Musculoskeletal Care最新文献

Background and purpose: Cervical spondylosis significantly impacts disability and sleep quality. Along with physiotherapy, selecting an appropriate pillow may improve spinal alignment, relieve neck strain, and enhance sleep. This study protocol aims to evaluate the effectiveness of different pillows in managing cervical spondylosis.

Methods: A participant-blinded, three-arm parallel pilot randomized clinical trial will be conducted at a super-speciality tertiary care hospital. Participants with cervical spondylosis will be randomized into three groups: Group 1 (Cervical pillow + Physiotherapy), Group 2 (Regular pillow + Physiotherapy), and Group 3 (Physiotherapy only). Physiotherapy sessions will include moist heat packs, sub-occipital release, TENS, and postural re-education exercises, delivered three times a week for 4 weeks. Outcome measures-Pittsburgh Sleep Quality Index, Neck Disability Index, Numerical Pain Rating Scale, and Range of Motion-will be assessed at baseline and after 4 weeks.

Results: Descriptive and inferential statistical analyses will be performed on the data. Depending on the results of the normality test, either parametric or non-parametric methods will be utilised for both within-group and between-group analyses.

Discussion: This study adopts a patient-centred approach, aiming to enhance understanding of the complex interplay between sleep, musculoskeletal health, and pillow selection in individuals suffering from cervical spondylosis.

Trial registration: Clinical Trials Registry of India (CTRI) with trial registration number CTRI/2024/04/065295.

Introduction: Primary care accounts for up to one-fifth of all NHS carbon emissions, with musculoskeletal (MSK) pain accounting for 14%-20% of all primary care consultations. Digital Health Technologies (DHTs), including self-management apps, offer a potential solution to help the NHS reduce its carbon footprint.

Aims: To investigate the carbon footprint impact that the implementation of a digitally supported self-management app has had within an NHS Musculoskeletal (MSK) service between 2023 and 2024.

Methods: Calculations were based on the reduction in carbon emissions associated directly from patients not needing to travel to in-person appointments alongside the subsequent reduction in use of NHS facilities. This reduction in carbon emissions was then offset by the software associated emissions and that of the technology partners' clinicians overseeing the digitally supported self-management pathway, allowing for the calculation of the net carbon savings.

Results: Six hundred and thirty-five patients were offered, accepted and accessed self-management support using the digital self-management app. The estimated reduction in emissions from reduced patient travel and infrastructure usage associated with NHS outpatient appointments was 63,741.2 kgCO₂ ^e. This total was offset by 551.46 kgCO₂ ^e of emissions associated with the digital app (Phio Engage) software and clinical oversight by the digital team, thus the overall reduction in carbon footprint was estimated to be 63,189.74 kgCO₂ ^e.

Conclusion: This 24-month evaluation demonstrates that implementation of a digital supported self-management pathway as an additional offer for patients accessing MSK care can lower the carbon footprint of a community MSK service and support the NHS in achieving its net zero strategy. It also provides a potential framework for MSK services to be used in the future when considering carbon costs of treatment pathways.

Introduction: Abrupt discontinuation of low dose glucocorticoids (GCs) in systemic lupus erythematosus (SLE) patients with clinical quiescent disease increased the risk of flares. This study aimed to evaluate the effect of a gradual GC withdrawal scheme on the flare rate among SLE patients with sustained clinical remission.

Methods: SLE patients who received prednisolone 5 mg/day for at least 4 weeks and had clinical SLE Disease Activity Index-2000 (cSLEDAI-2K) = 0 for a minimum of 6 months were recruited. The participants were randomly assigned in a 1:1 ratio to either the 16-week gradual discontinuation of prednisolone (withdrawal group) or continuation of prednisolone for 24 weeks (maintenance group) with a planned enrolment of 36. The primary outcome was the proportion of patients experiencing a flare, defined with either change of cSLEDAI-2K ≥ 4, SLE-Disease Activity Score ≥ 1.72 or any treatment escalation over 24 weeks.

Results: Twenty patients were assigned to the maintenance group (10 patients), and the withdrawal group (10 patients). The flare rate was higher in the withdrawal group compared with the maintenance group (3 vs. 1 patient; HR 3.57; 95% CI 0.37 to 34.51, p = 0.24). All patients who experienced a flare were serologically active clinically quiescent at screening. Adverse events (AEs) occurred more in the withdrawal group (7 vs. Two patients). The trial was terminated early due to the occurrence of flares and AEs.

Conclusion: Gradual tapering of 5 mg/day of prednisolone showed non-significant higher rate of relapse and AEs in SLE patients with clinical remission.

Clinical trial number: The trial was registered with ClinicalTrials.gov, NCT06234852.

Objective: To explore the information needs of people with elbow osteoarthritis.

Design: Qualitative interview study using reflexive thematic analysis.

Setting: A single National Health Service Teaching Hospital Trust and associated primary care services, providing musculoskeletal care across the clinical pathway. Interviews were conducted in person, by phone or video call according to participant preference.

Participants: Twelve adults with clinically diagnosed elbow osteoarthritis, under the care of a general practitioner or consultant elbow surgeon, were included.

Results: Four themes were developed: (1) self-management in action, (2) experience of treatment options and navigating surgical decision making, (3) negotiating uncertainty and (4) active information seeking. Participants experiences were wide ranging and their varied information needs were at times unmet, particularly when related to treatment options, prognosis and surgical decision making. Across the clinical pathway, information was reported by some to be unclear or contradictory. Participants discussed a range of preferences for information sources. Accessing information was challenging for some participants and various barriers were discussed.

Conclusions: This is the first study to report the lived experience of people with elbow osteoarthritis and their information needs. For some, accessing information can be challenging, and the unmet information needs can affect the ability to self-manage ongoing symptoms and participate in treatment decisions. These findings provide a platform for the development of accessible, meaningful and culturally sensitive information sources capable of contributing to optimal treatment pathways.

Background and purpose: Intra-articular corticosteroid (IAC) injections are widely used as adjuncts to the core non-surgical treatments for knee osteoarthritis. In the UK, they are administered by a range of healthcare professionals working in different settings, including general practitioners in primary care, and physiotherapists in musculoskeletal outpatient settings. The aim of this retrospective database study was to consider the impact of the injecting clinician's profession on treatment outcome.

Method: Data were collected from 1708 patients who received a single IAC injection within a 12-month period, administered by either a physiotherapist (1612 patients) or a doctor (96 patients) within Connect Health Limited's MSK services. Outcome was assessed using the EQ-5D-5L outcome measure. Parametric paired and independent sample t-tests were used, respectively, to examine differences in EQ-5D-5L pre- and post-intervention and based on injecting clinicians.

Results: On average, a statistically significant improvement (p < 0.001) in patients' EQ-5D-5L scores was observed across the study population following an IAC injection. The difference in post-injection EQ-5D-5L scores according to clinicians was also found to be statistically significant (p < 0.001), in favour of physiotherapist-administered IAC injections.

Conclusion: This study confirms the positive impact of IAC injections in the management of knee osteoarthritis, with the results suggesting that injections administered by physiotherapists may produce better outcomes than those administered by doctors.

Background: Minimalist footwear has emerged as an alternative to traditional footwear styles and advocated for the management of several foot and lower limb pathologies.

Objective: The objective of this scoping review was to map the clinical potential of minimalist footwear (concept) in the treatment and/or rehabilitation of lower limb impairments (context) across the life course (population).

Data sources: Systematic searches were undertaken across MEDLINE, EMBASE, and CINAHL from 2000 to 2024.

Study selection or eligibility criteria: Studies evaluating minimalist footwear as an intervention or adjunct to an intervention in clinical populations, or where a clinical need has been defined, across all age groups, were included. Eligible studies were primary research published in English from the year 2000 onwards.

Data synthesis: A narrative analysis was undertaken and our findings were reported in accordance with the PRISMA-ScR guidelines.

Results: Sixteen studies were identified in clinical populations ranging from adolescents with patello-femoral pain (14.3; SD: 1.7 years) to older adults with balance ability (73.4; SD: 3.9 years); studies focussing on knee pathology were the most common (n = 9). The influence of minimalist footwear on outcome measures varied across the studies and reported mechanisms of action included somatosensory, biomechanical and neuromuscular factors.

Conclusion and implications: Our review has mapped the clinical populations where minimalist footwear has been tested and most focus on knee pathology, specifically knee osteoarthritis. Our review has identified the biomechanical, functional, and clinical variables reported in studies and future work testing the clinical benefits of minimalist footwear interventions is recommended.

Objectives: The objectives of this study are to evaluate the impact and cost-consequence analysis of a new digital intervention providing water- and land-based exercises for people with musculoskeletal (MSK) conditions.

Methods: Data were collected from May 2021 to December 2023, during which the number of sites providing the intervention increased from 20 to 136. Participant recruitment and characteristics, pain intensity (0-100), physical function (Patient Specific Complaint, 0-100), and health and wellbeing (Office for National Statistics 4, ONS4) were measured. A minimal clinically important detectable (MCID) change of 15% was used. Symptoms, function and wellbeing were measured at 6, 12 and 26 weeks. A cost-consequence analysis was conducted comparing 12 digital exercise sessions to 6 face-to-face (F2F) physiotherapy sessions.

Results: In total, 4429 participants with MSK conditions, who completed at least 1 exercise session, were included in this study. 3515 (79.4%) were female, average age 58.7 ± 15.3 years old, 13% registered as ethnicity other than white, 33.5% were in the third quartile for high deprivation and 44.2% were sedentary. The knee (33.3%) was the most affected body region. In total, 40,995 exercise sessions were completed (91.6% water-based), and the average sessions per user were 9.3. Small significant (p < 0.05) improvements in function, happiness, and anxiety were seen at 6 weeks, with improvement in function and anxiety maintained at 12- and 26-week follow-ups. At 6 and 12 weeks, 33.8% and 38.6% reached MCID in pain intensity and 40% and 45% in physical function, improvements which are similar when compared to expected outcome of face-to-face physiotherapy. Cost-consequence analysis indicated an estimated saving of £168.72 per participant compared to F2F physiotherapy.

Conclusion: This digital MSK exercise solution delivered to people with MSK conditions had a positive effect on pain intensity and physical function with considerable potential cost savings.

Background: Cervical spine involvement remains one of the more serious complications of rheumatoid arthritis (RA). Several factors interfere with the occurrence of this complication. The aim of this work was to identify the risk factors associated with cervical involvement, specifying the contribution of MRI in screening for rheumatoid cervical spine and discussing the value of standard X-rays.

Methods: A cross-sectional study included 100 patients with RA who underwent both standard radiography and MRI of the cervical spine. Clinical, paraclinical and therapeutic data were collected.

Results: Cervical pain was the predominant functional sign. It was mechanical in 44% of cases and inflammatory in 29%. Physical signs revealed on clinical examination included: pain on cervical spine mobilisation (49%), cervical stiffness (37%) and abnormal neurological examination in 3% of cases. Standard radiographs revealed C1-C2 instability in 52% of cases: vertical displacement (28%), rotatory displacement (22%), anterior displacement (19%) and lateral displacement (1%). MRI confirmed the presence of the following types of atlantoaxial subluxation: vertical (34%) and anterior subluxation (27%). Other lesions were identified on MRI: synovial thickening (31%) with contrast enhancement (17%), hyperintensity on diffusion-weighted imaging (DWI; 6%) and odontoid erosion (16%). Cervico-Medullar Angle (CMA) was pathological (CMA < 135°) in 3% of patients. A study of the correlation between patient-related parameters, RA-related parameters, cervical symptomatology-related parameters and rheumatoid C1-C2 involvement concluded that age was positively correlated with C1-C2 instability (p = 0.036), as was the presence of Rheumatoid Factor (RF) (p = 0.038), coxitis (p = 0.042) and dry eye syndrome (p = 0.039). Cervical spine stiffness was positively correlated with C1-C2 instability (p = 0.01). The presence of inflammatory cervical pain (p = 0), and painful mobilisation on examination (p = 0.03) were correlated with C1-C2 synovitis.

Conclusions: The 'RA and cervical spine' entity is associated with phenotypes of seropositive, destructive RA, with peripheral synovitis and systemic manifestations. Systematic clinical and radiological screening for this condition is essential to preserve functional prognosis. Diffusion imaging of the craniocervical region appears to be a valuable adjunct for the quantitative assessment of synovitis.

Objective: To evaluate the impact of home working on the psychological well-being of European patients with Rheumatic and Musculoskeletal Diseases (RMDs) during the COVID-19 pandemic.

Methods: REUMAVID is a cross-sectional study that collected data through an online survey in seven European countries during the COVID-19 pandemic: Phase 1 (April-July 2020) and Phase 2 (February-April 2021). This analysis evaluated the impact of homeworking during Phase 2 (2021). Pearson's Chi-square test, Kruskal-Wallis and Mann-Whitney tests were used to explore possible associations between homeworking and psychological well-being (including anxiety and depression). Binary logistic regression was used to analyse factors associated with poor psychological well-being.

Results: Of the 365 patients included in the analysis, 39.9% were working from home, of whom only 37.4% reported having a dedicated home office space. Patients with poorer psychological well-being more frequently gave lower ratings for their computer, workplace, light, noise, calmness, and temperature at the home workspace. In the multivariable logistic regression, the factor most associated with poorer psychological well-being was the lack of a calm workspace.

Conclusion: More than one-third of patients with RMDs worked from home during the pandemic. The lack of a calm and dedicated workspace was significantly associated with poor psychological well-being. Given the growing prevalence of remote work, understanding the conditions under which RMD patients work from home is critical. Rheumatologists should be aware that inadequate home working environments may negatively affect patients' mental health and consider this when advising on work arrangements.

Introduction: Chronic neck pain is an important public health problem. Telerehabilitation has emerged as an important tool for individuals with musculoskeletal conditions.

Objectives: The study aims to identify the effectiveness of a telerehabilitation exercise programme compared with a digital self-care booklet on non-specific neck pain.

Methods: A randomised controlled trial assessor-blinded, 3 months follow-up. 70 patients were randomised into two groups of 35. The telerehabilitation group received 6 weeks of individualised training through vídeo calls and an online booklet. The control group received an online booklet. The primary outcome was functional disability. Secondary outcomes included pain intensity, global perceived effect, self-efficacy, quality of life, and kinesiophobia. All outcomes were assessed at baseline, 6 weeks, and a 3-month follow-up.

Results: There was a significant difference between groups for functional disability (Mean 10.3, CI 95% 4.8-15.7), pain intensity (Mean 2.8, CI 95% 1.4-4.1), global perceived effect (Mean -2.3, CI 95% -3.7 to -0.9), and self-efficacy (Mean -24.7, CI 95% -41.0 to -8.4) at the 6-week. At the 3-month follow-up, statistically significant differences were observed for perceived overall effect (Mean -2.0, CI 95% -3.4 to -0.6) and self-efficacy (Mean -26.3, CI 95% -42.8 to -9.8).

Conclusions: Telerehabilitation is effective in improving disability and pain intensity compared with self-care booklets only in individuals with non-specific chronic neck pain.

Trial registration: This trial is registered at https://ensaiosclinicos.gov.br/rg/RBR-10h7khvk under the registration number RBR10h7khvk at 09/16/2022.