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Background: There is limited knowledge about which risk factors that contribute to the high numbers of contra-lateral anterior cruciate ligament (C-ACL) injury after primary ACL injury. Objective:  To systematically review intrinsic risk factors for sustaining a C-ACL injury. Design: A systematic review with meta-analysis according to the PRISMA guidelines. Four databases (MEDLINE, CINAHL, EMBASE, Sport Discus) were searched from inception to January 2020. Meta-analyses were performed and expressed as odds ratios (OR). Setting: The included studies describe a variety of sport settings and activity levels. Participants: The review comprises studies including males and/or females of any age with ACL injury. Assessment of Risk Factors: The review comprises longitudinal studies investigating any intrinsic risk factor for future C-ACL injury. Main Outcome Measurements: C-ACL injury Results: Thirty-five moderate-to-high quality studies were eligible for meta-analysis, including up to ~59 000 individuals. The following factors all independently increased the odds of sustaining a C-ACL: Returning to a high activity level (OR: 3.26, 95% CI: 2.10–5.06), BMI < 25 (OR: 2.73, 95% CI: 1.73–4.36), Age ≤ 18 years (OR: 2.42, 95% CI: 1.51–3.88), Family history of ACL injury (OR: 2.07, 95% CI: 1.54–2.80), Primary ACL reconstruction performed ≤ 3 months post injury (OR: 1.65, 95% CI: 1.32–2.06), Female sex (OR: 1.35, 95% CI: 1.14–1.61) and Concomitant meniscal injury (OR 1.21, 95% CI: 1.03–1.42). There were no associations between the odds of sustaining a C-ACL injury and Smoking status, Pre-injury activity level, Playing soccer compared to other sports or Timing of return to sport. Conclusions: Demographic factors such as female sex, young age and family history of ACL injury, as well as early reconstruction and returning to a high activity level all contribute to the risk of sustaining a C-ACL injury. Studies on modifiable sensorimotor risk factors are warranted.

Background: Underlying factors contributing to increased risk of graft rupture after anterior cruciate ligament reconstruction (ACLR) are not well described. Objective: To systematically review intrinsic risk factors for sustaining a graft rupture. Design: A systematic review with meta-analysis according to the PRISMA guidelines. Four databases (MEDLINE, CINAHL, EMBASE, Sport Discus) were searched from inception to January 2020. Meta-analyses (random effect model) were performed and expressed as odds ratios (OR). Setting: The included studies describe a variety of sport settings and activity levels. Participants: The review comprises studies including males and/or females of any age who have had ACLR. Assessment of Risk Factors: All longitudinal studies investigating any intrinsic risk factor for future graft rupture were included. Main Outcome Measurements: Graft rupture. Results: Seventy-seven studies were eligible for meta-analysis. The following factors all independently increased the odds of sustaining a graft rupture after ACLR: Age ≤ 18 years (OR: 3.87, 95% CI: 2.32–6.46), higher pre-primary injury activity level (OR: 2.43, 95% CI: 1.56–3.82), family history of ACL injury (OR: 1.98, 95% CI: 1.50–2.62), returning to a high activity level (OR: 1.87, 95% CI: 1.11–3.15), and increased lateral tibial slope (OR: 1.64, 95% CI: 1.13–2,38). None of the following factors were found to be associated with future graft rupture; sex, smoking status, generalized joint laxity, timing of surgery or return to sport (RTS), playing soccer compared to other sports, hop performance at time of RTS or concomitant meniscal or collateral ligament injuries. Conclusions: Young age, family history of ACL injury, high tibial slope and previous and current high activity level should be considered when screening for increased risk of graft rupture following ACLR. Future studies on the possible role of sensorimotor factors, e.g., muscle activation and/or strength and proprioception for future graft ruptures are warranted.

The all-encompassing Second Edition of Prevention Practice and Health Promotion: A Health Care Professional's Guide to Health, Fitness, and Wellness offers foundational knowledge to health care professionals implementing primary, secondary, and tertiary prevention to healthy, at-risk, and disabled populations. Dr. Catherine Thompson along with her contributors, all with diverse backgrounds in physical therapy, rehabilitation, and healthcare, present the interdisciplinary health care perspective of health, fitness, and wellness concepts that are critical for providing preventive care to healthy, impaired, and at-risk populations using the World Health Organization's International Classification of Functioning, Disability, and Health model as a guideline for assessment and management. Based upon the goals outlined in Healthy People 2020, Prevention Practice and Health Promotion, Second Edition also combines the vision of direct access for health care professionals with the goals of national health care to increase the quality of years of healthy life, as well as to eliminate health disparities between various populations. Recognizing the cost effectiveness of preventive care, health care professionals have an expanded role in health promotion and wellness, complementing evidence-based medical management of acute and chronic conditions. Some topics covered inside Prevention Practice and Health Promotion, Second Edition include an overview of screening across the lifespan; effective interventions to promote health, fitness, and wellness; and options for program development, including marketing and management strategies to address both individual and community needs. Instructors in educational settings can visit www.efacultylounge.com for additional materials to be used for teaching in the classroom. Features of the Second Edition: Use of the American Physical Therapy Association's Guide to Physical Therapist Practice, Second Edition for health promotion Screening tools for special populations, including children, pregnant women, older adults, individuals with developmental disabilities, and people with chronic conditions affecting their quality of life Resources to promote healthy living, including nutrition, stress management, fitness training, and injury prevention Perfect for clinicians, students, allied health professionals, rehabilitation specialists, physical medicine specialists, and recreation therapists, the Second Edition to Prevention Practice and Health Promotion is a valuable resource for everyone in the areas of health, fitness, and wellness.

Concussion is a common injury in sport. Most individuals recover in 7-10 days but some have persistent symptoms. The objective of this study was to determine if a combination of vestibular rehabilitation and cervical spine physiotherapy decreased the time until medical clearance in individuals with prolonged postconcussion symptoms. This study was a randomised controlled trial. Consecutive patients with persistent symptoms of dizziness, neck pain and/or headaches following a sport-related concussion (12-30 years, 18 male and 13 female) were randomised to the control or intervention group. Both groups received weekly sessions with a physiotherapist for 8 weeks or until the time of medical clearance. Both groups received postural education, range of motion exercises and cognitive and physical rest until asymptomatic followed by a protocol of graded exertion. The intervention group also received cervical spine and vestibular rehabilitation. The primary outcome of interest was medical clearance to return to sport, which was evaluated by a study sport medicine physician who was blinded to the treatment group. In the treatment group, 73% (11/15) of the participants were medically cleared within 8 weeks of initiation of treatment, compared with 7% (1/14) in the control group. Using an intention to treat analysis, individuals in the treatment group were 3.91 (95% CI 1.34 to 11.34) times more likely to be medically cleared by 8 weeks. A combination of cervical and vestibular physiotherapy decreased time to medical clearance to return to sport in youth and young adults with persistent symptoms of dizziness, neck pain and/or headaches following a sport-related concussion. NCT01860755.

The 2016 Warwick Agreement on femoroacetabular impingement (FAI) syndrome was convened to build an international, multidisciplinary consensus on the diagnosis and management of patients with FAI syndrome. 22 panel members and 1 patient from 9 countries and 5 different specialties participated in a 1-day consensus meeting on 29 June 2016. Prior to the meeting, 6 questions were agreed on, and recent relevant systematic reviews and seminal literature were circulated. Panel members gave presentations on the topics of the agreed questions at Sports Hip 2016, an open meeting held in the UK on 27–29 June. Presentations were followed by open discussion. At the 1-day consensus meeting, panel members developed statements in response to each question through open discussion; members then scored their level of agreement with each response on a scale of 0–10. Substantial agreement (range 9.5–10) was reached for each of the 6 consensus questions, and the associated terminology was agreed on. The term ‘femoroacetabular impingement syndrome’ was introduced to reflect the central role of patients' symptoms in the disorder. To reach a diagnosis, patients should have appropriate symptoms, positive clinical signs and imaging findings. Suitable treatments are conservative care, rehabilitation, and arthroscopic or open surgery. Current understanding of prognosis and topics for future research were discussed. The 2016 Warwick Agreement on FAI syndrome is an international multidisciplinary agreement on the diagnosis, treatment principles and key terminology relating to FAI syndrome.The Warwick Agreement on femoroacetabular impingement syndrome has been endorsed by the following 25 clinical societies: American Medical Society for Sports Medicine (AMSSM), Association of Chartered Physiotherapists in Sports and Exercise Medicine (ACPSEM), Australasian College of Sports and Exercise Physicians (ACSEP), Austian Sports Physiotherapists, British Association of Sports and Exercise Medicine (BASEM), British Association of Sport Rehabilitators and Trainers (BASRaT), Canadian Academy of Sport and Exercise Medicine (CASEM), Danish Society of Sports Physical Therapy (DSSF), European College of Sports and Exercise Physicians (ECOSEP), European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA), Finnish Sports Physiotherapist Association (SUFT), German-Austrian-Swiss Society for Orthopaedic Traumatologic Sports Medicine (GOTS), International Federation of Sports Physical Therapy (IFSPT), International Society for Hip Arthroscopy (ISHA), Groupo di Interesse Specialistico dell’A.I.F.I., Norwegian Association of Sports Medicine and Physical Activity (NIMF), Norwegian Sports Physiotherapy Association (FFI), Society of Sports Therapists (SST), South African Sports Medicine Association (SASMA), Sports Medicine Australia (SMA), Sports Doctors Australia (SDrA), Sports Physiotherapy New Zealand (SPNZ), Swedish Society of Exercise and Sports Medicine (SFAIM), Swiss Society of Sports Medicine (SGMS/SGSM), Swiss Sports Physiotherapy Association (SSPA).

In order to effectively examine, test, and treat patients with exercise, physical therapists need to understand how physiology from the cellular to the systems level provides the basis for normal responses to exercise. But that is not enough.

Background. Over recent decades, chronic primary low back pain (CPLBP) has shown a consistent epidemiological increase worldwide. Although cognitive behavioural therapy (CBT) is not among the most commonly used interventions for this condition, several recent systematic reviews h ave demonstrated its efficacy. Given its limited implementation in clinical practice, this review aimed to assess the therapeutic validity of CBT by comparing it with physiotherapy (PT) interventions, designed according to the most recent clinical guidelin es for CPLBP.   Materials and Methods: Randomised controlled trials (RCTs) comparing CBT and PT in adults with CPLBP were included. The databases PubMed, Cochrane CENTRAL, Embase, CINAHL, Scopus, and PEDro were searched from inception to March 3, 2025. Risk of bias was independently assessed by two reviewers using the Cochrane Risk of Bias 2.0 (RoB 2.0) tool. Based on extracted data, several meta analyses were conducted, grouping outcomes into early phase, acute phase, and late phase follow ups. The certainty of evidence was evaluated according to the GRADE approach.   Results: Twelve RCTs were included, comprising a total of 1,762 participants. Meta analyses indicated very low certainty evidence that CBT is more effective than PT in reducing pain in the early p hase (n = 650, MD = −1.29, 95% CI = −2.00 to −0.59, p = 0.0003, I² = 83%), acute phase (n = 337, SMD = −0.16, 95% CI = −0.38 to +0.05, p = 0.14, I² = 0%), and late phase (n = 1108, SMD = −0.45, 95% CI = −0.87 to −0.03, p = 0.03, I² = 91%), as well as in de creasing disability in the early phase (n = 650, SMD = −1.00, 95% CI = −1.55 to −0.44, p = 0.0004, I² = 90%), acute phase (n = 337, MD = −0.27, 95% CI = −2.43 to +1.88, p = 0.80, I² = 75%), and late phase (n = 1108, SMD = −0.97, 95% CI = −1.52 to −0.41, p = 0.0007, I² = 95%). The results for early phase and late phase outcomes, for both pain and disability, were statistically significant.   Conclusions: Although supported by very low certainty evidence, these findings suggest that cognitive behavioural therap y may be a valuable intervention to integrate into clinical practice to reduce pain and improve disability in individuals with chronic primary low back pain. Further high quality randomised controlled trials are needed to confirm these results and draw more robust conclusions.

Parkinson’s disease (PD) is a neurological disorder that usually appears in the 6th decade of life and affects up to 2% of older people (65 years and older). Its therapeutic management is complex and includes not only pharmacological therapies but also physiotherapy. Exercise therapies have shown good results in disease management in terms of rehabilitation and/or maintenance of physical and functional capacities, which is important in PD. Virtual reality (VR) could promote physical activity in this population. We explore whether a commercial wearable head-mounted display (HMD) and the selected VR exergame could be suitable for people with mild–moderate PD. In all, 32 patients (78.1% men; 71.50 ± 11.80 years) were a part of the study. Outcomes were evaluated using the Simulator Sickness Questionnaire (SSQ), the System Usability Scale (SUS), the Game Experience Questionnaire (GEQ post-game module), an ad hoc satisfaction questionnaire, and perceived effort. A total of 60 sessions were completed safely (without adverse effects (no SSQ symptoms) and with low scores in the negative experiences of the GEQ (0.01–0.09/4)), satisfaction opinions were positive (88% considered the training “good” or “very good”), and the average usability of the wearable HMD was good (75.16/100). Our outcomes support the feasibility of a boxing exergame combined with a wearable commercial HMD as a suitable physical activity for PD and its applicability in different environments due to its safety, usability, low cost, and small size. Future research is needed focusing on postural instability, because it seems to be a symptom that could have an impact on the success of exergaming programs aimed at PD.

Currently, there is a lack of data concerning the organization and characteristics of Italian pediatric physiotherapy units for the treatment of patients with chronic lung diseases, especially those with rare conditions such as Primary Ciliary Dyskinesia (PCD) and non-Cystic Fibrosis bronchiectasis (NCFB).BACKGROUNDCurrently, there is a lack of data concerning the organization and characteristics of Italian pediatric physiotherapy units for the treatment of patients with chronic lung diseases, especially those with rare conditions such as Primary Ciliary Dyskinesia (PCD) and non-Cystic Fibrosis bronchiectasis (NCFB).A national descriptive study based on a survey questionnaire was conducted. The questionnaire consisted of three different sections: distribution and characteristics of the centres, services provided by respiratory therapists, physiotherapists' perception of the unit. The survey was distributed to all healthcare providers via an online platform, and a descriptive data analysis was performed.METHODSA national descriptive study based on a survey questionnaire was conducted. The questionnaire consisted of three different sections: distribution and characteristics of the centres, services provided by respiratory therapists, physiotherapists' perception of the unit. The survey was distributed to all healthcare providers via an online platform, and a descriptive data analysis was performed.The survey had a response rate of 97.5% with twenty-nine responses collected. The centers are heterogeneously distributed: thirteen in the northern regions, eight in the central regions and eight in the southern regions. Of the 29 centers with a physiotherapy unit, 19 had a specialized respiratory therapy unit. Respiratory therapy was provided in different care settings: regular wards (28/29 centers, 97%), outpatient service (29/29 centers, 100%), and intensive or semi-intensive care units (17/29 centers, 59%). The interventions provided by respiratory therapists involved more than just airway clearance (29/29). More specific interventions, such as pulmonary function tests (23/29), functional tests (27/29), educational training (26/29), management of workout exercise programs (25/29) and interventions developed in collaboration with physicians such as non-invasive ventilation (NIV) (23/29) and oxygen titration (21/29) are performed. It is interesting to note that therapists are also involved in various activities, such as telemedicine, physiotherapists' research projects, and supporting alongside physicians, for the prescription at home of medical devices. Perception of the unit was also evaluated.RESULTSThe survey had a response rate of 97.5% with twenty-nine responses collected. The centers are heterogeneously distributed: thirteen in the northern regions, eight in the central regions and eight in the southern regions. Of the 29 centers with a physiotherapy unit, 19 had a specialized respiratory therapy unit. Respiratory therapy was provided in different care settings: regular wards (28/29 centers, 97%), outpatient service (29/29 centers, 100%), and intensive or semi-intensive care units (17/29 centers, 59%). The interventions provided by respiratory therapists involved more than just airway clearance (29/29). More specific interventions, such as pulmonary function tests (23/29), functional tests (27/29), educational training (26/29), management of workout exercise programs (25/29) and interventions developed in collaboration with physicians such as non-invasive ventilation (NIV) (23/29) and oxygen titration (21/29) are performed. It is interesting to note that therapists are also involved in various activities, such as telemedicine, physiotherapists' research projects, and supporting alongside physicians, for the prescription at home of medical devices. Perception of the unit was also evaluated.The involved centers are heterogeneous in terms of distribution and treatments offered. The role of respiratory physiotherapists still seems to be fragmented. This first descriptive analysis of the physiotherapy units and the main differences between centers opens queries on the clinical approaches used for pediatric patients with PCD in terms of respiratory physiotherapy. However,in response to evolving treatment needs, a more specialized and standardized approach to patient care is required.CONCLUSIONSThe involved centers are heterogeneous in terms of distribution and treatments offered. The role of respiratory physiotherapists still seems to be fragmented. This first descriptive analysis of the physiotherapy units and the main differences between centers opens queries on the clinical approaches used for pediatric patients with PCD in terms of respiratory physiotherapy. However,in response to evolving treatment needs, a more specialized and standardized approach to patient care is required.