搜索结果：Physiotherapy theory and practice

Clinical placements are a vital element of physiotherapy education, where students must demonstrate competence across a range of professional attributes. Although core competencies such as clinical knowledge, ethical conduct, and communication are universally valued, clinical educators (CEs) from different cultural contexts may emphasize these attributes in different ways. Gaining insight into how Hong Kong CEs evaluate students is important for aligning academic expectations with clinical practice. This study identifies the key student attributes prioritized by Hong Kong CEs and summarizes the behavioral examples they use to distinguish performance levels on the Assessment of Physiotherapy Practice (APP) Global Rating Scale. A secondary qualitative analysis was conducted on 456 qualitative feedback comments from APP forms completed by 45 CEs assessing physiotherapy students across two cohorts. The data were analyzed using AI-assisted thematic analysis combined with human expert interpretation, followed by deductive validation across performance levels (Excellent, Good, Adequate, Not Adequate). Six core attributes emerged from the analysis: (1) communication and interpersonal skills, (2) clinical reasoning and decision‑making, (3) practical knowledge and technical competence, (4) learning attitudes and reflective practice, (5) professionalism and work ethics, and (6) safety and risk management and patient‑centered care. Behavioral examples were mapped across performance levels, revealing clear distinctions between competent and underperforming behaviors. Among these attributes, learning attitudes and reflective practice were consistently emphasized. Hong Kong CEs prioritize not only technical and cognitive competence, but also reflective and affective attributes rooted in professional training and local cultural values. The identified attributes and behavioral descriptors may guide curriculum design, educator development, and student preparation, supporting coherent and culturally attuned assessment practices in local contexts while also providing a foundation for greater international alignment among programs that use or adapt the APP instrument.

Developing clinical reasoning is a critical component of physiotherapy education. Active strategies such as simulation- and digital-based learning have been proposed to enhance these skills. However, their effectiveness, but also the best modalities remain largely unknown. Therefore, this systematic review aimed to evaluate the effectiveness of various educational strategies on clinical reasoning among physiotherapy students and clinicians. A systematic search of PubMed, Scopus, PsycINFO, and ProQuest Central was conducted for studies published between January 1, 2015 and February 28, 2026. Eligible designs included randomized controlled trials, controlled before - after studies, pre - post studies, and quasi-experimental designs. Methodological quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI) for quantitative studies and the Mixed Methods Appraisal Tool (MMAT) for qualitative or mixed-methods studies. Data were narratively synthesized by grouping studies into three pedagogical categories: (i) simulation- and digital-based learning, (ii) active and case-based learning methods, and (iii) structured educational programs and training. Thirty four studies (n = 3,048 participants) of moderate-to-high methodological quality were included in this study. Participants ranged from entry-level physiotherapy students to licensed clinicians. Simulation- and digital-based approaches, such as standardized patients, virtual reality, mobile applications, and computer-assisted learning, showed consistent improvements in clinical decision-making and performance, as well as gains in self-efficacy and motivation. Active and case-based learning strategies, including problem-based learning and concept mapping, were associated with increased satisfaction, reflective practice, and usability. Structured programs, such as residencies, workshops, and mentorship models, produced notable benefits in decision-making, self-efficacy, and professional attitudes. Overall, simulation-, digital-based and structured programs demonstrated the most consistent evidence of effectiveness across studies. Simulation, digital technologies, active learning, and structured programs effectively foster clinical reasoning in physiotherapy education. Simulation-based and active approaches appear particularly impactful. Future research should emphasize high-quality randomized trials and long-term outcomes, including patient-related measures.

Chronic neck pain is a common musculoskeletal disorder associated with functional limitations and reduced activities of daily living. The upper trapezius muscle plays an important role in posture, scapular stabilization, and accessory respiration, and may be affected metabolically in chronic neck pain. This study aimed to investigate the relationship between trapezius muscle oxygenation and respiratory and peripheral muscle strength and functional performance in patients with chronic neck pain. Fifty-one patients with chronic neck pain (age: 53.4&#x2009;&#xb1;&#x2009;12.3&#x2009;years) were included in the study. Muscle oxygenation (Moxy&#xae; monitor), maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) (mouth pressure device), peripheral muscle strength (hand-held dynamometer), upper extremity functional exercise capacity (six-minute pegboard and ring test [6-PBRT]), and activities of daily living (ADL) (Glittre ADL test) were evaluated. The minimum trapezius muscle oxygen saturation (SmO2) value had a moderate, significant positive correlation with MIP (r&#x2009;=&#x2009;0.511), MEP (r&#x2009;=&#x2009;0.522), the 6-PBRT score (r&#x2009;=&#x2009;0.634), and trapezius muscle strength (r&#x2009;=&#x2009;0.542), and a moderate, significant negative correlation with Glittre ADL test time (r&#x2009;=&#x2009; -0.581). It showed weak correlations with shoulder abductor and flexor strength, elbow flexor strength, and handgrip strength (r&#x2009;=&#x2009;0.30-0.49). The maximum SmO2 value demonstrated moderate correlations with MIP (r&#x2009;=&#x2009;0.637), MEP (r&#x2009;=&#x2009;0.606), and trapezius muscle strength (r =&#x2009;0.590); strong correlations with the 6-PBRT score (r&#x2009;=&#x2009;0.718) and Glittre ADL (r&#x2009;=&#x2009; -0.711) test time; and weak correlations with shoulder abductor and flexor strength, elbow flexor strength, and handgrip strength (r&#x2009;=&#x2009;0.30-0.49). Changes in SmO2 during exercise were significantly associated with MIP (&#x3b2;&#x2009;=&#x2009;0.400, R2&#x2009;=&#x2009;0.160, p&#x2009;=&#x2009;.004), MEP (&#x3b2;&#x2009;=&#x2009;0.327, R2&#x2009;=&#x2009;0.107, p&#x2009;=&#x2009;.019), 6-PBRT score (&#x3b2; = 0.510, R2&#x2009;=&#x2009;0.260, p&#x2009;<&#x2009;.001), and Glittre ADL test time (&#x3b2;&#x2009;=&#x2009;-0.354, R2&#x2009;=&#x2009;0.125, p&#x2009;=&#x2009;.011). Trapezius muscle oxygenation was associated with respiratory muscle strength, upper extremity exercise capacity, and activities of daily living. These findings suggest that trapezius muscle oxygenation may provide insight into underlying physiological mechanisms related to respiratory and functional impairment.

Australia's healthcare system, a crucial economic pillar, faces significant workforce shortages, impacting its ability to meet increasing demand. These shortages, particularly acute for physiotherapists, are exacerbated by an aging population, rising chronic disease incidence, and the COVID-19 pandemic. The Australian Government's 2024 Skills Priority List confirms this national shortage, highlighting the urgent need for strategies to improve workforce planning, expand roles, and enhance retention. Therefore, it is vital to gain a deeper understanding of why Australian physiotherapists leave clinical practice and what would encourage them to remain. This study aimed to explore physiotherapists' perspectives on factors associated with the retention and attrition of physiotherapists in Australia and to identify potential strategies to encourage physiotherapists to stay in practice. This study used a mixed-data collection approach, qualitatively analyzing open-ended cross-sectional survey responses from Australian registered physiotherapists and 21 semi-structured interviews with physiotherapists who volunteered to provide further insights. Study analysis identified four themes: (1) Anchors of physiotherapists retention, (2) Barriers to workforce entry: Navigating identity and system constraints, 3) Drivers of physiotherapists' attrition and (4) Retention strategies: Addressing systemic constraints and individual needs to sustain clinical engagement. These themes demonstrate the complex, bidirectional relationships between factors influencing physiotherapist workforce retention, highlighting a profession sustained by purpose but challenged by systemic issues. Overall, a collegial work environment, the ability to work close to family and being embedded in the local community, and career advancement motivate physiotherapists to stay in the profession. Conversely, poor financial sustainability, limited career progression pathways, and poor workplace conditions and burnout contribute to attrition. Strategies to support retention include improved remuneration, more opportunities for career progression and a focus on preventing burnout.

Perceptions of key stakeholders may be barriers or facilitators to advanced practice physiotherapy services. However, the experience and perception of orthopedic consultants regarding advanced practice physiotherapy roles is poorly understood. Explore orthopedic consultants' experiences and perceptions regarding advanced practice physiotherapists in adult orthopedic clinics. Qualitative study: Reflexive thematic analysis of data from semi-structured interviews with twelve orthopedic consultants practising at Royal Perth Hospital. Interviews were driven by indicative questions based upon contemporary literature regarding advanced practice physiotherapy and conducted using a constructivist lens to capture diverse perspectives. Themes/subthemes were reviewed by the entire research team. Four themes, capturing conflicting views, were derived: 1) APP role clarity. 2) Enhancement of orthopedic services. 3) Health system challenges. 4) Expectations of orthopedic services. Theme one reflected a lack of clarity, amongst orthopedic consultants interviewed, regarding the advanced practice physiotherapist's role, scope of practice and level of education, while complimenting their diagnostic skills. Theme two highlighted enhancement of orthopedic services through thorough biopsychosocial assessments, contrasting perceptions regarding advanced practice physiotherapist efficiency, and considered whether advanced practice physiotherapists are a burden on orthopedic clinics. Theme three considered shifting clinical responsibilities and the perceived need for clinical pathways. Theme four highlighted negative perceptions of patient and referrer feedback.

Ankle control is essential for safe and effective ambulation in children with spastic cerebral palsy (CP). However, performance-based assessments targeting this function are limited. The Foot Tapping Test (FTT) may serve as a simple clinical measure of ankle control. Objective: This study aimed to investigate the validity and reliability of the FTT with spastic CP. This cross-sectional study evaluates the FTT's validity, inter-rater reliability, and test - retest reliability. Convergent validity was analyzed using ankle dorsiflexion active range of motion (AROM), dorsiflexion strength, and the Five Times Sit-to-Stand Test (FTSST). AROM was measured through analysis of the angles of anatomical landmarks via ImageJ-Fiji. Retests were performed 7-10&#x2009;days later. Thirty-two children (mean age:10.66&#x2009;&#xb1;&#x2009;3.86&#x2009;years; male n&#x2009;=&#x2009;21) participated. The right (FTTright) and left FTT (FTTleft) were moderately correlated with dorsiflexion AROM (r&#x2009;=&#x2009;0.426 and r&#x2009;=&#x2009;0.552, respectively; p&#x2009;<&#x2009;.05). They were weakly correlated with dorsiflexion strength (FTTright r&#x2009;=&#x2009;0.352 and FTTleft r&#x2009;=&#x2009;0.368; p&#x2009;<&#x2009;.05), and FTSST (FTTright: r&#x2009;=&#x2009;-0.362; FTTleft and r&#x2009;=&#x2009;-0.386; p&#x2009;<&#x2009;.05). Inter-rater reliability was excellent for FTTright (ICC(2,1)&#x2009;=&#x2009;0.982) and FTTleft (ICC(2,1)&#x2009;=&#x2009;0.991). Test - retest reliability was good for raters A (FTTright, ICC(2,1)&#x2009;=&#x2009;0.835; FTTleft, ICC(2,1)&#x2009;=&#x2009;0.887) and B (FTTright, ICC(2,1)&#x2009;=&#x2009;0.830; FTTleft, ICC(2,1)&#x2009;=&#x2009;0.892). Bland - Altman analysis showed good inter-rater and test-retest agreement, with mean differences near zero. Limits of agreement were narrow between raters (-1.8 to 2.0) and wider across repeated testing (-6.3 to 5.8). The FTT was a valid and reliable tool for assessing ankle control in children with spastic CP, including those with diplegic and hemiplegic presentations. Also, FTT is a clinically valuable assessment for routine use, given its simplicity and feasibility with the important role that ankle control plays in gait and balance.

The hip abductor muscles are critical for maintaining mediolateral balance and preventing falls, yet age- and sex-related differences across adulthood remain unclear. Objectives: This cross-sectional study examined age- and sex-related differences in hip abductor maximal torque, submaximal power and velocity, and clinical functional outcomes. Forty-two adults were included: 14 young (27&#xb1;4y), 14 middle-aged (51&#xb1;9y), and 14 older adults (74&#xb1;6y); 20 male and 22 female. Participants completed hip abductor tests at 10-70% of estimated one-repetition maximum (1RM) and two clinical assessments: the 30-s Chair-Stand and the Stair-Climb Power Tests. MANCOVA was used to evaluate the effects of age and sex on eight power/velocity outcomes, while adjusting for height and weight. Mixed-effects models incorporated the repeated-measures structure across loads. Separate ANCOVAs were conducted to compare age groups for the clinical outcomes. Hip abductor power and velocity were lower with advancing age (p<.001). Sex showed an independent multivariate effect (p=.002), with load-specific male-female differences in power (p=.014). Age effects were significant across all clinical outcomes (p<.001). Younger individuals outperformed middle-aged and older adults in torque and chair stand tests. However, young and middle-aged adults performed similarly and better than older adults on the stair climb test. Hip abductor torque, power, and velocity differ across age groups, with lower values observed in middle-aged individuals. Sex differences occur mainly in high-load power but not in functional performance. Early evaluation and targeted training of the hip abductors may help preserve physical function across the lifespan.

Physical activity (PA) has a protective effect on impaired glucose and pilates effectively supports patients with high plasma glucose levels. This study aimed to evaluate the effects of ACSM (American College of Sports Medicine) person-centered PA counseling using the 5A model (Assess, Advise, Agree, Assist, And Arrange), combined with Pilates exercises, on metabolic control variables in patients with prediabetes (PD) and type 2 diabetes (T2D). Ninety women with T2D and PD were randomly assigned to three groups: Group 1 (Pilates&#x2009;+&#x2009;PA counseling), Group 2 (PA counseling), and Group 3 (standard treatment). Both intervention groups also received standard treatment. Primary outcomes were metabolic measures (blood glucose and lipid parameters). Secondary outcomes included body composition (body fat %, visceral fat, muscle mass) and physical performance (functional capacity, PA level, balance). Measurements were taken at baseline and after 12&#x2009;weeks. No significant between-group differences were found in metabolic or body composition outcomes. However, Group 1 showed higher PA levels (p&#x2009;=&#x2009;.002, &#x3b7;2&#x2009;=&#x2009;0.13) and step counts (p&#x2009;=&#x2009;.003, &#x3b7;2&#x2009;=&#x2009;0.12) compared with the control group. Both intervention groups improved functional capacity (p&#x2009;=&#x2009;.001, &#x3b7;2&#x2009;=&#x2009;0.15) and balance (p&#x2009;<&#x2009;.001, &#x3b7;2&#x2009;=&#x2009;0.26). In T2D participants, functional capacity improved in Group 1 and 2 (both p&#x2009;<&#x2009;.001, &#x3b7;2&#x2009;=&#x2009;0.25). In PD participants, steps counts increased in Group 1 (p&#x2009;=&#x2009;.003, &#x3b7;2&#x2009;=&#x2009;0.24) compared with Group 3, while PA levels and balance scores (p&#x2009;<&#x2009;.001, both, &#x3b7;2&#x2009;=&#x2009;0.31, &#x3b7;2&#x2009;=&#x2009;0.43, respectively) improved in Groups 1 and 2. The remaining parameters showed no differences (p&#x2009;>&#x2009;.05). Physical activity counseling using the 5A model plus Pilates exercises may improve functional capacity, PA level, number of steps, and balance. In Type 2 diabetes, PA counseling alone may prevent declines in functional capacity. In PD, PA counseling improves PA levels and balance, and adding Pilates may further boost daily steps.

Critically ill patients face a high risk of rapid muscle atrophy and deterioration in muscle biomechanical properties due to prolonged immobilization. Whole body vibration (WBV) and neuromuscular electrical stimulation (NMES) have emerged as adjunctive therapies to preserve muscle structure and function. This study aimed to compare the effects of WBV and NMES on muscle biomechanical properties and muscle thickness in patients in the intensive care unit (ICU). Forty-five participants were randomly assigned to groups: WBV plus conventional therapy (CT), NMES plus CT, and CT alone. All groups received 4&#x2009;weeks of treatment (5 sessions/week). The WBV group received vibration therapy, while the NMES group received electrical stimulation targeting the quadriceps femoris muscles. The control group received CT only, consisting of standard rehabilitation care. Muscle biomechanical properties of the rectus femoris and tibialis anterior muscles, together with muscle thickness of the quadriceps femoris and biceps brachii, were assessed using MyotonPRO and ultrasonography. Whole body vibration produced bilateral increases in muscle tone, stiffness, and elasticity (all p&#x2009;&#x2264;&#x2009;.004), with small-to-moderate effect sizes (&#x3b7;2&#x2009;&#x2264;&#x2009;0.12). Neuromuscular electrical stimulation also yielded significant within-group improvements, although these were smaller, whereas the control group showed minimal and mostly non-significant changes. Muscle thickness of the biceps brachii and quadriceps femoris increased significantly in both intervention groups (all p&#x2009;&#x2264;&#x2009;.006). Quadriceps femoris and biceps brachii thickness, rectus femoris tone, and tibialis anterior elasticity exceeded the Smallest Worthwhile Effect, indicating clinical improvements. Quadriceps femoris thickness demonstrated significant time&#xd7;group interaction effects with large effect sizes (&#x3b7;2&#x2009;=&#x2009;0.24-0.30), with greater increases observed in the WBV and NMES groups than in the control group. Both interventions enhanced muscle biomechanical properties and muscle thickness, with WBV demonstrating more consistent and pronounced effects. These interventions may offer clinically meaningful benefits for preserving muscle quality and morphology in patients in the ICU. (Identifier: NCT06872697).

Physiotherapists' choices of management methods for hip and knee osteoarthritis reflect their conceptions of the condition and how it should be managed. To be able to provide recommended, consistent, first-line methods, physiotherapists should have a common, up-to-date understanding of the condition and how to effectively manage it. In this qualitative study, we aimed to explore physiotherapists' conceptions of the management of hip and knee osteoarthritis, and to identify the critical differences between their conceptions. We followed a phenomenographic methodology and data-driven approach. The data were from semi-structured in-depth interviews of 20 physiotherapists (mean age 42&#x2009;years) who were involved in managing hip and knee osteoarthritis. The data were transcribed verbatim and analyzed using a phenomenographic analysis method. The analysis yielded four hierarchically broadening categories describing the management of hip and knee osteoarthritis: 1) a symptom-focused approach, 2) a functionality-oriented approach, 3) a whole-person approach, and 4) societal level approach. These conceptions covered five themes of expanding awareness and several critical aspects. Narrow conceptions of the management of hip and knee osteoarthritis may lead to passive, symptom-focused approaches and surgery, whereas broader perspectives can lead to holistic, proactive, evidence-based management that emphasizes sustainable health and societal actions. Identifying unhelpful conceptions and unraveling them is important for promoting effective osteoarthritis management and for enhancing professional education that supports person-centered, sustainable, and evidence-based management of osteoarthritis.

Central sensitization (CS), which alters how the central nervous system processes pain stimuli, leading to increased sensitivity, is a significant component of chronic pain and can also affect patients with low back pain. Beyond increased pain, this condition can also impact body awareness and muscle endurance. However, the relationship between CS severity and clinical outcomes in chronic nonspecific low back pain (CNLBP) remains unclear. To compare pain severity, pressure pain threshold (PPT), disability, muscle endurance, and body and low back awareness across CS-related symptoms severity in patients with CNLBP, and to examine the relationships between these variables. This study included 103 patients CNLBP referred from the neurosurgery clinic. Patients were divided into two groups according to Central Sensitization Inventory (CSI) scores: high CSI and low CSI. Pain severity (Visual Analog Scale (VAS)), PPT, disability (Oswestry Disability Index (ODI)), muscle endurance, body (Body Awareness Questionnaire (BAQ)), and low back awareness (Fremantle Back Awareness Questionnaire (FreBAQ)) were evaluated. According to CSI, 43.7% of the patients had high CSI. Patients in the high CSI group had statistically significantly higher VAS, ODI, and FreBaQ scores compared to the low CSI group (p&#x2009;<&#x2009;.05), while PPT, muscle endurance, and BAQ values were lower (p&#x2009;<&#x2009;.05). Lower muscle endurance (Odds ratio (OR)=0.963, p&#x2009;=&#x2009;.041) and BAQ (OR&#x2009;=&#x2009;0.970, p&#x2009;=&#x2009;.017) scores, and higher FreBaQ (OR&#x2009;=&#x2009;1.122, p&#x2009;=&#x2009;.006) scores were associated with a significant increase in the probability of high CSI (p&#x2009;<&#x2009;.001). Patients with high CSI in CNLBP experience increased pain and disability, decreased PPT and muscle endurance, and worsening body and low back awareness. Furthermore, impaired muscle endurance and awareness are associated with an increased likelihood of a high CSI. Therefore, to effectively manage CNLBP, CS-related symptoms should be identified early, and their relationships with psychosocial factors affecting patients' pain experience should be assessed. ClinicalTrials number: NCT06958263.

Interprofessional education (IPE) fosters collaboration among healthcare students which may improve patient-centered care. There are gaps in the literature describing IPE programs where healthcare professional students provide authentic clinical care by co-treating individuals with chronic stroke over prolonged periods. The purpose of this study was to describe the implementation of a dual-task experiential learning IPE program and evaluate the physical therapy (PT) and speech-language pathology (SLP) student perceptions of the IPE program. The convergent mixed-methods study evaluated an 8-week IPE program where PT and SLP students co-treated clients with chronic stroke using dual-task interventions. Data were collected through observations, focus groups, and surveys. Qualitative content analysis was conducted using an inductive-deductive approach and mapped to Interprofessional Education Collaborative (IPEC) Core Competencies. Trustworthiness was established through peer debriefing, member checking, external audits and triangulation. The IPEC Survey was completed at baseline, immediately post, and at 6-month follow-up. Friedman's test compared changes over time, with Wilcoxon signed-rank test using Bonferroni correction for post hoc analysis. Qualitative and quantitative data were integrated. Seventeen (11 PT and 6 SLP) students participated in focus groups where five qualitative themes emerged - Learning the Discipline, Learning to Co-Treat, Client-Centered Care, Teamwork, and Communication - that were aligned with the IPEC Core Competencies. Eleven students completed surveys at all timepoints. Significant improvements were found in Interprofessional Interactions (X2(2) = 11.13, p&#x2009;=&#x2009;.004) and Interprofessional Values (x2(2) = 14.97, p&#x2009;<&#x2009;.01) from baseline to immediately post that were maintained at 6&#x2009;months. The qualitative and quantitative findings were congruent and complementary. The prolonged experiential IPE program enhanced interprofessional competencies and promoted client-centered care among PT and SLP students. Integrating motor-cognitive-linguistic co-treatments within authentic rehabilitation contexts supported collaborative practice, teamwork and role development and can be modeled by future educators.

It remains unclear whether clinical outcomes from group-based physiotherapy are comparable to individual sessions, or if a mixed approach yields superior results in primary care. This study aimed to compare the effectiveness of supervised individual, group-based, and mixed physiotherapy approaches on pain and function in patients with chronic pain in primary care setting. In this retrospective observational study, clinical records were analyzed for 124 patients (mean age 58.6&#x2009;&#xb1;&#x2009;12.4&#x2009;years) with chronic pain (duration&#x2009;>&#x2009;6&#x2009;months). Patients received supervised individual (n&#x2009;=&#x2009;55), group-based (n&#x2009;=&#x2009;38), or mixed (n&#x2009;=&#x2009;31) physiotherapy. The outcome measures assessed pre- and post-intervention were physical function, pain intensity, and perception of change. No significant between-group differences were observed in any outcome measure at post-intervention (p&#x2009;>&#x2009;.05). Conversely, a significant main effect of time was observed across all outcome measures in the three intervention groups (p&#x2009;<&#x2009;.001). Statistically significant improvements were observed in all three groups for physical function (individual: &#x2206;&#x2009;=&#x2009;3.1 points, p&#x2009;<&#x2009;.001, d&#x2009;=&#x2009;1.31; group-based: &#x2206;&#x2009;=&#x2009;2.7 points, p&#x2009;<&#x2009;.001, d&#x2009;=&#x2009;1.16; mixed: &#x2206;&#x2009;=&#x2009;2.7 points, p&#x2009;<&#x2009;.001, d&#x2009;=&#x2009;1.24). Similarly, a statistically significant decrease in pain intensity was observed in all groups, with a medium to large effect sizes and changes that exceeded the Minimally Clinically Important Difference (MCID) (individual: &#x2206;&#x2009;=&#x2009;-3.6 points, p&#x2009;<&#x2009;.001, d&#x2009;=&#x2009;-1.14; group-based: &#x2206;&#x2009;=&#x2009;-3.6 points, p&#x2009;<&#x2009;.001, d&#x2009;=&#x2009;-1.44; mixed: &#x2206;&#x2009;=&#x2009;-2.3 points, p&#x2009;<&#x2009;.001, d&#x2009;=&#x2009;-0.70). The perception of change also exceeded the MCID in all groups (individual: &#x2206;&#x2009;=&#x2009;4.0 points; group-based: &#x2206;&#x2009;=&#x2009;4.1 points; mixed: &#x2206;&#x2009;=&#x2009;4.1 points). In a primary care setting, supervised individual, group-based, and mixed physiotherapy interventions demonstrated comparable clinical effectiveness in reducing pain and improving physical function in patients with chronic musculoskeletal pain. Future randomized controlled trials with adequate follow-up periods are needed to validate these results.

Assessing dual-task (DT) difficulties during activities of daily living is of substantial importance in people with multiple sclerosis (PwMS). The Dual-task Impact on Daily-living Activities Questionnaire (DIDA-Q) is a recently developed patient-reported outcome measures designed to assess the perceived DT difficulties. The purpose of this study was to translate and culturally adapt the DIDA-Q into Persian and to examine its validity and reliability in Iranian PwMS. Sixty-nine PwMS participated in this cross-sectional study. During the initial session, participants completed the Persian DIDA-Q, Arm Function in Multiple Sclerosis Questionnaire (AMSQ), and DT performance assessments including the Nine-Hole Peg Test (NHPT) and Timed Up and Go (TUG) with cognitive or motor secondary tasks. To assess test - retest reliability, the Persian DIDA-Q was re-administered one week later. Construct validity was examined using correlation analysis, while reliability was assessed through internal consistency and test - retest reliability. The standard error of measurement (SEM) and minimal detectable change (MDC95) were also calculated. No ceiling or floor effects were observed for the Persian DIDA-Q. Construct validity was supported by significant moderate-to-strong correlations between the DIDA-Q and the AMSQ, as well as objective DT performance on the NHPT and TUG tests (r&#x2009;=&#x2009;0.31-0.69, p&#x2009;<&#x2009;.05). The Persian DIDA-Q showed excellent test - retest reliability (Intraclass Correlation Coefficient3,1&#x2009;=&#x2009;0.98) and high internal consistency (Cronbach's &#x3b1;&#x2009;=&#x2009;0.94). The SEM and MDC95 were 2.08 and 6 points, respectively. The Persian DIDA-Q provides a clinically interpretable and culturally adapted tool for identifying and monitoring perceived DT difficulties in Persian-speaking PwMS, thereby supporting both clinical assessment and future rehabilitation research.

Environmental factors are critical determinants of healthy aging, directly impacting social participation and independence. To analyze the influence of environmental barriers and facilitators on the functioning of community-dwelling older adults, using standardized instruments that allow for a quantitative and multidimensional evaluation. This cross-sectional study included 100 older adults (age&#x2009;>&#x2009;60&#x2009;years). Instruments included the Measure of the Quality of the Environment (MQE), Vulnerable Elders Survey-13 (VES-13), World Health Organization Disability Assessment Schedule 2.0 - Brazilian Older Adult version (WHODAS-B.O), and the ICF Core Set for Physical Health in Older Adults. Physical environments were identified as the primary barriers, while technology and political systems were major facilitators. Individuals with moderate/severe disability (90th percentile WHODAS-B.O) demonstrated significantly higher limitations (median 17.2 vs. 9.4). Significant associations were found between social networks as facilitators and lower disability (Spearman's correlation (rho)&#x2009;=&#x2009;-0.75; p&#x2009;<&#x2009;.001) and between political barriers and activity restrictions (rho&#x2009;=&#x2009;0.78; p&#x2009;=&#x2009;.008). Physical environmental barriers and political obstacles are key drivers of activity restrictions, whereas strong social networks act as a significant facilitator against disability in older adults. Physiotherapy practice must transition toward a biopsychosocial approach that incorporates systematic environmental and social assessments within home-based and community rehabilitation. Interventions should prioritize the mitigation of physical barriers and the integration of social support systems and assistive technology to effectively reduce disability levels and optimize community participation in this population.

Hospitalization in older adults is associated with functional decline and reduced mobility. Physiotherapists (PTs) play an important role in maximizing function and minimizing activity limitations or participation restrictions. However, the range of instruments used to assess older patients in hospital remains unclear, as does whether these tools comprehensively address all domains of physical functioning. We aimed to identify the instruments, related domains, and subdomains of the International Classification of Functioning, Disability and Health (ICF) used by PTs when evaluating the physical functioning of older patients in hospital. Methods: An observational study using an online survey of PTs working in public and private hospitals in Brazil who cared for older adults. PTs were asked to select physical functioning instruments from a list and to provide an open-ended response. Instruments were classified by a committee of nine expert PTs with expertise in the ICF approach across various areas of practice, according to ICF domains. Responses from 397 PTs showed that most were women working in general inpatient wards in public hospitals, and that they reported using 33 different instruments to assess older patients. The top three instruments used were the Medical Research Council (MRC) (57.1%), the sit-to-stand test (STS) (53.4%), and handgrip strength (HGS) (40.0%). Most instruments assess the activity and participation domain related to mobility, and the most frequently reported activities were walking and moving (60.6%), changing and maintaining body position (48.4%), and personal care (24.2%). PTs working in hospital settings use a variety of instruments to assess older adults, predominantly targeting strength and mobility within the ICF activity domain. While this variability allows clinical flexibility, it hampers standardization and underrepresents aspects such as body functions, pain, and participation. There is a need for the systematic use of standardized, sensitive measures to improve clinical decision-making and discharge planning.

Dry beriberi presents with peripheral polyneuropathy, cognitive deficits, and functional decline that warrant physical therapy. The purpose of this report is to describe the clinical presentation and physical therapy management of a patient with dry beriberi, highlighting the role of neuroplasticity and motor learning strategies. A 36-year-old female transferred to inpatient rehabilitation. Evaluation revealed cognitive deficits inconsistent with the admitting diagnosis, Guillain-Barr&#xe9;. A medical workup identified thiamine deficiency, suggesting dry beriberi, consistent with her sensorimotor polyneuropathy and impairments in attention, memory, and executive function. Her history of alcohol abuse further supported the dry beriberi diagnosis. She received physical therapy across 26&#x2009;days in inpatient rehabilitation. Motor learning was promoted through the manipulation of practice conditions, feedback, and implicit processes to maximize mobility gains despite cognitive deficits. Repetition and salience were prioritized during task-specific mobility practice to promote neuroplasticity. Psychosocial factors impacted progress and clinical decision-making. Initially, she required over 50% assistance for all mobility. At discharge, she was modified independent with bed and wheelchair mobility. She required supervision for level and moderate assistance for unlevel slide board transfers, minimal assistance for floor transfers, and total assistance for walking. The Berg Balance Scale increased from 2/56 to 6/56, indicating a high fall risk in standing, with good sitting balance indicated by 53/56 at the final Function in Sitting Test. The Six-Minute Push Test improved from 52 to 133 meters. The Wheelchair Propulsion Test improved from 0.52 to 0.64&#x2009;m/s. She could neither return to her job nor live in her second-floor apartment; thus, discharge was to her family's ramp-accessible home. Despite the lack of diagnosis-specific physical therapy guidelines, a patient with dry beriberi-related deficits benefited from task-specific practice incorporating neuroplasticity and motor learning principles to learn compensatory movement strategies while she was unable to restore prior mobility methods.

While previous studies have extensively examined differences in lumbar spine kinematics in individuals with chronic low back pain (CLBP), movement patterns of the cervical and thoracic spine have been addressed to a limited extent. To compare cervical, thoracic, and lumbar kinematic patterns during functional tasks between individuals with CLBP and asymptomatic controls, and to investigate relationships between whole-spine kinematics. A total of 23 individuals with CLBP and 23 asymptomatic controls were included. Whole-spine kinematics were assessed using inertial measurement units during sit-to-stand, box lifting, step-up, and walking. Minimum and maximum joint angles, functional ranges of motion, and inter-segmental correlations were analyzed across cervical, thoracic, and lumbar regions. During sit-to-stand, greater transverse plane rotation at L3-L4 and reduced frontal plane motion at T12-L1 were observed in the CLBP group (p&#x2009;=&#x2009;.04). During box lifting, greater frontal plane motion at the T1-C7 segment (p&#x2009;=&#x2009;.04) and increased transverse plane rotation at the T1-C7 and atlanto-occipital segments were found (p&#x2009;=&#x2009;.002-.001). In the step-up task, sagittal plane motion at cervical segments was reduced in individuals with CLBP (p&#x2009;=&#x2009;.03-0.04). During walking, altered frontal and sagittal plane kinematics were observed at lumbar and cervical segments (p&#x2009;=&#x2009;.04-.007). Strong associations were consistently observed between lumbar and thoracic segment motions across tasks in both groups (r&#x2009;>&#x2009;0.80), whereas lumbar-cervical associations were task- and plane-specific and generally stronger in individuals with CLBP. However, after false discovery rate correction, only the findings related to lifting task remained statistically significant, while the other kinematic differences did not retain significance; correlation results remained significant after correction. Individuals with CLBP may exhibit task-dependent and segment-specific changes in spinal kinematics during daily activities. Further research is needed to better understand the distribution and relevance of these kinematic differences across spinal segments.

Item response theory (IRT), particularly the graded response model, provides a latent trait (&#x3b8;) that reflects balance ability and offers a complementary framework for psychometric evaluation. Although IRT is recommended for estimating clinical thresholds, its application to cutoff determination for stroke populations remains limited. We hypothesized that IRT-based approaches will yield cutoff values that differ from those derived using classical test theory and provide additional methodological insight for cutoff determination. To estimate and compare cutoff values for walking independence in inpatients with stroke using classical test theory and IRT. Data from 165 inpatients with stroke were analyzed. Balance was assessed using the Brief Balance Evaluation Systems Test (Brief-BESTest). Cutoff scores were calculated using receiver operating characteristic (ROC), IRT combined with ROC (IRT+ROC), prevalence-based IRT method (old IRT), and embedded state-item IRT method (new IRT). Discriminative performance was evaluated using area under the ROC curve (AUC), sensitivity, specificity, likelihood ratios, and accuracy. The cutoff values for walking independence were 12.37 (ROC), 11.46 (IRT+ROC), 10.54 (old IRT), and 7.90 (new IRT). All methods demonstrated comparable performance, with AUC values ranging from 0.769 to 0.794, indicating good discriminative ability of the Brief-BESTest for identifying walking independence. The new IRT method achieved the highest AUC and sensitivity; ROC and IRT+ROC methods achieved similar AUCs. Although cutoff values and classification metrics differed slightly across methods, their confidence intervals overlapped. To our knowledge, this is the first study to directly compare cutoff estimation methods incorporating IRT in stroke rehabilitation, suggesting that IRT-based approaches can yield cutoff values with stability comparable to that of classical test theory and providing methodological insight for future research and clinical assessment scale development.