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Background/Objectives: Neighborhood walkability is the extent to which built and social environments support walking. Walkability influences older adults' participation in outdoor physical activity. Identifying factors that influence physical therapists' (PTs) decisions about prescribing outdoor walking is needed, especially for those who are aging in place. The purpose of this study is to describe the neighborhood walkability knowledge, perceptions, and assessment practices of PTs who work with community-dwelling older adults. Methods: A cross-sectional survey was sent via email to 5,000 PTs nationwide. The 40-item survey assessed walking prescriptions, walkability perceptions and assessments, and gathered demographic data. Categorical variables were compared using Chi-square analyses. Results: Using a total of 122 PTs who worked in outpatient geriatric physical therapy settings, a significant difference was found between perceptions of whether PTs should assess walkability and whether they actually assess walkability (χ2 = 78.7, p <.001). Decisions to prescribe outdoor walking were influenced by the availability (n = 79, 64.8%) and maintenance (n = 11, 9.0%) of sidewalks, crime (n = 9, 7.4%), terrain (n = 7, 5.7%), and aesthetics (n = 6, 4.9%). Objective walkability measures were not used by the respondents. Conclusion: When considering the assessment of walkability, PTs prioritize the built environment over the social environment. Although most believe it is the responsibility of the PT to assess walkability, most do not. Significance/Implications: Assessment of walkability may allow PTs to identify barriers and make more informed recommendations concerning outdoor walking for older adults. Objective measures are available for PTs when prescribing outdoor walking. [ABSTRACT FROM AUTHOR]

Background: Athlete injury risk assessment and management is an important, yet challenging task for sport and exercise medicine professionals. A common approach to injury risk screening is to stratify athletes into risk groups based on their performance on a test relative to a cut-off threshold. However, one potential reason for ineffective injury prevention efforts is the over-reliance on identifying these 'at-risk' groups using arbitrary cut-offs for these tests and measures. The purpose of this commentary is to discuss the conceptual and technical issues related to the use of a cut-off in both research and clinical practice. Clinical Question: How can we better assess and interpret clinical tests or measures to enable a more effective injury risk assessment in athletes? Key Results: Cut-offs typically lack strong biologic plausibility to support them; and are typically derived in a data-driven manner and thus not generalizable to other samples. When a cut-off is used in analyses, information is lost, leading to potentially misleading results and less accurate injury risk prediction. Dichotomizing a continuous variable using a cut-off should be avoided. Using continuous variables on its original scale is advantageous because information is not discarded, outcome prediction accuracy is not lost, and personalized medicine can be facilitated. Clinical Application: Researchers and clinicians are encouraged to analyze and interpret the results of tests and measures using continuous variables and avoid relying on singular cut-offs to guide decisions. Injury risk can be predicted more accurately when using continuous variables in their natural form. A more accurate risk prediction will facilitate personalized approaches to injury risk mitigation and may lead to a decline in injury rates. Level of Evidence: 5 [ABSTRACT FROM AUTHOR]

Background Stretching programs are designed to improve hamstring flexibility by attempting to mechanically increase the length of the target tissue. However, other manual treatment approaches such as those utilized in Total Motion Release (TMR®), could be beneficial by identifying body asymmetries to assess and treat soft tissue impairments leading to diminished extensibility. Purpose The purpose of this study was to determine the effectiveness of the TMR® Fab 6 assessment and treatment to increase hamstring flexibility in healthy participants following one session of TMR®. Study Design Observational Cohort study Methods A convenience sample of 20 healthy participants (10 males, 10 females) were recruited from three institutions. Following collection of demographic information and a brief medical history, each participant performed a five minute warm-up on the stationary bike at a moderate intensity (80-90 RPMs) followed immediately by the bilateral performance of the Active Knee Extension Test (AKET) and Passive Straight Leg Raise (PSLR) to assess hamstring muscle length. Participants were randomly placed in the TMR® or control group. The TMR® group completed the "Fab 6" evaluation and treatment, while the control group performed one repetition of standing active hip flexion every 30-seconds for 15-minutes with both knees in full extension. Upon completion of treatment, control and TMR® groups were immediately re-evaluated on the AKET and the PSLR in the same order and fashion as baseline testing. Participants were asked to return in 24-hours for the same objective measurements as previously described. Results A significant time by group interaction was identified across all variables (p < 0.001) for AKET and PSLR except the PSLR preferred leg from post-treatment to 24hr follow-up. The most significant increase in the AKET occurred in the TMR® group between baseline and post-treatment of the non-preferred leg (12.15°±2.94) when compared to the control group (7.15°±1.56). [ABSTRACT FROM AUTHOR]

A 44-year-old woman suffered a carotid dissection causing a deep and superficial right middle cerebral artery stroke in October 2013, despite undergoing thrombolysis and thrombectomy. Sixteen months later, massive left upper extremity impairment persisted. She then agreed to embark upon a guided self-rehabilitation contract (GSC). This GSC is a moral contract where the physician or therapist identifies specific muscles, particularly hypoextensible and disabling that act as antagonists to functional activities. The physician or therapist then teaches and prescribes quantified daily high-load self-stretch postures for these muscles, alternating with repeated maximal amplitude movement exercises against their resistance. In turn, the patient commits to practicing the prescribed program and to delivering a diary of the stretch postures and alternating movement exercises performed each day. Over 4 years of GSC, the patient practiced upon prescription against a total of seven upper limb antagonists to common functional movements: shoulder extensors, shoulder internal rotators, elbow flexors, elbow pronators, wrist and finger flexors, and interossei muscles. She manually filled up her diary 99% of the days. Each day, she practiced an average of 20 min of high-load static self-stretch per muscle, alternating with about 50 maximal active efforts against the resistance of each targeted muscle's resistance. Overall, her mean static self-stretch time was 81 ± 2 (mean ± SEM) min/day, and her mean number of active maximal efforts was 285 ± 78/day, for a total daily selfrehabilitation time of over 2 h a day. Five years after her stroke, she had recovered all left upper extremity use in daily activities and resumed her previous job as a nurse's aide. She now spontaneously uses her left hand in most tasks. Functional MRI (March 2020) demonstrated bilateral primary motor and motor supplementary area activation upon left-hand exercise. Prolonged static self-stretch increased muscle extensibility (muscle plasticity) while maximal amplitude, alternating movement training reduced co-contraction in these muscles (neural plasticity). The Modified Frenchay Scale assessment was video-recorded by the clinician at each visit, allowing qualitative and quantitative evaluation of the functional capacities. The two videos of the first and last clinic visits have been uploaded and are available. [ABSTRACT FROM AUTHOR]

Background and Purpose The characteristics of Proximal Hamstring Tendinopathy (PHT) include deep, localized pain in the region of the ischial tuberosity. Chronic lesions are often found in long-distance runners. Compression of the tendon and shear force at its insertion at the ischial tuberosity during hip flexion/adduction is a key etiologic factor. The aim of this case report is to analyze the effectiveness of an exercise protocol with progression of tendon loading in PHT in an amateur runner, by assessing pain and functional capacity. Case Description The subject was a 30-year-old male runner. After participating in a 10km race, he experienced an insidious onset of deep buttock pain in the right ischial tuberosity. His pain was aggravated by running on sloped roads and prolonged sitting on hard surfaces, particularly while driving. The visual analog scale (VAS) for pain, the Puranen-Orave test (PO), the Bent-Knee stretch test (BK stretch), the supine plank test, the Victorian Institute of Sport Assessment-proximal hamstring tendons (VISA-H) questionnaire, and the sciatic nerve mobility (via the Slump test) were assessed. The intervention involved a 12-week progressive loading exercise program divided into four phases. Outcomes The initial pain was reduced at 6 weeks of intervention and further decreased at 12 weeks (VAS from 7, to 5 and to 1). Function increased at 6 weeks and at 12 weeks (VISA-H from 23, to 53, to 80). Sciatic nerve mobility was normal. Conclusion The progression of training in a subject with PHT tendon injury based on isometric exercise, concentric/eccentric, energy storage, progressively increasing hip flexion was beneficial, increasing function and decreasing pain. Studies with a larger sample size and a more precise methodological design would be necessary to support this type of intervention in clinical practice. Level of Evidence 5 [ABSTRACT FROM AUTHOR]

Balance assessments are an important component of rehabilitation. Considering the increasing use of telemedicine to meet rehabilitation needs, it is important to examine the feasibility of such assessments. This study aimed to examine the reliability and validity of the Tinetti Performance-Oriented Mobility Assessment Balance Subscale (POMA-B) when applied via synchronous and asynchronous tele-assessment. Twenty-five patients with chronic stroke were included in the study. The first physiotherapist assessed the patients on the first day in a face-to-face clinical setting. Synchronous or asynchronous tele-assessment was applied the next day. The assessments were performed in the same time zone, with an interval of one day. The synchronous tele-assessment was done online in real time by the first and second physiotherapists. A reference assessment video was sent to the patients for asynchronous tele-assessment. They were asked to make a video recording while performing the evaluation activities according to the reference video. Then the first and second physiotherapists assessed these video recordings separately. All the tests were repeated 10 days later to determine the intra-rater reliability of the tele-assessment methods. The intra-class correlation coefficients ranged from 0.96 to 0.98 for inter-rater reliability and from 0.97 to 0.98 for intra-rater reliability for both tele-assessment methods. Both asynchronous and asynchronous tele-assessment methods were medium correlated with the face-to-face versions. We demonstrated the validity and reliability of the POMA-B in chronic stroke patients with different tele-assessment methods, typically using the internet and available devices. [ABSTRACT FROM AUTHOR]

Copyright of Argentinian Journal of Respiratory & Physical Therapy (AJRPT) is the property of Asociacion Civil Cientifica de Difusion y Promocion de la Kinesiologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Physiotherapy Canada is the property of University of Toronto Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Several shifts in physiotherapy treatment of patients with rheumatoid arthritis (RA) have occurred over time. This paper aims to identify shifts in physiotherapy practice for patients with RA based on the author's work experiences from the 1980s until today at two Norwegian rheumatism hospitals, and to explore why shifts may have happened. A narrative was developed by describing events making a difference, categorizing, and ordering them with the help of narrative analysis and a sensitizing analytic lens on discourses. The storyline from the 1980s to approximately the turn of the millennium is called 'Shifts determined mainly by clinical context-driven events' which occurred in response to medical advances and physiotherapists' clinical experiences. These shifts were later justified by physiotherapists' research in the clinical context. The other storyline covers mainly the 2000s and is called 'Shifts increasingly determined by events beyond clinical physiotherapy context.' They include adjustments to further medical advances and implementation of biopsychosocial understanding of disease at the hospital, and to external research-based recommendations, health reforms, and economy. These processes have moved physiotherapy practice at the hospital from mainly providing individualized remedial and rehabilitative physiotherapy for the purpose to normalize physical function to an increasing focus on generic health measures for the purposes of health promotion and cardiovascular disease prevention. However, this shift may not fully match the complex needs presented by patients in disease remission with unrelenting fatigue and work inability and those who have multiple functional challenges and comorbidities. [ABSTRACT FROM AUTHOR]

Epidural spinal cord stimulation (eSCS) of the lower thoracic spinal cord has been shown to partially restore volitional movement in patients with complete chronic spinal cord injury (cSCI). Combining eSCS with intensive locomotor training improves motor function, including standing and stepping, but many patients with cSCI suffer from long-standing muscle atrophy and loss of bone mineral density, which may prohibit safe implementation. Safe, accessible, and effective avenues for pairing neuromodulation with activity-based therapy remain unexplored. Cycling is one such option that can be utilized as an eSCS therapy given its low-risk and low–weight-bearing requirement. We investigated the feasibility and kinematics of motor-assisted and passive cycle-based therapy for cSCI patients with epidural spinal cord stimulation. Seven participants who underwent spinal cord stimulation surgery in the Epidural Stimulation After Neurologic Damage (E-STAND) trial (NCT03026816) participated in a cycling task using the motor assist MOTOmed Muvi 300. A factorial design was used such that participants were asked to cycle with and without conscious effort with and without stimulation. We used mixed effects models assessing maximum power output and time pedaling unassisted to evaluate the interaction between stimulation and conscious effort. Cycling was well-tolerated and we observed no adverse events, including in participants up to 17 years post–initial injury and up to 58 years old. All participants were found to be able to pedal without motor assist, which primarily occurred when stimulation and effort were applied together (p = 0.001). Additionally, the combination of stimulation and intention was significantly associated with higher maximum power production (p < 0.0001) and distance pedaled (p = 0.0001). No association was found between volitional movement and participant factors: age, time since injury, and spinal cord atrophy. With stimulation and conscious effort, all participants were able to achieve active cycling without motor assistance. Thus, our stationary cycling factorial study design demonstrated volitional movement restoration with eSCS in a diverse study population of cSCI participants. Further, motor-assist cycling was well-tolerated without any adverse events. Cycling has the potential to be a safe research assessment and physical therapy modality for cSCI patients utilizing eSCS who have a high risk of injury with weight bearing exercise. The cycling modality in this study was demonstrated to be a straightforward assessment of motor function and safe for all participants regardless of age or time since initial injury. [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]

Stroke is a significant health problem that may result in long-term functional deficits. Balance and walking problems are among the most common post-stroke deficits, and they may negatively affect quality of life. Our aim in this study was to investigate the effects of cervical mobilization on balance and gait parameters after stroke. Participants were 24 adults (aged 30–65 years), who scored 24 or above on the Standardized Mini-Mental State Exam (MMSE) and no more than 3 on the Modified Rankin scale. Participants were randomly assigned to either an experimental Bobath therapy and cervical mobilization group (n = 12) or a control group who received Bobath therapy and a sham application (n = 12). Both groups received 60 minutes of Bobath therapy three times a week for four weeks; additionally, the experimental group received 15 minutes of cervical mobilization in each session, while the control group received 15 minutes of spinal sham mobilization each session. Pre and post treatment, we assessed all participants' demographic characteristics, gait parameters, balance parameters, and forward head posture values using a clinical data assessment form, spatiotemporal gait analysis (LEGSystm), portable computerized kinesthetic balance device (SportKAT 550), and craniovertebral angle (CVA), respectively. The groups showed no significant differences in their initial demographic and clinical characteristics (age, sex, stroke duration and disability levels.). In comparing changes on variables of interest, we observed significant experimental versus control group improvements in balance parameters except for their left side balance score (right side, left side, forward, backward and total balance scores were significant at p =.003, p =.089, p <.001, p =.022, p <.001, respectively), gait parameters (stride number, stride length, stride time, stride velocity, cadance at p =.007, p =.019, p =.013, p =.005, p =.001, respectively) and CVA (p <.001). Also, there were findings in favor of the experimental group on the modified timed up and go test on walk out, mid turn, walk back and total times (p =.028, p =.001, p =.016, and p =.001, respectively),but not for sit-to-stand time or stand-to-sit time. Clinicians involved in stroke rehabilitation should assess and treat the cervical region to enhance rehabilitation effectiveness. [ABSTRACT FROM AUTHOR]

Considering various factors that influence the accuracy of the Subjective Visual Vertical (SVV) and Subjective Postural Vertical (SPV), standardization of assessment methods is needed. This retrospective study examined the contribution of Head-on-Body (HOB) position, starting roll position (SRP) and visuospatial neglect (VSN) to SVV and SPV constant errors (i.e. deviation from true vertical). Also, the contribution of HOB position and VSN presence to SVV and SPV variability (i.e. intra-individual consistency between trials) was assessed. First-ever unilateral hemispheric stroke survivors (<85 years; <100 days post-stroke) were assessed with three HOB positions (neutral, contralesional, and ipsilesional) and seven starting positions (20°Contralesional to 20° ipsilesional) of the laser bar and tilt chair. Linear mixed models were selected to evaluate the contribution of HOB, SRP, and VSN to SVV/SPV constant errors and variability. Thirty-four subjects (24 VSN-/10 VSN+) were assessed. A tilted HOB position led to significantly higher constant errors for the SVV and SPV (the latter only in the VSN- group), and an increased SVV variability. SRP only significantly contributed to the SVV constant errors and only in the VSN- group. Furthermore, the presence of VSN resulted in a significantly higher SVV and SPV variability. HOB position and the presence of SRP and VSN are important factors to consider during SVV and SPV measurements. Assessment with a neutral HOB position leads to more accurate results. HOB position and SRP influence the results of SVV and SPV differently in individuals with and without VSN, which highlights the relevance of VSN assessment. [ABSTRACT FROM AUTHOR]

The purpose of this paper was first to gain an in-depth understanding of the barriers and facilitators to implementing the BPS model and pain neuroscience education in the current Lebanese physical therapy health care approach and explore its acceptability. A qualitative semi-structured interview using purposive sampling was conducted with eight Lebanese physical therapists practising in different governorates. The transcribed text from the interviews was analyzed using inductive thematic analysis. Two topics were generated and constructed by the researchers: (1) "barriers to the implementation of pain neuroscience education, with subthemes including (a) "current health care approach," (b) "basic curriculum and continuing education," (c) "patients' barriers"; (2) "facilitators to the implementation of pain neuroscience education," with subthemes containing (a) "interest in the BPS model, (b) "therapeutic alliance," and (c) "motivation for future training on BPS approach." The analysis of the results showed that Lebanese physical therapists currently hold a strong biomedical view of chronic pain, assessment, and treatment. However, despite the presence of barriers and challenges, they are aware and open to consider the implementation and future training about the BPS model and pain neuroscience education in their approach. The exploration of potential barriers and facilitators to the bio-psychosocial model and pain neuroscience education implementation may provide an opportunity for better development and design of a culturally sensitive pain neuroscience education material for Arab-speaking and Lebanese physical therapists. The exploration of barriers and facilitators to the implementation of pain neuroscience education will help to improve pain education and ensure better clinical pain management. The most important barriers were the dominant characteristic of the Lebanese physical therapist's health approach, which is focused on a biomechanically oriented model, and their lack of knowledge to approach chronic pain from a biopsychosocial perspective. [ABSTRACT FROM AUTHOR]

Rationale: There is a lack of consensus in the literature related to what is assessed clinically by physical therapists in people with neurological disorders. Aims: This mixed‐methods systematic review aimed to identify domains that physiotherapists routinely assess in people with neurological conditions in clinical settings and explored factors influencing assessment domains including country, clinical setting, therapist experience and neurological condition. Method: Five databases were searched from 1946 to 31st January 2023. Studies with any design reporting on domains assessed by a physiotherapist, in people with neurological conditions in any clinical setting, were included. Independent reviewers assessed eligibility and risk of bias using relevant McMaster critical appraisal tools. Data were extracted and synthesised following the Joanna Briggs Institute approach for mixed systematic reviews. Results: A total of 23 (16 quantitative, 7 qualitative) studies involving 3134 participants were included. The studies were rated as high (n = 14) or medium (n = 9) quality. The domains of function (n = 14); postural alignment and symmetry (n = 11); gait (n = 11); balance (n = 9), and muscle strength (n = 8) were most frequently included in assessments. Five key themes were identified from the qualitative studies: the clinical reasoning process, clinical use of standardised measures, utilisation of the senses, clinician experience and information gathering. There was minimal data on how country, clinical setting, therapist experience and neurological condition influence inclusion of assessed domains. Conclusion: Five domains were most frequently included in assessment: function; postural alignment and symmetry; gait; muscle strength; and balance. This limited number of domains is in stark contrast to the full neurological physiotherapy assessment recommended by expert textbooks. Further research is needed to understand the reasons why this might be so. [ABSTRACT FROM AUTHOR]

Background: As the field of physical therapy increasingly acknowledges the integral role of nutritional assessment and counseling, revisiting this subject is essential due to limited updated information regarding this topic. Furthermore, it is crucial to investigate the factors that may influence physical therapists' attitudes toward integrating nutritional assessment and counseling into their physical therapy practice. The study's primary aim was to explore the attitudes of registered physical therapists in Israel toward incorporating nutritional assessment and counseling into their clinical practice. We also explored the relation between personal and professional characteristics of physical therapists and their attitudes. Methods: An anonymous nationwide online self-report survey was conducted. It included three sections: personal and professional background characteristics, self-reported level of nutritional knowledge and sources of nutritional knowledge, and attitudes toward incorporating nutritional assessment and counseling into practice. Descriptive statistics were calculated for all outcome measures. The total score of the attitude statements was compared between different groups of participants. Multiple linear regression analysis was used to predict positive attitudes. Results: The study included 409 physical therapists. The attitude score was 19.78 (2.53) of 25, indicating a positive attitude. A majority (67%) reported that they did not acquire knowledge regarding nutrition during their entry-level studies or in other formal settings (63%). The three primary sources of nutritional information for the participants reported were the Internet (87.0%), registered dietitian (70.0%), and professional, scientific journals (36.0%). Prior knowledge acquired during entry-level physical therapist studies and clinical experience of ≥ 13 years significantly predicted positive attitudes (β = 0.17, β = −0.13, respectively). Conclusion: Registered physical therapists held a positive attitude toward incorporating nutritional assessment and counseling into their clinical practice. Two background professional characteristics were predictors of positive attitudes. Accordingly, there is need to appropriate formal education regarding nutritional issues. Further studies are required to explore the actual integration of nutrition into the physical therapy framework. [ABSTRACT FROM AUTHOR]

Poor technological proficiency is a barrier to engaging with digital health for older adults, preventing providers from recommending digital health tools to patients aged 60+years. Effect of age and gender on engagement with a digital physical therapy application was assessed over 5883 episodes. The 60+ age group had 78% increased odds of engagement compared with the 20-29 years age group. The 60+ age group performed 64% to 101% more workouts per week. Women aged 60+ years were significantly more engaged than other demographics. Patients using app-based physical therapy are highly engaged. Age and gender do not appear to preclude engagement with digital physical therapy. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Creating a competent healthcare workforce that can meet the demands of the 21st century's globalised healthcare system is a top priority. The purpose of this study was to understand how competency behaviours of final-year physical therapy students are promoted through an evidence-based Programmatic Clinical Portfolio (Pro-CP). If Pro-CP can develop competency behaviours, this study further explores the factors contributing to the development of competency behaviours. The Pro-CP instrument was developed based on contemporary principles of the programmatic assessment model, which provides a valid measure of workplace competence. A phenomenological study design was used to capture the experiences of final-year physical therapy graduates. The sample (n = 32) was drawn from both public and private settings during a four-week clinical internship. Data from the focus group discussions (FGDs) were coded deductively using the Theory of Planned Behaviour (TPB) to assist in answering the research questions. Five themes emerged from the thematic analysis, namely, (a) Increased behaviours towards Pro-CP; (b) Decreasing subjective norms towards Pro-CP; (c) Increased self-efficacy towards Pro-CP; (d) Increased learning autonomy towards Pro-CP; (e) Need for institutional support. This qualitative study highlights the key elements of behavioural beliefs, normative beliefs, and perceived behavioural control concerning self-efficacy to understand the cultivation of competence behaviours. Consideration of programmatic assessment principles in the design of the competence assessment instrument holds promise for providing a valid value that genuinely defines the competency behaviours of physical therapy graduates. This study adds new thinking to competence assessment instrument in physical therapy. [ABSTRACT FROM AUTHOR]

The present work is the result of applied research, which describes how the physical therapy program at the Universidad Santiago de Cali approached the support of the learning processes from the Guide to Physical Therapist Practice issued by the American Physical Therapy Association (APTA) from a teaching perspective using information technologies with an emphasis on mobile devices (D-Learning). The implementation process was conducted using the PSP (Personal Software Process) methodology, condensing its six characteristic moments to address the problem in four stages: planning, design, development, and validation, corresponding to phases 2 and 3 of the interdisciplinary project developed by and between the Schools of Engineering and Health Sciences, thereby understanding that the remaining phases exceed the scope of this paper (these phases include a systematic review, an analysis, and feedback from the academic community). A preliminary assessment describes the knowledge gathering and idea conception processes, as well as the solution design process in Enterprise Architect. Subsequently, the prototype was implemented, the corresponding documentation was prepared, and its usability was validated by the academic community at the university. Therefore, a supporting tool was generated, focusing specifically on learning about the Guide to Physical Therapist Practice. [ABSTRACT FROM AUTHOR]

The need for early detection and appropriate management of flags in physical therapy has been established. The lack of early detection has been shown to lead to poor outcomes such as serious pathology, increased disability, prolonged symptoms, and increased healthcare utilization. The main purpose of this survey study was to assess third-year Doctor of Physical Therapy (DPT) students' adherence to clinical practice guidelines specifically in the identification and management of red and yellow flags through a case-based approach. A survey including three different flag case scenarios was sent to DPT students in 15 geographically diverse physical therapy programs. Previously published case scenarios measuring adherence to practice guidelines were used. Correlational analyses were performed to link student demographic details and guideline adherent management. The survey was completed by 64 students. Guideline adherent management was greater for red flags (85%) than yellow flag cases (25% and 42%). No significant relationship was noted between the student details and guideline adherent management. DPT students may need additional educational content related to yellow flag screening. Educators may consider utilizing published red and yellow flag cases to guide decision-making and highlight best screening practices. [ABSTRACT FROM AUTHOR]

Copyright of Physiotherapy Canada is the property of University of Toronto Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

To review clinical practice guidelines (CPGs) and recent literature to identify common recommendations guiding "best practice" pain care for adults with spinal cord injury (SCI). We searched four scientific databases and four guideline repositories from January 2010 to February 2022 for CPGs relating to the management of pain following SCI. We excluded guidelines that related to a single treatment modality, complementary medicines, specific disease processes, and guidelines that were not freely available. We identified 1373 records from which 11 met all eligibility criteria. Seven were classified as "tier 1" and were used to generate 46 care components related to neuropathic pain management. We organised these into three themes: screening and assessment, principles of evaluation and management, and management recommendations; and seven subthemes: screening, assessment and diagnosis, addressing complex care needs, ongoing evaluation, management – interventional, management – pharmacological, and management – non-pharmacological. Four CPGs were classified as "tier 2" and were used to provide supporting evidence. We identified 12 recommendations related to the management of nociceptive pain. This synthesis of recommendations can guide consumers, clinicians, researchers, and policy makers to inform understanding and clinical implementation of evidence-based "best practice" management of pain in adults with SCI. Persistent pain is a frequent problem for individuals following spinal cord injury and its effective management is challenging for clinicians. High-quality clinical practice guidelines that are up-to-date and readily accessible have the potential to enhance care quality and outcomes. This synthesis of 58 key care recommendations can guide consumers, clinicians, researchers, and policy makers towards improving pain care for adults with spinal cord injuries. [ABSTRACT FROM AUTHOR]

Background and Purpose: Patients with Duchenne muscular dystrophy (DMD) change their movement patterns to compensate for muscle weakness. The Duchenne Video Assessment (DVA) measures ease of movement through evaluation of compensatory movements. The DVA directs caregivers to video record patients performing home‐based movement tasks using a mobile application, and DVA‐certified physical therapists evaluate the videos using scorecards with prespecified compensatory movement criteria. Two qualitative interview studies were conducted to select movement tasks for the DVA that are relevant to patients with DMD and able to reflect changes in function. Methods: Qualitative interviews with eligible physical therapists were conducted remotely. Physical therapists were asked to spontaneously suggest movement tasks prior to evaluating specific movement tasks selected a priori. Analysts conducted a content analysis to investigate whether movement tasks selected a priori were confirmed as relevant to the population of interest and able to show changes in function. Results: The studies included five physical therapists to select tasks for ambulatory patients with DMD and six for non‐ambulatory patients. For an ambulatory population, all five experts confirmed Climb Five Stairs, Run, Stand Up from Sitting, Sit Up from Supine, and Jump Forward, and four (80%) confirmed Walk as relevant and able to show functional changes. For a non‐ambulatory population, all six experts confirmed Eat 10 Bites, Roll Over in Bed, Shift Weight in Bed, Take T‐Shirt Off, Put T‐Shirt On, Put Arms on Armrest, and Reach Across Table to Grab Cell Phone, and five (83%) confirmed Raise Hands Above Head as relevant and able to show functional changes. Discussion: Physical therapists confirmed the DVA movement tasks as relevant to patients with DMD and able to reflect changes in function. The use of the DVA in clinical trials provides an opportunity to collect data not seen in clinic and reduce travel burden for families. [ABSTRACT FROM AUTHOR]

To develop a new assessment form that is assessed by therapists for the performance of public transportation use for stroke survivors through content validation. The items for the tentative assessment form were selected using hierarchical clustering analysis on previous records of 76 field-based training sessions for public transportation use for stroke survivors. After the modification of the tentative form based on 6 months of clinical use, the final form was developed through content validation using the Delphi method by 71 therapists who had been working at the hospital for more than 2 years and had experience with training for public transportation use. The Public Transportation use Assessment Form (PTAF) for stroke was successfully developed through three validation processes. It consists of four categories (plan for going out, mobility, using trains, and using buses) including 15 items that cover various tasks of public transportation use. The scoring for each was as follows: 3, independent; 2, requires supervision of verbal assistance; 1, requires assistance; and N, not applicable. The PTAF, developed through content validation, could assess the ability of public transportation use, and identify specific problems for each stroke survivor in clinical setting. We developed the Public Transportation use Assessment Form (PTAF) to assess the ability of stroke survivors to use public transportation. The PTAF could identify specific problems related to public transportation use for stroke survivors and aid in planning rehabilitation programs based on the results. The PTAF could share information about which task need support in public transportation use and could augment the hospital discharge plan. [ABSTRACT FROM AUTHOR]

Progressive supranuclear palsy (PSP) is a neurodegenerative condition, typically presenting with, but not limited to, impairments of postural instability, gait, and gaze stability. This case report describes the multifactorial assessment and rehabilitation of a patient with atypical PSP who has significant gaze deficits, asymmetrical stepping responses, trunk rigidity, and reduced posterior excursion on limits of stability. Evaluation utilized computerized gait and balance assessments, foot clearance analysis, a squat test, and a timed stepping test. The intervention included boxing, stepping tasks, and treadmill training each with eye movement challenges. A total of 15 hours of physical therapy was provided; 1 hour, 2 times a week. Post-intervention improvements were noted subjectively, on eye-body coordination, and objectively, on limits of stability, foot clearance, and task performance (squats, timed stepping). Follow-up demonstrated some decline from posttest results; however, patient-reported adherence to the program was less than recommended. A multifactorial rehabilitation program can improve balance, eye-body coordination, and strength in a high functioning patient with atypical PSP. Longitudinal randomized controlled studies are suggested to further investigate this interventional approach in high functioning individuals diagnosed with atypical PSP. [ABSTRACT FROM AUTHOR]

Background: Normal pressure hydrocephalus is a disease directly related to the change in intracranial compliance and consequent repercussions in the brain parenchyma. Invasive monitoring of such parameters proves to be reliable especially for prognosis in neurocritical patients; however, it is not applicable in an outpatient service setting. The present study describes the comparison between the tap test results and the parameters obtained with a non-invasive sensor for monitoring intracranial compliance in patients with suspected NPH. Methods: Twenty-eight patients were evaluated before and after lumbar puncture of 50mL of CSF (the tap test), comprising clinical assessment, magnetic resonance imaging, physical therapy assessment using the Timed Up and Go test, Dynamic Gait Index, BERG test, neuropsychological assessment, and recording of non-invasive intracranial compliance data using the Brain4care® device in three different positions (lying, sitting, and standing) for 5 min each. The tap test results were compared to the Time to Peak and P2/P1 ratio parameters obtained by the device. Results: The group that had a positive Tap test result presented a median P2/P1 ratio greater than 1.0, suggesting a change in intracranial compliance. In addition, there was also a significant difference between patients with positive, negative, and inconclusive results, especially in the lying position. Conclusion: A non-invasive intracranial compliance device when used with the patient lying down and standing up obtained parameters that suggest correspondence with the result of the tap test. [ABSTRACT FROM AUTHOR]

Background and Purpose The Expanded Cutting Alignment Scoring Tool (E-CAST) is a two-dimensional qualitative scoring system that has demonstrated moderate inter-rater and good intra-rater reliability for the assessment of trunk and lower extremity alignment during a 45-degree sidestep cut. The primary purpose of this study was to examine the reliability of the quantitative version of the E-CAST among physical therapists and to compare the reliability of the quantitative E-CAST to the original qualitative E-CAST. The hypothesis was that the quantitative version of the E-CAST would demonstrate greater inter-rater and intra-rater reliability compared to the qualitative E-CAST. Study Design Observational cohort, repeated measures reliability study Methods Twenty-five healthy female athletes (age 13.8±1.4 years) performed three sidestep cuts with two-dimensional video capturing frontal and sagittal views. Two physical therapist raters independently scored a single trial using both views on two separate occasions. Based on the E-CAST criteria, select kinematic measurements were extracted using a motion analysis phone application. Intraclass correlation coefficients and 95% confident intervals were calculated for the total score, and kappa coefficients were calculated per kinematic variable. Correlations were converted to z-scores and compared to the six original criteria for significance (α<0.05). Results Cumulative intra- and inter-rater reliability were both good (ICC=0.821, 95% CI 0.687-0.898 and ICC=0.752, 95% CI 0.565-0.859). Cumulative intra-rater kappa coefficients ranged from moderate to almost perfect, and cumulative inter-rater kappa coefficients ranged from slight to good. No significant differences were observed between the quantitative and qualitative criteria for either inter- or intra-rater reliability (Zobs(intra)= -0.38, p=0.352 and Zobs(inter)= -0.30, p=0.382). Conclusion The quantitative E-CAST is a reliable tool to assess trunk and lower extremity alignment during a 45-degree sidestep cut. No significant differences were observed in reliability of the quantitative versus qualitative assessment. Level of evidence 3b [ABSTRACT FROM AUTHOR]

Background: The Alzheimer's and Music Therapy (ALMUTH) study is the first randomised controlled trial (RCT) design with 12 months of active non-pharmacological therapy (NPT) implementing music therapy (MT) and physical activity (PA) for participants with Alzheimer's disease (AD). The aim of the present article is to retrospectively examine the inclusion of mild-to-moderate Alzheimer's Disease patients into the main ALMUTH study protocol and to determine if continued inclusion of AD patients is warranted. Methods: The randomised pilot trial was conducted as a parallel three-arm RCT, reflecting the experimental design of the ALMUTH study. The trial was conducted in Bergen, Norway, and randomisation (1:1:1) was performed by an external researcher. The study was open label and the experimental design features two active NPTs: MT and PA, and a passive control (no intervention, CON) in Norwegian speaking patients with AD who still live at home and could provide informed consent. Sessions were offered once per week (up to 90 min) up to 40 sessions over 12 months. Baseline and follow-up tests included a full neuropsychological test battery and three magnetic resonance imaging (MRI) measurements (structural, functional, and diffusion weighted imaging). Feasibility outcomes were assessed and were determined as feasible if they met the target criteria. Results: Eighteen participants with a diagnosis of mild-to-moderate AD were screened, randomised, and tested once at baseline and once after 12-months. Participants were divided into three groups: MT (n = 6), PA (n = 6), and CON (n = 6). Results of the study revealed that the ALMUTH protocol in patients with AD was not feasible. The adherence to the study protocol was poor (50% attended sessions), with attrition and retention rates at 50%. The recruitment was costly and there were difficulties acquiring participants who met the inclusion criteria. Issues with study fidelity and problems raised by staff were taken into consideration for the updated study protocol. No adverse events were reported by the patients or their caregivers. Conclusions: The pilot trial was not deemed feasible in patients with mild-to-moderate AD. To mitigate this, the ALMUTH study has expanded the recruitment criteria to include participants with milder forms of memory impairment (pre-AD) in addition to expanding the neuropsychological test battery. The ALMUTH study is currently ongoing through 2023. Trial registration: Norsk Forskningsråd (NFR) funded. Regional Committees for Medical and Health Research Ethics (REC-WEST: reference number 2018/206). ClinicalTrials.gov: NCT03444181 (registered retrospectively 23 February 2018, https://clinicaltrials.gov/ct2/show/NCT03444181). [ABSTRACT FROM AUTHOR]

The article reports that the rheumatoid arthritis is a relatively common disease affecting approximately one percentage of adults. Topics include examines it is a chronic, systemic autoimmune disease that affects the joints of the hands, wrists, shoulders, elbows, knees, ankles and feet; and considered RA can present with a range of symptoms, including joint swelling, chronic pain.

Introduction: The anterior cruciate ligament (ACL) is one of the crucial ligaments in the knee that often gets injured during intense activities. This injury, sometimes resulting in a tear, is more common among professional athletes. The aim of this study is to compare reconstruction surgery and physiotherapy treatments in an educational hospital. Materials and Methods: In a cross-sectional study, 63 individuals aged between 19 and 38 with ACL injuries, categorized into four occupational groups (soldiers, military personnel, athletes, and freelancers), were examined. Thirty-two individuals underwent reconstru ction surgery, while 31 underwent physiotherapy. Patients were followed up for one to six months. The International Knee Documentation Committee (IKDC) questionnaire was completed for them, and the collected data were entered into SPSS for analysis using two- way ANOVA and Bonferroni post hoc test. Results: The results showed that both the type of treatment and occupation had an impact. Surgical reconstruction scored significantly higher than physiotherapy (surgery group: 69.7 ± 0.7, physiotherapy group: 66.3 ± 1.0). Among occupations, soldiers scored significantly lower than the other groups, with no significant difference observed among freelancers, military personnel, and athletes. Conclusion: The findings indicate that both the chosen treatment method and the patient's occupation are effective in follow-up. Excluding pain criteria, surgical reconstruction was markedly superior to physiotherapy, as patients exhibited higher sports and functional performance despite experiencing more pain, resulting in higher scores. [ABSTRACT FROM AUTHOR]

Simultaneous bilateral shoulder dislocations are extremely rare occurrences and are rarely associated with exercise. We present an unusual case of bilateral simultaneous shoulder dislocation which occurred during an unsupervised Pilates Reformer exercise session. A 41-year-old female felt sudden severe pain and forward displacement in both shoulders during abduction and external rotation. Bilateral anterior shoulder dislocation was confirmed with initial X-rays in the emergency department. Spontaneous reduction of the right shoulder was observed in the emergency room and then the left side was reduced under general anesthesia. Physical therapy modalities, exercises for shoulder girdle and core strength were implemented as conservative management. The patient returned to desk work and had pain-free range of motion with satisfactory strength on both sides in the fourth week and performed daily life activities without any symptoms in the tenth week. This case highlights the importance of training under supervision of an exercise instructor, even if it is considered a "so-called safe" exercise method. [ABSTRACT FROM AUTHOR]

Overactive Bladder Syndrome (OAB) has multiple treatment methods including pharmacotherapy, pelvic floor muscle training, electrostimulation, or surgery. One of the nonpharmacological treatment options is physiotherapy including pelvic floor muscle training. The patient was a 25 year-old woman who attended the urogynecological physiotherapy consulting room due to frequent sensations of bladder pressure. Manual inspection and ultrasound imaging was used by the physiotherapist in order to assess the function of pelvic and abominal structures. The patient reported pain symptoms during examination of several pelvic floor and abdominal muscles. The patient was judged eligible for urogynecological physiotherapeutic treatment. Manual therapy of the lumbopelvic hip complex, manual therapy per vaginum, manual therapy of the musculus piriformis, and therapy of the superficial back line myofascial meridian and the lateral line myofascial meridian were used. During the final session, the patient reported an improvement in relation to the symptoms presented, most notably no frequent feeling of bladder pressure. Treatment of OAB is often a multistage process involving application of different therapies by a multidisciplinary team. For this patient, physiotherapy assessment and intervention were an integral part of the conservative management of OAB. [ABSTRACT FROM AUTHOR]

Functional neurological disorder (FND) in children and adolescents involves the biological embedding of lived experience in the body and brain. This embedding culminates in stress-system activation or dysregulation and in aberrant changes in neural network function. In pediatric neurology clinics, FND represents up to one-fifth of patients. Current research shows good outcomes with prompt diagnosis and treatment using a biopsychosocial, stepped-care approach. At present, however--and worldwide--FND services are scarce, the result of long-standing stigma and ingrained belief that patients with FND do not suffer from a real ("organic") disorder and that they therefore do not require, or even deserve, treatment. Since 1994, the Mind-Body Program for children and adolescents with FND at The Children's Hospital at Westmead in Sydney, Australia--run by a consultation-liaison team--has delivered inpatient care to hundreds of patients with FND and outpatient care to hundreds of others. For less-disabled patients, the program enables community-based clinicians to implement biopsychosocial interventions locally by providing a positive diagnosis (by a neurologist or pediatrician), a biopsychosocial assessment and formulation (by clinicians from the consultation-liaison team), a physical therapy assessment, and clinical support (from the consultation-liaison team and the physiotherapist). In this Perspective we describe the elements of a biopsychosocial mind-body program intervention capable of providing, as needed, effective treatment to children and adolescents with FND.Our aimis to communicate to clinicians and institutions around the world what is needed to establish effective community treatment programs, as well as hospital inpatient and outpatient interventions, in their own health care settings. [ABSTRACT FROM AUTHOR]

Stroke is a leading cause of long-term disability in adults in the United States. As the healthcare system moves further into an era of digital medicine and remote monitoring, technology continues to play an increasingly important role in post-stroke care. In this Analysis and Perspective article, opportunities for using human pose estimation—an emerging technology that uses artificial intelligence to track human movement kinematics from simple videos recorded using household devices (e.g., smartphones, tablets)—to improve motor assessment and rehabilitation after stroke are discussed. The focus is on the potential of two key applications: (1) improving access to quantitative, objective motor assessment and (2) advancing telerehabilitation for persons post-stroke. [ABSTRACT FROM AUTHOR]

Introduction: Gait is a major function of independence that determines the quality of life, participation, and restriction. Gait assessment in physical therapy practice is fundamental for assessing musculoskeletal conditions. This study planned to determine the extent and barriers of using gait assessment tools by physical therapists in clinical practice in Saudi Arabia. Method: A cross-sectional design was used. A standardized survey was sent through e-mail and social media to physical therapists working in hospitals, clinics, and rehabilitation centers in different Saudi Arabian regions. Results: A total of 320 physical therapists from different regions in Saudi Arabia participated. There was a significant relationship between using gait assessment tools by physical therapists and patient groups (p = 0.002), receiving training (p = 0.001), dealing with patients who suffer from gait problems (p = 0.001), and visiting the gait laboratory (p = 0.001). Physical therapists' use of gait assessment tools for musculoskeletal conditions in clinical practice in Saudi Arabia was limited. The primary barrier preventing physical therapists from using gait assessment methods in clinical practice was a lack of resources, including instruments, space, time, and funds. [ABSTRACT FROM AUTHOR]

Symptom modification techniques have been recently dichotomously labeled as either passive or active therapies. Active therapy such as exercise has been rightfully advocated for while "passive" therapies, mainly manual therapy have been regarded as low value within the physical therapy treatment spectrum. In sporting environments where physical activity and exercise are inherent to the athletic experience, the utilization of exercise-only strategies to manage pain and injury can be challenging when considering the demands and qualities of a sporting career which include chronically high internal and external workloads. Participation may be impacted by pain and its influence on related factors such as training and competition performance, career length, financial earning potential, educational opportunity, social pressures, influence of family, friends, and other key stakeholders of their athletic activity. Though highly polarizing viewpoints regarding different therapies create black and white "sides," a pragmatic gray area regarding manual therapy exists in which proper clinical reasoning can serve to improve athlete pain and injury management. This gray area includes both historic positive reported short-term outcomes and negative historical biomechanical underpinnings that have created unfounded dogma and inappropriate overutilization. Applying symptom modification strategies to safely allow the continuation of sport and exercise requires critical thinking utilizing not only the evidence-base, but also the multi-factorial nature of sports participation and pain management. Given the risks associated with pharmacological pain management, the cost of passive modalities like biophysical agents (electrical stimulation, photobiomodulation, ultrasound, etc), and the indications from the evidence-base when combined with active therapies, manual therapy can be a safe and effective treatment strategy to keep athletes active. [ABSTRACT FROM AUTHOR]

Background Recently, researchers have commented that shoulder special tests cannot identify the structure causing rotator cuff symptoms and should only be considered pain provocation tests. Others have disagreed, reporting that special tests were able to accurately detect the presence of rotator cuff involvement. Purpose The purpose of this study was to determine the knowledge, use, and perceived effectiveness of 15 selected special tests utilized to examine patients with possible rotator cuff dysfunction. Study Design Descriptive study using survey. Methods An electronic survey was returned by 346 members of the Academies of Orthopedic and Sports Physical Therapy through list serves. Descriptions and pictures for 15 special tests of the shoulder were included in the survey. Information regarding years of clinical experience and American Board of Physical Therapy Specialties (ABPTS) specialist certification in Sports or Orthopedics was collected. Respondents were asked if they could identify and use the special tests to evaluate dysfunction of the rotator cuff - and how confident they were in ability of the tests to diagnose dysfunction of the rotator cuff. Results The four tests most readily known by respondents included the empty can, drop arm, full can, and Gerber's tests, and the four tests used regularly by the respondents included the infraspinatus, full can, supraspinatus, and champagne toast tests. The infraspinatus, champagne toast, external rotation lag (ERLS), and the belly-off tests were found to be the be most useful for establishing a diagnosis of the muscle-tendon complex involved. Years of experience and clinical specialization was not relevant to knowledge or use or these tests. Conclusions This study will allow clinicians and educators to understand which special tests are easily identified, regularly used, and perceived as helpful for the diagnosis of muscles involved in a rotator cuff dysfunction. Level of Evidence 3b [ABSTRACT FROM AUTHOR]