Archives of Physiotherapy

Mim-pong: a serious game for assessment and treatment of the lower limb in hemiparetic stroke patients

2025-03-25T08:19:53+00:00

Introduction: The motor impairment evidenced post-stroke results in limitations to performing activities of daily living (ADL), especially when it involves locomotion. The Serious Games (SG) are an interesting therapeutic option, as they allow the performance of exercises according to stroke treatment guidelines. However, there is little research exploring the evaluation potential of SG. This study aimed to evaluate the possible metric properties of the mim-pong SG in addition to the therapeutic effects.

Methods: Twenty-four hemiparetic stroke patients were divided into two non-randomized groups: the experimental group (EG) (n = 16) and the control group (CG) (n = 8). Participants were evaluated in terms of motor impairment (lower limb), muscle strength (MS), motor control, and functional mobility.

Results: The significant correlations observed between the score generated by the SG and clinical variables in both groups are highlighted, especially with MS (rho = 0.62-0.66; p = 0.000, and rho = 0.67-0.71; p = 0.002-0.005, for the experimental and CGs, respectively) and motor function of the lower limb for the EG (rho = 0.41, p = 0.018). In addition, the results indicated improvements in all variables in the EG, with superiority over the CG.

Conclusions: This study showed that the mim-pong serious game could be considered a potential resource for the assessment and treatment of hemiparetic stroke patients.

The Use of Digital Technologies in Physiotherapy Higher Education: a Mixed-Methods Study

2025-03-10T15:34:08+00:00

Background: Previous studies demonstrated that digital tools can be effectively integrated into physiotherapy higher education. However, their adoption remains limited. This study aimed to 1) evaluate the perceived knowledge, confidence, and frequency of digital technology use among Italian lecturers and 2) explore lecturers’ experiences with digital technology in higher education.

Methods: We performed a convergent mixed-method study using an online survey instrument for Italian physiotherapy lectures. We employed a 5-point Likert to evaluate perceived knowledge, confidence, and frequency of digital technology use, with consensus defined as an agreement of ≥70% on a statement. An optional qualitative section explored lecturers’ experiences with technology, which we analyzed using Reflexive Thematic Analysis.

Results: Between June and September 2023, 118 lecturers (mean age: 45 ± 11; 69% female, n = 81) completed the survey. Participants expressed confidence in utilizing digital tools such as videoconferencing (95%), online repositories (88%), and communication apps (78%). On average, 32% reported using technologies “often” or “always.” In the qualitative section, completed by 77 participants, we generated three themes: 1) “Technology can promote a constructive educational approach”; 2) “Action of technologies on students’ learning process,” with mixed results on their impact; and 3) “Technology is not within everyone’s reach,” due to barriers to its implementation in didactics. Qualitative and quantitative findings confirmed one another, allowing for a deeper understanding of digital technologies among Italian physiotherapy lecturers.

Conclusions: Our findings indicate that digital tools are still underutilized among Italian physiotherapy lecturers. The main barriers include inadequate infrastructure and a lack of digital competencies.

Scaling new heights: a pilot study of the impact of climbing on balance, agility, and dexterity in individuals with Parkinson’s disease

2025-03-04T09:25:26+00:00

Introduction: Exercise benefits individuals with Parkinson’s disease (PD). Rock climbing includes exercise characteristics from clinical guidelines (e.g., aerobic, resistance, balance training, cued-movements, community-based) and offers unique somatosensory and visuospatial experiences that may aid motor learning. This study examined climbing’s effects on PD physical function.
Methods: This quasi-experimental observational pilot study used pre-to-post-test comparisons to assess participants with mild to moderate PD (Hoehn and Yahr 1-3) who walked independently. The intervention included 12 weeks of community-based, twice-weekly top-rope climbing under one-on-one supervision, tailored to skill level. Wall angles, hand/foot holds, and routes varied and became progressively more difficult as skills increased. The primary outcome was the Community Balance & Mobility Scale (CBMS); secondary measures included the Agility T-Test (ATT), 9-Hole Peg Test (9HPT), upper extremity reaction time using BlazePods (UE-React), and grip strength.
Results: 28 participants completed the study: 8 women/20 men; mean age = 66.1 (sd = 7.4) years; average disease duration = 4.0 (sd = 3.6) years. Paired t-tests comparing pre- and post-test scores and effect sizes (ES) with 95% confidence intervals (CI) were calculated for significant results using Hedge’s g. Findings were: CBMS (p < 0.001; ES = 0.573, 95% CI = 0.178-0.960), ATT (p < 0.001; ES = 0.462, 95% CI = 0.078-0.838), 9HPT (p < 0.001; ES = 0.480, 95% CI = 0.094-0.858), UE-React (p <0.001; ES = 0.329, 95% CI = −0.045-0.696); GS changes were non-significant.
Conclusions: Rock climbing demonstrated medium-size effects on mobility/balance and small-size effects on agility and dexterity that could impact functioning in everyday activities.

Comparisons of the effects of psychologically-informed and usual physiotherapy on pain sensitivity in chronic low back pain: an exploratory randomized controlled trial

2025-02-17T14:42:43+00:00

Introduction: The presence of altered central pain processing and modulation, as well as negative psychological factors, have been suggested to impede recovery in chronic low back pain (CLBP). Psychologically-informed physiotherapy (PiP) aims to specifically address the latter factors—in addition to physical factors—to improve treatment effects. This study aims to determine if the effect of PiP is superior to usual physiotherapy (UP) on pain sensitivity and modulation in participants with CLBP and if changes in these variables were associated with changes in clinical outcomes.

Methods: Forty participants with CLBP were randomly allocated to PiP or UP. Seven physiotherapy sessions over 6 weeks plus a booster session at an 11-week follow-up were delivered. Pressure pain threshold (PPT), temporal summation of pain (TSP), and exercise-induced hypoalgesia were assessed on lumbar, upper, and lower limb sites at baseline and after 6 weeks. Linear mixed models tested if PiP was superior to UP on pain sensitivity/modulation. Linear regressions tested if pain sensitivity/modulation changes were associated with changes in clinical outcomes (pain intensity, physical functioning, symptoms of central sensitization).

Results: PiP was not superior to UP to modulate pain sensitivity/modulation variables. All PPTs increased after 6 weeks regardless of the approach. Lumbar PPT and lumbar and lower limb TSP changes were associated with physical functioning changes.

Conclusion: Although our study suggests that neither approach has a superiority to impact on pain sensitivity, both approaches elicited widespread hypoalgesia. Future powered trials should verify if pain sensitivity can be a mediator of physical functioning improvement, as suggested by our results.

Perceived bioethical issues in cancer rehabilitation: a qualitative study among Italian physiotherapists

2025-02-13T13:42:00+00:00

Introduction: Literature on bioethics in physiotherapy, particularly in cancer management, is limited. This study explores the perceived bioethical issues in cancer rehabilitation by Italian physiotherapists.

Participants: Thirty-one physiotherapists (Age: 42 ± 10.5 years; 20 women, 11 men) with expertise in cancer rehabilitation were purposefully selected.

Data Collection: Six online focus groups were conducted, guided by a focus group guide based on existing literature and refined by experts in cancer rehabilitation and bioethics.

Data Analysis: Sessions were recorded, transcribed, and analyzed using Braun and Clarke’s ‘Reflexive Thematic Analysis’.

Results: Four primary themes emerged: 1) Challenges of (Non)-Disclosure in Diagnosis and Prognosis – ethical difficulties around withholding diagnosis or prognosis information; 2) Balancing Hope and Realism in Patient and Caregiver Expectations – navigating hope versus realistic rehabilitation goals; 3) Weighing Efficacy and Safety in Cancer Rehabilitation – balancing treatment outcomes with patient safety; 4) Decisions on Withdrawing Treatment – ethical considerations in discontinuing treatment.

Discussion: These themes highlight common ethical dilemmas faced by physiotherapists in cancer rehabilitation, mirroring broader healthcare challenges. Addressing them requires a nuanced understanding of ethical principles within the cancer rehabilitation context.

Conclusions: The study provides insights into the bioethical issues in cancer rehabilitation, stressing the need for a patient-centered approach to navigate these challenges effectively.

Discriminative ability, responsiveness, and interpretability of smoothness index of gait in people with multiple sclerosis

2025-02-04T08:15:29+00:00

Introduction: Gait impairments are common in People with Multiple Sclerosis (PwMS). Several studies have examined the clinometric properties of Inertial Measurement Units (IMUs), with LDLJa identified as a robust metric for gait smoothness. However, its responsiveness and interpretability have not been explored.

Methods: This cross-sectional study at IRCCS Santa Lucia Hospital enrolled 44 PwMS (age: 28-71; EDSS: 0-6) and 43 age- and gait-speed-matched healthy participants (HP). Two physiotherapists conducted assessments with five synchronized IMUs during a 10-meter walk at participants’ preferred speed. Data were collected at baseline (T0) and after 4 weeks of training (T1).

Results: Significant differences in log dimensionless jerk (LDLJa) were found between PwMS and HP in the AP (p < 0.001, d = 0.63), ML (p < 0.001, d = 1.08), and CC (p = 0.03, d = 0.68) directions. PwMS had lower LDLJaAP values (< -4.88) and LDLJaML values (< -5.40) with probabilities of 63% and 76%, respectively. ΔLDLJaML demonstrated good responsiveness to rehabilitation (AUC ~0.80), with improvements >4.02% representing the optimal MCID for clinical improvement in MiniBesTest.

Conclusion: Lower LDLJa values in the AP and ML directions characterize gait smoothness impairment in PwMS. LDLJa in the ML direction is responsive to balance-focused rehabilitation, highlighting its potential for tracking gait disorders and rehabilitation progress.

Coronavirus Disease 2019 (COVID-19) and pelvic floor signs and symptoms: a scoping review of the literature

2025-01-30T10:42:13+00:00

Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic presents a substantial global health challenge. While the disease is known to impact multiple systems, leading to long-term consequences that require monitoring and rehabilitation, its effects on the pelvic floor remain unclear.
Methods:We conducted a scoping review following the Arksey and O’Malley framework. A systematic search was performed in PubMed, CINAHL, and Embase databases up to March 19, 2024, to identify studies examining pelvic floor-related signs and symptoms in COVID-19 patients. Two reviewers independently extracted study and participant characteristics, areas involved (e.g., anorectal, sexual, urogenital), and signs and symptoms using an ad-hoc data extraction form. Signs and symptoms were classified as direct (e.g., directly impacting the pelvic floor) or indirect (e.g., indirectly affecting it with potential long-term consequences).
Results: We included 104 studies, primarily a systematic review (N = 40; 38.46%) and focused on adult populations (N = 80; 76.92%), investigating 140 signs and symptoms from various regions worldwide. Most (N = 124; 88.57%) were indirect signs and symptoms, while the minority were direct (N = 16; 11.43%). The most prevalent indirect symptom was diarrhea (n = 81; 70,43%) in the anorectal bowel area (n = 115). The most prevalent direct were lower urinary tract symptoms (LUTS) (n = 16; 84.21%) in the urogenital area (n = 19).
Conclusion: This study highlights the significant prevalence of both direct and indirect pelvic floor symptoms in COVID-19 patients. Clinicians should be aware of the potential link between COVID-19 and pelvic floor dysfunction.