Musculoskeletal Care最新文献

Background: Direct access to physiotherapy has been introduced in several countries. In France, the healthcare system is evolving towards its introduction; however, no study has described the ability of physiotherapists in this context.

Objective: To describe the ability of physiotherapists practicing in France to formulate correct diagnostic hypotheses and make appropriate management decisions using clinical vignettes.

Methods: Pre-existing validated clinical vignettes were used and integrated into a numerical questionnaire. The percentages of correct answers were calculated from the results concerning the choice of diagnostic hypothesis and the management decision, both overall and for the three different patient categories: musculoskeletal, non-critical medical, and critical medical.

Results: Four hundred eighty-two participants (1.7%) responded to the study. For the formulation of a diagnostic hypothesis, there were 43.0% (415/964), 26.6% (128/482), and 17.8% (86/482) correct answers respectively for the musculoskeletal, non-critical medical, and critical medical categories. For management decisions, there were 60.8% (586/964), 61.6% (297/482), and 85.1% (410/482) correct answers respectively for the same categories.

Conclusions: Our results related to the management decision were better than those for the diagnostic hypothesis, especially for the critical medical category. There is still room for improvement. It might be interesting to support this initial study by using more clinical vignettes validated in a French context.

Purpose: To determine if a consumer co-designed infographic increased knowledge of physical activity and self-efficacy for exercise after total knee joint replacement surgery.

Methods: Forty-four adults with primary knee joint replacement surgery were recruited from a public and a private hospital in Melbourne, Australia. Participants were randomly allocated to an experimental or control group. The experimental group received a consumer co-designed infographic. All participants received usual care. Primary outcome measures were knowledge of physical activity and self-efficacy for exercise. Outcomes were administered at baseline, week 1 and week 6. Semi-structured interviews with experimental group participants explored the acceptability, implementation and efficacy of the infographic.

Results: There were no between-group differences for knowledge of physical activity at week 1 (MD -0.02 units, 95% CI -0.9 to 0.9) or week 6 (MD 0.01 units, 95% CI -0.9 to 0.9). Self-efficacy for exercise increased at week 1 (MD 14.2 units, 95% CI 2.9-25.4) but was not sustained. Qualitative data showed that the infographic was embraced by some participants but not by others.

Conclusions: A consumer co-designed infographic did not improve knowledge of physical activity but may have had a short-term positive effect on self-efficacy for exercise after knee joint replacement. Trial registration ACTRN12621000910808.

Introduction: Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children and causes short- and long-term disability. Optimal management requires pharmacologic and non-pharmacologic interventions. Few studies have explored the youth and family experience of the management of JIA. This study's objective was to explore the management experience of youth with JIA and their parents.

Methods: This qualitative study used semi-structured interviews with youth 12-18 years of age with JIA receiving biological medication and parents of children with JIA on biological medication. Participants were recruited in clinics using convenience sampling. A thematic analysis approach was employed for data analysis.

Results: Nine youth and 14 parents participated. Four themes were identified that encompassed an overarching theme of participants managing JIA within the context of their life: aspects of life affected by JIA and its management, lived experience with JIA management, medication decision-making, and involvement in decision-making. Juvenile idiopathic arthritis management is situated within the context of their life but is normally (outside acute events) not central.

Conclusion: Two dimensions were added to those in the literature: parents' overall approaches to health and the sense of urgency surrounding decision-making. Our findings reinforce the importance of person- and family-centred care in paediatric rheumatology. That is, identifying what matters most to youth and their parents given their current life circumstances to provide a foundation for discussions of how they want to manage their JIA.

Question(s): What are the experiences and preferences of individuals living with a musculoskeletal disorder regarding prognosis?

Design: Exploratory phenomenological study.

Participants: Individuals aged 18-year or older currently experiencing a musculoskeletal disorder and receiving treatment from a physiotherapist.

Data analysis: Data were collected through semi-structured interviews and analysed using inductive coding and thematic analysis.

Results: Five themes were identified. First, participants described seeking a cause for their pain. This influenced their experience of prognosis as they perceived a diagnosis was required to inform their prognosis. Second, whilst participants wished to receive a prognosis from their physiotherapist, this was often not their experience. Third, participants perceived that physiotherapists have the potential to impact prognosis through exercise prescription, management of conditions, and improving function. Fourth, receiving a prognosis can have both a positive and negative impact on the individual. Positive impacts include planning for the future, motivation, knowledge acquisition, and instilling hope. However, receiving a prognosis can be disheartening if a patient's expectations are unmet. Finally, participants have several preferences regarding receiving a prognosis including when and how often the prognosis is discussed, what prognostic information is provided, how the prognosis is presented, and what prognosis based on.

Conclusion: Individuals wish to receive a prognosis, although this is not always their experience. Individuals perceive that physiotherapists have the ability to provide a prognosis and impact their prognosis. Furthermore, receiving a prognosis has an impact on itself. To ensure patient-centred care, physiotherapists should explicitly discuss the prognosis with patients and consider their preferences when providing a prognosis.

Objectives: To determine factors associated with fatigue in patients with rheumatoid arthritis (RA), and to identify baseline predictors of persistent fatigue at 12 months of follow-up.

Methods: We enroled patients with RA fulfiling the 2010 American College of Rheumatology/European League Against Rheumatism criteria. Fatigue was assessed using the Arabic version of the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F). Using univariate and multivariate analyses, we examined baseline variables associated with fatigue and persistent fatigue (if the FACIT-F score was less than 40 at baseline and 12 months of follow-up).

Results: We included 100 RA patients of whom 83% reported fatigue. At baseline, the FACIT-F score was significantly associated with older age (p = 0.007), pain (p < 0.001), global patient assessment (GPA) (p < 0.001), tender joint count (TJC) (p < 0.001), swollen joint count (p = 0.003), erythrocyte sedimentation rate (ESR) (p < 0.001), disease activity score (DAS28 ESR) (p < 0.001), and health assessment questionnaire (HAQ) (p < 0.001). At 12 months of follow-up, the percentage of patients who reported persistent fatigue was 60%. The FACIT-F score was significantly associated with age (p = 0.015), symptom duration (p = 0.002), pain (p < 0.001), GPA (p < 0.001), TJC (p < 0.001), C-Reactive Protein (p = 0.007), ESR (p = 0.009), DAS28 ESR (p < 0.001), and HAQ (p < 0.001). Pain was an independent baseline predictor of persistent fatigue (OR = 0.969 (95% CI [0.951-0.988]), p = 0.002).

Conclusions: Fatigue is a frequent symptom in RA. Pain, GPA, disease activity and disability were associated with fatigue and persistent fatigue. Baseline pain was the only independent predictor of persistent fatigue.

Background: A work-focused fatigue management intervention, Fatigue and Activity Management Education for Work (FAME-W) programme was developed for individuals with inflammatory arthritis (IA) to manage fatigue in order to maintain demands of their work activities and tasks. This paper presents the protocol for a randomized control trial that will test the effectiveness and acceptability of FAME-W in improving work performance.

Methods: This protocol presents a multisite randomized control trial and mixed methods process evaluation. Eligible participants will be aged 18-65 years with a diagnosis of inflammatory arthritis and will be in paid employment. The primary outcome of the study will be Work Role Functioning (WRF) questionnaire, and the secondary outcomes will be fatigue, mood, health-related quality of life (HRQOL) and pain. Data will be collected immediately pre- and post-intervention and at 3 months of follow-up. The process evaluation will consist of focus groups and individual interviews to explore participants' experiences of FAME-W. Occupational therapists delivering the programme will complete a facilitator log to assess the fidelity and quality of intervention implementations. Facilitators will participate in individual interviews to explore intervention delivery and acceptability.

Results: Results will be expected to show that FAME-W will improve work performance by helping participants gain self-management strategies around managing fatigue and other symptoms related to fatigue.

Conclusion: It is hoped that FAME-W will be an effective and acceptable intervention for individuals with IA in improving work performance by helping them manage their symptoms.

Trial registration: ClinicalTrials.gov: NCT05138445, Registered on 30 November 2021.

Background: Psychosocial variables are known to play an important role in musculoskeletal pain. Recent efforts incorporating psychological theory into rehabilitative medicine, as part of patient-centred care or psychologically informed physical therapy, have gained broader acceptance. The fear-avoidance model is the dominant psychosocial model and has introduced a variety of phenomena which assess psychological distress (i.e., yellow flags). Yellow flags, such as fear, anxiety and catastrophizing, are useful concepts for musculoskeletal providers but reflect a narrow range of psychological responses to pain.

Objective: Clinicians lack a more comprehensive framework to understand psychological profiles of each patient and provide individualised care. This narrative review presents the case for applying personality psychology and the Big-Five trait model (extraversion, agreeableness, conscientiousness, neuroticism and openness to experience) to musculoskeletal medicine. These traits have strong associations with various health outcomes and provide a robust framework to understand patient emotion, motivation, cognition and behaviour.

Key results: High conscientiousness is associated with positive health outcomes and health promoting behaviours. High neuroticism with low conscientiousness increases the odds of negative health outcomes. Extraversion, agreeableness and openness have less direct effects but have positive correlations with important health behaviours, including active coping, positive affect, rehabilitation compliance, social connection and education level.

Clinical application: The Big-Five model offers an evidence-based way for MSK providers to better understand the personality of their patients and how it relates to health. These traits offer the potential for additional prognostic factors, tailored treatments and psychological intervention.

Introduction: Persistent musculoskeletal (MSK) pain is associated with physical inactivity in older people. While walking is an acceptable form of physical activity, the effectiveness of walking interventions in this population has yet to be established.

Objectives: To assess the acceptability and feasibility of conducting a randomised controlled trial (RCT) to test the effectiveness of a healthcare assistant-led walking intervention for older people with persistent MSK pain (iPOPP) in primary care.

Methods: A mixed method, three arm pilot RCT was conducted in four general practices and recruited patients aged ≥65 years with persistent MSK pain. Participants were randomised in a 1:1:1 ratio to: (i) usual care, (ii) usual care plus a pedometer intervention, or (iii) usual care plus the iPOPP walking intervention. Descriptive statistics were used in an exploratory analysis of the quantitative data. Qualitative data were analysed using thematic analysis. A triangulation protocol was used to integrate the analyses from the mixed methods.

Results: All pre-specified success criteria were achieved in terms of feasibility (recruitment, follow-up and iPOPP intervention adherence) and acceptability. Triangulation of the data identified the need, in the future, to make the iPOPP training (for intervention deliverers) more patient-centred to better support already active patients and the use of individualised goal setting and improve accelerometry data collection processes to increase the amount of valid data.

Conclusions: This pilot trial suggests that the iPOPP intervention and a future full-scale RCT are both acceptable and feasible. The use of a triangulation protocol enabled more robust conclusions about acceptability and feasibility to be drawn.