Musculoskeletal Care最新文献

Background: Knee osteoarthritis (KOA) is characterised by altered gait mechanics, which can lead to significant functional impairments. This study aims to investigate plantar pressure distribution during walking and assess functional mobility in patients with early-stage KOA, providing insights for targeted therapeutic interventions.

Methods: Eighteen women with KOA were matched with 18 healthy controls for this study. We assessed plantar pressure distribution, relative phase durations during the stance phase, and performance on the Timed Up and Go (TUG) test. Independent sample t-tests were employed to identify group differences, with significance set at p < 0.05.

Results: Patients with KOA exhibited significantly lower maximum plantar pressure in the Toe 1 (p < 0.01), medial heel (p < 0.01), and lateral heel (p < 0.01) regions, while demonstrating higher pressure in the Metatarsal 4 (p < 0.01) and midfoot (p < 0.01) areas. Furthermore, KOA patients spent less time in the initial contact (p = 0.01), foot-flat (p < 0.01), and forefoot push-off (p = 0.03) phases but more time in the forefoot plantarflexion phase (p < 0.01). Additionally, KOA patients demonstrated longer TUG times (p < 0.01), indicating reduced functional mobility.

Conclusions: Early-stage KOA patients display distinct patterns of plantar pressure distribution and impaired functional mobility compared with healthy controls. These findings highlight the necessity for interventions aimed at addressing altered gait mechanics in KOA, which could help mitigate mobility limitations and enhance patient outcomes.

Background: Clinical decision making to develop an exercise program and then prescribe that program should be based on the best evidence available. However, little evidence exists to guide the development of an exercise program, determining optimal dosage parameters or for effective prescription techniques to achieve best patient outcomes possible.

Objective: To gain consensus from expert clinical physiotherapists in the field of musculoskeletal rehabilitation on key recommendations for developing and prescribing effective exercise programs in musculoskeletal rehabilitation in a one-on-one setting.

Methods: Delphi study method involving three rounds of questionnaires with subsequent rounds developed based upon results of the previous round, aiming to achieve consensus in the final round. The consensus threshold was set at 80% agreement. Participants were physiotherapists considered experts in the field of musculoskeletal rehabilitation as acknowledged by the Australian College of Physiotherapists, being Clinical Fellows of the College in musculoskeletal or sports and exercise physiotherapy.

Results: Thirteen experts completed the three rounds of questionnaires. Most experts reported 'always' prescribing exercises to their patients. The expert clinicians agreed that a clinician should blend evidence-based protocols, clinical experience, and empirical knowledge to develop the exercise program, and then tailor the program further based on individual patient factors. Most experts agreed that it was essential to collaborate with the patient when designing the exercise program.

Conclusion: Future research is needed to determine the effectiveness and necessity of each element of the exercise program in musculoskeletal rehabilitation in a one-on-one setting to achieve best patient outcomes possible.

Background: Patellofemoral pain syndrome (PFPS) is a common knee issue in young adults characterised by anterior knee pain during knee flexion with weight-bearing or prolonged sitting. Physical therapy is the primary treatment. This systematic review and meta-analysis compares the efficacy of hip and knee muscle strengthening (HKS) versus knee muscle strengthening alone (KS) in managing PFPS.

Methods: Following PRISMA guidelines, a systematic search of Elsevier, PubMed, Cochrane, and Web of Science identified randomized controlled trials (RCTs) comparing HKS and KS in PFPS patients. A risk of bias tool assessed study quality. Outcomes, including pain, functional activity, and muscle strength, were analysed using a random-effects model with standardized mean difference (SMD) and 95% confidence intervals.

Results: Six RCTs involving 241 patients (96.3% females) were included. HKS significantly improved pain (SMD = -1.29, 95% CI [-1.98, -0.59], p = 0.0003, I² = 87%) and functional activity (SMD = 0.99, 95% CI [0.22, 1.76], p = 0.01, I² = 88%) compared to KS. No significant difference was observed in muscle strength (SMD = 0.20, 95% CI [-0.31, 0.71], p = 0.44, I² = 63%).

Conclusion: HKS effectively reduces pain and improves functional activity in patients with PFPS. Further research is needed to confirm these findings and address study limitations.

Study registration: This systematic review was registered in PROSPERO (CRD42023451065) and reported by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.

Background: Physical activity is beneficial for patients with rheumatoid arthritis (RA). However, little is known about how healthcare professionals counsel and support patients with RA to be physically active.

Aim: This study aims to explore nurses' and physiotherapists' perceptions of delivering physical activity counselling for patients with RA during routine follow-up appointments.

Method: A mixed-methods convergent parallel design was employed, using survey and interview data from nurses and physiotherapists (n = 9) at a rheumatology outpatient clinic. Statistical and inductive content analyses were conducted. COREQ guidelines were followed.

Findings: Nurses and physiotherapists perceived physical activity counselling to be central in the overall RA care. They considered it partly challenging as delivering effective counselling requires understanding the specific characteristics of RA and tailoring advice to the individual patient's needs. In general, they focused on motivating patients to be physically active by demonstrating the benefits of physical activity. However, they also reported a lack of awareness regarding the content discussed during each other's appointments, highlighting issues with information sharing between professionals.

Conclusion: Physical activity counselling is multidimensional, constitutes part of professional competence and requires extensive knowledge of RA and physical activity recommendations. Future interventions are needed to enhance nurses' and physiotherapists' competence in delivering physical activity counselling.

Aim: The aim of the study was to evaluate the ultrasonographic (United States) alterations of the median nerve, the performance of the Kamath screening questionnaire and the clinical examination (Tinel and Phanel test) in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) with previous or present inflammatory involvement of the radio-ulno-carpal joint.

Patients and methods: A cross-sectional study was carried out. Patients with RA and PsA and clinical symptoms suggestive of CTS were consecutively recruited. The main clinical-demographic characteristics were collected in all patients. The Kamath questionnaire was administered to all patients during the clinic visit. The US examination was used as a 'gold-standard' for the diagnosis of CTS (transverse nerve area > 12 mm² and morpho-structural alterations) and was used to assess the sensitivity and specificity of the Kamath questionnaire and the Tinel and Phanel clinical tests.

Results: 44 patients, 34 patients with RA and 10 patients with PsA were evaluated. 7 (16%) patients had a median nerve cross-sectional area > 12 mm², associated with US abnormalities of the nerve. The Kamath questionnaire showed moderate sensitivity values (71.4%) but low specificity (56.7%) for ultrasonographic diagnosis of CTS with a negative predictive value of 91.3%. Clinical tests show low sensitivity but high specificity. No statistically significant correlations were found with the main clinical variables.

Conclusions: The screening questionnaire showed moderate sensitivity but low specificity compared to the ultrasound 'gold standard'. Clinical tests may support the diagnosis of CTS in these conditions.

Objectives: This study aimed to investigate the knowledge and strategies used by Brazilian physical therapists in assessing and promoting self-efficacy and self-management in musculoskeletal rehabilitation.

Methods: A nationwide cross-sectional online survey was conducted with licenced physical therapists recruited through professional networks and social media. The questionnaire, developed based on the CHERRIES checklist, assessed participants' knowledge, clinical strategies, and perceived barriers related to self-efficacy and self-management interventions. Data were analysed using descriptive statistics and logistic regression models.

Results: A total of 348 responses were analysed. While 97.7% of respondents acknowledged self-efficacy as a key factor in treatment adherence, only 43.6% frequently applied strategies to enhance it in clinical practice, as per Bandura's theory. The most commonly cited interventions were self-management education and exercises (81.2%). However, limited professional training and low patient adherence emerged as major barriers. Logistic regression analysis revealed that therapists who engaged more frequently with literature on the subject were 3.48 times more likely (95% CI: 1.6-7.4) to implement self-efficacy strategies in practice compared with those who engaged less frequently.

Conclusion: Despite acknowledging the importance of self-efficacy, Brazilian physical therapists face challenges in applying structured strategies in practice. Enhancing education and integrating behavioural approaches into curricula may facilitate the implementation of evidence based self-efficacy interventions.

Introduction: Persistent musculoskeletal (MSK) disorders are one of the leading reasons for years lived with disability within the UK. Guidelines encourage integrating self-management support. Hydrotherapy supports patients with persistent MSK conditions; however, self-management following NHS-led hydrotherapy has been inconsistent.

Aim: To identify outcomes of hydrotherapy alongside the barriers, facilitators, and contributory factors affecting self-management in the local persistent MSK pain population.

Methods: Between April 2023 and May 2023, a service evaluation was undertaken exploring factors affecting self-management in the local persistent MSK pain population following NHS-led hydrotherapy. Demographics, clinical factors, functional status (MSK-HQ) and patient-reported experiences, including barriers and facilitators to self-management, were recorded. Data was analysed using descriptive statistics alongside exploration of themes.

Results: Ninety patients completed hydrotherapy. White British (n = 24) and Indian British (n = 23) were the most common groups to attend. Multiple joint (n = 27) and spinal conditions (n = 26) were the most common MSK conditions. Mean pre- and post-MSK-HQ scores were 20.8 and 26.1, respectively. Among the contactable patients (n = 69), 49 patients did not maintain independent water-based self-management reporting barriers such as ongoing support, access and financial concerns. Patients supported the establishment of a support group (n = 56) to help maintain water-based exercises.

Conclusions: The local persistent MSK pain population lacks self-efficacy for independent water-based self-management. A supportive and collaborative approach is proposed to address this via a patient-led hydrotherapy support group.

Introduction: Frozen shoulder is a disabling condition characterised by severe pain and loss of shoulder movement. Corticosteroid injections are targeted at reducing pain in the earlier painful phase. There are multiple studies on the effectiveness of injections for frozen shoulder, but none were identified to assess if this guidance has been translated into clinical practice. The aim of this survey was to investigate the current practice and opinion of musculoskeletal health professionals regarding corticosteroid injections for frozen shoulder.

Design and methods: The online survey was disseminated via the social media platform 'X' (at the time of the survey known as Twitter) over a 5-week period. Recruitment was by the 'snowball' effect. Responses to multiple choice survey questions were analysed with descriptive data. Free text questions were analysed using content analysis.

Results: The number of respondents to the survey was 235. Respondents felt injections have an important role in the management of frozen shoulder (155/235, 66%) and the best time to inject is during the pain predominant phase (191/233; 82%). The glenohumeral joint was the preferred anatomical site to inject (136/235; 58%) with triamcinolone as the preferred steroid (66/155; 43%). A steroid dose of 40 mg/mL was favoured by 55% (83/151) of respondents.

Conclusion: Corticosteroid injections play an important role in the management of frozen shoulder. There was consensus for the type and dose of corticosteroid and anaesthetic; however, the range of preparations used indicated that many decisions may be based on personal preference or local guidelines.

Objectives: The decision to undergo total shoulder replacement surgery is a major one and should be a joint one between the patient and surgeon. It is important that patients are provided with accessible, meaningful and appropriate information to enable an informed decision. The aim of this study was to explore the content and language used within publicly available information leaflets produced by UK National Health Service (NHS) Trusts for people considering shoulder replacement surgery and to consider how this may influence surgical decision making.

Design: An online search of publicly available NHS shoulder replacement patient information leaflets (PIL) was undertaken. The text within the PIL was analysed using reflexive thematic analysis.

Results: Thirty-eight PIL were identified. The volume of information and content varied greatly. All PIL discussed the clinical problem, mainly within a biomedical framework and from a clinician's perspective in which normal shoulder anatomy was contrasted with shoulder pathology. Only a minority of the PIL discussed non-surgical treatments and of those that did, such approaches were predominantly portrayed as a temporary management option only, whilst surgery was frequently portrayed as the optimum treatment.

Conclusion: There is variation in the content of NHS shoulder replacement PIL. The content and language used may not adequately support people in making an informed decision about whether surgery is the right treatment option for them. We need to better understand the information needs of people considering shoulder replacement surgery, and provide information that is accessible, culturally sensitive, and capable of facilitating shared decision making.