Physiotherapy Profession Research Articles

Physiotherapists' experiences on assisting physiotherapy users during the COVID-19 pandemic with lockdown measures in Spain.

Physiotherapists had faced a new healthcare scenario characterised by the restrictions caused by the COVID-19 pandemic. To explore the impact of the COVID-19 pandemic on the physiotherapy profession from the perspective of physiotherapists working in the public and private sectors. Qualitative study based on semi-structured personal interviews with 16 physiotherapists working in public, private, or public-private partnership sectors in Spain. The data were collected between March and June 2020. Inductive qualitative content analysis was performed. The participants (13 women, 3 men; aged 24-44years) had professional experience in diverse healthcare settings (primary, hospital, home, consultations, insurance companies, associations). Five categories were identified: (1) the impact of lockdown on the health of physiotherapy users; (2) managing the demand for physiotherapy services during lockdown; (3) introducing protocols and protective measures in physiotherapy consultations; (4) changes in therapeutic approaches; and (5) future expectations in the physiotherapy care model. Physiotherapists perceived that lockdown caused a decline in the functionality of people with chronic conditions, together with a reduction in the physiotherapy services. Difficulties in prioritising users considered urgent became evident, and the inclusion of prophylactic measures affected treatment duration differently depending on the care setting and the pandemic prompted the use of telerehabilitation. The pandemic affected the functional status of chronic physiotherapy users and made treatment time, quality of care and triage protocols visible. In physiotherapy, technological barriers need to be solved, such as digital literacy, families without resources, situations of dependency and cultural barriers.

Is physiotherapy a luxury? What can the perplexing absence of the physical therapies tell us about the profession’s future?

ABSTRACT Physiotherapists interested in the profession’s future have turned in recent years to historical evidence to understand how the physical therapies were practiced before the advent of modern healthcare. However, studies to date suggest that their practice was largely confined to social elites, and those from working-class or poor populations rarely, if ever, experienced them. To test this theory further, this study focuses on British sailors during the Napoleonic wars (1803–1815). Utilizing historical and semi-fictional accounts, this study shows that healthcare on board naval fighting ships concentrated almost entirely on the prevention of disease, and the medical and surgical management of acute trauma. Even though sailors experienced shocking levels of traumatic injury, none appear to have experienced any form of physical therapy. This study supports the argument that prior to the 20th century, the physical therapies were luxuries available primarily to those with surplus time and money, and that widespread access to physiotherapy has relied on state-sponsored universal health coverage. It follows, then, that the decline of universalized healthcare may have profound implications for many marginal groups in society, as well as the physiotherapy profession itself.

Understanding colonialism and its influences on contemporary physiotherapy education and research: students’ perspectives on decolonializing solutions

ABSTRACT Background Compared to other health professions, physiotherapy is a relatively new profession in Malawi and the United States, yet in both countries, past colonialism has influenced current physiotherapy education and research. The authors of this article are from Malawi and the United States, and they worked collaboratively to explore the impact of colonialization on physiotherapy education and research in their respective locations, and to discuss the similarities and contextual differences. Decolonializing physiotherapy education and research must begin by identifying how colonialization currently manifests within the profession. Purpose The purpose of this article is to spark discussion about colonialization in physiotherapy education and research. Discussion Although decolonialization literature specific to physiotherapy is limited, the literature gathered about physiotherapy and other health professions prompted generative discussion and reflection among the authors. These discussions and reflections led to student-driven recommendations that are outlined in this article and could be included in the decolonialization efforts in physiotherapy. Conclusion We propose that reflecting on how colonialism has influenced physiotherapy education and research could lead to international collaborations that support decolonialization in physiotherapy.

An HBCU track-and-field student-athlete perspective on the role of the pharmacist and physical therapist in sports

BackgroundPharmacy is a profession with the capacity to provide services in a variety of venues, including sports and sporting events. The physical therapy profession is often involved in treating the injured athlete; however, direct interactions with collegiate sport teams is limited and inconsistent. A literature review showed a limited and inconsistent role of the pharmacist and physical therapist in sports, especially at Historically Black Colleges and Universities (HBCU). ObjectiveTo examine collegiate track-and-field student-athlete perceptions related to the role of the pharmacist and physical therapist. MethodsA cross-sectional study using a convenience sample was conducted to assess the perceptions of NCAA track-and-field student-athletes from a HBCU. A survey utilizing modified Likert-scale and open-ended questions was administered electronically to fifty-four student-athletes via email. Inclusion criteria were age ≥ 18 years old and a current track-and-field student-athlete. Descriptive statistics were used for data analysis. ResultsThis study, one of the first to examine an HBCU student-athlete population, yielded a 100% response rate. About 80% want to discuss the directions for use and side effects of certain medications or dietary supplements with a team pharmacist. Over 75% of student-athletes desired to consult with a physical therapist about injury management and prevention. Overall, most respondents felt that pharmacists (81.5%) and physical therapists (78.8%) should have a role with NCAA sports to benefit student athletes. ConclusionInterprofessional collaboration and communication among healthcare professionals is essential to improve student-athlete health knowledge and performance. The student-athletes expressed interests in receiving consultation and educational sessions from pharmacists and physical therapists.

The Occupational Prestige of the Physiotherapy Profession

Background: Occupational prestige defines the social standing of a profession. It is a useful indicator of the profession’s marketability and desirability. Objectives: This study aimed at determining the perception of Nigerian students on the prestige of the physiotherapy profession relative to some other selected occupations, and how their perception was influenced by some selected sociodemographics. Materials and Methods: Four hundred and twenty-two copies of a self-administered questionnaire were distributed, completed, and returned from students on the two campuses in Southeastern Nigeria. Data were analyzed using descriptive statistics, Kendall’s W, and chi-square analysis. Results: Respondents included 212 males (50.2%) and 210 females (49.8%). Most of them were between the ages of 20 and 30 years (88.6%). The result of the study showed that Physiotherapy was ranked second on the levels of education, social standing, and responsibility; and third on the levels of income and usefulness to society. The only sociodemographics that influenced the overall perceived occupational prestige of the Physiotherapy profession significantly were age and gender (P < 0.05). Conclusion: There is a need to further improve and maintain the social standing of the physiotherapy profession, to bring about a more improved perception of their profession by the students and the public.

Awareness of Physiotherapy among Medical Professionals: A Cross Sectional Survey

Objectives:
 The study aim to determine the knowledge and awareness of physical therapy in medical professionals.
 Methodology:
 A descriptive, cross sectional study was used to examine 105 medical practitioners in Haripur. A standardized questionnaire was used in collecting data for 3 months, starting from June, 2018. Those participants (Medical practitioners) that were registered in different Haripur hospitals were included in sampling, whereas those hospitals/clinics participant that were not registered with PMDC (Pakistan Medical and Dental Council) and were not able to complete the questionnaire were excluded from the study. Prior to collecting the data, the individuals provided their written informed consent. According to the type of variable being studied, descriptive statistics were extracted from the response after it had been processed using SPSS-20.
 Results:
 The majority of medical professionals—94.3%—had shown to have good knowledge about physiotherapy. The findings indicated that 21% of medical practitioners receive physiotherapy care. According to the results, 84.76% of practitioners referred patients for physiotherapy care. Orthopedic cases were most frequently referred by doctors (554.28%), followed by sports injuries cases (10.47%), fitness cases (10.47%), cardiopulmonary cases (5.71%), women's health cases (5.71%), geriatric cases (3.83%), and the least in neurological cases (1.90%) and paediatric cases (1.90%). Physiotherapy was regarded as significant and very important in the health industry by about 40% and 47% of professionals, respectively. More, the majority of professionals, 87%, suggested that every hospital should have a physiotherapy department.
 Conclusions: 
 Senior medical professionals have extremely positive perceptions of the responsibilities that physical therapists play in patient care and health promotion. Leading medical professionals understood physiotherapy well. Yet, doctors think that the major therapy strategy utilised by therapists is prescription exercises, and there is little knowledge of the most recent developments and inventions in the field of rehabilitation. The most successful physiotherapy treatments, according to practitioners, are orthopaedic treatment and treatment for sports injuries. Despite the fact that medical practitioners are generally aware of physiotherapy and its benefits, there is still need for progress in this area in order to get better functional results. Hence, proper steps must be done to raise awareness of and foster a positive attitude towards the profession of physiotherapy.

Physiotherapists' practice patterns for the diagnosis and management of patients with chronic contracted frozen shoulder in the United Arab Emirates.

Adhesive capsulitis or contracted shoulder, known as frozen shoulder, is a persistent painful condition that may last for more than three months. It is a common disease-causing morbidity that causes pain and loss of shoulder range of motion. Physical therapy is advocated for the restoration of a pain-free state and normal use of the upper extremity, along with other interventions. This study aimed to explore the level of current clinical practice for managing chronic contracted frozen shoulder (CCFS) among physiotherapy professionals in the United Arab Emirates (UAE) compared to well-established evidence-based practices, and to identify the most common therapy practiced in UAE to manage CCFS. This study was based on a cross-sectional quantitative analysis using an adapted questionnaire. The main themes of questions were the presence of a special interest in CCFS, management options, symptoms, diagnosis, referral, and best physiotherapy intervention recommendations. The results were analyzed using simple descriptive analyses, such as frequency, mean, and percentage of total responses; additionally, thematic and content analyses were performed for open-ended questions. Overall, 101 physiotherapy professionals participated in the survey: 62% female and 38% male; 59% were bachelors- and 36% masters-degree holders, respectively. In the closed ended question regarding the interest in CCFS, male physiotherapists (PTs) were more interested than females (82% vs. 68%). For the most common indication of CCFS, 76% of the participants selected "Limitation of movement" as the main indication. However, only 42% confirmed the presence of clinical protocols in their employment setting. In their opinion, the most effective therapies were patient education, superficial heat or cold, manual joint mobilization, and sustained stretching exercises. A well-established professional competence exists among physiotherapists in the UAE to manage and treat patients with CCFS. The findings showed sufficient standard, theoretical, and practical knowledge among the study groups.

Impact of Task-Fit Misalignment and the Director of Clinical Education: A Grounded Theory Study.

The roles and responsibilities of the director of clinical education (DCE) are of interest in the academic physical therapist (PT) community. This study explored the impact of professional and positional task characteristics of the DCE position on task-fit misalignment within PT education programs. Task-fit explores how the tasks of a particular job align with the appropriately trained person who holds the position. A recently published DCE Matrix highlights 2 extremes of misalignment and nonoptimal task-fit between the position and the person. Misalignment was investigated rather than alignment because negative connotations often have greater impact on behavior, decision making, and relationships. The impact of misalignment is unknown. Program directors and DCEs among ACAPT member PT programs were surveyed. A qualitative grounded theory design was used. Two rounds of surveys with focused questions about the impact of task-fit misalignment. Qualitative content data analysis through a constant comparative process was followed. Respondent descriptive statistics were collected. Three realms of impact were identified when misalignment of positional and professional characteristics exists. The realms include the 1) individual person holding the position; 2) academic program; or 3) physical therapy profession. There is a high level of agreement that task-fit misalignment affects each realm; variability exists about its prevalence. There seems to be an interconnectedness of impact among the person, the program, and the profession when misalignment exists between the fit of the DCE to the job or the work environment to the DCE. Findings indicate job crafting may be necessary to evolve the nature of the DCE work toward higher director-level tasks. This is the first study of its kind to explore the impact intersection of person-job fit and task-fit and the impact on a DCE's responsibilities. Nonrespondent or attrition bias may have limited sample size.

물리치료학과 학생들의 재활필라테스에 대한 인식도와 선호도 조사

This study was to identify the awareness and preference of rehabilitation Pilates of university students majoring in physical therapy. from August 25 to September 7, subjects completed a survey which conducted on 204 students from the Department of Physical Therapy at six universities nationwide. The questionnaire consisted of questions about the recognition level and preference of rehabilitation Pilates. The results of this study showed that the higher the level of conceptual awareness of rehabilitation pilates, the higher the level of desire to participate in lectures (p<.05). In conclusion, these findings suggest that if the university's physical therapy department can provide students with accurate information about rehabilitation pilates, it can induce a lot of participation, which will help more active physical therapy professionals enter the rehabilitation pilates field. This study might be useful for further studies that university education institutions consider reflecting rehabilitation pilates in their subjects.

Weathering the Storm: Professional Quality of Life in Acute Care Physical Therapy Before and During the COVID-19 Pandemic.

To describe levels of compassion satisfaction and compassion fatigue (consisting of burnout and secondary trauma) among a similar cohort of acute care physical therapy staff prior to and approximately 1 year into the pandemic. Cross-sectional online survey methodology using the ProQOL was completed. A convenience sample of acute care physical therapy professionals employed at a large Midwestern academic medical center was surveyed at separate time points in 2018 (prepandemic) and 2021 (pandemic). A total of 54 (2018) and 53 (2021) acute care physical therapy professionals completed the survey. Overall, respondents reported moderate to high levels of compassion satisfaction with low to moderate levels of burnout and secondary trauma at both periods, consistent with other previously reported health care professionals. However, the respondents exhibited a shift toward worsening compassion fatigue, with increasing levels of burnout and secondary traumatic stress, and a decreased level of compassion satisfaction. Describing the professional quality of life in a cohort of acute care physical therapy professionals before and during the pandemic provides a foundation of further understanding burnout and secondary traumatic stress. Future studies could be completed longitudinally to track changes in acute care physical therapy staff and explore effective support strategies.

Trials and tribulations of transparency related to inconsistencies between plan and conduct in peer-reviewed physiotherapy publications: A methodology review.

The physiotherapy profession strives to be a leader in providing quality care and strongly recognizes the value of research to guide clinical practice. Adherence to guidelines for research reporting and conduct is a significant step towards high-quality, transparentand reproducible research. Assess integrity between planned and conducted methodology in randomized controlled trials (RCTs) and systematic reviews (SRs) published in physiotherapy journals. Eighteen journals were manually searched for RCTs and SRs published from 1 July 2021 through 31 December 2021. Studies were included if the journal or specific study was indexed in PubMed and published/translated in English. Descriptive statistics determined congruence between preregistration data and publication. Forty RCTs and 68 SRs were assessed. Forty-three SRs included meta-analysis (MA). Of the 34 registered RCTs, 7 (20.6%) had no discrepancy between the registration and publication. Two trials (5.9%) addressed all discrepancies, 4 (11.8%) addressed someand 21 (61.8%) did not address any discrepancies. Of the 36 registered MAs, 33 (91.7%) had discrepancies between the registration and publication. Two (5.6%) addressed all discrepancies and three (8.3%) had no discrepancies. Eight SRs without MA published information not matching their registration, and none provided justification for the discrepancies. Most RCTs/SRs were registered; the majority had discrepancies between preregistration and publication, potentially influencing the outcomes and interpretations of findings. Journals should require preregistration and compare the submission with the registration information when assessing publication suitability. Readers should be aware of these inconsistencies and their implications when interpreting and translating results into practice.

Student Physical Therapists' Orientation to Postprofessional Education and Perceptions of Strain: Identification of 4 Subgroups of Students Based on Cluster Analysis.

Determining why physical therapists choose certain pathways to expertise is not well understood. Developing an understanding of these different choices is important for the physical therapy profession and the future of postprofessional education. Pathways to expertise as a physical therapist have evolved over the history of the profession, including the most recent emergence of residency education. Regardless of the path taken, physical therapists have a societal duty to be lifelong learners. The decision on which path to pursue is influenced by many factors, including financial stress, personal factors, and relational obligations. Developing an understanding of these different pathways and barriers for physical therapists is essential if the physical therapy profession is to advance with the evolving needs of society. Participants were from a stratified purposive sample of Doctor of Physical Therapy Students (n = 124) across the eastern, central, and western regions of the United States. This study was a secondary analysis using hierarchical cluster analysis based on students' orientation toward lifelong learning and future professional engagement, self-rated likelihood of pursuing various postprofessional education pathways, and perception of personal and interpersonal strains as a barrier to postprofessional education. The cluster analysis resulted in a 4-cluster solution representing different student subtypes: clinically oriented average learners; resilient, clinically oriented lifelong learners; academically oriented lifelong learners; and strain-limited, clinically oriented lifelong learners. Results from this study describe important differences in how student physical therapists view postprofessional education and the pathways they choose to pursue. Factors such as lack of awareness and the perception of personal or interpersonal strain may influence these decisions. Understanding postprofessional education decision making of student physical therapists is of particular interest to the physical therapy profession given the current debates related to student debt and the necessity of residency education. Further research is needed to understand how to increase awareness and diminish barriers to quality postprofessional education for physical therapists.

MIND THE GAP DISCRIMINATION AND MANAGEMENT CHALLENGES AMONG FEMALE PHYSICAL THERAPISTS

Gender matters and has an impact, and it is intended to encourage readers to think about this important issue in clinical practice, education, research, and a wider context of public health1. Due to the dearth of gender theoretical knowledge that has been discovered within the field of physiotherapy, there are still many difficulties that women must overcome in today's world of gender equality and feminism for women's rights2. Historically, women are predominated in the physiotherapy profession, although this has gradually changed throughout the years3. According to Chartered Society of Physiotherapists (CSP) data for both practicing and non-practicing physiotherapists, the gender split changed from 76% female to 24% male to 74% female to 26% male between 2017 and 2020. Although women make up more than 50% of the physiotherapy workforce globally, they make up fewer than 50% of executive positions in national physiotherapy associations3.

Research from low-income and middle-income countries will benefit global health and the physiotherapy profession, but it requires support

Research from low-income and middle-income countries will benefit global health and the physiotherapy profession, but it requires support

Feminization of the physiotherapy profession? Results from a single-center cross-sectional study

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Łukasik KK, Rekowski W. Feminization of the physiotherapy profession? Results from a single-center cross-sectional study. Physiotherapy Review. 2023;27(1):50-58. doi:10.5114/phr.2023.126010. APA Łukasik, K. K., & Rekowski, W. (2023). Feminization of the physiotherapy profession? Results from a single-center cross-sectional study. Physiotherapy Review, 27(1), 50-58. https://doi.org/10.5114/phr.2023.126010 Chicago Łukasik, Karolina K, and Witold Rekowski. 2023. "Feminization of the physiotherapy profession? Results from a single-center cross-sectional study". Physiotherapy Review 27 (1): 50-58. doi:10.5114/phr.2023.126010. Harvard Łukasik, K., and Rekowski, W. (2023). Feminization of the physiotherapy profession? Results from a single-center cross-sectional study. Physiotherapy Review, 27(1), pp.50-58. https://doi.org/10.5114/phr.2023.126010 MLA Łukasik, Karolina et al. "Feminization of the physiotherapy profession? Results from a single-center cross-sectional study." Physiotherapy Review, vol. 27, no. 1, 2023, pp. 50-58. doi:10.5114/phr.2023.126010. Vancouver Łukasik K, Rekowski W. Feminization of the physiotherapy profession? Results from a single-center cross-sectional study. Physiotherapy Review. 2023;27(1):50-58. doi:10.5114/phr.2023.126010.

Courses on physiotherapy in Hungary: overview and characteristics

This paper provides an overview of the current situation and characteristics of courses on physiotherapy in Hungary. The research aimed to map the training opportunities for physiotherapy professionals. The authors analysed available Hungarian courses on the Internet, examining the type of courses, teaching methods, duration, cost, target audience, instructor qualifications, as well as the nature of exams and certificates. A total of 26 courses were examined, specialising in various areas and professional needs. A wide range of courses is available, providing professionals with opportunities for further professional development and the acquisition of new techniques. Courses can be taken in person, through blended/hybrid learning, or online. Teaching methods include instructor videos, practical demonstrations, online materials, and lectures. The instructors are typically physiotherapists or specialised doctors. The courses are generally of shorter duration, and online courses become immediately accessible after payment. Participants receive a certificate upon completion of the courses, and some courses require a final test or exam. The prices of the courses are generally affordable, but longer and qualification-providing courses may be more expensive. In conclusion, the paper highlights the wide range of physiotherapy education options available in Hungary, offering professionals opportunities for further professional development and the mastery of the latest techniques.

Dementia knowledge among physiotherapists in Nigeria

With the growing population of older adults in Nigeria comes a simultaneous rise in the incidence of dementia in the country. Adequate knowledge of dementia is needed to effectively administer interventions for persons living with dementia. Physiotherapy is one of the professions providing care for people with dementia. The aim of this study was to evaluate the knowledge of dementia among physiotherapists in Nigeria. An online survey method was used to collect data from the sample population of practicing physiotherapists in Nigeria. Data was collected using the 21-item Dementia Knowledge Assessment Tool Version Two (DKAT2) and the respondents also provided some demographic information. Mann Whitney test, Kruskal Wallis test and Spearman's rho correlation were used to test for association between the DKAT2 scores and the demographic variables and this association was further explored with multiple linear regression analysis. A total number of 223 physiotherapists participated in this study. The findings of the study show that there is limited knowledge of dementia among the physiotherapists. Number of years of professional experience and specialty groups predicted significantly higher knowledge scores. The knowledge deficits found among physiotherapists in Nigeria indicate that older adults living with dementia might not be receiving the best evidence-based physiotherapy treatments for their condition. This research therefore advocates for an educational intervention to be carried out within the physiotherapy profession in order to improve the quality of services rendered to their patients.

Ethics and Moral Agency for a Postpandemic Era: Beyond the Storm.

Laura Lee (Dolly) Swisher, PT, MDiv, PhD, FAPTA, the 53rd Mary McMillan Lecturer, is professor emerita and former director of the school of physical therapy and rehabilitation sciences at the University of South Florida in the USF Health Morsani College of Medicine. Dr Swisher received a bachelor of arts degree from Wilson College and is a 1986 physical therapy graduate of the University of Tennessee Health Science Center, Memphis. She received the M.Div. from Andover Newton Theological School and a doctoral degree in public administration from Tennessee State University. Dr Swisher is a highly regarded expert on professionalism, ethics, and interprofessional education and has been a featured speaker at local, state, and national conferences. She is the coauthor of Rehabilitation Ethics for Professional Practice, Professionalism in Physical Therapy and Legal and Ethical Issues in Physical Therapy and is a lead author or coauthor of multiple peer reviewed articles and individual book chapters. She served as a member and chair of the Commission on Accreditation for Physical Therapy Education, was former chair and member of the APTA Ethics and Judicial Committee, and served as co-chair of the Task Force to Revise the Core Ethics Documents. Dr Swisher served on the Editorial Board of the Journal of Physical Therapy Education and is a member of the Editorial Board of the Journal of Humanities in Rehabilitation. She is the recipient of APTA's Lucy Blair Service Award and the Polly Cerasoli Lecture Award and is a Catherine Worthingham Fellow of the APTA.

What Is Known About How Physiotherapy Students Make Sense of Movement as a Component of the Clinical Reasoning Process? A Scoping Review

Background: Observing and analysing movement is a core component of the diagnostic process of physiotherapists and yet, little is known about how students understand the role of movement within the clinical reasoning process. In recent years, there has been an increase in research regarding the importance of movement within the reasoning process of physiotherapists. The way in which movement is observed and analysed directly impacts diagnostic and therapeutic decisions. Purpose: This purpose of this scoping review is to determine what is known about how students understand movement and the role of movement within the clinical reasoning process. Methods: A systematic search of the databases CINAHL, ERIC, GALE, PubMed, MEDLINE and SCOPUS between the years of 2011 and 2021 was conducted by the author. Reference lists of included studies were also scanned. Studies were included if they discussed the concept of movement in relation to the clinical reasoning process, how students learn to clinically reason, or how physiotherapists incorporate movement into their reasoning processes, and qualitative data analysis was undertaken. Results: Ten articles remained after the screening processes. Data was extracted, by one reviewer, into a template that included the characteristics of each paper and four key themes were developed in order to answer the research question. These themes will be discussed further throughout this review. Conclusion: The findings of this review suggest that there is limited evidence regarding how students understand movement within the clinical reasoning process. Further research on this topic is important for the physiotherapy profession, academics and clinical educators as it might demonstrate a gap in the way that clinical reasoning is currently taught and could create a shift in the way movement is considered as a component of the clinical reasoning process.

Tennisgame Physio: A tool for amputees physiotherapy based on gamification

The present work aims to develop a computational solution in hardware and software that uses gamification methodologies to help physiotherapy professionals in the rehabilitation sessions of upper and lower limb amputees, who are in the pre-prosthetic and prosthetic stages. Thus, a table tennis match simulator is developed to instigate patients to reach the flow state during the session. Thus, a mobile program is developed to collect data from the smartphone’s gyroscope sensor and, through Bluetooth communication with the Arduino prototyping board, this information is forwarded to the simulator. The data received is used to move the virtual racket in the game. Furthermore, physiotherapists have a tool integrated with the tennis match simulator, to monitor the progress of patients during the sessions. In short, this solution turns out to be effective in helping both patients and physical therapists in physical rehabilitation sessions.