Musculoskeletal Care最新文献

Background: This study aimed to explore the awareness, experiences, and beliefs of individuals with osteoarthritis (OA) regarding their healthcare management, along with assessing their overall satisfaction levels.

Methods: A cross-sectional online survey was conducted in Italy, Sweden, and Russia, rigorously developed based on OA international guidelines in collaboration with healthcare professionals and individuals with OA. Participants over 40 years of age with self-reported hip and/or knee OA were eligible. The analytical framework included descriptive analysis (assessment of awareness levels for 'recommended', 'optional', and 'not recommended' treatments), analysis of suggested treatments and taken treatments, exploration of beliefs, barriers and satisfaction analysis (0-100 scale).

Results: A total of 401 participants (mean age: 59.7, 78.3% female, 28% Italian, 49% Swedish, 23% Russian) contributed to the study. In Sweden, 57%-72% accurately identified recommended treatments, while in Russia, the range was 34%-91%, and in Italy, it was 35%-73%. The predominant suggested and taken treatments were oral anti-inflammatory drugs in Italy (87/81%) and Russia (97/97%) and specific exercise in Sweden (84/79%). Notably, only Sweden reached a consensus on the effectiveness of exercise for everyone, while Russia and Italy insisted on radiographic findings as a prerequisite for exercise. Mean satisfaction levels were 59.7 (Italy), 47.4 (Sweden), and 35.2 (Russia).

Conclusions: This study uncovered variations in awareness, treatment preferences, and beliefs among the three countries, underscoring the necessity for tailored education on OA management that accounts for regional differences across Europe.

Objectives: Bath Ankylosing Spondylitis Patient Global Score (BAS-G) is a uni-dimensional scale that enables patients to evaluate the effects of their illness on their health. The aim of this study was to determine the impact of disease related outcomes on the BAS-G scores in patients with axSpA.

Methods: A total of 309 patients (56.6% of whom were male, mean age 44 ± 11) were included in the study. Socio-demographic characteristics (age, sex and education level) and clinical characteristics such as disease activity (BASDAI and CRP), spinal mobility (BASMI), functional status (BASFI), radiographic structural damage (mSASS, mNY, and BASRI-hip), and health related quality of life (SF-36 and ASQoL) of the patients were recorded at baseline. In addition, BASDAI total and each item score, BASFI, BAS-G, and CRP levels were collected at 6, 12, and 24 months.

Results: Female patients had significantly higher BAS-G scores (p = 0.037). Baseline BASDAI total score (p < 0.001) and all BASDAI item scores (p < 0.001 for each item), BASFI total score (p < 0.001), ASQoL total score (p < 0.001), and SF-36 PCS sum-score (p < 0.001) were moderately/highly correlated with BAS-G. Multivariate analysis revealed that back pain (BASDAI Q2) (p < 0.001) and the severity of morning stiffness (BASDAI Q5) (p < 0.001) were the main determinants of BAS-G in patients with axSpA. In 2-year follow-up, BASDAI Q1, BASDAI Q5, and BASFI scores were independent determinants of BAS-G in patients with axSpA.

Conclusion: According to the results of the present study, patients with axSpA mainly rely on morning stiffness and back pain to determine their global health status. Moreover, fatigue, severity of morning stiffness and function are the determinants of BAS-G during follow-up.

Background: The Osteoarthritis Knowledge Scale (OAKS) is a validated tool for assessing knowledge about hip and knee osteoarthritis (OA). However, to date, there has been no translation and adaptation of the OAKS for the Turkish population.

Objectives: To translate and cross-culturally adapt the OAKS into Turkish and to assess its psychometric properties in the Turkish population with and without hip or knee OA.

Methods: The OAKS was translated following accepted guidelines. A validation study assessed internal consistency, test-retest reliability and measurement error. An exploratory factor analysis was conducted to assess the factor structure.

Results: A total of 278 participants (n = 70 with hip OA, n = 105 with knee OA, and n = 103 without OA) were included. Internal consistency was 0.72, 0.79 and 0.79 for participants with hip OA, knee OA, and no OA, respectively. The test-retest intraclass correlation coefficient was 0.72 (95% CI; 0.45-0.85), 0.89 (95% CI; 0.82-0.93) and 0.88 (95% CI; 0.79-0.93) for participants with hip OA, knee OA and no OA, respectively. It had three principal components accounting for 57.2% of the total variance.

Conclusions: The Turkish version of the OAKS is a reliable and valid tool for measuring OA knowledge in the Turkish population, including those with and without hip and knee OA. Test-retest reliability was below acceptable levels in the population with hip OA only. Therefore, we recommend that the ICC be interpreted with caution when used in this population.

Aims: Rotator cuff related shoulder pain (RCRSP) is a prevalent cause of musculoskeletal pain. Patients presenting with this condition often undergo diagnostic imaging. However, many patients appear to have difficulty recalling the nature of their diagnosis. This may impact their rehabilitation outcomes. The aim of this study was to explore peoples' recall of their structural features relating to RCRSP by comparing their recalled description of their condition with the contents of their imaging reports as reported in an online questionnaire. In doing so, we aim to explore the potential emphasis they place on structural features related to their condition.

Methods: This study was a content analysis embedded within a larger survey study published previously. Data containing patients' recall of their diagnosis was used from the study, and analysed using content analysis to quantify content in terms of codes and categories. The aims of frequency, completeness and accuracy of recall were then explored.

Results: The analysis identified eight categories of terminology either recalled by patients or reported in imaging reports. The most frequent categories in reports were tendinopathy (71%) and joint (67%), but only 17% and 36% of participant responses contained these codes, respectively. Participants' completeness of recall compared with their imaging report was 30% on average. In terms of accuracy, only 8 out of 95 participants recalled their diagnoses 100% correctly.

Conclusion: This study indicates that patients have poor overall recall of their RCRSP-related structural features. We contend that participants may have been able to recall what they viewed to be the most prominent structural feature in their imaging findings. It may be important for clinicians to consider the impact of diagnostic labelling, and whether a patient's ability to recall such labelling may have an influence on their outcomes.

Background: Understanding the influence of contextual factors (CFs) on interventions for mechanical neck pain (MNP) is essential for evidence-based practice in physical therapy. However, the specific effects and synergies of combining different CFs remain unclear.

Objective: The primary purpose of this study will be to determine if a CFs-Enriched Standard Care (SC) approach is an effective treatment for MNP in terms of reducing pain and improving function.

Methods: This will be an assessor-blinded, 2-group (1:1) randomised clinical trial (RCT) aiming to enrol 94 participants with neck pain persisting for more than 4 weeks. Both groups will undergo 4 weeks of SC twice weekly, following established clinical practice guidelines. In the intervention group, CFs will be enhanced, encompassing the physical, psychological, and social elements inherent in the clinical encounter, based on existing evidence. The primary outcomes will encompass changes in pain and disability after 4 weeks of treatment, with a follow-up reassessment at week 12 post-treatment. Secondary outcomes will include changes in Active Range of Motion, Global Rating of Change, and Satisfaction with treatment. The change between groups after treatment and at the 12-week follow-up will be reported for all outcomes, considering the difference from scores recorded at baseline.

Results: We hypothesise that a 4-week CFs-Enriched SC approach will be superior to SC alone in terms of patient-reported disability and pain, with measurements conducted using the Northwick Park Neck Pain Questionnaire and the Numeric Pain Rating Scale, respectively.

Conclusion: This RCT rigorously assesses the effect of purposeful manipulation of CFs during MNP treatment. By elucidating the role of these factors, our findings have the potential to significantly refine clinical practice in managing MNP, thereby enhancing patient care, and advancing the fields of physical therapy and rehabilitation.

Introduction: We aimed to systematically review contemporary evidence on the barriers and enablers to implementing and sustaining short-stay arthroplasty programs for elective primary total hip and knee replacement from the perspectives of patients, health professionals, carers, healthcare administrators, funders and policymakers and to map the findings to the Theoretical Domains Framework (TDF).

Methods: Medline, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and the Cochrane Central Register of Controlled Trials were searched (up to 19 August 2023). Primary qualitative or mixed-methods studies reporting on perspectives relating to the review aims that utilised a short-stay programme were eligible for inclusion. Study quality was assessed using the qualitative critical appraisal tool from the Joanna Briggs Institute. Data were analysed inductively. The final themes were mapped to the TDF. The confidence in the findings was assessed using GRADE CERQual.

Results: Fifteen studies were included. Twelve barrier themes and twelve enabler themes were identified. Three themes were graded with high confidence, 10 were graded with moderate confidence, three were graded with low confidence, and eight were graded with very low confidence. The most pertinent domains that the themes were mapped to for patients were beliefs about capabilities, reinforcement, and the environmental context and resources. Health professionals identified knowledge, environmental context and resources as important domains. Two domains were identified for carers: (1) social/professional role and identity and (2) memory, attention, and decision processes.

Conclusion: We identified key barrier and enabler themes linked to the TDF that can be used to guide implementation initiatives and promote the sustainability of short-stay arthroplasty programs.

Background: Low back pain (LBP) is the leading cause of disability worldwide. A recent realist review identified the behavioural mechanisms of trust, motivation, and confidence as key to optimising exercise prescription for persistent LBP.

Objectives: Our objectives were to (1) design and develop an online training programme, and (2) gain end-user feedback on the useability, usefulness, informativeness and confidence in using the online training programme using a mixed-methods, pre-post study design.

Participants and intervention: The online training programme was designed and developed using the results from a realist review, and input from a multi-disciplinary stakeholder group. A five-module online training programme was piloted by the first 10 respondents who provided feedback on the course. Further modifications were made prior to additional piloting. The satisfaction, usefulness, ease of use, and confidence of clinicians in applying the learned principles were assessed on completion.

Results: The online programme was advertised to clinicians using social media. Forty-four respondents expressed initial interest, of which 22 enrolled and 18 completed the course. Of the participants, most were physiotherapists (n = 16/18, 88.9%), aged between 30 and 49 (n = 11/18, 61.1%). All participants were satisfied with the course content, rated the course platform as easy to use and useful, and reported that they were very confident to apply the learning. Most (n = 10/14, 71.4%) reported that their manner of prescribing exercise had changed after completion of the course.

Conclusions: An online training programme to optimise exercise prescription for persistent LBP appears to be easy to use, informative and improves confidence to apply the learning.

Background: Medical guidelines recommend structured prehabilitation protocols consisting of lifestyle modifications and exercise to enhance post-operative outcomes for patients undergoing a total knee replacement (TKR). However, current research showing effectiveness is limited and has primarily focused on outcomes of exercise-based prehabilitation.

Objectives: To investigate whether a structured prehabilitation protocol consisting of exercise and lifestyle modifications improves physical function and patient-reported outcomes following TKR surgery compared with usual care.

Design: Systematic review.

Methods: Five databases were searched to identify randomised controlled trials comparing structured prehabilitation programs consisting of lifestyle modifications and exercise, with usual care, for those undergoing a TKR. Methodological quality of included studies was assessed via the RoB 2.0 tool and results synthesis via a Grading of Recommendation Assessment, Development and Evaluation approach was performed to determine the certainty evidence for each outcome.

Results/findings: Four studies were included in this review. Despite a positive trend supporting the inclusion of a structured prehabilitation protocol, additional improvements in post-operative pain, physical function and self-reported function were only seen in one study. Reductions in hospital length of stay were also seen in one study. No additional improvements in post-operative quality of life following prehabilitation were reported.

Conclusion: Limited evidence supporting prehabilitation reported in our review is likely attributed to the intervention type, intensity, and delivery model of included studies. However, there remains to be strong evidence supporting the use of a structured prehabilitation protocol consisting of lifestyle modifications and exercise to improve post-operative outcome.

Background: First Contact Physiotherapy Practitioners (FCPPs) provide expert care for patients with musculoskeletal (MSK) conditions in General Practice. Access to FCPPs can facilitate timely care and efficient use of health services. However, there is little evidence about patient experiences of accessing FCPP appointments.

Objective: To explore the experiences of patients with MSK conditions who have accessed an FCPP appointment in a General Practice setting in the UK.

Design: Exploratory qualitative design.

Methods: Patients with MSK conditions who had experience of accessing FCPP appointments were recruited via social media. Semi-structured interviews were conducted and recorded via MS Teams. Data were analysed using thematic analysis.

Results: Of 13 patients interviewed, there were 10 females and three males, with an age range between 20 and 80 years. The main themes identified were: (1) Awareness of FCPP, (2) Access routes, (3) Facilitators to access, (4) Barriers to access, (5) Likelihood of re-accessing FCPP. Awareness of FCPP was generally low amongst participants. There were a variety of routes to access FCPP appointments; some were felt to be sub-optimal by participants. Facilitators included quick/easy access to FCPP. Barriers included difficulty contacting General Practitioner (GP) surgeries and public perception of needing to see a GP initially. The likelihood of re-consultation with a FCPP was low when participants had disappointing care experiences.

Conclusion: This study provides new evidence about patient experiences of accessing FCPP. It explores positive and negative aspects of access from patients' perspectives. It also highlights areas for improvement in terms of GP staff/patient awareness and understanding of FCPP.