Eleni Kapreli

We thank the authors for their constructive comments on our work

This study aimed to develop a website providing physiotherapy, exercise, and disease knowledge information as a digital tool for use with children with chronic suppurative lung diseases (CSLDs). Data were analyzed using a mixed qualitative and quantitative approach. Initially, a comprehensive list of the website’s content and functions was developed through a Focus Group study with healthcare professionals (HCPs) and parents. Afterward, two rounds of an online Delphi survey were conducted with a group of expert HCPs (pediatricians and physiotherapists) who were recruited based on their expertise in the field of pediatric physiotherapy. The Focus Groups established 10 main themes. Two rounds of Delphi questionnaires established the important items of a website, based on expert consensus from HCPs. A Delphi survey containing 36 outcomes was completed by participants from Greece. The findings support the integration of multidisciplinary and user-centered approaches in the design of a pediatric website. This website is expected to enhance disease self-management, improve treatment adherence, and support families in daily care.

Background/Objectives: The aim of this study was to examine the effectiveness of an exercise program based on principles of motor learning with cognitive elements (such as attention) in the correction of Forward Head Posture (FHP). Methods: A total of 55 university students from the University of Thessaly, aged between 18 and 25 years, participated in this study. Volunteers found to have a craniovertebral angle n = 27) and the control group CG (n = 28). The IG followed a treatment protocol consisting of three 30–45-min sessions per week for four weeks, a total of twelve sessions, while the control group received the same content instructions and group sessions upon completion. Results: After the four-week intervention period, significant improvements were observed in both static and dynamic craniovertebral angle measurements (p < 0.05) when comparing the IG to the CG. Additionally, there was a notable increase in the endurance of the deep neck flexors (p < 0.05), even though the intervention for the IG did not include specific strength exercises. Furthermore, participants with FHP were able to transfer (B–C) motor skills (p < 0.01) acquired during static position tasks to a similar but dynamically untrained task. They also retained (B–D) improvements in posture and strength during the two-week detraining period (p < 0.01), indicating sustained motor learning effects. Conclusions: The exercise intervention was successful at decreasing FHP in subjects, sustaining the results for a two-week period. This study supports the effectiveness of postural training by a program based on motor learning principles. New rehabilitation strategies based on motor control and motor learning could be introduced into physiotherapy practice to increase effectiveness.

This study aimed to develop a website providing physiotherapy, exercise, and disease knowledge information as a digital tool for use in children with chronic suppurative lung diseases (CSLDs). Data were analyzed using a mixed qualitative and quantitative approach. Initially, a comprehensive list of the website’s content and functions was developed through a focus group study with healthcare professionals (HCPs) and parents. Afterward, two rounds online Delphi survey were conducted with a group of expert HCPs (pediatricians and physiotherapists) who were recruited based on their expertise in the field of pediatric physiotherapy. The focus groups established 10 main themes. Two rounds of Delphi questionnaires established the important items of a website, based on expert consensus from HCPs. A Delphi survey containing 36 outcomes was completed by participants from Greece. The findings support the integration of multidisciplinary and user-centered approaches in the design of pediatric website. This website is expected to enhance disease self-management, improve treatment adherence, and support families in daily care.

Background/Objectives: The International Association for the Study of Pain (IASP) recently introduced clinical criteria and a grading system to identify nociplastic pain, marking a pivotal step toward improving diagnostic accuracy. This study aimed to evaluate the reliability and validity of the IASP criteria using clinical vignettes, assessing their effectiveness in identifying nociplastic pain in clinical settings. Methods: A reliability and diagnostic accuracy study was conducted using 32 clinical vignettes based on the literature and pre-existing clinical data. The vignettes represented patients with and without the characteristics of nociplastic pain and were reviewed independently by two expert physiotherapists. Inter-rater and intra-rater reliability were evaluated with a 1-month interval between assessments. Criterion validity was analyzed by comparing the IASP criteria against the standardized vignettes as the reference standard. Sensitivity, specificity, and predictive values were calculated to assess diagnostic accuracy. Results: The IASP criteria demonstrated moderate-to-perfect intra-rater agreement (κ = 0.71–1.00, p < 0.05) and weak-to-perfect inter-rater agreement (κ = 0.52–1.00, p < 0.05). Criterion validity was moderate (κ = 0.68), with strong specificity (89.0%) and moderate sensitivity (69.0%). Positive and negative predictive values were high at 81.8% and 81.0%, respectively, supporting the criteria’s accuracy in identifying and excluding nociplastic pain. Conclusions: The IASP criteria for nociplastic pain exhibited satisfactory reliability and criterion validity in this preliminary study, particularly after initial rater familiarization. Future research should evaluate their application in real-world clinical settings, explore concurrent and prognostic validity, and involve a broader range of raters to enhance generalizability.

Background/Objectives: The Athletic Shoulder Test (ASH) has been described as one of the most promising upper-extremity tests to assess performance in overhead athletes. Its high reliability rates, short testing period, and applicability in any environment with portable and cheap equipment have been highlighted as some of the advantages of the test. However, it has yet to be evaluated in a non-adult athletic population. Therefore, the aim of this study was to investigate the ASH test’s psychometric properties in a sample of young tennis players. Methods: A total of 33 adolescent tennis players were evaluated among two sessions with a week interval. Intra-rater, inter-rater, and test-retest reliability were investigated. Additionally, possible correlations with measures of rotational shoulder strength and upper-extremity performance were examined. Two novice physiotherapists performed all the measurements following appropriate training. Results: The relative reliability scores, as calculated by intraclass correlation coefficient (ICC) indices, were found to be excellent (ICC = 0.924–0.988). Standard error of measurement and minimal detectable change scores have been estimated per position (SEM = 2.74–7.06 N, MDC = 7.55–19.42N). Test-retest reliability provided slightly higher SEM and MDC scores on average (SEM = 3.33–6.47, MDC = 9.32–18.04) than intra-rater and inter-rater reliability. Associations between ASH and the two tests were found to be moderate to strong (r = 0.584–0.856), with the dominant arm providing higher correlation scores (r = 0.605–0.856) than the non-dominant one (r = 0.584–0.823). Absolute values were collected and are provided for all three upper-limb tests; normalized values were calculated for ASH and rotational strength and peak torque only for the ASH measurements. Conclusions: The excellent reliability rates establish the ASH test as a highly recommended testing protocol for adolescent tennis players.

Background: Rotator cuff-related shoulder pain (RCRSP) is a prevalent musculoskeletal issue, encompassing various shoulder conditions. While exercise typically forms the foundation of conservative treatment, there exists ongoing discourse regarding the effectiveness and role of passive treatments. International guidelines recommend initial conservative management, with surgery considered only after failed conservative treatment. However, recent studies reveal discrepancies between recommended practices and actual clinical management. The aim of the study was to assess current practices in managing RCRSP among Greek physiotherapists, with a focus on understanding the alignment of these practices with international guidelines for conservative treatment. Methods: A cross-sectional survey was conducted among Greek physiotherapists to assess current practices in managing RCRSP. The survey, adapted from previous studies, collected demographic data and assessed clinical reasoning through a vignette-based approach. Responses were analyzed for alignment with guideline-recommended care. Results: Out of over 9000 contacted physiotherapists, 163 responded. A majority expressed a specific interest in shoulder pain (85%). Patient education (100%) and exercise (100%) were widely endorsed, with limited support for imaging (44%), injection (40%), and surgery (26%). Younger respondents were less inclined towards surgical referral (p = 0.001). Additionally, adjunctive interventions like mobilization (66%) and massage therapy (58%) were commonly employed alongside exercise and education. Treatment duration typically ranged from 6 to 8 weeks, with exercises reviewed weekly. Conclusions: The study highlights a consistent preference for conservative management among Greek physiotherapists, aligning with international guidelines. However, there are variations in practice, particularly regarding adjunctive interventions and exercise prescription parameters. Notably, there is a disparity between recommended and actual use of certain modalities.

The psychological readiness of athletes and its connection to their functional status in returning to sport after a musculoskeletal injury has been previously studied. The “Psychological Readiness of Injured Athlete to Return to Sport” (PRIA-RS) questionnaire is a widely used tool designed to assess an athlete’s psychological readiness to return to sport. The purpose of the present study is to investigate the validity and reliability of the PRIA-RS questionnaire in Greek football athletes. The questionnaire was administered to 113 football athletes, and its face validity, content validity, concurrent validity, construct validity, test–retest reliability, and internal consistency were assessed. The face and content validity of the PRIA-RS were supported, and an exploratory factor analysis confirmed the instrument’s original two-factor structure. Its concurrent validity was demonstrated by examining correlations between the PRIA-RS and three other measures: the Causes of Re-Injury Worry Questionnaire, the Sport Confidence Questionnaire for Rehabilitated Athletes Returning to Competition, and the Attention Questionnaire for Rehabilitated Athletes Returning to Competition. The PRIA-RS exhibited a good internal consistency (Cronbach’s α = 0.82). The intraclass correlation coefficients (ICCs) for the test–retest reliability of each factor were excellent (ICC = 0.97−0.99). Overall, the PRIA-RS appears to be a valid and reliable tool that rehabilitation professionals can utilize in both clinical practice and research by realizing the athletes’ psychological needs and helping them to return safer with no future musculoskeletal injuries.

The objectives of this study were to estimate the intra-rater and inter-rater reliability of the Pressure Pain Threshold (PPT) and Conditioned Pain Modulation (CPM) in healthy participants and patients with chronic shoulder pain. Additionally, the Standard Error of Measurement (SEM) and Smallest Detectable Change (SDC) were calculated. Thirty-one healthy volunteers and twenty patients with chronic shoulder pain were assessed using the PPT and CPM by two raters, with a 24 h interval between sessions. Excellent intra-rater reliability was demonstrated for PPT, with similar SEM and SDC when assessed by the same rater. The inter-rater reliability for PPTs in patients was moderate to good (ICC = 0.59–0.89) with higher SEM (73.83–121.98 kPa) and SDC (61.58–97.59) values than the asymptomatic group (ICC = 0.92–0.96, SEM = 49.61–103.12 kPa, SDC = 42.01–56.30) respectively. CPM’s intra-rater reliability was good (ICC = 0.82) in the patients and moderate (ICC = 0.67) in the asymptomatic group, while inter-rater reliability was low for the asymptomatic group (ICC = 0.37) and extremely low (ICC = 0.074) for the patients, with comparable SEM and SDC outcomes in both groups. PPT and CPM measurements are highly reliable when conducted by the same rater on the same day. Patients had lower inter-rater PPT reliability but better intra-rater CPM reliability. Clinicians need to be mindful of potential variability when interpreting these test results.