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• v.66(4); Fall 2014

Language: English | French

Types and Quality of Physical Therapy Research Publications: Has There Been a Change in the Past Decade?

Kaitlyn snell.

* Department of Physical Therapy, University of Toronto

Lauren Sutherland

Tristan senior, tania janaudis-ferreira.

† Sunnybrook Health Sciences Centre

‡ West Park Healthcare Centre, Toronto, ON.

Dina Brooks

Associated data.

Purpose: To describe and compare the type and quality of evidence published in physical therapy (PT) journals during two time periods (2000–2002 vs. 2010–2012) and to explore scientific editors' opinions on changes in the types and quality of articles. Methods: A quantitative, longitudinal, retrospective journal review was used to categorize and assess the methodological rigour of items published in four PT journals using the Hedges Project. A quantitative, descriptive, cross-sectional survey explored the opinions of scientific editors. Percentages and frequencies of article types (as defined by the Hedges Project criteria), items passing rigour, and editor responses were calculated. Statistical significance of differences in article type and rigour between the two time periods was determined using Fisher's Exact Test. Results: There was a significant increase in original studies and review articles from 2000–2002 to 2010–2012 ( p <0.001, p =0.002, respectively). The overall pass rate for rigour was 33.3% in 2000–2002 and 42.5% in 2010–2012, showing a significant increase ( p =0.019). The majority of editors reported an increase in systematic reviews, qualitative designs, and randomized controlled trials and believed that quality had improved by 2010–2012. Conclusion: From 2000–2002 to 2010–2012, the quality of articles published in PT journals improved and the proportion of original studies and review articles increased.

RÉSUMÉ

Objectif : Décrire et comparer le type et la qualité des données probantes publiées dans les revues de physiothérapie de deux périodes (2010–2012 et 2000–2002) et explorer les opinions des rédacteurs scientifiques sur l'évolution du type et de la qualité des articles. Méthodes : Un examen rétrospectif quantitatif et longitudinal des revues a permis de classer par catégorie les articles publiés dans quatre revues de physiothérapie et d'évaluer leur rigueur méthodologique, grâce au projet Hedges. Une étude transversale descriptive quantitative a permis d'explorer les opinions des rédacteurs scientifiques. Les pourcentages et les fréquences des types d'article (selon la définition des critères du projet Hedges), les articles d'une rigueur suffisante et les réponses des rédacteurs ont été calculés. La signification statistique des différences dans le type et la rigueur des articles entre les deux périodes a été déterminée à l'aide de la méthode exacte de Fisher. Résultats : Il y a eu une importante augmentation dans le nombre d'études originales et d'exposés de synthèse de 2000–2002 à 2010–2012 ( p <0,001, p =0,002, respectivement). Le taux de réussite global pour ce qui est de la rigueur était de 33,3% en 2000–2002 et de 42,5% en 2010–2012, ce qui constitue une augmentation importante ( p =0,019). La majorité des rédacteurs ont signalé une augmentation des examens systématiques, des conceptions qualitatives, et des essais contrôlés randomisés, et ils étaient d'avis que la qualité s'était améliorée. Conclusion : De 2000–2002 à 2010–2012, la qualité des articles publiés dans les revues de physiothérapie s'est améliorée et la proportion d'études originales et d' exposés de synthèses a augmenté.

Physical therapists need high-quality scientific literature to inform their own evidence-based practice (EBP). 1 Various study designs can contribute to providing evidence for EBP, including randomized controlled trials (RCTs), 2 – 5 single-subject designs and case series, 6 cohort and observational studies, 5 and qualitative methodologies. 7 , 8 While RCTs have been viewed as the “gold standard” for quality in research design, 9 they cannot always be applied to physical therapy (PT) practice; 6 furthermore, some questions are better answered using other designs. For example, qualitative methodologies may be more appropriate for obtaining information on clients' experiences and feelings. 7

The amount of published PT literature has increased significantly over the years: 10 – 14 Wiles and colleagues 12 found that the number of articles published in Physical Therapy doubled from 1945 to 2010, Fell and colleagues 13 found that the number of articles indexed in Medline more than doubled between 2000 and 2009, and Kumar and colleagues found that there was a sharp increase in PT publications in PubMed from 2000 to 2010. 14

Trends in types of PT literature have also been evaluated. Wiles and colleagues 12 found that systematic reviews, cohort studies, and non-randomized controlled trials in Physical Therapy increased in prevalence from 1945 to 2010; Coronado and colleagues 10 found an increased percentage of research reports, systematic reviews, and qualitative studies, but a decrease in topical reviews and non-systematic reports from 1980 to 2009, with no change in case reports or RCTs. 10 More recently, Kumar and colleagues 14 examined PT literature in PubMed between 1970 and 2010; they found that clinical trials, RCTs, and review articles were most prevalent, with a rapid increase after 1995.

It is not clear whether the growth in PT literature has corresponded to an increase in quality. A variety of tools have been used to assess quality in PT and rehabilitation journals, including quantitative content analyses driven by hierarchical levels of evidence 1 , 5 and citation-driven bibliometric analyses. 10 , 12 , 13 , 15 , 16 However, these measures have shortcomings: not all research questions are appropriately answered by RCT methodology, 6 , 17 and bibliometric analyses measure trends and interest in published reports rather than the quality of the literature.

Miller and colleagues 18 have assessed quality using a unique standard, the Hedges Project, which uses rigour criteria as a measure of quality for different study designs. 18 The Hedges Project classifies publications by format ( original study , review article , case report , or general and miscellaneous ), interest to human health care ( of interest or not of interest ), purpose ( etiology ; prognosis ; diagnosis ; treatment, prevention, continuing medical education, or quality improvement ; economics ; clinical prediction guide ; qualitative study ; or something else ), and rigour. The rigour criteria correspond to each purpose of publication ( Box 1 ; see Miller and colleagues 18 for complete Hedges Project criteria). Miller and colleagues 18 assessed 179 articles from core PT journals published from 2000 to 2001 and found that approximately 11% of those articles passed the assessment for rigour.

Rigour Criteria for Each Purpose Category as Defined in the Hedges Project from Miller and colleagues 18 (p.131)

Purpose category	Rigour criteria
Etiology	Prospective standardized data collection, a clearly identified comparison group for those at risk for, or having, the outcome of interest, and blinding of observers to outcome of exposure
Prognosis	An inception cohort of individuals, all initially free of the outcome of interest, and follow-up of at least 80% of patients until a major study end point occurs or the study ends
Diagnosis	Clearly identified comparison groups, at least one of which is free of the disorder of interest, interpretation of a diagnostic (“gold”) standard without knowledge of the test results, interpretation of test without knowledge of the diagnostic standard result
Treatment and prevention	Random allocation of participants to comparison groups, follow-up of at least 80% of the participants entering the investigation
Continuing medical education and quality improvement	Random allocation of participants or units to comparison groups and follow-up of at least 80% of the participants
Economics	The economic question addressed must be based on comparison of alternatives. Alternative diagnostic or therapeutic services are compared on the basis of both the outcome produced (effectiveness) and the resources consumed (cost)
Clinical prediction guide	Generation of the guide in one or more sets of patients (training set), validation in another set of patients (test sets)
Reviews	Explicit statement of the inclusion and exclusion criteria applied for selecting articles, a description of the methods indicating the specific database sources, and at least one of the articles must meet the above noted criteria for treatment, diagnosis, prognosis, clinical prediction, etiology, quality improvement, or economics of health care
Qualitative study	The content relates to how people feel or experience certain situations; collection methods and analyses are appropriate for qualitative data

Another way to assess the quality of evidence is to seek the opinions of experts in PT literature: the editors of PT journals. Editors' opinions on the quality of literature have not been evaluated in rehabilitation or PT; previous surveys have mainly evaluated editors' practices and behaviours in medical and nursing journals 19 , 20 and the issue of excessive publication in scientific literature. 21 , 22

To capture the trends in publication of PT literature, we need a measure of quality that encompasses more than the hierarchy of evidence or bibliometrics, as well as the opinions of leaders in the field. The purpose of our study, therefore, is to describe the types and quality of evidence published in PT journals and to explore the future of those journals. By applying the Hedges Project criteria and exploring editors' opinions, the study describes the current types and quality of research in PT journals. The specific objectives of this study are (1) to describe the types and quality of evidence published in core PT journals, (2) to compare the types and quality of evidence published in core PT journals (2010–2012 vs. 2000–2002), and (3) to explore the opinions of scientific editors of international peer-reviewed PT journals about changes in types and quality of articles published during their tenure and about future trends in these publications.

Our study had two parts. The first part was a quantitative, longitudinal, retrospective journal review designed to compare the types and quality of evidence published in PT journals in two time periods: 2010–2012 (to provide a benchmark of quality at the time of the study) and 2000–2002 (a decade earlier, which we considered sufficient time to be able to observe a change). The second part was a quantitative, descriptive, cross-sectional survey that explored the opinions of editors of international PT journals regarding the changes in types and quality of articles during their tenure and future trends in these publications. The University of Toronto Ethics Review Board approved this study and the research conforms to the Human and Animal Rights requirements of the February 2006 International Committee of Medical Journal Editors' Uniform Requirements for Manuscripts Submitted to Biomedical Journals.

Study sample

For part one, we chose four PT journals—the Journal of Physiotherapy, Physical Therapy, Physiotherapy , and Physiotherapy Canada —based on the following inclusion criteria: ranked on the 2011 ISI Journal Citation Report 23 , peer reviewed, includes “Physical Therapy” or “Physiotherapy” in the journal title, circulates internationally, and published in an English-speaking country.

For part two, we included all known scientific or lead editors of peer-reviewed journals published in English and indexed in CINAHL and Scopus with “Physical Therapy,” “Physical Therapists,” “Physiotherapy,” or “Physiotherapists” in the title who had a valid email address and Internet access. We contacted eligible editors via email and sent our online questionnaire (see Appendix 1 online ) using LimeSurvey (Lime Survey Project Team, Hamburg, Germany).

Evaluation of journal articles

For part one, we accessed all indexed items in all issues of the four journals in both time periods (2000–2002 and 2010–2012) via the University of Toronto Library database. Print issues of Physiotherapy Canada from 2000–2002 were used for our analysis, as these issues were not available online. All items were evaluated using the criteria of the Hedges Project, an instrument designed to assess the clinical applicability and methodological quality of health research articles without grading their quality based on research design alone. 18 , 24 For the purposes of this article, the term item refers to any published material in a journal, including book reviews and editorials, as well as articles.

Our evaluation protocol is set out in Figure 1 and was carried out separately for each time period studied. Each of the five evaluators assessed approximately the same number of articles. Before evaluation began, we trained in the use of the Hedges Project by contacting Miller and colleagues 18 for direction on applying the tool and evaluating 20 articles as a group to increase our collective consistency of assessment. Following the training period, consensus was reached through group evaluation for any articles that an individual evaluator found difficult to assess. A total of 2,166 items ( n =1,162 for 2000–2002, n =1,004 for 2010–2012) were first formatted into four categorical types: (1) original study , (2) review article , (3) case report , and (4) general and miscellaneous . General and miscellaneous items, such as editorials and book reviews, were excluded from further quality assessment. For feasibility purposes, a sample of approximately 60% of items was randomly chosen using the random number generator function in Microsoft Excel 2007 (Microsoft Corp., Redmond, WA), yielding a total of 669 articles. These 669 articles were then assessed for relevance to human health care. Articles of interest to human health care, excluding case reports, were then evaluated further and placed in the appropriate purpose category: etiology ; prognosis ; diagnosis ; treatment, prevention, continuing medical education, or quality improvement ; economics ; clinical prediction guide ; qualitative study ; or something else . Articles in the economics and something else categories were subsequently excluded. The Hedges Project has criteria for each purpose category listing specific requirements needed to receive a “pass” for methodological rigour. As such, the remaining articles were assessed for rigour, receiving either a “pass” or “fail” status. Further information regarding criteria for format categories, purpose categories, and rigour can be found in the study conducted by Miller and colleagues. 18

Evaluation process for journal articles

We made minor assumptions and modifications when applying the Hedges Project tool to article evaluation to reduce both open-ended interpretation of criteria and subjective evaluation of format category, purpose category, and methodological rigour ( Box 2 ).

Assumptions and Modifications Applied to Hedges Project Criteria

Hedges Project criteria	Assumption	Modification
		• Includes all items (not only articles) listed in a journal that are not , , or (e.g. editorials, book reviews)
		• Considered if has fewer than 10 subjects but performs analysis/analyses
	• The study must have direct applicability to some aspect of health care or clinical practice
	• Studies may still influence health care without using subjects with known impairments or disabilities
	• The term “exposure” can also refer to a disease or condition
	• Study participants are free of the outcome of interest at the beginning of the study
		• Diagnostic “gold” standard is not essential criterion
	• Includes measurement studies other than validity (e.g., reliability, minimal detectable change)	• Training set or tool development allowed to be carried out in a previous study rather than in the article being evaluated; however, previous study must be cited
	• Study results have no impact on methodological rigor (e.g., the results of tool's validity or reliability)	• Measurement property and subjects in current study do not have to match previous work (e.g., reliability vs. validity; COPD vs. geriatric)
		• Measurement property can be measured in the same population at two time frames (does not have to be different subjects)
	• Research group has developed themes and codes
	• Question development via literature search or clinical expertise
		• Study must meet rigour criteria for both purpose categories to pass

COPD=chronic obstructive pulmonary disease.

Survey of editors

For part two, we recruited editors using a modified Dillman approach: 25 potential participants were contacted on three separate occasions with an invitation to participate in the study by completing a questionnaire. Participation was anonymous, and responses were not linked to the participant in any way. We initially piloted our 33-item questionnaire with two retired editors and then made revisions based on their feedback and on further critique among the authors.

For part one, we defined two different pass rates (see Figure 1 ): overall pass rate , defined as the number of articles in the ∼60% random sample for each time period that passed, and specific pass rate , defined as the number of articles evaluated for methodological rigour—the final step of the Hedges Project criteria—that passed for that time period. Descriptive and inferential statistics were used to evaluate and compare the types and quality of literature published in PT journals between the two time periods using SPSS version 20 (IBM Corp. Armonk, NY). Nominal scale data were calculated as percentages and frequencies for format category, purpose category, and pass rate for each time period. We used Fisher's Exact Test (2-tailed), with α set at 0.05 and β at 0.2, to determine the statistical significance of differences in format categories and methodological rigour between the two time periods; to compare purpose categories, α was set at 0.01.

For part two, editor responses were evaluated using descriptive statistics. Nominal and ordinal data were calculated as percentages and frequencies.

Format categories and interest to human health care

Table 1 presents the number of items classified per time period by journal title. Figure 2 shows the subsequent division of these items into the format categories. In 2000–2002, the highest proportion of items fell into the general and miscellaneous category, with original study the second most frequent; in contrast, these two categories were reversed in 2010–2012. Comparison of format categories between the two time periods revealed a significant increase in the proportion of both original studies ( p <0.001) and review articles ( p =0.002) and a significant decrease in the proportion of general and miscellaneous items ( p <0.001) in 2010–2012 ( Figure 2 ). The majority of our random sample of articles was of interest to human health care (2000–2002: 232/267 [86.9%]; 2010–2012: 362/402 [90.0%]); the difference between time periods was not significant ( p =0.21).

Number of Items Classified by Journals Studied ( n =2,166).

	No. (%)
Journal	2000–2002	2010–2012
	182 (15.66)	199 (19.82)
	286 (24.61)	429 (42.73)
	559 (48.11)	179 (17.83)
	135 (11.62)	197 (19.62)
Total	1,162	1,004

Comparison of format category proportions between the time periods studied ( n =2166). There was a significant increase in the proportion of original studies (2000–2002: 330/1162 [28.4%]; 2010–2012: 513/1004 [51.1%]) and review articles (2000–2002: 60/1162 [5.2%]; 2010–2012: 85/1004 [8.5%]) and a significant decrease in the proportion of general and miscellaneous items in 2010–2012 (2000–2002: 721/1162 [62.0%]; 2010–2012: 343/1004 [34.2%]).

Purpose categories

Figure 3 shows articles that were of interest to human health care divided into purpose categories. In both time periods, the most frequent purpose category was treatment, prevention, continuing medical education, or quality improvement , followed by clinical prediction guide . There was only one item in the economics category, which was therefore excluded as an outlier. Comparison of purpose categories between time periods found no significant differences in their proportions within each time period (see Figure 3 ; all p values >0.10).

Comparison of Purpose Category Proportions Between the Studied Time Periods ( n =522). No differences in proportions were found for any purpose category when compared between the two time periods (all p values>0.10).

For all purpose category articles that we evaluated for rigour, the specific pass rate was 47.1% (89/189) for 2000–2002 and 54.8% (171/312) for 2010–2012 (see Figure 4 ; p =0.10). A more detailed analysis found no difference between time periods in the specific pass rate for any of the purpose categories (all p values >0.30). In contrast, the overall pass rate was 33.3% in 2000–2002 and 42.5% in 2010–2012, representing a significant increase over time ( Figure 4 ; p =0.019). Further analysis showed that the increase in overall pass rate of review articles was significant (2000–2002: 7/267 [2.6%]; 2010–2012: 28/402 [7.0%]; p =0.013). However, the overall pass rate of original studies was not significantly different between time periods (2000–2002: 82/267 [30.7%]; 2010–2012: 143/402 [35.6%]; p =0.21).

Overall Pass Rate ( n =669) and Specific Pass Rate ( n =501) Compared Between the Two Time Periods.

Survey results

Of the 36 questionnaires sent, 15 were returned; data from one questionnaire were not usable, leaving 14 responses for analysis. All editors were trained physical therapists. The majority had at least 4 years' experience as an editor ( n =9, 64%) and a current education level of “PhD” or “post-doctoral” ( n =12, 86%).

All editors ( n =14, 100%) reported that the number of submissions to their journal had increased during their appointment ( n =14, 100%). The majority believed that there had been a change in the types of manuscripts submitted ( n =9, 64%), that the number of studies published had increased during their tenure ( n =11, 79%), and that the quality of publications had improved ( n =13, 93%). Editors believed systematic reviews ( n =5, 36%), “other” designs (including qualitative) ( n =3, 21%), and RCTs ( n =2, 14%) had increased the most, while narrative reviews ( n =7, 50%) had decreased the most.

Editors identified inadequate funding for PT research ( n =13, 93%) and researchers' preference of submitting higher quality studies to non-PT journals ( n =11, 71%) as barriers to improving the quality of publications.

The majority of editors predicted a continuing increase in the number of PT journals ( n =9, 64%) and the number of submissions to PT journals ( n =14, 100%) in the future. They identified systematic reviews ( n =14, 100%) and RCTs ( n =12, 86%) as the two research designs most likely to increase in the future. Finally, editors considered systematic reviews ( n =14, 100%) and RCTs ( n =12, 86%) as most beneficial to future clinical decision-making.

This was the first study to describe the types and quality of evidence published in PT journals and to compare two time periods by applying the Hedges Project criteria and seeking the opinions of editors. We found that the overall rigour of articles, assessed by the criteria of the Hedges Project, was greater in 2010–2012 than in 2000–2002; that a greater proportion of original studies and review articles were published in 2010–2012; and that almost all editors considered the quality of publications to have increased in recent years.

There has recently been greater emphasis on EBP in the PT profession, with the research community providing more robust evidence to support professional practice. This shift toward EBP has likely produced stronger research designs, increased adherence to scientifically sound criteria, and emphasized knowledge translation. These factors, in addition to an increase in the proportion of original studies and review articles and a decrease in general and miscellaneous items from 2000–2002 to 2010–2012, may have contributed to the increase in overall pass rate in 2010–2012.

The pass rate calculation of Miller and colleagues 18 is comparable to our specific pass rate rather than our overall pass rate . For the articles they evaluated for rigour, Miller and colleagues 18 reported a 66% pass rate, higher than the 47% and 55% pass rates we found for articles published in 2000–2002 and 2010–2012, respectively. These rates cannot be directly compared due to several differences between the methodology employed by Miller and colleagues 18 and in our study. First, Miller and colleagues 18 analyzed articles published in 2000–2001; our study included articles from 2000–2002, and our random sample of approximately 60% of items yielded a larger number of articles for evaluation using the Hedges Project ( n =267 vs. n =179). Second, we made assumptions and modified the Hedges Project criteria to reduce ambiguity in format and purpose categories and rigour criteria; thus, the Hedges Project tool we used differed slightly from the one used by Miller and colleagues. 18 Third, Miller and colleagues 18 took consecutive issues of the four chosen PT journals for analysis, whereas we used a random sample from all issues published in 2000–2002. Finally, Miller and colleagues 18 used only one reviewer to identify the format and purpose categories and assess for rigour, whereas we used five evaluators.

In addition to using a quantitative measure that considered quality, we supplemented our results by seeking the opinions of editors. The majority of editors reported that the quality of articles has increased in recent years, which supports our findings regarding publication quality improvement as defined by the Hedges Project criteria. Editors also reported an increase in the number of submissions and predicted an increase in the number of journals and article submissions in the future. Similarly, Frontera and colleagues, 26 reporting on editors' opinions in the field of physical and rehabilitation medicine, stated that both the amount of research and the number of articles submitted for review are increasing and that there will be a need for more journals in the future.

In terms of study design, the editors surveyed in our study saw the greatest increase in systematic reviews, RCTs, and “other” methodologies, including qualitative studies. This finding cannot be directly compared with our findings using the Hedges Project criteria, as the Hedges Project did not allow us to look specifically at different study designs. In agreement with our findings, an editorial by Durward 27 regarding the journal Physiotherapy Research International reported that several qualitative studies have been published since the journal's first publication in 1996. In 2002, Refshauge, 17 also discussing Physiotherapy Research International , noted that more RCTs have been included since the journal's first publication. In accordance with our findings, Crosbie 28 suggested that there are now more systematic reviews published; he also suggested that future PT literature will include more RCTs and that systematic reviews will replace literature reviews. 28

Future studies including rehabilitation journals in addition to PT journals would improve power and sensitivity in evaluating article quality in rehabilitation. It may also be worthwhile to explore possible reasons behind the change observed in types and quality of articles.

This study has several limitations. While the Hedges Project is a useful tool in that it is standardized and allows for evaluation of a variety of research designs, some of its criteria are vague and less applicable to PT than to other health care professions. In addition, articles from only four journals were evaluated for rigour. This decreases our ability to generalize our results to other PT and rehabilitation journals. Furthermore, five evaluators were used to apply the Hedges Project criteria; while a large number of evaluators can leave room for discrepancy and variance, we minimized this possibility by training with the Hedges Project criteria before assessment and by consulting members of the group to reach a consensus in cases of uncertainty.

There was an improvement in the quality of articles from 2000–2002 to 2010–2012. There was an increase in the proportion of original studies and review articles between those time periods. According to editors, this reflects an increase in RCTs and systematic reviews. Collectively, these findings imply a shift in PT journals toward higher quality, evidence-based research. Physical therapists can rely on PT journals as one source to inform their clinical practice but must still evaluate each article to determine its efficacy for clinical decision-making.

Key messages

What is already known on this topic.

There has been an increase in published PT literature over the years, as well as a change in the types of publications. A variety of tools have been used to assess quality of literature in PT and rehabilitation journals including the Hedges Project.

What this study adds

The growth in PT literature over the years has been associated with an increase in quality over the last decade. There was in increase in the proportion of original studies and review articles in that time period.

Supplementary Material

Physiotherapy Canada 2014; 66(4);382–391; doi:10.3138/ptc.2013-67

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	Title	Type
1		journal	4.691 Q1	224	268	920	9934	8227	562	6.59	37.07	36.82
2		journal	3.492 Q1	229	183	508	15849	4622	416	8.36	86.61	30.25
3		journal	2.744 Q1	65	106	257	6441	2487	216	8.87	60.76	37.04
4		journal	2.485 Q1	151	148	476	8584	3755	471	5.72	58.00	58.58
5		journal	2.363 Q1	266	445	1358	16995	6758	1197	4.42	38.19	22.08
6		journal	2.022 Q1	49	62	179	3721	1285	178	8.56	60.02	55.72
7		journal	1.736 Q1	91	90	272	1787	964	95	2.75	19.86	47.15
8		journal	1.688 Q1	118	21	94	1385	453	79	3.69	65.95	31.75
9		journal	1.546 Q1	44	119	249	5275	1231	249	4.78	44.33	17.96
10		journal	1.485 Q1	143	225	645	9535	2814	609	3.84	42.38	34.45
11		journal	1.470 Q1	261	245	867	11318	3402	831	3.70	46.20	36.79
12		journal	1.446 Q1	47	118	306	7452	1533	299	4.21	63.15	29.15
13		journal	1.431 Q1	145	89	295	3085	1172	236	4.15	34.66	40.46
14		journal	1.388 Q1	94	200	716	5548	2376	676	3.29	27.74	18.70
15		journal	1.349 Q1	27	87	193	3806	742	180	3.56	43.75	20.79
16		journal	1.273 Q1	54	100	173	5166	788	172	4.24	51.66	46.36
17		journal	1.253 Q1	42	128	374	4586	1462	357	3.91	35.83	40.08
18		journal	1.222 Q1	125	133	599	4517	2027	545	2.97	33.96	32.33
19		journal	1.193 Q1	176	148	707	6785	2587	616	3.29	45.84	58.29
20		journal	1.174 Q1	83	41	144	2350	552	143	3.28	57.32	36.00
21		journal	1.167 Q1	65	163	282	6097	1026	255	3.27	37.40	30.20
22		journal	1.141 Q1	131	125	435	4314	1245	419	2.37	34.51	47.95
23		journal	1.141 Q1	161	365	1449	15246	4541	1438	2.77	41.77	20.54
24		journal	1.136 Q1	55	54	173	3127	732	172	3.81	57.91	36.84
25		journal	1.115 Q1	163	201	902	9661	3155	885	2.84	48.06	28.33
26		journal	1.091 Q1	216	310	894	12546	2962	738	3.13	40.47	51.31
27		journal	1.078 Q1	79	246	518	9306	1870	516	3.65	37.83	27.27
28		journal	1.064 Q1	80	138	249	7490	971	242	3.71	54.28	44.41
29		journal	1.046 Q1	126	182	733	9564	3158	730	3.97	52.55	39.04
30		journal	1.008 Q1	50	59	233	2808	788	208	2.98	47.59	57.09
31		journal	0.986 Q1	38	73	303	4191	1413	302	4.42	57.41	50.48
32		journal	0.979 Q1	81	85	246	3557	790	238	2.57	41.85	24.59
33		journal	0.955 Q1	75	86	358	3728	1210	309	3.02	43.35	54.82
34		journal	0.954 Q1	78	41	164	2386	493	164	2.11	58.20	66.00
35		journal	0.949 Q1	125	118	439	5470	1499	409	3.10	46.36	56.85
36		journal	0.939 Q1	88	132	455	5775	1257	431	2.60	43.75	51.35
37		journal	0.921 Q1	118	105	456	3493	1045	438	2.13	33.27	37.18
38		journal	0.910 Q1	70	40	223	1424	657	189	2.35	35.60	54.97
39		journal	0.892 Q1	60	21	99	534	259	88	2.23	25.43	15.15
40		journal	0.886 Q1	113	86	276	3941	743	267	2.26	45.83	57.47
41		journal	0.873 Q1	62	107	430	4827	1104	426	2.38	45.11	34.93
42		journal	0.865 Q1	17	199	598	6345	1296	595	2.08	31.88	18.36
43		journal	0.857 Q1	47	98	170	3496	486	170	2.35	35.67	31.74
44		journal	0.850 Q1	13	20	51	861	120	47	3.09	43.05	76.56
45		journal	0.849 Q1	48	99	523	3940	1642	513	3.06	39.80	27.89
46		journal	0.849 Q1	58	66	213	4135	553	207	2.36	62.65	17.28
47		journal	0.823 Q1	64	31	108	1160	277	90	1.79	37.42	53.42
48		journal	0.808 Q1	55	87	357	3549	979	357	2.08	40.79	22.66
49		journal	0.808 Q1	113	86	362	3120	1031	344	2.54	36.28	53.40
50		journal	0.804 Q1	55	108	214	4449	591	206	2.57	41.19	26.25

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JSmol Viewer

Trends in physiotherapy of chronic low back pain research: knowledge synthesis based on bibliometric analysis.

1. Introduction

• What is the volume, scope and dynamics of the research literature production on physiotherapy in CLBP?
• What is the spatial distribution of physiotherapy in CLBP literature production among the most prolific source titles, institutions, countries and funding institutions?
• What is the most prolific physiotherapy in CLBP research themes, how have they evolved over time and what is their association?

2. Materials and Methods

2.1. search procedure, 2.2. data analysis, 2.3. thematic analysis, 3.1. volume and prevalence of the research literature production, 3.2. the dynamics of the research literature production, 3.3. the thematic analysis, 3.4. the chronological analysis.

• Development of pain assessment tools: pain measurement → pain assessment → pain management . These tools first measure and evaluate pain, in order to ultimately contribute to the most functional treatment possible;
• Development of CLBP processing: disease severity → disability evaluation → disease duration → treatment duration → clinical outcomes and effectiveness . The evolution of CLBP processing first began with assessing the severity and then the inability to perform normal bodily functions caused by the pain. The latter affected the duration of the disease, which in turn resulted in the duration of the treatment. Research in this area has continued in the field of studying the clinical outcomes and effectiveness of therapeutic methods of treating CLBP;
• Development of study methodology: follow-up studies → comparative studies → randomized control trials → meta-analysis → cohort analysis . The methodological design first started with follow-up studies, followed by comparative studies and later by randomized control trials. Based on the conclusions of these studies, after further research authors began to summarize the main findings and suggest further possibilities for the development of physiotherapy for CLBP in meta-analysis. They were followed by cohort analyses studying causal factors over time.

4. Discussion

5. conclusions, author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest.

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Click here to enlarge figure

Institution	Number of Funded Publications	Percentage of Funded Information Sources (in %)
National Institutes of Health	84	8.97
National Center for Complementary and Integrative Health	67	7.15
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior	30	3.20
National Health and Medical Research Council	28	2.99
Fundação de Amparo à Pesquisa do Estado de São Paulo	23	2.46
National Natural Science Foundation of China	23	2.46
Pfizer	18	1.92
U.S. Department of Veterans Affairs	18	1.92
National Institute on Aging	17	1.81
National Institute of Child Health and Human Development	16	1.71

Source Title	Number of Sources	Percentage of All Sources (in %)	IF 2022	H-Index of Journal	Quartiles (Q)
Spine	129	6.79	3.0	292	Neurology (clinical) (Q1) Orthopedics and Sports Medicine (Q1) Sports Science (Q1)
BMC Musculoskeletal Disorders	81	4.27	2.3	122	Orthopedics and Sports Medicine (Q2) Rheumatology (Q2)
European Spine Journal	52	2.74	2.8	164	Orthopedics and Sports Medicine (Q1) Surgery (Q1)
Spine Journal	52	2.74	4.5	136	Neurology (clinical) (Q1) Orthopedics and Sports Medicine (Q1) Surgery (Q1)
Pain	51	2.69	7.4	296	Anesthesiology and Pain Medicine (Q1) Neurology (Q1) Neurology (clinical) (Q1) Pharmacology (Q1)
Journal Of Back and Musculoskeletal Rehabilitation	48	2.53	1.6	39	Orthopedics and Sports Medicine (Q3) Physical Therapy, Sports Therapy and Rehabilitation (Q2) Rehabilitation (Q2)
Clinical Journal of Pain	47	2.48	2.9	145	Anesthesiology and Pain Medicine (Q1) Neurology (clinical) (Q2)
Pain Medicine United States	46	2.42	No data	No data	No data
Journal of Pain Research	44	2.32	2.7	71	Anesthesiology and Pain Medicine (Q2)
BMJ Open	34	1.79	2.9	160	Medicine (miscellaneous) (Q1)

Theme (Color)	Representative Keywords	Categories	The Newest/Most Cited Papers	Focus of Research
Pathophysiology of CLBP and the assessment tools (yellow)	Oswestry Disability Index, pilot studies, single-blind method, exercise therapy, pathophysiology, range of motion, spine mobility	Pain quantification tools, Muscle physiology, Rehabilitation, Kinesiology	] ] ] ] ]	The Visual Analogue Scale (VAS) and the Numeric Pain Rating Scale (NPRS) are the most commonly used scales of perceived pain intensity, but otherwise there is no established gold standard for pain measurement in the literature. Physiotherapy interventions through behavioral (teaching the patient about the biology of their pain) or instructional modalities demonstrate better treatment outcomes for CLBP.
Diagnostics and CLBP treatment (red)	Magnetic resonance imaging (MRI), diagnostic imaging, conservative treatment, risk assessment, radiculopathy, herniation, operation	Diagnostics, Analgesia, Risk assessment, Pathology, Other treatment methods	] ] ] ] ]	MRI is the most widespread method for researching pain networks in the brain. A newer method is ultra-short echo time (UTE) MRI. Research indirectly suggests a psychoneuroimmunological connection in CLBP. Pain-related fear and avoidance appear to be essential features for the development of chronic pain. The thalamus plays the most important role in regulation of pain-related emotions. Expression of pain-related molecules is mediated by CD14+ cells via inflammatory cytokines.
CLBP questionnaires and surveys (violet)	Reproducibility, validity, assessment, rating scale, catastrophizing, nerve blockade	Questionnaires and surveys, Pain, Patients’ impact	] ] ] ]	Studies recommend measuring several outcomes to assess the strength of CLBP and the effectiveness of physiotherapy, namely functional (Oswestry Disability Index, Rolland–Morris Disability Index, etc.), pain (NPRS, Pain Disability Index, etc.), psychosocial (Fear Avoidance Beliefs Questionnaire) and other (return to work, complications or adverse effects, etc.) outcomes and quality-of-life assessment (SF-36, etc.). Negative behavioral emotion regulation is reported to result in spiraling negative affect and subsequent CLBP relapse.
Quality of life (light blue)	Sleep quality, quality of life, functional status, treatment outcome, neuromodulation, balneotherapy	Quality of life, Intermethod comparison, Newer therapeutic methods	] ] ] ]	Depression, anxiety, coping behavior and catastrophizing are the main components of the quality-of-life assessment and influence the strength of CLBP and the success of physiotherapy. The concept of a multidisciplinary approach emphasizes the connection between the psychological and physical components of pain. More recent studies are also focused on investigating the effects of the environment and report that a calmer and green living environment should have a positive effect on the expression of CLBP and pain in general.
Complementary methods in physiotherapy (dark blue)	Physical therapy modalities, clinical protocol, yoga, cognitive behavioral therapy, coping behavior, interpersonal communication, mindfulness, lifestyle	Physiotherapy, Complementary therapies, Personal relationships, Coping behavior	] ] ] ] ]	The physiotherapist–patient relationship plays an important role in the success of physiotherapy, as it affects the patient’s trust. The effectiveness of rehabilitation is also influenced by non-verbal communication, the patient’s ability to cope with pain and associated relaxation methods (meditation).
Psychosocioeconomic aspects (green)	Cost–benefit analysis, healthcare costs, sick leave, social aspects, psychotherapy, depression, prognosis	Economy, Absenteeism, Socioeconomic factors, Disability, Risk factors	] ] ]	Research shows an increasing prevalence of CLBP and associated healthcare costs. Early multidisciplinary treatment of CLBP is essential to reduce the rate of sick leave and work disability.

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Šajnović, U.; Kokol, P.; Završnik, J.; Vošner, H.B. Trends in Physiotherapy of Chronic Low Back Pain Research: Knowledge Synthesis Based on Bibliometric Analysis. Healthcare 2024 , 12 , 1676. https://doi.org/10.3390/healthcare12161676

Šajnović U, Kokol P, Završnik J, Vošner HB. Trends in Physiotherapy of Chronic Low Back Pain Research: Knowledge Synthesis Based on Bibliometric Analysis. Healthcare . 2024; 12(16):1676. https://doi.org/10.3390/healthcare12161676

Šajnović, Urška, Peter Kokol, Jernej Završnik, and Helena Blažun Vošner. 2024. "Trends in Physiotherapy of Chronic Low Back Pain Research: Knowledge Synthesis Based on Bibliometric Analysis" Healthcare 12, no. 16: 1676. https://doi.org/10.3390/healthcare12161676

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A quantitative analysis of research publications in physical therapy journals

Affiliation.

• 1 [email protected]
• PMID: 12564948

Background and purpose: Many physical therapists depend on their professional journals for high-quality evidence. The purpose of this study was to evaluate the rigor of research and review articles in 4 national physical therapy journals.

Subjects and methods: All articles in 6 consecutive issues of the Australian Journal of Physiotherapy, Physical Therapy, Physiotherapy, and Physiotherapy Canada, published between January 2000 and June 2001 (N=179), were reviewed. One trained reviewer identified the type and purpose of each article and assessed the rigor of treatment and review articles according to explicit criteria.

Results: The majority of articles reviewed were original studies (56%). The majority of the research articles that dealt with human health care (66%) addressed topics that were not directly applicable to the provision of patient care such as measurement topics and studies on subjects without identified pathologies or impairments. Of the 179 journal articles, 19 met the standards for rigor (11%). The majority of these articles dealt with treatment. The pass rate per journal was as follows: Australian Journal of Physiotherapy, 10% (4/42); Physical Therapy, 15% (7/47); Physiotherapy, 12% (4/34); and Physiotherapy Canada, 7% (4/56).

Discussion and conclusion: Because such a small percentage of articles in these professional journals were identified as having direct application to patient care, physical therapists should attempt to access other sources of information to find additional high-quality evidence. A larger sample with a greater number of issues per journal may have yielded different results and indicated different trends, and further research appears to be warranted.

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• A valuable and timely analysis of research publications in 4 premiere physical therapy journals. Jette AM. Jette AM. Phys Ther. 2003 Feb;83(2):131-2; discussion 133. Phys Ther. 2003. PMID: 12587598 No abstract available.

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e-Publications@Marquette

Home > Health Sciences > Physical Therapy, Department of > PHYS_THERAPY_FAC

Physical Therapy Faculty Research and Publications

The Physical Therapy Faculty Research and Publications Series is comprised of books and articles published by Marquette University's physical therapy faculty.

Submissions from 2011 2011

Perspective Paper: Assessing Air Quality as Part of a Physical Therapy Plan of Care , Dennis Sobush and Monika Burrescia

Submissions from 2010 2010

A Role for the Kolliker-Fuse Nucleus in Cholinergic Modulation of Breathing at Night During Wakefulness and NREM Sleep , Joshua M. Bonis, Suzanne E. Neumueller, Katie L. Krause, T. Kiner, A. Smith, B. D. Marshall, B. Qian, Lawrence Pan, and Hubert V. Forster

The Pontine Respiratory Group, Particularly the Kölliker-Fuse Nucleus, Mediates Phases of the Hypoxic Ventilatory Response in Unanesthetized Goats , Joshua M. Bonis, Suzanne E. Neumueller, K. L. Krause, T. Kiner, A. Smith, B. D. Marshall, B. Qian, Lawrence Pan, and Hubert V. Forster

Site-specific Effects on Respiratory Rhythm and Pattern of Ibotenic Acid Injections in the Pontine Respiratory Group of Goats , Joshua M. Bonis, Suzanne Neumueller, Katie L. Krause, T. Kiner, A. Smith, B. D. Marshall, B. Qian, Lawrence Pan, and Hubert Forster

Ultrasound for Wound Debridement and Healing , Luther C. Kloth and Jeffery A. Niezgoda

Electromagnetic Stimulation for Wound Repair , Luther C. Kloth and Arthur A. Pilla

Endogenous and Exogenous Electrical Fields for Wound Healing , Luther C. Kloth and Min Zhao

Wound Healing: Evidence-Based Management, 4th Edition , Joseph M. McCulloch and Luther C. Kloth

Submissions from 2009 2009

The Role of Physical Therapy in Wound Management - Part One , Luther C. Kloth

The Roles of Physical Therapists in Wound Management, Part III: Select Biophysical Technologies and Management of Patients With Diabetic Foot Ulceration , Luther C. Kloth

The Roles of Physical Therapists in Wound Management, Part II: Patient and Wound Evaluation , Luther C. Kloth

The Roles of Physical Therapists in Wound Management: Part IV , Luther C. Kloth

Normal Breathing Pattern and Arterial Blood Gases in Awake and Sleeping Goats after Near Total Destruction of the Presumed Pre-Bötzinger Complex and the Surrounding Region , Katie L. Krause, Hubert Forster, T. Kiner, S. E. Davis, Joshua M. Bonis, B. Qian, and Lawrence Pan

Focal Acidosis in the Pre-Bötzinger Complex Area of Awake Goats Induces a Mild Tachypnea , K. L. Krause, Hubert V. Forster, S. E. Davis, T. Kiner, Joshua M. Bonis, Lawrence Pan, and B. Qian

μ-Opioid Receptor Agonist Injections Into the Presumed Pre-Bötzinger Complex and the Surrounding Region of Awake Goats Do Not Alter Eupneic Breathing , K. L. Krause, Suzanne E. Neumueller, B. D. Marshall, T. Kiner, Joshua M. Bonis, Lawrence Pan, B. Qian, and Hubert V. Forster

Observation of Amounts of Movement Practice Provided during Stroke Rehabilitation , Catherine E. Lang, Jillian R. MacDonald, Darcy S. Reisman, Lara Boyd, Teresa Jacobson Kimberley, Sheila M. Schindler-Ivens, T. George Hornby, Sandy A. Ross, and Patricia L. Scheets

Elastic, Viscous, and Mass Load Effects on Poststroke Muscle Recruitment and Co-contraction During Reaching: A Pilot Study , Tina M. Stoeckmann, Katherine J. Sullivan, and Robert A. Scheidt

Sex differences in response to cognitive stress during a fatiguing contraction , Tejin Yoon, Manda Linea Keller, Bonnie Schlinder-Delap, April L. Harkins, Romuald Lepers, and Sandra K. Hunter

Submissions from 2008 2008

Lower Extremity Passive Range of Motion in Community-Ambulating Stroke Survivors , Sheila M. Schindler-Ivens, Davalyn Desimone, Sarah Grubich, Carolyn Kelley, Namita Sanghvi, and David A. Brown

Submissions from 2007 2007

Co-Localization of p-CREB and p-NR1 in Spinothalamic Neurons in a Chronic Muscle Pain Model , Marie K. Hoeger Bement and Kathleen A. Sluka

Antibacterial Activity of Positive and Negative Polarity Low-voltage Pulsed Current (LVPC) on Six Typical Gram-positive and Gram-negative Bacterial Pathogens of Chronic Wounds , Georg Daeschlein, Ojan Assadian, Luther C. Kloth, Christina Meinl, Frank Ney, and Axel Kramer

Bactericidal and Cytotoxic Effects of Chloramine-T on Wound Pathogens and Human Fibroblasts In Vitro , Luther C. Kloth, Joseph E. Berman, Linda Jean Laatsch-Lybeck, and Phyllis A. Kirchner

The Cerebellar Fastigial Nucleus Contributes to CO 2 -H + Ventilatory Sensitivity in Awake Goats , P. F. Martino, S. Davis, C. Opansky, Katie L. Krause, Joshua M. Bonis, Lawrence Pan, B. Qian, and Hubert V. Forster

Submissions from 2006 2006

Effect of Keyswitch Design of Desktop and Notebook Keyboards Related to Key Stiffness and Typing Force , Marcia J. Bufton, Richard W. Marklin, Mark L. Nagurka, and Guy G. Simoneau

Ralph Steiner, The Cloud Series, 1981-82 , Zbigniew Sorbjan

Submissions from 2005 2005

Electrical Stimulation , Luther C. Kloth

Electrical Stimulation for Wound Healing: A Review of Evidence From In Vitro Studies, Animal Experiments, and Clinical Trials , Luther C. Kloth

Characterization of Motor Adaptation and Limb Posture Regulation During Arm Reaching Movements Following Stroke , Robert A. Scheidt and Tina M. Stoeckmann

Wound Debridement with 25 kHz Ultrasound , Margaret McCarty Stanisic, Barbara Provo, David L. Larson, and Luther C. Kloth

Submissions from 2004 2004

Management of Postsurgical Hyperhidrosis With Direct Current and Tap Water , Bernadette T. Gillick, Luther C. Kloth, Andrew John Starsky, and Laura Cincinelli-Walker

Design Features of Alternative Computer Keyboards: A Review of Experimental Data , Richard W. Marklin and Guy G. Simoneau

Submissions from 2003 2003

Effect of Computer Keyboard Slope on Wrist Position and Forearm Electromyography of Typists Without Musculoskeletal Disorders , Guy G. Simoneau, Richard W. Marklin, and Joseph E. Berman

Submissions from 2002 2002

5 Questions–and Answers–About Negative Pressure Wound Therapy , Luther C. Kloth

Adjunctive Interventions for Wound Healing , Luther C. Kloth

Electrical Stimulation for Wound Healing , Luther C. Kloth

A Randomized Controlled Clinical Trial to Evaluate the Effects of Noncontact Normothermic Wound Therapy on Chronic Full-thickness Pressure Ulcers , Luther C. Kloth, Joseph E. Berman, Marilyn Nett, Paula Papanek, and Sonia Dumit-Minkel

Submissions from 2001 2001

Walker-Assisted Gait in Rehabilitation: A Study of Biomechanics and Instrumentation , Rebecca Ann Bachschmidt, Gerald F. Harris, and Guy G. Simoneau

5 Questions–and Answers–About Electrical Stimulation , Luther C. Kloth

Effect of Computer Keyboard Slope and Height on Wrist Extension Angle , Richard W. Marklin and Guy G. Simoneau

Effect of Setup Configurations of Split Computer Keyboards on Wrist Angle , Richard W. Marklin and Guy G. Simoneau

Biomechanics of Elastic Resistance in Therapeutic Exercise Programs , Guy G. Simoneau, Shellie M. Bereda, Dennis Sobush, and Andrew John Starsky

Submissions from 2000 2000

Effects of a Normothermic Dressing on Pressure Ulcer Healing , Luther C. Kloth and Paula Papanek

Whole Body Momentum During Gait: A Preliminary Study of Non-Fallers and Frequent Fallers , Guy G. Simoneau and David E. Krebs

Effects of Electrical Stimulation on Wound Closure in Mice with Experimental Diabetes Mellitus , Habiba A. Thawer, Pamela E. Houghton, Luther Kloth, and Anna Butryn

Submissions from 1999 1999

The APTA Electrical Stimulation Lawsuit and Its Aftermath , Luther C. Kloth

Wrist and Forearm Posture From Typing on Split and Vertically Inclined Computer Keyboards , Richard W. Marklin, Guy G. Simoneau, and John F. Monroe

Wrist and Forearm Postures of Users of Conventional Computer Keyboards , Guy G. Simoneau, Richard W. Marklin, and John F. Monroe

Foot and Ankle Neuropathy, Proprioception, and Postural Stability , R. W. M. van Deursen and Guy G. Simoneau

Submissions from 1998 1998

The Impact of Various Anthropometric and Flexibility Measurements on the Sit-and-Reach Test , Guy G. Simoneau

Influence of Hip Position and Gender on Active Hip Internal and External Rotation , Guy G. Simoneau, Karen J. Hoenig, Johanna E. Lepley, and Paula Papanek

Submissions from 1997 1997

Changes in Ankle Joint Proprioception Resulting From Strips of Athletic Tape Applied Over the Skin , Guy G. Simoneau, Rebecca M. Degner, Cindi A. Kramper, and Kent H. Kittleson

Submissions from 1996 1996

Promotion of Wound Healing with Electrical Stimulation , Luther C. Kloth and Joseph M. McCulloch

Commentaries on Venous Leg Ulcers Diagnostic and Treatment Draft Guideline , Mary Y. Sieggreen, I. Kelman Cohen, Luther C. Kloth, Keith G. Harding, and Nancy A. Stotts

Diabetic Sensory Neuropathy Effect on Ankle Joint Movement Perception , Guy G. Simoneau, Janice A. Derr, Jan S. Ulbrecht, Mary B. Becker, and Peter R. Cavanagh

The Lennie Test for Measuring Scapular Position in Healthy Young Adult Females: A Reliability and Validity Study , Dennis Sobush, Guy G. Simoneau, Kristin E. Dietz, John A. Levene, Ronald E. Grossman, and William B. Smith

Submissions from 1995 1995

In vitro Effects of Two Silver Electrodes on Select Wound Pathogens , Linda Jean Laatsch-Lybeck, Poh Chye Ong, and Luther C. Kloth

Role of Somatosensory Input in the Control of Human Posture , Guy G. Simoneau, Jan S. Ulbrecht, Janice A. Derr, and Peter R. Cavanagh

Submissions from 1994 1994

Postural Instability in Patients with Diabetic Sensory Neuropathy , Guy G. Simoneau, Jan S. Ulbrecht, Janice A. Derr, Mary B. Becker, and Peter R. Cavanagh

Antibacterial Effects of a Silver Electrode Carrying Microamperage Direct Current in vitro , Poh Chye Young, Luther C. Kloth, and Linda Jean Laatsch-Lybeck

Submissions from 1993 1993

Ulceration, Unsteadiness, and Uncertainty: The Biomechanical Consequences of Diabetes Mellitus , Peter R. Cavanagh, Guy G. Simoneau, and Jan S. Ulbrecht

Submissions from 1992 1992

Posture and Gait in Patients with Diabetic Distal Symmetrical Polyneuropathy , Guy G. Simoneau, Peter R. Cavanagh, and Jan S. Ulbrecht

The Effects of Visual Factors and Head Orientation on Postural Steadiness in Women 55 to 70 Years of Age , Guy G. Simoneau, Herschel W. Leibowitz, Jan S. Ulbrecht, Richard A. Tyrrell, and Peter R. Cavanagh

Submissions from 1991 1991

Chronic Dermal Ulcer Healing Enhanced with Monophasic Pulsed Electrical Stimulation , Jeffery A. Feedar, Luther C. Kloth, and Gary D. Gentzkow

Improved Healing of Pressure Ulcers Using Dermapulse, A New Electrical Stimulation Device , Gary D. Gentzkow, Sheldon V. Pollack, Luther C. Kloth, and Harrison A. Stubbs

The Influence of Visual Factors on Fall-Related Kinematic Variables During Stair Descent by Older Women , Guy G. Simoneau, Peter R. Cavanagh, Jan S. Ulbrecht, Herschel W. Leibowitz, and Richard A. Tyrrell

Submissions from 1990 1990

Isokinetic Characteristics of Ankle Evertors and Invertors in Female Control Subjects Using the Biodex Dynamometer , Guy G. Simoneau

Submissions from 1988 1988

Acceleration of Wound Healing with High Voltage, Monophasic, Pulsed Current , Luther C. Kloth and Jeffery A. Feedar

Submissions from 1983 1983

Supervised Versus Independent Student Laboratories , Luther C. Kloth and Mary Ann Morrison

Physical Fitness of Physical Therapy Students , Dennis Sobush and Richard Fehring

Submissions from 1974 1974

Effect of Age on Hemodynamic and Metabolic Response to Static Exercise , Daniel J. McDermott, William J. Stekiel, Joseph J. Barboriak, Luther C. Kloth, and James J. Smith

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151+ Research Topics For Physiotherapy Students [Updated]

Welcome to the world of physiotherapy, where movement is medicine, and every step leads to healing. In the area of physiotherapy education, research is a powerful tool. It helps us understand the human body better, discover new techniques for rehabilitation, and improve the quality of life for countless individuals. Today, we dive into the diverse and fascinating world of research topics for physiotherapy students. 

Whether you’re a student, a curious reader, or someone passionate about health and well-being, this journey promises to be enlightening.

What is Physiotherapy Research?

Table of Contents

Physiotherapy research is the investigation and exploration of various aspects of physical therapy. It delves into the effectiveness of different treatments, the impact of exercises on specific conditions, and the development of innovative techniques to enhance rehabilitation. This research isn’t just about lab coats and test tubes; it’s about real people, real struggles, and real triumphs.

Why Research Matters in Physiotherapy Education

Research isn’t just an academic exercise—it’s the heartbeat of progress in physiotherapy. For students, engaging in research opens doors to understanding the science behind the practice. It fosters critical thinking, hones problem-solving skills, and prepares future physiotherapists to deliver evidence-based care.

Most importantly, research enhances the quality of care patients receive, ensuring they benefit from the latest advancements in the field.

How Do I Choose A Research Topic For Physiotherapy Students?

Choosing a research topic for physiotherapy students involves several considerations to ensure it aligns with your interests, the field’s needs, and feasibility. Here’s a step-by-step guide:

• Identify Your Interests
• Passion: Choose a topic that genuinely interests you. Your enthusiasm will drive your motivation throughout the research process.
• Personal Experience: Reflect on any personal experiences or observations in physiotherapy that sparked your curiosity.
• Consider Relevance
• Field Needs: Look into current trends and gaps in physiotherapy research. What areas need more exploration or improvement?
• Clinical Significance: Choose a topic with practical applications in clinical settings. Will your research contribute to better patient outcomes or practice?
• Review Literature
• Literature Search: Conduct a thorough literature review to understand what’s been done. Identify gaps where your research can make a valuable contribution.
• Read Journals: Explore recent publications in physiotherapy journals to get ideas and understand the latest advancements.
• Discuss with Peers and Mentors
• Peer Feedback: Discuss potential topics with classmates or colleagues. They might offer insights or suggest areas you hadn’t considered.
• Mentor Guidance: Seek advice from professors or experienced researchers. They can guide you towards viable topics and methodologies.
• Assess Feasibility
• Resources: Consider the resources available to you, such as access to equipment, databases, and funding.
• Timeframe: Evaluate the time you have for research. Ensure your topic is manageable within the given timeframe.
• Narrow Down and Define
• Specificity: Narrow your topic to a specific question or problem. Broad topics can be overwhelming and challenging to research effectively.
• Clear Objective: Define a clear research question or hypothesis. This guides your study’s direction and methods.
• Brainstorm Potential Topics
• Use the Outline: Refer to the outline provided earlier for inspiration. Consider topics in musculoskeletal, neurological, pediatric, geriatric, or cardiovascular physiotherapy.
• Innovative Approaches: Explore the use of technology, patient compliance, psychological aspects, or sports-related research.
• Evaluate Ethical Considerations
• Ethical Approval: Ensure your chosen topic aligns with ethical guidelines. Consider factors like informed consent, patient privacy, and data handling.
• Choose Your Topic!
• Final Selection: After considering all these factors, select a topic that excites you, addresses a gap in the field, and is feasible within your resources and timeframe.

Remember, choosing a research topic is an exciting journey. Embrace the opportunity to contribute to the field of physiotherapy, improve patient care, and expand your knowledge and skills.

151+ Research Topics For Physiotherapy Students: Category Wise

Musculoskeletal physiotherapy.

• Effectiveness of Kinesio Taping in Ankle Sprains
• Comparison of Manual Therapy and Exercise for Low Back Pain
• The Role of Pilates in Improving Core Strength and Stability
• Efficacy of Dry Needling in Myofascial Pain Syndrome
• Impact of Virtual Reality on Rehabilitation After ACL Reconstruction
• Muscle Imbalance and its Relationship to Injury Risk
• Use of Blood Flow Restriction Training in Muscle Rehabilitation
• Effectiveness of Cupping Therapy for Musculoskeletal Pain
• Effects of Different Running Techniques on Knee Joint Stress
• Long-Term Effects of High-Intensity Interval Training on Muscle Function

Neurological Physiotherapy

• Rehabilitation Strategies for Improving Balance in Multiple Sclerosis
• Impact of Aquatic Therapy on Motor Function in Parkinson’s Disease
• Effectiveness of Constraint-Induced Movement Therapy in Stroke Recovery
• Virtual Reality for Upper Limb Rehabilitation in Stroke Patients
• Gait Training Techniques for Individuals with Cerebral Palsy
• Neuroplasticity and its Implications for Rehabilitation
• Role of Robotics in Neurological Rehabilitation
• Effects of Tai Chi on Balance and Fall Prevention in Older Adults with Stroke
• Music Therapy for Motor Rehabilitation in Stroke Survivors
• Vestibular Rehabilitation in Patients with Vestibular Disorders

Cardiovascular and Pulmonary Physiotherapy

• Cardiac Rehabilitation Programs: Effectiveness and Adherence Rates
• Inspiratory Muscle Training for COPD Patients
• Role of Yoga in Improving Cardiovascular Health
• Exercise Prescription for Patients with Heart Failure
• Effects of High-Altitude Training on Lung Function
• Pulmonary Rehabilitation in Patients with Chronic Respiratory Diseases
• Non-Invasive Ventilation in Neuromuscular Disorders
• Effects of Smoking Cessation on Respiratory Function
• Impact of Breathing Exercises on Asthma Control
• Exercise Interventions for Pulmonary Hypertension

Pediatric Physiotherapy

• Early Intervention Programs for Children with Developmental Delays
• Hydrotherapy for Pediatric Rehabilitation
• Motor Learning Strategies in Children with Autism Spectrum Disorder
• Constraint-Induced Movement Therapy in Pediatric Hemiplegia
• Sensory Integration Therapy for Children with Sensory Processing Disorder
• Effects of Biking on Gross Motor Skills in Children
• Role of Play-Based Therapy in Pediatric Rehabilitation
• Pediatric Obesity and its Impact on Musculoskeletal Health
• Effects of Early Mobility in Preterm Infants
• Dance Therapy for Children with Cerebral Palsy

Geriatric Physiotherapy

• Falls Risk Assessment and Prevention Strategies in Older Adults
• Effectiveness of Chair Yoga in Elderly Fall Prevention
• Role of Physical Activity in Cognitive Function in the Elderly
• Home-Based Exercise Programs for Aging Adults
• Effects of Tai Chi on Balance and Mobility in Elderly
• Impact of Nutritional Interventions on Sarcopenia
• Role of Multidisciplinary Teams in Geriatric Rehabilitation
• Frailty Screening Tools and Interventions
• Effects of Ageism on Physical Activity in Older Adults
• Dementia and Exercise: Benefits and Challenges

Sports Physiotherapy

• Prevalence and Risk Factors of Sports Injuries in Soccer Players
• Effectiveness of Taping Techniques in Athletes
• Return to Play Guidelines Following ACL Reconstruction
• Role of Biomechanics in Running Injury Prevention
• Sports-Specific Rehabilitation Protocols
• Impact of Sports Specialization on Injury Risk in Youth Athletes
• Effects of Cryotherapy on Muscle Recovery
• Psychological Factors in Sports Injury Rehabilitation
• Nutritional Strategies for Performance Enhancement in Athletes
• Role of Physiotherapy in eSports Injury Prevention

Women’s Health and Pelvic Physiotherapy

• Pelvic Floor Muscle Training for Stress Urinary Incontinence
• Effects of Pregnancy on Musculoskeletal Health
• Postpartum Exercise Programs and Recovery
• Role of Physiotherapy in Pelvic Organ Prolapse Management
• Chronic Pelvic Pain Management Strategies
• Diastasis Recti: Assessment and Rehabilitation
• Impact of Menopause on Bone Health and Exercise
• Role of Physiotherapy in Breast Cancer Rehabilitation
• Pre- and Post-Operative Physiotherapy for Gynecological Surgeries
• Pelvic Girdle Pain in Pregnancy: Assessment and Treatment

Orthopedic Physiotherapy

• Manual Therapy Techniques for Frozen Shoulder
• Effects of TENS Therapy on Osteoarthritis Pain
• Post-Operative Rehabilitation Following Total Knee Replacement
• Role of Physiotherapy in Rotator Cuff Tears
• Conservative Management of Lumbar Disc Herniation
• Motor Control Exercises for Patellofemoral Pain Syndrome
• Effects of PNF Techniques on Range of Motion
• Role of Physiotherapy in Ankle Instability
• Prehabilitation Programs for Anterior Cruciate Ligament Tears
• Postural Correction Strategies for Neck Pain

Occupational Physiotherapy

• Ergonomics and Workplace Injury Prevention
• Role of Physiotherapy in Work Rehabilitation Programs
• Return to Work Interventions for Musculoskeletal Injuries
• Job Demands Analysis and Physical Capacity Assessments
• Effects of Standing Desks on Musculoskeletal Health
• Role of Physiotherapy in Hand Rehabilitation
• Post-Operative Rehabilitation Following Hand Surgery
• Workplace Stress and its Impact on Musculoskeletal Health
• Functional Capacity Evaluations in Occupational Settings
• Role of Physiotherapy in Ergonomic Design Consultations

Pain Management

• Multimodal Approaches to Chronic Pain Management
• Effects of Mindfulness-Based Stress Reduction on Pain Perception
• Role of Physiotherapy in Fibromyalgia Management
• Cognitive Behavioral Therapy for Chronic Pain
• Pain Neuroscience Education for Patients with Persistent Pain
• Effects of Acupuncture on Chronic Low Back Pain
• Role of Physiotherapy in Complex Regional Pain Syndrome
• Telehealth for Pain Management
• Pain Catastrophizing and its Influence on Treatment Outcomes
• Effects of Sleep Quality on Pain Perception

Rehabilitation Technology

• Wearable Technology for Monitoring Physical Activity
• Virtual Reality for Motor Rehabilitation
• Robotics in Rehabilitation: Current Trends and Future Directions
• Smart Textiles for Monitoring Muscle Activity
• Tele rehabilitation: Benefits and Challenges
• 3D Printing in Orthopedic Rehabilitation
• Biofeedback Systems for Muscle Rehabilitation
• Wearable Sensors for Gait Analysis
• Virtual Reality for Phantom Limb Pain
• Brain-Computer Interfaces in Stroke Rehabilitation

Health Promotion and Wellness

• Effects of Exercise on Mental Health and Wellbeing
• Role of Physiotherapy in Obesity Management
• Exercise Programs for Older Adults in Assisted Living Facilities
• Workplace Wellness Programs: Impact on Employee Health
• Community-Based Exercise Programs for Cardiovascular Health
• Effects of Mindfulness Meditation on Stress Reduction
• Role of Physiotherapy in Smoking Cessation Programs
• Nutritional Counseling for Chronic Disease Prevention
• Exercise Prescription for Mental Health Disorders
• Impact of Social Support on Physical Activity Adherence

Rehabilitation in Specific Populations

• Effects of Exercise on Bone Density in Postmenopausal Women
• Role of Physiotherapy in Refugee Rehabilitation
• Rehabilitation Needs of LGBTQ+ Individuals
• Cultural Competence in Physiotherapy Practice
• Effects of Exercise on Immune Function in Cancer Patients
• Role of Physiotherapy in Prison Rehabilitation Programs
• Rehabilitation Challenges in Homeless Populations
• Effects of Exercise on Quality of Life in HIV/AIDS Patients
• Role of Physiotherapy in Rehabilitation After Human Trafficking
• Exercise Programs for Individuals with Disabilities

Innovative Approaches in Rehabilitation

• Biofeedback Training for Improving Motor Control
• Effects of Exergaming on Physical Function in Older Adults
• Role of Photobiomodulation Therapy in Tissue Healing
• Virtual Reality for Pain Management in Burn Patients
• Mindfulness-Based Interventions for Chronic Fatigue Syndrome
• Role of AI and Machine Learning in Rehabilitation
• Effects of Hippotherapy on Balance and Coordination
• Role of Music Therapy in Rehabilitation
• Hydrogen Water Therapy for Musculoskeletal Injuries
• Role of Graded Motor Imagery in Chronic Pain Rehabilitation

Ethics and Professionalism in Physiotherapy

• Informed Consent Practices in Physiotherapy Research
• Confidentiality in Telehealth Consultations
• Role of Physiotherapists in Health Advocacy
• Ethical Considerations in Exercise Prescription
• Cultural Competence in Patient Care
• Role of Physiotherapists in End-of-Life Care
• Patient Autonomy and Shared Decision-Making in Treatment
• Professional Boundaries in Physiotherapy Practice
• Ethical Implications of Social Media Use for Physiotherapists
• Conflict of Interest in Physiotherapy Research

Global Health and Physiotherapy

• Role of Physiotherapists in Disaster Relief Efforts
• Health Disparities in Access to Physiotherapy Services
• Physiotherapy in Low-Resource Settings: Challenges and Solutions
• Cross-Cultural Communication in Physiotherapy Practice
• Role of Physiotherapists in Addressing Climate Change Health Impacts

Ethical Considerations in Physiotherapy Research

• Informed Consent: Ensuring patients fully understand the research and voluntarily agree to participate.
• Confidentiality of Patient Information: Safeguarding patient privacy and protecting their personal data.
• Data Collection and Storage: Using secure methods to collect, store, and analyze research data.
• Research Ethics Committee Approval: Obtaining ethical approval before conducting any research involving human participants.

Research in physiotherapy is a dynamic and essential part of the field. For students embarking on their research journeys, the possibilities are limitless. 

From improving rehabilitation techniques to enhancing patient care, each study contributes to a brighter, healthier future.

So whether you’re intrigued by the mysteries of the musculoskeletal system or fascinated by the potential of technology in therapy, there are  research topics for physiotherapy students waiting for you to explore. Together, let’s continue pushing the boundaries of knowledge and empowering individuals to move, heal, and thrive.

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• Introduction
• Conclusions
• Article Information

Trial Protocol

eTable 1. Demographic and Clinical Characteristics of Participants in Each Group at Baseline

eTable 2. The Number and Percentage of Participants Who Met MCID for Pain Level and Functional Status at 3, 6 and 12 Months

eTable 3. Primary Outcomes for the Two Groups at 3, 6, and 12 Months (Per-Protocol Analysis)

eTable 4. Secondary Outcomes for the Two Groups at 3, 6, and 12 Months (Per-Protocol Analysis)

eTable 5. Outcomes for the Two Groups at 3, 6, and 12 Months (Intention-to-Treat Analysis With the Worst Case)

Data Sharing Statement

• Errors in Table 3, Outcome Measures, Results, Supplement 1, and Supplement 2 JAMA Network Open Correction March 29, 2024

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Peng M , Wang R , Wang Y, et al. Efficacy of Therapeutic Aquatic Exercise vs Physical Therapy Modalities for Patients With Chronic Low Back Pain : A Randomized Clinical Trial . JAMA Netw Open. 2022;5(1):e2142069. doi:10.1001/jamanetworkopen.2021.42069

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Efficacy of Therapeutic Aquatic Exercise vs Physical Therapy Modalities for Patients With Chronic Low Back Pain : A Randomized Clinical Trial

• 1 Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
• 2 Department of Rehabilitation Medicine, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
• 3 Department of Rehabilitation Medicine, Qingtian People’s Hospital, Lishui, China
• 4 Department of Rehabilitation Medicine, Changzhou Seventh People’s Hospital, Jiangsu Changzhou, China
• 5 The Second School of Clinical Medicine, Xuzhou Medical University, Xuzhou, China
• 6 Department of Rehabilitation Medicine, Shanghai Shangti Orthopaedic Hospital, Shanghai, China
• Correction Errors in Table 3, Outcome Measures, Results, Supplement 1, and Supplement 2 JAMA Network Open

Question   Is therapeutic aquatic exercise as effective as physical therapy modalities in the management of adults with chronic low back pain?

Findings   In this randomized clinical trial of 113 individuals with chronic low back pain, therapeutic aquatic exercise had a greater influence on pain, function, quality of life, sleep quality, and mental state than physical therapy modalities after a 3-month intervention, and the effect was present up to the 12-month follow-up. The recommendation rate of therapeutic aquatic exercise was significantly higher than that of physical therapy modalities.

Meaning   The findings of this trial suggest that therapeutic aquatic exercise is an effective treatment for adults with chronic low back pain.

Importance   Therapeutic aquatic exercise is frequently offered to patients with chronic low back pain, but its long-term benefits are unclear.

Objective   To assess the long-term effects of therapeutic aquatic exercise on people with chronic low back pain.

Design, Setting, and Participants   This 3-month, single-blind randomized clinical trial with a 12-month follow-up period was performed from September 10, 2018, to March 12, 2019, and the trial follow-up was completed March 17, 2020. A total of 113 people with chronic low back pain were included in the experiment.

Interventions   Participants were randomized to either the therapeutic aquatic exercise or the physical therapy modalities group. The therapeutic aquatic exercise group received aquatic exercise, whereas the physical therapy modalities group received transcutaneous electrical nerve stimulation and infrared ray thermal therapy. Both interventions were performed for 60 minutes twice a week for 3 months.

Main Outcomes and Measures   The primary outcome was disability level, which was measured using the Roland-Morris Disability Questionnaire; scores range from 0 to 24, with higher scores indicating more severe disability. Secondary outcomes included pain intensity, quality of life, anxiety, depression, sleep quality, kinesiophobia, fear avoidance, recommendation of intervention, and minimal clinically important difference in pain and function. Intention-to-treat and per-protocol analyses were performed.

Results   Of the 113 participants, 59 were women (52.2%) (mean [SD] age, 31.0 [11.5] years). Participants were randomly allocated into the therapeutic aquatic exercise group (n = 56) or the physical therapy modalities group (n = 57), and 98 patients (86.7%) completed the 12-month follow-up. Compared with the physical therapy modalities group, the therapeutic aquatic exercise group showed greater alleviation of disability, with adjusted mean group differences of −1.77 (95% CI, −3.02 to −0.51; P  = .006) after the 3-month intervention, −2.42 (95% CI, −4.13 to −0.70; P  = .006) at the 6-month follow-up, and −3.61 (95% CI, −5.63 to −1.58; P  = .001) at the 12-month follow-up ( P  < .001 for overall group × time interaction). At the 12-month follow-up point, improvements were significantly greater in the therapeutic aquatic exercise group vs the physical therapy modalities group in the number of participants who met the minimal clinically important difference in pain (at least a 2-point improvement on the numeric rating scale) (most severe pain, 39 [69.64%] vs 20 [35.09%]; average pain, 30 [53.57%] vs 12 [21.05%]; and current pain, 22 [39.29%] vs 10 [17.54%]) and disability (at least a 5-point improvement on the Roland-Morris Disability Questionnaire) (26 [46.43%] vs 4 [7.02%]). One of the 56 participants (1.8%) in the therapeutic aquatic exercise group vs 2 of the 57 participants (3.5%) in the physical therapy modalities group experienced low back pain and other pains related to the intervention.

Conclusions and Relevance   The therapeutic aquatic exercise program led to greater alleviation in patients with chronic low back pain than physical therapy modalities and had a long-term effect up to 12 months. This finding may prompt clinicians to recommend therapeutic aquatic exercise to patients with chronic low back pain as part of treatment to improve their health through active exercise rather than relying on passive relaxation.

Trial Registration   Chinese Clinical Trial Registry: ChiCTR1800016396

Low back pain is a high-incidence and high-burden condition. 1 The incidence rate of low back pain in a lifetime is 84% and that of chronic low back pain is approximately 23%. 2 A systematic analysis of global burden of disease showed that the number of years lived by patients with low back pain disability increased by 17.5% between 2007 and 2017. 3 In the US, the annual total direct expenses for each patient with chronic low back pain reached $8386. 4 Clinical practice guidelines recommend therapeutic exercise and physical therapy modalities for low back pain. 5 - 7 Therapeutic exercise and physical therapy modalities can relieve pain intensity and alleviate back disability for patients with low back pain. 8 - 12 Transcutaneous electrical nerve stimulation and infrared ray thermal therapy are common modalities that are frequently used for treatment of chronic low back pain. 13 , 14 Among the numerous therapeutic exercises available, therapeutic aquatic exercise is often prescribed by physicians for chronic low back pain, and it is becoming increasingly popular for treatment of chronic low back pain. 15 , 16 Therapeutic aquatic exercise refers to water-based treatments or exercise. Water is an ideal environment for conducting an exercise program given its various properties, including buoyancy pressure, density, thermal capacity, and conductivity. 17 - 22

Two systematic reviews suggested that therapeutic aquatic exercise can reduce pain intensity and improve function in patients with chronic low back pain. 23 , 24 However, to our knowledge, evidence of the long-term benefits of therapeutic aquatic exercise in patients with chronic low back pain does not exist, and no study has compared the efficacy of therapeutic aquatic exercise and physical therapy modalities for chronic low back pain. Thus, we conducted a single-blind randomized clinical trial to compare the effects of therapeutic aquatic exercise with physical therapy modalities in patients with chronic low back pain over a 12-month follow-up period.

We conducted a 3-month assessor-blinded randomized clinical trial with a 12-month follow-up period to compare the effects of therapeutic aquatic exercise and physical therapy modalities on chronic low back pain. All participants were included in a WeChat group for them to receive information about the trial. Regular offline health lectures were also held to offer educational information to the participants and carry out the measurements during the follow-up period. The protocol of this study registered in the Chinese Clinical Trial Registry has been updated and is provided in Supplement 1 . The Ethics committee of Shanghai University of Sport agreed with the modifications of protocol within the allowable range. This study was approved by the ethics committee of the Shanghai University of Sport, Shanghai, China. Before enrolling in the project, all participants provided written informed consent. We recruited participants between September 10, 2018, and March 12, 2019. The trial follow-up was completed March 17, 2020. This study followed the Consolidated Standards of Reporting Trials ( CONSORT ) reporting guideline.

Inclusion criteria were age between 18 and 65 years; pain between the buttock band and the rib arch, with or without lower limb pain; pain intensity (when the most painful) of 3 or higher on a numeric rating scale; and chronic low back pain lasting at least 3 months. Exclusion criteria comprised mental illness or cognitive impairment, specific lumbago, regular low back pain exercise intervention during the past 6 months, pregnancy or lactation, chlorine allergy, and water-related anxiety or inability to adapt to an aquatic environment.

A researcher who was separate from the intervention team selected 113 numbers from a certain position in the random number table and randomly divided them into the experimental and control groups. Then, the paper with numbers was placed into a sealed, opaque envelope. The envelopes were scrambled and numbered in turn. After inclusion, participants received the numbered envelopes consecutively and were divided into the corresponding groups according to the number on the paper within the envelope. Assessors were responsible for the measurements but unaware of the group assignments and remained distant from the intervention.

The intervention sessions were carried out by qualified physiotherapists (M.-S.P., Y.-Z.W., and C.-C.C.) who did not participate in data collection. Both programs lasted for 12 weeks and were administered for 60 minutes twice per week for a total of 24 treatment sessions. The participants were encouraged to complete the intervention as designed. The expected adherence rate was at least 75%. 25 Attendance frequency and adverse events during the sessions were recorded on a daily record form. Once a participant was observed to be absent from an intervention session, they were contacted immediately to determine the reason for their absence. Participants who withdrew halfway, failed to attend the evaluations, or missed more than 2 weeks were considered to have dropped out. 25

Participants in the therapeutic aquatic exercise group started the exercise with a 10-minute active warm-up session to enhance neuromuscular activation. Then, they performed an aquatic session for 40 minutes and had a 10-minute cool-down session. The target exercise intensity depended on the individual’s self-rated score of approximately 13, indicating 60% to 80% of their maximum heart rate on the Borg Scale Rating of Perceived Exertion, which is a measure sufficiently reliable for quantifying the training load for aquatic exercise. 26 The participants in the physical therapy modalities group received transcutaneous electrical nerve stimulation and infrared ray thermal therapy. Both modalities were focused on pain points, and each had a duration of 30 minutes. 27 - 30 Details of the interventions are presented in Supplement 1 .

Experienced physiotherapists carried out the measurements at baseline, after the 3-month intervention, at the 6-month follow-up, and at the 12-month follow-up from baseline. The primary outcome was the Roland-Morris Disability Questionnaire, which contains 24 items that are closely related to the daily life activities of patients with chronic low back pain. 31 With scoring of 1 (yes) and 0 (no), the final score varies from 0 to 24. Higher scores are associated with more severe disability. 32

One of the secondary outcomes, pain intensity, was measured with a numeric rating scale, which consisted of 11 numbers from 0 to 10: 0 (painless), 1 to 3 (mild pain), 4 to 6 (moderate pain), and 7 to 10 (strong and unbearable pain). The participants reported the pain intensity they experienced during the past week. 33

Other secondary outcomes included quality of life, anxiety, depression, sleep quality, kinesiophobia, fear avoidance, and minimal clinically important difference in pain and function. Considering that chronic low back pain may seriously affect the sleep quality of patients who have been experiencing pain for a long time and may lead to adverse psychological reactions, such as fear avoidance belief, we included the 36-item Short-form Health Survey, 34 Self-rating Anxiety Scale, 35 Zung Self-Rating Depression Scale, 36 Pittsburgh Sleep Quality Index, 37 Pain Anxiety Symptoms Scale, 38 Tampa Scale for Kinesiophobia, 39 , 40 Fear Avoidance Beliefs Questionnaire, 41 minimal clinically important difference in pain and function, 42 , 43 global perceived effect, 44 , 45 adverse events, and participants’ recommendation levels on the intervention that they received as the secondary outcomes. Details on the outcome measures are presented in Supplement 1 .

Sample size was calculated by G*Power, version 3.1.9 (Heinrich-Heine-Universität Düsseldorf) based on the following conditions. As in the Costantino and Romiti 46 trial, the participants in the intervention cohort received 3 months of therapeutic aquatic exercise, and those in the control group received the back school program. The effect size was calculated to be 0.35 by using the Roland-Morris Disability Questionnaire mean (SD) score of the intervention group (5.37 [1.82]) and the control group (6.11 [2.36]) during the 3-month follow-up. Results in the 2 groups were measured 4 times by using a mixed design of repeated-measures analysis of variance. Considering that α = .05, power (1-β) = 0.95, and correlation among repeated measures = 0.5, the total sample size was 70. Considering the possibility of a 20% missing rate, the minimum sample size was 88.

The data were collected and analyzed with Microsoft 2016 (Microsoft Corp) and SPSS, version 20.0 (IBM SPSS). In all analyses, statistical significance was accepted as P  < .05 (2-tailed). For baseline variables, the χ 2 test was used to test categorical variables (eg, sex and educational level), and the Mann-Whitney test was used to test continuous variables (eg, age and body mass index). The results are presented as number (percentage) or mean (SD).

The experimental results were compared through adjusted 2-way repeated-measures analysis of variance (group × time). The adjustment factors included sex, age, body mass index, physical activity, low back pain duration, numeric rating scale level of the most severe low back pain, medication, and smoking history. A χ 2 test was conducted to compare the proportion of each group’s participants who met the minimal clinically important difference for pain and function at postintervention. Although the use of the minimal clinically important difference for the Roland-Morris Disability Questionnaire and numeric rating scale remains controversial, values of 5.0 and 2.0 are considered reasonable and are commonly used. 43 The χ 2 test was also applied to determine the difference between the 2 groups for the proportion of participants reporting global perceived effect, adverse events, and treatment recommendations.

Considering that some participants might drop out midway, all of the data were analyzed by using intention-to-treat analysis (including all randomized participants) and per-protocol analysis (participants who completed the intervention). Intention-to-treat was regarded as the primary analysis. Participants who withdrew from the intervention were contacted immediately to investigate their reasons for dropping out and were encouraged to continue the measurements to minimize the loss of follow-up data. If the participants failed to follow-up or withdrew from the group, their last observation results were carried forward to fill in the missing data for intention-to-treat analysis.

Of the 191 potential participants who were screened, 113 met all inclusion criteria and were randomly allocated into the therapeutic aquatic exercise group (n = 56) or the physical therapy modalities group (n = 57); of these, 98 patients (86.7%) completed the 12-month follow-up ( Figure ). The overall mean (SD) age of the participants was 31.0 (11.5) years, 54 were men (47.8%), and 59 were women (52.2%) ( Table 1 ; eTable 1 in Supplement 2 ).

Compared with the participants in the physical therapy modalities group, those in the therapeutic aquatic exercise group showed improvement in disability by an additional −1.77 (95% CI, −3.02 to −0.51) points after the 3-month intervention, −2.42 (95% CI, −4.13 to −0.70) points at 6 months, and −3.61 (95% CI, −5.63 to −1.58) points at the 12-month follow-up ( P  < .001 for overall group × time interaction) ( Table 2 ). Functional improvement was not significantly affected by age, sex, body mass index, low back pain duration, educational level, or pain level.

The secondary outcomes are presented in Table 3 . Compared with the participants in the physical therapy modalities group, those in the therapeutic aquatic exercise group showed improvement in the most severe pain by an additional −0.79 (95% CI, −1.31 to −0.27) points after the 3-month intervention, −1.34 (95% CI, −2.06 to −0.62) points at 6 months, and −2.04 (95% CI, −2.75 to −1.34) points at the 12-month follow-up ( P  < .001 for overall group × time interaction). The slightest pain of the therapeutic aquatic exercise group improved by an additional −0.64 points after the 3-month intervention, −0.72 points at 6 months, and −1.17 at the 12-month follow-up ( P  = .005). All pain scores at each time point were significantly different between the 2 groups. The effect of the intervention on the most severe pain was significantly modified by the participants’ most severe pain level. Compared with the participants in the physical therapy modalities group, those in the therapeutic aquatic exercise group showed more improvements on the 36-item Short-form Health Survey (overall group × time interaction, P  = .003), Pittsburgh Sleep Quality Index (overall group × time interaction, P  = .02), Tampa Scale for Kinesiophobia (overall group × time interaction, P  < .001), and Fear-Avoidance Beliefs Questionnaire (physical activity subscale overall group × time interaction, P  = .04). These improvements were not influenced by age, sex, body mass index, low back pain duration, educational level, or pain level.

For minimal clinically important difference, the number of participants who had at least a 2-point improvement on the numeric rating scale for the most severe pain differed between the 2 groups at all time points (3 months: odds ratio [OR], 3.68 [95% CI, 1.64 to 8.26]; P  = .001; 6 months: OR, 2.29 [95% CI, 1.08 to 4.89], P  = .03; and 12 months: OR, 4.33 [95% CI, 1.90 to 9.88]; P  < .001). For average pain, the percentage of patients who met the minimal clinically important difference varied between the 2 groups at all time point (3 months: OR, 5.24 [95% CI, 1.93 to 14.25]; P  = .001; 6 months: OR, 3.68 [95% CI, 1.64 to 8.26], P  = .001; and 12 months: OR, 4.24 [95% CI, 1.93 to 9.33]; P  < .001). For current pain, the percentage of patients who met the minimal clinically important difference varied between the 2 groups at the 12-month follow-up (OR, 3.04 [95% CI, 1.28 to 7.25]; P  = .01). Moreover, the number of patients who met the minimal clinically important difference threshold for the disability significantly differed between the 2 groups at all time points (3 months: OR, 2.53 [95% CI, 1.17 to 5.47]; P  = .02; 6 months: OR, 3.89 [95%CI, 1.68 to 9.03]; P  = .001; and 12 months: OR, 11.48 [95% CI, 3.66 to 36.05]; P  < .001) (eTable 2 in Supplement 2 ).

Two of 56 participants (3.6%) in the therapeutic aquatic exercise group vs 4 of the 57 participants (7.0%) in the physical therapy modalities group experienced low back pain and other pains related to the intervention. Several patients also experienced pain that was unrelated to the intervention. Characteristics of participants who reported adverse events were not different between the 2 groups. A total of 41 participants (73.2%) in the therapeutic aquatic exercise group and 37 participants (64.9%) in the physical therapy modalities group reported improvements in their low back pain symptoms after the 3-month intervention. Global perceived effect in the therapeutic aquatic exercise group was significantly better than that in the physical therapy modalities group (χ 2  = 11.7; P  = .03). Among the participants, 52 (92.9%) were willing to recommend therapeutic aquatic exercise to other patients with low back pain, whereas 44 (77.2%) were willing to recommend physical therapy modalities. The recommendation rates for the 2 treatments differed significantly (χ 2  = 9.5, P  = .01). ( Table 4 ).

The results of per-protocol analysis are included in eTable 3 and eTable 4 in Supplement 2 . An intention-to-treat analysis using the worst case of the participants’ group was performed to minimize the bias of follow-up; the results are presented in eTable 5 in Supplement 2 .

The intention-to-treat analyses of the3-month intervention trial and 12-month follow-up of therapeutic aquatic exercise vs physical therapy modalities for chronic low back pain showed that the participants in the therapeutic aquatic exercise group gained significantly greater and more clinically meaningful improvement in disability compared with improvement in the physical therapy modalities group. We also found that therapeutic aquatic exercise was a more effective treatment than physical therapy modalities on pain intensity, quality of life, sleep quality, kinesiophobia, and fear avoidance for patients with chronic low back pain.

Shi et al 23 published a meta-analysis that included 8 randomized clinical trials of therapeutic aquatic exercise for chronic low back pain. The duration of the therapeutic aquatic exercise intervention was 4 to 15 weeks. The intervention was administered 2 to 5 times a week, each for 30 to 80 minutes. The results suggested that therapeutic aquatic exercise could significantly reduce the pain intensity of patients with chronic low back pain and improve their functional level. Consistent with these results, our findings showed that the improvement in pain and dysfunction in the therapeutic aquatic exercise group was not only statistically significant but was also clinically significant. Baena-Beato et al 47 and Bronwyn 48 divided patients with chronic low back pain into the therapeutic aquatic exercise group and the waiting group and found that therapeutic aquatic exercise could significantly improve pain degree, dysfunction level, and quality of life. In addition, therapeutic aquatic exercise had a good effect on the anxiety level of patients with chronic low back pain. Sugano and Nomura 49 reported that therapeutic aquatic exercise lowered the anxiety level in patients with chronic low back pain and, in a study by Bayraktar et al, 50 most patients had high adherence to therapeutic aquatic exercise and were willing to recommend this treatment to others.

To our knowledge, the efficacy of therapeutic aquatic exercise in the treatment of patients with chronic low back pain has never been compared with that used in our control group of physical therapy modalities. Some researchers who chose to carry out similar exercises in water and on land discovered that the efficiency of therapeutic aquatic exercise and degree of pain relief associated with therapeutic aquatic exercise were better than those of land exercise. 19 , 51 , 52 Even after a single intervention, the frequency of pain in the therapeutic aquatic exercise group was reduced to half of that in the land exercise group. Participants in the therapeutic aquatic exercise group also experienced greater improvement in quality of life and dysfunction than those in the land exercise group. Other researchers provided treatment, such as conventional physical therapy (low back pain pamphlet and lumbar exercise), multimodal physical therapy, or low back pain school, as an intervention in the control group. 46 , 53 , 54 The dysfunction and quality of life of patients with chronic low back pain significantly improved after the therapeutic aquatic exercise intervention was added to the treatments.

Our study had several strengths. To our knowledge, this was the first study to compare the efficacy of therapeutic aquatic exercise and physical therapy modalities in the treatment of chronic low back pain. The control treatment consisted of transcutaneous electrical nerve stimulation and infrared ray thermal therapy, which are widely used in clinical practice and are proven to exert good curative effects in patients with chronic low back pain. Second, self-reported information related to chronic low back pain was recorded in detail, and basic information, such as age, sex, low back pain duration, and pain level, which might affect the results, were selected as covariates in statistical analysis. Third, considering that differences between adherent and nonadherent participants might influence the results, intention-to-treat analysis and per-protocol analysis were performed. Both analyses supported the fact that therapeutic aquatic exercise was better than physical therapy modalities in some measured aspects. Fourth, this work had a long follow-up period and a large experimental sample, which ensured adequate statistical power for detecting the minimal clinical and long-term effects.

This study also had several limitations. First, although the age range was limited to 18 to 65 years, most of the participants were younger. Therefore, a stratified age design should be considered for future studies. Second, the self-reported pain level was low. Thus, the research results may not be generalizable to the whole population of people with chronic low back pain. The benefits and safety of therapeutic aquatic exercise for people with high levels of low back pain warrant study. Thus, individuals with different pain levels should be considered in future research. Third, given that the therapeutic aquatic exercise group received aquatic exercise and the physical therapy modalities group did not receive exercise, whether the effect of therapeutic aquatic exercise originated from the benefits of the water environment or from the benefits of active exercise was unclear. Future studies designed to include a group that receives land exercise to reflect the benefits of therapeutic aquatic exercise on chronic low back pain are needed. Fourth, combining therapeutic aquatic exercise and physical therapy modalities might be a better rehabilitation program for patients with chronic low back pain—this is widely used in some rehabilitation centers. Further studies could design a 3-group comparison. Fifth, blinding of participants and interventionists was impossible. Sixth, whether the medical costs and productivity losses of the 2 treatment options differed was unclear; socioeconomic indicators can be included for analysis in future works.

In this randomized clinical trial, patients with chronic low back pain who received therapeutic aquatic exercise showed greater improvement in terms of function, pain, quality of life, sleep quality, and mental state than those who underwent physical therapy modalities. Therapeutic aquatic exercise is a safe treatment for chronic low back pain and most participants who received it were willing to recommend it to other patients with chronic low back pain.

Accepted for Publication: November 7, 2021.

Published: January 7, 2022. doi:10.1001/jamanetworkopen.2021.42069

Correction: This article was corrected on March 29, 2024, to fix errors across main article, Supplement 1, and Supplement 2.

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2022 Peng MS et al. JAMA Network Open .

Corresponding Authors: Pei-Jie Chen, PhD ( [email protected] ) and Xue-Qiang Wang, PhD ( [email protected] ), Department of Sport Rehabilitation, Shanghai University of Sport, 399 Changhai Rd, Shanghai, 200438, China.

Author Contributions: Dr X.-Q. Wang and Ms Peng had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Peng, C. Chen, Song, P.-J. Chen, X.-Q. Wang.

Acquisition, analysis, or interpretation of data: R. Wang, Y.-Z. Wang, J. Wang, Liu, Guo, P.-J. Chen.

Drafting of the manuscript: Peng, Song.

Critical revision of the manuscript for important intellectual content: Peng, R. Wang, Y.-Z. Wang, C.-C. Chen, J. Wang, Liu, Guo, P.-J. Chen, X.-Q. Wang.

Statistical analysis: J. Wang.

Administrative, technical, or material support: C. Chen, Guo, P.-J. Chen.

Supervision: Peng, R. Wang, Y.-Z. Wang, Liu.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was supported by grants 81871844 from the National Natural Science Foundation of China, 161092 from the Fok Ying-Tong Education Foundation of China, 19080503100 from the Science and Technology Commission of Shanghai Municipality, and 11DZ2261100 from the Shanghai Key Lab of Human Performance (Shanghai University of Sport), as well as by the Shanghai Frontiers Science Research Base of Exercise and Metabolic Health.

Role of the Funder/Sponsor: The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Data Sharing Statement: See Supplement 3 .

Additional Contributions: We thank all of the patients for participation in this study; Yi-Li Zheng, MSc, Hao-Yu Hu, MSc, Jing-Zhao Yang, MSc, Bao Wu, MSc, Qing Cao, MSc, Tian-Tian Chang, MSc, Xuan Su, MSc, and Yan-Qiao Zhao, MSc (Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China), assisted with completion of the study. No financial compensation outside of salary was provided.

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67 Best Physical Therapy schools in Russia

Updated: February 29, 2024

• Art & Design
• Computer Science
• Engineering
• Environmental Science
• Liberal Arts & Social Sciences
• Mathematics

Below is a list of best universities in Russia ranked based on their research performance in Physical Therapy. A graph of 64.8K citations received by 15.4K academic papers made by 67 universities in Russia was used to calculate publications' ratings, which then were adjusted for release dates and added to final scores.

We don't distinguish between undergraduate and graduate programs nor do we adjust for current majors offered. You can find information about granted degrees on a university page but always double-check with the university website.

1. Moscow Medical Academy

For Physical Therapy

2. Moscow State University

3. Russian National Research Medical University

4. St. Petersburg State University

5. Kazan State Medical University

6. Tomsk State University

7. RUDN University

8. Kazan Federal University

9. National Research University Higher School of Economics

10. Pavlov First Saint Petersburg State Medical University

11. Peter the Great St.Petersburg Polytechnic University

12. Tomsk Polytechnic University

13. Ural Federal University

14. Saint Petersburg State Pediatric Medical Academy

15. South-Western State University

16. Belgorod State University

17. South Ural State University

18. Privolzhsky Research Medical University

19. Lobachevsky State University of Nizhni Novgorod

20. Volgograd State Medical Academy

21. Kemerovo State University

22. Kuban State Medical University

23. petrozavodsk state university.

24. Rostov State Medical University

25. Novosibirsk State University

26. ITMO University

27. Southern Federal University

28. Siberian State Medical University

29. Siberian Federal University

30. Far Eastern Federal University

31. Moscow Institute of Physics and Technology

32. Immanuel Kant Baltic Federal University

33. Bauman Moscow State Technical University

34. Moscow State Pedagogical University

35. Yaroslavl State Medical University

36. altai state medical university.

37. Russian Presidential Academy of National Economy and Public Administration

38. Voronezh State University

39. National University of Science and Technology "MISIS"

40. National Research Nuclear University MEPI

41. Tula State University

42. Russian State University of Oil and Gas

43. n.r.u. moscow power engineering institute.

44. Voronezh State Medical Academy

45. Tambov State University

46. Saint Petersburg State Electrotechnical University

47. Omsk State Medical Academy

48. Chelyabinsk State Medical Academy

49. novosibirsk state medical university, 50. ulyanovsk state university.

51. Saratov State University

52. Finance Academy under the Government of the Russian Federation

53. Plekhanov Russian University of Economics

54. Moscow Aviation Institute

55. Perm State Technical University

56. Chuvash State University

57. northern arctic federal university.

58. Samara National Research University

59. University of Tyumen

60. Pacific State Medical University

61. Russian State Social University

62. North-Eastern Federal University

63. Novosibirsk State Technical University

64. Ogarev Mordovia State University

65. Kursk State Medical University

66. Moscow State Institute of International Relations

67. Moscow Polytech

The best cities to study Physical Therapy in Russia based on the number of universities and their ranks are Moscow , Saint Petersburg , Kazan , and Tomsk .

Medicine subfields in Russia

Duke Orthopaedics Research Team to Receive the 2025 Charles S. Neer Award

Congratulations to Chad E. Cook, PT, PhD, MBA, FAPTA, professor of Orthopaedic Surgery; director of Clinical Facilitation Research; director, Duke Center of Excellence in Manual and Manipulative Therapy, June Kennedy, MS, PT , a board-certified specialist in orthopaedic physical therapy, Duke Sports Medicine, and Emily  Reinke, PhD , Senior Research Program Leader, Duke Sports Medicine  and other contributors for receiving the 2025 Charles S. Neer Award from the American Shoulder and Elbow Surgeons (ASES) Foundation in the clinical science.

The Neer Award, a prestigious recognition established in honor of Dr. Charles S. Neer, one of the founding members and the first president of ASES, holds significant value in orthopaedics. It acknowledges outstanding clinical and basic science investigations contributing to understanding, caring for, or preventing shoulder injuries. 

The two studies, the SHORT and PMADS Trials, have significantly advanced our understanding of Shoulder rehabilitation. They explored outcomes associated with home exercise-based and physical therapist-based approaches, showing no differences in two-year outcomes across 196 randomized individuals with reverse total shoulder arthroplasty. The study also looked at treatment-effect moderators, providing valuable insights for tailoring care to selected groups and ultimately improving patient outcomes.   

The study was funded by an Orthopaedic Research and Education Foundation (OREF) grant Grant E. Garrigues, MD , associate professor and director of Upper Extremity Research, Rush University, received in 2018 while at Duke Orthopaedics. This award will be presented during the October ASES Annual Meeting in San Antonio, TX.

AgBioResearch

New msu research shows gardening improves mental, social well-being.

Cameron Rudolph <[email protected]> - August 26, 2024

Researchers observed that participating in community gardening boosts mental and social well-being through caring for plants, connecting to nature and feeling a sense of accomplishment.

EAST LANSING, Mich. — Newly published research from Michigan State University demonstrates that participating in community gardening bolsters mental and social well-being through caring for plants, connecting to nature and feeling a sense of accomplishment.

Findings were published in the journal People and Nature .

The project was led by Katherine Alaimo , a nutritional epidemiologist and associate professor in the Department of Food Science and Human Nutrition . Alaimo, whose work is also supported by MSU AgBioResearch , is an expert in community-based participatory research on topics such as food justice, community food security, urban agriculture and gardening, and school nutrition and health.

Alongside Alaimo were colleagues from MSU, Wayne State University and the University of South Carolina. To conduct the study, they partnered with Denver Urban Gardens in Denver, Colorado, one of the largest independent networks of food-producing community gardens in the U.S.

In recent years, a multitude of research has shown mounting support for gardening and other nature-based activities as viable tools to boost mental and physical health. From finding purpose and joy to feelings of accomplishment, Alaimo said there are several benefits.

Her previous research uncovered that gardening increases consumption of vegetables and fiber, encourages physical activity, and lowers perceived stress and anxiety. Community gardening builds social support networks and improves physical functioning.

“Community gardening offers many positive things to participants such as encouraging healthier behaviors, improving mental and physical health, and increasing access to green spaces,” said Linda Appel Lipsius, executive director of Denver Urban Gardens. “Our study aimed to identify key aspects of gardening that are meaningful to people, help them stay involved in gardening, and contribute to their mental and social well-being.”

Alaimo said that as many chronic, noncommunicable diseases continue to rise in prevalence, the healthcare system is becoming increasingly taxed. Researchers aimed to highlight nature-based interventions that positively affect some of the leading causes of these diseases and discover ways to make the interventions accessible to a variety of groups.

“One of the most important aspects of implementing these interventions and ensuring the equity of their impact is engaging diverse populations,” Alaimo said. “This includes low-income families and immigrant communities who may not have easy access to land and other resources. It’s also important to identify how their participation can be sustained over time.”

For this project, researchers conducted qualitative interviews with 34 individuals who were new to community gardening. The participants took part in community gardening for one season.

The team explored each participant’s initial motivation to begin gardening and their previous gardening experiences. Alaimo and her team then examined the meaning of gardening to participants, how social support influenced gardening engagement, and how individuals overcame gardening challenges over the course of the season.

The researchers found there was significant fulfillment for participants in growing food and being active in their gardens. The team coined the term “the gardening triad,” which refers to three additional key elements of the gardening experience that kept participants active and had mental and social benefits:

• The responsibility and act of caring for their gardens, and forming a nurturing and loving relationship with their plants.
• Feelings of pride and a sense that they were accomplishing something important.
• Feeling connected to nature, which included appreciation, fascination and wonder.

“We were surprised to find that the gardening triad was nearly universal among the participants and that love was integrated throughout the gardening experience — love and connection with plants, self and nature,” Alaimo said.

Several of the new gardeners reported that they formed new emotional bonds with fellow participants, and their existing social relationships improved as well.

“We saw that many individuals found joy, purpose and meaning in their work, and their confidence and self-esteem was boosted, which helped them deal with mental health challenges such as depression, anxiety and stress,” said Eva Coringrato, an author on the study who was previously at Wayne State University during the research.

Alaimo believes the results show that gardening should be considered as a viable intervention on a larger scale.

“The act of gardening itself holds many benefits, but when participants gardened with others, whether that was fellow community gardeners or family or friends, those benefits were enhanced even further,” Alaimo said. “Understanding how and why gardening improves health and well-being is important, particularly when designing nature-based health programs. Based on our findings, we believe that gardening should absolutely be explored as an avenue for improving well-being and should be widely supported.”

Michigan State University AgBioResearch scientists discover dynamic solutions for food systems and the environment. More than 300 MSU faculty conduct leading-edge research on a variety of topics, from health and climate to agriculture and natural resources. Originally formed in 1888 as the Michigan Agricultural Experiment Station, MSU AgBioResearch oversees numerous on-campus research facilities, as well as 15 outlying centers throughout Michigan. To learn more, visit  agbioresearch.msu.edu .

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Finding a Therapist Who Can Help You Heal

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Treating anxiety disorders with therapy

Cognitive behavioral therapy (cbt) for anxiety, thought challenging in cbt for anxiety, exposure therapy for anxiety, complementary therapies for anxiety disorders, making anxiety therapy work for you, therapy for anxiety disorders.

Want to control your anxiety, stop worrisome thoughts, and conquer your fears? Here’s how therapy can help.

Whether you’re suffering from panic attacks , obsessive or intrusive thoughts , unrelenting worries , or an incapacitating phobia , it’s important to know that you don’t have to live with anxiety and fear. Treatment can help, and for many anxiety problems, therapy is often the most effective option. That’s because anxiety therapy—unlike anxiety medication —treats more than just the symptoms of the problem. Therapy can help you uncover the underlying causes of your worries and fears; learn how to relax; look at situations in new, less frightening ways; and develop better coping and problem-solving skills. Therapy gives you the tools to overcome anxiety and teaches you how to use them.

Anxiety disorders differ considerably, so therapy should be tailored to your specific symptoms and diagnosis. If you have obsessive-compulsive disorder (OCD) , for example, your treatment will be different from someone who needs help for generalized anxiety disorder (GAD) , social anxiety disorder (SAD) , or anxiety attacks . The length of therapy will also depend on the type and severity of your anxiety disorder. However, many anxiety therapies are relatively short-term. According to the American Psychological Association, many people improve significantly within 8 to 10 therapy sessions.

While many different types of therapy are used to treat anxiety, the leading approaches are cognitive behavioral therapy (CBT) and exposure therapy. Each anxiety therapy may be used alone, or combined with other types of therapy. Anxiety therapy may be conducted individually, or it may take place in a group of people with similar anxiety problems. But the goal is the same: to lower your anxiety levels, calm your mind, and overcome your fears.

Online vs. in-person therapy

Accessing help online can help you avoid the expense and inconvenience of having to meet in-person and being in a familiar, comfortable environment can make it easier to talk openly about your issues. For many people with anxiety, online therapy can be just as effective as traditional, in-person therapy. Some online therapy platforms even accept insurance .

However, not all online therapy is the same. Communicating via a messaging app, phone, or email, for example, is no substitute for live face-to-face interaction using video chat.

Facial expressions, mannerisms, and body language are important tools in therapy. They allow your therapist pick up on any inconsistencies between your verbal and nonverbal responses, recognize things that you’re unable to put into words, and understand the true meaning behind what you’re saying. From your point of view, interacting face-to-face is crucial to building a strong connection with a therapist that so often determines the success of therapy.

Speak to a Licensed Therapist

BetterHelp is an online therapy service that matches you to licensed, accredited therapists who can help with depression, anxiety, relationships, and more. Take the assessment and get matched with a therapist in as little as 48 hours.

Cognitive behavioral therapy (CBT) is the most widely-used therapy for anxiety disorders. Research has shown it to be effective in the treatment of panic disorder, phobias, social anxiety disorder, and generalized anxiety disorder, among many other conditions.

CBT addresses negative patterns and distortions in the way we look at the world and ourselves. As the name suggests, this involves two main components:

• Cognitive therapy examines how negative thoughts, or cognitions , contribute to anxiety.
• Behavior therapy examines how you behave and react in situations that trigger anxiety.

The basic premise of CBT is that our thoughts—not external events—affect the way we feel. In other words, it’s not the situation you’re in that determines how you feel, but your perception of the situation.

For example, imagine that you’ve just been invited to a big party. Consider three different ways of thinking about the invitation, and how those thoughts would affect your emotions.

Situation: A friend invites you to a big party

Thought #1: The party sounds like a lot of fun. I love going out and meeting new people!

Emotions: Happy, excited.

Thought #2:  Parties aren’t my thing. I’d much rather stay in and watch a movie.

Emotions: Neutral.

Thought #3: I never know what to say or do at parties. I’ll make a fool of myself if I go.

Emotions:  Anxious, sad.

As you can see, the same event can lead to completely different emotions in different people. It all depends on our individual expectations, attitudes, and beliefs.

[Read: Anxiety Disorders and Anxiety Attacks]

For people with anxiety disorders, negative ways of thinking fuel the negative emotions of anxiety and fear. The goal of cognitive behavioral therapy for anxiety is to identify and correct these negative thoughts and beliefs. The idea is that if you change the way you think, you can change the way you feel.

Thought challenging—also known as cognitive restructuring—is a process in which you challenge the negative thinking patterns and cognitive distortions that contribute to your anxiety, replacing them with more positive, realistic thoughts. This involves three steps:

• Identifying your negative thoughts. With anxiety disorders, situations are perceived as more dangerous than they really are. To someone with a germ phobia, for example, shaking another person’s hand can seem life threatening. Although you may easily see that this is an irrational fear, identifying your own irrational, scary thoughts can be very difficult. One strategy is to ask yourself what you were thinking when you started feeling anxious. Your therapist will help you with this step.
• Challenging your negative thoughts. In the second step, your therapist will teach you how to evaluate your anxiety-provoking thoughts. This involves questioning the evidence for your frightening thoughts, analyzing unhelpful beliefs, and testing out the reality of negative predictions. Strategies for challenging negative thoughts include conducting experiments, weighing the pros and cons of worrying or avoiding the thing you fear, and determining the realistic chances that what you’re anxious about will actually happen.
• Replacing negative thoughts with realistic thoughts. Once you’ve identified the irrational predictions and negative distortions in your anxious thoughts, you can replace them with new thoughts that are more accurate and positive. Your therapist may also help you come up with realistic, calming statements you can say to yourself when you’re facing or anticipating a situation that normally sends your anxiety levels soaring.

How thought challenging works

To understand how thought challenging works in cognitive behavioral therapy, consider the following example: Maria won’t take the subway because she’s afraid she’ll pass out, and then everyone will think she’s crazy. Her therapist has asked her to write down her negative thoughts, identify the errors—or cognitive distortions—in her thinking, and come up with a more rational interpretation. The results are below.

Challenging Negative Thoughts
Negative thought #1: What if I pass out on the subway?
Predicting the worst. I’ve never passed out before, so it’s unlikely that I will pass out on the subway.
Negative thought #2: If I pass out, it will be terrible!
Blowing things out of proportion. If I faint, I’ll come to in a few moments. That’s not so terrible.
Negative thought #3: People will think I’m crazy.
Jumping to conclusions. People are more likely to be concerned if I’m okay.

Replacing negative thoughts with more realistic ones is easier said than done. Often, negative thoughts are part of a lifelong pattern of thinking. It takes practice to break the habit. That’s why cognitive behavioral therapy includes practicing on your own at home as well.

CBT may also include:

• Learning to recognize when you’re anxious and what that feels like in the body.
• Learning coping skills and relaxation techniques to counteract anxiety and panic.
• Confronting your fears (either in your imagination or in real life).

Anxiety isn’t a pleasant sensation, so it’s only natural to avoid it if you can. One of the ways that people do this is by steering clear of the situations that make them anxious. If you have a fear of heights, you might drive three hours out of your way to avoid crossing a tall bridge. Or if the prospect of public speaking leaves your stomach in knots, you might skip your best friend’s wedding in order to avoid giving a toast. Aside from the inconvenience factor, the problem with avoiding your fears is that you never have the chance to overcome them. In fact, avoiding your fears often makes them stronger.

[Read: Phobias and Irrational Fears ]

Exposure therapy , as the name suggests, exposes you to the situations or objects you fear. The idea is that through repeated exposures, you’ll feel an increasing sense of control over the situation and your anxiety will diminish. The exposure is done in one of two ways: Your therapist may ask you to imagine the scary situation, or you may confront it in real life. Exposure therapy may be used alone, or it may be conducted as part of cognitive behavioral therapy.

Systematic desensitization

Rather than facing your biggest fear right away, which can be traumatizing, exposure therapy usually starts with a situation that’s only mildly threatening and works up from there. This step-by-step approach is called systematic desensitization . Systematic desensitization allows you to gradually challenge your fears, build confidence, and master skills for controlling panic.

Systematic desensitization involves three parts:

• Learning relaxation skills. First, your therapist will teach you a relaxation technique, such as progressive muscle relaxation or deep breathing. You’ll practice in therapy and on your own at home. Once you start confronting your fears, you’ll use this relaxation technique to reduce your physical anxiety response (such as trembling and hyperventilating) and encourage relaxation.
• Creating a step-by-step list. Next, you’ll create a list of 10 to 20 scary situations that progress toward your final goal. For example, if your final goal is to overcome your fear of flying, you might start by looking at photos of planes and end with taking an actual flight. Each step should be as specific as possible, with a clear, measurable objective.
• Working through the steps. Under the guidance of your therapist, you’ll then begin to work through the list. The goal is to stay in each scary situation until your fears subside. That way, you’ll learn that the feelings won’t hurt you and they do go away. Every time the anxiety gets too intense, you will switch to the relaxation technique you learned. Once you’re relaxed again, you can turn your attention back to the situation. In this way, you will work through the steps until you’re able to complete each one without feeling overly distressed.

Facing a fear of flying

Step 1: Look at photos of planes.

Step 2: Watch a video of a plane in flight.

Step 3: Watch real planes take off.

Step 4: Book a plane ticket.

Step 5: Pack for your flight.

Step 6: Drive to the airport.

Step 7: Check in for your flight.

Step 8: Wait for boarding.

Step 9: Get on the plane.

Step 10: Take the flight.

As you explore your anxiety disorder in therapy, you may also want to experiment with complementary therapies designed to bring your overall stress levels down and help you achieve emotional balance.

Exercise is a natural stress and anxiety reliever . Research shows that as little as 30 minutes of exercise three to five times a week can provide significant anxiety relief. To achieve the maximum benefit, aim for at least an hour of aerobic exercise on most days.

Relaxation techniques such as mindfulness meditation and progressive muscle relaxation , when practiced regularly, can reduce anxiety and increase feelings of emotional well-being.

[Read: Relaxation Techniques for Stress Relief]

Biofeedback uses sensors that measure specific physiological functions—such as heart rate, breathing, and muscle tension—to teach you to recognize your body’s anxiety response and learn how to control it using relaxation techniques.

Hypnosis is sometimes used in combination with CBT for anxiety. While you’re in a state of deep relaxation, the hypnotherapist uses different therapeutic techniques to help you face your fears and look at them in new ways.

There is no quick fix for anxiety. Overcoming an anxiety disorder takes time and commitment. Therapy involves facing your fears rather than avoiding them, so sometimes you’ll feel worse before you get better. The important thing is to stick with treatment and follow your therapist’s advice. If you’re feeling discouraged with the pace of recovery, remember that therapy for anxiety is very effective in the long run. You’ll reap the benefits if you see it through.

[Read: Finding a Therapist Who Can Help You Heal]

You can also support your own anxiety therapy by making positive choices. Everything from your activity level to your social life affects anxiety. Set the stage for success by making a conscious decision to promote relaxation, vitality, and a positive mental outlook in your everyday life.

Learn about anxiety. In order to overcome anxiety, it’s important to understand the problem. That’s where education comes in. Education alone won’t cure an anxiety disorder, but it will help you get the most out of therapy.

Cultivate your connections with other people. Loneliness and isolation set the stage for anxiety. Decrease your vulnerability by reaching out to others. Make it a point to see friends, join a self-help or support group, or share your worries and concerns with a trusted loved one.

Adopt healthy lifestyle habits. Physical activity relieves tension and anxiety, so make time for regular exercise. Don’t use alcohol and drugs to cope with your symptoms, and try to avoid stimulants such as caffeine and nicotine, which can make anxiety worse.

Reduce stress in your life . Examine your life for stress, and look for ways to minimize it. Avoid people who make you anxious, say no to extra responsibilities, and make time for fun and relaxation in your daily schedule.

For help finding an anxiety disorder therapist

Use the Find a Therapist Directory . (Anxiety Disorders Association of America)

Find Psychological therapies services . (NHS)

Find a Psychologist . (Anxiety Treatment Australia)

Search Anxiety/Panic . (Therapist Directory)

More Information

• Exercises - Treatment options for anxiety, including exercise and breathing techniques. (Better Health Channel)
• Worksheet - Worksheet to help you cope. (Centre for Clinical Interventions)
• RCP - Including its use as a therapy for anxiety. (Royal College of Psychiatrists)
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• Kandola, A., Vancampfort, D., Herring, M., Rebar, A., Hallgren, M., Firth, J., & Stubbs, B. (2018). Moving to Beat Anxiety: Epidemiology and Therapeutic Issues with Physical Activity for Anxiety. Current Psychiatry Reports, 20(8), 63. Link
• Anxiety Disorders. (2013). In Diagnostic and Statistical Manual of Mental Disorders . American Psychiatric Association. Link

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A message from the chancellor: Remembering Dr. Zijie Yan

In a campus email, Lee H. Roberts shared mental health resources and detailed Carolina’s plans to honor the memory of Dr. Yan as the one-year anniversary of the campus shooting approaches.

Dear Carolina Community,

This Wednesday, Aug. 28, marks one year since the tragic loss of Dr. Zijie Yan, who was killed in a shooting on our campus.

Dr. Yan was an associate professor in the Department of Applied Physical Sciences in the College of Arts and Sciences and had been a member of our faculty since 2019. He was a respected colleague, mentor and friend to many on our campus.

On Wednesday, the Bell Tower will chime with Hark the Sound at 1:15 p.m. in honor of Dr. Yan’s memory. Recognizing Dr. Yan’s legacy is an important way that we can come together as a community to acknowledge the loss we feel and to support one another.

We know that the anniversary of this event may be difficult for many, so I’d like to remind you of the resources that we have available.

For students, counseling sessions are available through Counseling and Psychological Services . For students who may need mental health services outside of business hours, please call the 24/7 Counseling and Psychological Services (CAPS) line: 919-966-3658.

For faculty and staff, the Employee Assistance Program (EAP) support is available online at guidanceresources.com . Log on with a username and password or register with Web ID: TARHEELS. You may also call 877-314-5841 to make an appointment with a counselor. Support is free and confidential.

While I was not yet at Carolina when this event occurred, I have spoken with many about the direct impact this experience had on students, faculty, staff, parents and our local community. I’ve been grateful to learn about the ways our community came together during such a difficult and scary time.

Safety on campus is always the top priority, and we have learned a lot in the last year about improving our safety procedures . I appreciate the quick and focused action of Emergency Management and Planning and UNC Police to better our practices, and we will continue to find ways to make our security measures even more effective.

Moving forward after this kind of tragedy is not linear. Grief and sadness may surprise us, but I know this campus is full of support and kindness. This is our home, and — especially in tough times — we must continue to strengthen our Tar Heel family together.

Lee H. Roberts Chancellor

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Five research teams receive Creativity Hubs grants

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