Musculoskeletal Care最新文献

Background: Carpal tunnel syndrome (CTS) is a considerable concern, impacting individual health and socio-economic factors. A systematic review and meta-analysis of CTS prevalence would offer valuable insights for healthcare planning, improving outcomes and reducing the burden on affected individuals.

Methods: In line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a meta-analysis was conducted to estimate the prevalence of CTS. Medline, CINAHL, AMED, Scopus, and Web of Science databases were searched for studies published from 1 January 2012 to 10 October 2024. The pooled prevalence rates were determined using a random effects model.

Results: The search yielded 548 initial findings, 103 duplicate records were eliminated, and only 31 of these papers were deemed relevant for inclusion in this review. The prevalence estimates were sourced from 15 different countries, including the United States (n = 8), Saudi Arabia (n = 5), Ethiopia (n = 3), Turkey (n = 2), Iran (n = 2) and Brazil (n = 2), among others. Each of the following countries contributed one study: China, France, Germany, India, Kuwait, the United Kingdom, Korea, the Netherlands, and Sweden. In total, the included studies analysed 5,311,785 individuals, revealing a prevalence of CTS ranging from 0.003 to 0.743. The random-effects meta-analysis yielded an overall prevalence estimate of 0.144, with a 95% confidence interval (CI) of 0.067-0.282, based on 30 studies.

Conclusion: The prevalence estimates for CTS are notably high, highlighting the need for effective surgical management strategies. Developing and implementing these interventions is crucial to enhancing health outcomes for individuals affected by CTS.

Objective: To examine the effect of biological sex on wait-times to first rheumatology appointment in a central triage system before, during and after the COVID-19 pandemic.

Methods: De-identified data of patients referred to one centralised Rheumatology referral centre between November 2019 and December 2023 were extracted from the electronic medical record. Variables collected and analysed included time from referral to first appointment, biological sex, referral period, triage urgency, age, and geographic location.

Results: 19,681 referrals were identified. In the pre-COVID period, there was no significant difference in wait-times by biological sex or age. After adjusting for triage level, age and geographic location, females waited significantly longer in the peri-COVID period versus males (10.2 days, 95% CI 7.1, 13.3), which persisted in the post-COVID period (7.5 days, 95% CI 4.0, 11.1). Similarly, younger patients waited longer than older patients in the peri-COVID period (4.7 fewer days per decade increase in age (95% 3.9, 5.6)). This age discrepancy persisted through the post-COVID period (2.3 days, 95% CI 1.6, 3.5). Geographic location was a significant predictor of wait-times in the post-COVID period, with those outside of Edmonton waiting longer than in Edmonton. Once the change in referral pattern from Northwest Territories was accounted for, this discrepancy ceased.

Conclusions: Female and younger patients have been disproportionately impacted by wait-time increases during the COVID-19 pandemic, with minimal improvements observed during the post-COVID period. These findings should prompt further investigation into the underlying causes of these observed inequities in access to rheumatology care to identify solutions.

Background: Shoulder osteoarthritis is a common cause of pain, disability and difficulty sleeping. Patient information leaflets are produced by NHS Trusts with the aim of informing patients about their diagnosis and available treatment options.

Objectives: The aim of this study was to identify and describe the non-surgical management of people with shoulder osteoarthritis according to publicly available information leaflets produced by NHS Trusts.

Methods: One reviewer undertook an electronic search using Google to identify publicly available patient-facing information leaflets (PIL) produced by NHS Trusts which detailed non-surgical management strategies for people with shoulder osteoarthritis. Relevant data were extracted by one reviewer and verified by two reviewers.

Results: Seventeen PILs from 17 different UK NHS Trusts were identified ranging from December 2016 to February 2024. Information provided in the PIL varied, with topics including general osteoarthritis management, exercise, analgesia, injections, and surgical indications. No PIL covered all areas recommended in the NICE Osteoarthritis Management guidelines.

Conclusion: PILs developed and published by NHS Trusts are variable in content and do not fully reflect current clinical guidelines. High-quality research to inform consistent, clinically, and cost-effective treatment pathways, including information provision, for patients with shoulder osteoarthritis is needed.

Background: Fibromyalgia Syndrome (FMS) is characterised by widespread and persistent pain, intrusive fatigue and cognitive issues, affecting approximately 5.4% of the UK population. Non-pharmacological therapies and education are current management recommendations, but these approaches rely on patients having an active role in their healthcare management. It is therefore important to identify the factors associated with FMS patients being active partners, as this could influence person-centred care provision.

Aim: The aim of this study is to explore the factors associated with patients being an active partner in the management of FMS.

Methods: This is a protocol for mixed methods systematic literature review with convergent integrated approach in accordance with JBI methodology. The databases AMED, MEDLINE, PsychINFO and CINAHL will be searched via EBSCOhost. Screening and selection will be conducted by two reviewers. Primary qualitative, observational and experimental studies from July 2005 to July 2024 will be included. Critical appraisal of eligible studies will be conducted using appropriate JBI tools. Data will be extracted, transformed where necessary and synthesised without meta-analysis.

Discussion: This mixed methods systematic review will provide a comprehensive understanding of the factors associated with patients being active partners, offering not only the 'what' but also the 'why' behind patients taking an active role in their healthcare. This will help guide future research and practice in supporting patients to be active partners in FMS management.

Trial registration: This systematic review has been registered with PROSPERO (registration number: CRD42024575159).

Introduction: Despite growing research, the relationship between social determinants of health (SDoH) and low back pain (LBP) remains inconsistent. This study aimed to investigate the associations between SDoH and self-reported LBP in the Portuguese population in 2019 and explore potential differences between rural and urban areas.

Methods: This is a cross-sectional study that includes 13,230 participants from the 2019 Portuguese National Health Interview Survey. Multivariable logistic regression models were used to assess the associations between SDoH and LBP. Interaction effects were examined to determine whether these relationships are modified by the degree of urbanisation/rurality.

Results: The regression model for demographic and economic determinants showed associations between LBP and sex, age, marital status, education and financial capacity, with older rural residents having a higher likelihood of reporting LBP. The psychosocial model revealed that poor health status, sleep disturbances, fatigue, and dissatisfaction with life course were positively associated with LBP. In the behavioural model, obesity and history of smoking increased the probability of reporting LBP, whereas exercise behaviours reduced it and significantly varied across urban and rural regions. Health-system factors, including hospital visits, medication use, consultations with rehabilitation professionals, delayed healthcare access, and unmet health needs due to financial constraints, were associated with LBP. Rural residents were more likely to seek outpatient care at hospitals.

Discussion: These findings emphasise the importance of integrating the evaluation of SDoH into healthcare settings to develop tailored interventions for LBP management.

Conclusion: LBP was influenced by several SDoH, but differences between rural and urban areas were limited.

Background: Rheumatoid arthritis (RA) is a disabling common chronic inflammatory joint disease. In Ontario, the burden is higher in those aged 65 and older, in females, and in northern communities. This study examined patient disease impact and healthcare provider access and satisfaction as well as provider satisfaction, patient experience and educational suggestions.

Methods: Semi-structured interviews and reflexive thematic analysis were used.

Results: Interviews occurred with: (1) 18 Northern (N) Ontario patients, (2) 6 N Ontario family physicians, (3) 6 N Ontario pharmacists and (4) a rheumatologist and 4 advanced clinical practitioners in arthritis care (ACPACs) who treat N Ontario patients. Patients emphasised the need to: (1) act on early symptoms, (2) self-advocate, (3) attract more N Ontario rheumatologists, (4) educate the public, (5) recognise that medication can change over time and (6) pace physical tasks. Satisfaction was expressed with providers. Family physicians mentioned the need to: (1) be front-line educators, (2) commence initial treatment, (3) enhance undergraduate medical curricula and (4) require rheumatology rotations. Pharmacists expressed: (1) acting as patient educators, (2) assisting with insurance plans, (3) encouraging family physicians to commence treatment, (4) monitoring medication interactions and (5) professional collaboration. The ACPACs and rheumatologist stressed the value of: (1) patient advocates, (2) family physicians initiating treatment, (3) pharmacists monitoring for drug interactions, (4) expanding undergraduate medical school rheumatology curricula and (5) accessing local care.

Conclusion: Additional patient and public education are needed. Enhancing undergraduate and graduate medical school rheumatology curricula, rotations, continuing rheumatology education and interprofessional collaboration were recommended.

Background: Many outcome measures used in lower-limb osteoarthritis (OA) present ceiling effects. This compromises the ability of those measures to accurately assess people with higher levels of physical function. Understanding of the difficulty and importance of physical activities would enable the inclusion of challenging and meaningful activities in new outcome measures.

Purpose: To explore the perceived difficulty and importance of 40 physical activities by people with and without lower limb OA.

Methods: We conducted a discrete choice experiment (DCE) using 1000minds software. We recruited people with and without OA using OA databases and social media. Participants were asked to complete two comparison tasks, first about the relative difficulty and then about the importance of the physical activities. Pairwise comparisons were presented (i.e., two alternatives at a time), and participants selected the most difficult/important.

Results: We analysed data from 613 participants, of whom 215 had OA. Rankings of difficulty and importance were obtained. No major differences existed in the difficulty ranking between people with and without OA. People with OA rated activities like kneeling and balancing activities as more important than those without OA. In contrast, people without OA rated jogging, squatting, and running as more important than those with OA. Challenging activities were generally rated as less important.

Conclusions: A DCE ranked 40 different lower limb physical activities in terms of difficulty and importance. Challenging activities were found to be less important than easier ones. People with OA gave more importance to easier activities than people without OA.

Objectives: To explore physiotherapists' experiences and perceived acceptability of delivering a bracing intervention for knee osteoarthritis (OA) in the 'PROvision of braces for Patients with knee OA' (PROP OA) randomised controlled trial.

Method: Semi-structured telephone interviews with consenting physiotherapists who received the PROP OA training programme and delivered the knee bracing intervention (advice, information and exercise instruction plus knee brace matched to patients' clinical and radiographic presentation and with adherence support). Interviews were recorded and transcribed verbatim. Two-stage analytic framework: inductive thematic analysis preceded mapping to constructs of the Theoretical Framework of Acceptability.

Results: Eight physiotherapists were interviewed and six key themes were developed. Perceptions of the training programme were generally positive, but additional formal training and experiential learning consolidated confidence and skills in novel intervention components. Advice, information, and exercise instruction reflected usual physiotherapy care for knee OA. Physiotherapists were confident in delivering the knee brace, but determining the pattern of knee OA to inform brace type selection was challenging. Physiotherapists valued brace adherence enhancing strategies and the follow-up appointment to facilitate adherence. Perceived impact of the bracing intervention for people with OA was positive. The bracing intervention was perceived as acceptable, although improving self-efficacy to deliver novel intervention components (e.g., reading x-rays) would enhance acceptability.

Conclusion: The complex knee bracing intervention was broadly perceived as acceptable by physiotherapists. If implemented within clinical practice beyond the trial, physiotherapists might benefit from not only initial training in brace selection but also ongoing support and mentoring to increase self-efficacy in delivery.

Introduction: Musculoskeletal (MSK) conditions are one of the leading causes of years of living with disability in the UK, resulting in pressure on the health system and the UK economy. In response to the increasing levels of patients accessing NHS care with MSK conditions across Sandwell and West Birmingham (SWB), a digital triage and self-management tool was implemented in 2023.

Aims: To optimise safety, efficiency, and choice within the community MSK service from the first contact through to specialist MSK care through digital triage and supported self-management.

Methods: SWB's community MSK service implemented two digital tools in January 2023. Objectives included 1. Increase safety, through providing 24/7 access to rapid digital MSK triage; 2. Optimise workforce by releasing clinicians back to face-to-face care, increasing clinical capacity, 3. Increase patient choice by offering digitally supported self-management to appropriate low risk patients.

Results: 4804 patients self-referred to the MSK service through the digital triage tool within the first 12 months. 378 of these patients were offered, accepted, and accessed self-management support using the digital self-management app. These innovations led to the release of 1240 clinical hours for face-to-face care, an average 8-week reduction in waiting times and high patient satisfaction (80% good/very good).

Conclusion: Evaluation over the first 12 month showed that the digital innovations were safe, led to enhanced access to and choice of care pathways, optimised use of clinical staff, and received positive patient feedback. Research is needed in this newly emerging area of practice to support further adoption across the healthcare system.

Background: Knee Osteoarthritis (KOA) can cause considerable impairment of functional capacity and quality of life (QoL), especially in elderly individuals.

Objectives: To evaluate the impact of KOA on the functional capacity and QoL of elderly patients and to identify the factors associated with their impairment.

Methods: This was a cross-sectional study including patients aged 65 years or more with primary KOA. Functional capacity was assessed using the WOMAC index and QoL using the WHOQOL-OLD instrument. The p significance level was set at 0.05.

Results: Fifty patients were included, 3 men and 47 women, with a mean age of 71.9 ± 6.3 years. The mean WOMAC total score was 49.2 ± 21.7, WOMAC pain 12 ± 5.2, WOMAC function 33.4 ± 15.2 and WOMAC stiffness 4 ± 2.6. Factors associated with better functional capacity were the use of analgesics, functional rehabilitation and physical activity. The mean WOQOL-OLD total score was 84.2 ± 13.4. The autonomy and intimacy dimensions had the highest scores (92.1 ± 13.8 and 91.3 ± 16.5 respectively). The death and dying dimension had the lowest score (69.9 ± 37.1). Factors associated with a poor QoL were diabetes, unilateral involvement, duration of KOA, absence of analgesic treatment and the absence of physical activity. Functional limitation was significantly associated with poorer QoL.

Conclusion: In our study, KOA was found to be associated with impaired functional capacity and QoL among elderly patients. Comorbidities, inadequate use of analgesics and lack of physical activity seem to be determining factors contributing to this impairment.