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To translate, cross-culturally adapt, and psychometric testing the Western Ontario Shoulder Instability index (WOSI) into Persian Seventy-two patients diagnosed with shoulder instability participated in reliability, construct validity, and responsiveness analysis. All the patients filled out the WOSI with an interval of two weeks to assess reliability. The shortened Disability of Arm, Shoulder and Hand (Quick-DASH), Shoulder Pain and Disability Index (SPADI), and the 36-Item Short-Form Survey (SF-36) were assessed to evaluate construct validity. In order to assess responsiveness patients filled out WOSI before and after the physiotherapy and global rating of change scale at last session of physiotherapy. Reliability was assessed by intra-class correlation coefficient (ICC (1,2)), construct validity by two tailed Pearson (r), and responsiveness by longitudinal validity and receiver operating characteristics (ROC) curve analysis. The ICC (1,2) was 0.90 and correlation analysis revealed high level of correlation with: Quick-DASH (r = 0.82); SPADI (r = 0.72); physical SF-36 (r = −0.52); and mental SF-36 (r = −0.48). Responsiveness analysis demonstrated the area under curve was 0.90, with minimal clinical important difference 46.87. We found the Persian-WOSI as a valid, reliable, and responsive questionnaire to evaluate quality of life of patients with shoulder instability. [ABSTRACT FROM AUTHOR]

The relationship between chronic pain and the occurrence of falls in healthy older adults has been clarified in previous studies, but its relationship in older adults with disabilities has not. This study aimed to determine whether chronic pain is related to the occurrence of falls in older adults with disabilities. The participants were 101 older adults above 65 years old who used long-term care insurance services in Japan. Of these, 30 were fallers and 71 were non-fallers. Chronic pain, defined as pain lasting more than three months, was assessed using questionnaires, and the falls' occurrence was followed up for six months using a fall calendar. Logistic regression analysis was used to analyze the data, with falls as the dependent variable, chronic pain as the independent variable, and age, sex, body mass index, number of drugs, sleep disorders, and depression as covariates. After adjusting for covariates, chronic pain significantly influenced the occurrence of falls (odds ratio: 3.168, 95% confidence interval: 1.057–9.495, p =.04). Chronic pain was related to the occurrence of falls in older adults with disabilities. There is a need to focus on chronic pain presence in falls' prevention among older adults with disabilities. [ABSTRACT FROM AUTHOR]

Chronic traumatic neck pain has a high prevalence of post-traumatic stress symptoms (PTSS). However, whether PTSS moderates treatment effects is unknown. This study investigated: 1) whether PTSS was associated with patient-reported outcomes and clinical test results at baseline; 2) whether PTSS moderated the effect of a multimodal physiotherapy intervention of exercise therapy and patient education; and 3) whether adherence to the intervention differed across PTSS groups. Secondary data analysis from a randomized controlled trial on chronic neck pain with 12-month follow-up was conducted. Patients were divided into three groups (NT = non-traumatic, LT = traumatic low PTSS, HT = traumatic high PTSS) based on self-reported onset of pain and the Impact of Event Scale. The baseline data were used to analyze the association of PTSS with patient demographics and scores of physical and mental health-related quality of life, depression, neck-related disability, kinesiophobia, and clinical tests. Baseline, 4-month and 12-month follow-up data were analyzed to investigate possible moderating effects on outcomes. Data on adherence were collected at four months. 115 participants were included (NT n = 45; LT n = 46; HT n = 24). The HT group reported lower mental health scores and more depressive symptoms at baseline. PTSS did not significantly moderate the treatment effect on any outcomes. The HT group tended to have lower adherence to the multimodal physiotherapy intervention than the LT group. For patients with traumatic neck pain, high levels of PTSS are associated with poorer psychological outcomes but do not affect the outcomes of multimodal physiotherapy intervention. [ABSTRACT FROM AUTHOR]

Women with breast cancer who underwent taxane-based chemotherapy demonstrate diminished postural stability. However, the data concerning dynamic postural stability among women with breast cancer during taxane-based chemotherapy remains insufficient. To investigate postural stability among women with breast cancer during taxane-based chemotherapy. Fifteen women with breast cancer participated in this study. Postural stabilities were assessed at five intervals during the course of chemotherapy treatment. Static postural stability was measured during single leg with eyes open (SEO) and eyes closed (SEC) conditions, while dynamic postural stability was measured during performance of the limit of stability test (LOS). Postural stability was described using 95% confidence ellipse area (EA), center of pressure (COP) path length (PL), and COP average velocity (AV). For static postural stability assessment, SEO condition was found to have significant increases in EA, PL, and AV (p =.001, p <.001, and p =.02, respectively). For dynamic postural stability assessment, a significant difference in EA was observed in the forward, backward, right, and left directions (p =.02, p =.02, p <.001, and p =.01, respectively). In addition, a significant difference in PL was found while performing in a backward direction (p =.02). The findings showed that women with breast cancer may have experienced decreased static and dynamic postural stability. [ABSTRACT FROM AUTHOR]

Walking speed is an important clinical tool in the physical therapy examination of older adults, but not always feasible to measure. Clinicians may be limited by space, a client's functional limitations, or use of telehealth. The Walking Speed Questionnaire (WSQ) can be used to estimate walking speed, but the effects of testing protocols on the accuracy and diagnostic capability of the WSQ have not yet been investigated The purposes of this study were to compare estimated with recorded walking speed and examine effects of start condition and instructions in healthy older adults. One hundred community dwelling adults 60 years or older were tested. After completing the WSQ, participants performed two trials of six walking conditions that included standing and walking starts under instructions to "walk at a usual pace," "as if crossing a street," and "fast." Participants averaged 72.4 (9.6) years of age. The WSQ average walking speed was 1.22 (0.16) m/s and was slower than each condition, p-value = 0.001, except for those performed with instructions to walk at usual pace with both standing, 1.23 (0.29) m/s and walking starts, 1.26 (0.30) m/s. Compared to the usual pace walking start condition, the WSQ sensitivity and specificity were 31% and 94% respectively with an 82% accuracy. A modified cutoff of the WSQ to 1.17 m/s improves sensitivity If walking testing cannot be performed, the WSQ is a reasonable alternative providing an accurate estimate of a client's walking speed when walking at a usual pace. [ABSTRACT FROM AUTHOR]

Occupational self-efficacy is a stable predictor for professionals' motivation to engage with new methods and tasks. Yet, the delivery of tele-physiotherapy (Tele-PT) by physiotherapists (PTs) during the coronavirus disease of 2019 (COVID-19) outbreak without advance training may have had the potential to increase work stress and damage their motivation, regardless of their occupational self-efficacy. The present study examined whether the relations between PTs' overall occupational self-efficacy and motivation to provide Tele-PT was mediated by role stress (i.e. role conflict and ambiguity). Between February 4 and April 23, 2021, 150 Israeli PTs completed an online survey that measured their overall occupational self-efficacy, their role stress induced by the provision of Tele-PT, their motivation to provide Tele-PT, and their demographic characteristics. PTs' overall occupational self-efficacy was positively associated with PTs' motivation to provide Tele-PT (r= 0.328, p <.01) and fully mediated by role conflict (0.1757, 95% CI = [0.0231, 0.3797]) and by role ambiguity (0.1845, 95% CI = [0.0196, 0.4184]) (components of role stress) caused by the provision of Tele-PT. It is important to investigate the predictors and mediators of the motivation to provide Tele-PT because in the post-COVID-19 era health organizations are likely to adopt many tele-medicine services, and they need to find ways to mitigate perceived challenges. [ABSTRACT FROM AUTHOR]

Patients with idiopathic pulmonary fibrosis (IPF) often present with dyspnea, fatigue, and desaturation. These symptoms can be highly limiting, as they lead to a decrease in performing activities of daily living (ADL). Therefore, it is essential to evaluate the degree of functional limitation of these individuals. The present study aimed to evaluate the validity and reliability of the Glittre-ADL test (TGlittre) and its association with self-reported limitation in ADL and health-related quality of life (HRQoL) in patients with IPF. Twenty-seven individuals with IPF (60.5 ± 10.6 years), with forced vital capacity 2.26 ± 1.03 L (51.09 ± 20.62% of predicted) were assessed for the time spent in TGlittre, 6-minute walking distance (6MWD), limitation in ADL and HRQoL. TGlittre was reliable (intraclass correlation coefficient3,1 = 0.96; P <.001); however, a learning effect of 10.6% was observed between the first and second execution of TGlittre. The time spent in TGlittre correlated with 6MWD, limitation in ADL, and disease-specific HRQoL (P <.05). TGlittre is valid and reliable for assessing functional capacity in patients with IPF. Still, it presents a learning effect and should be performed twice when assessing functional capacity in clinical practice. [ABSTRACT FROM AUTHOR]

Individuals with Down syndrome (DS) require more time to develop motor and/or cognitive skills. Neuromodulation is used to assist in this development. However, there is a gap in the literature on neurophysiological changes that may occur in the primary motor cortex in individuals with DS following neuromodulation. Our objective was to investigate possible neurophysiological changes in brain wave behavior of the primary motor cortex following the administration of anodal transcranial direct current stimulation combined with sensorimotor training. The study involved 12 participants with DS. EEG equipment was used to investigate brain activity. The participants received neuromodulation involving anodal tDCS for 20 minutes with a current of 1 mA combined with virtual reality (VR) training three times a week for a total of ten sessions. We analyzed EGG signals and 3D movement during a reaching movement of the dominant upper limb before and after the ten-session protocol. Significant differences in event-related desynchronization and event-related synchronization of the alpha and beta rhythms were found throughout the evaluations. Brain mapping revealed reductions in power and frequency, demonstrating changes in the patterns of these rhythms in the cerebral cortex. Revealed reorganization of the behavior of alpha and beta waves, as demonstrated by distribution of synchronization and desynchronization of these waves among the regions of the brain. The results suggest that anodal tDCS promotes the reorganization of brain impulses, redirecting these impulses to the required regions more efficiently and contributing to better motor planning. [ABSTRACT FROM AUTHOR]

The Osteoarthritis Research Society International has recommended a core set of performance-based tests of physical function for use in knee osteoarthritis (OA) patients. The core set includes 30-second chair stand test (30-s CST), 4 × 10 m fast-paced walk test (40-m FPWT), and a stair climb test. This study aimed to evaluate responsiveness and minimal important changes (MICs) of these performance-based measures in knee OA patients following physiotherapy. Sixty patients with knee OA, undergoing 4-week physiotherapy performed 30-s CST, 40-m FPWT, and 4-step stair climb test (4-step SCT) at pre- and post-intervention. Patients also completed the 7-point global rating scale as an external anchor at post-intervention. Responsiveness was evaluated using receiver operating characteristics curve and correlation analysis. All three performance-based measures of physical function showed area under the curve > 0.70. Correlation analysis showed relationship of 30-s CST, 40-m FPWT, and 4-Step SCT with the external anchor fell within moderate to good range (Spearman = 0.43–0.63). Furthermore, MIC values reflecting improvement for 30-s CST, 40-m FPWT, and 4-Step SCT were 2.5, 0.21, and 3.21, respectively. Our findings demonstrated all three performance-based measures have good responsiveness to measure improvement in physical functions of knee OA patients following physiotherapy. The MIC reflecting improvement can help clinicians and researchers to make a decision based on the clinical significance of improvements in patients' functional status. [ABSTRACT FROM AUTHOR]

This study aimed to compare the effectiveness of cervical thrust manipulation and exercise in patients with mechanical neck pain (MNP). Sixty (mean age 31.45 ± 7.31 years) patients were randomized into three groups: manipulation (Group 1); exercise (Group 2); and manipulation plus exercise (Group 3). All interventions were performed 2 days a week for 6 weeks. The visual analog scale (VAS) and Neck Disability Index (NDI) were primary outcome measures; pressure pain threshold (PPT), range of motion (ROM), Short form-36 (SF-36), and Global Rating of Change (GROC) were secondary outcome measures. All parameters improved in all groups (p <.05). Only the minimal clinically important difference (MCID) for NDI was achieved in Group 3. Group 3 had greater improvement in: VAS-rest (p =.004); NDI (p <.001); PPT-left (p =.012); and vitality (p =.002), as well as higher GROC compared to the other groups (p =.043). Group 3 was superior to Group 2 in terms of: ROM (Lateral flexion [LF]-right, p =.003/left, p =.003, rotation-right, p =.012/left, p =.010), PPT-right (p =.022); and emotional well-being (p =.003). Group 1 was superior to Group 2 in terms of ROM (LF-left, p =.043/rotation-left, p =.049). The between-group effect sizes were large (0.12–0.36). The combined application of cervical thrust manipulation and exercise in MNP resulted in greater improvement in clinical parameters, especially function, and higher patient satisfaction in the short term compared to their application alone. Because of its positive effects, cervical thrust manipulation can be added to the exercise program according to the patient's needs and suitability for manipulation. [ABSTRACT FROM AUTHOR]

The Work Role Functioning Questionnaire 2.0 (WRFQ 2.0) is an important instrument within the context of occupational health, consisting of 27 items and 5 domains. In addition, a short version of WRFQ 2.0 with 5 items (WRFQ-5) was proposed, showing agreement with the long version. Thus, we aimed to confirm the number of factors of the WRFQ-5 short version and to verify the structural, construct, and criterion validity, reliability, internal consistency, and analysis of ceiling and floor effects of the Brazilian version of the WRFQ-5 in a general workers population. A questionnaire validation and measurement properties study. We evaluated the internal structure of the WRFQ-5 by means of confirmatory factor analysis. Construct validity was assessed by correlating the WRFQ-5 with the Numerical Pain Rating Scale (NPRS), Work Ability Index (WAI), and Self-Estimated Functional Inability because of Pain (SEFIP-work). Criterion validity was assessed by correlating the WRFQ-5 with the 5 domains of the WRFQ 2.0. Test-retest reliability and internal consistency were also evaluated. We observed positive correlations (p <.05) between the WRFQ-5 and the WAI (rho = 0.161 to 0.308) and negative correlations (p <.05) between the WRFQ-5 and the SEFIP-work (rho = −0.293). The WRFQ-5 significantly and positively correlates with the 5 domains of WRFQ 2.0 (rho = 0.742 to 0.830). The test-retest reliability of the WRFQ-5 was excellent (ICC2,1 = 0.935) and the internal consistency was adequate (Cronbach's alpha = 0.938). We did not observe ceiling and floor effects. The one-dimensional internal structure of the WRFQ-5 in Brazilian Portuguese has a valid internal structure and construct, as well as adequate reliability and internal consistency. [ABSTRACT FROM AUTHOR]

The Andago is an electromechanical gait trainer providing dynamic body weight support while simultaneously enabling over ground walking. The aim of this study was to compare the effects of the Andago with over ground walking on selected gait parameters, during a single gait reeducation session in a post-acute rehabilitation population Twenty-seven participants (mean age 78 yrs. (SD = 9.2), female 55.6% (n = 15)) undergoing rehabilitation for neurological (51.8%, n = 14), orthopedic (33.3%, n = 9), and medical conditions (14.8%, n = 4) completed the study. This was a single group, cross sectional, repeated measures study. Participants completed a 10-meter walk test (10MWT) and a 20-minute gait reeducation session under two conditions: i) harnessed in the Andago with body weight support or ii) using their normal walking pattern. Walking speed, steps taken, distance walked, rest breaks, Borg ratings of perceived exertion, and fear of falling were compared over both conditions Walking speed was significantly slower with the Andago (10MWT mean difference 0.12 (95% CI 0.03–0.20), eta squared 0.24, p =.008; 20-min gait mean difference 0.04 (95% CI 0.00–0.09), eta squared 0.15, p =.049). During the 20-minute gait reeducation session, step count, distance walked, and duration of walking was similar over both conditions, however participants recorded less rest breaks and fear of falling at minutes 10 and 20 in favor of the Andago Gait parameters measured during a single gait reeducation session in the Andago, in a mixed cohort of predominately older rehabilitation patients, appear comparable to conventional over ground training, other than walking speed which was reduced. [ABSTRACT FROM AUTHOR]

Regaining independent living can be challenging in patients undergoing inpatient geriatric rehabilitation. Given the paucity of evidence-based physiotherapy programs for this particular heterogeneous group, the Geriatric Activation Program Pellenberg (GAPP) was developed. Investigate the evolution of functional performance, and predict detectable changes throughout 4 weeks of GAPP. Methods: Participants in this observational study (2017–2019) followed GAPP as part of their rehabilitation program. Functional balance (Berg balance scale (BBS)) and independence (Katz scale) were the primary outcomes, with gait speed, elbow and knee extension strength, cognitive processing speed, and mood as secondary outcomes. All outcomes were assessed at baseline, 2 weeks and 4 weeks later. Prediction analysis was conducted using logistic regression modeling. Previously reported minimal detectable change with 95% confidence interval (MDC95) was used as detectable change. We recruited 111 participants, with 83 completing 4 weeks of GAPP and all assessments. Over 4 weeks, all outcome measures showed a significant improvement (p ≤.007). Detectable change was found for BBS (mean improvement of 12.8 points (95% CI: 10.9–14.8), MDC95 = 6.6) and gait speed (mean improvement of 0.24 m/s (95% CI: 0.19–0.29), MDC95 = 0.1 m/s). We found that baseline scores lower than 26 on the BBS (75% sensitivity, 65% specificity) and gait speed lower than 0.34 m/s (53% sensitivity, 81% specificity) were associated with participants achieving detectable change at 4 weeks on BBS and gait speed, respectively. Functional performance of a heterogeneous group of geriatric inpatients improved notably after 4 weeks of GAPP. Baseline scores on BBS and gait speed can partially predict detectable changes in functional performance. [ABSTRACT FROM AUTHOR]

In this novel advanced practice physiotherapy (APP) model of care, advanced practice physiotherapists (APPTs) assess, triage, and manage adults with spinal disorders to alleviate the growing demands in specialized spine medical care. To describe this APP model of care, to assess change in disability 3 months after rehabilitation care and to assess surgical triage and diagnostic concordance between APPTs and spine surgeons. In this retrospective observational study, consecutive patients who completed the 3-month follow-up data were analyzed. Sociodemographic, clinical characteristics, and self-reported disabilities including the Oswestry Disability Index (ODI) and Neck Disability Index (NDI) at baseline and 3 months were extracted. Paired t-tests were used to assess changes in disability. Surgical triage and diagnostic concordance between APPTs and surgeons were measured with raw agreement, Cohen's Kappa, and PABAK. In this model, trained APPTs triaged surgical candidates and provided rehabilitation care including education and exercises to patients with spinal disorders. The APPTs referred only 18/46 participants to spine surgeons. Surgical triage and diagnostic concordance were high with raw agreement of 94% and 89%. At the 3-month follow-up, significant improvements in disability were observed among nonsurgical candidates with back (mean difference (MD): −13.0/100 [95%CI: −19.8 to −6.3], n = 23) or neck disorders (MD: −16.0/100 [95%CI: −29.6 to −2.4], n = 5), but not among surgical candidates referred by APPTs to spine surgeons. In this limited sample, adults with spinal disorders that were initially referred to a spine surgeon by family physicians were effectively assessed, triaged, and managed by an APPT. [ABSTRACT FROM AUTHOR]

Low back pain (LBP) is the top health condition requiring rehabilitation in the United States. The financial burden of managing LBP is also amongst the highest in the United States. Clinical practice guidelines (CPGs) provide management recommendations and have the potential to lower health costs. Limited evidence exists on the impact of CPG implementation on downstream medical costs. To examine the impact of CPG implementation in physical therapist (PT) practice on direct and downstream costs for patients with LBP. A retrospective observational study examined billing data from 270 patients with LBP who were treated at multiple sites within one large academic medical center by PTs who participated in a multifaceted CPG implementation program. Costs were analyzed for direct PT services, downstream medical services, and PT utilization from September 2017 to March 2018 (pre-implementation group) and compared with costs from June 2018 to December 2018 (post-implementation group). Direct PT costs were significantly lower post-implementation than pre-implementation mean: $2,863 USD (SD: $1,968) vs. $3,459 USD (SD: $2,838), p =.05, 95% CI [11, 1182]. All downstream costs were lower post-implementation with statistically significant lower costs found in downstream imaging: p =.04, 95% CI [32, 1,905]; pharmacy: p =.03, 95% CI [70, 1,217]; surgery: p =.03, 95% CI [446, 9,152], and "other": p =.02, 95% CI [627, 7,920]. Implementing the LBP CPG in outpatient PT practice can have a positive impact on lowering downstream costs and the potential to increase the value of PT services. [ABSTRACT FROM AUTHOR]

Several classification systems are used to grade the severity of lymphedema. Their agreement with each other has not been reported. To evaluate the agreement between the American Physical Therapy Association (APTA) criteria, the criteria of Ramos et al., and the International Society of Lymphology (ISL) criteria in patients with upper and lower extremity lymphedema. A total of 156 patients (63 and 93 patients with upper and lower extremity lymphedema, respectively) were included. The circumference measurements and limb volume were measured. The severity of lymphedema of the patients was classified as mild, moderate, and severe lymphedema using the APTA criteria, the criteria of Ramos et al., and the ISL criteria. The agreement between the classification systems was assessed with Krippendorff's alpha. An acceptable and poor agreement were found between the criteria in upper (Krippendorff's alpha > 0.667) and lower extremity lymphedema (Krippendorff's alpha < 0.667), respectively. In pairwise comparisons, an acceptable agreement was found among each comparison in upper extremity lymphedema (Krippendorff's alpha > 0.667), and a poor agreement was found among each comparison in lower extremity lymphedema (Krippendorff's alpha < 0.667) except between the APTA criteria and the criteria of Ramos et al (Krippendorff's alpha > 0.667). Patients with upper extremity lymphedema classified according to these criteria can be assumed to be samples of the same population; however, patients with lower extremity lymphedema graded according to the ISL criteria may be included in a different classification when they grade with the APTA criteria and the criteria of Ramos et al. [ABSTRACT FROM AUTHOR]

To evaluate the effect of neck-specific exercise (NSE) compared to prescribed physical activity (PPA) on headache and dizziness in individuals with cervical radiculopathy (CR). Also, to investigate associations between headache or dizziness and pain, neck muscle endurance (NME), neck mobility, physical activity, and fear avoidance beliefs. Individuals randomized to either NSE or PPA were selected to a headache subgroup (n = 59) and/or a dizziness subgroup (n = 73). Data were evaluated, according to headache and/or dizziness outcomes at baseline and at 3, 6, and 12-month follow-ups. No significant between-group differences were found between NSE and PPA in either subgroup. In the headache subgroup, significant within-group improvements were seen at all follow-ups for NSE (p <.001) and from baseline to 3 (p =.037) and 12 (p =.003) months for PPA. For dizziness, significant within-group improvements were seen from baseline to 3 months for NSE (p =.021) and from baseline to 3 (p =.001) and 6 (p =.044) months for PPA. Multiple regression models showed significant associations at baseline between headache intensity and neck pain (adjusted R-square = 0.35, p <.001), and for dizziness with neck pain and dorsal NME (adjusted R-square = 0.34, p <.001). NSE and PPA show similar improvements in headache intensity and dizziness in individuals with CR. Headache intensity is associated with neck pain, and dizziness with neck pain and dorsal NME, highlighting the importance of these factors when evaluating headache and dizziness. [ABSTRACT FROM AUTHOR]

There is a relationship between low back pain (LBP) and central nervous system dysfunction. Needling therapies (e.g. acupuncture, dry needling) are proposed to impact the nervous system, however their specific influence is unclear. Determine how needling therapies alter functional connectivity and LBP as measured by functional magnetic resonance imaging (fMRI). Databases were searched following PRISMA guidelines. Studies using fMRI on individuals with LBP receiving dry needling or acupuncture compared to control or sham treatments were included. Eight studies were included, all of which used acupuncture. The quality of studies ranged from good (n = 6) to excellent (n = 2). After acupuncture, individuals with LBP demonstrated significant functional connectivity changes across several networks, notably the salience, somatomotor, default mode network (DMN) and limbic networks. A meta-analysis demonstrated evidence of no effect to potential small effect of acupuncture in reducing LBP (SMD −0.28; 95% CI: −0.70, 0.13). Needling therapies, like acupuncture, may have a central effect on patients beyond the local tissue effects, reducing patients' pain and disability due to alterations in neural processing, including the DMN, and potentially other central nervous system effects. The meta-analysis should be interpreted with caution due to the narrow focus and confined sample used. [ABSTRACT FROM AUTHOR]

The aims of this study were to evaluate the diagnostic accuracy of common physical examination and functional evaluation tests, and to determine a set of tests with the highest diagnostic accuracy for diagnosing patellofemoral pain syndrome (PFPS) in patients with anterior knee pain. Based on careful evaluation of clinical findings and imaging methods by orthopedic physicians, 162 patients with anterior knee pain were classified into two groups of PFPS and non-PFPS. The physical examination and functional tests were performed by two physiotherapists. The accuracy of these measures was determined by calculating sensitivity, specificity, area under the receiver operating characteristic (ROC) curve (AUC), likelihood ratio (LR), and predictive value (PV). Our results showed the most sensitive tests in identifying patients with PFPS were as follows: eccentric step test [0.82 (95%CI: 0.72–0.89)]; palpation test [0.81(95%CI: 0.70–0.88)]; and prolonged sitting [0.73 (95%CI: 0.62–0.82)]. The palpation test, patellar tilt test, eccentric step test, navicular drop test, squatting, and stair descending tests had an acceptable accuracy (AUC ≥ 70). The strongest combination of the physical examination and functional tests included pain severity between 3 and 10 during stair descending test and pain severity between 6 and 10 during prolonged sitting test. This combination showed a positive LR of 19.47 (95% CI: 6.36–59.65) and a posttest probability of 95%. Our findings provide evidence for the good accuracy of the palpation test, patellar tilt test, eccentric step test, navicular drop test, squatting, and stair descending and prolonged sitting tests for diagnosing PFPS. Also, the combination of stair descending test and prolonged sitting test could be very useful for ruling in PFPS patients. [ABSTRACT FROM AUTHOR]

Pain might be approached from a biomedical or biopsychosocial perspective. There is a lack of research on the attitudes and beliefs about pain among physiotherapy students. In this context, the Pain Attitudes and Belief Scale for Physiotherapists (PABS-PT) is an instrument widely used from a clinical and educational perspective, but its psychometric properties have not yet been tested in a student-based population. To develop the Spanish version of the PABS-PT scale and to assess its psychometric properties among students in physiotherapy. The study was carried out among 103 students in their final years of academic studies in the Degree in Physiotherapy in the University of Murcia (Spain). Sociodemographic and PABS-PT related variables were collected. The instrument was translated into Spanish and tested through factor analysis, internal consistency, test-retest reliability, and known-groups validity. The 95% minimal detectable change of the instrument was also calculated. The factor analysis revealed two factors within the instrument: Biomedical (9 items) and Biopsychosocial (7 items) factors, with Cronbach's alpha values of 0.730 and 0.708, respectively. The Intraclass Correlation Coefficient (3,2) was 0.851 for the Biomedical factor and 0.699 for the Biopsychosocial factor. The minimal detectable changes (95% CI) for the Biomedical and Biopsychosocial factors were 6.01 and 5.56, respectively. The pre-specified hypothesis for the known-groups validity test was met and revealed large effect sizes (d = 1.24). The Spanish version of the instrument PABS-PT-SP covers two factors. It shows satisfactory psychometric properties and it is therefore an effective framework to discriminate between the biomedical and/or biopsychosocial thoughts and attitudes toward pain in physiotherapy. [ABSTRACT FROM AUTHOR]

Evidence has suggested that a history of falls and fear of falling (FOF) are associated with reduced mobility among older adults. Although many studies have explored the association between the history of falls and FOF in the context of decreased mobility, most have had small sample sizes, limiting the generalizability of the results. Therefore, this study sought to contribute to the body of knowledge around these constructs to further support the previous findings. To investigate the association between a history of falls and FOF with low mobility in community-dwelling older adults. This cross-sectional study included 308 older adults (69.9 ± 7.1 years, 57.8% female). The Timed Up and Go (TUG) test was used to classify mobility limitations in participants and the Falls Efficacy Scale–International - Brazil was used to quantify FOF. Participants were also asked if they had fallen in the previous 12 months. Multivariable logistic regression was used. The prevalence rates of a history of falls and FOF were 32.7 and 48.4%, respectively. Older adults with a history of falls and FOF had 2.20 (95%CI: 1.20; 4.02) and 3.80 (95%CI: 1.90; 7.58) greater odds of presenting low mobility than older adults without these health problems, respectively. History of falls and FOF are associated with higher odds of low mobility in community-dwelling older adults. Therefore, it is of the utmost importance to introduce public health programs aimed at preventing falls in older adults to reduce possible adverse health outcomes, including low mobility. [ABSTRACT FROM AUTHOR]

Increased therapy time and task-specific practice can improve functional recovery post stroke. This observational study aimed to determine whether the clinical implementation of circuit training increases therapy time and improves function in stroke rehabilitation. In a retrospective clinical audit, medical records of 110 people (mean age 78.7, standard deviation 13.0, 49.1% male, 57.3% severe stroke) admitted to a stroke inpatient rehabilitation ward were evaluated to determine the differences between pre (Individual Therapy (IT), n = 55) and post (Circuit Class Therapy (CCT), n = 55) service change implementation. The primary outcome was the amount of time spent in physiotherapy daily (minutes). Secondary outcomes included the Functional Independence Measure (FIM) score and length of stay (LOS). The CCT Group spent significantly more time in physiotherapy daily during their rehabilitation LOS compared to the IT Group (mean difference 8.45 (95% CI 5.99 to 10.90) mins, p < 0.001). No significant between-group differences were observed for FIM scores or LOS (p ≥ 0.066). This study suggests that the clinical implementation of CCT can significantly increase therapy time by close to 9 minutes per session, with functional gains that are equivalent to usual care. This was achieved with a patient-to-staff ratio of 3:1, compared to the 1:1 ratio in IT, concurring with existing evidence in support of CCT as an alternative service delivery model for inpatient stroke rehabilitation. [ABSTRACT FROM AUTHOR]

To determine individual characteristics (i.e. sociodemographic and medical, obstetric and gynecological, and musculoskeletal and anthropometric parameters) for greater pelvic floor distress (PFD). A cross-sectional study was performed in 253 women with pelvic floor dysfunction. PFD was assessed using the Pelvic Floor Distress Inventory-20 (PFDI-20). The score of Urogenital Distress Inventory-6 (UDI-6) was used to perform secondary analyses. Sociodemographic, medical, and obstetric & gynecological parameters were recorded. Waist and hip circumferences and pelvic diameters were measured as anthropometric parameters. Pearson test, t-test, and linear regression analyses were conducted with a significance level of 0.05. Education level (r = −0.23, p <.001; r = −0.24, p <.001), number of vaginal births (r = 0.15, p =.012; r = 0.12, p =.048), total vaginal birth weight (r = 0.15, p =.021; r = 0.16, p =.019), and Body Mass Index (r = 0.12, p =.043; r = 0.16, p =.007) were significantly correlated with the higher PFDI-20 and UDI-6 scores. The maternal age at the first vaginal birth (r = −0.13, p =.049) and pelvic antero-posterior diameter (r = 0.17, p =.013) were also significantly correlated with higher UDI-6 score. Linear regression analyses revealed that younger age (Beta coefficient (β) = −1.10, p =.005), greater symptom duration (β = 2.28, p =.001), the presence of chronic cough/constipation (β = 25.72, p =.001), and increased total vaginal birth weight (β = 2.38, p =.030) were associated with the greater PFDI-20 score. Increased pelvic antero-posterior diameter (β = 0.88, p =.049) was a contributory factor for the greater UDI-6 score. This study showed that younger age, chronic cough/constipation, higher total vaginal birth weight, greater symptom duration, and pelvic antero-posterior diameter can be contributors of greater PFD. We suggest further longitudinal studies that better reveal the causal relationship between individual characteristics and PFD. [ABSTRACT FROM AUTHOR]

Physical therapists (PTs) should know how to best treat patients with inflammatory arthritis. To document interventions chosen by PTs for patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) and whether choices follow evidence-based practice. Licensed musculoskeletal PTs in Quebec, Canada responded to an online survey. Descriptive statistics illustrated proportions for each treatment choice and inferential statistics explored associations with demographic and practice-related factors. There were 298 PTs who responded to the survey. For both RA and AS respectively, most common interventions were mobility exercises (91.0%; 98.3%) and patient education (90.1%; 92.8%). For both cases, slightly >60% selected strengthening exercises. Passive forms of therapy were chosen by 36% of PTs for RA and 58% for AS. Aerobic exercise was rarely selected. PTs working in the public sector were less likely to use manual therapy for both RA (Odds Ratio (OR) 0.43, 95% confidence interval (CI) 0.22,0.86) and AS (OR 0.46, 95% CI 0.22,0.97). Most PTs chose mobility exercises and patient education, representing evidence-based approaches. Despite current recommendations, strengthening and especially aerobic exercises were not used as much. There is a need to increase awareness regarding the benefits of strengthening and aerobic exercise for these patients. [ABSTRACT FROM AUTHOR]

The treadmill, lift, and carry (TLC) battery is a composite functional performance test created to measure the effectiveness of a functional restoration (FR) program in a military population. To determine the validity, reliability, and minimal clinically important differences (MCIDs) of the individual tests and the composite TLC battery. We assessed the validity by mean differences, effect sizes, and standardized response means pre- and post-FR; and by correlations between the TLC battery and other established measures. We assessed reliability by correlating pre- and post-FR scores. We used principal component analysis (PCA) to create a composite measure. We determined MCIDs via distribution methods and receiver operator curve analysis. There were significant (p <.001) mean changes and large effect sizes (0.6–0.8) pre- to post-FR. Pre- and posttest Spearman's correlations ranged from 0.5 to 0.6. Spearman's correlations between TLC battery scores and other measures were small (± 0.3–0.4) and significant (p <.001). PCA supported use of a single-component composite. MCIDs were treadmill time: 3 minutes; metabolic equivalent of task: 1.5 units; floor-to-waist lift: 15 lbs; waist-to-shoulder lift: 10 lbs; 40-foot carry: 10 lbs; and composite score: 6 units. This secondary data analysis provides preliminary support for the validity and reliability of the TLC battery for use in military populations. [ABSTRACT FROM AUTHOR]

Greater trochanteric pain syndrome (GTPS) is a common cause of lateral hip pain. The objectives of this study were to translate the Victorian Institute of Sports Assessment for Gluteal Tendinopathy (VISA-G) questionnaire into the Turkish language and to examine its reliability and validity. 108 individuals (45 female, 63 male) participated in the translation and the reliability and validity analysis. The original VISA-G questionnaire was translated into Turkish language using Beaton guidelines. The Turkish version of the VISA-G, Harris Hip Score (HHS), Oswestry Disability Index (ODI), Oxford Hip Score (OHS), and International Physical Activity Questionnaire (IPAQ) were applied to 108 individuals with GTPS for convergent validity. The VISA-G was retested to investigate its reliability after one week. The VISA-G had a good correlation with HHS (r = 0.694, p <.001), ODI (r = −0.659, p <.001), OHS (r = 0.678, p <.001), and IPAQ (r = 0.440, p <.001). The reliability and internal consistency were excellent (ICC (2,1) value = 0.943; Cronbach's α = 0.946, respectively). And no floor and ceiling effects were revealed related VISA-G. The Turkish version of the VISA-G has good validity and excellent reliability. It can be used in clinical and research practices in the Turkish population with GTPS. [ABSTRACT FROM AUTHOR]

For some of the most commonly used motor measures, psychometric properties, and minimal detectable change (MDC95) remain largely unknown, limiting the interpretability of tests. The aim was to establish intrarater reliability, MDC95 and floor- and ceiling effects for a modified version of the Motor Assessment Scale (M-MAS UAS-99). Data was derived from an intervention study that enrolled 41 individuals with chronic stroke. Test scores from two subsequent assessments with 3 weeks apart were used for establishing the floor and ceiling effect, the intraclass correlation coefficient (ICC[2,1]), standard error mean (SEM) and the MDC95 for the total score, and subdomains of the M-MAS UAS-99. The intrarater reliability was excellent with an ICC[2,1] between 0.970 and 0.995 for both total score and subdomains. The MDC95 for the M-MAS UAS-99 total score was 1.22 which means ≥ 2.0 points on an individual basis. For bed mobility subdomain, a ceiling effect was seen, but not for the total score of the test. No floor effect was seen for the test. M-MAS UAS-99 has excellent intrarater reliability. Any individual increase in test scores must reach 2.0 to be considered a true change. [ABSTRACT FROM AUTHOR]

Pain neuroscience education (PNE) and graded exposure have not been explored in occupational settings for low back pain (LBP). To pilot feasibility and assess preliminary effectiveness of PNE and graded exposure for LBP. A pilot study where workers were randomized to either PNE and graded exposure or Pilates and postural education. Both interventions consisted of weekly individual face-to-face sessions for 8 weeks (a total of 8 sessions). The primary outcome was pain intensity. Secondary outcomes were disability, catastrophizing, fear-avoidance, sleep, endurance of back extensor muscles, and patient's perceived impression of change. Seventeen participants entered the PNE and graded exposure group and 20 the Pilates and postural education group. PNE and graded exposure were feasible to implement. Between-group comparisons suggest higher improvements in the PNE group for extensor muscle endurance (p <.001, η2p =.29), pain catastrophizing (p <.001; η2p =.56) and fear-avoidance related to physical activity (p <.001; η2p =.48) and work (p <.001; η2p =.47). In the PNE group, at least 13 (76.5%) participants reported being at least "moderately better" against 6 (30%) participants in the Pilates group. PNE and graded exposure can be successfully implemented in an occupational context and is potentially more beneficial than Pilates and postural education for extensor muscle endurance, catastrophizing, and fear avoidance and similarly as beneficial for pain intensity and disability. Further studies are needed to confirm these results. [ABSTRACT FROM AUTHOR]

Mini-Balance Evaluation Systems Test (mini-BESTest) is a widely used measure to assess balance impairments. This study aimed to assess the validity, reliability, responsiveness, and minimal clinically important change (MCIC) of the Persian mini-BESTest among ambulatory People with Multiple Sclerosis (PwMS). Fifty ambulatory PwMS participated in this study. Persian mini-BESTest validated against Berg Balance Scale (BBS) and Timed-Up and Go (TUG) with/without a cognitive task. To assess the reliability, the Persian mini-BESTest was re-administered for a sample of 30 participants after 1 week. Also, 32 PwMS were tested before and after a 4-week of balance and gait training to assess the responsiveness. No floor/ceiling effect was found for the mini-BESTest total score. There were significant excellent correlations (p <.001) between mini-BESTest and BBS (r = 0.71), TUG (r = −0.76), and cognitive TUG (r = −0.73). No strong correlations were observed between the subscales (r = 0.37–0.55). Test–retest reliability and internal consistency of Persian mini-BESTest total score were excellent, with Intra-class Correlation Coefficient (ICC3,1 and Cronbach's alpha level of 0.89 and 0.80, respectively. The minimal detectable change was 4 points. The Persian mini-BESTest had acceptable responsiveness (AUC = 0.83), and MCIC was 5 points. The Persian mini-BESTest is a valid, reliable, and responsive measure of balance performance in Iranian ambulatory PwMS. [ABSTRACT FROM AUTHOR]

The Subgrouping for Targeted Treatment (STarT) musculoskeletal (MSK) tool stratifies patients with MSK disorders (MSDs) into prognostic categories based on poor outcomes. This study aimed at investigating the validity and reliability of the Persian STarT MSK tool in people suffering from painful MSDs in Iran. A total of 593 subjects with painful MSDs including neck, shoulder, low back, knee, and multisite pain received and completed the STarT MSK tool, visual analog scale (VAS), EuroQol five-dimensions three-levels questionnaire (EQ-5D-3 L), short form-36 health survey questionnaire (SF-36), and Örebro musculoskeletal pain screening questionnaire (ÖMPSQ) in the first visit. To examine test–retest reliability, 234 patients completed the STarT MSK tool 2 days after the initial visit. In this study, 139 (23.5%), 266 (44.9%), and 188 (31.7%) participants were classified as low-, medium-, and high-risk groupings for poor outcomes, respectively. Spearman's correlation coefficient showed a strong relationship among Persian STarT MSK tool and EQ-5D-3 L (−0.78), SF-36 (−0.76), and OMPSQ (0.70). The results of known-group validity indicated that this tool could distinguish among the participants in different risk subgroups based on the scores of the ÖMPSQ, VAS, SF36, and EQ-5D-5 L (p <.001). No ceiling and floor effects were observed. Cronbach's alpha and intra-class correlation coefficient (ICC2,1) were acceptable (0.71) and excellent (0.98), respectively. The Persian version of STarT MSK tool has shown to be a valid and reliable instrument to stratify people with painful MSDs into low-, medium-, and high-risk subgroups based on persistent pain disability. [ABSTRACT FROM AUTHOR]

The main feature of fibromyalgia syndrome is extensive musculoskeletal pain and tenderness. It not only has a significant impact on patients but also brings a huge burden to families and society. Exercise is considered to be the most important part of the fibromyalgia treatment, and aquatic physical therapy can be considered one of the most recommended interventions. Therefore, the effects of aquatic physical therapy on fibromyalgia patients were discussed in this article. The purpose of this study was to evaluate the effects of aquatic physical therapy on clinical symptoms, physical function, and quality of life in patients with fibromyalgia. Eight databases were retrieved. "Fibromyalgia," "Aquatic Therapy," "Aquatic Exercise," and "Hydrotherapy" was used for retrieval. Randomized controlled trials of the effects of aquatic physical therapy on patients with fibromyalgia were included. The Cochrane risk of bias tool to assess research quality. Meta-analysis was performed by Revman version 5.3. Finally, 14 articles (762 patients) were included in the analysis. Compared with other exercises or no exercise, aquatic physical therapy has more significant effects. There were significant differences in visual analogue scale (MD: – 0.98, 95%CI: – 1.36 to – 0.60, Z = 5.03, P <.00001), six minute walk test (MD: 38.12, 95%CI: 13.65 to 62.59, Z = 3.05, P =.002), fibromyalgia impact questionnaire total scores(MD: – 7.35, 95%CI: – 13.05 to – 1.65, Z = 2.53, P =.01), vitality of short form 36 (MD: 9.53, 95%CI: 0.62 to 18.43, Z = 2.10, P =.04) and general health of short form 36 (MD: 10.39, 95%CI: 1.42 to 19.36, Z = 2.27, P =.02). Aquatic physical therapy may have some benefits on the clinical symptoms, physical function, and quality of life of patients with fibromyalgia. [ABSTRACT FROM AUTHOR]

Cervicogenic headache (CGH) is a common condition with a neuroanatomical basis involving the trigeminal nerve. Dry needling (DN) is a safe and effective treatment for CGH but most studies involve deep DN to cervical musculature. The aim of this study was to investigate immediate effects of superficial DN of the trigeminal nerve innervation field on numeric pain rating scale (NPRS), flexion-rotation test (FRT), cervical range of motion (AROM), and pain-pressure threshold (PPT) of right (R) and left (L) supraorbital (SO), and right (R) and left (L) greater occipital (GO) nerves in participants with CGH. A parallel controlled randomized design involving 30 participants with CGH received either superficial DN (N = 17) or sham DN (N = 13). Participants and outcome assessors were blind to group assignment. Wilcoxon signed rank analyzed within-group effects and Mann–Whitney U analyzed between-group. Statistically significant between-group differences were observed for NPRS (P <.001) and AROM (P <.006) favoring DN and were clinically meaningful. Right and left Flexion rotation tests (FRT) outcomes were non-significant (P =.137) but clinically meaningful. No differences were observed for PPT over: R SO (P =.187); L SO (P =.052); R GO (P =.187); or L GO (P =.052). Between-group effect sizes across variables were moderate to large (0.53–1.4) but confidence intervals were wide. Superficial DN targeting the innervation field of the trigeminal nerve improves clinical outcomes in patients with CGH. Only the immediate effects were analyzed and the sample size was small. Larger, longer-term assessments are needed comparing superficial DN of the trigeminal innervation field and other conservative interventions for CGH. [ABSTRACT FROM AUTHOR]

To evaluate the accuracy of and determine the best cutoff point for craniovertebral angle (CVA) and forward shoulder angle (FSA) in discriminating between two groups of individuals with different severities of forward head posture (FHP). A sample of 90 subjects aged 20–50 who had different severities of FHP was recruited. Participants were categorized into two groups based on observational method, namely individuals with slight FHP and those with moderate-to-severe FHP. The CVA and FSA were assessed using the photographic device. The accuracy of these measures was determined by calculation of sensitivity, specificity, area under the receiver operating characteristic curve, likelihood ratio (LR), and predictive value (PV). Our results show that CVA has high sensitivity (0.93) and acceptable area under the curve (0.88) in discriminating between the two groups of FHP (P <.01), but FSA cannot discriminate between the two groups of FHP (P =.06). The LR and PV results show that the CVA has a low negative LR (0.13) and a large negative PV (0.93). The best cutoff point for CVA was determined at 45.5 degrees. Overall, the results of the present study showed that CVA has a good accuracy in discriminating between two groups of individuals with slight and moderate-to-severe FHP. It can be valuable in correctly identifying the slight FHP and screening the moderate and severe grades of the FHP. Researchers and clinicians can also use the optimal cutoff point for the CVA obtained in this study to accurately quantify and classify the severity of the FHP. [ABSTRACT FROM AUTHOR]

Systematic implementation of evidence-based, clinical practice guidelines for management of knee osteoarthritis (OA) in primary care physiotherapy in Australia is embryonic. Clinical practice guidelines have been implemented in the public healthcare sector at a State-level for physiotherapists in the form of multidisciplinary programs, but the reach of physiotherapy-led OA management programs is grossly inadequate in the private sector. To provide a snapshot of the management of people with knee OA in private physiotherapy practice in an Australian setting. Primarily the aim was to determine the alignment between the treatment provided and guideline-based management. Secondary aims included the capture of both patient-reported improvement after 3-months and patient satisfaction with treatment. Whether patient-reported outcome measures (PROMS) were routinely used was also ascertained. A prospective, observational study enrolling adults >=45 years with knee OA across nine primary care physiotherapy practices. Knee injury OA Outcome Score (KOOS) and Routine Assessment Patient Index 3 (RAPID3) were collected (baseline; 3 months) by researchers along with satisfaction with treatment. Treatment details and use of PROMS were obtained from physiotherapy record audit and patient interview. The treatment provided was compared to the minimum core elements of management stipulated in OA management guidelines. Twenty-six adults (58% female, mean age 60 (9) years, 54% overweight or obese) participated. 100% were prescribed ≥1 appropriate exercise(s); 42% received OA education; 12% received weight management advice. Mean improvement (95%CI) in KOOS Pain was 9.8 (3.4 to 16.1) and RAPID3 was −3.4 (−5.5 to −1.3). Satisfaction with treatment was high (8.3/10). No PROMs were used for assessment or monitoring. Primary care physiotherapy treatment of knee OA did not meet minimum criteria per clinical practice guidelines. However, participant improvement at three months reached minimally important change thresholds for patient-reported measures and satisfaction was high. The data provide useful insights about areas that are deficient, thus, should inform future implementation strategies designed to improve care delivery and the uptake of routine measurement of patient-reported outcomes. [ABSTRACT FROM AUTHOR]

Individuals with fibromyalgia (FM) exhibit generalized hyperalgesia to pain stimuli, and physical activity (PA) is critical to manage FM symptoms. This study examined the relationship between exercise-induced muscle pain, symptom severity, and PA in 28 women with FM. Muscle pain rating (MPR) was assessed during 3 minutes of submaximal isometric handgrip exercise, whereas PA and symptom severity were evaluated via self-report questionnaires. The analysis examined the relationship between the variables, with the specific interest in the mediating role of PA in the relationship between exercise-induced muscle pain and symptom severity. MPR was positively associated with symptom severity (b = 1.89; 95% CI = 0.01, 3.76; P =.048) and inversely associated with PA levels (b = −0.16; 95% CI = −0.30, −0.03; P =.021). PA levels were inversely associated with symptom severity (b = −7.94; 95% CI = −12.46, −3.42; P =.001). After statistically controlling for PA levels, the relationship between MPR and symptom severity was no longer significant (b = 0.60; Wald 95% CI = −1.05, 2.25; P =.474). Results show the link between the variables, and specifically demonstrate that PA mediates the relationship between exercise-induced muscle pain and symptom severity. [ABSTRACT FROM AUTHOR]

The 3-min walk test (3MWT) has been used in the clinical setting. To present the 3MWT value and investigate its association with motor and respiratory functions of healthy older adults. Two hundred six older adults and 27 younger adults were enrolled. The 3MWT was assessed by the walking distance within 3 min. Knee extension muscle strength (KEMS), 5-repetition sit-to-stand (5 R-STS), Timed Up and Go (TUG), forced vital capacity (FVC), forced expiratory volume 1.0 (FEV1.0), maximal expiratory pressure (MEP), and maximal inspiratory pressure (MIP) were measured. The 3MWT distance was examined by age group (18–39, 60–69, 70–79, and 80–89 years). A multivariate regression analysis investigated the association between 3MWT and motor function test. The 3MWT values in each age group were 273–385, 233–414, 93–351, and 171–345 m for men and 215–375, 220–349, 198–325, and 174–332 m for women respectively. The 3MWT values were correlated with age, body mass index (BMI), KEMS, 5 R-STS, TUG, FVC, FEV1.0, MEP, and MIP. On the multivariate regression analysis, 3MWT was significantly associated with BMI (standard beta = −0.18; 95% confidence interval [CI], −3.20 to 0.83), KEMS (standard beta = 0.37; 95% CI, 0.06–0.13), 5 R-STS (standard beta = −0.13; 95% CI, −5.70 to −0.13), and TUG (standard beta = −0.36; 95% CI, −17.15 to −7.73) in older adults (adjusted R2 = 0.47). The 3MWT distance decreased with age and was associated with motor and respiratory functions. No range trends were observed among groups. Our findings suggest that 3MWT reflects functional capacity. [ABSTRACT FROM AUTHOR]

To assess the content validity of the preliminary core set for knee dysfunction based on the opinion of experts. A panel of 180 experts in knee disorders or on the use of the International Classification of Functioning, Disability, and Health for musculoskeletal conditions was invited for this Delphi study. The experts gave their opinion on whether to include the categories of the preliminary core set for knee dysfunction in a more comprehensive core set, using a six-item Likert scale. Kappa coefficient was used to analyze the agreement between the experts, and a consensus of 75% among responses was considered acceptable. Nineteen experts participated in all rounds. Of the 24 categories from the preliminary core set for knee dysfunction, 15 remained in the comprehensive core set and one category was further detailed into three new categories. Seven new categories were included. Thus, the comprehensive core set for knee dysfunction was composed of 25 categories with an agreement of 81.5% among responses and a Kappa value of 0.63. After validation by experts, the comprehensive core set for knee dysfunction was composed of 25 categories that can be used to assess the functioning of patients with knee dysfunction. [ABSTRACT FROM AUTHOR]

Strengthening of the hip abductors has been advocated for persons with patellofemoral pain (PFP). It is not clear if these individuals activate the hip abductor muscles appropriately to achieve the desired therapeutic effects. To compare activation of the hip abductor muscles between persons with and without PFP during the performance of hip abductor exercises. Thirty-two individuals participated (12 with PFP and 20 without PFP). The average age (± standard deviation) was 29.7 ± 5.9 years for the PFP group and 28.1 ± 6.9 for the control group. Electromyographic (EMG) signals from the gluteus medius (GMED), superior gluteus maximus (SUP-GMAX), and tensor fascia lata (TFL) were obtained using fine-wire electrodes while participants performed 11 different exercises. Normalized EMG activity of each muscle was compared between groups across all exercises. When averaged across all exercises, persons with PFP exhibited significantly greater EMG activity of TFL (mean = 25.3% MVIC; 95% CI = 19.2, 31.3) compared to those without PFP (mean = 17.6% MVIC; 95% CI = 12.8, 22.4) and significantly lower EMG activity of SUP-GMAX (mean = 16.4% MVIC; 95% CI = 11.0, 22.0) compared to those without PFP (mean = 25.4% MVIC; 95% CI = 21.0, 29.8). Persons with PFP exhibited lower EMG activity of GMED, but only for 3 out of the 11 exercises evaluated (hip abduction, hip hike, step-up). Compared to persons without PFP, those with PFP exhibited activation differences during the performance of exercises used to target the hip abductors. Our results highlight the need for activation training prior to the initiation of strengthening exercises to achieve desired therapeutic effects. [ABSTRACT FROM AUTHOR]

Diastasis recti abdominis (DRA) affects a significant number of women in the postpartum period. This study compared the effectiveness of suspension training system (STS) with that of isometric-isotonic (ISoM-ISoT) exercises in the treatment of DRA and its secondary complications. Thirty-six women with DRA participated in this study. They were divided into the three groups of STS, ISoM-ISoT, and control. Inter-recti distance (IRD), proprioception, lumbopelvic control, postural stability, low back pain, and disability were assessed using a digital caliper, a goniometer, a lateral step-down test, a Biodex balance system, a visual analogue scale (VAS), and the Oswestry Disability Index (ODI), respectively. Two intervention groups underwent training for 8-week and the control group resumed their normal lives. Positive effects were observed in the STS and ISoM-ISoT groups compared with the control group in: IRD (P =.001); lumbopelvic proprioception (P =.001); lumbopelvic control (P =.001); overall static balance (P =.010); overall dynamic balance (P =.012); low back pain (P =.001); and disability (P =.001). However, there was no significant difference between the training groups in: IRD (P =.12, MD = −2.76); lumbopelvic proprioception (P =.48, MD = −0.50); lumbopelvic control (P =.14, MD = 1.53); static balance (P =.62, MD = 0.07); dynamic balance (P =.27, MD = 0.33); pain (P =.25, MD = −0.52); and disability (P =.48, MD = −1.74). The results of the minimal clinically important difference (MCID) and minimal detectable change (MDC) suggested that the STS exercises outperformed ISoM-ISoT training regarding IRD, pain, disability, and proprioception, whereas ISoM-ISoT training had a better effect in lumbopelvic control and balance. The results of our study showed that the STS had a positive effect on women with DRA and like the ISoM-ISoT exercises can be used to treat this dysfunction. [ABSTRACT FROM AUTHOR]

Evidence-based physiotherapy practice (EBPTP) is becoming increasingly important to improve patient outcomes and clinical decision-making in the physiotherapy profession To evaluate the EBPTP in Jordan and identify the barriers to its implementation in clinical practice The study used a cross-sectional survey of licensed physiotherapists working in Jordan using EBPTP self-reported questionnaire. Frequencies, percentages, and one sample Wilcoxon rank test were used to evaluate the EBPTP level. The EBPTP implementation was evaluated by demographic variations of participants, Spearman's correlation, and stepwise multiple linear regression analyses at 95% confidence interval A total of 210 participants completed the survey. All EBPTP questionnaire elements showed significant positive levels (p =.00) except facility support reflecting non-significant negative level (p =.08). The EBPTP implementation was at a significantly lower level of uptake (p =.00). Clinical decision-making was based mainly on personal experience. The EBPTP implementation was significantly correlated with elements of the EBPTP questionnaire and differed by personal/organizational characteristics. There were four significant predictors of EBPTP implementation: understanding of EBPTP terminologies, facility support, formal training in EBPTP, and being a clinical instructor The findings confirm a clear gap in EBPTP implementation among physiotherapists in Jordan. The EBPTP implementation factors were mainly based on education sectors and work facilities. Engagement of stakeholders and education sectors in EBPTP implementation is required to strengthen the standing of the physiotherapy profession in Jordan. [ABSTRACT FROM AUTHOR]

Lower urinary tract symptoms (LUTS) are common in women with multiple sclerosis. To investigate the impact of LUTS on pelvic floor muscle contraction, sexual function, and quality of life in women with multiple sclerosis. Thirty-nine women with relapsing-remitting multiple sclerosis were enrolled in this study. Participants were divided into the presence or not of LUTS. Assessments involved the Expanded Disability Status Scale score, the NEW PERFECT scheme, the Female Sexual Function Index, and the Qualiveen Questionnaire. Statistical procedures involved Student t-tests, chi-squared, and regression analyses (R2). Nineteen women (48.7%) presented LUTS. Women with LUTS were in a more advanced stage of multiple sclerosis (p =.029), presented weaker pelvic muscle contraction (p =.009), less sexual function satisfaction (p =.018), and more limitations in the quality of life (p =.001) than women without LUTS. Regression analyses pointed out that the quality of life and sexual function of women with multiple sclerosis are affected by intercourse pain (R2 = 12.9) and perineal contraction force (R2 = 19.2). LUTS affects pelvic floor muscle contraction, sexual function, and quality of life in women with multiple sclerosis. A multi-professional rehabilitation team should assist women with multiple sclerosis, taking special care of LUTS. [ABSTRACT FROM AUTHOR]

To investigate the discriminative properties of the Six-Spot Step Test in older adults with self-reported balance problems. Seventy-five older adults aged ≥65 years completed the Six-Spot Step Test and the Timed "Up and Go" test. A Mini-BESTest score of ≤19 was used as a cutoff for defining the risk of falling, and a receiver operating characteristics curve was generated to determine relevant cutoff scores. An overall accuracy of 85% for the Six-Spot Step Test and 88% for the Timed "Up and Go" test were found. The probability of ruling out people at risk of falling increased with a test score shorter than 8.0 and 7.3 seconds on the Six-Spot Step Test and the Timed "Up and Go" test, respectively. Maximizing the total true positive and true negative test results generated a cutoff score of 8.8 seconds (accuracy 79%) and 8.3 seconds (accuracy 80%) for the Six-Spot Step Test and the Timed "Up and Go" test, respectively. The Six-Spot Step Test, which challenges the ability to adapt to more complex tasks during walking, discriminates accurately between older adults at risk of falling and those not at risk. Results as low as eight seconds qualify for fall-preventive interventions. [ABSTRACT FROM AUTHOR]

Community ambulation ability is one of the most important functional loss after stroke. The assessment of the level of community walking plays an important role in the multidimensional bio-psycho-social approach, to improve quality of life and social participation of stroke survivors. The modified Functional Walking Categories (mFWC) is a worldwide widely used tool to assess community ambulation in stroke survivors, but no Italian version is yet available. To cross-culturally adapt the mFWC into Italian and to assess its validity and reliability. According to the international guidelines, a multistep translation and cultural adaptation were conducted and revised by a committee of experts. Patients admitted to intensive inpatient rehabilitation with a sub-acute stroke were recruited. Inter- and intra-rater reliability and construct validity were studied. Sixty patients with sub-acute stroke were prospectively enrolled in this study. Findings showed almost perfect intra- and inter-rater reliability (k = 1.000 [95% CI 1.000–1.000] and k = 0.984 [95% CI 0.955–1.000], respectively). The construct validity of the scale was satisfactory, as 100.0% a-priori hypotheses were met. The Italian mFWC offers a valid tool for measuring community ambulation in stroke patients. Our work provides a validated and a cross-cultural adapted Italian version of the mFWC to accurately measure community ambulation both in clinical and research settings in Italy. [ABSTRACT FROM AUTHOR]

Backward walking (BW) is an important gait adaptation and BW speed may be an important indicator of walking function and fall risk. However, the measurement characteristics of a standardized assessment of BW post-stroke have not been fully established. To determine intra- and interrater reliability, concurrent validity and minimal detectable change (MDC) scores for the 3-Meter Backward Walk Test (3MBWT) post-stroke. Thirty-four individuals with subacute and 29 individuals with chronic stroke participated. Two trials of comfortable BW was measured over a total distance of 5-meters, while speed was calculated during the middle 3-meters of the walking distance. Intra and interrater reliability were determined by comparing the two trials from one rater and simultaneous assessment of two raters, respectively. Two additional trials were performed and BW speed was calculated using 3MBWT and an instrumented walkway to determine concurrent validity. Intraclass correlation coefficients (ICC) estimated reliability and validity. The MDC was calculated from the standard error of measurement. Excellent ICC values were obtained for the 3MBWT in the subacute (interrater: ICC2,1 = 0.99; intrarater: ICC2,1 = 0.96; validity: ICC2,1 = 0.96) and chronic (interrater: ICC2,1 = 0.99; intrarater: ICC2,1 = 0.94; validity: ICC2,1 = 0.97) groups. The MDC was 0.07 m/s (subacute) and 0.11 m/s (chronic). Establishment of the 3MBWT as a reliable and valid measure in assessing BW speed is an important addition to the assessment toolbox for rehabilitation post-stroke. [ABSTRACT FROM AUTHOR]

To evaluate the additive effect of Transcranial Direct Current Stimulation (tDCS) associated with multi-component training (MT) on the functional capacity (FC) of older adults and to assess whether these effects remain after the end of training. The secondary objectives were to evaluate the locomotion capacity, balance, functional independence, and quality of life and correlate them with functional capacity. Twenty-eight older adults were randomized into two groups: experimental (MT associated with active tDCS – a-tDCS) and control (MT associated with sham tDCS – s-tDCS). The FC was measured by the Glittre-ADL test, locomotion capacity by the 6-minute walk test, balance by the BESTest, functional independence by the FIM, and quality of life by the WHQOL. The assessments were performed pre-, post-intervention, and 30-day follow-up. There was a significant decrease in the time to the Glittre-ADL test when comparing the a-tDCS and s-tDCS groups after the interventions (139.77 ± 21.62, 205.10 ± 43.02, p <.001) and at the 30-day follow-up (142.74 ± 17.12, 219.55 ± 54.05, p <.001), respectively. There was a moderate correlation between FC and locomotion capacity and balance. The addition of tDCS potentiated the results of MT to impact FC, maintaining the positive results longer. Locomotion and balance influenced the improvement of functional capacity. [ABSTRACT FROM AUTHOR]

To analyze respiratory muscle strength of patients with heart failure (HF) and correlate with functional capacity. This cross-sectional study involved patients with compensated HF of both sexes, aged above 18 years. Respiratory muscle strength was assessed by measuring maximum inspiratory (MIP) and expiratory pressures (MEP) using a manovacuometer. Patients were randomized into two groups to assess functional capacity: six-minute walk test (6MWT) and incremental shuttle walk test (ISWT). Forty-eight patients were evaluated (23 from 6MWT and 25 from ISWT group). Most were male (67.8%), with mean age of 62.3 years and left ventricular ejection fraction of 40.8%. Mean predicted values of MIP [81.2% (74.7–87.8%)] and MEP [95.6% (88.2–103.0%)] did not indicate respiratory muscle weakness. The higher the New York Heart Association (NYHA) functional class, the lower the MIP (p =.011) and MEP (p =.016) values. Physically active patients presented higher respiratory muscle strength than those sedentary (MIP: 104.5 vs. 71.9 cmH2O, p <.001; MEP: 120.0 vs. 91.1 cmH2O, p =.004). Functional capacity was impaired [6MWT: 416.0 m (372.8–459.3 m); ISWT: 304 m (263.4–344.9 m)], and distance covered in the ISWT was shorter than 6MWT group (p <.001). Distance covered in the ISWT group presented a moderate positive correlation with MIP (r = 0.45; p =.022) and MEP (r = 0.41; p =.041). Most patients with HF presented respiratory muscle strength close to predicted values; however, sedentary patients and those with high NYHA functional class, showed reduced MIP and MEP. Functional capacity was reduced, and MIP and MEP correlated with distance covered in the ISWT. [ABSTRACT FROM AUTHOR]

Acromiohumeral distance (AHD) and supraspinatus tendon thickness (STT) measured by ultrasound (US) can be combined in the occupation ratio (OR). Inter-rater reliability on these subacromial measures depends on the US experience of raters and on the subject status, differing between asymptomatic or patients with subacromial shoulder pain (SSP). To evaluate inter-rater reliability between two raters with different US experience (experienced examiner and novice examiner). In total, 20 asymptomatic subjects (controls) and 21 patients with SSP were examined on one shoulder. Inter-rater reliability was evaluated with intraclass correlation coefficient (ICC). ICC for controls was good for AHD at rest and at 60° (0.76–0.77), moderate for STT and AHD at 60° with weights (0.53–0.72), while OR was poorly reliable (below 0.44). ICC for SSP was moderate for AHD at rest and at 60°, STT, OR at rest and at 60° (0.52–0.74) and poor for AHD at 60° with weights and OR at 60° with weights (0.33–0.36). Bland–Altman plots showed systematic bias. Inter-rater reliability varied largely from poor to good between two examiners with different US experience. Clinicians might use the US as additional tool for detecting the subacromial structures, but a structured training including also symptomatic subjects is suggested. Researchers may further investigate the OR in matched case–control studies, and an overall agreement phase is recommended before starting the inter-rater reliability phase. [ABSTRACT FROM AUTHOR]

The 30-second Chair Stand Test (30s-CST) and Modified Four Square Step Test (mFSST) are used to determine the functional status of individuals with multiple sclerosis (MS). No other studies have demonstrated the reliability and validity of the 30s-CST and mFSST. To identify the test-retest reliability, concurrent validity and the known-group validity of the 30s-CST and mFSST in persons with MS. A total of 64 persons with MS were enrolled. 30s-CST, mFSST, Timed Up and Go Test (TUG) and Five Times Sit to Stand (FTST) tests were performed. 30s-CST and mFSST were conducted again one-hour later. The mean age of the persons with MS were 37.9±11.3 years. The test-retest reliability of the 30s-CST and mFSST were excellent (ICC30s-CST = 0.974, 95%CI: 0.95-0.98; ICCmFSST = 0.992, 95%CI: 0.98-0.99). The 30s-CST was strongly correlated with FTST and TUG (r1 = −0.871, p1 = 0.0001; r2 = −0.741,p2 = 0.0001). There was a strong relationship between mFSST with TUG and FTST (r1 = 0.781,p1 = 0.0001;r2 = 0.788,p2 = 0.0001). The SEM95 and MDC95 values of the 30s-CST and mFSST were 0.41/1.13 and 0.34/0.94, respectively. Besides, there were significant differences between the persons with or without fall history in 30s-CST (MD: 1.66, CI: 0.27 to 3.05, p =.019) and mFSST CST (MD:-2.70, CI: −4.73 to −0.67, p =.010) performances. The 30s-CST and mFSST are both valid and reliable in mildly-disabled individuals with MS. [ABSTRACT FROM AUTHOR]

Postoperative incisional pain following lower segment cesarean section (LSCS) is one of the commonly reported complaints which may affect mother-infant bonding, and restrict mobility and functional activities. To study the influence of transcutaneous electrical nerve stimulation (TENS) on pain intensity and functional activities using the Numerical Pain Rating Scale (NPRS) and the Patient Specific Functional Scale (PSFS) following LSCS from the postoperative day (POD) 1 to POD 4. This quasi-experimental study consisted of 50 postpartum women who underwent LSCS and were assigned to an intervention group (IG) that received TENS and a control group (CG) that received routine hospital care. NPRS scores between CG and IG (pre-TENS application) showed a statistically significant difference (ηp2 = 0.542, p <.001) from POD 1 to POD 4. Study participants showed an improvement in PSFS scores (ηp2 = 0.412, 0.488, 0.661, 0.304, 0.262, and 0.395, p <.001) in IG compared to CG for bed transitions, bed transfers, sitting, sit to stand, walking, and toileting activities respectively from POD 1 to POD 4 which was statistically significant. Our study results suggest that administration of TENS following LSCS shows an improvement in pain intensity and functional activities as reported on NPRS and PSFS respectively. [ABSTRACT FROM AUTHOR]

To examine the effectiveness of Neuromobilization Exercises (NE) on pain, grip and pinch strength, two-point discrimination, motor and sensory distal latency, symptom severity, and functional status using the Boston Carpal Tunnel Questionnaire (BCTQ) in Carpal Tunnel Syndrome (CTS). Major electronic databases were searched from inception up to September 2021 for randomized trials comparing the effects of NE with or without other interventions against no treatment, surgery, or other interventions in patients with CTS. Standardized Mean Differences (SMD) and 95% confidence interval (CI) were calculated using a random-effects inverse variance model according to the outcome of interest and comparison group. Methodological quality was assessed with PEDro and quality of evidence with the GRADE approach. Twenty-five articles were included and sixteen of them demonstrated high methodological quality. NE was superior to no treatment on pain (very low-quality evidence; SMD = −2.36, 95% CI −4.31 to −0.41). NE was superior to no treatment on the functional scale of the BCTQ (low-quality evidence; SMD = −1.27 95% CI −1.60 to −0.94). Most importantly, NE did not demonstrate evidence of clinical effectiveness. Low to very low-quality evidence suggests that there are no clinical benefits of NE in patients with mild to moderate CTS. [ABSTRACT FROM AUTHOR]