Search Results (583)

Background/Objectives: Inflammatory bowel diseases (IBDs) cause gastrointestinal symptoms that affect patients’ quality of life. IBD improves with physical activity; however, fear of movement is a limiting factor. This study aimed to evaluate the impact of kinesiophobia and assess patients’ knowledge on the role of physical activity and physiotherapists in IBD management. Methods: Participants completed online questionnaires to evaluate demographic and clinical data, lifestyle, physical activity, joint complaints, and physiotherapy preferences. The Tampa Kinesiophobia Scale (TKS) was employed to assess kinesiophobia, and the Godin scale was used to assess regular physical activity. Results: Overall, 356 patients with IBD were analyzed. In total, 51% of the patients reported a decrease in physical activity. Of these, 93% have not consulted a physiotherapist, with 51% expressing a need for it. Meanwhile, 75% of the patients wanted additional information. Higher TKS scores were associated with CD, age, and joint pain. The level of kinesiophobia was high and negatively correlated with the amount of physical activity. Conclusions: Physiotherapists play an important role in patient education and influencing lifestyle in IBD. Their expertise is underutilized, and patients should be sufficiently informed regarding their illness. Integrating education and physiotherapy may reduce kinesiophobia and improve patients’ quality of life. Full article

Background: Shoulder injuries are highly prevalent in handball due to repetitive overhead actions and high mechanical demands, particularly in athletes with a history of previous injury who remain at increased risk of recurrence. Reliable monitoring of shoulder function is essential, and tele-assessment has emerged as a potential alternative to traditional face-to-face evaluation. The aim of this study was to evaluate the level of agreement between face-to-face and tele-assessment methods for measuring shoulder range of motion, dynamic stability, muscular endurance, and scapular dyskinesia in female handball players with a history of shoulder injury. Methods: A cross-sectional agreement study was conducted in 25 competitive female handball players with a history of shoulder injury. Each participant underwent two evaluations (face-to-face and videoconference-based) performed by experienced physiotherapists in randomized order within the same session. Outcomes included shoulder range of motion, dynamic stability assessed by the Upper Quarter Y Balance Test, muscular endurance, and scapular dyskinesia. Agreement between methods was analyzed using two-way random-effects intraclass correlation coefficients. Results: Excellent agreement was observed for range of motion, dynamic stability, and muscular endurance (ICC = 0.96–1.00), with narrow confidence intervals. Scapular dyskinesia demonstrated good agreement (Cohen’s Kappa coefficient 0.59 (p < 0.05)). Mean differences between face-to-face and tele-assessment were minimal, ranging from 0.04° to 0.31° for ROM and 0.10 cm to 0.16 cm for stability measures. Conclusions: Tele-assessment provides clinically comparable results to in-person evaluation and may represent a feasible and reliable tool for remote monitoring of shoulder function in female overhead athletes with a history of injury. Full article

Background: Technology such as telerehabilitation, virtual reality, robotics, and wearable systems are reshaping pediatric physiotherapy. While evidence remains fragmented, there is little guidance on how these approaches can be integrated into coherent, family-centered care pathways. Objective: To develop the Digital Pediatric Physiotherapy Framework (DPPF) based on a systematic review of randomized evidence on digital interventions in pediatric physiotherapy. Methods: Several databases were searched for randomized trials published after 1 January 2020, including PubMed, Web of Science Core Collection, and Google Scholar. The included studies assessed the results of physiotherapist-delivered or physiotherapist-supervised digital interventions in children and adolescents aged 18 and younger. Population, intervention, outcome, implementation, and safety data were extracted. Considering the substantial heterogeneity of the findings, they were synthesized narratively. Cochrane RoB 2 was used to assess risk of bias, and GRADE was used to evaluate certainty of evidence. Results: Twenty-nine trials involving 1196 participants were included. Most studies examined virtual reality and gaming-based interventions, with fewer evaluating telerehabilitation/tele-exercise and robotic or wearable technologies. Digital interventions were most often directed at body-function and activity-level outcomes, while participation outcomes were less frequently studied. The strongest evidence supported short-term benefits in balance, gross motor function, upper-limb activity, pain, and selected fitness outcomes, particularly in children with cerebral palsy. Evidence for telerehabilitation and robotic or wearable approaches was more limited but generally promising. Implementation, equity, cost, and long-term outcomes were rarely reported. No eligible trial directly evaluated electronic patient-reported outcome measures, digital triage, or clinical decision support as stand-alone interventions. Conclusions: Digital interventions have the potential to strengthen pediatric physiotherapy, particularly for short-term motor and functional outcomes. The proposed DPPF provides an implementation-informed structure to guide future research, pathway design, and more purposeful integration of digital health into pediatric rehabilitation practice. Full article

Background: Tension-type headache (TTH) is the most prevalent primary headache disorder worldwide and represents a major source of disability related to chronic pain. Despite its high prevalence, uncertainty remains regarding optimal conservative management strategies, and limited evidence is available on how physiotherapists apply existing recommendations in routine clinical practice. Objective: The objective was to explore physiotherapists’ perceptions, clinical experiences, and treatment strategies in the management of tension-type headache, with particular emphasis on commonly used interventions, clinical decision-making, and characteristics of physiotherapy care. Methods: A cross-sectional survey study was conducted using a self-administered online survey developed in accordance with the CHERRIES guidelines. One hundred Spanish physiotherapists with clinical experience in treating patients with TTH participated. Quantitative data were analyzed descriptively, while open-ended responses were examined using inductive thematic analysis following the framework proposed by Braun and Clarke. Results: Manual therapy was the most frequently reported intervention (96%), followed by therapeutic exercise (61%) and invasive techniques, primarily dry needling (48%). The suboccipital and upper cervical regions were consistently identified as primary therapeutic targets, reflecting a predominant craniocervical treatment focus. Most respondents reported individualized treatment plans, typically delivered in weekly sessions lasting 45–60 min, with expected clinical improvement within 4–6 weeks. Pain education strategies were reported infrequently. Considerable variability was observed in the selection and combination of therapeutic techniques. Conclusions: Physiotherapists managing tension-type headache commonly adopt a multimodal approach, largely centered on manual and tissue-focused interventions. Although many reported practices are aligned with current evidence, the substantial heterogeneity observed and the limited integration of biopsychosocial strategies highlight the need for consensus-based guidelines and further research addressing real-world clinical effectiveness. Full article

Background: Healthcare policy in the United Kingdom recognizes that teenagers and young adults (TYAs: 16–24 years at diagnosis) require specialist care. In England, Principal Treatment Centers (PTCs) exist, delivering enhanced care exclusively within the PTC or as ‘joint care’ with designated hospitals (DHs). Central to this is the TYA multidisciplinary team (MDT) and an outreach model coordinating care between hospitals. We previously reported similar outcomes regardless of care location. Aims: To compare TYA experiences of care with healthcare professionals’ perspectives of the service they deliver. Methods: Mixed methods across England and Wales were used. The TYA-MDT identified TYAs who then received a postal invite to a cross-sectional survey capturing experiences of places of care, treatment, healthcare professional support (HCP), mental health, sexuality/fertility, clinical trials and care coordination. Comparisons were made based on exposure to care in a specialist TYA environment within 6 months of diagnosis: all-TYA-PTC (all care in the TYA-PTC, n = 70, 28%), no-TYA-PTC (no care in the TYA-PTC (n = 87, 35%): care delivered in a children/adult unit only), and joint care (care in a TYA-PTC and in a children’s/adult unit, n = 91, 36%). HCP perspectives were captured by rapid ethnography. Results: A total of 250/1056 (24%) TYAs participated. Overall, 200 (80%) rated their teams as excellent/good for helping them prepare for treatment. No evidence of significant differences existed between categories of care for proportions receiving support from key TYA-related professionals: TYA cancer nurse specialists (all-TYA-PTC n = 58, 91%; joint care n = 71, 88%; no-TYA-PTC n = 64, 82%) and social workers (all-TYA-PTC n = 30, 55%; joint care n = 36, 48%; no-TYA-PTC n = 28, 38%). A trend of diminishing support from youth support co-coordinators existed (all-TYA-PTC 63%; joint care 49%; no-TYA-PTC 40%, p = 0.069). This may explain why few differences in patient experiences existed across categories of care. Forty-nine HCPs participated. They were more critical in their interpretation of care, highlighting inequity in resources and challenges in some pathways and coordination. Conclusions: Similar access to age-appropriate support across care settings is likely to reflect recruitment methods. When TYAs are known to the MDT, age-appropriate care can be mobilized beyond TYA units, which could explain the equitable outcomes observed across different care locations in young people who responded to the survey. Nevertheless, gaps persist in communication and coordination, particularly within joint care models, and in the involvement of allied health professionals such as dieticians and physiotherapists, whose input is essential for rehabilitation and return to normal life. Strengthening these areas will require continued investment in workforce capacity and digital infrastructure to support genuinely coordinated, developmentally appropriate TYA cancer care. Full article

Background: Complications developing in individuals with Type 2 Diabetes Mellitus (T2DM) lead to functional impairments and losses in postural balance; however, changes in cognitive functions are also observed and are often overlooked. Dual-task exercises allow simultaneous engagement of balance and cognitive functions. Therefore, this study aimed to investigate the effects of dual-task exercise training on cognitive functions, balance, and functional status in individuals with T2DM. Methods: In this study, 40 individuals diagnosed with T2DM were randomly assigned to three groups: the dual-task exercise group (DTEG, n = 13), the single-task exercise group (STEG, n = 13), and the control group (CG, n = 14). Over eight weeks, balance exercises were administered to the STEG, while simultaneous balance and cognitive exercises were applied to the DTEG, twice weekly under the supervision of a physiotherapist. Participants in the control group received no intervention. Dual-task performance, cognitive functions, balance, and functional status were assessed at baseline and at the end of eight weeks. Dual-task performance was defined as the primary outcome. Results: After the intervention, for the primary outcome, dual-task performance (TUG single-task condition and TUG dual-task condition), both exercise groups showed greater improvements than controls. Both exercise groups also demonstrated significant improvements in balance, functional status, and cognitive outcomes compared to the control group. In the between-group comparisons, both exercise groups showed significant improvements in several cognitive functions compared with the control group (p < 0.05). In addition, the MoCA total score was significantly higher in the DTEG compared with the other groups. Conclusions: Both dual-task and single-task exercises improve cognitive function, balance, and functional status in individuals with T2DM. Full article

Background: Habitual physical activity (PhA) may contribute to overall physiological reserve, yet its relevance for lung transplantation (LTx) remains unclear, as existing studies almost exclusively explore short-term exercise interventions. This study evaluates whether life-course PhA before LTx influences postoperative outcomes: functional capacity measured by 6 min walk test (6MWT), chronic lung allograft dysfunction (CLAD), and length of hospital stay (LOS). Methods: In this retrospective study, ninety-seven LTx recipients completed the Historical Adulthood Physical Activity Questionnaire (HAPAQ), assessing PhA from age 20 to transplantation. All participants were assessed within the same time frame, with varying time intervals since transplantation. Patients were classified into no/recreational/intensive sport groups based on regular participation. Statistical analyses examined sport group differences in 6MWT, CLAD, and LOS and interactions with sex, pulmonary disease type, and secondary pulmonary hypertension (PH). Results: Lifelong PhA did not significantly differentiate quantitative 6MWT, CLAD, or LOS, and no interaction effects were observed. A modest trend was noted in patients without secondary PH, among whom intensive PhA corresponded to more frequent within-norm qualitative 6MWT results. Outcomes were comparable between single- and double-lung (DLTx) recipients, although a moderate effect between sports groups suggested a possible DLTx compensatory advantage. Conclusions: This study provides the very first life-course assessment of PhA in LTx recipients, highlighting the value of HAPAQ for estimating pre-transplant physiological reserve. Despite postoperative outcomes being largely independent of lifelong PhA, and recovery appearing multifactorial, habitual PhA should not be overlooked in developing individualized prehabilitation strategies in transplant medicine. Full article

Background/Objectives: American football (AF) is a contact sport with a high injury risk, where an integrated model of interdisciplinary care may support recovery. The aim of this study was to assess the relationship between diet quality, supplementation, dietician’s and physiotherapist’s support, injury rates and musculoskeletal pain among AF players in Poland. Methods: The study involved 53 male players from the FA Panthers Wrocław team and was conducted using the KomPAN questionnaire and an original survey on supplementation, injuries and pain intensity. Results: The results showed that, although players using supplements had a significantly greater proportion of healthy foods in their overall diet (p = 0.02), they did not report fewer injuries in the last 12 months and 7 days than those who did not use supplements (p = 0.87; p = 0.58, respectively). However, a positive correlation (p$\le$ 0.001, r = 0.53) was found between the healthy diet index and the number of injuries. Those who used the services of a dietitian and physiotherapist showed a higher quality of diet (p$=$ $0.02$; p$=$ $0.02$, respectively) and reported higher total pain intensity (p$=$ $0.009$; p$=$ $0.03$), while those who used only the services of a physiotherapist reported higher average pain intensity (p$\le$ 0.001). Conclusions: These results suggest that supplementation and professional support in this group are primarily due to exposure after injuries caused by severe pain, rather than serving a preventive function. Full article

Background/Objectives: The Gross Motor Function Classification System–Expanded & Revised (GMFCS-E&R) is widely used to describe gross motor performance in children with cerebral palsy (CP). Although Greek-language materials are available, interrater reliability across healthcare professionals and parents has not been examined. This study evaluated the reliability of the Greek GMFCS-E&R among a pediatric neurologist, a pediatric physiotherapist, and parents, with an emphasis on descriptors and illustrations for older children and adolescents. Methods: A cross-sectional study was conducted with 111 children and adolescents with CP aged 2–18 years. Professionals classified each child using the Greek GMFCS-E&R brochure (ages 2–6) or the descriptors and illustrations (ages 6–12 and 12–18). Parents completed the age-appropriate GMFCS Family Report Questionnaire. Agreement among the three raters was assessed using Fleiss’ kappa (κ_F), and pairwise agreement using weighted Cohen’s kappa (κ_Cw), overall and by age band. Results: Overall interrater reliability was substantial (κ_F = 0.77). Agreement by GMFCS level ranged from κ_F = 0.68 (Level V) to κ_F = 0.85 (Level I). Reliability increased with age, reaching κ_F = 0.74–0.85 in adolescents. Pairwise agreement was excellent across all rater pairs, with near-perfect concordance between the pediatric neurologist and physiotherapist (κ_Cw = 0.98). In >60% of disagreements, parents assigned higher levels, typically between adjacent categories. Conclusions: The Greek-language GMFCS-E&R demonstrates high interrater reliability among healthcare professionals and parents, with excellent agreement when using descriptors and illustrations for older children and adolescents. The GMFCS-FR effectively incorporates parental perspectives and complements clinical assessment, supporting the use of the Greek GMFCS-E&R in routine clinical practice and research settings. Full article

Background/Objectives: This study aimed to analyze the perceptions and experiences of health professionals regarding teamwork as an interprofessional competency within the context of Intensive Care Units (ICUs) in a Brazilian public teaching hospital. Methods: This was a qualitative, exploratory study guided by a constructivist–interpretative perspective. The scenario consisted of Intensive Care Units of a public teaching hospital, which is a reference for emergency care, located in Brazil. Sampling was intentional and involved 29 professionals, most of whom, 25 (86.20%), were females, including nurses, nursing technicians, physicians, physiotherapists, and others. In order to collect data, individual semi-structured face-to-face interviews were conducted in 2025, which were audio-recorded and fully transcribed. The criterion for determining the number of participants was theoretical saturation. Data analysis followed the steps of Braun and Clarke’s thematic analysis, conducted inductively, with peer validation and the use of illustrative quotations to ensure credibility. Results: Five main categories emerged: “Understanding teamwork as an interprofessional competency,” “Factors that facilitate interprofessional teamwork,” “Factors that hinder teamwork,” “Tools used in the ICU to develop interprofessional teamwork” and “Individual actions to develop interprofessional teamwork.” The analysis revealed a central tension: although professionals discursively value interprofessional teamwork, its practical implementation is constrained by organizational and hierarchical barriers. Communication was identified as a transversal axis, functioning at times as a facilitator and at other times as a barrier. Conclusions: This study demonstrates that interprofessionality in Brazilian ICUs cannot be sustained solely through individual initiatives, but requires structured institutional strategies, such as formal collaboration protocols, interprofessional education programs, and a revision of hospital organizational culture. Furthermore, although health professionals value interprofessional teamwork, their practice still faces significant barriers. These findings may support managers’ reflection on the need to implement in-service teaching and learning strategies that facilitate interprofessional teamwork, especially those in high-technology units, thus enhancing collaborative practice in health. Full article

Background/Objectives: Evidence-based practice (EBP) is a core competence in physiotherapy, yet its implementation in routine clinical practice remains inconsistent. This study aimed to describe self-reported EBP competencies among physiotherapists and to examine factors associated with daily EBP and readiness to implement EBP. Methods: A cross-sectional analytic survey was conducted among 337 practicing Estonian physiotherapists (75% female) between 2022 and 2024. EBP competencies were assessed using the Estonian version of the Evidence-Based Practice Questionnaire (EBPQ-E). Two multiple linear regression models examined associations of demographic and professional characteristics and EBP competencies with (1) daily EBP and (2) readiness to implement EBP. Results: The mean total EBPQ-E score was 4.72 (SD = 0.89), with the highest scores in Attitude, followed by Knowledge/Skills, Practice, and Sharing. While physiotherapists strongly endorsed the value of EBP, critical appraisal and knowledge sharing were less frequent. Readiness to implement EBP was associated with supervisory experience, dual employment, and working with colleagues (p < 0.05), explaining 7.5% of the variance. Daily EBP was primarily explained by EBP competencies (40.8% variance), whereas 5–10 years of qualification showed a negative association. Conclusions: While professional and contextual factors support readiness for EBP, sustained implementation relies on continuous competency development and career-long support for practicing physiotherapists, shifting focus away from static background characteristics, workload, and time constraints. Full article

Background: Physical inactivity remains a major public health challenge, particularly for underserved populations lacking exercise facility access. AI-powered smartphone applications with real-time human pose estimation offer scalable solutions, but they lack rigorous clinical validation. Objective: This study validates the clinical efficacy of a 16-week on-device AI-driven resistance training program using MediaPipe pose estimation technology in young adults with limited facility access. Primary outcomes included muscular strength (1RM squat), body composition, functional movement (FMS), and cardiorespiratory fitness (VO₂max). Methods: A single-group pre–post study enrolled 216 participants (mean age 23.77 ± 4.02 years; 69.2% male), with 146 (67.6%) completing the protocol. Participants performed three 30 min weekly sessions of seven compound exercises delivered via a smartphone app providing real-time pose analysis (97.2% key point accuracy, 28.6 ms inference), multimodal feedback, and personalized progression using self-selected equipment. Results: Significant improvements across all domains: muscular strength (+4.39 kg 1RM squat, p < 0.001, d = 1.148), body fat (−2.92%, p < 0.001, d = −1.373), skeletal muscle mass (+2.19 kg, p < 0.001, d = 1.433), FMS (+0.29 points, p = 0.001, d = 0.285), and VO₂max (+1.82 mL/kg/min, p < 0.001, d = 0.917). Pose classification accuracy reached 95.8% vs. physiotherapist assessment (ICC = 0.94). Conclusions: This study provides the first clinical evidence that on-device AI pose estimation enables facility-independent resistance training with outcomes comparable to traditional programs. Unlike cloud-based systems, our lightweight model (28.6 ms inference) supports real-time mobile deployment, advancing accessible precision exercise medicine. Limitations include a single-arm design and gender imbalance, warranting future RCTs with diverse cohorts. Full article

Background/Objectives: Neuromuscular fatigue (NMF) can impair manual dexterity and strength in healthcare professionals. Due to their high physical and cognitive workloads, physiotherapists (PTs) are particularly susceptible to NMF. This study investigated whether NMF, expressed as changes in manual dexterity and grip strength, occurs over a workday and across a workweek in PTs, and explored its relationship with stress and sleep quality. Methods: A total of 43 full-time PTs (25 female, mean age 37.72 ± 11.94 years) were recruited. Manual dexterity was assessed using the Functional Dexterity Test (FDT), while maximal grip strength (MGS) was measured by a hand dynamometer. Reliability was evaluated on a subgroup using Intraclass Correlation Coefficients (ICC_3,1) and Standard Error of Measurement (SEM). Evaluations were conducted at the beginning and at the end of the work shift, on Monday and Friday. Subjective fatigue, perceived stress, and sleep quality were also recorded. Results: The FDT showed excellent intra-rater reliability (ICC > 0.93; SEM < 0.94 s). FDT performance was significantly slower on Friday evening compared to all other time points (p < 0.01), exceeding the minimal detectable change thresholds. No significant changes were observed in MGS across the week. Perceived stress was strongly correlated with fatigue levels on Monday (ρ = 0.731) and Friday (ρ = 0.612) evenings. Sleep quality and professional experience did not correlate with performance changes. Conclusions: PTs experience a significant decline in manual dexterity by the end of the workweek, suggesting an accumulation of NMF. While MGS remains stable, fine motor control is more sensitive to fatigue. Psychosocial stress appears to be a major driver of perceived fatigue in this population. Full article

Background and Clinical Significance: Parkinson’s disease (PD) is a neurodegenerative condition characterized by motor and non-motor symptoms, which significantly impact patients’ autonomy and quality of life levels. Basically, the PD diagnosis is clinical and, in some cases, can be challenging to diagnose due to the heterogeneity of the symptoms. Case Presentation: A 58-year-old woman who, during the COVID-19 lockdown, referred to experiences of slight tremor and stiffness in her left hand at rest, but without any other associated symptoms. Firstly, after consulting a general practitioner (GP), the patient was diagnosed with cervical radiculopathy (CR), presented as essential tremor and stiffness to the hand. Nevertheless, during the initial physiotherapy evaluation, the motor symptoms did not fully align with the diagnosis of CR. For this reason, the presence of non-motor symptoms was thoroughly investigated. Notably, hyperhidrosis was identified as a significant non-motor symptom, leading to the patient’s subsequent referral to a neurologist, who finally diagnosed PD. Conclusions: This case report highlights the essential role of physiotherapists in conducting independent assessments and comprehensive investigations of all patients’ symptoms, even when a medical diagnosis has already been established. This is particularly crucial when there is suspicion that musculoskeletal symptoms may be indicative of neurodegenerative diseases such as PD, which is well-known for its extensive array of non-motor symptoms. Especially in women with PD, non-motor symptoms tend to emerge earlier and in a more subtle manner than motor symptoms, making diagnosis challenging. Therefore, meticulous anamnestic data collection is essential, especially by physiotherapists working in direct-access settings. Full article

Background/Objectives: This study explores the diagnostic and management pathways for dyspareunia in women seeking specialist care, focusing on gynecologists’ feedback and women’s perceptions of their experience. Methods: An online survey was conducted among 225 sexually active women to explore their perceptions of dyspareunia, its impact on relationships, and experiences with healthcare feedback, diagnosis, and treatment. The Numeric Rating Scale (NRS) for pain assessment and the Female Sexual Function Index (FSFI) were used. Gynecologists’ feedback was classified as positive, neutral, or negative based on its influence on the therapeutic pathway. Results: Of 78 women reporting dyspareunia, 12 with pain level ≥5 on NRS were selected for in-depth analysis. The mean pain score was 7.0 ± 1.53, with symptoms lasting from several months to over two years and occurring during most sexual encounters. The mean FSFI score was 24.86 ± 4.54, with half of the participants scoring within the sexual dysfunction range. Qualitative findings revealed frequent dismissive responses from healthcare professionals and limited access to appropriate management. Common self-management strategies included changing sexual positions and using lubricants, while half of the participants had not undergone a formal diagnostic process. Most frequent diagnoses were hormonal disorders and recurrent genital tract infections, and women were advised to undergo pharmacological treatment. Half of the participants were unaware of the possibility of physiotherapeutic management. Conclusions: Women with dyspareunia often face an inadequate diagnostic and therapeutic process. The care received is often insufficient and not aligned with a biopsychosocial model. Full article