Defining minimum workforce standards for intensive care physiotherapy in Australia and New Zealand: A Dephi study.

BACKGROUND: Intensive care staffing guidelines provide recommendations for the safe and effective delivery of health care while recognising professional requirements of the workforce. To guide recommendations for physiotherapy staffing guidelines, profession-specific consultation is needed. OBJECTIVES: The objective of this study was to develop consensus-based recommendations for minimum workforce standards for physiotherapy in intensive care. METHODS: A Delphi survey process was conducted involving physiotherapists from Australia and New Zealand. RESULTS: The panel consisted of 65 physiotherapists in the first round and 60 in the second round (92% retention). Respondents were from both Australia (49, 76%) and New Zealand (16, 24%) who had been physiotherapists for an average of 18.8 ± 9.0 years and were primarily senior intensive care physiotherapists (44, 68%). Respondents had experience across level 3 (50, 77%), level 2 (18, 28%), and level 1 (5, 8%) adult intensive care units (ICUs), adult high-dependency units (27, 42%), and paediatric intensive care (6, 9%). A total of 42 statements were presented, with 37 reaching consensus after two rounds. After two rounds, consensus was achieved for a minimum staffing ratio in paediatric ICUs of one physiotherapist per six (1:6) beds. For adult ICUs, use of the median value of the participant's responses was supported to establish minimum staffing ratios of 1:8, 1:7, 1:6, and 1:8 for levels 1, 2, and 3 ICUs and high-dependency units, respectively. The requirement for an additional allocation for senior physiotherapist staffing for each ICU level was also established. Statements that also gained consensus included recommendations for access to on-call and weekend services for all ICU settings and the consideration of evening shifts specifically for level 3 and paediatric ICUs. CONCLUSIONS: Recommendations for minimum staffing for physiotherapy in intensive care settings were achieved and supported requirements for clinical service delivery, supervision, and training.

Physiotherapy rehabilitation experiences of people with shoulder dislocation in ARTISAN study: a qualitative study.

BACKGROUND: Acute Rehabilitation following Traumatic anterior shoulder dISlocAtioN (ARTISAN) was a large trial comparing the clinical and cost-effectiveness of two rehabilitation interventions in adults with a first-time traumatic shoulder dislocation. Participants were allocated to receive either a single session of advice (ARTISAN) or a single session of advice and a programme of physiotherapy (ARTISAN plus). Trial results illustrated that additional physiotherapy after an initial session was not superior in improving functional outcomes for participants. OBJECTIVES: In this study, we aim to explore the experiences of a purposive sample of participants from both the ARTISAN and ARTISAN plus groups regarding their rehabilitation journey. DESIGN: This is a semistructured interview-based study. SETTING: The study was conducted in the United Kingdom. PARTICIPANTS: Thirty-one participants of ARTISAN trial: 16 participants from ARTISAN group and 15 from ARTISAN plus group. OUTCOME MEASURES AND ANALYSIS: The study follows the consolidated criteria for reporting qualitative research. The framework analysis was used to synthesise the participants' experiences. The interviews were coded through NVivo 12.6.1. RESULTS: Three dominant and interrelated topics emerged from the interview data: (1) feelings about their shoulder rehabilitation outcome, (2) judgement of ARTISAN rehabilitation materials, (3) assessment of shoulder rehabilitation service provision. CONCLUSION: Both forms of intervention have some merit for some individuals. Thus, it may be appropriate to look at the patients' preference for offering treatment to them. Recognising and facilitating this will be of benefit to both the patients and healthcare as a whole.

Effects of dry needling on vertical jump performance in female volleyball players. A randomized controlled trial.

Introduction: Injury prevention and performance enhancement are paramount goals in sports. Myofascial Pain Syndrome, primarily caused by myofascial trigger points, can result in referred pain, stiffness, muscle shortening, and weakness. This study aimed to assess the impact of dry needling (DN) on latent myofascial trigger points on vertical jump performance in female volleyball players. Methods: A single-blind, randomized controlled clinical trial was conducted with twenty-six healthy female volleyball players who had no lower limb injuries in the last six months, exhibited latent trigger points in the triceps surae muscles, and were familiar with the countermovement jump test. Participants were randomly assigned to either a control group or an experimental group (which received a single DN session). Vertical jump performance variables, including jump height as the primary outcome, were assessed using a force platform at five time points: before the intervention, immediately post-treatment, 24 h post-treatment, 72 h post-treatment, and one-week post-intervention. Results: The experimental group showed significantly lower values for vertical jump height, flight time, velocity, strength, and power immediately after the needling intervention (p < 0.05). However, these values were significantly higher one-week post-intervention across all variables (p < 0.01). These findings indicate that DN initially decreases jumping performance, but improvements are observed one week after the intervention. In the comparison between groups, the experimental group exhibited higher values at the one-week follow-up for vertical jump height, flight time, speed, and power compared to the control group (p < 0.05). Conclusions: DN appears to be an effective technique for improving vertical jump performance in female volleyball players one week after its application. Clinical Trial Registration: ClinicalTrials.gov, identifier (NCT06184672).

"I feel more confident": a mixed methods evaluation of the influence of Good Life with osteoarthritis Denmark (GLA:D®) on physical activity participation, capability, barriers, and facilitators in people with knee osteoarthritis.

BACKGROUND: A mixed methods study which aimed to evaluate the influence of Good Life with osteoArthritis Denmark (GLA:D®) on physical activity participation, including perceived capability, barriers, and facilitators in people with knee osteoarthritis. OBJECTIVE: Quantify changes in physical activity participation at 3- and 12-months for people with knee osteoarthritis who participated in an education and exercise-therapy program (GLA:D®). METHODS: A mixed-methods study involving 44 participants with knee osteoarthritis who completed GLA:D®. Guided by the Theoretical Domains Framework, 19 were interviewed, with transcripts analysed using reflexive thematic analysis. University of California Los Angeles physical activity scores were dichotomised as 'more' (≥7) or 'less' active (≤6), and compared between baseline and 3- and 12-months using McNemar's test. Motivation and confidence to exercise (0-10 scale); fear of knee joint damage with exercise (yes/no); and Knee Osteoarthritis Outcome Scores (KOOS) were evaluated. RESULTS: Four overarching themes were identified: prior to GLA:D® 1) fear of knee joint damage, and scarcity of exercise and physical activity information prior to GLA:D®; and following GLA:D® 2) varied exercise-therapy and physical activity participation; 3) facilitators including reduced fear of knee damage, increased confidence, routine, strategies, and support; and 4) ongoing barriers including persistent knee pain, comorbidities, cost, and lack of opportunity and motivation. There was no difference in the proportion of 'more' active participants between baseline (41%) and at 3-months (37%, p = 0.774) or 12-months (35%, p = 0.375). The proportion with fear of damage reduced from baseline (50%) to 3-months (5%) and 12-months (21%). Self-reported motivation (9.1/10) and confidence (9.1/10) to exercise at 3-months were high, and all KOOS subscales improved from baseline to 3-months (effect sizes = 0.41-0.58) and 12-months (effect sizes = 0.29-0.66). CONCLUSION: Varied and often inadequate physical activity participation following GLA:D® indicates more targeted interventions to address ongoing barriers may be required.

Predictive Factors for Outcomes Following Surgical Treatment of Lumbar Disc Herniation.

BACKGROUND: Lumbar disc herniation (LDH) is a common cause of radicular pain with an annual incidence between 5 and 20 cases per 1000 adults. LDH is typically treated by microdiscectomy, of which more than 300,000 are performed in the United States each year. Despite this frequency, 25% to 33% of patients report poor surgical outcomes. This study sought to present a retrospective analysis of patients who underwent microdiscectomy surgery for the treatment of LDH with the aim of identifying demographic, historical, and surgical factors that may contribute to inadequate surgical results. METHODS: A retrospective study of 241 patients at Stony Brook Medicine from 2017 to 2022 was performed, 123 of whom had follow-up of 90 days or more and were included for final analysis. Data collection included demographics, medical/surgical history, and surgical methodology. Good outcomes were defined as meeting the absolute point change threshold (ACT)-3.5pt reduction in pain reported by the Numerical Rating System (NRS) or the resolution of either radicular pain or neurological symptoms. RESULTS: Univariate analysis revealed that 100% of patients with prior fusion surgery (P = 0.039) and 73.2% who underwent preoperative physical therapy (PT; P = 0.032) failed to meet the ACT. Additionally, 79.1% (P = 0.021) and 82.8% (P = 0.026) of patients who had PT had residual radicular pain and neurological symptoms, respectively. Multivariate logistic regression confirmed correlations between preoperative PT and failure to meet the ACT (P = 0.030, OR = 0.252) and resolution of radicular (P = 0.006, OR = 0.196) and neurological (P = 0.030, OR = 0.177) complaints. ACT directly correlated with higher preoperative NRS scores in univariate (P = 0.0002) and multivariate (P = 0.002, OR = 1.554) analyses. CONCLUSION: Our results show that higher preoperative NRS scores, PT, and prior fusion surgery are associated with poorer outcomes. While PT is considered a viable nonoperative treatment for LDH, our findings suggest detrimental effects when preceding surgery, indicating the need for additional research into the effects of PT on patients with high grade LDH.

Promotion of sports, exercise and physical activity participation during postoperative interventions for adolescent idiopathic scoliosis: protocol for an international e-Delphi study.

INTRODUCTION: Adolescent idiopathic scoliosis (AIS) is present in 2%-3% of those under 18 years old and has a significant impact on pain, function and quality of life. Up to 10% of adolescents with AIS progress to spinal fusion surgery, and of those individuals many experience reduced musculoskeletal function and do not return to sports postoperatively. Physiotherapists have a significant role in promoting participation and offering a graded return to sports, exercise and physical activity. However, there is a lack of evidence and variability between surgeons and physiotherapists worldwide regarding rehabilitation milestones and return to exercise, sports and physical activity. This study aims to reach a consensus on when it is safe and how an individual might begin a graded return to sports, exercise and physical activity. METHODS AND ANALYSIS: This protocol was written in accordance with the Guidance on Conducting and REporting DElphi Studies (CREDES) guidelines. An international expert sample of surgeons and physiotherapists in AIS will be recruited. This electronic Delphi is anticipated to consist of three iterative rounds. Round 1 will be a series of open-ended questions examining rehabilitation milestones and return to sports, exercise and physical activity postoperatively. Round 2 will commence with a summary of the existing literature for participants to review. Rounds 2 and 3 will involve a collated summary of results from the previous round, including any dissonance. During rounds 2 and 3, participants will be asked to privately rate responses on a 5-point Likert scale. The study steering group and patient and public involvement representative have been involved from conceptualisation and will continue to be involved until final dissemination. ETHICS AND DISSEMINATION: Full ethical approval has been provided by the University of Birmingham, reference number: ERN_1617-Nov2023. Dissemination will take place through conference presentation and peer-reviewed publications.

The IntegraPark Study: An Opportunity to Facilitate High-Intensity Exercise with Immersive Virtual Reality in Parkinson's Disease Patients.

BACKGROUND: high-intensity exercise is a feasible and effective modality in the early stages of Parkinson's disease (PD). However, there are only a few studies that have carried out this type of intervention in customizable immersive virtual reality (IVR) environments. We explore the feasibility and effects of IVR-based high-intensity training through rowing and cycling exercises on the functional capacity, quality of life, and progression of PD. METHODS: a total of 12 participants (61.50 ± 10.49 years old; 41.7% female, 58.3% male; stages I-III) were part of the study, which consisted of interventions of rowing and cycling in an IVR commercial exergame (25 min; twice per week for 14 weeks). The main variables measured were functional capacity, handgrip strength, functional mobility (TUG), functional lower-limb strength (FTSST), aerobic capacity (2-min step test), quality of life (PDQ-39), and Parkinson's disease progression (MDS-UPDRS). RESULTS: the results showed a general improvement in handgrip strength in both hands (p = 0.008; d = 0.28), FTSST (p = 0.029; d = 0.96), and TUG times (p = 0.152; d = 0.22). Aerobic capacity, assessed by a 2-min step test, showed enhanced scores (p = 0.031; d = 0.78). Related to the PDQ-39, all dimensions of the scale were enhanced, highlighting activities of daily living (p = 0.047; d = 0.29) and bodily discomfort (p = 0.041; d = 0.37). Finally, the main symptoms of the disease were reduced, with an improvement in the parameters that show a better incidence of disease progression, such as Part IA and IB (p = 0.013; d = 0.29 and p = 0.021; d = 0.25, respectively), Part II (p = 0.021; d = 0.23), Part III (p = 0.040; d = 0.39), and Part IV (p = 0.013; d = 0.39). CONCLUSIONS: the therapeutic exercise (rowing and cycling), when carried out at a high intensity and in a personalized IVR scenario, appear to be a feasible and safe modality for patients with stages I-III of PD, improving their functional capacity, quality of life, and disease progression.

Effects of hippotherapy on motor function of children with cerebral palsy: a systematic review study.

Cerebral palsy includes a spectrum of neurodevelopmental disorders caused by brain damage, leading to impairment of movement, posture, and balance for a lifetime. There are many therapeutic interventions for cerebral palsy. One of them is hippotherapy, an alternative physical therapy. It is a type of equine-assisted activity and therapy where children with cerebral palsy and motor function skills interact with a horse. We aimed to study the effects of hippotherapy, as an alternative therapy, on the motor function of children with cerebral palsy. We performed a review of the latest literature on hippotherapy and cerebral palsy. The criteria we used were specific keywords, publication date, age of the subjects/studied population, and article type. The outcome of our research resulted in ten relevant studies. The findings demonstrate improvements in various aspects of motor function - more specifically in gross motor function skills, balance, coordination, gait parameters, and muscle strength. Two of ten studies used the Horse-Riding Simulator with significant improvements in postural control in sitting, motor function, and hip abduction range of motion. Hippotherapy can improve motor function skills of children between 2 and 14 years of age with cerebral palsy, affecting their well-being and overall quality of life. It can have a positive effect either as a standalone treatment or as a part of other traditional therapies. Extended research is needed to assess whether hippotherapy may present significant long-term changes in motor skills in children with cerebral palsy.

Long-Term Prognosis and Influencing Factors of Chinese Adolescents With Temporomandibular Disorder After Physical Therapy.

BACKGROUND: Physical therapy is the preferred conservative treatment for patients with temporomandibular disorder (TMD). However, few studies have investigated the application of physical therapy in adolescents, especially follow-up studies on the long-term prognosis of these patients. This study investigated the short-term effects and long-term prognosis of physical therapy in adolescent patients with TMD and the factors influencing long-term symptoms. METHODS: Information regarding baseline data, specific treatment methods, treatment times and evaluation results was collected retrospectively for adolescent patients with TMD who received physical therapy. Patients were followed up via telephone and online questionnaires, and the influence of age, sex, disease course, mouth opening, pain intensity, oral parafunctional habits and treatment methods on long-term symptoms was analysed. RESULTS: Pain intensity, maximum mouth opening and the joint noise score improved significantly in 270/286 patients who received individualised comprehensive physical therapy. TMD-related symptoms improved with no noticeable impact on daily life in 187/199 patients who were followed up for an extended period (average, 30.71 ± 10.86 months) and were divided into asymptomatic or symptomatic groups according to the persistence of symptoms. Logistic regression analysis revealed that uncorrected oral parafunctional habits and fewer treatments were related to long-term symptoms. CONCLUSION: The long-term prognosis of adolescent patients with TMD after physical therapy was satisfactory. However, 52.8% of the patients experienced persistent TMD-related symptoms for an extended period, possibly due to insufficient treatment times and parafunctional habits. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT05781607.

Critical Appraisal of Clinical Trials Evaluating Physical Therapy Treatments for Temporomandibular Disorders: A Scoping Review.

BACKGROUND: Physical therapy seems the most promising treatment for temporomandibular disorders (TMD), although their effectiveness is controversial in general, due to high heterogeneity regarding study designs, applied treatments and outcomes measures. OBJECTIVES: The aim of this scoping review is to analyse the methodological characteristics of clinical trials evaluating physical therapy treatments in subjects with TMD. METHODS: A systematic search was conducted in Medline/PubMed, SPORTDiscus, Scopus, Web of Science, SciELO, Cochrane, ScienceDirect and EMBASE databases on 31 October 2023. Clinical trials evaluating physical therapy interventions in patients older than 18 years with TMD, published in English or Spanish languages. Data regarding content reporting of study designs, sample characteristics, interventions and outcome measures was extracted. Descriptive summary statistics were reported. RESULTS: The search retrieved 15 322 records, and 136 were included. There were 107 randomised clinical trials, 5 non-randomised controlled trials and 24 non-controlled trials. Most studies had moderate to high risk of bias, small sample sizes (median, 44 subjects) and short follow-up periods (1-3 months). The most common diagnostic criteria used was the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) (48.9%). The most reported experimental interventions were manual therapy (40.4%), exercise (30.2%) and electrotherapy modalities (27.2%), and the most common outcome measure domains were pain (83.8%), range of movement (61.8%), disability (45.6%) and mechanosensitivity (29.4%). There was poor content reporting of experimental interventions. CONCLUSIONS: Current literature of clinical trials of physical therapy interventions for TMD has moderate to high risk of bias, poor content reporting, small sample size and short-term follow-ups which limit internal and external validity, as well as applicability into clinical practice.

Umbrella Review of Primary Care Treatments for Adults With Chronic Low Back Pain.

OBJECTIVES: The purpose of this study was to identify, critically assess, and summarize evidence of the effectiveness of primary care treatments for adults with non-specific chronic low back pain (NSCLBP). METHODS: We conducted an umbrella review of systematic reviews focusing on primary care treatments for NSCLBP. We searched the PubMed and Cochrane library databases for systematic reviews of randomized controlled trials (RCTs) evaluating primary care treatments for adults with NSCLBP published between January 2007 and March 2021. Two reviewers independently assessed the quality of these systematic reviews using the AMSTAR checklist. We selected systematic reviews with a low or moderate risk of bias and graded the evidence based on Grading of GRADE criteria. RESULTS: Among the initial 66 systematic reviews meeting our inclusion criteria, 19 systematic reviews with low or moderate bias risk were selected for analysis. These reviews included a total of 365 studies involving 62 832 participants. The evidence suggested moderate to high support for the effectiveness of certain primary care treatments in improving pain and function in NSCLBP patients. These treatments included NSAIDs and opioids compared to placebos, spinal manipulation versus exercise/physical therapy, and MBR versus exercise/education/advice/no treatment. CONCLUSIONS: Recommendations for specific primary care treatments for NSCLBP in adults remain inconclusive. Further high-quality systematic reviews and RCTs are needed to better understand the effectiveness of these treatments. Future RCTs should prioritize the assessment of NSAIDs, opioids, spinal manipulation, and MBR, as they appear promising for improving NSCLBP outcomes in certain comparisons.

Appropriateness of Prior Authorization Requirements for Total Shoulder Arthroplasty: A Systematic Review.

INTRODUCTION: Total shoulder arthroplasty (TSA) has become increasingly utilized for managing glenohumeral osteoarthritis (GHOA), with procedure rates expected to rise. Consequently, there has been a surge in prior authorization (PA) requests for TSA, imposing a substantial administrative burden and highlighting the need for physician advocates to challenge the current PA system. A notable PA requirement is preoperative physical therapy (PT), a treatment modality for GHOA that has not been extensively studied and is not endorsed by the American Academy of Orthopedic Surgery (AAOS) as necessary for the treatment for GHOA. METHODS: We conducted a systematic literature search using PubMed, Embase, and Medline, adhering to PRISMA guidelines. Our search focused on studies with level IV evidence or higher that examined the efficacy preoperative PT for patients with GHOA. RESULTS: We found 210 studies of which three met our inclusion criteria. Our results were mixed, with two of the three studies supporting the use of preoperative PT. Only one study employed a randomized controlled trial (RCT) design, underscoring the need for more high-quality studies in this area. DISCUSSION/CONCLUSION: Our findings suggest that there is limited evidence for the benefit of preoperative PT in GHOA. This contradicts the current PA requirements which require patients to undergo preoperative PT to receive coverage for treatment. This review highlights the need for physician engagement in advocacy efforts to challenge these current requirements and improve patient care.

Effects of moderate physical activity on diabetic adhesive capsulitis: a randomized clinical trial.

Background: Moderate physical activity (MPA) has proven advantages for glycemic control, cardiovascular health, and functional independence. However, physical activity is not part of routine conventional physical therapy (CPT) in managing diabetic adhesive capsulitis patients. Objective: To determine the effects of moderate MPA on diabetic adhesive capsulitis (AC). Methodology: A randomized control trial was conducted at the Combined Military Hospital (CMH), Muzaffarabad, Pakistan from March 2022 to October 2022. A total of n = 44 patients with diabetic AC, aged 40 to 65 years, HbA1c > 6.5% were enrolled. Group A received MPA and CPT, while Group B only received CPT for six weeks. The upper extremity function, pain, and range of motion were assessed at baseline, third week, and sixth week through the disability of arm, shoulder, and hand (DASH) questionnaire, numeric pain rating scale (NPRSS), and goniometer respectively. Results: The NPRS score and ROMs showed significant improvement (p < 0.05) in group A compared to group B with a large effect size. When comparing the mean difference of the DASH score (73 + 7.21 vs. 57.9 + 12.64, p < 0.001, Cohen's d = 1.46) was significantly improved with large effect size in group A as compared to group B. Conclusion: MPA along with CPT has positive effects on patient pain, range of motion, and disability in patients with diabetic adhesive capsulitis.

Prosthetic Rehabilitation for a Patient With Purpura Fulminans Undergoing Quadruple Amputation: A Case Report.

Purpura fulminans (PF) is a rare and life-threatening syndrome characterized by cutaneous purpura resulting from disseminated intravascular coagulation (DIC) and intravascular thrombosis. PF typically develops as a severe complication of infections and is associated with high mortality rates. Effective treatment involves early recognition, aggressive resuscitation, appropriate antibiotic therapy, and the correction of coagulation abnormalities. Nevertheless, despite effective treatment, patients often ultimately require amputation of the affected limbs. This case report details the rehabilitation process of a patient with PF who underwent quadruple amputation. The patient, a 48-year-old male, underwent quadruple amputation due to PF. After intensive care, he was admitted to a convalescent rehabilitation ward for prosthetic rehabilitation. The rehabilitation process combined physical and occupational therapy to facilitate independent living through the use of upper and lower limb prostheses and assistive devices. The patient presented with ulcerative lesions on the anterior surfaces of both knee joints upon admission. During treatment, he developed osteomyelitis of the right patella, which required intravenous antibiotics and limited rehabilitation to bed-based exercises. Following the administration of intravenous therapy, the prosthetist proceeded with the fabrication of lower limb prostheses. Subsequently, the patient was able to commence standing and gait training, and by the time of discharge, he was able to walk without a cane. Upper limb prostheses enabled independence in activities of daily living (ADLs) such as eating, dressing, and toileting. He was also able to perform cooking-related activities that are part of the instrumental activities of daily living (IADLs). This case highlights the importance and achievable outcomes of rehabilitation for patients with PF who have undergone quadruple amputation. A multidisciplinary approach utilizing both upper and lower limb prostheses, as well as assistive devices, enabled significant functional recovery.

The Effects of Running Foot Strike Manipulation on Pelvic Floor Muscle Activity in Healthy Nulliparous Females.

Vertical loading rate (VLR) and pelvic floor muscle activity (PFA) increase with running velocity, which may indicate a relationship between VLR and PFA. Foot strike pattern has been shown to influence VLR while running, but little is known about its influence on PFA. Twenty healthy women ran on a treadmill for 2 conditions: with a rearfoot strike and with a forefoot strike. PFA was measured with electromyography. Running kinematics associated with VLR were collected using inertial measurement units and tibial accelerometers. Change scores between conditions were calculated for average PFA and running kinematics: peak vertical tibial acceleration, vertical excursion of the center of mass (VO), and cadence. Paired t tests assessed differences between running conditions for all variables. Pearson correlations assessed the relationships between changes in PFA and running kinematics. PFA was significantly higher during the forefoot compared with the rearfoot strike condition. Change in vertical tibial acceleration was positively correlated with change in PFA during the right stance. Change in cadence was negatively correlated, and change in vertical excursion of the center of mass was positively correlated with change in PFA during left stance. The average PFA increased during the forefoot strike pattern condition. Changes in PFA were correlated with changes in running kinematics associated with VLR.

Frozen shoulder: subjects' needs and perspectives and clinicians' beliefs and management strategies: do they align? A cross-sectional study.

OBJECTIVE: Physiotherapists (PTs) play a crucial role in managing individuals with Frozen Shoulder (FS), frequently being the first healthcare professionals involved in the treatment of this condition. AIM: This study aimed to compare the beliefs, expectations, and perspectives of individuals with FS with the knowledge, skills, and strategies of PTs, highlighting similarities and differences. METHOD: This study adhered to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). From May 1st to August 1st, 2023, a two-part survey was conducted involving PTs and individuals diagnosed with FS. The survey focused on comparing key areas such as clinical assessment, patient education, treatment expectations, and the psychological aspects of the patient-clinician relationship. RESULTS: A total of 501 PTs and 110 subjects with FS participated in the survey. Most PTs showed proficiency in FS pathoanatomical conditions and were also attentive to psychological aspects (88.4%), describing the pathology evolution in three or two stages (68.2%). They also highlighted the importance of patient education (89.6%) and recognized the potential benefits of a multiprofessional collaboration in managing FS (82.2%). Reassurance was reported as a priority by 32.3% of PTs. Subjects with FS expressed a preference for PTs who are both expert and empathetic (73.6%). Regarding their understanding of FS, 29.09% of subjects reported receiving a three-phase explanation, while 26.36% felt inadequately informed. Nearly half of the subjects (49.09%) anticipated being managed independently by a PT, with 93.64% prioritizing the improvement of their range of motion. CONCLUSION: This study revealed a general agreement between subjects with FS and PTs regarding aspects of the therapeutic relationship, patient education, pathology management, compliance and motivation strategies, and pain management preferences. However, significant differences emerged concerning the perception of physiotherapy effectiveness, primary treatment goals, subjects' priorities, and the importance of psychological assessment.

Combined Treatment of Face-to-Face Physical Therapy and Telerehabilitation in Workers with Whiplash Syndrome.

Objective: Interventions through telerehabilitation have shown positive effects in various clinical conditions, facilitating the return to work of the working population. This study aimed to compare conventional, center-based physiotherapy versus an intervention combining home- and center-based treatment for whiplash syndrome in workers enrolled in a mutual insurance company, evaluating differences in the number of face-to-face sessions and the duration of sickness absence. The secondary aim was to assess the acceptability and usability of the telerehabilitation intervention. Methods: The study population (n = 387) comprised workers aged 16 to 65 years who required physiotherapy due to whiplash (ICD-9 847.0). The main outcome variable was the number of face-to-face sessions. The duration of sickness absence was also calculated. A survey was also conducted to determine patient acceptance and usability of the platform. The analyses were adjusted for sex, age, occupation, and the center where the physiotherapy treatment was administered. Results: The number of face-to-face physiotherapy sessions dropped significantly, from 9 to 7, due to the implementation of telerehabilitation. This decrease was not associated with a longer duration of sickness absence. The difference in the median duration of sickness absence between patients who had not undergone telerehabilitation and those who had undergone telerehabilitation was -1 [95% CI= (-6 to 2)]. Conclusion: Telerehabilitation reduces the number of face-to-face physiotherapy sessions needed, which can reduce the care burden in physiotherapy centers and avoid the need for patients to travel (with a corresponding reduction in transportation costs), without increasing the duration of sickness absence.

Benefits of inspiratory muscle training therapy in institutionalized adult people with cerebral palsy: A double-blind randomized controlled trial.

BACKGROUND: Respiratory health problems are one of the main causes of morbidity and mortality in adult people with cerebral palsy (CP). The influence of respiratory muscle training has not yet been studied in this population group. The objective of the study was to evaluate and compare the efficacy of two protocols with inspiratory muscle training (IMT), low intensity and high intensity, to improve respiratory strength and pulmonary function in adults with CP. METHODS: The study was a controlled, randomized, double-blind trial with allocation concealment. Twenty-seven institutionalized CP patients were recruited and randomly distributed in the high-intensity training group (HIT) or low-intensity training group (LIT). Over 8 weeks, an IMT protocol was followed 5 days/week, 10 series of 1 min with 1 min rest between them. HIT trained with a load of 40% of the maximum inspiratory pressure (MIP) and LIT with 20%. Respiratory strength and pulmonary function were evaluated. RESULTS: After IMT intervention, MIP, maximum expiratory pressure, forced expiratory volume in 1 s (FEV1) and peak expiratory flow increased in both groups; in HIT 29%, 19%, 13%, and 8%, respectively (p = 0.000, p = 0.000, p = 0.002, p = 0.001) and in LIT 17%, 7%, 3%, and 4%, respectively (p = 0.000, p = 0.000, p = 0.049, p = 0.113). All the improvements were significantly higher in HIT than in LIT. CONCLUSION: Inspiratory muscle training improved respiratory muscle strength and pulmonary function in adults with CP. Training with a 40% MIP load improved all the evaluated parameters and was the most effective treatment for adults with CP.

Rehabilitation and Return to Sports after Achilles Tendon Repair.

Rehabilitation protocols post-Achilles tendon repair vary widely, particularly regarding weight bearing (WB) and immobilization duration, impacting recovery trajectories significantly. This commentary focuses on rehabilitation strategies following acute Achilles tendon repair (ATR), emphasizing early mobilization and progressive loading. Techniques such as blood flow restriction training (BFRT) and progressive loading to restore strength and tendon mechanical properties are discussed in the context of optimizing recovery, minimizing tendon elongation and facilitating safe return to sport (RTS). This manuscript highlights current evidence and clinical insights to guide practitioners in optimizing rehabilitation protocols for athletes recovering from ATR, aiming to improve functional outcomes and support safe return to athletic activity.

High-quality research on physical therapy in psoriatic arthritis is needed: a systematic review.

Objectives: Although physical therapy is recommended as part of the non-pharmacological management of patients with psoriatic arthritis (PsA), the evidence is still unclear. Therefore, this study aimed to systematically review and appraise the quality of research on physical therapy in the management of patients with PsA. Methods: In June 2024, a systematic literature search using four different databases (Medline, Embase, Web of Science and the Cochrane Library) was performed to include interventional and observational studies examining physical therapy in patients with PsA (PROSPERO ID 255501). A risk of bias assessment was conducted. Due to the wide variety of interventions and outcomes, a narrative synthesis was used. Results: Of 9442 abstracts, 15 papers examining physical therapy uptake in clinical practice (N = 2) and different physical therapy interventions (N = 13) were included: cardiorespiratory exercises (N = 5), resistance exercises (N = 2), therapeutic modalities (N = 4) and mixed rehabilitation programs (N = 2). A low risk of bias was scored in only one RCT assessing cardiorespiratory exercises. The well-tolerated 11-week high-intensity interval training resulted in a long-term increase in peak oxygen uptake and a short-term decrease in truncal fat percentage in patients with low disease activity. Resistance training in patients with active disease did not increase muscle strength, but improved functional capacity, disease activity, pain and general health after the intervention. Evidence for other modalities was inconclusive. Conclusion: High-quality evidence on physical therapy in PsA was scarce. Cardiorespiratory and resistance exercises demonstrated promising results to positively influence cardiometabolic risk as well as disease-related outcomes. Future research on physical therapy in PsA with adequate methodological quality is needed.