Musculoskeletal Care最新文献

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.

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: 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 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.

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.