Musculoskeletal Care最新文献

Objective: To evaluate the effect of various doses of intra articular corticosteroid injection (IACI) on pain reduction in knee osteoarthritis when compared with normal saline and perform a between-dose comparison.

Methods: A systematic review with meta-analysis was conducted searching four databases until April 2024. RCTs comparing the effect of IACI with normal saline on pain relief in knee osteoarthritis were included. The different doses were pooled into three categories: low (< 40 mg methylprednisolone equivalent), usual (40 mg), or high dose (> 40 mg). Their effect compared to normal saline was evaluated at very short (VST, 1-3 weeks), short (ST, 4-8 weeks) and middle term (MT, 10-16 weeks). A multivariate analysis carried out the influence of dosage on pain relief, at each time point. The Jadad scale was used to assess risks of bias and GRADE for certainty of evidence.

Results: Eleven studies were included in the meta-analyses (n = 1125 patients). Low dose was significantly superior to normal saline in the VST, but not in the ST (low-quality evidence). No data were available for the MT. The usual dose was significantly superior to normal saline in the ST, but not in the VST and MT (moderate-quality evidence). A high dose was significantly superior to normal saline in the ST and MT (low-quality evidence). Multivariate analysis showed that the dose significantly influenced pain reduction at ST and MT, but not in the VST (low-quality evidence).

Conclusion: The dose of IACI doesn't influence pain reduction in the peak effect, but a higher dose seems to have a more prolonged effect.

Objective: To determine the relationship between Nail Psoriasis Severity Index (NAPSI) and cardiovascular risk (CVR) assessed by 10 CVR calculators.

Methods: Cross-sectional, observational, and comparative study of psoriatic arthritis (PsA) patients aged 30-75, classified according to established diagnostic criteria. The NAPSI was assessed, classifying patients into two groups: with (≥ 1) and without (< 1) nail involvement. The CVR was evaluated through: Framingham (FRS) lipids and body mass index (BMI), American College of Cardiology/American Heart Association- Atherosclerotic Cardiovascular Disease 2013 (ACC/AHA ASCVD 2013), Systematic Coronary Risk Evaluation (SCORE), SCORE 2, SCORE-Older Persons (OP), QRISK3, Reynolds Risk Score (RRS), Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) atherosclerotic cardiovascular disease (ASCVD) and PREVENT Heart Failure (HF) calculator. Group distribution was assessed using the Kolmogorov-Smirnov test. Comparisons were conducted accordingly with Chi-Squared, T-Student, U-Mann-Whitney, and Kruskal-Wallis tests. Correlations were performed using Spearman's rho. Statistical significance was set at p ≤ 0.05.

Results: Seventy-one patients with PsA were included, 31 with nail involvement and 40 without. CVR score was higher in PsA patients with nail involvement using SCORE (2.0 (1.0-3.7) versus 1.0 (0.0-2.0), p = 0.02). Regarding CVR, positive correlations were found between NAPSI and the following calculators: ACC/AHA ASCVD 2013 (Spearman's rho = 0.202, p = 0.045), FRS BMI (Spearman's rho = 0.229, p = 0.027), SCORE (Spearman's rho = 0.344, p = 0.002), PREVENT ASCVD (Spearman's rho = 0.198, p = 0.049), and PREVENT HF (Spearman's rho = 0.291, p = 0.007).

Conclusions: A NAPSI ≥ 1 score is related to higher CVR assessed through SCORE and positively correlates with ACC/AHA, PREVENT TM ASCVD, and PREVENT HF.

Introduction: Digital health can support exercise and symptom management in hip and knee osteoarthritis (OA), but uptake may depend on digital readiness (e.g., the capability) to use such tools. This study assessed digital readiness profiles in individuals with hip and/or knee OA initiating in-person physiotherapist-led GLA:D exercise and education and their associations with sociodemographic and health characteristics.

Methods: Baseline GLA:D registry questionnaire data were analysed. The eHealth Readiness Scale measured digital readiness. Latent class analysis identified profiles, and multinomial logistic regression examined associations.

Results: Among 3555 participants (mean age 66.7 years, 67% female), 53% reported confidence using the internet, 32% agreed that it improved efficiency, and only 26% agreed to use lifestyle tracking devices. Three profiles (low, intermediate, and high) were identified. Compared with the high profile, low readiness was associated with older age (odds ratio (OR) 1.96, 95% confidence interval (CI) 1.71-2.24)), female sex (OR 0.72, 95% CI 0.57-0.90), lower education (OR 0.62, 95% CI 0.45-0.88), living alone (OR 1.39, 95% CI 1.11-1.76), and more comorbidities (OR 1.10, 95% CI 1.04-1.17). The intermediate profile showed similar trends but were also associated with less obesity (0.75, 95% CI 0.60-0.95) and lower walking speed (0.72, 95% CI 0.53-0.97).

Conclusions: Digital readiness profiles differed notably by age, sex, and education, underscoring the importance of readiness to enhance uptake and guide implementation and resource allocation of digital health in OA care. Future studies should address digital readiness improvement strategies.

Background: Janus kinase (JAK) inhibitors are effective therapies for autoimmune rheumatic diseases (ARDs), but concerns persist regarding their cardiovascular effects, particularly in diverse patient populations. Identifying determinants of cardiovascular risk is essential for optimising therapy and outcomes, especially in multi-ethnic cohorts.

Objective: To assess clinical and socioeconomic determinants, including age, deprivation decile and ethnicity, in predicting cardiovascular events among patients on JAK inhibitors in a multi-ethnic cohort.

Methods: A retrospective cohort study of 309 patients with ARDs (mean age 59.3 years, 77% female, 73% White, 25% South Asian) receiving JAK inhibitors at a UK teaching hospital was conducted. Cardiovascular events, including myocardial infarctions, strokes and cardiovascular-related deaths, were recorded. Multivariate logistic regression assessed associations between age, deprivation decile, ethnicity and cardiovascular outcomes.

Results: The combined effect of age and deprivation decile significantly predicted cardiovascular events (p = 0.031). Older age demonstrated an odds ratio (OR) of 1.06 (95% CI: 1.00-1.13). Neither age nor deprivation decile alone achieved statistical significance, but their combination provided a robust model with an AUC of 0.837. Ethnicity was not independently predictive in this cohort.

Conclusions: In a multi-ethnic cohort, age and deprivation decile jointly predict cardiovascular events in patients on JAK inhibitors. Socioeconomic factors should be integrated into cardiovascular risk assessment models to inform personalised care strategies for patients receiving JAK inhibitor therapy.

Objectives: Falls in older adults are a public health concern, yet little is known about falls in adults with hip or knee total joint arthroplasty (TJA) who may be at a higher risk than the general population. The study objectives were to compare the number of fallers and fear of falling in TJA patients to age and sex matched community controls, and determine whether the type of risk factors for falls reported in TJA differed from the community group.

Methods: A cross sectional comparative study was conducted with patients waiting or recovering from TJA and age and sex matched comparison group of older adults residing in the community. Reported falls and risk factors for falling were compared to age and sex matched controls from the community. Fear of falling was measured using the Activities-specific Balance Confidence (ABC) Scale. Logistic regression was used to determine risk factors associated with falls in TJA and community participants.

Results: Of the 198 TJA participants, 29% (n = 57) reported falls within the past 12 months compared to 24% (n = 24) of 100 participants in the control group (p = 0.36). Of those who fell, 25 (44%) were recurrent fallers in the TJA cohort compared with 6 (25%) in the community cohort. Eleven participants reported falls after TJA surgery. Fear of falling was greater in the TJA group (ABC score, mean ± SD: 67.1 ± 24.4) than in the community group (88.1 ± 14.9) (p < 0.001).

Conclusion: Although the number of participants who reported falls was comparable in both groups, the TJA group had more recurrent falls, different risk factors for falls, and more fear of falling. Fall prevention programs should be embedded in pre-operative programs for patients undergoing surgery for TJA.

Aim: To test the mediating role of personal mastery in the relationship between self-compassion and medical coping modes in patients with rheumatoid arthritis (RA).

Design: A cross-sectional questionnaire survey was administered.

Methods: We enrolled a convenience sampling of patients with RA from a Class A tertiary hospital. Date were collected from May 2023 to April 2024. Using self-compassion, medical coping modes, and personal mastery self-reported questionnaires. The data were analysed using correlation analyses, multiple linear regression analysis and structural equation modelling.

Results: A total of 245 participants were included in this study. Personal mastery was an independent predictor of medical coping modes (β = 0.15, SE = 0.07, 95% CI [0.01, 0.30]). Significant correlations were identified between self-compassion, personal mastery, and medical coping strategies among these patients. Personal mastery was found to mediate the relationship between self-compassion and confrontation (β = 0.724, 95%CI: 0.367-1.081, p < 0.05) and avoidance coping strategies (β = -0.179, 95%CI: -0.336 to -0.022, p < 0.05). Additionally, self-compassion was directly linked to resignation coping (β = -0.309, 95%CI: -0.515 to -0.136, p < 0.05), with no mediation effect observed.

Conclusion: Personal mastery mediates the impact of self-compassion on the adoption of medical coping strategies among RA patients. Self-compassion is shown to have a direct influence on personal mastery. It is imperative for healthcare providers to consider the self-compassion and personal mastery of their patients, encouraging adaptive coping mechanisms to enhance life quality.

Introduction: No data describe what patients search for related to scoliosis. We aimed to quantify the Google search volume for scoliosis, identify the most sought-after information, and evaluate the associated online resources.

Methods: Search volume and 'People Also Ask' (PAA) questions were documented for the following terms: scoliosis, idiopathic scoliosis, adolescent idiopathic scoliosis, congenital scoliosis, and neuromuscular scoliosis. PAA questions were categorised based on intent and websites were categorised on source. Quality and readability of the sources were determined using the JAMA criteria, Flesch Reading Ease (FRE) score, and Flesch-Kincaid Grade Level (FKGL).

Ethical approval: This investigation was exempted from Institutional Review Board approval.

Results: Search volume for 'scoliosis' has significantly increased since 2015, with an average monthly search volume of 219,055 (p < 0.0001). 182 PAA questions were extracted. Most were related to technical details, the evaluation of current treatments, or alternative treatments. Academic websites were the most common resource, followed by medical practices and government websites. Only 4% of websites met the criteria for universal readability.

Discussion and conclusion: Scoliosis is a relatively common condition and a popular topic among Google users. However, only 4% of online resources provided by Google were written at an appropriate reading level. The lack of patient-friendly resources related to scoliosis is concerning, particularly given that this patient population has been shown to search for information online at twice the rate of others. This data provides a framework for healthcare professionals to begin addressing common questions related to scoliosis in a patient-centred manner.

Aim: This study aims to compare physical activity (PA) levels and exercise-related perceptions, including barriers and facilitators, between radiographic axial spondyloarthritis (r-axSpA) and non-radiographic axial spondyloarthritis (nr-axSpA) patients, and to explore the relationships between PA, exercise perceptions and clinical parameters in axSpA patients.

Methods: A cross-sectional design was used to recruit 123 axSpA patients, comprising 83 r-axSpA and 40 nr-axSpA. Clinical parameters, including disease activity, pain, spinal mobility, enthesopathy, physical function, fatigue, sleep quality, quality of life, fibromyalgia symptoms, kinesiophobia, and mental health, were assessed. PA levels were measured using the International Physical Activity Questionnaire-Short Form, while exercise perception was evaluated using the Exercise Benefits/Barriers Scale. Multivariable regressions examined the relationships between PA, exercise perception, and clinical variables.

Results: Physical activity levels were comparable between subgroups (p = 0.654), but r-axSpA patients reported significantly higher exercise barriers (p = 0.023). In the r-axSpA group, the most commonly endorsed benefit was "Exercise improves my flexibility" (94%), while in the nr-axSpA group, it was "Exercise increases my physical fitness" (95%). In both groups, the most common barrier was "Exercise tires me". Higher PA was linked to improved physical function and reduced kinesiophobia in nr-axSpA, and lower anxiety in r-axSpA (p < 0.05). Regression analysis revealed that PA level was related to symptom duration and enthesopathy, while exercise benefits were associated with health status, depression, physical function, and barriers with fatigue in axSpA patients.

Conclusion: Tailored interventions are essential to promote exercise participation in axSpA patients by addressing subgroup-specific barriers and clinical factors.