Evidence-based Physical Therapy Research Articles

Methods of examination in physical therapy, and occupational therapy of people after stroke (clinical case)

the prognosis of recovery of patients after acute cerebrovascular accident depends on the type, severity, and area of brain damage. This article highlights standardized tests and scales for physical therapy and occupational therapy for patients after stroke. An example is given of a clinical case of a patient with stroke consequences, with right-sided spastic hemiplegia. Medical rehabilitation was provided in April 2023 at the Municipal Non-Profit Enterprise "Consultative and Diagnostic Center", branch №6, Sviatoshynskyi district, Kyiv, Department of Physical and Rehabilitation Medicine. After the patient visited the outpatient department of physical and rehabilitation medicine, the examination was conducted by the attending physician. A multidisciplinary team of a physical therapist and an occupational therapist was involved. An important step is the use of standardized tests and scales in physical therapy and occupational therapy. Based on the results of the examinations, the patient's goals are determined, and an individual rehabilitation program is built using evidence-based physical therapy and occupational therapy methods to provide a high-quality and effective rehabilitation cycle. Description of the objective. The standardized tests and scales in physical therapy, and occupational therapy are analyzed on the example of a clinical case of a patient after a stroke with right-sided spastic hemiplegia. Materials and methods. The clinician's handbook for 2020 on stroke rehabilitation was analyzed, with the justification of standardized tests and scales for physical therapy, and occupational therapy. A systematic review of the PubMed database was conducted, which included 44 scientific randomized trials and meta-analyses with accurate diagnoses of tests and scales for physical therapy and occupational therapy. The National Institutes of Health Stroke Scale (NIHSS) and the Modified Rankin Scale (mRS) were used to assess stroke. Modified Ashworth Scale for the assessment of spastic muscles in patients with neurological disorders. To determine cognitive outcomes and complications after stroke: Montreal Outcome Cognitive Assessment (MOCA); Modified Barthel Index (BI); Line Drawing Test. For motor function: Fugl-Meyer Assessment (FMA); Chedoke Arm and Hand Activity Instrument (CAHAI). Berg Balance Assessment; Morse Fall Risk Test; Stand and Walk Test. Results. The results of the initial examination in physical therapy and occupational therapy determined the patient's functional and cognitive state, consequences, and limitations arising after a stroke. The intermediate examination summarizes the effectiveness of the selected rehabilitation measures. If the patient's results remain unchanged, the physical and occupational therapist changes the approach and methods to achieve the goals. The final examination analyzes the dynamics of restoration of impaired functions, and achievement of goals by the end of the rehabilitation cycle. Therefore, we used the patient's clinical case to compare the initial, intermediate, and final examinations. This allowed us to analyze the results and determine the effectiveness of the selected individual rehabilitation program. Conclusions. The main principle of providing quality rehabilitation measures is the examination in the clinical practice of a physical therapist, and occupational therapist, which is used to measure the goals and compare the results achieved.

Protocol for a randomized controlled trial to evaluate a year-long (NICU-to-home) evidence-based, high dose physical therapy intervention in infants at risk of neuromotor delay.

Developmental disabilities and neuromotor delay adversely affect long-term neuromuscular function and quality of life. Current evidence suggests that early therapeutic intervention reduces the severity of motor delay by harnessing neuroplastic potential during infancy. To date, most early therapeutic intervention trials are of limited duration and do not begin soon after birth and thus do not take full advantage of early neuroplasticity. The Corbett Ryan-Northwestern-Shirley Ryan AbilityLab-Lurie Children's Infant Early Detection, Intervention and Prevention Project (Project Corbett Ryan) is a multi-site longitudinal randomized controlled trial to evaluate the efficacy of an evidence-based physical therapy intervention initiated in the neonatal intensive care unit (NICU) and continuing to 12 months of age (corrected when applicable). The study integrates five key principles: active learning, environmental enrichment, caregiver engagement, a strengths-based approach, and high dosage (ClinicalTrials.gov identifier NCT05568264). We will recruit 192 infants at risk for neuromotor delay who were admitted to the NICU. Infants will be randomized to either a standard-of-care group or an intervention group; infants in both groups will have access to standard-of-care services. The intervention is initiated in the NICU and continues in the infant's home until 12 months of age. Participants will receive twice-weekly physical therapy sessions and caregiver-guided daily activities, assigned by the therapist, targeting collaboratively identified goals. We will use various standardized clinical assessments (General Movement Assessment; Bayley Scales of Infant and Toddler Development, 4th Edition (Bayley-4); Test of Infant Motor Performance; Pediatric Quality of Life Inventory Family Impact Module; Alberta Infant Motor Scale; Neurological, Sensory, Motor, Developmental Assessment; Hammersmith Infant Neurological Examination) as well as novel technology-based tools (wearable sensors, video-based pose estimation) to evaluate neuromotor status and development throughout the course of the study. The primary outcome is the Bayley-4 motor score at 12 months; we will compare scores in infants receiving the intervention vs. standard-of-care therapy.

The value of virtual physical therapy for musculoskeletal care.

To estimate the economic benefit of evidence-based patient-initiated virtual physical therapy (PIVPT) service among a nationally representative sample of commercially insured patients with musculoskeletal (MSK) conditions. Counterfactual simulation. Using a nationally representative sample from the 2018 Medical Expenditure Panel Survey, we simulated the direct medical care savings and indirect cost savings from reduced absenteeism resulting from PIVPT among commercially insured working adults with self-reported MSK conditions. Model parameters of the impact of PIVPT are drawn from peer-reviewed literature. Four potential benefits of PIVPT are explored: (1) more rapid access to PT, (2) improved adherence to PT, (3) less expensive PT care per episode, and (4) reduced/avoided referral costs of PT. The mean medical care savings per person per year from PIVPT range between $1116 and $1523. Savings are mainly attributed to early initiation of PT (35%) and lower cost of PT (33%). The benefits of PIVPT result in a mean reduction of 6.6 hours in pain-related missed work per person per year. The return on investment of PIVPT is 2.0 (medical savings only) or 2.2 (medical savings plus reduced absenteeism). PIVPT service provides added value to MSK care by facilitating earlier access and better adherence to PT and lowering the cost of PT.

Musculoskeletal Pain: Current and Future Directions of Physical Therapy Practice

Musculoskeletal (MSK) pain is 1 of the most common problems managed by clinicians in MSK care. This article reviews current frameworks for the assessment and management of MSK pain within evidence-based physical therapy practice. Key considerations related to the biopsychosocial model of pain, evidence-based practice, assessment, treatment, physical activity/movement behavior, risk stratification, communication as well as patient education and self-management skills within physical therapy and physical and rehabilitation medicine are addressed. The future direction of MSK pain management is also discussed, including strategies to promote evidence-based practice, behavior change, social prescribing, and the use of technologies.

Pledget Sensor to Monitor Loading in Tendon and Ligament Sutures During Postoperative Physical Therapy

Tendon and ligament injuries are common complications in orthopedic and sports medicine. Tears to tendons and ligaments, many of which are treated surgically via suturing, require postoperative physical therapy to restore tissue structure and function. However, to effectively treat these injuries, the duration and intensity of rehabilitation need to be regulated to prevent tissue reinjury while promoting regeneration. Currently, physical therapy procedures following tendon and ligament repair rely on qualitative factors such as tissue swelling or patient pain tolerance, which can prevent optimal healing outcomes due to the patient and medical caregiver variability. Therefore, the goal of this project is to develop and characterize a sensing platform for detecting tension magnitude in sutures for rehabilitation applications. Specifically, a wireless suture pledget sensor was engineered to provide quantitative biofeedback during physical therapy by monitoring tension in sutures after soft tissue repair. To measure suture loading, an electrical resonance biosensor was integrated into the design of commercially available suture pledgets. This innovative approach had many advantages over previous suture monitoring systems including remote operation and passive function. In this work, a prototype suture pledget sensor was fabricated for proof-of-concept functionality studies. Loading experiments showed that the sensor could reliably detect suture loading forces ranging from 2 to 12 N, while signal transmission distance through tissue mimics was tested up to 16 mm. Overall, this device could be used to develop evidence-based physical therapy guidelines to accelerate rehabilitation and improve healing outcomes for patients with tendon and ligament injuries.

Acute Care Physical Therapy and Sickle Cell Disease

Background and Purpose: Vaso-occlusive crises (VOC) are the most common cause for hospitalization in children and adolescents with sickle cell disease (SCD) in the United States. Physical therapy interventions provide nonpharmacological pain management and help hospitalized patients maintain mobility and function, but little is known about their application to the unique pathophysiology of those with SCD. The purpose of this review is to summarize evidence relevant to the physical therapy management of children and adolescents hospitalized with VOC. Methods: A literature search of PubMed, Cochrane, CINAHL, and EMBASE databases was performed using key words relevant to physical therapy interventions for children and adolescents with SCD and acute pain. Results: Sixteen articles were included in this review. Interventions identified included heat, mobilization, transcutaneous electrical nerve stimulation, massage, yoga, mindfulness, breathing exercises, virtual reality, incentive spirometry, and patient/family education. Conclusions: Physical therapists may be able to aid in the acute pain management of patients with SCD. Current literature relies on small observational studies making generalization difficult. Future studies are critical to improve evidence-based physical therapy practice in this population.

Is the quality of systematic reviews influenced by prospective registration: a methods review of systematic musculoskeletal physical therapy reviews

ABSTRACT Introduction It is unknown if verified prospective registration of systematic reviews (SRs) and the randomized clinical trials (RCTs) that they use affect an SR’s methodological quality on A MeaSurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). Methods Data originated from interventional SRs published in International Society of Physiotherapy Journals Editors (ISPJE) member journals, indexed in MEDLINE, between 1 January 2018 and 18 August 2021. Blinded reviewers identified the SRs and extracted the data for the variables of interest for the SRs and the RCTs. Results Two of 14 ISPJE member journals required prospective SR registration. Twenty SRs were identified, and 169 unique, retrievable RCTs were included within those SRs. One (5.0%) of the 20 SRs and 15 of the 169 (8.9%) RCTs were prospectively registered and published consistent with this intent. Nineteen (95.0%) of the 20 identified SRs was categorized as ‘critically low’ on the AMSTAR 2. Discussion SRs and the RCTs identified within them were infrequently prospectively registered, prospectively verifiable, or prospectively verified based on the established research record. Conclusions Ensuring that SRs and RCTs have fidelity with the research record from conception to publication may help rule out low-value interventions, decrease variability in physical therapy practice, and solidify evidence-based physical therapy practice.

Identifying Perceptions, Experiences, and Recommendations of Telehealth Physical Therapy for Patients With Chronic Low Back Pain: A Mixed Methods Survey

ObjectiveTo describe concerns, advantages, and disadvantages encountered in an evidence-based physical therapy (PT) program for persons with chronic low back pain (CLBP) delivered by telehealth. DesignMixed methods survey and semistructured interview of persons with CLBP. SettingProspective observational cohort study of persons with CLBP from 3 health care systems receiving 8 sessions of evidence-based telehealth PT. ParticipantsParticipants were selected after completing week 10 (from baseline) assessment from an ongoing cohort study. We enrolled 31 of 126 participants (mean age, 42.4 years; 71.0% female) from the cohort study (N=31). InterventionsParticipants had completed 8 sessions of evidence-based telehealth PT and participated in semistructured interviews. Main Outcome MeasuresBaseline and week 10 and 26 assessments assessed psychosocial risk (StarTBack Screening Tool), working alliance (Working Alliance Inventory-Short Form), pain (Oswestry Disability Index), and health-related quality of life (Patient-Reported Outcomes Measurement Information System-29 profile, version 2). Semistructured interviews were conducted by telephone and consisted of open-ended questions assessing perception, satisfaction, and likelihood of recommending telehealth PT. Participants identified advantages and disadvantages to telehealth PT. Interviews were recorded, transcribed, and coded using an iterative qualitative process. Statistical comparisons by experience were made using analysis of variance (continuous) and Fisher exact test (categorical). ResultsCompared with the negative experience group (n=5), participants in positive (n=16) and neutral (n=10) experience groups endorsed higher bond working alliance with their therapist. Participants with a positive experience were more likely to view telehealth PT as cost-saving (n=10, 62.5%) compared with those with a neutral (n=1, 10.0%) or negative (n=1, 20.0%) experience and less likely to view telehealth PT as lower quality (n=0, 0.0%; n=1, 10.0%; n=2, 40.0%, respectively). Prior to starting telehealth, based on semistructured interviews, 18 participants (58.1%) had concerns and these persisted after starting in half of this group. Concerns regarded telehealth being different from or inferior to in-person PT, lack of physical correction, and worries of not using technology appropriately. Convenience, time savings, and personalization were seen as advantages. Difficulty making a personal connection with the therapist, lack of physical correction, and problems with technology were seen as disadvantages.Many participants endorsed a hybrid approach that included in-person and telehealth PT. Providing necessary equipment and technology assistance was seen as ways to improve telehealth PT experience. ConclusionsTelehealth is an acceptable modality to deliver PT for patients with CLBP with most having a positive experience and reporting advantages. Improvements could include offering a hybrid approach (in-person and telehealth combined) and providing necessary equipment and technical support. More research is needed to optimize the most effective strategies for providing telehealth PT for patients with CLBP.

An Evidence-based Physical Therapy Prescription for Adults With X-linked Hypophosphatemia.

ContextX-linked hypophosphatemia (XLH) is a rare and progressive metabolic phosphate-wasting disorder characterized by lifelong musculoskeletal comorbidities. Despite considerable physical disability, there are currently no disease-specific physical therapy (PT) recommendations for XLH designed to improve engagement and confidence in performing activities of daily living (ADL).ObjectiveThe objective of this patient-centered study was to develop an evidence-based PT program to address gaps in the management of adult XLH without imposing unintended harm.MethodsCreation of the program was informed by a prior controlled clinical study to evaluate the physical and functional effect of XLH on adulthood, and guided by the physical presentation of participants, subjective data and patient goals acquired at intake, and by performance on multiple active range of motion (ROM) movements from the standing position. A weekly standardized interview process was used to assess progression of physical and functional abilities, gains and concerns, and to obtain timely feedback to inform future exercise modifications. Outcomes were evaluated using validated functional tools and subjective data obtained throughout the study.ResultsA remote 12-week PT program was created based on collected data. Open and closed kinetic-chain exercises were developed and implemented. Functional improvements were documented, and weekly surveys indicated improved abilities and confidence to engage in ADL. Minimal improvements were observed in active upper and lower extremity ROM, reflective of substantial bony restrictions characteristic of XLH.ConclusionThis study represents the first disease-specific PT recommendations for XLH to mitigate the unique physical challenges of the adult disorder that can be modified to adapt to the current progression status of the adult disorder.

Combining Cognitive Behavioral Therapy for Insomnia and Chronic Spinal Pain Within Physical Therapy: A Practical Guide for the Implementation of an Integrated Approach.

Most people who have nonspecific chronic spinal pain (nCSP) report comorbid insomnia. However, in current treatment strategies for nCSP, insomnia is usually not addressed. Considering the bidirectional interaction between pain and sleep and its underlying psychophysiological mechanisms, insomnia may increase the risk of developing adverse physical and psychological health outcomes and should thus no longer be left untreated. As suggested by previous pilot studies, adding cognitive behavioral therapy for insomnia to the contemporary evidence-based biopsychosocial physical therapy approach may also improve pain outcomes in nCSP. This manuscript aims to provide practical guidelines on hybrid physical therapy, including the combination of the following components: (1) pain neuroscience education (eg, to reconceptualize pain) and cognition-targeted exercise therapy (eg, graded exposure to functional daily life movements), and (2) cognitive behavioral therapy for insomnia (sleep psychoeducation, behavioral and cognitive therapy, correction of sleep hygiene, and relaxation therapy) can be deployed for the management of patients who have chronic spinal pain. Impact. Due to the major impact sleep disturbances have on pain and disability, insomnia as a comorbidity should no longer be ignored when treating patients with chronic spinal pain.

Outcomes of Telehealth Physical Therapy Provided Using Real-Time, Videoconferencing for Patients With Chronic Low Back Pain: A Longitudinal Observational Study

ObjectiveTo describe the feasibility of an evidence-based physical therapy (PT) program for persons with chronic low back pain (LBP) originally designed for in-person delivery, adapted for telehealth using videoconferencing. DesignProspective, longitudinal cohort. SettingThree health care systems in the United States. ParticipantsAdults, aged 18-64 years (N=126), with chronic LBP recruited from August through December 2020. InterventionUp to 8 weekly sessions of telehealth PT. Main Outcome MeasuresFollow-up assessments were 10 and 26 weeks after baseline. Participant outcomes collected were the Oswestry Disability Index, Patient-Reported Outcomes Measurement Information System-29 health domains, and pain self-efficacy. Implementation outcomes included acceptability, adoption, feasibility, and fidelity assessed using participant surveys and compliance with session attendance. ResultsWe enrolled 126 participants (mean age, 51.5 years; 62.7% female). Baseline perceptions about telehealth were generally positive. Eighty-eight participants (69.8%) initiated telehealth PT, with a median of 5 sessions attended. Participants in telehealth PT were generally satisfied (76.3%), although only 39.5% perceived the quality equal to in-person PT. Telehealth PT participants reported significant improvement in LBP-related disability, pain intensity, pain interference, physical function, and sleep disturbance at 10- and 26-week follow-ups. ConclusionsThe findings generally support the feasibility of telehealth PT using videoconferencing. Implementation and participant outcomes were similar to in-person PT as delivered in the participating health care systems. We identified barriers that may detract from the patient experience and likelihood of benefitting from telehealth PT. More research is needed to optimize and evaluate the most effective strategies for providing telehealth PT for patients with chronic LBP.

THE MODERN VIEW OF PHYSICAL THERAPY ON RECOVERY OF PATIENTS AFTER STROKE WITH UPPER LIMB SPASTITY

The purpose of the article is to analyze recommendations for physical therapy methods after acute cerebrovascular accident. Most often, complications of the function of the upper limb occur, this causes difficulties in everyday and professional life. In most cases, the function in the arm is restored worse than in the leg. In case of insufficient restoration of hand function, an occupational therapist teaches the patient the basic skills of self-care: eating, bathing, personal toilet, dressing, controlling bowel movements and urination, using the toilet, moving around, the ability to move on a flat surface, climbing stairs. There are many technical devices that allow you to be independent: an anti-slip mat, prevention of falling in the bathroom, handrails, a step into the bathtub, seats in the bathtub, etc. In the first month of the recovery period, people after a stroke develop complications – contractures of the affected limbs, pain and pulling sensations; spasticity develops, which impairs coordination and balance and, as a result, increases dependence on others. Spasticity increases unevenly, the patient develops a peculiar Wernicke-Mann posture: the upper limb is bent at the elbow and radial wrist joints, the fingers are clenched into a fist; the lower limb is straightened at the hip, knee and ankle joints. Unqualified recommendations and improper selection of a physical therapy program provoke an increase in spasticity. Objective. To find effective evidence-based physical therapy methods that affect the restoration of upper limb function. Methods. Scientific literature analysis, synthesis, generalization, pedagogical observation. An important question for a physical therapist is the selection of effective methods that positively affect the restoration of functional movement of the upper limb, the patient receives an achievable request, and the specialist is able to prevent negative consequences and get good results in a short time.

POSA288 Virtual Reality and Gaming Technology in Clinical Research: Past Trends and Future Prospects

Digital therapeutics (DTx) is a category of regulated software designed to improve health outcomes via the delivery of evidence-based behavioral or physical therapy to treat or prevent disease. Virtual reality (VR) and video games (VG) represent new modalities with the potential to increase patient engagement for the delivery of DTx. This research aims to characterize how these technologies have been studied.

Sustainment of proactive physical therapy for individuals with early-stage Parkinson\u2019s disease: a quality improvement study over 4 years

BackgroundImplementation science frameworks aided the development of a new, evidence-based clinical physical therapy program. The purpose of this report is to describe the process of sustaining a clinical program in practice for over 4 years. We present a framework for integrating tools for sustainability with the Knowledge-to-Action model in the context of a proactive physical therapy (PAPT) program for individuals with early-stage Parkinson’s disease.MethodsSustainability of implementation strategies was addressed using the Dynamic Sustainability Framework and sustainability assessment tools. Repeated retrospective medical record reviews and phone interviews were used to evaluate the reach and adoption of the PAPT over 4 years. Characteristics of those who engaged with PAPT, implementation fidelity, and clinical effectiveness were assessed for year 1 and year 3. Sustainability was measured using RE-AIM, NHS Sustainability Model, and Clinical Sustainability Assessment Tool.ResultsReach increased from 28 to 110 total patients per year and spread occurred from one to three sites. PAPT user age, sex, Hoehn and Yahr rating, time since diagnosis, and type of insurance were similar in year 1 and year 3 (p > 0.05). The program sustained its effect to help participants increase or maintain self-reported exercise (Y1, 95%; Y3, 100%). However, upon evaluation PAPT users in year 3 had longer time since symptom onset and worse UPDRS motor scores compared to the PAPT users in year 1 (p < 0.05). All sites sustained the core intervention components, with sustainability scores of 71/100 (± 9.9) on the NHS Sustainability Model and 6.1/7 (± 0.9) on the Clinical Sustainability Assessment Tool.ConclusionsIntegrating multiple sustainability models and assessments supported continued effectiveness, spread, and sustainment of PAPT for 4 years. Effective planning, anticipating common healthcare changes, and addressing sustainability determinants early in program implementation were essential aspects of long-term success.

Clinical Practice Guideline for Physical Therapist Management of People With Rheumatoid Arthritis.

This guideline revises the 2008 Royal Dutch Society for Physical Therapy guideline for physical therapy for patients with rheumatoid arthritis (RA). This revised guideline was developed according to the Appraisal of Guidelines for Research and Evaluation tool and the Guidelines International Network standards. A multidisciplinary guideline panel formulated clinical questions based on perceived barriers in current care. For every clinical question, a narrative or systematic literature review was undertaken, where appropriate. The guideline panel formulated recommendations based on the results of the literature reviews, the values and preferences of patients and clinicians, and the acceptability, feasibility, and costs, as described in the Grading of Recommendations Assessment, Development and Evaluation evidence-to-decision framework. The eventual guideline describes a comprehensive assessment based on the International Classification of Functioning, Disability and Health Core Set for RA. It also includes a description of yellow and red flags to support direct access. Based on the assessment, 3 treatment profiles are distinguished: (1) education and exercise instructions with limited supervision, (2) education and short-term supervised exercise therapy, and (3) education and intensified supervised exercise therapy. Education includes RA-related information, advice, and self-management support. Exercises are based on recommendations concerning the desired frequency, intensity, type, and time-related characteristics of the exercises (FITT factors). Their interpretation is compliant with the individual patient's situation and with public health recommendations for health-enhancing physical activity. Recommended measurement instruments for monitoring and evaluation include the Patient-Specific Complaint instrument, Numeric Rating Scales for pain and fatigue, the Health Assessment Questionnaire Disability Index, and the 6-minute walk test. An evidence-based physical therapy guideline was delivered, providing ready-to-use recommendations on the assessment and treatment of patients with RA. An active implementation strategy to enhance its use in daily practice is advised. This evidence-based practice guideline guides the physical therapist in the treatment of patients with RA. The cornerstones of physical therapist treatment for patients with RA are active exercise therapy in combination with education. Passive interventions such as massage, electrotherapy, thermotherapy, low-level laser therapy, ultrasound, and medical taping play a subordinate role.

Creation of an Evidence-Based Physical Therapy Program for Adults with XLH: Translational Application of an Interprofessional Clinical Study

X-linked hypophosphatemia (XLH) arises due to inactivating mutations of the PHEX gene resulting in elevated circulating levels of the hormone FGF23, producing phosphaturia and impaired intestinal phosphate absorption. XLH is a lifelong metabolic disease with musculoskeletal comorbidities that dominate the adult clinical picture, and are resistant to standard therapies. We have previously reported the physical and functional impact of the adult disorder (J Clin Endocrinol Metab. 2020 Apr 1;105(4)). Bilateral and diffuse enthesophytes, degenerative arthritis and osteophytes were reported at the spine and synovial joints across subjects. Passive range of motion (ROM) was decreased at the spine, hips, knees, and ankles compared to controls. Gait analysis, relative to controls, revealed increased step width, markedly increased lateral trunk sway, and physical restriction at the hip, knees and ankle joints that translated into limitations through the gait cycle. These studies have been translated into an evidence-based physical therapy (PT) intervention study to address these major physical and functional comorbidities. Participants were enrolled in a remote 12-week PT program consisting of balance exercises and basic stretches with/without resistance. Subjects were evaluated at baseline and at every 4-weeks to assess ROM, gait, and functional ability. Several validated tools were employed to assess overall function: Berg Balance Scale, the Timed Up and Go (TUG) Test, and the Five Times Sit to Stand Test (5XSST). Subjective questionnaires, including the Lower Extremity Functional Scale (LEFS) and Activities-Specific Balance Confidence (ABC) Scale, were administered along with a weekly survey. At the conclusion of the study, minimal to modest improvements were seen in active ROM for the upper and lower extremity which reflect the significant bony restriction caused by XLH. However, improvements were seen in functional measures including the Berg Balance Scale, TUG, 5XSST, LEFS, and ABC. Weekly surveys indicated that participants improved their ability to balance, perform activities of daily living (ADLs), walk, and bend down to reach the ground. Results from this study will be applied to the creation of an evidence-based PT program to maintain functional capacity and improved ability to perform ADLs across the lifespan.

Commentary on "Describing the Delivery of Evidence-Based Physical Therapy Intervention to Individuals With Cerebral Palsy".

Commentary on "Describing the Delivery of Evidence-Based Physical Therapy Intervention to Individuals With Cerebral Palsy".

The effect of tongue and suprahyoid muscles release in the treatment of chronic non-specific neck pain: Study protocol for a randomized controlled trial

The mechanisms behind non-specific neck pain (NS-NP) have not yet been fully clarified. The anatomic relation between the tongue and structures that attach to the cervical spine suggests a possible clinical relation with NS-NP. This study protocol describes a randomized controlled clinical trial.The aim of the proposed study is to determine the effect of a standard treatment for chronic NS-NP combined with tongue and suprahyoid muscles release on pain intensity, cervical range of motion and neck function.Forty patients with chronic NS-NP will be randomly allocated to two groups. The experimental group (EG) will be submitted to a clinical intervention considered the gold standard for the treatment of chronic neck pain together with a tongue and suprahyoid muscles release protocol. The control group (CG) will only receive the gold standard treatment for chronic neck pain. All patients will receive six sessions of treatment twice a week and will be evaluated before and one week after the end of treatment. The primary outcome will be pain intensity measured by a numerical pain rating scale. The secondary outcomes will be the Pain Catastrophizing Scale, Patient-Specific Functional Scale, Neck Disability Index and cervical range of motion. Comparisons between groups before and after treatment will demonstrate whether the tongue and suprahyoid muscles release exerts a supplementary effect on pain intensity, cervical range of motion and neck function in individuals with NS-NP.The data will be published after the study is completed. The study will support the practice of evidence-based physical therapy for individuals with NS-NP.

A clinical practice guideline for physical therapy in patients with hip or knee osteoarthritis.

The purpose of this paper is to revise the 2010 Dutch guideline for physical therapy (PT) in patients with hip or knee osteoarthritis (OA), issued by the Royal Dutch Society for Physical Therapy (KNGF). This revised guideline was developed according to the Appraisal of Guidelines for Research and Evaluation (AGREE) and Guidelines International Network (G-I-N) standards. A multidisciplinary guideline panel formulated clinical questions based on perceived barriers to current care. A narrative or systematic literature review was undertaken in response to each clinical question. The panel formulated recommendations based on evidence and additional considerations, as described in the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Evidence-to-Decision framework. A comprehensive assessment should be based on the International Classification of Functioning Disability and Health (ICF) core set for OA, including the identification of OA-related red flags. Based on the assessment, four treatment profiles were distinguished: (1) education and instructions for unsupervised exercises, (2) education and short-term supervised exercise therapy, (3) education and longer term supervised exercise therapy, and (4) education and exercise therapy before and/or after total hip or knee surgery. Education included individualized information, advice, instructions, and self-management support. Exercise programs were tailored to individual OA-related issues, were adequately dosed, and were in line with public health recommendations for physical activity. Recommended measurement instruments included the Patient-Specific Complaints Instrument, the Numeric Pain Rating Scale, the Hip Disability and Osteoarthritis Outcome Score/the Knee Injury Osteoarthritis Outcome Score, and the Six Minute Walk Test. An evidence-based PT guideline for the management of patients with hip or knee OA was developed. To improve quality of care for these patients, an extensive implementation strategy is necessary.

Evidence-Based Physical Therapy for Individuals with Rett Syndrome: A Systematic Review.

Rett syndrome is a rare genetic disorder that affects brain development and causes severe mental and physical disability. This systematic review analyzes the most recent evidence concerning the role of physical therapy in the management of individuals with Rett syndrome. The review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A total of 17319 studies were found in the main scientific databases. Applying the inclusion/exclusion criteria, 22 studies were admitted to the final phase of the review. Level of evidence of the included studies was assessed using the Oxford Centre for Evidence-Based Medicine—Levels of Evidence guide. Nine approaches to physical therapy for patients with Rett syndrome were identified: applied behavior analysis, conductive education, environmental enrichment, traditional physiotherapy with or without aids, hydrotherapy, treadmill, music therapy, computerized systems, and sensory-based treatment. It has been reported that patients had clinically benefited from the analysed approaches despite the fact that they did not have strong research evidence. According to the results, a multimodal individualized physical therapy program should be regularly recommended to patients with Rett syndrome in order to preserve autonomy and to improve quality of life. However, more high-quality studies are needed to confirm these findings.