Musculoskeletal Care最新文献

Background: Plantar fasciitis (PF) is a prevalent cause of heel pain and is commonly managed through conservative physiotherapeutic interventions. Despite widespread clinical use, the relative effectiveness of various modalities remains unclear.

Objective: To evaluate the efficacy of different physiotherapeutic interventions on pain and function in adults with plantar fasciitis through systematic review and meta-analysis of randomized controlled trials (RCTs).

Methods: A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science (January 2020-May 2025) for RCTs assessing physiotherapy-based interventions for PF. Primary outcomes included pain (Visual Analog Scale [VAS]) and function (Foot Function Index [FFI]). Meta-analyses were performed using random-effect models, and the GRADE framework was applied to assess evidence certainty.

Results: Twenty-one RCTs (n = 1196) were included. Interventions included extracorporeal shock wave therapy (ESWT), kinesiology taping, laser therapy, manual therapy, and needling techniques. At 1-month follow-up, physiotherapy yielded a non-significant trend towards pain reduction (SMD = -0.390, 95% CI: -0.888 to 0.109, p = 0.125; I² = 88.7%). Functional outcomes showed no significant improvement (SMD = 0.000, 95% CI: -0.195 to 0.195, p = 1.000). Heterogeneity was high, and overall evidence quality was rated low.

Conclusion: Physiotherapeutic interventions may modestly reduce pain in the short term but show limited impact on functional improvement in plantar fasciitis. ESWT and kinesiology taping appear most promising. Further high-quality, long-term studies are warranted to clarify their clinical utility.

Background: Knee osteoarthritis (KOA) is a common degenerative condition causing pain, affecting mobility, and quality of life. As muscle weakness worsens in KOA, this review evaluates the effectiveness of quadriceps strengthening exercises in managing pain.

Methods: This review used the PubMed database to identify free full-text randomized controlled trials from the past 5 years, limited to English-language human studies, guided by the PICO framework. The Joanna Briggs Institute Critical Appraisal Tool was used to assess study quality; RCTs scoring ≥ 80% were included. Data were analysed descriptively, and effect sizes were calculated using G*Power software.

Results: Nine RCTs showed that quadriceps strengthening significantly reduced pain and improved function in KOA. Effective exercises included straight leg raises, terminal knee extensions, and open/closed chain movements over 8-12 weeks.

Conclusion: Quadriceps strengthening as a part of lower extremity strengthening is effective in reducing pain in KOA and should be prioritised in patient-specific programs.

Background: The rise of telehealth has transformed healthcare delivery, but its impact on treatment adherence compared with traditional outpatient departments (OPD) remains underexplored.

Objective: This study aimed to assess and compare patient adherence to treatment protocols in telehealth with regular OPD settings among patients with neck pain.

Methods: A cross-sectional study was conducted at SGT University with neck pain patients in telehealth and traditional OPD settings. Adherence was measured using a validated adherence scale and electronic health records. Data were analysed using statistical methods to identify significant differences between the two groups.

Results: A total of 300 patients participated, with 150 in the telehealth group and 150 in the regular OPD group. Preliminary findings indicated adherence rates. Factors influencing adherence, such as convenience and accessibility, were also analysed.

Conclusion: Telehealth appears to enhance treatment adherence compared with traditional outpatient care. These findings suggest that integrating telehealth into healthcare delivery may improve patient outcomes. Future research should explore long-term adherence trends and the underlying mechanisms that drive these differences.

Background: Knee osteoarthritis (KOA) is a chronic degenerative condition. Pain is the most prominent symptom of KOA, which can be exacerbated by obesity. The US Food and Drug Administration recommends using patient-reported outcome (PRO) measures to assess KOA pain and function in clinical trials, but none have been validated for patients with KOA and obesity/overweight. The objective of this study was to explore and document the patient experience of signs, symptoms, and health-related quality of life (HRQoL) impacts of KOA pain, including the impact of obesity/overweight, to facilitate future validation studies.

Methods: A targeted literature review and interviews with US participants with KOA pain (including some with comorbid obesity) were conducted. Publications and interview transcripts were analysed using content analysis methods to develop a conceptual model of KOA pain experience.

Results: Eighteen publications were reviewed and 25 participants were interviewed. All participants in the interviews reported knee pain and described that their physical functioning had been negatively affected. Many experienced a negative emotional/psychological impact. Many participants believed that there was a relationship between their weight and experience of KOA pain, reporting a 'vicious cycle' of pain and weight gain due to KOA.

Conclusions: This study highlights the burden of living with KOA pain and the negative impact of obesity/overweight on patients' HRQoL. A conceptual model was developed, which may be used to explore the content validity of PRO measures and promote a robust understanding of the patient experience of living with KOA pain during the development of new therapies.

Objectives: The aim of this study was to investigate the effects of a digitally supported physical activity (PA) intervention on pain, physical function, exercise adherence and quality of life in females with knee osteoarthritis (OA).

Methods: Thirty female participants with knee OA were randomly assigned to either a control group (n = 15) receiving patient education, smartwatch use, and a home exercise programme, or an intervention group (n = 15) receiving an additional digitally supported walking programme. The primary outcome measures were pain severity (Numerical Pain Rating Scale [NPRS]), physical function (Western Ontario and McMaster Universities Arthritis Index [WOMAC]) and exercise adherence. Secondary outcomes included quality of life (European Quality of Life Scale 5 Dimensions/EQ-5D-3L), daily step count and pain catastrophizing (Pain Catastrophizing Scale/PCS). Assessments were performed at baseline and after 8 weeks.

Results: The intervention group showed significantly greater improvements in pain severity (1.4 cm larger improvement on NPRS; p = 0.005), physical function (6.4-point larger improvement on WOMAC total score; p = 0.003) and daily step count (1548 steps larger improvement; p = 0.045) compared to the control group. Both groups demonstrated similar significant improvements in exercise adherence, pain catastrophizing, and quality of life (p < 0.05).

Conclusions: A digitally supported PA intervention, in addition to patient education and a home exercise programme, significantly improved pain, physical function and PA in females with knee OA. These findings support the efficacy of structured, supervised digital interventions for enhancing outcomes in this population. Future studies should explore strategies to enhance long-term adherence through digital PA interventions.

Trial registration: This study was conducted in compliance with the Declaration of Helsinki (Clinical Trial Registry Number: NCT05810376).

Introduction: Communication gaps between patients and physicians in musculoskeletal (MSK) care can affect satisfaction and outcomes. While many studies focus on patient dissatisfaction, few compare it directly with physician perceptions. This study aimed to identify perceptual gaps during MSK consultations by analysing both perspectives across key communication domains.

Methods: A cross-sectional survey was administered to 950 patients and 85 physicians in outpatient MSK clinics in Jordan. Structured questionnaires assessed perceptions of consultation quality across eight patient domains and five physician domains. Independent sample t-tests were used to compare satisfaction groups. Perceptual gaps were identified by matching patient and physician responses.

Results: Dissatisfied patients reported significantly lower scores in key domains: diagnosis understanding (4.08 vs. 6.15, p = 0.04), clarity of condition explanation (4.23 vs. 6.91, p = 0.01), involvement in treatment decisions (3.23 vs. 6.19, p = 0.002), and consultation time adequacy (3.03 vs. 6.91, p = 0.03). In contrast, physicians in non-satisfactory encounters rated higher feelings of being rushed (8.56 vs. 3.33, p = 0.002), perceived patient disorganisation (8.64 vs. 2.02, p = 0.001), and resistance to non-pharmacologic advice (7.58 vs. 2.20, p = 0.001). These findings reveal six major gaps: consultation time, communication clarity, patient organisation, treatment receptiveness, shared decision-making, and trust.

Conclusion: This study revealed six communication gaps between patients and physicians in MSK care-spanning time, clarity, decision-making, and trust. Physicians often believed they communicated effectively, while patients felt rushed, confused, or excluded. Bridging these gaps requires clearer communication, active patient involvement, and greater attention to how care is delivered and perceived.

Level of evidence: Level III-Cross-sectional observational study.

Background: Cauda equina syndrome (CES) is a spinal emergency. Over half of known cases first present to primary care for initial assessment. In February 2023, the Getting It Right First Time (GIRFT) national programme launched new CES guidelines, which included an important change in practice: a new urgent referral route.

Aim: This study aims to explore the awareness and use of the GIRFT guidelines in a primary care setting in England.

Design and setting: A cross-sectional online survey was used to collect data from primary care clinicians working across England.

Method: Using purposive sampling, the survey was shared with primary care clinicians across England and conducted between 21-10-2024 and 24-12-2024. The RE-AIM framework underpinned the survey design. Descriptive analysis was employed to interpret frequency and Likert data.

Results: A total of 515 responses were received from across all 42 integrated care boards in England. Of the 515 participants, 452 (88%) were aware of a CES guideline or pathway, with 297/515 (58%) being aware of the GIRFT guidelines. Two-thirds had access to a local CES pathway (n = 304/452, 67%). Nearly all clinicians highlighted that consulting either a local CES pathway or national guidelines supported their clinical decision making.

Conclusion: This is the first study to investigate the awareness and utilisation of the GIRFT guidelines in primary care across England. The use of locally agreed CES pathways was shown to increase adherence to their recommendations in primary care. These findings suggest that using up-to-date local CES pathways can increase adherence to the GIRFT guidelines.

Objective: To investigate campaigns developed for the dissemination of clinical practice guidelines for the appropriate use of imaging for low back pain.

Method: A scoping review was conducted to identify resources which report on dissemination strategies for low back pain imaging clinical practice guidelines. A database search was conducted of MEDLINE, CINAHL, Cochrane Reviews, Scopus, Google, Google Scholar and National Health Service Websites. The full text of relevant resources identified from the title and abstract screen were retrieved and assessed for inclusion eligibility.

Results: The initial search identified 1087 resources. Following a title, abstract and full-text screen, 26 resources were included for final synthesis. Relevant data were extracted and categorised into the following three key components: (1). Location of the campaign, (2). Campaign details, (3). Dissemination strategies as defined by five methods (educational resources, presentations and interactive interventions, media form, clinical decision support, and other). Educational resources and interactive interventions were the most commonly used strategies, with media resources implemented the least.

Conclusion: Low back pain imaging clinical practice guidelines have been disseminated to clinicians at regional and national levels; however, there are few international campaigns. The comprehensive list of dissemination strategies included in this study has created a foundation to facilitate the design of future campaigns to enhance the scope of trialled strategies to consider the complexities of clinical practice and its ever present need to change.

Background: Musculoskeletal (MSK) conditions equate to one third of a general practitioners (GP's) caseload. First contact practitioner physiotherapists (FCPPs) have been shown to be a clinically and cost-effective alternative to GPs for managing MSK conditions. However, their impact on primary care workload(s) requires further evaluation.

Aim: To determine the percentage of patients who, having seen an FCPP for a musculoskeletal disorder, then reattend with a GP, nurse practitioner (NP), or paramedic practitioner (PP) within 12 weeks, and the reasons for reattendance.

Design and setting: National, retrospective service evaluation from 70 primary care networks (PCNs) across England.

Method: Data on the rate of and reasons for reattendance following an FCPP appointment were collected retrospectively between 01 January 2024 and 30 April 2024. Consent was obtained from each PCN/practice site. Extracted data consisted of patient demographics, and whether the patient reattended with a GP/NP/PP at three predetermined timepoints within 12 weeks. Reasons for reattendance at each time point were recorded against 8 predetermined criteria.

Results: Two thousand one hundred forty out of 2725 patients (78.5%) did not reattend within 12 weeks of an FCPP appointment. Medication/analgesia prescribed was the most common reason for reattendance < 8 weeks and onward referral was the most common reason for reattendance between 8 and 12 weeks.

Conclusion: FCPPs do have a significant impact on reducing the burden of MSK conditions in primary care. Medication was the most common reason for reattendance, supporting the advanced practice component of the FCPP role.