Musculoskeletal Care最新文献

Objective: This study aims to investigate the impact of two-way social support on rehabilitation exercise compliance among patients undergoing total knee arthroplasty and examine psychological flexibility's mediating role.

Design: Cross-sectional study.

Methods: A convenience sample of 266 total knee arthroplasty patients was recruited from the orthopaedic department of a tertiary hospital in Guiyang, Guizhou Province, between November 12, 2024, and March 20, 2025. Data were collected using standardised instruments, including a general demographic questionnaire, a brief two-way social support scale, a simplified multidimensional psychological flexibility inventory, and a rehabilitation exercise adherence scale. Amos 29.0 software was used to construct a structural equation model of the mediating effect of psychological flexibility between two-way social support and rehabilitation exercise compliance.

Results: Pearson correlation analysis revealed significant positive associations among two-way social support, psychological flexibility, and rehabilitation exercise compliance ( $r$  = 0.538-0.730, $p$  < 0.001). Mediation analysis demonstrated that two-way social support enhanced rehabilitation exercise compliance indirectly through increased psychological flexibility (effect size = 0.336, 95% $CI$ [0.253-0.442], $p$  < 0.05), accounting for 53.0% of the total effect. Additionally, a significant direct effect of two-way social support on rehabilitation exercise compliance was observed (effect size = 0.298, 95% $CI$ [0.181-0.432], $p$  < 0.05).

Conclusion: Two-way social support has a positive influence on rehabilitation exercise compliance in TKA patients, with psychological flexibility serving as a partial mediator. These findings suggest that healthcare professionals can improve patient compliance with rehabilitation protocols by fostering greater psychological flexibility.

Background: Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disorder causing joint damage, pain, and functional limitations. While pharmacotherapy remains central to management, physiotherapeutic interventions are increasingly recognised for their supportive role in symptom alleviation and quality of life enhancement.

Objective: This systematic review and meta-analysis aimed to evaluate the effectiveness of various physiotherapeutic interventions in reducing pain and improving function and quality of life in patients with RA.

Methods: Following PRISMA guidelines, a comprehensive search of PubMed, Scopus, and Web of Science (2010-2025) identified randomized controlled trials (RCTs) assessing physiotherapy modalities in RA. Methodological quality was appraised using the Cochrane RoB 2.0 tool. Pain outcomes were synthesised via meta-analysis using a random-effects model.

Results: Seventeen RCTs involving 1362 participants were included. Interventions encompassed aerobic/resistance exercise, hydrotherapy, manual therapy, electrotherapy, and multimodal approaches. Meta-analysis of five trials (n = 307) revealed a statistically significant reduction in pain favouring physiotherapy (SMD = -0.347; 95% CI: -0.571 to -0.124; p = 0.002; I* = 0%). No significant publication bias was detected. Narrative synthesis indicated potential benefits in functional and cardiorespiratory outcomes, especially with combined exercise and lifestyle interventions.

Conclusions: Physiotherapeutic interventions, particularly structured exercise programs, demonstrate moderate evidence for pain reduction in RA. Integrating multimodal physiotherapy with diet and adjunct therapies may enhance patient outcomes. Further high-quality, standardized RCTs are warranted to optimise intervention protocols and assess long-term benefits.

Background: Low back pain (LBP) is one of the most prevalent musculoskeletal conditions globally, often leading to diminished quality of life, reduced physical function, and increased healthcare utilization. Recent advancements in remote sensor-based technologies have introduced innovative methods for continuous monitoring and personalised rehabilitation of individuals with LBP.

Objective: This Narrative review aims to explore and synthesize current evidence on the use of remote sensor-based monitoring in the management of low back pain, with a focus on outcomes related to quality of life, functional recovery, and patient-centred care.

Methods: A systematic search was performed across four major databases-PubMed, Scopus, Web of Science, and Google Scholar-for studies published between 2010 and 2025. Search terms included low back pain, remote monitoring, wearable sensors, digital health, and rehabilitation outcomes. Inclusion criteria comprised randomized controlled trials, cohort studies, systematic reviews, scoping and literature reviews that examined sensor-driven interventions in outpatient or home-based LBP rehabilitation settings.

Results: The review identified evidence supporting the use of wearable sensors in enhancing patient engagement, tracking physical activity, and enabling real-time feedback during exercises. Improvements were noted in pain management, functional mobility, and patient-reported quality of life. Moreover, remote monitoring promoted adherence and early detection of relapses. Nonetheless, heterogeneity in sensor types, data interpretation, and outcome reporting was observed across studies.

Conclusion: Remote sensor-based monitoring holds significant potential to complement conventional rehabilitation strategies for low back pain. Future research should prioritise standardized frameworks, integration into clinical pathways, and evaluation of long-term cost-effectiveness and patient acceptability.

Background: Subacromial pain syndrome (SAPS) is the most common shoulder pain condition in primary care. Despite the importance of shared decision-making (SDM) being increasingly recognised, its application in SAPS care remains poorly understood. The primary aim of this study was to explore the influence of a decision aid on patient and observer perceptions of SDM, and secondarily to explore correlations between these ratings in the primary care management of patients with SAPS.

Methods: We conducted a multi-methods study including observations of consenting patients with SAPS in their clinical consultations with clinicians from four Danish primary care practices using OPTION-12. We gathered patients' perceptions of SDM 2 weeks after the consultation using the CollaboRATE questionnaire and Shared Decision-Making Questionnaire (SDM-Q-9). We observed consultations with and without the introduction of a decision aid tailored to support the management of patients.

Results: Thirty-four consultations were observed (16 with and 18 without the decision aid). Without the aid, the mean (SD) OPTION-12 score was 10.5 (3.3), while the median (IQR) CollaboRATE and mean (SD) SDM-Q-9 scores were 5 (1.3) and 22.2 (7.5), respectively. With the aid, scores significantly increased: OPTION-12 to 22.7 (6.87, range 5-32), CollaboRATE to 6.5 (1.4), and SDM-Q-9 to 30.6 (8.4). Patients' and observers' OPTION-12 and SDM-Q-9 scores correlated significantly across both phases, but no significant correlation was found between CollaboRATE, OPTION-12, and SDM-Q-9 scores in either phase.

Conclusion: A decision aid significantly improved observer- and patient-rated SDM in primary care consultations for patients with SAPS. Observer-rated SDM scores more than doubled with the decision aid, and patients reported higher levels of SDM.

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.

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: 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.