Archives of Physiotherapy

Does the modified shuttle test exhibit a ceiling effect in healthy and cystic fibrosis children and adolescents?

Marta Amor-Barbosa — 2024-12-18

Introduction: The modified shuttle test-15 (MST-15) is a valid alternative for assessing exercise capacity when a cardiopulmonary exercise testing is not feasible. This study aims to describe the percentage of healthy and cystic fibrosis (CF) children and adolescents reaching the MST-15 ceiling. Additionally, it examines associations between MST-15 distance and demographic, anthropometric, and lung function data.

Methods: This retrospective cross-sectional study involved 286 healthy volunteers (11.5 ± 3.3 years) and 70 CF patients (11.9 ± 4.4 years). Data on age, gender, weight, height, body mass index, lung function, and MST-15 were collected. The ceiling effect was determined by the absolute and relative number of participants reaching the 15th level. Univariate linear regression and correlation analyses were conducted to explore associations with MST-15 distance.

Results: A ceiling effect for the MST-15 was found in 19 healthy participants (6.6%) and 1 CF patient (1.4%). The ceiling effect was correlated with age (r = 0.777 for healthy; r = 0.538 for CF), with no cases under 10 years and reaching 25% in healthy participants aged 17-19. Regression analysis showed significant associations between age and MST-15 distance in healthy participants (β = 53.6) and CF patients (β = 32.1). Additionally, sex was significantly associated with MST-15 distance in healthy participants (β = 107.0), and FEV₁ with MST-15 distance in CF patients (β = 31.0).

Conclusions: The ceiling effect on the MST-15 is age-dependent, with no occurrences observed in children under 10 years and a gradual increase in incidence as participants age.

Perspectives, perceptions, and expectations of subjects with frozen shoulder: a web-based Italian survey

Fabrizio Brindisino — 2024-12-09

Introduction: Frozen shoulder (FS) is a musculoskeletal disorder affecting the glenohumeral joint. This condition leads to disability and a worsening in quality of life. Despite its considerable impact on patients and its economic burden, research on the psychological and social implications of FS—as well as patients’ perspectives and needs—is limited. This study aims to explore the perspectives, perceptions, and expectations of individuals suffering from FS, providing a comprehensive understanding of their experiences and needs.

Methods: A cross-sectional observational study was conducted following STROBE guidelines. A 59-question survey was administered to Italian individuals diagnosed with FS from April 1 to July 1, 2023.

Results: All 110 participants completed the survey. Most preferred an experienced and empathetic physiotherapist (73.64%) and relied primarily on physiotherapy (49.09%) for FS management. Additionally, 45.45% were open to a multidisciplinary approach. Subjects reported reducing night pain (71.82%) and achieving full range of motion (ROM) recovery (70.91%) as their top priorities. Participants reported a notable shift in their mood from “pre” to “post” FS, with many experiencing fear and catastrophizing thoughts and perceiving a lack of social support. Furthermore, 27.27% were open to cortisone use, while 25.45% considered electrophysical agents beneficial for managing the painful phase of FS.

Conclusion: These results underscore a strong preference for empathetic physiotherapists and the value of a multidisciplinary approach. Addressing night pain and restoring ROM are crucial priorities—emphasizing the need for tailored and shared decision-making. Additionally, these findings highlight the importance of addressing psychological well-being alongside physical symptoms.

The Italian version of the Postural Assessment Scale for Stroke Patients (PASS): transcultural translation and validation

Elena Lora — 2024-12-03

Introduction: The Postural Assessment Scale for Stroke Patients (PASS) is commonly used by health professionals in Italy in several different translations. This study aimed to provide a validated version in Italian. The main focus is on the evaluator, to guarantee a uniform application and interpretation of the statements and scoring for each item in the Italian context.

Methods: A standardized protocol was used for the translation and cross-cultural adaptation. A pilot study conducted using the first draft of the scale led to a revised version, PASS-IT. A principal component analysis (PCA) was performed. The correlation with the Trunk Control Test (TCT) was examined for concurrent validity. In addition, the relationship with the Barthel Index (BI) and the Functional Ambulation Categories (FAC) was tested. Patients with recent stroke were tested for intra-rater (N = 49) and inter-rater agreement (N = 30). Cronbach’s alpha, item-to-total correlation, corrected inter-item correlation, the intraclass correlation coefficient (ICC), and measurement error were used to evaluate internal consistency and intra-/inter-rater reliability.

Results: The PCA showed a two-dimensional structure, with high reliability in both subsections (“non-weight-bearing” α = 0.865; “weight-bearing” α = 0.949). A strong correlation (ρ > 0.80) was found with the TCT, the BI, and the FAC. The PASS-IT showed high internal consistency, intra-rater (ICC = 0.942) and inter-rater reliability (ICC = 0.940).

Conclusions: The PASS-IT is a recommended scale, suitable for clinical practice and research in the acute and subacute stage. The introduction of operating instructions resulted in the uniform application. A different order of the items allows faster administration, reducing changes of posture.

Indoor and outdoor 10-Meter Walk Test and Timed Up and Go in patients after total hip arthroplasty: a reliability and comparative study

Federico Temporiti — 2024-11-04

Introduction: The 10-Meter Walk Test (10MWT) and Timed Up and Go (TUG) are valid tools for gait performance and mobility assessment after total hip arthroplasty (THA). The study aimed to assess test-retest reliability of 10MWT and TUG in indoor and outdoor environments in patients in acute phase after THA and compare their indoor vs. outdoor performance during these tests.

Methods: Thirty-five inpatients performed 10MWT and TUG in indoor and outdoor settings on the second postoperative day. An additional evaluation session was performed after 1 hour under the supervision of the same operator. Test-retest reliability was assessed using Intraclass Correlation Coefficient (ICC: 2.1) and Minimal Detectable Change (MDC₉₅), while paired t-tests were used to compare indoor vs. outdoor performance.

Results: Indoor (ICC: 0.94, MDC₉₅: 0.13 m/s) and outdoor (ICC: 0.91, MDC₉₅: 0.16 m/s) 10MWT at maximum speed and indoor (ICC: 0.92, MDC₉₅: 2.5 s) and outdoor (ICC: 0.93, MDC₉₅: 2.4 s) TUG revealed excellent reliability. Indoor (ICC: 0.86, MDC₉₅: 0.16 m/s) and outdoor (ICC: 0.89, MDC₉₅: 0.16 m/s) 10MWT at spontaneous speed revealed good reliability. Spontaneous (mean difference [MD]: 0.05 m/s, 95% confidence interval [CI₉₅]: 0.03, 0.07, p < 0.001) and maximum (MD: 0.02 m/s, CI₉₅: 0.01, 0.04, p < 0.001) 10MWT revealed higher gait speed when performed outdoors compared to indoors.

Conclusions: Indoor and outdoor 10MWT and TUG are reliable tests in acute phase after THA. Higher gait speed during outdoor 10MWT may depend on test score variability, due to MDs being lower than MDC₉₅.

Intra- and inter-rater reliability of goniometric finger range of motion using a written protocol

Takuya Nakai — 2024-10-08

Introduction: Goniometric finger range of motion (ROM) is the most common outcome measure used for functional evaluation of finger joints, but its reliability is not well-evaluated. This study aimed to investigate intra- and inter-rater reliability of goniometric finger ROM using a written protocol for active, passive, and composite movements in healthy adults.

Methods: The design was a single-center, cross-sectional, reliability study. Participants were 20 healthy adults (mean ± standard deviation, 36.4 ± 10.9 years). ROM for active, passive, and composite movements of the fingers was assessed by three occupational therapists with at least 5 years clinical experience in the field of physical disabilities. To standardize the measurement method used, we developed a written protocol, stabilized the wrist position, and trained the evaluators. Intraclass correlation coefficient (ICC) values were used for the reliability analysis. ICC (1,1) was used for intra-rater reliability. ICC (2,1) was used for inter-rater reliability. Hand-shaped heatmaps were used to summarize the reliability data.

Results: Most of the results (88.7%) showed moderate to good intra-rater reliability (ICC ≥ 0.50), while inter-rater reliability showed less (69.0%). Both intra- and inter-rater reliability showed no trends between dominant and non-dominant hands, type of movement, finger, or joint.

Conclusions: Intra-rater reliability was relatively high and using a written protocol was beneficial. Inter-rater reliability tended to be lower, and differences in the physical structure of both raters and participants may have affected inter-rater reliability values.

Neurological conditions and community-based physical activity: physical therapists’ belief and actions

Louise Declerck — 2024-09-30

Introduction: Physical therapists (PTs) are key actors in physical activity (PA) promotion. However, it remains unclear whether PTs in community settings promote community-based PA such as adapted physical activity (APA) and adaptive sports (AS) to their patients with neurological conditions (NCs). The main purposes were to evaluate the beliefs PTs have of APA and AS, and to explore actions they undertake to promote it to their patients with NCs.

Methods: An online survey was created specifically for the study. PT associations and institutions were contacted and licensed PTs working in community-based settings, treating at least one patient with a NC, were invited to participate. Questionnaires were analyzed only if all mandatory questions had been answered.

Results: A total of 165 questionnaires were analyzed. PTs reported prioritizing active treatment. They viewed APA and AS as beneficial for their patients with NCs; however, its promotion remained largely infrequent due to a number of barriers. The PTs’ own level of PA seemed to significantly influence their beliefs of the benefits of APA and AS (p = 0.001), while being specialized in neurologic physical therapy enabled the PTs to increase frequency of promotion (p = 0.003).

Conclusion: Though community-based PTs are aware of the importance of PA for individuals with NCs, they face difficulties in promoting it to their patients. However, these difficulties are reduced among PTs who are specialized in neurologic physical therapy. Efforts should be made toward educating PTs to neurological pathologies and their specificities when it comes to PA.

First-contact physiotherapists’ perceived competency in a new model of care for low back pain patients: a mixed methods study

Amélie Kechichian — 2024-09-13

Background: A new advanced practice model of care enables French physiotherapists to perform medical acts for low back pain (LBP) patients as first-contact physiotherapists (FCPs).

Objective: The aim of this study is to determine the self-perceived competency of FCPs and to further explore factors underpinning this feeling.

Methods: A mixed-methods explanatory sequential design was conducted. A survey was used to self-assess the perceived competency of FCPs in performing medical tasks. Semi-structured interviews were then performed to explore determining factors of perceived competency. Inductive thematic analysis was performed.

Results: Nine FCPs answered the survey and were interviewed (mean age 40.1, standard deviation [SD]: ±10.0). FCPs felt very competent with making medical diagnosis (3.44/4, SD: ±0.53), analgesic prescription (3.11, SD: ±0.78) and referring onward to physiotherapy (3.78, SD: ±0.55). They did not feel competent with nonsteroidal anti-inflammatory drug prescription (2.78, SD: ±0.67) and issuing sick leave certificate (2.67, SD: ±1.0). The main identified influencing factors were previous FCPs’ experience, training, knowledge, collaboration with family physicians, high responsibility and risk management associated with decision-making.

Conclusion: French FCPs appeared to have the necessary skills to directly manage LBP patients without medical referral. Future training focusing on analgesic prescription and issuing sick leave certificate is however needed.

Defining the glenohumeral range of motion required for overhead shoulder mobility: an observational study

Linda Dyer — 2024-08-27

Background: Recovery of overhead mobility after shoulder surgery is time-consuming and important for patient satisfaction. Overhead stretching and mobilization of the scapulothoracic and glenohumeral (GH) joints are common treatment interventions. The isolated GH range of motion (ROM) of flexion, abduction, and external rotation required to move above 120° of global shoulder flexion in the clinical setting remains unclear. This study clarified the GH ROM needed for overhead mobility.

Methods: The timely development of shoulder ROM in patients after shoulder surgery was analyzed. Passive global shoulder flexion, GH flexion, abduction, and external rotation ROM were measured using goniometry and visually at 2-week intervals starting 6-week postsurgery until the end of treatment. Receiver operating characteristic curves were used to identify the GH ROM cutoff values allowing overhead mobility.

Results: A total of 21 patients (mean age 49 years; 76% men) after rotator cuff repair (71%), Latarjet shoulder stabilization (19%), and arthroscopic biceps tenotomy (10%) were included. The ROM cutoff value that accurately allowed overhead mobility was 83° for GH flexion and abduction with the area under the curve (AUC) ranging from 0.90 to 0.93 (p < 0.001). The cutoff value for GH external rotation was 53% of the amount of movement on the opposite side (AUC 0.87, p < 0.001).

Conclusions: Global shoulder flexion above 120° needs almost full GH flexion and abduction to be executable. External rotation ROM seems less important as long as it reaches over 53% of the opposite side.

The psychometric properties of the modified fear of falling avoidance behavior questionnaire in Parkinson’s disease and older adults

Merrill Landers — 2024-05-02

Introduction: The Fear of Falling Avoidance Behavior Questionnaire (FFABQ) has good psychometric properties. However, a recently modified version (mFFABQ) was theorized to be easier to understand because the updated Likert responses are more consistent with the item stem. This study aimed to examine the reliability and validity of the mFFABQ in older adults and in people with Parkinson’s disease (PD).

Methods: A total of 88 participants, 39 with PD (age = 72.2 ± 9.5; 29 males, 10 females) and 49 older adults (age = 72.8 ± 5.0; 13 males, 36 females) answered the mFFABQ twice, separated by one week, for test-retest reliability. Construct validity was evaluated through correlational analyses with fall history, Activities-Specific Balance Confidence Scale (ABC), Berg Balance Scale (BBS), Timed Up and Go, 30 Second Sit to Stand, Sensory Organization Test, Zung Anxiety Scale, Beck Depression Inventory; Consequences of Falling Questionnaire (CoFQ), and average daily activity levels using an activity monitor.

Results: The mFFABQ had good overall test-retest reliability (ICC = 0.822 (older adult ICC = 0.781, PD ICC = .806). The mFFABQ correlated with fall history (r=-0.430) and exhibited high correlation with the ABC (rho=-.804) and moderate correlations with CoFQ (rho=.582) and BBS (rho=-.595). The mFFABQ also correlated with time stepping (rho=-.298), and number of steps (rho=-.358).

Discussion: These results provide supportive evidence for the reliability and validity of the mFFABQ in older adults and people with PD, which supports its suitability as a clinical and research tool for the assessment of fear of falling avoidance behavior.

Treatment fidelity in clinical trials

Chad Cook — 2024-09-16

In the context of clinical trials, treatment fidelity (TF) has traditionally referred to the extent to which an intervention or treatment is implemented by the clinicians as intended by the researchers who designed the trial. Updated definitions of TF have included an appropriate design of the intervention that was performed in a way that is known to be therapeutically beneficial. This requires careful attention to three key components: (1) protocol and dosage adherence, (2) quality of delivery, and (3) participant adherence. In this viewpoint, we describe several cases in which TF was lacking in clinical trials and give opportunities to improve the deficits encountered in those trials. We feel that along with quality, risk of bias, and certainty of evidence, TF should be considered an essential element of the veracity of clinical trial.

A decade of growth: preserving the original meaning of research for physiotherapists

Marco Barbero — 2024-10-03

Not applicable

Red flags for potential serious pathologies in people with neck pain: a systematic review of clinical practice guidelines

Daniel Feller — 2024-12-04

Introduction: We conducted a systematic review of clinical practice guidelines to identify red flags for serious pathologies in neck pain mentioned in clinical practice guidelines, to evaluate agreement in red flag recommendations across guidelines, and to investigate the level of evidence including what study type the recommendations are based on.

Methods: We searched for guidelines focusing on specific and nonspecific neck pain in MEDLINE, EMBASE, and PEDro up to June 9, 2023. Additionally, we searched for guidelines through citation tracking strategies, by consulting experts in the field, and by checking guideline organization databases.

Results: We included 29 guidelines, 12 of which provided a total of 114 red flags for fracture (n = 17), cancer (n = 21), spinal infection (n = 14), myelopathy (n = 15), injury to the spinal cord (n = 1), artery dissection (n = 7), intracranial pathology (n = 3), inflammatory arthritis (n = 2), other systemic disease (n = 6), or unrelated to a specific condition (n = 19). Overall, there is very little agreement (median Fleiss’ kappa of 0) between guidelines on the red flags to screen for serious pathologies.

Conclusion: Red flags were mainly supported by expert opinions. We also observed a general lack of consensus among guidelines regarding which red flags to endorse. Considering the current limitations of the evidence, specific recommendations on which red flags to use cannot be provided, except for using the Canadian C-Spine rule for screening posttraumatic fractures.

Hip microinstability and its association with femoroacetabular impingement: A scoping review

Rahel Caliesch — 2024-08-01

Introduction: Hip microinstability has become a recognized cause of non-arthritic hip pain and disability in young patients. However, its pathophysiology remains unclear. We want to (1) present an overview of the evidence of hip microinstability and of its association with femoroacetabular impingement (FAI), (2) map out the type of evidence available, and (3) make recommendations for future research.

Methods: A deductive analysis and extraction method was used to extract information. In addition, diagnostic accuracy statistics were extracted or calculated.

Results: Of the 2,808 identified records, 123 were eligible for inclusion. Different definitions for microinstability exist. A standardized terminology and clear diagnostic criteria are lacking. FAI and microinstability may be associated and may aggravate each other. Conservative treatment strategies for FAI and microinstability are similar. The reported prevalence of microinstability in combination with FAI ranges from 21% to 42% in adults undergoing hip arthroscopy or magnetic resonance arthrography (MRA) of the hip.

Conclusion: Hip microinstability and FAI may be associated, occur together, or exacerbate each other. To better address this topic, a standardized terminology for microinstability is essential. Achieving consensus on physical examination and diagnosis is also necessary. Initial efforts to establish uniform diagnostic criteria have been made, but further work is needed. Specifically, randomized controlled trials are required to evaluate the effectiveness of training programmes aimed at reducing symptoms in individuals with microinstability, with or without FAI. Such studies will enable clinicians to manage microinstability with greater confidence within this context.

Impact of direct access on the quality of primary care musculoskeletal physiotherapy: a scoping review from a patient, provider, and societal perspective

Erik Cattrysse — 2024-07-01

Introduction: Worldwide many countries provide direct access in physiotherapy. The aim of this scoping review was to synthesize the available evidence on the quality of primary care musculoskeletal physiotherapy from different perspectives.

Methods: Systematic searches were conducted in three databases up to September 2022. Studies were included when regarding assessment of at least one of the following perspectives: patient (quality of Life, patient satisfaction, pain, functioning, adverse events), provider (treatment compliance, responsibility, liability, status, prestige, job satisfaction), and society (number of referrals, amount of medical imaging, medication use, number of sessions needed for rehabilitation, and overall costs and cost-effectiveness). Selection and methodological quality assessment of systematic reviews were performed. Data extraction and analysis were performed separately for systematic reviews and individual primary studies.

Results: Five systematic reviews as well as 17 primary studies were included. From a patient perspective, no significant effect of direct access was found for pain and a tendency in favour of direct access was found for quality of life, functioning, and well-being. Concerning providers, higher treatment compliance was found in direct access to physiotherapy and decision-making was more accurate. From a societal perspective, significant differences in favour of direct access physiotherapy were found for waiting time, prescribed medication, and medical imaging. In addition, there was a tendency towards lower health care costs.

Pragmatism in manual therapy trials for knee osteoarthritis: a systematic review

Kyle R. Adams — 2024-02-26

Introduction: Manual therapy is an often-utilized intervention for the management of knee osteoarthritis (OA). The interpretation of results presented by these trials can be affected by how well the study designs align applicability to real-world clinical settings.

Aim: To examine the existing body of clinical trials investigating manual therapy for knee OA to determine where they fall on the efficacy-effectiveness spectrum.

Methods: This systematic review has been guided and informed by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Randomized controlled trials that investigated manual therapy treatments for adults with knee OA were retrieved via searches of multiple databases to identify trials published prior to April 2023. The Rating of Included Trials on the Efficacy-Effectiveness Spectrum (RITES) tool was used to objectively rate the efficacy-effectiveness nature of each trial design. The Cochrane Risk of Bias 2.0 assessment tool (RoB-2) was used to assess the risk of bias across five domains.

Results: Of the 34 trials, a higher percentage of trials had a greater emphasis on efficacy within all four domains: participant characteristics (76.5%), trial setting (82.4%), flexibility of intervention (61.8%), and clinical relevance of experimental and comparison intervention (50.0%). In addition, 14.8% of the trials had low risk of bias, 44.1% had high risk of bias, and 41.2% had some concerns regarding bias.

Conclusions: While many trials support manual therapy as effective for the management of knee OA, a greater focus on study designs with an emphasis on effectiveness would improve the applicability and generalizability of future trials.

Erratum in: Pragmatism in manual therapy trials for knee osteoarthritis: a systematic review

Kyle R. Adams — 2024-10-21