BACKGROUND: People with knee osteoarthritis (KOA) often have pain at the contralateral knees in addition to the symptomatic knee. Transcutaneous electrical nerve stimulation (TENS) has been shown to relieve movement-evoked pain (MEP) with frequency-specific effects. Although the application of TENS to the lower back (TENS-LB) potentially produces analgesia at multiple sites based on the mechanisms of TENS, its effects on knee pain have not been well established. OBJECTIVE: We first evaluated the effects of TENS-LB on MEP at the symptomatic knee, with a focus on the optimal frequency. METHODS: We randomly allocated 192 people with KOA to three groups: high-frequency TENS (HF-TENS), modulated-frequency TENS (MF-TENS), placebo TENS (P-TENS). All TENS were administered to the lower back. A test of MEP during land-based activities was conducted at baseline and during the TENS administrations. RESULTS: A final total of 57 people with KOA thus completed this study. Compared to P-TENS, both HF-TENS and MF-TENS significantly relieved MEP of both the symptomatic knee and bilateral knees. CONCLUSIONS: TENS-LB may be beneficial for clinical treatment of people with KOA. Future studies are warranted to elucidate whether TENS-LB produces widespread analgesia and enhances activity levels.

Pain perception is not solely determined by peripheral input but is influenced by multiple factors, and it is known to fluctuate across trials. Such intra-individual variability in pain perception has been reported to be associated with pain sensitivity and cognitive factors. Recent studies have suggested that activity in the left dorsolateral prefrontal cortex (L-DLPFC), a region involved in attentional control, is related to this variability; however, causal evidence remains limited. The present study aimed to investigate whether modulating cortical excitability in the left dorsolateral prefrontal cortex (L-DLPFC) using transcranial direct current stimulation (tDCS) affects variability in pain perception. 42 healthy adults were randomly assigned to anodal, cathodal, or sham stimulation groups. Thermal stimulation was delivered at an individually calibrated intensity corresponding to a visual analogue scale rating of 30. Variability in pain perception was assessed before and during the tDCS intervention. Results showed no significant differences in variability between the three groups. However, in the anodal stimulation group, a negative correlation was observed between baseline variability and the degree of change in the variability during tDCS. These findings indicate that while overall group effects of tDCS on pain variability were not detected, individual differences may play a crucial role in determining responsiveness to the tDCS.

Background: The understanding of research trends in the field of physical therapy in Japan has traditionally relied on the empirical knowledge of experts rather than on objective data. This study aimed to quantitatively and visually clarify these trends and their chronological changes using text mining. Methods: We analyzed the titles of 635 presentations from the academic conferences of the Japanese Physical Therapy Association over the past decade (2015–2024). Using KH Coder software, we performed co-occurrence network analysis to identify thematic clusters and correspondence analysis to examine time-series trends. Results: The co-occurrence network analysis successfully identified nine major research theme clusters, revealing the knowledge structure of the field. Furthermore, the correspondence analysis visualized a clear chronological shift in research focus. The trend transitioned from basic and mechanistic research centered on terms such as “analgesic effect” and “pulse”, to clinical applications for functional improvement using “functional electrical stimulation (FES)” for post-stroke patients. More recently, the focus has shifted toward applying new modalities, such as “extracorporeal shock wave therapy,” to specific clinical challenges like “spasticity”. Conclusion: This study provides an objective, data-driven visualization of the evolution of research in the Japanese physical therapy field. By mapping the research landscape, these findings offer a valuable resource for understanding the field’s trajectory and identifying future research directions.

Objective: Reports are scarce regarding the indications for vibration stimulation therapy that targets the reflexive and non-reflexive components of post-stroke spasticity. In this study, we investigated the inter-rater reliability of the range of motion (ROM) measurements obtained using the modified tardieu scale (MTS) and the immediate changes induced by vibration stimulation therapy. Methods: Ten patients with chronic-phase stroke participated in this study. The inter-rater reliability of the MTS ROM was examined by two physical therapists. The MTS involves stretching muscles at specified velocities (V1: as slowly as possible, V3: as quickly as possible), with the respective ROM at which resistance is first encountered defined as R2 and R1. Vibration stimulation therapy was performed on the biceps brachii and gastrocnemius muscles, and immediate changes were assessed using the MTS. Results: Inter-rater reliability for elbow flexors was higher than reported in previous studies, but it was lower for plantar flexors in some cases. Immediate changes after vibration stimulation therapy showed significant improvement in R1 for plantar flexors (at knee extension) and elbow flexors, and in R2 for plantar flexors (with the knee at 90° flexion). Conclusion: The inter-rater reliability of the MTS differs depending on the measurement site, indicating a need for further improvement in accuracy. The results suggest that vibration stimulation immediately improves spasticity, potentially through reflexive elements in the gastrocnemius and biceps brachii muscles, and non-reflexive elements in the soleus muscle.

Objective: This study aimed to evaluate the consistency between clinical evidence supporting heat therapy for acute low back pain and its positioning within the judo therapist reimbursement system in Japan. Methods: A literature-based policy evaluation study was conducted using publications retrieved from PubMed, the Cochrane Library, and CiNii. Randomized controlled trials, systematic reviews, and clinical practice guidelines addressing heat therapy for acute low back pain were included. The extracted studies were analyzed using an original policy evaluation framework consisting of three dimensions: (1) level of clinical evidence, (2) recommended timing of clinical application, and (3) reimbursement conditions within the judo therapist system. Results: Previous studies consistently reported short-term pain relief and functional improvement associated with heat therapy in patients with acute low back pain. Most interventions were applied within several days after symptom onset. However, under the current reimbursement system, heat therapy is reimbursable only after a designated waiting period following injury, which restricts its application during the acute phase. Conclusion: A discrepancy was identified between the clinical evidence supporting early heat therapy for acute low back pain and its current reimbursement positioning in the judo therapist system. Further evidence-based discussion is required to improve the alignment between clinical practice and reimbursement policy.