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Physical therapists’ perspectives and practices on weight management for chronic pain patients with obesity: a cross-sectional survey
Introduction: Overweight and obesity management in primary care gained importance due to its global rise and association with cardiometabolic diseases and chronic musculoskeletal disorders (MSD). Physical therapists are well-positioned to incorporate weight management in their practice. This survey evaluates attitudes, barriers and clinical practices of physical therapists regarding weight management for individuals with chronic pain and comorbid overweight or obesity. Methods: German-speaking physical therapists in Switzerland volunteered in an online survey. Descriptive statistics summarized physical therapists’ attitudes, barriers and practices. Logistic regression analyses identified factors associated with recommending and implementing weight reduction interventions. Results: Of the 581 respondents, 92.1% acknowledged the importance of educating patients on obesity-related health risks, and 81.6% recommended weight reduction. Two-thirds offered weight reduction interventions in physical therapy, although fewer (57.3%) received corresponding training during entry-level education. Most weight reduction interventions focused on movement, endurance, and strength, whilst a minority addressed nutrition, sleep or stress. The odds of offering weight reduction interventions were higher among those with entry-level education (OR: 2.1, 95% CI: 1.4-3.3), further education (OR: 1.9, 95% CI: 1.1-3.3), and for those who perceived weight reduction interventions (OR: 6.5, 95% CI: 3.5-12.3) and counseling on other lifestyle factors (OR: 2.9, 95% CI: 1.2-7.3) as within their professional scope. Conclusions: While physical therapists showed positive attitudes toward weight reduction interventions for individuals with chronic pain and overweight or obesity, their education and implementation remain inconsistent, primarily focusing on improving physical activity. Clear competencies and structured training are needed to integrate evidence-based weight management into clinical practice.
Copyright (c) 2025 Melanie Liechti, Massimo Menegon, Alexander Philipp Schurz, Matteo Vanroose, Ron Clijsen, Anneleen Malfliet, David Faeh, Heiner Baur, Jan Taeymans, Nathanael Lutz https://creativecommons.org/licenses/by-nc/4.0
Development and feasibility testing of a video-based exercise program for improving upper limb motor function among stroke survivors in a low-income setting
Background: Rehabilitation after stroke often falls short of providing optimal benefits to patients due to challenges related to restricted access, financial burden, and lack of adherence. Video-based intervention may help to overcome these barriers. Purpose: To develop and test the feasibility of video-based telerehabilitation (TR) exercises for facilitating upper extremity motor function among stroke survivors. Method: The study was conducted in two phases: video development and feasibility testing. The research team developed the video. Feasibility was assessed using a single-group pre-test–post-test design, focusing on adherence, acceptability, satisfaction, and motor function. A total of 30 stroke survivors were purposively recruited. Each participant received a 3-minute-42-second video-based TR program to be performed three times weekly over four weeks. Adherence and acceptability were monitored through participant-maintained diaries. Satisfaction and motor function were measured using the Client Satisfaction Questionnaire-8 (CSQ-8) and the Wolf Motor Function Test (WMFT), respectively. Results: Twenty-nine participants (15 males) completed the study. The participants showed a strong commitment to the intervention with a 97% adherence rate. They accepted and reported the intervention as satisfactory. A remarkable score of satisfaction corroborates this based on the CSQ-8 (Mean [SD] = 28.6 [4.90]). A significant improvement in the WMFT was observed (p < 0.001) with a large effect size (d = 1.14) post-intervention. The mean difference was 8.8, with a 95% confidence interval ranging from 4.75 to 12.9. Conclusion: The video-based TR is feasible and can be deployed as a supplementary intervention. Future evaluation of the intervention is warranted to establish its effectiveness.
Copyright (c) 2025 Hafsat Maina Ali, Surajo Kamilu Sulaiman, Jibrin Sammani Usman, Muhammad Aliyu Abba, Aminu Alhassan Ibrahim, Umar Muhammad Bello, Dauda Salihu, Auwal Abdullahi https://creativecommons.org/licenses/by-nc/4.0
Usability of Myosuit exosuit and effects of device-mediated rehabilitation on chronic stroke survivors: a non-randomized pilot study
Objectives: The aim of this study is to assess the usability of the Myosuit within a chronic stroke survivors’ rehabilitation program and to explore its therapeutic and assistive role on gait, stair negotiation, sit-to-stand transfers, and balance. Methods: Ten chronic stroke survivors with gait impairments were enrolled. The System Usability Scale (SUS) was the primary outcome of the study; secondary outcomes were the Stroke Self-efficacy Questionnaire (SSEQ), the Short Physical Performance Battery, the 10-meter Walking Test (10mWT), the 2-minute Walking Test (2minWT), and the Stair Climbing Test. Tests were carried out before (T0) and after (T1) the training sessions, with and without the exoskeleton. Results: The SUS rated poor-to-ok in 30% of the participants, good in 40%, and excellent to best imaginable in 30%. Comparing T1 vs T0, all the functional tests, except stair descending, showed statistically significant improvements without the exoskeleton, and SSEQ did not change significantly. T1 vs T0 comparisons with the exoskeleton showed improvements in all functional tasks, statistically significant for all, except for 2minWT and 10mWT. Conclusions: This study confirmed the feasibility of a Myosuit-mediated treatment in a sample of chronic stroke survivors. Despite the usability of the wearable robot being generally positively perceived, it varied among users. Furthermore, the Myosuit exhibited both therapeutic and assistive potential in the sample.
Copyright (c) 2025 Stefano Doronzio, Silvia Campagnini, Andrea Mannini, Chiara Basla, Tommaso Ciapetti, Michele Piazzini, Angela Politi, Chiara Pedrini, Erika Guolo, Serena Malloggi, Teresa Barretta, Robert Riener, Francesca Cecchi https://creativecommons.org/licenses/by-nc/4.0
Biochemical and clinical effects of McKenzie therapy versus muscle endurance exercises in chronic low-back pain
Background and objective: Low back pain (LBP) involves not only mechanical dysfunction but also inflammatory and muscle-related biochemical changes. Biomarkers such as IL-10, an anti-inflammatory cytokine, provide objective indicators of physiological responses beyond subjective clinical measures. This study evaluated the effects of McKenzie Extension Protocol (MEP), Static Back Extension Endurance (SBEE), and Dynamic Back Extension Endurance (DBEE) on clinical outcomes and biomarkers of muscle status [creatine kinase (CK)] and inflammation (IL-4, IL-10) in LBP. Methods: A randomized controlled trial with 76 patients with chronic LBP assigned to MEP, SBEE, or DBEE was conducted. MEP consisted of lumbosacral repeated extension movements. SBEE included five progressive endurance protocols for back extensors. DBEE replicated SBEE dynamically. Primary outcomes were pain, CK, IL-4, and IL-10; secondary outcomes were disability and quality of life. Assessments occurred at baseline, week 3, and week 6. Results: MEP and SBEE produced significant effects on all variables (p < 0.05) except IL-4 and IL-10 (p > 0.05). DBEE showed no significant effects on IL-4 and IL-10 (p > 0.05). MEP reduced pain significantly (p < 0.05). SBEE had stronger effects on IL-4 and IL-10 at weeks 3 and 6 (p < 0.05). At week 6, interventions had comparable effects on other clinical parameters (p > 0.05). Serum CK rose in all groups without indicating muscle damage. Conclusion: MEP was more effective for pain reduction, while SBEE produced greater increases in IL-4 and IL-10. Findings suggest these exercises may modulate inflammation, enhance muscle status, and support tissue repair in chronic LBP management.
Copyright (c) 2025 Mistura Iyabo Olaoye, Raphael Okonji, Adekola Ademoyegun, Tadesse Gebrye, Gillian Yeowell, Francis Fatoye, Chidozie Mbada https://creativecommons.org/licenses/by-nc/4.0
Biomechanical of bilateral heel rise, and its association with balance, functional mobility, and walking speed in older adults
Introduction: Aging advancing decreases ankle-foot strength and mobility, affecting gait and balance control. The heel-rise (HR) task requires the ankle-foot to control different biomechanical demands. It is still unclear whether these demands during HR are associated with functional performance in older adults. The aim was to describe the association between HR biomechanical parameters and single-leg stability, functional mobility, and walking speed in community-dwelling older adults. Methods: Sixty-nine older adults (73.0, SD 6.8 years) were tested on a force platform performing bilateral rapid HR in the rise and drop phases. The biomechanical parameters measured were peak force and time, impulse, root mean square and displacement of the center of pressure (CoP), as well as displacement and velocity of the center of mass (CoM), and vertical stiffness. Functional performance was assessed through balance using the single-leg stance test (SLS), functional mobility with the Timed Up & Go test (TUG), and walking speed (WS). Associations between functional tests and biomechanical parameters were determined using correlation tests. Results: HR peak strength and time showed a medium to large association with TUG and WS but not SLS. CoP anteroposterior displacement showed a large association in the drop phase with all functional tests but not in the rise phase. CoM velocity and vertical stiffness were associated with all tests in both phases. Conclusion: Older adults HR biomechanical parameters are more closely associated with functional mobility and walking speed tests (TUG and WS) than with static balance tests such as SLS.
Copyright (c) 2025 Cristian Caparrós-Manosalva, Rodrigo Guzmán-Venegas, Francisca Gajardo-Garrido, Marion González-Fuentes, Víctor Pino-Domínguez, Jessica Espinoza-Araneda, Ivan Palomo, Nacim Molina https://creativecommons.org/licenses/by-nc/4.0
What do people search online about sciatica? What answers do they get from Dr. Google? A mixed analysis of Italian web-based data
Introduction: Spine-related leg pain (SRLP), also commonly referred to as sciatica, is characterized by many unanswered questions. Nowadays, patients search for information online to find answers not provided by clinicians. Therefore, this work aimed to (i) collect the main questions and keywords searched by the Italian general population related to SRLP, (ii) analyze the content of the most clicked web pages, (iii) investigate its alignment with evidence-based recommendations, and (iv) assess their credibility and (v) readability. Methods: SEMrush was used to collect questions, keywords, search volumes, and web pages. Credibility was assessed through the QUality Evaluation Scoring Tool (QUEST). Readability was evaluated by the Gulpease index. Thematic and content analyses were performed. Results: Monthly search volumes ranged from 4,400 to 33,100. QUEST scores ranged from 1 to 14 out of 28. Readability scores ranged from 20 to 47 out of 100. Common themes highlighted the roles of medications and physiotherapy, the value of doing effortless activities, and the importance of sleep. Content analysis showed that 11 codes (41%) were aligned with, 7 (26%) were contradicted by, and 26 (96%) were entirely omitted from at least one web page. Conclusion: The findings suggest that inaccurate, poorly credible, and difficult-to-read information on SRLP are common online, leading to plausible targets for the educational intervention of clinicians dealing with SRLP patients. Clinicians are now more aware of the questions that their patients could be asking to Google and the answers it provides about SRLP.
Copyright (c) 2025 Massimo Esposto, Matteo Cioeta, Giuseppe Giovannico, Valerio Barbari, Alessandra Arca https://creativecommons.org/licenses/by-nc/4.0
Primary care rehabilitation after Knee Replacement – a cross sectional study
Background: Rehabilitation after Knee Replacement (KR) surgery often entails an extensive rehabilitation in primary care but evidence-based high-quality guidelines are lacking. There is also a knowledge gap regarding current rehabilitation modalities applied in primary care in Sweden. This study aimed to (I) describe rehabilitation in primary care after KR and (II) explore physiotherapists’ perceptions of patients’ challenges during the rehabilitation. Methods: A cross-sectional, web-based survey was conducted among Swedish physiotherapists working in primary care. Questions were categorical or open-ended and related to current rehabilitation practices, treatment modalities, and physiotherapists’ perceptions of patients’ challenges in rehabilitation after KR. Data were described descriptively and open-ended answers were analyzed with quantitative and qualitative content analysis. Results: In total, 202 physiotherapists answered the survey. Rehabilitation focused on home exercises with recurrent physiotherapy visits. Common treatment modalities were knee range of motion exercises, strength training, and stationary cycling. Key rehabilitation challenges included the following categories: Patients are unprepared, Challenging to find the optimal load, and Restoring function and trust in the knee. Conclusion: Rehabilitation after KR in Swedish primary care seems to be in line with previously recommended international treatment modalities. According to the physiotherapists in this study, some of the key challenges that patients faced were not being prepared for the severe pain regaining function and trust in the knee, balancing load/recovery, and resuming physically demanding activities.
Copyright (c) 2025 Elin Östlind, Marcus Ljung, Caroline Ståhl, Anna Cronström, Thérèse Jönsson https://creativecommons.org/licenses/by-nc/4.0
Motor and cognitive changes across 2 years: a longitudinal study in early Multiple Sclerosis
Background: Functional disorders appear early in the course of the disease and develop over time impacting participation and quality of life. However, little is known about functional deterioration assessed by clinical and instrumented tools in longitudinal studies. Objective: To investigate motor and cognitive short-term trajectories in early-diagnosed, non-disabled People with Multiple Sclerosis (PwMS). Methods: We included 63 PwMS with Expanded Disability Status Scale (EDSS) ≤2.5points, disease duration≤5years, and aged (Mean±Standard Deviation) 38.7±10.7years. Participants were assessed at baseline and after 2 years with clinical and instrumented evaluations. Data on disability and functional disorders were collected using EDSS, Six-Minute Walk Test (6MWT), Multiple Sclerosis Walking Scale-12 (MSWS-12), Fatigue Severity Scale (FSS), and Symbol-digit modality test (SDMT), while instrumented data measuring complexity and intensity of balance disorders and gait symmetry-regularity-instability were extracted from wearable devices. Results: Clinical scales (EDSS, 6MWT, FSS, MSWS-12, and SDMT) did not show a statistically significant deterioration when baseline and 2-year follow-up were compared: EDSS (Median and min-max) from 2 (0-2.5) to 2(0-4.5)points, 6MWT from 568.4±80.5 to 577.0±93.5m, FSS from 3.1(1-7) to 3.2(1-7)points, MSWS-12 from 25(20-65) to 25(20-78.3) points, and SDMT from 55.3±14.5 to 61.3±15.2points. We observed similar results innstrumented variables: complexity from 0.00±0.69 to -0.17±0.78[au], intensity from 0.00±0.69 to -0.17±0.78[au], gait regularity from 0.87±0.07 to 0.88±0.08[au], gait symmetry from 80.24±20.24 to 83.0±8.85[au], and gait instability from 0.67±0.11to 0.70±0.13[au]. Conclusion:Contrary to our hypothesis, our data showed a functional stability of the disease after 2 years. This held even when an instrumented assessment to assess subtle functional disorders was added.
Copyright (c) 2025 Elisa Gervasoni, Claudio Solaro, Denise Anastasi, Rachele Di Giovanni, Marco Rovaris, Giampaolo Brichetto, Paolo Confalonieri, Andrea Tacchino, Ilaria Carpinella, Davide Cattaneo https://creativecommons.org/licenses/by-nc/4.0
Head Pain Reproduction and Resolution Behavior in Response to Sustained Mobilization of the Upper Cervical Spine: A Case Series
Background: Reproduction and resolution of head pain with sustained upper cervical mobilisation has been proposed as a diagnostic indicator of cervicogenic headache (CGH). However, there has been little focus describing head pain response during the application of these manoeuvres. The purpose of this study was to describe the head pain response during the performance of sustained upper cervical spine mobilisation in people with probable cervicogenic headache. Methods: In this case series of 20 individuals with probable CGH as defined under the International Headache Society criteria, were assessed by one experienced physiotherapist who administered five sustained upper cervical spine mobilisation techniques on each participant. Reproduction of head pain during mobilisation was noted. At the start, during and end of each mobilisation technique, change in head pain intensity and time taken to achieve head pain resolution was recorded. Results: Sixteen of the 20 participants experienced reproduction and resolution of head pain within 90 seconds of sustained upper cervical mobilisation. This phenomenon occurred no more frequently with mobilisation of C2 than with C1. Neck pain was present in 13 of the 20 participants. Conclusion: Neither the duration (measured in seconds) nor the magnitude of reduction in head pain intensity was markedly different across dominant compared to non-dominant head pain sides or across cervical levels, indicating reproduction and resolution behaviour is irregular. The presence of CGH without neck pain is possible.
Copyright (c) 2025 Damien C Cummins, Lucy C Thomas, Peter Osmotherly https://creativecommons.org/licenses/by-nc/4.0
Validation of a Novel device for Assessing Neck Muscle Strength
Background: The Neuromuscular Cranio-Cervical Device (NOD) was originally designed to evaluate Cranio-Cervical Flexion Test performance but can also be used as a handheld dynamometer for testing other muscle groups, including neck muscle strength. It offers a potential alternative to the Multi-Cervical Unit (MCU), a fixed dynamometer, more closely aligned with isokinetic dynamometry, the gold standard. However, its validity and reliability need to be established. This study aimed to evaluate concurrent validity compared to the MCU and inter- and intra-rater reliability of the NOD for measuring neck flexion and extension muscle strength. Methods: Twenty participants were assessed for neck flexion/extension strength whilst in a seated position, with the measurements repeated over three sessions. Concurrent validity was assessed by comparing NOD measurements to the MCU using Pearson correlation coefficients, and reliability was determined using Intraclass Correlation Coefficients (ICCs). Results: Concurrent validity was strong for extension (r = 0.954) but lower for flexion (r = 0.705), indicating some variability in flexion measurements. Inter-rater reliability was good to excellent for both flexion (ICC = 0.931) and extension (ICC = 0.896). Intrarater reliability for extension was good to excellent (ICC = 0.893), while flexion ranged from moderate to excellent (ICC = 0.844). Conclusions: The NOD is a valid tool, particularly for extension measurements, although further refinement of testing is needed to improve the accuracy for flexion strength measurements. It is also reliable for both extension and flexion, showing promise as a practical, affordable, portable tool with real-time feedback for the assessment of neck muscle strength in clinical settings.
Copyright (c) 2025 Michail Arvanitidis, Hon Hin Ken Mak, Eduardo Martinez-Valdes, Marco Barbero, Deborah Falla https://creativecommons.org/licenses/by-nc/4.0
Application and adaptation of the Virtual Eggs Test for assessing hand dexterity in subjects with stroke: a pilot study
Objectives: To verify the feasibility of the Virtual Eggs Test (VET) and establish the ranges of fragilities of the Virtual Eggs (VEs) for assessing dexterity of stroke subjects and to collect feedback to improve its usability. Methods: An observational non-profit study, with a pre-market medical device. It was conducted at a hospital neurorehabilitation unit. Nine subjects with chronic stroke (5 males; mean age 55.8 ± 18.9) performed the pilot with their paretic arm. Time to complete the test (TT), the number of failures for each VE, the threshold (T), and participants’ self-reported comfort in performing the test were measured. Results: The T varied among participants from 1.70 to 4.88 N/N. The average TT was 20.1 ± 6.5 minutes (range 11-33). Only one subject found the test uncomfortable. Conclusions: The study found that the VET, with minor modifications, is feasible in stroke subjects. It might be useful for assessing sensorimotor impairment in both the affected and the less affected arm. Its metric properties and normative values in the healthy population will be determined in a study currently underway.
Copyright (c) 2025 Michele Piazzini, Lucia Angelini, Tommaso Ciapetti, Stefano Doronzio, Marco Baccini, Robinson Guachi, Paola Mucci, Marco Controzzi, Francesca Cecchi https://creativecommons.org/licenses/by-nc/4.0
Association of physiotherapy dose with motor recovery in early subacute phase after stroke: results from a multicenter Italian study
Introduction: The literature investigating the factors associated with functional recovery after stroke suggests that, in the early subacute phase, time is the factor that most significantly drives the recovery. However, it is unclear whether the dose of physiotherapy (PT) delivered is equally associated with recovery of motor function and independence. Methods: A multivariable modeling of data from a multicenter longitudinal prospective cohort study investigating the contents of neurological PT interventions in Italy was developed, with the aim to estimate the association between the dose of PT received in the early subacute phase after stroke and recovery of walking, motor function, and independence. Results: A total of 96 patients were included in the analyses. PT dose seems associated with recovery of manual dexterity, measured by the Box and Block test (BBT), but not with the level of independence nor walking function. The probability of achieving a score higher than 31 at the BBT is 46% (95%CI: 18-76) after 10 hours and 76% (95%CI: 42-93) after 20 hours of PT, respectively. Conclusions: In the early subacute phase after stroke, the higher the dose of PT provided, the better the probability of significant recovery of upper limb (UL) dexterity should be.
Copyright (c) 2025 Silvia Salvalaggio, Nicola Valè, Thomas Bowman, Davide Cattaneo, Cristina Allera Longo, Serena Bocini, Viviana Bonci, Michele Gennuso, Francesca Marazzini, Francesco Giuseppe Materazzi, Elisa Pelosin, Martina Putzolu, Andrea Turolla, Susanna Mezzarobba, Fabiola Giovanna Mestanza Mattos, Simone Gambazza https://creativecommons.org/licenses/by-nc/4.0
Differences in cervical mobility and pain sensitivity between patients with rotator cuff-related shoulder pain and asymptomatic subjects: a cross-sectional study
Introduction: The cervical spine’s role in shoulder pain remains unclear, particularly regarding its influence on shoulder pain severity and functional limitations. This study aimed to compare neck mobility, pain sensitivity, and strength between patients with rotator cuff-related shoulder pain (RCRSP) and asymptomatic controls and to explore associations between neck active range of motion (AROM) and shoulder outcomes. Methods: A cross-sectional study was conducted with 50 patients with RCRSP and 50 asymptomatic controls. Neck AROM was measured with a CROM device, pressure pain thresholds (PPTs) with a digital algometer, and isometric neck strength with a handheld dynamometer. Shoulder pain and disability were assessed using the Visual Analog Scale (VAS) and the Shoulder Pain and Disability Index (SPADI). Results: Compared to controls, patients with RCRSP exhibited reduced neck rotation toward the affected shoulder (mean difference: −5.19°; 95% CI: −8.84 to −1.38) and lower PPTs bilaterally (affected side: −1.49 kg/cm²; 95% CI: −1.99 to −1.00; unaffected side: −1.42 kg/cm²; 95% CI: −1.98 to −0.91). No differences were found in neck strength. Regression analysis showed that greater neck flexion, lateral flexion toward the affected side, and reduced protraction were associated with higher SPADI scores. Additionally, neck lateral flexion and rotation toward the affected side were negatively associated with shoulder pain intensity over the last week. Conclusion: These findings suggest a potential interaction between the cervical spine and shoulder in RCRSP, underscoring the importance of a comprehensive assessment of both cervical and shoulder impairments in this condition.
Copyright (c) 2025 Néstor Requejo-Salinas, Rubén Fernández Matías, Roy La Touche Arbizu, Javier Gordo Herrera, Pablo Conesa López, Enrique Lluch Girbés https://creativecommons.org/licenses/by-nc/4.0
Entry-level physical therapist curricula in geriatric care: an Italian national survey study
Introduction: To address the health needs of the aging population, it is necessary to map entry-level curricula for health professionals. This survey investigated geriatric-related content in entry-level physical therapist (PT) curricula offered by Italian universities. Methods: A cross-sectional observational study was conducted using the CROSS checklist. A 66 questions survey was developed and sent via e-mail to all entry-level PT program directors of the Italian universities. Results: A total of 34 physical therapist undergraduate course directors out of 62 completed the survey, yielding a 54.8% response rate. These results highlight the need for greater emphasis on health promotion and prevention. Although essential competencies such as the promotion of an active lifestyle and fall prevention appear to be well covered, other aspects remain underrepresented. Relevant gaps were also noted in the care and rehabilitation of some common chronic conditions (e.g., constipation, depression, and diabetes), as well as in therapeutic education. Greater attention to these topics could help align training with the emerging needs of the healthcare system. However, 11.76% of Italian PT programs do not include specific modules or courses dedicated to geriatric rehabilitation. Overall, there is considerable variability in teaching hours, topic coverage, and depth. Conclusions: This study provides meaningful insights for updating the current PT curricula in geriatric care. This survey could represent a tool for future longitudinal research on mapping curricula over time in response to the aging population.
Copyright (c) 2025 Francesco Bucchi, Sara Dal Ben, Antonio Culcasi, Stefano Lecora, Roberto Tedeschi, Marco Da Roit https://creativecommons.org/licenses/by-nc/4.0
Mim-pong: a serious game for assessment and treatment of the lower limb in hemiparetic stroke patients
Introduction: The motor impairment evidenced post-stroke results in limitations to performing activities of daily living (ADL), especially when it involves locomotion. The Serious Games (SG) are an interesting therapeutic option, as they allow the performance of exercises according to stroke treatment guidelines. However, there is little research exploring the evaluation potential of SG. This study aimed to evaluate the possible metric properties of the mim-pong SG in addition to the therapeutic effects. Methods: Twenty-four hemiparetic stroke patients were divided into two non-randomized groups: the experimental group (EG) (n = 16) and the control group (CG) (n = 8). Participants were evaluated in terms of motor impairment (lower limb), muscle strength (MS), motor control, and functional mobility. Results: The significant correlations observed between the score generated by the SG and clinical variables in both groups are highlighted, especially with MS (rho = 0.62-0.66; p = 0.000, and rho = 0.67-0.71; p = 0.002-0.005, for the experimental and CGs, respectively) and motor function of the lower limb for the EG (rho = 0.41, p = 0.018). In addition, the results indicated improvements in all variables in the EG, with superiority over the CG. Conclusions: This study showed that the mim-pong serious game could be considered a potential resource for the assessment and treatment of hemiparetic stroke patients.
Copyright (c) 2025 Fernando L. F. Eichinger, Fabrício Noveletto, Susana C. Domenech, Thierry Moulin, Yoshimasa Sagawa, Antonio Vinicius Soares https://creativecommons.org/licenses/by-nc/4.0
The Use of Digital Technologies in Physiotherapy Higher Education: a Mixed-Methods Study
Background: Previous studies demonstrated that digital tools can be effectively integrated into physiotherapy higher education. However, their adoption remains limited. This study aimed to 1) evaluate the perceived knowledge, confidence, and frequency of digital technology use among Italian lecturers and 2) explore lecturers’ experiences with digital technology in higher education. Methods: We performed a convergent mixed-method study using an online survey instrument for Italian physiotherapy lectures. We employed a 5-point Likert to evaluate perceived knowledge, confidence, and frequency of digital technology use, with consensus defined as an agreement of ≥70% on a statement. An optional qualitative section explored lecturers’ experiences with technology, which we analyzed using Reflexive Thematic Analysis. Results: Between June and September 2023, 118 lecturers (mean age: 45 ± 11; 69% female, n = 81) completed the survey. Participants expressed confidence in utilizing digital tools such as videoconferencing (95%), online repositories (88%), and communication apps (78%). On average, 32% reported using technologies “often” or “always.” In the qualitative section, completed by 77 participants, we generated three themes: 1) “Technology can promote a constructive educational approach”; 2) “Action of technologies on students’ learning process,” with mixed results on their impact; and 3) “Technology is not within everyone’s reach,” due to barriers to its implementation in didactics. Qualitative and quantitative findings confirmed one another, allowing for a deeper understanding of digital technologies among Italian physiotherapy lecturers. Conclusions: Our findings indicate that digital tools are still underutilized among Italian physiotherapy lecturers. The main barriers include inadequate infrastructure and a lack of digital competencies.
Copyright (c) 2025 Francesca Trentini, Chiara Fanta, Flavio Manganello, Marco Testa, Simone Battista https://creativecommons.org/licenses/by-nc/4.0
Scaling new heights: a pilot study of the impact of climbing on balance, agility, and dexterity in individuals with Parkinson’s disease
Introduction: Exercise benefits individuals with Parkinson’s disease (PD). Rock climbing includes exercise characteristics from clinical guidelines (e.g., aerobic, resistance, balance training, cued-movements, community-based) and offers unique somatosensory and visuospatial experiences that may aid motor learning. This study examined climbing’s effects on PD physical function. Methods: This quasi-experimental observational pilot study used pre-to-post-test comparisons to assess participants with mild to moderate PD (Hoehn and Yahr 1-3) who walked independently. The intervention included 12 weeks of community-based, twice-weekly top-rope climbing under one-on-one supervision, tailored to skill level. Wall angles, hand/foot holds, and routes varied and became progressively more difficult as skills increased. The primary outcome was the Community Balance & Mobility Scale (CBMS); secondary measures included the Agility T-Test (ATT), 9-Hole Peg Test (9HPT), upper extremity reaction time using BlazePods (UE-React), and grip strength. Results: 28 participants completed the study: 8 women/20 men; mean age = 66.1 (sd = 7.4) years; average disease duration = 4.0 (sd = 3.6) years. Paired t-tests comparing pre- and post-test scores and effect sizes (ES) with 95% confidence intervals (CI) were calculated for significant results using Hedge’s g. Findings were: CBMS (p < 0.001; ES = 0.573, 95% CI = 0.178-0.960), ATT (p < 0.001; ES = 0.462, 95% CI = 0.078-0.838), 9HPT (p < 0.001; ES = 0.480, 95% CI = 0.094-0.858), UE-React (p <0.001; ES = 0.329, 95% CI = −0.045-0.696); GS changes were non-significant. Conclusions: Rock climbing demonstrated medium-size effects on mobility/balance and small-size effects on agility and dexterity that could impact functioning in everyday activities.
Copyright (c) 2025 Julie Ries, Molly Cupka, Andrew Guccione https://creativecommons.org/licenses/by-nc/4.0
Comparisons of the effects of psychologically-informed and usual physiotherapy on pain sensitivity in chronic low back pain: an exploratory randomized controlled trial
Introduction: The presence of altered central pain processing and modulation, as well as negative psychological factors, have been suggested to impede recovery in chronic low back pain (CLBP). Psychologically-informed physiotherapy (PiP) aims to specifically address the latter factors—in addition to physical factors—to improve treatment effects. This study aims to determine if the effect of PiP is superior to usual physiotherapy (UP) on pain sensitivity and modulation in participants with CLBP and if changes in these variables were associated with changes in clinical outcomes. Methods: Forty participants with CLBP were randomly allocated to PiP or UP. Seven physiotherapy sessions over 6 weeks plus a booster session at an 11-week follow-up were delivered. Pressure pain threshold (PPT), temporal summation of pain (TSP), and exercise-induced hypoalgesia were assessed on lumbar, upper, and lower limb sites at baseline and after 6 weeks. Linear mixed models tested if PiP was superior to UP on pain sensitivity/modulation. Linear regressions tested if pain sensitivity/modulation changes were associated with changes in clinical outcomes (pain intensity, physical functioning, symptoms of central sensitization). Results: PiP was not superior to UP to modulate pain sensitivity/modulation variables. All PPTs increased after 6 weeks regardless of the approach. Lumbar PPT and lumbar and lower limb TSP changes were associated with physical functioning changes. Conclusion: Although our study suggests that neither approach has a superiority to impact on pain sensitivity, both approaches elicited widespread hypoalgesia. Future powered trials should verify if pain sensitivity can be a mediator of physical functioning improvement, as suggested by our results.
Copyright (c) 2025 Hugo Massé-Alarie, Amélie Desgagnés, Claudia Côté-Picard, Olivier Liberty , Pierre Langevin, Mathieu Piché, Yannick Tousignant-Laflamme https://creativecommons.org/licenses/by-nc/4.0
Perceived bioethical issues in cancer rehabilitation: a qualitative study among Italian physiotherapists
Introduction: Literature on bioethics in physiotherapy, particularly in cancer management, is limited. This study explores the perceived bioethical issues in cancer rehabilitation by Italian physiotherapists. Participants: Thirty-one physiotherapists (Age: 42 ± 10.5 years; 20 women, 11 men) with expertise in cancer rehabilitation were purposefully selected. Data Collection: Six online focus groups were conducted, guided by a focus group guide based on existing literature and refined by experts in cancer rehabilitation and bioethics. Data Analysis: Sessions were recorded, transcribed, and analyzed using Braun and Clarke’s ‘Reflexive Thematic Analysis’. Results: Four primary themes emerged: 1) Challenges of (Non)-Disclosure in Diagnosis and Prognosis – ethical difficulties around withholding diagnosis or prognosis information; 2) Balancing Hope and Realism in Patient and Caregiver Expectations – navigating hope versus realistic rehabilitation goals; 3) Weighing Efficacy and Safety in Cancer Rehabilitation – balancing ­treatment outcomes with patient safety; 4) Decisions on Withdrawing Treatment – ethical considerations in discontinuing treatment. Discussion: These themes highlight common ethical dilemmas faced by physiotherapists in cancer rehabilitation, mirroring broader healthcare challenges. Addressing them requires a nuanced understanding of ethical principles within the cancer rehabilitation context. Conclusions: The study provides insights into the bioethical issues in cancer rehabilitation, stressing the need for a patient-centered approach to navigate these challenges effectively.
Copyright (c) 2025 Gianluca Bertoni, Simone Battista, Valentina Conti, Marco Testa, Sara Patuzzo Manzati https://creativecommons.org/licenses/by-nc/4.0
Discriminative ability, responsiveness, and interpretability of smoothness index of gait in people with multiple sclerosis
Introduction: Gait impairments are common in People with Multiple Sclerosis (PwMS). Several studies have examined the clinometric properties of Inertial Measurement Units (IMUs), with LDLJa identified as a robust metric for gait smoothness. However, its responsiveness and interpretability have not been explored. Methods: This cross-sectional study at IRCCS Santa Lucia Hospital enrolled 44 PwMS (age: 28-71; EDSS: 0-6) and 43 age- and gait-speed-matched healthy participants (HP). Two physiotherapists conducted assessments with five synchronized IMUs during a 10-meter walk at participants’ preferred speed. Data were collected at baseline (T0) and after 4 weeks of training (T1). Results: Significant differences in log dimensionless jerk (LDLJa) were found between PwMS and HP in the AP (p < 0.001, d = 0.63), ML (p < 0.001, d = 1.08), and CC (p = 0.03, d = 0.68) directions. PwMS had lower LDLJaAP values (< -4.88) and LDLJaML values (< -5.40) with probabilities of 63% and 76%, respectively. ΔLDLJaML demonstrated good responsiveness to rehabilitation (AUC ~0.80), with improvements >4.02% representing the optimal MCID for clinical improvement in MiniBesTest. Conclusion: Lower LDLJa values in the AP and ML directions characterize gait smoothness impairment in PwMS. LDLJa in the ML direction is responsive to balance-focused rehabilitation, highlighting its potential for tracking gait disorders and rehabilitation progress.
Copyright (c) 2025 Stefano Filippo Castiglia, Fulvio Dal Farra, Dante Trabassi, Andrea Turolla, Mariano Serrao, Ugo Nocentini, Paolo Brasiliano, Elena Bergamini, Marco Tramontano https://creativecommons.org/licenses/by-nc/4.0
Is resistance training with external loads superior to unloaded exercise in the management of chronic low back pain? A systematic review and meta-analysis
Introduction: Chronic non-specific low back pain is a leading cause of disability worldwide. Resistance training using external loads is common in rehabilitation, but its added benefit over unloaded exercise remains uncertain, particularly regarding physical and psychological outcomes. Method: This systematic review and meta-analysis, registered on PROSPERO (CRD42022366975), included randomized controlled trials comparing externally loaded resistance training to unloaded exercise in adults with chronic non-specific low back pain. Primary outcomes were pain intensity and disability. Secondary outcomes included back muscle endurance, maximal strength, fear-avoidance beliefs, and pain catastrophizing. Random-effects meta-analyses were conducted, stratified by follow-up duration. Results: Thirteen trials including 778 participants were analyzed. At follow-up beyond seven weeks, externally loaded resistance training showed a small but significant reduction in pain compared with unloaded exercise (mean difference –0.52 on a 0–10 scale; 95% CI –0.92 to –0.08). No significant differences were found at short-term or post-washout assessments. Effects on disability were inconsistent. Resistance training improved back muscle endurance and may enhance long-term maximal strength, though wide prediction intervals limit certainty. No meaningful differences were found for psychological outcomes, and pain catastrophizing was reported in only one trial. Conclusion: Externally loaded resistance training is safe and feasible for chronic non-specific low back pain, but its effects on pain, disability, and psychosocial outcomes are similar to unloaded exercise. Improvements likely reflect exposure, adherence, and therapeutic context rather than load intensity alone. Exercise prescription should remain individualized and embedded within a biopsychosocial framework.
Copyright (c) 2025 Marco Ranzani, Andrea Pozzi, Daniele Fornasari, Diego Ristori, Marco Testa https://creativecommons.org/licenses/by-nc/4.0
Metric properties of the Tonic Stretch Reflex Threshold (TSRT) as a measure of spasticity: a systematic review with meta-analysis
Introduction: Spasticity is a common symptom after brain injury, often interfering with functional recovery and rehabilitation. The Tonic Stretch Reflex Threshold (TSRT) was proposed as an objective neurophysiological assessment of spasticity that could overcome the limitations of clinical scales. This systematic review aimed to appraise the current evidence on the metric properties of TSRT. Methods: Electronic databases (MEDLINE, CINAHL, Scopus, Web of Science, and EMBASE) were screened from inception to June 30, 2025, for studies reporting data on reliability, validity, and/or responsiveness of TSRT in adults with stroke. Two reviewers independently selected the studies, assessed the methodological quality, and extracted relevant data. When possible, pooled estimates for each property were computed. Results: Of the 9804 titles retrieved, 17 were eventually included, to which 2 articles from cross-references were added. We found insufficient values for both intra-rater (two studies, ICC = 0.548, 0.330-0.710) and inter-rater (three studies, ICC = 0.687, 0.511-0.808) reliability, with high measurement error. Data on validity were found in 14 articles, with conflicting results on the association of TSRT with clinical scales of spasticity and motricity, but good ability to discriminate among relevant groups. Only one study investigated responsiveness with an external anchor, finding that TSRT measurements failed to accurately detect improved participants. Conclusion: Despite the potential of TSRT as a measure of spasticity, its metric properties, particularly reliability, are not fully supported. Future research should prioritize improving its reliability and investigating its validity and responsiveness with neurophysiological measures rather than relying solely on clinical scales.
Copyright (c) 2025 Diego Longo, Marco Baccini, Giulio Cherubini, Aurora Caporaso, Mario De Marco, Angela Politi, Guido Santini, Francesca Cecchi, Maria Angela Bagni https://creativecommons.org/licenses/by-nc/4.0
What are the evidence-based medical management approaches for the concussed youth athlete? A scoping review
Background: Concussion management in youth sport relies on the experience of adults pitch-side as to injury recognition, removal, and management decisions. Little consensus exists on the consistency of pitch-side and medical pathway management approaches. Objectives: A scoping review was completed to identify and synthesise primary research as to the management of the concussed youth athlete. Methods: A systematic search was completed in Medline, CINAHL, PubMed, SPORTDiscus, OVID emcare, Web of Science, ScienceDirect, and Cochrane Library databases and Google Scholar from inception to 1st March 2025 according to PRISMA-ScR guidelines. Primary research studies that provided outcome data on management approaches for concussed youth athletes at all stages post-injury were included. Articles were synthesised and reported in themes. Results: 36 studies were included and four themes identified: Exercise, activity, and neuromuscular training interventions (n = 14), Pitch-side, sub-acute management and monitoring (n = 6), Novel treatment interventions (n = 5), and individual management in specific populations (n = 11). Conclusion: Published primary research for concussed youth athlete management approaches with outcome data supports early activity recommendations and sub-threshold exercise programmes. Few data exist for alternative management approaches. Case reports/ series saturated this review, with limited generalisable data reported on. Further transparency on concussion injury reporting and management, with outcome data, is warranted.
Copyright (c) 2025 Tom McKeever, Micheal Leavitt, Stephanie Valentin, David Hamilton https://creativecommons.org/licenses/by-nc/4.0
Evaluation and synthesis of physiotherapy protocols for Femoroacetabular Impingement Syndrome (FAIS): a scoping review
Introduction: The physiotherapeutic treatment of femoroacetabular impingement syndrome (FAIS) is a topic of growing interest in the literature. The aim of this study is to present all of the treatment modalities used in scientific research in order to analyze the extent to which the protocols are explicit. Method: This is a scoping review. The literature search was performed using the Cochrane, Embase and PubMed databases. The data was collected in various tables and the protocols were assessed using the Template for Intervention Description and Replication (TIDieR) and the Consensus on Exercise Reporting Template (CERT) tools. Results: Twenty-four studies were selected and 30 protocols were analyzed. The most frequently reported treatment modalities were strengthening (n = 25), manual therapy (n = 22) and stretching (n = 21). The average total score was 47% for studies evaluated by the TIDieR checklist and 40% for studies evaluated by the CERT checklist. Discussion: The treatment modalities identified are similar to those used for other musculoskeletal conditions. Specific treatments were found and were generally consistent with the clinical characteristics of FAIS. The lack of precision in the reporting of interventions compromises their clinical use. The same lack of detail is noted for other physiotherapeutic interventions in the musculoskeletal field. Conclusion: Numerous treatment methods are presented in the literature. However, the protocols lack in explicitness and the use of the TIDieR and CERT evaluation grids is not widespread.
Copyright (c) 2025 Céline Berguerand, Noemie Rossi, Rahel Caliesch https://creativecommons.org/licenses/by-nc/4.0
Clinical relevance of the effects of robotic rehabilitation for upper limb recovery after stroke in randomized studies: a systematic review with meta-analysis
Introduction: Recent randomized clinical trials (RCTs) provide evidence on the effects of robot-assisted training (RAT) for upper limb impairments in stroke subjects; however, evidence on the clinical relevance of these differences is lacking. This study aimed to perform a systematic review with meta-analyses of RCTs on clinical relevance, expressed as minimal clinically important difference (MCID), of RAT to improve independence in activities of daily living, arm function, and impairments in patients with stroke. Methods: Four databases were searched. RCTs investigating RAT aimed at recovering motor and functional skills of the upper limb in adult post-stroke patients were included. MCID values were retrieved from specific databases. Two independent reviewers performed screening, data extraction, and assessment of methodological quality. Meta-analyses for both statistical significance and clinical relevance were performed. Clinical relevance was expressed as a standardized MCID overall score (SMOS) for each outcome measure, calculated as the difference between mean outcome measures in experimental and control groups divided by corresponding MCID, when available. Results: Eighty-five studies were included. Conventional meta-analyses showed that RAT, compared to control, had significant effects in the domains of activities of daily living, dexterity, arm function, and strength, but not on pain. Meta-analyses for clinical relevance reported non-clinically relevant differences between groups for all domains. Conclusion: RAT produces some significant improvements for the upper limb, but these differences are not clinically relevant when compared to other therapies. Improvements in using the RAT in clinical practice may not be more clinically relevant than other therapies for stroke patients.
Copyright (c) 2025 Sofia Verola, Alessandro Ugolini, Leonardo Pellicciari, Mauro Di Bari, Matteo Paci https://creativecommons.org/licenses/by-nc/4.0
Effectiveness of physical therapy interventions for coccydynia: a systematic review with a narrative synthesis
Introduction: Various physical therapy interventions for coccydynia have been evaluated, but their effectiveness has not yet been comprehensively synthesized. This systematic review aims to evaluate the effectiveness of physical therapy interventions in adults with coccydynia. Methods: A systematic search of relevant randomized controlled trials (RCTs) was conducted in PubMed/MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Physiotherapy Evidence Database (PEDro). Outcomes of interest included pain, function, mobility, and patient satisfaction. Due to the heterogeneity of the included studies, a narrative synthesis was performed. Results: A total of 515 adults with coccydynia across 10 studies were included in the review. Physical therapy interventions, including extracorporeal shock wave therapy, kinesiotaping plus exercise, levator anus stretching or massage, manipulation alone or manipulation plus electrotherapy or exercise, and muscle energy technique, showed significant improvements in pain and function in the short term. Additionally, kinesiotaping plus exercise showed significant short-term improvement in trunk mobility. In the intermediate term, manipulation alone and levator anus stretching or massage were effective at reducing pain, whereas manipulation alone was effective at improving function. In the long term, levator anus stretching or massage showed sustained improvement in pain. Conclusions: Overall, physical therapy interventions led to short-term improvements in pain and function for adults with coccydynia. However, there is a need for high-quality studies with long-term follow-ups to compare the efficacy of various physical therapy interventions, both in isolation and in combination.
Copyright (c) 2025 Mohammad Sidiq, Hariharasudhan Ravichandran, Balamurugan Janakiraman, Aksh Chahal, Richa Hirendra Rai, Ahmed Hamoud Alotaibi, Ali Hamoud Alotaibi, Abdullah Saad Alotaibi, Aminu Alhassan Ibrahim, Eid Abed Alharbi, Faizan Zaffar Kashoo, Hemlata Vats https://creativecommons.org/licenses/by-nc/4.0
Coronavirus Disease 2019 (COVID-19) and pelvic floor signs and symptoms: a scoping review of the literature
Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic presents a substantial global health challenge. While the disease is known to impact multiple systems, leading to long-term consequences that require monitoring and rehabilitation, its effects on the pelvic floor remain unclear. Methods:We conducted a scoping review following the Arksey and O’Malley framework. A systematic search was performed in PubMed, CINAHL, and Embase databases up to March 19, 2024, to identify studies examining pelvic floor-related signs and symptoms in COVID-19 patients. Two reviewers independently extracted study and participant characteristics, areas involved (e.g., anorectal, sexual, urogenital), and signs and symptoms using an ad-hoc data extraction form. Signs and symptoms were classified as direct (e.g., directly impacting the pelvic floor) or indirect (e.g., indirectly affecting it with potential long-term consequences). Results: We included 104 studies, primarily a systematic review (N = 40; 38.46%) and focused on adult populations (N = 80; 76.92%), investigating 140 signs and symptoms from various regions worldwide. Most (N = 124; 88.57%) were indirect signs and symptoms, while the minority were direct (N = 16; 11.43%). The most prevalent indirect symptom was diarrhea (n = 81; 70,43%) in the anorectal bowel area (n = 115). The most prevalent direct were lower urinary tract symptoms (LUTS) (n = 16; 84.21%) in the urogenital area (n = 19). Conclusion: This study highlights the significant prevalence of both direct and indirect pelvic floor symptoms in COVID-19 patients. Clinicians should be aware of the potential link between COVID-19 and pelvic floor dysfunction.
Copyright (c) 2025 Valentina Di Tommaso, Marta Rossi, Silvia Gianola, Greta Castellini, Silvia Bargeri, Giacomo Rossettini, Arianna Bortolami https://creativecommons.org/licenses/by-nc/4.0
Authors’ reply to: “Comments on: Impact of direct access on the quality of primary care musculoskeletal physiotherapy: a scoping review from a patient, provider, and societal perspective”
Copyright (c) 2025 Erik Cattrysse, Jona Van Den Broeck, Robin Petroons, Amber Teugels, Aldo Scafoglieri, Emiel van Trijffel https://creativecommons.org/licenses/by-nc/4.0
Comments on: Impact of direct access on the quality of primary care musculoskeletal physiotherapy: a scoping review from a patient, provider, and societal perspective
Copyright (c) 2025 Jean-François Kaux, Marc Schiltz, Patrick Linden, Geoffrey Brands, Bruno Schoonejans, Thierry Lejeune https://creativecommons.org/licenses/by-nc/4.0
A new test protocol and device for measuring the cranio-cervical flexion test in participants with bruxism
Introduction: The craniocervical flexion test (CCFT) has been proposed to assess muscular stabilization using deep neck flexors. Reliability of the CCFT using a pressure biofeedback unit has been regarded as doubtful, and the level of evidence is reportedly low. The aim of the current study is to pilot test an alternative measurement protocol by using a new digital device during the staged CCFT when compared to surface electromyography (sEMG) of neck flexor muscles in participants with bruxism. Methods: Cross-sectional pilot study including five participants with bruxism and five controls. Measuring five incremental stages (20-100%), from a maximum force of 17 N for the CCFT and parallel to sEMG measurements of bilateral sternocleidomastoideus (SCM) and masseter muscles. SEMG data were normalized to their activity during maximal voluntary contraction. Performance during the staged CCFT was fed back via a smartphone screen. Results: A two-way repeated measures ANOVA found a significant stage (F = 32.56, df = 4, p = 0.001) but not group (0.30, df = 1, p = 0.65) main effect for SCM activity, with both groups demonstrating higher normalized sEMG activity for incremental stages of the CCFT. Neither group nor stage effects were found for normalized masseter activity during the staged CCFT. Conclusion: A new measurement protocol and test device for the CCFT were examined in participants with and without bruxism. In parallel, sEMG used showed differences in SCM activity for incremental test stages. Group differences could not be found.
Copyright (c) 2025 Mareile Jung, Annika Zind, Markus Ernst https://creativecommons.org/licenses/by-nc/4.0
Using AI to enhance scientific discourse by transforming journals into learning communities
The introduction of generative AI into scientific publishing presents both opportunities and risks for the research ecosystem. While AI could enhance knowledge creation and streamline research processes, it may also amplify existing problems within the system. In this viewpoint article, I suggest that generative AI is likely to reinforce harmful processes unless scientific journals and editors use these technologies to transform themselves into vibrant knowledge communities that facilitate meaningful discourse and collaborative learning. I describe how AI could support this transformation by surfacing connections between researchers’ work, making peer review more dialogic, enhancing post-publication discourse, and enabling multimodal knowledge translation. However, implementing this vision faces significant challenges, deeply rooted in the entrenched incentives of the current academic publishing system. Universities evaluate faculty based largely on publication counts, funding bodies rely on traditional metrics for grant decisions, and publishers benefit from maintaining existing models. Making meaningful change, therefore, requires coordinated action across multiple stakeholders who must be willing to accept short-term costs for long-term systemic benefits. The key to success lies in consistently returning to journals’ core purpose: advancing scientific knowledge through thoughtful research and professional dialogue. By reimagining journals as AI-supported communities rather than metrics-driven repositories, we can better serve both the scientific community and the broader society it aims to benefit.
Copyright (c) 2025 Michael Rowe https://creativecommons.org/licenses/by-nc/4.0