Musculoskeletal Care最新文献

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.

Background: After surgery, physical therapy is thought to be crucial for getting the best results. A growing number of people believe that virtual reality (VR) could be a useful tool for providing medical interventions. The impact of VR-based rehabilitation on results after lower limb surgeries is examined in this systematic analysis.

Objectives: Evaluating the effectiveness of virtual reality and related technologies in postoperative lower limb rehabilitation using a systematic study.

Design: systematic review of relevant literature (PROSPERO ID: CRD42024605158).

Methods: The databases PubMed, Cochrane, Scopus, PEDro, and Google Scholar were used to search for the literature. To identify papers that satisfied the inclusion criteria, titles, abstracts, and then the full texts were screened. The methodological qualities of the studies were evaluated using the 11-point PEDro scale. Risk of Bias evaluation was performed through the Risk of Bias 2 (RoB 2) tool in Cochrane review tools.

Results: Twenty-four studies met the inclusion criteria. Combined results showed that virtual reality (VR) and game-based interventions appear to be effective and safe adjuncts to traditional rehabilitation for lower limb surgeries, improving outcomes such as pain relief, proprioception, balance, and motivation, though their superiority over standard rehabilitation alone remains inconsistent and warrants further research.

Conclusion: VR and game-based rehabilitation enhance traditional therapy for knee and hip surgeries, but further research is needed to confirm long-term benefits and effectiveness.

Purpose: To determine the effect of Pilates exercises on pain, endurance, quality-of-life, and disability in post-menopausal women with low back pain.

Methods: After obtaining signed written consent, 128 women in the post-menopausal stage were randomly allocated to two groups: group 'A' (experimental) and group 'B' (control-conventional). The participants underwent evaluations for disability using the Oswestry Disability Scale. Pain levels were recorded using a numerical pain rating scale (NPRS), while endurance was tested using the Krause Weber test. Quality of life (QOL) was evaluated using the Menopause-Specific Quality of Life (MENQOL) Questionnaire.

Results: Both the exercises Pilates (group A) and the conventional exercise (group B) showed improvement and compared to group B, group A showed significant changes in all outcome variables.

Conclusion: Pilates training proves superior to conventional physical therapy for alleviating non-specific LBP and enhancing lumbar health in post-menopausal women.

Trial registration: Clinical Trials Registry-India (CTRI), CTRI/2024/04/065057. Registered on 02/04/2024.

Purpose: This systematic review evaluated the efficacy of postoperative rehabilitation for patients at risk of poorer outcomes after total knee arthroplasty.

Methods: Six databases were searched, and only randomised controlled trials were included. Two reviewers independently screened, extracted data, and appraised the quality of the studies.

Results: Twenty-three studies were included. Insufficient evidence supports cognitive behavioural therapy for patients with kinesiophobia, while continuous passive motion may not be effective for range of motion deficits. The impact of exercise therapy on functional recovery is conflicting; however, longer durations tend to be more effective for older patients and those with functional limitations. Limited evidence suggests that exercise may not alleviate pain. Outpatient exercise therapy improves health-related quality of life more than home-based programs for older patients and those with functional limitations. The efficacy of other rehabilitation aspects remains inconclusive due to high heterogeneity in interventions and outcome measures, and high or unclear risk of bias in most studies.

Conclusion: While limited evidence suggests benefits for specific rehabilitation interventions, there is insufficient data to assess the efficacy of most interventions on postoperative recovery in those at risk of poorer outcomes. More robust evidence is needed to guide clinical practice and standardise outcome measures.

Trail registration: PROSPERO CRD42022355574.

Purpose: To compare treatment utilisation for osteoarthritis (OA) and satisfaction with OA management between individuals with and without comorbid metabolic conditions (e.g., diabetes, obesity, dyslipidaemia, hypertension).

Methods: Secondary analysis of a cross-sectional international survey study (Italy, Russia, Sweden) on people ≥ 40 years old with knee/hip OA. Metabolic comorbidity was self-reported. We used direct standardisation with prevalence ratios and mixed-effect models to estimate the associations between comorbidity with treatment utilisation and satisfaction (score 0-100).

Results: We analysed 401 individuals (48% Sweden, 28% Italy, 24% Russia; 53% with ≥ 1 metabolic condition). Those with and without comorbid metabolic conditions showed similar prevalence for first-line interventions (exercise, education, and weight management). Metabolically unhealthy individuals showed higher use of opioids (prevalence ratio [95% CI] 1.9 [1.3-2.4]), antidepressants (1.8 [1.1-2.5]), corticosteroid injections (1.4 [1.0-1.8]), and homoeopathic products (2.1 [1.2-3.0]). Satisfaction with care (adjusted difference: -3.9 [95% CI: -8.5 to 2.4]) and information received about treatments (-4.0 [-9.7 to 1.7]) were similar.

Conclusions: While first-line OA interventions were similarly used, those with metabolic conditions relied more on second-line and non-recommended treatments, showing comparable satisfaction. More effort is needed to increase the adoption of lifestyle-focused treatments in OA and to minimise the use of less recommended options among individuals with metabolic comorbidities.

Introduction: Low back pain (LBP) imposes a significant burden on global health, yet it remains deficient in comprehensive investigations pertaining to its incidence patterns. The aim of this study was to analyse global, regional and national trends and associated factors in the incidence of LBP from 1990-2019.

Methods: In order to examine global and country-specific 30-year incidence patterns of LBP, data were obtained from the 2019 Global Burden of Disease Study. An age-period cohort (APC) model was utilised to determine annual percent changes, age-specific changes, and period/cohort effects.

Results: The age-standardized global LBP incidence rate significantly declined from 1990-2019. However, the absolute number of cases increased by 2.39 billion, predominantly in middle-, low-middle- and low-socio-demographic index (SDI) regions, affecting mostly 50-69 years old with a higher incidence in women. LBP incidence increased progressively from low to high SDI regions. Period and cohort effects trended downward in all regions except high-SDI countries, which had the lowest incidence decline and a slight rebound after 2012.

Conclusions: Our study updates global and regional LBP incidence from 1990-2019 using APC modelling, showing declining age-standardized rates globally but increased case numbers due to population growth and ageing. Prevention likely helped reduce incidence, but more health strengthening and minimally invasive treatments are still needed, especially where LBP has plateaued or rebounded recently.

Background: Psychosocial interventions may improve QoL in people with wider chronic pain conditions. However, the evidence requires refining for application to EDS/JHMS. This systematic review aimed to identify, assess and synthesise the evidence of the effectiveness of psychosocial interventions concerning EDS/JHMS. EBSCO, OpenGrey, Cochrane, Prospero, Researchgate and BPS Wiley online were searched for papers published approximately 2000-2024 for studies in which (1) Participants diagnosed with EDS/JHMS. (2) Quantitative or mixed methods. (3) Assessed a Psychosocial intervention to a (4) quality of life outcome. (5) in English. EPHPP quality assessment tool was used to assess the quality and risk of bias.

Main text: The study identified six studies, including 343 participants aged 13-69 (F = 248, M = 8), of unknown ethnicity. Five studies were cohort and one non-randomised controlled trial. Key methodological flaws included no reported effect size and no control group. With quality assessed as low (5) or moderate (1), there was weak evidence that psychosocial interventions containing mindfulness and CBT resulted in a general improvement in QoL compared to no intervention.

Conclusions: Findings from this review indicate the potential of mindfulness and CBT in improving QOL in EDS/JHMS and, in some studies, pain and fatigue. However, existing research is at high risk of bias, has low methodological quality, and is predominately focused on female patients. Future research should adopt methodologically robust approaches such as RCTs and more inclusive samples and consider co-production.