Physiotherapy Care Research Articles

A Phenomenological Qualitative Study Protocol and Semi-Structured Interview Guide Development to Identify Perceptions, Experiences, Facilitators and Inhibitors in Patients With Knee Osteoarthritis Undergoing Rehabilitation in a Low- and Middle-Income Country.

Perceptions, experiences, facilitators, and inhibitors of disease among patients may be shaped by their lifestyle and cultural background. Despite the significance of understanding their perspectives and experiences about disease for the prevention and management of osteoarthritis (OA) through physiotherapy, this subject has not been explored among patients with knee OA (PKOA) from lower and middle-income countries (LMICs). This study aims to explore the perception, and experiences of knee OA and physiotherapy treatment and identify the facilitators and inhibitors of physiotherapy treatment in PKOA from a lower- and middle-income country, India. 40 PKOA (n=10 in each Kellgren and Lawrence grade) will be recruited using a purposive sampling technique. Data will be collected through semi-structured interviews which are composed of pre-determined open-ended questions. Based on patients' flexibility and feasibility, the interview will be conducted face-to-face or by telephone or videoconference. The interview will be recorded using a digital audio recorder. Recorded data will be transcribed verbatim. Data will be analysed using thematic analysis based on the Braun and Clark approach. The verbatim transcript will be evaluated to identify sub-themes and themes through thematic analysis. Generated data will be investigated through inductive qualitative analysis to examine the viewpoints of PKOA. This study will explore the patients' perspectives, experiences, and the factors which will facilitate and inhibit the physiotherapy treatment for knee osteoarthritis. The result might reveal a new way to promote insightful decision-making towards physiotherapy care for PKOA and help to improve their access to physiotherapy care.

Personalised decision support in the management of patients with musculoskeletal pain in primary physiotherapy care: a cluster randomised controlled trial (the SupportPrim project).

We developed the SupportPrim PT clinical decision support system (CDSS) using the artificial intelligence method case-based reasoning to support personalised musculoskeletal pain management. The aim of this study was to evaluate the effectiveness of the CDSS for patients in physiotherapy practice. A cluster randomised controlled trial was conducted in primary care in Norway. We randomised 44 physiotherapists to (1) use the CDSS alongside usual care or (2) usual care alone. The CDSS provided personalised treatment recommendations based on a case base of 105 patients with positive outcomes. During the trial, the case-based reasoning system did not have an active learning capability; therefore, the case base size remained the same throughout the study. We included 724 patients presenting with neck, shoulder, back, hip, knee, or complex pain (CDSS; n = 358, usual care; n = 366). Primary outcomes were assessed with multilevel logistic regression using self-reported Global Perceived Effect (GPE) and Patient-Specific Functional Scale (PSFS). At 12 weeks, 165/298 (55.4%) patients in the intervention group and 176/321 (54.8%) in the control group reported improvement in GPE (odds ratio, 1.18; confidence interval, 0.50-2.78). For PSFS, 173/290 (59.7%) patients in the intervention group and 218/310 (70.3%) in the control group reported clinically important improvement in function (odds ratio, 0.41; confidence interval, 0.20-0.85). No significant between-group differences were found for GPE. For PSFS, there was a significant difference favouring the control group, but this was less than the prespecified difference of 15%. We identified several study limitations and recommend further investigation into artificial intelligence applications for managing musculoskeletal pain.

High-load strength training compared with standard care treatment in young adults with joint hypermobility and knee pain: study protocol for a randomised controlled trial (the HIPEr-Knee study)

IntroductionPatients with generalised joint hypermobility, including knee hypermobility (GJHk), often experience knee pain and are typically managed with low-intensity strength training and/or proprioceptive training as part of standard care. However,...

Establishing a Specialist Physiotherapy service with a Regional Specialist Memory Clinic

Abstract Background Patients with complex motor-cognitive syndromes (E.g. Dementia with Lewy Bodies, Corticobasal syndrome, Progressive Supranuclear Palsy and Huntington’s disease) present with a wide variety of symptoms. Accordingly, these patients have traditionally been managed under different services from Neurology-led movement disorder clinics to age-related services, without dedicated access to specialist physiotherapy input. Recognising this, the Model of Care for Dementia in Ireland recommended that all regional specialist memory services (RSMC) should have a dedicated Clinical Specialist Physiotherapist. The aim of this study was to provide an overview of clinic activity in the first six months of operation. Methods Physiotherapy referrals were collected from September 2023 to March 2024. Referral details were captured using Microsoft Excel and included patient demographics, reason for referral, diagnosis and previous physiotherapy input. Following triage of referrals, patients were placed in one of the following three care pathways: Results 63 referrals were generated. Of these, 15 patients were referred for pre-diagnostic assessment, 46 were referred for rehabilitation, and 2 were referred for secondary prevention. Of those referred for rehabilitation; 18 patients had a diagnosis of DLB, 27 had another form of atypical Parkinsonism, 1 patient had HD. 22 patients had previous physiotherapy input. Conclusion This is the first specialist physiotherapy service in Ireland within a RSMC. This presents a challenge as there is no specific physiotherapy care pathway established for this service elsewhere, but also opportunity for service development and innovation. This overview will help with strategic and service planning and enables KPIs to be established to ensure patients receive a quality service.

Implementation of a Virtual Reality Intervention in Outpatient Physiotherapy for Chronic Pain: Protocol for a Pilot Implementation Study.

Chronic pain is a global health issue that causes physical, psychological, and social disabilities for patients, as well as high costs for societies. Virtual reality (VR) is a new treatment that provides an opportunity to narrow the gap between clinical practice and recommended care in the use of patient education and behavioral interventions in the outpatient physiotherapy setting. However, there is currently no implementation strategy to integrate VR treatments into this setting. This protocol outlines a pilot implementation study that aims to (1) identify barriers and facilitators for implementing a VR intervention in outpatient physiotherapy care for people with chronic pain and (2) develop and pilot test an implementation strategy in 5 practices in Germany. The study consists of 4 phases. The first phase involves adapting the treatment protocol of the VR intervention to the local context of outpatient physiotherapy practices in Germany. The second phase includes the collection of barriers and facilitators through semistructured interviews from physiotherapists and the development of a theory-driven implementation strategy based on the Theoretical Domains framework and the Behavior Change Wheel. This strategy will be applied in the third phase, which will also include a 6-month span of using VR interventions in practices, along with a process evaluation. The fourth phase consists of semistructured interviews to evaluate the developed implementation strategy. The recruitment process and phase 1, including the adaptation of the treatment protocol, have already been completed. We recruited 5 physiotherapy practices in Lower Saxony, Germany, where the VR intervention will be implemented. The collection of barriers and facilitators through semistructured interviews is scheduled to begin in February 2024. This pilot implementation study aims to develop a theory-driven implementation strategy for integrating a VR intervention into outpatient physiotherapy care for people with chronic pain. The identified barriers and facilitators, along with the implementation strategy, will serve as a starting point for future randomized controlled implementation studies in different settings to refine the implementation process and integrate VR interventions into the outpatient care of people with chronic pain. German Clinical Trials Register DRKS00030862; https://tinyurl.com/3zf7uujx. DERR1-10.2196/58089.

Exploring the Opportunities and Barriers of Implementing the Health Focused Physical Therapy Model

The Health-Focused Physical Therapy Model integrates lifestyle behavior management into physical therapy practice using a standardized care model and motivational patient interviewing. The purpose of this study was to identify the perceived opportunities and barriers physical therapists, physical therapist assistants, and rehab administrators may face when implementing the model. This study included a survey of 19 physical therapy clinicians, and interviews with four rehabilitation administrators from one healthcare system. All participants attended a continuing education course covering the model and then completed a survey detailing their perceptions. Participants included female (100%), physical therapists (78.9%) and physical therapy assistants (21.1%), with variable educational degrees, and at least 16 years of clinic experience (73.7%). Four rehabilitation administrators, 100% female with at least 11 years of PT practice, participated in a semi-structured interview. Survey analysis revealed participants were confident in their understanding of the model and believed the model would positively impact the health of patients. However, over half perceived time limitations as a barrier. Meanwhile, three themes from the interview emerged including holistic care, implementation barriers, and needed resources. This study demonstrated time limitations and productivity standards could limit the implementation of health-focused physical therapy care. Future research should analyze opportunities and barriers of the model with broadened participant sampling methods and triangulation across healthcare practitioner roles to guide implementation and realistic practice standards.

Communicating safety-netting information in primary care physiotherapy consultations for people with low back pain

BackgroundSafety-netting involves communicating information to patients about diagnostic uncertainty, the likely time-course of their condition and how to appropriately seek help from a healthcare professional if their condition persists or worsens. Little is known about how physiotherapists communicate safety-netting information to people with low back pain (LBP). ObjectivesThis research aimed to use a Safety-Netting Coding Tool (SaNCoT) to explore how physiotherapists communicate safety-netting information to people with LBP. MethodsThe SaNCoT was used to conduct a secondary analysis of audio-recordings and transcripts from 79 primary care physiotherapy consultations (41 initial and 38 follow-up) involving 12 physiotherapists and 41 patients with LBP in Southern England. Quantitative data from the SaNCoT were analysed descriptively. FindingsThe study found evidence of diagnostic uncertainty in 53 (67%) appointments and no examples of physiotherapists providing patients with specific information about their condition time-course. Eight patients were given safety-netting advice, but most (57.9%, n = 11) episodes of safety-netting advice did not include specific signs and symptoms for patients to monitor. Potential missed opportunities for safety-netting advice were identified in 19 appointments (24.1%) which tended to relate to the patient's associated leg symptoms but also included possible serious pathology. ConclusionThe SaNCoT was successfully used to measure safety-netting communication within physiotherapy consultations and found missed opportunities for providing clear safety-netting advice. Physiotherapists can use the findings to reflect on how they can provide clear safety-netting information to patients with LBP to effectively support patients to self-manage and help them seek appropriate care if their condition deteriorates.

Effectiveness of Hospital Fit on Physical Activity in Hospitalized Patients: A Stepped-Wedge Cluster-Randomized Trial and Process Evaluation.

This study investigates the effectiveness of using Hospital Fit as part of usual care physiotherapy on the physical activity (PA) behavior of hospitalized patients compared to patients who received physiotherapy before implementation of Hospital Fit. In addition, a process evaluation is conducted. A prospective, multi-center, mixed-methods stepped wedge cluster randomized trial was performed at the cardiology and medical oncology departments of two Dutch university medical centers. Patients were included in the non-intervention or intervention phase. During the non-intervention phase, patients received usual care physiotherapy. During the intervention phase, Hospital Fit was additionally used. Mean time spent walking, standing, lying/sitting per day and the number of postural transitions from lying/sitting to standing/walking positions were measured using an accelerometer and analyzed using linear mixed models. A process evaluation was performed using questionnaires and semi-structured interviews with patients and focus-group interviews with healthcare professionals. A total of 77 patients were included, and data from 63 patients were used for data analysis. During the intervention phase, the average time spent walking per day was 20 min (95% confidence interval: -2 to 41 min) higher than during the non-intervention phase (p = 0.075). No significant differences were found for mean time spent standing per day, mean time spent lying/sitting per day, or the number of postural transitions per day either. During the intervention phase, 87% of patients used Hospital Fit at least once, with a median daily use of 2.5 to 4.0 times. Patients and healthcare professionals believed that Hospital Fit improved patients' PA behavior and recovery. Insufficient digital skills and technical issues were described as challenges. Although patients and healthcare professionals described Hospital Fit as an added value, no statistically significant effects were found.

Treatment Among Commercial and Medicaid-Insured Adults With Incident Chronic Pain Episodes

Analyses of health care data can reveal utilization of treatment options that comprise a multidisciplinary approach to chronic pain management. This retrospective cohort study aimed to characterize treatments among commercially versus Medicaid-insured adults with incident episodes of chronic pain. We used MarketScan data to identify patients with diagnoses for conditions associated with chronic pain, assess procedure codes that align with broad categories of treatment options, and compare receipt of treatments by insurance type. Among enrollees aged ≥18 years, 4,254,818 adults with commercial insurance and 583,369 with Medicaid met continuous enrollment criteria and had no chronic pain episodes in 2017. Among patients with incident chronic pain episodes during 2018 to 2020, we determined the proportions receiving different categories of treatment options during the year following diagnosis. Cohen’s h determined meaningful differences by insurance. Study cohorts included 1,095,358 commercial (mean [standard deviation] age, 47.3 [13.3] years; 54.3% women) and 176,607 Medicaid adults (38.1 [12.7] years; 70.6% women) with incident chronic pain episodes during 2018 to 2020. More commercial than Medicaid patients received restorative therapies such as physical therapy (38.6% vs 19.2%), complementary or integrative care such as chiropractic treatment (31.1% vs 9.0%), and 2 or more different types of nonmedication treatment procedures (34.1% vs 16.3%). Median days to treatments were shorter for commercial patients. Disparities in the provision, patterns, and timing of treatments by insurance suggest differential access to the full range of treatment options early during the course of care and identify opportunities to align coverage and reimbursement policies with current practice guidelines. PerspectiveThis analysis of medical claims for patients with incident chronic pain episodes found disparities in the provision, patterns, and timing of treatments by insurance type. These results suggest differential access to evidence-based treatment options early during care and identify opportunities to align coverage and reimbursement policies with current practice guidelines.

‘Their role has a lot of purpose beyond being just being about exercises’: a qualitative study of patients’ experiences of physiotherapy following a mild traumatic brain injury

Following a mild traumatic brain injury (mTBI; also known as concussion), physiotherapists may be involved in injury identification, assessment and rehabilitation. However, how people perceive and experience the physiotherapist’s role...

Defining minimum workforce standards for intensive care physiotherapy in Australia and New Zealand: A Delphi study

BackgroundIntensive care staffing guidelines provide recommendations for the safe and effective delivery of health care while recognising professional requirements of the workforce. To guide recommendations for physiotherapy staffing guidelines, profession-specific consultation is needed. ObjectivesThe objective of this study was to develop consensus-based recommendations for minimum workforce standards for physiotherapy in intensive care. MethodsA Delphi survey process was conducted involving physiotherapists from Australia and New Zealand. ResultsThe panel consisted of 65 physiotherapists in the first round and 60 in the second round (92% retention). Respondents were from both Australia (49, 76%) and New Zealand (16, 24%) who had been physiotherapists for an average of 18.8 ± 9.0 years and were primarily senior intensive care physiotherapists (44, 68%). Respondents had experience across level 3 (50, 77%), level 2 (18, 28%), and level 1 (5, 8%) adult intensive care units (ICUs), adult high-dependency units (27, 42%), and paediatric intensive care (6, 9%). A total of 42 statements were presented, with 37 reaching consensus after two rounds. After two rounds, consensus was achieved for a minimum staffing ratio in paediatric ICUs of one physiotherapist per six (1:6) beds. For adult ICUs, use of the median value of the participant's responses was supported to establish minimum staffing ratios of 1:8, 1:7, 1:6, and 1:8 for levels 1, 2, and 3 ICUs and high-dependency units, respectively. The requirement for an additional allocation for senior physiotherapist staffing for each ICU level was also established. Statements that also gained consensus included recommendations for access to on-call and weekend services for all ICU settings and the consideration of evening shifts specifically for level 3 and paediatric ICUs. ConclusionsRecommendations for minimum staffing for physiotherapy in intensive care settings were achieved and supported requirements for clinical service delivery, supervision, and training.

A Retrospective Chart Review of Factors That Influence Outpatient Physical Therapy Care for Individuals With Chronic Constipation Utilizing an Intersectionality Lens

Purpose: This study sought to investigate intersectional factors regarding race, gender, health status, barriers to care, and socioeconomic factors surrounding adult individuals referred to outpatient physical therapy care with chronic constipation in the Miami, Florida metro area. Methods: The study was a retrospective chart review of 200 individuals referred to outpatient physical therapy at the University of Miami Health System over five years. The four primary questions that sought to explain physical therapy wait times, distance driven for care, duration of constipation on initial evaluation, and subjective well-being on the last physical therapy appointment were analyzed through binary logistic regression. Results: Our results demonstrate that subjective well-being at the end of outpatient physical therapy care for chronic constipation was negatively affected by identifying as African American/Black versus Caucasian (77.3%, odds ratio = 0.227 95% confidence interval, 0.061-0.847) and high durations of constipation ≥5 years (86.4%, odds ratio = 0.136; 95% confidence interval, = 0.026-0.723). Additionally, subjective well-being at the end of physical therapy care for CC was positively affected by an increasing number of sessions (9%, OR = 1.09; 95% CI, 1.002-1.194). Conclusion: Our findings indicated race and duration of constipation may impact clinical outcomes for individuals seeking outpatient physical therapy care for chronic constipation. Descriptive statistics also demonstrate the need to reach individuals with chronic constipation sooner and call for a more equitable and diverse representation of individuals in chronic constipation research and clinical care.

Mindfulness vs. Physiotherapy vs. Medical Therapy: Uncovering the Best Postoperative Recovery Method for Low Back Surgery Patients during the COVID-19 Pandemic-A Single Institution's Experience.

This study aimed to evaluate the efficacy of mindfulness therapy compared to traditional physiotherapy and usual care in alleviating postoperative pain and improving functional outcomes in patients undergoing lumbar spine surgery during the COVID-19 pandemic. Ninety patients undergoing lumbar decompression and fusion (LDF) who presented persistent low back pain after surgery were prospectively followed for one year. They were randomly divided into three groups: mindfulness therapy, physiotherapy, and medical therapy. The primary outcome was the improvement of the Oswestry Disability Index (ODI) score postoperatively and at six months follow-up. Both mindfulness and physiotherapy groups showed significant improvement in ODI scores compared to the control group, with mean variations of 10.6 and 11.6 points, respectively, versus 4.9 points in the control group. There was no significant difference between mindfulness and physiotherapy (p = 0.52), but both were superior to medical care (p < 0.0001 for physiotherapy and p = 0.0007 for mindfulness). This study demonstrated that mindfulness therapy is more effective than usual care in improving postoperative outcomes for patients undergoing lumbar spine surgery. In our cohort, its efficacy was comparable to that of physiotherapy, making it a viable alternative, especially when access to healthcare services is restricted, as seen during the COVID-19 pandemic. Future research should validate the findings of this study and examine the long-term effects on surgical patient populations.

Maternal Health Disparities in Acute Care Rehabilitation.

Patients with a high-risk pregnancy or who immediately give birth are often not provided access to acute care occupational and physical therapy during their hospital admission. The greatest potential for health care crises, including maternal mortality, occurs during the first 6 weeks after birth. Maternal mortality and morbidity, which continue to rise in the United States, are considered indicators of the overall population health of a country. It is estimated that over 80% of pregnancy-related deaths are preventable. The leading causes of death within the first 6 days after birth are hemorrhage, hypertensive disorders, and infection. Implicit biases about childbearing individuals who are perceived to be relatively young, independent, active, and healthy may unintentionally contribute to areas of substandard care that adversely impact maternal health outcomes. It is a professional and ethical imperative that health providers, including occupational and physical therapists, establish themselves as allies to patient groups at high risk for disparate treatment. The Acute Care OB Rehab Implicit Bias Self-Reflection Tool is an instrument designed for health providers to identify stereotypes that may contribute to inequitable access to rehabilitation in the hospital after birth. Including rehabilitation services for the perinatal population in the hospital setting can play a pivotal role in early detection of adverse events with activity that may directly impact the increasing maternal mortality rate in the United States.

Resiliency among older adults receiving lung cancer treatment (ROAR-LCT): A novel supportive care intervention for older adults with advanced lung cancer

IntroductionNovel supportive care interventions designed for an aging population with lung cancer are urgently needed. We aimed to determine the feasibility of a novel supportive care physical therapy (PT) plus progressive muscle relaxation (PMR) intervention delivered to older adults with advanced lung cancer in the United States (US). Materials and MethodsThis clinical trial, Resiliency Among Older Adults Receiving Lung Cancer Treatment (ROAR-LCT: NCT04229381), recruited adults aged ≥60 years with unresectable stage III/IV non-small cell (NSCLC) or small cell lung cancer (SCLC) receiving cancer treatment at The James Thoracic Oncology Center (planned enrollment, N = 20). There were no exclusion criteria pertaining to performance status, laboratory values, prior cancer diagnoses, comorbidities, or brain metastases. Participants were evaluated by PT and psychology and given an exercise pedaler, resistance bands, a relaxation voice recording, and instructions at study initiation. Participants were evaluated in-person by PTs and psychologists at the start and end of the 12-session intervention, with the intervening sessions conducted via virtual health. Participants completed self-reported measures of functional status, symptoms, and mood longitudinally with the following instruments: EQ-5D-5L, Patient Health Questionnaire-9, and General Anxiety Disorder-7. PT assessments included the Short Physical Performance Battery (SPPB) and the two-minute walk test. Feasibility was defined as at least 60% of participants completing at least 70% of all intervention sessions. Optional gut microbiome samples and activity monitoring data (ActiGraph®) were also collected. ResultsThe ROAR-LCT study concluded after consenting 22 patients. Among the 22 consented, 18 (81.8%) started the intervention; 11 participants (61.1%) completed at least 70% of all study sessions. All participants with SCLC completed the intervention. Reasons for withdrawal included progression of disease or hospitalization. The majority (88.9%) of patients who started were able to complete at least one virtual health session. Participants' functional status, SPPB, depression, and anxiety scores were stable from pre- to post-intervention. Participants who withdrew had worse baseline scores across domains. Seven microbiome and six ActiGraph® samples were collected. Discussion: This is one of the first PT + PMR supportive care interventions using virtual health among older adults with advanced lung cancer to achieve feasibility in the US.

Effectiveness of digital Cognitive-Behavioural Therapy for Insomnia in patients with musculoskeletal complaints and insomnia in primary care physiotherapy: study protocol for a randomised controlled trial

IntroductionInsomnia is prevalent among patients visiting physiotherapists due to musculoskeletal complaints and associated with poorer pain prognosis. Cognitive-Behavioural Therapy for Insomnia (CBT-I) may be effective for improving sleep quality and...

Exploring patients and caregivers needs and experiences in oncological physiotherapy: a call for collaborative care

PurposeThis study explores whether the full potential of physiotherapy is reaching cancer patients and their caregivers at all stages of the oncological process, aiming to identify gaps and opportunities for improving care.MethodsThe World Cafe co-design methodology facilitated discussions among cancer patients and caregivers. This dynamic, inclusive, and engaging approach fostered diverse perspectives and deeper insights through collaborative and flexible discussions. Sessions were recorded, transcribed, and qualitatively analyzed.ResultsSixteen participants were involved (eight cancer survivors and eight caregivers). The mean age of cancer survivors was 63.8 years, while the average age of caregivers was 59.3 years. Breast cancer was the most prevalent diagnosis among patients, and most caregivers had lost their family members to cancer. Analysis revealed two primary themes: “feeling cared for” and “the role of physiotherapy in the oncological process.” Key findings highlight the need for more humanized healthcare, with professionals providing support through effective communication and empathy. Significant gaps were detected in both systematic referrals to physiotherapists and their integration into care teams. Testimonies highlighted the lack of knowledge about the full potential of physiotherapy in oncology, hindering access. There was also a demand for recognizing specialized oncological physiotherapists.ConclusionsThese findings highlight significant gaps in physiotherapy care for cancer survivors and caregivers, including unmet needs due to the lack of information, resources, and effective communication. Future efforts should focus on increasing the visibility of physiotherapy, integrating specialized physiotherapists into oncology teams, and enhancing the emotional education of healthcare professionals to provide more humanized care.

Point of Care Ultrasound Guided Management of Lateral Ankle Sprains: A Case Series.

Lateral ankle sprain (LAS) is a common injury with incidence rates reported at 7.2 per 1000 person-years. Physical examination strategies provide limited information to guide rehabilitation that can maximize clinical outcomes. Early and accurate diagnostic information using ultrasound imaging enables individualized care and the ability to monitor healing along with its response to activity and rehabilitation. The purpose of this study was to describe and observe the outcomes associated with Point of Care Ultrasound (POCUS) guided early management of acute and sub-acute lateral ankle sprains. Case series. Individuals with a LAS within the prior 28 days underwent a clinical evaluation to include a POCUS exam to assess ligamentous integrity. Objective and POCUS findings were integrated to classify each LAS into one of four categories. Each grade of ankle sprain corresponded to levels of bracing for the protection of injured structures with each patient receiving physical therapy care based on rehabilitation guidelines. Participants completed the Foot and Ankle Ability Measure (FAAM) activities of daily living and Sports subscale, the Foot and Ankle Outcome Score (FAOS), Patient Reported Outcomes Measurement Information Systems Global Health, Tampa Scale of Kinesiophobia (TSK-11), Cumberland Ankle Instability Tool (CAIT), and the Numeric Pain Rating Scale as well as the Ankle Lunge Test and Figure 8 measurements at baseline, 4 weeks, 8 weeks and 12 weeks post enrollment. The FAAM Sport subscale, all FAOS subscales, and the TSK-11 were also collected at 24 weeks while the CAIT was collected at baseline and 24 weeks. Fourteen participants were enrolled with 11 participants completing all data collection. FAAM Sport scores significantly improved at 4, 8, 12 and 24 weeks. All components of the FAOS significantly increased except for Sport scores at four weeks and Quality of Life scores at four and eight weeks. POCUS guided early management and ligamentous protection of LASs resulted in significant short and long-term improvement in function and return to sporting activity. This case series highlights the feasibility of using ultrasound imaging to assess the severity of ligamentous injury and align bracing strategies for ligamentous protection. The observations from this case series suggest that functional bracing strategies focused on ligamentous protection to promote healing and reduce re-injury rates does not delay improvement in functional outcomes. Level IV, Case Series.

Exploring the association between adherence to home-based exercise recommendations and recovery of nonspecific low back pain: a prospective cohort study

BackgroundAdherence to home-based exercise (HBE) recommendations is critical in physiotherapy for patients with low back pain (LBP). However, limited research has explored its connection with clinical outcomes. This study examined how adherence to HBE relates to changes in physical function, pain intensity, and recovery from LBP in patients undergoing physiotherapy treatment.MethodsData from a multicenter cluster randomized controlled trial in the Netherlands involving patients with LBP from 58 primary care physiotherapy practices were used. Adherence to HBE was assessed with the Exercise Adherence Scale (EXAS) at each treatment session. Previously identified adherence trajectories served as a longitudinal measure of adherence and included the classes “declining adherence” (12% of participants), “stable adherence” (45%), and “increasing adherence” (43%). The main outcomes included disability (Oswestry Disability Index), pain (Numeric Pain Rating Scale), and recovery (pain-free for > 4 weeks), which were measured at baseline and after three months. Linear and binomial logistic regression analyses adjusted for confounders were used to examine adherence–outcome relationships.ResultsIn the parent trial, 208 participants were included. EXAS scores were available for 173 participants, collected over a median of 4.0 treatment sessions (IQR 3.0 to 6.0). Forty-five (28.5%) patients considered themselves to have recovered after three months. The median changes in the Oswestry Disability Index and Numeric Pain Rating Scale were − 8 (IQR − 1 to -20) and − 2 (IQR − 0.5 to -4), respectively. The mean EXAS scores varied among patient classes: “declining adherence” (46.0, SD 19.4), “stable adherence” (81.0, SD 12.4), and “increasing adherence” (39.9, SD 25.3), with an overall mean of 59.2 (SD 25.3). No associations between adherence and changes in physical functioning or pain were found in the regression analyses.ConclusionsNo association between adherence to HBE recommendations and changes in clinical outcomes in patients with LBP was found. These findings suggest that the relationship between adherence to HBE recommendations and treatment outcomes may be more complex than initially assumed. Further research using detailed longitudinal data combined with qualitative methods to investigate patient motivation and beliefs may lead to a deeper understanding of the relationship between adherence and clinical outcomes in patients with LBP.

Feasibility of interdisciplinary evaluation in non-arthritic hip pain: A randomized trial

BackgroundPhysical therapy and orthopaedic surgery are two common treatments for non-arthritic hip pain. Interdisciplinary evaluation across these disciplines may produce a more supportive treatment-planning process; however, the feasibility of such an evaluation remains unknown. Hypothesis ObjectiveTo assess the feasibility of an interdisciplinary evaluation with an orthopaedic surgeon and physical therapist for non-arthritic hip pain. Study designObservational feasibility study of a randomized controlled trial. MethodsParticipants were randomized to an interdisciplinary (surgeon + physical therapist) or standard (surgeon) evaluation in a hip preservation clinic. Recruitment rate was recorded. Retention rate was calculated for all variables of interest. Enrollment and refusal reasons were recorded as patient quotes and categorized by a single grader. Time spent in clinic was compared across groups using Mann Whitney U tests (P ≤ 0.05). Study clinicians were interviewed, and responses were categorized based on pre-determined themes. ResultsEighty-one percent of eligible patients enrolled over a 15-month recruitment period. Willingness(n = 16), urgency to resolve pain(n = 10), financial compensation(n = 1), interest in research(n = 42), physical therapy(n = 6), or multiple-provider care(n = 15) were participants’ enrollment reasons; reason was not recorded for 22 participants. Time(n = 11), preference for single-provider care(n = 6), current physical therapy treatment(n = 1), and disinterest in physical therapy(n = 7) or research(n = 2) were refusal reasons of patients who did not enroll. Retention for primary variables of interest was 100% in both groups. Participants spent, on average, 23.5 min more time in clinic for the interdisciplinary evaluation compared to the standard (P < 0.001). ConclusionsAn interdisciplinary evaluation for patients with non-arthritic hip pain that included a physical therapist and orthopaedic surgeon in a hip preservation clinic was feasible and may better inform the treatment planning process.