Musculoskeletal Care最新文献

Purpose: This systematic review evaluated the efficacy of postoperative rehabilitation for patients at risk of poorer outcomes after total knee arthroplasty.

Methods: Six databases were searched, and only randomised controlled trials were included. Two reviewers independently screened, extracted data, and appraised the quality of the studies.

Results: Twenty-three studies were included. Insufficient evidence supports cognitive behavioural therapy for patients with kinesiophobia, while continuous passive motion may not be effective for range of motion deficits. The impact of exercise therapy on functional recovery is conflicting; however, longer durations tend to be more effective for older patients and those with functional limitations. Limited evidence suggests that exercise may not alleviate pain. Outpatient exercise therapy improves health-related quality of life more than home-based programs for older patients and those with functional limitations. The efficacy of other rehabilitation aspects remains inconclusive due to high heterogeneity in interventions and outcome measures, and high or unclear risk of bias in most studies.

Conclusion: While limited evidence suggests benefits for specific rehabilitation interventions, there is insufficient data to assess the efficacy of most interventions on postoperative recovery in those at risk of poorer outcomes. More robust evidence is needed to guide clinical practice and standardise outcome measures.

Trail registration: PROSPERO CRD42022355574.

Purpose: To compare treatment utilisation for osteoarthritis (OA) and satisfaction with OA management between individuals with and without comorbid metabolic conditions (e.g., diabetes, obesity, dyslipidaemia, hypertension).

Methods: Secondary analysis of a cross-sectional international survey study (Italy, Russia, Sweden) on people ≥ 40 years old with knee/hip OA. Metabolic comorbidity was self-reported. We used direct standardisation with prevalence ratios and mixed-effect models to estimate the associations between comorbidity with treatment utilisation and satisfaction (score 0-100).

Results: We analysed 401 individuals (48% Sweden, 28% Italy, 24% Russia; 53% with ≥ 1 metabolic condition). Those with and without comorbid metabolic conditions showed similar prevalence for first-line interventions (exercise, education, and weight management). Metabolically unhealthy individuals showed higher use of opioids (prevalence ratio [95% CI] 1.9 [1.3-2.4]), antidepressants (1.8 [1.1-2.5]), corticosteroid injections (1.4 [1.0-1.8]), and homoeopathic products (2.1 [1.2-3.0]). Satisfaction with care (adjusted difference: -3.9 [95% CI: -8.5 to 2.4]) and information received about treatments (-4.0 [-9.7 to 1.7]) were similar.

Conclusions: While first-line OA interventions were similarly used, those with metabolic conditions relied more on second-line and non-recommended treatments, showing comparable satisfaction. More effort is needed to increase the adoption of lifestyle-focused treatments in OA and to minimise the use of less recommended options among individuals with metabolic comorbidities.

Introduction: Low back pain (LBP) imposes a significant burden on global health, yet it remains deficient in comprehensive investigations pertaining to its incidence patterns. The aim of this study was to analyse global, regional and national trends and associated factors in the incidence of LBP from 1990-2019.

Methods: In order to examine global and country-specific 30-year incidence patterns of LBP, data were obtained from the 2019 Global Burden of Disease Study. An age-period cohort (APC) model was utilised to determine annual percent changes, age-specific changes, and period/cohort effects.

Results: The age-standardized global LBP incidence rate significantly declined from 1990-2019. However, the absolute number of cases increased by 2.39 billion, predominantly in middle-, low-middle- and low-socio-demographic index (SDI) regions, affecting mostly 50-69 years old with a higher incidence in women. LBP incidence increased progressively from low to high SDI regions. Period and cohort effects trended downward in all regions except high-SDI countries, which had the lowest incidence decline and a slight rebound after 2012.

Conclusions: Our study updates global and regional LBP incidence from 1990-2019 using APC modelling, showing declining age-standardized rates globally but increased case numbers due to population growth and ageing. Prevention likely helped reduce incidence, but more health strengthening and minimally invasive treatments are still needed, especially where LBP has plateaued or rebounded recently.

Background: Psychosocial interventions may improve QoL in people with wider chronic pain conditions. However, the evidence requires refining for application to EDS/JHMS. This systematic review aimed to identify, assess and synthesise the evidence of the effectiveness of psychosocial interventions concerning EDS/JHMS. EBSCO, OpenGrey, Cochrane, Prospero, Researchgate and BPS Wiley online were searched for papers published approximately 2000-2024 for studies in which (1) Participants diagnosed with EDS/JHMS. (2) Quantitative or mixed methods. (3) Assessed a Psychosocial intervention to a (4) quality of life outcome. (5) in English. EPHPP quality assessment tool was used to assess the quality and risk of bias.

Main text: The study identified six studies, including 343 participants aged 13-69 (F = 248, M = 8), of unknown ethnicity. Five studies were cohort and one non-randomised controlled trial. Key methodological flaws included no reported effect size and no control group. With quality assessed as low (5) or moderate (1), there was weak evidence that psychosocial interventions containing mindfulness and CBT resulted in a general improvement in QoL compared to no intervention.

Conclusions: Findings from this review indicate the potential of mindfulness and CBT in improving QOL in EDS/JHMS and, in some studies, pain and fatigue. However, existing research is at high risk of bias, has low methodological quality, and is predominately focused on female patients. Future research should adopt methodologically robust approaches such as RCTs and more inclusive samples and consider co-production.

Introduction: Fibromyalgia (FM) is a chronic syndrome characterised by widespread pain, fatigue, and symptoms such as sleep disturbances, cognitive impairment, and mood disorders. FM prevalence is notably higher among systemic lupus erythematosus (SLE) patients compared with the general population, often leading to diagnostic challenges. Misinterpreting FM as SLE activity can result in overtreatment. This study aimed to evaluate fibromyalgianess and its relationship with the clinical and immunological characteristics of SLE patients using comprehensive scoring methods for better diagnostic accuracy.

Materials and methods: This cross-sectional study included 50 SLE patients meeting the 2019 EULAR/ACR classification criteria. Patients with coexisting autoimmune diseases or severe systemic conditions were excluded. Clinical data, SLEDAI scores, and fibromyalgianess severity were assessed using the Polysymptomatic Distress Scale (PSDS). Patients were categorised into groups based on fibromyalgia diagnostic criteria: widespread pain and SLE-FM. Statistical analysis was performed using SPSS, with p < 0.05 considered significant.

Results: Among 50 patients (45 female, 5 male; mean age 42.04 ± 12.5), 24% had fibromyalgianess, and 18% experienced widespread pain. Female patients exhibited significantly higher PSDS scores (p < 0.05). While NSAID use was associated with increased PSDS scores (p < 0.001), no significant relationship was found between fibromyalgianess and SLEDAI scores or organ involvement.

Conclusion: Fibromyalgianess in SLE patients primarily reflects heightened pain sensitivity and symptom severity rather than disease activity. Incorporating fibromyalgianess assessment into routine SLE management may prevent diagnostic and therapeutic pitfalls and improve treatment outcomes. Multidisciplinary approaches, including pharmacological and non-pharmacological strategies, are essential for effective care.

Objective: This study aimed to determine the number and proportion of exercise interventions within preexisting clinical trials for people with knee osteoarthritis (KOA) that satisfied the World Health Organisation's (WHO) guidelines for physical activity.

Methods: A descriptive analysis of studies included in an umbrella review was undertaken. Data from each exercise intervention relating to the type, dose and intensity of exercise was extracted, and the number and proportion of interventions that satisfied the WHO guidelines (aerobic, muscle strengthening, balance [for studies where the average age was more than 65 years old], a combination or all) was recorded at the study and intervention level.

Results: Data were extracted from 199 studies containing 266 exercise interventions. Overall, only one study (0.5%) satisfied all components of the WHO guidelines. Of the 122 interventions that had an average participant age over 65, none fulfiled all aspects of the WHO guidelines, which included balance. There were 16 (6.0%) and 12 (4.5%) other interventions that satisfied the aerobic or muscle strengthening components of the guidelines, respectively.

Conclusion: This descriptive analysis highlighted the lack of exercise interventions in clinical trials for people with KOA that satisfied the WHO guidelines. Thus, they may not be dosed appropriately to achieve broader health outcomes associated with following the physical activity guidelines.

Objectives: Osteoarthritis (OA) contributes substantially to global disability. We analysed global and national OA incidence trends and associated factors.

Methods: Data obtained from the 2019 Global Burden of Disease Study were used to examine 30-year OA incidence patterns globally and for 204 countries/territories. An age-period-cohort (APC) model determined annual percent changes, age-specific changes, and period/cohort effects.

Results: From 1990 to 2019, global OA incidence rose by 21.3 million, with the highest cases in China, India, the United States, and Japan. Incidence was higher in women versus men and peaked at ages 20-24 years, though shifting towards middle-aged adults. The annual increase was 0.225% (95% confidence interval [CI] 0.157, 0.293) and 0.158% (95% CI: 0.114, 0.201) in high and low socio-demographic index countries, respectively, with most countries showing increasing incidence. Disadvantageous incidence trends over time and birth cohorts occurred in all regions except middle-high index countries, which had the lowest increase and declining period effect after 2005.

Conclusion: OA represents an escalating public health burden, predominantly affecting middle-aged and elderly populations, and more women than men. Obesity and ageing are major drivers of rising OA incidence. Swiftly implementing policies to prevent modifiable risks and ensure proper treatment access is imperative to mitigate the impact of OA.

Objectives: This service evaluation examined the impact of offloader knee bracing for unicompartmental osteoarthritis (OA) on pain, quality of life (QoL) and activities of daily living (ADL).

Design: The retrospective service evaluation was completed at two NHS community primary care clinics offering offloader knee bracing services. Between 2015 and 2023 patients prescribed offloader knee braces with unicompartmental osteoarthritis were invited to complete a Knee injury and Osteoarthritis Outcome Score (KOOS) at baseline, one, six and 12 months and at two and three years. KOOS data were analysed to assess the change in ADL, Pain and QoL domains from baseline to one, six and twelve months and up to three years using a paired t-test. Demographic data collected included age, sex, and type of OA.

Results: Two hundred and forty-three patients were issued an offloader knee brace. There were statistically significant differences in pain and ADL for both braces at one and six months (p < 0.05). Participants issued with an ÖSSUR brace demonstrated statistically significant changes in pain and ADL for up to two years (p = 0.0101; p = 0.0153) and QoL up to one year (p = 0.0011). There was no statistically significant difference in either brace at three years. The ÖSSUR brace demonstrated a minimal clinically significant difference at one month for all domains, at one year for pain and ADL and two and three years for pain, ADL and QoL.

Conclusions: Results indicate that offloader knee bracing for unicompartmental knee OA could reduce patients' pain, ADL and QoL in the long term.

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.