Weekly Literature Review: Physical Therapy Research Highlights

Welcome to this week's literature review, where we explore the latest research impacting physical therapy practice. Each day features a key study with clinical relevance to help you stay current with evidence-based practice.

Monday: AI and Machine Learning Integration Framework

Citation: Morelli, N. (2025). Seeing past the event horizon: A framework for integrating artificial intelligence and machine learning into physical therapy. Physical Therapy, 105(2), pzae137. https://doi.org/10.1093/ptj/pzae137

Summary: This article presents a comprehensive framework for integrating artificial intelligence and machine learning into physical therapy practice. Morelli introduces the SALIENT framework for staged implementation, spanning from problem definition through randomized controlled trials. The article addresses three types of bias (sample, annotator, and temporal), outlines levels of autonomy from assistive to fully autonomous systems, and proposes adoption drivers across four domains: reasons (addressing inefficiencies), means (infrastructure and training), method (workflow integration), and desire (professional fulfillment). The author emphasizes that successful AI/ML adoption requires transparency, reproducibility, regulatory oversight, and alignment with APTA policies that support ethical AI use while opposing payer misuse to restrict services.

Relevance to Physical Therapy: As AI tools become increasingly prevalent in healthcare, this framework provides physical therapists with a roadmap for thoughtful integration. Rather than viewing AI as a replacement for clinical judgment, the article positions these technologies as augmentative tools that can enhance diagnosis, personalize care, and improve efficiency. Understanding the SALIENT framework helps PTs participate meaningfully in AI implementation at their organizations, while awareness of bias types and adoption drivers ensures these tools serve diverse populations equitably. This forward-looking perspective prepares the profession to harness innovation while maintaining human-centered care and professional autonomy.

Tuesday: Telerehabilitation Outcomes

Citation: Cottrell, M. A., Galea, O. A., O'Leary, S. P., Hill, A. J., & Russell, T. G. (2017). Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: A systematic review and meta-analysis. Clinical Rehabilitation, 31(5), 625-638. https://doi.org/10.1177/0269215516645148

Summary: This systematic review and meta-analysis evaluated the effectiveness of real-time telerehabilitation compared to traditional face-to-face physical therapy for musculoskeletal conditions. Analyzing 15 studies with 1,155 participants, the researchers found that telerehabilitation produced outcomes comparable to in-person treatment for pain, function, and patient satisfaction. Effect sizes were similar between delivery methods across various musculoskeletal conditions.

Relevance to Physical Therapy: With the expansion of telehealth services, this research validates that physical therapists can deliver effective care remotely without compromising patient outcomes. This evidence supports the integration of telerehabilitation into standard practice, expanding access to care for patients with transportation barriers, rural locations, or scheduling constraints. PTs can confidently incorporate virtual visits as a viable treatment option, particularly for appropriate musculoskeletal conditions.

Wednesday: Blood Flow Restriction Training

Citation: Hughes, L., Paton, B., Rosenblatt, B., Gissane, C., & Patterson, S. D. (2017). Blood flow restriction training in clinical musculoskeletal rehabilitation: A systematic review and meta-analysis. British Journal of Sports Medicine, 51(13), 1003-1011. https://doi.org/10.1136/bjsports-2016-097071

Summary: This meta-analysis examined blood flow restriction (BFR) training combined with low-load resistance exercise in clinical populations. The review included 31 studies and found that BFR training produced significant improvements in muscle strength and hypertrophy when combined with low-intensity exercise (20-40% of 1RM). These gains were comparable to traditional high-load resistance training without BFR, making it particularly valuable for patients who cannot tolerate heavy loads.

Relevance to Physical Therapy: BFR training offers physical therapists an innovative tool for rehabilitation when patients cannot perform high-intensity exercises due to pain, post-surgical precautions, or other limitations. This technique is particularly valuable for post-operative protocols, acute injuries, or older adults who may benefit from muscle strengthening without the mechanical stress of heavy weights. Understanding the evidence for BFR allows PTs to implement this modality safely and effectively in appropriate clinical scenarios.

Thursday: Manual Therapy for Neck Pain

Citation: Gross, A., Langevin, P., Burnie, S. J., Bédard-Brochu, M. S., Empey, B., Dugas, E., Faber-Dobrescu, M., Andres, C., Graham, N., Goldsmith, C. H., Brønfort, G., Hoving, J. L., & LeBlanc, F. (2015). Manipulation and mobilization for neck pain were contrasted against an inactive control or another active treatment. Cochrane Database of Systematic Reviews, 2015(9), CD004249. https://doi.org/10.1002/14651858.CD004249.pub4

Summary: This Cochrane review evaluated the effectiveness of cervical manipulation and mobilization for neck pain. Analyzing 51 trials with 2,920 participants, the review found moderate-quality evidence that mobilization and manipulation produce clinically important improvements in pain and function for acute, subacute, and chronic neck pain when compared to control interventions. Benefits were most consistent when manual therapy was combined with exercise.

Relevance to Physical Therapy: Manual therapy remains a valuable tool in the physical therapist's treatment arsenal for neck pain management. This evidence supports the use of spinal mobilization and manipulation techniques, particularly when integrated with therapeutic exercise. The findings help guide clinical decision-making regarding when and how to incorporate hands-on techniques, emphasizing a multimodal approach rather than relying solely on manual interventions. This reinforces evidence-based practice patterns for one of the most common complaints in outpatient PT.

Friday: Graded Motor Imagery for Complex Regional Pain Syndrome

Citation: Bowering, K. J., O'Connell, N. E., Tabor, A., Catley, M. J., Leake, H. B., Moseley, G. L., & Stanton, T. R. (2013). The effects of graded motor imagery and its components on chronic pain: A systematic review and meta-analysis. The Journal of Pain, 14(1), 3-13. https://doi.org/10.1016/j.jpain.2012.09.007

Summary: This systematic review and meta-analysis examined graded motor imagery (GMI) programs for chronic pain conditions, particularly complex regional pain syndrome (CRPS). The review found significant reductions in pain following GMI treatment, with particularly strong effects for CRPS. The three-stage approach, laterality training, motor imagery, and mirror therapy, demonstrated meaningful clinical improvements in both pain intensity and function.

Relevance to Physical Therapy: Graded motor imagery provides physical therapists with an evidence-based treatment approach for challenging pain conditions like CRPS, where traditional interventions may be insufficient. This neuroplasticity-based treatment addresses pain through cortical reorganization without requiring physical movement, making it ideal for patients who cannot tolerate traditional exercise. Understanding GMI expands the PT's ability to treat complex pain presentations and demonstrates the profession's evolution toward brain-based pain management strategies alongside biomechanical approaches.

Conclusion

Conclusion

This week's literature review demonstrates the essential role of evidence-based practice in advancing the physical therapy profession and improving patient outcomes. From understanding how to integrate cutting-edge AI technologies into clinical workflows to applying well-established interventions like exercise and manual therapy, staying current with research is not optionalit is a professional imperative.

The Value of Evidence-Based Practice in Physical Therapy

Evidence-based practice represents the integration of the best available research evidence with clinical expertise and patient values. This triad ensures that our interventions are not based on tradition or anecdote alone, but on rigorous scientific inquiry that has demonstrated effectiveness across diverse populations and settings.

The studies highlighted this week underscore several key aspects of EBP's value:

Clinical Decision-Making: Research provides the foundation for confident clinical reasoning. Whether determining the appropriate exercise dosage for chronic low back pain or deciding when to incorporate manual therapy for neck pain, evidence guides our choices and helps us explain our rationale to patients, colleagues, and payers.

Professional Credibility: As a relatively young profession, physical therapy continues to establish its identity as an autonomous, doctorate-level healthcare discipline. Robust engagement with research (both consuming and producing it) elevates our professional standing and demonstrates that PT interventions are grounded in science, not just empirical observation.

Optimizing Patient Outcomes: Evidence-based practice helps us identify which interventions work, for whom, and under what circumstances. Understanding effect sizes, confidence intervals, and clinical significance allows us to set realistic expectations with patients and select interventions most likely to produce meaningful improvements in pain, function, and quality of life.

Innovation and Adaptation: The Morelli article on AI integration exemplifies how EBP extends beyond traditional clinical trials. As healthcare technology evolves, physical therapists must critically evaluate emerging tools using the same evidence standards we apply to therapeutic interventions. This ensures we adopt innovations that truly enhance care rather than those driven solely by marketing or convenience.

Equity and Access: Research helps identify disparities in outcomes and access to care. By examining studies with diverse populations and considering external validity, we can work toward more equitable practice patterns that serve all patients effectively, regardless of socioeconomic status, geography, or cultural background.

Lifelong Learning: The literature is constantly evolving. What we learned in PT school represents a snapshot in time; evidence-based practice demands ongoing professional development. Regular engagement with current research through journal clubs, literature reviews, and continuing education ensures our practice evolves alongside the science.

Bridging the Research-Practice Gap: As several studies this week demonstrate, simply having evidence is insufficient. We must actively translate knowledge into clinical practice. Understanding barriers to implementation, developing clinical pathways, and fostering a culture that values both clinical expertise and scientific inquiry are essential to closing the gap between what we know and what we do.

This week's collection (spanning AI frameworks, telerehabilitation, blood flow restriction training, manual therapy, and graded motor imagery) illustrates the remarkable breadth of our profession. Physical therapists treat diverse conditions using varied approaches, and each intervention we choose should be defensible through evidence, tailored to individual patient needs, and delivered with clinical expertise.

As you move through your clinical week, consider: How are you incorporating evidence into your daily practice? What barriers do you face in accessing or applying research? And how can you contribute to the growing body of evidence that will guide the next generation of physical therapists?

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