OBJECTIVE: To identify culturally relevant functioning issues experienced by Indian adults with knee osteoarthritis (KOA) using the International Classification of Functioning, Disability and Health (ICF) framework. METHODS: A qualitative descriptive study using semi-structured focus group interviews was conducted with 38 ambulatory adults (35-85 years) diagnosed with knee osteoarthritis (KOA). Participants were recruited from physiotherapy outpatient departments and community settings using maximum variation sampling. Interviews were conducted in Gujarati, audio-recorded, transcribed verbatim, translated into English and analysed using reflexive thematic analysis. Meaningful concepts were systematically linked to ICF categories using established linking rules. Dual independent coding and consensus discussions ensured the analytic rigour. RESULTS: This study included 38 participants with KOA. Fifty-five meaningful second-level categories were identified. The most represented components were activities and participation (41.2%) and body functions (29.4%). Frequently mapped first-level categories included mobility (n = 22), neuromusculoskeletal and movement-related functions (n = 9), d6 domestic life (n = 10), community, social and civic life (n = 7) and products and technology (n = 9). Sixteen additional categories not represented in the existing ICF Core Set for OA emerged, particularly relating to culturally embedded activities such as floor sitting, squatting for toileting and religious participation. Environmental barriers, including inaccessible infrastructure and limited rehabilitation services, influenced disability experience. CONCLUSION: Functioning among Indian adults with KOA is influenced by culturally embedded participation demands and contextual barriers that are insufficiently captured in the existing ICF Core Set for osteoarthritis (OA). These findings provide preliminary empirical support for contextual validation of the ICF Core Set for OA and inform potential culturally responsive adaptation for KOA.
OBJECTIVE: Intrinsic capacity (IC) serves as the foundation for functional performance in older adults, and its decline exerts a significant negative impact on their overall health status. However, the dose-response relationship between physical activity (PA) and IC decline is unclear. The objective of this study was to examine the dose-response relationship between PA and IC decline in hospitalised older adults. METHODS: This cross-sectional study was conducted from August 2024 to July 2025, with hospitalised older patients recruited from three tertiary hospitals in Gansu Province, China. Data were collected using a general information questionnaire, the IC Assessment Scale and the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Binary logistic regression and restricted cubic spline (RCS) models were used to explore the association between PA and IC decline, adjusting for potential confounders. RESULTS: The final analyses included a total of 534 hospitalised older patients. Using the low PA group as the reference, the moderate PA group was associated with a 66% lower likelihood of IC decline (OR = 0.34, 95% CI: 0.23-0.50), and the high PA group was associated with a 74% lower likelihood (OR = 0.26, 95% CI: 0.14-0.49). In the RCS analysis, a J-shaped nonlinear association was observed between PA levels and IC decline. Subgroup analyses by sex indicated that sex may serve as a potential moderator in the association between PA and IC decline. CONCLUSIONS: This study revealed a J-shaped nonlinear association between PA and the likelihood of IC decline, with moderately higher PA levels associated with a lower likelihood of IC decline.
Musculoskeletal careYasser A Elmotaleb Gazar, Sherif Ismail, Saad Ghanem, Taha Ibrahim Aladrosy, Adel Ibrahim Azzam
BACKGROUND: The comparative effectiveness of adjunctive physical modalities alongside exercise for ankylosing spondylitis (AS) remains inadequately evaluated. OBJECTIVE: To compare the relative association of focused extracorporeal shock wave therapy (ESWT) versus therapeutic ultrasound, both added to identical exercise-based rehabilitation, with long-term functional outcomes in AS. METHODS: This assessor-blinded randomized comparative trial (conducted March 2024-August 2025) evaluated 106 AS patients with chronic lumbar stiffness (90 completed 12-month follow-up). Participants received either focused ESWT (weekly × 4 weeks, n = 45) or ultrasound (3 × /week × 4 weeks, n = 45), alongside identical 12-week supervised exercise and stable pharmacotherapy. The primary outcome was functional capacity (BASFI). Secondary outcomes included disease activity (BASDAI), pain, spinal mobility (modified Schober) and disability (DFI). This trial was not prospectively registered and lacked an exercise-only control arm; therefore, findings should be interpreted as exploratory. RESULTS: Both groups improved significantly across all outcomes (p < 0.001). At 12 months, the ESWT group was associated with lower BASFI scores (2.2 ± 1.8 vs. 3.7 ± 2.3; p = 0.001; Cohen's d = 0.72) and lower disability (DFI: p = 0.003; d = 0.63) than the ultrasound group. Lumbar mobility differed nominally (p = 0.030) but did not survive correction for multiple secondary comparisons. No significant between-group differences were observed for BASDAI (p = 0.424) or pain (p = 0.284). CONCLUSIONS: When added to identical exercise and pharmacotherapy, focused ESWT was associated with greater long-term functional improvement compared with therapeutic ultrasound. However, in the absence of an exercise-only control, the incremental benefit of either modality over exercise alone cannot be determined. Given the lack of prospective registration and other methodological limitations, these preliminary findings require confirmation through properly registered trials before any clinical recommendations can be made.
BACKGROUND: Elderly patients with cervical radiculopathy present therapeutic challenges owing to comorbidities and medication-related risks. Long-term pharmacotherapy and surgical interventions are often suboptimal, necessitating evaluation of optimized pulsed radiofrequency strategies under image guidance. OBJECTIVES: This superiority trial compared the efficacy and safety of ultrasound-guided cervical nerve root high-voltage pulsed radiofrequency (HVP-PRF) versus conventional pulsed radiofrequency (C-PRF) for pain management in elderly patients with cervical radiculopathy. METHODS: This single-center, parallel-group, assessor-blinded randomized controlled trial enrolled patients aged 60-85 years with cervical radiculopathy, randomly assigned (1:1) to HVP-PRF (70 V) or C-PRF (45 V). Procedures were performed under ultrasound guidance with sensory/motor stimulation confirmation and temperature ≤42°C. The primary outcome was change in upper-limb radiating pain on the Numeric Rating Scale (ΔNRS) from baseline to 3 months. Secondary outcomes included Neck Disability Index (NDI), neck pain NRS, Patient Global Impression of Change, responder rates, rescue analgesia use, and adverse events. Follow-up occurred at 1 week, 1, and 3 months. RESULTS: A total of 104 patients were randomized and 101 received treatment. At 3 months, HVP-PRF demonstrated significantly greater radiating pain improvement versus C-PRF (adjusted mean difference 1.24, 95% CI 0.46-2.02, P=0.002). Functional improvement (NDI) was superior in the HVP-PRF group at 3 months (AMD 6.47, 95% CI 2.11-10.83, P=0.004). Responder rates (≥50% pain reduction) were higher with HVP-PRF at 3 months (68.75% vs. 42.22%, OR 3.01, P=0.011) and 6 months (65.22% vs. 43.18%, OR 2.52, P=0.035). Rescue analgesic use was lower in the HVP-PRF group during 1-3 months intervals (both P<0.05). Adverse event rates were comparable (27.45% vs. 32.00%). CONCLUSION: Under ultrasound visualization and electrical stimulation-based target confirmation with temperature control ≤42°C, HVP-PRF provided greater and more durable relief of upper limb radiating pain compared with C-PRF in elderly patients with cervical radiculopathy, with a comparable safety profile.
Pain practice : the official journal of World Institute of PainTigran Kesayan, Vida Motamedi, Jessica Hanflink, Patrick Assi, Salam Kassis
BACKGROUND: Surgical site infections (SSI) associated with spinal cord stimulation (SCS) implants pose risks of morbidity, mortality, and increased healthcare costs. Immunocompromised patients are especially vulnerable due to impaired immune responses, delaying diagnosis and increasing complications. Current guidelines recommend SCS explantation for deep or inadequately treated superficial SSI, though the role of capsulectomy remains underexplored despite its use in other fields like plastic surgery and cardiology. CASE PRESENTATION: We present two cases of immunocompromised patients with SSI treated with SCS explantation and capsulectomy. Case 1 involved a 64-year-old woman with ulcerative colitis and psoriatic arthritis treated with immunosuppressive agents who developed fever and myalgia and had normal imaging. Despite treatment with a course of antibiotics, she developed granulation tissue at the midline incision which tracked to the lead anchors. Explantation revealed necrotic tissue, and capsulectomy of the implanted pulse generator pocket and around lead anchors was performed. Staphylococcus schleiferi, likely linked to pet exposure, was identified. Case 2 involved a 52-year-old woman with postlaminectomy syndrome and rheumatoid arthritis on immunosuppressants, who presented with erythema and wound dehiscence weeks post-implant. Explantation and capsulectomy were performed to remove fibrotic tissue potentially harboring biofilm. MRSA infection was identified. Targeted antibiotics facilitated recovery in both cases. CONCLUSION: These cases suggest capsulectomy during SCS explantation may mitigate complications, particularly in immunocompromised patients. Current guidelines recommend capsule debridement but do not routinely address capsulectomy; its use may improve infection resolution in high-risk populations, perhaps by eliminating biofilm associated with the capsule.
Pain practice : the official journal of World Institute of PainGeert Oldenbeuving, Monique C M Schel-Huisman, Jeroen S Vos, Anastasios Kyriazopoulos
INTRODUCTION: Spinal cord stimulation (SCS) is an effective method for pain relief in patients with Persistent Spinal Pain Syndrome (PSPS) type II. International guidelines recommend preoperative imaging to assess spinal anatomy for placement of thoracic SCS leads. This study examines the clinical implications of routine preoperative imaging in patients scheduled for thoracic percutaneous SCS lead placement. METHODS: A single-center retrospective study of MRIs was performed in patients who were planned for SCS lead placement in a period from January 2020 to March 2023. The study excluded lead revisions and cervical or dorsal root lead placements. We examined the impact of imaging findings on procedural planning and execution, categorizing the clinical impact as minor (additional imaging or consultation) or major (cancellation or technical modification of the procedure). We also evaluated the correlation between abnormalities in the epidural space and periprocedural (but not postprocedural) complications such as dural puncture or improper lead positioning at Th7. RESULTS: Of the 167 patients who underwent MR imaging, 129 continued with SCS lead placement. The major reason for not proceeding with lead placement was patient and/or physician preference for conservative treatment. MRI revealed abnormalities in 58 patients-22 in the relevant epidural space and 36 incidental findings. In 29 of the patients (17.4% of total) these abnormalities had no clinical consequences. There were minor consequences in 23 patients (13.8% of total) and major consequences in 6 patients (3.6% of total). Major consequences included the decision to perform a primary surgical implantation in one patient, changes in epidural entry level in two patients, surgical decompression in two patients, and cancellation of the procedure in one patient. Of all MRI findings with clinical implications, 14 of 29 (48.2%) (and 3 of 6 for major consequences) were visible on prior imaging. Although not specifically powered for this correlation, statistical analysis using a Fisher exact test found no significant association between epidural abnormalities on MRI and the occurrence of dural puncture, the inability to place the lead at the desired position, or perioperative neurological sequelae. CONCLUSION: Routine preoperative MRI before thoracic SCS lead placement often detects abnormalities with major consequences in 3.6% of cases. In half of these cases, the abnormalities could not be identified on previous imaging, all of which were in the thoracic region. There was no association between epidural abnormalities and periprocedural complications in our data.
Pain practice : the official journal of World Institute of PainÇiğdem Yalçın, Mehmet Alper Salman, Güldane Turhan, Suna Aşkın Turan
OBJECTIVE: Pulsed radiofrequency of the dorsal root ganglion (DRG) is an established treatment for chronic lumbosacral radicular pain, yet comparative evidence on monopolar versus bipolar configurations, particularly regarding quality-of-life outcomes, remains limited. This study aims to compare the analgesic and quality-of-life effects of bipolar versus monopolar pulsed radiofrequency of the lumbosacral DRG. METHODS: We conducted a mixed retrospective and prospective observational review of 143 patients with chronic radicular pain due to lumbosacral disc herniation who underwent DRG pulsed radiofrequency in 2022 and 2023. Patients received either bipolar (n = 79) or monopolar pulsed radiofrequency (n = 64). Pain intensity was recorded using the Numeric Rating Scale at baseline and at 1st, 2nd, and 6th month post-procedure. Quality of life was assessed with Short Form-36 (SF-36) at baseline and 6 months. Any potential complications were recorded to evaluate the safety of procedures. RESULTS: Baseline demographic and clinical characteristics were comparable between groups. All patients exhibited significant reductions in pain scores over time (p < 0.001). However, bipolar pulsed radiofrequency produced significantly greater pain relief at all follow-up points, with mean pain scores at 6 months of 2.32 versus 4.78 in the monopolar group (p < 0.001). At 6 months, bipolar pulsed radiofrequency also resulted in significantly higher SF-36 scores across all eight domains and in total score (583.61 vs. 425.29, p < 0.001). DISCUSSION: Bipolar pulsed radiofrequency of the lumbosacral DRG was associated with greater improvements in pain and quality of life compared with the monopolar modality in patients with chronic lumbosacral radicular pain. These show the potential of bipolar PRF to enhance clinical and functional outcomes in this population.
Nursing in critical careZahra Ahmed Sayed, Mohamed Ali Abdraboh, Eman Mohamed Ebrahim Abdelrazek
BACKGROUND: Early mobilisation is central to contemporary critical care, yet implementation remains inconsistent and ethically complex, particularly when patient safety, autonomy and resource constraints must be balanced. AIMS: To examine ICU nurses' perceptions of ethical concerns and implementation barriers related to early mobilisation in critically ill adults, including older adults, and their associations with professional characteristics. DESIGN: A single-centre analytical cross sectional study. METHODS: A convenience sample of ICU nurses completed a self-administered questionnaire comprising demographic and professional data and the researcher-developed Ethical Issues in Early Mobilisation-Critical Care Scale and Early Mobilisation Barriers Scale. Data were analysed using descriptive statistics, independent-samples t-tests, one-way analysis of variance, Pearson's correlation and multiple linear regression. RESULTS: A total of 100 ICU nurses participated in the study. The mean ethical-concern score was 113.41/150 (75.6% of the maximum possible score), and the mean barrier score was 69.94/90 (77.7%). Beneficence and Patient Well-being had the highest ethical-domain score. Patient-related barriers had the highest descriptive domain score, although all four barrier domains were closely distributed (76.6%-79.2%). Ethical-concern and barrier scores were modestly correlated (r = 0.292, 95% CI 0.103-0.461; p = 0.003), indicating limited shared variance. In mutually adjusted models, education level, ICU experience and previous early-mobilisation training were associated with both outcomes. The coded ICU-type term was associated with ethical-concern scores only, whereas professional nursing classification was associated with neither outcome. Age and gender were not associated with either score. CONCLUSIONS: Early mobilisation emerged as an ethical and organisational challenge, not merely a technical task. Ethical concerns and implementation barriers were related but largely distinct. Associations with education, ICU experience and training should be interpreted as correlational rather than causal. Integrated, context-sensitive approaches combining graded safety assessment, ethical decision-making, role clarity and organisational support warrant prospective evaluation. RELEVANCE TO CLINICAL PRACTICE: The findings support the development of evidence-based protocols, targeted educational initiatives and organisational strategies that strengthen nurses' clinical decision-making and facilitate the safe and consistent implementation of early mobilisation in critical care settings.
Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of NursingSusana Malgrat-Caballero, Maite Franco, Oriol Planesas-Pérez, Estefania Garbero Garcia, Eleonora Alexandrova, Maria Z Techera, M Perea-Garcia, Belen Sendra Cri…
INTRODUCTION: Urinary incontinence (UI) is a prevalent geriatric syndrome that significantly affects the physical, psychological, and social well-being of older adults. Non-pharmacological interventions are recommended as the first-line approach, especially in frail older adults. DESIGN: This was a prospective pre-post observational study. METHODS: The study included sixty-one patients with rehabilitable UI who were admitted to an intermediate care hospital. The nurse-led multidisciplinary program integrated education, hygiene-dietary measures, pelvic floor physiotherapy, behavioral strategies, and transcutaneous electrical nerve stimulation (TENS). The primary outcomes were UI severity (International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF)), voiding awareness, diurnal and nocturnal voids, disposable absorbent product use, functional status (Barthel Index), cognitive status (Pfeiffer test), and quality of life (EQ-5D). Data were collected at baseline and discharge. RESULTS: Data from 61 participants were analyzed. Significant improvements were observed in the ICIQ-SF scores (16.72 ± 3.39 vs. 9.10 ± 5.86; p < 0.001), daytime voiding awareness (83.6% vs. 100%; p = 0.002), nocturnal voiding awareness (66.7% vs. 88.5%; p = 0.002), nocturnal voids (3.46 ± 2.22 vs. 2.35 ± 1.68; p < 0.001), Barthel Index (49.83 ± 23.84 vs. 70.33 ± 19.59; p < 0.001), and EQ-5D scores (0.39 ± 0.28 vs. 0.56 ± 0.26; p < 0.001). The use of disposable absorbent products decreased from 98.36% to 62.30% (p = 0.065). The patient's cognitive status remained stable. The mean satisfaction with the program was 8.53/10. CONCLUSIONS: A nurse-led, multidisciplinary, non-pharmacological intervention effectively reduced UI severity, increased voiding awareness, enhanced functional autonomy, and improved the quality of life in older adults. These findings support the implementation of individualized, evidence-based programs in intermediate care settings. CLINICAL RELEVANCE: Non-pharmacological interventions led by advanced practice nurses provide effective, patient-centered management of urinary incontinence, improving autonomy and quality of life while potentially reducing healthcare costs.
Pain practice : the official journal of World Institute of PainDanilo Donati, Lucia D'Auria, Vincenzo Ricci, Paolo Boccolari, Roberto Tedeschi, Luigi Tarallo
OBJECTIVE: Complex regional pain syndrome (CRPS) is a complex and multifaceted condition in which pain may be neuropathic, nociplastic, nociceptive, or mixed in nature. This review aims to summarize the available pharmacological and non-pharmacological strategies for managing neuropathic pain in CRPS Types I and II. METHODS: Scopus, PubMed, Cochrane Library, and Google Scholar were searched for randomized controlled trials, meta-analyses, case series, and case reports addressing the management of CRPS, with a focus on neuropathic pain. Studies were analyzed from the perspective of pharmacological and non-pharmacological approaches, with attention to differences between CRPS Type I and II. RESULTS: Gabapentin (Level 1 evidence) and physiotherapy (Level 2 evidence) showed the strongest support among the treatments reviewed. Evidence remains limited or inconsistent for other pharmacological options (e.g., anticonvulsants other than gabapentin, opioids, antidepressants, ketamine, botulinum toxin) and for non-pharmacological interventions (e.g., mirror therapy, spinal cord stimulation, acupuncture). No significant differences in treatment efficacy were identified between CRPS Type I and II. CONCLUSION: Given the complex and heterogeneous nature of CRPS, a multimodal, individualized treatment approach is recommended. Further well-structured studies are needed to strengthen the evidence base for the management of neuropathic pain in CRPS.
NMR in biomedicineFrederique Dupuis, David B Berry, Lara Havandjian, Armin Zavareh, Zachary Brumm, Anirudh Anand, Samuel R Ward, Kamshad Raiszadeh, Bahar Shahidi
Chronic low back pain (LBP) is the leading cause of disability worldwide, yet responses to exercise-based rehabilitation vary substantially and remain not well characterized. Impaired activation of the lumbar paraspinal muscles has been proposed as a mechanism limiting rehabilitation treatment response. Intravoxel incoherent motion (IVIM) magnetic resonance imaging assesses muscle diffusion and perfusion after exercise, offering physiological markers of dynamic function. In a previous pilot study, we reported that acute exercise-induced IVIM responses were reduced in individuals with LBP and that thresholds in diffusion (D) and pseudodiffusion (D*) parameters could predict those who would or would not respond to an exercise-based rehabilitation program. The present study aimed to prospectively validate these findings in a larger, independent cohort. Thirty-seven individuals with chronic LBP underwent IVIM before and after an acute standardized lumbar extension exercise, followed by a 12-week rehabilitation program. Participants were classified as responders or nonresponders based on changes in disability after 12 weeks (Δ Oswestry Disability Index Score ≥ or < 0). In line with the pilot study, responders exhibited higher increase in D following acute exercise than nonresponders (p = 0.05). Previously identified thresholds for D and D* did not discriminate between responders and nonresponders within this new cohort (Sn < 0.40 and Sp = 0.65). Exploratory analyses revealed that baseline disability moderated IVIM responses, as a marked increase in D was primarily observed in responders with low baseline disability, whereas individuals with higher disability showed attenuated responses. New significant thresholds were explored within the validation cohort while controlling for disability levels. An increase ≥ 0.014 × 10-3 mm2/s for D predicted who would respond to the exercise-based program, with a Sn of 0.59 and a Sp of 0.90 (area under the curve [AUC] 0.72, 95%CI 0.55 to 0.90, p = 0.02). These findings confirm that acute IVIM responses are associated with rehabilitation outcomes but may be better understood as part of a broader, integrative framework characterizing the physiological mechanisms associated with treatment response. Integrating physiological and clinical factors to better understand variability in treatment response will help guide more personalized approaches to LBP rehabilitation.
Clinical physiology and functional imagingMason A Howard, Paola M Rivera, Sean M Lubiak, Christopher E Proppe, Jeffrey T Schmidt, Thalia L Fraifer, Ezra D Shobe, Ethan C Hill
The purpose of this investigation was to assess muscle size and perceptual responses following acute bouts of low-load blood flow restriction resistance exercise performed with a 75-repetition (1 × 30, 3 × 15), 3 sets to failure, and a 1 set to failure protocols. Nineteen females randomly performed a 75-repetition, 3 sets to failure, and 1 one set to failure low-load blood flow restriction protocols consisting of unilateral, submaximal (30% of maximal voluntary isometric contraction), isokinetic (90°·s-1), leg extension muscle actions. The minimal difference (MD) was used to determine real changes in each dependent variable from pretest to posttest. There were no significant (p = 0.191-0.567) interactions, main effects of Condition (p = 0.108-0.931), or main effects of Muscle (p = 0.103-0.958) for muscle thickness (MTH), cross-sectional area (CSA), or echo intensity (EI) of the rectus femoris or vastus lateralis. Across the protocols, the changes in MTH, CSA, and EI exceeded the minimal difference for 16-19, 18-19, and 11-19 of the 19 participants, respectively. Following the final set of each protocol, 3 sets to failure (8.94 ± 1.07 au) resulted in a greater rating of perceived exertion compared to the 1 set to failure (8.02 ± 1.08 au) and 75-repetition (8.05 ± 1.35 au) protocols. All three protocols resulted in comparable acute changes in muscle size; however, the 3 sets to failure resulted in the greatest perceptual response. Therefore, comparable acute muscle size responses can be achieved with the 75-repetition protocol or one set performed to failure with a reduced level of exertion.
Pain practice : the official journal of World Institute of PainSteven Falowski, Jack Smith
INTRODUCTION: Intermittent passive recharge burst therapy is an established therapy to optimize pain relief and mitigate the problems associated with battery life and charging burden. Newer programming parameters have been explored to provide patients with this targeted burst therapy in multiple areas. These areas are programmed separately to optimize pain relief for a complex patient population and those with multi-area pain. This study examined single vs. multi-area passive recharge burst therapy in a neurostimulation naive population during percutaneous SCS trial. METHODS: This study was performed at a single institution by a single trialing physician. Candidates for the study were enrolled on a consecutive basis for any painful condition in the management of chronic intractable pain of the back, trunk and limbs. Subjects were randomized to receive either single area burst therapy or two-area burst therapy-with both subject and physician blinding. Programming was adjusted mid-trial based on optimizing pain relief and could include up to four-area burst. Patient outcomes included VAS, percent pain relief, proceeding to implant, and PROMIS-29 scores. RESULTS: All planned 30 patients completed follow up. The average VAS pain score was 70.2 at baseline and 22.2 at the end of the trial. The average pain relief at mid-trial was 53%, which improved to 67% at the end of the trial with conversion to multi-area programming. There was an overall 87% trial to permanent conversion ratio, with 83% of the patients ending trial on multi-area burst therapy. Analysis of PROMIS-29 scores demonstrates the most significant improvements in pain intensity, pain interference, physical function, sleep, and anxiety. CONCLUSION: Multi-area passive recharge burst has demonstrated a high rate of trial success with significant pain and symptom relief. In addition, there were improvements in pain intensity, pain interference, physical function, sleep, and anxiety. Multi-area passive recharge burst therapy is a viable option to be utilized during a trial to improve patient outcomes and optimize trial success.
Sexual healthOurlad Alzeus G Tantengco, Mikayla Francesca N de Guzman, Amina C Kunting, Sheriah Laine M de Paz-Silava, Michele H Diwa, Ian Kim B Tabios
BACKGROUND: Self-collected vaginal sampling for human papillomavirus (HPV) DNA testing provides a promising alternative to physician-collected Pap smears, especially in low-resource settings. However, data on its acceptability and preferences among Filipino women remain limited. This study aimed to assess women's perceptions, experiences, willingness and preferences regarding self-collected vaginal sampling for HPV DNA testing compared with Pap smears. METHODS: A cross-sectional study was conducted among 592 women. Participants underwent both physician-collected Pap smears and self-collected vaginal sampling for HPV DNA testing. Perceptions were measured using five-point Likert scale questionnaires before and after self-collection. Descriptive statistics were used, and paired and independent Wilcoxon tests were used to compare Likert responses. Willingness to undergo screening was analyzed with Cochran's Q and McNemar tests. Participants' reasons for their preferred screening method were categorized thematically and displayed in stacked bar charts. RESULTS: Self-collection was generally viewed as painless, not uncomfortable, non-embarrassing, and easy and convenient. Acceptability significantly increased after participants performed self-collection (P < 0.001 for pain and discomfort). Compared with Pap smears, self-collection was seen as less embarrassing (P < 0.001), but rated as less easy (P = 0.01) and less convenient (P = 0.004). Most participants preferred physician-administered screening (84.8%) due to trust in medical expertise, and confidence in the procedure's accuracy, safety and cleanliness. CONCLUSIONS: Self-collected vaginal sampling was highly acceptable, yet physician-collected screening remained the preferred method. Improving education, demonstrations, and support for self-collection may enhance the uptake of HPV DNA testing and broaden access to cervical cancer screening in the Philippines.
European journal of psychotraumatologyMarg Rogers, Victoria Williamson, Einar B Thorsteinsson, Neil Greenberg, Michelle Gossner, Amy Johnson, Yonggang Ren, Margaret Sims, Philip Siebler, Michèle L …
Background: Children living with a parent with complex post-traumatic stress disorder (CPTSD) may struggle to understand and respond to parental behaviours, increasing their risk of distress and mental health difficulties. Despite this, few evidence-informed narrative resources exist to support these children.Method: A free bibliotherapy e-storybook was co-created with over 30 participants from the affected communities and partners, including individuals with lived experience, service providers, clinicians, and an international interdisciplinary research team. Public feedback on a draft version informed further refinement. A cross-sectional online survey of additional community members and partners assessed the e-storybook. Twenty-two additional participants completed closed-ended and six open-ended survey questions.Results: Findings indicated that the co-creation approach was effective in developing a targeted and relevant resource for children.Conclusion: The e-storybook was perceived as a useful bibliotherapy tool to support child and family outcomes and to facilitate meaningful conversations about family experiences.
PulmonologyCíntia Dias, Raquel Marinho, José Joaquim Alvarelhão, Eduarda Tinoco, Tiago Alfaro, Vânia Fernandes, Sérgio Campainha, Chris Burtin, Alda Marques
BACKGROUND: Measurement properties of patient-reported outcome measures assessing functional performance and activity limitations in interstitial lung disease (ILD) are often unknown. RESEARCH QUESTION: To evaluate the reliability and validity of the Canadian Occupational Performance Measure (COPM) and the Pulmonary Functional Status and Dyspnea Questionnaire-Modified version (PFSDQ-M) in European Portuguese among people with ILD, and to explore differences between fibrotic and non-fibrotic ILD. STUDY DESIGN AND METHODS: Cross-sectional study. Internal consistency (Cronbach's α), test-retest/intra-rater and inter-rater reliability assessed using intraclass correlation coefficients [ICC2,1[95%CI]], standard error of measurement (SEM), minimal detectable change at 95% confidence level (MDC95) and Bland-Altman analysis, and floor/ceiling effects were evaluated. Construct validity was explored with correlations: convergent validity with the LCADL, CIS-8, 6MWT and 1-minSTS, only for PFSDQ-M; divergent validity with age and lung function for both instruments. Subgroup analyses compared fibrotic and non-fibrotic ILD. RESULTS: A total of 334 participants were included. The COPM showed moderate test-retest/intra-rater and inter-rater reliability (ICC2,1 = 0.68[0.57-0.77]-0.72[0.63-0.80]), with SEM = 1.08-1.42 and MDC95 = 3.00-3.94, and no floor/ceiling effects. The PFSDQ-M demonstrated excellent internal consistency (α = 0.90-0.96) and good test-retest and inter-rater reliability (ICC2,1 = 0.80[0.74-0.85]-0.92[0.89-0.94]), with SEM = 15.80 and MDC95 = 43.80 for total score. Bland-Altman analysis showed no systematic bias for the COPM and a small bias for the PFSDQ-M test-retest. Moderate-to-strong correlations with LCADL/CIS-8 and weak-to-moderate with 6MWT/1-minSTS supported convergent validity for PFSDQ-M. Negligible-to-weak correlations with age and lung function for COPM and PFSDQ-M supported divergent validity. Subgroup results were similar. CONCLUSION: The European Portuguese COPM and PFSDQ-M demonstrated reliability. The COPM showed evidence of divergent validity, whereas the PFSDQ-M demonstrated both convergent and divergent validity. These findings support their use for assessing functional performance in people with ILD.
Current urology reportsHayley Premo, Meghan Cooper
PURPOSE OF REVIEW: This manuscript aims to provide an overview of minimally invasive treatment for overactive bladder (OAB) in men, highlighting how concomitant bladder outlet obstruction in men can complicate management and lead to underutilization of these therapies in this patient population. RECENT FINDINGS: The 2024 AUA/SUFU guidelines now allow practitioners to offer minimally invasive therapy as an upfront treatment for OAB. Recent studies have closely examined the efficacy of several key procedures, including intradetrusor onabotulinumtoxin-A (BTX-A), sacral neuromodulation (SNM), and tibial nerve stimulation via percutaneous or implantable devices. All three modalities are effective in terms of improving OAB symptoms, however the evidence base is largely female-derived. This highlights the ongoing need for adequately powered, male-specific clinical trials to address this disparity and help guide individualized treatment planning.
OBJECTIVE: To examine associations between a 4-week seated dual-task (DT) ergometer program and cognitive and mobility outcomes in older convalescent rehabilitation inpatients. MATERIALS AND METHODS: This retrospective observational study included 125 rehabilitation episodes involving older adults undergoing inpatient convalescent rehabilitation , primarily for orthopaedic disorders and stroke. Participants received seated DT ergometer training (n = 79) or conventional recumbent ergometer exercise (n = 46) for 4 weeks. Primary outcomes were the Mini-Mental State Examination (MMSE), Trail Making Test-Japanese Part A (TMT-J Part A), 10-m DT walking time, and the Timed Up and Go test (TUG). Analysis of covariance models adjusted post-training outcomes for baseline values, age, and diagnosis using HC3 robust standard errors. RESULTS: Adjusted between-group differences (DT minus conventional exercise) were nonsignificant for MMSE (0.08 points; 95% confidence interval [CI], -0.78 to 0.93; p = 0.862), TMT-J Part A (-6.59 s; 95% CI, -22.06 to 8.87; p = 0.403), DT walking time (-0.89 s; 95% CI, -2.77 to 0.99; p = 0.354), and TUG (-0.97 s; 95% CI, -2.62 to 0.67; p = 0.246). The six-sessions-per-week sensitivity analysis yielded consistent results. Exploratory analyses showed greater improvements in DT walking time (p = 0.003) and TUG (p = 0.016) in the MMSE ≥27 stratum. Within standard TMT-J limits, adjusted Part A time was shorter in the DT group (p = 0.035), whereas the unadjusted change-score comparison was nonsignificant (p = 0.182). CONCLUSIONS: Seated DT ergometer training did not demonstrate a clear advantage over conventional ergometer exercise in cognitive or mobility outcomes. Exploratory findings are hypothesis-generating. Prospective randomized studies with standardized training exposure are needed.
Clinical oral investigationsDavid Han, Christopher Chun, Catherine Kim, Laurel Martinez, Jooyoung Song
OBJECTIVES: To characterize indications for endodontic microsurgery (EMS) and compare the relative proportion of these indications across two calendar periods before and after the practice's adoption of laser-activated irrigation (LAI). MATERIALS AND METHODS: A retrospective time-period comparison of consecutive EMS cases (n = 1,672) treated by six endodontists (April 2019-August 2025) was analyzed. Two periods were prespecified based exclusively on the date of surgery: Before-Laser Treatment (BLT) and After-Laser Treatment (ALT) following implementation of an Er, Cr: YSGG intracanal LAI protocol (August 2022). Each surgical tooth was assigned one or two predefined reasons. Proportions were compared between periods using Generalized Estimating Equations (GEE) adjusting for patient clustering, demographics, tooth class, and provider. RESULTS: The most frequent indications overall were large post (22.2%), uncleaned accessory canal (21.8%), and excessive calcification (14.4%). In adjusted models, the proportion of EMS cases attributed to uncleaned accessory canals decreased from 26.6% (204/767) in BLT to 17.7% (160/905) in ALT (adjusted OR = 0.49; 95% CI 0.37 to 0.65; P < .001). Conversely, the proportion of EMS cases attributed to excessive calcification increased from 10.8% (83/767) to 17.3% (157/905) (adjusted OR = 1.65; 95% CI 1.21 to 2.25; P = .002). CONCLUSIONS: In this practice-based case series, the ALT period was associated with a lower proportion of EMS cases performed for uncleaned accessory canals. By contrast, the proportion of EMS cases attributed to excessive calcification was higher in the ALT period. Causal inference regarding LAI effectiveness is limited by the time-period design and the lack of non-surgical denominator. CLINICAL RELEVANCE: Following the adoption of laser-activated irrigation (LAI) in non-surgical endodontics, uncleaned accessory anatomy constituted a smaller relative share of subsequent microsurgical cases. Conversely, clinicians should anticipate a continued substantial burden of calcification- and post-related surgical challenges.
Southern medical journalRobyn L Reese, George G A Pujalte, Manisha Salinas, Andre Abadin, Ryan Milon, Michael R Mayo
The aim of this review was to outline critical considerations for physicians caring for older adults engaged in sports and exercise. The number of older adults in the United States is projected to increase, requiring physicians to deepen their understanding of geriatric exercise to provide optimal care. Enhanced physical activity among older adults is associated with improved strength, endurance, functionality, stress reduction, and cognitive health. Physicians can evaluate patient readiness for exercise through physical examinations, echocardiography, exercise stress tests, and bone mineral density tests. A recommended regimen includes 150 minutes of moderate intensity or 75 minutes of vigorous intensity aerobic activities weekly, alongside twice-weekly muscle-strengthening exercises. Physiologic changes and slower healing rates in older adults heighten their injury risks, however. As such, physicians should ensure a safe exercise environment to minimize these risks while maximizing health benefits. With proper guidance, older adults can enhance their quality of life through tailored exercise programs.
Hu li za zhi The journal of nursingPei-Chun Tsai, Chin-Yen Wu, Chih-Hsuan Chen, Hsuan-Ping Chang, Ching-Yao Chen
BACKGROUND & PROBLEMS: Patients undergoing hemodialysis require adequate self-care ability to balance disease control with daily life activities. Inadequate self-care may lead to complications such as dyspnea, electrolyte imbalance, and catheter-related infections, increasing the risk of re-hospitalization. Based on a situational assessment and cause analysis, the authors identified the self-care implementation rate among hemodialysis patients to be only 65.8%. The major contributing factors included incomplete delivery of health education by nursing staff, inconsistent handover of education evaluation results information, patients' limited absorption of verbally delivered health education, and the absence of appropriate, practical educational support tools. PURPOSE: This project was designed to improve the rate of successful self-care implementation among hemodialysis patients using diversified improvement strategies to reduce repeated hospitalizations and enhance patient quality of life. RESOLUTION: A health education evaluation and handover checklist, a catheter care manual, educational videos, teaching models, and an app-based interactive quiz game on catheter-related infection prevention were developed. Through inter-professional collaboration, a food water-content chart was designed, home care experiential learning sessions were conducted, and a discharge passport was provided to integrate health education content and establish continuous care records. RESULTS: After implementation of the project interventions, the self-care implementation rate among hemodialysis patients increased from 65.8% to 90.5%, achieving the project's targeted goal. CONCLUSIONS: Integrating visual materials, multimedia educational tools, and experiential learning courses has the potential to enhance the effectiveness of health education and learning motivation among hemodialysis patients, thus improving their self-care ability. In addition, these strategies may reduce the time required by nursing staff to deliver health education and thus improve the efficiency of clinical nursing care.
Australian occupational therapy journalDillon Tepper, Ben Sellar, Sheryl Shipley, Rachel Smith, Carolyn Murray M
INTRODUCTION: Borderline personality disorder (BPD) is a severe and prevalent mental illness. Longitudinal research consistently demonstrates that people diagnosed with BPD experience persistent functional impairment despite current psychotherapeutic treatment. Functional impairment is typically defined in terms of performance in vocational and relational domains. However, functional recovery across multiple domains of functioning should also be considered, such as leisure, self-care, health and household management. This study aimed to describe the daily living functioning of people diagnosed with BPD from multistakeholder perspectives. METHODS: This qualitative descriptive study used semi-structured interviews with 22 participants, including consumers (n = 4), carers (n = 5) and clinicians (n = 13). Data were analysed using reflexive thematic analysis. CONSUMER AND COMMUNITY INVOLVEMENT: Consumer, carer and clinician consultants reviewed a draft of the interview guide and provided feedback on the terminology, question ordering and provision of practical examples. Their feedback was incorporated and amendments were made prior to data collection. FINDINGS: Five themes were generated: (1) structured routines, (2) extremes of doing, (3) a lot of energy required to manage in daily life, (4) doing when disconnected from values and identity and (5) doing through others. People diagnosed with BPD experienced challenges establishing and maintaining structured routines, engaged in boom-and-bust activity patterns, expended considerable energy managing emotions and interpersonal interactions, struggled to identify values to derive meaning from daily activities and relied on others to initiate and complete daily activities. CONCLUSION: Functional recovery outcomes are important for people diagnosed with BPD. Occupational therapists are well positioned to support functional recovery for this population, which could involve exploring daily living functioning beyond a psychotherapeutic framework, including the structure of routines, sleep patterns, activity pacing, energy conservation, values identification, and the extent of carer involvement in daily activities.
Australian occupational therapy journalAleksandra Westcott, Lorrae Mynard, Gabrielle Pitt, Susan Darzins
INTRODUCTION: Identifying and addressing the support needs of forensic mental health patients in daily life occupations is critical yet complex due to the health comorbidities and environmental restrictions impacting their participation. Occupational therapists support forensic patient recovery by facilitating their performance in daily life occupations required at home and in the community. Standardised assessments of daily living are important for guiding interventions. The Home Support Needs Assessment (HSNA) is a standardised measure identifying unmet support needs in daily life occupations. The aim of this study was to evaluate its initial acceptability and feasibility for occupational therapists' use in a forensic mental health setting. METHODS: An exploratory convergent, parallel mixed-methods design was used. Semi-structured interviews with five forensic occupational therapists explored their perspectives about using the HSNA in practice. Interview transcripts were analysed using reflexive thematic analysis. HSNA data were extracted from 13 patient medical records and summarised using descriptive statistics. CONSUMER AND COMMUNITY INVOLVEMENT: There was no consumer and community involvement in this research as the focus of the study was on occupational therapists. FINDINGS: Three overarching themes were generated: value of the assessment, informed care planning, and applicability to the environment. The HSNA was found to structure observations, facilitate discussions about daily life occupations, and clarify ongoing support needs. An over-support of some needs emerged as a unique factor of the forensic mental health environment. Some items were viewed as not applicable to the setting. CONCLUSION: The HSNA highlighted that the safety focus of the secure environment inadvertently limited opportunities for patients' involvement in daily life occupations. Acceptability was associated with enabling holistic occupational assessment. Further tailored training may increase overall implementability.
Physiotherapy research international : the journal for researchers and clinicians in physical therapyAhmed M Elfahl, Heba M Elfeky
BACKGROUND: Non-specific neck pain (NSNP) is a frequent issue that can negatively affect both mobility and function. Recently, there has been growing interest in newer therapeutic approaches, including rib mobilization and diaphragm release techniques, as potential ways to address NSNP and support better outcomes for those affected. PURPOSE: To find out the immediate effects of how (DRT) combined with (RMT) affects the level of pain and the extent to which patients' functional abilities are improved in cases of NSNP. METHODS: For this prospective RCT, 96 participants aged 20 to 45 years were randomly assigned to one of three equal groups based on their pain score (VAS). Group B engaged in (DRT) for 40 minutes, three times weekly for 8 weeks, in contrast to Group A, which got both RMT combined with DRT. Group C (active control) received advice and some exercises. Measurements were collected before and after the intervention; the primary outcomes included pain severity, evaluated using a visual analog scale (VAS); active neck range of motion (ROM), measured with a cervical range of motion (CROM) device; and neck flexion endurance. Additionally, the secondary outcome of neck-related disability was assessed using the Neck Disability Index (NDI). RESULTS: No statistically significant difference was identified among the three groups at baseline; nevertheless, a treatment effect emerged after 8 weeks (p = 0.001 and f-value = 4.15, ƞ2 = 0.306). A statistically significant time-treatment interaction was seen when comparing the pre- and post-treatment periods in groups A and B (p = 0.001, f-value = 3.16, ƞ2 = 0.251). CONCLUSION: The addition of rib mobilization to diaphragm release techniques in patients with non-specific neck pain resulted in statistically significant improvements in pain intensity, cervical flexion, right lateral rotation, left lateral rotation, right rotation, and neck flexor endurance, with moderate to large effect sizes for pain reduction and cervical motion. However, no statistically significant differences were observed between groups for cervical extension, left rotation, or the Neck Disability Index (NDI), and only a marginal clinical improvement in NDI was noted in Group A. The observed benefits in the combined intervention group may not be attributable solely to rib mobilization. The increased treatment complexity and greater therapist interaction inherent in the combined approach could also have influenced the outcomes. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT07133646.
Physiotherapy research international : the journal for researchers and clinicians in physical therapyEllen Cristine Ferreira da Silva, Wenderson de Souza Morais, Rodrigo Luiz Carregaro, Patricia Azevedo Garcia, Josevan Cerqueira Leal, Felipe Augusto Dos Santos…
BACKGROUND AND PURPOSE: Cognitive impairment manifests early in Parkinson's disease (PD), adversely affecting patients' daily activities and mental health. Utilizing exergames via the Xbox 360 Kinect (XBK) console presents a promising therapeutic avenue to mitigate cognitive decline in PD. This study aimed to assess the efficacy of the XBK system in enhancing cognitive performance and reducing anxiety levels among individuals with PD. METHOD: A non-randomized controlled trial, controlled, single-blind clinical trial was conducted. Forty-three PD participants were selected through convenience sampling and non-randomly assigned to either the XBK experimental group (n = 23) or the Control Group (n = 23). Participants underwent pre, post, and 30-day post-intervention evaluations using the Digit Span Tests, Semantics, Verbal Fluency Test, and Beck Anxiety Inventory. The control group received no intervention, while the experimental group underwent 10 sessions employing four XBK games. This study was approved by the Institutional Ethics Committee of the University of Brasília (Approval No. 2.109.826). Analysis of variance (ANOVA 2 × 3) with Sidak post hoc test and Bonferroni correction was utilized to examine intergroup outcomes. RESULTS: The XBK-trained group exhibited enhancements in short-term memory post-intervention (p = 0.04) and at follow-up (p = 0.01), as well as operational memory post-intervention (p = 0.006) and at follow-up (p = 0.001), although without significant between-group differences. Although no significant interaction effect was observed (p = 0.126), a reduction in anxiety levels was verified up to 30 days post-training (p = 0.03), exclusively within the XBK group, accompanied by a significant between-group difference (p = 0.01), also in follow-up. DISCUSSION: Although the intervention did not demonstrate a superior effect compared with the control group, our findings suggest that training with the Xbox 360 Kinect may have the potential to reduce anxiety in individuals with Parkinson's disease. Further research through randomized clinical trials is necessary to validate these findings and evaluate the long-term benefits of this intervention. TRAIL REGISTRATION: University of Brasília, CAAE: 12248513.9.0000.0030. N°: 2.109.826 https://ensaiosclinicos.gov.br/rg/RBR-7h6b8mg.
Physiotherapy research international : the journal for researchers and clinicians in physical therapyKim Michéle Feder, Lonny Stokholm, Hans Bjarke Rahr, Kim Gordon Ingwersen, Marianne Djernes Lautrup
BACKGROUND: Breast cancer survival has improved substantially, yet many women continue to experience late effects that may require physiotherapy. Shoulder impairment, lymphedema, and fatigue are among the most common physiotherapy-relevant late effects following primary breast cancer treatment. Understanding how guideline treatments for breast cancer influence these impairments is essential for the early identification of high-risk patients and the development of targeted rehabilitation strategies. PURPOSE: To investigate the association between Danish guideline treatments for breast cancer and the risk of three physiotherapy-relevant self-reported late effect dimensions 3-7 years postoperatively. METHODS: National cohort study of 5729 women who underwent surgical treatment for primary breast cancer between 2015 and 2019. Participants completed a questionnaire 3-7 years postoperatively addressing shoulder impairment, lymphedema, and fatigue. Treatment codes were extracted from the Danish National Patient Registry and categorized according to Danish guideline regimens for surgery and radiotherapy. Logistic regression analyses, adjusted for relevant confounders, were performed to estimate associations, and absolute risks were calculated. RESULTS: Compared with breast-conserving surgery (BCS) and sentinel lymph node biopsy (SLNB) with radiotherapy, treatment combinations involving mastectomy or axillary lymph node dissection (ALND) with radiotherapy were associated with approximately threefold higher odds of self-reported late effects. The highest risk was observed after mastectomy and SLNB with radiotherapy (ORadj 3.10, 95% CI 2.48-3.88), followed by mastectomy with ALND and radiotherapy (ORadj 2.90, 95% CI 2.02-4.15) and BCS with ALND and radiotherapy (ORadj 2.76, 95% CI 2.25-3.39). Shoulder impairment was consistently the most frequent self-reported late effect across all treatment types. DISCUSSION: Guideline treatments involving mastectomy, and/or ALND in combination with radiotherapy substantially increased the risk of self-reported late effects, particularly shoulder impairment. These findings highlight the need for early targeted physiotherapy interventions and improved detection strategies to mitigate late effects in breast cancer survivors.
Physiotherapy research international : the journal for researchers and clinicians in physical therapyTsung-Hsien Wang, Ying-Po Hsu, Cheng-Shin Tsai
BACKGROUND AND PURPOSE: Prolonged weaning-characterized by failure in three consecutive spontaneous breathing trials (SBTs) and requiring over 7 days of mechanical ventilation post-initial SBT-presents a critical clinical challenge often exacerbated by intensive care unit-acquired weakness (ICU-AW) and impaired airway clearance. Mobilization and chest physiotherapy (CPT) are promising therapeutic strategies. This study evaluated the association between a combined mobilization and CPT protocol and weaning outcomes in subjects requiring prolonged mechanical ventilation using a retrospective historical control design. METHODS: This retrospective cohort study analyzed 202 subjects who need a requirement for prolonged mechanical ventilation exceeding 21 days admitted to Respiratory Care Center (RCC). Outcomes were compared between a historical control cohort (2018/01/01-2020/01/01; n = 100), which received standard medical care without mobilization or CPT, and an intervention cohort (2020/01/01-2022/03/01; n = 102), which received the combined protocol. The primary outcome was occurrence of weaning failure; the secondary outcome was RCC mortality occurrence. Multivariable logistic regression was performed to determine independent predictors of weaning failure occurrence. RESULTS: Multivariable logistic regression demonstrated that receiving mobilization and CPT was independently associated with lower weaning failure occurrence (OR 0.22, 95% CI [0.10, 0.49], p < 0.001), and Acute Physiology and Chronic Health Evaluation II (OR 1.08, 95% CI [1.01, 1.15], p = 0.018) were also associated with higher weaning occurrence, whereas age (OR 1.02, 95% CI [0.99, 1.02], p = 0.174) and GCS (OR 1.03, 95% CI [0.95, 1.11], p = 0.442) were not. No significant difference was detected in RCC mortality occurrence with non-adjusted comparison (OR 1.58, 95% CI [0.54-4.63], p = 0.398). DISCUSSION: Receiving mobilization and CPT was independently associated with lower odds of weaning failure occurrence in RCC, likely due to improved pulmonary hygiene and reduced ICU-acquired weakness. RCC mortality occurrence did not differ between groups, supporting safety.
Physiotherapy research international : the journal for researchers and clinicians in physical therapyAlice Jugand, Maxi Miciak, Parker Lay, Michael H Bernstein, Leo Druart
BACKGROUND AND PURPOSE: Therapeutic alliance (TA) refers to mutuality and congruence concerning the bonds, goals, and tasks shared between the physiotherapist and patient. It relies on positive connections through partnership, communication, empathy, and mutual respect. TA is recognized as a central factor in the success of rehabilitation; however, most research remains rooted in psychological frameworks. In physiotherapy, the use of touch or physical activity creates unique relational dynamics that have not been studied in the French healthcare context. Thus, this study aims to identify and describe the characteristics of the TA in French physiotherapy. METHODS: A qualitative interpretive description design was chosen for its flexible, practice-oriented approach suitable for exploring complex clinical phenomena. Inductive analysis allowed themes to emerge from participants' experiences without a preconceived framework. Individual semi-structured interviews were conducted with private practice musculoskeletal physiotherapists and rehabilitation patients. Interview transcripts were analyzed using inductive thematic analysis to identify key themes. Rigor was enhanced through reflexive journaling, peer debriefing, and an audit trail. RESULTS: Thirteen interviews were completed. Three main themes were identified-"foster trust," "find meaning and collaborate," and "weigh going the extra mile and boundaries"-all encompassed by an overarching theme of creating a climate of safety. In addition to common TA qualities, physiotherapy-specific factors emerged: centrality of the body in care, frequent appointments, informal interactions, and social support. French contextual factors were also noted, such as extended patient contact time and the physician's influential role. DISCUSSION: The resulting framework supports reflection on relational practices and deepens understanding of the TA in physiotherapy in relation to other disciplines such as psychotherapy or cultural contexts.
INTRODUCTION: There is an increase in the number of graduates entering the occupational therapy workforce with graduates having to navigate both broader systemic influences and personal preferences in their decision-making process. This study investigated how and why occupational therapy graduates from a regional Australian university selected their first job as practising occupational therapists. METHODS: An online exploratory, cross-sectional survey design was utilised to collect quantitative and qualitative data from new graduate occupational therapists. Descriptive statistics were used to analyse quantitative responses. Free-text responses were interpreted using reflexive thematic analysis. CONSUMER AND COMMUNITY INVOLVEMENT: There was no consumer or community involvement. RESULTS: A total of 30 new graduate occupational therapists completed the survey. The most commonly reported practice areas of work were disability, health and aged care. The most commonly reported practice settings were community, clinic and hospital. Participants rated work-life balance, professional development opportunities and interpersonal relationships as the most important factors that are considered when seeking their first job. Proactive and multifaceted processes, combining practical job-seeking strategies, reflective decision-making and the use of professional networks, were used to navigate the employment process. CONCLUSIONS: Job selection was influenced more by relational, developmental and lifestyle workplace factors than by specific practice settings. Understanding these factors is important for informing occupational therapy education and recruitment strategies.
INTRODUCTION: Chronic pain is a biopsychosocial experience that can impact peoples' ability to participate in everyday occupations. Mobile health applications, or apps, have the potential to make chronic pain services more effective and accessible. However, the quality of many health apps is not known, which creates a critical challenge for occupational therapists who aim to deliver evidence-informed intervention. This study rated the quality of apps available for Australian occupational therapists to use with clients who have chronic pain. CONSUMER AND COMMUNITY INVOLVEMENT: No consumer and community involvement. METHODS: This study used a cross-sectional descriptive design to (1) identify chronic pain-relevant apps through browser and app store searches, and through a survey of Australian occupational therapists; and (2) evaluate the quality of the apps relevant to occupational therapy practice, at a single point in time, using the Mobile Application Rating Scale. RESULTS: A total of 27 eligible apps were identified (n = 27). The 27 apps were rated for quality. The mean Objective Quality score of all apps was 3.33/5.00 (acceptable), with a range of 2.14 (poor) to 4.13 (good). The mean Objective Subsection Quality scores were 3.88 (acceptable) for Functionality, 3.25 (acceptable) for Aesthetics, 3.23 (acceptable) for Information, and 2.96 (poor) for Engagement. The mean Subjective Quality score of all apps was 2.67 (poor), with a range of 1.00 (inadequate) to 4.25 (good). CONCLUSION: There was no consistent standard to the quality of chronic pain-relevant apps identified. Occupational therapists may not be identifying all high-quality chronic pain-relevant apps currently available. Findings highlight that occupational therapists lack access to an easy method to identify and verify high-quality apps for use with clients who have chronic pain. Further work is needed to ensure occupational therapists can identify and evaluate the quality of chronic pain-relevant apps in a rapidly changing field of practice.
Physiotherapy research international : the journal for researchers and clinicians in physical therapyAliaa M Elabd, Yara N Marwan, Omar M Elabd, Waleed T Mansour, Doaa A Elimy, Zeinab A Ali, Engy B Moustafa, Nesma M Allam, Kerolous I Kelini
BACKGROUND AND PURPOSE: Neck pain is prevalent in postpartum women due to postural stress and muscle dysfunction. Although postural correction exercises are widely used, adding manual therapy techniques such as positional release and Tui-Na may enhance outcomes. However, comparative evidence, particularly using surface electromyography (sEMG), remains limited. This study examined the effects of Tui-Na (TN) versus positional release techniques (PRT) added to postural correction exercises (PCEs) on postpartum neck pain. METHODS: Sixty women with postpartum neck pain were randomly assigned to three groups for 4 weeks of prescribed treatment. Group A (control) received PCEs, while either PRT or Tui-Na were added to PCEs for Groups B and C, respectively. The primary outcome was neck pain intensity measured by the Visual Analogue Scale (VAS). Secondary outcomes included the Neck Disability Index (NDI) and upper trapezius electromyographic characteristics (normalized root mean square [RMS] and median frequency [MDF]). A two-way repeated-measures MANOVA was used for statistical analysis. RESULTS: Significant multivariate effects were observed for group effects (F = 4.798, p < 0.001, partial η2 = 0.147), time (F = 851.51, p < 0.001, partial η2 = 0.968), and group-by-time interaction (F = 3.87, p < 0.001, partial η2 = 0.122). Pain intensity was significantly reduced in both groups B (p = 0.035) and C (p = 0.003) when compared to group A. UT-MDF was significantly increased in group C when compared to groups A (p < 0.001) or B (p = 0.02). All groups demonstrated significant within-group improvements in all outcome measures. DISCUSSION: Both Tui-Na and PRT combined with PCEs improved pain and disability in postpartum women with neck pain. Compared with PRT, Tui-Na demonstrated greater improvements in pain intensity and upper trapezius EMG frequency characteristics. However, these findings should be interpreted cautiously because of the short intervention period and lack of long-term follow-up. TRIAL REGISTRATION: NCT07261605.
Swiss dental journalAugusto José Alves, Camila das Virgens Braz, Eriston Lorran da Silva Mourão, Julio Eustáquio Melo Oliveira, Nathan Rodrigues Souza, Paula Cristina Pelli Paiva,…
Temporomandibular disorders (TMDs) are among the most common causes of chronic orofacial pain. Although photobiomodulation therapy (PBMT), traditionally referred to as low-level laser therapy (LLLT), and transcutaneous electrical nerve stimulation (TENS) are widely used conservative modalities, their comparative efficacy remains uncertain due to inconsistent evidence. This systematic review compared the efficacy of both therapies and critically appraised the reporting quality and selected methodological characteristics of the included clinical studies. A systematic review was conducted in accordance with PRISMA guidelines, with the protocol registered in PROSPERO. Clinical trials comparing TENS and PBMT were searched in Medline, Web of Science, Scopus, Cochrane, and Embase databases using the descriptors "low-level laser therapy," "photobiomodulation," "transcutaneous electrical nerve stimulation," and "temporomandibular joint disorders," without restrictions on publication year or language. The reporting quality and selected methodological characteristics of the included studies were critically appraised using a CONSORT-based assessment framework. A total of 402 records were identified, of which 14 met the inclusion criteria, comprising 620 patients with joint pain, muscle pain, and/or disc displacement. A greater number of included studies reported numerically larger improvements in pain relief and maximum jaw opening following PBMT than TENS. However, twelve of the fourteen included studies were classified as Level III, indicating limited reporting quality according to the adapted CONSORT-based methodological appraisal framework. Substantial heterogeneity in diagnostic characteristics, treatment protocols, and outcome assessment limited direct comparisons between interventions. Overall, the available evidence suggests that both PBMT and TENS may improve pain and mandibular function in patients with temporomandibular disorders. However, these findings should be interpreted cautiously, as the absence of quantitative synthesis and the substantial clinical and methodological heterogeneity preclude definitive conclusions regarding the comparative efficacy or superiority of either modality.
Pakistan journal of pharmaceutical sciencesJiali Lou, Guoli Zhang, Wei Zhang, Ling Ye
BACKGROUND: Sudden sensorineural hearing loss (SSNHL) is a medical emergency that can significantly impact patients' quality of life, often accompanied by anxiety and depression. Although pharmacotherapy is a common treatment, its effectiveness in improving both auditory and psychological outcomes remains limited. Acupuncture, especially electroacupuncture (EA), has shown potential in treating SSNHL and related affective disorders, but its adjunctive role with pharmacotherapy needs further investigation. OBJECTIVES: This randomized controlled trial aimed to evaluate the incremental benefits of adding EA to standard pharmacotherapy on audiological and psychological outcomes in patients with SSNHL accompanied by anxiety or depression. METHODS: A randomized controlled trial was conducted involving 78 SSNHL patients, divided equally into two groups: P group (n=39) and EA+P group (n=39). The EA+P group received additional EA therapy for 7 days besides the pharmacological treatments. Baseline demographics, pure tone audiometric thresholds (0.25, 0.5, 1, 2, 4, 8 kHz) and psychological scores (HAMD, HAMA) were recorded. Pre-treatment and post-treatment assessments were performed to evaluate changes in hearing thresholds and mental health outcomes. RESULTS: The EA+P group showed significant improvements at all frequencies (p < 0.001). Hearing gain was significantly greater in the EA+P group across all frequencies (p ≤ 0.044). Besides, the EA+P group demonstrated significant reductions in HAMD and HAMA scores (p < 0.001), whereas the P group showed no significant changes (p ≥ 0.051). CONCLUSIONS: Combined EA+P therapy significantly improves hearing recovery and reduces psychological symptom in SSNHL patients with anxiety and depression compared to drug treatment alone. This suggests a synergistic benefit of integrating acupuncture with conventional treatment.
Australian occupational therapy journalClare Stephenson, Sophia Hadjimichael, Kasia Bail, Diane Gibson, Stephen Isbel, Michelle Bennett, Nathan M D'Cunha
INTRODUCTION: There is limited availability of community-based rehabilitation for people with dementia. This study explored stakeholder perspectives to inform the design of an occupational therapy-led at-home dementia rehabilitation programme. METHODS: Four co-design workshops were conducted over 6 months with 16 participants, including people with dementia, care partners and health-care professionals. Transcribed workshop discussions underwent iterative thematic analysis to inform the final intervention components and philosophical foundations. CONSUMER AND COMMUNITY INVOLVEMENT: People with dementia and their care partners discussed what an at-home dementia rehabilitation programme should entail. As consumer and community contributors, they informed programme refinements by shaping decisions about intervention content at each workshop. FINDINGS: Four themes underpinned the intervention components and philosophical foundations for the programme: (1) accessible dementia care, driven by increased community awareness; (2) person-centred care: understanding a person's unique needs, preferences and goals; (3) empowerment through community engagement and continuous support; and (4) coordinated multidisciplinary care, essential for continuity and effectiveness. Person-centred care requires tailoring individual goals within a multidisciplinary structure, with allied health assistant intervention delivery and personalised resources prepared with oversight from the occupational therapist. Stakeholders endorsed programme leadership by occupational therapists, with physiotherapy support where mobility or exercise components were required and delivery by allied health assistants under clinical supervision. CONCLUSION: Codesign workshops defined an at-home dementia rehabilitation intervention founded on occupational therapy philosophies of care, with accessibility, empowerment and a comprehensive referral and intake process as central to individualisation. Assessing the programme's feasibility and effectiveness may enable personalised care that helps people with dementia maintain independence at home. Allied health assistants may offer a cost-effective option, improving access to rehabilitation for people with dementia, as with other chronic conditions.
Physiotherapy research international : the journal for researchers and clinicians in physical therapyShashwath P Naidu, Anjali Suresh, Sarulatha Haridass, Karvannan Harikesavan
BACKGROUND AND PURPOSE: Current guidelines for the management of lumbar radiculopathy recommend patient education, staying active, manual therapy, and nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line treatments. Physiotherapy-specific interventions for low back pain that radiates to the leg include specific trunk muscle activation, muscle strengthening and endurance, movement control, centralisation, directional preference exercises and nerve mobilisation. While exercise therapy is widely recognised as an effective non-invasive intervention, there is currently limited evidence for a standardised framework that integrates different evidence-based exercise approaches and clinical expertise into a structured, practically applicable protocol. The purpose of this study was to develop and content-validate a structured, evidence-based exercise framework for the physiotherapy management of lumbar radiculopathy. METHODS: A comprehensive review of the literature supplemented by expert input with at least 10 years of experience was conducted to identify commonly prescribed exercise interventions for lumbar radiculopathy. Based on the identified impairments and functional deficits associated with the condition, an initial draft framework, which included trunk stabilization, mobility and flexibility training, was constructed. The draft framework was then subjected to expert validation using the content validity index (CVI) and modified kappa to confirm the relevance and perceived ease of performance of exercise by 10 physiotherapists. RESULTS: The 4-stage exercise framework demonstrated excellent agreement with high CVI (100%-90%) and modified kappa (1-0.90). While some exercises of phase 2 and phase 3 were considered slightly difficult to perform, they were relevant for the condition. DISCUSSION: The developed exercise framework exhibited excellent content validity, supporting its relevance and perceived ease of performance in physiotherapy practice for managing patients with lumbar radiculopathy.
Physiotherapy research international : the journal for researchers and clinicians in physical therapyLaura Hoffmann, Carole Geimer, Gudrun Diermayr, Markus Reindl, Mike C Horton, Barbara Seebacher
BACKGROUND AND PURPOSE: Therapeutic alliance (TA)-the collaborative therapist-client partnership-is pivotal to outcomes, yet TA tools tailored to telerehabilitation are limited. We developed and preliminarily validated a therapist-reported measure for physiotherapists (PTs), occupational therapists (OTs), and speech and language therapists (SLTs): the Working Alliance Inventory-Telerehabilitation (WAI-Tele-Reha-G). METHODS: Items drew on expert interviews, adaptation guidelines, and the German WAI-Short Revised (therapist version) and were refined via cognitive interviews (n = 9) and pilot testing (n = 34). Validation involved German-speaking PTs, OTs, and SLTs (test: n = 128; retest: n = 84). Rasch partial credit modelling assessed model fit, unidimensionality, local independence, threshold ordering, and differential item functioning (DIF). Reliability (Cronbach's alpha, Person Separation Index [PSI]), test-retest reliability (Lin's concordance correlation coefficient [CCC]), convergent validity (with the Unified Theory of Acceptance and Use of Technology-2 Questionnaire [UTAUT-2], Technology Commitment-Short Scale, 5-item Revised Vocational Self-Efficacy Scale), known-groups validity, and targeting were evaluated. RESULTS: Goal, task and bond scales generally fit the Rasch model and were unidimensional with ordered thresholds; no DIF was detected in this sample. Minor local dependence in the task scale was handled via a superitem during Rasch estimation; scoring remained at the item level. Internal consistency was good (alpha = 0.80-0.81) and PSI modest (0.72-0.74). Test-retest reliability was excellent (CCC = 0.81-0.93). Correlations among goal, task, and bond were moderate-to-strong; correlations with technology acceptance/commitment and vocational self-efficacy were low-to-moderate, as hypothesised. Ceiling effects were < 15%, with targeting skewed towards higher TA levels. DISCUSSION: The WAI-Tele-Reha-G shows preliminary evidence of satisfactory psychometric properties for a therapist-reported assessment of TA in telerehabilitation. Interpretation should consider the modest sample, therapist-only perspective, targeting skew, and Rasch adjustments. Future work should add more challenging items to improve discrimination at high TA levels and develop a patient-reported version to capture the dyadic nature of TA.
Geriatrics & gerontology internationalBruno Costa Poltronieri, Cíntia Monteiro Carvalho, Karin Reuwsaat, Maria Eduarda Alves Reis, Ana Carolina Madeira, Thayná de Carvalho Freire, Rogerio Panizzutti
BACKGROUND: This study aimed to investigate whether a higher cumulative dose of digital cognitive training leads to greater and more sustained improvements in cognition and functionality among older adults with Mild Neurocognitive Disorder. METHODS: We recruited participants aged 60 or older with mild neurocognitive disorder to a double-blinded, randomized, stepped wedge clinical trial of digital cognitive training (DCT) compared to an active control group of commercial computer games. Participants were evaluated for functionality and cognition before, after 10 h and 20 h of intervention and in the follow-up. RESULTS: Sixty-seven participants completed DCT and were evaluated. The group that received 20 h of DCT showed significant improvements in functionality and satisfaction, as well as gains in processing speed, verbal fluency, and inhibitory control. The 10 h group also showed improvements in specific areas such as processing speed and recognition. In the 20 h group, the benefits were maintained at 3- and 6-month follow-ups, especially in functionality. DISCUSSION: This study suggests that a higher cumulative dose of DCT may lead to more sustained improvements in functionality performance among older adults with mild neurocognitive disorder. Findings highlight the need for further research to determine optimal training dosage for long-term improvements in cognition and functionality. TRIAL REGISTRATION: The studies reported in the manuscript were pre-registered at ClinicalTrials.gov under the identifier NCT03911765.
Physiotherapy research international : the journal for researchers and clinicians in physical therapyNeha Thakare, Manish Prannath Shukla, Vaibhav Kapre
BACKGROUND & PURPOSE: Patients with diabetes mellitus undergoing coronary artery bypass grafting (CABG) with saphenous vein harvesting are at increased risk of impaired lower extremity perfusion and wound-related complications. Buerger-Allen exercises have been proposed to improve peripheral circulation; however, evidence supporting their effectiveness following CABG remains limited. This study evaluated the effect of Buerger-Allen exercises as an adjunct to phase I cardiac rehabilitation on lower extremity perfusion and wound healing in diabetic patients undergoing CABG. METHODS: A randomized controlled trial was conducted involving 60 diabetic patients undergoing CABG with saphenous vein harvesting. Participants were randomly allocated to an intervention group receiving standard phase I cardiac rehabilitation plus Buerger-Allen exercises (n = 30) or a control group receiving standard rehabilitation alone (n = 30). The primary outcome was ankle-brachial index (ABI). Secondary outcomes included wound healing disturbances and peripheral ankle swelling. Postoperative ABI was analyzed using two-way repeated-measures ANOVA, whereas categorical outcomes were analyzed using Fisher's exact test or the Chi-squared test. RESULTS: A significant effect of time on ABI was observed (p = 0.004), whereas neither the group effect (p = 0.754) nor the group × time interaction (p = 0.711) was statistically significant. An earlier resolution of mild wound-related pain was observed on postoperative day 3 in the intervention group (p = 0.038); however, no between-group differences were present on postoperative day 5. No intervention-related adverse events were reported. DISCUSSION: Buerger-Allen exercises were safe and feasible during early postoperative rehabilitation but did not provide additional improvement in lower extremity perfusion beyond standard rehabilitation during the 5-day postoperative period. The isolated improvement in wound-related pain should be interpreted cautiously. CONCLUSION: Buerger-Allen exercises did not significantly improve the primary outcome of lower extremity perfusion following CABG. Although they appeared safe and were associated with transient improvement in wound-related pain, further adequately powered studies with longer follow-up are required to determine whether clinically meaningful benefits exist. TRIAL REGISTRATION: This study was prospectively registered in the Clinical Trial Registry India (CTRI/2023/10/058535).
Physiotherapy research international : the journal for researchers and clinicians in physical therapyHeba Saeid Mohamed, Omaima M Ali Kattabei, Hassan Hussein Ahmed, Heba M Elfeky, Rania Reda Mohamed
BACKGROUND AND PURPOSE: This study investigated the effect of Global Postural Re-Education (GPR) versus conventional physical therapy in text neck syndrome (TNS). A prospective, single-blinded, parallel-group randomized controlled trial design was used. METHODS: Sixty participants with TNS (aged 18-40 years) were randomly assigned to either conventional treatment or GPR plus conventional treatment. Both groups received supervised therapy for three sessions per week over 4 weeks. Outcome measures included craniovertebral and shoulder angles assessed by photogrammetry, pain intensity via Visual Analog Scale, and Cervical Range of Motion via a smartphone application (Clinometer). Measured before and after the intervention. RESULTS: Within-group analyses showed significant improvements in pain and CROM in both groups (p < 0.001). However, the between-group analysis revealed no superiority of GPR for pain or CROM (p > 0.05). In contrast, GPR demonstrated statistically significant superiority in postural correction, with greater improvements in craniovertebral angle (MD: 2.14°; 95% CI: 0.69-3.59; p = 0.005) and shoulder angle (MD: 3.2°; 95% CI: 0.33-6.07; p = 0.03), exceeding MCID thresholds and indicating clinically meaningful benefits. However, these findings should be interpreted with caution because of the longer session duration in the GPR group. DISCUSSION: Incorporating Global Postural Reeducation (GPR) into conventional treatment provided significant additional benefits for postural parameters (craniovertebral and shoulder angles) in individuals with text neck syndrome. However, GPR demonstrated no added superiority over conventional treatment alone regarding pain intensity and cervical range of motion outcomes.
Physiotherapy research international : the journal for researchers and clinicians in physical therapyNafisa Sarfaraz, Kalpana Zutshi, Ifra Aman, Heba Parwaiz
BACKGROUND: Hamstring flexibility can potentially affect the mobility and function of remote musculoskeletal areas, including the cervical spine and temporomandibular joint (TMJ), thereby increasing tension along the myofascial chain and potentially reducing mouth opening, contributing to orofacial discomfort. This review aims to inform clinical practice by exploring the integrated impact of these interventions within the framework of neuro-myofascial connectivity. METHODS: A comprehensive search was performed across PubMed, Scopus, Web of Science, and PEDro databases spanning the period from the year 2006-2025, restricted to studies published in the English language. Keywords and MeSH terms corresponding to hamstring stretching, mouth opening and Temporomandibular Joint (TMJ) mobility were used incorporating Boolean operators. Randomized control trials and experimental studies investigating acute or short term effects of hamstring stretching on Temporomandibular Joint (TMJ) pain and mouth opening were included. RESULTS: The preliminary results indicate that hamstring stretching can result in temporary improvements in pressure pain threshold and mouth opening; however, the results should be interpreted with caution and the number of the RCTs is small and heterogeneous. CONCLUSION: The findings support the possibility of myofascial and neural interconnections between the posterior chain and masticatory system; however, the current evidence is insufficient to establish definitive mechanistic conclusions. TRIAL REGISTRATION: PROSPERO number: CRD420251173297.