Objectives: We examined whether motor imagery (MI), included as a preparatory component within an integrated MI-plus-physical-practice protocol, could influence fear of falling (FoF), gait, and balance in a Parkinson’s disease (PD) patient presenting with both FoF and freezing of gait (FOG). Methods: This single-case ABAB study focused on a male patient in his 70s with Hoehn–Yahr stage 3 PD and a history of multiple falls. Baseline phases (A1 and A2) included conventional physiotherapy. Intervention phases (B1 and B2) included 20 min of MI targeting the Timed Up and Go Test (TUG), performed before and after task execution within physiotherapy sessions, with pre-task MI serving as a preparatory component. Each phase lasted 5 consecutive days. Outcome measures included TUG, FoF, Functional Reach Test (FRT), and Single-Leg Stance (SLS). Effects were evaluated using Tau-U. Results: Significant differences between phases were observed for TUG, FoF, and SLS. Improvements were observed during the intervention phases (B1 and B2), with partial retention after the intervention. In contrast, FRT showed improvements primarily during the intervention phases without retention. Conclusions: An integrated MI-plus-physical-practice protocol including a preparatory MI component appeared to be associated with improvements in gait, balance, and FoF in this patient with PD presenting with both FoF and FOG. Preparatory MI may facilitate subsequent physical practice and help reduce movement-related anxiety.

Objectives: Understanding how respiratory sarcopenia affects force, velocity, and muscle power is crucial for comprehending exercise impairments associated with respiratory sarcopenia and for developing effective intervention strategies. This study aimed to examine the relationships among force, velocity, muscle power, and probable respiratory sarcopenia in community-dwelling older adults. Methods: Eighty community-dwelling older adults aged 60 years or older were included. The primary outcomes measured were force, velocity, and muscle power. Force, velocity, and muscle power were calculated using a five-times sit-to-stand test based on a previous study. Additional outcomes assessed included probable respiratory sarcopenia, skeletal muscle functions, and basic and medical information. Probable respiratory sarcopenia was defined as low respiratory muscle strength combined with a reduced skeletal muscle mass index. Hierarchical multiple regression analysis was performed to examine the factors associated with force, velocity, and muscle power as dependent variables. Independent variables were probable respiratory sarcopenia, skeletal muscle functions, and basic medical information. Results: Hierarchical multiple regression analysis revealed that probable respiratory sarcopenia (P <0.05) was a significant predictor of force, velocity, and muscle power. Conclusions: Probable respiratory sarcopenia was significantly associated with indicators of skeletal muscle functions, including force, velocity, and muscle power. These findings suggest that probable respiratory sarcopenia may progress as part of a multiple low in skeletal muscle functions, which is an important insight for future evaluation methods and intervention strategies.

Objectives: This study aimed to describe the quality of life (QoL) of persons with lower limb amputations (LLAs) in Cambodia both before and after rehabilitation, and to identify predictor variables associated with increased QoL outcomes post-rehabilitation. Methods: A total of 164 participants with LLA from 7 physical rehabilitation centers (PRCs) across Cambodia completed the baseline assessment; however, only 125 participants (58% below- or through-knee amputations; 98% unilateral) completed the 3-month follow-up, with 39 participants lost to follow-up. Participants were interviewed using the Comprehensive Quality of Life Scale Adult questionnaire (which includes both objective and subjective scores). Baseline data were collected on the first day of admission at the PRC, following referrals from hospitals after the limb surgery. Follow-up data were gathered 3 months after discharge from rehabilitation. A paired t-test was used to assess the difference in QoL scores, and linear regression identified factors potentially associated with changes in QoL. Results: Our findings indicate that both objective and subjective QoL scores of persons with LLA increased significantly 3 months after rehabilitation (p <0.001). The absence of residual stump pain was significantly associated with higher QoL scores (p = 0.002). In contrast, a longer delay (>12 months) between amputation and receipt of rehabilitation services was associated with a smaller improvement in subjective QoL (p = 0.023). Conclusions: The findings suggest that early rehabilitation after amputation and the inclusion of effective pain management may be associated with better QoL outcomes; however, these approaches should be evaluated through further research to validate their impact.

Objectives: Some patients referred to physical therapy demonstrate deficits in initiation and completion of physical therapy exercises during appointments. These challenges may create a barrier to benefitting from therapy. We evaluated the effect of observation-to-imitate plus practice (OTI + PP) on decreasing latency to exercise initiation and increasing exercise completion for 2 participants referred for inpatient rehabilitation physical therapy. Methods: We used an AB multiple-baseline single-case research design to compare the OTI + PP intervention to each participant’s baseline condition for their latency to exercise initiation and completion. Results: Visual inspection indicates some improvement for 1 of the 2 participants to produce more consistent responding during OTI + PP, but there is an insufficient demonstration of a functional relation due to the small number of participants and lack of effect using visual analysis. The percentage of all nonoverlapping data indicates moderate to large effect sizes of OTI + PP to decrease latency to exercise initiation and increase completion. Conclusions: It is possible that OTI + PP could decrease latency to exercise initiation and increase completion, but individual variability, insufficient replication, and the small number of participants could limit conclusions and should be considered.

Heart failure (HF), chronic kidney disease (CKD), and chronic obstructive pulmonary disease (COPD) frequently coexist and collectively constitute a high-risk multimorbid state characterized by shared pathophysiology, compounded exercise intolerance, frailty, and worse clinical outcomes. These overlapping conditions interact through several mechanisms, including neurohormonal activation, systemic inflammation, oxidative stress, endothelial dysfunction, hemodynamic interactions, and skeletal muscle abnormalities. These mechanisms restrict functional capacity through both central and peripheral pathways. Exercise-based rehabilitation has emerged as an essential nonpharmacological intervention across cardiovascular, renal, and pulmonary medicine and is supported by robust evidence for improvements in exercise capacity and health-related quality of life in single-organ disease populations. However, patients with overlapping cardio-renal-pulmonary impairment remain underrepresented in rehabilitation trials, and evidence for the triple overlap of HF, CKD, and COPD remains particularly scarce. This narrative review synthesizes current evidence on the pathophysiology of cardio-renal-pulmonary multimorbidity and the mechanisms of exercise intolerance. Furthermore, it summarizes functional phenotypes, clinical assessments, and the effects of exercise-based rehabilitation across single-organ and overlapping disease states. Finally, practical implications for individualized exercise prescription, delivery models, and safety monitoring are discussed. We propose a phenotype-guided, function-centered framework for rehabilitation in this complex population and outline key research priorities to strengthen the evidence base for this high-risk, underserved population.

Objectives: This exploratory study investigated the association between trunk muscle quality assessed at admission, including muscle fat infiltration, and the development of aspiration pneumonia within 12 months after hip fracture in older women. Methods: This retrospective, single-center study included women aged ≥75 years with hip fracture who underwent abdominal computed tomography at admission. Trunk muscle quality, including muscle fat infiltration and the proportions of normal-attenuation and low-attenuation muscle, was assessed. Participants were classified according to the occurrence of aspiration pneumonia within 12 months after hip fracture, and trunk muscle characteristics were compared between groups. Results: Women who developed aspiration pneumonia showed a significantly higher intramuscular adipose tissue/total attenuation muscle area index in the erector spinae at admission. In multivariable logistic regression analysis, reduced muscle quality of the erector spinae was associated with the subsequent development of aspiration pneumonia (odds ratio, 1.29; 95% confidence interval, 1.05–1.60). Conclusions: Fat infiltration in the erector spinae muscle may be associated with the subsequent development of aspiration pneumonia in older women with hip fracture. Trunk muscle quality at admission may reflect underlying vulnerability. However, these findings should be interpreted with caution given the exploratory design, small sample size, and potential residual confounding; no causal relationship can be established.

Kinesiopathology describes how suboptimal movement patterns generate progressive mechanical stress on tissues, contributing to structural changes and the onset of neuromusculoskeletal pain conditions. The purpose of this article is to discuss kinesiopathology as a framework for understanding the progressive nature of neuromusculoskeletal dysfunctions and its implications for physical therapy practice. Empirical evidence from biomechanical and clinical research across multiple conditions supports the relationship between altered movement patterns and musculoskeletal pathology. The nervous system consolidates frequently repeated movement patterns into automatized motor programs that operate below conscious awareness, perpetuating suboptimal tissue loading over time. This supports the reframing of traditionally defined orthopedic conditions as neuromusculoskeletal conditions, in which neuromuscular activation patterns govern movement behavior and influence tissue stress. Five phases of kinesiopathology are proposed, describing the progression from subtle, asymptomatic movement patterns through repetitive tissue loading, structural changes, and symptom development to chronic neuromusculoskeletal dysfunction. This framework highlights the clinical value of the early identification and modification of suboptimal movement patterns. Systematic movement system examination—including observation of alignment, neuromuscular activation patterns, and movement strategies during functional tasks—positions physical therapists to identify and address the movement-related mechanisms underlying neuromusculoskeletal conditions. How a person moves is not incidental to their neuromusculoskeletal health, but is fundamental to it. As movement system experts, the recognition and modification of movement dysfunction in its earliest phases represent both the defining competency and the greatest clinical opportunity of the profession.

Objectives: This study aimed to evaluate the intra- and inter-examiner reliability of ultrasound-derived diaphragm thickness (Tdi) and diaphragmatic excursion (DE) in individuals with chronic obstructive pulmonary disease (COPD). Methods: This prospective cross-sectional study included outpatients with stable COPD. Six participants were analyzed for intra-examiner reliability and 16 for inter-examiner reliability. Two trained examiners performed diaphragmatic ultrasound using a same-day standardized protocol. In the intra-examiner phase, 1 examiner performed 2 repeated measurements in 6 participants on the same day. In the inter-examiner phase, 2 examiners performed 2 measurements in 16 participants under the same-day standardized protocol. Tdi was measured at functional residual capacity (FRC), residual volume (RV), and total lung capacity (TLC), and DE was measured from resting expiration to maximal inspiration. Intra-examiner reliability was assessed using intraclass correlation coefficients (ICCs; ICC [1,1]), and inter-examiner reliability was evaluated using ICC (2,1); standard error of measurement and minimal detectable change were also calculated. Results: Intra-examiner ICCs ranged from 0.70 to 0.98. Tdi at TLC (Tdi_TLC) and DE demonstrated high intra-examiner reliability (ICCs ≥0.83 for both examiners). Inter-examiner analysis showed high agreement for Tdi_TLC and DE (ICCs = 0.83 and 0.88, respectively), whereas Tdi at FRC and RV showed moderate agreement (ICCs = 0.57 and 0.59, respectively). Conclusions: Ultrasound-derived diaphragm parameters—particularly Tdi_TLC and DE—demonstrated high intra- and inter-examiner reliability in individuals with stable COPD under a same-day standardized protocol. This suggests the potential clinical utility of diaphragmatic ultrasound for the reliable evaluation and short-term monitoring of diaphragmatic function in clinical and research settings.

Objectives: This study aimed to investigate how changes in torque curves and histological alterations in joint structures occur in relation to the duration of immobilization, using a rat knee joint contracture model. Methods: A total of 58 male Wistar rats were divided into 6 groups: 3 immobilization groups with knee joints immobilized for 4, 8, or 16 weeks and 3 control groups receiving only standard housing until the same age. After each immobilization period, the torque curves during knee extension were measured. From the torque curves, the knee extension angle at 10, 30, 60, and 120 mNm and the slope of the linear region were calculated and compared among groups. Subsequently, the articular complex structures were histologically examined. The length of the posterior joint capsule and the flatness of the tibial articular surface were calculated from tissue images and compared among groups. Results: As the immobilization duration increased, the knee extension angle significantly decreased at all torque values, and the slope of the linear region became significantly gentler. The length of the posterior joint capsule was significantly shorter in the immobilized groups than in the control groups. Additionally, the tibial articular surface was significantly flatter in the immobilized groups than in the control groups. However, no significant differences were observed between the immobilized groups. Conclusions: With joint immobilization, the shape of the torque curve changes, which is influenced by the posterior joint capsule and other factors.

Objectives: This study compared the effects of sit-to-stand exercise instruction (STS instruction) and participant-led goal-setting on sedentary behavior in chronic stroke survivors with reduced walking ability. We hypothesized that STS instruction would reduce prolonged sitting bouts more effectively than goal-setting. Methods: Twelve chronic stroke survivors completed a randomized crossover trial consisting of two 2-week interventions (STS instruction and participant-led goal-setting) separated by a 1-month washout. Physical activity time was measured using a thigh-worn activPAL4 accelerometer. The primary outcomes were the number and total duration of prolonged sitting bouts ≥30 min. Secondary outcomes included total sitting/lying time, standing/walking time, sit-to-stand transitions, and prolonged sitting bouts ≥60 min. Results: A significant intervention × time interaction was observed for prolonged sitting bouts ≥30 min (p = 0.049), with different pre–post patterns between intervention phases (STS: 8.4–7.0/day; goal-setting: 8.1–9.3/day). The interaction for the total duration of ≥30-min bouts was not statistically significant (p = 0.156). No significant intervention × time interactions were observed for total sedentary time, standing/walking time, or for the number or total duration of sitting bouts ≥60 min. Conclusions: STS instruction may contribute to modifying sitting patterns in chronic stroke survivors with limited walking ability, even without changes in total sedentary or upright time. These preliminary findings suggest that a simple, task-oriented approach may help modify sedentary patterns, although clear superiority over participant-led goal-setting was not demonstrated. Larger and longer-term trials are needed.

Objectives: We aimed to clarify the current state of cancer rehabilitation in palliative care units (PCUs) in Japan, thus helping to improve cancer rehabilitation and effectively address patients’ complex needs. Methods: A nationwide questionnaire survey was conducted, targeting 462 hospitals in Japan that met the eligibility criteria for reimbursement of inpatient fees for PCUs and had submitted notifications to local health authorities. The survey focused on cancer types, intervention types, duration and frequency of interventions, and other characteristics of cancer rehabilitation in PCUs. Results: Responses were received from 265 facilities (response rate, 57.4%), of which 242 (91.3%) provided cancer rehabilitation in their PCU. Cancer rehabilitation in Japanese PCUs primarily targeted patients with lung, hepatobiliary and pancreatic, colorectal, gastric, and breast cancers. Interventions included relaxation therapy, walking, basic mobility training, resistance exercises, and range-of-motion exercises. Support for quality of life, ikigai (a Japanese concept for a sense of meaning and purpose in life), and temporary discharge from the PCU were identified as distinctive elements of rehabilitation in palliative care. In many facilities, sessions lasted 20–40 min, with interventions provided 3–4 times per week. Conclusions: The findings highlight the need for further evaluation of the effectiveness of interventions tailored to unmet medical needs, as well as the development of evidence stratified by cancer type and disease stage. Such evidence may inform future policies to strengthen rehabilitation within PCUs.

Objectives: This study aimed to develop 2 multiple linear regression models to predict the Functional Independence Measure (FIM) motor score at discharge in patients with stroke and low FIM at admission (total FIM score ≤55) admitted to a convalescent rehabilitation ward, and to compare their predictive accuracy and internal validity. Model 1 used admission assessments only, whereas Model 2 combined admission assessments with reassessment information at 3 weeks after admission. Methods: Participants were 104 patients with stroke admitted with a total FIM score of ≤55. The outcome was the discharge FIM motor score (continuous variable). Candidate predictors included basic information and measures of physical and cognitive function. Models were developed using multiple linear regression, and internal validity was evaluated through bootstrap resampling. In Model 1, predictors were age, days since onset, the Berg Balance Scale, and admission FIM motor and cognitive scores. In Model 2, predictors were age, days since onset, admission FIM cognitive score, and the FIM motor score at 3 weeks after admission. Results: Model 2 showed a higher adjusted R² (0.71) and smaller prediction errors than Model 1 across the evaluated error metrics, indicating superior predictive accuracy. The calibration of Model 2 was also improved compared with Model 1 based on internal validation. Conclusions: Incorporating reassessment information at 3 weeks improved time-updated prediction of discharge activities of daily living outcomes in this single-center cohort. However, given limited generalizability, external validation using multicenter data (and, if necessary, model updating) is required before broader clinical application.

Background: There are no reports on physiotherapy to promote behavioral changes in the immediate postoperative period for lower limb amputees. Patient: A 7-year-old girl patient underwent transfemoral amputation as a treatment for osteosarcoma located at the proximal fibula. Course of Physiotherapy: As a result of continuous physiotherapy for the patient from prior to surgery, she was able to obtain a prosthetic gait without support before the end of chemotherapy. The intervention was performed according to the mental state and behavioral change status of this patient, who was reluctant to undergo physiotherapy while undergoing chemotherapy. Conclusion: In this patient, increasing self-efficacy and improving motivation for prosthetic gait can be attributed to many interventions, such as continuous physiotherapy from before surgery, self-monitoring after surgery, behavioral goal-setting methods appropriate for self-assessment, interaction with other lower limb amputee patients, accumulation of positive experiences, and discussion of collaborative problem-solving methods. The combination of a behavioral change approach in physiotherapy for a pediatric patient undergoing transfemoral amputation was useful.

Objectives: Square-stepping exercise (SSE) is a preventive program that reduces the risk of falls and improves physical function and agility in community-dwelling older adults. Although SSE has shown benefits in community-dwelling older adults, its feasibility in Japanese daycare service facilities, where physical and cognitive conditions may differ, remains unclear. This study aimed to assess its implementation and acceptability among older adults in daycare service facilities. Methods: A single-arm, 4-week intervention was conducted at Daycare Service Facility A in Kagoshima, Japan. Participants performed SSE once weekly for 4 weeks, with each session lasting 60 min. Safety (absence of injuries or illnesses), program completion rates, and session attendance rates were monitored throughout the intervention, and one-on-one semi-structured interviews were conducted to assess acceptability. Results: The participants were 21 older adults (mean age 87.4 ± 4.6 years). Adherence was high, with a 95.2% completion rate and 100% attendance rate. No injuries were observed. All participants completed the exercises by following the step patterns, as instructed. Interviews revealed positive psychological changes, such as enjoyment and a sense of accomplishment, and physical improvements, including better lower-limb conditions and overall health. Conclusions: The findings suggest that SSE may be safely implemented with high adherence in older females with care levels of 3 or below in daycare service facilities and may also promote positive psychological changes. It is necessary to conduct a more detailed evaluation of its effectiveness.

Objectives: Physical therapists (PTs) face various psychosocial risks that affect their mental health; however, profession-specific reports on organizational exposures remain limited. This study aimed to examine total overtime, workplace harassment, and workplace consultation availability and their associations with current mental distress among PTs in Japan. Methods: A nationwide cross-sectional web survey of PTs, conducted from August 12 to September 20, 2025, was analyzed. The primary outcome was current mental distress (yes/no). The main exposures were total overtime in the past 3 months (per 10 h/3 months), workplace harassment (yes/no), and workplace consultation availability (yes/no). Separate multivariable logistic models were fit for each exposure with a common adjustment set (sex, age, tenure in current workplace [midpoint, years], employment status, hospital bed size, and number of PTs). Missing covariates were handled via multiple imputation (multiple imputation by chained equations, m = 15) with pooling by Rubin’s rules. Results: Of the 718 PTs surveyed, 312 (43.5%) were classified as distress present. Mean total overtime was 16.7 ± 15.0 h over 3 months and was higher in the distress-present group. Adjusted associations were total overtime adjusted odds ratio (aOR) 1.13 (95% confidence interval [CI] 0.98–1.31) per additional 10 h, harassment aOR 2.29 (95% CI 1.67–3.14), and workplace consultation availability aOR 0.60 (95% CI 0.43–0.84). Conclusions: Workplace harassment was associated with higher rates of mental distress, whereas workplace consultation availability was inversely associated. Total overtime showed a positive trend in the adjusted model. These findings point to organizational targets, including overtime management, harassment prevention, and accessible consultation routes.

Objectives: Physical activity levels vary seasonally, but the short-term impact of intensity-specific activity changes on older adults’ physical function remains unclear. This study aimed to examine seasonal changes in physical activity and their effects on physical function among older adults in a rural, snowy region. Methods: Thirty-nine older adults from Tobetsu-cho, Hokkaido, Japan, were included. Body composition and physical function were assessed during the non-snowfall season (June–September 2023) and 1 year later (June–September 2024). Accelerometers measured step counts and activity levels during both the non-snowfall and snowfall seasons (January–February 2024). Participants were grouped by the extent of change in activity levels (greater-change vs. smaller-change). Two-way analysis of variance (ANOVA) assessed differences in 1-year changes in physical function. Results: Repeated-measures 2-way ANOVA showed a significant main effect of season on body fat percentage, appendicular skeletal muscle mass index, grip strength, and walking speed in the light-intensity physical activity (LPA) category. A significant interaction was observed for the Five Times Sit-to-Stand Test (FTSST). Bonferroni’s test revealed a significant worsening of FTSST scores (p <0.01) after 1 year, but only in the group with a greater LPA decline. Conclusions: A greater decrease in LPA during the snowfall was associated with short-term declines in lower-limb function, as measured by FTSST. Given its link to fall risk and loss of independence, maintaining LPA during snowy seasons may be essential for maintaining lower-limb function in older adults.

Japan’s primary care system is evolving from a specialist-dominated model to one incorporating board-certified family physicians and generalist training pathways. However, the system remains fragmented, with limited integration of multi-professional teams. Primary care due to legal and systemic barriers, including the requirement for physician referrals and limited training for autonomous practice. Drawing on international evidence, this paper examines the potential role of physiotherapists as first-contact practitioners (FCPs) and advanced practice physiotherapists (APPs) within Japan’s evolving primary care system, with particular attention to system integration, workforce capacity, and care for musculoskeletal and chronic conditions. Studies demonstrate improved clinical outcomes, patient satisfaction, operational efficiency, and cost-effectiveness with physiotherapy-led models. FCPs reduce physician workload, medication use, and diagnostic imaging, while enhancing patient self-management and adherence to guidelines. However, challenges such as role ambiguity, diagnostic uncertainty, and inadequate funding hinder effective integration. Addressing these barriers requires legislative reform, comprehensive training, role clarity, and improved inter-professional collaboration. For Japan, embedding physiotherapists in multidisciplinary primary health care could support integrated community care, addressing the needs of an aging population and fragmented services. This transition necessitates redefining physiotherapy roles, expanding the scope of practice, and aligning with chronic care models. Coordinated policy initiatives on funding, training, and regulation are essential to develop multi-professional primary care teams and optimize patient outcomes. Lessons from international models provide valuable insights for advancing physiotherapy’s role in Japan’s primary care system.