Purpose This study aimed to evaluate the intra-rater and inter-rater reliability of the ActivForce2 digital dynamometer for measuring maximum isometric neck muscle strength in patients with chronic neck pain. Materials and Methods Thirty-one adults with chronic neck pain (mean age 38.7 years; 68% female; mean NPRS score = 6.2) participated in the study. Two physiotherapists assessed neck muscle strength using the ActivForce2 dynamometer across two sessions held one week apart. Participants, blinded to their results performed three repetitions of each neck movement (flexion, extension, lateral flexions, and rotations) in seated position. The mean force value was used for analysis. Intra-rater reliability was assessed by repeating measurements by the same examiner across sessions, while inter-rater reliability compared measurements between examiners. Reliability metrics included Intraclass Correlations Coefficient (ICC), Standard Error of Measurement (SEM), Minimal Detectable Change (MDC), and Bland-Altman plots. Results The ActivForce2 digital dynamometer demonstrated excellent reliability. Intra-rater ICC values ranging from 0.977 to 0.997, and inter-rater ICCs from 0.969 to 0/995. SEM values were low, and Bland-Altman plots showed narrow 95% limits of agreement across all tests. Conclusion The ActivForce2 digital dynamometer demonstrates excellent intra-rater and inter-rater reliability for measuring cervical isometric strength in patients with chronic neck pain, supporting its use in clinical and research contexts.

Background Individuals with conditions that affect the processing of vestibular cues, such as those with concussion and vestibular migraines, often require extensive home exercise programs (HEPs) for habituation to physical and visual stimuli. Low adherence to HEPs can hinder recovery and long-term outcomes. Due to the nature of treatment, which can trigger symptoms, clients may develop fear-avoidance behaviours. Psychological co-morbidities often exist, and therapists may lack the training to motivate their clients under these conditions. Methods We developed a visual model to serve as a framework for ease of implementation by clinicians of autonomy supportive behaviours, as described by Self-Determination Theory (SDT), to enhance motivation for vestibular rehabilitation. Encouraging client autonomy through tailored relationship building and fostering self-management skills can mitigate barriers to clients desired outcomes. Results The model introduces a teaching phase, coaching phase, supporting phase, and transitioning phase with recommended autonomy supportive behaviours in each phase for the rehabilitation professional. Conclusion We introduce the Autonomy-Supportive Therapeutic Relationship Model to provide a simplified visual tool for improving implementation of autonomy supportive behaviours into the evolving therapist-client relationship to facilitate participation and outcomes in rehabilitation.

Background Various virtual reality (VR) approaches in rehabilitation aim to improve the functional status of people with Multiple Sclerosis (PwMS). This systematic review examines the VR tools used, identifying key factors for efficiency and improvement in upper limb (UL) function and quality of life (QoL). Given the ongoing need for PwMS to maintain or improve their quality of life, rehabilitation interventions hold significant potential. Methods Two independent investigators conducted the primary search for eligible studies using PubMed, Science Direct, Web of Science, Cinahl, and PEDro databases. Data on design, methods, and results were then extracted from the retrieved articles and analysed for validity and bias using the RoB 2 tool and PEDro scale by three independent assessors. Results From 343 articles, we selected 12 randomised controlled trials using VR environments in PwMS that evaluated UL function and QoL. Studies differed greatly regarding the therapy content, setting, and therapy dosage, but they often indicated improvement in fine and gross motor skills, manual dexterity, improved UL functioning, bimanual coordination, and grip strength within the intervention group. In most cases, the effect on QoL was non-significant except for one finding that the intervention had a positive impact on the physical domain of MSQoL-54. Conclusion We conclude that virtual reality is a suitable tool for rehabilitation in PwMS with substantial benefits. This improvement in perceived health and QoL was mostly not reflected. The question also remains whether and to what extent VR could be more effective than standard therapy.

Purpose Describe an intervention combining a home exercise programme (HEP) and circuit class training (CCT) to increase motor practice dosage, with strategies to improve adherence. Methods This development study presents the intervention using the Template for Intervention Description and Replication (TIDieR) framework. It details the rationale, application and adherence strategies for the HEP and CCT, emphasising task-oriented training (TOT). Participants Individuals in the subacute phase after a stroke. Results A complex intervention called motor training and application of Adherences trategies in Two modalities, CCT and HEP (MATCH) was developed, comprising two manuals (HEP and CCT) that can be used separately or combined. The HEP features customised booklets with four tasks, aiming for at least 100 repetitions per task daily to support independent practice. The CCT involves 12 sessions, each lasting 60 min. Key components focus on adherence strategies, including providing information, tailoring tasks to individual preferences, promoting self-monitoring, and addressing barriers to practice. Conclusion The MATCH manuals offer therapists and researchers a structured approach to designing interventions that increase motor practice dosage and adherence. Relevance The MATCH aims to improve motor and functional recovery, participant motivation, and self-management for HEP, particularly for post-stroke individuals. Future studies should evaluate adoption, fidelity, penetration and cost-effectiveness in implementation trials, including those planned within Public Health Centres.

Background Low back pain (LBP) disproportionately affects socioeconomically disadvantaged individuals, minority ethnic communities, and those with multiple long-term health conditions; groups often under-represented in research studies. This scoping review aims to establish who participates in randomised controlled trials (RCTs) evaluating physiotherapy interventions for persistent LBP. Methods The review protocol was registered (https://doi.org/10.17605/OSF.IO/Y9CR4). Six databases were searched between January 2020 and June 2024. Eligible studies were RCTs of physiotherapy interventions for adults (18+) with persistent LBP. RCTs could be conducted in any setting and published in English. Data were analysed descriptively. Results 108 RCTs were eligible. Most RCTs did not report on key participant characteristics, such as ethnicity (n = 103, 95%) or comorbidities (n = 100, 93%). Where reported, mean age was 42.3 years (±9.6), 50.8% (±23.9) were female and 72.4% (±8.5) were from white ethnic backgrounds. Age (n = 102, 94%) and duration of LBP (n = 99, 92%) were the most common inclusion criteria. Language restrictions were the most reported participant characteristic (n = 24, 22%). The most reported reason for exclusion was previous spinal surgery (n = 74, 69%). People with mental health conditions were excluded in 30% (n = 32) of RCTs. Conclusion Most RCTs evaluating physiotherapy interventions for LBP do not report key participant characteristics, such as ethnicity, work status and health comorbidities. Where reported, people at higher risk of persistent and disabling LBP, particularly those with mental health conditions and from ethnic minority groups, are often excluded or under-represented. Future RCTs should adopt inclusive strategies to better reflect the populations most affected by LBP.

Background Access to healthcare is a fundamental right, yet persons with disabilities continue to face numerous barriers in accessing services. In South Africa, the Framework and Strategy for Disability and Rehabilitation (FSDR) was established to improve rehabilitation care for persons with disabilities. While studies have explored access from the perspectives of persons with disabilities, caregivers, and clinicians, limited attention has been given to the views of policy stakeholders involved in the framework’s development and implementation. This study aimed to examine factors influencing access to healthcare and rehabilitation from the perspectives of policy stakeholders. Methods A descriptive qualitative design was adopted. Twelve semi-structured interviews were conducted with policy stakeholders engaged in the development and implementation of the FSDR. Participants were identified through purposive and snowball sampling. Interview transcripts were analysed inductively and thematically using MAXQDA software. Results Analysis generated eight themes, grouped into barriers and facilitators. Barriers included poor disaggregation of disability data (limited indicators), human resources constraints (staff commitment, awareness, and capacity), inadequate equipment and infrastructure, poor socio-economic conditions, and weak intersectoral collaboration. Facilitators included positive staff attitudes, strong advocacy, and community-based interventions. Conclusion Significant barriers to healthcare and rehabilitation access for persons with disabilities remain and outweigh existing facilitators, resulting in poorer outcomes. Addressing these challenges requires stronger investment in rehabilitation services and supportive work environments that enhance staff capacity and commitment. Findings may inform future policy and practice, advancing the rights of persons with disabilities in South Africa.

Introduction and aims High-intensity interval training (HIIT) is safe and more effective than moderate-intensity continuous training (MICT) for improving cardiorespiratory fitness in adults with cardiac disease. Healthcare settings are gradually adopting home-based delivery models of cardiac rehabilitation to improve uptake and participation of programs. The aim of this systematic review was to explore the implementation of home-based HIIT programs in adults with cardiac disease. Methods A systematic search was conducted in three electronic databases. Studies were included if they compared home-based HIIT to other centre-based or home-based exercise interventions. Implementation was explored using the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. Results Data from 164 participants were included in the analysis. There were no differences in exercise capacity or quality of life (QoL) between home-based HIIT and other centre-based or home-based exercise interventions (p > 0.05). Adherence to the home-based HIIT protocol varied between 36% and 100%. The rate of adverse events was 3%. Key components of the RE-AIM framework such as implementation costs, long term outcomes, and intervention satisfaction were inadequately reported. Conclusions Home-based HIIT appears to be safe and equally effective as other cardiac rehabilitation exercise programs. A home-based HIIT program may be provisionally recommended for adults with stable cardiac disease.

Purpose The main aim of this study was to develop a biomechanical, subjective, and clinical characterisation of shoulder instability patients. Methods 38 adults with glenohumeral instability were enrolled. To assess the outcome variables, a goniometer, dynamometer, ultrasound, MoveUS Test, T-Fast Test, Western Ontario Shoulder Instability Index (WOSI), Quick-Piper fatigue scale, and Questionnaire on the athlete’s self-perception of returning to standardised training after an injury (RTP) were used. Results Results showed that WOSI was correlated with the range of motion (r = −0.379 to −0.513; p < 0.002), and with the Quick-Piper Fatigue Scale (r = 0.807; p < 0.001). Furthermore, RTP showed correlations with the range of motion (r = 0.357 to 0.370; p < 0.028), 120” T-Fast Test (r = 0.324; p = 0.047), WOSI (r = −0.746; p < 0.001), and Quick Piper Fatigue Scale (r= −0.389; p < 0.001). Likewise, muscle thickness at contraction showed a direct correlation with force peak (r = 0.334; p = 0.040); and T-Fast Test with pressure in push-ups (r = 0.441; p = 0.006), and explosive force peak (r = 0.355; p = 0.029). Moreover, three significant estimation models demonstrated that the quality of life, the capacity to return to play, and the endurance could be estimated using simple strength and mobility tests. Conclusions Goniometric, ergometric, dynamometric, sonographic, and subjective properties are greatly correlated in patients with glenohumeral instability, facilitating the development of short evaluations to predict the most complex variables.