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.

Objectives: This study aimed to compare the effects of repetitive peripheral magnetic stimulation (rPMS) and neuromuscular electrical stimulation (NMES) on hemodynamics and obtain basic data to verify the safety of rPMS in healthy adults. Methods: rPMS and NMES were performed for 5 min in the supine position using a maximum-intensity stimulation that did not cause pain in the quadriceps femoris of 20 healthy adult males. Regarding the measurement items, the maximum inferior vena cava diameter (IVCDmax) was measured using an echocardiograph to determine the increase or decrease in venous return. Right atrial pressure (RAP) was estimated from the measured IVCDmax and respiratory collapsibility index to determine the cardiac preload. Systolic blood pressure (SBP) and heart rate (HR) were measured as indicators of cardiovascular response. Results: A significant interaction was observed for IVCDmax (p <0.05). Multiple comparison tests showed no significant change in IVCDmax for NMES but showed a significant increase during stimulation for rPMS (p <0.01). No significant changes were observed in the HR, SBP, or RAP throughout the experiment. Conclusions: rPMS may produce a stronger muscle pump action than NMES, resulting in increased venous return and IVCDmax expansion. However, since rPMS did not significantly change HR, SBP, or RAP, it is suggested that it does not cause excessive hemodynamic stress in healthy participants.

Objectives: In this study, we aimed to identify the predictive subitems and cutoff values of the Functional Assessment for Control of the Trunk (FACT) for independent gait in patients with acute stroke. Methods: This retrospective observational study included 110 stroke patients. The FACT was assessed early after mobilization. Logistic regression analysis was conducted with independent gait at discharge as the dependent variable and 11 independent variables, including FACT subitems 3–10 and potential confounding factors. Receiver-operating characteristic (ROC) analysis was used to determine cutoff values for the total FACT score in predicting independent gait. Results: For level-ground gait, FACT items 4 and 5 (odds ratios: 4.71 and 2.89, respectively) were significant predictors. For uneven-ground gait, FACT item 8 (odds ratio: 1.87) was significant. The cutoff values were 11 points (sensitivity: 84.0%; specificity: 93.3%; area under the curve [AUC]: 0.95) for level-ground gait and 15 points (sensitivity: 77.8%; specificity: 95.0%; AUC: 0.89) for uneven-ground gait. Conclusions: Early FACT scores predicted independent gait. For level-ground gait, coordinated movement of the lower limbs and trunk during forward and lateral weight shifts and extensive lateral weight-shifting ability (items 4 and 5) were key. For uneven-ground gait, the rotational ability of the bilateral lower trunk during extensive lateral weight shifts (item 8) was crucial. The present findings suggest that these predictors and cutoff values can assist in guiding the prioritization of trunk assessment and devising tailored intervention plans aimed at functional gait acquisition during the early physical therapy phase following stroke onset.

Objectives: The impact of rehabilitation (RH) started on postoperative day 0 (Day 0) and the association between intensive RH and time to home discharge after hip fracture surgery remain unclear. We aimed to investigate the influence of the RH starting date and RH provision volume on time to home discharge. Methods: Using the Diagnosis Procedure Combination database, we retrospectively analyzed patients who underwent surgery within 7 days of admission between April 2020 and March 2022. RH starting date was classified as Day 0, postoperative day 1 (Day 1), postoperative day 2 (Day 2), or postoperative day 3 or later (≥Day 3). RH provision volume was calculated as the average number of daily RH units. Time to home discharge was used as the outcome, with home discharge as the event occurrence. Cox proportional hazards regression models were used to examine these associations. Results: A total of 207450 patients were included. Both variables had a statistically significant association with time to home discharge. The adjusted hazard ratio based on RH started on ≥Day 3 was 0.97 (95% confidence interval: 0.93–1.02) for Day 2, 1.05 (1.01–1.09) for Day 1, and 1.18 (1.10–1.27) for Day 0. The adjusted hazard ratio based on the lowest dose (0–1.0 units/day) was 1.12 (1.08–1.15) for 1.1–2.0 units/day, 1.10 (1.06–1.14) for 2.1–3.0 units/day, 1.04 (1.00–1.08) for 3.1–4.0 units/day, 1.09 (1.04–1.14) for 4.1–5.0 units/day, and 1.11 (1.06–1.17) for ≥5.1 units/day. Conclusions: Starting RH on Day 0 was suggested to potentially facilitate faster or easier home discharge. Additionally, providing at least one unit of RH appears effective.

Objectives: This report describes the functional recovery of a patient who developed severe intensive care unit-acquired weakness (ICUAW) following aortic valve replacement (AVR). It focuses on the utility of preoperative physical function assessment and changes in patient-reported health-related quality of life (HRQOL). Case Presentation: The patient was a woman in her 70s who developed ICUAW after undergoing AVR. Preoperative assessments included the Barthel Index (BI), Short Physical Performance Battery, gait speed, and grip strength to evaluate physical function, and the EuroQol 5 Dimensions 3 Levels (EQ-5D-3L) to assess HRQOL. A progressive rehabilitation program was initiated after the surgery. Postoperatively, we regularly assessed the Medical Research Council sum score (MRCss) and functional performance metrics, and we tracked HRQOL using the EQ-5D-3L over time. Discussion: The MRCss of the patient was 16 at ICU discharge, indicating severe muscle weakness. Based on preoperative assessments, tailored rehabilitation goals were set, and the patient was transferred to a post-acute rehabilitation facility. The HRQOL trajectory reached its lowest score on postoperative day (POD) 27 (EQ-5D-3L: −0.166) but gradually improved over time. By POD 102, the patient had achieved near-complete functional recovery with an MRCss of 57, BI of 95, gait speed of 1.33 m/s, and EQ-5D-3L of 0.746 and was discharged. Conclusions: Functional recovery may be possible even in cases of severe ICUAW with marked muscle weakness at ICU discharge. Preoperative physical function assessments may provide valuable insights into recovery potential and guide rehabilitation planning, thereby contributing to an improved quality of care.

Objectives: This prospective cohort study investigated the relationship between preoperative functional disability, as determined by the Oswestry Disability Index (ODI), and perioperative Life-Space Assessment (LSA) scores using generalized linear mixed-effects models (GLMM). Methods: We included 262 patients (mean age, 76.1 ± 6.0 years; male, n = 140; female, n = 122) with lumbar spinal stenosis scheduled for surgery. LSA was examined preoperatively and at 3 and 6 months postoperatively, while ODI was assessed preoperatively. Patients were classified based on ODI quartiles (Q1: 0%–28.89%, Q2: 28.89%–40.0%, Q3: 40.0%–53.33%, and Q4: 53.33%–86.67%). We explored the relationship between ODI and LSA using GLMM. Results: The mean preoperative ODI score was 41.2% ± 17.1%. In the crude model, ODI showed a significant negative association with LSA (β = −0.38, 95% CI: −0.58 to −0.18); this relationship remained significant in the adjusted model (β = −0.30, 95% CI: −0.49 to −0.11). Older age (β = −1.20, 95% CI: −1.76 to −0.65) and female sex (β = −11.81, 95% CI: −18.24 to −5.38) were associated with life-space restriction; body mass index, number of decompressed levels, and comorbidity burden did not show any such significant associations. Conclusions: Preoperative functional disability significantly affected perioperative life-space mobility among older patients with lumbar spinal stenosis. A comprehensive assessment from the preoperative period is important for older female patients.

Knee osteoarthritis (OA), patellofemoral pain, and anterior cruciate ligament (ACL) injuries are major musculoskeletal disorders often treated through conservative or postoperative physical therapy. Patellofemoral pain syndrome and patellar instability have been linked to femoral morphology specifically femoral anteversion (proximal) and trochlear groove (distal), as well as patellofemoral joint malalignment. Knee OA has been associated with an increased medial proximal tibial angle, indicating tibial varus alignment. ACL injuries are linked to abnormal bony morphology, including femoral intercondylar width, alpha angle, and posterior tibial slope angle. Preventing these abnormalities may reduce the risk of future diseases. Recent animal studies have shown that insufficient mechanical loading during growth alters bone geometry and joint alignment, which are risk factors for these musculoskeletal disorders. This review summarizes the bone morphological abnormalities and joint malalignments implicated in major lower limb musculoskeletal disorders, which have not been traditionally considered as therapeutic targets.

Objectives: This study structurally analyzed physiotherapists’ activity outcomes dispatched via the Japan International Cooperation Agency (JICA) volunteer program, aiming to develop future strategies for physiotherapy education, practice, and global health engagement. Methods: We analyzed Reports 1–5 from 123 JICA-dispatched physiotherapists (2014–2024), focusing primarily on the “activity outcomes” section of Report 5 using KH Coder for text mining. Additional variables, such as year of dispatch, gender, host country, geographic region, and number of physiotherapists at the placement site, were extracted. Regions were divided into 5 categories: Asia, Africa, Oceania, Latin America and the Caribbean, and Central Asia and the Middle East. Frequency and hierarchical cluster analyses were also performed. Utilizing clustering patterns, activity outcomes were classified into 8 categories. External variables—region and staffing levels—were used for cross-tabulations. Results: The study grouped outcomes into 2 main types: 4 categories reflecting direct support through clinical practice and technology transfer, and 3 categories representing institutional and organizational contributions rooted in logical problem solving. The small effect sizes indicated that external factors had limited influence on activity outcomes, such as a greater use of the community-based rehabilitation (CBR) approach in Latin America and areas with limited physiotherapy personnel. Conclusions: These findings indicate that JICA volunteer physiotherapists consistently fulfilled core professional roles across diverse contexts, emphasizing clinical support, capacity development, and system improvement. Despite regional and contextual differences, the weak effect sizes suggest that individual adaptability and shared professional values contribute to sustaining context-appropriate rehabilitation practices in global health settings.

Objectives: Gait variability, related to gait stability, is crucial because it is associated with the risk of falls in patients with hemiparesis following stroke. However, there is a lack of understanding regarding changes in gait variability over time in patients with stroke. This case report aimed to describe the improvement in gait variability over 24 months in an individual with hemiparesis following stroke. Case Description: A 34-year-old man was admitted to the hospital with a diagnosis of cerebral infarction due to atherosclerosis. The patient presented with severe motor paralysis of the right extremities, scoring 6 and 13 on the Fugl–Meyer Assessment for the upper and lower extremities, respectively. Data collection for patient examination started at 1 month post-stroke. Two measures were employed for quantifying gait variability: the Gait Variability Index (GVI) and the coefficient of variation (CV). Nine spatiotemporal parameters were collected for calculating the GVI and CV. Results: The patient was discharged after 5 months post-stroke. At 24 months, he was able to walk independently outdoors without using a cane or an ankle–foot orthosis. Improvements in the GVI and CV were observed during the first 4 months following stroke; however, no marked changes were noted thereafter. At 24 months, the CV for step length, single support time, and swing time demonstrated the most marked improvements. Conclusions: Gait variability in this patient showed the most improvement during the subacute phase. Additionally, improvement in gait variability may be the basis for achieving independent walking, and future research is warranted.

Objectives: Total knee arthroplasty (TKA) effectively improves motor function and reduces pain in patients with osteoarthritis (OA). However, recent research emphasizes the distinction between rest pain and post-TKA pain due to their impact on treatment and recovery. This study aimed to identify factors associated with rest pain and pain intensity during movement 1 year post-TKA. Methods: A total of 126 individuals (103 females, average age: 72.3 ± 8.1 years) undergoing TKA were included. All variables were assessed 1 year postoperatively. Multiple regression analyses were performed using rest pain and pain intensity during movement as dependent variables. Independent variables included age, sex, body mass index (BMI), short form of Central Sensitization Inventory (CSI-9) score, the Fremantle Knee Awareness Questionnaire (FreKAQ) score, inappropriate femorotibial angle, and β angle. Results: Multiple regression analyses demonstrated that FreKAQ score was a significant independent predictor for both rest pain (β = 0.583, 95% confidence interval [CI]: 0.72–1.34) and pain intensity during movement (β = 0.486, 95% CI: 0.72–1.52). Additionally, CSI-9 score (β = 0.183, 95% CI: 0.02–0.93) and the β angle (β = −0.218, 95% CI −3.17 to −0.60) were significant independent predictors for pain intensity during movement only. Conclusions: Specific treatments addressing disturbed body perception may benefit patients with rest pain. Conversely, pain intensity during movement was found to be influenced by various factors, including coronal alignment of the knee joint, central sensitization (CS)-related symptoms, and disturbed body perception. This suggests a need for more comprehensive treatment strategies for pain intensity during movement.