Reducing sick leave, improving work ability, and quality of life in patients with mild to moderate Long COVID through psychosocial, physiotherapeutic, and nutritive supportive digital intervention (MiLoCoDaS): study protocol for a randomized controlled trial.

BACKGROUND: Following SARS-CoV-2 infection, a relevant proportion of patients suffer from persistent or recurring sequela, even after initially mild primary illness. Many patients experience exhaustion and fatigue, rendering them incapable of working. Long COVID exerts a substantial burden on society and the healthcare system: at least 65 million people are currently affected worldwide. The underlying pathobiology is a complex derangement in several organ systems. To date, causal pharmaceutical therapies remain elusive. Waiting lists for specialist care are long. Rapidly scalable digital interventions offering support for the frequent subgroup of patients with mild to moderate impairment from Long COVID are urgently needed. The MiLoCoDaS study compares three intensities of a potentially rapidly scalable digital intervention aiming to accelerate recovery. The overall objective is to figure out if there is a difference in the effect sizes between these modalities. METHODS: The online intervention uses a learning platform (LMS, TYPO3 framework) comprising 12 sessions of medical, psychological, physiotherapeutic, and nutritional content. The three modalities differ as follows: patient information only (sham intervention, control), information plus interactive digital workbook including practical exercises (digital intervention), and the digital workbook augmented by once-weekly online seminars and discussion groups (person and peer-contact). Eligible patients are 18-67 years old satisfying Long COVID diagnostic criteria. Patients are recruited through primary care physicians and randomly allocated. The primary endpoint is the number of sick leave days during the 6-month observation period; secondary endpoints are patient-reported symptoms, quality of life, and work ability. The study size provides a power of 80% at a type I error of < 0.05 to show an effect size of Cohen = 0.3 between the augmented and the sham intervention (N = 152 per arm, total accounting for attrition N = 600). DISCUSSION: If one of the two interventions is superior to providing information alone, MiLoCoDaS would provide the starting point for a rapidly scalable digital intervention for the frequent and currently underserved patient group with mild to moderate impairment from Long COVID. Several caveats pertain to the heterogeneity of Long COVID manifestation and duration prior to inclusion. It is conceivable that the possible effect of the intervention may differ across subgroups. Therefore, a priori defined secondary analysis will be conducted. TRIAL REGISTRATION: German Clinical Trials Register (DRKS) DRKS00028964. Registered on 24 August 2022.

The Stepping Threshold Test for Reactive Balance: Validation of Two Observer-Based Evaluation Strategies to Assess Stepping Behavior in Fall-Prone Older Adults.

Introduction: Measurement of reactive balance is critical for fall prevention but is severely underrepresented in the clinical setting due to the lack of valid assessments. The Stepping Threshold Test (STT) is a newly developed instrumented test for reactive balance on a movable platform, however, it has not yet been validated for fall-prone older adults. Furthermore, different schemes of observer-based evaluation seem possible. The aim of this study was to investigate validity with respect to fall risk, interpretability, and feasibility of the STT using two different evaluation strategies. Methods: This study involved 71 fall-prone older adults (aged ≥ 65) who underwent progressively increasing perturbations in four directions for the STT. Single and multiple-step thresholds for each perturbation direction were determined via two observer-based evaluation schemes, which are the 1) consideration of all steps (all-step-count evaluation, ACE) and 2) consideration of those steps that extend the base of support in the direction of perturbation (direction-sensitive evaluation, DSE). Established balance measures including global (Brief Balance Evaluations Systems Test, BriefBEST), proactive (Timed Up and Go, TUG), and static balance (8-level balance scale, 8LBS), as well as fear of falling (Short Falls Efficacy Scale-International, FES-I) and fall occurrence in the past year, served as reference measurements. Results: The sum scores of STT correlated moderately with the BriefBEST (ACE: r = 0.413; DSE: r = 0.388) and TUG (ACE: r = -0.379; DSE: r = -0.435) and low with the 8LBS (ACE: r = 0.173; DSE: r = 0.246) and Short FES-I (ACE: r = -0.108; DSE: r = -0.104). The sum scores did not distinguish between fallers and non-fallers. No floor/ceiling effects occurred for the STT sum score, but these effects occurred for specific STT thresholds for both ACE (mean floor effect = 13.04%, SD = 19.35%; mean ceiling effect = 4.29%, SD = 7.75%) and DSE (mean floor effect = 7.86%, SD = 15.23%; mean ceiling effect = 21.07%, SD = 26.08). No severe adverse events occurred. Discussion: Correlations between the STT and other balance tests were in the expected magnitude, indicating convergent validity. However, the STT could not distinguish between fallers and non-fallers, referring to a need for further studies and prospective surveys of falls to validate the STT. Current results did not allow a definitive judgment on the advantage of using ACE or DSE. Study results represented a step toward a reactive balance assessment application in a clinical setting.

Evidence-based practice in physical therapy in Austria: current state and factors associated with EBP engagement.

RATIONALE, AIMS AND OBJECTIVES: Research examining the use of evidence-based practice (EBP) in physical therapy in many countries has revealed positive attitudes, varying degrees of EBP use and barriers at practitioner, patient and organizational levels. In contrast to these countries, Austria does not have an academic or research tradition in physical therapy. Engagement in EBP in countries such as Austria is unknown. The objectives of the study were to describe the current state of EBP engagement and identify factors associated with EBP engagement among Austrian physical therapists (PTs). METHODS: A cross-sectional online survey was conducted. Existing questionnaires and the theory of planned behaviour guided questionnaire development. Face and content validity and ease of use of the questionnaire were evaluated in pilot tests. Item-level response frequencies and percentages were determined. Simple and multiple regressions were used to identify factors associated with EBP engagement. RESULTS: The final sample size was 588 (response rate: 17.5%). Ten percent of participants fully agreed that they regularly use guidelines and standardized assessment tools in clinical practice. While 49.9% reported not using electronic databases for literature searching, 41.9% reported reading research articles 2-5 times per month. Most frequently cited barriers to EBP engagement were lack of scientific skills, lack of time and insufficient organizational support. Research awareness, attitude, behavioural control, involvement in research and degree level were final correlates of EBP engagement. CONCLUSION: Austrian PTs show a low level of engagement in EBP. Initiatives to advance EBP in Austria and other countries with no academic or research tradition should primarily target practitioner-level factors.

[Potential analysis for research on physiotherapy-led treadmill training in Parkinson's disease]. / Potenzialanalyse zur physiotherapeutischen Laufbandtherapie bei Morbus Parkinson.

HEALTH PROBLEM: Parkinson's disease is one of the major neurodegenerative disorders with prevalence rates between 0.1 and 0.2 % in the global population and 1.8 % in people aged 64 years and over. Future incidence rates are estimated to increase within aging societies. The progressive course of Parkinson's disease is clinically characterised by bradykinesia, rigidity and tremor. These limitations in motor functioning reduce the capacity to work, social participation and the clients' quality of life. Parkinson's disease causes incapacity to work and a large number of days off from work. The benefits clients expect from physiotherapy-led treatment include an improvement of gait, a better speed of motion and the decrease of fatigue and rigidity. CORPUS OF EVIDENCE: A recent Cochrane review (Mehrholz et al., 2010) analysed seven randomised comparisons with 153 participants and found that treadmill training compared with no treatment improved gait speed (SMD 0.50; 95 % confidence interval [0.17 to 0.84]). A lack of evidence exists on how to reduce fatigue and rigidity. There is also need to evaluate long-term effects and cost-effectiveness. Furthermore, an updated meta-analysis should include eleven new randomised trials on treadmill training after 2009. Physiotherapy-led treadmill training can easily be transferred into the German healthcare context since the environmental and educational preconditions are met by German physiotherapeutic care. IMPLICATION FOR RESEARCH: Within the German context, there is need to prepare a randomised clinical trial evaluating the impact of physiotherapy-led treadmill training on motor functioning, quality of life, costs, adverse events und long-term effects. Prior to this, a feasibility study should explore the acceptance and intensity of treadmill training as well as the access of private physiotherapy practices to people suffering from early- to mid-stage Parkinson's disease.

The effect of prophylactic ankle support during simulated soccer activity.

OBJECTIVE: Ankle injuries are common in soccer and may result in ongoing functional deficiency. Ankle-joint prophylactic support is hypothesized to reduce the risk of injury. Analysis of the effects of prophylactic support has so far lacked application to soccer. Therefore, the purpose of this study was to illustrate the effects of tape and brace on selected proprioceptive components and range of motion (ROM) before, after, and during a soccer-match-simulation protocol. DESIGN AND SETTING: A crossover study design was used to investigate plantarflexion (PF) ROM, inversion (INV) ROM, and joint-position sense (weight bearing and non-weight-bearing [NWBJPS]; ± error) in tape, brace, and control conditions. Measures were gathered from the dominant leg in a biomechanics laboratory at 0, 15, 30, and 45 min of a soccer-specific aerobic field test 90-min (SAFT90) protocol. PARTICIPANTS: Eight healthy male subjects (age 20.5 ± 0.5 y) experienced the 3 conditions in random order with 7 d between conditions. INTERVENTION: The tape condition used an open basket-weave technique; the brace was an AirCast AirSport brace. For the control condition no prophylactic support was applied. RESULTS: Application of prophylactic support significantly decreased active ROM in PF and INV (P < .05), with tape performing better than the brace (0 min). Tape lost its restrictive benefits by 15 min (P < .001) and was no different than control, while the brace maintained some effect until 45 min. Application of prophylactic support increased NWBJPS performance (P < .01; 0 min); by 15 min the tape had lost its proprioceptive benefit (P < .01) compared with the brace. CONCLUSIONS: Our findings suggest that the clinical usefulness of ankle-joint prophylactic support is limited if the aim is to restrict ROM and improve proprioceptive capability under soccer-specific conditions. The relative benefits of each type of support need to be considered in the context of the time-specific nature of the activity.

The influence of ankle taping on changes in postural stability during soccer-specific activity.

CONTEXT: Postural stability diminishes with longer activity, which may increase the risk of injury. Tape can increase stability, but this effect diminishes after exercise. OBJECTIVE: To investigate the influence of ankle taping on postural stability during soccer-specific activity. PARTICIPANTS: 10 male, injury-free, semiprofessional soccer players. INTERVENTION: A 45-min treadmill protocol replicating the activity profile of soccer match play--with and without ankle tape. Postural stability was assessed every 7.5 min, requiring response to sudden ankle plantar flexion and inversion during single-leg stance. MAIN OUTCOME MEASURE: Reaction time to perturbation and center-of-gravity (CoG) displacement. RESULTS: Reaction time was significantly longer (P < .05) with longer exercise for both movements and conditions. No significant effect was evident in CoG displacement. For both outcome measures a nonsignificant benefit of taping was observed during the first 22.5 min of activity. CONCLUSION: Prolonged exposure to soccer-specific activity negates any beneficial effect of taping in improving postural stability.