本谷 郁雄

In individuals with Parkinson’s disease (PD), bradykinesia severity is related to physical activity (PA) inside homes. We aimed to investigate the effectiveness of the Lee Silverman Voice Treatment (LSVT)® BIG intervention in increasing at-home PA in individuals with PD. To evaluate the effect of the intervention, we compared pre- and post-intervention scores on the Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Parts 3 and 2, as well as the time spent at home in three categories of PA intensity. For statistical testing, paired t-tests were used when the data met the assumptions of normality, and the Wilcoxon signed-rank test was applied otherwise. Differences were considered statistically significant at p < 0.05. This preliminary retrospective observational study included 10 eligible individuals with PD (4 males). The participants’ mean age was 71.0 ± 10.8 years, with median Hoehn and Yahr stage 3 [interquartile range: 1 to 4]. The MDS-UPDRS Part 3 score, bradykinesia score calculated from a part of that score, and the MDS-UPDRS Part 2 score significantly improved after the intervention (Wilcoxon signed-rank test, p < 0.05). The time spent in sedentary behavior (SB) significantly decreased from 516.4 ± 72.6 to 484.0 ± 70.0 min, whereas that spent in light PA (LPA) significantly increased from 137.8 ± 46.2 to 169.5 ± 32.1 min (paired t-test, p < 0.05). The time spent on moderate-to-vigorous PA (MVPA) did not change significantly (paired t-test, p = 0.533). The results suggested that LSVT® BIG is an effective intervention for increasing at-home PA in individuals with PD. In addition, regarding the specific details of the increase, the time spent on MVPA may not change, and the increase may be mainly attributed to increased LPA and reduced sedentary time.

BACKGROUND: Newly graduated physical therapists require effective training to enhance their clinical skills. On-the-job training (OJT) and off-the-job training (Off-JT) are commonly used methods, but their comparative effectiveness remains unclear. This study aimed to compare the effectiveness of OJT and Off-JT in improving the clinical competencies of newly graduated physical therapists. MATERIAL AND METHODS: A crossover study was conducted involving 13 newly graduated physical therapists. Participants alternated between OJT and Off-JT interventions. The objective-structured clinical examination assessed four key skills—joint range of motion measurement, muscle testing, assistance in getting up, and assistance in transferring. Evaluations were conducted at four time points. A Mann–Whitney U -test was used to compare the change in average scores between the two groups from Assessment 1 to Assessment 2. A two-way analysis of variance was conducted to analyze the interaction effects of training methods and assessment timing. RESULTS: Off-JT was more effective than OJT in improving clinical skills, especially in muscle testing and patient assistance tasks. Both training methods enhanced joint range of motion measurement skills; however, no significant differences were found between the groups. Some tasks showed performance declines in the final assessment, indicating the necessity of continued practice. CONCLUSIONS: Off-JT provides a more effective approach for improving clinical skills, particularly for tasks that require specialized knowledge and structured learning. However, OJT remains valuable for reinforcing routine clinical tasks. Future research should explore the long-term effects of these training methods on various clinical competencies.

Background/Objectives: Individuals with Parkinson’s disease (PD) often experience four major motor symptoms—tremor, rigidity, bradykinesia, and postural instability/gait disorder. Although these symptoms have been shown to affect activities of daily living, their impact on the level of at-home physical activity (PA) in this population remains unexplored. We aimed to investigate the relationship between the four major motor symptoms of PD and at-home PA in these individuals. Methods: This retrospective cross-sectional study included 17 individuals with PD. We examined the relationship between the Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale Part 3 score and the time spent in three PA intensities (sedentary behavior, light PA [LPA], and moderate-to-vigorous PA) within the home. Pearson’s correlation coefficient was used for statistical analysis. Results: In the initial step analysis, a significant negative correlation was observed between the overall motor symptom score and the time spent in LPA inside the home (rs [95% confidence interval]: −0.72 [−0.93 to −0.25]; p < 0.01). In the second step analysis, a significant negative correlation was observed between the bradykinesia score and the time spent in LPA inside the home (rs: −0.74 [−0.92 to −0.30]; p < 0.01). Conclusions: Among the four major motor symptoms, only the severity of bradykinesia influenced the time spent in LPA inside the home. Thus, rehabilitation treatment focusing on bradykinesia may be beneficial for increasing the time spent in LPA inside the home for individuals with PD.

Background and Objectives: This study aimed to examine the development of clinical competence of novice physical therapists (PTs) during their first year of employment, following the implementation of an original in-house educational program. The educational program was designed to offer diverse training opportunities at an early stage, during the first year of employment. Methods: Thirty-eight novice PTs (21 males and 17 females, mean age 23.4 ± 3.2 years) participated in this study. All participants underwent educational programs and a self-assessment using the Clinical Competence Evaluation Scale in Physical Therapy (CEPT) on the first day of employment (entry-level) and after 1, 3, 6, and 12 months of employment. The total score and CEPT component-wise scores—“knowledge,” “clinical reasoning,” “skill,” “communication,” “attitude,” “self-education,” and “self-management”—at the 4 assessment points (1, 3, 6, and 12 months) were compared with values on the first day. Results: The total scores at 3, 6, and 12 months of employment were significantly higher than those on the first day of employment (P < .05). Among the total scores on the 7 components, those for “knowledge,” “clinical reasoning,” “skill,” and “communication” at 3, 6, and 12 months after employment were also significantly higher than those on the first day of employment (P < .05). The scores for “attitude” and “self-education” 12 months after employment were significantly higher than those on the first day of employment. However, the “self-management” scores at 1, 3, 6, and 12 months after employment did not significantly change compared with those on the first day of employment. Conclusions: The total score was significantly higher after 3 months. The participant’s clinical competence may have improved because they participated in an educational program related to “knowledge,” “clinical reasoning,” “skills,” and “communication” at an earlier stage in the first year. However, their progress was comparatively slower in other areas, suggesting that the content might not have been sufficient. This study revealed the effectiveness of the educational program on novice PTs’ clinical competence at a single institution in Japan. Positive outcomes were obtained for several parameters. Furthermore, the results reveal the need for content modifications within the educational program to improve PTs’ performance across all evaluated items.

Abstract Background Patients with Parkinson's disease (PwPDs) experience a progressive decline in their sit‐to‐stand (STS) ability, including a prolonged STS time, rising failure, and seat‐off failure. The clinical and biomechanical factors contributing to this decline are unclear. Objectives We investigated clinical and biomechanical factors associated with the different stages of STS decline in PwPDs. Methods This cross‐sectional study included 23 healthy controls (HCs) plus 40 PwPDs who we categorized by STS ability: 18 successful STS (SS), 12 failure‐to‐rise (FR), and 10 failure‐to‐seat‐off (FS). Clinical assessments included motor symptoms (Movement Disorder Society‐sponsored revision of the Unified Parkinson's Disease Rating Scale), balance (Mini‐Balance Evaluation Systems Test), and lower‐limb strength. Biomechanical parameters measured using force plates included repetitive movements, slope of first‐peak loading, and amplitude and temporal parameters. We conducted group comparisons and determined the age‐adjusted area under the receiver operating characteristic curve (AAUC) and Spearman's correlations with the STS time (P < 0.05). Results In the SS group, prolonged STS time was significantly correlated with amplitude and temporal parameters (rs = −0.849 to 0.986), for example, first‐peak feet loading and its slope, reflecting impaired weight shifting from the buttocks onto the soles. These parameters effectively differentiated FR from SS (AAUC = 0.778–0.884) and FS from FR (AAUC = 0.758–0.992). Lower‐limb bradykinesia differentiated FR from SS (AAUC = 0.870). All balance‐related measures also strongly distinguished FS from FR (AAUC = 0.817–0.925). Conclusions These findings highlight that weight‐shifting impairments, along with bradykinesia in the earlier stages and balance deficits in the later stages, play pivotal roles in the progressive STS decline in PwPDs. Interventions targeting weight shifting, as well as bradykinesia, and postural control, could potentially help mitigate this decline.