IMPORTANCE: Exercise is recommended as a core treatment for knee osteoarthritis; yet uptake is suboptimal, with identified barriers including pain, difficulty (overly effortful), and boredom. Virtual reality (VR) shows promise in overcoming these barriers, although whether VR-enhanced exercise is acceptable to people with osteoarthritis and feasible in physical therapy settings is unknown. OBJECTIVE: The objective was to assess the feasibility of conducting a clinical trial to evaluate VR-enhanced cycling and explore preliminary efficacy of this intervention. DESIGN: A prospectively registered (ACTRN12624000122550), two-arm feasibility randomized controlled trial was conducted. SETTING: The trial was conducted at a clinical trials facility. PARTICIPANTS: Forty-one participants with painful knee osteoarthritis were enrolled. INTERVENTIONS: Participants were randomized (1:1 ratio) to receive VR-enhanced cycling or traditional (no-VR) cycling, both involving twelve, 30-minute cycling sessions over 6-weeks, supervised by a physical therapist. MAIN OUTCOMES AND MEASURES: A priori feasibility criteria surrounding recruitment and enrolment rate, intervention adherence, technical difficulty, retention, and participant experience (acceptability, credibility, adverse events) were evaluated. Clinical outcomes (pain, function) and exercise capacity (perceptually regulated exercise test) were assessed at baseline, post-intervention, 1-month follow-up (clinical outcomes only). Within-session exercise engagement (work, time) and experience (perceived exertion, affect) were evaluated as process variables. RESULTS: All feasibility criteria were met. An average of 6.8 participants per week were eligible with a 73% enrollment rate. Participants attended 91% of intervention sessions, and 90% of participants completed follow-up assessments. VR technical issues were rare (3% of sessions) as were adverse events (2 unrelated to VR). Treatment acceptability and credibility was high and clinical outcomes improved in both groups. CONCLUSIONS: Progression to a full trial is supported due to high feasibility, acceptability, and improvement in clinical outcomes. RELEVANCE: Although not powered to evaluate efficacy, the within-group changes observed demonstrate that both cycling modalities can improve knee pain, function, and exercise capacity.
Abstract Randomized clinical trials (RCTs) are considered the ideal method for assessing the effectiveness of physical therapist interventions. However, RCTs are resource-intensive and usually take several years to complete, often providing insights well after they are needed to inform practice. Due to the constantly evolving nature of physical therapy, study designs are needed that can more rapidly generate evidence that can be used to guide clinical care. Target trial emulation (TTE) provides a framework that improves researchers’ abilities to draw causal inferences from observational data, by specifying protocol components of a hypothetical RCT and emulating those components with observational data elements. By leveraging data generated through routine care encounters, TTE allows researchers to examine the effectiveness of interventions as they are being used in clinical care – enhancing researchers’ abilities to generate evidence when it is most needed. However, TTE has not been used extensively among physical therapy researchers, potentially due to a lack of familiarity with this concept or challenges related to the way physical therapy is delivered or the types of data generated during physical therapist encounters. In this manuscript, the authors provide an introduction to the TTE framework, using an ongoing study examining the effectiveness of remote therapeutic monitoring as a case example. The authors also discuss considerations and challenges associated with TTE studies within the context of physical therapy and recommend strategies for addressing these challenges. They also discuss how TTE studies can be enhanced through the addition of implementation-focused data collection and conclude with a discussion of limitations associated with TTE studies.
ABSTRACT Importance Artificial intelligence (AI) is increasingly integrated into health care delivery, but its influence on consumer perceptions of physical therapist services remains unclear. Objective The objective was to examine how the use of AI influences consumer perceptions of in-person and telerehabilitation physical therapist services. Design This study used a randomized 2 × 2 factorial experimental design comparing AI use and delivery mode. Setting The experiment was conducted online in Australia. Participants The study included 710 Australian adults recruited through a paid panel. Exposure Participants were randomized to 1 of 4 hypothetical physical therapist consultation scenarios (in-person vs telerehabilitation; AI used vs not used). Main Outcomes and Measures Perceived warmth; competence; safety; provider trust; emotional trust; relational and functional service quality; working alliance; and intention to use were measured on 7-point Likert-scales. Composite mean scores were analyzed using ordinary least squares regression with heteroskedasticity-robust standard errors. Results Mean scores in the no-AI, in-person condition ranged from 4.8 to 5.8. Among in-person scenarios, described AI use was associated with lower ratings across all outcomes, including warmth (b = -0.3, 95% CI = -0.5 to -0.1), competence (-0.4, -0.6 to -0.2) and safety (-0.8, -1.1 to -0.6), provider trust (-0.5, -0.7 to -0.3) and intention to use (-0.8, -1.0 to -0.5). Without AI, telerehabilitation also reduced ratings by 0.2 to 0.7 points across outcomes. Positive interaction effects indicated attenuation of AI-related reductions in telerehabilitation for relational (interaction b = 0.4, 95% CI = 0.1 to 0.8) and functional service quality (0.36, 0.02 to 0.70), intention to use (0.6, 0.1 to 1.0), and perceived safety (0.5, 0.1 to 0.9). Conclusions Hypothetical in-person consultations described as involving AI were associated with poorer consumer perceptions of physical therapists and services. Telerehabilitation was also perceived less favorably than in-person care. Relevance Future studies should test whether transparency and reassurance mitigate the effects of AI-use on consumer perceptions of physical therapy.
Abstract Importance Hospitalization-associated disability (HAD), defined as a decline in activities of daily living following hospitalization, is a common complication in older patients with heart failure (HF) and is associated with adverse clinical outcomes. Early identification of patients at high risk for HAD may facilitate timely rehabilitation and discharge planning. Objective The objective was to evaluate whether baseline physical function, assessed using the Short Physical Performance Battery (SPPB), is associated with HAD onset in older patients hospitalized with HF. Design This was a prospective cohort study. Setting The study was conducted at a single-center acute care hospital. Participants The study included 417 patients aged 65 years or older who were hospitalized with HF and prescribed physical therapy between June 2023 and December 2025. Exposure Baseline SPPB was assessed within 3 days after transfer to the general ward. Main Outcomes and Measures The primary outcome was HAD, defined as a decline of 5 or more points in the Barthel Index from prehospitalization to hospital discharge. Results Multivariable logistic regression identified baseline SPPB score as independently associated with HAD onset. Receiver operating characteristic analysis demonstrated good discrimination (AUC = 0.811), with an optimal cutoff value of 6.5 points (<7 points). Decision tree analysis identified the baseline 4-meter walk score as the SPPB subitem most strongly associated with HAD onset. Supplementary logistic regression showed that a low baseline 4-meter walk score was independently associated with HAD onset. Conclusions Baseline SPPB scores assessed after transfer to the general ward were independently associated with HAD onset and may help identify older patients hospitalized with HF who are at increased risk for HAD. External validation is warranted before clinical implementation. Relevance The SPPB is a simple and feasible bedside assessment that may support early risk stratification for HAD in older patients hospitalized with HF.
Abstract IMPORTANCE Pain affects up to half of survivors of breast cancer and is one of the most common long-term consequences of cancer treatment, yet it remains under-recognized and undertreated. Pharmacological options often provide limited relief and may cause adverse effects. Evidence from other pain populations supports a biopsychosocial approach combining pain education and physical activity. OBJECTIVE The objective is to evaluate whether pain science education (PSE) with behavioral graded activity (BGA) versus usual care (UC), reduces pain intensity and interference in survivors of breast cancer with pain. Secondary aims include assessing health-related quality of life (HRQoL) and central pain modulation. DESIGN This study is a multicenter, two-arm, assessor- and statistician-blinded, randomized controlled superiority trial. SETTING The trial will be conducted in Belgium, with interventions delivered in hospital and academic research settings. PARTICIPANTS Two hundred women with a history of breast cancer and persistent pain will be recruited. INTERVENTIONS Participants will be randomized to either (1) PSE (1 session) plus 5 BGA sessions delivered by a trained physical therapist, or (2) usual care with a standardized biomedical pain information leaflet, over a 12-week period. MAIN OUTCOMES AND MEASURES The primary outcome will be pain intensity and interference (Brief Pain Inventory). Secondary outcomes will include HRQoL (EORTC QLQ-C30) and central pain modulation (Quantitative Sensory Testing). Exploratory outcomes include sleep, fatigue, pain-related cognitions, and health care utilization. Assessments will be conducted at baseline, post-intervention, and at 3-month (primary endpoint), 1-year, and 2-year follow-ups. CONCLUSIONS This trial will determine whether a structured PSE+BGA program improves pain and HRQoL in survivors of breast cancer, offering a potential scalable non-pharmacological treatment. RELEVANCE These findings may guide targeted rehabilitation strategies and strengthen the role of physical therapists in managing post-cancer pain, particularly in light of the growing population of survivors of breast cancer and the increasing prevalence of persistent symptoms.
