Breadth and Depth

It is an honor to write the editorial for this issue of Cardiopulmonary Physical Therapy Journal (CPTJ). With the 2023 American Physical Therapy Association (APTA) Combined Sections Meeting in the rearview mirror, I find myself reflecting on and being humbled by the breadth and depth of physical therapist practice and research. It, therefore, is not surprising that this issue of CPTJ is yet another example of the quality and type of research being completed by our colleagues around the globe. This issue of CPTJ includes a systematic review, survey research, a classic experimental design, and investigations using histochemical measurement techniques and ultrasonography. Unsurprising perhaps, but nonetheless, always impressive.

The systematic review by Scott et al¹ on the physical therapist management of the postacute sequelae of COVID (PASC) reveals an all too familiar situation: A lack of sufficient evidence such that clinicians must use still use their clinical judgment and consider “the risks and benefits of the decisions they make.” The authors succinctly summarize what is known about our core interventions of aerobic exercise, resistance training, and breathing exercises in the management of this patient population and highlight some important implications—vital sign monitoring and a word of caution for novice clinicians given the wide variation and severity of the clinical presentation of PASC.

Qu et al² exemplify the breadth of physical therapist practice internationally and highlight an important consideration for the physiotherapist practicing in the neuromuscular and respiratory failure clinic setting. Their survey research investigates the effectiveness of patient education regarding the cleaning and maintenance of home ventilation equipment. Although at first glance this may seem to apply to only a small number of clinicians in these highly specialized clinical settings, do not be fooled. There is clear application for our home health care colleagues, and it reinforces my admiration for these, our intrepid colleagues, who accept immense responsibility in comprehensively caring for a wide variety of patients, including those with chronic respiratory failure.

Lindenberg et al³ use a classic experimental methodology to examine the effectiveness of kinesiology tape on ventilatory muscle function using osteokinematic, electromyographic, and force production measurements. Although this is largely a “negative” study, its publication in CPTJ shows our commitment to avoiding publication bias and publishing good science in the name of advancing the profession as we seek to learn what does and does not work in the care of our patients.

From Dr. Gurovich's laboratory, Amador et al⁴ demonstrate the depth of basic science skills of some of our physical therapist researcher colleagues as they seek to understand the cellular and histochemical mechanisms behind exercise training and their implications for dosing of exercise. This is the type of bench-to-practice translational research that is needed to inform individualized exercise prescription.

Last, Rodrigues and Beneck⁵ provide an important addition to the research surrounding the debate on the role and importance of sternal precautions after median sternotomy. Most fascinating is that they found there is still motion of the sternal edges up to 8 to 10 weeks after surgery in normally healing patients without symptoms. This may be surprising to many of us who assume that there would be complete bony union at that point. Given emerging literature on the use of an individualized, risk-based approach to liberalizing sternal precautions,⁶ Rodrigues and Beneck remind us that mitigating sternal forces during mobility and daily functioning remains a critical aspect of physical therapist management of these patients.