Showing papers in "Physical Therapy in 2020"

COVID-19 and the Advancement of Digital Physical Therapist Practice and Telehealth.

Abstract: CO RR EC TE D MA NU SC RI PT TITLE: COVID-19 and the Advancement of Digital Physical Therapist Practice and Telehealth Alan Lee, on behalf of the Digital Physical Therapy Practice Task Force of the World Confederation for Physical Therapy and the International Network of Physiotherapy Regulatory Authorities RUNNING HEAD: COVID-19 and Digital PT Practice and Telehealth TOC CATEGORY: COVID-19 ARTICLE TYPE: Point of View

Aerobic Exercise Recommendations to Optimize Best Practices in Care After Stroke: AEROBICS 2019 Update.

Abstract: Most stroke survivors have very low levels of cardiovascular fitness, which limits mobility and leads to further physical deconditioning, increased sedentary behavior, and heightened risk of recurrent stroke. Although clinical guidelines recommend that aerobic exercise be a part of routine stroke rehabilitation, clinical uptake has been suboptimal. In 2013, an international group of stroke rehabilitation experts developed a user-friendly set of recommendations to guide screening and prescription-the Aerobic Exercise Recommendations to Optimize Best Practices in Care after Stroke (AEROBICS 2013). The objective of this project was to update AEROBICS 2013 using the highest quality of evidence currently available. The first step was to conduct a comprehensive review of literature from 2012 to 2018 related to aerobic exercise poststroke. A working group of the original consensus panel members drafted revisions based on synthesis. An iterative process was used to achieve agreement among all panel members. Final revisions included: (1) addition of 115 new references to replace or augment those in the original AEROBICS document, (2) rewording of the original recommendations and supporting material, and (3) addition of 2 new recommendations regarding prescription. The quality of evidence from which these recommendations were derived ranged from low to high. The AEROBICS 2019 Update should make it easier for clinicians to screen for, and prescribe, aerobic exercise in stroke rehabilitation. Clinical implementation will not only help to narrow the gap between evidence and practice but also reduce current variability and uncertainty regarding the role of aerobic exercise in recovery after stroke.

Telerehabilitation in the Age of COVID-19: An Opportunity for Learning Health System Research.

Abstract: T he COVID-19 pandemic has impacted all aspects of health care delivery. To protect health care workers and patients across the country from the risk of disease transmission, rules, regulations and reimbursement policies were altered to enable widespread use of telecommunications technology in lieu of in-person clinical visits. As a result, the delivery of rehabilitation in many settings was drastically and suddenly altered with physical therapists utilizing telehealth modalities in new ways and with new populations. The shift to telerehabilitation provides a tremendous learning opportunity. This point of view provides an overview of how a learning health care system (LHS) approach to the study of telerehabilitation can promote innovation in optimal health care delivery and fuel new scientific discovery.

Is Motor Impairment in Autism Spectrum Disorder Distinct From Developmental Coordination Disorder? A Report From the SPARK Study.

Abstract: Background Motor impairments are pervasive in Autism Spectrum Disorder (ASD); however, children with ASD rarely receive a dual diagnosis of Developmental Coordination Disorder (DCD). The Simons Foundation SPARK study engaged families affected by ASD through an online study. Objectives The DCD parent questionnaire (DCDQ) was used to assess the prevalence of a risk for motor impairment or DCD in children with ASD between 5 and 15 years of age. Design This study utilizes parent reports from a large database of children with ASD. Methods A total of 16,705 parents of children with ASD completed the DCDQ. We obtained our final SPARK dataset (n = 11,814) after filtering out invalid data, using stronger cut-offs to confirm ASD traits, and excluding children with general neuromotor impairments/intellectual delays. We compared DCDQ total and subscale scores from the SPARK dataset with published norms for each age between 5 and 15 years. Results The proportion of children with ASD at risk for a motor impairment was very high at 86.9%. Children with ASD did not outgrow their motor impairments and continued to present with a risk for DCD even into adolescence. Yet, only 31.6% of children were receiving physical therapy services. Limitations Our analysis of a large database of parent-reported outcomes using the DCDQ did not involve follow-up clinical assessments. Conclusions Using a large sample of children with ASD, this study shows that a risk for motor impairment or DCD was present in most children with ASD and persists into adolescence; however, only a small proportion of children with ASD were receiving physical therapist interventions. A diagnosis of ASD must trigger motor screening, evaluations, and appropriate interventions by physical and occupational therapists to address the functional impairments of children with ASD while also positively impacting their social communication, cognition, and behavior. Using valid motor measures, future research must determine if motor impairment is a fundamental feature of ASD.

Systematic Review of Changes and Recovery in Physical Function and Fitness After Severe Acute Respiratory Syndrome-Related Coronavirus Infection: Implications for COVID-19 Rehabilitation.

Abstract: Objective This review sought to (1) compare physical function and fitness outcomes in people infected with Severe Acute Respiratory Syndrome-related Coronavirus (SARS-CoV) with healthy controls, (2) quantify the recovery of physical function and fitness following SARS-CoV infection, and (3) determine the effects of exercise following SARS-CoV infection. Methods Four databases (CINAHL, MEDLINE, ProQuest, and Web of Science Core Collections) were searched in April 2020 using keywords relating to SARS-CoV, physical function, fitness, and exercise. Observational studies or randomized controlled trials were included if they involved people following SARS-CoV infection and either assessed the change or recovery in physical function/fitness or evaluated the effects exercise postinfection. Results A total 10 articles were included in this review. Evidence from 9 articles demonstrated that SARS-CoV patients had reduced levels of physical function and fitness postinfection compared with healthy controls. Furthermore, patients demonstrated incomplete recovery of physical function, with some experiencing residual impairments 1 to 2 years postinfection. Evidence from 1 randomized controlled trial found that a combined aerobic and resistance training intervention significantly improved physical function and fitness postinfection compared with a control group. Conclusions Physical function and fitness are impaired following SARS-CoV infection, and impairments may persist up to 1 to 2 years postinfection. Researchers and clinicians can use these findings to understand the potential impairments and rehabilitation needs of people recovering from the current coronavirus 2019 (COVID-19) outbreak. While 1 study demonstrated that exercise can improve physical function and fitness postinfection, further research is required to determine the effectiveness of exercise in people recovering from similar infections (eg, COVID-19). Impact Considering the similarities in pathology and clinical presentation of SARS-CoV and COVID-19, it is likely that COVID-19 patients will present with similar impairments to physical function. Accordingly, research is required to measure the extent of functional impairments in COVID-19 cohorts. In addition, research should evaluate whether rehabilitation interventions such as exercise can promote postinfection recovery.

Recommendations for Hospital-Based Physical Therapists Managing Patients With COVID-19.

Abstract: OBJECTIVE: The COVID-19 pandemic is rapidly evolving and has led to increased numbers of hospitalizations worldwide Hospitalized patients with COVID-19 experience a variety of symptoms, including fever, muscle pain, tiredness, cough, and difficulty breathing Elderly people and those with underlying health conditions are considered to be more at risk of developing severe symptoms and have a higher risk of physical deconditioning during their hospital stay Physical therapists have an important role in supporting hospitalized patients with COVID-19 but also need to be aware of challenges when treating these patients In line with international initiatives, this article aims to provide guidance and detailed recommendations for hospital-based physical therapists managing patients hospitalized with COVID-19 through a national approach in the Netherlands METHODS: A pragmatic approach was used A working group conducted a purposive scan of the literature and drafted initial recommendations based on the knowledge of symptoms in patients with COVID-19 and current practice for physical therapist management for patients hospitalized with lung disease and patients admitted to the intensive care unit An expert group of hospital-based physical therapists in the Netherlands provided feedback on the recommendations, which were finalized when consensus was reached among the members of the working group RESULTS: The recommendations include safety recommendations, treatment recommendations, discharge recommendations, and staffing recommendations Treatment recommendations address 2 phases of hospitalization: when patients are critically ill and admitted to the intensive care unit, and when patients are severely ill and admitted to the COVID ward Physical therapist management for patients hospitalized with COVID-19 comprises elements of respiratory support and active mobilization Respiratory support includes breathing control, thoracic expansion exercises, airway clearance techniques, and respiratory muscle strength training Recommendations toward active mobilization include bed mobility activities, active range-of-motion exercises, active (assisted) limb exercises, activities-of-daily-living training, transfer training, cycle ergometer, pre-gait exercises, and ambulation

Physical Therapist Management of Total Knee Arthroplasty.

Abstract: A clinical practice guideline on total knee arthroplasty was developed by an American Physical Therapy (APTA) volunteer guideline development group that consisted of physical therapists, an orthopedic surgeon, a nurse, and a consumer. The guideline was based on systematic reviews of current scientific and clinical information and accepted approaches to management of total knee arthroplasty.

The Effect of Exercise on Cancer-Related Cognitive Impairment and Applications for Physical Therapy: Systematic Review of Randomized Controlled Trials

Abstract: Background Cancer-related cognitive impairment (CRCI), often called “chemo-brain” or “chemo-fog,” is a common side effect among adults with cancer, which can persist well after treatment completion. Accumulating evidence demonstrates exercise can improve cognitive function in healthy older adults and adults with cognitive impairments, suggesting exercise may play a role in managing CRCI. Purpose The purpose was to perform a systematic review of randomized controlled trials (RCTs) to understand the effect of exercise on CRCI. Data Sources Relevant literature was retrieved from CINAHL, Medline (Ovid), and EMBASE. Study Selection Eligible articles were RCTs that prescribed aerobic, resistance, combined aerobic/resistance, or mind-body (eg, yoga or Qigong) exercise during or following cancer treatment and included cognitive function outcome measures. Data Extraction Descriptive information and Cohen d effect sizes were directly extracted or calculated for included trials. Data Synthesis Twenty-nine trials were included in the final analysis. A statistically significant effect of exercise on self-reported cognitive function, both during and postadjuvant treatment, was reported in 12 trials (41%) (Cohen d range: 0.24–1.14), most commonly using the EORTC QLQ-C30. Ten trials (34%) performed neuropsychological testing to evaluate cognitive function; however, only 3 trials in women with breast cancer reported a significant effect of exercise (Cohen d range: 0.41–1.47). Limitations Few RCTs to date have evaluated the effect of exercise on CRCI as a primary outcome. Twenty-six trials (90%) in this review evaluated CRCI as secondary analyses. Conclusions Evidence supporting exercise as a strategy to address CRCI is limited. Future research evaluating CRCI as a primary outcome, including self-reported and objective measures, is needed to confirm the possible role of exercise in preventing and managing cognitive impairments in adults with cancer.

COVID-19 Pandemic and Beyond: Considerations and Costs of Telehealth Exercise Programs for Older Adults With Functional Impairments Living at Home-Lessons Learned From a Pilot Case Study.

Abstract: Objective The purpose of this study was to describe the process and cost of delivering a physical therapist-guided synchronous telehealth exercise program appropriate for older adults with functional limitations. Such programs may help alleviate some of the detrimental impacts of social distancing and quarantine on older adults at-risk of decline. Methods Data were derived from the feasibility arm of a parent study, which piloted the telehealth program for 36 sessions with 1 participant. The steps involved in each phase (ie, development, delivery) were documented, along with participant and program provider considerations for each step. Time-driven activity-based costing was used to track all costs over the course of the study. Costs were categorized as program development or delivery and estimated per session and per participant. Results A list of the steps and the participant and provider considerations involved in developing and delivering a synchronous telehealth exercise program for older adults with functional impairments was developed. Resources used, fixed and variable costs, per-session cost estimates, and total cost per person were reported. Two potential measures of the "value proposition" of this type of intervention were also reported. Per-session cost of $158 appeared to be a feasible business case, especially if the physical therapist to trained assistant personnel mix could be improved. Conclusions The findings provide insight into the process and costs of developing and delivering telehealth exercise programs for older adults with functional impairments. The information presented may provide a "blue print" for developing and implementing new telehealth programs or for transitioning in-person services to telehealth delivery during periods of social distancing and quarantine. Impact As movement experts, physical therapists are uniquely positioned to play an important role in the current COVID-19 pandemic and to help individuals who are at risk of functional decline during periods of social distancing and quarantine. Lessons learned from this study's experience can provide guidance on the process and cost of developing and delivering a telehealth exercise program for older adults with functional impairments. The findings also can inform new telehealth programs, as well as assist in transitioning in-person care to a telehealth format in response to the COVID-19 pandemic.

Home and Community-Based Physical Therapist Management of Adults With Post-Intensive Care Syndrome.

Abstract: More than 4 million adults survive a stay in the intensive care unit each year, with many experiencing new or worsening physical disability, mental health problems, and/or cognitive impairments, known as post-intensive care syndrome (PICS). Given the prevalence and magnitude of physical impairments after critical illness, many survivors, including those recovering from COVID-19, could benefit from physical therapist services after hospital discharge. However, due to the relatively recent recognition and characterization of PICS, there may be limited awareness and understanding of PICS among physical therapists practicing in home health care and community-based settings. This lack of awareness may lead to inappropriate and/or inadequate rehabilitation service provision. While this perspective article provides information relevant to all physical therapists, it is aimed toward those providing rehabilitation services outside of the acute and postacute inpatient settings. This article reports the prevalence and clinical presentation of PICS and provides recommendations for physical examination and outcomes measures, plan of care, and intervention strategies. The importance of providing patient and family education, coordinating community resources including referring to other health care team members, and community-based rehabilitation service options is emphasized. Finally, this perspective article discusses current challenges for optimizing outcomes for people with PICS and suggests future directions for research and practice.

Interventions for Breast Cancer-Related Lymphedema: Clinical Practice Guideline From the Academy of Oncologic Physical Therapy of APTA.

Abstract: A work group from the American Physical Therapy Association (APTA) Academy of Oncologic Physical Therapy developed a clinical practice guideline to aid clinicians in identifying interventions for people with breast cancer-related lymphedema, targeting volume reduction, beginning at breast cancer diagnosis and continuing through cancer treatments and survivorship Following a systematic review of published studies and a structured appraisal process, recommendations were developed to guide physical therapists and other health care clinicians in their intervention selection Overall, clinical practice recommendations were formulated based on the evidence for each intervention and were assigned a grade based on the strength of the evidence The evidence for each specific intervention was synthesized and appraised by lymphedema stage, when the information was available In an effort to make recommendations clinically applicable, they were presented by modality throughout the care trajectory Methodology and research populations varied significantly across studies, and it will be important for future research to use standardized definitions for participant characteristics, diagnostic criteria, and interventions

Promoting Physical Activity via Telehealth in People With Parkinson Disease: The Path Forward After the COVID-19 Pandemic?

Abstract: Objective There is mounting evidence in support of exercise and physical activity as a first-line approach to managing symptoms and potentially altering disease progression in people with Parkinson disease (PD). For many patients, a critical gap is the need for expert guidance to overcome barriers, set realistic goals, and provide personalized advice to optimize exercise uptake and adherence. The purpose of this case report is to describe a physical activity coaching program (Engage-PD) for individuals newly diagnosed with PD and to highlight rapid modifications made to this program in response to the COVID-19 pandemic. Methods (case description) Engage-PD is a single cohort implementation study of a coaching intervention grounded in self-determination theory being conducted at Columbia University Parkinson's Foundation Center of Excellence in New York City, NY (USA), the early epicenter of the COVID-19 pandemic in the United States. The project was uniquely positioned to be adapted to telehealth delivery and to address an immediate need for support and guidance in the home environment, including people with early-mid-stage PD. Participants completed baseline and follow-up (3 months) assessments and participated in up to 4 coaching sessions, all delivered via a telehealth platform. The intervention incorporated 1:1 coaching, goal-setting, physical activity monitoring, and use of a disease-specific workbook to promote and support safe exercise uptake. Results While the program is ongoing, 52 referrals were received and 27 individuals with PD enrolled in the first 2 months of the pandemic for a recruitment rate of 52%. Although direct comparisons with pre-coronavirus recruitment are difficult due to the recency of the Engage-PD implementation study, this recruitment rate was larger than expected, which may have been due to several factors (eg, most patients had limited, if any, access to in-person programs and therapy services during this time, so the Engage program filled an immediate need to provide exercise and activity guidance). There was a wide range of scores for both baseline physical activity and self-efficacy measures. Conclusion Remotely delivered interventions may serve as a sustainable platform for physical activity coaching programs for people with PD as well as other neurodegenerative diseases. Impact With the uncertainty brought about by the current pandemic, this case report highlights the opportunity to shift the current model of care for individuals with neurodegenerative diseases such as PD.

Doctor of Physical Therapy Education in a Hybrid Learning Environment: Reimagining the Possibilities and Navigating a "New Normal".

Abstract: Professional physical therapist education has experienced a transformation over the last few decades, moving to a doctoring profession with more autonomy and a broader scope of practice. These changes have occurred in parallel with systemic and structural changes in health care and higher education, both of which have experienced challenges with improving access and controlling costs, and have become a centerpiece of legislative and political discourse. At the same time, advances in technology have introduced new possibilities in education, with the emergence of online, blended, and "flipped" learning models that supplement or replace face-to-face instruction with distance learning. Hybrid education is a type of blended learning, utilizing both face-to-face and online instructional strategies. In a hybrid learning environment, online content may be delivered synchronously or asynchronously, replacing traditional face-to-face instructional time and reducing "seat time" for students. Recent attention has been brought to online and hybrid/blended learning in physical therapist education in the wake of the COVID-19 pandemic, as programs have been required to abruptly move from face-to-face to remote instruction. Hybrid and other forms of blended learning strategies have been described at the physical therapist education course level. However, there is no literature describing hybrid learning implementation at the physical therapist education program "levels," and there has been limited discussion on best practices for delivering hybrid, blended, and online instruction in physical therapist education. This perspective provides an overview of hybrid education, describes theoretical frameworks that guide implementation of a hybrid education curriculum, and discusses future directions for hybrid physical therapist education and educational research.

Italian Physical Therapists' Response to the Novel COVID-19 Emergency.

Abstract: 1 Italian Physical Therapists’ Response to the Novel COVID-19 Emergency Italian Physical Therapists’ Response to COVID-19 Point of View Point of View Paolo Pedersini, Camilo Corbellini, Jorge Hugo Villafañe P. Pedersini, PT, MSc, Clinical Research Department, IRCCS Fondazione Don Carlo Gnocchi, Via Capecelatro 66, Milan, Italy. Address all correspondence to Dr Pedersini at: pedersini93@gmail.com. C. Corbellini, PT, PhD, Casa di Cura Villa Serena, Piossasco, Italy. J.H. Villafañe, PT, PhD, Clinical Research Department, IRCCS Fondazione Don Carlo Gnocchi.

Effects of Pulsed Electromagnetic Field Therapy on Pain, Stiffness, Physical Function, and Quality of Life in Patients With Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials.

Abstract: Objective Pulsed electromagnetic field (PEMF) therapy is a potentially useful treatment for osteoarthritis (OA), but its effectiveness is still controversial. This study aimed to examine the effects of PEMF therapy and PEMF parameters on symptoms and quality of life (QOL) in patients with OA. Methods Cochrane Central Register of Controlled Trials, PubMed, CINAHL, EMBASE, PEDro, clinical trial registers, and reference lists were searched until April 2019. This study examined randomized, placebo-controlled trials, patients with OA, symptom and/or QOL related outcomes, and articles published in English. Two authors extracted data and completed quality assessment. Results Sixteen studies were included in our systematic review, while 15 studies with complete data were included in the meta-analysis. Our primary outcome was the standardized mean difference, which was equal to the treatment effect in the PEMF group minus the treatment effect in the placebo group divided by the pooled standard deviation. For pain, the standardized mean difference was 1.06 (95% CI = 0.61 to 1.51), for stiffness 0.37 (95% CI = 0.07 to 0.67), for function 0.46 (95% CI = 0.14 to 0.78), and for QOL 1.49 (95% CI = -0.06 to 3.04). PEMF parameters did not influence symptoms. Conclusions Compared with placebo, there was a beneficial effect of PEMF therapy on pain, stiffness, and physical function in patients with OA. Duration of treatment may not be a critical factor in pain management. Further studies are required to confirm the effects of PEMF therapy on QOL. Impact Our study suggests that PEMF therapy has clinically significant effects on pain in patients with OA. The current evidence was limited to the short-term effects of PEMF therapy.

Surface Perturbation Training to Prevent Falls in Older Adults: A Highly Pragmatic, Randomized Controlled Trial.

Abstract: Background Falls are the leading cause of injuries among older adults, and trips and slips are major contributors to falls. Objective The authors sought to compare the effectiveness of adding a component of surface perturbation training to usual gait/balance training for reducing falls and fall-related injury in high-risk older adults referred to physical therapy. Design This was a multi-center, pragmatic, randomized, comparative effectiveness trial. Setting Treatment took place within 8 outpatient physical therapy clinics. Patients This study included 506 patients 65+ years of age at high fall risk referred for gait/balance training. Intervention This trial evaluated surface perturbation treadmill training integrated into usual multimodal exercise-based balance training at the therapist's discretion versus usual multimodal exercise-based balance training alone. Measurements Falls and injurious falls were assessed with a prospective daily fall diary, which was reviewed via telephone interview every 3 months for 1 year.A total of 211/253 (83%) patients randomized to perturbation training and 210/253 (83%) randomized to usual treatment provided data at 3-month follow-up. At 3 months, the perturbation training group had a significantly reduced chance of fall-related injury (5.7% versus 13.3%; relative risk 0.43) but no significant reduction in the risk of any fall (28% versus 37%, relative risk 0.78) compared with usual treatment. Time to first injurious fall showed reduced hazard in the first 3 months but no significant reduction when viewed over the entire first year. Limitations The limitations of this trial included lack of blinding and variable application of interventions across patients based on pragmatic study design. Conclusion The addition of some surface perturbation training to usual physical therapy significantly reduced injurious falls up to 3 months posttreatment. Further study is warranted to determine the optimal frequency, dose, progression, and duration of surface perturbation aimed at training postural responses for this population.

Population Health, Prevention, Health Promotion, and Wellness Competencies in Physical Therapist Professional Education: Results of a Modified Delphi Study.

Abstract: Objective Physical therapists are well positioned to meet societal needs and reduce the global burden of noncommunicable diseases through the integration of evidence-based population health, prevention, health promotion, and wellness (PHPW) activities into practice. Little guidance exists regarding the specific PHPW competencies that entry-level clinicians ought to possess. The objective of this study was to establish consensus-based entry-level PHPW competencies for graduates of US-based physical therapist education programs. Methods In a 3-round modified Delphi study, a panel of experts (N = 37) informed the development of PHPW competencies for physical therapist professional education. The experts, including physical therapists representing diverse practice settings and geographical regions, assessed the relevance and clarity of 34 original competencies. Two criteria were used to establish consensus: a median score of 4 (very relevant) on a 5-point Likert scale, and 80% of participants perceiving the competency as very or extremely relevant. Results Twenty-five competencies achieved final consensus in 3 broad domains: preventive services and health promotion (n = 18), foundations of population health (n = 4), and health systems and policy (n = 3). Conclusions Adoption of the 25 accepted competencies would promote consistency across physical therapist education programs and help guide physical therapist educators as they seek to integrate PHPW content into professional curricula. Impact This is the first study to establish consensus-based competencies in the areas of PHPW for physical therapist professional education in the United States. These competencies ought to guide educators who are considering including or expanding PHPW content in their curricula. Development of such competencies is critical as we seek to contribute to the amelioration of chronic disease and transform society to improve the human experience.

Immediate Effect of Abdominal and Pelvic Floor Muscle Exercises on Interrecti Distance in Women With Diastasis Recti Abdominis Who Were Parous.

Abstract: Objective There is a lack of consensus on which abdominal or pelvic floor muscle (PFM) exercises to recommend for the treatment of diastasis recti abdominis (DRA). The objective of this study was to investigate the immediate effect of abdominal and PFM exercises on interrecti distance (IRD) in women with DRA who are parous. Methods In this cross-sectional study, 38 women who were parous, with a mean age of 36.2 years (SD = 5.2), diagnosed with DRA participated. IRD was assessed with 2-dimensional real-time ultrasonography during rest and during 8 randomly ordered different exercises. A paired t test was used to compare the IRD at rest with the IRD recorded during each exercise as well as the differences between exercises. Means with 95% CI are reported. Results Head lift and twisted curl-up exercises significantly decreased the IRD both above and below the umbilicus. Above the umbilicus, the mean IRD difference from rest during head lift was 10 mm (95% CI = 7 to 13.2), whereas during twisted curl-up it was 9.4 mm (95% CI = 6.3 to 12.5). Below the umbilicus, the corresponding values were 6.1 mm (95% CI = 3.2 to 8.9) and 3.5 mm (95% CI = 0.5 to 6.4), respectively, but PFM contraction, maximal in-drawing, and PFM contraction + maximal in-drawing increased the IRD (mean difference = -2.8 mm [95% CI = -5.2 to 0.5], -4.7 mm [95% CI = -7.2 to -2.1], and - 5.0 mm [95% CI = -7.9 to -2.1], respectively). Conclusions Head lift and twisted curl-up exercises decreased the IRD both above and below the umbilicus, whereas maximal in-drawing and PFM contraction exercises only increased the IRD below the umbilicus. A randomized controlled trial is needed to investigate whether head lift and twisted curl-up exercises are effective in permanently narrowing the IRD. Impact To date there is scant scientific knowledge of which exercises to recommend in the treatment of DRA. In-drawing and PFM contraction leads to an acute increase in IRD, while head lift and twisted curl-up leads to an acute decrease in IRD in postpartum women. There is a need for high-quality randomized controlled trials to investigate if there is a long-term reduction in IRD by doing these exercises over time. The acute IRD increase and decrease during the different exercises is also present in a sample of women with larger separations.

Effect of Virtual Reality on Balance in Individuals With Parkinson Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Abstract: Background Virtual reality (VR) is a frequently used intervention for the rehabilitation of individuals with neurological disorders. Purpose The aims of this review were to identify the short-term effect of VR on balance and to compare it with the effect of active interventions in individuals with Parkinson disease (PD). Data sources Searches for relevant articles available in English were conducted using the MEDLINE (via PubMed), EMBASE, CENTRAL, CINAHL, PsycINFO, and Physiotherapy Evidence Database databases from inception until March 2019. Study selection All randomized controlled trials comparing the effect of training with VR and the effect of training without VR on balance in individuals with PD were included. Data extraction Two authors independently extracted data, assessed the methodological quality, and evaluated the evidence quality of the studies. Data synthesis Fourteen randomized controlled trials including 574 individuals were eligible for qualitative analyses, and 12 of the studies involving 481 individuals were identified as being eligible for meta-analyses. Compared with active interventions, the use of VR improved the Berg Balance Scale score (mean difference = 1.23; 95% CI = 0.15 to 2.31; I2 = 56%). The Dynamic Gait Index and Functional Gait Assessment results were also significant after the sensitivity analyses (mean difference = 0.69; 95% CI = 0.12 to 1.26; I2 = 0%). Both provided moderate statistical evidence. However, the Timed "Up & Go" Test and the Activities-Specific Balance Confidence Scale did not differ significantly. Limitations Publication bias and diversity in the interventions were the main limitations. Conclusions Existing moderate evidence of the effectiveness of VR with the Berg Balance Scale, Dynamic Gait Index, and Functional Gait Assessment for individuals with PD was promising. Although the differences did not reach the clinically important change threshold, VR was comparable to active interventions and could be considered an adjuvant therapy for balance rehabilitation in individuals with PD.

Translating COVID-19 Evidence to Maximize Physical Therapists' Impact and Public Health Response.

Abstract: Coronavirus disease 2019 (COVID-19) has sounded alarm bells throughout global health systems As of late May, 2020, over 100,000 COVID-19-related deaths were reported in the United States, which is the highest number of any country This article describes COVID-19 as the next historical turning point in the physical therapy profession's growth and development The profession has had over a 100-year tradition of responding to epidemics, including poliomyelitis; 2 world wars and geographical regions experiencing conflicts and natural disasters; and, the epidemic of noncommunicable diseases (NCDs) The evidence-based role of noninvasive interventions (nonpharmacological/nonsurgical) that hallmark physical therapist practice has emerged as being highly relevant today in addressing COVID-19 in 2 primary ways First, despite some unique features, COVID-19 presents as acute respiratory distress syndrome in its severe acute stage Acute respiratory distress syndrome is very familiar to physical therapists in intensive care units Body positioning and mobilization, prescribed based on comprehensive assessments/examinations, counter the negative sequelae of recumbency and bedrest; augment gas exchange and reduce airway closure, deconditioning, and critical illness complications; and maximize long-term functional outcomes Physical therapists have an indisputable role across the contiuum of COVID-19 care Second, over 90% of individuals who die from COVID-19 have comorbidities, most notably cardiovascular disease, hypertension, chronic lung disease, type 2 diabetes mellitus, and obesity Physical therapists need to redouble their efforts to address NCDs by assessing patients for risk factors and manifestations and institute evidence-based health education (smoking cessation, whole-food plant-based nutrition, weight control, physical activity/exercise), and/or support patients' efforts when these are managed by other professionals Effective health education is a core competency for addressing risk of death by COVID-19 as well as NCDs COVID-19 is a wake-up call to the profession, an opportunity to assert its role throughout the COVID-19 care continuum, and augment public health initiatives by reducing the impact of the current pandemic

Constraint-Induced Movement Therapy for Lower Extremity Function: Describing the LE-CIMT Protocol.

Abstract: Constraint-induced movement therapy (CIMT) is comprised of a set of techniques shown to produce significant changes in upper extremity (UE) function following stroke and other disorders. The significant positive results obtained with the UE protocol have led to the development of LE-CIMT, an intervention to improve lower extremity (LE) function. However, some modifications of the UE protocol were needed, including omitting use of a restraint device, development of supervised motor training tasks to emphasize movement of the lower limb, and adaptation of the UE Motor Activity Log for the lower extremity. The LE-CIMT protocol includes: (1) intensive supervised training delivered for 3.5 h/d for 10 consecutive weekdays, (2) use of shaping as a strategy for motor training, (3) application of a transfer package, and (4) strongly encouraging use of the more-affected LE with improved coordination. The transfer package consists of several strategies to facilitate transfer of the improved motor skills developed during supervised treatment to everyday situations. Research to date has yielded positive results. However, the intervention protocol continues to evolve. The purpose of this article is to describe the components of the complete LE-CIMT protocol to promote further development and investigation of this approach.

The Debt Burden of Entry-Level Physical Therapists.

Abstract: Background The growing student debt of physical therapists entering the workforce, coupled with the growth in projected need, raises concerns about where and how entry-level physical therapists will practice and if these choices will be affected by their debt burden. Objective The purpose of this study was to identify the debt profile of entry-level physical therapists and explore relationships between student debt and clinical practice setting choices. Methods This study utilized a cross-sectional survey design to identify debt profiles and explore relationships between student debt and the clinical practice choices of entry-level physical therapists. Results The mean debt-to-income ratio based on the total reported educational debt was 197% (93%). The most frequently reported debt range for doctor of physical therapy (DPT) debt and total educational debt was $100,000 to $124,999. Despite the setting itself being rated as the most important factor (83%), 28% of participants reported debt as a barrier to their desired practice setting. In addition, when considering job choice overall, 57% of the participants reported that their student debt has had an effect on their decision. Limitations This study is limited by its small sample size, originating from 1 state, and being taken by convenience from a special interest group. Data were collected via an anonymous survey, which increases the risk of selection bias. In addition, there are further personal, family, and institutional characteristics that were not collected in this study, which may influence the interaction between student debt and clinical practice choices. Conclusion The results of this study suggest that practice setting choice may be affected by physical therapist student debt, and student debt may be a barrier overall to practice and career choices in physical therapy.

Integrating Motivational Interviewing in Pain Neuroscience Education for People With Chronic Pain: A Practical Guide for Clinicians.

Abstract: Pain neuroscience education (PNE) and motivational interviewing (MI) have been widely implemented and tested in the field of chronic pain management, and both strategies have been shown to be effective in the short term (small effect sizes) for the management of chronic pain. PNE uses contemporary pain science to educate patients about the biopsychosocial nature of the chronicity of their pain experience. The goal of PNE is to optimize patients' pain beliefs/perceptions to facilitate the acquisition of adaptive pain-coping strategies. MI, on the other hand, is a patient-centered communication style for eliciting and enhancing motivation for behavior change by shifting the patient away from a state of indecision or uncertainty. Conceptually, PNE and MI appear to be complementary interventions, with complementary rather than overlapping effects; MI primarily improves cognitive and behavioral awareness and, potentially, adherence to treatment principles, whereas PNE potentially increases pain knowledge/beliefs, awareness, and willingness to explore psychological factors that are potentially associated with pain. Therefore, combining PNE with MI might lead to improved outcomes with larger and longer-lasting effect sizes. The combined use of PNE and MI in patients having chronic pain is introduced here, along with a description of how clinicians might be able to integrate PNE and MI in the treatment of patients experiencing chronic pain. Clinical trials are needed to examine whether combining PNE with MI is superior to PNE or MI alone for improving pain and quality of life in patients having chronic pain.

Effectiveness of an evidence-based amputee rehabilitation program: A pilot randomized controlled trial

Abstract: Background Despite the prevalence of lower limb amputation (LLA), only a small percentage of people with LLA actually receive physical therapy post amputation and are rehabilitated to their full potential level of function. There is a need for the development of a rehabilitation program that targets impairments and limitations specific to people with LLA. Objective The objective of this study was to determine whether the Evidence-Based Amputee Rehabilitation program would improve functional mobility of people with unilateral transtibial amputation (TTA) who have already completed physical therapy and prosthetic training. Design This study was a randomized, wait-list control, single-blinded pilot clinical trial. Setting This study researched participants who had received postamputation rehabilitation to varying degrees, either in an inpatient and/or outpatient settings. Participants The participants in this study included veterans and nonveterans with unilateral TTA due to dysvascular disease and trauma. Intervention This study included a prescription-based rehabilitation program for people with amputations. Measurements Results were measured with The Amputee Mobility Predictor with (AMPPro) and without a prosthesis (AMPnoPro) and 6-Minute Walk Test (6MWT) at baseline and at the end of the 8-week intervention. Results The intervention group improved on the AMPPro scores (36.4 to 41.7), AMPnoro scores (23.2 to 27.1), and 6MWT distance (313.6 to 387.7 m). The effect size for the intervention was very large (1.32). In contrast, the wait-list control group demonstrated no change in AMPPro scores (35.3 to 35.6), AMPnoPro scores (24.7 to 25.0), and 6MWT distance (262.6 m to 268.8 m). Limitations The sample size was small. A total 326 potential candidates were screened with 306 unable to meet inclusion criteria or unwilling to participate. Conclusion People with unilateral TTA who received Evidence-Based Amputee Rehabilitation program demonstrated significant improvement in functional mobility, with most participants (66.7%) improved at least 1 K-level (58.3%) and greater than the minimal detectable change (66.7%).

Physical Therapist Clinical Practice Guideline for the Management of Individuals With Heart Failure.

Abstract: The American Physical Therapy Association (APTA), in conjunction with the Cardiovascular and Pulmonary Section of APTA, have commissioned the development of this clinical practice guideline to assist physical therapists in their clinical decision making when managing patients with heart failure. Physical therapists treat patients with varying degrees of impairments and limitations in activity and participation associated with heart failure pathology across the continuum of care. This document will guide physical therapist practice in the examination and treatment of patients with a known diagnosis of heart failure. The development of this clinical practice guideline followed a structured process and resulted in 9 key action statements to guide physical therapist practice. The level and quality of available evidence were graded based on specific criteria to determine the strength of each action statement. Clinical algorithms were developed to guide the physical therapist in appropriate clinical decision making. Physical therapists are encouraged to work collaboratively with other members of the health care team in implementing these action statements to improve the activity, participation, and quality of life in individuals with heart failure and reduce the incidence of heart failure-related re-admissions.

Cancer Rehabilitation Publications (2008-2018) With a Focus on Physical Function: A Scoping Review.

Abstract: Background Cancer rehabilitation research has accelerated over the last decade. However, closer examination of the published literature reveals that the majority of this work has focused on psychological interventions and cognitive and behavioral therapies. Recent initiatives have aggregated expert consensus around research priorities, highlighting a dearth in research regarding measurement of and interventions for physical function. Increasingly loud calls for the need to address the myriad of physical functional impairments that develop in people living with and beyond cancer have been published in the literature. A detailed survey of the landscape of published research has not been reported to our knowledge. Purpose This scoping review systematically identified literature published between 2008 and 2018 related to the screening, assessment, and interventions associated with physical function in people living with and beyond cancer. Data sources PubMed and CINAHL were searched up to September 2018. Study selection Study selection included articles of all levels of evidence on any disease stage and population. A total of 11,483 articles were screened for eligibility, 2507 full-text articles were reviewed, and 1055 articles were selected for final inclusion and extraction. Data extraction Seven reviewers recorded type of cancer, disease stage, age of participants, phase of treatment, time since diagnosis, application to physical function, study design, impairments related to physical function, and measurement instruments used. Data synthesis Approximately one-third of the articles included patients with various cancer diagnoses (30.3%), whereas the rest focused on a single cancer, most commonly breast (24.8%). Most articles (77%) measured physical function following the completion of active cancer treatment with 64% representing the assessment domain. The most commonly used measures of physical function were the Medical Outcomes Study 36-Item Health Survey Questionnaire (29%) and the European Organization for Research and Treatment of cancer Quality of Life Questionnaire-Cancer 30 (21.5%). Limitations Studies not written in English, study protocols, conference abstracts, and unpublished data were excluded. Conclusions This review elucidated significant inconsistencies in the literature regarding language used to define physical function, measurement tools used to characterize function, and the use of those tools across the cancer treatment and survivorship trajectory. The findings suggested that physical function in cancer research is predominantly measured using general health-related quality-of-life tools rather than more precise functional assessment tools. Interdisciplinary and clinician-researcher collaborative efforts should be directed toward a unified definition and assessment of physical function.

Perceptions of Kinesiophobia in Relation to Physical Activity and Exercise After Myocardial Infarction: A Qualitative Study.

Abstract: Objective Physical activity and exercise are central components in rehabilitation after a myocardial infarction. Kinesiophobia (fear of movement) is a well-known barrier for a good rehabilitation outcome in these patients; however, there is a lack of studies focusing on the patient perspective. The aim of this study was to explore patients' perceptions of kinesiophobia in relation to physical activity and exercise 2 to 3 months after an acute myocardial infarction. Methods This qualitative study design used individual semi-structured interviews. Face-to-face interviews were conducted with 21 patients post-myocardial infarction who were screened for kinesiophobia (≥32 on the Tampa Scale for Kinesiophobia Heart). The interviews were transcribed and analyzed according to an inductive content analysis. Results An overarching theme was defined as "coping with fear of movement after a myocardial infarction-a dynamic process over time" comprising 2 subthemes and explaining how coping with kinesiophobia runs in parallel processes integrating the patient's internal process and a contextual external process. The 2 processes are described in a total of 8 categories. The internal process was an iterative process governed by a combination of factors: ambivalence, hypervigilance, insecurity about progression, and avoidance behavior. The external process contains the categories of relatives' anxiety, prerequisites for feeling safe, information, and the exercise-based cardiac rehabilitation program. Conclusion Coping with fear of movement after a myocardial infarction is a dynamic process that requires internal and external support. To further improve cardiac rehabilitation programs, person-centered strategies that support the process of each person-as well as new treatment strategies to reduce kinesiophobia-need to be elaborated. Impact Patients with a myocardial infarction were found to be ambivalent about how they expressed their fear of movement; therefore, it is crucial for physical therapists to acknowledge signs of fear by listening carefully to the patient's full story in addition to using adequate self-reports and tests of physical fitness. These results will inform the design, development, and evaluation of new treatment strategies, with the overall aim of reducing kinesiophobia and increasing physical activity and participation in exercise-based cardiac rehabilitation.