Guideline-based exercise management for hip and knee osteoarthritis: a cross-sectional comparison of healthcare professional and patient beliefs in Ireland.

OBJECTIVES: To identify within-stakeholder agreement and between-stakeholder differences in beliefs regarding exercise for osteoarthritis among general practitioners (GPs), physiotherapists (PTs) and people with hip and knee osteoarthritis (PwOA). A secondary objective was to explore the association between referral patterns and beliefs of PwOA. DESIGN: Cross-sectional. SETTING: Online surveys administered to GPs, PTs and PwOA in Ireland via social media and healthcare networks. PARTICIPANTS: 421 valid responses (n=161 GPs, n=163 PTs, n=97 PwOA). PRIMARY AND SECONDARY OUTCOME MEASURES: Nine belief statements related to exercise effectiveness, safety and delivery were rated on a 5-point Likert scale and analysed for within-stakeholder consensus. χ2 tests assessed differences in agreement between groups. Multivariable linear regression models tested associations between beliefs in PwOA and referral to/attendance at physiotherapy. RESULTS: Positive within-stakeholder consensus (>75% agreement) was reached for most statements (7/9 GPs, 6/9 PTs, 5/9 PwOA). However, beliefs of PwOA were significantly less positive compared with healthcare professionals for six statements. All stakeholders disagreed that exercise is effective regardless of the level of pain. Attendance at physiotherapy (49% of PwOA), rather than referral to physiotherapy from a GP only, was associated with positive exercise beliefs for PwOA (ß=0.287 (95% CI 0.299 to 1.821)). CONCLUSIONS: Beliefs about exercise therapy for osteoarthritis are predominantly positive across all stakeholders, although less positive in PwOA. PwOA are more likely to have positive beliefs if they have seen a PT for their osteoarthritis. Knowledge translation should highlight the effectiveness of exercise for all levels of pain and osteoarthritis disease.

Vestibular Rehabilitation: Improving Symptomatic and Functional Outcomes of Persons with Vestibular Schwannoma: A Systematic Review.

OBJECTIVE: Persons with vestibular schwannoma suffer from dizziness, imbalance, and decreased function leading to reduced quality of life. Other forms of peripheral vestibular hypofunction show improvements in these signs and symptoms with vestibular rehabilitation; however, the efficacy of this intervention for those with vestibular schwannoma is unknown. Therefore, the aim of this systematic review was to determine the effect of vestibular physical therapy on subjective and objective measures of vestibular symptoms and function in people with vestibular schwannoma. METHODS: Four electronic databases were searched: PubMed, CINAHL, EMBASE, and Cochrane. Included studies were experimental or observational in design and featured patients with vestibular schwannoma who had undergone vestibular physical therapy. Screening and quality assessment was completed independently by 2 researchers. Risk of bias was assessed with a tool appropriate for study design (eg, Cochrane Risk of Bias 2.0 tool for randomized trials). The Grading of Recommendations Assessment, Development and Evaluation approach was used to synthesize findings. RESULTS: Twenty-three studies were included. Overall, the effect of vestibular physical therapy for patients with vestibular schwannoma was uncertain. Outcomes of dizziness, static and dynamic balance, and vestibular function all showed very low certainty on the Grading of Recommendations Assessment, Development and Evaluation assessment. Multimodal physical therapist interventions consistent with clinical practice guidelines (eg, gaze stability, habituation, balance training, gait training) demonstrated potential for improvement in dizziness, balance, and vestibular function, respectively. Results were mostly insignificant when a single modality was used. CONCLUSION: There may be benefit in multimodal vestibular physical therapy for people with vestibular schwannoma to improve symptoms and function. More high-quality studies specific to vestibular schwannoma prehabilitation and rehabilitation are needed to increase the certainty in the evidence. IMPACT: Physical therapists are encouraged to use multimodal vestibular rehabilitation for vestibular schwannoma in clinical practice in line with clinical guidelines for peripheral vestibular hypofunction.

Transgender, Gender-Diverse, and Nonbinary Experiences in Physical Therapy: A Descriptive Qualitative Study.

OBJECTIVE: The objective was to explore experiences with and identify barriers and facilitators of utilizing physical therapy for people who identify as transgender, gender diverse, and nonbinary (TGNB). METHODS: A qualitative descriptive design was employed using semistructured interviews conducted in New Zealand. Eligible participants were individuals who were 12 years old or older, who self-identified as TGNB, and who had accessed physical therapy at a community-based clinic that also provides a gender-affirming service. Participants were recruited via email invitation to the clinic database. Interview data were analyzed using reflexive thematic analysis. Demographics are reported descriptively. RESULTS: Seventeen individuals (15-64 years old and identifying as 11 different genders) participated. All participants reported physical therapist experiences relating to 1 or more of the following 4 themes: challenging cisnormativity at policy, environmental, clinic, and therapist levels; safety and trust throughout the clinical experience, including clinic credibility for being a safe provider, clinic displays of TGNB inclusivity, implementation of safe clinic processes, and respectful therapist interactions; inclusive experiences in a clinic that provided affordable care and took active steps to understand and affirm TGNB identities and with physical therapists who had a high level of knowledge of TGNB-specific health issues and took a biopsychosocial approach to care; and sensitivity to body discomfort or dysphoria triggers. Barriers to and facilitators of care were identified at policy, environmental, clinic, and therapist levels. CONCLUSION: People who identify as TGNB face challenges to accessing safe and culturally sensitive physical therapy. However, there are achievable areas for improvement at policy, environmental, clinic, and physical therapist levels to gain trust and engagement in care for the TGNB community. IMPACT: This study provides a detailed exploration of TGNB physical therapist experiences and identifies specific areas of improvement for TGNB physical therapy care to provide clinicians and physical therapy clinics insights into the provision of safe and culturally sensitive physical therapy.

The Italian Consensus Conference on the role of rehabilitation for children and adolescents with leukemia, central nervous system tumors, and bone cancer, part 2: general principles for the rehabilitation treatment of motor function impairments.

In Italy, 1400 children and 800 adolescents are diagnosed with cancer every year. About 80% of them can be cured but are at high risk of experiencing severe side effects, many of which respond to rehabilitation treatment. Due to the paucity of literature on this topic, the Italian Association of Pediatric Hematology and Oncology organized a Consensus Conference on the role of rehabilitation of motor impairments in children/adolescents affected by leukemia, central nervous system tumors, and bone cancer to state recommendations to improve clinical practice. This paper includes the consensus on the rehabilitation of children and adolescents with these cancers.

Predicting performance in a doctor of physical therapy gross anatomy course based on an exploratory factor analysis of the anatomical self-efficacy instrument.

Measuring self-efficacy can be a valuable means for instructors to predict student performance. However, it is crucial to measure self-efficacy within specific contexts to effectively gauge students' perceptions of their capabilities. This study evaluated the factors comprising the Anatomical Self-Efficacy Instrument (ASEI) and determined whether these factors could predict performance in gross anatomy. Three cohorts of Doctor Physical Therapy (DPT) students completed the ASEI at the start of gross anatomy. An exploratory factor analysis (EFA) analyzed the ASEI's dimensionality, and Cronbach's alpha evaluated the internal consistency of the extracted factors. Linear regression was used to determine whether ASEI's total or subdomain scores predicted final anatomy course performance scores. In total, 142 of 287 (49.5%) DPT students completed the ASEI. EFA revealed three distinct factors, including "cognitive," "psychomotor," and "clinical anatomy self-efficacy", and explained 44.9%, 13.7%, and 5.2% of the total variance, respectively. Only cognitive self-efficacy predicted final gross anatomy course performance (ß = 0.34; R2 = 0.071; F(3,138) = 3.51; p < 0.05). Overall, the ASEI's 3-factor solution implies its multidimensionality, a finding that could inform the development of more comprehensive self-efficacy measures. Notably, "cognitive self-efficacy" was the only subdomain that predicted DPT student performance in anatomy, suggesting its potential as a tool for identifying students in need of additional learning support. The ASEI's practical usability should be further explored through additional psychometric testing.

Evaluating the efficacy of wearable biofeedback on the outcomes of exercise interventions in people with chronic non-specific spinal pain: protocol for a systematic review and meta-analysis.

INTRODUCTION: Wearable neuromuscular and biomechanical biofeedback technology has the potential to improve patient outcomes by facilitating exercise interventions. We will conduct a systematic review to examine whether the addition of wearable biofeedback to exercise interventions improves pain, disability and quality of life beyond exercise alone for adults with chronic non-specific spinal pain. Specific effects on clinical, physiological, psychological, exercise adherence and safety outcomes will also be examined. METHODS AND ANALYSIS: A systematic search will be conducted from inception to February 2024. Full articles in the English language will be included. MEDLINE, PubMed, CINAHL, EMBASE, Web of Science, PsycINFO, AMED, SPORTDiscus, CENTRAL databases, clinical trial registries and ProQuest (PQDT) will be used to search for eligible studies. Grey literature and conference proceedings (2022-2024) will be searched for relevant reports. Randomised controlled trials using wearable neuromuscular or kinematic biofeedback devices as an adjunct to exercise interventions for the treatment of chronic spinal pain will be included in this systematic review. The comparators will be wearable biofeedback with exercise versus exercise alone, or wearable biofeedback with exercise versus placebo and exercise. Risk of bias will be assessed using Cochrane Back Review Group criteria and the quality of evidence using Grading of Recommendations Assessment, Development and Evaluation recommendations. ETHICS AND DISSEMINATION: The systematic review will be based on published studies, and therefore, does not require ethical approval. The study results will be submitted for publication in an international, open-access, peer-reviewed journal and shared through conferences and public engagement. PROSPERO REGISTRATION NUMBER: CRD42023481393.

Melorheostosis (Leri's Disease): A Review.

Melorheostosis is a noncancerous bone disease characterized by abnormal bone and soft tissue growth. Despite being identified almost a century ago, there are still many unknown aspects surrounding this condition. It can often be an incidental discovery, with patients experiencing associated pain and deformities. Diagnosis typically relies on X-rays, although not all cases exhibit the classic candle wax appearance. A new imaging sign known as the "dumpling on a plate sign" has been proposed for flat bones for both MRI and CT scans. A biopsy may be necessary in cases of uncertainty, as there is not a definitive histological feature. It is not uncommon for melorheostosis to be linked with other conditions, and a collaborative approach involving a multidisciplinary team should be considered. This condition should be considered in the differential diagnosis of sclerotic bone conditions. Management is generally aimed at symptom relief, either through conservative measures or surgical intervention.

From the Intensive Care Unit to Recovery: Managing Post-intensive Care Syndrome in Critically Ill Patients.

Post-intensive care syndrome (PICS) is the term used to describe the decline in the physical, cognitive, and/or mental condition of individuals who have been discharged from the intensive care unit (ICU). This complication could result in a significant reduction in quality of life, with some patients experiencing symptoms of prolonged weakness, depression, anxiety, and post-traumatic stress disorder (PTSD). Intensive care advancement over the years has resulted in an increase in ICU survival rates and a proportional increase in PICS, creating a need for more in-depth research into the prevention and management of the disease. Hence, this study aims to examine the present body of literature on PICS, encompassing its underlying physiological processes and elements that contribute to its development, methods for evaluating and diagnosing the condition, current treatment choices as well as potential new approaches, and the constraints in managing PICS and the necessity for further investigation. In this article, studies were compiled from several databases, including, but not limited to, Google Scholar, PubMed, and Cochrane Library. These studies were reviewed, and their data were used to highlight important aspects regarding the efficacy of current PICS screening tools, the optimization and limitations of both pharmacologic and non-pharmacologic treatment methods, and the feasibility and safety of emerging treatments and technologies. The major conclusions of this review were centered around the need for multidisciplinary management of PICS. From pharmacological management using analgesia to non-pharmacological management using early mobilization and exercise therapy, the effective treatment of PICS requires a multifaceted approach. Patient follow-up and its importance were touched upon, including strategies and policies to bolster proper follow-up, thereby increasing favorable outcomes. Lastly, the importance of family involvement and the increased need for research into this topic were highlighted.

Comparison of the efficacy of low intensity laser and peloid therapy in patients with subacromial impingement syndrome.

The objective of this study was to compare the impact of peloid and low-level laser (LLLT) treatment in conjunction with a home exercise programme on short-term symptomatic pain, functional status and quality of life in individuals diagnosed with subacromial impingement syndrome (SIS). A total of 168 patients diagnosed with SIS were included in the study, with 56 receiving LLLT + exercise, 56 receiving peloidotherapy + exercise, and 56 receiving exercise only. Patients underwent clinical evaluations prior to treatment (first measurement), after treatment completion (second measurement), and one month post-treatment (third measurement). Pain was evaluated using the Visual Analog Scale (VAS). Functional status was evaluated using the Shoulder Pain and Disability Index (SPADI), and quality of life was evaluated using the Short Form 36 (SF-36). Active range of motion of the shoulder was measured by the same investigator using a goniometer. Statistically significant improvements in VAS, SPADI, SF-36, and ROM parameters were achieved after treatment and at 1 month follow-up compared to pretreatment in both active treatment groups (p < .05). The third group showed significant improvements in ROM and SF-36 physical components after treatment and 1 month later (p < .05). Low-level laser therapy or peloid therapy given in addition to home exercise therapy for SIS were found to have similar short-term effects on pain, functional status, quality of life and ROM.

The Integral Role of Physiotherapy in Optimizing Movement and Function in a Case of Polytrauma: A Case Report.

Multiple fractures are frequently encountered in adults following road traffic accidents. A 32-year-old male presented with multiple fractures in his right lower extremity, including a femoral shaft fracture, distal third fractures of the tibia and fibula, as well as a calcaneal fracture. The patient provided a history indicative of a road traffic accident. X-rays were performed on both hip joints, both knee joints, and the ankle joints. Treatment involved open reduction and internal fixation (ORIF) with interlocking nailing for the femur, tibia, and fibula, alongside ORIF with plating using a screw-out set (SOS) and cannulated cancellous (CC) screw fixation for the calcaneal fracture. Additionally, the Ilizarov procedure was conducted following debridement over the right foot. Post-surgery, the patient experienced primary symptoms of hip joint pain and restricted hip joint movement. Physiotherapy was initiated to address these issues. Evaluation of outcome measures indicated a reduction in joint pain, significant enhancement in joint mobility, and an increase in muscle strength.

Photobiomodulation therapy for chronic knee pain in obese patients in pre-rehabilitation for bariatric surgery: randomised, placebo-controlled, double-blinded, clinical trial protocol.

INTRODUCTION: Obesity has become a worldwide public health problem and is directly linked to loss of quality of life, complications and comorbidities. One of them is chronic pain, especially in the knees, which increases significantly and proportionally with weight gain. In patients with severe obesity, with indication for bariatric surgery, the presence of chronic pain disables and often prevents their participation in a pre-surgical rehabilitation programme. As an analgesic therapy, photobiomodulation (PBM) has been studied with safety, efficacy, well-tolerated used and low costs. Thus, this study aims to evaluate the use of PBM for the treatment of chronic knee pain in obese patients undergoing a pre-surgical rehabilitation programme for bariatric surgery. METHODS AND ANALYSES: This is a double-blinded, randomised, placebo-controlled clinical, superiority, trial protocol. The PBM will be applied in bilateral knees and lumbar paraspinal points levels referring to the roots of innervation of the knee. The outcomes evaluated will be pain intensity, functionality, quality of life and clinical signs of neurological sensitization of chronic knee pain pathways. ETHICS AND DISSEMINATION: This protocol has already been approved by the Comitê de Ética em Pesquisa do Hospital das Clínicas da Universidade Federal de Goiás/EBSERH-Ethics Committee and it is following SPIRIT guidelines. The results will be statistically analysed and subsequently published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: Clinical Trials Platform (https://clinicaltrials.gov/) with the number NCT05816798.

A Web-based Survey on the Telerehabilitation Knowledge, Attitude, and Practice of Physical Therapists in a Developing Country during the COVID-19 Pandemic: An Analytical Cross-sectional Study.

Background and Objective: Pre-pandemic, various healthcare settings were not used to seeing patients virtually. The unprecedented need to adopt virtual care during the COVID-19 pandemic may have caught physical therapists (PTs) unready for it. This study aimed to determine the telerehabilitation knowledge, attitude, and practice of PTs in the Philippines during the COVID-19 pandemic and determine the association between demographic and study outcome variables. Methods: This is an analytical cross-sectional study among members of the Philippine Physical Therapy Association, Inc. (PPTA) practicing in the Philippines. Purposive sampling (total enumeration) was employed. All PPTA members were invited to the study through e-mail and official social media group chats. A self-administered questionnaire was used to obtain data on telerehabilitation knowledge (through test questions on various theoretical aspects), attitude, and practice. Results: The questionnaire items had a content validity index of >0.80. The study yielded a 40% response rate. Most respondents were practicing clinicians in urban-based, private rehabilitation centers. Approximately half had average telerehabilitation knowledge, while the majority had agreeable telerehabilitation attitudes across different constructs. Among the respondents, 15.9% used telerehabilitation pre-pandemic, while 64.8% used it during the pandemic. Hybrid (synchronous and asynchronous) telerehabilitation sessions usually lasted one hour per patient, mostly using Facebook Messenger. Conclusion: Telerehabilitation was not widely practiced locally pre-pandemic, which may explain their average telerehabilitation knowledge. The positive telerehabilitation attitudes may represent a small group of PTs favoring telerehabilitation, while information from the larger population remains unknown. Early adopters of telerehabilitation may help introduce virtual care to colleagues and guide them in developing relevant knowledge and skills amid and beyond the enduring COVID-19 crisis.

The impact of physical therapy intervention of dysphagia on preventing pneumonia in acute stroke patients: A randomized controlled trial.

BACKGROUND AND OBJECTIVES: Dysphagia is a common complication following stroke. It corresponds to the development of pneumonia, which is always associated with bad prognosis, longer hospital stays and increased mortality. The aim of the study was to assess the impact of physical therapy intervention of dysphagia on preventing pneumonia in acute stroke patients. METHODS: A single-blind randomized controlled trial was carried out on 70 ischemic stroke patients with oropharyngeal dysphagia, age ranged from 49 to 65 years. They were randomly assigned to two groups (control and study) of equal number. Patients in the control group received oral care and nasogastric tube feeding, while patients in the study group received the same program in addition to the designed physical therapy program (exercises and neuromuscular electrical stimulation). The intervention program was applied for 40 min/session, 1 session/day, and 5 days/week for 4 weeks. Gugging swallowing screen (GUSS), and stroke associated pneumonia (SAP) control and prevention criteria were used to assess dysphagia and incidence of pneumonia at baseline, after two and 4 weeks of intervention for both groups. RESULTS: Before treatment, all patients were susceptible to pneumonia after two and 4 weeks of intervention; there were a significant increase in GUSS score in both groups with more improvement in favor of the study group (p < 0.05) and a statistically significant increase in incidence of SAP after 2 weeks of intervention only in the control group (p < 0.05). The results also showed a significant negative correlation between GUSS score and SAP (r = - 0.3662, p = 0.0018) IMPLICATIONS FOR PHYSIOTHERAPY PRACTICE: adding physical therapy (exercise therapy and neuromuscular electrical stimulation) to oral care and nasogastric tube feeding is effective in improving oropharyngeal dysphagia and decreasing the incidence of aspiration pneumonia in acute ischemic stroke patients.

Conservative Management of Occipital Neuralgia Supported by Physical Therapy: A Review of Available Research and Mechanistic Rationale to Guide Treatment.

PURPOSE OF REVIEW: Conservative management is consistently recommended as a first line intervention for occipital neuralgia (ON); however, there is limited clinical research regarding conservative intervention for ON. This lack of research may lead to underutilization or unwarranted variability in conservative treatment. This article provides mechanism-based guidance for conservative management of ON as a component of a multimodal treatment approach, and discusses the role of the physical therapist in the care team. It also highlights opportunities for further research to refine conservative management of this condition. RECENT FINDINGS: Published research on conservative interventions specific to ON is limited to very low-quality evidence for the use of TENS. The contemporary shift toward precision pain management emphasizing treatment based on a patient's constellation of clinical features-a phenotype-rather than solely a diagnosis provides more personalized and specifically targeted pain treatment. This paradigm can guide treatment in cases where diagnosis-specific research is lacking and can be used to inform conservative treatment in this case. Various conservative interventions have demonstrated efficacy in treating many of the symptoms and accepted etiologies of ON. Conservative interventions provided by a physical therapist including exercise, manual therapy, posture and biomechanical training, TENS, patient education, and desensitization have mechanistic justification to treat symptoms and causes of ON. Physical therapists have adequate time and skill to provide such progressive and iterative interventions and should be included in a multimodal treatment plan for ON. Further research is required to determine appropriate dosing, sequencing, and progression of conservative treatments.

The potential of vascular normalization for sensitization to radiotherapy.

Radiotherapy causes apoptosis mainly through direct or indirect damage to DNA via ionizing radiation, leading to DNA strand breaks. However, the efficacy of radiotherapy is attenuated in malignant tumor microenvironment (TME), such as hypoxia. Tumor vasculature, due to the imbalance of various angiogenic and anti-angiogenic factors, leads to irregular morphology of tumor neovasculature, disordered arrangement of endothelial cells, and too little peripheral coverage. This ultimately leads to a TME characterized by hypoxia, low pH and high interstitial pressure. This deleterious TME further exacerbates the adverse effects of tumor neovascularization and weakens the efficacy of conventional radiotherapy. Whereas normalization of blood vessels improves TME and thus the efficacy of radiotherapy. In addition to describing the research progress of radiotherapy sensitization and vascular normalization, this review focuses on the strategy and application prospect of modulating vascular normalization to improve the efficacy of radiotherapy sensitization.

Independence in activities of daily living was achieved using aerobic exercise without overwork weakness during rehabilitation: a case report of Lambert-Eaton myasthenic syndrome.

[Purpose] Lambert-Eaton myasthenic syndrome (LEMS) is an autoimmune disease characterized by decreased transmitter secretion from neuromuscular junctions and nerve terminals. Such cases require physical therapy for independently performing daily activities; however, care must be taken to avoid overwork weakness. This study aimed to investigate the effects of aerobic exercise-based physical therapy in patients with LEMS. [Participants and Methods] We report a case of LEMS with decreased muscle endurance due to inactivity. The participant was subjected to physical therapy with an exercise modality-improved muscle endurance with low-intensity repetitions, while monitoring subjective exercise intensity over time. [Results] The participant achieved independence activities of daily living without developing overwork weakness. [Conclusion] Appropriate physical therapy is an important aspect in treating LEMS.

Leadership and physiotherapy: A scoping review.

Questions: The challenges faced by healthcare organizations require effective leaders. Leadership has been extensively studied in medicine and nursing, but it is limited in physiotherapy. The objective of this study is to know and analyze the published research on the characteristics of leadership in physiotherapy. Design: A scoping review was conducted following the PRISMA extension guidelines. MEDLINE, The Cochrane Library, PEDro, Embase, CINAHL, Web Of Science and Scopus databases were reviewed between 01/01/2000 and 30/06/2022.All quantitative studies addressing the characteristics of leadership in physiotherapy were selected. Data extraction was performed using a table including author, year of publication, country of origin, title, objective, measurement instrument, sample and main findings. Data synthesis: The results obtained were framed within the framework for the study of leadership designed by Bolman and Deal. Results: Eight studies were selected. The characteristics most valued or used by physiotherapists are communication, desire for continuous learning and improvement, credibility and professionalism. Conclusion: Leadership is very important for physiotherapists, and for physiotherapy, as profession they consider it very important to have vision and to lead change. Communication skills are the most highly regarded characteristic.

The Effect of Physiotherapy Intervention on an Infant With Congenital Heart Defect Associated With Developmental Delay: A Case Report.

Congenital heart defects (CHDs) are one of the most prevalent anomalies present at birth globally. Children with CHD often face developmental challenges, including motor, language, and cognitive impairments. This case report presents the clinical profile of a 1.2-year-old female child with CHD and developmental delay (DD) post-CHD surgery. The child exhibited delayed gross motor, fine motor, language, and personal-social milestones, along with significant cardiac anomalies observed on CT angiograms. Physiotherapy interventions were initiated to address these DDs, encompassing manual techniques, neurodevelopmental treatment, and multimodal stimulation. The objective of this study was to assess the impact of physiotherapy interventions on improving developmental outcomes in infants with CHD-associated DD. The New Ballard Score and Hammersmith Infant Neurological Examination were utilized to evaluate improvements post-intervention. Significant enhancements in developmental outcomes were observed. This case underscores the significance of holistic care approaches in mitigating the impact of CHD on developmental trajectories and improving the quality of life for affected children.

The association between physical intervention use and treatment outcomes in patients participating in an online and psychologically informed pain management program.

BACKGROUND: The availability of multidisciplinary care for the management of chronic pain is uncommon outside specialist clinics. The current study aims to determine the physical intervention use of patients participating in an online psychological pain management program and whether exposure to physical interventions in these patients alters treatment outcomes compared to patients who do not access physical interventions. METHODS: Data were obtained from two previously published randomised control trials of an online psychological pain management program. Physical intervention exposure (category: None, 1-3, 4+ sessions) was assessed at baseline, post-treatment and at 3-month follow-up. Primary outcomes included depression, anxiety, pain intensity and pain-related disability. Generalised estimating equation models were used to compare treatment outcomes between those with different physical intervention frequencies and period of exposure. We assessed whether changes in primary outcomes differed (moderated) depending on the period and category of physical intervention exposure. RESULTS: N = 1,074 patients completed the baseline questionnaire across both RCTs, of whom 470 (44%) reported physical intervention use at baseline, 383 (38%) at post-treatment and 363 (42%) at 3-month follow-up. On average, there were moderate-large reductions from baseline to post-treatment with respect to all outcomes (Cohen's d = 0.36-0.82). In all outcomes, the interaction of time by physical intervention exposure was statistically non-significant. CONCLUSION: A substantial proportion of patients who participated in a psychologically informed pain management program were establishing, continuing, or stopping additional physical interventions. The frequency and period of exposure to physical interventions did not appear moderate treatment outcomes.

Cancer Rehabilitation: Impact on Breast Cancer Survivors' Work Ability and Health-Related Quality of Life.

BACKGROUND: Breast cancer survivors (BCSs) report persistent, diminished ability to work, and decreased health-related quality of life (HRQoL). Cancer rehabilitation interventions (physical therapy or occupational therapy [PT/OT]) aim to improve these outcomes, but little is known about their impact in the community. METHODS: This retrospective, pre-post, uncontrolled study examined cases of younger BCSs (age <65 years) who attended cancer-specialized PT/OT over a 2-year period. Outcomes and covariates (age, race, US region, payer type, number of visits, length of care [weeks]) were extracted from electronic medical records. Patient-reported outcomes were overall-Work Ability Score (WASoverall), physical-WAS (WASphysical), and mental-WAS (WASmental) and PROMIS Global Physical Health (GPH), Global Mental Health (GMH), Physical Function (PF), and Ability to Participate in Social Roles and Activities (SRA). We used linear mixed effect models to examine pre- to post-rehabilitation change overall, and separately, while controlling for covariates. RESULTS: PT/OT cases (NPT=758; NOT=140) had a mean [SD] age of 51.39 [8.49] years and attended approximately 12 visits (IQR, 8.0-19.0) over 10.71 weeks (IQR, 6.14-17.00). Overall, work ability outcomes (WASoverall: +1.79; WASphysical: +0.78; WASmental: +0.47; all P<.001) and HRQoL outcomes improved significantly (GPH: +5.38; GMH: +2.90; PF: +5.17; SRA: +5.83; all P<.001), and average change on each HRQoL outcome exceeded the minimal important change (2 points). Outcome scores were similar at each timepoint for both PT and OT cases (all P>.05) and both groups improved significantly (all P<.01). CONCLUSIONS: In this large study of the impact of cancer-specialized, community-based PT and OT, younger BCSs reported significant improvement in ability to work and HRQoL. Although more research is needed, these findings suggest improved access to PT/OT could improve work ability and HRQoL for younger BCSs.