Common Musculoskeletal Conditions Research Articles

A physiotherapist-led biopsychosocial education and exercise programme for patients with chronic low back pain in Ghana: a mixed-methods feasibility study

BackgroundLow back pain is a common musculoskeletal condition which causes substantial disability globally. The biopsychosocial model of management has been recommended in national and international guidelines for the management of patients with chronic low back pain (CLBP). However, biopsychosocial approaches are predominantly delivered in high income countries (HICs), although the prevalence of LBP is substantially higher in low- and middle-income countries (LMICs) especially in Africa (39%; 95% CI 30–47). Understanding the effectiveness of BPS interventions in LMICs especially in Africa is underexplored, with substantial inequity between research from HICs and LMICs. Ghana is a LMIC where the effectiveness of biopsychosocial interventions has been underexplored. Therefore, the aim of this study was to explore the feasibility of delivering a physiotherapist-led BPS programme for the management of patients with CLBP in Ghana.MethodsThis was a mixed-methods, sequential, pretest-posttest feasibility study. Participants involved thirty patients with CLBP. The biopsychosocial intervention involved an exercise and patient education programme based on principles of cognitive behavioural strategies with emphasis on self-management. The biopsychosocial intervention was delivered for six weeks for each participant. Feasibility outcomes regarding management and processes were captured pre-intervention, post-intervention, and three-months post intervention. Semi-structured interviews were conducted post-intervention to explore participants’ experiences with the biopsychosocial intervention. Patients’ demographics were collected at baseline. Patient reported outcome measures such as intensity of pain, disability, pain catastrophising, kinesiophobia, self-efficacy, and general quality of life, were collected pre-intervention, post-intervention and at three-months follow-up. Qualitative analysis explored participants’ experiences regarding the acceptability of the biopsychosocial intervention.ResultsThe results of this feasibility study demonstrated that the training programme was acceptable to physiotherapists. Recruitment rate (5 patient participants per week − 100% recruitment met), retention rate post-intervention (90%), data completion rate post-intervention (99.8%) and intervention fidelity (83.1%), all met feasibility thresholds. There were no adverse events. Qualitative data also demonstrated that the biopsychosocial intervention was acceptable to participants.ConclusionThis study has established the potential to deliver a biopsychosocial intervention programme in a Ghanaian hospital setting. This biopsychosocial intervention therefore shows promise, and the result of the study provides a platform to develop future clinical studies.

Enhancing Temporomandibular Disorders Education for Initial Care Clinicians Through Interprofessional Education.

Temporomandibular disorders (TMDs) are common musculoskeletal pain conditions that can significantly impact daily activities such as eating, talking, breathing, intimacy, and expressing emotion. TMDs are often complex and multifactorial, and many patients experience overlapping pain conditions, sleep difficulties, and mental health challenges. The National Academies of Sciences, Engineering and Medicine (NASEM) has called for improved TMD education and training for health professionals, as current training opportunities are limited. To prepare health professionals to care for patients who have a TMD, we designed a 5-hour, interactive, module-based curriculum aligned with the 2020 NASEM recommendations. The four-part module set addresses TMD physiology and pathophysiology, assessment, diagnosis, and management. Instructional methods are founded on the Cognitive Theory of Multimedia Learning and include engaging videos, clinical evaluation and education tools, and interactive digital simulation scenarios. Thirty learners from diverse health professional backgrounds (medicine, dentistry, physician assistant, nursing, physical therapy) participated. Multiple-choice question assessments and pre/post retrospective survey scores demonstrated enhanced knowledge (M = 2.9 vs. M = 4.2, p < .001) and perceived competence (M = 1.9 vs. M = 3.4, p < .001), respectively. Encouragingly, all participants indicated applicability to their clinical practice. Our modules offer educators and clinicians a valuable resource to improve TMD knowledge and facilitate best practices. Supplementary resources included in the curriculum are conducive to clinical implementation, fostering improved clinician assessment and patient education.

Machine learning insights into scapular stabilization for alleviating shoulder pain in college students

Non-specific shoulder pain is a common musculoskeletal condition, especially among college students, and it can have a negative impact on the patient’s life. Therapists have used scapular stabilization exercises (SSE) to enhance scapular control and mobility. This study investigates the prediction of the impact of scapular stability exercises in treating non-specific shoulder pain, leveraging advanced machine learning techniques for comprehensive evaluation and analysis. Using a diverse range of regression models, including Gamma Regressor, Tweedie Regressor, Poisson Regressor, and others, the study examines the relationship between the effectiveness of various exercises and their impact on shoulder pain management. Furthermore, the study employs optimization techniques, such as Hyperopt, scikit-optimize, optunity, GPyOpt, and Optuna, to fine-tune the exercise protocols for optimal outcomes. The results reveal that scapular stabilization exercises, when optimized using machine learning algorithms, significantly contribute to reducing shoulder pain in college students. Among the optimization techniques, scikit-optimize demonstrated the best performance, resulting in a mean squared error of 0.0085, a mean absolute error of 0.0712, and an impressive R2 score of 0.8501. This indicates that the scikit-optimize approach yielded the most accurate predictions and effectively captured the relationship between the exercises and shoulder pain management. The findings highlight the critical role of scapular stabilization exercise interventions in ameliorating non-specific shoulder pain and underscore the potential of machine learning techniques in optimizing therapeutic strategies for musculoskeletal health management. The utilization of scikit-optimize, in particular, showcases its effectiveness in fine-tuning the exercise protocols for optimal outcomes. The study’s results serve as a crucial stepping stone in developing personalized rehabilitation programs for non-specific shoulder pain, emphasizing the importance of integrating machine learning methodologies in the assessment and treatment of musculoskeletal disorders among college students.

Efficacy and safety of acupuncture treatment for stiff neck: A systematic review and meta-analysis.

Stiff neck is a common acute musculoskeletal condition that significantly affects the quality of life of patients. Acupuncture is recommended as an effective method for alleviating pain and restoring neck mobility in patients with stiff neck, but there is currently a lack of scientific evidence supporting its efficacy and safety. The purpose of this study was to investigate the efficacy and safety of acupuncture in the treatment of stiff neck. This study searched 8 Chinese and English electronic medical databases, including China Biology Medicine disc, VIP database, Wanfang Data, China National Knowledge Infrastructure, Web of Science, PubMed, Embase, and the Cochrane Library, with a search period up to May 13, 2024. The focus was on clinical randomized controlled trials evaluating acupuncture treatment for stiff neck. The primary outcome measures were the total effective rate and visual analog scale scores. The quality of evidence and methodology of the included studies were assessed according to the GRADEpro guidelines. Meta-analysis was conducted to assess the results, with heterogeneity analysis, sensitivity analysis, subgroup analysis, trial sequential analysis, and publication bias analysis performed to verify the robustness of the combined results and explore potential sources of heterogeneity. This study evaluated 10 clinical randomized controlled trials comparing acupuncture therapy with conventional treatment, involving 754 patients. The treatment group received acupuncture alone or in combination with conventional treatment, whereas the control group received only conventional treatment. The analysis results showed that the treatment group was significantly superior to the control group in improving the total effective rate (risk ratio = 1.12, 95% confidence interval [CI] [1.04, 1.21], P = .002), reducing visual analog scale scores (mean difference [MD] = -0.93, 95% CI [-1.29, -0.57], P < .001), reducing neck disability index scores (MD = -6.39, 95% CI [-6.79, -6.00], P < .001), and restoring cervical range of motion (cervical lateral flexion: MD = 4.29, 95% CI [3.15, 5.43], P < .001; cervical rotation: MD = 6.08, 95% CI [4.46, 7.70], P < .001). Acupuncture is an effective and safe method for treating stiff neck. However, to validate this conclusion, more rigorously designed and higher-quality studies are needed in the future.

Musculoskeletal mimics for lumbosacral radiculopathy. Part 1: Theoretical considerations.

The diagnosis of lumbosacral radiculopathy includes the exclusion of common musculoskeletal conditions that can cause similar symptoms. Neurology and physiatry physicians use history taking and physical examination findings to develop a differential diagnosis. Appropriate diagnostic testing is then utilized to narrow down this differential diagnosis to determine a working hypothesis of the cause of a patient's symptoms, leading to a treatment plan. There are stark limitations of patient symptoms and physical examination findings in making the diagnosis of lumbosacral radiculopathy and added value of a combination of symptoms and signs to distinguish patients with lumbosacral radiculopathy from patients with mimic disorders. Diagnostic tests have variable strengths and limitations in helping to confirm this diagnosis, contrasting the high sensitivity and lower specificity of magnetic resonance imaging (MRI) with the high specificity but lower sensitivity of electromyography (EMG). Further complexity is added to the task of making a diagnosis and setting a treatment plan by the fact that these disorders are common and interact with each other; they are present concomitantly in up to 25% of patients presenting for electrodiagnostic evaluation. A companion paper will review common musculoskeletal mimics of lumbosacral radiculopathy and provide tools to anchor testing for those conditions to the traditional neurological evaluation of lumbosacral radiculopathy.

Efficacy and tolerability of extracorporeal shock wave therapy in patients with plantar fasciopathy: a systematic review with meta-analysis and meta-regression.

Plantar fasciopathy (PF) is a common musculoskeletal condition characterized by heel pain and functional impairment. Extracorporeal shock wave therapy (ESWT) has gained increasing interest in the treatment of PF, but the optimal ESWT program is still debated. Therefore, this systematic review with meta-analysis and meta-regression aimed at providing a comprehensive assessment of the efficacy and tolerability of ESWT in PF management. Randomized controlled trials (RCTs) published until February 2023 were systematically searched on PubMed/MEDLINE, Scopus, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and PEDro. Studies assessing adult patients with PF treated with ESWT were considered. The primary outcome was the tolerability of ESWT, measured by treatment adherence, dropouts, and safety. Secondary outcomes were pain intensity and functional outcomes. Meta-analysis and meta-regression were performed to examine the relationship between ESWT program characteristics and treatment outcomes. The quality of included studies was assessed using the Jadad scale and the Cochrane risk-of-bias tool. Eleven studies met the inclusion criteria and were included in the analysis. Our findings showed that ESWT is effective in reducing pain intensity assessed by Visual Analogue Scale [focal-ESWT: -2.818 (SE 0.803, -4.393, -1.244; P< 0.0001; radial-ESWT: -3.038 (SE 0.428, -3.878, -2.199; P<0.001)]. Meta-regression analysis indicated a positive relationship between specific ESWT parameters (frequency, number of pulses, energy flux density and frequency, and number of pulses, pressure) and pain intensity (all P<0.05) and dropout (all P<0.05). ESWT seems to be an effective and tolerable treatment for PF, albeit the peculiarity of parameters might affect both the efficacy in pain relief and the adherence to the treatment. Physicians should consider individual patient characteristics when selecting the ESWT parameters for PF treatment. Further high-quality studies are warranted to establish the optimal ESWT protocol to treat PF.

Stem cell treatment for regeneration of the rotator cuff: study protocol for a prospective single-center randomized controlled trial (Lipo-cuff).

Rotator cuff tears (RCT) are a common musculoskeletal condition, especially in the aging population. The prevalence of rotator cuff tears varies based on factors like age, occupation, and activity level. In the general population, the prevalence of rotator cuff tears is estimated to be around 20 to 25%. Rotator cuff tears (RCT) have an impact in patients' pain level, shoulder function, sleep disturbance, and quality of life. Primary tendon surgery is in mostly cases necessary. This study aimed to examine if treatment of rotator cuff lesions with implantation of micro-fragmented adipose tissue can improve patients' reported pain and function compared to conventional surgery. The study is a prospective superiority parallel-group single-center randomized controlled trial including 30 patients between 40 and 69years of age in Denmark. Patients will be allocated 1:1 ratio to reconstruction of the supraspinatus tendon with an injection of micro-fragmented adipose tissue into the related muscle (stem cell treatment) or the standard of care (SOC), which is conventional surgery. Patients, project assistants, physicians, and outcome adjudicators are not blinded to randomization due to practical constraints. The radiologist and the statistician performing the analysis will be blinded. The primary outcome will be the Oxford shoulder score at 12months post-surgery. This study will assess whether adding micro-fragmented adipose tissue therapy to conventional rotator cuff tear treatment can enhance recovery, accelerate return to daily activities, and improve functional outcomes. The research will also determine if this minimally invasive procedure could be standardized for routine patient care. ClinicalTrials.gov NCT06505135. Registered on July 10, 2024.

Correlation of psychosocial factors with pain, posture, function, and disability in chronic mechanical neck pain patients: a cross-sectional study

BackgroundChronic neck pain is a common musculoskeletal condition that has an impact on the function and quality of life of an individual. Psychosocial factors along with the physical factors may have an impact on the perception of pain. Hence, the study aimed to find the correlation of psychosocial factors with pain, posture, function, and disability in chronic mechanical neck pain patients.MethodA cross-sectional study using a convenient sampling method was conducted in 55 chronic mechanical neck pain patients. The pain was assessed using numerical pain rating scale (NPRS), pain pressure threshold (PPT) using a pressure algometer, kinesiophobia using Tampa Scale for Kinesiophobia (TSK), pain catastrophizing using Pain Catastrophizing Scale, Posture analysis was done by various postural angle and flexicurve, cervical muscle endurance was tested using the craniocervical flexion test, cervical proprioception was measured using head repositioning accuracy test and Neck disability index was used to score disability.ResultA significant positive correlation was found between TSK and NDI (r = 0.34, p = 0.01). There is a negative correlation of PTT (right sternocleidomastoid) with Kinesiophobia (r = − 0.35, p = 0.008). There is a moderate positive correlation between posture (shoulder angle on the left side) and TSK (r = 0.3, p = 0.02).ConclusionThe study concludes that psychosocial factors not only have a significant role but are correlated to pain, posture, function, and disability in patients with chronic mechanical neck pain.

The Effect of TENS and Ultrasound Diathermy on Osteoarthritis Patients in Physical Medicine and Rehabilitation Unit of Patut Patuh Patju Hospital, West Nusa Tenggara

Osteoarthritis is generally recognized as a common musculoskeletal condition in Indonesia, characterized by the degeneration of joint cartilage and narrowing of the joint space. The form of therapy that can be given to knee OA patients is a combination of TENS therapy and ultrasound diathermy (USD). WOMAC is an index used to measure osteoarthritis patiens based on pain, stiffness, and physical function. Patut Patuh Patju General Hospital is the only hospital in West Lombok district where physical medicine and medical rehabilitation have recently been introduced. This research aims to determine the effects of administering TENS and ultra sound diathermy on OA patients in the physical medicine and rehabilitation unit of Patut Patuh Patju Hospital, a newly established district hospital in NTB, which has been operational for the past year. This type of research uses a pre-experimental design with a one group pretest-posttest method. Sampling was taken using a purposive sampling technique with a total sample of 30. The research population was knee osteoartritis patients undergoing physiotherapy treatment at the Medical Rehabilitation Unit of Patut Patuh Patju General Hospital. Data was collected using the WOMAC questionnaire before and after 6 until 8 times therapy. The distribution of research data was analyzed using the Shapiro-Wilk test. If the data distribution is normal, it is analyzed using the paired t-test, whereas if it is not normal, it is analyzed using the Wilcoxon test. The combination of TENS therapy and ultra sound diathermy results in improvement of WOMAC scores in knee osteoarthritis patients with p-value = 0.000 (p &lt; 0.05).

Duration, Cost, and Escalation of Care Events for Physical Therapy Management of Low Back Pain in Service Members With Limb Loss.

Physical therapy (PT) is recommended as a primary treatment for low back pain (LBP), a common and impactful musculoskeletal condition after limb loss. The purpose of this brief report is to report the duration and cost of PT care, and subsequent escalation of care events, for LBP in service members with and without limb loss. This was a retrospective cohort, descriptive study. Service members with and without limb loss (matched) who received PT for LBP at a military treatment facility from 2015 to 2017 were included. Duration of PT care, number of PT visits, and escalation of care events 1 year after PT were extracted from medical records. Escalation of care events was identified as epidural steroid injections, referrals to specialists (e.g., orthopedists, spine surgeons, and pain management), and LBP-related hospitalizations.LBP-related PT encounters were queried; duration of care, number of visits, and cost of care were quantified. Escalation of care events, including opioid prescription, epidural steroid injections, specialty referrals, and hospitalizations, were identified up to 1 year after PT care. The average course of PT care for LBP was 12.9 more visits, 48.7 days longer, and $764.50 more expensive in service members with limb loss (n = 16) vs. those without limb loss (n = 48). Higher rates of opioid prescriptions and specialty referrals were observed in service members with limb loss. This study suggests that service members with limb loss and LBP received higher quantities and longer durations of PT than those without limb loss, yielding a nearly 4 times higher cost of PT.

An exploratory data-driven approach to classify subgroups of patients with temporomandibular disorders based on pain mechanisms

Temporomandibular disorders (TMDs) are a common musculoskeletal condition, presenting treatment challenges due to their non-specific nature. Categorizing patients with TMDs into clusters based on neurobiological pain mechanisms could provide a promising approach to facilitate targeted treatments. This observational study (1) used a network analysis (NA) to explore the complexity of TMDs by investigating relationships among biopsychosocial variables, and (2) validated potential TMD subgroups based on mechanism-specific pain categories. One hundred and two patients with TMD were included. Biopsychosocial variables covered: general health, psychosocial features, TMD pain, and TMD characteristics. A NA evaluated the associations between variables and determined the role of each feature within the network. Hierarchical clustering was used to identify TMD subgroups. The NA revealed significant correlations primarily within the same feature domains, indicating a strong interplay between symptoms and psychological factors. Cluster analysis identified two subgroups driven by nociceptive and nociplastic pain mechanisms; the nociplastic group exhibited higher levels of anxiety, depression, pain catastrophization, central sensitization, pain duration, and more pain locations, along with poorer sleep quality, quality of life, and health status. In contrast, the nociceptive group exhibited restricted maximal mouth opening (MMO), heightened pain during TMJ palpation and mouth opening, and a greater positive response to manual therapy. Across all features, psychological factors, pain locations, and MMO primarily contributed to the separation of subgroups. By adopting a data-driven approach, these results support the significant role of considering the neurobiological basis of pain to improve patient classification. This knowledge may facilitate clinical reasoning and personalized treatments. PerspectiveThis study used a network analysis to explore the complex biopsychosocial interactions present in people with TMDs, identifying important variables such as the Central Sensitization Inventory and pain-free maximal mouth opening. The findings distinguish potential nociceptive and nociplastic pain subgroups, offering important insights for targeted therapeutic strategies.

Effect of Pediatric Physical Therapy Interventions on Congenital Muscular Torticollis: A Systematic Review.

This review explores the current pediatric physiotherapy approaches for treating infants with congenital muscular torticollis (CMT). CMT is a common musculoskeletal condition characterized by an unequal position of the neck due to unilateral shortening of the sternocleidomastoid muscle. Our comprehensive literature search assessed articles published between 2014 and March 2024. The review emphasizes various pediatric physical therapy interventions, such as manual therapy, stretching, soft tissue mobilization techniques, kinesio taping, and microcurrent therapy, along with parental education. The effectiveness of these interventions was assessed in terms of improving the cervical range of motion, reducing muscle tightness, correcting head posture, and improving functional outcomes in infants with CMT. The review underlines the need for early diagnosis and prompt initiation of physiotherapy interventions in order to improve treatment outcomes and reduce long-term musculoskeletal complications associated with CMT. Future research directions are also highlighted to improve our understanding and treatment of this common pediatric condition.

Patient acceptance of care of a novel care pathway for those at risk of poor outcomes from musculoskeletal pain: A mixed methods study

ObjectiveInvestigate people's acceptance of specialist musculoskeletal care within a new care pathway for common musculoskeletal conditions (low back pain, neck pain/whiplash, knee osteoarthritis). DesignConvergent parallel mixed methods design referencing the Theoretical Framework of Acceptability. The study included a subset of participants (n = 29) at-risk of poor outcomes from the intervention arm of the PAthway of CarE for common musculoskeletal conditions (PACE-MSK) trial. In the PACE-MSK arm, participants received specialist physiotherapist care as an adjunct to the care provided by their primary healthcare professional(s). One-to-one semi-structured interviews were conducted around 3-months after commencing in the trial. Quantitative data were collected at baseline and 3-month follow-up (health-related quality of life, pain self-efficacy, global perceived change, satisfaction). ResultsFive themes were identified (Expectations and beliefs shaped patient experience; Clinical expertise and competence influence acceptance; Person-centred care; Mechanisms facilitating beneficial responses to care; Gaps in care pathway implementation). There were positive individual changes in physical quality of life for 17/29 (59%) participants, mental health quality of life for 12/29 (41%), pain self-efficacy for 8/29 (28%) and global perceived change for 19/29 (66%). Management met expectations with the majority reporting high levels of satisfaction. Integrating the qualitative and quantitative data with the Theoretical Framework of Acceptability, there were complementary meta-inferences in the constructs of ‘ethicality’, ‘intervention coherence’, ‘self-efficacy’ and ‘affective attitude’. Divergence was identified in ‘perceived effectiveness’. DiscussionIn general, there was positive acceptance of the care pathway by participants. Specialist physiotherapists’ care was perceived as a positive addition to usual care.

Prevalence and Predictors of Carpal Tunnel Syndrome Symptoms Among Teachers in Jazan: A Cross-Sectional Study.

Background Carpal tunnel syndrome (CTS) is a common musculoskeletal condition of the hand and wrist frequently associated with repetitive hand motion and environmental considerations. Teachers are more likely to acquire CTS because of their lengthy writing and computer use. This study aimed to determine the prevalence of CTS symptoms and related variables among schoolteachers in Jazan, Saudi Arabia. Methods This study was conducted as a cross-sectional survey of teachers in Jazan, utilizing an online platform for data collection. The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) was the primary tool used to determine symptom intensity and functional status. The data were rigorously analyzed using a range of statistical methods, including descriptive statistics, the Mann-Whitney U test, the Kruskal-Wallis test, Spearman's correlation, the chi-square test, Fisher's exact test, and binary logistic regression, ensuring the robustness of the findings. Results The study comprised 336 schoolteachers with a mean age of 43.3 ± 6.5 years, of whom 58.0% were female and 42.0% were male. About 8.0% of instructors reported CTS symptoms. Female gender (median Symptom Severity Scale (SSS): 15.0 vs. 12.0, p < 0.001; median Functional Status Scale (FSS): 8.0 vs. 8.0, p < 0.001), increased time spent writing (r = 0.237, p < 0.001 for SSS; r = 0.217,p < 0.001 for FSS), and presence of comorbidities such as diabetes (median SSS: 16.0, p = 0.002; median FSS: 8.0, p = 0.001) had a negative correlation with symptom severity (r = -0.174, p = 0.002) and functional impairment (r = -0.141, p = 0.011). Surgical therapy (median SSS: 32.0; median FSS: 24.0; p<0.001) and post-treatment symptom recurrence (median SSS: 28.0; median FSS: 22.0; p<0.001) were associated with increased severity and disability. According to binary logistic regression, increased writing time significantly predicted CTS diagnosis (OR = 1.151, 95% CI: 1.024-1.295, p = 0.018). Conclusion CTS symptoms are common among Jazan teachers, and various sociodemographic, vocational, and clinical variables influence their intensity and functional status. Ergonomic treatment, early identification, and suitable management measures are critical for preventing and mitigating the effects of CTS among teachers. Additional research is required to develop focused therapies and enhance the results of this occupational group.

Contemporary treatments for mid-substance achilles tendinopathy: a review

Mid-substance Achilles tendinopathy is primarily a degenerative condition that frequently affects quality of life, especially for patients wanting to continue a high level of activity. It can differ from insertional Achilles tendinopathy both in terms of its epidemiology as well as its management strategies. Currently, numerous treatment options exist in the literature for this fairly common musculoskeletal condition. However, many of these treatments remain experimental with no substantial evidence for efficacy. A number of these options, including regenerative and biologic medicines, have nonetheless demonstrated improvements in patient-reported outcomes and promising potential. As such, there remains no standard approach for management beyond stretching/exercise therapy. This article reviewed the current literature surrounding treatment options and provided summaries and recommendations of eight treatment modalities for this condition. It is intended to serve as a general review as well as an objective evaluation of recent evidence that may provide some guidance for healthcare providers when discussing treatment options with patients.

Musculoskeletal Disorder (MSD) Health Data Collection, Personalized Management and Exchange Using Fast Healthcare Interoperability Resources (FHIR).

With the proliferation and growing complexity of healthcare systems emerges the challenge of implementing scalable and interoperable solutions to seamlessly integrate heterogenous data from sources such as wearables, electronic health records, and patient reports that can provide a comprehensive and personalized view of the patient's health. Lack of standardization hinders the coordination between systems and stakeholders, impacting continuity of care and patient outcomes. Common musculoskeletal conditions affect people of all ages and can have a significant impact on quality of life. With physical activity and rehabilitation, these conditions can be mitigated, promoting recovery and preventing recurrence. Proper management of patient data allows for clinical decision support, facilitating personalized interventions and a patient-centered approach. Fast Healthcare Interoperability Resources (FHIR) is a widely adopted standard that defines healthcare concepts with the objective of easing information exchange and enabling interoperability throughout the healthcare sector, reducing implementation complexity without losing information integrity. This article explores the literature that reviews the contemporary role of FHIR, approaching its functioning, benefits, and challenges, and presents a methodology for structuring several types of health and wellbeing data, that can be routinely collected as observations and then encapsulated in FHIR resources, to ensure interoperability across systems. These were developed considering health industry standard guidelines, technological specifications, and using the experience gained from the implementation in various study cases, within European health-related research projects, to assess its effectiveness in the exchange of patient data in existing healthcare systems towards improving musculoskeletal disorders (MSDs).

A Treatment Protocol for Achilles Tendinopathy with Extracorporeal Shockwave Therapy.

Achilles tendinopathy is a common musculoskeletal condition characterized by pain, lower muscle strength, gait abnormality, and reduced quality of life. There are two categories of Achilles tendinopathy: insertional Achilles tendinopathy and mid-portion Achilles tendinopathy. Currently, mechanical loading programs are considered the standard of care for the population with Achilles tendinopathy. Extracorporeal shockwave therapy (ESWT) is considered a secondary conservative treatment for tendinopathy as it is effective and safe. It can be used either as a monotherapy or as part of a multimodal treatment plan. ESWT has been extensively studied in orthopedics, where it was shown to intensify fracture healing and successfully treat overuse conditions of tendons and fascia. It is believed that shockwaves have both mechanical and cellular effects that ultimately result in the repair of damaged tendinous tissue and improved function of the Achilles tendon. However, there is a lack of consistency in the literature surrounding the effectiveness, especially the protocols. Therefore, we enrolled 36 patients with a diagnosis of Achilles tendinopathy, using radial ESWT (0.48 mJ/mm2, 2,000 shockwaves, 10 Hz, 1.6bars, 2 sessions once a week). Freedom from pain was experienced by 16.7% of these participants, and there was a significant decrease in pain in all of them.

Effectiveness of a physiotherapy self-management programme for adult patients with chronic non-specific low back pain in low- and middle-income countries: protocol for a systematic review and meta-analysis

IntroductionChronic non-specific low back pain (CNLBP) is among the most common musculoskeletal system conditions reported worldwide; however, few studies are available from low- and middle-income countries (LMICs). Self-management is a...

Individualized Cognitive Functional Therapy Compared with Conservative Treatment for Patients with Chronic Neck Pain-Study Protocol for a Single Blind Pragmatic Randomized Controlled Trial.

Chronic neck pain (CNP) is one of the most common musculoskeletal conditions, is considered the second leading cause of pain, and is among the leading causes of disability. Cognitive Functional Therapy (CFT) is a novel behavioral therapy for individualizing the management of spinal pain targeting the multidimensional aspect of musculoskeletal pain. This study outlines the protocol for an assessor-blind randomized controlled trial (RCT) designed to compare an individualized Cognitive Functional Therapy (CFT) intervention with usual care in terms of pain and disability. Aiming for a pragmatic intervention, the CFT group will receive 16 sessions based on patient's condition characteristics, and clinical presentation and progression. The control group will receive 16 sessions of standardized usual care (electrotherapy, massage, posture exercise, and educations). Both groups will have the same intervention duration. Patients will be randomly allocated into groups and will be assessed at baseline, at the 8th session, at the 16th session, and 3 months after randomization. Primary outcomes will be pain, disability, cervical range of motion, and neck muscle isometric strength. To our knowledge, this study will be the first RCT to compare the clinical effectiveness of CFT compared to UC for adults with CNP. The study results will provide information about the use of CFT in clinical practice.

Effects of Intramuscular Electrical Stimulation for Treatment of Non-Traumatic Shoulder Pain

Non-traumatic shoulder pain is the third most common cause of consultations for musculoskeletal pain in primary health care. It is one of the common musculoskeletal conditions of the shoulder which may develop sensory-motor and autonomic dysfunctions at the various level of the neuromuscular system. The objective of the study to find out the Effects of Intramuscular Electrical Stimulation for Treatment of Non-Traumatic Shoulder Pain. The pain and dysfunction caused by NSP were primarily treated with physical therapy and pharmacological agents in order to achieve pain free movements. However, in recent years intramuscular electrical stimulation (IMES) with conventional electrode placement was used by researchers to maximize therapeutic values. But, in this study an inverse electrode placement was used to deliver electrical impulses intramuscularly to achieve neuro-modulation at the various level of the nervous system. Nine patients with NSP were treated with intramuscular electrode stimulation using inversely placed electrodes for a period of three weeks. All nine subjects recovered from their shoulder pain and disability within the few weeks of intervention. So, this IMES may be more appropriate for treatment approach for Non traumatic shoulder pain management.