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Sports Physiotherapy is a specialised area of practice requiring specific competencies and standards to be met. The initial Sports Physiotherapy Competencies and Standards at the international level were first developed in 2005. With the sports physiotherapy landscape evolving, ensuring the currency and an update of the 2005 competencies was important. Through the SportsComp project (Higher Education to Improve Competency in Sports Physiotherapy) funded by an Erasmus+ grant, a consortium of five partners, including the International Sports and Exercise Physiotherapy Assocation, updated these competencies and standards. Using a three-phase process that incorporated perspectives from experienced sports physiotherapists including a Delphi study, a qualitative study of focus groups and interviews of stakeholders, and a consensus meeting of expert sports physiotherapy researchers and educators, the International Sports Physiotherapy Competencies and Standards (2025) ("the Competencies") were finalized. The final competencies are at a Master's level, and are contemporary and relevant to the current context of the practice of sports physiotherapy. The knowledge and behaviors to be demonstrated and standards to be achieved are able to be implemented in sports physiotherapy career pathways internationally. An overview of the key changes in the Competencies is presented and the full list of the Competencies are included as Supplementary Material. # Level of Evidence 5.
Although the benefits of physical activity are well-recognized, the relationship between it and the psychological state and quality of life of patients with inflammatory bowel disease (IBD) in China remains unclear. Here, this study explores the association analysis between the level of physical activity in IBD and fatigue, anxiety, depression, and quality of life. In this multicentre investigative study, clinical data including age, work status, disease duration, disease stage, and bowel manifestations were collected from 321 patients with IBD. Physical activity level, fatigue, psychological status, and quality of life of IBD patients were assessed by the International Physical Activity Questionnaire (IPAQ), Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT-F), Generalized Anxiety Disorder-7 items (GAD-7), Patient Health Questionnaire Depression Inventory (PHQ-9), and Inflammatory Bowel Disease Quality of Life Questionnaire (IBD-Q), respectively. Of the 321 IBD patients, 57.3% (n = 184) were diagnosed with Crohn's disease (CD) and 42.7% (n = 137) with ulcerative colitis (UC). Among the CD patients, 42.93% had a low level of physical activity, 54.89% experienced severe fatigue, 46.20% had varying degrees of anxiety, and 50.0% had depression problems. Additionally, 21.74% reported a poor quality of life. The mean IBD-Q score was 188.09 ± 28.21. The correlation between physical activity level, psychological status, and quality of life was not statistically significant in CD patients. However, in UC patients, physical activity level was correlated with the GAD-7, IBD-Q total scores, affective functioning, and social functioning scores (P = 0.02, P = 0.023, P = 0.012, and P = 0.004, respectively), with higher levels of physical activity associated with lower GAD-7 scores and higher IBD-Q scores. Furthermore, self-fatigue and lack of time were the main reasons preventing patients from participating in physical activities. Aerobic exercise was more accepted and chosen by patients than muscle training and flexibility training. IBD has a low overall physical activity level and suffers from varying degrees of fatigue, anxiety, and depression, which affect its quality of life. Higher levels of physical activity are associated with better psychological status and quality of life. Therefore, it is essential to enhance physical activity levels among individuals with IBD.
People with longstanding hip and groin pain (LHGP) are often referred to orthopaedic care. Physical therapist-led interventions are recommended in consensus statements as the first line of treatment, but it is unknown if structured interventions are more effective than usual care. The aim of this trial is to evaluate the effectiveness of a structured physical therapist-led treatment model (HIPSTER) compared with usual care on hip-related quality of life at 4 months for people with LHGP referred to orthopaedic care. This is a preregistered (clinicaltrials.gov, NCT05853640) study protocol for a double-blinded two-armed pragmatic randomised controlled trial. Patients with LHGP (n=122), referred to the Department of Orthopaedics at a university hospital in Sweden, will be randomised into the HIPSTER model or usual care. The HIPSTER model is a 16-week structured, individualised progressive treatment using exercise therapy and patient education. Usual care consists of a recommendation to contact a physical therapist in primary care. Both groups will undergo standard examinations and a surgical consultation at the Department of Orthopaedics. The primary outcome will be the mean group change in the International Hip Outcome Tool from baseline to 4 months, according to intention-to-treat principles. Secondary outcomes include patient-reported outcomes (such as perceived improvement, psychological factors and physical activity), physical impairment tests and radiographic measures. Additional time points will be 1, 2 and 5 years after baseline. Subgroups of patients will complete semistructured interviews and report additional data on psychosocial variables to provide more information on patient experience as well as determinants of adherence. The Swedish Ethical Review Authority approved this study (Dnr 202205023-01). The results of this study will be published, regardless of results, in scientific journals and as plain language summaries for participants. NCT05853640.
Women's basketball has a high incidence of anterior cruciate ligament (ACL) injuries, many of which occur during change of direction (COD) movements. Evaluating movement quality during these maneuvers can provide valuable insight into an athlete's ACL injury risk. The primary aim of this study was to assess the reliability of the Cutting Movement Assessment Score (CMAS) in female basketball players when utilized by physical therapists (PTs) with varying levels of clinical experience and expertise. Cross-sectional study. Qualitative movement assessment was conducted using 2-dimensional video recording of a 45° change of direction (COD) task of 20 female basketball players and scored using the CMAS. Intra-rater and inter-rater reliability were assessed across two experts with ≥8 years of clinical experience and orthopaedic and sports clinical specializations, and one novice rater with <2 years of clinical experience and no board certifications. Intra- and inter-rater reliability for total CMAS scores were evaluated using intraclass correlation coefficients (ICCs). Agreement for individual CMAS items was assessed using percent agreement and kappa coefficients. The CMAS demonstrated excellent intra-rater reliability (ICC = 0.96) and moderate inter-rater reliability (ICC = 0.67) for total scores across all three raters. For individual CMAS items, intra-rater percentage agreement was excellent (80-100%), and kappa coefficients were moderate to excellent (k = 0.59-1.00). Inter-rater percentage agreement for individual items was moderate to excellent (60-90%), and kappa coefficients were slight to excellent (k = 0.12-0.79). The CMAS can be a reliable tool for evaluating COD movement quality among PTs at various levels of clinical experience and expertise, although the identification of movement faults may have a relationship with years of clinical experience. The findings of this investigation suggest stronger intra-rater reliability than inter-rater reliability. Level 3.
The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.
Interval throwing programs (ITP) are commonly used while returning from injuries in baseball players. Recent advances in the understanding of the biomechanics and workloads of throwing programs have led to the development of ITPs that allow for a precise and gradual increase in workload to the arm. UCL treatment options continue to evolve and now include various procedures using an internal brace and hybrid approach in addition to traditional reconstruction and nonoperative care. Each variation has different timelines for clinicians to follow. The purpose of this paper is to describe four ITP variations of various durations that can be used for a variety of non-operative and postoperative injuries in baseball players. While these programs can be used for a variety of shoulder and elbow injuries, the application of these programs for UCL injuries will be explored. Cross-sectional descriptive study. Elbow varus torque per throw was estimated from a 2nd order polynomial regression derived from a relationship between throwing distance and elbow varus torque, based on a dataset of 238,611 throws collected from healthy collegiate baseball pitchers. This model was then applied to construct 4 ITPs: 7-month progression for UCL reconstruction (with and without a hybrid internal brace), 5-month progression for a UCL repair with internal brace, and two short-term progressions of 12-weeks and 6-weeks for nonoperative injuries. For each program, individual throws were assigned estimated torque values to calculate cumulative workload (daily, chronic, and acute), and acute-to-chronic workload ratio (ACWR). These values were plotted over time to evaluate workload progression. The 6-week program had a final chronic workload of 7.6 and stayed in the ACWR optimal range (0.7-1.3) the entire time. The 12-week program had a final chronic workload of 7.8 and stayed in the optimal ACWR range 98% of the time. The 5-month program finished with a chronic workload of 10.0 and stayed in the optimal range 95% of the program. The 7-month had a final chronic workload of 10.8, and stayed in the optimal range for 91% of the program. The four variations in ITPs each showed a gradual ramp-up of chronic workload over the duration of the program while maintaining within the recommended range of ACWR. These ITPs may be used to gradually build workload in baseball players returning from injuries. Due to the various lengths, the ITPs may be used as models to apply to a variety of common injuries or surgeries of the throwing shoulder and elbow. Level 3.
Current literature has shown benefit of radial pressure wave (RPW) and focused shockwave (FSW) for management of proximal hamstring tendinopathy (PHT), although there remains a lack of consensus on treatment parameters and optimal patient positioning. The purpose of this narrative review and clinical commentary is to report what has been described for patient positioning during treatment of PHT with RPW or FSW and propose an alternative side lying approach. A search was conducted of MEDLINE/PubMed and EMBASE electronic databases for studies published from January 2005 to January 2026. Key search terms included proximal hamstring tendinopathy, shockwave therapy, extracorporeal shockwave treatment, radial pressure wave, hamstring tendinosis, hamstring tendinitis, and hamstring pain. Studies were included if they evaluated RPW or FSW for the treatment of PHT. Six manuscripts were identified for inclusion, two randomized controlled trials (RCT), two retrospective reviews, and two case reports; a total of 217 patients (145 female, 72 male) with PHT were treated with RPW and/or FSW. One RCT provided an in-depth description of patient positioning during shockwave treatment with the patient supine, with the hip and knee flexed, compared to other manuscripts detailing clinical focusing techniques only. One case report involving a para swimmer included a figure of treatment with the patient in a prone position. Improvement in patient reported outcomes with RPW and/or FSW was noted, with one RCT showing no differences between physiotherapy compared to RPW and FSW treatment. RPW and FSW have some evidence regarding their benefits for treatment of PHT but controlled studies are limited and no consensus on treatment protocols or patient positioning during treatment have been determined. The authors' preferred approach in treating PHT involves having the patient side lying with the hip and knee flexed to allow patient and clinician comfort while also creating compression of the proximal hamstring about the ischial tuberosity. It remains unclear how variance in patient positioning affects patient-reported outcomes. Future studies using RPW and FSW should include documentation of patient positioning when evaluating RPW and FSW efficacy. 5.
Hip Osteoarthritis (OA) is a degenerative joint disease associated with pain, reduced physical function, and impaired quality of life (QoL). Identifying patient characteristics associated with these outcomes may improve understanding of disease impact and support individually tailored treatment. To explore associations between patient characteristics and key outcomes of pain, physical function, and QoL among individuals with hip OA. Secondarily, to investigate differences in pain, physical function, and QoL between patients recruited from hospitals and physiotherapy clinics in Denmark. Study design: Explorative cross-sectional study, with baseline data from a randomized controlled trial. Baseline data from The Hip Booster Trial was analyzed, including 159 adults with clinically diagnosed hip OA recruited from physiotherapy clinics and hospitals in Denmark. Associations between BMI, physical activity, age, sex, symptom duration, analgesic use (yes/no), muscle power (watts), educational level, and patient reported outcomes (HOOS pain, ADL, QoL) and the 30s-Chair Stand Test (CST) were evaluated using multiple linear regression. Change in the independent variable required to achieve a minimal important difference (MID) was calculated. Of the eight characteristics investigated, two were associated with all key outcomes. Higher muscle power was associated with less pain (0.08 points, 95% CI 0.02; 0.13), better QoL (0.05 points, 95% CI -.01; 0.11), and better physical function; HOOS ADL (0.10 points, 95% CI 0.04; 0.16), 30s-CST (0.02 repetitions, 95% CI 0.01; 0.03). The use of analgesics was associated with worse HOOS pain (-10.99 points, 95% CI -15.66; -6.31), worse HOOS QoL (-7.89 points, 95% CI -13.30; -2.49), and poorer physical function measured by HOOS ADL (-8.25 points, 95% CI -13.63; -2.86), and 30s-CST (-.76 repetitions, 95% CI -1.84; 0.32). Greater muscle power was associated with better outcomes for HOOS Pain, QoL, ADL, and the 30s-CST, whereas use of analgesics was negatively associated with these outcomes.
Rehabilitation practices and recovery timelines are variable following anterior cruciate ligament reconstruction (ACLR). Elucidating associations between longitudinal temporal characteristics of rehabilitation and relevant functional outcomes following ACLR may help with improving outcomes and reducing re-injury risk. The purpose of this systematic review was to analyze the effect of the duration of supervised rehabilitation on strength, functional performance, and self-reported outcomes following ACLR. A systematic review was conducted in the PubMed, Embase, Scopus, CINAHL, and Pedro databases following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Search terms included terms pertaining to diagnosis (e.g., 'anterior cruciate ligament', 'ACL reconstruction'), rehabilitation (e.g., 'rehabilitation', 'physiotherapy', 'physical therapy'), and outcomes (e.g., 'functional status', 'return to sport', 'return to play'). Inclusion criteria were studies that 1) included patients who had undergone primary ACLR, 2) reported outcome measures of strength, physical performance testing (such as hop testing), and/or patient reported functional status, and 3) measurements of the duration of supervised rehabilitation following ACLR. Exclusion criteria included a lack of direct statistical comparison of the effect of rehabilitation duration on outcome measures, studies that were not available in full-text in the English language, or studies that were later retracted. The Downs and Black checklist was implemented to assess the quality of the studies included, and risk of bias was assessed with the ROBINS-I tool. Out of 5598 studies initially retrieved, 44 underwent full-text screening and nine studies (one randomized controlled trial, one retrospective cohort, and seven cross-sectional studies) met inclusion criteria and were included in this study. These studies showed trends for higher knee strength, improved performance testing, and greater self-reported outcomes with a longer duration of rehabilitation. There was considerable variety in the duration assessed and time points for when the outcomes were measured. Limited quality evidence exists to support supervised rehabilitation of at least six months in duration following ACLR for knee strength, performance testing, and patient-reported functional outcomes. Level 3.
Muscle power is a critical determinant of functional capacity and overall health, particularly in aging and athletic populations. The 30-second Sit to Stand Power Test (30STSPT) offers a practical means of assessing lower limb power, yet its widespread clinical adoption is limited by the need for specialized equipment. Emerging technologies, such as 2D Artificial Intelligence (AI)-based camera systems, may offer scalable and accessible alternatives for power assessment. # PURPOSEThe purpose of this study was to determine (1) the concurrent validity against a dual force plate system and (2) the test-retest reliability of a 2D AI-camera for capturing and calculating the muscle power for a 30STSPT. It was hypothesized that the 2D AI-camera would have high test-retest reliability and strong concurrent validity with the power measured by a dual force plate system and inertial measurement unit (IMU). # STUDY DESIGNValidation and reliability study # METHODSA convenience sample of 24 healthy adults (20-55 years) completed two maximal-effort trials of the 30-second Sit-to-Stand Power Test (30STSPT). During each trial, repetitions were counted by research personnel, the AI-based camera system, and the criterion system (dual force plates synchronized with an inertial measurement unit [IMU]). The AI system automatically calculated trial-level mean power (W·kg-1) using body mass, stature, chair height, and performance time via a validated equation. The criterion method computed power from average peak vertical ground-reaction forces and IMU-derived vertical displacement. Concurrent validity between AI and criterion power was assessed using Pearson's correlation coefficient (r) with 95% confidence intervals (CI) and Bland-Altman analysis. Test-retest reliability for AI and criterion measures was evaluated using a two-way mixed-effects intraclass correlation coefficient (ICC(3,1)) with 95% CI, and measurement error was quantified via the standard error of measurement (SEM) and minimal detectable change at 95% confidence (MDC₉₅). A total of 24 individuals (M:F, 9:15) with a mean age of 34.4 ± 9.4 years and an average BMI of 24.9 ± 4.1 kg·m-2 completed two trials of the 30STSPT. AI-derived power demonstrated excellent correlation with the criterion method for Trial 1 (r = 0.945, 95% CI 0.861-0.979) and Trial 2 (r = 0.934, 95% CI 0.833-0.975). Bland-Altman analysis showed a mean bias of +0.66 W·kg-1 (LoA: -0.51 to +1.83) for Trial 1 and +0.53 W·kg-1 (LoA: -1.07 to +2.12) for Trial 2, with proportional bias evident in both trials (Trial 1 slope = -0.195, p = 0.027; Trial 2 slope = -0.285, p = 0.0049). Test-retest reliability of AI-derived power was excellent (ICC(3,1) = 0.942, 95% CI 0.860-0.977), with SEM = 0.362 W·kg-1 (7.13%) and MDC₉₅ = 1.004 W·kg-1 (19.8%). Criterion reliability was good-to-excellent (ICC(3,1) = 0.916, 95% CI 0.790-0.968), with SEM = 0.489 W·kg-1 (11.4%) and MDC₉₅ = 1.355 W·kg-1 (31.6%). The findings of this study support the use of a 2D AI-camera system as a valid and highly reliable tool for quantifying muscle power during the 30-second Sit to Stand Power Test. The 2D AI-camera system offers a promising solution for scalable, objective performance testing in clinical and remote settings.
Adherence to physical activity (PA) during hospitalization remains low in patients with oral cancer, despite the benefits of early mobilization emphasized in oncological rehabilitation protocols. Insight into how patients perceive PA in the immediate postoperative period is crucial for designing effective, patient-centered interventions. This qualitative study explored patients' experiences of PA during hospitalization following oral cancer surgery. A qualitative study was conducted using semistructured interviews guided by the behavior change wheel (BCW) framework. Dutch-speaking patients treated for oral cancer at the oral and maxillofacial department of University Hospitals Leuven (Belgium) and head and neck surgical oncology department of University Medical Center Utrecht (The Netherlands) were purposively sampled. Interviews were conducted at discharge, transcribed verbatim, and thematically analyzed in NVivo (QSR International, version 12, Burlington, MA, USA). Fifteen patients were included until saturation occurred. Seven overarching themes were identified: (A) barriers to PA, (B) activities of daily living (ADL), (C) support, (D) emotional state, (E) perceptions of PA, (F) PA patterns, and (G) recovery expectations. Walking was the most common activity, but participation was restricted by fatigue, medical devices, and a predominantly passive hospital culture. PA was strongly linked to regaining autonomy, coping with confinement, and preparing for discharge. Despite substantial barriers, patients with oral cancer demonstrate intrinsic motivation to remain active. However, this motivation often remains unmet due to insufficient personalized support and limited integration of PA into routine care. Perioperative physiotherapeutic interventions may help to overcome barriers and promote sustainable engagement in recovery-oriented activity.
Consensus is lacking regarding the underlying cause of two prevalent risk factors for shoulder and elbow pain in overhead throwing athletes: loss of shoulder internal rotation (IR) range of motion (ROM) and strength of the external rotators (ER). Consideration of cervical spine contribution may have important implications for rehabilitation and coaching of overhead throwers. The purpose of this study was to investigate the effect of performing active cervical retraction and retraction with extension exercises between innings of pitching a simulated game on shoulder IR ROM and ER strength following completion of the game. Randomized controlled study. Passive shoulder IR ROM at 90° of abduction and ER strength at 0° of abduction were assessed in healthy male baseball pitchers. Participants were randomized to a control or experimental group and completed a simulated game totaling 60 pitches. Those in the experimental group performed 10 repetitions of active cervical retraction and retraction with extension exercises with a 3-second hold at end-range between innings, while those in the control group rested. Shoulder IR ROM and ER strength were re-assessed immediately following the simulated game. Independent samples t-test was used to assess for between-group differences and effect sizes were calculated using Cohen's d. Twenty pitchers (mean age=19.2 ± 3.3) completed the study. All 10 pitchers in the experimental group demonstrated an increase in shoulder IR ROM (mean gain 7.7° ± 4.9) while all 10 pitchers in the control group demonstrated a loss of ROM (mean loss 8.4° ± 5.3), resulting in a significant between-group difference of 16.1° (p<0.001). Though the experimental group demonstrated a mean ER strength loss of 0.5kg compared to a 1.0kg loss in the control group, this difference was not statistically significant (p=0.399). Active cervical retraction and retraction with extension exercises performed between innings during a simulated game resulted in increased shoulder IR ROM compared to controls. Although ER strength loss was attenuated in the experimental group, this finding did not reach significance and is worthy of further exploration. Level 2.
Approximately 40% of women stop endocrine therapy for hormone-receptor-positive breast cancer within the first 5 years of prescribed treatment because of side effects. Musculoskeletal complaints are among the most frequently reported side effects. The Cancer Of the BReast Asanas (COBRA) study examines the effect of an 18-week yoga programme on endocrine therapy-associated musculoskeletal complaints in women with breast cancer. In total, 140 women will be randomised in a 1:1 ratio to the intervention or waitlist control group. The intervention programme consists of two times a week 1-hour supervised Hatha or (easy) Vinyasa yoga classes at a yoga or sports centre for 18 weeks and once per week a half-hour at home using videos. The waitlist control group is asked to maintain their habitual lifestyle during the first 18 weeks and will participate in a similar yoga programme to the intervention group for the following 18 weeks. The control group yoga programme is offered live-remote. The primary outcome (musculoskeletal complaints) is assessed with the Brief Pain Inventory questionnaire at baseline and 18 weeks (primary comparison) and additionally at 36 weeks. Secondary outcomes include lower and upper extremity joint complaints, menopausal symptoms, fatigue, sleep, quality of life, anxiety and depression, cognitive complaints and habitual physical activity (all patient-reported), vital signs and anthropometrics, physical fitness, blood biomarkers, medication use, safety data and patient and teacher experiences. At baseline and 18 weeks, cognitive complaints are also assessed with an online neuropsychological test battery. The COBRA study was approved by the Medical Ethical Committee of the University Medical Center Utrecht. The study started on 8 October 2024, and 65 participants have been included (20 January 2026). Results will be submitted to an international peer-reviewed journal. NCT06480513.
Breast cancer survivors frequently experience adverse changes in body composition, cardiometabolic biomarkers, functional capacity and quality of life that may worsen long-term prognosis, yet the comparative effectiveness of lifestyle interventions across delivery formats and supervision levels remains unclear. Background/Objectives: This systematic review assessed the effects of structured diet and exercise interventions on body composition, metabolic and inflammatory biomarkers, functional capacity, dietary habits and quality of life in breast cancer survivors. Methods: Following PRISMA guidelines, Cochrane, PubMed, Scopus and Web of Science were searched for randomized controlled trials and quasi-experimental studies published in English between 2016 and 2026. Risk of bias was assessed with RoB 2 and ROBINS-I and certainty of evidence with GRADE. Results: Of 1413 records, 15 studies (11 RCTs; mean age 46-60 years; mostly overweight or obese post-treatment women) met the inclusion criteria; twelve interventions were supervised and three home-based or web-based. Within the assessed domains, many studies reported significant improvements in body composition, quality of life and metabolic or inflammatory biomarkers. Effects were larger in multimodal supervised programs combining caloric restriction with moderate-to-vigorous aerobic plus resistance training (5-8% weight loss; 19-29% visceral fat reduction; improved insulin, IGF-1, leptin, adiponectin and EORTC QLQ-C30 scores), whereas digital or low-intensity interventions produced smaller, less uniform objective effects despite improving dietary behaviors. GRADE certainty ranged from very low to moderate-high. Conclusions: Multimodal supervised programs offer the most robust benefits; digital formats require additional supervision. Standardized protocols and longer follow-up are needed.
Multidirectional shoulder instability (MDI) is characterized by symptomatic subluxation or dislocation in multiple directions and is difficult to treat. Conservative management primarily involves exercise therapy aimed at strengthening the rotator cuff and scapular stabilizing muscles. However, when the instability is severe, performing such exercises can be challenging. This case report describes the clinical course of a school-aged karate athlete with MDI in whom exercise therapy was effectively facilitated through figure-of-eight taping. A 12-year-old female karate athlete with no history of trauma presented with discomfort, pain, and a clicking sensation in the right shoulder. Clinical examination revealed predominantly inferior and anterior instabilities with subluxation occurring just below 90° of active shoulder flexion. Rehabilitation was conducted over a five-month period, from April to September 2025 and was divided into three phases. In Phase 1, exercises to promote scapular upward rotation and strengthen the rotator cuff were performed; however, the sensation of subluxation persisted at approximately 90° of flexion. Therefore, figure-of-eight taping was introduced in Phase 2. Immediately after taping, the active range of flexion improved from 95° to 140°, and sense of instability decreased. Accordingly, rehabilitation was continued while wearing the tape. In Phase 3, stable active flexion was achieved without taping, and exercises for the scapular and rotator cuff muscles were performed actively in the elevated position. After five months, active shoulder flexion improved from 85° to 180°, and abduction increased from 70° to 170°. The Rowe score improved from 10 to 80 of 100, and the Quick-DASH disability/symptom and sports module scores improved by 6.8 and 25 points, respectively, from the 1-month to 5-month assessment. The subject returned to daily and sports activities without difficulty. In this school-aged karate athlete with MDI, figure-of-eight taping may have provided immediate support and served as a useful adjunct to facilitate exercise therapy. 5.
Patellofemoral conditions are common causes of knee symptoms in young and active individuals and have been linked in prior literature to neuromuscular and movement-related deficits that also have been associated with anterior cruciate ligament (ACL) injury risk. However, whether a prior diagnosis of patellofemoral conditions is associated with increased subsequent ACL injury risk remains unclear. To determine whether prior diagnosis of patellofemoral conditions (PFC) is associated with an increased risk of subsequent anterior cruciate ligament (ACL) injury or other intra-articular knee pathology. Retrospective cohort study. Electronic medical records from a multi-state health system were reviewed to identify patients aged 14-40 years with patellofemoral conditions (PFC) diagnosed between 2014 and 2016. Exclusion criteria included prior major lower extremity injury or surgery, systemic rheumatologic disease, and incomplete records. Identified patients were followed through 2024 for incident knee injuries or knee-related surgical procedures. The primary outcome tracked was incident ACL injury. Secondary tracked outcomes included meniscal, chondral, medial patellofemoral ligament, and other ligamentous injuries of the knee, as well as knee-related surgical procedures. Cumulative incidence was estimated, and risk factors were compared using Wilcoxon rank-sum, chi-square tests, and multivariable logistic regression adjusting for age, sex, and body mass index (BMI). Of 3,108 screened charts, 1,232 patients met inclusion criteria (median age: 19 years; 69.2% female). During the follow-up time period, 10.9% sustained an intra-articular knee injury or underwent a knee-related surgical procedure. ACL injuries occurred in 2.5% and meniscal injuries in 4.1%; less frequent events included medial collateral ligament injuries (0.7%), osteotomies (0.6%), and patellar tendon injuries (0.2%). The ACL incidence in this cohort was 246 per 100,000 person-years, a 3.6-fold higher rate compared with the general population. Injuries occurred predominantly ipsilateral to the index PFC diagnosis. In adjusted analysis, greater weight and BMI were associated with subsequent knee injury; however, multivariable logistic regression did not identify age, sex, or BMI as independent predictors of ACL injury. Patients with patellofemoral conditions showed a substantially elevated incidence of subsequent ACL injury compared to the general population. A prior diagnosis of PFC may identify a subgroup at greater risk for later intra-articular knee injury and may warrant closer rehabilitation and injury-prevention consideration. 3.
Rotator cuff injuries are one of the more common injuries that occur in the shoulder. Four muscles and tendons make up the rotator cuff. These include the supraspinatus, infraspinatus, subscapularis, and the teres minor. The teres minor is the smallest of the rotator cuff muscles. It originates from the middle third of the lateral border of the scapula, just below the insertion of the teres major. It inserts onto the inferior facet of the greater tubercle of the humerus. The teres minor is innervated by the axillary nerve, and its muscular action is that of external rotation, and it can be a weak abductor of the shoulder. It is part of a larger force couple between the rotator cuff group and the deltoid, which stabilizes the humeral head during humeral elevation. Although the teres minor can be torn in massive rotator cuff tears, it is also commonly overused during repetitive activities requiring overhead lifting or external rotation. An accurate diagnosis of teres minor overuse, partial tears, or ruptures is essential for appropriate treatment planning and optimizing patient outcomes. Diagnostic musculoskeletal ultrasound (MSKUS) offers a portable, real-time, and cost-effective alternative that is gaining traction in rehabilitation and sports medicine settings. MSKUS has emerged as a valuable, non-invasive imaging modality for evaluating rotator cuff injuries, including tendinopathy, muscle strains (partial tears), and ruptures. MSKUS is excellent at detecting changes in tendon and muscle composition and continuity. This manuscript will review the utility of MSKUS in evaluating teres minor tendon and muscle injuries, including anatomy, common injury mechanisms, sonographic techniques, and clinical implications for those in the rehabilitation profession. By integrating MSKUS into clinical practice, providers can improve diagnostic accuracy, enhance diagnostic confidence, monitor healing progression, and guide rehabilitation strategies to achieve optimal patient outcomes for those with teres minor injuries.
BACKGROUND: Stroke patients are less physically active than the general population. Various determinants can affect post-stroke physical activity; understanding these determinants can help tailor targeted interventions. The Determinants of Physical Activity Questionnaire (DPAQ), based on the Theoretical Domains Framework, assesses determinants of physical activity. This study aimed to translate the DPAQ into Dutch and evaluate its content validity (comprehensibility, relevance and comprehensiveness) in a stroke population and their peers without stroke. METHODS: The DPAQ was translated according to international guidelines. Content validity was assessed at an outpatient neurorehabilitation clinic. Seven stroke patients completed the DPAQ using think aloud and cognitive debriefing. Audio-recorded data were transcribed, coded and analysed. The DPAQ was adapted and re-tested in seven other stroke patients and seven peers. RESULTS: The translation and content validity test resulted in the following adaptations: the DPAQ introduction was clarified; the response option ‘Do not want to answer’ was changed to ‘Cannot answer’; and some negatively phrased items were converted to positive. Of the adapted version, most items were found comprehensible and relevant by both stroke patients and peers, except for items on coping planning (complex sentence structure and abstract item-wording) and goal conflict (irrelevant for some patients and peers). The DPAQ was found comprehensive for both patients and peers. CONCLUSIONS: A Dutch version of the DPAQ was created, which was considered comprehensible, relevant and comprehensive for both stroke patients and peers without stroke.
Shoulder injuries are highly prevalent in overhead sports such as water polo due to repetitive high-intensity throwing demands. While structural pathologies have been widely studied, there is a lack of evidence regarding the role of myofascial dysfunction in this athletic population. This study aims to analyze the relationship between myofascial dysfunction in the shoulder musculature and self-perceived functional capacity in competitive water polo players. Observational cohort. Male water polo players from youth and senior categories of two clubs in Madrid (Spain) were recruited for participation in this study. A clinical evaluation of myofascial dysfunction was performed through manual assessment of myofascial trigger points (MTrPs) using a composite score (0-6) based on the presence of six diagnostic criteria and completion of the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score questionnaire were performed. Spearman correlation analysis and hierarchical multiple regression were performed to examine the association between MTrPs and shoulder function. A total of 33 water polo players aged 18.30 ± 2.82 years were included. Significant moderate negative correlations were found between myofascial trigger point scores and the KJOC score for the infraspinatus (r = -0.413, p = 0.017), subscapularis (r = -0.377, p = 0.030), and anterior (r = -0.580, p < 0.001), middle (r = -0.480, p = 0.005), and posterior deltoid (r = -0.534, p = 0.001). The findings suggest that myofascial dysfunction significantly negatively impacts shoulder function and performance in water polo athletes. Level 3.