Musculoskeletal Care最新文献

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.

Objectives: The objectives were to assess current job retention vocational rehabilitation (JRVR) services for employed individuals with inflammatory arthritis (IA) in rheumatology therapy departments interested in participating in the Workwell trial. Additionally, to modify a JRVR training course to support therapists in delivering JRVR and to evaluate changes in therapists' knowledge, confidence, and ability following the training.

Methods: This was a mixed-methods study. Current work services were explored with lead therapists through a cross-sectional survey about their work rehabilitation service; and one-to-one interviews. Feedback from previous course attendees and trainers informed modifications to the training course. Participating therapists completed mailed questionnaires pre-and post-training.

Results: Lead therapists from 28 interested departments reported providing JRVR to a median of 7 patients per month (IQR 3-12) for an average of 60 min (IQR 41.25-90). Nine therapists participated in pre-trial interviews, with themes highlighting variability in referrals, the use of work assessment tools, and advice on ergonomic adjustments. The training course was shortened from three to 2 days by incorporating a pre-training self-study pack and reducing lecture time, while increasing practical content such as work assessment demonstrations and extended workshops. Following the training, 32 therapists showed significant improvements in their knowledge and confidence in delivering JRVR (p < 0.001).

Discussion: The need for training in work assessment and delivery of complex JRVR was identified. The therapist training course provided was favourably received. Post-training, therapists' ability to assess and plan complex JRVR improved.

Trial registration: WORKWELL Trial: ISRCTN: 61762297; Clinical Trials.Gov: NCT03942783.

Background: Fibromyalgia-one of the chronic pain syndromes-characterised by pain, fatigue, and tenderness. The role of certain micronutrients like vitamin D, vitamin B12, and ferritin has been previously investigated in many primary studies aiming to assess both their therapeutic and diagnostic potential in the management of fibromyalgia.

Aim: To compare the levels of vitamin D, ferritin, and vitamin B12 between fibromyalgia patients and healthy controls.

Methods: Our study protocol was registered prospectively on PROSPERO (CRD42024585826) and was conducted in accordance with the PRISMA guidelines. Literature search, article screening, and data collection were conducted by two independent investigators. The mean difference along with its 95% confidence interval for each of the three outcomes was pooled under a random effects model.

Results: Twenty-five studies were included in the final analysis; 22 reported vitamin D levels, 5 reported ferritin levels, and 3 reported vitamin B12 levels. Generally, fibromyalgia patients had lower vitamin D and ferritin levels compared with healthy controls (MD = -3.86, 95% CI [-6.99; -0.73] and -14.78, [-18.95; -10.62], respectively). Vitamin B12 showed no difference between the two groups (-20.70 [-51.57; 10.16]).

Conclusion: Vitamin D and ferritin levels were found to be lower in patients with fibromyalgia. Whether vitamin D supplementation improves fibromyalgia symptoms remains under debate. However, we recommend both routine empirical supplementation of vitamin D along with ferritin level testing in all patients. Further studies are needed to confirm whether lower ferritin and vitamin B12 levels contribute to fibromyalgia.

Background: The prevalence of chronic low back pain (CLBP) and its concomitant cost implications have continued to rise across the globe. Currently, there is no effective treatment for CLBP that leads to long-term improvement. Hence, there is growing recognition of the need for behaviour techniques including motivational interviewing (MI) to address CLBP.

Objective: To determine the effect of MI and exercise on pain in individuals with CLBP.

Method: We searched for trials in seven databases from inception to April 2024. Trials were included if MI was used alone or in addition to an exercise programme for improving CLBP in adults aged (≥ 18 years).

Results: From 3062 records retrieved, we included three randomized controlled trials (RCTs). Only one study was rated as having a low risk of bias. There is no evidence to support the benefit of MI and exercise on improving pain (SMD-0.23, 95% CI-0.55 to 0.09, I² = 0%, p = 0.16), disability (MD-1.80, 95% CI-4.55 to 0.94, I² = 85%, p = 0.20) and physical functioning (SMD 0.00, 95% CI-1.31 to 1.32, I² = 93%, p = 0.99).

Conclusion: There is insufficient evidence to support the effect of MI and exercise on pain in individuals with CLBP. More large-scale RCTs are needed in evaluating the effectiveness of MI and exercise in individuals with CLBP.

Aim: To develop a deeper understanding of strategies used to manage uncertainty by Musculoskeletal First Contact Practitioners (MSK FCPs), including barriers to and facilitators for these strategies.

Background: MSK FCP services provide patients with an alternative to seeing their GP regarding MSK complaints. Research suggests that the role demands different skills and attributes from traditional physiotherapy roles, including the ability to deal with greater clinical uncertainty. There is a lack of research evaluating the strategies FCPs find most helpful for managing uncertainty.

Method: A qualitative study using semi-structured online interviews. Participants were recruited using convenience sampling. Data was analysed using Braun & Clarke's reflexive approach to thematic analysis. The research was underpinned by a theoretical framework of hermeneutic phenomenology.

Findings: Nine participants were recruited. Three main themes were developed: (1) Being comfortable with being uncomfortable; (2) Teamwork makes the dream work and (3) Navigating uncertainty with patients.

Conclusion: This study provides further insight into how FCPs manage uncertainty. Management of uncertainty was influenced by many factors, including: clinician experience, patient complexity and wider medical knowledge, fear of over-medicalising patients, communication and consultation styles and having protected non-clinical time. Recommendations for clinical practice include: consideration of the challenges facing FCPs, and what support is needed to maintain staff retention, health and wellbeing; consideration of how FCPs might best approach meeting the needs of an ageing population and supporting change in health and wellness behaviour. The key to successful management of uncertainty was having a supportive team which encouraged open non-judgemental discussions about uncertainty.

Introduction: We aimed to assess the effects of a patient therapeutic education (PTE) programme on the course of the disease and treatment management skills in rheumatoid arthritis (RA) patients treated with biologics.

Methods: From January to December 2023, 52 RA patients participated in a face-to-face education session of 1 h, delivered to groups of four to six patients by 2 rheumatologists qualified in PTE. Disease activity, quality of life parameters and patient's skills using the BioSecure score were assessed before the education programme and 3 months later.

Results: A statistically significant decrease in mean pain visual Analogue Scale (p = 0.001), mean morning stiffness duration (p = 0.002), mean number of night awakenings (p = 0.01), mean tender joints count (p = 0.001) and mean 28-Disease-activity-score (p = 0.001) were observed 3 months after the PTE. A statistically significant decrease in functional status (HAQ) and fatigue scores (FACIT-F) was observed after PTE (p = 0.03 and p = 0.001, respectively). The mean BioSecure score climbed from 47.9 ± 14.9 at baseline to 74.8 ± 12.9 after PTE (p = 0.001). The variation of BioSecure score was significantly more important in patients with third-level education, patients receiving subcutaneous biotherapy and those on TNF alpha inhibitors therapy.

Conclusion: PTE may be effective in improving clinical outcomes and safety skills in RA patients receiving biological treatment.

Objective: The burden of chronic low back pain (CLBP) is increasing rapidly along with the global population ageing. Such an increase will occur more rapidly in low- and middle-income countries (LMICs). Yet, few studies have explored the experiences of older adults with CLBP, and these are primarily conducted in high-income countries. To address this concern, we explored the experiences of older Brazilian adults with CLBP.

Methods: We used a descriptive qualitative study and gathered data through interviews and drawings from participants representing their experiences. Data were analysed using reflexive thematic analysis principles.

Results: We interviewed 22 participants and identified the following themes: (1) Low back pain: an intense sensory and emotional experience; (2) causes of pain: wear and tear due to ageing, physical overload and emotional overload; (3) seeking treatment and not improving; (4) health professionals with a biomedical and pessimistic view; (5) the impact of pain on life: functional limitations and social repercussions; and (6) dealing with pain through movement, resilience and passive strategies.

Conclusions: Participants described CLBP as a sensory and emotional experience that impacts various aspects of their lives. Wear and tear due to ageing, physical and emotional overload were highlighted as causes of pain, and health professionals as a source of pessimism. Despite this, many participants discussed coping through movement, resilience, and passive strategies. Health professionals should address the emotional aspects associated with CLBP, explore its impact on their patients' lives and provide information that aligns with current evidence, promoting reassurance and a multidimensional understanding of CLBP.

Objectives: This study sought to quantify the impact of participation in an interactive class for patients with chronic pain called Movement, Mindfulness, and Pain Science (MMaPS), on physical function, pain catastrophizing, and quality of life.

Methods: Patients with chronic pain of any type were enroled in an 8-week course that implemented principles of safe movement, mindfulness, and meditation practice, and also incorporated education related to the biopsychosocial model of pain science. Questionnaires were collected from participants who attended the MMAPS programme in the 2018 through 2020 sessions prior to and after the class to measure participant outcomes, which included the pain catastrophizing scale (PCS), Adverse Childhood Events score (ACE), Quality of Life scale (QOL), Patient Specific Functional Score (PSFS), 30 s sit to stand (30 STS), and 4-stage balance (4SBT).

Results: One hundred fifty-five people completed the class. The median Pain Catastrophizing Scale score dropped from 19 to 11 (p < 0.001). Median Quality of Life scores increased from 5 to 6 (p < 0.001) on a 10-point scale. Patient Specific Functional Scale scores improved from an average score of 2.5 to 5.1 (p < 0.001). Median 30 Second Sit-to-Stand scores improved from 8 to 11 (p < 0.001). The 4-stage balance test improved with 39% of patients having completed all four stages at intake and 56% completing all four stages by the end of class (p = 0.001).

Conclusion: Patients with chronic pain had significant improvements in several measures of wellness and physical function after participating in the MMaPS class.

Aim: The aim was to identify independent variables associated with chronic knee pain (CKP) 6 months after knee arthroplasty (KA) and to determine whether CKP influenced improvement in patient reported outcomes measures (PROMs).

Methods: A retrospective study was conducted over an 8-year period and included 3310 patients with completed PROMs at 6 months postoperatively; with a mean age of 69.9 (standard deviation 9.3) and 1823 (55.1%) were females. The Oxford knee score (OKS) pain component score was used to define patients with CKP (≤ 14 points) at 6 months.

Results: There were 551 (16.6%) patients with CKP. Gender (p < 0.001), BMI (p = 0.025), preoperative EQ-5D (p = 0.010) and pain VAS (p < 0.001) as well as questions 2: washing (p = 0.006), 8: night pain (p = 0.001), 10: stability (p = 0.008) and 11: shopping (p = 0.047) of the OKS were independently associated CKP. The pre-operative OKS total score (p = 0.542) was not independently associated with CKP. The risk of CKP was shown to vary from 3.0% to 30.5% when discriminatory threshold values were used in the pre-operative responses to questions 2, 8, 10 and 11 of the OKS. Patients with CKP had significantly (p < 0.001) worse 6-month OKS, EQ-5D, EQ-VAS, and pain VAS scores and improvements in scores relative to preoperative baseline that were potentially not clinically meaningful (OKS mean difference 2.6, 95% CI 2.1-3.2). Those with CKP were significantly less likely to be satisfied with their KA (odds ratio 0.076, p < 0.001): only 231 (42.9%) patients with CKP were satisfied.

Conclusions: Approximately one-in-six (16.6%) patients had CKP at 6 months following KA, which was associated with significantly worse PROMs and lower satisfaction. Preoperative responses to four (2, 8, 10 and 11) of the pre-operative OKS questions were independently associated with CKP. These questions could be used to inform patients of their risk of CKP (3.0%-30.5%) following KA and potentially with expectation modification this may improve their PROMs.

Level of evidence: Retrospective study, Level III.