Musculoskeletal Care最新文献

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.

Aim: To measure the level of adherence of patients with primary knee osteoarthritis (KOA) to an interventional therapeutic and rehabilitation programme and investigate factors that hinder patients' adherence.

Methods: A total of 154 participants with primary knee osteoarthritis (KOA) were divided into intervention and control groups. The intervention protocol included patient education on the nature and treatment of KOA, therapeutic exercise, a weight loss programme for overweight patients, and a physical therapy programme. Participants were followed for 3 months. The Visual Analog Scale for Pain (VAS-p), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and knee Kellgren-Lawrence OA grading were measured before and after the intervention. Additionally, the Morisky adherence questionnaire and the WHO Multidimensional Framework for factors affecting adherence were assessed.

Results: One fifty four participants with KOA were randomly allocated into intervention and control groups. A low level of adherence was detected in both groups (68.8% in the intervention group vs. 84.4% in the control group). Patients who followed the interventional programme were more adherent. Adherence to therapy was associated with a reduction in the Visual Analog Scale for Pain (VAS-p) (p = 0.016) and improved function as measured by WOMAC (p = 0.018). Factors primarily associated with patient non-adherence included unemployment (67.8%), low income (59.3%), no previous response to therapy (58.5%), less frequent follow-up visits (55.1%), lack of insurance (66.9%), difficult access to services (59.3%), and high cost of services (55.1%).

Conclusion: Adherence to treatment in OA patients is a significant concern and a common problem, appearing to be associated more with socioeconomic factors than with pain and function.

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.

Background: TENS is a non-pharmacological adjunctive treatment commonly recommended for analgesic purposes, with widespread use and acceptance in clinical practice; however, its effects simultaneously with exercise are controversial, and there are gaps regarding its effectiveness and applicability, especially regarding the parameters and protocols used to treat pain. In view of this, the aim of this study was to systematically review the effects of TENS applied simultaneously with functional activities or exercises in the treatment of individuals with pain.

Method: A bibliographic search was performed in electronic databases, including EMBASE, PubMED, Scopus, Web of Science, PEDro, SPORTDiscus, and the grey literature. The search yielded a total of 634 articles, of which only six met the inclusion criteria and were analysed individually. Of the selected studies, four evaluated the simultaneous use of TENS in patients with chronic pain, one in patients with fatigue-induced injury, and one in healthy subjects.

Results: The articles selected for synthesis of the review were assessed using the RoB 2.0 risk of bias tool, which found that three of the included studies had a low risk of bias, while two studies were analysed as high risk and only one with some concern. It is concluded that the use of TENS in conjunction with functional activities and exercises may benefit people with pain.

Conclusion: The studies showed that the use of TENS with high frequency and intensity at the sensory threshold and applied simultaneously with exercise produced more significant analgesic effects, but new clinical trials with robust methodological designs should be carried out.

Objectives: This scoping review will explore the literature related to rehabilitation interventions for the treatment of adults living with complex regional pain syndrome (CRPS), describe the domains and outcome measures used to assess their effectiveness, and examine the neurophysiological bases of these interventions.

Introduction: The unremitting symptoms of CRPS, a chronic pain condition, are associated with long-term disability, poor psychological health, decreased emotional and social well-being, and reduced quality of life. Effective treatment for persistent symptoms is notoriously difficult. Therapeutic approaches such as graded motor imagery or pain exposure therapy are recommended for CRPS but show mixed results, insufficient effectiveness, variability in outcome measures, and unclear neurophysiological bases.

Inclusion criteria: This review will consider studies that include any form of non-invasive rehabilitation intervention delivered by a healthcare professional in any setting for adults with a CRPS diagnosis. Quantitative, qualitative and observational studies, text and opinion papers will be considered.

Methods: The Joanna Briggs Institute (JBI) methodology will be used to conduct this scoping review. MEDLINE, Embase, Scopus, APA PsycINFO, CINAHL, Cochrane, OpenGrey Google and ProQuest Dissertations and Theses Global (ProQuest) will be searched for studies in English published between 2007 and 2024. Two independent reviewers will screen the titles, abstracts, and full texts of the selected studies. Data collection will be performed using a tool developed by the researchers based on the standardised JBI tool. Data will be presented in a comprehensive narrative summary.

Trail registration: https://doi.org/10.17605/OSF.IO/P967T.

Introduction: Enhanced Recovery after Surgery (ERAS) protocols adopt a multidisciplinary approach in perioperative care to reduce Length of Stay (LOS). This study aims to identify predictive factors resulting in short-stay following TKR with an ERAS programme.

Methods: Retrospective analysis was performed on a consecutive series of patients who underwent unilateral TKR by a single surgeon in a tertiary institution between August 2019 and December 2021. Patient demographics, comorbidities and length of stay were collected using Electronic Medical Records. Short-stay was defined as LOS within 1 day or less, while standard-stay was defined as LOS exceeding 2 days or more. Statistical analysis was performed using R version 4.3.1. Logistic regression was performed for multivariate analysis.

Results: Ninety-nine patients were included in the study, comprising 45 short-stay patients and 54 standard-stay patients. Short-stay patients were significantly younger (mean 66.1, 95% CI [64.5, 67.7], p = 0.0212) than standard-stay patients (mean 69.2, 95% CI [67.1, 71.2]). There was a significantly lower mean BMI among short-stay patients (26.98, 95% CI [25.52, 28.45], p = 0.021) than among standard-stay patients (29.31, 95% CI [27.96, 30.66]). A significantly higher proportion of short-stay patients (84.4%, 95% CI [73.4, 95.5], p = 0.00132) were premorbid community ambulant without aids than standard-stay patients (51.9%, 95% CI [38.1, 65.6]). There was no significant difference in sex, race, smoking, American Society of Anaesthesiologists score and Charlson Comorbidity Index (p > 0.05). Multivariate logistic regression revealed the following significant factors: Age < 75 (p = 0.0293), BMI < 25 (p = 0.00688), and premorbid community ambulant without aids (p = 0.0402).

Conclusions: In conclusion, predictive factors for short-stay after TKR include age < 75, BMI < 25 and being premorbid community ambulant without aids.