Search

Introduction: Studies analyzing postures and mobility of the thoracic spine in the context of cervicogenic headache are missing. Insight in these parameters is needed since the cervical and thoracic spine are biomechanically related. Objective: To compare self-perceived optimal and habitual postures, active-assisted maximal range of motion, and repositioning error of the upper-thoracic and lower-thoracic spine between a cervicogenic headache-group and matched healthy control-group before and after a 30 min-laptop-task. Methods: A non-randomized longitudinal design was used to compare thoracic postures and mobility between 18 participants with cervicogenic headache (29–51 years) and 18 matched healthy controls (26–52 years). Outcomes were: self-perceived optimal and habitual postures, active-assisted maximal range of motion, and repositioning error of the upper-thoracic and lower-thoracic spine evaluated in sitting with a 3D-Vicon motion analysis system. Results: Habitual upper-thoracic postures in the cervicogenic headache-group were significantly (p =.04) less located toward the maximal range of motion for flexion compared to the control-group, self-perceived optimal upper-thoracic posture was significantly (p =.004) more extended in the cervicogenic headache-group compared to the control-group, and self-perceived optimal lower-thoracic posture could not be reestablished in the cervicogenic headache-group after the laptop-task (p =.009). Conclusion: Thoracic postures differ between a cervicogenic headache-group and control-group. These differences were detected by expressing the habitual thoracic posture relative to its maximal range of motion, and by analyzing the possibility of repositioning the thoracic spine after a headache provoking activity. Longitudinal studies are needed to determine the contribution of these musculoskeletal dysfunctions to the pathophysiology of cervicogenic headache. [ABSTRACT FROM AUTHOR]

Background: Social participation levels of individuals with Multiple Sclerosis (iwMS) are lower than those of healthy individuals. Objective: This study aimed to evaluate to which extent the walking capacity, balance, and fear of falling (FoF) affect the community integration levels of iwMS. Methods: Thirty-nine iwMS were evaluated for their participation levels [The Community Integration Questionnaire (CIQ)], walking capacity [The Six-Minute Walk Test (6MWT)], balance [Kinesthetic Ability Trainer (SportKAT®)], and FoF [The Modified Falls Efficacy Scale (MFES)]. Correlation and regression analyses were performed to detect the effects of SportKAT®, 6MWT, and MFES on CIQ. Results: CIQ scores were significantly correlated with 6MWT (p =.043) and MFES (p =.005) scores, while CIQ was not related with static (for two feet test p =.356, for right single-leg stance test p =.412, for left single-leg stance test p =.730) and dynamic balance (for clockwise test p =.097, for counterclockwise test p =.540) measured with the SportKAT®. It was found that CIQ could be predicted by 6MWT and MFES at the level of 16% and 25%, respectively. Conclusion: FoF and walking capacity are associated with community integration in iwMS. Therefore, physiotherapy and rehabilitation programs of iwMS should be combined with treatment goals to increase community integration, balance, and gait and decrease the disability and FoF from an early stage. Comprehensive studies examining other factors that may impact participation in iwMS with different levels of disability are needed. [ABSTRACT FROM AUTHOR]

Introduction: Inter-individual variability may contribute to impaired cervicocephalic kinesthetic sensibility (CKS) in patients with nonspecific neck pain. Objectives: To identify subgroups of participants with nonspecific neck pain based on cervical joint position errors (JPEs) and to determine potential factors associated with identified subgroups. Methods: One hundred participants with nonspecific neck pain (unidentified pathoanatomical cause) and 50 controls were recruited. JPEs were measured in cervical extension and rotation, using a laser pointer. JPEs were expressed as absolute (AEs), constant (CEs), and variable (VEs) errors. Clinical characteristics were pain intensity, duration, disability, side of pain, dizziness, psychological features, and range of motion. All tests were performed within 1 day. A cluster analysis was conducted based on AEs. A logistic regression was used to identify factors associated with the cluster groups. Results: Analysis divided neck pain participants into two groups: cluster 1 with greater impaired CKS (n = 36) and cluster 2 with lesser impaired CKS (n = 64). The AEs (all cervical movements) and CE (left rotation) were larger in cluster 1 than 2 (p ≤.002). Overall, participants in clusters 1 and 2 had larger AEs, CEs, and VEs than controls (p ≤.04). The presence of dizziness was a risk factor associated with cluster 1 (OR=2.5, p =.04). The other characteristics were not associated with the cluster groups (p ≥.09). Conclusion: The AEs identified two subgroups of patients with nonspecific neck pain. Participants in subgroup 1 had greater impaired CKS, and participants in subgroup 2 had lesser impaired CKS. Dizziness was a potential risk factor associated with greater impaired CKS. [ABSTRACT FROM AUTHOR]

Background: Changes in the trunk and lower limbs' sagittal movements may cause patellofemoral pain (PFP) because they influence the forces acting on this joint. Objectives: To compare trunk and lower limb sagittal kinematics between women with and without PFP during functional tests and to verify whether sagittal trunk kinematics are correlated with those of the knees and ankles. Methods: A total of 30 women with PFP and 30 asymptomatic women performed single-leg squat (SLS) and step-down (SD) tests and were filmed by a camera in the sagittal plane. The trunk inclination angle, forward knee displacement, and ankle angle were calculated. Results: The PFP group exhibited less trunk flexion (SLS, p =.006; SD, p =.016) and greater forward knee displacement (SLS, p =.001; SD, p =.004) than the asymptomatic group; there was no significant difference in ankle angle (SLS, p =.074; SD, p =.278). Correlation analysis revealed that decreased trunk flexion was associated with increased forward knee displacement (SLS, r = −0.439, p =.000; SD, r = −0.365, p =.004) and ankle dorsiflexion (SLS, r = −0.339, p =.008; SD, r = −0.356, p =.005). Conclusion: Women with PFP present kinematic alterations of the trunk and knee in the sagittal plane during unipodal activities. Furthermore, the trunk and lower limb sagittal movements were interdependent. [ABSTRACT FROM AUTHOR]

Introduction: Hamstring strain injuries (HSI) are one of the most common injuries for soccer players and there is a need for new clinical-based studies on the rehabilitation of these injuries. Objective: This study aimed to create a consensus on physiotherapy and rehabilitation approaches used in HSI by physiotherapists with super league experience in Turkey. Methods: Twenty-six male physiotherapists (duration of experience in professional life, on athlete health, and in the super league: 12.84 ± 6.04 years, 12.19 ± 5.96 years, 8.71 ± 5.31 years, respectively) from different institutions participated in the study. The research was carried out in three rounds using the Delphi method. Results: Data collected using LimeSurvey and Google Forms were analyzed using the Microsoft Excel and SPSS 22 software. The response rates over the three rounds were 100%, 96%, and 96%, respectively. The 10 main items that were agreed upon in Round 1 were divided into 93 sub-items. Their numbers in the second and third Rounds were 60 and 53, respectively. At the end of Round 3, the highest consensus was on eccentric exercise, dynamic stretching, interval running, and movement-enhancing field training. All sub-items at this round were classified as SUPER (S: Soft tissue restoration techniques; U: Using supportive approaches; P: Physical fitness exercises; E: Electro-hydro-thermal methods; and R: Return to sport activities). Conclusion: SUPER rehabilitation provides a new conceptual framework in terms of approaches used by clinicians in rehabilitation for athletes with HSI. Recognizing the lack of evidence for the various approaches involved, clinicians can modify their practice and researchers can explore whether these approaches are scientifically correct. [ABSTRACT FROM AUTHOR]

Dry needling (DN) uses a monofilament needle to reduce pain and is performed by various healthcare professions. Due to the invasive needle puncture, adverse events (AEs) have been associated with DN. It is unclear, which AEs should be included in a risk statement for Informed Consent (IC). The purpose of this study was to identify which AEs should be included in a risk statement for IC. A three-round e-Delphi study was undertaken using a panel of DN experts. Expert inclusion criteria included: (1) ≥5 years practice performing DN and one of the following secondary criteria: (A) certification in DN; (B) completion of a manual therapy fellowship that included DN training; or (C) ≥1 publication involving the use of DN. Participants rated their level of agreement using a 4-point Likert scale. Consensus was defined as either: 1) ≥80% agreement; or 2) ≥70% and <80% agreement with median ≥3, interquartile range ≤1, and standard deviation ≤1. A total of 14 (28%) AEs achieved final consensus in Round 3 for inclusion on IC. Kendall's Coefficient (w) of agreement for Round 2 was 0.213 and improved to 0.349 after Round 3. Wilcoxon rank tests revealed statistically significant changes for 12 of the 50 AEs. Consensus was attained for 14 AEs for inclusion on IC. The AEs identified can be used for the development of a shorter, more concise IC risk statement. A total of 93.6% of experts agreed on definitions for AE classification. [ABSTRACT FROM AUTHOR]

Although exercise is the mainstay of treatment for neck pain (NP), uncertainty remains over optimal decision-making concerning who may benefit most from such, particularly in the long term. To identify the subgroup of patients with nonspecific NP most likely to benefit from stretching and muscle-performance exercises. This was a secondary analysis of treatment outcomes of 70 patients (10 of whom dropped out) with a primary complaint of nonspecific NP in one treatment arm of a prospective, randomized, controlled trial. All patients performed the exercises, twice weekly for 6 weeks, and a home exercise program. Blinded outcome measurements were collected at baseline, after the 6-week program, and at a 6-month follow-up. Patients rated their perceived recovery on a 15-point global rating of change scale; a rating of "quite a bit better" (+5) or higher was defined as a successful outcome. Clinical predictor variables were developed via logistic regression analysis to classify patients with NP that may benefit from exercise-based treatment. NP duration since onset≤6 months, no cervicogenic headache, and shoulder protraction were independent predictor variables. The pretest probability of success was 47% after the 6-week intervention and 40% at the 6-month follow-up. The corresponding posttest probabilities of success for participants with all three variables were 86% and 71%, respectively; such participants were likely to recover. The clinical predictor variables developed in this study may identify patients with nonspecific NP likely to benefit most from stretching and muscle-performance exercises in the short and long terms. [ABSTRACT FROM AUTHOR]

Evidence supports direct referral for imaging by physical therapists. Accuracy and self-efficacy for imaging decisions have not been investigated in entry-level doctor of physical therapy (DPT) students. The purpose of this study was to understand the relationship between entry-level DPT instruction and accuracy and self-efficacy for imaging referral due to acute knee trauma. A second purpose was to identify relationships between accuracy and self-efficacy. An online survey was sent via e-mail to program directors in accredited DPT programs in the United States with an invitation to forward the survey to DPT students. The survey captured demographic information and included five questions that assessed the respondent's ability to apply the Ottawa Knee Rules (OKR). Self-efficacy was assessed using the Physiotherapist Student Self-Efficacy (PSE) questionnaire, a self-rated 5-point Likert scaled tool. Of 240 surveys, DPT students who completed imaging coursework had greater accuracy and higher self-efficacy (68.0% correct (95% CI, 63.6–72.5), PSE = 3.67, P <.001) compared to students who had not (45.8% correct (95% CI, 40.8–50.7), PSE = 2.67, P <.001). Conclusion: Accuracy by DPT students who completed imaging coursework was significantly improved and comparable to values from autonomous providers. [ABSTRACT FROM AUTHOR]

This study investigated the impact of surgical treatment on the health-related quality of life (HRQOL) of Japanese patients with colorectal cancer (CRC). This three-institution cohort study included 106 Japanese patients with CRC (69 men; mean age: 62.6 ± 12.4 years; age range = 30–85 years). HRQOL was evaluated using the Short-Form 36-Item Health Survey version 2 one to two days prior to surgery (baseline) and four weeks after surgery. Clinical characteristics, social characteristics, and HRQOL at baseline were investigated. Physical functioning, role-physical, bodily pain, and social functioning decreased significantly at four weeks after surgery compared with baseline, whereas mental health significantly improved. Physical functioning and general health perception showed an especially strong relation with the six-minute walk test (6MWT) at four weeks after surgery and HRQOL scores at baseline. The cutoff value for the 6MWT for clinically relevant improvement was 552.5 meters for physical functioning (area under curve [AUC] = 0.780, 95% confidence interval [CI] = 0.692–0.867) and 480.3 meters for general health perception (AUC = 0.721, 95% CI = 0.626–0.817). Patients with CRC could potentially improve their postoperative HRQOL by increasing their walking capacity post-surgery, and they may need follow-up interventions after discharge such as physical rehabilitation to do so. The results provide a potential pathway for improving HRQOL of Japanese patients with CRC. [ABSTRACT FROM AUTHOR]

Training the plantar intrinsic foot muscles (PIFMs) has the potential to benefit patients with lower extremity musculoskeletal conditions as well as the aged population. Isolated foot exercises, often standard in clinical practice, are difficult to perform, whereas functional exercises are much easier to accomplish. However, it is unclear whether functional exercises are comparable to isolated foot exercises in activating the PIFMs. This study aims to compare the activation of PIFMs between functional exercises versus isolated foot exercises. Using surface electromyography (EMG), muscle activation of three PIFMs was measured in four functional exercises (i.e. normal/unstable toe stance, toe walking, and hopping) versus a muscle-specific isolated foot exercise in 29 younger adults, resulting in 12 comparisons. Functional exercises showed larger mean EMG amplitudes than the isolated foot exercises in 25% of the 12 comparisons, while there was no difference in the remaining 75%. Functional exercises provoked comparable or even more activation of the PIFMs than isolated foot exercises. Given that functional exercises are easier to perform, this finding indicates the need to further investigate the effectiveness of functional exercises in physical therapy to improve muscle function and functional task performance in populations that suffer from PIFM weakness or dysfunction. [ABSTRACT FROM AUTHOR]

Background: Improving early trunk control, balance, and sitting activity following acute stroke is critical for functional prognosis. Purpose: To compare the immediate efficacy of Kinesio Taping® (KT) application on anterior and posterior trunk muscles in terms of improving trunk control, balance, and sit-to-stand performance in the acute stage of stroke. Methods: Sixty-nine patients with acute mild stroke were allocated to the anterior KT group (AKT) (age = 65.95 ± 9.67; 12 females, 11 males; Modified Rankin Score = 3), posterior KT group (PKT) (age = 65.39 ± 10.39; 10 females, 13 males; Modified Rankin Score = 3), and control group (CG) (age = 65.34 ± 8.91; 11 females, 12 males; Modified Rankin Score = 2). Trunk control, balance, and sit-to-stand performance were assessed at the baseline and after 45 minutes and 48 hours post-KT. Data were analyzed using repeated-measures ANOVA. Results: All outcome measures scores improved in all groups significantly after 48 hours (p <.001). A significant improvement after 45 minutes was only seen in trunk control compared to the CG (p <.001; d = 1.32 for AKT and p =.038; d = 0.75 for PKT). Trunk control, balance, and sit-to-stand performance improved in both AKT and PKT compared to the CG at 48 hours post-taping. Trunk control (p <.001; d = 0.26) and balance (p <.001; d = 0.72) results were in favor of the AKT, while sit-to-stand performance results did not make a difference between KT groups (p =.335; d = 0.47). Conclusion: KT application on anterior or posterior trunk muscles was effective for improving trunk control, balance, and sit-to-stand performance in acute stage of stroke in the short term. KT application on anterior trunk muscles had the advantage of improving trunk control and balance. [ABSTRACT FROM AUTHOR]

Many non-pharmacological interventions have been proposed for spasticity modulation in spastic stroke subjects. To investigate the immediate effect of dry needling (DN), electrical stimulation (ES), and dry needling with intramuscular electrical stimulation (DN+IMES) on H-reflex in post-stroke spasticity. Spastic subjects with stroke (N = 90) (55–85 years) were evaluated after 1 month of stroke onset using Modified Ashworth Scale (MAS) score ≥1. Subjects were randomly allocated to receive one session of DN – Soleus (N = 30), ES – posterior lateral side of the leg with 100 Hz and 250 μs pulse width (N = 30), or DN+IMES – Soleus (N = 30). MAS, H-reflex, maximum latency, H-amplitude, M-amplitude and H/M ratio, were recorded before and after one session of intervention. Relationships for each variable within group or the difference among groups were calculated by effect size. Significant decrease in H/M ratio in Gastrocnemius and Soleus at post-treatment within DN group (P =.024 and P =.029, respectively), large effect size (d = 0.07 and 0.62, respectively); and DN+IMES group (P =.042 and P =.001, respectively), large effect size (d = 0.69 and 0.71, respectively). No significant differences in all variables at pre-treatment and post-treatment was recorded among ES, DN, and DN+IMES groups. Significant decrease in MAS was recorded at post-treatment compared to pre-treatment within ES group (P =.002), DN group (P =.0001), and DN+IMES group (P =.0001), but not significant (P >.05) among three groups at pre-treatment (P =.194) and post-treatment (P =.485). Single session of DN, ES, and the DN+IMES can significantly modulate post-stroke spasticity by possible bottom-up regulation mechanisms. [ABSTRACT FROM AUTHOR]

An estimation error is the difference between motor imagery and actual motor time. Previous studies have reported that overestimation (motor imagery time < actual motor time) is related to physical functions in healthy individuals. However, this finding is unclear among individuals diagnosed with a stroke. We investigated whether overestimation is related to physical function in individuals diagnosed with a stroke. This study included 71 individuals diagnosed with a stroke (mean age, 67.2 ± 13.4 years; mean time since stroke, 68.4 ± 44.7 days). Imagined timed up and go test (iTUGT) was performed to assess the estimation error. First, the iTUGT was performed; subsequently, the TUGT was performed. The estimation error was calculated by subtracting the TUGT from the iTUGT, with two standard deviations (2 SDs) being calculated. Furthermore, patients were classified into appropriate estimation (AE, within ±2 SD) and overestimation (OE, over −2 SD) groups. Both groups were tested using the estimation error, iTUGT, TUGT, Berg Balance Scale (BBS), and Brunnstrom Recovery Stage (BRS). Subsequently, a correlation analysis was performed. The OE group had a significantly higher estimation error than the AE group (OE: −7.08 ± 6.87 s, AE: −0.29 ± 1.53 s, P <.001). Moreover, the OE group had significantly lower TUGT and BBS than the AE group. The estimation error was correlated with the TUGT, BBS, and lower-limb BRS (ρ = −0.454, 0.431, 0.291, respectively; P <.05). Overestimation was associated with TUGT and balance function in individuals diagnosed with a stroke. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the effects of local calf vibration on balance, blood flow, and nerve conductivity in patients with diabetic peripheral neuropathy (DPN). An open-label controlled trial was designed. Patients with confirmed diagnoses of type 2 diabetes and DPN were enrolled in the study and underwent ten sessions of local calf vibration therapy for the dominant leg. The other leg was considered the control. Balance evaluation, nerve conduction studies, and color Doppler ultrasound were performed before and after the treatment course. The Wilcoxon signed rank test and the Mann–Whitney test were used to evaluate the differences between the test results before and after the intervention and between the intervention and control legs. Seventeen patients with a mean age of 60.3 ± 5.6 years (11 males) participated in the study. Mean Brief BESTest total scores were significantly improved (14.06 vs. 17.35; P =.01, Cohen's d = 0.743). There were no significant differences between the treated and control legs regarding the nerve conduction and color Doppler ultrasound parameters before and after the intervention (P ≥.054). Changes in the parameters were also not significantly different between legs (P ≥.078), except for common peroneal nerve conduction velocity, for which there was a higher increase in its value in the treated legs compared to the control legs (4.17 vs. 0.9, P =.002). Local calf vibration may positively affect balance and lower extremities nerve conduction in patients with DPN, and the findings of this study can be a basis for studies evaluating the efficacy of local calf vibration for treating DPN. [ABSTRACT FROM AUTHOR]

Previous studies reported inconsistent outcomes on elastic taping for three potential reasons: 1) poor control of placebo effect; 2) no consensus regarding the optimal tape tension; and 3) lack of investigation on muscle endurance, as the proposed tape recoiling force may not promote peak force generation but exert a consistently low force and improve submaximal contraction. This study compared the effects of elastic tape and its tension on muscle activity and endurance in people with extremely positive and negative personal belief on elastic tape. Using a validated instrument, we identified 20 participants with extremely positive personal belief on elastic tape (+ belief), and 20 with extremely negative personal belief (- belief). They performed wrist isometric endurance tests under three taping conditions (i.e. no tape, 50%, and 100% tension). We measured isometric wrist extensor muscle endurance, electromyography muscle activity, and self-perceived performance for each condition. The differences between the two groups in isometric muscle endurance (p =.85) and muscle activity (p =.53) were not statistically significant, regardless of tape conditions. However, participants with + belief reported better perceived performance than those with – belief (p <.001, partial eta squared = 0.70). Specifically, 100% tape tension yielded stronger self-perceived performance than 50% tension (Cohen's d = 0.91) and no tape (Cohen's d = 1.86). On the other hand, participants with – belief perceived similar performance across tape tensions (p =.55). Elastic tape does not modulate muscle activity and enhance muscle endurance. People with a strong positive personal belief on elastic tape may perceive a better performance with a greater tape tension. [ABSTRACT FROM AUTHOR]

How the weight-bearing asymmetry pattern and related maximum lateral weight-bearing capacity, physical functions, balance, and mobility involved in weight-bearing asymmetry and lesions are related to weight-bearing asymmetry in patients with early-onset stroke remains unclear. To investigate the difference between weight-bearing in the early phase after stroke categorized as symmetrical or nonsymmetrical regarding impairments, balance, walking, and independence, and any lesion location difference. This cross-sectional study included 46 persons with hemiparetic stroke within 3 weeks from onset undergoing inpatient rehabilitation and classified into symmetrical, paretic, and non-paretic groups. We performed posturographic, functional, mobility, and lesion location assessments on participants once the evaluation was possible. The symmetrical, paretic, and non-paretic groups included 14, 11, and 21 patients, respectively. The non-paretic group had lesser mean % body weight in maximum lateral weight-bearing to the paretic direction (79% versus 55%, p <.001), motor function of the hip lower limb (64 versus 58, p =.003) per the Stroke Impairment Assessment Set, Trunk Impairment Scale (18 versus 15, p =.020), and Berg Balance Scale (42 versus 32, p =.047) than the paretic group with more lesions in the insula (55% versus 0%, p <.001) and parietal cortex (36% versus 0%, p =.009) than the non-paretic group. The non-paretic group had low dynamic balance, severe motor paresis, and trunk dysfunction. The paretic group had lesions in the insula or parietal cortex. [ABSTRACT FROM AUTHOR]

To investigate the motor repertoire of infants diagnosed with spinal muscular atrophy Type I (SMA Type I) without administration of any disease-modifying agent. Motor Optimality Score-Revised (MOS-R) was calculated from videos recorded between post-term weeks 9–17 for 22 infants with SMA Type I. The MOS-R of infants with SMA Type I was compared with those of 22 infants with cerebral palsy (CP) and 22 infants with typical development. Of the infants with SMA Type I, 17 had absent fidgety movements (FMs) and 5 had sporadic FMs. Age adequate movement repertoire was absent, and the variety of movements in infants was very low. Movements were symmetrical but movements of four limbs remained on the surface level. Antigravity movements were very rare. Movement characterization was monotonous, slow speed, and small amplitude. The MOS-R of infants with SMA Type I was lower than those of infants with typical development but similar to those of infants with CP. Infants with SMA Type I had a motor repertoire similar to infants with CP, while they had a poorer motor repertoire than infants with typical development in the fidgety period as evidenced by MOS-R. Central nervous system involvement in these infants with SMA Type I with absent FMs and reduced MOS-R is unknown. Further studies are needed to determine the role of problems in the afferent and efferent pathways of spinal cord and muscle atrophy in the observation of normal FMs. [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]

Trunk control is associated with gross motor development. This study examines the relationship between segmental trunk control and gross motor performance in low birth weight (LBW) infants A total of 42 LBW infants and 43 normal birth weight (NBW) infants aged 3–9 months were sampled for this cross-sectional study. All infants were evaluated one time by the Segmental Assessment Trunk Control (SATCo) and the Alberta Infant Motor Scale (AIMS) Statistically high and significant correlations were found between gross motor performance and segmental trunk control in all sample populations (r = 0.835; p =.001). No statistically significant difference was found regarding the segmental trunk control between the groups (p =.119). The LBW infants with atypical motor development had poorer trunk control than the LBW infants with typical development (f = 5.480; p =.001). Our results show that LBW infants with atypical motor development had poorer trunk control than LBW infants with typical motor development. It was found that the segmental trunk controls of LBW infants were 0.398 times lower than in NBW infants. [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]

Enhancing the therapeutic alliance has been associated with improved outcomes for patients with chronic low back pain (CLBP). Qualitatively trust has been described to be part of the therapeutic alliance, but it has not been measured quantitatively within the physical therapy literature. Examine the relationship between trust and outcomes during physical therapy for CLBP. Observational study of patients with CLBP being seen for physical therapy were assessed through self-report measures. The Primary Care Assessment Survey (PCAS) trust measurement scale was completed by patients at initial, post-initial, and discharge visit. These measurements were compared for correlations with patient reported outcome measures for pain and function recorded at initial visit and discharge. A convenience sample of 29 patients (49.3 ± 15 years old) with CLBP were measured. The PCAS showed correlations for changes in trust throughout treatment for improvements in pain and discharge pain rating. Average discharge pain rating correlated to changes in the PCAS (rs = −0.692, p <.001), with lower pain ratings relating to higher changes in trust over time. Average change in pain (rs = 0.745, p <.001) throughout treatment also correlated with higher changes in trust. Higher trust scores at discharge also correlated with improved Global Rating of Change and Oswestry Disability Index scores at discharge. The linear regression model showed adjusted R2 values for the trust scores and outcomes varied between 0.247 and 0.642. Both increases in trust throughout the treatment and end trust scores during physical therapy were related to improved outcomes for patients with CLBP. [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]

Physical activity levels are low in cancer survivors. Remotely delivered programs which harness wearable technology may potentially be beneficial. To evaluate the feasibility and preliminary efficacy of a remotely delivered, physical activity intervention which harnessed wearable technology. This single arm pre-post longitudinal study included cancer survivors who had completed treatment in the preceding 3 years. Participants were supplied with a Fitbit One® or Flex® for 12 weeks. Physical activity goals were discussed during support phone calls. Outcome measures, assessed at baseline (T1), 12 weeks (T2), and 24 weeks (T3), included feasibility (recruitment, adherence, safety, acceptability) and efficacy [physical activity (Godin leisure time Index, ActiGraph GT3X+), quality of life (functional assessment of cancer therapy – general, short form 36 physical functioning component), functional capacity (six-minute walk test)]. Forty-five participants completed T1 assessments (10 males, 35 females). Thirty-nine (86.6%) of those underwent assessment at T2 and 31 (68.8%) at T3. The intervention was perceived positively with no adverse effects. There were increases in functional capacity (six-minute walk test, p =.002) between T1-T3, an increase in quality of life [short form 36 physical functioning measure (p =.0035), functional assessment of cancer total score (p =.02)] and self-report physical activity levels (p =.000123) between T1-T2, although effect sizes were generally low (d = 0.180 to d = 0.418). Objectively measured physical activity did not change. A physical activity intervention including wearable technology was safe, feasible, and well received by cancer survivors. An intervention based on this proof of concept should be followed up in further studies. [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]

Chronic lymphedema is a progressive and inflammatory disease caused by impaired lymphatic transport. This study evaluates the effects of complex decongestive therapy (CDT) and aquatic physiotherapy on markers of the inflammatory process and lower limb volumes in individuals with lymphedema. A randomized controlled clinical trial was carried out with three groups: patients with lymphedema submitted to CDT, patients with lymphedema submitted to aquatic physiotherapy, and control group of individuals without lymphedema. The evaluation was performed through blood count, CRP measurements, C3, C4 complement, measurement of serum levels of cytokines interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), interleukins 4 (IL-4), 6 (IL-6), and 10 (IL-10), and the volume of a lower limb using the volume formula of a truncated cone. The study was registered with the Brazilian Clinical Trials Registry (RBR-4tpkszn). Our work showed a reduction in the TNF-α levels of patients in the CDT group (p =.028). Significant differences were found between the control group and the CDT group for IL-10 (p =.049) and Monocytes (p =.039). No significant reduction in limb volume was found. Our results show that CDT was able to significantly reduce the inflammatory marker TNF-α in patients with lymphedema, suggesting an anti-inflammatory effect of the therapy. [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]

Cardiopulmonary responses during unsupported upper limb function assessment may vary in chronic obstructive pulmonary disease (COPD). To compare the cardiopulmonary responses during the function assessment with the Six-Minute Pegboard and Ring Test (6PBRT) and the incremental Unsupported Upper Limb Exercise (UULEX) test in COPD and to investigate the correlations with muscle strength and the limitations on activity of daily living (ADLs). This was a cross-sectional study. Cardiopulmonary variables were recorded during tests using a breath-by-breath analyzer. Muscle strength was assessed using a hand-held dynamometer. Self-reported ADL was evaluated using the modified Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ-M). Paired t-test, Wilcoxon signed rank test, and Spearman correlation coefficients were used. Fifteen individuals with moderate-to-severe COPD participated (66 ± 9 years old, forced expiratory volume in the first second [FEV1]: 48%±14% of predicted). The UULEX induced higher oxygen consumption (0.54 ± 0.20 vs. 0.44 ± 0.09 L/min, p =.01) and dyspnea (4.0 [2.6 to 6.9] vs. 0.5 [0.9 to 5.1], p <.01) than 6PBRT. The performance in both tests was correlated with self-reported ADL limitations on PFSDQ-M (6PBRT: r = −0.69, p <.01; UULEX: r = −0.62, p =.01). The UULEX promoted greater cardiopulmonary responses than 6PBRT, and performance in 6PBRT and UULEX was correlated with ADL limitations in individuals with COPD. [ABSTRACT FROM AUTHOR]

Despite the high prevalence of sleep disturbances in idiopathic pulmonary fibrosis (IPF), the relationship between physical activity in daily life (PADL) and sleep in this population remains unclear Investigate the impact of sleep on different domains of PADL in IPF and characterize their PADL profile Sixty-seven participants (thirty-three with IPF and thirty-four healthy subjects [control group]) were included. The subjects underwent assessments of pulmonary function, exercise capacity, respiratory and peripheral muscle strength, PADL, sleep, dyspnea, and health-related quality of life. PADL and sleep measures were assessed using an activity monitor (Actigraph®, wGT3x-BT). Associations between sleep and PADL were done using correlation and regression models. In the IPF, sleep duration at night associated significantly with step counts, sedentary, light, and moderate-to-vigorous physical activity (MVPA) (−0.82 ≤ R ≤ 0.43; p <.05 for all). Lung function and sleep partially explained PADL variables (0.19 ≤ R2 ≤ 0.65, p <.05 for all). Compared to controls, the IPF subjects presented lower step counts, less time spent in MVPA, standing position, and more time spent in lying position (p <.05, for all) Sleep duration is associated with PADL in IPF. The PADL profile of patients is worse than in control subjects. [ABSTRACT FROM AUTHOR]

In Cardiovascular Rehabilitation (CR), patient adherence to the maintenance phase is a major challenge. Virtual reality-based therapy (VRBT) promotes acute hemodynamic and autonomic repercussions similar to traditional rehabilitation and can increase patient adherence to the program. However, it is unknown whether the combination of VRBT to a traditional CR manages to maintain or even improve clinical and autonomic variables in long term. To analyze whether VRBT combination in a traditional CR can maintain or improve clinical and autonomic variables in cardiac patients in the maintenance phase of these programs. Twenty-six volunteers (62.04 ± 12.22 years) were evaluated, who underwent an initial assessment and two other assessments (in the sixth and 12th week) of the following outcomes: systolic and diastolic blood pressure, respiratory rate, pulse saturation of oxygen, heart rate, perceived exertion, and cardiac autonomic modulation, using linear and non-linear heart rate variability methods. Except for the apparent lack of clinical significance observed in Shannon Entropy, LF (nu), and HF (nu), the combination of VRBT as routine in a traditional program did not cause significant changes in the analyzed variables. combination of VRBT was able to maintain the chronic hemodynamic and autonomic repercussions caused by traditional CR. [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]

Understanding the concept of pain and its underlying biological mechanisms is an essential part of physiotherapists' professional knowledge. The first aim of the study was to translate and cross-culturally adapt the revised Neurophysiology of Pain Questionnaire into Finnish (RNPQ-FI) and to evaluate its reliability (internal consistency and test-retest reliability) in a sample of Finnish physiotherapists and physiotherapy students. The second aim was to compare the knowledge of pain neurophysiology between these two groups. Translation and cross-cultural adaptation followed the COSMIN Study Design checklist. Participants (202 physiotherapists and 97 physiotherapy students) completed an online survey containing RNPQ-FI. Internal consistency was assessed with Cronbach's alpha and test-retest reliability using Intraclass correlation coefficient (ICC3,1). Cronbach's alpha was 0.44 and ICC was 0.70 (p <.001). The mean percentage of correct responses was 61.4% for physiotherapists and 62.1% for students. Forty-seven percent of the physiotherapists and 35.1% of the students reported difficulties in understanding the items. A higher amount of pain education was associated with higher RNPQ-FI scores. The RNPQ-FI showed low internal consistency and moderate test-retest reliability among Finnish physiotherapists and physiotherapy students. Physiotherapists and students had equal amount of pain neurophysiology knowledge. Pain education is encouraged. [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]

The purpose of this study was to assess the prevalence of sleep disturbances in adults seeking physical therapy services. Participants were issued an electronic survey to provide demographic information and the following questionnaires: Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Sleep Hygiene Index (SHI), Insomnia Severity Index (ISI), STOP-BANG (obstructive sleep apnea (OSA) risk), and restless leg syndrome (RLS) risk. Percentages were calculated to describe prevalence of sleep disturbances, and Spearman's correlations were used to identify associations between pain and sleep questionnaires. Eighty-eight participants (47.9 ± 15.8 years, 68 females) completed the survey. Seventy-eight percent (n = 69) scored >5 on the PSQI; 32% (n = 28) scored ≥10 on the ESS; 52% (n = 46) scored ≥16 on the SHI; 51% (n = 45) scored ≥10 on the ISI; 28% (n = 25) had intermediate or high risk of OSA; and 40% (n = 35) indicated possible RLS. Pain level was significantly associated with PSQI (r(86) = 0.277, p =.009) and ISI (r(86) = 0.268, p =.012). There was a higher prevalence of sleep disturbances in adults seeking physical therapy services than in the general population. Increased pain severity was associated with poorer sleep quality and increased insomnia symptoms. This study highlights the need to screen patients for sleep disturbances. [ABSTRACT FROM AUTHOR]

Persons with stroke live with residual sensorimotor impairments in their lower limbs (LL), which affects their gait. We investigated whether these residual impairments and resulting gait deficits can be reduced through concurrently applied assisted movement, biofeedback, and proprioceptive stimulation. A robotic device provided impairment-oriented training to the affected LL of 24 persons with stroke (PwS) with moderate-to-severe LL impairment. Participants were given 22–30 training sessions over 2–3 months. During training, the interventional device cyclically dorsiflexed and plantarflexed the ankle at 5 deg/s through ±15 deg for 30 min while the participant assisted with the imposed movement. Concurrently, participants received visual biofeedback of assistive joint torque or agonist EMG while mechanical vibration was applied to the currently lengthening (i.e. antagonist) tendon. Sensorimotor impairment significantly decreased over the training period, which was sustained over 3 months, based on the Fugl-Meyer Assessment (FMA-LL) (p <.001), modified Ashworth scale in dorsiflexors (p <.05), and an ankle strength test (dorsiflexors and plantarflexors) (p <.05). Balance and gait also improved, based on the Tinetti Performance Oriented Mobility Assessment (POMA) (p <.05). Impairment-oriented training using a robotic device capable of applying assisted movement, biofeedback, and proprioceptive stimulation significantly reduces LL impairment and improves gait in moderately-to-severely impaired PwS. [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]

Empathy is a key value in health-related occupations such as physiotherapy. This longitudinal study aimed to determine the empathy levels of students in a four-year bachelor of physiotherapy program. A total of 120 physiotherapy students at a non-governmental university in Istanbul participated in the study between 2016 and 2019. The Turkish adaptation of the student version of the Jefferson Scale of Physician Empathy was used. Empathy scores were compared according to year of study and gender. Most participants were women (n = 101, 84.2%). Empathy scores differed by years of study (p <.001) being highest in the first year and lowest in the fourth year. There was no difference in empathy scores between women and men (p =.26). This is the first longitudinal study to contribute data on empathy levels in Turkish physiotherapy students. The decline in empathy seen in fourth-year physiotherapy students is associated more with the academic program and clinical practice than with any other factor. Further studies are warranted to explore why there are variations in empathy levels in physiotherapy students during their education. Ensuring students develop awareness and skills related to empathy during their undergraduate studies could result in a higher quality of care early in their professional practice. [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]

Hemiplegic shoulder pain (HSP) is common after stroke. The pain perception may exacerbate changes in the motor behavior of the ipsi-lesional upper limb, contributing to the functional decline of an individual's motor performance This study evaluates the influence of pain perception on the aiming movements performed with the ipsilesional upper limb in individuals with unilateral chronic stroke A cross-sectional study was conducted with 41 participants divided into three groups: 1) stroke with contralesional shoulder pain ≥ 3 by the Visual Numerical Pain Scale (SPSG; n = 13); 2) stroke no shoulder pain (nSPSG; n = 14); and 3) healthy control (CTG; n = 14) matched by sex and age. Individuals with stroke were matched for the severity of sensorimotor impairment by the Fugl-Meyer upper limb subscale and the injured hemisphere side. Stroke groups performed aiming movements with the ipsilesional upper limb and the CTG with the corresponding limb using a pen tip on the sensitive surface of a digitizing tablet. Performance across groups was compared by one-way analysis of variance, considering the time since injury as a covariate. The planning and execution variables of the movement trajectory were analyzed, and the significance was set at 5%. Trajectories of the SPSG were slower (p =.010; η2 = 0.22), were less smooth (p =.002; η2 = 0.30), had more directional error (p =.002; η2 = 0.28), and were less accurate (p =.034; η2 = 0.17) than the CTG. The nSPSG and CTG showed similar performance The perception of pain impairs aiming movements performed with the ipsilesional upper limb in individuals with unilateral chronic stroke. [ABSTRACT FROM AUTHOR]

A greater understanding of physiotherapists' work-life during their first year of work in private practice, and whether their experiences are mediated by personal traits, may provide valuable information to support their transition and retention. Describe the first year of practice for graduate physiotherapists in terms of employee engagement, job satisfaction, performance, and burnout, and evaluate the relationship between these measures and personal traits (resilience, grit, mind-set). One-year longitudinal mixed-methods study. Twenty new graduate physiotherapists completed questionnaires evaluating resilience, grit, and mind-set within 1-week of commencing employment. Engagement and job satisfaction were evaluated at 3, 6 and 12-months, and burnout evaluated at 12-months. Performance data (number of patients seen, revenue) were collected throughout the year. Individual semi-structured interviews were conducted at baseline, 3, 9 and 12-months. Engagement and satisfaction were high at all time points. At 12-months, burnout was at a medium level. Resilience was positively associated with job satisfaction at 6 (ρ = 0.56, p =.019) and 12-months (ρ = 0.54, p =.027). Engagement (ρ = −0.57, p =.04) and job satisfaction (ρ = −0.56, p =.03) were negatively associated with burnout at 12-months. All participants remained passionate about their work although increasing administrative burden and patient complexity contributed to feelings of burnout. Resilience was positively associated with job satisfaction suggesting those with capacity to 'bounce back' were more satisfied and engaged with their job. Although moderate levels of burnout were reported at 12-months, those with higher job satisfaction and employee engagement had lower levels of burnout. Participants proposed practical strategies to help mitigate burnout. [ABSTRACT FROM AUTHOR]

Balance impairment occurs after a hip fracture, but the characteristics of the impairment are not clear. To investigate the uni-dimensionality, fit statistics, and item difficulty of the Berg Balance Scale (BBS) in older adults with hip fracture by conducting a Rasch analysis. This was an observational cross-sectional study. The 254 participants were all ≥ 65 years old and had been hospitalized for rehabilitation after a unilateral hip fracture incurred during a fall. We collected their BBS scores at the time of hospital discharge and conducted a Rasch analysis to examine the uni-dimensionality, fit statistics, and item difficulty. The principal component analysis (PCA) of the Rasch model demonstrated that the BBS is uni-dimensional. The information-weighted mean square (MnSq) fit statistic was within the range of fit criteria for all items. The underfit item of the outlier-sensitive MnSq fit statistics was "Standing unsupported eyes closed" with the MnSq of 2.06. The difficult items were in order of logits: "Standing on one leg" (logits = 4.01); "Step tool" (logits = 2.74); and "Turn 360°" (logits = 2.61). The BBS is uni-dimensional and conforms with the Rasch model. The BBS most difficult items for older adults with a hip fracture required one-legged support and dynamic balance. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the efficacy of low intensity (0.1–0.8 Watt/cm2) pulsed ultrasound on chondrocyte cell proliferation and migration. Low-intensity pulsed ultrasound (frequency 3 MHz, duty cycle 25%, and pulse repetition frequency 150 Hz) for 5 minutes at different spatial average intensities was applied on chondrocyte cells. First, the optimum dose with significantly increased proliferation was determined to be 0.5 W/cm2 for 5 minutes of duration. Then, 0.5 W/cm2 ultrasound intensity was applied for durations of 2.5, 5, 7.5, and 10 minutes, and healing was assessed by monitoring cell migration and proliferation. At the intensity of 0.5 W/cm2 48 hours after the application, a statistically significant increase in proliferation (p =.0089) was observed in chondrocyte cells compared to the control group. Proliferation was analyzed at 4, 8, 24, and 48 hours after applying 0.5 W/cm2 ultrasound for durations of 2.5, 5, 7.5, and 10 minutes. Statistically significant increases were observed at 4 hours (p =.009), 8 hours (p =.032), 24 hours (p =.0084), and 48 hours (p =.00098) with 10 minutes of exposure. For 7.5 min of exposure duration, significant increases were observed at 48 hours (p =.045). In migration for all parameters, no statistically significant improvement (p >.05) was observed. It was shown that low intensity pulsed ultrasound induces cartilage cell proliferation; therefore, it may have a disease-modifying effect in the treatment of osteoarthritis. However, no positive effect was observed on cartilage cell migration. [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]

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]

To determine the reproducibility, criterion-related validity, and minimal clinically important difference (MCID) of the stair negotiation test (SNT) after total hip arthroplasty (THA). Sixty patients who underwent THA were included in this study. They performed the SNT and rated their difficulty in stair negotiation (question 7 of the Oxford Hip Score [OHSQ7]) before and 6 months after surgery. The SNT determined the time taken by a patient to ascend, turn around, and descend the stairs (15 cm × 4 steps) and was measured twice each time. As a measure of reproducibility, the intraclass correlation coefficient (ICC1,1) was calculated using the preoperative SNT. As an index of criterion-related validity, Spearman's rank correlation coefficient was used to evaluate the relationship between the better score of two trials in the preoperative SNT and the OHSQ7. The MCID of the SNT was calculated using the distribution-based method and the anchor-based method. The change in the OHSQ7 between before and after surgery was used as an anchor in the latter method. The ICC1,1 of the SNT was 0.97. The SNT was significantly correlated with the OHSQ7 (r = 0.40, p <.05). Moreover, the anchor-based MCID of the SNT was 1.98 seconds. The SNT is an objective assessable test of stair negotiation ability in post-THA patients that has good reproducibility and moderate criterion-related validity. Changes in the SNT beyond the MCID (1.98 seconds) represent clinically important changes in stair negotiation ability. [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]

This study investigated the characteristics of physical activity according to sit-to-stand, standing, and stand-to-sit abilities in subacute stroke with walking difficulty. In this study, 29 participants with subacute stroke and walking difficulty were enrolled and classified into two groups: participants who successfully completed three items (i.e., sit-to-stand, standing, and stand-to-sit) of the Functional Balance Scale (independent group, n = 13) and those who showed incomplete scores on any of the three items (dependent group, n = 16). Light-intensity physical activity (LIPA) and moderate-to-vigorous physical activity (MVPA) were measured using an accelerometer at three periods (i.e. daytime, therapy time, and non-therapy time) for a week. Two-way analysis of variance (groups × physical activity intensity) demonstrated a significant interaction in each period. Post-hoc tests showed significantly more LIPAs and MVPAs in the independent group in all periods, except for MVPA in the non-therapy time. Particularly, LIPA showed significant between-group differences in each period. Among individuals with subacute stroke and walking difficulty, those who could completely perform sit-to-stand, standing, and stand-to-sit could perform more LIPAs. Increasing sit-to-stand, standing, and stand-to-sit abilities could be an important factor in increasing the opportunity to perform LIPAs. [ABSTRACT FROM AUTHOR]

Hippotherapy (HPOT) is a physical therapy (PT) treatment tool using equine movement to improve mobility for children with movement impairments. Although research suggests HPOT improves body structure and function, there is limited evidence regarding its impact on activity and participation outcomes in a clinical setting. The Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) may be useful in HPOT settings to highlight changes in activity and participation. 1) Evaluate the PEDI-CAT's sensitivity to changes in activity and participation among children receiving PT using HPOT; 2) determine feasibility of administering the PEDI-CAT in a HPOT setting; and 3) examine how PEDI-CAT scores influence clinical decision-making. Participants (N = 34) were children who attended weekly PT using HPOT for 6 months. The PEDI-CAT was completed for all participants by a parent or caregiver at initial treatment (T1) and 6 months later (T2). A linear mixed effects model was used to evaluate changes in scores over time. Team meetings occurred monthly to discuss how PEDI-CAT scores impacted treatment. There were significant improvements across 3 PEDI-CAT domains between T1 and T2 for all children with small effect sizes and nonsignificant changes noted within two diagnostic subgroups with small-to-medium effect sizes. The PEDI-CAT was completed by all participants without interrupting treatment flow. PEDI-CAT score reports enriched therapist-client conversations increasing shared decision-making. PTs who treat children using HPOT may feasibly use the PEDI-CAT to assess changes in activity level outcomes and to assist clinical decision-making. [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]