Musculoskeletal Care最新文献

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.

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.