At its heart, physiotherapy research is about improving the daily lives of people who live with a variety of symptoms and concerns about access to healthcare. 

The research in the October issue ranges from clinical trials and systematic reviews to mediation analyses and economic preference studies but each paper is united by its focus on what really matters to patients. 

Living with back pain: what drives improvement? 

For many people with chronic low back pain, common disabling elements include fear, loss of confidence and reduced quality of life. 

Emily Walker and colleagues from Sydney investigated whether these factors explain the benefits of a comprehensive and effective intervention: patient-led goal setting combined with pain science education. 

Their mediation analysis of a randomised trial found that improvements in pain and disability were not just a direct result of the intervention itself. 

Rather, they were mediated by increased pain self-efficacy, reductions in kinesiophobia and improvements in health-related quality of life. 

This finding emphasises that targeting confidence and beliefs about pain can be just as important as addressing the pain itself. 

Clinicians can target these mechanisms by building confidence, reframing perceived threats and supporting reengagement in valued activities. 

This may include grading goals and enabling individuals to experience improvements that build confidence, refining education to address unhelpful beliefs about activity and harm, and focusing on meaningful, values-based goals that foster intrinsic motivation and help individuals reconnect with important roles and activities. 

What people want from physiotherapy 

Even when evidence-based interventions exist, people’s preferences and priorities shape whether they are taken up. 

Dr Maame Esi Woode and colleagues from Melbourne explored this in a discrete choice experiment with more than 800 people with chronic knee pain. 

Participants compared two scenarios: in-person physiotherapy consultations and telerehabilitation delivered by videoconference. 

Most preferred in-person care but willingness to use telerehabilitation increased sharply when, in addition to no travel time, it offered shorter waiting, more communication with the physiotherapist and lower cost. 

Younger adults, women, people who aren’t working, those with less severe knee pain and those confident with videoconferencing were more likely to prefer telerehabilitation. 

While in-person care continues to be preferred, the potential market for telerehabilitation is substantial if it offers greater convenience and affordability. 

Breathing strategies for breathless lives 

Breathlessness is a frightening and limiting symptom for people with chronic lung disease, yet pulmonary rehabilitation programs that reduce dyspnoea remain underused. 

Makayla Pinna and colleagues from Perth reviewed non-pharmacological interventions other than exercise training for their effects on breathlessness, identifying 15 randomised trials across a variety of chronic lung diseases. 

They found promising evidence that simple breathing strategies—ie, pursed-lip breathing and breathing retraining—can reduce dyspnoea and improve quality of life. 

Inhaling I-menthol may provide immediate relief from the unpleasantness of breathlessness. 

These approaches appear safe, simple and low cost, suggesting that even small benefits may be worthwhile. 

Such strategies can make a tangible difference for patients struggling with daily breathlessness. 

Understanding and managing scoliosis 

For adolescents with spinal asymmetry and their families, the possibility that spinal curves will worsen during growth creates ongoing uncertainty and concern. 

Professor Arnold Wong and Tony Chiu from Hong Kong provide a comprehensive review of adolescent idiopathic scoliosis, covering epidemiology, natural history, assessment and physiotherapy management. 

They describe how scoliosis-specific exercise programs may help mitigate curve progression, while also supporting proprioception and muscle control. 

This review equips physiotherapists to deliver evidence-based care that addresses not only spinal alignment but also the fears and hopes of families living with this condition. 

Exercise for endometriosis-related pain 

Women with endometriosis often live with persistent pelvic and genital pain despite hormonal or surgical treatments. 

Rakel Gabrielsen and colleagues from Norway and Australia tested whether supervised exercise and pelvic floor muscle training could help. 

In their randomised trial, the intervention did not improve the worst pain experienced but it did reduce current pain and this benefit persisted at 12 months. 

Although effects on other symptoms such as dyspareunia and constipation were unclear, the study adds to the emerging evidence that exercise-based strategies may form an important part of multimodal management for people with endometriosis.

Behaviour change 

Beyond the individual papers, this issue also includes the largest article collection assembled in the Journal, focusing on behaviour change. 

These papers highlight the fact that even when physiotherapists know what interventions are effective, their impact depends on whether people are able—and willing—to adopt and sustain them. 

The collection showcases strategies ranging from digital prompts and health coaching to co-designed exercise programs, all with the common goal of bridging the gap between intention and action. 

By drawing together dozens of recent studies across many physiotherapy sub-disciplines, the collection reinforces that behaviour change is not a side issue but a central challenge in physiotherapy practice. 

It reminds us that evidence-based care only achieves its purpose when it is translated into meaningful, sustained changes in the lives of patients. 

Clinical Associate Professor Mark Elkins APAM is the scientific editor of Journal of Physiotherapy. Follow the Journal on X @JPhysiother and be sure to read the research at journal.physio 

Course of interest:  

• PEDro evidence-based physiotherapy practice level 3