Question What was the fidelity of a remote multicomponent rehabilitation intervention in intensive care unit survivors (iRehab) across the National Institutes of Health Behavior Change Consortium Treatment Fidelity framework domains (design, training, delivery, receipt and enactment)? Participants iRehab participants (n = 429; 231 intervention, 198 standard care); interviews involved 20 intervention participants, 15 standard care participants and six intervention staff. Methods A mixed-methods fidelity assessment was embedded within the process evaluation of a multicentre randomised controlled trial. Quantitative fidelity was assessed using structured checklists, participant-level tracking data and longitudinal monitoring of potential drift. Qualitative interviews explored fidelity processes across domains. Results Study design fidelity was maintained, with clear differentiation between the experimental intervention and standard care. Provider training included structured training, competency assessment and ongoing multidisciplinary support. Delivery fidelity was high for one-to-one sessions, with no systematic drift in sampled sessions. Of 231 participants allocated to iRehab, 169 (73%) attended at least five one-to-one appointments. The uptake of optional group-based components was more variable. Qualitative findings indicated participant understanding and engagement, whereas tracking data and participant accounts provided evidence of strategies being applied in daily life. Conclusion The iRehab intervention was delivered with high delivery fidelity while allowing individualisation to patient needs. For physiotherapists, monitoring of fidelity should extend beyond attendance and exercise prescription to whether patients can independently apply rehabilitation strategies when symptoms, fatigue and everyday demands fluctuate. Defined core components, staff training, staff competency assessment, ongoing support and fidelity monitoring may help support consistent remote delivery.
Question What research areas need to be addressed to advance the physiotherapy profession globally? Design Mixed methods. Methods Seventy-four individuals with advanced physiotherapy profession knowledge contributed to a five-step participatory concept-mapping process. Participants brainstormed statements in response to the above question (n = 49) and then thematically sorted (n = 29) and rated (n = 31) them for importance and feasibility (5-point Likert scales). Statements were grouped using multidimensional scaling and hierarchical cluster analyses, and the final cluster solution and conceptual fit of statements were iteratively reviewed and refined to optimise conceptual congruence. Results Sixty-four unique statements were brainstormed, sorted and rated. A nine-cluster map was identified as the most appropriate representation of the data. From most to least important (number of statements, cluster mean importance/5), the clusters were: ‘Prevention and rehabilitation across the lifespan’ (7, 3.59); ‘Technology, innovation and digital transformation’ (6, 3.45); ‘Equitable access and value-based care’ (9, 3.38); ‘Contextually responsive care’ (5, 3.35); ‘Generating and moving evidence into practice’ (11, 3.32); ‘Health systems’ (8, 3.28); ‘Practice competence and sustainability’ (5, 3.21); ‘Education and professional development’ (5, 3.17); and ‘Professional identity’ (8, 3.12). ‘Research on the impact of rehabilitation on quality of life and reduction in care needs’ was rated the most feasible statement, whereas ‘Investigate strategies for physiotherapists to impact the political, social and economic environment of vulnerable and marginalised populations’ was the least feasible statement. Conclusion These findings are a resource for World Physiotherapy, the wider physiotherapy profession and key interest holder groups to inform research strategic direction, project development and advocacy.
Question In adults with chronic non-specific low back pain, does adding photobiomodulation therapy (PBMT) to a program of motor control exercise (MCE) improve pain intensity, disability and circulating prostaglandin E2 (PGE2) concentrations compared with sham PBMT plus MCE? Design A randomised controlled trial was conducted with concealed allocation, intention-to-treat analysis and blinding of participants, therapists and assessors. Participants Adults aged 18 to 65 years seeking treatment for chronic non-specific low back pain of ≥ 3 months in duration. Intervention Participants were randomly allocated to active PBMT plus MCE or sham PBMT plus MCE. Both groups received 12 treatment sessions over 6 weeks. Outcome measures Assessments were completed at baseline and 6 weeks, with follow-up assessments at 1 month after the end of the intervention period and at 3, 6 and 12 months after randomisation. Primary outcomes were pain intensity (0 to 10 numerical rating scale) and disability (0 to 24 Roland-Morris Disability Questionnaire) at 6 weeks, in which higher scores indicated greater severity. Secondary outcomes were: pain and disability at follow-up timepoints; circulating PGE2 concentrations at 6 weeks; and medication use, concomitant care and adverse events throughout the follow-up period. Results A total of 148 participants were randomised (74 per group). The intention-to-treat analysis showed that PBMT plus MCE had a negligible effect compared with sham plus MCE at 6 weeks for pain intensity (MD –0.4 points, 95% CI –1.2 to 0.4), disability (MD –0.7 points, 95% CI –2.4 to 0.9) or circulating PGE2 concentrations (MD 31 pg/ml, 95% CI –4 to 66). Negligible between-group differences were observed throughout the 12-month follow-up period, and no treatment-related adverse events occurred. Conclusion Adding PBMT to MCE did not provide clinically important additional improvements in pain intensity, disability or circulating PGE2 concentrations compared with sham plus the same exercise program. Registration NCT05487118.
