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Core competencies for first contact physiotherapists in a direct access model of care for adults with musculoskeletal disorders: A scoping review. 在为患有肌肉骨骼疾病的成人提供直接护理的模式中,首次接触理疗师的核心能力:范围综述。
IF 1.3 Q2 Health Professions Pub Date : 2023-12-01 Epub Date: 2023-08-28 DOI: 10.1002/msc.1813
Robin Vervaeke, Simon Lafrance, Anthony Demont

Introduction: To optimise the management of Musculoskeletal disorders (MSKDs), many countries have implemented direct access to physiotherapy; however, the core competencies required for first contact physiotherapists (PTs) have not been precisely defined. The aim of this scoping review is to identify and describe the core competencies required for first contact PTs treating adults with MSKDs.

Methods: We conducted a scoping review of the literature by searching eight databases and grey literature up to July 2023. We performed a thematic analysis of the competencies identified based on predefined themes relevant to first contact physiotherapy in direct access models in primary or emergency care settings.

Results: Sixty-five articles were included. Seventeen core competencies were identified and grouped into 5 themes: (1) Assessment and examination; (2) Management and interventions; (3) Communication; (4) Cooperation and collaboration; and (5) Professionalism and leadership.

Conclusions: Our findings provide an international perspective on the core competencies required for first contact PTs.

导言:为了优化肌肉骨骼疾病(MSKDs)的治疗,许多国家都实施了直接物理治疗;然而,对第一接触物理治疗师(PTs)所需的核心能力却没有准确的定义。本范围综述旨在确定并描述治疗成人 MSKDs 的首诊物理治疗师所需的核心能力:我们搜索了八个数据库和截至 2023 年 7 月的灰色文献,对文献进行了范围界定。我们根据预先确定的与初级或急诊环境中直接就医模式下的第一接触物理治疗相关的主题,对所确定的能力进行了主题分析:结果:共纳入 65 篇文章。确定了 17 项核心能力,并将其分为 5 个主题:(1) 评估与检查;(2) 管理与干预;(3) 沟通;(4) 合作与协作;以及 (5) 专业精神与领导能力:我们的研究结果从国际视角探讨了首次接触的护理人员所需的核心能力。
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引用次数: 0
Can social prescribing put the 'social' into the biopsychosocial management of people with long-term musculoskeletal disorders? 社会处方能否为长期肌肉骨骼疾病患者的生物-心理-社会管理注入 "社会 "元素?
IF 1.3 Q2 Health Professions Pub Date : 2023-12-01 Epub Date: 2023-08-28 DOI: 10.1002/msc.1810
Declan J O'Sullivan, Lindsay M Bearne, Janas M Harrington, Joseph G McVeigh

Background: Chronic musculoskeletal disorders (MSD) are a significant burden on individuals' quality of life and society and are made more complex by the presence of multimorbidity. It is recommended that interventions targeting MSD be sustainable, equitable and incorporate the biopsychosocial model of care (BPS).

Aims: A criticism of the BPS approach is that the social component of this model is not addressed adequately during the management of people with long-term MSD and that a gap exists between theory and implementation. The use of social prescribing (SP) as an intervention to bridge this gap is discussed.

Results and discussion: Social prescribing is a holistic non-medical person-centered approach to well-being that utilizes link workers (LW) to support individuals with long-term conditions (LTC) in the community. Social prescribing referrals are received from primary healthcare practitioners to LW and range from light touch signposting for employment or financial advice to more intensive support for LTC such as obesity, decreased physical activity and mental health needs.

Conclusion: There is evidence to suggest that SP interventions are effective in the management of LTC; however, due to the paucity of high-quality evidence, it is difficult to be conclusive. Large-scale randomised controlled trials are recommended to support the use of SP interventions in the management of LTC.

背景:慢性肌肉骨骼疾病(MSD)对个人的生活质量和社会造成了沉重负担,并且由于多病共存而变得更加复杂。建议针对 MSD 的干预措施应具有可持续性、公平性,并纳入生物-心理-社会护理模式(BPS)。目的:对生物-心理-社会护理模式的批评是,该模式中的社会因素在管理长期 MSD 患者的过程中没有得到充分考虑,理论与实施之间存在差距。本文讨论了如何利用社会处方(SP)作为一种干预措施来弥补这一差距:社会处方是一种非医疗性的以人为本的整体福利方法,它利用联系工作者(LW)为社区中的长期病患者提供支持。社会处方转介由初级医疗保健从业人员转介给联系工作者,转介范围从就业或财务咨询的轻触式指路,到针对肥胖、体力活动减少和心理健康需求等长期病症的强化支持:有证据表明,SP 干预措施在管理 LTC 方面是有效的;但是,由于高质量的证据很少,因此很难得出结论。建议进行大规模随机对照试验,以支持在长寿老人管理中使用 SP 干预措施。
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引用次数: 0
Creaky knees: Is there a reason for concern? A qualitative study of the perspectives of people with knee crepitus. 膝盖咯吱咯吱响有必要担心吗?对膝关节疼痛患者观点的定性研究。
IF 1.3 Q2 Health Professions Pub Date : 2023-12-01 Epub Date: 2023-06-21 DOI: 10.1002/msc.1793
Elise E Drum, Alexandre Kovats, Matthew D Jones, Sarah Dennis, Justine Naylor, Kathryn Mills, Jeanette M Thom

Objective: Crepitus is a feature of osteoarthritis that may affect one's participation in exercise. An informed understanding is required of the perceptions that people have of their knee crepitus and how it affects their exercise behaviours. This study aims to investigate the role that crepitus may play in beliefs about exercise and knee health.

Methods: Focus group and individual interviews were conducted online with participants who had knee crepitus. The transcripts were thematically analysed through an inductive approach.

Results: Five main themes were identified from 24 participants: (1) individual variation of, (2) occurrence of, (3) meaning of knee crepitus, (4) attitudes and exercise behaviours regarding crepitus, and (5) knowledge deficits and needs concerning crepitus during exercise. The variety of crepitus sounds described occurred with a range of exercises or after inactivity. For those already with osteoarthritis or other symptoms, crepitus was of less concern than symptoms such as pain. Most participants had not ceased exercise but may have modified movement due to crepitus and associated symptoms; some had increased intentional strength training to try alleviating it. Participants agreed that more understanding about the processes causing crepitus and what exercise was safe for knee health would be beneficial.

Conclusion: Crepitus does not appear to be a major cause of concern for people who experience it. However, it is a factor that influences exercise behaviours as is pain. If health professionals could guide people with concerns about their crepitus, they may be more confident in exercising to benefit their joint health.

目的:膝关节疼痛是骨关节炎的一个特征,可能会影响患者参加锻炼。我们需要了解人们对膝关节疼痛的看法以及疼痛如何影响他们的运动行为。本研究旨在调查膝关节嘎吱声在运动和膝关节健康观念中可能扮演的角色:方法:对患有膝关节疼痛的参与者进行了焦点小组和个人在线访谈。通过归纳法对访谈记录进行了主题分析:结果:从 24 名参与者中确定了五大主题:(1) 膝盖异响的个体差异;(2) 膝盖异响的发生;(3) 膝盖异响的含义;(4) 关于膝盖异响的态度和运动行为;(5) 关于运动中膝盖异响的知识缺陷和需求。所描述的各种咯吱声都是在一系列运动或不运动后出现的。对于那些已经患有骨关节炎或出现其他症状的人来说,与疼痛等症状相比,吱吱声并不那么令人担忧。大多数参与者并没有停止锻炼,但可能会因为嘎吱声和相关症状而改变运动方式;一些人增加了有意的力量训练,试图缓解嘎吱声。参与者一致认为,更多地了解引起皱褶的过程以及哪些运动对膝关节健康是安全的将是有益的:结论:膝关节挛缩似乎并不是引起膝关节挛缩的主要原因。然而,与疼痛一样,它也是影响运动行为的一个因素。如果医疗专业人员能够指导那些对膝关节挛缩感到担忧的人,他们可能会更有信心进行有益于关节健康的锻炼。
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引用次数: 0
Is there an association between plantar fasciitis and knee osteoarthritis? 足底筋膜炎与膝关节骨性关节炎有关联吗?
IF 1.3 Q2 Health Professions Pub Date : 2023-12-01 Epub Date: 2023-05-22 DOI: 10.1002/msc.1784
Saoussen Miladi, Sirine Bouzid, Alia Fazaa, Hiba Boussaa, Yasmine Makhlouf, Leila Souabni, Kmar Ouenniche, Salma Kassab, Salma Chekili, Kaouther Ben Abdelghani, Ahmed Laatar

Background: Knee osteoarthritis (OA) and plantar fasciitis share similar risk factors including ageing, occupation, obesity, and inappropriate shoe wear. However, the association between knee OA and heel pain caused by plantar fasciitis has received limited attention to date.

Aim: We aimed to assess the prevalence of plantar fasciitis using ultrasound in patients with knee OA and to identify factors associated with plantar fasciitis in these patients.

Patients and methods: We conducted a cross-sectional study including patients with Knee OA, fulfiling the European League Against Rheumatism criteria. The Western Ontario and McMaster Universities Osteoarthritis (WOMAC) and the Lequesne indexes were used to evaluate pain and function of the knees. The Manchester Foot Pain and Disability Index (MFPDI) was used to estimate foot pain and disability. Each patient underwent a physical examination, plain radiographs of the knees and the heels, and an ultrasound examination of both heels to find signs of plantar fasciitis. Statistical analysis was performed using SPSS.

Results: We included 40 knee OA patients, with a mean age of 59.85 ± 9.65 years [32-74] and a male-to-female ratio of 0.17. The mean WOMAC was 34.03 ± 19.9 [4-75]. The mean Lequesne for knees was 9.62 ± 4.57 [3-16.5]. Among our patients, 52% (n = 21) experienced heel pain. The heel pain was severe in 19% (n = 4). The mean MFPDI was 4.67 ± 4.16 [0-8]. Limited ankle dorsiflexion and plantar flexion were noted in 47% of patients (n = 17) each. High and low arch deformities were seen in 23% (n = 9) and 40% (n = 16) of patients. Ultrasound revealed a thickened plantar fascia in 62% (n = 25). An abnormal hypoechoic plantar fascia was noted in 47% (n = 19), with the loss of normal fibrillar architecture in 12 cases (30%). No Doppler signal was exhibited. Patients with plantar fasciitis had significantly limited dorsiflexion (n = 2 (13%) versus n = 15 (60%), p = 0.004) and plantar flexion (n = 3 (20%) versus n = 14 (56%), p = 0.026). The range of supination was also less important in the plantar fasciitis group (17.73 ± 4.1 vs. 12.8 ± 6.46, p = 0.027). The low arch was statistically more present in patients with plantar fasciitis (G1: 36% [n = 9] vs. G0: 0% [n = 0], p = 0.015). However, the high arch deformity was statistically more present in patients without plantar fasciitis (G1: 28% [n = 7] vs. G0: 60% [n = 9], p = 0.046). Multivariate analysis showed that the risk factor for plantar fasciitis in knee OA patients was limited dorsiflexion (OR = 3.889, 95% CI [0.017-0.987], p = 0.049).

Conclusion: In conclusion, our work showed that plantar fasciitis is frequent in knee OA patients, with reduced ankle dorsiflexion being the main risk factor for plantar fasciitis in these patients.

背景:膝关节骨关节炎(OA)和足底筋膜炎具有相似的风险因素,包括年龄增长、职业、肥胖和穿鞋不当。目的:我们旨在使用超声波评估膝关节 OA 患者足底筋膜炎的患病率,并确定这些患者足底筋膜炎的相关因素:我们进行了一项横断面研究,研究对象包括符合欧洲抗风湿联盟标准的膝关节OA患者。我们使用西安大略和麦克马斯特大学骨关节炎(WOMAC)和勒克斯指数来评估膝关节的疼痛和功能。曼彻斯特足部疼痛和残疾指数(MFPDI)用于评估足部疼痛和残疾情况。每位患者都接受了体格检查、膝关节和足跟的普通X光检查以及双足跟的超声波检查,以发现足底筋膜炎的迹象。统计分析采用 SPSS:我们共纳入了 40 名膝关节 OA 患者,平均年龄为(59.85 ± 9.65)岁 [32-74],男女比例为 0.17。WOMAC 平均值为 34.03 ± 19.9 [4-75]。膝关节莱克斯平均值为(9.62 ± 4.57)[3-16.5]。在我们的患者中,52%(n = 21)的患者有足跟痛的症状。19%的患者(n = 4)足跟疼痛严重。MFPDI的平均值为4.67 ± 4.16 [0-8]。47%的患者(17 人)踝关节背屈和跖屈受限。分别有 23% (9 人)和 40% (16 人)的患者出现高低足弓畸形。超声波检查显示,62%的患者(25 人)足底筋膜增厚。47%(19 例)的患者足底筋膜出现异常低回声,12 例(30%)的患者失去了正常的纤维结构。未显示多普勒信号。足底筋膜炎患者的背伸(n = 2(13%)对 n = 15(60%),p = 0.004)和跖屈(n = 3(20%)对 n = 14(56%),p = 0.026)明显受限。足底筋膜炎组的仰卧幅度也较小(17.73 ± 4.1 对 12.8 ± 6.46,p = 0.027)。据统计,足底筋膜炎患者更容易出现低足弓(G1:36% [n = 9] vs. G0:0% [n = 0],p = 0.015)。然而,高足弓畸形在统计学上更多地出现在无足底筋膜炎的患者中(G1:28% [n = 7] vs. G0:60% [n = 9],p = 0.046)。多变量分析显示,膝关节 OA 患者发生足底筋膜炎的风险因素是外翻受限(OR = 3.889,95% CI [0.017-0.987],P = 0.049):总之,我们的研究表明,膝关节OA患者中足底筋膜炎的发病率很高,而踝关节外翻减少是这些患者患足底筋膜炎的主要风险因素。
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引用次数: 0
Cross-perspectives on care pathways for painful osteoarthritis: A qualitative analysis in patients and healthcare professionals. 疼痛性骨关节炎护理路径的交叉观点:对患者和医护人员的定性分析。
IF 1.3 Q2 Health Professions Pub Date : 2023-12-01 Epub Date: 2023-07-05 DOI: 10.1002/msc.1795
Serge Perrot, Guillaume Roucoux, Philippe Bertin, Catherine Beauvais, Françoise Alliot-Launois, Olivier Chassany, Martin Duracinsky

Purpose: To analyse and compare patients' and healthcare professionals' (HPs) perspectives concerning patient care pathways for painful osteoarthritis (OA).

Patients and methods: We performed a qualitative study of two focus groups corresponding to eight patients with painful OA and eight HPs involved in OA management.

Results: Six key themes emerged from the interviews: (1) representations of OA, (2) OA pain, (3) quality of life, (4) care pathways, (5) actors involved in the care pathway, and (6) treatments. Both groups considered general practitioners, pharmacists and physiotherapists to be first-line HPs, and no well-defined OA specialist was identified. Patients and HPs reported similar difficulties concerning the adaptation of management to individual cases, late diagnosis and treatment, whereas only patients mentioned financial issues. Communication difficulties were identified as a major problem both between patients and HPs, and between HPs. Patients reported a lack of knowledge concerning pain and OA. The coordination between the various HPs is required, with education on both pain and OA. Several possible solutions were put forward by both patients and HPs.

Conclusion: The care pathways of patients with painful OA are complex, with an unclear definition of the roles of the various HPs and suboptimal coordination. The role of HPs should be defined and collaboration between HPs developed.

目的:分析并比较患者和医护人员(HPs)对疼痛性骨关节炎(OA)患者护理路径的看法:我们对两个焦点小组进行了定性研究,这两个焦点小组分别对应八名疼痛性 OA 患者和八名参与 OA 管理的医护人员:访谈中出现了六个关键主题:(1) OA 的表征;(2) OA 疼痛;(3) 生活质量;(4) 护理路径;(5) 护理路径中的参与者;(6) 治疗。两组人都认为全科医生、药剂师和物理治疗师是一线医疗保健人员,没有发现明确的 OA 专家。患者和医疗保健人员报告了类似的困难,包括根据个人情况调整治疗方法、晚期诊断和治疗,而只有患者提到了经济问题。沟通困难被认为是患者和医疗保健人员之间以及医疗保健人员之间的主要问题。患者表示对疼痛和 OA 缺乏了解。各医疗机构之间需要进行协调,并开展有关疼痛和 OA 的教育。患者和医务人员都提出了几种可能的解决方案:结论:疼痛性 OA 患者的护理路径非常复杂,各医疗保健机构的角色定义不明确,协调性也不理想。应明确医疗保健人员的作用,发展医疗保健人员之间的合作。
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引用次数: 0
Psoriatic Arthritis Quality of Life questionnaire: Translation, cultural adaptation and validation into Arabic language. 银屑病关节炎生活质量问卷:阿拉伯语的翻译、文化适应和验证。
IF 1.3 Q2 Health Professions Pub Date : 2023-12-01 Epub Date: 2023-06-17 DOI: 10.1002/msc.1788
Rawdha Tekaya, Haifa Hajji, Leila Rouached, Selma Bouden, Meriem Jones, Wafa Hamdi, Nabil Sakly, Leila Metoui, Aicha Ben Tekaya, Ines Mahmoud, Olfa Saidane, Leila Abdelmoula

Background: Psoriatic arthritis (PsA) is a multifaceted inflammatory disease that has a strong negative impact on the quality of life (QoL) of patients. The Psoriatic Arthritis Quality of Life (PsAQoL) questionnaire was the first disease-specific patient-derived instrument developed to measure the QoL in patients with PsA. Our objective was to translate the PsAQol into Arabic language and evaluate its reliability and validity in patients with PsA.

Methods: This was a cross-sectional study including patients with PsA. A clinical and biological assessment of the patients was performed at inclusion. The translation of the original PsAQoL into Arabic was performed by a professional bilingual and lay panel. Eight patients were interviewed to assess face and content validity. A separate sample of PsA patients (n = 30) were invited to participate in a test-retest postal study in order to investigate reproducibility and construct validity. One week separated the two administrations. The Arabic version of Health Assessment Questionnaire (HAQ) was used as a comparator instrument for convergent validity.

Results: Face and content validity were satisfactory. The Arabic version of the PsAQoL was found to be relevant, understandable and easy to complete in only a few minutes. One item was excluded (item 16). It had no correlation with either the other 19 items or the total score of PsAQol. The Arabic PsAQol had excellent internal consistency (Cronbach's a = 0.926), and test-retest reliability (r = 0.982). There was a positive correlation between the total score of the PsAQoL and the Arabic version of HAQ (Spearman's r = 0.838, p < 10-3 ). Exploratory factor analysis had extracted two factors explaining 55% of the total variance.

Conclusion: Nineteen items were selected to compose the Arabic version of PsAQoL, which was found to be relevant and understandable and has excellent reliability and construct validity. The new measure will be a valuable new tool for use in routine care for patients' assessment.

背景:银屑病关节炎(PsA)是一种多发性炎症性疾病,对患者的生活质量(QoL)有很大的负面影响。银屑病关节炎生活质量(PsAQoL)问卷是首个针对特定疾病的患者衍生工具,用于测量银屑病关节炎患者的生活质量。我们的目标是将 PsAQol 翻译成阿拉伯语,并评估其在 PsA 患者中的可靠性和有效性:这是一项包括 PsA 患者在内的横断面研究。纳入患者时对其进行了临床和生物学评估。由一个专业的双语和非专业小组将 PsAQoL 原文翻译成阿拉伯文。对八名患者进行了访谈,以评估面效和内容效度。另外还邀请了一组 PsA 患者(n = 30)参加邮寄重测研究,以调查重现性和结构效度。两次测试间隔一周。阿拉伯语版的健康评估问卷(HAQ)被用作比较工具,以获得收敛效度:结果:表面效度和内容效度均令人满意。阿拉伯语版的 PsAQoL 被认为贴切、易懂且易于完成,只需几分钟即可完成。有一个项目被排除在外(项目 16)。该项目与其他 19 个项目或 PsAQol 总分均无相关性。阿拉伯语 PsAQol 具有良好的内部一致性(Cronbach's a = 0.926)和测试-再测可靠性(r = 0.982)。PsAQoL 总分与阿拉伯语版 HAQ 之间存在正相关(Spearman's r = 0.838,p -3)。探索性因子分析提取了两个因子,解释了总方差的 55%:结论:阿拉伯语版 PsAQoL 选取了 19 个项目,这些项目具有相关性和可理解性,并具有良好的信度和建构效度。新的测量方法将成为一种有价值的新工具,可用于日常护理中对患者进行评估。
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引用次数: 0
Transforming rheumatology telephone advice line services. 改造风湿病学电话咨询热线服务。
IF 1.3 Q2 Health Professions Pub Date : 2023-12-01 Epub Date: 2023-10-13 DOI: 10.1002/msc.1833
Julie Begum, Robert Clark, Trish Cornell, Sarah Ryan
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引用次数: 0
Patients' experiences of subacute pain management following total hip or knee arthroplasty: A qualitative study. 全髋关节或膝关节置换术后患者亚急性疼痛管理的经验:一项定性研究。
IF 1.3 Q2 Health Professions Pub Date : 2023-12-01 Epub Date: 2023-10-31 DOI: 10.1002/msc.1837
Shania Liu, Hadi A Almansour, Lily Pham, Furkan Genel, Ian A Harris, Asad E Patanwala, Sam Adie, Jennifer Stevens, Geraldine Hassett, Kate Luckie, Jonathan Penm, Justine Naylor

Background: Total hip and knee arthroplasties are common surgeries performed worldwide, but the management of pain during the subacute period (defined as hospital discharge to 3 months postoperatively) is poorly understood. This study aimed to determine patients' experiences, facilitators and barriers to subacute pain management following total hip or knee arthroplasty.

Methods: Semi-structured interviews with a purposive sample of patients following total hip or knee arthroplasty were conducted between June and August 2022. Participants were recruited from two tertiary metropolitan hospitals. Interviews were audio-recorded and transcribed verbatim. Data were analysed using an inductive thematic approach to identify common themes.

Results: In total, 30 interviews were conducted with patients following hip or knee arthroplasty. Four main themes were identified: (i) Physical constitution before surgery (joint condition, analgesic use, age, and hearing); (ii) Attitude and knowledge (motivation, outlook on life, attitude towards taking medications, individual benchmarking, and knowledge); (iii) Socio-ethno-cultural factors (family and community connection, language, and religion), and (iv) Health-system support (health-professional delivered education, medications, services, staff, and costs).

Conclusions: Participants' experiences of subacute pain following hip or knee arthroplasty were shaped by multidimensional factors. Strategies to empower patients through increased education and support during postoperative opioid tapering as well as a shift to a biopsychosocial approach to pain management during the subacute period may improve patient and health-system outcomes.

背景:全髋关节和膝关节置换术是世界范围内常见的手术,但对亚急性期(定义为出院至术后3个月)的疼痛管理知之甚少。本研究旨在确定患者在全髋关节置换术或膝关节置换术后亚急性疼痛管理的经验、促进因素和障碍。方法:在2022年6月至8月期间,对全髋关节或膝关节置换术后的患者进行了半结构化访谈。参与者来自两所大都市三级医院。访谈录音并逐字转录。采用归纳专题法对数据进行分析,以确定共同主题。结果:总共对髋关节或膝关节置换术后的患者进行了30次访谈。确定了四个主要主题:(i)手术前的身体状况(关节状况、镇痛药的使用、年龄和听力);二态度和知识(动机、人生观、服药态度、个人基准和知识);(iii)社会民族文化因素(家庭和社区联系、语言和宗教),以及(iv)卫生系统支持(卫生专业人员提供的教育、药物、服务、工作人员和费用)。结论:参与者髋关节或膝关节置换术后亚急性疼痛的经历是由多方面因素决定的。通过在术后阿片类药物减量期间增加教育和支持,以及在亚急性期转向生物-心理-社会方法进行疼痛管理来增强患者能力的策略,可能会改善患者和卫生系统的结果。
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引用次数: 0
Predictors of persistent pain in patients with acute neck pain treated with physical therapy: A prospective study with 2 years follow up. 接受物理治疗的急性颈部疼痛患者持续疼痛的预测因素:一项为期两年的前瞻性研究。
IF 1.3 Q2 Health Professions Pub Date : 2023-12-01 Epub Date: 2023-05-04 DOI: 10.1002/msc.1775
Mosab M Aldabbas, Tarushi Tanwar, Iram Iram, Amer Ghrouz, Zubia Veqar

Background: Clinicians specialising in musculoskeletal medicine have observed that patients with neck pain often seek repeat consultations because of recurring neck pain. Despite this pattern, there is a lack of research exploring the persistence nature of neck pain. Understanding potential predictors of persistent neck pain could help clinicians develop effective treatment approaches to prevent the chronicity of these conditions.

Objective: The current study investigated the potential predictors of persistent neck pain over a 2-year period among patients with acute neck pain treated with physical therapy.

Methods: A longitudinal study design was employed. Data were collected at baseline and at 2-year follow-up from 152 acute neck pain patients aged (29.2 ± 6.7). Patients were recruited from physiotherapy clinics. Logistic regression was used for analysis. At 2-year follow-up, participants were reassessed for their pain intensity (Dependent variable) and categorised as recovered or reporting persistent neck pain. Baseline acute neck pain intensity, sleep quality, disability, depression, anxiety, and sleepiness were used as potential predictors.

Results: Among 152 participants, 51 (33.6%) patients with acute neck pain reported persistent neck pain at 2-year follow-up. 43% of the variation in the dependent variable was explained by the model. Despite the strong correlations between persistent pain at follow-up with all potential predictors, only sleep quality 95% CI (1.1,1.6), and anxiety 95% CI (1.1,1.4) were the significant predictors of persistent neck pain.

Conclusion: Our results suggest that poor sleep quality and anxiety may serve as potential predictors of persistent neck pain. The findings highlight the importance of a comprehensive approach to managing neck pain that addresses both physical and psychological factors. By targeting these co-morbidities, healthcare providers may be able to improve outcomes and prevent the progression of the case.

背景:肌肉骨骼医学专业的临床医生发现,颈部疼痛患者常常因为颈部疼痛反复发作而反复就诊。尽管存在这种模式,但缺乏对颈部疼痛持续性的研究。了解持续性颈部疼痛的潜在预测因素有助于临床医生制定有效的治疗方法,防止这些疾病的慢性化:本研究调查了接受物理治疗的急性颈部疼痛患者在两年内出现持续性颈部疼痛的潜在预测因素:方法:采用纵向研究设计。收集了 152 名急性颈部疼痛患者的基线数据和 2 年随访数据,患者年龄为(29.2 ± 6.7)岁。患者均来自物理治疗诊所。分析采用逻辑回归法。在 2 年的随访中,对参与者的疼痛强度(因变量)进行了重新评估,并将其分为痊愈和持续性颈痛两类。基线急性颈部疼痛强度、睡眠质量、残疾程度、抑郁、焦虑和嗜睡都是潜在的预测因素:在 152 名参与者中,有 51 名(33.6%)急性颈部疼痛患者在 2 年的随访中报告了持续性颈部疼痛。该模型解释了因变量中 43% 的变化。尽管随访时的持续性疼痛与所有潜在的预测因素都有很强的相关性,但只有睡眠质量 95% CI (1.1,1.6) 和焦虑 95% CI (1.1,1.4) 是持续性颈痛的重要预测因素:我们的研究结果表明,睡眠质量差和焦虑可能是持续性颈痛的潜在预测因素。研究结果凸显了针对生理和心理因素综合治疗颈痛的重要性。通过针对这些并发症的治疗,医疗服务提供者或许能够改善治疗效果并防止病情恶化。
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引用次数: 0
What are Brazilian orthopaedists' views on the diagnosis and treatment of patients with chronic nonspecific low back pain? A qualitative investigation. 巴西骨科医生对慢性非特异性腰背痛患者的诊断和治疗有何看法?一项定性调查。
IF 1.3 Q2 Health Professions Pub Date : 2023-12-01 Epub Date: 2023-05-16 DOI: 10.1002/msc.1778
Fabiana Silveira Murray, Nathalia Costa, Fabianna Jesus-Moraleida, Ney Meziat-Filho

Background: Orthopaedists are often the first point of contact for patients who present with low back pain (LBP) and chronic LBP in Brazil.

Aim: To explore the views of orthopaedists on therapeutic approaches for chronic non-specific low back pain (CNLBP) with a view to gain insights into aspects of clinical practice considered important to them.

Methods: A qualitative design underpinned by interpretivism was employed. Participants were (n = 13) orthopaedists with experience in treating patients with CNLBP. Following the pilot interviews, semi-structured interviews were conducted, audio-recorded, transcribed and de-identified. Interview data were thematically analysed.

Results: Four themes were identified. (1) Biophysical aspects are important and predominate, but sometimes their relevance can be unclear; (2) Psychosocial aspects and lifestyle factors influence the therapeutic approach; (3) Treatment of CNLBP - including medication, physical activity, surgery and other invasive procedures and other therapeutic modalities; and (4) Nuances of clinical practice - "it goes beyond medicine".

Conclusion: Brazilian orthopaedists value identifying the biophysical cause(s) of chronic low back pain. Psychological factors were often discussed secondary to biophysical aspects, whereas social aspects were rarely mentioned. Orthopaedists highlighted their difficulties in navigating patients' emotions and reassuring patients without referrals to imaging tests. Orthopaedists may benefit from training that targets communication and other relational aspects of care in order to work with people who present with CNLBP.

背景:目的:探讨骨科医生对慢性非特异性腰背痛(CNLBP)治疗方法的看法,以期深入了解他们认为重要的临床实践方面:方法:采用以解释学为基础的定性设计。参与者为(n = 13)具有治疗 CNLBP 患者经验的骨科医生。在试点访谈之后,进行了半结构化访谈、录音、转录和去身份化。对访谈数据进行了主题分析:结果:确定了四个主题。(1) 生物物理方面非常重要且占主导地位,但有时其相关性可能不明确;(2) 社会心理方面和生活方式因素影响治疗方法;(3) CNLBP 的治疗--包括药物治疗、体育锻炼、手术和其他侵入性程序以及其他治疗方式;(4) 临床实践的细微差别--"它超越了医学":巴西骨科医生重视找出慢性腰背痛的生物物理原因。对心理因素的讨论往往次于生物物理因素,而社会因素则很少被提及。矫形外科医生强调,他们难以驾驭患者的情绪,也难以在不转诊进行影像学检查的情况下安抚患者。矫形外科医生可能会受益于针对沟通和其他护理关系方面的培训,以便与出现 CNLBP 的患者合作。
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Musculoskeletal Care
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