Musculoskeletal Disorders Research Articles

Passive shoulder occupational exoskeleton reduces shoulder muscle coactivation in repetitive arm movements.

Humans naturally employ muscle coactivation to facilitate a broad range of movements, enhancing joint stability and movement accuracy. However, excessive muscle coactivation can become unfavorable or even detrimental. This phenomenon is often observed in industrial workers who endure repetitive or prolonged joint stress, particularly in areas such as the shoulders. Prolonged stress can result in soft tissue damage and the onset of work-related musculoskeletal disorders (MSDs). In recent years, there have been efforts to mitigate the emergence of work-related MSDs among industrial workers through the implementation of upper-limb occupational exoskeletons (OEs). While previous research has demonstrated their effectiveness in reducing shoulder muscle activation, particularly in static and overhead work activities, there has been a lack of studies examining the impact of upper-limb OEs on muscle coactivation during repetitive arm movements. To bridge this gap in knowledge, our study systematically assesses the influence of a passive exoskeleton's anti-gravitational support on shoulder muscle coactivation during repetitive arm movements. Results show that peak and mean coactivation levels linearly decrease with the increase of the amount of anti-gravitational support provided by the upper-limb OE, reaching approximately 51% and 54%, respectively. Conversely, the percentage of the movement cycle corresponding to the coactivation peak appears unaffected by the level of assistance. This study marks the first instance in which a passive upper-limb OE has been shown to reduce shoulder muscle coactivations, potentially paving the way for a novel methodology in their evaluation.

Religiously Integrated Forgiveness Therapy: A Psychotherapeutic Tool for Depression and Pain Among Pakistani Patients with Chronic Widespread Pain.

Individuals experiencing chronic widespread musculoskeletal pain (CWP) frequently have comorbid depression. The presence of depression and pain-related outcomes in these patients are found to be positively correlated with inability to forgive or let go of interpersonal hurts and maltreatments. So for these patients, the current study aimed to apply a religiously integrated forgiveness intervention and to find out its efficacy in lessening depression and pain. The first part of research consisted of developing a religiously integrated forgiveness intervention by incorporating Islamic principles in Enright's process model of forgiveness. The other half was a randomized-control design where Depression Subscale of Depression Anxiety Stress Scale Urdu version as reported by Zafar (Urdu translations of the DASS, 2014) and Heartland Forgiveness Scale Urdu version (Butt in Interdiscip J Contemp Res Bus 4:769-792, 2012) were applied on a total of 272 adults (122 male and 150 female). After screening, 60 individuals (18 males and 39 females) were selected on the basis of high and low score on depression and forgiveness scales, respectively. Their ages ranged from 26 to 45years. Selected individuals were randomly assigned to be a part of either treatment or control group. Religiously integrated forgiveness therapy (RIFT) was applied on 30 individuals in comparison to the 30 participants from control group. Results indicated that in comparison with control group, from pretest to posttest participants in forgiveness intervention group scored lower on depression as well as pain and scored higher on forgiveness (p>.001). It was found that the religiously integrated model of forgiveness therapy was efficacious in enhancing forgiveness and in reducing depression among individuals with chronic widespread musculoskeletal pain.

A combined approach of design for Six Sigma, generic product development process and ergonomics-safety philosophy to reduce musculoskeletal disorder problems

Purpose The purpose of this paper is to decrease musculoskeletal disorder (MSD) problems using a combined approach including design for Six Sigma, generic product development process, and ergonomic-safety philosophies. Design/methodology/approach A total of 550 students voluntarily participated in this study. Kolmogorov–Smirnov and t-tests were used to analyze the collected anthropometry. A cause-and-effect diagram, Pareto’s chart, a brainstorming session, and a priority matrix were also used to extract the 22 design parameters of the product. Moreover, Cronbach’s alpha values were determined to verify the validity of qualitative and quantitative data. Findings Results showed that students are at a high risk of developing MSD issues. The most serious MSD problems among the students were neck pain (74%), back pain (73%), muscle and joint pain (67%), knee pain (57%), leg pain (54%), etc. Besides, all anthropometrics of males are higher than females except Hip Breadth. Among 12 anthropometries, two measurements and one measurement showed statistical significance at p < 0.01 and p < 0.05, respectively. Six design parameters of the mounted desktop (Seat Height, Desk Height, Seat to Desk Clearance, Seat Width, Seat Depth, and Backrest Height) are the most crucial design parameters to design and develop the product. Practical implications The proposed design of the mounted desktop can be used in different tertiary educational institutes to reduce MSDs among students. Originality/value To the best of the authors’ knowledge, this is the first attempt that introduces a combined approach to reduce MSD issues by applying Six Sigma, a generic product development process, and ergonomics-safety philosophy to design and measurement of 22 design parameters of mounted desktop for university students.

HEALTH IN THE WORKPLACE: POSTURE, ERGONOMICS AND MUSCULAR DISORDERS

Objective: The study aimed to map the epidemiological profile of chronic musculoskeletal disorders and the ergonomic risks of body posture in the office environment. Methods: Data were collected using an electronic form consisting of sociodemographic questions and adapted versions of the Nordic Musculoskeletal Symptom and Rapid Office Strain Assessment questionnaires. Results: The mean age of the 73 participants in the extension project was 25.3 years and most had higher education. Of these, 86.3% felt pain, numbness or tingling in the last 12 months and of these, 90.5% had more than one body part affected by the symptoms. Of the thirteen body postures evaluated (sitting, leaning, position of the knees, feet, elbows, forearms and head), all were identified as ergonomically inadequate, especially those related to the chair used. Conclusion: There is a clear need for immediate health care actions for this population, since the office environments were not ergonomically adequate and the workers were already ill. Ergonomic intervention and health education actions are essential to guide the risks of this environment and propose behavioral changes to reduce/prevent musculoskeletal disorders. A limitation of the study may be that the sample was affected by the healthy worker effect, that is, those who were already affected by chronic musculoskeletal disorders were interested in participating in the project.

Redesign of work facilities at the tofu pressing station with a participatory ergonomic approach

Tahu Palda is a small and medium-sized micro business in the food industry that produces tofu. This factory has been producing tofu since 2005, located in North Aceh. The workers in this tofu usually five workers, with an average of 7 working hours per day. Based on the observations at several workstations, initial data indicate that the dominant work posture is standing, bending, and lifting heavy loads such as a 20 kg weight for pressing and lifting a mold holder with a 15 kg load. This is done continuously for 7 working hours each day. Based on the results of the distribution of the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ), it was found that workers at the station experience complaints such as back pain, lower back pain, and upper arm pain due to the high frequency of lifting heavy loads. If this continues to be neglected, it can lead to work-related diseases such as musculoskeletal disorders. The assessment of workers' posture using the Rapid Entire Body Assessment (REBA) method shows that the score obtained for the job of pouring soybean paste is 7, which means a moderate risk, the job of lifting the press weight is 5, which means a moderate risk, and the job of flipping molds has a score of 10, which falls into the high-risk category and needs improvement. Improvements were made using a participatory ergonomics approach, resulting in the decision to redesign the tofu press tool to fit the workers' body anthropometry. The anthropometric calculations for the height range of the press support tool and cutting tool are 141.1 cm, the press support range is 68.78 cm, the width of the press tool is 49.4 cm, the height of the tray is 4.54 cm, and the height of the tray holder is 103.85 cm.

Abstract 4145822: The Enigma of Chest Pain: Rare Presentation of ALCAPA Syndrome in a Young Adult

Introduction: Anomalous Left Coronary Artery Arising from the Pulmonary Artery (ALCAPA), also known as Bland-White-Garland syndrome, is a rare congenital anomaly(incidence:1 in 300,000 live births) typically presenting during infancy. Adult presentations are even rarer due to a high mortality rate of nearly 90% in the first year of life without surgical intervention. This report examines an adult patient with exercise-induced chest pain who received a delayed diagnosis of ALCAPA via multimodal imaging. Case Summary: A 21-year-old male presented to the emergency department(ED) with severe retrosternal chest pain radiating to both shoulders and arms, which began during exercise 30 minutes prior. He had a history of similar, milder episodes during exercise, previously treated as musculoskeletal pain and gastroesophageal reflux disease in the ED. His medical, social, and family histories were unremarkable. Physical examination revealed a soft, continuous murmur along the left sternal border. During this visit, An EKG done showed sinus tachycardia at 110 bpm and deep T-wave inversions in the anterolateral leads, a dynamic ST-T changes from his baseline.Serial Cardiac biomarkers and a lipid profile were within normal ranges. Initially managed for acute coronary syndrome-unstable angina with antithrombotic therapy, beta-blockers, and nitrates, he underwent urgent coronary angiography. This revealed a dilated right coronary artery (RCA) with retrograde flow to the left coronary artery (LCA) into the main pulmonary artery (PA) via collaterals, with no evidence of atherosclerosis (Figure 1).Echocardiography (Figure 2) and coronary CT angiography (Figure 3) confirmed the diagnosis of ALCAPA. The patient underwent successful surgical repair with aortic reimplantation of the LCA and was discharged in good health. Discussion: In adult ALCAPA patients, good collateral circulation may develop; however, myocardial ischemia can occur due to the "coronary steal phenomenon" and poor collateral flow regulation, leading to angina, arrhythmias, and sudden cardiac death. ALCAPA should be considered a differential diagnosis in adults presenting with exercise intolerance, as most sudden cardiac death cases occur by the fourth decade. A high index of clinical suspicion and a multimodality imaging approach is essential for the early diagnosis of this rare coronary anomaly, underscoring the critical role of early surgical intervention in preventing catastrophic, life-threatening events.

Depression and the risk of fibromyalgia syndrome: a two-sample Mendelian randomization study

BackgroundFibromyalgia (FM) is a common illness with a wide range of symptoms, mainly manifested by unexplained chronic systemic musculoskeletal pain, sleep disorders and fatigue, sometimes accompanied by cognitive impairment, psychiatric symptoms and autonomic dysfunction. Previous studies have indicated a correlation between depression and the risk of FM; however, it remains uncertain whether this association reflects a causal relationship.MethodsWe evaluated the etiological association between the genetically predicted depression and the risk of developing FM by conducting a two-sample Mendelian Randomization (MR) study. The data on single nucleotide polymorphisms (SNPs) related to depression were obtained from the UK Biobank (UKB) and the Psychiatric Genomics Consortium (PGC) of White British European ancestry, and the data for FM were from the 5th release of the FinnGen study. We adopted the Inverse Variance Weighted (IVW) approach as the principal standard. In order to detect the existence of horizontal pleiotropy and heterogeneity, we adopted the MR-Egger approach as the sensitivity analysis.ResultsIn our MR analysis, 42 depression-related variants were identified as valid instrumental variables (IVs). The IVW approach’s results manifest that there is no etiologic causality between genetically predicted depression and the risk of FM (odds ratio [OR]: 1.673, 95% confidence interval [CI]: 0.852—3.287, P = 0.135). The study did not find any significant heterogeneities or horizontal pleiotropies (P > 0.05).ConclusionsOur results suggest that there is no significant genetic evidence linking depression to an increased risk of FM. However, further research is necessary to investigate the potential relationship and underlying mechanisms between depression and the risk of FM.

IMPACTOS DA FISIOTERAPIA NA REDUÇÃO DAS DORES MUSCULOESQUELÉTICAS EM MULHERES ADULTAS COM LOMBALGIA, UMA REVISÃO DE LITERATURA

Introduction: Low back pain is defined as one of the leading causes of disability in adult women, primarily affecting functionality and well-being. Physiotherapy aims to provide comfort and improve quality of life through strategies that seek to minimize the discomfort caused by this condition. This paper analyzes and presents physiotherapy techniques for reducing musculoskeletal pain in adult women with low back pain. Objective: The objective was to identify the most effective approaches for symptom relief and functional rehabilitation of these patients. Methodology: The structure is a literature review, composed of articles published between 2018 and 2024 from databases such as PubMed, BVS, Lilacs, and Scielo. Descriptors in both Portuguese and English were used according to DeCS/MeSH (Health Sciences Descriptors). Keywords were applied with filters for language (Portuguese and English), publication year (2018-2024), article type (clinical trial, observational study), and full-text availability. Results: The search highlighted the results of physiotherapy, particularly through specific stability exercises and pain neuroscience education. These interventions significantly reduced pain and improved the quality of life in women with low back pain, as the overall prevalence of low back pain was notably higher in women compared to men. Discussion: Various techniques were examined to evaluate the main evidence on the impacts of physiotherapy in reducing musculoskeletal pain in adult women with low back pain. There was some complexity in finding evidence that specifically addressed the topic. Conclusion: Physiotherapists are trained to rehabilitate and prevent, playing a crucial role in pain reduction, functional improvement, and improving lives. They hold an essential and indispensable role in this context.

MiR203a-3p as a potential biomarker for synovial pathology associated with osteoarthritis: a pilot study.

Osteoarthritis (OA) is a degenerative musculoskeletal disease that significantly impacts the quality of life. Currently, no validated biomarkers for early detection of OA are defined. The possibility of discovering OA biomarkers is the focus of this study. Human primary OA synovial cells (SVs), isolated from discarded joint tissue of patients with Kellgren & Lawrence score (KL) < 3, (mild/moderate) and KL ≥ 3 (severe), were characterized by FACS analysis. Through qRT-PCR and ELISA assays the inflammation, fibrosis status and the different miRNAs expression has been investigated. The role of miR-203a-3p and its precursors were evaluated through gain and loss of function study, IL-1β synoviocytes treatments and methylation analysis of miR203a promoter. The qRT-PCR analysis of miR203a-3p and pre-miR203a on plasma (isolated 24h before surgery, 3days and 1month after surgery) and synovial fluid (recovered during the surgery) were done to support our in vitro data. MiR203a-3p expression is inversely correlated with the aggressiveness of OA, modulating the expression of epithelial to mesenchymal transition (EMT) and pro-inflammatory factors, as well as regulating the expression of secreted protein acidic and rich in cysteine (SPARC) mRNA. Methylation analysis of the miR203a promoter and SVs IL-1β treatment's highlighted the impact of inflammation on miR203a-3p and pre-miR203a expression; as confirmed by both miRNAs detection in biological fluids derived from patients with severe OA. Our preliminary results suggest that miR-203a-3p might be a potential candidate for staging OA progression and a new protective/predictive biomarker for synovial OA degeneration. Further studies are needed to validate its potential impact on OA.

INNV-03. BEYOND ANALGESICS: PHOTOBIOMODULATION THERAPY AS A PARADIGM SHIFT IN PAIN MANAGEMENT

Abstract BACKGROUND Pain constitutes a primary cause of medical care demand and disability among patients. The predominant method employed for pain management entails analgesic administration. Nonetheless, prolonged use of analgesics may lead to adverse effects, including cardiovascular and gastrointestinal complications. Photobiomodulation therapy (PBMT) emerges as a novel approach to pain treatment, demonstrating effective pain reduction and anti-inflammatory properties. This systematic review aims to elucidate the impacts of PBMT on pain modulation and assess its potential for widespread application. METHODS A systematic review was conducted utilizing Boolean operators combining terms such as “Photobiomodulation” AND “Pain Management”; “Photobiomodulation therapy” AND “pain”; “PBMT” AND “Pain”. Electronic databases including Cochrane Library, PubMed, and Scopus were searched. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Statement. RESULTS The systematic review revealed that PBMT is a non-invasive, safe, and cost-effective technique for pain management. It has demonstrated efficacy across various conditions, encompassing neurological and musculoskeletal disorders. PBMT can complement existing interventions such as exercise programs, transcutaneous electrical nerve stimulation (TENS), or surgical procedures. However, further research with long-term follow-up is warranted to validate these findings. CONCLUSIONS PBMT emerges as a promising modality for pain management, offering a non-invasive alternative with favorable safety profiles. Its efficacy in diverse conditions underscores its potential utility as an adjunctive or standalone treatment option. Nonetheless, additional studies with extended follow-up periods are necessary to confirm and further elucidate its therapeutic benefits.

Improving diets and multimorbidity prevention.

In 2023, the UK government announced a Major Conditions Strategy, publishing 'The case for change and our strategic framework', which set out the focus on cancers, diabetes, dementia, mental ill health, musculoskeletal disorders, CVD and chronic respiratory diseases. Together, these conditions account for 60% of total disability-adjusted life years lost to early death or ill health in England, and one in four adults has at least two (multimorbidity). This review considers some of the key dietary risks for these major conditions and population policies that may improve diets and reduce risks. UK Government dietary recommendations, based on independent risk assessment and advice from the Scientific Advisory Committee on Nutrition, are encapsulated in the national food model, the Eatwell Guide. Based on key sources of dietary data - chiefly consumption data from the National Diet and Nutrition Survey and consumer purchase data from Kantar - most people do not meet dietary recommendations. This review considers how science and evidence inform health improvement policy. This includes policies that encourage healthier food choices, such as labelling and public procurement standards to those that minimise the impact of the less healthy choice such as sugar and salt reduction and reformulation. The review also considers nutritional approaches to managing some non-communicable diseases. Given the role nutrition and excess weight play in the onset, prognosis and quality of life for those living with one or more of the major conditions, there are huge potential gains from even small dietary improvements across population groups.

Co-occurrence of occupational outcomes and associated factors among hospitals cleaners, eastern ethiopia: a cross sectional study.

Hospital cleaners face a complex and varied work environment due to several potentially dangerous circumstances, including the risk of getting injured by sharp objects and being subjected to various ergonomic and physical risks. They thus acquire a combination or co-occurrence of outcomes associated to their line of work. In this study it stands for occurrence of occupational injuries and musculoskeletal disorders (MSDs) during study period, which has not been explored in developing countries like Ethiopia, particularly among hospital cleaners. To assess the prevalence of co-occurrence of occupational outcomes and associated factors among hospital cleaners, Eastern Ethiopia. A cross sectional study was conducted on 741 cleaners in eight hospitals in eastern Ethiopia from May, 2023 to 30th August, 2023. Face-to-face interview was conducted. The data quality was maintained by designing standard questions that preserved both external and internal validity. The entered data was exported from Epi-Data 3.1 to Stata 17MP. Descriptive statistic was used to characterize one variable, While, binary logistic regression was used to explore the relationship of the predictors. At binary analysis variables having a p-value of < 0.20 were candidates for multivariate logistic regression. The crude odds ratio and adjusted odds ratio (AOR) with a 95% confidence interval (CI) were presented. Those variables having < 0.05 were reported. The variance inflation factor used to test multicollinearity. While, Hosmer-Lemeshow goodness-of-fit-test was applied for model fit. From total of 741 hospital cleaners, 679 (91.63%) of them were responded. The prevalence co-occurrence of occupational outcome among cleaners was 25.04% (95%CI: 21.82, 28.47). The multivariate logistic regression shows that those had workload (AOR:2.78, 95%CI: 1.25,6.17), those worked more than 8r/day (AOR:3.45, 95%CI:2.34,6.32), those have sleeping disorders (AOR: 4.61,95%CI: 2.89, 8.03), those had work stress (AOR:2.05, 95%CI:0.98,4.29), those highly exposed with hazards (AOR: 4.22, 95%CI:2.40, 7.45) and those had poor knowledge of risk (AOR:2.41, 95%CI:1.06, 5.50) were more likely increase the odds of co-occurrence of occupational outcome as compared to their counterparts. The current study concluded that one-fourth of the co-occurrence of occupational outcomes was reported among hospital cleaners. The study also found that lack of supervision, workload, working more hours per a day, severely presence of occupational hazards, lack of regular job rotation, the sleeping disorders and having work stress all increased the odds of co-occurrence occupational outcome.

STABILOMETRY AS A METHOD FOR DIAGNOSIS AND TRAINING OF THE HUMAN POSTURAL BALANCE

Introduction. Posture is intrinsically linked to balance and the maintenance of an upright body position. Achieving stable posture and upright movement relies on the body’s complex neuromuscular regulation system. In clinical practice, stabilometry is employed to assess balance function and postural control. This study aims to synthesize data on the effectiveness of stabilometry as a diagnostic tool for evaluating postural balance and as a training method to enhance it. Materials and Methods. An analysis of 45 sources from databases including Academia.edu, PubMed, ResearchGate, and Google Scholar over the past decade was conducted using Keywords: posture, stabilometry, and postural balance. Results. Stabilometry is a contemporary technique for tracking the projection of the body’s center of mass on the support plane, as well as its fluctuations while standing or performing diagnostic tests and medical procedures. This review examines the application of stabilometry both for diagnosing balance and as a supplementary training method to improve postural balance in athletes and individuals with musculoskeletal disorders. Stabilometry results have highlighted correlations between stomatognathic system dysfunctions and musculoskeletal issues and demonstrated the positive impact of occlusal adjustments on body balance. As such, stabilometry can serve as an effective diagnostic tool for assessing posture in a dental clinic, useful for both diagnostic assessments and evaluating preventive or treatment outcomes. Conclusions. Training that combines myogymnastic exercises with stabilometric platform exercises significantly improved balance and functional efficiency in patients, as shown through stabilometric analysis. A key area of ongoing research is the interplay between posture and other bodily systems, particularly the stomatognathic system, which may be pivotal in treating temporomandibular joint dysfunction.

Variability and repeatability of spinal manipulation force-time characteristics in thoracic spinal manipulation on a manikin.

As part of multimodal therapy, spinal manipulation (SM) is a recommended and effective treatment for musculoskeletal pain. However, the underlying physiological mechanisms for pain relief are largely unknown. SM thrusts can be described and quantified using force-time characteristics (e.g. preload force, peak force, thrust speed, thrust duration, and thrust impulse). If these biomechanical parameters of SM are important for clinical outcomes, a large variability in the delivery of SM could lead to inconsistent responses and could thereby potentially mask a significant clinical effect. Our goal was to determine variability, and repeatability of thoracic spinal manipulation (SM) force-time profiles in a sample of Swiss chiropractors. All interventions were performed on a human analogue manikin. Participating chiropractors received three case scenarios with the following scenarios: 50-year-old male patient, 30-year-old male athlete, and a 70-year-old female patient, each presenting with uncomplicated musculoskeletal thoracic pain. Clinicians were asked to perform three consecutive thoracic SM thrusts for each of the scenarios and repeated the same interventions after 24-48h. Eighty-one chiropractors participated in the study, including 32 females (39.5%) with a mean age of 45.22 ± 12.96years. The variability in SM force-time characteristics between clinicians was substantial, with preload forces ranging from 4.50 to 450.25 N and peak forces ranging from 146.08 to 1285.17 N. Significant differences between case scenarios were observed for peak force (p < 0.0001), maximum thrust speed (p = 0.0002), and thrust impulse (p = 0.0004). Except for thrust duration, repeatability within and between sessions was fair to excellent (ICCs between 0.578 and 0.957). Substantial variability in application of SM was evident across clinicians and between case scenarios. Despite substantial clinician-dependent variability, the high repeatability of thoracic SM thrusts suggests a level of standardization in SM delivery, indicating that chiropractors might have 'their' individual force-time profile that they are capable to reproduce. Further research based on these findings should explore how to enhance the consistency, effectiveness, and safety of thoracic SM delivered clinically to humans.

A PATIENT WITH OSTEOARTHRITIS AND HYPERTENSION IN GENERAL MEDICAL PRACTICE

Osteoarthritis is one of the most common diseases in Ukraine and worldwide, often leading to early disability in people of working age, making it both a medical and social concern. According to the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis, and Musculoskeletal Diseases, as well as the International Society for the Study of Osteoarthritis, it is known that a middle-aged patient with osteoarthritis typically has four accompanying pathologies. In elderly patients, in addition to osteoarthritis, up to eight other chronic conditions are often diagnosed. Comorbidity is frequently observed in middle-aged patients with osteoarthritis. Understanding the pathogenetic links between osteoarthritis and comorbid conditions plays an important role in the timely diagnosis and treatment of these diseases, helping to maintain a high quality of life for patients. Objevtive: the study of the pathogenesis of osteoarthritis and arterial hypertension, along with the proposed therapy for treating comorbidities in patients with both osteoarthritis and arterial hypertension, aims to enhance the treatment outcomes. Materials and methods. Analytical and bibliosemantic methods were used in this study. During the scientific search, 38 modern literature sources were reviewed and analyzed concerning the pathogenetic impact on the development of osteoarthritis and arterial hypertension, as well as their shared mechanisms in the development and progression of both conditions. The study was carried out at the Department of Family Medicine and Therapy of the Regional Rheumatology Center, M. V. Sklifosovsky Poltava Regional Hospital. A total of 50 people were examined; the main group consisted of 35 individuals with stage II hypertension, grade 2, combined with stage II knee osteoarthritis (according to the Kellgren-Lawrence scale), with joint dysfunction of stages 1-2. These patients were aged 40-65 years (mean age 51.8±2.14 years). The duration of hypertension was 10.07±1.24 years, and the duration of manifested osteoarthritis was 8.56±1.03 years. The comparison group consisted of 20 individuals with stage II, grade 2 hypertension (mean age 52.5±2.38 years), with a mean hypertension duration of 11.31±1.17 years. The clinical diagnosis of osteoarthritis was established according to the recommendations of the European Alliance of Associations for Rheumatology (2018). The diagnoses of comorbid conditions were confirmed in accordance with relevant orders from the Ministry of Health of Ukraine, with verification by specialized experts. Patients with osteoarthritis received standard treatment, and, when necessary, additional treatment for comorbid conditions was prescribed (a hypotensive combination of an ACE inhibitor and long-acting calcium. Results: The presence of osteoarthritis exerts an additional negative impact on heart rate variability in patients with hypertension. The reduction of the Low Frequency/High Frequency (LF/HF) index due to the use of this therapy (a combination of an ACE inhibitor and a long-acting calcium antagonist in doses of 4/5 mg, 4/10 mg, 8/5 mg, 8/10 mg) in the treatment of patients with comorbidity of hypertension and osteoarthritis contributes to the activation of the sympathetic nervous system, reduction of patient mortality, balancing of the nervous system by inhibiting sympathetic nervous tone, and lowering high blood pressure. Conclusions: The proposed combination therapy for patients with osteoarthritis and hypertension contributes to prolong remission of both the primary disease and comorbid conditions, reduces the frequency of hospitalizations, and shortens inpatient treatment by 3-4 days.

A Video-based Lifting Action Recognition Using Rank-Altered Kinematic Feature Pairs

Low-back musculoskeletal disorders (MSDs) are the primary work-related injuries among manual material handling (MMH) workers, who are frequently exposed to repetitive lifting. To prevent low-back MSDs in the workplace, we present a video-based lifting action recognition method using rank-altered kinematic feature pairs, called top-scoring pairs (TSPs). We derive TSPs from a video dataset containing lifting and other activities commonly seen in MMH. These TSPs collectively classify each frame as lifting and non-lifting. The validation process involves evaluating classification performance. The proposed method minimizes computational and memory requirements while achieving performance comparable to more complex methods with greater computational demands. This makes it suitable for systems with limited hardware resources, thereby providing extensive feasibility across a variety of MMH environments to improve workplace safety.

Nonlinear Stress-Induced Transformations in Collagen Fibrillar Organization, Disorder and Strain Mechanisms in the Bone-Cartilage Unit.

By developing a 3D X-ray modeling and spatially correlative imaging method for fibrous collagenous tissues, this study provides a comprehensive mapping of nanoscale deformation in the collagen fibril network across the intact bone-cartilage unit (BCU), whose healthy functioning is critical for joint function and preventing degeneration. Extracting the 3D fibril structure from 2D small-angle X-ray scattering before and during physiological compression reveals of dominant deformation modes, including crystallinity transitions, lateral fibril compression, and reorientation, which vary in a coupled, nonlinear, and correlated manner across the cartilage-bone interface. A distinct intermolecular arrangement of collagen molecules, and enhanced molecular-level disorder, is found in the cartilage (sliding) surface region. Just below, fibrils accommodate tissue strain by reorientation, which transitions molecular-level kinking or loss of crystallinity in the deep zone. Crystalline fibrils laterally shrink far more (20×) than they contract, possibly by water loss from between tropocollagen molecules. With the calcified plate acting as an anchor for surrounding tissue, a qualitative switch occurs in fibrillar deformation between the articular cartilage and calcified regions. These findings significantly advance this understanding of the complex, nonlinear ultrastructural dynamics at this critical interface, and opens avenues for developing targeted diagnostic and therapeutic strategies for musculoskeletal disorders.

Strategies to optimise the health equity impact of digital pain self-reporting tools: a series of multi-stakeholder focus groups.

There are avoidable differences (i.e., inequities) in the prevalence and distribution of chronic pain across diverse populations, as well as in access to and outcomes of pain management services. Digital pain self-reporting tools have the potential to reduce or exacerbate these inequities. This study aimed to better understand how to optimise the health equity impact of digital pain self-reporting tools on people who are experiencing (or are at risk of) digital pain inequities. This was a qualitative study, guided by the Health Equity Impact Assessment tool-digital health supplement (HEIA-DH). We conducted three scoping focus groups with multiple stakeholders to identify the potential impacts of digital pain self-reporting tools and strategies to manage these impacts. Each group focused on one priority group experiencing digital pain inequities, including older adults, ethnic minorities, and people living in socio-economically deprived areas. A fourth consensus focus group was organised to discuss and select impact management strategies. Focus groups were audio-recorded, transcribed verbatim, and analysed using a framework approach. We derived codes, grouped them under four pre-defined categories from the HEIA-DH, and illustrated them with participants' quotes. A total of fifteen people living with musculoskeletal pain conditions and thirteen professionals took part. Participants described how digital pain self-reports can have a positive health equity impact by better capturing pain fluctuations and enriching patient-provider communication, which in turn can enhance clinical decisions and self-management practices. Conversely, participants identified that incorrect interpretation of pain reports, lack of knowledge of pain terminologies, and digital (e.g., no access to technology) and social (e.g., gender stereotyping) exclusions may negatively impact on people's health equity. The participants identified 32 strategies, of which 20 were selected as being likely to mitigate these negative health equity impacts. Example strategies included, e.g., option to customise self-reporting tools in line with users' personal preferences, or resources to better explain how self-reported pain data will be used to build trust. Linked to people's personal and social characteristics, there are equity-based considerations for developing accessible digital pain self-reporting tools, as well as resources and skills to enable the adoption and use of these tools among priority groups. Future research should focus on implementing these equity-based considerations or strategies identified by our study and monitoring their impact on the health equity of people living with chronic pain.

The association between students' confidence and ability to modulate spinal manipulation force-time characteristics of specific target forces: a cross-sectional study.

Spinal manipulative therapy (SMT) is a guideline-recommended care for musculoskeletal pain taught in various undergraduate programs. Visual feedback through force-sensing tables can improve modulation of SMT force-time characteristics and, potentially, students' confidence, both factors important for clinical competence and patient outcomes. However, it is unclear if a link exists between students' confidence and ability in SMT force-time modulation. We aim to investigate this relationship and whether it was moderated by experience. This cross-sectional study recruited first- to third-year Canadian Memorial Chiropractic College students. Participants provided information about their confidence in performing SMT using different impulse forces of 200N, 400N, and 800N with a pre-established pre-load and a time-to-peak force < 150ms. SMT impulse forces of 200N, 400N, and 800N were targeted on a Human Analogue Mannequin positioned prone on a force-sensing table. We described the confidence levels and SMT force-time characteristics and assessed their association using linear mixed models. We re-ran the models interacting with SMT experience. The order of the three SMT impulse forces was randomly performed. Participants and outcome assessors were blinded to force-time characteristics recordings. One-hundred-and-forty-nine participants provided usable data. Participants were confident in delivering 200N and 400N impulse forces. However, confidence decreased for 800N forces. Accordingly, participants performed impulse forces close to the 200N and 400N but had difficulty accurately modulating to 800N forces. A positive association was found between confidence and the ability to modulate their force-time characteristics, especially keeping the same pre-load force, keeping the time to peak force < 150ms, and providing the 800N impulse force. This association was not moderated by experience. Students were more confident in their abilities to perform lower SMT forces but lacked confidence in their abilities to perform higher (800N) forces. This aligned with their skills, as many struggled to apply 800N force. However, students who had higher confidence levels generally performed better overall. There was substantial variability in SMT force-time characteristics, which may have implications for adverse events and patient satisfaction. Some of this variability could be attributed to students' confidence. Thus, further investigations are necessary in undergraduate settings to implement and optimize these findings. https://osf.io/6f7d5.

Knee pain improvement after genicular artery embolization for the management of knee osteoarthritis: an updated systematic review and meta-analysis of 21 studies.

Knee osteoarthritis is aprogressive inflammatory musculoskeletal disease with aprevalence of approximately 15-23% and limited treatment options. In recent years, transcatheter genicular artery embolization (GAE) has been proposed due to promising results concerning symptomatic knee pain relief and mobility. This systematic review and meta-analysis aimed to evaluate the aggregated data on the safety and efficacy of GAE for pain reduction in the treatment of knee osteoarthritis. Asystematic search of the three major databases (MEDLINE, Embase, and CENTRAL) from inception to 27February 2024 was conducted according to the PRISMA guidelines. Studies reporting pain reduction according to the Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)-Total, WOMAC-Pain, and Knee Injury and Osteoarthritis Outcome Score (KOOS)-Pain scales and adverse event rates were included. Meta-analysis was performed by estimating the mean differences and by fitting random-effect models. Overall, 21studies were included, comprising of 633 patients and 758 knees treated. The combined data analysis showed that patients who underwent GAE demonstrated mean declines in the VAS score of -38.5 points (95% confidence interval [CI]: -44.9, -32.0) at 1month, -36.2 points (95%CI -43.0, -29.5) at 3months, -40.3 points (95%CI: -49.0, -31.7) at 6months, and -40.5 points (95%CI: -54.5, -26.6) at 12months. Similarly, significant differences at all time points were also found for the WOMAC-Total, WOMAC-Pain, and KOOS-Pain scores. No difference between permanent and non-permanent embolic material was found in the subgroup analysis for all time points. Genicular artery embolization is safe and effective for the treatment of painful knee osteoarthritis. This result was not affected by the type of embolic material used (permanent vs. non-permanent).