BACKGROUND:Platelet-rich plasma injections (PRPI) are a relatively new and evolving treatment option for a variety of musculoskeletal injuries. It has been theorized that there is an increased risk of septic arthritis (SA) with PRPI, though there have been no dedicated studies to assess the incidence of SA and only three cases have been previously reported to the authors' knowledge. By comparison, corticosteroid injections (CSI) have been a widely used treatment for decades, with a well-established risk profile and a variably reported incidence of SA between 1 in 555 to 77,000 injections. OBJECTIVE:To identify the incidence of SA after peripheral joint/bursa PRPI, specifically in comparison to CSI. DESIGN:Case-Control Series. SETTING:Two large academic medical centers. MAIN OUTCOME MEASURE(S):Incidence of SA, location of infection. PATIENTS:All patients who underwent CSI or PRPI over the study timeframe. METHODS:A search of electronic medical records was conducted to identify patients who underwent CSI and PRPI, with a subsequent encounter for a joint infection within 3-60 days of injection. Records were then reviewed by a physician to verify correlation. RESULTS:A total of 1,067,498 total injections were identified in 366,541 patients: 1,053,953 CSIs in 358,079 patients and 13,545 PRPIs in 8462 patients. There were 69 confirmed cases of SA after CSI and one case of SA after PRPI. The incidence of SA after CSI and PRPI was 1 per 15,275 (95% CI 12,077-19,342) injections and 1 per 13,545 (95% CI 2392-76,923) injections, respectively. CONCLUSIONS:To the authors' knowledge, this is the first study to report the incidence of SA following peripheral joint/bursa PRPI. One case of SA after PRPI was identified. There is a low incidence of SA after both CSI and PRPI, consistent with previously published data for CSI.
BACKGROUND:Eating a whole-food, plant-predominant diet reduces chronic systemic inflammation, which can improve pain in people with chronic musculoskeletal conditions. However, 85% of people have dietary perceptions that do not accurately reflect their actual dietary quality. OBJECTIVE:To determine whether patients' dietary perceptions align with dietary quality, assess correlations between dietary perception and lifestyle metrics, and evaluate how dietary perceptions relate to outcomes following Lifestyle Medicine (LSM) program completion. DESIGN:Retrospective review of repository data. SETTING:Tertiary orthopedic center. PATIENTS:Seven hundred eighty-three adults enrolled in the LSM program from March 2022-August 2024. INTERVENTIONS:Patients chose to participate in an intensive (multiple-visit) or selective (single-visit) track of the LSM program to treat musculoskeletal conditions and chronic diseases. MAIN OUTCOME MEASURES:Dietary perceptions were evaluated by asking patients if they had a healthy diet. Dietary quality was assessed by determining percentages of whole-food on a plate per meal (healthy diet: ≥50%). Lifestyle metrics included physical activity, sleep health, anxiety/depression, social connections, and smoking status. Program outcomes included the ability to attain goals to have hip or knee arthroplasty in a subset of 158 patients. RESULTS:Of the 783 patients (74.3% female, 60.3 ± 10.8 years), 60.4% (95% confidence interval [CI]: 56.9%-63.9%) had healthy dietary perceptions. Lifestyle metrics did not differ between patients with concordant versus discordant dietary perceptions (p > .05). Compared to patients with unhealthy dietary perceptions, patients with healthy dietary perceptions were more likely to be physically active (41.5% vs. 33.5% [p = .025]) and report good social connections (94.6% vs. 82.3% [p < .001]), with less sleep impairment (73.9% vs. 86.1% [p < .001]) and anxiety/depression (42.9% vs. 59.5% [p < .001]). Hip or knee arthroplasty rates did not differ by dietary perception status. CONCLUSION:Perceiving one's diet as healthy, rather than concordance with actual dietary quality, was associated with favorable lifestyle metrics. This suggests positive health perceptions may help predict engagement in other healthy behaviors.
BACKGROUND:Access to greenspace (eg, parks) may improve aspects of physical and mental health that are known biopsychosocial contributors to back pain. However, little is known about the association between access to greenspace and back pain. METHODS:This cross-sectional analysis used data from the Study of Osteoporotic Fractures (SOF) and the Osteoporotic Fractures in Men Study (MrOS) to investigate the association of proximity to greenspace with back pain among community-dwelling older adults living in Portland, Oregon, USA. Geospatial software characterized proximity to greenspace (distance from residential address to nearest park) into three categories thought to be relevant for walkability among older adults: <0.125, 0.125-0.5, and >0.5 mile. We estimated the crude prevalence of any back pain (yes/no) during the past year by proximity-to-greenspace categories and their association as gender-specific prevalence ratios (aPRs) using log-binomial regression models adjusted for age, race, education, and neighborhood socioeconomic status. RESULTS:Participants were 1839 SOF women (mean age = 74.6 years, SD = 5.3) and 422 MrOS men (mean age = 73.7 years, SD = 5.8). Living >0.5 mile from a park, compared to living <0.125 mile, was associated with a greater prevalence of back pain among women (crude prevalence: 71.1% vs. 61.6%, aPR = 1.15 [1.02-1.29]) but not men (64.2% vs. 76.4%, aPR = 0.82 [0.66-1.02]). Sensitivity analyses that used more severe back pain phenotypes provided heterogenous results. CONCLUSION:In this cross-sectional study, living near a park was associated with a modestly lower prevalence of back pain for women but not men. Large prospective studies are needed to further evaluate whether living close to parks, or other greenspaces, is associated with back pain in older adults.
INTRODUCTION:Posterior shoulder subluxation and glenohumeral dysplasia are known secondary complications of birth brachial plexus palsies (BBPP) that contribute to functional limitations. The prevalence of shoulder subluxation in infants with BBPP and the timeline of when subluxation occurs in the first year of life remain unclear, with prior literature ranging from 7% to 56% prevalence, in part owing to lack of standardized protocols for screening. OBJECTIVE:To determine the prevalence of posterior shoulder subluxation in infants with BBPP and persistent neurological deficits with universal ultrasound screening. DESIGN:Retrospective cohort study setting: Tertiary multidisciplinary specialty clinic. PATIENTS:114 infants with BBPP referred to a multidisciplinary brachial plexus clinic between 2011 and 2023 with persistent neurological deficits beyond neurapraxic injuries. INTERVENTIONS:Screening shoulder ultrasound examinations were performed at 3 and 6 months of age (unless they otherwise met the institutional cutoff of alpha angle ≥40 degrees for early intervention). MAIN OUTCOME MEASURE(S):Alpha angle, Active Movement Score (AMS) for shoulder movements, shoulder passive range of motion (PROM). RESULTS:On initial screening at 3 months, 83.3% (95 patients) had shoulder subluxation. Sixty-six patients (57.9%) had alpha angles ≥40 degrees (severe). The mean alpha angle for the affected shoulder was 45.57 (SD 17.12), and 26.92 (SD 5.84) for the contralateral unaffected shoulder. On linear regression, decreased PROM with shoulder external rotation in adduction was correlated with higher alpha angle measurements (β = -0.599, 95% CI -0.758 to -0.308, r = -0.484, p < .001). Of the patients with normal PROM-ER, 74.6% (50 patients) had shoulder subluxation on imaging. 43.9% (29 patients) with severe subluxation had normal PROM-ER. Thirty-seven patients underwent a second screening ultrasound at 6 months of age, of which 64.9% (24 patients) had subluxation, and 21.6% (8 patients) had severe subluxation. Only 4 patients without subluxation at 3 months developed mild subluxation at 6 months. CONCLUSIONS:The prevalence of shoulder subluxation is much higher than previously reported in the literature. Over half of patients with subluxation on imaging have no PROM deficits on exam. Multicenter prospective longitudinal data are needed to further evaluate if early detection of shoulder subluxation allows for timely intervention and treatment for joint preservation.
Although telerehabilitation has demonstrated effectiveness comparable to traditional face-to-face rehabilitation for low back pain and joint replacement, the lack of standardized protocols after lumbar spine surgery hinders optimal recovery. We mapped existing evidence on telerehabilitation interventions for patients undergoing lumbar spine surgery, focusing on intervention characteristics, identifying evidence gaps, and providing insights for clinical implementation. We searched PubMed, Web of Science, and Physiotherapy Evidence Database for studies published between January 2000 and April 2025. This was a scoping review following the Arksey and O'Malley framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Adults (≥18 years) who underwent lumbar spine surgery and received telerehabilitation interventions were included. The outcome measures were as follows: pain outcomes, functional outcomes, patient engagement in rehabilitation, self-efficacy, and adherence rates. Thirteen reports from eight unique primary studies, encompassing 724 participants (mean age: 40-65 years, 56.6% female) were included. Considerable heterogeneity in intervention timing (preoperatively to 3 months postoperatively), content (exercise therapy, education, counseling, and monitoring), and technology platforms (telephone, smartphone apps, wearable devices, and web platforms) was observed. Six of the eight primary studies reported short-term improvements in pain and functional outcomes; however, reports on long-term effectiveness (>1 year) were inconsistent. Patient engagement in rehabilitation, self-efficacy, and adherence were critical success factors. Telerehabilitation shows promise for supporting patients undergoing lumbar spine surgery, particularly for short-term functional improvements. Future studies should focus on the validation of long-term effectiveness and optimal intervention methods, with patient stratification required to identify the approaches that work best for different patient profiles.
BACKGROUND:Patient reported outcome measures (PROMs) can be used to quantify responses to treatment and for quality measurement purposes. However, the clinical importance of a given change in a PROM score is hard to interpret. The minimal important change (MIC) is the smallest change in score that patients consider important. OBJECTIVE:To estimate MICs for three PROMs at 3- and 9-month follow-ups for a large five-institution sample of patients with carpal tunnel syndrome. DESIGN:Cohort study. SETTING:Two university, two Veterans Affairs, and one community nonprofit health care systems. PATIENTS:Patients receiving initial consultation with a hand surgeon for carpal tunnel syndrome. MEASURES AND METHODS:Patients completed baseline, 3-month, and 9-month PROMs: the Boston Carpal Tunnel Questionnaire Symptom (BCTQ-SS) and Functioning (BCTQ-FN) Scales, and the Quick Disabilities of the Arm, Shoulder, and Hand (QDASH) scale. Anchor-based methods and Youden J-statistics were used to find the optimal MIC cut points that maximized sensitivity and specificity for patients being satisfied with the outcome of treatment. RESULTS:Six hundred thirty-five patients completed the baseline PROMs, and 551 (87%) and 516 (81%) completed the 3- and 9-month PROMs, respectively. The percentage of patients who were at least somewhat satisfied with the results of treatment differed between the carpal tunnel release and nonoperative subgroups (91% vs. 67% at 9 months), as did the MIC estimates. At 9 months, 295 of 326 (91%) of carpal tunnel release patients were satisfied with the results of treatment, with MICs of 0.81, 0.66, and 15.7 for the BCTQ-SS, BCTQ-FN, and QDASH, respectively. We also produced MICs for the 3-month assessment, the nonoperative, and overall samples. CONCLUSIONS:These MIC estimates can be used in clinics or research to gauge response to treatment and used in the design of PROM-based quality measures.
Abstract Objective The aim of this systematic review and meta‐analysis is to determine the effects of transcranial direct current stimulation (TDCS) on pain (considering the different types of pain measured) and function in adults with knee osteoarthritis (OA). Literature Survey The Cochrane Library, MEDLINE, Web of Science, Embase, Scopus, Physiotherapy Evidence Database, Literatura Latinoamericana y del Caribe en Ciencias de la Salud , and Science Direct were searched from inception to December 2023. Reference lists of selected trials and previously published and cited reviews were also examined. Results were restricted to randomized controlled trials on adults with knee OA, with TDCS as the primary intervention. Studies that included other knee issues or that compared TDCS with other therapies without a control group were excluded. Methodology Study characteristics, such as author, year of publication, study design, intervention description, sample characteristics and outcomes, were described. The Cochrane risk‐of‐bias tool and the Grading of Recommendations Assessment, Development, and Evaluation system were used to assess the individual and global risk of bias and quality of evidence. To analyze the effects of the interventions on clinical outcomes, a meta‐analysis was performed. The outcomes included were self‐reported pain and function, pain pressure threshold (PPT), and conditioned pain measure (CPM). Intervention comparisons were grouped as “active TDCS” and “sham TDCS”. Synthesis A total of 1045 participants completed the interventions. The meta‐analysis demonstrated significant improvement in self‐reported pain intensity measured with the visual analogue scale or numerical rating scale (Cohen's d = −1.05 [95% CI, −1.40 to −0.70]), pain measured according to PPT (Cohen's d = −0.77 [95% CI, −1.45 to −0.09]) and function (Cohen's d = −0.29 [95% CI, −0.54 to −0.04]) with active TDCS as compared with sham TDCS. There was no difference in CPM between interventions. Conclusions TDCS intervention alone or in combination with other techniques improves self‐reported pain intensity (as measured by visual analogue scale, numerical rating scale, or PPT) and function in knee OA but has no impact on the endogenous pain inhibition system as measured with CPM.
BACKGROUND:Platelet-rich plasma (PRP) is increasingly used for treatment of knee osteoarthritis, but there is limited understanding regarding which patients will benefit most. The impact of lifestyle-related chronic diseases, which are linked to systemic inflammation, and behavioral factors, such as agreed-upon out-of-pocket costs, have been underevaluated as predictors of PRP response. OBJECTIVE:To investigate patient-specific factors for favorable response to intra-articular PRP injection in treating knee osteoarthritis, with a focus on lifestyle-related chronic disease burden (ie, hypertension, hyperlipidemia, type-2 diabetes, obstructive sleep apnea, anxiety/depression, gastroesophageal reflux disease, autoimmune disease, some cancers) and patients' agreed-upon out-of-pocket costs. DESIGN:Retrospective review. SETTING:Tertiary orthopedic institution. PATIENTS:Patients who underwent first-time, single, intra-articular PRP injections for symptomatic knee osteoarthritis. INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURES:Numerical rating scale or visual analog scale pain scores were collected at baseline and at 3-6 months post injection. Patients who achieved minimal clinically important reductions of 20% in pain score, or overall pain improvement of ≥60%, were classified as responders. RESULTS:Two hundred nine initial intra-articular PRP injections in 199 unique patients with symptomatic knee osteoarthritis were included. The mean age was 65 ± 11 years (113/209 [54%] female). A majority (91%) of the cohort had more than one lifestyle-related chronic disease, with the most common being hyperlipidemia; 74% had two or more lifestyle-related chronic diseases. Of the 209 injections, 85 (41% [95% confidence interval (CI): 34%-48%]) were classified as responders. Obstructive sleep apnea was more prevalent in nonresponders than responders (9% vs. 1%; p = .019). On multivariable logistic regression, having fewer than two lifestyle-related chronic diseases (odds ratio [OR]: 2.06 [95% CI, 1.01-4.16]; p = .046) or paying higher out-of-pocket procedure costs (OR: 1.28 [95%CI, 1.04-1.59] per $500-increase in out-of-pocket cost; p = .022) was associated with greater likelihood of positive response to PRP injection at 3-6 months. CONCLUSIONS:The effectiveness of PRP injections for knee osteoarthritis may be reduced in patients with higher cumulative disease burden of lifestyle-related chronic diseases, as well as in patients paying lower out-of-pocket procedure costs.
BACKGROUND:Adjustable-volume prosthetic sockets have been developed to allow users to accommodate volume fluctuations throughout the day. Improvement in socket fit is thought to enhance the connection between the user's residual limb and prosthesis and may therefore improve postural control and balance. However, no studies have assessed balance-related outcomes or falls between different adjustable socket designs. OBJECTIVE:To compare balance-related outcomes for people with transfemoral limb loss using three styles of adjustable-volume sockets and a laminated socket. DESIGN:Randomized clinical trial. SETTING:Prosthetics clinics and research laboratories. PARTICIPANTS:A convenience sample of 29 individuals with unilateral transfemoral amputation were recruited, of whom 23 completed testing in at least one adjustable-volume socket and were included. INTERVENTION:Participants completed four 4-week trials with each of three adjustable-volume prosthetic sockets and a laminated socket, in random order. Adjustable-volume sockets included Infinite (LIM Innovations, San Francisco, CA, USA), CJ (CJ Sockets Technologies, Beverly, MA, USA), and Quatro (Quorum, Windsor, CO, USA). MAIN OUTCOME MEASURES:The primary outcomes were self-reported balance, number of falls and stumbles, and balance confidence. Secondary outcomes included the Narrow Beam Walk Test (NBWT) and Timed Up and Go Test (TUG). Surveys were conducted after at least 3 weeks of use of each socket, and functional measures were collected after 4 weeks. RESULTS:There were no main effects of socket type on self-reported balance (p = .316), balance confidence (p = .963), NBWT (p = .159), or TUG (p = .581). Eighteen participants (78%) reported falling or stumbling at least once in a 3-week period in at least one socket condition. There were no differences in the proportion of fallers (1+ falls) or stumblers (1+ stumbles) between the laminated condition and any adjustable-socket condition (p > .210). CONCLUSIONS:The adjustable-volume prosthetic sockets tested demonstrated comparable performance to laminated sockets for balance and fall-related outcomes. The high number of falls and stumbles reported suggests that future studies should focus on balance and falls training, acknowledging that changes to the socket may be insufficient to address this issue.
BACKGROUND:Rehabilitation for hip joint-related pain (HRP) is challenging to navigate and often leads to suboptimal clinical outcomes and frustration for both clinicians and patients. OBJECTIVE:To determine physical therapist (PT)-identified facilitators and barriers to rehabilitation for patients with HRP to inform strategies for improving rehabilitation. DESIGN:Qualitative; focus groups. SETTING:Academic and clinical. PARTICIPANTS:Licensed PTs who treat patients with HRP (N = 20; 12 female/8 male) participated in virtual focus groups (N = 4 groups; 4-6 PTs per group). MAIN OUTCOME MEASURE(S):PTs reported demographics (age, gender, race, ethnicity), number of years practicing, practice setting, and additional certifications. We used a hybrid deductive-inductive thematic analysis to determine PT-identified facilitators and barriers to rehabilitation for HRP. RESULTS:PTs reported treating an average of 15 patients with HRP per month. Thematic analyses revealed five main facilitators to rehabilitation: (1) patient education, (2) patient empowerment, (3) traditional biomedical rehabilitation interventions, (4) collaborative model, and (5) therapeutic alliance and patient-centered care. Barriers to rehabilitation included (1) patients' mood, (2) treatment expectations, (3) structural or logistical challenges, (4) lack of physician support, and (5) pain perception. CONCLUSIONS:Improving interprofessional communication, setting realistic treatment expectations, and considering biopsychosocial contributors to hip pain may be opportunities to improve rehabilitation engagement and outcomes for patients with HRP. Future work examining the efficacy and dose-response of movement retraining and postural correction is warranted, as physical therapists reported relying heavily on these rehabilitation interventions.
BACKGROUND:Thoracic spine mobility is essential for optimal pitching mechanics and injury prevention in baseball players. While shoulder and hip range of motion (ROM) changes after pitching have been reported, there is a lack of evidence regarding immediate changes in thoracic spine ROM after pitching. OBJECTIVE:To investigate the immediate effects of repetitive pitching on thoracic spine extension and rotation ROM in high school baseball players and to identify which assessment method is most sensitive to these changes. DESIGN:Randomized controlled trial. SETTING:High school baseball fields. PARTICIPANTS:Thirty-four male high school baseball players were randomly assigned to a pitching group (n = 17) or a control group (n = 17). Players with prior elbow surgery or recent injuries were excluded. INTERVENTIONS:The pitching group performed 100 maximum-effort fastballs, and the control group rested for an equivalent duration. MAIN OUTCOME MEASURES:Thoracic kyphosis angle, upper and lower trunk extension ROM, total trunk extension ROM, and six thoracic mobility tests were assessed before and after the intervention. The primary outcome was dominant-side thoracic rotation ROM measured by the side-lying rotation test. RESULTS:A significant group × time interaction was observed for dominant-side rotation in the side-lying rotation test (p = .015). Post hoc analysis revealed a significant increase in ROM after pitching in the pitching group (mean difference [pre-post] = -3.4°; p = .004; 95% CI: -5.675 to -1.266). No statistically significant correlation was found between ball velocity and dominant-side rotation ROM (r = 0.454, p = .067), although a moderate-to-large effect size was observed. CONCLUSIONS:Repetitive pitching acutely increases thoracic rotation ROM toward the throwing side in high school baseball players, detectable by the side-lying rotation test. This test may serve as a practical tool to monitor pitching-induced mobility changes relevant to performance and injury prevention.
BACKGROUND:Osteoarthritis (OA) is a leading cause of disability worldwide. To standardize management, Peru's Social Health Insurance (EsSalud) approved its Clinical Practice Guideline (CPG) for OA in 2018, updated in 2024. However, adherence to these recommendations among physiatrists and physical medicine and rehabilitation (PM&R) residents is unknown. OBJECTIVE:To assess adherence and perceptions regarding the Peruvian OA CPG among physiatrists and PM&R residents. METHODS:A cross-sectional survey (May-July 2025) was conducted via two national WhatsApp groups. Sociodemographic and professional data were collected, along with agreement levels for 10 CPG recommendations using a 5-point Likert scale. For five prioritized recommendations, stages of implementation were assessed using the transtheoretical model. Factors associated with agreement on ≥6 recommendations were analyzed with Poisson regression and robust variance. RESULTS:Eighty-eight participants completed the survey; 55.7% were physiatrists and 44.3% residents. Awareness of the OA CPG was reported by 42.1%, and only 3.4% had received prior training. Agreement was highest for oral nonsteroidal anti-inflammatory drugs and avoidance of tramadol and lowest for avoidance of hyaluronic acid, prolotherapy, and acupuncture. Most respondents were in early stages of implementation. Employment in national specialized institutes was significantly associated with higher agreement (prevalence ratio, 2.53; 95% confidence interval: 1.20-5.36). Main reasons for disagreement included perceived clinical effectiveness and positive experience. Suggested strategies to improve adherence were workshops and educational meetings. CONCLUSIONS:Awareness and training on the Peruvian OA CPG are limited, with heterogeneous adherence across recommendations. Educational strategies are needed to enhance evidence-based OA management in Peru.
BACKGROUND:The prosthetic socket is central to the comfort, function, and satisfaction for lower-limb prosthesis users. Traditional fixed-geometry sockets offer limited adjustability and sometimes fail to accommodate daily changes in residual limb volume or shape, leading to poor load distribution, discomfort, skin issues, and reduced quality of life. Adjustable volume sockets (AVS) have been introduced as a potential solution. OBJECTIVE:To evaluate the impact of AVS on socket comfort, quality of life, general satisfaction, satisfaction with walking ability, and prosthetic mobility in a large clinical population. DESIGN AND SETTING:A retrospective longitudinal study was conducted across multiple U.S. prosthetic clinics, reviewing data from 2023 to 2025. PARTICIPANTS:Adults with lower-limb amputation (n = 444). INTERVENTION:Adjustable-volume socket. MAIN OUTCOMES MEASURES:Socket Comfort Score (SCS), quality of life, satisfaction, satisfaction with walking ability, and Prosthetic Limb Users Survey of Mobility (PLUS-M). RESULTS:Significant improvements were observed across all outcomes instruments. Mean SCS increased from 5.59 to 7.16 (p < .001, Cohen's d = .64). Quality of life, general satisfaction, and satisfaction with walking ability all improved significantly (p < .001), with small-to-medium effect sizes. PLUS-M T-scores increased from 44.8 to 46.9 (p < .001). Change score correlations demonstrated that improvements in SCS were positively associated with increases in all secondary outcomes including higher mobility (r = .32, p < .001), improved quality of life (r = .48, p < .001), and greater satisfaction (r = .49, p < .001). Greater improvements in SCS were also correlated with longer prosthesis wear times (r = .13, p = .003). CONCLUSION:Use of AVS was associated with clinically meaningful improvements in comfort, satisfaction, and functional mobility among prosthesis users.
BACKGROUND:Aerobic exercise is beneficial in managing Parkinson disease (PD), yet its potential remains less clear in early stages. This study investigates the impact of long-term aerobic exercise habits in individuals with early-stage PD compared with healthy controls. DESIGN:Cross-sectional study. OBJECTIVES:To evaluate whether long-term exposure to moderate- to high-intensity exercise was associated with more favorable physical, cognitive, and patient-reported outcomes in early PD, by comparing "highly active" individuals (self-reported moderate- to high-intensity aerobic exercise ≥ twice weekly for >3 months) with "low-active" individuals (self-reported moderate- to high-intensity aerobic exercise ≤ twice weekly for >3 months) and healthy controls. SETTING:University. PARTICIPANTS:Seventy low-active individuals with PD, 35 highly active individuals with PD, and 35 healthy controls were included. INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURE(S):Assessments included Timed Up and Go Test, Six Spot Step Test, 6-Minute Walk Test, Mini Balance Evaluation Systems Test, Lower Extremity Muscle Peak Power, Aerobic Capacity, Physical Activity, Montreal Cognitive Assessment, Symbol Digit Modalities Test, Parkinson's Disease Questionnaire, Non-Motor Symptoms Questionnaire, Falls Efficacy Scale-International, European Quality of Life Questionnaire, Beck Depression Inventory-II, and Movement Disorders Society-sponsored revision of the Unified Parkinson's Disease Rating Scale. RESULTS:Highly active individuals with PD outperformed low-active individuals with PD (p < .05) in physical function outcomes, motor symptom severity, physical activity levels, and nonmotor symptoms, while showing comparable results to healthy controls across several tests covering physical and cognitive function and physical activity level. Low-active participants showed impairments in several physical function and activity outcomes relative to healthy controls (p < .05). Cognitive function outcomes were comparable across the PD groups, but healthy controls performed better in processing speed (p < .05). No significant differences were found between participant groups in quality of life or depressive symptoms. CONCLUSIONS:Regular engagement in moderate- to high-intensity aerobic exercise in early PD may preserve physical function, suggesting a potential role in limiting disease-related motor decline. These findings support the consideration of early, high-intensity aerobic exercise interventions as part of a comprehensive management strategy for PD.
OBJECTIVE:This systematic review and meta-analysis aimed to synthesize the current evidence on the efficacy of various technological interventions for gait rehabilitation in adults with incomplete spinal cord injury (iSCI). LITERATURE SURVEY:MEDLINE (accessed by PubMed), Embase, Cochrane Central Register of Controlled Trials (Cochrane CENTRAL), and the Physiotherapy Evidence Database (PEDro) from inception to March 2025. METHODOLOGY:Eligible studies evaluated the effects of innovative rehabilitation technologies on gait-related outcomes in individuals with iSCI. The primary outcome was gait speed. Secondary outcomes were functional mobility and functional capacity assessed before and after intervention. Two reviewers independently performed study selection and data extraction. SYNTHESIS:Twenty-one studies involving 601 participants were included. The interventions assessed encompassed robot-assisted gait training (RAGT), body-weight-supported treadmill training (BWSTT), exoskeletons (EXO), repetitive transcranial magnetic stimulation, functional electrical stimulation, electromyography (EMG)-triggered stimulation, virtual walking, and weight support feedback. Outcomes focused on gait speed, functional mobility, and functional capacity. RAGT was the only intervention associated with improvements in all three outcomes. BWSTT and EMG improved gait speed, while EXO enhanced functional mobility. CONCLUSIONS:RAGT appears to be the most consistently effective intervention for improving gait-related outcomes in individuals with iSCI. However, additional high-quality randomized controlled trials are needed to confirm these findings and to support clinical decision-making.
INTRODUCTION/OBJECTIVE:Diagnostic nerve blocks (DNBs) involve the injection of anesthetic around peripheral nerves to temporarily reduce motor tone. Although they are used clinically to inform spasticity treatment with neurotomy and chemodenervation, there is little research exploring the predictive nature of DNBs. METHODS:A systematic review was conducted to identify and analyze studies that compared clinical outcomes between DNBs and neurotomies or chemodenervation with botulinum toxin. RESULTS:In total, nine eligible articles were analyzed, with five studies involving neurotomies and four studies involving chemodenervation. These studies focused exclusively on lower limb spasticity. There were different DNB protocols used across the eligible articles. DNBs resulted in similar clinical outcomes after neurotomy on gait and spasticity measurements. DNBs resulted in reduced agonist muscle strength as compared to neurotomy outcomes, particularly those collected a year or longer after surgery. DNBs were less predictive of clinical response to chemodenervation and to range of motion assessments. CONCLUSION:This review has identified a gap in research regarding the predictability of DNBs, with heterogeneity in study design. As DNBs resulted in more similar spasticity and gait outcomes when compared to neurotomy rather than chemodenervation procedures, this may suggest that DNBs have a larger role to play in surgical decision-making. Given the current research, future studies on DNBs should explore upper extremity spasticity management as well as outcomes that relate to patient reported goals and experiences.
OBJECTIVE:Blood flow restriction (BFR) has demonstrated beneficial effects by enabling muscle growth and strength with lighter weights, thereby reducing joint stress. BFR training has been studied in various joints such as after reconstruction of the anterior cruciate ligament, but its application in chronic ankle instability (CAI) remains underexplored. This systematic review aims to fill this gap by investigating the effects of BFR training on balance, ankle strength, and patient-reported outcomes in individuals with CAI. LITERATURE SURVEY:A systematic search was conducted in PubMed, Scopus, CINAHL, and SPORTDiscus for randomized controlled trials published in English from 2000 onward. Studies were included if they examined BFR interventions in individuals with CAI. Methodological quality was assessed using the Physiotherapy Evidence Database scale. METHODOLOGY:Two independent reviewers screened studies and extracted data. A random-effects meta-analysis synthesized outcomes related to balance, ankle strength, and self-reported instability. SYNTHESIS:Nine trials met inclusion criteria. Meta-analysis revealed significant improvements in balance (standardized mean difference [SMD] = 0.33-2.72), patient-reported outcomes (SMD = 0.04-2.84), and ankle strength (foot abduction SMD = 0.01-1.13; adduction SMD = 1.12-1.92). Substantial heterogeneity was observed, and most studies reported short-term effects. CONCLUSIONS:BFR training may improve balance, ankle strength, and perceived stability in individuals with CAI. These findings support its potential as a rehabilitation adjunct, but high-quality trials are needed to confirm long-term efficacy and guide clinical implementation. REGISTRATION:PROSPERO CRD42025638559.
BACKGROUND:Adapting programs to fit the needs of different contexts allows for greater reach. Live Long Walk Strong is a physical therapy program designed to improve mobility among older adults. OBJECTIVE:To describe adaptation of Live Long Walk Strong, an age-friendly physical therapy program, across four different clinical settings. DESIGN:Process evaluation. SETTING:Urban outpatient, rural outpatient, skilled nursing facility, and virtual (telehealth) settings within the Veterans Health Administration. PARTICIPANTS:Physical therapists and physical therapist assistants delivering Live Long Walk Strong (n = 11). INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURE(S):Barriers encountered and adaptations made to the program as it was implemented across settings. We used the Consolidated Framework for Implementation Research (CFIR) to organize and analyze collected data. RESULTS:We identified barriers across the Innovation, Outer Setting, Inner Setting, and Individuals domains of the CFIR. Several barriers were encountered across all contexts. These barriers related to CFIR constructs Design, Partnerships & Connections, and Access to Knowledge & Information. The shared barriers led to central adaptations beneficial to all current and future sites. We also identified barriers unique to specific contexts, which resulted in adaptations to improve fit and allow the program to best meet the needs of patient populations in those settings. Facilitators were similar across settings and did not result in further adaptation of the program; however, they likely contributed to the program's successful spread across different contexts. Facilitators fell under the Design and Relative Advantage constructs of the Innovation domain, as well as under the Relational Connections and Mission Alignment constructs of the Inner Setting domain. CONCLUSIONS:We present practice-based evidence on adaptations to an age-friendly physical therapy program implemented across diverse settings. Our findings provide practical information that may improve the efficiency of implementation of future programs, as potential barriers can be addressed during the planning phase.
