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Journal: Physical therapy


Biomedical approaches for diagnosing and managing disabling low back pain (LBP) have failed to arrest the exponential increase in health care costs, with a concurrent increase in disability and chronicity. Health messages regarding the vulnerability of the spine and a failure to target the interplay among multiple factors that contribute to pain and disability may partly explain this situation. Although many approaches and subgrouping systems for disabling LBP have been proposed in an attempt to deal with this complexity, they have been criticized for being unidimensional and reductionist and for not improving outcomes. Cognitive functional therapy was developed as a flexible integrated behavioral approach for individualizing the management of disabling LBP. This approach has evolved from an integration of foundational behavioral psychology and neuroscience within physical therapist practice. It is underpinned by a multidimensional clinical reasoning framework in order to identify the modifiable and nonmodifiable factors associated with an individual’s disabling LBP. This article illustrates the application of cognitive functional therapy to provide care that can be adapted to an individual with disabling LBP.


1) Compare physical function and fitness outcomes in people infected with SARS-CoV to healthy controls; 2) quantify the recovery of physical function and fitness following SARS-CoV infection; 3) determine the effects of exercise following SARS-CoV infection.


Self-management interventions fostering self-efficacy improve the well-being of people with chronic pain.


Paresis acquired in the intensive care unit (ICU) is common in patients who are critically ill and independently predicts mortality and morbidity. Manual muscle testing (MMT) and handgrip dynamometry assessments have been used to evaluate muscle weakness in patients in a medical ICU, but similar data for patients in a surgical ICU (SICU) are limited.

Concepts: Medicine, Physician, Illness, Muscular system, Paralysis, Hand strength, Grip strength, Muscle memory


BACKGROUND: Physical activity is assumed to be important in the prevention and treatment of frailty. It is however unclear to what extent frailty can be influenced, because an outcome instrument is lacking. OBJECTIVES: An Evaluative Frailty Index for Physical activity (EFIP) was developed based on the Frailty Index Accumulation of Deficits and clinimetric properties were tested. DESIGN: The content of the EFIP was determined in a written Delphi procedure. Intra-rater reliability, inter-rater reliability, and construct validity were determined in an observational study (n=24) and to determine responsiveness, the EFIP was used in a physical therapy intervention study (n=12). METHOD: Intra-rater reliability and inter-rater reliability were calculated using Cohen’s kappa, construct validity was determined by correlating the score on the EFIP with those on the Timed Up &Go Test (TUG), the Performance Oriented Mobility Assessment (POMA), and the Cumulative Illness Rating Scale for geriatrics (CIRS-G). Responsiveness was calculated by means of the Effect Size (ES), the Standardized Response Mean (SRM), and a paired sample t-test. RESULTS: Fifty items were included in the EFIP. Inter-rater (Cohen’s kappa: 0,72) and intra-rater reliability (Cohen’s kappa: 0,77 and 0,80) were good. A moderate correlation with the TUG, POMA, and CIRS-G was found (0,68 -0,66 and 0,61 respectively, P< 0.001). Responsiveness was moderate to good (ES: -0.72 and SRM:-1.14) for an intervention with a significant effect (P< 0.01). LIMITATIONS: The clinimetric properties of the EFIP have been tested in a small sample and anchor based responsiveness could not be determined. CONCLUSIONS: The EFIP is a reliable, valid, and responsive instrument to evaluate the effect of physical activity on frailty in research and clinical practice.

Concepts: Scientific method, Psychometrics, Student's t-test, Reliability, Cohen's kappa, Inter-rater reliability, Jacob Cohen, Fleiss' kappa


Weakness and debilitation are common following critical illness. Studies that assess whether early physical activity initiated in the intensive care unit (ICU) continues after a patient is transferred to a ward are lacking.

Concepts: Health care, Patient, Intensive care medicine, Illness, Intensive-care medicine, Montgomery Ward, Aaron Montgomery Ward


Promotion of increased physical activity is advocated for survivors of an intensive care unit (ICU) admission to improve physical function and health-related quality of life.

Concepts: Scientific method, Life, Observational study, Intensive care medicine


Survivors of critical illness can experience long-standing functional limitations that negatively affect their health-related quality of life. To date, no model of rehabilitation has demonstrated sustained improvements in physical function for survivors of critical illness beyond hospital discharge.

Concepts: Set theory


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


This report describes the effects of long-term (10 years) participation in a community exercise program for a client with mixed Corticobasal Degeneration (CBD) and Progressive Supranuclear Palsy (PSP) features. The effects of exercise participation on both functional status and brain volume are described.

Concepts: Progressive supranuclear palsy, Corticobasal degeneration, Dudley Moore