Musculoskeletal Care最新文献

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.

Objective: Knee osteoarthritis is a primary cause of disability across the world and current standard care fails to address all biopsychosocial contributions to pain. The current review aims to evaluate randomised controlled trials examining the effect of adding cognitive behavioural therapy or pain coping skills training to standard care on pain and function outcomes for individuals with knee osteoarthritis.

Data sources: Systematic searches were conducted of CINAHL, EMBASE (OVID), Medline (EBSCO) and PsycINFO databases until July 2024 with no date restrictions.

Methods: This systematic review followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Risk of bias was assessed using the Risk of bias 2 tool. Meta-analysis using a random-effects model was carried out using the ​Statistical Package for the Social Sciences, and effect sizes from standardised mean differences were calculated using Cohen's d statistic. Heterogeneity was assessed using I-squared and Tau-squared tests.

Results: Four randomised controlled trials met eligibility criteria (n = 628, mean age 62.91), demonstrating a low risk of bias. The addition of cognitive behavioural therapy or pain coping skills training to standard care for knee osteoarthritis produced statistically significant changes in standardised mean differences (p < 0.001), showing small to medium effect sizes in pain (0.488) and function (0.340) between 3- and 6-month time points. Heterogeneity measured by I^-squared and Tau-squared was low for pain and function.

Conclusion: Adding psychological interventions to standard care for knee osteoarthritis improves outcomes in both pain and function. These findings support the integration of psychological interventions into clinical practice.

Objective: To investigate the relation of radiographic knee osteoarthritis (RKOA) and type 2 diabetes mellitus (T2DM) to physical activity, pain, physical function, and quality of life.

Methods: Data on physical activity (light and moderate-vigorous physical activity minutes/day, steps/day, sedentary time percent of wear time), pain, physical function (Western Ontario and McMaster Index, walking speed during 20-m walk) and quality of life (SF-12) from the Osteoarthritis Initiative at the 48-month visit were included. Participants (n = 1788) were categorised into no RKOA or T2DM, RKOA-alone, T2DM-alone, and RKOA and T2DM. Multivariable regression models, adjusted for age, sex, and BMI, assessed the relationship of disease status to outcomes.

Results: Compared to RKOA-alone, RKOA and T2DM were associated with lower moderate-vigorous physical activity (Coefficient: 4 min/day, 95% CI: [-7, -1]) and steps/day (-817 steps/day [-1291, -343]) and higher sedentary time percent (1.3%/day [-0.2, 2.8]). No significant differences were found in light physical activity (-11 min/day [-25, 2]). The RKOA and T2DM groups reported greater pain (1.0 [0.4, 1.6]) and functional limitations (3 [1, 5]), slower walking speed (-0.09 m/s [-0.12, -0.05]), and worse quality of life (-3.2 [-4.8, -1.6]). T2DM-alone was also associated with lower physical activity and worse quality of life than RKOA-alone.

Conclusions: The comorbidity of RKOA and T2DM and T2DM-alone were associated with lower physical activity and worse quality of life than RKOA-alone. Management should address both conditions concurrently rather than in isolation.

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.

The aim of this study is to describe patient experiences with the dietetic service in a multidisciplinary orthopaedic physiotherapy screening clinic for the management of osteoarthritis, specifically nutrition-related indicators of success, such as changes to weight and diet. A retrospective observational medical chart audit was conducted of patients with osteoarthritis within the dietetic clinic over a 12-month period in a large, urban setting in Australia. In total, 38 patients met the inclusion criteria; 68% were female. Patients spent an average of 182 days in dietetics care, with an average of 5 appointments per patient. Approximately one-third (32%) of patients achieved a clinically significant weight loss (> 5% of body weight), 58% had no change in weight, and 11% of patients gained weight (> 5% of body weight). Of patients in the successful weight loss group, 50% had been advised to follow a very low energy diet, compared to 19% in the no weight loss group (p = 0.05). Patients appeared to be increasing their consumption of fruits and vegetables and decreasing their discretionary foods, but changes did not reach statistical significance. We found that the current clinic was resource-intensive, provided varied nutritional treatments, and resulted in some, but limited, success. Findings from this study suggest areas for improvement in clinics that primarily serve patients with osteoarthritis.

Background: Chronic neck pain (CNP) significantly impacts individuals' quality of life and functional capacity. Cervical stabilisation exercises (CSEs), targeting deep cervical muscles and improving postural alignment, have emerged as a promising intervention. This systematic review evaluates the efficacy of CSEs in managing CNP.

Objective: To determine the effectiveness of CSEs in alleviating pain, improving function, and enhancing quality of life in individuals with CNP.

Methods: A systematic review of the literature was conducted following PRISMA guidelines. Searches were performed across PubMed, Scopus, and the PEDro. Eligible studies included randomised controlled trials (RCTs) published within the past 10 years. Methodological quality was assessed using the PEDro scale.

Results: Twelve studies met the inclusion criteria, with most rated as moderate to high quality. Findings demonstrated that CSEs significantly reduce pain (as measured by VAS and NRS), improve functional capacity (e.g., Neck Disability Index), and correct postural abnormalities such as forward head posture. Multimodal interventions combining CSEs with manual therapy, thermotherapy, or dynamic exercises yielded superior outcomes compared with CSEs alone. Intervention duration of 6-8 weeks was most effective. Variability in outcomes was attributed to differences in population characteristics and methodological quality.

Conclusion: CSEs are an effective, evidence-based intervention for managing CNP. Tailored programs, particularly those integrating multimodal approaches, enhance therapeutic outcomes. Future research should focus on long-term effects and subpopulation-specific benefits to optimise clinical implementation.

Objectives: This scoping review will explore and map the extent and type of literature related to physiotherapy capabilities in the health care of adult patients at increased risk of osteoporotic fractures and identify gaps in the literature.

Background: With an ageing population, osteoporosis and fractures and their associated costs are increasing. Unfortunately, many people with, or at increased risk of, osteoporotic fractures remain undiagnosed and untreated. The scope of physiotherapy has expanded over recent years with enhanced, advanced and consultant roles. This presents opportunities for physiotherapists to help reduce the osteoporosis care gap. Clarifying capabilities is important to ensure successful implementation of new roles and development of holistically competent practitioners.

Eligibility criteria: Literature will be included if it relates to capabilities of qualified physiotherapists involved in the health care of adult patients (aged 18 and over) at increased risk of osteoporotic fractures in any clinical setting. All published and non-published literature to include research studies, editorials, and grey literature will be considered.

Methods: A scoping review will be carried out in accordance with JBI guidelines. Peer-reviewed databases including MEDLINE, EMBASE, EMCARE, CINAHL, SCOPUS, Cochrane, PEDro and ProQuest will be searched for literature between 2003 and 2025, alongside a comprehensive search for grey literature (including reports and government publications) from additional sources to ensure a broad representation of available evidence. Source selection will use the PRISMA-ScR flow chart against agreed eligibility criteria. Data extraction will be mapped out in tabular and/or diagrammatic format with a supporting narrative synthesis.

Trial registration: https://doi.org/10.17605/OSF.IO/47UYE.