Research Insights & Reviews: Physiotherapy & Rehabilitation

Measurement Properties and Minimal Detectable Change of the 6‐Min Step Test for Estimating Cardiorespiratory Fitness in Hospitalized Individuals After Stroke

2026-05-18T08:14:52+00:00

Background: The 6‐minuteute step test is an alternative for estimating cardiorespiratory fitness after stroke.

Objective: To investigate its measurement properties and minimal detectable change early after stroke.

Methods: Cross‐sectional, methodological study. Participants were inpatient individuals in the acute/subacute phase after stroke, who performed the 6‐min step and the 6‐min walk tests. The outcomes of interest were test–retest and inter‐rater reliabilities, validity, measurement error, and minimal detectable change.

Results: Fifty‐one individuals (34 men) with a mean time of 6 days (SD 2) since stroke, and a mean walking speed of 0.9 m/s (SD 0.2) were included. The 6‐min step test had a very‐high test‐retest (ICC 0.93; 95% CI 0.88–0.96) and inter‐rater reliability (ICC 0.95; 95% CI 0.91–0.97). The correlation between the 6‐min‐step test and the 6‐min walk was moderate (r = 0.5; 95% CI 0.3–0.7). The measurement error was 8 (10%) and the minimal detectable change was 21 repetitions.

Conclusion: The 6‐min step test demonstrated appropriate test‐retest and inter‐rater reliability. Agreement with the 6‐min walk test was imprecise, which may reflect the greater physical demand of the 6‐min‐step test. Further studies are needed to examine the relationship between the 6‐min‐step test and maximal cardiorespiratory capacity.

Core Stability Training for Post‐Stroke Recovery: A Multifaceted Approach to Enhance Postural Control and Motor Function

2026-08-31T07:22:48+00:00

Stroke survivors commonly experience deficits in postural control and motor function, significantly impacting their independence and quality of life. Core Stability Training (CST) has emerged as a promising intervention to address these challenges. This review explores the multifaceted mechanisms by which CST promotes recovery, including: Biomechanical: CST strengthens the core musculature, providing a stable foundation for limb movement and optimizing force transmission throughout the kinetic chain. Neurophysiological: CST drives neural plasticity through repetitive, task‐specific sensorimotor stimulation, facilitating cortical reorganization and restoring anticipatory postural adjustments. Functional and Systemic: CST improves respiratory function and may contribute to the modulation of pathological muscle tone, promoting overall health and well‐being. Clinical evidence demonstrates that CST effectively enhances balance, gait parameters, upper limb function, and performance in activities of daily living. This review also discusses current challenges and future perspectives, including the need for standardized protocols, personalized interventions, and the integration of technological advancements to optimize CST delivery. By addressing the core deficits in post‐stroke motor recovery, CST offers a valuable tool for improving the functional outcomes and quality of life for stroke survivors.

Psychological Factors Are Associated With Lower Limb Kinematics During Uphill Walking and Running in Women With Patellofemoral Pain

2026-08-31T07:01:59+00:00

Background and Purpose: Patellofemoral pain (PFP) is a common condition in women and is associated with high recurrence rates. Kinematic alterations are among the factors that may persist even after muscle strengthening programs. Given the multifactorial nature of PFP, non‐mechanical factors, such as kinesiophobia, may be related to the movement patterns adopted by this population. This study aimed to investigate the associations between kinesiophobia, pain‐related factors, and lower limb kinematics during uphill walking and treadmill running in women with PFP.

Methods: This was a cross‐sectional study. Data were collected from 22 young women (24.0 ± 5.87 years) with PFP. Anthropometric data were collected, and participants completed the Tampa Scale for Kinesiophobia, the Pain Catastrophizing Scale, and the Numerical Rating Scale for pain. Subsequently, kinematics of the affected lower limb was analyzed during uphill walking and treadmill running. The angles of knee flexion, hip flexion, ankle dorsiflexion, knee valgus, and pelvic tilt were calculated. Pearson's correlation coefficient was used for statistical analysis, with the significance level set at p < 0.05.

Results: Significant negative correlations were observed between knee flexion angle and kinesiophobia (r = −0.381, p = 0.040) as well as pain catastrophizing (r = −0.482, p = 0.023) during uphill walking. During treadmill running, stronger negative correlations were found between knee flexion angle and both kinesiophobia (r = −0.694, p = 0.008) and pain catastrophizing (r = −0.972, p = 0.008). No significant correlations were observed for the other joint angles analyzed.

Discussion: The findings of this study indicate that higher levels of kinesiophobia and pain catastrophizing are associated with reduced knee flexion during uphill walking and treadmill running in women with PFP. Rather than suggesting a causal effect, these results highlight a meaningful relationship between psychological factors and movement patterns during functional activities. Reduced knee flexion may reflect a protective or avoidance strategy commonly observed in individuals with elevated fear of movement or maladaptive pain‐related beliefs. Clinically, these associations underscore the importance of considering psychological factors during assessment and rehabilitation, as they may be related to altered movement strategies and functional performance in individuals with knee pain.

Acute Effect of Percussive Massage on Cross‐Section Area, Muscle Strength, and Late Muscle Pain of the Quadriceps Muscle Following a Fatigue Protocol in Physically Active Men: Randomized Clinical Trial

2026-08-31T08:09:47+00:00

Background and Purpose: The massage gun is widely used to alleviate delayed‐onset muscle soreness (DOMS); however, empirical evidence regarding its physiological effects remains limited.

Objectives: This study aimed to evaluate the acute effects of percussive massage on the quadriceps muscle's cross‐sectional area (CSA), strength performance, and pain perception following a fatigue protocol.

Methods: A randomized clinical trial was conducted including 37 physically active men. Participants performed a fatigue protocol on a 45° leg press, at 70% of their one‐repetition maximum (1RM). The volunteers were allocated to an intervention group (G0 n = 19, mean ± SD; 25.7 ± 4.5 years, 83.7 ± 10.6 kg, 176.8 ± 6.3 cm) and control group (G1 n = 18, mean ± SD; 27.6 ± 5.0 years, 76.8 ± 15.7 kg, 174 ± 7.3 cm). Assessments were performed at baseline, 24 and 48 h, using ultrasound imaging, isometric dynamometer and VAS questionnaire (visual analog pain scale).

Results: Regarding the muscle area, significant increases were observed in the control group p < 0,05 for the rectus femoris at both measurement points compared with the baseline, which suggests that percussive massage may mitigate exercise‐induced edema. While no statistically significant differences were observed between groups or across time points for muscle strength, G0 demonstrated a large effect size (d > 2.0) in strength maintenance at 24 and 48 h compared to G1. Both groups showed reduction in pain over time, while G0 demonstrated a significant decrease at 48 h compared to 24 h (53%, p < 0.001).

Conclusion: Within‐group assessments revealed significant reductions in pain perception over time for the intervention group. Regarding muscle strength, despite a large exploratory effect size observed during recovery, no statistically significant between‐ group superiority over passive rest was established. The findings suggest potential preliminary benefits for symptom relief without acute performance deficits.

Measurement Properties of the Modified Incremental Step Test for Assessing Exercise Capacity in Individuals With Type 2 Diabetes

2026-08-31T07:14:47+00:00

Background and Purpose: A reduction in exercise capacity (EC) can be observed in individuals with type 2 diabetes (T2D) on cardiopulmonary exercise test (CPET). However, CPET is a costly maximal exercise test, limiting its routine use. This study aimed to analyze the criterion validity, convergent validity, and test‐retest reliability of the Modified Incremental Step Test (MIST), a simple, inexpensive, and portable submaximal exercise test, for assessing EC in individuals with T2D.

Methods: Fifty individuals with T2D (56.9 ± 11.4 years old, 50% male) attended two visits within a 2‐ to 10‐day interval. On the first visit, participants underwent a CPET. On the second visit, two repetitions of the submaximal exercise tests, the MIST and the 6‐minute walk test (6MWT), were conducted in a random order. Criterion validity was assessed using the Pearson correlation coefficient between the number of steps climbed in the best‐performed MIST and peak oxygen consumption (peak VO₂) from CPET. Convergent validity was evaluated by the Pearson correlation coefficient between the best MIST performance and the distance covered in the best 6MWT. Test–retest reliability was determined using the intraclass correlation coefficient (ICC) between two MIST repetitions.

Results: Convergent validity was supported by a moderate correlation between the number of steps climbed in the best-performed MIST and the distance covered in the best 6MWT (r = 0.65; p < 0.001; n = 50). In contrast, criterion validity (r = 0.53; p = 0.023; n = 18) and test‐retest reliability (ICC [95% CI] = 0.64 [0.44–0.78]) did not meet the criteria for adequate measurement properties.

Discussion: This multicenter methodological study, conducted in accordance with COSMIN recommendations, contributes to the literature by evaluating the psychometric properties of the MIST for assessing EC in individuals with T2D. Although the findings do not support the MIST as a substitute for CPET, its convergent validity may support its use when 6MWT execution is not possible.