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A systematic review of current evidence on clinical outcomes of lumbar roll and modified SIMS manipulation techniques in sacroiliac joint dysfunction
Introduction: The lumbar roll and modified SIMS are two manipulation techniques commonly used to treat sacroiliac joint dysfunction (SIJD), a frequent cause of low back and pelvic pain. However, recent evidence comparing their relative clinical efficacy remains limited. Methods: This systematic review was registered in PROSPERO (Reg. No. CRD420251253094) and conducted according to PRISMA 2020 guidelines. Studies published between January 2021 and December 2025 were identified through searches of PubMed, Scopus, Web of Science, CINAHL, PEDro, the Cochrane Library, and Google Scholar (first 200 results). Eligible studies included randomized controlled trials, quasi-experimental trials, and controlled clinical studies evaluating lumbar roll or modified SIMS manipulation in adults with SIJD diagnosed using imaging-assisted criteria or validated provocation tests. Screening, data extraction, and risk-of-bias assessment (RoB-2 and ROBINS-I) were independently performed by two reviewers. Results: Of 1,264 identified records, nine studies met the inclusion criteria, with sample sizes ranging from 30 to 90 participants. Most studies reported significant short-term improvements in pain (VAS/NPRS) and disability (ODI/functional measures) following manipulation, with lumbar roll and modified SIMS showing comparable clinical benefits. Several studies also reported improvements in pelvic alignment and mobility. Adverse events were infrequent, transient, and no serious complications were reported. Conclusion: Lumbar roll and modified SIMS manipulation provide consistent short-term clinical benefits for SIJD, particularly in reducing pain and disability. However, evidence remains limited by the lack of direct head-to-head comparisons, methodological heterogeneity, and short follow-up periods. Further high-quality studies are needed to establish long-term efficacy and optimal treatment protocols.
Copyright (c) 2026 Farooq Islam, Umair Ahmed, Christopher McCarthy, Maryam Shabbir, Ashfaq Ahmad, Arooj Munawar https://creativecommons.org/licenses/by-nc/4.0
Postural stability during low-intensity respiratory loading in pre-COPD and healthy adults: a cross-sectional study
Introduction: Pre-COPD is characterized by the presence of respiratory symptoms and/or structural abnormalities, without spirometry-confirmed airflow limitation. However, pre-COPD may be associated with extrapulmonary manifestations that are not apparent at rest. The aim of this study was to assess postural stability through center of pressure (CoP) dynamics during low-intensity inspiratory and expiratory loading between adults with pre-COPD and healthy adults. Methods: This cross-sectional observational study included 31 volunteer adults (17 with pre-COPD, 14 healthy adults; mean age 47.9 years). CoP was calculated from ground reaction forces and torques recorded with a force plate during quiet standing across three breathing conditions (without, inspiratory, and expiratory loads). Respiratory loads were set at 10% of the individuals’ maximal inspiratory and expiratory pressures. CoP mean amplitude (m-1) and velocity (m-1·s-1) in anteroposterior and mediolateral directions, normalized by the base of support area, were calculated from a 30-second period, averaged across three trials. Results: During inspiratory loading, all mean velocity outcomes were significantly higher in adults with pre-COPD compared to healthy adults (anteroposterior: p = 0.002, 95% CI [0.991, 4.014]; mediolateral: p < 0.001, 95% CI [0.971, 3.324]; total: p = 0.002, 95% CI [1.314, 5.270]). Although mean amplitude showed no overall group difference, significant load × group interaction revealed that adults with pre-COPD exhibited a greater postural disturbance during inspiratory loading than healthy adults. Expiratory loading only significantly differentiated groups for mediolateral velocity (p = 0.034, 95% CI [0.096, 2.292]). Conclusions: During quiet standing, low-intensity inspiratory loading was associated with increased CoP differences between adults with pre-COPD and healthy adults.
Copyright (c) 2026 Leonel A. T. Alves, Edgar Ribeiro, Carlos Crasto, Cristina Argel de Melo, Rita Santos, Rubim Santos, João Paulo Vilas-Boas, António Mesquita Montes https://creativecommons.org/licenses/by-nc/4.0
Utilization of physiotherapy services and associated factors among stroke survivors attending hospitals in Gondar Town, Northwest Ethiopia
Introduction: The physiotherapy service plays a vital role in stroke rehabilitation by improving mobility, reducing disability, and enhancing quality of life. This study assessed physiotherapy service utilization and associated factors among stroke survivors attending hospitals in Gondar Town, Northwest Ethiopia. Methods: An institution-based cross-sectional study was conducted from April to May 2025. A systematic random sampling technique was used to select participants. Data was collected using a structured interviewer-administered questionnaire supported by medical record review. Descriptive statistics were used to summarize participant characteristics. Variables with a p-value of less than 0.25 in the Bivariable regression were entered into a multivariable logistic regression, and a p-value of <0.05 was considered statistically significant. Results: A total of 400 stroke survivors participated in the study, of whom 46.75% utilized physiotherapy services. Utilization of physiotherapy service was significantly associated with the acute phase of stroke survivors (AOR = 1.63, p < 0.000), stroke survivors those who were dependence in activities of daily living (AOR = 1.07, p = 0.002), stroke survivors with balance impairment (AOR = 1.12, p = 0.019), and those with abnormal speed of mobility (AOR = 1.01, p = 0.018) were significantly associated with utilization of physiotherapy service. Conclusion: Physiotherapy service utilization among stroke survivors in Gondar Town was suboptimal. Utilization was significantly associated among patients in the acute phase and those with dependence in activities of daily living, balance impairment and abnormal speed of mobility. Improving access, strengthening referral systems, and enhancing follow-up care are recommended to increase physiotherapy service utilization.
Copyright (c) 2026 Melese Gobezie, Addisu Yihenew, Kassahun Cherkoss, Ermias Solomon, Ashenafi Zemed, Destaw Marie Merawie, Gashaw Jember Belay, Mihret Dejen Takele, Molla Fentanew, Gebremariam Bekele Gesese, Yibeltal Wolelaw Admas, Yeshambel Ejigu Anteneh, Setegn Fentahun, Mulualem Kelebie, Mequanente Dagnaw https://creativecommons.org/licenses/by-nc/4.0
Perceptions and experiences of Italian physiotherapists in managing patients’ mental and cognitive health: a cross-sectional study
Introduction: Mental and cognitive health content has been integrated into Italian guidelines for nearly five years. Therefore, this study aimed to investigate how these recommendations have translated into practice by examining the perceptions and experiences of physiotherapists in Italy. Methods: A cross-sectional online survey was conducted between January 2024 and April 2025. Physiotherapists were reached through social media and official channels. Descriptive and regression analyses were used to examine participants’ profiles, predictors of self-perceived competence, referral likelihood, and changes in educational training over time. Results: Among 423 physiotherapists, 39.4% and 60.7% reported low competence in managing cognitive and mental health issues, respectively. Physiotherapists working in neurological practice had higher odds of feeling competent in both cognitive (OR = 2.47, p < 0.001) and mental health (OR = 1.90, p = 0.040) care and of receiving cognitive care referrals (OR = 1.94; p = 0.003). Greater clinical experience was associated with confidence in managing cognitive health (p = 0.010). Reliance on physiotherapists as an information source was linked to lower competence in cognitive health (OR = 0.53, p = 0.023). Years of experience predicted the educational training undertaken for cognitive and mental health care (p = 0.034). Conclusion: The reported practice patterns may indicate care gaps and limited implementation of the national guidelines among physiotherapists in Italy. Since cognitive impairments and mental health issues are commonly encountered across physiotherapy specialties, we recommend that undergraduate curricula include more content in these areas and that additional opportunities for professional development be provided.
Copyright (c) 2026 Inaihá Laureano Benincá, Maria Gattuso, Stefania Butti, Mattia Mazzoleni, Francesca Morganti https://creativecommons.org/licenses/by-nc/4.0
Investigating the clinical pattern of motor relearning in people with multiple sclerosis
Introduction: Understanding how people with multiple sclerosis (PwMS) acquire motor skills during rehabilitation is essential for optimizing treatment strategies. Motor learning theory suggests that skill acquisition follows predictable trajectories, but the time course and variability of learning during task-oriented rehabilitation remain poorly defined in PwMS. The aim was to investigate the learning trajectory and performance variability in PwMS undergoing task-oriented rehabilitation, using mathematical modeling of behavioral changes over time. Methods: This longitudinal prospective study included 44 PwMS admitted to a rehabilitation unit. Participants received either balance-specific or non-specific motor impairment treatments. Balance performance was assessed with the Berg Balance Scale (BBS) after each session. Session-to-session changes were analyzed using linear and exponential models to characterize the learning pattern, and residuals were examined to quantify variability. Results: An exponential mixed model (Akaike information criterion (AIC) = 2514.1) best described learning trajectories and provided more accurate estimates of pre-to-post improvement compared to a linear model (AIC = 2672.1). Performance variability decreased across sessions, from 1.16 to 0.75 points. Participants receiving specific balance treatment reached the minimal clinically important difference after three sessions, while participants receiving non-specific treatments achieved MCID only after 7 sessions. Conclusions: Motor performance changes in PwMS during rehabilitation resemble motor learning in healthy individuals: improvements follow an exponential function and are accompanied by reduced variability. Treatment specificity enhances the velocity and magnitude of learning, underscoring the importance of targeted interventions in neurorehabilitation.
Copyright (c) 2026 Davide Cattaneo, Elisa Gervasoni, Matteo Meotti, Johanna Jonsdottir https://creativecommons.org/licenses/by-nc/4.0
Effectiveness of manual therapy as a prophylactic treatment for migraine: a randomized controlled trial
Introduction: Migraine is a leading cause of disability worldwide. Although effective, the use of pharmacological prophylaxis is low due to suboptimal efficacy and poor tolerability. This has led to a growing interest in non-pharmacological approaches such as manual therapy (MT), especially among patients with comorbid neck pain. While evidence for MT remains inconclusive, its adjunctive use is recommended. This study evaluated the effect of MT in patients with migraine and neck pain, compared to usual care provided by general practitioners (UC). Methods: In this randomized controlled trial in primary care, participants with migraine and neck pain were allocated to MT (n = 36) or UC (n = 31). MT included mobilizations, exercises and myofascial techniques. Follow-up assessments were performed at 12-, 26-, and 52-weeks post-inclusion. The primary outcome was the number of migraine days. Secondary outcomes included migraine intensity, disability, medication use, neck pain intensity, neck muscle endurance, pressure pain thresholds, allodynia, and perceived recovery. Results: There were no significant between-group differences in migraine days or most secondary outcomes. Compared with usual care, the MT group demonstrated significantly higher-pressure pain thresholds over the occipital muscles and reported greater perceived recovery at both 12 and 52 weeks. Use of prophylactic medication was higher in the UC group throughout follow-up. Conclusion: MT, including postural and cranio-cervical exercises, was not superior to usual care in reducing migraine days and most secondary outcomes. Still, patient preference and treatment satisfaction for MT were high and may be considered in migraine management.
Copyright (c) 2026 Andreas L. Amons, Rene F. Castien, Willem De Hertogh, Johannes C. van der Wouden, Jos W.R. Twisk, Joost Dekker, Henriëtte E. van der Horst https://creativecommons.org/licenses/by-nc/4.0
The immediate effect of peripheral stimulation on cervical dystonia disease outcomes: single-case experimental design
Introduction: Limited cervical range of motion (CROM) and pain are among the most common symptoms of cervical dystonia (CD), which are treated with botulinum neurotoxin (BoNT) injections. However, adjunctive interventions may offer additional benefit. Therefore, this study evaluated the immediate effects of peripheral stimulation comprising conventional transcutaneous electrical nerve stimulation (TENS), muscle stimulation (NMES), and muscle vibration on CROM and pain in patients with CD. Methods: A single-case experiment design (SCED), alternating treatment design was conducted with 19 CD patients, recruited at the Antwerp University Hospital (UZA). Participants randomly received conventional TENS, NMES and muscle vibration on three different days. Main outcome measures were CROM, measured using a 3D-stereophotogrammetric scanning system (3dMD Inc., GA, USA) and pain, quantified by Visual Analog Scale (VAS). Results: Mean age of participants was 59.87 ± 8.9 years. Baseline CROM for rotation ranged from 87° to 137.6° and from 79° to 132.4° for flexion/extension. Improvements in neck rotation were observed in 5 (33.3%) participants after conventional TENS, 8 (42.1%) after NMES, and 8 (42.1%) after muscle vibration. Similarly, improvement in flexion and extension was observed in 10 (55.6%) after conventional TENS, 8 (53.3%) after NMES, and 7 (46.7%) after muscle vibration. Significant reductions in pain shortly after the three interventions were observed in patients experiencing pain. Conclusions: These findings suggest that peripheral stimulation may provide immediate symptomatic relief in CD, particularly for improving CROM and reducing pain. While promising, these results should be considered as exploratory and warrant further investigation in larger, controlled studies.
Copyright (c) 2026 Shimelis Girma Kassaye, David Crosiers , Esayas Kebede Gudina , Nasser Nadjmi , Elke Van de Casteele , Joke De Pauw , Willem De Hertogh https://creativecommons.org/licenses/by-nc/4.0
Mastering the use of hand-held dynamometry in clinical practice
Measures of muscle performance, such as strength and the rate of force development (RFD), are important for function, rehabilitation, and successful aging. Clinicians seeking to use objective measurement methods of muscle performance in support of their assessments and rehabilitation programs have many affordable dynamometry options. However, substantive differences exist between devices on important characteristics such as sampling frequency, load capacity and determining force onset, which dramatically affect the ability to obtain accurate estimates of muscle performance. The assessment environment and setup also require careful consideration. Busy clinicians are often unaware of the extent to which methodological variability and inconsistencies in testing protocols can inflate measurement error and render tests insensitive to change. Where data inform treatment and return-to-play decisions (vs. motivational aid), ensuring validity and reliability is paramount, particularly given that clinicians typically assess individual, not group performance. This is because ascertaining change or difference in intra-individual performance demands a greater level of measurement precision compared to assessing performance between groups of people. This evidence-informed Masterclass will exemplify some of the critical technical and methodological factors that intrude on measurement accuracy. It will provide readers with the knowledge: how to critically evaluate the utility of dynamometers, answering the question, which to buy and why? How to construct assessment protocols to improve quality data collection, and how to understand what constitutes real change in performance beyond “differences” caused by measurement error.
Copyright (c) 2025 Claire Minshull https://creativecommons.org/licenses/by-nc/4.0
The relationship between clinical outcomes and gait biomechanics in individuals with plantar fasciitis
Introduction: Plantar fasciitis (PF) is a common musculoskeletal disorder characterized by heel pain that disrupts gait and daily function. This study examined relationships between clinical outcomes and gait biomechanics, determined whether these relationships differ between recent- and chronic-onset cases, and identified key clinical predictors of gait speed. Methods: A cross-sectional study was conducted with 42 individuals with PF. Clinical outcomes included worst pain, normalized gastrocnemius and soleus muscle length, normalized lower limb muscle strength, and normalized dynamic balance. Gait biomechanics during barefoot walking were captured using a motion analysis system and force plates, focusing on spatiotemporal parameters and ground reaction forces (GRFs). Correlation coefficients were used to assess relationships across the overall cohort, as well as in recent- and chronic-onset PF, while multiple linear regression identified clinical predictors of gait speed. Results: Clinical outcomes related differently to sptiotemporal parameters and GRFs depending on symptom duration, with the recent-onset PF showing widespread correlations and chronic-onset PF showing more selective links with ankle strength and dynamic balance. Regression analysis identified gastrocnemius muscle length and anterior reach distance on the Y-Balance Test (YBT) as significant predictors of gait speed, explaining 28.0% of the variance (p = 0.002). Conclusion: Symptom duration influences gait biomechanics in PF, with recent onset showing broad adaptations and chronic onset exhibiting more specific strength- and balance-related changes. Gastrocnemius muscle length and dynamic balance in the anterior direction were identified as significant contributors to gait performance. Targeting these factors, with consideration of symptom duration, may improve gait in individuals with PF.
Copyright (c) 2026 Hataitip Boonchum, Roongtiwa Vachalathiti, Richard Smith, Satoshi Muraki, Sunee Bovonsunthonchai https://creativecommons.org/licenses/by-nc/4.0
Postoperative education for patients after hip/knee arthroplasty: a systematic review with meta-analysis of randomized controlled trials
Introduction: Guidelines often recommend patient education in the management of hip or knee replacement, despite evidence of its effectiveness is scarce. The aim of this study was to assess the effectiveness of postoperative patient education on pain, function, quality of life, and psychosocial issues. Methods: We performed a systematic review and meta-analysis of RCTs investigating the effects of patient education (alone or in combination with other treatments) compared to usual care delivered after hip/knee replacement. Risk of bias was assessed using the Cochrane Risk of Bias 2.0. Certainty of evidence was established according to the GRADE approach. Results: We included five trials. We found that patient education likely results in little to no effects compared to usual care in the medium-term on pain (SMD −0.09, 95% CI −0.41-0.22) and quality of life (MD 0.11, 95% CI 0.00-0.22). Similarly, it likely results in little to no effect on anxiety in both short- (MD 1.59, 95% CI −3.16 to −0.02) and medium-term (MD −1.51, 95% CI −3.07-0.05), as well as on depression in the short- (SMD −0.22, 95% CI −0.58-0.15) and medium-term (SMD −0.22, 95% CI −0.55-0.12). In contrast, usual care may improve long-term physical function (SMD 0.64, 95% CI −0.03-1.3). Conclusion: Postoperative patient education provided no to small benefit on pain, physical function, quality of life or psychosocial issues compared to usual care. Its role may be more impactful when patient-tailored and integrated into multimodal rehabilitation strategies for people after hip/knee arthroplasty.
Copyright (c) 2025 Leonardo Piano, Chiara Brossa, Leandro Francesco Gioia, Adele Occhionero, Andrea Dell'Isola, Marco Trucco https://creativecommons.org/licenses/by-nc/4.0
Trunk-head coordination in chronic neck pain, reliability, influence of visual feedback, and relationship to patient-reported outcomes
Introduction: Neck pain (NP) is associated with sensorimotor impairments, including altered trunk-head coordination. Limited data are available on the reliability of such assessments and influence of visual feedback in individuals with NP. Relationships between trunk-head coordination performance and NP, dizziness disability levels, or NP onset (traumatic or idiopathic) remain unclear. Methods: This cross-sectional study evaluated intra- and inter-session reliability of accelerometer-based trunk-head coordination assessment in traumatic and idiopathic NP subjects. Assessments were conducted under both visual and non-visual feedback conditions. The latter was repeated twice on the same day and once more within a week. Head movement during the task, represented by Constant Error (CE), Absolute Error (AE), Sum of Absolute Errors (SAE), and Variable Error (VE) was analyzed for reliability. Differences between visual feedback conditions and pain onset, and correlations with the Neck Disability Index (NDI) and Dizziness Handicap Inventory (DHI) were examined. Results: CE, AE, and SAE of 19 NP subjects demonstrated at least moderate intra-session reliability. None of the error types reached moderate inter-session reliability. Visual feedback significantly reduced head movement errors for AE and SAE. Correlations between error types and self-reported outcomes were weak to fair and did not reach statistical significance. No significant differences emerged between traumatic and idiopathic NP groups. Conclusion: Accelerometer-based trunk-head coordination showed moderate intra-session but lower inter-session reliability, suggesting variability in performance over time in individuals with NP. Visual feedback improved trunk-head coordination. Performance did not appear to be influenced by levels of perceived disability, dizziness, or the origin of NP.
Copyright (c) 2026 François Tharin, Julia Treleaven, Sari Merilampi, Merja Sallinen, Markus J. Ernst https://creativecommons.org/licenses/by-nc/4.0
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
Stair walking is associated with returning home after inpatient stroke rehabilitation in Belgium and Switzerland: a multicentric retrospective study
Introduction: Identifying factors associated with discharge destination after inpatient stroke rehabilitation is important for patients and healthcare professionals. It supports discharge planning and prevents delayed discharge. Objective: To identify key variables from socio-demographic and clinical data associated with returning home after inpatient stroke rehabilitation, focusing on patients from three rehabilitation centers in Belgium and Switzerland. Methods: This multicenter retrospective study, conducted in three centers, included 1475 adult patients with stroke admitted to an inpatient rehabilitation unit between December 2012 and June 2021. A logistic regression with backward selection was used to define the model for discharge destination. The dependent variable was the discharge destination (home vs other). The independent variables were selected from the socio-demographic, medical, neurological, care pathway, and functional data and included age, gender, living arrangement, type of stroke, previous stroke, cognitive impairments, independence in grooming, eating, and stair walking. Results: The final model included three variables (independence in stair walking, living arrangement, and cognitive impairment). Stair walking had the strongest association with returning home. Patients who were partially (OR 5.83, 95% CI 3.67-9.26) or fully independent (OR 14.31, 95% CI 9.34-21.93) were more likely to return home than patients who were unable to walk the stairs. The results were similar for subgroups and for discharge and admission data. Conclusion: The study showed that independence in walking stairs is strongly associated with discharge destination. Aligned with another study, these results should be confirmed in further research.
Copyright (c) 2026 Odile Chevalley, Emmanuelle Opsommer, Steven Truijen, Grégoire Eberlé, Isabelle Lehmann, Katrien Van-Den-Keybus Deglon, Wim Saeys https://creativecommons.org/licenses/by-nc/4.0
Frontline agreement in diagnosis and treatment for musculoskeletal dysfunctions. A prospective, randomized, controlled study
Introduction: Due to shortages of general practitioners and increasing emergency department (ED) presentations for non urgent musculoskeletal conditions (MSKDs), Advanced Physiotherapy Practice (APP) roles have been implemented internation ally. However, this model remains novel in Switzerland. This study evaluated agreement in diagnosis, treatment, and discharge decisions between physiotherapists and resident physicians compared with senior physicians as the reference standard in the ED of Bethesda Hospital Basel (BSAG). Methods: A randomized controlled trial was conducted from October to December 2023. Patients presenting musculoskeletal complaints without evidence of serious pathology were allocated to either an intervention group managed by physiotherapists or a control group receiving standard care by resident physicians. Clinical decisions from both groups were reviewed by senior physicians. Agreement was assessed using Cohen’s Kappa (κ) and Gwet’s AC1 statistics. Results: A total of 102 patients were included (mean age 52 years, SD 16.3; 61% female; 51% with low back pain). Physio therapists demonstrated good to excellent agreement with senior physicians for diagnosis (κ = 0.72-0.96; AC1 = 0.73-0.97) and management (κ = 0.69-0.88; AC1 = 0.71-0.89). Residents showed high agreement for diagnosis (κ = 0.85; AC1 = 0.86) and perfect agreement for management (κ = 1.00; AC1 = 1.00). No adverse events occurred. Patient satisfaction was higher in the physiotherapy group (mean 4.79 vs. 4.19/5). Conclusion: Experienced physiotherapists demonstrated high agreement with senior physicians in diagnosing and managing MSKDs in the ED. APP appears safe and may improve patient satisfaction without increasing adverse events.
Copyright (c) 2026 Birol Zeybeker, Roger Hilfiker, Amir Tal-Akabi https://creativecommons.org/licenses/by-nc/4.0
Socio-demographic predictors of admission to Bachelor of Physiotherapy Programme: a retrospective cohort study
Introduction: The influence of socio-demographic variables on admission to a Bachelor of Physiotherapy Programme is a debated topic. The study investigated the socio-demographic predictors of admission test success and scores for a Bachelor of Physiotherapy Programme. Moreover, the study assessed the effects of different proportions of logical reasoning (LR) and scientific knowledge (SK) questions on the distribution of socio-demographic variables of admitted candidates. Methods: A retrospective cohort study was conducted on applicants to the Bachelor of Physiotherapy Programme at Humanitas University, Milan, Italy, from 2016 to 2023. Logistic and linear regression models were used to investigate socio-demographic predictors of admission and test scores. Logistic regression model and chi-square test were used to investigate socio-demographic predictors and their distribution in admitted candidates of 3 cohorts selected with a different proportion of logical reasoning (LR) and scientific knowledge (SK) questions. Results: High-school type, gender, and geographic origin were socio-demographic predictors of the Bachelor of Physiotherapy Programme test success (pseudo-R² = 0.06) and total score (R² = 0.13). A higher proportion of candidates who attended a scientific high school and males were found among admitted applicants, regardless of the proportion of LR and SK questions. Discussion: Socio-demographic predictors of admission to the Bachelor of Physiotherapy Programme were identified, but these predictors marginally improved the model fitting or explained a small portion of the variance. These results suggested that admission outcomes were poorly predicted by socio-demographic factors considered in the current study. Admission test contents did not seem to influence the socio-demographic profile of candidates admitted to a Bachelor of Physiotherapy Programme.
Copyright (c) 2026 Emanuela Elsa De Martino, Federico Temporiti, Paola Adamo, Luca Timoniere, Pietro Avanzini, Roberto Gatti 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
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
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
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
Exploring gender differences in Physiotherapy research in Italy: a cross-sectional analysis
Introduction: Gender equity in scientific research, especially in Physiotherapy, reveals significant underrepresentation of women, affecting career advancement, salary, and research recognition. This study aims to examine the characteristics, knowledge, attitudes, and productivity of Physiotherapy researchers in Italy, focusing on gender distribution. Methods: This cross-sectional study was conducted on Italian Physiotherapists who either have a PhD or are currently enrolled in PhD programs. We used a survey consisting of 62 items that explored demographic and educational characteristics, research experience, worklife balance, attitude and social norms, and career-related factors. Performance metrics included H-index, number of publications (during PhD and in the whole career), and awards. Results: Of the 167 Physiotherapists surveyed, 102 participated. Female participants reported worse attitudes and social norms perception, and during their PhD, were less satisfied with work conditions compared to males. Females reported a median of 3 publications during their PhD, and males 5. However, after adjusting for age, time invested in research, and whether the interviewee lives with a partner, age remains the only associated factor. There is no evidence of an association between gender and H-index or awards. Conclusion: Gender-based disparities in research attitudes exist in Physiotherapy, particularly during the PhD phase, favoring males. Further research is needed to promote gender equity.
Copyright (c) 2026 Martina Putzolu, Simone Gambazza, Greta Castellini, Andrea Turolla, Silvia Gianola 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
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
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
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
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
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
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
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
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