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The exemplary physical therapist students in clinical education: a phenomenological study.

Physical therapy educators strive to achieve excellence in education and develop clinicians who are prepared to meet the health needs of society. Previous research has focused on describing the traits, beliefs, and experiences of exemplary educators and clinicians to inform didactic and clinical curricula and serve as a model for expert practice. However, no studies have explored the experiences and perspectives of exemplary students. The aim of this phenomenological study was to describe the traits, beliefs, and experiences of exemplary physical therapist (PT) students in clinical education. A phenomenological design was utilized to gather data through semi-structured interviews with 26 students from the United States who met the criteria for exemplary and were completing their terminal clinical experience or were within six months of graduation. Data were analyzed using constant comparison and methodological rigor was maintained using an inquiry audit, peer debriefing, member checking, and pilot interviewing. A Desire to Serve emerged as an overarching theme. The essence of being exemplary was further elucidated through the following themes: (1) Being adaptable (2) Being reflective (3) Embracing challenges and seeking opportunities (4) Valuing a collaborative relationship with their CI (5) Importance of self-care, and (6) Coming into my own as a PT. Given the emphasis on excellence in physical therapy education, these results can provide insights for defining the necessary qualities for achieving excellence in both classroom and clinical environments. Additionally, these findings can assist educators in fostering excellence-driven attributes among entry-level students.

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Blood flow restriction training for an individual with Kellgren–Lawrence grade 4 ankle osteoarthritis following childhood clubfoot repair: A case report

ABSTRACT Background Ankle osteoarthritis (OA) is a disease involving pain and decreased physical function which can attenuate the tolerance to perform high-load resistance training. Low-load blood flow restriction (BFR) training has been demonstrated to improve muscle strength, muscle size, and physical function in patients suffering from OA. Objective We examined the effects of 12 weeks of BFR-training performed 4 times a week in an individual with Kellgren–Lawrence (KL) grade 4 ankle OA. Case Description A 32-year-old woman with KL grade 4 right ankle OA subsequent to a clubfoot repair in childhood performed 12 weeks of BFR-training. Four exercises with concurrent blood flow restriction (60% of arterial occlusion pressure) targeting the lower leg were performed 4 times/week. The following outcome measures were collected at baseline and 12 weeks after BFR-training: The Foot and Ankle Outcome Score (FAOS), calf circumference, maximal isometric muscle strength, single-leg heel raise test, single-leg stance test, and lateral side-hop test. Outcomes Adherence to the training was 93.75%. The patient demonstrated improvements in FAOS subscale symptoms, pain, and sports/recreational activities by 19–47 points (minimal detectable change (MDC) = 18–21.5 points); maximal muscle strength in plantarflexion (36%), eversion (55%), and inversion (38%) (MDC for plantarflexion = 16.81–29.97%). The single-leg heel raise test and the lateral side-hop test improved with 66% and 51%, respectively. Calf circumference was maintained. Conclusion BFR-training improved patient-reported outcomes, lower leg muscle strength, and physical function in an individual suffering from KL grade 4 ankle OA following childhood clubfoot repair.

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Physiotherapist managers views on advanced practice physiotherapy in Ireland. A qualitative study

ABSTRACT Introduction The introduction of physiotherapists working with advanced scope of practice has contributed to improvements in healthcare services. Objective This qualitative study explores the views of physiotherapist managers on the Advanced Practice Physiotherapy role and the barriers and enablers to progression of this career pathway. Methods A qualitative focus group study was conducted online with 10 purposefully sampled physiotherapist managers. The focus groups were audio-recorded, transcribed and thematically analyzed. Results Three main themes were identified; 1) Physiotherapists working in advanced practice are recognized as experts and strong advocates for the physiotherapy profession; 2) Barriers to Advanced Practice Physiotherapy in Ireland include inconsistent role definition and protection, a lack of legislation and uncertainty concerning clinical governance; and 3) Physiotherapist managers can support Advanced Practice Physiotherapy through mentoring and resource provision, and implementation of the Advanced Practice Competency Framework. Conclusion Physiotherapist managers recognized the value of Advanced Practice Physiotherapy to the Irish health service but suggest that the role and reporting structures need to be clarified. They highlighted barriers preventing the full potential of this these roles being realized and provided suggestions to support the progression of this healthcare model.

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Relationship of total sagittal spinal alignment index of thoracic kyphosis and lumbar lordosis with physical function in community-dwelling older adults

ABSTRACT Background Overall spinal curvature is evaluated by calculating the difference between the angles of lumbar lordosis (LL) and thoracic kyphosis (TK) and is expressed as LL minus TK (LL-TK). It is unclear whether LL-TK is associated with physical function in community-dwelling older adults and whether it is more relevant than TK or LL alone. Objective This study aimed to identify whether LL-TK is associated with physical function in community-dwelling older adults, and whether it is strongly associated than TK or LL alone. Methods The participants comprised 1,674 community-dwelling older adults who underwent physical assessments (women, n = 1,099; mean age, 67.4 ± 5.3 years). As spinal alignment indices, TK and LL were measured using skin surface methods, and LL-TK was calculated as the difference between them. Decreased LL-TK indicated increased overall spinal curvature. Physical function was determined by measuring single-leg standing, five-times chair-stand, and usual gait speed. Stepwise multiple regression analyses were performed with each physical function as the dependent variable and spinal alignment indices as the independent variables, with adjustments. Results Multiple regression analyses showed that single-leg standing (β = 0.092, 95% confidence interval [CI] = 0.071 to 0.214, p < .001) and five-times chair-stand (β=-0.142, 95% CI = −0.037 to −0.019, p < .001) were significantly associated with LL-TK, but not LL. Both LL-TK (β = 0.121, 95% CI = 0.001 to 0.004, p < .001) and LL (β = 0.087, 95% CI = 0.001 to 0.003, p = .003) were significant determinants of usual gait speed. Conclusions This study showed that decreased LL-TK may be associated with poor physical function. This association may be stronger than that observed for TK or LL alone.

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Acceptability of multimodal and multidisciplinary group-based program for chronic low back pain: a qualitative study

ABSTRACT Background The Programa d’Atenció Integral pels Pacients amb Dolor Crònic (PAINDOC) is a multimodal and multidisciplinary group-based program that integrates pain neuroscience education, mindfulness meditation, pain psychotherapy, Empowered Relief, and therapeutic exercise. It serves as a therapeutic option for individuals with chronic low back pain, providing them with comprehensive adaptive strategies for pain management. Objective This qualitative study explores participants’ retrospective acceptability of the PAINDOC Program. Methods To ensure demographic variability and information power, a purposive sampling approach was applied. Twelve participants were interviewed through three focus groups, supplemented with four individual semi-structured interviews. Data was analyzed using reflexive thematic analysis and evaluated based on the Therapeutic Framework of Acceptability. Results Participants provide positive feedback regarding active pain coping strategies and improved self-management. While certain aspects of the Program were more emphasized, participants integrated tools from all components. Strategies included pain reconceptualization, positive self-talk, or problem-solving. The Program’s ethicality was closely linked to individual values and may also be influenced by time constraints of certain program elements, the immediate effects of specific approaches, participant perceptions, and individual preferences. Conclusions The findings provide valuable insights into the acceptability of the PAINDOC Program, guiding future improvements and the development of similar interventions.

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Effects of combining rTMs and augmented reality gait adaptive training on walking function of patients with stroke based on three-dimensional gait analysis and sEMG: a randomized controlled trial

ABSTRACT Background Augmented reality gait adaptive training (ARGAT) and repetitive transcranial magnetic stimulation (rTMS) have both demonstrated efficacy in improving lower limb motor function in survivors of stroke. Purpose To investigate the effects of combining rTMS and ARGAT on motor function in survivors of stroke. Methods The experimental group received a combination of rTMS and ARGAT, while the control group received ARGAT alone. The interventions comprised a total of 20 sessions, conducted over four weeks with five consecutive daily sessions. Outcome measures included three-dimensional gait analysis (3DGA), surface electromyography (sEMG), Fugl-Meyer assessment for the lower extremity (FMA-LE), and the Berg Balance Scale (BBS). Results Following the intervention, both groups showed significant improvements in walking speed, symmetry index, affected step length, affected stride length, FMA-LE, and BBS scores (p < .05). Furthermore, the experimental group demonstrated greater improvements in walking speed (F = 4.58, p = .040), cadence (F = 5.67, p = .023), affected step length (F = 5.79, p = .022), affected stride length (F = 4.84, p = .035), FMA-LE (Z = 2.43, p = .019), and BBS (F = 4.76, p = .036) compared to the control group. The experimental group demonstrated a significant improvement in the co-contraction index (CCI) of the knee joint (F = 14.88, p < .001), a change not observed in the control group (F = 2.16, p = .151). However, neither group showed significant alterations in CCI of the ankle joint (F = 1.58, p = .218), step width (F = 0.24, p = .630), unaffected step length (F = 0.22, p = .641), or unaffected stride length (F = 2.99, p = .093). Conclusion The combination of low-frequency rTMS and ARGAT demonstrated superior effects on motor function recovery compared to ARGAT alone in survivors of stroke.

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The reliability and minimal detectable change of common tests and measures for temporomandibular disorders

ABSTRACT Background Temporomandibular disorders are a source of orofacial pain. Understanding clinimetric properties of evaluation procedures is necessary for assessing impairments and determining response to interventions. Purpose Reliability, minimal detectable change (MDC95), and 95% limits of agreement of TMJ examination procedures were investigated. Methods Occlusion (central incisor alignment, overjet, overbite), mandibular dynamics (maximal incisor opening, laterotrusion, protrusion active range of motion (AROM)), auscultation, tenderness, and joint play were measured on 50 asymptomatic adults (30 females), mean age 24.8. The inter-rater reliability assessment used an intra-session design. Participants returned 24–48 h later for intra-rater assessments. Intraclass correlation coefficients (ICC) and Kappa values were used to determine reproducibility. Results Intra-rater reliability for occlusion and AROM was ICC 3,1 ≥ 0.75, whereas interrater reliability was ICC 2,1 ≥ 0.68. Kappa values for inter-rater agreement of joint mobility was K = .18, whereas auscultation and palpation were K ≥ 0.48. Intra-rater Kappa values were ≥ 0.24, with lateral pterygoid region palpation having poor agreement. The MDC95 for occlusion was 1 mm, whereas AROM ranged from 3 to 6 mm. Mean AROM differences between raters were −1.16, −0.42, −0.18, and −0.8 mm for maximal incisor opening, left and right laterotrusion, and protrusion, respectively. Conclusion AROM and occlusion measurements may be used with confidence; however, poor agreement for joint mobility measurements and lateral pterygoid region palpation must be recognized. When re-assessing measurements, a 3–6 and 1-mm change in AROM and occlusion, respectively, is required to be 95% certain change is not due to error. Future symptomatic population research is needed (250/250).

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Group exercise for balance in people with Parkinson’s disease: a systematic review with meta-analysis

ABSTRACT Background High-quality evidence shows that exercise helps people with Parkinson’s disease improve functional abilities including balance. However, few studies have investigated whether the setting and format through which balance-focused exercise programs are provided matters. This systematic review investigated group exercise compared to individual exercise, and to no-exercise control (CTL), on clinical measures of balance for people with Parkinson’s disease. Methods MEDLINE, EMBASE, CINAHL and Cochrane CENTRAL databases were searched through March 24, 2024, on terms for Parkinson’s disease; exercise or physical activity; community-based or group classes; balance or postural control. Citations, abstracts and full-text articles were independently reviewed, and included studies were rated on risk of bias by two authors. Results Twenty-seven randomized controlled trials (30 reports) with 1200 participants met criteria. Meta-analysis using mean difference (MD) compared group exercise to CTL on seven clinical measures of balance. Three yielded significant differences favoring group exercise: Timed Up and Go = -2.29 (MD), −3.56 to −1.02 (95% Confidence interval) (95% CI); Mini-BEST = 2.72 (MD), 1.88 to 3.57 (95% CI); Berg Balance Scale = 4.31 (MD), 1.33 to 7.29 (95% CI). Meta-analyses were also conducted on six clinical measures of balance, comparing group exercise to individual exercise, yielding no significant differences. Conclusions For people with Parkinson’s disease, group exercise may be more effective than CTL on some clinical measures of balance and it yields similar results to individual exercise. People with Parkinson’s disease are encouraged to participate regularly in group or individual exercise based on preference and accessibility.

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Group exercise for balance in people with Parkinson’s disease: a systematic review with meta-analysis

ABSTRACT Background High-quality evidence shows that exercise helps people with Parkinson’s disease improve functional abilities including balance. However, few studies have investigated whether the setting and format through which balance-focused exercise programs are provided matters. This systematic review investigated group exercise compared to individual exercise, and to no-exercise control (CTL), on clinical measures of balance for people with Parkinson’s disease. Methods MEDLINE, EMBASE, CINAHL and Cochrane CENTRAL databases were searched through March 24, 2024, on terms for Parkinson’s disease; exercise or physical activity; community-based or group classes; balance or postural control. Citations, abstracts and full-text articles were independently reviewed, and included studies were rated on risk of bias by two authors. Results Twenty-seven randomized controlled trials (30 reports) with 1200 participants met criteria. Meta-analysis using mean difference (MD) compared group exercise to CTL on seven clinical measures of balance. Three yielded significant differences favoring group exercise: Timed Up and Go = -2.29 (MD), −3.56 to −1.02 (95% Confidence interval) (95% CI); Mini-BEST = 2.72 (MD), 1.88 to 3.57 (95% CI); Berg Balance Scale = 4.31 (MD), 1.33 to 7.29 (95% CI). Meta-analyses were also conducted on six clinical measures of balance, comparing group exercise to individual exercise, yielding no significant differences. Conclusions For people with Parkinson’s disease, group exercise may be more effective than CTL on some clinical measures of balance and it yields similar results to individual exercise. People with Parkinson’s disease are encouraged to participate regularly in group or individual exercise based on preference and accessibility.

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Tactile acuity and active joint repositioning sense in individuals with and without chronic low back pain: a cross-sectional study

ABSTRACT Background Sensorimotor dysfunction, as measured by tactile acuity and active joint repositioning, has been identified as a contributing factor of chronic low back pain (CLBP). Existing research suggests that further research is necessary to improve the characterization of sensorimotor perception in patients with CLBP. Objectives The main aim is to investigate whether tactile acuity and repositioning errors differ between individuals with CLBP and controls without CLBP. A secondary aim was to investigate the association between age, body mass index (BMI) and physical activity, and tactile acuity and repositioning sense. Methods Cross-sectional study. Sixty-eight participants (36 with, 32 without CLBP) were examined. Two-Point Discrimination (TPD) test (four measures: horizontal and vertical run, left and right side) and Active Joint Reposition Sense (AJRS) test (2 directions: to flexion and to extension) were used. Results No differences were found for TPD (right horizontal run: p = .069; left horizontal run: p = .066; right vertical run: p = .933; left vertical run: p = .285) or AJRS (flexion: p = .792; extension: p = .956) between participants with and without CLBP. Older subjects had significantly worse tactile acuity (3 sites, p = .018, p = .004, p = .041) and worse repositioning sense (2 directions, p = .026, p = .040,) than younger subjects. Individuals with BMI ≥ 25 had significantly worse TPD compared to individuals with normal weight (2 sites, p = .028, p = .020). Conclusions Individuals with CLBP did not have impaired tactile and repositioning accuracy when compared to controls without CLBP. Future studies comparing sensorimotor performance should consider age and BMI as potential confounding factors.

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