Musculoskeletal Care最新文献

Background: NHS Lanarkshire (NHSL) Physiotherapy Musculoskeletal (MSK) service receives approximately 30,000 referrals annually, facing long waiting times and workforce pressures. To address these challenges, NHSL piloted Community Appointment Days (CADs)-a patient-centred model offering same-day assessment, advice, and community support in non-medical settings.

Methods: A mixed-methods service evaluation was conducted using retrospective analysis of data from ten CADs delivered across three leisure centres in 2024-2025. Quantitative data from the Patient Management System included attendance, outcomes, and re-access rates. Qualitative data were collected via patient passports, surveys, and interviews. Objectives were to assess impact on waiting times, patient experience, cost avoidance, and sustainability.

Results: Of 2,287 patients booked, 1,866 attended. Outcomes included discharge (10%), patient-initiated review (PIR) (53%), and return appointment (37%). Average time per CAD was 69 minutes. PIR return rate was 8%, with 0% ED attendances for the same condition. CADs enabled a 3.7-fold increase in new patient capacity on the day, reducing waiting times in targeted waiting lists by 5 weeks in 2024 and 9 weeks in 2025. Initial setup costs were £16,388; subsequent CADs projected cost avoidance of £4,132 each. Patient feedback was highly positive, with strong Care CollaboRATE scores, though some reported environmental challenges. Staff reported CADs as less stressful or similar to routine work.

Conclusion: CADs are a scalable, patient-centred model that improves access, reduces waiting times, and supports self-management while maintaining safety. Future work should refine triage, enhance booking systems, and evaluate long-term outcomes to ensure sustainability.

Purpose: Chronic nonspecific neck pain (CNNP) is a multifactorial condition associated with pain-related emotional impact and sleep disturbance. Its impact on health-related quality of life (HRQoL) in non-Western populations remains understudied. This cross-sectional study examined associations between disability, pain, sleep, pain-related emotional and social factors, and HRQoL in Iranian adults with CNNP.

Methods: Adults with CNNP were recruited from tertiary rehabilitation centres in Tehran. Of 135 screened, 107 were analysed. Instruments included the NDI, NPDS, VAS, PSQI, and SF-36. Spearman's correlation, multivariable regression, and bootstrapped indirect-association analyses were used to identify factors associated with HRQoL.

Results: Participants exhibited moderate disability (NDI 17.2 ± 6.5; NPDS 48.1 ± 16.5) and poor sleep (PSQI 6.4 ± 3.7). Pain was correlated with disability (ρ = 0.44), sleep dysfunction (ρ = 0.55), and lower SF-36 scores (p < 0.05). Sleep disturbance was the primary independent factor associated with reduced Vitality, Mental Health, and Social Functioning, while sleep latency further contributed to lower Vitality; together, these variables explained 28%-49% of the variance across these domains (adjusted R² = 0.28-0.49). Lifting difficulty and pain with walking predicted poorer Physical Functioning, and lifting difficulty also predicted greater Bodily Pain. Difficulty working overhead uniquely contributed to lower General Health. Pain interference with work contributed to reduced Physical Functioning, while daytime dysfunction was associated with Bodily Pain. A BMI ≥ 25 kg/m² was associated with greater pain severity, poorer sleep, and lower HRQoL. A more negative Pain-Related Outlook on Life/Future was linked to lower Vitality, and pain-related emotional impact corresponded to reduced Mental Health. No severe multicollinearity or construct redundancy was detected.

Conclusions: CNNP was associated with disability, sleep disturbance, and pain-related emotional and social interference, each contributing independently to reduced HRQoL. Findings support the importance of individualised, multidisciplinary rehabilitation strategies incorporating biomechanical, sleep-focused, and psychological interventions.

Aims: To investigate compartment-specific concordance between self-reported measures (SRM) and performance-based measures (PBM) of physical function, and to compare the functional outcomes between isolated patellofemoral joint osteoarthritis (PFJ OA) and tibiofemoral joint osteoarthritis (TFJ OA) subgroups.

Method: This cross-sectional study recruited 168 adults (45-65 years) with radiographically confirmed knee osteoarthritis (KOA). Participants were stratified into PFJ OA (n = 83) or TFJ OA (n = 85) using Multicenter Osteoarthritis Study (MOST)-adapted radiographic criteria and symptom profile. Self-reported function was measured using the Gujarati modified WOMAC (mWOMAC) physical function subscale. Performance-based functions were assessed with the OARSI minimum core set: 30-s Chair Stand Test (30-s CST), 40-m Fast-Paced Walk Test (40-m FPWT), and 11-step Stair Climb Test (11-step SCT). Pearson's correlations evaluated within-group associations; unpaired t-test compared groups.

Results: TFJ OA participants reported significantly greater functional limitation on mWOMAC (45.8 ± 17.1) than the PFJ OA group (35.9 ± 12.8) (p < 0.001) despite objectively superior performance on 30-s CST (9.0 ± 2.2 vs. 7.4 ± 1.1 repetitions; p < 0.001) and 40-m FPWT (1.4 ± 0.4 vs. 0.9 ± 0.1 m/s; p < 0.001). Stair-climb time was comparable between groups (p = 0.969). Within-group correlations revealed task-specific patterns: PFJ OA showed strong correlation only with 11-step SCT (r = 0.589, p < 0.001), whereas TFJ OA exhibited moderate-to-strong correlations with 11-step SCT (r = 0.366) and 40-m FPWT (r = 0.646; both p < 0.001).

Conclusion: TFJ OA exhibits a striking paradox of greater perceived disability despite objectively better performance on the OARSI minimum core set. These findings highlight the limitation of relying on single assessment methods. A comprehensive assessment approach incorporating both self-reported and performance-based measures is recommended. Additionally, adopting an integrated compartment-specific evaluation framework is strongly advocated to facilitate precise clinical interpretation and optimise rehabilitation planning.

Objective: Many people with rheumatoid arthritis (RA) have chronic pain and flares of arthritis. The National RA Society has co-produced a freely available online learning module with an NHS multidisciplinary rheumatology team to support people with self-managing these RA impacts. This service evaluation assessed peoples' self-reported knowledge and confidence in self-managing pain/flares before and after accessing the module, the extent to which they used the module suggestions, and how they felt the module could be improved.

Methods: A survey was sent via email in March 2024 to the 500 people completing the module who consented to contact for feedback. Survey questions covered: pain experience/management; knowledge/confidence on managing pain/flares; likelihood of trying module suggestions; and free-text feedback. Descriptive statistics summarised responses. Fisher's exact tests compared Likert-type responses for knowledge/confidence pre-/post-module.

Results: One hundred and thirty four people completed the survey (27% response rate), of whom 98% experienced pain in the past 3 months and 36% reported 'high impact' chronic pain. More (95%) reported being 'very/fairly/somewhat' knowledgeable at managing pain after completing the module compared to before completing the module (62%; p < 0.01). For managing flares, these levels were 93% post-module versus 52% pre-module (p < 0.01). Similar findings were seen for confidence. 90% reported themselves as 'very/fairly/somewhat' confident at managing pain post-module versus 50% pre-module (p < 0.01). For managing flares, these levels were 90% post-module versus 44% pre-module (p < 0.01). Most reported they were likely to try module suggestions.

Conclusions: This freely available online digital information about pain/flares was appreciated by people with RA and helped them deal with these common condition aspects.

Objective: To compare the effect of 24 sessions of progressive intensity strength training on the impact of fibromyalgia (primary outcome). Furthermore, we evaluated its effects on sleep, anxiety, depression, wind-up mechanism, conditioned pain modulation, cutaneous sensory threshold, musculoskeletal performance, walking ability, perceived improvement, and treatment adherence (secondary outcomes).

Design: A blinded randomised controlled trial.

Setting: After blinded outcome assessments, 66 people were randomised and concealed and allocated to progressive (n = 22), constant (n = 22), or walking (n = 22) strength training groups.

Participants: People with fibromyalgia.

Interventions: In the progressive group, exercise intensity increased by 20% of maximum strength each month: 50% in the first month, 70% in the second month, and 90% in the third month. In the constant or walking exercise groups, moderate intensity was maintained at the end of the treatment. Each person received 24 individual exercise sessions (2x/week), with three months of exercise and three months of no exercise.

Main outcome measure: Fibromyalgia impact.

Results: Groups were similar at baseline. There were no significant between-group differences in the primary outcome at any time point. In within-group comparisons, we observed significant differences indicating that all three types of exercise reduced fibromyalgia symptoms; however, no variable achieved a minimal clinically important difference. In between-group comparisons for the secondary outcomes, groups reported a positive perception of improvement, but most of each group did not adhere to treatment and/or did not answer about adherence after follow-up without exercise.

Conclusions: Twenty-four sessions of progressive intensity strength training did not provide a greater reduction in the fibromyalgia impact than constant intensity or walking exercises.

Trial registration: Brazilian Registry of Clinical Trials (ReBEC): RBR-9pbq9fg, date of registration: October 06, 2022.

Protocol publication: BMC Musculoskeletal Disorders: Doi - 10.1186/s12891-023-06952-3 | Published: Volume 24, article number 816, October 14, 2023.

Objective: To describe the self-reported occurrence and anatomical distribution of musculoskeletal injuries among recreational tennis players and to explore associated modifiable factors among respondents.

Methods: A cross-sectional online survey was completed by 172 recreational tennis players (mean age 50.2 ± 12.1 years; 64.5% men). Data included participation habits (warm-up/cool-down/stretching and equipment use), self-reported injury characteristics, management, return to play, and return to performance. Injury correlates were analysed using logistic regression.

Results: Overall, 73.3% (126/172) reported at least one tennis-related injury. Common sites were the elbow (34.9%), ankle (32.5%), knee (28.6%), and wrist/hand (27.8%). Muscle strain (45.6%) and ligament sprain/tear (34.4%) were the most frequently reported injury types. Warm-up/cool-down/stretching habits and overgrip use were not significantly associated with injury status, and weekly playing frequency showed only a borderline univariate association (p = 0.054). Players who sought medical evaluation reported longer return-to-play time (median 90 vs. 25 days; p < 0.001). Median return-to-play time increased with treatment intensity (20 days pharmacological; 30 days spontaneous recovery and conservative management; 90 days physical therapy; 180 days surgery), and 86.6% returned to their pre-injury performance level.

Conclusions: Tennis-related injuries were common among respondents and recovery duration varied markedly by clinical course and treatment intensity. Findings should be interpreted as sample-based self-report rather than population-level prevalence; prospective studies with defined sampling and clinical verification are warranted. These observational findings do not allow causal or preventive inferences regarding modifiable habits.

Introduction: Guideline-recommended management of low back pain (LBP) is associated with improved patient outcomes and costs. This study aimed to assess Italian physiotherapists' attitudes towards and adherence to LBP clinical practice guidelines (CPGs).

Methods: We conducted an online cross-sectional survey of Italian physiotherapists. Participants' demographics, attitudes towards, and familiarity with CPGs were collected. Six vignettes of patients with LBP were presented. For each, participants selected management options from a pre-specified list. Management options were categorised as recommended, not recommended, and no recommendation based on CPG recommendations and systematic reviews. Ordinal logistic regression assessed associations between participant characteristics and the number of vignettes for which recommended and not recommended care options were selected (stratified by non-specific LBP and red flag vignettes).

Results: Of the 272 participants completing the demographic section of the survey, 142 completed all vignettes. Care that was recommended, not recommended, and had no recommendation was selected by 87%, 32%, and 93% of participants on average in the six vignettes, respectively. Working in a hospital setting was associated with a reduced likelihood of selecting recommended care for non-specific LBP (coefficient: -1.28; 95% CI: -2.20, -0.36). Stronger self-reported familiarity with three published CPGs was associated with decreased likelihood of selecting not recommended care but was not associated with selecting recommended care for non-specific LBP. All other variables were not associated with selecting recommended and not recommended care.

Conclusions: Physiotherapists commonly selected recommended care options for patients with LBP, yet there remains considerable scope to reduce selection of care which is not recommended.