Musculoskeletal Care最新文献

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.

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.

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: Knee osteoarthritis is a common orthopaedic disease, is the leading cause of disability in the elderly, and can lead to pain, loss of function, and reduced quality of life. This research aims to determine how PA programs can be effectively classified and customised to align with the stages of knee OA according to the KL classification.

Objective: The research aims to fill the gap in understanding the relationship between the type and intensity of PA and the stages of OA as defined by the KL classification.

Materials and methods: A systematic search was performed using PubMed, Web of Science, and Scopus databases. This review included different types of studies published after January 1, 2013.

Results: Two thousand one hundred and thirty-six were picked up and only nine articles met the inclusion criteria. The beneficial effects of exercise were found in the function of the joints, pain, and quality of life. Aerobic, isometric, and resistance training showed positive effects and presented improvements in physical function, quality of life, and pain.

Conclusion: The exercise programs appear to be both safe and effective in subjects with knee osteoarthritis with regard to quality of life, pain, and knee function.

Trial registration: PROSPERO registration number: CRD42024550463.

Objectives: To describe characteristics and primary healthcare utilisation in Danish patients with low back pain (LBP) or neck/thoracic spine pain (NTP) 8 years before and 2 years after assessment in secondary care.

Methods: In this cohort study, we included patients aged ≥ 18 who were assessed at an outpatient spine clinic from 2013 to 2021 and linked self-reported information with national registry data. We calculated the prevalence of all-cause healthcare utilisation in primary care. Then, we determined changes in the number of consultations from before to after assessment in secondary care using generalised estimating equations.

Results: We included 56,949 LBP patients and 18,926 NTP patients. The baseline characteristics were similar overall. For both LBP and NTP, all-cause healthcare utilisation increased slightly over time, with a substantial increase in the quarter before the secondary care assessment and a decrease after. Before the assessment, almost all patients consulted general practitioners (95%), while some consulted physiotherapists or chiropractors (60%). Overall, consultations decreased by 19% and 17% for patients with LBP and NTP from 12 to 1 month before to 1-12 months after the assessment. In contrast, 13-24 months after assessment, we found a slight increase in consultations in both groups compared to the same period before.

Conclusions: Patients with LBP and NTP were similar and used similar primary healthcare, which slightly increased over the 10 years. As physiotherapists and chiropractors are first-line providers of guideline-recommended spine pain treatment, the finding that 40% did not consult these professions the year before the secondary care assessment indicates that not all patients receive recommended care before referral.

Objective: The available evidence on orthosis management in the knee osteoarthritis (KOA) remains questionable. This study aims to evaluate existing recommendations and achieve consensus on their implementation through the modified Delphi method.

Methods: Experienced experts in orthosis management for KOA patients participated in three Delphi rounds. Each round involved addressing various questions related to recommended orthosis type such as insole, knee brace, footwear, indications and contraindications, dosage of orthosis usage, follow-up period, long-term side effects, fitting, and weaning procedure. Consensus was defined as  ≥ 70% agreement with a question.

Results: Consensus was achieved for all questions. Experts frequently recommended custom-made insoles, neoprene knee braces, and appropriate footwear. The recommended duration of insole and knee brace usage averaged 3-6 months. Insole usage was advised during all weight-bearing activities, while knee braces were suggested for 4-6 h per day. Experts recommended orthosis follow-up for an average of 4-6 months. Reduced compliance with orthoses was highlighted by experts as the most significant long-term side effect. The fitting of orthoses is typically evaluated through gait analyses, assessment of symptoms and comfort, and observation of the corrective effects on impaired biomechanics in the clinical setting. Besides, experts commonly recommend a gradual weaning process from orthoses.

Conclusions: This study addresses the existing lack of consensus on orthosis management in KOA and provides essential clinical practice recommendations from multidisciplinary experts.

Objectives: Direct hand function is not commonly evaluated in patients with rheumatoid arthritis (RA). The Functional Dexterity Test (FDT) assesses a patient's ability to use the hand for daily tasks and is an accepted quantitative assessment tool in occupational medicine. This pilot study aimed to examine the correlations of FDT-measured hand performance with disease activity status in a cohort of RA patients.

Methods: Forty-eight patients with established RA performed the FDT during their regular follow-up visits. The dominant and non-dominant hands were assessed separately. FDT results were compared among patients with active RA and Clinical Disease Activity Index (CDAI) > 10, RA patients achieving controlled disease activity state (CDAI ≤ 10), and 20 volunteers with no rheumatic disease.

Results: Mean FDT for the dominant hand was 43 s in active RA, 35 s in controlled RA, and 25 s in persons without arthritis. Corresponding FDT results for the non-dominant hand were 50, 38, and 29 s, respectively. FDT significantly correlated with CDAI in the entire cohort of RA patients and the subgroup with CDAI > 10. Patients with controlled disease, CDAI ≤ 10, still demonstrated significantly reduced hand performance compared with non-rheumatic controls.

Conclusions: FDT is a sensitive tool for assessing rheumatoid hand function. Reduced hand performance by FDT in many RA patients who have already achieved existing treatment goals speaks to the question of the suitability of direct hand performance assessment as an RA outcome measure.

Background: Patient and clinician expectations of benefit from recommended management approaches may potentially impact the success of managing musculoskeletal conditions.

Methods: This was a multisite study in an advanced practice musculoskeletal service across Queensland, Australia. Relationships between patient and clinician (advanced physiotherapy practitioner) expectations of benefit, patient characteristics, and clinical outcome recorded 6 months later were explored with regression analysis in 619 patients undergoing non-surgical multidisciplinary care for either knee osteoarthritis (n = 286), low back pain (n = 249) or shoulder impingement syndrome (n = 84).

Results: Patient and clinician expectation ratings had a weak positive association (standardized coefficient (β) 0.28, adjusted R² 0.09). Higher patient expectation ratings were associated with higher readiness for change scores (β 0.31, model adjusted R² = 0.18), while higher clinician expectation ratings were associated with the condition managed, higher patient education level, lower potential presence of neuropathic pain or yellow flags, and more favourable radiological findings (model adjusted R² 0.4). Patient expectations and self-reported engagement with care were poorly correlated. Higher patient (β 0.33, adjusted R² 0.12) and clinician (β 0.32, adjusted R² 0.14) expectations were associated with better clinical outcomes. This positive association was stronger when patient and clinician expectation ratings were congruent.

Conclusions: Findings suggest that expected benefits from recommended care may impact outcomes and should be considered in the initial phases of management. In particular, congruence between patient and clinician expectations appears to have relevance to outcomes.

Objective: To evaluate the sociodemographic characteristics and disease-related factors associated with diagnostic delay in Canadian patients with axial spondyloarthritis (axSpA).

Methods: Data from 542 Canadian patients who participated in the International Map of Axial Spondyloarthritis online survey were analysed. Diagnostic delay was calculated as the difference between age at diagnosis and age at onset of the first symptoms reported by participants. Univariate and multivariate analyses were used to evaluate possible factors associated with diagnostic delay.

Results: The mean age (± SD) of the surveyed participants was 44.3 ± 13.9 years and 63.1% were female. The average diagnostic delay was 9.0 ± 10.5 years (median, 5.0 years; interquartile range, 1.0-13.8). In the multivariate regression analysis, the three variables most strongly associated with longer diagnostic delay were use of nonsteroidal anti-inflammatory drugs (NSAIDs) (B = 2.991; 95% CI = 1.075-4.909), medium or high functional limitation (B = 1.541; 95%CI = 0.186-2.896), and number of HCPs seen before diagnosis (B = 1.524, 95%CI = 1.072-1.977).

Conclusion: Diagnostic delay continues to be a barrier to optimal care for Canadian axSpA patients. Significant diagnostic delay, associated with a high number of HCP visits prior to diagnosis, high use of NSAIDs, and marked functional limitation in daily life, illustrate the convoluted axSpA patient journey.