Musculoskeletal Disorders Research Articles

Impact of complementary health approaches on opioid prescriptions among veterans with musculoskeletal disorders – A retrospective cohort study

To examine whether complementary and integrative health approaches mitigate opioid prescriptions for pain and whether the relationship differs by post-dramatic stress disorder (PTSD) diagnosis, we followed 1,993,455 Veterans with musculoskeletal disorders during 2005–2017 using Veterans Healthcare Administration electronic health records. Complementary and integrative health (CIH) approaches were defined as ≥ 1 primary care visits for meditation, Yoga, and acupuncture etc using natural language processing. Opioid prescriptions were ascertained from pharmacy dispensing records. A propensity score was estimated and used to match one control Veteran to each CIH recipient. Over the 2-year follow-up period after the index diagnosis, 140,902 (7.1 %) Veterans received ≥ 1 modalities. Among the matched analytic sample (272,296 Veterans), the likelihood of dispensing opioid prescriptions was significantly lower for Veterans in the CIH group than their controls [adjusted hazard ratio (aHR), 0.45 (95 % Confidence Intervals (CI): 0.44–0.46)]. The association did not differ between Veterans with [aHR: 0.46 (95 % CI: 0.45–0.47)] and without [aHR: 0.44 (95 % CI: 0.43–0.45)] PTSD. In sensitivity analyses, the exposure group had 3.82 (95 % CI: 3.76–3.87) months longer restricted mean survival time to opioid initiation, 2 % (95 % CI: 4 %–1 %) lower morphine equivalent and 17 % lower total days’ supply (95 % CI: 18 %–16 %). The relationship remains significant but was attenuated after eliminating waiting time for the exposure group (aHR, 0.63 (95 % CI: 0.62–0.64)). These observations suggest that CIH approaches may help reduce opioid prescriptions for Veterans with musculoskeletal disorders and related pain. The impact of the timing of receiving such approaches warrants further investigation. PerspectiveThis article presents a quasi-experimental investigation into potential benefit of complementary and integrative health approaches (CIH) on de-prescribing opioids. The findings may potentially help clinicians who are seeking non-pharmacological alternative options to manage patient pain and opioid dependence”.

Systematic Literature Review: The Effect of Work Posture on Musculoskeletal Disorders in Goods Loading and Unloading Workers

In lifting and transporting activities, many are still done manually, so in this activity, it is necessary to have the correct work posture when carrying out lifting and transporting goods. Lifting activities with the wrong working posture can increase the risk of occupational diseases, namely musculoskeletal disorders. This study aims to find out whether there is an influence of work posture on musculoskeletal disorders. The research method used is a literature review of seven journals that have been selected based on inclusion criteria. The results of this study showed that in lifting and transporting activities, work posture affects musculoskeletal disorders, so there is a need to improve the abnormal working posture in lifting activities.

Screening of musculoskeletal disorders and levels of depression in transgender people of Multan

Objective: To perceive transgender health issues by evaluating their susceptibility to musculoskeletal problems and depression. Method: The cross-sectional, analytical study was conducted from January to April 2023at the Government Girls Comprehensive Higher Secondary School, Multan, Pakistan, a school for transgenders, and comprised subjects aged 18-40 years. Body mass index was calculated for each subject, and further data was collected using the Standard Nordic Musculoskeletal Questionnaire, Beck Depression Inventory and Numeric Pain Rating Scale. Data was analysed using SPSS 25. Results: Of the 44 subjects, 26(59%) were transgender females and 18(41%) were transgender males. The overall mean age was 25.06±1.53. There were 17(39%) subjects who had received education, and 27(61%) were illiterate. Mean depression score was 24.7±11.5, and mean body mass index was 22.9±3.16. Mean pain intensity was 5.81±2.04. Correlation analysis revealed a complex relationship among age, gender, education, occupation and health variables (p<0.01). Conclusion: Musculoskeletal disorders and the level of depression were high and correlated with the occupation of transgender individuals. Key Words: Transgender persons, Musculoskeletal disorders, Social isolation, Depression.

Use of over-the-counter supplements, sleep aids, and analgesic medicines in rheumatology: results of a cross-sectional survey

Abstract Objectives Pain, fatigue, and sleep are common symptoms in patients with Rheumatic and Musculoskeletal diseases (RMDs) that may prompt the use of over-the-counter (OTC) supplements, sleep aids, and analgesics as self-management strategies. This study evaluated the prevalence of OTC supplements, sleep aids, pain relievers and the financial burden associated with their use in rheumatology. Methods A web-based survey developed with patients, was administered in rheumatology clinics in an English hospital. Participants shared demographic information and detailed their use of OTC supplements, sleep aids, and pain relief in the past week. The data was analysed using descriptive statistics and logistic regression models to identify influencing factors. Results In total 876 people consented to participate in the survey. Over half of patients (54.5%) reported daily supplement intake, typically spending £10/month (IQR 5-20), ranging up to £200 per month. The most commonly administered supplements were vitamin D, multivitamins, vitamin C, vitamin B/B complex, Omega 3/6 supplements, with multiple overlaps. Prescription, OTC, or non-prescription pain relief was reported by 82% of respondents, with sleep aids being used by 13%. Of the 327 patients who took NSAIDs, 165 (50.4%) also reported taking OTC supplements, while among the 131 patients using opioids (20.5%), 66 (50.3%) reported supplement use, some of which have documented interactions. Conclusion The administration of OTC supplements, pain relief, and sleep aids is common in patients with RMDs. Health care professionals should be encouraged to proactively ask about these during consultations especially from a drug safety perspective, but also to provide timely, reliable advice about such strategies that may be sought by patients.

Prevalence of low back pain and associated factors among medical students in Wachemo University Southern Ethiopia

Low back pain(LBP) is the most common musculoskeletal disorder in adults. According to previous studies medical students were found vulnerable for the development of LBP. We assessed the prevalence of LBP and associated factors among Medical students in Wachemo University, Southern Ethiopia. An institution-based cross-sectional study design and simple random sampling technique was employed to select 370 medical students. A structured pretested interviewer administered questionnaire was used to collect the data. The data were entered into Epi-info version 3.1 and analysed by SPSS version 25. Analytical and descriptive statistics were conducted. Simple and multiple logistic regression analyses were employed to assess factors associated with LBP. Variables at p-value ≤ 0.25 in simple logistic regression analysis were entered into multiple logistic regression. Statistical significance was declared at P-value, < 0.05 in multiple logistic analysis. The prevalence of low back pain among medical students was found to be 40.1%with 95% CI (38.5–41.8). Being male students [AOR (95% CI): 1.83 (1.09–3.08)], design of study sitting chairs without back support [adjusted odds ratio(AOR) (95% C.I): 2.81 (1.74–4.55)], stress during class [AOR (95% C.I): 2.60 (1.56–4.35)], and daily study hours greater than 6 h and above [AOR: 4.33, 95% CI (2.30–8.12)] had a significant association with LBP. The prevalence of LBP in this study is high. Better ergonomic facilities and psychosocial supports to medical students are recommended to reduce the effects of predisposing factors on LBP.

Gender Differences in the Relationship between Physical Activity, Postural Characteristics and Non-Specific Low Back Pain in Young Adults.

Background/Aim: University students are a particularly vulnerable population, as they spend increasing amounts of time sitting, which poses a major threat to their musculoskeletal health and posture. The aim of this cross-sectional study was to investigate gender differences in the relationships between physical activity (PA) and sedentary behavior, spinal curvatures and mobility, the endurance and balance of the trunk muscles, and the possible presence of non-specific low back pain (NS-LBP) in young adults aged 18-25 years. Methods: A total of 139 students completed all required tests. Results: Male students engaged in significantly more PA related to recreation, sports and leisure and were significantly more likely to be hyperkyphotic than female students. The more the male students participated in sports, the more pronounced the thoracic kyphosis. Female students had significantly more pronounced lumbar lordosis and anterior pelvic tilt that correlated with lumbar lordosis. Female students generally had significantly higher trunk extensor endurance and more balanced trunk musculature than males. NS-LBP correlated with PA in female students who generally had higher levels of NS-LBP than male students, with a statistically significant difference between those who practiced the most PA. Conclusions: Our results suggest that female students practice less PA and have pronounced lordosis and trunk extensor endurance, in contrast to males who practice more PA and have pronounced trunk flexor endurance and hyperkyphosis. Our findings suggest that more PA should be encouraged but implemented with caution and as an individualized gender-specific approach to prevent postural deformities and chronic musculoskeletal disorders, including NS-LBP.

Effect of Multimorbidity on Old-Age Disability Among Adults Over 50 Years Old: Evidence From a Meta-Analysis.

This is a meta-analysis study to assess the relationship between multimorbidity and disability among older adults over 50 years old. Population-based studies, aged ≥50 years, assessing associations between multimorbidity (numbers and patterns) and disability in older adults, and reporting risk estimation with odds ratios (OR), were included. Homogeneity (I2), risk of bias, and publication bias were assessed. PROSPERO registration: 411007, and this meta-analysis was reported in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) recommendations. Twelve studies were included. For the older adults with 2 chronic conditions and ≥3 chronic conditions, the ORs of disability are 2.52 (95% CI 2.30-2.76) and 3.38 (95% CI 3.05-3.75), respectively. Among three multimorbidity patterns, the combination of cardiovascular and metabolic diseases pattern (OR 8.01, 95% CI 7.60-8.44) had the highest disability incidence rate. Chronic conditions in the multimorbidity patterns of combination of cardiovascular and metabolic diseases and mental health problems have an enhancement effect (1 + 1 > 2) on old-age disability impairment, whereas those in the multimorbidity pattern of musculoskeletal disorders have a dampening effect (1 + 1 < 2). The differentiated and specific early interventions should be developed based on the different multimorbidity patterns to prevent the old-age functional decline and disability in older adults.

Exploring the use of wearable sensors for assessing risk factors during orthopedic surgeries: A protocol for data collection

During orthopedic surgeries, surgeons are generally exposed to prolonged periods of standing, awkward and sustained body postures, and forceful movements, which can increase the likelihood of developing work-related musculoskeletal disorders (WRMSD). Therefore, this study proposes a protocol to measure parameters related to physical risk factors contributing to lower limb WRMSD, during orthopedic surgery procedures. The protocol development was preceded by an initial phase of understanding and specifying the context of use, followed by pre-tests in laboratory environment. It integrates a motion capture system, using inertial measurement units (IMU) to collect posture data from hip, knee, and ankle, and electromyography system (EMG) to measure and record data from muscle activity of biceps femoris, rectus femoris, and gastrocnemius lateralis. Pre-tests provided insights for protocol optimization, estimating a 3-hour data collection session per surgery due to sensor battery limitations, streamlining the process by placing EMG sensors before IMU and refining thigh sensor placement strategies. The protocol presents an opportunity for a real-time and quantitative approach to monitor surgeon's exposure to risk factors contributing to lower limb WRMSD while performing surgical procedures. Two months after pre-tests, the protocol implementation began in a real work context. The study's final outcomes fall outside the paper's scope.

Association between Drug Use and Perception of Mental Health in Women Diagnosed with Fibromyalgia: An Observational Study.

Fibromyalgia (FM) is a chronic syndrome characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and mental health issues. It affects approximately 1.78% of the general population; an estimated 4:1 ratio between women and men is observed. It significantly impacts quality of life and carries both clinical and social stigma. This study aims to evaluate the relationship between drug use and mental health in female patients with fibromyalgia. This study is prospective, observational, and cross-sectional. A questionnaire was administered to 544 subjects, achieving a representative sample size from a population of 800,000 subjects by using an algorithm for proportion estimation with a known sampling frame. The selection was non-random, making the sampling non-probabilistic. Logistic regression models were applied to assess the effect of drug use on perception of mental health; presence of symptoms such as comprehension and memory problems, insomnia, depression, and anxiety; and severity of cognitive symptoms and non-restorative sleep. To quantify the impact, odds ratios and confidence intervals have been observed. The findings indicate the non-recommended use of medications and reveal the ineffectiveness and adverse effects of drug interactions on mental health. The use of benzodiazepines and sedative-hypnotics is significantly associated with a negative perception of mental health. Benzodiazepines do not improve symptoms or significantly reduce their severity. SSRI antidepressants do not enhance mental health perception; however, when used exclusively, they are effective in reducing the severity, but not the prevalence, of cognitive symptoms. The results highlight the complexity of pharmacological management in FM and raise concerns about the inappropriate use of ineffective or counterproductive drug interactions affecting patients' mental health. They underscore the need for multidisciplinary and personalized strategies that include close and careful monitoring, as well as the simultaneous use of non-pharmacological treatments that have demonstrated evidence in improving quality of life without negatively affecting mental health, such as patient education, psychological therapy, physiotherapy, and mindfulness.

Dapagliflozin for rheumatic musculoskeletal disease in patients with chronic kidney disease.

To elucidate the effectiveness of dapagliflozin, a sodium-glucose cotransporter 2 (SGLT-2) inhibitor, on renal function in patients with rheumatic musculoskeletal diseases complicated by chronic kidney disease (CKD) and identify factors associated with the response to dapagliflozin. We conducted a retrospective analysis of patients with rheumatic musculoskeletal disease and CKD who were treated with dapagliflozin for more than a year. The good response was defined as an improvement in the estimated glomerular filtration rate (eGFR) slope per year after dapagliflozin treatment compared to that before treatment. Additionally, we investigated the response rate and its predictive factors. In this analysis, 43 patients were included. The average eGFR slope demonstrated a significant improvement after dapagliflozin treatment compared to that before the treatment (0.04 vs -0.55 mL/min/1.73m²/year, p=0.001). A good response rate was 69.8% and was associated with low average levels of C-reactive protein, a high frequency of angiotensin II receptor blocker (ARB) use, and a low frequency of tacrolimus use compared to non-response (0.08 ± 0.18 vs 0.25 ± 0.29 mg/dL, p=0.03; 80.0% vs 38.4%, p=0.01; 10.0% vs 76.9%, p<0.01). Dapagliflozin is effective for rheumatic musculoskeletal diseases patients with CKD for preventing deterioration of renal function. Antihypertensive treatment with ARBs and inflammation control without tacrolimus was associated with a high likelihood of favorable response to dapagliflozin.

Ergonomics Risk Assessment of Musculoskeletal Disorder During Ultrasound-Guided Internal Jugular Venous Cannulation.

Acutely sick patients can receive emergency intravenous access through central venous cannulation to administer fluids and medicines, perform haemodynamic monitoring and extracorporeal therapies, including plasmapheresis or haemodialysis. Using the Seldinger procedure, access is gained by percutaneous puncture, frequently guided by ultrasonography into the femoral, subclavian or internal jugular veins. This study aimed to identify ergonomic risk factors for musculoskeletal disorders (MSDs) in operators performing ultrasonography-guided internal jugular vein (IJV) cannulation at various table heights and probe orientations. Sixty emergency medicine residents participated in a cross-sectional study conducted by the Emergency and Trauma Department of Hospital Universiti Sains Malaysia, Kelantan. Participants were instructed to perform the cannulation at two distinct table heights and with two distinct probe orientations. To compute the ergonomic risk score, the Rapid Entire Body Assessment (REBA) method was used. The table height of 0.5 elbow factor with varied probe resulted in a median REBA score of 5.0, whereas the table height of 0.7 elbow factor with varied probe had a median REBA score of 4.0. All four positions exhibited medium risk for MSDs. This study showed that the table height of 0.7 elbow factor is more ergonomically favourable while still imposed medium risk for MSDs.

What is needed to address psychosocial hazards in road transport? Using implementation science to understand the gaps

Work-related psychosocial hazards have a significant influence on the development of musculoskeletal and mental health disorders (MSDs and MHDs). This study used behavioural change theory to guide understanding of barriers and enablers for leaders working in the Heavy Vehicle Road Transport industry, to address workplace psychosocial hazards. The findings will be used to inform design of a future intervention to support leaders to more effectively address these hazards. Principal results and major conclusions: A higher number of barriers than enablers were identified. The most prevalent barriers were inadequate knowledge and interpersonal skills, and environmental context and inadequate resources, and the most prevalent enabler was risk management. The findings extend previous evidence by providing more specific detail regarding requirements for addressing psychosocial hazards. Further, the findings identified there is a need to improve the capability, opportunity and motivation of leaders to enable them to more effectively address psychosocial hazards.

Effectiveness of Virtual Reality-Based Multi-Therapy Systems for Physio-Psychological Rehabilitation: A Clinical Study

The worldwide increase in the number of disorders requiring rehabilitation is weighing more and more on healthcare systems, seriously affecting the quality of life of patients. Emergent technologies and techniques should be used more and more in both physical and psychological rehabilitation, after a thorough study of their potential and effects. Our paper presents an original virtual reality-based system including gamified immersive physio-psychological exercises, which was tested in a clinical setting with 25 patients suffering from various musculoskeletal, neuromotor, or mental disorders. A thorough testing protocol was followed during a two-week period, including repeated trials, progress tracking, and objective and subjective instruments used for data collection. A statistical analysis helped us identify interesting correlations between complex virtual reality games and people’s performance, and the high level of relaxation and stress relief (4.57 out of 5 across all games) which can be offered by VR-based psychotherapy exercises, as well as the increased ease of use (4.26 out of 5 perceived across all games) of properly designed training exercises regardless of patients’ level of VR experience (84% of patients with no or low experience and no patient with high experience).

Cross-cultural adaptation and psychometric properties of the Arabic version of the Central Sensitization Inventory in people with chronic musculoskeletal pain.

The Central Sensitization Inventory (CSI) is a patient-reported screening instrument that can be used to identify and assess central sensitization (CS)/Central Sensitization Syndrome (CSS)-related symptoms. The aim was to translate the CSI into Arabic (CSI-Ar) and to subsequently validate its psychometric properties. Cross-sectional. The CSI was translated and cross-culturally adapted into Arabic, and validated following international standardized guidelines. This study included patients with chronic musculoskeletal pain (n = 264) and healthy control participants (n = 56). Patients completed the CSI-Ar, Pain Catastrophizing Scale (PCS), Depression, Anxiety, and Stress scale (DASS-21), Tampa Scale of Kinesiophobia (TSK), and 5-level EuroQol-5D (EQ-5D). Patients completed the CSI-Ar twice to assess test-retest reliability. To evaluate discriminative validity, healthy controls participants completed the CSI-Ar. Statistical analyses were conducted to test the internal consistency, reliability, and structural, construct and discriminant validity of CSI-Ar. The CSI-Ar showed acceptable internal consistency (Cronbach's alpha = 0.919) and excellent test-retest reliability (intraclass correlation coefficient = 0.874). The CSI-Ar scale had significant correlations (P < 0.001) with all PCS subscales and total score (Spearman's rho = 0.459-0.563, P < 0.001), all DASS-21 subscales and total score (Spearman's rho = 0.599-0.685, P < 0.001), the TSK (Spearman's rho = 0.395, P < 0.001), and the EQ-5D (Spearman's rho = -0.396, P < 0.001). The Mann-Whitney U-test showed a statistically significant difference between the patient group and the healthy control group (P < 0.001), with the healthy controls displaying a lower average CSI-Ar score (12.27 ± 11.50) when compared to the patient group (27.97 ± 16.08). Factor analysis indicated that the CSI-Ar is a unidimensional tool. The CSI-Ar is a reliable and valid screening tool that can be used to assess CS/CSS-related symptoms in Arabic-speaking people with chronic musculoskeletal pain.

Work-related musculoskeletal disorders in dockworkers. Systematic review and meta-analysis.

Dockworkers are exposed to physical overloads that can contribute to the development of musculoskeletal disorders, leading to functional disability and absenteeism. to map, critically appraise, and synthesize the available evidence on the prevalence of musculoskeletal diseases associated with port occupational activities. A comprehensive search was conducted in structured and unstructured databases in August 2023, with no date or language restriction, to identify observational studies evaluating the prevalence of musculoskeletal disorders in dockworkers' occupational activity. The risk of bias was assessed using validated tools based on the included study designs. Data from studies were pooled in meta-analyses. The certainty of the evidence was assessed using the GRADE approach. We identified 12 analytical cross-sectional studies involving 7821 participants in ports of five countries. Most studies (75%) had a moderate methodological quality according to the Joanna Briggs Institute tool. Considering the overall worker categories and any musculoskeletal disorders, the meta-analysis showed a prevalence of 58% (95% Confidence Interval [95% CI] 37% to 78%), with degenerative spinal diseases 42% (95% CI -0.6% to 91%) and low back pain 36% (95% CI 21% to 50%) being the most prevalent conditions. Symptoms were predominantly in foremen and stevedores. The certainty of the evidence was very low. Musculoskeletal disorders seem prevalent among dockworkers, mainly degenerative spinal diseases and low back pain. Studies with greater methodological consistency are still needed to validate these hypotheses and assist in decision-making for implementing preventive and informational policies in maritime port management organizations. PROSPERO registry CRD42021257677.

Assessment of occupational musculoskeletal disorders (MSDs) among heavy vehicle drivers.

Professional driving requires long hours of work, uncomfortable seats, negotiating rough terrain and highways, and possibly minor repairs and other auxiliary transportation duties. Heavy vehicle drivers driving vehicles such as trucks, bulldozers, etc. due to such working structures are more prone to various musculoskeletal disorders (MSDs) and pain, which is of great concern. In the present study, it is planned to investigate possible ergonomic risk factors such as age, weight, driving exposure, seat suspension systems, lifting heavy weights causing MSDs in drivers of various heavy vehicles. The results of the study are expected to help drivers reduce the risk of MSDs. For the present study, the Nordic questionnaire on musculoskeletal disorders was modified and standardized and was administered to the 48 heavy vehicle drivers randomly selected to collect the data. The analysis divulged that over the past 12 months, lower back pain (LBP) emerged as the most dominant pain experienced by 56% of drivers, followed by knee pain (KP) (43%) and neck pain (NP) (39%) respectively. The prevalence of shoulder pain (SP) was observed to be much lower than in previous literature. The logistic regression model further revealed that increasing age, poor suspension system and poor body posture were significantly associated with lower back pain. Additionally, a poor suspension system and lifting heavy weights had significant effect on the drivers' knee pain. The results demonstrated the evident necessity for ergonomic consideration in vehicle designing and ergonomic training for heavy vehicle drivers.

Effect of Blood Flow Restriction on Gait and Mobility in Older Adults: A Systematic Review and Meta-Analysis.

Older adults demonstrate gait impairments that increase their risk for falls. These age-related mobility impairments are in part due to declines in muscle mass and strength. High-intensity exercise can improve muscle strength and mobility but may not be tolerable for older adults due to musculoskeletal injury and pain. Blood flow restriction (BFR) with lower-intensity exercise offers a strategy that may be more tolerable for older adults, but whether BFR improves gait and mobility in older adults is unclear. The purpose of this systematic review and meta-analysis was to determine the effect of BFR on gait and mobility in healthy older adults. PubMed, Embase, Cochrane Library, and CINAHL were systematically searched for articles utilizing BFR in older adults. Articles were included if adults were over 60 years, did not have chronic health conditions, had undergone randomized controlled trials, and presented objectively measured gait outcomes. The search identified 1501 studies, of which 9 were included in the systematic review and 8 studies in the meta-analysis. Outcome measures included the Timed Up and Go (TUG), 6-Minute Walk Test (6MWT), 400 m walk test, Short Physical Performance Battery (SPPB), and 10 m walk test. Meta-analyses found improvements in the TUG (mean difference (MD) = -0.71; 95% CI = -1.05, -0.37; p < 0.001) and SPPB (MD = -0.94; 95% CI = -1.48, -0.39; p < 0.001) in BFR compared to no BFR. There were no differences in gait speed (MD = 0.59; 95% CI = -0.22, 1.41; p = 0.16). BFR may be effective for gait and mobility tasks over shorter distances. Clinicians may consider incorporating BFR to improve mobility and gait function in older adults.

The evolution of new and emerging occupational health and safety risks: A qualitative review.

Work itself and occupational health and safety (OHS) have evolved through industrial revolutions and will also continue to evolve in the future. The aim of this qualitative literature review was to examine how the scientific discussion on new and emerging risks (NERs) related to OHS has evolved in recent decades in developed and newly industrialized countries. A search of the Scopus database yielded 34 articles published before 2000 and from 2020 onwards. A review of the articles identified NERs themes related to changes in work patterns, changing workforce and growth in some sectors, climate change, new materials or increased use of materials, new technology and technological development, and viruses. In both article collection periods, possible adverse OHS effects discussed included musculoskeletal disorders, exposure to toxic agents, chemical compounds and hazardous materials, increased stress, increased likelihood of errors and accidents, psychosocial problems, mental fatigue, and increases in work-related illnesses and accidents. The articles published during both periods discussed similar themes. The main differences were regarding specific time-related cases, such as climate change and COVID-19. Based on the findings of this review, points to consider in OHS management and future studies are discussed.

Autologous Peripheral Blood-Derived Orthobiologics for the Management of Hip Osteoarthritis: A Systematic Review of Current Clinical Evidence.

Osteoarthritis (OA) of the hip affects millions of people with a sizable health-related economic burden. Conventional treatment modalities are prioritized, turning to surgical intervention only when they have failed. Nevertheless, these approaches have flaws, regularly trying to provide symptomatic pain relief instead of focusing on the underlying etiology. The last two decades have seen a significant increase in the use of autologous peripheral blood-derived orthobiologics (APBOs) for managing musculoskeletal disorders, including OA of the hip. Platelet-rich plasma (PRP) is the most regularly used APBO. Yet, studies have shown its inefficacy in improving pain and function along with a high incidence of reporting bias in systematic reviews and meta-analyses involving PRP injections for hip OA. Thus, the potential of using other APBOs, including platelet lysate (PL), autologous conditioned serum (ACS), gold-induced cytokine (GOLDIC), plasma rich in growth factors (PRGF), autologous protein solution (APS), and hyperacute serum (HS), for managing OA of the hip was investigated. This review summarizes the results of clinical studies involving the mentioned APBOs to manage OA of the hip.Multiple databases (Scopus, Embase, PubMed, and Web of Science) were searched employing terms for these 'APBOs' and 'OA of the hip' for articles published in the English language till September 21, 2024, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Only two articles fit the scope of our study, andboth included articles involved the use of ACS. No clinical studies involving the use of PL, GOLDIC, PRGF, APS, and HS were identified. No ongoing clinical trials were listed on any of the searched registers involving the use of the aforesaid APBOs.Intra-articular administration of ACS is safe and can reduce pain in patients with OA of the hip. Nonetheless, given the dearth of pertinent literature and limitations of included articles, more adequately powered, prospective, multicenter, controlled, open-label or blinded, randomized, and non-randomized trials with extended follow-up are necessary to determine the efficacy of various APBOs for managing hip OA. Further comparative studies to assist clinicians in finding the ideal APBO for the treatment of OA of the hip are needed.

Generative AI-based knowledge graphs for the illustration and development of mHealth self-management content.

Digital therapeutics (DTx) in the form of mobile health (mHealth) self-management programs have demonstrated effectiveness in reducing disease activity across various diseases, including fibromyalgia and arthritis. However, the content of online self-management programs varies widely, making them difficult to compare. This study aims to employ generative artificial intelligence (AI)-based knowledge graphs and network analysis to categorize and structure mHealth content at the example of a fibromyalgia self-management program. A multimodal mHealth online self-management program targeting fibromyalgia and post-viral fibromyalgia-like syndromes was developed. In addition to general content, the program was customized to address specific features and digital personas identified through hierarchical agglomerative clustering applied to a cohort of 202 patients with chronic musculoskeletal pain syndromes undergoing multimodal assessment. Text files consisting of 22,150 words divided into 24 modules were used as the input data. Two generative AI web applications, ChatGPT-4 (OpenAI) and Infranodus (Nodus Labs), were used to create knowledge graphs and perform text network analysis, including 3D visualization. A sentiment analysis of 129 patient feedback entries was performed. The ChatGPT-generated knowledge graph model provided a simple visual overview with five primary edges: "Mental health challenges", "Stress and its impact", "Immune system function", "Long COVID and fibromyalgia" and "Pain management and therapeutic approaches". The 3D visualization provided a more complex knowledge graph, with the term "pain" appearing as the central edge, closely connecting with "sleep", "body", and "stress". Topical cluster analysis identified categories such as "chronic pain management", "sleep hygiene", "immune system function", "cognitive therapy", "healthy eating", "emotional development", "fibromyalgia causes", and "deep relaxation". Gap analysis highlighted missing links, such as between "negative behavior" and "systemic inflammation". Retro-engineering of the self-management program showed significant conceptual similarities between the knowledge graph and the original text analysis. Sentiment analysis of free text patient comments revealed that most relevant topics were addressed by the online program, with the exception of social contacts. Generative AI tools for text network analysis can effectively structure and illustrate DTx content. Knowledge graphs are valuable for increasing the transparency of self-management programs, developing new conceptual frameworks, and incorporating feedback loops.