Musculoskeletal Conditions Research Articles

Evaluating the effects of mobile application-based rehabilitation on improving disability and pain in patients with disputed thoracic outlet syndrome: A randomized controlled trial

BackgroundDisputed thoracic outlet syndrome (D.TOS) stands as one of the primary global contributors to physical disability, presenting diagnostic and treatment challenges for patients and frequently resulting in prolonged periods of pain and functional impairment. Mobile applications emerge as a promising avenue in aiding patient self-management and rehabilitation for D.TOS. This study aimed to investigate the impact of a certain mobile application-based rehabilitation on pain relief and the improvement of disability in patients experiencing D.TOS. MethodsEighty-eight patients diagnosed with D.TOS randomized 1:1 to either the control group (n = 44) or the intervention group (n = 44). Participants in the control group were provided with a brochure containing standard rehabilitation exercise instructions, a written drug prescription from the physician, and guidance on recommended physical activity levels, including home exercises. In contrast, all participants in the intervention group used the mobile application. Disability and pain levels in patients were assessed after six weeks in both groups. ResultBoth groups improved pain and disability based on the scaled measurements. According to the questionnaire scale, the intervention group showed a considerable decline in disability; however, there was a significant difference in just one question (P < 0.05). Furthermore, the intervention group showed significant improvement in neck pain NRS (p = 0.024) compared to the control. Based on the shoulder and head pain numeric rate scale (NRSs), both groups showed improvement in disability conditions; but there were no significant differences between the groups (p > 0.05). ConclusionMobile applications are promising tools for alleviating disabilities and pain in patients with musculoskeletal conditions. This study confirmed the potential of mobile technology to enhance active and corrective physical activity, thereby reducing pain in patients with D.TOS. Trial RegistrationIranian Registry of Clinical Trials (IRCT) with the identifier IRCT20141221020380N3 (http://www.irct.ir/)

Identifying Risk Factors for Cardiovascular Events Among Active-Duty Service Members and Veterans Prescribed Nonsteroidal Anti-Inflammatory Drugs (NSAIDs).

Oral NSAIDs are widely used analgesic medications for the treatment of musculoskeletal and inflammatory conditions. NSAIDs are associated with adverse effects that arise from COX enzyme inhibition including cardiovascular events. The combined role of patient and prescription factors associated with NSAID use on cardiovascular risk is not well characterized. The purpose of this study is to identify the risk factors with cardiovascular events among NSAID users. This study is a retrospective, nested case-control study, within the DAVINCI database, among active-duty service members and veterans with at least one NSAID pharmacy claim between fiscal year (FY) 2015-FY2020. Inclusion criteria individuals ≥18 years of age received a prescription NSAID for ≥7-day supply and a duration ≥1 month overall. Cases experienced nonfatal myocardial infarction, nonfatal stroke, or new onset heart failure. Ten controls were selected per case. Risk factors were identified through logistic regression modeling. The risk factors with strongest association to the primary outcome included age starting at 45 up to 75 and older, the first 90 days of NSAID exposure, cerebrovascular disease, cardiomyopathy, and history of myocardial infarction. Cox-selectivity and dose did not appear to be clinically significant in their association with cardiovascular events. The results of this study indicate that age, initial NSAID exposure, and comorbidities are more predictive than NSAID-specific factors such as COX-selectivity and dose. The results provide the framework for development of a risk score to improve prediction of NSAID-associated cardiovascular events.

The Effect of Combining Spinal Manipulation and Dry Needling in Individuals With Nonspecific Low Back Pain

Low back pain (LBP) is one of the most common and costly musculoskeletal conditions impacting health care in the United States. The development of multimodal strategies of treatment is imperative in order to curb the growing incidence and prevalence of LBP. Spinal manipulative therapy (SMT), dry needling (DN), and exercise are common nonpharmacological treatments for LBP. This study is a 3-armed parallel-group design randomized clinical trial. We enrolled and randomized 96 participants with LBP into a multimodal strategy of treatment consisting of a combination of DN and SMT, DN only, and SMT only, followed by an at-home exercise program. All participants received 4 treatment sessions in the first 2 weeks followed by a 2-week home exercise program. Outcomes included clinical (Oswestry Disability Index, numeric pain intensity rating) and mechanistic (lumbar multifidus, erector spinae, and gluteus medius muscle activation) measures at baseline, 2, and 4 weeks. Participants in the DN and SMT groups showed larger effects and statistically significant improvement in pain and disability scores, and muscle percent thickness change at 2 weeks and 4 weeks of treatment when compared to the other groups. This study was registered prior to participant enrollment. PerspectiveThis article presents the process of developing an optimized multimodal treatment plan utilizing SMT, DN, and exercise to address the burden of LBP for impacted individuals and the health care system. This method could potentially help clinicians who treat LBP to lower initial pain and increase exercise compliance. (clinicaltrials.gov NCT05802901)

Exploring the interplay between ankle muscle strength, postural control, and pain intensity in chronic ankle instability: A comprehensive analysis

BackgroundChronic Ankle Instability (CAI) is a common musculoskeletal condition characterized by recurring ankle sprains and impaired postural control (PC). Understanding the relationship between ankle muscle strength, PC, and the role of pain is essential for effective management. ObjectivesThis prospective cross sectional study aimed to 1. Compare ankle isometric muscle strength (IMS) and PC between CAI and asymptomatic sides. 2. Assess the correlations between ankle IMS and PC and explore the potential mediating effect of pain in individuals with CAI. MethodsA total of 44 individuals with CAI, were enrolled in the study. Ankle IMS (dorsiflexors, plantar flexors, invertors, and evertors) was measured using a dynamometer, while PC was evaluated using sway parameters (anterior-posterior and medial-lateral sway, ellipse area). Pain levels were reported using a Visual Analog Scale. ResultsThe CAI ankles exhibited significantly lower ankle IMS in all muscle groups compared to the asymptomatic ankles (p < 0.001). Additionally, the CAI side showed increased postural sway and a larger ellipse area (p < 0.001), indicating reduced PC. Negative correlations were observed between ankle IMS and PC parameters on the CAI side, with dorsiflexor strength showing correlations ranging from −0.423 to −0.387, plantar flexor strength ranging from −0.423 to −0.371, invertor strength ranging from −0.412 to −0.238, and evertor strength ranging from −0.451 to −0.365 (p < 0.001). Mediation analysis revealed that pain played a significant mediating role in connecting ankle IMS and PC parameters among individuals with CAI, with statistical significance (p < 0.05). ConclusionsIndividuals with CAI exhibit weaker ankle IMS and diminished PC in comparison to their healthy side. Moreover, pain was identified as a mediator in the relationship between ankle IMS and PC in CAI. These findings underscore the importance of addressing both ankle IMS and pain in the rehabilitation and management of CAI.

Tizanidine: Advances in Pharmacology & Therapeutics and Drug Formulations.

Skeletal muscle relaxants (SMRs) are widely used in treating musculoskeletal conditions. All SMRs, with the exception of baclofen and tizanidine, are on the list of 2023 American Geriatrics Society Beers Criteria® for potentially inappropriate medication use in older adults. In our geriatric practice, off-label use of tizanidine as preemptive analgesia drove us to find recent advances in its pharmacology and therapeutics. An update review of tizanidine was thus presented, aiming to bring the latest knowledge to clinicians and promote further research and practical exploration. Relevant literature up to December 2023 was identified through searches of PubMed, Web of Science, and Embase. Tizanidine, a centrally acting alpha-2 adrenoceptor agonist with both antispastic and antispasmodic activity, shows efficacy in the common indications for all SMRs. From the perspective of drug safety, tizanidine has lower incidences of adverse events (injury, delirium, encephalopathy, falls, and opioid overdose) compared to baclofen, no association with risk of Alzheimer's disease as with orphenadrine, no risk of serotonin syndrome like metaxalone when comedicated with serotonergic drugs, no significant pharmacokinetic changes in CYP2C19 poor metabolizers unlike diazepam and carisoprodol, and no physically addictive or abuse properties like carisoprodol and diazepam. From the perspective of new and potential therapeutic uses, tizanidine has additional benefits (eg, gastroprotection that can improve patient tolerance to nonsteroidal anti-inflammatory agents, anti-neuropathic pain, a key component of multimodal analgesia strategy to reduce early postoperative pain, and anti-tumor effects). New delivery systems of tizanidine are developing to improve the pharmacokinetics of oral products, including buccal patches, transdermal delivery systems, nasal spray, and in situ rectal gel. Tizanidine is an SMR with unique features and may be an optimal initial choice for older adults. There would be more scientific studies, wider therapeutic applications, and new drug formulations in the future.

Quadriceps femoris muscle ultrasound in sarcoidosis: an observational case-control study.

Although loss of muscle mass may be associated with general weakness, intolerance to physical activity and fatigue, it is underestimated and poorly understood in patients with sarcoidosis. To compare the quadriceps femoris muscle (QFM) thickness measured by ultrasonography (US) between the female patients with sarcoidosis and controls, secondly to assess the correlation between the muscle strength, fatigue and QFM thickness. Observational, case-control study. Physical Medicine and Rehabilitation Department of a University Hospital. Thirty-one women with sarcoidosis and 27 healthy volunteers were included in the study. The participants were evaluated for the following outcomes: 1) handgrip strength; 2) QFM thickness measured using US; and 3) sonographic thigh adjustment ratio (STAR). The sarcoidosis group was also evaluated with the 30-second chair stand test (30s-CST) and Fatigue Severity Scale (FSS). The QFM thickness and STAR values of the patients with sarcoidosis were significantly lower than those of the controls (P=0.0001). However, no statistically significant difference was observed between the handgrip strengths of the groups (P=0.581). There was no statistically significant correlation between the STAR values and handgrip strength in the sarcoidosis group; however, there was a significant positive correlation between the STAR values and 30s-CST (r=0.467, P=0.008). Loss of muscle mass is one of the musculoskeletal conditions in patients with sarcoidosis that may be associated with nonspecific symptoms, such as general debility, intolerance to physical activity, and fatigue. In the present study, no difference was observed in hand grip strength between the groups, while we found that QFM thickness was affected in patients with sarcoidosis when compared to the controls. The ultrasonographic QFM evaluation seems to be an innovative tool which may be used at all stages of sarcoidosis patient follow-up. The grip strength is a commonly used test to detect muscle weakness, but onset of a decrease in muscle mass in the lower extremities may occur earlier. Considering the increased burden of musculoskeletal problems in this population, performing 30s-CST and sonographic QFM thickness is practical methods to identify risky patients.

Efficacy of Integrated Yoga and Naturopathy With Physiotherapy or Acupuncture for Low Back Pain: A Parallel, Two-Arm, Randomized Trial.

Low back pain (LBP) is a musculoskeletal condition that affects many individuals. While physiotherapy and acupuncture are frequently used treatments, determining their specific contributions when used alongside integrated yoga and naturopathy (IYN) therapy for relieving chronic LBP symptoms and enhancing quality of life is important. In the present prospective randomized comparative trial, a total of 60 participants were divided into the following two groups: physiotherapy with IYN and acupuncture with IYN. The treatment duration was 10 days, and assessments were conducted both before (baseline) and after the intervention. Various assessment tools, such as the visual analogscale (VAS), Oswestry Disability Index (ODI), fingertip-to-floor test (FTF), State-Trait Anxiety Inventory (STAI), and Short Form 36 (SF-36), were utilized. The statistical analysis was performed using SPSS version 21.0 (Armonk, NY:IBM Corp). The results revealed significant differences in VAS score, ODI, FTF score, STAI score, and SF-36 score between the physiotherapy and acupuncture groups (p<0.001). A t-test for the equality of means and a Mann-Whitney U test were used to compare the two groups; these tests revealed a significant difference in disability levels, range of motion, and state of anxiety. The acupuncture group showed a significant difference in the ODI (15.9 {12.6, 19.3}; p <0.001) and state anxiety (23.0 {20.0, 26.0}; p<0.001) compared to the physiotherapy ODI (22.4 {18.5, 26.4}) and state anxiety (27.5 {25.0, 30.0}). The physiotherapy group showed a significant difference in range of motion (7.7 {5.7, 9.7}; p<0.001) compared to the acupuncture group (11.6 {9.8, 13.5}). The present study findings revealed that both physiotherapy and acupuncture, as interventions along with integrated yoga and naturopathy may be considered an effective treatment strategy for chronic LBP.

A pictorial guide for performing dynamic musculoskeletal ultrasound techniques of the Upper Limb

IntroductionDynamic techniques should be used to compliment static imaging in the field of Musculoskeletal ultrasound. Performing limb movements and imaging simultaneously, allows for diagnosing certain musculoskeletal conditions not otherwise confirmed by still images. This article aims to provide guidance on how to perform a selection of these dynamic musculoskeletal ultrasound techniques with a focus on the upper limb. MethodsThis pictorial guide features techniques gathered from literature review and experience gained in the field. ResultsApplication of dynamic ultrasound techniques has been evidenced in the literature to diagnose conditions such as trigger finger, dislocating tendons and causes of peripheral neuropathy. ConclusionMusculoskeletal conditions only elicited during limb movement can be difficult to diagnose. Appropriate use of dynamic techniques increases likelihood of correct diagnosis of the described conditions. Implications for practiceUltrasound provides a unique opportunity to visualise these conditions thus ultrasound users should aim to familiarise themselves with dynamic ultrasound techniques to improve patient outcomes.

Evading Musculoskeletal Conditions Using Qigong as a Rescue Technique.

Classically, Qigong is a Chinese technique that has been practiced in China for the past 3,000 years for healing the inner self. Qigong, wherein "Qi" means body energy and "Gong" denotes cultivation, regulates the energy flow in the body. The Qigong technique comprises a package of deep breathing training, gentle and rhythmic movement, and muscle-strengthening exercises that heal the body to activate one's internal soul energy. It has demonstrated its efficacy by inducing relaxation, building up stamina, strengthening immunity, appreciating muscle conditioning, and minimizing anxiety and depression. Furthermore, it has been beneficial in improving awareness of joint and movement senses. Specifically, Qigong brings healing by regulating energy flow in the whole-body systems. Moreover, it has exhibited a variety of regenerating effects by inducing emotional and mental relaxation. In today's world, Qigong exercises are being used for treating musculoskeletal disorders that are work- and stress-related by nature. Qigong is practiced globally as deep breathing exercises, and meditation is practiced for peace of mind and spirituality, whereas vigorous practice includes martial arts.

Using an Arabic Version of the Life-Space Assessment to Evaluate How Gait Speed and Gender Predict Mobility Restrictions among Older Adults.

Background and Objectives: The Life-Space Assessment (LSA) serves as an assessment tool for evaluating mobility and participation in older adults. To date, no studies have investigated the validity and reliability of the LSA within Arabic-speaking communities. The purpose of this study was to examine the reliability and validity of an Arabic version of the LSA and to investigate the potential predictors of mobility restrictions in older Arabic-speaking adults. Materials and Methods: This study involved a cohort of 75 Arabic-speaking older adults (with a mean age of 67.2 ± 5.9). The LSA was administered twice, with a one-week interval, to assess its test-retest reliability. The internal consistency and test-retest reliability of the LSA were assessed using Cronbach's alpha and intra-class correlation coefficients (ICCs), respectively. The validity of the LSA was determined by analyzing its correlation with outcome measures related to the fear of falling, depression, quality of life, lower limb strength, physical performance, and gait speed. Results: The test-retest reliability of the LSA composite score demonstrated good results (ICC = 0.83). The validity of the LSA was supported by significant correlations between its scores and factors such as gender, education level, and all other outcome measures. Notably, being female and having a lower gait speed emerged as significant predictors of mobility restrictions in older Arabic-speaking adults, accounting for 49% of the variance (R2 = 49%) in the multiple logistic regression analysis conducted. Conclusions: The Arabic version of the LSA has proven to be a reliable and valid measure of mobility and participation among older Arabic-speaking adults. This study endorses the application of the Arabic LSA in both research and clinical settings involving older adults and emphasizes the need for further investigation to fully understand its psychometric features in other Arabic-speaking individuals afflicted with neurological and musculoskeletal conditions.

Responsiveness of Subjective and Objective Measures of Pain and Function Following Operative Interventions for Musculoskeletal Conditions: A Narrative Review.

Musculoskeletal (MSK) disorders affect ~50% of US adults and 75% of those over the age of 65, representing a sizable economic and disability burden. Outcome measures, both objective and subjective, help clinicians and investigators determine whether interventions to treat MSK conditions are effective. This narrative review qualitatively compared the responsiveness of different types of outcome measures, a key measurement characteristic that assesses an outcome measure's ability to detect change in patient status. We evaluated elective orthopedic interventions as a model for assessing responsiveness because the great majority of patients improves following surgery. We searched for articles reporting responsiveness (quantified as effect size [ES]) of subjective and objective outcome measures after orthopedic surgery and included 16 articles reporting 17 interventions in this review. In 14 of 17 interventions, subjective function measures had an ES 10% greater than that of objective function measures. Two reported a difference in ES of <10%. The sole intervention that demonstrated higher ES of objective function used a composite measure. Sixteen interventions reported measures of subjective pain and/or mixed measures and subjective function. In nine interventions, subjective pain had a higher ES than subjective function by >10%, in three, subjective function had a higher ES than subjective pain by >10%, and in the remaining four, the difference between pain and function was <10%. These findings reinforce the clinical observation that subjective pain generally changes more than function following elective orthopedic surgery. They also suggest that subjective function measures are more responsive than objective function measures, and composite scores may be more responsive than individual performance tests.

Which Remote Rehabilitation Interventions Work Best for Chronic Musculoskeletal Pain and Depression? A Bayesian Network Meta-Analysis.

OBJECTIVE: To evaluate the effectiveness of remote rehabilitation interventions for people living with chronic musculoskeletal pain and depression. DESIGN: A systematic review with network meta-analysis (NMA) of randomized control trials. LITERATURE SEARCH: Cochrane Central Register of Controlled Trials, CINAHL, EMBASE, LILACS, MEDLINE, PSYNDEX and PsycINFO until May 2023. STUDY SELECTION CRITERIA: Randomized controlled trials that evaluated the effectiveness of remote rehabilitation interventions in people with chronic musculoskeletal pain and depression. DATA SYNTHESIS: We used Bayesian random-effects models for the NMA. Effect estimates were comparisons between rehabilitation interventions and waitlist. We performed a sensitivity analysis based on bias in the randomisation process, large trials (>100 patient per arm) and musculoskeletal condition. RESULTS: Fifty-eight randomized controlled trials involving 10,278 participants (median sample size: 137 (IQR: 77 to 236) were included. Interactive-voice-response cognitive behavioural therapy (CBT) (SMD -0.66, 95%CrI -1.17 to -0.16), CBT in person (SMD -0.50, 95%CrI -0.97 to -0.04) and mobile-app CBT plus exercise (SMD -0.37, 95% CrI -0.69 to -0.02) were superior to waitlist at 12-weeks follow-up for reducing pain (> 98% probability of superiority). For depression outcomes, Internet-delivered CBT & tele-care was superior to waitlist at 12-weeks follow-up (SMD -0.51, 95% CrI -0.87 to -0.13) (> 99% probability of superiority). For pain outcomes, the certainty of evidence ranged from low to moderate. For depression outcomes, the certainty of evidence ranged from very low to moderate. The proportion of dropouts attributed to adverse events was unclear. No intervention was associated with higher odds of dropout. CONCLUSION: Interactive-voice-response CBT, and mobile-app CBT plus exercise showed similar treatment effects with in-person CBT on pain reduction among people living with chronic musculoskeletal pain and had over 98% probability of superiority than waitlist control at 12-weeks follow-up. Internet-delivered CBT & tele-care had over 99% probability of superiority than waitlist control for improving depression outcomes at 12-weeks follow-up.

The confidence in the results of physiotherapy systematic reviews in the musculoskeletal field is not increasing over time: a meta-epidemiological study using AMSTAR 2 tool

ObjectivesTo assess the confidence in the results of systematic reviews on the effectiveness of physiotherapy for musculoskeletal conditions in the past 10 years and to analyze trends and factors associated. MethodsThis is a metaepidemiological study on systematic reviews (SRs) with meta-analysis of randomized controlled trials (RCTs). MEDLINE, Cochrane Database of Systematic Reviews, CINAHL, and PEDro were searched for SRs of RCT on physiotherapy interventions for musculoskeletal disorders from December 2012 to December 2022. Two researchers independently screened the records based on the inclusion criteria; a random sample of 100 studies was selected, and each journal, author, and study variable was extracted. The methodological quality of SRs was independently assessed with the AMSTAR 2 tool. Any disagreement was solved by consensus. ResultsThe confidence in SRs results was critically low in 90% of the studies, and it did not increase over time. Cochrane reviews are predominantly represented in the higher AMSTAR 2 confidence levels, with a statistically significant difference compared to non-Cochrane reviews. The last author's H-index is the only predictor of higher confidence among the variables analyzed (OR 1.04; 95% CI: 1.01, 1.06). ConclusionThe confidence in SRs results is unacceptably low. Given the relevance of musculoskeletal disorders and the impact of evidence synthesis on the clinical decision-making process, there is an urgent need to improve the quality of secondary research by adopting more rigorous methods.

What Are the Underlying Mental Health Constructs Associated With Level of Capability in People With Knee and Hip Osteoarthritis?

Mental health characteristics such as negative mood, fear avoidance, unhelpful thoughts regarding pain, and low self-efficacy are associated with symptom intensity and capability among patients with hip and knee osteoarthritis (OA). Knowledge gaps remain regarding the conceptual and statistical overlap of these constructs and which of these are most strongly associated with capability in people with OA. Further study of these underlying factors can inform us which mental health assessments to prioritize and how to incorporate them into whole-person, psychologically informed care. (1) What are the distinct underlying factors that can be identified using statistical grouping of responses to a multidimensional mental health survey administered to patients with OA? (2) What are the associations between these distinct underlying factors and capability in knee OA (measured using the Knee Injury and Osteoarthritis Outcome Score, Joint Replacement [KOOS JR]) and hip OA (measured using Hip Disability and Osteoarthritis Outcome Score, Joint Replacement [HOOS JR]), accounting for sociodemographic and clinical factors? We performed a retrospective cross-sectional analysis of adult patients who were referred to our program with a primary complaint of hip or knee pain secondary to OA between October 2017 and December 2020. Of the 2006 patients in the database, 38% (760) were excluded because they did not have a diagnosis of primary osteoarthritis, and 23% (292 of 1246) were excluded owing to missing data, leaving 954 patients available for analysis. Seventy-three percent (697) were women, with a mean age of 61 ± 10 years; 65% (623) of patients were White, and 52% (498) were insured under a commercial plan or via their employer. We analyzed demographic data, patient-reported outcome measures, and a multidimensional mental health survey (the 10-item Optimal Screening for Prediction of Referral and Outcome-Yellow Flag [OSPRO-YF] assessment tool), which are routinely collected for all patients at their baseline new-patient visit. To answer our first question about identifying underlying mental health factors, we performed an exploratory factor analysis of the OSPRO-YF score estimates. This technique helped identify statistically distinct underlying factors for the entire cohort based on extracting the maximum common variance among the variables of the OSPRO-YF. The exploratory factor analysis established how strongly different mental health characteristics were intercorrelated. A scree plot technique was then applied to reduce these factor groupings (based on Eigenvalues above 1.0) into a set of distinct factors. Predicted factor scores of these latent variables were generated and were subsequently used as explanatory variables in the multivariable analysis that identified variables associated with HOOS JR and KOOS JR scores. Two underlying mental health factors were identified using exploratory factor analysis and the scree plot; we labeled them "pain coping" and "mood." For patients with knee OA, after accounting for confounders, worse mood and worse pain coping were associated with greater levels of incapability (KOOS JR) in separate models but when analyzed in a combined model, pain coping (regression coefficient -4.3 [95% confidence interval -5.4 to -3.2], partial R 2 0.076; p < 0.001) had the strongest relationship, and mood was no longer associated. Similarly, for hip OA, pain coping (regression coefficient -5.4 [95% CI -7.8 to -3.1], partial R 2 0.10; p < 0.001) had the strongest relationship, and mood was no longer associated. This study simplifies the multitude of mental health assessments into two underlying factors: cognition (pain coping) and feelings (mood). When considered together, the association between capability and pain coping was dominant, signaling the importance of a mental health assessment in orthopaedic care to go beyond focusing on unhelpful feelings and mood (assessment of depression and anxiety) alone to include measures of pain coping, such as the Pain Catastrophizing Scale or Tampa Scale for Kinesiophobia, both of which have been used extensively in patients with musculoskeletal conditions. Level III, prognostic study.

What are patients' perspectives on the value of physical therapy? A prospective cohort study.

To assess and identify patients' perceptions about the overall value of physical therapy services for musculoskeletal conditions and how these values were associated with their outcomes. The association between the perceived value of physical therapy (as a score) and Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference and physical function at 6-weeks was assessed in a prospective cohort. Generalised linear models were used to identify relationships between the value of physical therapy score and PROMIS outcomes. Kendall's tau was used to identify correlations between responses and outcomes. A total of 133 participants met the final inclusion criteria. The majority of participants were female (63.9%) with a mean age of 55.53 (SD 15.36) years. A majority of participants (63.9%) reported a previous positive personal experience with physical therapy. There was no significant relationship between perceived value of physical therapy and pain interference (β -0.32, p=0.07, 95% CI-0.67, 0.03) or physical function (β 0.19, p=0.29, 95% CI-0.16, 0.54). Stronger beliefs in agreement with the value of non-invasive treatment were significant, but weakly correlated with lower pain interference (r=-0.18, p=0.048) and higher physical function scores (r=0.22, p=0.03). Participants had an overall positive perception of the value of physical therapy prior to initiating physical therapy, but this perception was not associated with 6-week pain and function outcomes. A better understanding of the driving factors encouraging patients to seek physical therapy services is needed to provide value-based care.

Patient perception of group consultations for knee osteoarthritis and influence of area-level deprivation: A service evaluation in a physiotherapy musculoskeletal setting.

Group consultations are considered valuable for managing musculoskeletal (MSK) conditions. This service evaluation aimed to assess the perception of knee osteoarthritis (OA) patients regarding group consultations in NHS Lanarkshire's MSK service. It also explored the impact of area-level deprivation on patient engagement. Surveys were developed to gauge patient satisfaction, preferences, and experiences in virtual and face-to-face (FTF) group consultations. Patients were categorised into opt-out, did not attend (DNA), or opt-in groups. We used the Scottish Index of Multiple Deprivation for area-level deprivation analysis. Descriptive statistics were used for quantitative data, while qualitative data were thematically analysed. A total of 84 patients participated, and area-level deprivation was similar across groups. Common engagement barriers included disinterest and transportation issues in opt-out and DNA groups, and IT problems in the DNA virtual group. Most patients expressed a preference for one-on-one consultations. FTFopt-in patients reported high satisfaction and increased confidence in managing their condition post-consultation. Virtual opt-in patients had a more neutral satisfaction level and mixed confidence. They were also less comfortable interacting with others during the consultation. Thematic analysis revealed positive experiences, and areas for improvement such as individual privacy concerns and additional resources. Overall, patients were generally satisfied with group consultations for knee OA. The evaluation identified strategies to enhance engagement. Area-level deprivation did not significantly impact patient participation in group consultations.

Effects of Lifestyle Interventions on the Improvement of Chronic Non-Specific Low Back Pain: A Systematic Review and Network Meta-Analysis.

Chronic non-specific low back pain (CNSLBP) is a highly prevalent musculoskeletal condition that has a great socioeconomic impact on health systems. Instead of focusing on mechanical causes and direct workload in the development of CNSLBP, genetics, psychosocial environment, lifestyle and quality of life are coming to the forefront in its approach. The main objective was to analyze whether interventions aimed at modifying lifestyle can be effective in improving pain intensity and functional disability in CNSLBP. A search in PubMed, Web of Science, Scopus and SportDiscus databases was performed. Both a univariate and a multivariate network meta-analysis were applied with the difference pre/post-treatment. A total of 20 studies were included for qualitative analysis, of which 16 were randomized clinical trials with a moderate-high methodological quality and were part of the quantitative analysis. The interventions that had the greatest effect in reducing pain intensity were cognitive therapy combined with functional exercise programs, lumbar stabilization exercise and resistance exercise; meanwhile, for functional disability, they were functional exercise programs, aerobic exercise and standard care. In conclusion, a multimodal intervention aimed at changing one's lifestyle that encompasses cognitive, behavioral, and physical aspects seems to be highly effective in improving pain intensity and functional disability caused by CNSLBP; however, it is not yet known if these improvements are maintained in the long term.

Changes of trunk muscle stiffness in individuals with low back pain: a systematic review with meta-analysis.

Low back pain (LBP) is one of the most common musculoskeletal conditions. People with LBP often display changes of neuromuscular control and trunk mechanical properties, including trunk stiffness. Although a few individual studies have examined back muscle stiffness in individuals with LBP, a synthesis of the evidence appears to be lacking. Therefore, the aim of this systematic review with meta-analysis was to synthesize and evaluate the available literature investigating back muscle stiffness in association with LBP. We conducted a systematic review of the literature according to the PRISMA guidelines. We searched Pubmed, Scopus, Web of Science and ScienceDirect for studies, that compared back muscle stiffness, measured either by ultrasound-based elastography or myotonometry, between individuals with and without LBP. Pooled data of the included studies were presented descriptively. Additionally, we performed two meta-analyses to calculate the standardized mean difference between the two groups for resting stiffness of the multifidus and erector spinae muscle. For both meta-analyses, the random effect model was used and the weight of individual studies was calculated using the inverse-variance method. The quality of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional studies. Furthermore, the certainty of evidence was evaluated using the GRADE approach. Nine studies were included in our systematic review. Our results suggest that individuals with LBP have higher stiffness of the multifidus (SMD = 0.48, 95% CI: 0.15 - 0.81, p < 0.01; I2 = 48 %, p=0.11) and erector spinae at rest (SMD = 0.37, 95% CI: 0.11 - 0.62, p < 0.01; I2 = 39 %, p=0.14) compared to asymptomatic controls. On the other hand, the evidence regarding muscle stiffness during submaximal contractions is somewhat contradictory. Based on the findings of this systematic review we conclude that people with LBP may have higher back muscle stiffness compared to asymptomatic controls. Addressing muscle stiffness might represent an important goal of LBP treatment. Nevertheless, our findings should be interpreted with extreme caution due to a limited quality of evidence, small number of included studies and differences in measurement methodology.

Biomechanical Evaluation of Plantar Pressure Distribution towards a Customized 3D Orthotic Device: A Methodological Case Study through a Finite Element Analysis Approach

Plantar pressure distribution is a thoroughly recognized parameter for evaluating foot structure and biomechanical behavior, as it is utilized to determine musculoskeletal conditions and diagnose foot abnormalities. Experimental testing is currently being utilized to investigate static foot conditions using invasive and noninvasive techniques. These methods are usually expensive and laborious, and they lack valuable data since they only evaluate compressive forces, missing the complex stress combinations the foot undergoes while standing. The present investigation applied medical and engineering methods to predict pressure points in a healthy foot soft tissue during normal standing conditions. Thus, a well-defined three-dimensional foot biomodel was constructed to be numerically analyzed through medical imaging. Two study cases were developed through a structural finite element analysis. The first study was developed to evaluate barefoot behavior deformation and stresses occurring in the plantar region. The results from this analysis were validated through baropodometric testing. Subsequently, a customized 3D model total-contact foot orthosis was designed to redistribute peak pressures appropriately, relieving the plantar region from excessive stress. The results in the first study case successfully demonstrated the prediction of the foot sole regions more prone to suffer a pressure concentration since the values are in good agreement with experimental testing. Employing a customized insole proved to be highly advantageous in fulfilling its primary function, reducing peak pressure points substantially. The main aim of this paper was to provide more precise insights into the biomechanical behavior of foot pressure points through engineering methods oriented towards innovative assessment for absolute customization for orthotic devices.

What factors influence pain scores following Corticosteroid injection in patients with Greater Trochanteric Pain Syndrome? A systematic review

BackgroundCortico-Steroid Injections (CSI) are commonly used to treat patients with Greater Trochanteric Pain Syndrome (GTPS) but it is unclear which patients will experience improvements in pain.ObjectivesTo identify factors that influence improvements in pain for patients with GTPS treated with CSI.DesignSystematic review.MethodsA search was undertaken of AMED, CINAHL, Cochrane Library, EMBASE, Medline and PEDro databases. Studies were eligible for inclusion if they investigated factors that influenced changes in pain experienced by patients with GTPS who received a CSI. Studies needed to include relevant summary statistics and tests of clinical significance. Risk Of Bias in Non-randomised Trials Of Interventions (ROBINS-I) and Risk Of Bias 2 (ROB2) tools were used to assess bias.ResultsThe search identified 466 studies, 8 were included in the final review with a total of 643 participants. There was no association between demographic variables such as age, sex, symptom duration or obesity and pain outcomes post-CSI. Having a co-existing musculoskeletal (MSK) condition such as knee osteoarthritis or sacroiliac/lumbar spine pain was associated with less pain reduction post-CSI. Injections into the Trochanteric Bursa were associated with longer lasting pain reduction than Gluteus Medius Bursa or extra-bursal injections. Image guidance of CSI maintained lower pain scores at six months but did not increase the duration of the therapeutic effect past six months. The presence of specific ultrasound scan features was not associated with differences in pain scores.ConclusionsPatients with co-existing MSK conditions may not respond to CSI as well as those without. Injections into the Greater Trochanteric Bursa may have longer lasting benefit. Further research is needed on the use of USS imaging findings and image guidance.