Journal of Clinical Physiotherapy Research

Background: Artificial Intelligence has vast potential to transform physiotherapy and digital rehabilitation through the following aspects: improving the accuracy of diagnosis, treatment planning, and patient outcomes.  Its fast adoption into the healthcare industry, however, requires an in-depth review of the legal and other ethical concerns involved. These issues cut across key domains of information privacy, algorithm discrimination, transparency, accountability, and the maintenance of human-centered care, which are essential in the responsible use of Artificial Intelligence. Methods: The article is based on a descriptive-analytical approach to discovering, summing up, and evaluating the legal and ethical issues related to the artificial intelligence in physiotherapy and rehabilitation. The reviewed databases were Medline (PubMed), Embase (OVID), Scopus, Web of Science, Google Scholar and SSRN. Articles that were published within the period of 2010 to 2025 were searched so that only the most recent development and discussion in this field are reflected.Findings: The potential of Artificial Intelligence is indeed great, but there are numerous compound ethical and legal challenges to its application. Among the ethical concerns, there is patient data privacy. Algorithm’s bias develops the possibility of unfair outcomes. Some Artificial Intelligence systems have a black box character, which contests transparency and explain ability and undermine trust and informed decision-making. It is legally unclear how to delineate accountability and liability in the case of errors caused by Artificial Intelligence because there are no established regulatory frameworks.Conclusion: The ethical and successful introduction of Artificial Intelligence into physiotherapy and digital rehabilitation is determined by a proactive approach to the challenges that this technology poses in the legal and ethical context. This necessitates the formulation of sound regulatory policies, explicit ethics, and thorough training of medical workers. The importance of data privacy, reducing algorithmic bias, improving transparency, and better understanding accountability is of utmost priority in making Artificial Intelligence an extension and not a replacement of human-centered care. The future of Artificial Intelligence in this aspect relies on a fine line between the technological innovation and the firm adherence to the ethics and the best interests of patients.

Background : Identifying spinal abnormalities and assessing the physical condition of people in the community with accurate and reliable tools is of great importance. The main purpose of this study was to compare the flexible ruler with Microsoft Kinect tool in spine arch evaluation. Methods: The present study is a descriptive study and for this purpose, 44 male athletes aged 20 to 42 years in Rasht who were purposefully selected participated in this study. First, a flexicurve ruler was used to evaluate the arch of the spine, and then the Microsoft Kinect tool was used. It was measured in three steps with an interval of 15 minutes. Results: Pearson correlation coefficient was used to investigate the relationship between flexicurve ruler and Microsoft Kinect measurements (for validity) and intragroup correlation coefficient was used to evaluate the reliability of kyphosis and lordosis measurements. The results showed that there was moderate validity between the measurements obtained by Microsoft Kinect and the flexicurve ruler (r = 0.407 for kyphosis and r = 0.396 for lordosis), but the in-test reliability of this device was very high (kyphosis ICC = 0/998 and lordosis ICC = 0/998) was obtained. Conclusion: The results of the present study showed that Microsoft Kinect is a reliable tool in evaluating and measuring the angle of kyphosis and lordosis and also has validity. Therefore, this device can be used quickly and accurately in the evaluation of the spine arch.

Background : Muscle shortness is the cause of many musculoskeletal pain syndromes. Although stretching exercise reduces muscle shortness, the immediate effect of stretching on muscular strength and power needs further investigation. In this study, the immediate effect of "static stretching duration" on the isokinetic strength and power of shortened triceps Surae muscle (STSM) was investigated. Methods: It was a quasi-experimental study. In the descriptive part of research, the range of motion of the active dorsiflexion of 57 male students was measured. With the criterion of active dorsiflexion range of motion less than 20 degrees, 12 people (20.8±1.5 years, 177.7±4.7 cm, 74.4±12.9 kg) were selected for the experimental part of the research, which included 4 sessions. In the first session, the strength and power of the subjects was measured as a pre-test by an isokinetic dynamometer. In the next three sessions, in every session, one of the three static stretching protocols of 30, 120, and 360 seconds was randomly applied to STSM of each subject and Immediately after the stretch, strength and power were measured as the post-test. Data analysis was performed by dependent t-test and alpha level was set at 0.05. Results: Our findings showed that, compared to the pretest, the power was significantly increased by all three stretch protocols of 30 (P = 0.04), 120 (P = 0.03) and 360 seconds (P = 0.03). However, for muscular strength, 120 (P = 0.03) and 360 second (P = 0.03) stretch protocols led to significant increase, but 30 second stretch did not significantly increase it (P = 0.13). Conclusion: The present study showed that different durations of static stretching on STSM do not immediately reduce muscular strength and power compared to before stretching. Accordingly, it seems that in the warm-up phase of sport training, performing any of these stretching protocols is applicable.

Background : Obesity is an epidemic problem that cause of atherosclerosis development and increase risk of cardiovascular diseases. Increase of adhesion molecule such as the P-selectin and E-selectin in obese people have key role in atherosclerosis phenomena. The purpose of this study was to investigate of high-intensity and moderate- intensity aerobic training on plasma levels of P-selectin and E-selectin in obese boys.  Methods: In the semi-experimental study 36 obese student boys )age 13.4 ± 0.69 years old, height 163.06 ± 7.88 cm and weight 85.72 ± 8.42 kg) were randomly assigned to three groups: high-intensity aerobic training (n= 12), moderate-intensity aerobic training (n= 12) and control (n=12). The training was performed at 50-65% maximal heart rate (moderate-intensity) and 70-85% maximal heart rate (high-intensity), 3 day per week for 10- weeks. The blood sample was collected 48-h before and 48-h after last sessions of exercise training. The P-selectin and E-selectin were measured by ELISA. Data were analyzed using two-way repeated ANOVA with SPPS version 18.Results: The results of tow-way ANOVA analysis indicated that body percent fat (P = 0.028) and body weight (P = 0.042) were significantly decreased after 10- weeks training intervention. There is  a significantly decrese of body fat percent and body weight in high-intensity training compared with moderate-intensity training (P= 0.027). The results of tow-way ANOVA analysis indicated that VO2max value significantly increased (P = 0.018). The plasma levels of P-selectin (P=0.001) and E-selectin (P=0.016) were significantly decreased after training intervention. Additionally, there is a significantly decrease of P-selectin in high-intensity training compared with moderate-intensity training (P= 0.034), but there is no significantly different between high-intensity training and moderate-intensity training in plasma levels of E-selectin in obese boys (P> 0.05). Conclusion: It seems that high-intensity aerobic training compared with moderate-intensity training has greater reduction in plasma levels of E-selectin, P-selectin, body weight and BMI, and increase of VO2max.

Introduction: Children with Attention-Deficit/Hyperactivity Disorder (ADHD) often experience heightened distractibility and sensory regulation difficulties that compromise their therapeutic engagement. Despite growing recognition of environmental influences on child behavior, limited research has objectively quantified how architectural factors impact rehabilitation outcomes. This study investigated the relationship between built environmental features and attentional performance among ADHD children and evaluated the effect of targeted spatial modifications on therapeutic engagement. Methods: A mixed-methods, within-subject design was implemented in two phases involving 36 children aged 8–12 years with clinically confirmed ADHD. Eye-tracking systems were used to measure fixation duration, saccadic frequency, and gaze dispersion during therapy sessions in baseline and modified environments. Environmental modifications included decluttering, neutral color adjustments, optimized lighting, and visual zoning. Standardized instruments, Short Sensory Profile 2 (SSP2), Conners Continuous Performance Test (CPT-3), and Strengths and Difficulties Questionnaire (SDQ), were administered pre- and post-intervention. Results: Results demonstrated significant reductions in fixation on irrelevant stimuli (p < 0.01), increased task-oriented gaze fixation (p < 0.05), and improved sensory regulation scores on the SSP2. Children showed fewer sensory over-responsivity behaviors (SSP2), improvement in sustained attention (CPT-3) and emotional regulation (SDQ). Engagement scores also increased significantly (p < 0.001). Conclusion: These findings confirm that physical space is a modifiable determinant of therapeutic success. Integrating environmental design with clinical practice supports an evidence-based framework for sensory-conscious rehabilitation. This interdisciplinary approach has implications for the design of therapy centers, classrooms, and inclusive educational environments optimized for neurodiverse children.

Background: Objective measures such as eye tracking offer promise to quantify attention modulation. We report a controlled intervention in which visual distractors in the therapy room were removed and then systematically reintroduced, examining changes in sensory profiles and eye-tracking metrics. Methods: Five children with ADHD were enrolled in intervention group and 5 as controls. At baseline, all participants completed the Short Sensory Profile-2 (SSP-2) and an eye-tracking session to detect primary visual distractors. During a first 3-month, all distractors were removed in both groups, and standard therapy proceeded. After 3 months, all assessments were repeated. In the intervention group, over the next 3 months, architectural distractors were gradually reintroduced (one every 3 weeks) while the control group remained in the distraction-free environment. At the end of 6 months, SSP2and eye tracking were reassessed and compared. Results: In the intervention group, mean total SSP2score improved) from 130 ± 8 at baseline to 145 ± 10 after the first 3 months (p = 0.02), then declined modestly to 138 ± 9 after the second 3 months (p = 0.04). Eye-tracking metrics showed significant reductions in distractor engagement in the second period relative to the midpoint (p<0.03). The control group showed continued gradual improvement in SSP2 (128 ± 7 → 135 ± 9 → 140 ± 10) but no major change in distractor zone metrics. The net SSP2change in intervention group attenuated compared to control (p = 0.04). Conclusions: Findings support the use of eye tracking as an objective outcome measure in sensory-based interventions and highlight the importance of environmental control in autism therapy. Larger controlled trials are needed.

Background : Diabetic neuropathy (DN) is a common chronic complication of diabetes mellitus and having active lifestyle is a way of control for diabetic neuropathies. The aim of this study was to investigate the effect of eight weeks aerobic exercise with high and moderate intensities on quality of life, life expectancy and anthropometric indices of patients with diabetic neuropathy. Materials and Methods: This study is a quasi-experimental study with pretest-posttest design by control group. The statistical population included all women with diabetic neuropathy from endocrine clinic of Emam Khomeini Hospital of Ardabil University of Medical Sciences in 2020; then 90 samples were selected by convenience sampling method. Subjects were randomly assigned to Exercise with high intensity (Exercise with 80% of maximum heart rate, n=30), Exercise with moderate intensity (Exercise with 70% of maximum heart rate and routine care, n=30), and control (routine care, n=30) groups. The subjects of exercise groups has trained aerobic exercise for 8 weeks; 3d/w under supervision of researcher in Health Center of University of Mohaghegh Ardabili. A demographic and disease characteristic questionnaire, short-form of health (SF-36) to assessing quality of life and 48-item Miller questionnaire  to assessing  life expectancy were completed by all patients at the beginning and after eight week. Waist-to-height and waist-to-hip ratios were measured by a tape measure. Multivariate covariance test (MANCOVA) was used to analysis of data. The significant level was considered as 0.05. Results: The physical heath and its subtitle (general health) of exercise group with 70-80% were significantly higher than exercise group with 60-70% (p=0.001, p=0.001) and control group (p<0.001, p<0.001). The psychological health and its subtitle (social function) of this group were higher than control group (p=0.012, p=0.005). Life expectancy index of exercise groups were higher than control. Also, waist to height ratio in exercise groups was lower than control group (p=0.005, p=0.016). However, there is no difference between aerobic with high and moderate intensities in life expectancy index and waist to height ratio (p= 0.107, p=0.760). Conclusion: Aerobic exercise with high intensity effect on quality of life of Diabetic neuropathy patients more than moderate intensity. Also, both intensities can increase the life expectancy of these patients and improve some of the anthropometric indices. Therefore, it is suggested that aerobic exercise especially with higher intensity will insert into treatment plan of diabetic neuropathy patients.

Introduction: Physiotherapy in Pediatric Intensive Care Units (PICUs) plays a critical role in optimizing respiratory function and promoting early mobilization. Despite its importance, implementation remains inconsistent due to multiple barriers at institutional, patient, and professional levels. Identifying these barriers and facilitators is essential for improving physiotherapy integration in pediatric critical care. This study aimed to investigate barriers and facilitators of physiotherapy practice among physiotherapists working in PICUs across multiple centers in Iran, focusing on both respiratory and mobilization domains.  Methods: A multi‑center cross‑sectional descriptive‑analytic study was conducted between September–November 2025 in four pediatric hospitals (Mofid, Ali Asghar, Children’s Medical Center, and Tabriz Pediatric Hospital). A total of 20 physiotherapists were recruited using convenience sampling. Data were collected using a structured, self‑administered questionnaire covering demographic information and four domains: institutional barriers, patient‑related barriers, staff cooperation, and facilitators. Statistical analysis was performed using SPSS version 26.  Results: A total of 20 questionnaires were analyzed. Institutional barriers make up the largest portion at 40%, indicating systemic challenges such as limited resources or lack of formal protocols. Facilitators account for 30%, showing that supportive elements like staff training and administrative backing play a significant role. Staff cooperation (20%) and patient-related barriers (10%) also contribute, highlighting interpersonal dynamics and clinical limitations. Institutional barriers were the most prominent obstacles to physiotherapy implementation in the PICU, with limited supportive administrative policies receiving the highest rating among these factors (80%). Conclusion: Physiotherapy implementation in the PICU is mainly hindered by institutional and professional barriers, while patient-related factors were less significant. Facilitators were unanimously recognized as essential, and physician engagement, clear protocols, and multidisciplinary collaboration are key to advancing practice. The limited number of PICU staff, reflected in our sample of only 20 cases across several centers, highlights the need for broader multicenter studies.

Introduction: Background and Purpose: Bone sarcomas are rare malignant bone tumors, and large lesions often necessitate complex Limb-Salvage Surgery (LSS), such as Total Femur Replacement (TFR). While LSS is the standard of care, there is a paucity of detailed, evidence-based rehabilitation protocols, especially for patients undergoing extensive, multi-joint reconstructions. This case report aims to document the effect of a structured, early post-operative physical rehabilitation program in a patient who underwent TFR for extensive femoral sarcoma. Case presentation:  A 54-year-old male with recurrent osteosarcoma and multiple prior surgeries underwent a revision Total Hip and Knee Replacement with TFR. Six weeks post-surgery, the initial assessment revealed severe pain (visual analog scale: 6), major limitations in Range of Motion (ROM) (e.g., knee flexion 30∘), and severe muscle weakness (manual muscle testing (MMT: 1 in most muscles). Outcomes: The patient underwent a 20-session structured rehabilitation program focusing on pain management (High-Frequency TENS), early ROM recovery (Continuous Passive Motion (CPM)), and progressive strengthening. After 20 sessions, the patient achieved a significant pain reduction to VAS: 2 and significant ROM recovery, including 90∘ of knee and hip flexion. Functional progress was seen as the patient moved from a partial weight-bearing walker to walking with a single cane. The primary residual challenge was severe knee extensor (quadriceps) weakness (MMT: 2), causing the knee to "give way". Conclusion: This case demonstrates that a structured and progressive early rehabilitation protocol is highly effective in achieving rapid pain control and significant recovery of joint range of motion following complex TFR. The persistence of severe quadriceps weakness is a known challenge that requires targeted intervention. 

Introduction: One of the treatment methods for people suffering from secondary lymphedema is manual lymph drainage (MLD). Considering the importance and high impact of manual lymph drainage on reducing the volume of lymphedema in people with secondary lymphedema, the purpose of this systematic review is to analyze the results of previous studies about MLD on patients with breast cancer. Methods: A search was performed in the Google Scholar, PubMed, Cochrane Library, Scopus, and Web of Science databases using the keywords 'physiotherapy, lymphedema, manual lymph drainage, and breast cancer' for studies published between 2002 and 2024. Results: Among the retrieved articles, only the articles that investigated MLD in the treatment of patients with lymphedema were included in the study. As a result, 13 out of 3390 articles were included in this study.Conclusion: The review of the selected articles shows that MLD is a non-invasive and acceptable treatment method for lymphedema. Considering the safety and effectiveness of MLD, along with its ease of use and potential for combination with exercise therapy, it is recognized as a therapeutic modality for lymphedema. 

Introduction: Achieving a successful return to sport after anterior cruciate ligament reconstruction remains a significant challenge. Despite high patient expectations, only about 55% of athletes return to competitive sports, and up to 20% of those suffer a second ACL injury. Although various RTS test batteries have been developed to assess readiness and reduce re-injury risk, many athletes fail to meet these criteria, and passing them does not consistently prevent re-injury, indicating limited predictive validity. This narrative review critically evaluates RTS testing, rehabilitation quality, and the RTS continuum from a holistic perspective over the past 15 years.Methods: This narrative review synthesizes literature from the past 15 years, focusing on three core areas: 1) RTS testing protocols and their limitations, 2) the structure, content, and quality of rehabilitation programs, and 3) the dynamic and individualized nature of the RTS continuum.Results: Current RTS test batteries, while multidimensional, lack ecological validity and fail to reliably predict re-injury. Rehabilitation programs often underprepare athletes for sport-specific demands due to insufficient loading, lack of neurocognitive integration, and inadequate on-field progression. Psychological readiness, influenced by fear of re-injury and communication styles, is a critical yet often overlooked component. A holistic, individualized approach incorporating progressive strength training, external focus instruction, neurocognitive challenges, and on-field rehabilitation is essential for improving RTS outcomes. The RTS continuum model (OFR, RTT, RTC, RTP) emphasizes phased reintegration, supported by shared decision-making and ongoing monitoring.Conclusion: RTS after ACLR is a complex, individualized process. Enhancing RTS success requires ecologically valid testing, high-quality progressive rehabilitation, psychological support, neurocognitive training, and structured on-field progression. Future efforts should prioritize personalized rehabilitation strategies and long-term secondary prevention to ensure safer and more effective returns to sport.

The research team in the article "Infants Motor Development of 3-18 Month Premature Infants in Comparison with Their Normally Developing Peers based on Home Environment Affordance" has given an important part of the puzzle in learning the issues that premature infants face once out of the NICU (neonatal intensive care unit). Our task is to construct the therapeutic system; the critical diagnostic data will be found in their work. Through exaggerating the research results by applying specific digital health solutions, we will be able to empower parents with the skills and self-efficacy required to establish the enhanced home environments that their children need to succeed. This requires more cooperation among clinical researchers, developmental specialists, and health technologists to develop all-encompassing systems of care, which would support premature infants and their families smoothly, all the way, whether it is the intensive care unit or a safe and nurturing home setting.

Dear Editor

I am writing to address a critical aspect of anterior cruciate ligament (ACL) reconstruction that warrants further attention in the orthopedic community: the optimization of graft selection and rehabilitation protocols to minimize complications and improve long-term outcomes. Despite significant advancements in surgical techniques and graft materials, the incidence of postoperative complications, such as graft failure, arthrofibrosis, and persistent instability, remains a concern. This issue underscores the need for a more comprehensive understanding of the interplay between graft options, patient-specific factors, and rehabilitation strategies. The choice of graft material whether autograft, allograft, or synthetic is a pivotal decision in ACL reconstruction. Each option carries unique advantages and limitations, and the variability in patient outcomes suggests that a one-size-fits-all approach may not be optimal. For instance, while autografts are associated with robust biological integration, they pose challenges such as donor-site morbidity. Conversely, allografts eliminate donor-site complications but may be associated with slower incorporation and higher failure rates in younger, more active patients. Furthermore, emerging evidence highlights the potential of synthetic grafts, yet their long-term durability and biocompatibility remain under scrutiny.