Physical Therapy

Garbin, Alexander J; Tran, Melissa K; Graber, Jeremy; Derlein, Danielle; Currier, Deborah; Altic, Rebecca; Will, Robert; Cumbler, Ethan; Forster, Jeri E; Mangione, Kathleen K; Stevens-Lapsley, Jennifer E

doi: 10.1093/ptj/pzae173pmid: 39704301

ObjectiveThe optimal approach for improving physical function following acute hospitalization is unknown. A recent clinical trial of home health physical therapy compared a high-intensity, progressive, multi-component (PMC) intervention to enhanced usual care (EUC). While both groups improved in physical function, no between-group differences were observed. However, the EUC group received care that differed from real world practice due to standardized treatments and a higher frequency of visits. This study compared a non-randomized true usual care (TUC) group to the EUC and PMC groups.MethodsParticipants in the parent trial were randomly assigned to the EUC group (n = 100) and PMC group (n = 100) following hospital discharge. A subset of eligible patients (n = 55) were concurrently enrolled in the TUC group. Both the PMC and EUC groups received strength, activities of daily living, and gait training that differed in intensity but were matched in frequency and duration. TUC group care was determined by the home health agency. The primary outcome at 60-days was the Short Physical Performance Battery (SPPB).ResultsIn comparison to the TUC group, the EUC and PMC groups had significantly greater improvements in SPPB score (EUC: +1.04 points [CI = 0.18–1.90]; PMC: +1.12 points [CI = 0.23–2.00]).ConclusionWhile participants in the EUC and PMC groups experienced greater functional recovery compared to those in the TUC group, it cannot be determined whether these differences are due to the interventions received or confounding factors associated with the addition of a third, non-randomized, study group during the trial period.ImpactThis study illustrates the importance of design and interpretation of control groups for clinical trials. Further, the differences between the TUC group and the enhanced intervention groups warrant future research exploring whether increasing visits and standardizing care improve function in older adults receiving home health physical therapy after hospital associated deconditioning.Lay summaryParticipants in the intervention groups received standardized and more therapy than usual care, and experienced greater functional improvements. However, these differences may be due to factors associated with the addition of a non-randomized group during an ongoing clinical trial.

doi: 10.1093/ptj/pzae163pmid: 39692075

Fuentes-Aparicio, Laura; Pérez-Alenda, Sofia; Carrasco, Juan J; Valls-Donderis, Begoña; Dueñas, Lirios; Balasch-Bernat, Mercè

doi: 10.1093/ptj/pzae141pmid: 39385454

ObjectiveThe purpose of this study was to evaluate the differences between primiparous and multiparous women at 6 months postpartum and nulliparous women regarding the thickness (including thickness pattern) and contractile function of the abdominal and lumbar muscles.MethodsA cross-sectional observational study of 80 women, both primiparous (n = 29) and multiparous (n = 25), as well as including nulliparous as a comparison group (n = 26), was conducted. B-mode ultrasound imaging was used for the measurement of abdominal and lumbar muscle thickness in two conditions (resting and activation). Moreover, the contractile function of these muscles was determined by the thickness ratio.ResultsSignificant differences between groups were observed in abdominal muscle thickness. During activation, the obliques showed a lower thickness in both groups of postpartum women compared to nulliparous women, while lower values for the thickness for the transverse abdominis (TrA) were only observed in primiparous women. The thickness pattern observed in nulliparous women both in resting and in activation (internal oblique [IO] > external oblique [EO] > TrA) was also achieved among postpartum women, despite no statistical differences observed between IO and EO in these groups. No significant differences between groups were observed for contractile function, showing the TrA greater values, followed by IO and EO in both nulliparous and postpartum women.ConclusionsThis study suggests that the thickness (and the thickness pattern) of the abdominal muscles in women at 6 months postpartum differs from nulliparous, while for the lumbar muscles, it is comparable to nulliparous. However, despite the obliques being thinner in postpartum women, the abdominal muscles are functionally competent.ImpactThis is believed to be the first study to compare abdominal and lumbar muscles thickness and contractile function specifically between primiparous and multiparous women. Although at 6 months’ postpartum abdominal thickness differs from nulliparous women, these muscles are functionally competent. These findings provide valuable insights for use in the development of postpartum interventions.

Deutsch, Judith E

doi: 10.1093/ptj/pzae156pmid: 39696814

Judith E. Deutsch, PT, PhD, FAPTA, the 55th McMillan Lecturer, is professor and director of the Research in Virtual Environments and Rehabilitation Sciences (Rivers) Lab in the Doctoral Programs in Physical Therapy in the School of Health Professions at Rutgers University. Her current research includes the development and testing of virtual reality, serious games to improve mobility and fitness of individuals with neurologic health conditions, and knowledge translation to strengthen evidence-based practice. Her research has been funded by the National Institutes of Health, the National Science Foundation, and the American Hospital Association. She also has longstanding interest and scholarship in integrating complementary therapies into physical therapy. Dr Deutsch has been recognized with awards for teaching, research, mentoring, service and publications from the American Physical Therapy Association (APTA), Academy of Neurologic Physical Therapy, the New Jersey chapter of APTA, the International Society for Virtual Rehabilitation, the Kessler Institute for Rehabilitation, the University of Southern California, and Rutgers University.

Casanovas-Álvarez, Anabel; Estanyol, Blanca; Ciendones, Magda; Padròs, Josep; Cuartero, Jordi; Barnadas, Agustí; García-Valdecasas, Bárbara; González-Colom, Rubèn; Sebio-García, Raquel; Masià, Jaume

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Green, Karlyn J; North, Rebecca; DeVore, Adam D; Green, Samantha; Poole, Ashley K

doi: 10.1093/ptj/pzae135pmid: 39255365

ObjectiveThe resiliency of patients who have advanced heart failure (HF) and undergo a physical stressor such as heart transplantation or left ventricular assist device implantation has yet to be studied in the physical, cognitive, and psychosocial domains. The primary aim of this pilot study was to assess the feasibility of a multidomain resiliency assessment in patients who have advanced HF and require surgery.MethodsA battery of assessments in each of the domains was completed at baseline before surgical intervention, after intensive care discharge, and 3 and 6 months after surgery. Feasibility was assessed through completion rates, time required to complete the assessments, and qualitative feedback from assessors.ResultsAlthough various completion rates were noted at different time points, high completion rates were seen for grip strength, the modified Fried frailty phenotype, and the Montreal Cognitive Assessment. Additionally, when controlled for patients who were medically restricted from physical function, the Short Physical Performance Battery, gait speed, and the 30-second chair stand test also had high completion rates. A trend toward return to baseline status or an improvement in baseline status was observed in all physical and cognitive assessments and most psychosocial assessments at 3 and 6 months. Minimal change was noted in the Brief Resilience Scale questionnaire.ConclusionThis pilot study demonstrates that a multidomain assessment of resiliency is feasible in patients with advanced HF. Future studies are needed to help determine specific assessments or patient factors that would help predict positive postsurgical outcomes in this population.ImpactThis study has implications for clinical practice on the most feasible assessments in multiple domains for patients who have advanced HF and are being evaluated for heart transplantation or left ventricular assist device.

doi: 10.1093/ptj/pzae165pmid: 39704491

Prosser, Laura A; Paremski, Athylia C; Skorup, Julie; Alcott, Morgan; Pierce, Samuel R

doi: 10.1093/ptj/pzae125pmid: 39223953

ObjectivePhysical therapists routinely deliver and prescribe motor practice to improve function. The ability to select optimal practice regimens is limited by a current lack of detail in the measurement of motor practice. The objective of this study was to quantify the type, amount, and timing of gross motor practice during physical therapist sessions.MethodsA secondary video coding analysis of physical therapist sessions from the iMOVE clinical trial (NCT02340026) in young children with cerebral palsy (CP) was conducted. The 37 children who completed the treatment phase were included (mean age = 22.1 months). Children could initiate pulling to stand but were unable to walk. Videos of randomly selected therapy sessions were coded for gross motor activity (422 videos total). The 10 gross motor activity codes included lying, sitting, four point, crawling, kneeling, knee walking, standing, walking, transitions between floor postures, and transitions to/from an upright posture. Twenty percent of each video was double coded for reliability. Time per session, number of bouts, and median time per bout were calculated for each gross motor activity and for 2 aggregate measures: movement time and upright time.ResultsParticipants spent more than half of therapy time in sitting and standing combined (60.3%). Transitions occurred more frequently than any other motor activity (49.3 total transitions per session). Movement time accounted for 16.3% of therapy time. Upright time accounted for 53.3% of therapy time.ConclusionsCritical practice time to gain motor skill is not equivalent to chronological time or time spent in therapy. Toddlers with CP spent a small amount of therapy time moving. Future work should explore the relations between motor practice and rehabilitation outcomes.ImpactPhysical therapists are ideally suited to detail the content of motor practice and ultimately to prescribe optimal patterns of motor practice. We report the characteristics of gross motor practice during therapy in children with CP.

Sharp, Amanda; Bilyeu, Catherine; Wengrovius, Carissa; Myers, Katherine

doi: 10.1093/ptj/pzae138pmid: 39283624

ObjectiveA competency framework for clinical teaching in physical therapy was established in a recent study. Validation of competency frameworks requires multiple steps, including consideration of end-user perceptions of value and utility. The purpose of this study was to further validate the Clinical Teaching Competency Framework by gathering input specifically from clinical education faculty.MethodsThis study used an explanatory sequential mixed-methods approach to seek input from clinical instructors (CIs) and site coordinators of clinical education (SCCE) from diverse practice areas and geographic regions. A survey invited participation from active clinical education faculty, and survey respondents were invited to participate in a focus group. Two focus groups were held via Zoom.ResultsSurvey responses from those holding roles of CI (59.3%), SCCE (11.3%), and CI/SCCE (29.4%) indicated support for the competency framework, including perceived value to their role (93.1%) and improvement in the quality of clinical education (94.1%). Concern regarding the ease of utilization of the framework was indicated by 24% of respondents. There were no statistically significant differences in responses based on role or credentials. The focus groups resulted in an overarching theme of collective impact, with 4 subthemes: assessment, CI development, implementation, and guidelines.ConclusionClinical education faculty perceive value and utility in the Clinical Teaching Competency Framework. Implementation of the framework should be collaborative and consistent across academic and clinical education programs.ImpactThis study moves the profession one step closer to the use of a competency framework specifically targeted at clinical teaching in physical therapy. Clinical education faculty will be primary users of a competency framework, and buy-in from this user group is key to implementation. Continued efforts to validate this framework contribute to addressing the need for CI development and support in delivering excellence in clinical education.

Thiveos, Lena; Kent, Peter; Pocovi, Natasha C; O’Sullivan, Peter; Hancock, Mark J

doi: 10.1093/ptj/pzae128pmid: 39236249

ObjectiveThe objective was to investigate the effectiveness of cognitive functional therapy (CFT) in the management of people with chronic nonspecific low back pain (LBP) and explore the variability in available trials to understand the factors which may affect the effectiveness of the intervention.MethodsA systematic review with meta-analyses was conducted. Four databases were searched from inception to October 12, 2023. Randomized controlled trials investigating CFT compared with any control group in patients with nonspecific LBP were included. Mean difference and 95% CIs were calculated for pain, disability, and pain self-efficacy. Certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation approach.ResultsSeven trials were included. Low to moderate certainty of evidence was found that CFT was effective for disability at short, medium, and long term time points compared with alternate treatments, including usual care. Low to moderate certainty of evidence was found that CFT is effective for pain in the short and medium terms and probably in the long term. There was high certainty evidence CFT was effective in increasing pain self-efficacy in the medium and long terms. A single study found CFT was cost-effective compared with usual care. Variability was found in the training and implementation of CFT across the included trials, which may contribute to some heterogeneity in the results.ConclusionThe results show promise in the use of CFT as an intervention likely to effectively manage disability, pain, and self-efficacy in people with chronic nonspecific LBP. The number of clinicians trained, their experience, and quality of training (including competency assessment) may be important in achieving optimal effectiveness.ImpactThis is the most comprehensive review of CFT to date and included investigation of between-trial differences. CFT is a promising intervention for chronic LBP and high-quality synthesis of evidence of its effectiveness is important for its clinical application.