Introduction:The Cranio-Cervical Flexion Test (CCFT) is a validated clinical test used to evaluate deep cervical flexor muscle function. A pressure biofeedback unit (PBU) has traditionally been the reference device. Recently, a new portable digital device known as the Neuromuscular Cranio-cervical Device (NOD) has been developed as a potential alternative. Methods:In this cross-sectional concurrent validation study, 88 participants were recruited from four outpatient physiotherapy practices, including individuals with current neck pain and individuals with a previous history of neck pain. All participants performed the CCFT using both devices. The PBU was inflated to a baseline pressure of 20 mmHg, with the participant then performing C-CF to increase the pressure in increments of 2 mmHg over five progressive stages, while the NOD was calibrated to corresponding force targets. Agreement and concurrent validity between the devices were assessed, and C-CF range of motion (ROM) was analyzed using linear mixed-effects models. Results:Agreement between CCFT performance scores obtained with the NOD and the PBU was 94.3%, with a very strong positive correlation (Spearman's ρ = 0.930, p < 0.001). The NOD measured slightly greater C-CF ROM than the PBU (mean difference 0.68°), with significant differences at lower CCFT stages that converged at higher stages of the test. Conclusion:These findings demonstrate strong concurrent validity between the NOD and the PBU, supporting the NOD as a valid digital alternative for assessment of the CCFT.
Introduction:The lumbar roll and modified SIMS are two common manipulation techniques used in clinical practice for sacroiliac joint dysfunction (SIJD), a common cause of low back and pelvic pain. However, there hasn't been clear evidence of these methods' relative clinical efficacy in recent literature. Methods:This review was registered in PROSPERO (Reg. No. CRD420251253094) and adhered to PRISMA 2020 guidelines. Studies published between January 2021 and December 2025 were found through a search of PubMed, Scopus, Web of Science, CINAHL, PEDro, Cochrane Library, and Google Scholar (first 200 results). Randomized controlled trials, quasi-experimental trials, and controlled clinical studies evaluating lumbar roll or modified SIMS manipulation in adults with SIJD using imaging-assisted criteria or validated provocation tests were all considered eligible. Screening, data extraction, and risk-of-bias assessment (RoB-2 and ROBINS-I) were carried out independently by two reviewers. Results:Nine of the 1,264 records that were found satisfied the requirements for inclusion. The number of participants in the sample varied from 30 to 90. Following manipulation, the majority of trials reported significant short-term reductions in pain (VAS/NPRS) and disability (ODI/functional measures), with lumbar roll and modified SIMS demonstrating similar clinical benefit. Improvements in pelvic alignment and mobility have been documented in several studies. There were a few transient adverse events, and no significant complications were noted. Conclusion:Although more high-quality trials are required to confirm long-term efficacy and ideal treatment protocols, lumbar roll and modified SIMS manipulation techniques consistently show short-term clinical benefits for SIJD. However, due to the absence of direct head-to-head comparisons and reliance on indirect classification of techniques, these findings should be interpreted as exploratory rather than definitive.
Introduction:Pre-COPD is characterized by the presence of respiratory symptoms and/or structural abnormalities, without spirometry-confirmed airflow limitation. However, pre-COPD may be associated with extrapulmonary manifestations that are not apparent at rest. The aim of this study was to assess postural stability through center of pressure (CoP) dynamics during low-intensity inspiratory and expiratory loading between adults with pre-COPD and healthy adults. Methods:This cross-sectional observational study included 31 volunteer adults (17 with pre-COPD, 14 healthy adults; mean age 47.9 years). CoP was calculated from ground reaction forces and torques recorded with a force plate during quiet standing across three breathing conditions (without, inspiratory, and expiratory loads). Respiratory loads were set at 10% of the individuals' maximal inspiratory and expiratory pressures. CoP mean amplitude (m-1) and velocity (m-1·s-1) in anteroposterior and mediolateral directions, normalized by the base of support area, were calculated from a 30-second period, averaged across three trials. Results:During inspiratory loading, all mean velocity outcomes were significantly higher in adults with pre-COPD compared to healthy adults (anteroposterior: p = 0.002, 95% CI [0.991, 4.014]; mediolateral: p < 0.001, 95% CI [0.971, 3.324]; total: p = 0.002, 95% CI [1.314, 5.270]). Although mean amplitude showed no overall group difference, significant load × group interaction revealed that adults with pre-COPD exhibited a greater postural disturbance during inspiratory loading than healthy adults. Expiratory loading only significantly differentiated groups for mediolateral velocity (p = 0.034, 95% CI [0.096, 2.292]). Conclusions:During quiet standing, low-intensity inspiratory loading was associated with increased CoP differences between adults with pre-COPD and healthy adults.
Introduction:Due to shortages of general practitioners and increasing emergency department (ED) presentations for non-urgent musculoskeletal conditions (MSKDs), Advanced Physiotherapy Practice (APP) roles have been implemented internationally. However, this model remains novel in Switzerland. This study evaluated agreement in diagnosis, treatment, and discharge decisions between physiotherapists and resident physicians compared with senior physicians as the reference standard in the ED of Bethesda Hospital Basel (BSAG). Methods:A randomized controlled trial was conducted from October to December 2023. Patients presenting musculoskeletal complaints without evidence of serious pathology were allocated to either an intervention group managed by physiotherapists or a control group receiving standard care by resident physicians. Clinical decisions from both groups were reviewed by senior physicians. Agreement was assessed using Cohen's Kappa (κ) and Gwet's AC1 statistics. Results:A total of 102 patients were included (mean age 52 years, SD 16.3; 61% female; 51% with low back pain). Physiotherapists demonstrated good to excellent agreement with senior physicians for diagnosis (κ = 0.72-0.96; AC1 = 0.73-0.97) and management (κ = 0.69-0.88; AC1 = 0.71-0.89). Residents showed high agreement for diagnosis (κ = 0.85; AC1 = 0.86) and perfect agreement for management (κ = 1.00; AC1 = 1.00). No adverse events occurred. Patient satisfaction was higher in the physiotherapy group (mean 4.79 vs. 4.19/5). Conclusion:Experienced physiotherapists demonstrated high agreement with senior physicians in diagnosing and managing MSKDs in the ED. APP appears safe and may improve patient satisfaction without increasing adverse events.
Introduction: Physiotherapy for rotator cuff-related shoulder pain (RCRSP) typically includes patient education and exercise prescription, with manual therapy used as an adjunct to exercise. This parallel two-arm non-inferiority pilot trial determined the feasibility of a full randomised clinical trial comparing pragmatic physiotherapy with manual therapy (MT Group) to pragmatic physiotherapy without manual therapy (NoMT Group) for RCRSP, and explored preliminary treatment effects on patient-reported outcomes.Methods: Sixty-eight participants with persistent RCRSP were randomised to MT or NoMT groups, receiving physiotherapytreatments over a 3-month period, with only the MT group receiving manual therapy. Feasibility outcomes were recruitmentand retention rates, adherence, and intervention fidelity. Research outcome measures were patient-related outcomes at baseline,3, and 6-month follow-up.Results: Of 239 volunteers completing the online screening questionnaire, 108 were physically screened, and 70 (65%) wereallocated. After two withdrawals, 33 in the MT group and 35 in the NoMT group completed baseline assessment. Retention,adherence, and fidelity exceeded 80% for both groups. Median treatment sessions were 7 for the MT group and 6 for theNoMT group. In the MT group, glenohumeral joint, thoracic spine, and soft tissue mobilisations were commonly used. Deliveryof patient education and exercise prescription was similar between groups. QuickDASH between-group mean differences werebelow the non-inferiority margin. Self-efficacy favoured the MT group at 6-month follow-up.Conclusion: Results support feasibility for a full trial. Strategies to improve participant diversity are required. Definitive outcomesrequire confirmation in a full trial.
Introduction: Gender equity in scientific research, especially in Physiotherapy, reveals significant underrepresentation of women, affecting career advancement, salary, and research recognition. This study aims to examine the characteristics, knowledge, attitudes, and productivity of Physiotherapy researchers in Italy, focusing on gender distribution. Methods: This cross-sectional study was conducted on Italian Physiotherapists who either have a PhD or are currently enrolled in PhD programs. We used a survey consisting of 62 items that explored demographic and educational characteristics, research experience, work-life balance, attitude and social norms, and career-related factors. Performance metrics included H-index, number of publications (during PhD and in the whole career), and awards. Results: Of the 167 Physiotherapists surveyed, 102 participated. Female participants reported worse attitudes and social norms perception, and during their PhD, were less satisfied with work conditions compared to males. Females reported a median of 3 publications during their PhD, and males 5. However, after adjusting for age, time invested in research, and whether the interviewee lives with a partner, age remains the only associated factor. There is no evidence of an association between gender and H-index or awards. Conclusion: Gender-based disparities in research attitudes exist in Physiotherapy, particularly during the PhD phase, favoring males. Further research is needed to promote gender equity.
Introduction: The influence of socio-demographic variables on admission to a Bachelor of Physiotherapy Programme is adebated topic. The study investigated the socio-demographic predictors of admission test success and scores for a Bachelorof Physiotherapy Programme. Moreover, the study assessed the effects of different proportions of logical reasoning (LR) andscientific knowledge (SK) questions on the distribution of socio-demographic variables of admitted candidates.Methods: A retrospective cohort study was conducted on applicants to the Bachelor of Physiotherapy Programme at HumanitasUniversity, Milan, Italy, from 2016 to 2023. Logistic and linear regression models were used to investigate socio-demographicpredictors of admission and test scores. Logistic regression model and chi-square test were used to investigate socio-demographicpredictors and their distribution in admitted candidates of 3 cohorts selected with a different proportion of logical reasoning (LR) and scientific knowledge (SK) questions.Results: High-school type, gender, and geographic origin were socio-demographic predictors of the Bachelor of PhysiotherapyProgramme test success (pseudo-R² = 0.06) and total score (R² = 0.13). A higher proportion of candidates who attended ascientific high school and males were found among admitted applicants, regardless of the proportion of LR and SK questions.Discussion: Socio-demographic predictors of admission to the Bachelor of Physiotherapy Programme were identified, but thesepredictors marginally improved the model fitting or explained a small portion of the variance. These results suggested that admission outcomes were poorly predicted by socio-demographic factors considered in the current study. Admission test contents did not seem to influence the socio-demographic profile of candidates admitted to a Bachelor of Physiotherapy Programme.
Introduction: Mental and cognitive health content has been integrated into Italian guidelines for nearly five years. Therefore, this study aimed to investigate how these recommendations have translated into practice by examining the perceptions and experiences of physiotherapists in Italy. Methods: A cross-sectional online survey was conducted between January 2024 and April 2025. Physiotherapists were reached through social media and official channels. Descriptive and regression analyses were used to examine participants' profiles, predictors of self-perceived competence, referral likelihood, and changes in educational training over time. Results: Among 423 physiotherapists, 39.4% and 60.7% reported low competence in managing cognitive and mental health issues, respectively. Physiotherapists working in neurological practice had higher odds of feeling competent in both cognitive (OR = 2.47, p < 0.001) and mental health (OR = 1.90, p = 0.040) care and of receiving cognitive care referrals (OR = 1.94; p = 0.003). Greater clinical experience was associated with confidence in managing cognitive health (p = 0.010). Reliance on physiotherapists as an information source was linked to lower competence in cognitive health (OR = 0.53, p = 0.023). Years of experience predicted the educational training undertaken for cognitive and mental health care (p = 0.034). Conclusion: The reported practice patterns may indicate care gaps and limited implementation of the national guidelines among physiotherapists in Italy. Since cognitive impairments and mental health issues are commonly encountered across physiotherapy specialties, we recommend that undergraduate curricula include more content in these areas and that additional opportunities for professional development be provided.
Introduction:Cancer rehabilitation is increasingly recognized as a core component of cancer care, yet little is known about how people with cancer perceive its ethical dimensions. This study explored how patients experience autonomy, safety, equity, and relational care within physiotherapy-led cancer rehabilitation. Methods:We conducted a qualitative interview study using reflexive thematic analysis (RTA). Twenty adults with a previous cancer diagnosis who had received physiotherapy related to cancer rehabilitation within the past three years were purposively sampled to maximize variation in age, gender, diagnosis, stage, care setting, and geographical area. Interviews were conducted online, audio-recorded, transcribed verbatim, anonymized, and analyzed inductively from a constructionist, experiential perspective. Results:Five themes captured ethically salient aspects of rehabilitation experiences: (1) struggles for meaningful participation, where involvement in decisions was sometimes limited despite rhetoric of autonomy; (2) balancing safety and control, where professional caution was experienced as both protective and at times over-restrictive; (3) unequal access as systemic injustice, with geography, logistics, and poor information affecting access to services; (4) empathy and emotional presence, which fostered trust, dignity, and motivation; and (5) limits of standardized care, where rigid protocols and time pressure risked depersonalization unless offset by flexibility. Participants did not view rehabilitation as a merely technical intervention, but as an ethically charged practice shaped by everyday interactions, organizational contexts, and opportunities for agency. Conclusions:People with cancer experience rehabilitation as an ethical as well as clinical practice. Flexible, dialogic, and equitable models of care may better support dignity, participation, and shared decision-making.
Introduction:Neck pain (NP) is associated with sensorimotor impairments, including altered trunk-head coordination. Limited data exists on the reliability of assessments and the influence of visual feedback in NP. Relationships between trunk-head coordination performance and NP, dizziness, disability, or NP onset (traumatic or idiopathic) remain unclear. Methods:Repeated-measures study to explore intra- and inter-session reliability of trunk-head coordination assessment in traumatic and idiopathic NP subjects, using a head-mounted accelerometer. Assessments were conducted under visual and visually constrained feedback conditions. The latter was repeated twice on the same day and once within a week. Head movement during the task was analyzed for reliability using Constant Error (CE), Absolute Error (AE), Sum of Absolute Errors (SAE), and Variable Error (VE). Differences between visual feedback conditions and pain onset, and correlations with the Neck Disability Index (NDI) and Dizziness Handicap Inventory (DHI) were examined. Results:CE, AE, and SAE of 19 NP subjects (age 53 ± 18 years; 13 females; NDI 23 ± 11%; DHI 16 ± 15%) demonstrated moderate (VE) and good (CE, AE, SAE) intra-session reliability. All error types reached moderate inter-session reliability. Visual feedback significantly reduced head movement errors for AE (0.07m/s2) and SAE (9.02m/s2). Correlations between error types and self-reported outcomes were weak to fair and not statistically significant. No significant differences emerged between traumatic and idiopathic NP groups. Conclusion:Accelerometer-based trunk-head coordination showed moderate to good intra-session and moderate inter-session reliability, suggesting performance variability over time in NP subjects. Visual feedback improved trunk-head coordination. Performance was not associated with perceived disability, dizziness, or NP onset.
Introduction: Understanding how people with multiple sclerosis (PwMS) acquire motor skills during rehabilitation is essential for optimizing treatment strategies. Motor learning theory suggests that skill acquisition follows predictable trajectories, but the time course and variability of learning during task-oriented rehabilitation remain poorly defined in PwMS. The aim was to investigate the learning trajectory and performance variability in PwMS undergoing task-oriented rehabilitation, using mathematical modeling of behavioral changes over time. Methods: This longitudinal prospective study included 44 PwMS admitted to a rehabilitation unit. Participants received either balance-specific or non-specific motor impairment treatments. Balance performance was assessed with the Berg Balance Scale (BBS) after each session. Session-to-session changes were analyzed using linear and exponential models to characterize the learning pattern, and residuals were examined to quantify variability. Results: An exponential mixed model (Akaike information criterion (AIC) = 2514.1) best described learning trajectories and provided more accurate estimates of pre-to-post improvement compared to a linear model (AIC = 2672.1). Performance variability decreased across sessions, from 1.16 to 0.75 points. Participants receiving specific balance treatment reached the minimal clinically important difference after three sessions, while participants receiving non-specific treatments achieved MCID only after 7 sessions. Conclusions: Motor performance changes in PwMS during rehabilitation resemble motor learning in healthy individuals: improvements follow an exponential function and are accompanied by reduced variability. Treatment specificity enhances the velocity and magnitude of learning, underscoring the importance of targeted interventions in neurorehabilitation.
Introduction: Limited cervical range of motion (CROM) and pain are among the most common symptoms of cervical dystonia (CD), which are treated with botulinum neurotoxin (BoNT) injections. However, adjunctive interventions may offer additional benefit. Therefore, this study evaluated the immediate effects of peripheral stimulation comprising conventional transcutaneous electrical nerve stimulation (TENS), muscle stimulation (NMES), and muscle vibration on CROM and pain in patients with CD.Methods: A single-case experiment design (SCED), alternating treatment design was conducted with 19 CD patients, recruited at the Antwerp University Hospital (UZA). Participants randomly received conventional TENS, NMES and muscle vibration on three different days. Main outcome measures were CROM, measured using a 3D-stereophotogrammetric scanning system (3dMD Inc., GA, USA) and pain, quantified by Visual Analog Scale (VAS).Results: Mean age of participants was 59.87 ± 8.9 years. Baseline CROM for rotation ranged from 87° to 137.6° and from 79° to 132.4° for flexion/extension. Improvements in neck rotation were observed in 5 (33.3%) participants after conventional TENS, 8 (42.1%) after NMES, and 8 (42.1%) after muscle vibration. Similarly, improvement in flexion and extension was observed in 10 (55.6%) after conventional TENS, 8 (53.3%) after NMES, and 7 (46.7%) after muscle vibration. Significant reductions in pain shortly after the three interventions were observed in patients experiencing pain.Conclusions: These findings suggest that peripheral stimulation may provide immediate symptomatic relief in CD, particularly for improving CROM and reducing pain. While promising, these results should be considered as exploratory and warrant further investigation in larger, controlled studies.
Introduction: Plantar fasciitis (PF) is a common musculoskeletal disorder characterized by heel pain that disrupts gait and daily function. This study examined relationships between clinical outcomes and gait biomechanics, determined whether these relationships differ between recent-and chronic-onset cases, and identified key clinical predictors of gait speed. Methods: A cross-sectional study was conducted with 42 individuals with PF. Clinical outcomes included worst pain, normalized gastrocnemius and soleus muscle length, normalized lower limb muscle strength, and normalized dynamic balance. Gait biomechanics during barefoot walking were captured using a motion analysis system and force plates, focusing on spatiotemporal parameters and ground reaction forces (GRFs). Correlation coefficients were used to assess relationships across the overall cohort, as well as in recent-and chronic-onset PF, while multiple linear regression identified clinical predictors of gait speed. Results: Clinical outcomes related differently to sptiotemporal parameters and GRFs depending on symptom duration, with the recent-onset PF showing widespread correlations and chronic-onset PF showing more selective links with ankle strength and dynamic balance. Regression analysis identified gastrocnemius muscle length and anterior reach distance on the Y-Balance Test (YBT) as significant predictors of gait speed, explaining 28.0% of the variance (p = 0.002). Conclusion: Symptom duration influences gait biomechanics in PF, with recent onset showing broad adaptations and chronic onset exhibiting more specific strength-and balance-related changes. Gastrocnemius muscle length and dynamic balance in the anterior direction were identified as significant contributors to gait performance. Targeting these factors, with consideration of symptom duration, may improve gait in individuals with PF.
Introduction: Migraine is a leading cause of disability worldwide. Although effective, the use of pharmacological prophylaxis is low due to suboptimal efficacy and poor tolerability. This has led to a growing interest in non-pharmacological approaches such as manual therapy (MT), especially among patients with comorbid neck pain. While evidence for MT remains inconclusive, its adjunctive use is recommended. This study evaluated the effect of MT in patients with migraine and neck pain, compared to usual care provided by general practitioners (UC). Methods: In this randomized controlled trial in primary care, participants with migraine and neck pain were allocated to MT (n = 36) or UC (n = 31). MT included mobilizations, exercises and myofascial techniques. Follow-up assessments were performed at 12-, 26-, and 52-weeks post-inclusion. The primary outcome was the number of migraine days. Secondary outcomes included migraine intensity, disability, medication use, neck pain intensity, neck muscle endurance, pressure pain thresholds, allodynia, and perceived recovery. Results: There were no significant between-group differences in migraine days or most secondary outcomes. Compared with usual care, the MT group demonstrated significantly higher-pressure pain thresholds over the occipital muscles and reported greater perceived recovery at both 12 and 52 weeks. Use of prophylactic medication was higher in the UC group throughout follow-up. Conclusion: MT, including postural and cranio-cervical exercises, was not superior to usual care in reducing migraine days and most secondary outcomes. Still, patient preference and treatment satisfaction for MT were high and may be considered in migraine management.
Introduction:Identifying factors associated with discharge destination after inpatient stroke rehabilitation is important for patients and healthcare professionals. It supports discharge planning and prevents delayed discharge. Objective:To identify key variables from socio-demographic and clinical data associated with returning home after inpatient stroke rehabilitation, focusing on patients from three rehabilitation centers in Belgium and Switzerland. Methods:This multicenter retrospective study, conducted in three centers, included 1475 adult patients with stroke admitted to an inpatient rehabilitation unit between December 2012 and June 2021. A logistic regression with backward selection was used to define the model for discharge destination. The dependent variable was the discharge destination (home vs other). The independent variables were selected from the socio-demographic, medical, neurological, care pathway, and functional data and included age, gender, living arrangement, type of stroke, previous stroke, cognitive impairments, independence in grooming, eating, and stair walking. Results:The final model included three variables (independence in stair walking, living arrangement, and cognitive impairment). Stair walking had the strongest association with returning home. Patients who were partially (OR 5.83, 95% CI 3.67-9.26) or fully independent (OR 14.31, 95% CI 9.34-21.93) were more likely to return home than patients who were unable to walk the stairs. The results were similar for subgroups and for discharge and admission data. Conclusion:The study showed that independence in walking stairs is strongly associated with discharge destination. Aligned with another study, these results should be confirmed in further research.
Measures of muscle performance, such as strength and the rate of force development (RFD), are important for function, rehabilitation, and successful aging. Clinicians seeking to use objective measurement methods of muscle performance in support of their assessments and rehabilitation programs have many affordable dynamometry options. However, substantive differences exist between devices on important characteristics such as sampling frequency, load capacity and determining force onset, which dramatically affect the ability to obtain accurate estimates of muscle performance. The assessment environment and setup also require careful consideration. Busy clinicians are often unaware of the extent to which methodological variability and inconsistencies in testing protocols can inflate measurement error and render tests insensitive to change. Where data inform treatment and return-to-play decisions (vs. motivational aid), ensuring validity and reliability is paramount, particularly given that clinicians typically assess individual, not group performance. This is because ascertaining change or difference in intra-individual performance demands a greater level of measurement precision compared to assessing performance between groups of people. This evidence-informed Masterclass will exemplify some of the critical technical and methodological factors that intrude on measurement accuracy. It will provide readers with the knowledge: how to critically evaluate the utility of dynamometers, answering the question, which to buy and why? How to construct assessment protocols to improve quality data collection, and how to understand what constitutes real change in performance beyond "differences" caused by measurement error.
Introduction:Guidelines often recommend patient education in the management of hip or knee replacement, despite evidence of its effectiveness is scarce. The aim of this study was to assess the effectiveness of postoperative patient education on pain, function, quality of life, and psychosocial issues. Methods:We performed a systematic review and meta-analysis of RCTs investigating the effects of patient education (alone or in combination with other treatments) compared to usual care delivered after hip/knee replacement. Risk of bias was assessed using the Cochrane Risk of Bias 2.0. Certainty of evidence was established according to the GRADE approach. Results:We included five trials. We found that patient education likely results in little to no effects compared to usual care in the medium-term on pain (SMD -0.09, 95% CI -0.41-0.22) and quality of life (MD 0.11, 95% CI 0.00-0.22). Similarly, it likely results in little to no effect on anxiety in both short- (MD 1.59, 95% CI -3.16 to -0.02) and medium-term (MD -1.51, 95% CI -3.07-0.05), as well as on depression in the short- (SMD -0.22, 95% CI -0.58-0.15) and medium-term (SMD -0.22, 95% CI -0.55-0.12). In contrast, usual care may improve long-term physical function (SMD 0.64, 95% CI -0.03-1.3). Conclusion:Postoperative patient education provided no to small benefit on pain, physical function, quality of life or psychosocial issues compared to usual care. Its role may be more impactful when patient-tailored and integrated into multimodal rehabilitation strategies for people after hip/knee arthroplasty.
Introduction:Chronic non-specific low back pain is a leading cause of disability worldwide. While resistance training using external loads is common in rehabilitation, its added value over unloaded exercise remains uncertain, particularly across physical and psychological variables. Method:This systematic review and meta-analysis, registered on PROSPERO (CRD42022366975), included randomized controlled trials comparing externally loaded resistance training to unloaded exercise in adults with chronic non-specific low back pain. Primary outcomes were pain intensity and disability. Secondary outcomes included back muscle endurance, maximal strength, fear-avoidance beliefs, and pain catastrophizing. Random-effects meta-analyses were conducted, stratified by follow-up duration. Results:Thirteen randomized trials (778 participants) were included. At follow-up periods beyond seven weeks, externally loaded resistance training showed a small but statistically significant reduction in pain compared to unloaded exercise (mean difference = -0.52 on a 0-10 scale; 95% confidence interval [-0.92, -0.08]). No significant differences were found at short-term or post-washout follow-ups. Effects on disability were inconsistent and highly variable. Resistance training was associated with improvements in back muscle endurance and suggested a possible effect on long-term maximal strength, although wide prediction intervals prevent definitive conclusions. No meaningful differences were found for psychological variables, and pain catastrophizing was assessed in only one trial, limiting conclusions. Conclusion:Externally loaded resistance training is safe and feasible for chronic non-specific low back pain, but its effects on pain, disability and psychosocial outcomes are comparable to unloaded exercise. In line with the multifactorial nature of chronic pain, improvements appear driven more by exposure, adherence and therapeutic context than by load intensity alone. Exercise prescription should therefore remain individualized and embedded within a biopsychosocial framework.
Introduction:Overweight and obesity management in primary care gained importance due to its global rise and association with cardiometabolic diseases and chronic musculoskeletal disorders (MSD). Physical therapists are well-positioned to incorporate weight management in their practice. This survey evaluates attitudes, barriers and clinical practices of physical therapists regarding weight management for individuals with chronic pain and comorbid overweight or obesity. Methods:German-speaking physical therapists in Switzerland volunteered in an online survey. Descriptive statistics summarized physical therapists' attitudes, barriers and practices. Logistic regression analyses identified factors associated with recommending and implementing weight reduction interventions. Results:Of the 581 respondents, 92.1% acknowledged the importance of educating patients on obesity-related health risks, and 81.6% recommended weight reduction. Two-thirds offered weight reduction interventions in physical therapy, although fewer (57.3%) received corresponding training during entry-level education. Most weight reduction interventions focused on movement, endurance, and strength, whilst a minority addressed nutrition, sleep or stress. The odds of offering weight reduction interventions were higher among those with entry-level education (OR: 2.1, 95% CI: 1.4-3.3), further education (OR: 1.9, 95% CI: 1.1-3.3), and for those who perceived weight reduction interventions (OR: 6.5, 95% CI: 3.5-12.3) and counseling on other lifestyle factors (OR: 2.9, 95% CI: 1.2-7.3) as within their professional scope. Conclusions:While physical therapists showed positive attitudes toward weight reduction interventions for individuals with chronic pain and overweight or obesity, their education and implementation remain inconsistent, primarily focusing on improving physical activity. Clear competencies and structured training are needed to integrate evidence-based weight management into clinical practice.
Background:Rehabilitation after stroke often falls short of providing optimal benefits to patients due to challenges related to restricted access, financial burden, and lack of adherence. Video-based intervention may help to overcome these barriers. Purpose:To develop and test the feasibility of video-based telerehabilitation (TR) exercises for facilitating upper extremity motor function among stroke survivors. Method:The study was conducted in two phases: video development and feasibility testing. The research team developed the video. Feasibility was assessed using a single-group pre-test-post-test design, focusing on adherence, acceptability, satisfaction, and motor function. A total of 30 stroke survivors were purposively recruited. Each participant received a 3-minute-42-second video-based TR program to be performed three times weekly over four weeks. Adherence and acceptability were monitored through participant-maintained diaries. Satisfaction and motor function were measured using the Client Satisfaction Questionnaire-8 (CSQ-8) and the Wolf Motor Function Test (WMFT), respectively. Results:Twenty-nine participants (15 males) completed the study. The participants showed a strong commitment to the intervention with a 97% adherence rate. They accepted and reported the intervention as satisfactory. A remarkable score of satisfaction corroborates this based on the CSQ-8 (Mean [SD] = 28.6 [4.90]). A significant improvement in the WMFT was observed (p < 0.001) with a large effect size (d = 1.14) post-intervention. The mean difference was 8.8, with a 95% confidence interval ranging from 4.75 to 12.9. Conclusion:The video-based TR is feasible and can be deployed as a supplementary intervention. Future evaluation of the intervention is warranted to establish its effectiveness.
