Abstract Back pain is one of the most common health problems worldwide. Digital, internet-based interventions have proven effective, while social media is increasingly used as a source of health-related information. However, limited quality control and insufficient digital health literacy may pose risks. Despite this development, it remains unclear how patients with chronic nonspecific back pain perceive and use such information. To describe the experiences and perceptions of patients with chronic non-specific low back pain in dealing with health information on Instagram. A qualitative, thematically descriptive interview study used an integrated think-aloud approach and an iterative design. A total of 12 participants with chronic non-specific low back pain were included. Data was collected via semi-structured online interviews and analyzed using structured qualitative content analysis according to Kuckartz. The use of Instagram as a source of health information was associated with the perception of insufficient support within the traditional healthcare system. Selection of information was predominantly algorithm-driven. Explanations of the causes of back pain, advice, and, in particular, exercise-related content are consumed. Information quality was evaluated based on social validation, content-related characteristics, and comparison with external sources and personal experiences in a trial-and-error manner, but was accompanied by uncertainty due to limited digital health literacy. Information use was influenced by personal relevance, visual and design features, and feasibility, and resulted in perceived outcomes ranging from no change to behavioural adaptations and improvements in back pain. In particular, the selection of content based on algorithms, the validation mechanisms employed, as well as the contexts in which information is consumed, underscore the need to develop specific measures for quality assurance and to promote digital health literacy.
Abstract Group therapy is rarely used in outpatient physiotherapy in Germany, although it is permitted according to the “Heilmittelrichtlinie” and would be preferable to individual therapy if equally suitable. Group therapy could help expand treatment capacities, reduce costs, and promote factors such as motivation and adherence. Whether it is similarly effective to individual therapy for diagnoses that are frequently prescribed, however, remains unclear. To provide an overview of the current evidence on group-based physiotherapy for diagnoses with high prescription rates. An overview of reviews was conducted. A systematic literature search was performed in MEDLINE, CINAHL, EBP, PEDro, OT Seeker, and Google Scholar. Systematic reviews investigating group-based physiotherapy for mobility impairments, back pain, and shoulder lesions were included. Screening and data extraction were conducted according to established standards. The methodological quality of the reviews was assessed using AMSTAR 2. The results were synthesized narratively. Fifteen systematic reviews were included, addressing back pain (n = 7) and mobility impairments (n = 8). No review on shoulder lesions was identified. Some of the reviews reported positive effects of group therapy on functional outcomes and pain compared to no treatment or usual care. Compared to individual therapy, no consistent evidence of superiority or inferiority was found. No direct negative effects of group therapy were reported. The interventions and control groups in the included reviews were mostly heterogeneous. The methodological quality of most reviews is low or critically low. Existing evidence on the effectiveness of group-based physiotherapy is limited and heterogeneous. Most included reviews are of low methodological quality; therefore, no reliable conclusions regarding the effectiveness of group therapy can be drawn. In light of current requirements of the Heilmittelrichtlinie and the high relevance for healthcare provision, there is a need for methodologically rigorous and focused systematic reviews on this topic. If these continue to reveal relevant gaps in the evidence, appropriate clinical studies should be initiated.
Abstract Peripheral facial palsy is the most common form of cranial nerve lesion. Currently, exercise therapy is not part of standard care in Germany. Existing systematic reviews on the effectiveness of exercise-based treatment do not currently distinguish between the different stages of recovery at which treatment begins, even though these might significantly influence treatment outcomes. The aim of this systematic review is to investigate the effectiveness of exercise therapy for the facial muscles specifically during the acute and subacute phases (up to six months after the onset of the condition). A systematic review was conducted. The literature search was performed in MEDLINE via PubMed, the Cochrane Library, and via Epistemonikos. Randomised trials were included that compared exercise therapy within the first 6 months of onset with standard care in adult patients with peripheral facial palsy, with regard to the severity of paralysis, the risk of synkinesis and disease-specific quality of life. The methodological quality of the studies was assessed using the revised Cochrane risk of bias tool for randomised trials (RoB 2). The assessment of the certainty of the evidence was based on the recommendations of the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. 8 RCTs with a total of 590 participants were included. There is currently low certainty of evidence that facial muscle exercise therapy improves the severity of paralysis (4 out of 7 studies showed statistically significant improvements in favour of the intervention) and reduces the development of synkinesis (3 out of 5 studies showed a statistically significant lower number of synkinesis). The certainty of the evidence is limited by a high risk of bias in the included studies, a small sample size, limited comparability of the study populations, differences in the type and duration of the interventions, and incomplete reporting of outcomes. The results indicate the effectiveness of exercise-based treatment. However, further high-quality efficacy studies are needed to determine the extent of the effect and to derive recommendations regarding the type and dosage of exercise therapy. The study was prospectively registered on 23 April 2025 in the OSF Registry (osf.io) under the registration DOI: 10.17 605/OSF.IO/58SQJ.
Abstract Immobility in hospitalized patients is associated with increased morbidity and mortality. In early rehabilitation, device-assisted bedside training may enhance recovery and functional outcomes. To evaluate the feasibility, safety, and user-friendliness of a bedside training device in an early rehabilitation setting (non-neurological/neurosurgical, non-geriatric). In this single-center randomized pilot study, 20 patients were allocated to an intervention group (bedside training with THERA-Trainer bemo plus standard rehabilitation) or a control group (standard rehabilitation). Outcomes included usability (System Usability Scale, SUS), patient satisfaction, mobility (CHARMI), independence (Barthel Index), muscle strength and safety. The intervention was safe, no device-related adverse events occurred. Usability was rated high by patients (SUS 83.8) and therapists (78.8). Patient satisfaction reached 77.4/100. Bedside device-assisted training is feasible, safe, and well accepted in early rehabilitation. Larger confirmatory trials are needed to determine its clinical effectiveness.
Abstract Systematic reviews form a crucial foundation for evidence-based decision-making in healthcare, and consequently in physiotherapy. They are utilized for various purposes, including clinical decision-making, the planning and design of clinical trials, and guideline development. For users, it is essential that systematic reviews can be located quickly and easily, and that the retrieved reviews demonstrate high methodological quality. Only methodologically rigorous systematic reviews can provide trustworthy results. Methodological flaws introduce a risk of biased or inaccurate findings, which can ultimately lead to flawed healthcare decisions. The scientific literature has long highlighted problems with systematic reviews that undermine confidence in their results and, thus, question their utility. Although these problems have been widely documented, they appear to remain insufficiently recognized and addressed to date, including within the German-speaking region. In a German-language article published in November 2025, the authors of the present paper, together with colleagues, addressed these problems with systematic reviews and called for proactive measures to improve or resolve them. This article revisits the contents of that publication with a specific focus on physiotherapy. It is based on the closing lecture delivered at the Physiotherapy Research Symposium (Forschungssymposium Physiotherapie, FSPT) at Hochschule Bremen in November 2025 (Speaker: Cordula Braun).
