Achilles tendinopathy have less ankle dorsiflexion, lower hip extension strength, lower ankle plantar flexion endurance, impaired hop performance, and greater Achilles tendon angle, tibia varus alignment, and first ray and midfoot abduction laxity. Clinicians should consider these impairments when assessing patients with Achilles tendinopathy.</div></div>","PeriodicalId":49621,"journal":{"name":"Brazilian Journal of Physical Therapy","volume":"29 4","pages":"Article 101212"},"PeriodicalIF":3.1,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143928751","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":"Translation, cross-cultural adaptation, and measurement properties of the Brazilian version of the pediatric rehabilitation intervention measure of engagement scale—Observation version (PRIME-O)","authors":"Agnes Flórida Santos da Cunha ,&nbsp;Hércules Ribeiro Leite ,&nbsp;Rejane Vale Gonçalves ,&nbsp;Gillian King ,&nbsp;Ana Cristina Resende Camargos","doi":"10.1016/j.bjpt.2025.101209","DOIUrl":"10.1016/j.bjpt.2025.101209","url":null,"abstract":"<div><h3>Background</h3><div>The Pediatric Rehabilitation Intervention Measure of Engagement - Observation Version (PRIME-O) is a standardized tool that assesses client engagement, which can be the child, youth, or parent/caregiver, as well as service provider engagement, during a pediatric rehabilitation session from the perspective of an external observer.</div></div><div><h3>Objective</h3><div>To translate and cross-culturally adapt the PRIME-O into Brazilian Portuguese and evaluate measurement properties.</div></div><div><h3>Methods</h3><div>This study included translation, cross-cultural adaptation, back-translation, analysis of face validity, test-retest reliability, standard error of measurement, internal consistency, and Bland-Altman analysis of the PRIME-O Brazilian version. Fifty-one respondents included physical therapists (<em>n</em> = 47) and occupational therapists (<em>n</em> = 4) working in pediatric rehabilitation in Brazil.</div></div><div><h3>Results</h3><div>Translation and cross-cultural adaptation resulted in a Brazilian version of the PRIME-O that is easily understandable with local language appropriateness, semantically equivalent to the original version. In the face validity analysis, all PRIME-O items were considered useful, appropriate, and relevant for assessing engagement. Test-retest reliability ranged from 0.81 to 0.93 across all domains and total score. Cronbach's alpha ranged from 0.90 to 0.95 and the SEM ranged from 0.40 to 0.42 on average across domains with a value of 0.27 for the total test score. Bland-Altman plot analysis showed that most data points were within agreement limits, without proportional bias (<em>p</em> = 0.74).</div></div><div><h3>Conclusion</h3><div>The PRIME-O Brazilian version is a reliable and valid tool for measuring client and service provider engagement in pediatric rehabilitation sessions.</div></div>","PeriodicalId":49621,"journal":{"name":"Brazilian Journal of Physical Therapy","volume":"29 4","pages":"Article 101209"},"PeriodicalIF":3.1,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143898539","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 most effective therapeutic exercises for pain intensity in women with fibromyalgia: A systematic review and network meta-analysis","authors":"Álvaro-José Rodríguez-Domínguez ,&nbsp;Manuel Rebollo-Salas ,&nbsp;Raquel Chillón-Martínez ,&nbsp;Abel Rosales-Tristancho ,&nbsp;Inmaculada Villa-del-Pino ,&nbsp;José-Jesús Jiménez-Rejano","doi":"10.1016/j.bjpt.2025.101226","DOIUrl":"10.1016/j.bjpt.2025.101226","url":null,"abstract":"<div><h3>Background</h3><div>Therapeutic exercise (TE) is the only intervention with strong recommendation for fibromyalgia. However, there is controversy as to which type of exercise is the most beneficial.</div></div><div><h3>Objective</h3><div>To determine which TE approach is the most effective in reducing pain intensity in women with fibromyalgia.</div></div><div><h3>Methods</h3><div>A systematic review was performed with a network meta-analysis (NMA). Six databases were searched from inception until January 2024. Randomized controlled trials (RCTs) evaluating the effects of TE on pain intensity were included in women with fibromyalgia. Methodological quality was assessed using the Physiotherapy Evidence Database scale. The size of the effect and the clinically important difference were determined in the short-term (≤3 months) and long-term (&gt;3 months).</div></div><div><h3>Results</h3><div>Sixty-one studies were identified, of which 51 were included in the quantitative synthesis (<em>n</em> = 2873). Fifteen TE interventions and eight comparison interventions (comparators) were identified. Aquatic exercise (p-score: 0.8713) was found to provide best benefits in the short-term and resistance training in the long-term (p-score: 0.9749). Statistically significant differences were found in favor of aquatic exercise, Pilates, qigong, resistance training, virtual reality, mixed exercise, and aerobic exercise (in the short-term) and in favor of resistance training, dance, functional training, aquatic exercise, virtual reality, and aerobic exercise (in the long-term) compared to usual care.</div></div><div><h3>Conclusion</h3><div>With a moderate level of evidence, our NMA shows that, in the short-term, aquatic exercise is the most effective TE intervention to reduce pain intensity in women with fibromyalgia, while resistance training is the most effective in the long-term. More RCTs are needed to strengthen these findings.</div></div>","PeriodicalId":49621,"journal":{"name":"Brazilian Journal of Physical Therapy","volume":"29 4","pages":"Article 101226"},"PeriodicalIF":3.1,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143898668","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":"Reply to Letter to Editor for the article “If by exercising I can conceive; I would like to exercise”. Exploring knowledge, perception, and practices about exercise among women with infertility: A qualitative study","authors":"Gundimi Shashwathi ,&nbsp;Bhamini Krishna Rao ,&nbsp;Ajay Bailey ,&nbsp;Pratap Kumar ,&nbsp;Preetha Ramachandra","doi":"10.1016/j.bjpt.2025.101211","DOIUrl":"10.1016/j.bjpt.2025.101211","url":null,"abstract":"","PeriodicalId":49621,"journal":{"name":"Brazilian Journal of Physical Therapy","volume":"29 4","pages":"Article 101211"},"PeriodicalIF":3.1,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143898540","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":"How do foot-ankle exercises improve clinical and plantar pressure outcomes in people with diabetic peripheral neuropathy? A mediation analysis of a randomized controlled trial","authors":"Ronaldo H. Cruvinel-Júnior,&nbsp;Jane S.S.P. Ferreira,&nbsp;Isabel C.N. Sacco","doi":"10.1016/j.bjpt.2025.101213","DOIUrl":"10.1016/j.bjpt.2025.101213","url":null,"abstract":"<div><h3>Background</h3><div>Foot-ankle exercises targeting modifiable risk factors, such as peak pressure, ankle motion, and foot strength, may reduce ulcer risk and improve gait biomechanics, but the pathways driving these improvements are unclear.</div></div><div><h3>Objectives</h3><div>To identify the causal pathways through which a 12-week foot-ankle exercise program improved foot function, pain, and plantar pressure during gait by examining key mediators of these effects.</div></div><div><h3>Methods</h3><div>A total of 62 participants with diabetic peripheral neuropathy (DPN) were assigned to either a web-based foot-ankle program or usual care. The outcomes included peak pressure, pressure–time integral at the forefoot, foot pain, and foot function. Mediators included hallux and toe strength, sagittal ankle range of motion (ROM) during gait stance phase, ankle plantar flexion angle at push-off, ankle extensor moment at push-off, and foot pain and function. Outcomes and mediators were assessed at baseline, 12 weeks, and 24 weeks. Mediation models were tested using ordinary least squares regression with bias-corrected bootstrap confidence intervals.</div></div><div><h3>Results</h3><div>The analysis revealed consistent and inconsistent mediation effects. Improvements in foot function were mediated by reductions in foot pain (1.71, 95 % CI: 0.21, 4.43) and increases in ankle plantar flexion angle at push-off (0.45, 95 % CI: 0.15, 0.74). While the intervention directly reduced forefoot peak pressure, inconsistent mediation occurred, with indirect increases through reduced foot function (3.84, 95 % CI: 1.04, 11.38). Consistent mediation was observed, with increased sagittal ankle ROM during gait stance phase (9.02, 95 % CI: 2.47, 17.68) mediating a rise in the forefoot pressure-time integral.</div></div><div><h3>Conclusion</h3><div>The program reduced pain, improved function, and influenced plantar pressure through mediated pathways, highlighting a complex interplay of consistent and inconsistent mediation effects.</div></div>","PeriodicalId":49621,"journal":{"name":"Brazilian Journal of Physical Therapy","volume":"29 4","pages":"Article 101213"},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892029","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}