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.
Abstract Importance Missed appointments disrupt outpatient care and may be particularly consequential in private physical therapy, where continuity of care, appointment management, and fee-for-service remuneration are closely linked. Objective This study aimed to identify strategies used by private physical therapists to manage missed appointments and assess their perceived effectiveness. Design This study used a national cross-sectional online survey design. Setting The study was conducted in private outpatient physical therapist practice in France. Participants Participants were physical therapists working in private outpatient practice who completed an anonymous online questionnaire. Exposure The strategies examined included organizational, communication, and digital reminder strategies used to manage missed appointments. Main Outcomes and Measures Outcomes included the perceived effectiveness of strategies assessed using a 4-point Likert scale; responses to 3 predefined statements concerning relational and emotional effects; and exploratory association between digital reminder use and perceived overall effectiveness. Results A total of 1246 physical therapists participated. Online booking platform reminders were rated as effective or very effective by 78.9% of users (95% CI = 74.1%–83.2%), and SMS reminders by 77.7% (95% CI = 72.4%–82.9%). In-clinic posters received lower ratings (20.0%; 95% CI = 16.6%–23.4%). Digital reminder use was weakly associated with higher perceived overall effectiveness (Cramér V = 0.105). Respondents frequently agreed that missed appointments affected their relationship with the patient concerned (82.9%) and that they had experienced frustration or anger after a missed appointment (91.3%); 46.2% agreed that these feelings influenced their interactions with patients more generally. Exploratory content analysis of open-ended responses identified financial deterrents, organizational and reminder strategies, attendance rules, communication and patient education, and restriction or discontinuation of care after repeated absences. Conclusions Digital reminders were perceived as the most effective strategies for managing missed appointments, but objective attendance outcomes were not assessed. Relational and emotional findings should be interpreted cautiously because they were based on 3 directionally framed, nonvalidated statements. Relevance Future studies should evaluate strategies using objective attendance data and balanced measures.
ABSTRACT Importance Physical therapists routinely make discharge recommendations for patients in the hospital, yet the reasoning that drives these decisions is poorly characterized. Objective The objective was to describe contemporary acute care physical therapists’ discharge reasoning and examine associations between reasoning constructs and recommended discharge intensity. Design This study used a cross-sectional clinical vignette-based survey. Therapists provided a discharge recommendation and supporting rationale. Free-text rationales were analyzed using directed content analysis, and quantitative associations between coded reasoning constructs and discharge recommendation intensity were examined using regression modeling. Setting The survey was conducted electronically with United States physical therapists practicing in hospitals. Participants Participants were eighty-nine acute care physical therapists who completed discharge recommendations and free-text rationales for 10 vignettes. Interventions none Main outcomes The three main outcomes for this study included: (1) Frequency and co-occurrence of coded reasoning constructs; (2) therapist-level reasoning profiles; and (3) associations between constructs and discharge intensity. Results Across 1604 construct code applications, 3 constructs dominated discharge reasoning: therapist prior experience (29.6%), patient functioning and disability (26.3%), and patient life context (25.3%). The majority (69.7%) of therapists demonstrated mixed reasoning patterns while less than one-third demonstrated a dominant reasoning profile. Patient functioning and disability was the only construct statistically associated with recommending more intensive post-acute care in ordered (OR = 1.70; 95% CI = 1.22–2.39) and binary (OR = 2.21; 95% CI = 1.30–3.74) models. Conclusions Acute care discharge reasoning concentrates on functional status, professional experience, and patient life context, with other domains functioning mainly as situational amplifiers. Relevance A refined framework for discharge reasoning may support clearer interdisciplinary communication, inform targeted education, and guide efforts to optimize post-acute care utilization.
Abstract Importance Individuals hospitalized with COVID-19 are at increased risk for prolonged physical, cognitive, and psychosocial impairments. Timely post-acute rehabilitation may reduce these sequelae and accelerate recovery. Objective The objective is to determine whether a REmotely monitored, Mobile health-supported Multidomain Rehabilitation Program incorporating High-intensity Interval Training (REMM-HIIT-CoV) after COVID-19 hospitalization improves functional exercise capacity. Design This study is a multicenter, single-blinded, attention controlled, prospective randomized controlled trial. Setting Five academic medical centers will enroll participants for remotely delivered and monitored rehabilitation. Participants The study will enroll 140 community-dwelling adults discharged within 60 days of COVID-19 hospitalization. Intervention Participants are randomized to either (1) a 12-week, individually tailored, structured and progressive multidomain physical rehabilitation intervention—targeting deficits in balance, mobility, strength, and endurance—delivered via videoconference and remotely monitored using activity trackers and a mobile health application; or (2) an exercise education control group without individualized exercise prescription. Main Outcomes and Measures The primary outcome is functional exercise capacity, measured by 6-min walk distance at 3 months post-randomization. Secondary outcomes include cardiorespiratory fitness (VO2peak), physical function (Short Physical Performance Battery, 30 Second Sit-to-Stand, Grip Strength), frailty (Fried Frailty Index), and cognitive function (Montreal Cognitive Assessment), self-reported quality of life (EQ-5D-5L), functional status (Duke Activity Status Index, Lawton Instrumental Activities of Daily Living), mental health (Hospital Anxiety and Depression Scale), and health-related social needs (Accountable Health Communities Health-related Social Needs Screening Tool). Exploratory outcomes include blood-derived biomarkers of inflammation and mitochondrial function, and ultrasound measures of lower extremity skeletal muscle structure. Conclusions REMM-HIIT-CoV is the first randomized trial to evaluate a remotely delivered, structured, and tailored multidomain rehabilitation program incorporating HIIT in post-hospitalized COVID-19 survivors. Relevance Findings may inform evidence-based guidelines and policy-relevant models for home-based remote rehabilitation after severe respiratory infections.
