Musculoskeletal Care最新文献

Aim: To test the mediating role of personal mastery in the relationship between self-compassion and medical coping modes in patients with rheumatoid arthritis (RA).

Design: A cross-sectional questionnaire survey was administered.

Methods: We enrolled a convenience sampling of patients with RA from a Class A tertiary hospital. Date were collected from May 2023 to April 2024. Using self-compassion, medical coping modes, and personal mastery self-reported questionnaires. The data were analysed using correlation analyses, multiple linear regression analysis and structural equation modelling.

Results: A total of 245 participants were included in this study. Personal mastery was an independent predictor of medical coping modes (β = 0.15, SE = 0.07, 95% CI [0.01, 0.30]). Significant correlations were identified between self-compassion, personal mastery, and medical coping strategies among these patients. Personal mastery was found to mediate the relationship between self-compassion and confrontation (β = 0.724, 95%CI: 0.367-1.081, p < 0.05) and avoidance coping strategies (β = -0.179, 95%CI: -0.336 to -0.022, p < 0.05). Additionally, self-compassion was directly linked to resignation coping (β = -0.309, 95%CI: -0.515 to -0.136, p < 0.05), with no mediation effect observed.

Conclusion: Personal mastery mediates the impact of self-compassion on the adoption of medical coping strategies among RA patients. Self-compassion is shown to have a direct influence on personal mastery. It is imperative for healthcare providers to consider the self-compassion and personal mastery of their patients, encouraging adaptive coping mechanisms to enhance life quality.

Objectives: The objectives were to assess current job retention vocational rehabilitation (JRVR) services for employed individuals with inflammatory arthritis (IA) in rheumatology therapy departments interested in participating in the Workwell trial. Additionally, to modify a JRVR training course to support therapists in delivering JRVR and to evaluate changes in therapists' knowledge, confidence, and ability following the training.

Methods: This was a mixed-methods study. Current work services were explored with lead therapists through a cross-sectional survey about their work rehabilitation service; and one-to-one interviews. Feedback from previous course attendees and trainers informed modifications to the training course. Participating therapists completed mailed questionnaires pre-and post-training.

Results: Lead therapists from 28 interested departments reported providing JRVR to a median of 7 patients per month (IQR 3-12) for an average of 60 min (IQR 41.25-90). Nine therapists participated in pre-trial interviews, with themes highlighting variability in referrals, the use of work assessment tools, and advice on ergonomic adjustments. The training course was shortened from three to 2 days by incorporating a pre-training self-study pack and reducing lecture time, while increasing practical content such as work assessment demonstrations and extended workshops. Following the training, 32 therapists showed significant improvements in their knowledge and confidence in delivering JRVR (p < 0.001).

Discussion: The need for training in work assessment and delivery of complex JRVR was identified. The therapist training course provided was favourably received. Post-training, therapists' ability to assess and plan complex JRVR improved.

Trial registration: WORKWELL Trial: ISRCTN: 61762297; Clinical Trials.Gov: NCT03942783.

Aim: This study aims to compare physical activity (PA) levels and exercise-related perceptions, including barriers and facilitators, between radiographic axial spondyloarthritis (r-axSpA) and non-radiographic axial spondyloarthritis (nr-axSpA) patients, and to explore the relationships between PA, exercise perceptions and clinical parameters in axSpA patients.

Methods: A cross-sectional design was used to recruit 123 axSpA patients, comprising 83 r-axSpA and 40 nr-axSpA. Clinical parameters, including disease activity, pain, spinal mobility, enthesopathy, physical function, fatigue, sleep quality, quality of life, fibromyalgia symptoms, kinesiophobia, and mental health, were assessed. PA levels were measured using the International Physical Activity Questionnaire-Short Form, while exercise perception was evaluated using the Exercise Benefits/Barriers Scale. Multivariable regressions examined the relationships between PA, exercise perception, and clinical variables.

Results: Physical activity levels were comparable between subgroups (p = 0.654), but r-axSpA patients reported significantly higher exercise barriers (p = 0.023). In the r-axSpA group, the most commonly endorsed benefit was "Exercise improves my flexibility" (94%), while in the nr-axSpA group, it was "Exercise increases my physical fitness" (95%). In both groups, the most common barrier was "Exercise tires me". Higher PA was linked to improved physical function and reduced kinesiophobia in nr-axSpA, and lower anxiety in r-axSpA (p < 0.05). Regression analysis revealed that PA level was related to symptom duration and enthesopathy, while exercise benefits were associated with health status, depression, physical function, and barriers with fatigue in axSpA patients.

Conclusion: Tailored interventions are essential to promote exercise participation in axSpA patients by addressing subgroup-specific barriers and clinical factors.

Objectives: This study sought to quantify the impact of participation in an interactive class for patients with chronic pain called Movement, Mindfulness, and Pain Science (MMaPS), on physical function, pain catastrophizing, and quality of life.

Methods: Patients with chronic pain of any type were enroled in an 8-week course that implemented principles of safe movement, mindfulness, and meditation practice, and also incorporated education related to the biopsychosocial model of pain science. Questionnaires were collected from participants who attended the MMAPS programme in the 2018 through 2020 sessions prior to and after the class to measure participant outcomes, which included the pain catastrophizing scale (PCS), Adverse Childhood Events score (ACE), Quality of Life scale (QOL), Patient Specific Functional Score (PSFS), 30 s sit to stand (30 STS), and 4-stage balance (4SBT).

Results: One hundred fifty-five people completed the class. The median Pain Catastrophizing Scale score dropped from 19 to 11 (p < 0.001). Median Quality of Life scores increased from 5 to 6 (p < 0.001) on a 10-point scale. Patient Specific Functional Scale scores improved from an average score of 2.5 to 5.1 (p < 0.001). Median 30 Second Sit-to-Stand scores improved from 8 to 11 (p < 0.001). The 4-stage balance test improved with 39% of patients having completed all four stages at intake and 56% completing all four stages by the end of class (p = 0.001).

Conclusion: Patients with chronic pain had significant improvements in several measures of wellness and physical function after participating in the MMaPS class.

Background: A cohort of patients in the rehabilitation wards also suffer from Fibromyalgia, which is considered the most prevalent cause of chronic pain. Poor function, subjective cognitive impairment, instability and imbalance are all common features of Fibromyalgia, among other more prominent features such as the use of chronic pain medication. The main purpose of this study was to examine the differences in Length of Stay (LOS) and functional outcome parameters.

Methods: A retrospective cohort trial was conducted at the Soroka University Medical Centre. The time of data collection was conducted from January 2015 to December 2021. Patients were divided into two groups based on their exposure status: With Fibromyalgia (n = 43) and Control group Without Fibromyalgia (n = 1119). A 1:10 matching process and regression analysis were performed to avoid confounding factors. Matching was based on age, gender, and ethnicity. Various rehabilitation outcomes were collected along with pain assessment and pain medication use during the hospitalisation. Statistical analysis was performed using R software. A p value of < 0.05 will be considered statistically significant.

Results: No statistically significant difference was found in the duration of hospitalisation, the FIM index at admission and discharge, or the change in the FIM index (ΔFIM) during hospitalisation between the two groups. No statistically significant differences were demonstrated in stability and balance indices (DGI, BBS) or cognitive assessment tests (MoCA).

Conclusions: The stigma is incorrect, as patients with fibromyalgia can improve their functional parameters during an inpatient rehabilitation programme to the same degree as those without fibromyalgia.

Introduction: Persistent musculoskeletal (MSK) disorders are one of the leading reasons for years lived with disability within the UK. Guidelines encourage integrating self-management support. Hydrotherapy supports patients with persistent MSK conditions; however, self-management following NHS-led hydrotherapy has been inconsistent.

Aim: To identify outcomes of hydrotherapy alongside the barriers, facilitators, and contributory factors affecting self-management in the local persistent MSK pain population.

Methods: Between April 2023 and May 2023, a service evaluation was undertaken exploring factors affecting self-management in the local persistent MSK pain population following NHS-led hydrotherapy. Demographics, clinical factors, functional status (MSK-HQ) and patient-reported experiences, including barriers and facilitators to self-management, were recorded. Data was analysed using descriptive statistics alongside exploration of themes.

Results: Ninety patients completed hydrotherapy. White British (n = 24) and Indian British (n = 23) were the most common groups to attend. Multiple joint (n = 27) and spinal conditions (n = 26) were the most common MSK conditions. Mean pre- and post-MSK-HQ scores were 20.8 and 26.1, respectively. Among the contactable patients (n = 69), 49 patients did not maintain independent water-based self-management reporting barriers such as ongoing support, access and financial concerns. Patients supported the establishment of a support group (n = 56) to help maintain water-based exercises.

Conclusions: The local persistent MSK pain population lacks self-efficacy for independent water-based self-management. A supportive and collaborative approach is proposed to address this via a patient-led hydrotherapy support group.

Objectives: This study aimed to investigate the knowledge and strategies used by Brazilian physical therapists in assessing and promoting self-efficacy and self-management in musculoskeletal rehabilitation.

Methods: A nationwide cross-sectional online survey was conducted with licenced physical therapists recruited through professional networks and social media. The questionnaire, developed based on the CHERRIES checklist, assessed participants' knowledge, clinical strategies, and perceived barriers related to self-efficacy and self-management interventions. Data were analysed using descriptive statistics and logistic regression models.

Results: A total of 348 responses were analysed. While 97.7% of respondents acknowledged self-efficacy as a key factor in treatment adherence, only 43.6% frequently applied strategies to enhance it in clinical practice, as per Bandura's theory. The most commonly cited interventions were self-management education and exercises (81.2%). However, limited professional training and low patient adherence emerged as major barriers. Logistic regression analysis revealed that therapists who engaged more frequently with literature on the subject were 3.48 times more likely (95% CI: 1.6-7.4) to implement self-efficacy strategies in practice compared with those who engaged less frequently.

Conclusion: Despite acknowledging the importance of self-efficacy, Brazilian physical therapists face challenges in applying structured strategies in practice. Enhancing education and integrating behavioural approaches into curricula may facilitate the implementation of evidence based self-efficacy interventions.

Introduction: Frozen shoulder is a disabling condition characterised by severe pain and loss of shoulder movement. Corticosteroid injections are targeted at reducing pain in the earlier painful phase. There are multiple studies on the effectiveness of injections for frozen shoulder, but none were identified to assess if this guidance has been translated into clinical practice. The aim of this survey was to investigate the current practice and opinion of musculoskeletal health professionals regarding corticosteroid injections for frozen shoulder.

Design and methods: The online survey was disseminated via the social media platform 'X' (at the time of the survey known as Twitter) over a 5-week period. Recruitment was by the 'snowball' effect. Responses to multiple choice survey questions were analysed with descriptive data. Free text questions were analysed using content analysis.

Results: The number of respondents to the survey was 235. Respondents felt injections have an important role in the management of frozen shoulder (155/235, 66%) and the best time to inject is during the pain predominant phase (191/233; 82%). The glenohumeral joint was the preferred anatomical site to inject (136/235; 58%) with triamcinolone as the preferred steroid (66/155; 43%). A steroid dose of 40 mg/mL was favoured by 55% (83/151) of respondents.

Conclusion: Corticosteroid injections play an important role in the management of frozen shoulder. There was consensus for the type and dose of corticosteroid and anaesthetic; however, the range of preparations used indicated that many decisions may be based on personal preference or local guidelines.

Objectives: The decision to undergo total shoulder replacement surgery is a major one and should be a joint one between the patient and surgeon. It is important that patients are provided with accessible, meaningful and appropriate information to enable an informed decision. The aim of this study was to explore the content and language used within publicly available information leaflets produced by UK National Health Service (NHS) Trusts for people considering shoulder replacement surgery and to consider how this may influence surgical decision making.

Design: An online search of publicly available NHS shoulder replacement patient information leaflets (PIL) was undertaken. The text within the PIL was analysed using reflexive thematic analysis.

Results: Thirty-eight PIL were identified. The volume of information and content varied greatly. All PIL discussed the clinical problem, mainly within a biomedical framework and from a clinician's perspective in which normal shoulder anatomy was contrasted with shoulder pathology. Only a minority of the PIL discussed non-surgical treatments and of those that did, such approaches were predominantly portrayed as a temporary management option only, whilst surgery was frequently portrayed as the optimum treatment.

Conclusion: There is variation in the content of NHS shoulder replacement PIL. The content and language used may not adequately support people in making an informed decision about whether surgery is the right treatment option for them. We need to better understand the information needs of people considering shoulder replacement surgery, and provide information that is accessible, culturally sensitive, and capable of facilitating shared decision making.