Musculoskeletal Care最新文献

Background: Total Knee Arthroplasty (TKA) is a widely accepted intervention for end-stage knee osteoarthritis, significantly improving pain relief and overall function. However, many patients continue to report dissatisfaction with the results, especially in low- and middle-income countries (LMICs), where various contextual challenges may influence recovery outcomes.

Objective: This study aimed to explore experiences, satisfaction and quality of life in patients following physiotherapy after TKA through repeated interviews.

Methods: A phenomenological qualitative design was employed. Seven patients' who had completed postoperative physiotherapy were recruited through purposive sampling. In-depth interviews were conducted one and 3 months after surgery. The interviews were transcribed verbatim and analysed using reflexive thematic analysis to identify key patient satisfaction and recovery themes.

Results: Fourteen interviews identified four key themes: (1) Pain and recovery, (2) Functional ability, (3) Satisfaction with care, and (4) Psychological aspects. While patients' experienced improvements in pain and mobility, many continued to deal with discomfort and limitations. Cultural norms, home environments, and individual expectations influenced their perspectives on recovery. Strong family support and positive interactions with therapists also contributed to higher satisfaction levels.

Conclusions: Patients expressed mixed feelings about their pain relief and functional abilities, which impacted their overall quality of life. Although the initial recovery phase was largely positive, many patients' experienced increased pain and dissatisfaction by the third month. It was found that psychological, social, and environmental factors and clinical outcomes influence the recovery process.

Background: Rheumatoid Arthritis (RA) is a chronic musculoskeletal disorder that is a leading cause of disability worldwide, with early diagnosis and pharmacological treatment being critical to alleviate disease progression. However, the marginalised populations face significant barriers in accessing timely medical care, which contributes to functional impairment, and reduced quality of life (QoL). Despite this, little is understood about how intersecting marginalities influence access to musculoskeletal care, particularly in low-resource settings.

Purpose: To explore care-seeking pathways, underlying factors, and access constraints among the socioeconomically marginalised women living with RA in rural Kashmir.

Methods: Constructivist grounded theory approach of Cathy Charmaz was employed to obtain an in-depth comprehension of the phenomenon under study. Purposive and theoretical sampling strategies were employed to recruit 18 women diagnosed with RA from rural Kashmir. Data were collected through semi-structured interviews and analysed using the constant comparative method, which is well viewed to be the hallmark of the grounded theory approach.

Findings: Participants sought care from a pluralistic healthcare system involving a variety of untrained, and trained providers, and kept on changing from one provider to another without any restrictive access protocols. Their care-seeking trajectories usually began with self-medication, home-based remedies, traditional healers, spiritual intervention and local medicates. Conventional medical care was considered as the last resort, undertaken following a prolonged delay, and only when all other options proved ineffective. These care-seeking choices were largely influenced by illness/treatment perception, cultural norms, accessibility, affordability and organizational dynamics.

Conclusion: The delayed transition to formal healthcare highlights the need for strengthening health(care) awareness, affordability, and rural health infrastructure to ensure timely, equitable and culturally sensitive care for the vulnerable.

Background: Ankylosing spondylitis (AS) is a chronic, immune-mediated inflammatory condition that primarily affects the axial skeleton, leading to pain, stiffness, and functional limitations. While physiotherapy plays a critical role in the management of AS, access to in-person services remains limited, particularly in rural or underserved areas.

Objective: This narrative review aims to synthesise current evidence on the effectiveness and feasibility of tele-rehabilitation for individuals with ankylosing spondylitis and to identify future directions for optimising remote physiotherapy in clinical practice.

Methods: A comprehensive search was conducted across four major databases: PubMed, Scopus, Web of Science, and Google Scholar. Studies published between 2008 and 2025 were selected using keywords such as ankylosing spondylitis, tele-rehabilitation, remote physiotherapy, and digital health. Eligible studies included randomized controlled trials, systematic reviews and observational studies that evaluated remote physiotherapy interventions for AS. Inclusion criteria focused on non-pharmacological, exercise-based interventions delivered via digital or telecommunication platforms.

Results: The reviewed studies demonstrate that tele-rehabilitation can provide outcomes comparable to traditional physiotherapy in terms of pain reduction, improved mobility, and enhanced patient satisfaction. Digital platforms were also found to improve accessibility, adherence, and cost-efficiency. However, challenges such as inconsistent programme designs, technological barriers, and limited long-term outcome data were noted.

Conclusion: Tele-rehabilitation represents a promising adjunct or alternative to conventional physiotherapy for managing ankylosing spondylitis. Future research should aim to develop standardized protocols, improve technological accessibility, and conduct long-term evaluations to support integration into mainstream healthcare.

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.

Background: Low back pain (LBP) is a prevalent musculoskeletal condition often associated with lumbar instability, resulting from structural and functional spinal deficits. This instability leads to pain, reduced function, and diminished quality of life. Physiotherapy aims to restore stability, enhance strength, and improve neuromuscular control. This systematic review examines the effectiveness of physiotherapy in managing lumbar instability and its symptoms.

Research questions: Do physiotherapy interventions reduce pain in individuals with lumbar instability? Do they improve functional abilities and neuromuscular control? What is the role of adjunct techniques such as respiratory resistance training and neurodynamic interventions?

Objectives: To assess the effectiveness of physiotherapy in reducing pain, improving function, and enhancing muscle activation in individuals with lumbar instability.

Design: Systematic review (PROSPERO ID: CRD42025610915).

Methods: Studies involving patients with lumbar instability were identified through searches on PubMed and Google Scholar using the terms: (PHYSIOTHERAPY MANAGEMENT) AND (LUMBAR INSTABILITY). Outcomes assessed included spinal stability, strength, pain, and quality of life.

Results: Seventeen studies met the inclusion criteria. Lumbar stabilisation exercises, alone or combined with techniques such as respiratory resistance, whole-body vibration, or neurodynamic approaches, effectively reduced pain and improved function. Individualised and progressive programs showed greater benefits in muscle activation and overall well-being.

Conclusion: Physiotherapy, particularly lumbar stabilisation exercises, is effective in managing lumbar instability. Adjunct techniques enhance outcomes, supporting the use of tailored, evidence-based interventions.

Objective: To systematically review the evidence on the effectiveness of Isostretching on pain, physical function and quality of life in individuals with Low Back Pain (LBP).

Data sources: We searched the following databases until November 11, 2024: PubMed, Embase, Cochrane CENTRAL, CINAHL, PEDro, Virtual Health Library Regional Portal, Scopus, Web of Science, SportDiscus and Rehabilitation and Sports Medicine. PRISMA-S was used to strengthen the reporting quality of our search strategy.

Methods: This review followed the PRISMA checklist. Randomized clinical trials that investigated the effects of Isostretching against any control intervention in individuals with non-specific LBP were eligible. Literature screening and data extraction were performed independently by the authors. The PEDro scale, the GRADE approach and the TIDier checklist were used to assess the risk of bias, quality of the evidence and reporting quality of the intervention, respectively. Results were analysed and synthesised narratively.

Results: Five articles were included (pooled n = 155). Only adults (76% female) between 19 and 60 years were included. The PEDro score ranged from 2-8 points (mean of 5.6). Very-low quality evidence suggests that isostretching may reduce pain and improve functional capacity in the short term when compared with no intervention. Also, very-low quality evidence suggests that isostretching is not superior to any active intervention to reduce pain and improve functional capacity and quality of life. The mean number of reported TIDier items was 6.4.

Conclusion: This review supports Isostretching to reduce pain and improve physical function and quality of life in patients with non-specific LBP.

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.