Musculoskeletal Care最新文献

Introduction: Guideline-recommended management of low back pain (LBP) is associated with improved patient outcomes and costs. This study aimed to assess Italian physiotherapists' attitudes towards and adherence to LBP clinical practice guidelines (CPGs).

Methods: We conducted an online cross-sectional survey of Italian physiotherapists. Participants' demographics, attitudes towards, and familiarity with CPGs were collected. Six vignettes of patients with LBP were presented. For each, participants selected management options from a pre-specified list. Management options were categorised as recommended, not recommended, and no recommendation based on CPG recommendations and systematic reviews. Ordinal logistic regression assessed associations between participant characteristics and the number of vignettes for which recommended and not recommended care options were selected (stratified by non-specific LBP and red flag vignettes).

Results: Of the 272 participants completing the demographic section of the survey, 142 completed all vignettes. Care that was recommended, not recommended, and had no recommendation was selected by 87%, 32%, and 93% of participants on average in the six vignettes, respectively. Working in a hospital setting was associated with a reduced likelihood of selecting recommended care for non-specific LBP (coefficient: -1.28; 95% CI: -2.20, -0.36). Stronger self-reported familiarity with three published CPGs was associated with decreased likelihood of selecting not recommended care but was not associated with selecting recommended care for non-specific LBP. All other variables were not associated with selecting recommended and not recommended care.

Conclusions: Physiotherapists commonly selected recommended care options for patients with LBP, yet there remains considerable scope to reduce selection of care which is not recommended.

Objective: This study aims to investigate the impact of two-way social support on rehabilitation exercise compliance among patients undergoing total knee arthroplasty and examine psychological flexibility's mediating role.

Design: Cross-sectional study.

Methods: A convenience sample of 266 total knee arthroplasty patients was recruited from the orthopaedic department of a tertiary hospital in Guiyang, Guizhou Province, between November 12, 2024, and March 20, 2025. Data were collected using standardised instruments, including a general demographic questionnaire, a brief two-way social support scale, a simplified multidimensional psychological flexibility inventory, and a rehabilitation exercise adherence scale. Amos 29.0 software was used to construct a structural equation model of the mediating effect of psychological flexibility between two-way social support and rehabilitation exercise compliance.

Results: Pearson correlation analysis revealed significant positive associations among two-way social support, psychological flexibility, and rehabilitation exercise compliance ( $r$  = 0.538-0.730, $p$  < 0.001). Mediation analysis demonstrated that two-way social support enhanced rehabilitation exercise compliance indirectly through increased psychological flexibility (effect size = 0.336, 95% $CI$ [0.253-0.442], $p$  < 0.05), accounting for 53.0% of the total effect. Additionally, a significant direct effect of two-way social support on rehabilitation exercise compliance was observed (effect size = 0.298, 95% $CI$ [0.181-0.432], $p$  < 0.05).

Conclusion: Two-way social support has a positive influence on rehabilitation exercise compliance in TKA patients, with psychological flexibility serving as a partial mediator. These findings suggest that healthcare professionals can improve patient compliance with rehabilitation protocols by fostering greater psychological flexibility.

Background: Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disorder causing joint damage, pain, and functional limitations. While pharmacotherapy remains central to management, physiotherapeutic interventions are increasingly recognised for their supportive role in symptom alleviation and quality of life enhancement.

Objective: This systematic review and meta-analysis aimed to evaluate the effectiveness of various physiotherapeutic interventions in reducing pain and improving function and quality of life in patients with RA.

Methods: Following PRISMA guidelines, a comprehensive search of PubMed, Scopus, and Web of Science (2010-2025) identified randomized controlled trials (RCTs) assessing physiotherapy modalities in RA. Methodological quality was appraised using the Cochrane RoB 2.0 tool. Pain outcomes were synthesised via meta-analysis using a random-effects model.

Results: Seventeen RCTs involving 1362 participants were included. Interventions encompassed aerobic/resistance exercise, hydrotherapy, manual therapy, electrotherapy, and multimodal approaches. Meta-analysis of five trials (n = 307) revealed a statistically significant reduction in pain favouring physiotherapy (SMD = -0.347; 95% CI: -0.571 to -0.124; p = 0.002; I* = 0%). No significant publication bias was detected. Narrative synthesis indicated potential benefits in functional and cardiorespiratory outcomes, especially with combined exercise and lifestyle interventions.

Conclusions: Physiotherapeutic interventions, particularly structured exercise programs, demonstrate moderate evidence for pain reduction in RA. Integrating multimodal physiotherapy with diet and adjunct therapies may enhance patient outcomes. Further high-quality, standardized RCTs are warranted to optimise intervention protocols and assess long-term benefits.

Background: Low back pain (LBP) is one of the most prevalent musculoskeletal conditions globally, often leading to diminished quality of life, reduced physical function, and increased healthcare utilization. Recent advancements in remote sensor-based technologies have introduced innovative methods for continuous monitoring and personalised rehabilitation of individuals with LBP.

Objective: This Narrative review aims to explore and synthesize current evidence on the use of remote sensor-based monitoring in the management of low back pain, with a focus on outcomes related to quality of life, functional recovery, and patient-centred care.

Methods: A systematic search was performed across four major databases-PubMed, Scopus, Web of Science, and Google Scholar-for studies published between 2010 and 2025. Search terms included low back pain, remote monitoring, wearable sensors, digital health, and rehabilitation outcomes. Inclusion criteria comprised randomized controlled trials, cohort studies, systematic reviews, scoping and literature reviews that examined sensor-driven interventions in outpatient or home-based LBP rehabilitation settings.

Results: The review identified evidence supporting the use of wearable sensors in enhancing patient engagement, tracking physical activity, and enabling real-time feedback during exercises. Improvements were noted in pain management, functional mobility, and patient-reported quality of life. Moreover, remote monitoring promoted adherence and early detection of relapses. Nonetheless, heterogeneity in sensor types, data interpretation, and outcome reporting was observed across studies.

Conclusion: Remote sensor-based monitoring holds significant potential to complement conventional rehabilitation strategies for low back pain. Future research should prioritise standardized frameworks, integration into clinical pathways, and evaluation of long-term cost-effectiveness and patient acceptability.

Background: Subacromial pain syndrome (SAPS) is the most common shoulder pain condition in primary care. Despite the importance of shared decision-making (SDM) being increasingly recognised, its application in SAPS care remains poorly understood. The primary aim of this study was to explore the influence of a decision aid on patient and observer perceptions of SDM, and secondarily to explore correlations between these ratings in the primary care management of patients with SAPS.

Methods: We conducted a multi-methods study including observations of consenting patients with SAPS in their clinical consultations with clinicians from four Danish primary care practices using OPTION-12. We gathered patients' perceptions of SDM 2 weeks after the consultation using the CollaboRATE questionnaire and Shared Decision-Making Questionnaire (SDM-Q-9). We observed consultations with and without the introduction of a decision aid tailored to support the management of patients.

Results: Thirty-four consultations were observed (16 with and 18 without the decision aid). Without the aid, the mean (SD) OPTION-12 score was 10.5 (3.3), while the median (IQR) CollaboRATE and mean (SD) SDM-Q-9 scores were 5 (1.3) and 22.2 (7.5), respectively. With the aid, scores significantly increased: OPTION-12 to 22.7 (6.87, range 5-32), CollaboRATE to 6.5 (1.4), and SDM-Q-9 to 30.6 (8.4). Patients' and observers' OPTION-12 and SDM-Q-9 scores correlated significantly across both phases, but no significant correlation was found between CollaboRATE, OPTION-12, and SDM-Q-9 scores in either phase.

Conclusion: A decision aid significantly improved observer- and patient-rated SDM in primary care consultations for patients with SAPS. Observer-rated SDM scores more than doubled with the decision aid, and patients reported higher levels of SDM.

Background: Plantar fasciitis (PF) is a prevalent cause of heel pain and is commonly managed through conservative physiotherapeutic interventions. Despite widespread clinical use, the relative effectiveness of various modalities remains unclear.

Objective: To evaluate the efficacy of different physiotherapeutic interventions on pain and function in adults with plantar fasciitis through systematic review and meta-analysis of randomized controlled trials (RCTs).

Methods: A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science (January 2020-May 2025) for RCTs assessing physiotherapy-based interventions for PF. Primary outcomes included pain (Visual Analog Scale [VAS]) and function (Foot Function Index [FFI]). Meta-analyses were performed using random-effect models, and the GRADE framework was applied to assess evidence certainty.

Results: Twenty-one RCTs (n = 1196) were included. Interventions included extracorporeal shock wave therapy (ESWT), kinesiology taping, laser therapy, manual therapy, and needling techniques. At 1-month follow-up, physiotherapy yielded a non-significant trend towards pain reduction (SMD = -0.390, 95% CI: -0.888 to 0.109, p = 0.125; I² = 88.7%). Functional outcomes showed no significant improvement (SMD = 0.000, 95% CI: -0.195 to 0.195, p = 1.000). Heterogeneity was high, and overall evidence quality was rated low.

Conclusion: Physiotherapeutic interventions may modestly reduce pain in the short term but show limited impact on functional improvement in plantar fasciitis. ESWT and kinesiology taping appear most promising. Further high-quality, long-term studies are warranted to clarify their clinical utility.

Background: Knee osteoarthritis (KOA) is a common degenerative condition causing pain, affecting mobility, and quality of life. As muscle weakness worsens in KOA, this review evaluates the effectiveness of quadriceps strengthening exercises in managing pain.

Methods: This review used the PubMed database to identify free full-text randomized controlled trials from the past 5 years, limited to English-language human studies, guided by the PICO framework. The Joanna Briggs Institute Critical Appraisal Tool was used to assess study quality; RCTs scoring ≥ 80% were included. Data were analysed descriptively, and effect sizes were calculated using G*Power software.

Results: Nine RCTs showed that quadriceps strengthening significantly reduced pain and improved function in KOA. Effective exercises included straight leg raises, terminal knee extensions, and open/closed chain movements over 8-12 weeks.

Conclusion: Quadriceps strengthening as a part of lower extremity strengthening is effective in reducing pain in KOA and should be prioritised in patient-specific programs.