Musculoskeletal Care最新文献

Introduction: Fibromyalgia (FM) is a chronic syndrome characterised by widespread pain, fatigue, and symptoms such as sleep disturbances, cognitive impairment, and mood disorders. FM prevalence is notably higher among systemic lupus erythematosus (SLE) patients compared with the general population, often leading to diagnostic challenges. Misinterpreting FM as SLE activity can result in overtreatment. This study aimed to evaluate fibromyalgianess and its relationship with the clinical and immunological characteristics of SLE patients using comprehensive scoring methods for better diagnostic accuracy.

Materials and methods: This cross-sectional study included 50 SLE patients meeting the 2019 EULAR/ACR classification criteria. Patients with coexisting autoimmune diseases or severe systemic conditions were excluded. Clinical data, SLEDAI scores, and fibromyalgianess severity were assessed using the Polysymptomatic Distress Scale (PSDS). Patients were categorised into groups based on fibromyalgia diagnostic criteria: widespread pain and SLE-FM. Statistical analysis was performed using SPSS, with p < 0.05 considered significant.

Results: Among 50 patients (45 female, 5 male; mean age 42.04 ± 12.5), 24% had fibromyalgianess, and 18% experienced widespread pain. Female patients exhibited significantly higher PSDS scores (p < 0.05). While NSAID use was associated with increased PSDS scores (p < 0.001), no significant relationship was found between fibromyalgianess and SLEDAI scores or organ involvement.

Conclusion: Fibromyalgianess in SLE patients primarily reflects heightened pain sensitivity and symptom severity rather than disease activity. Incorporating fibromyalgianess assessment into routine SLE management may prevent diagnostic and therapeutic pitfalls and improve treatment outcomes. Multidisciplinary approaches, including pharmacological and non-pharmacological strategies, are essential for effective care.

Objective: This study aimed to determine the number and proportion of exercise interventions within preexisting clinical trials for people with knee osteoarthritis (KOA) that satisfied the World Health Organisation's (WHO) guidelines for physical activity.

Methods: A descriptive analysis of studies included in an umbrella review was undertaken. Data from each exercise intervention relating to the type, dose and intensity of exercise was extracted, and the number and proportion of interventions that satisfied the WHO guidelines (aerobic, muscle strengthening, balance [for studies where the average age was more than 65 years old], a combination or all) was recorded at the study and intervention level.

Results: Data were extracted from 199 studies containing 266 exercise interventions. Overall, only one study (0.5%) satisfied all components of the WHO guidelines. Of the 122 interventions that had an average participant age over 65, none fulfiled all aspects of the WHO guidelines, which included balance. There were 16 (6.0%) and 12 (4.5%) other interventions that satisfied the aerobic or muscle strengthening components of the guidelines, respectively.

Conclusion: This descriptive analysis highlighted the lack of exercise interventions in clinical trials for people with KOA that satisfied the WHO guidelines. Thus, they may not be dosed appropriately to achieve broader health outcomes associated with following the physical activity guidelines.

Objectives: Osteoarthritis (OA) contributes substantially to global disability. We analysed global and national OA incidence trends and associated factors.

Methods: Data obtained from the 2019 Global Burden of Disease Study were used to examine 30-year OA incidence patterns globally and for 204 countries/territories. An age-period-cohort (APC) model determined annual percent changes, age-specific changes, and period/cohort effects.

Results: From 1990 to 2019, global OA incidence rose by 21.3 million, with the highest cases in China, India, the United States, and Japan. Incidence was higher in women versus men and peaked at ages 20-24 years, though shifting towards middle-aged adults. The annual increase was 0.225% (95% confidence interval [CI] 0.157, 0.293) and 0.158% (95% CI: 0.114, 0.201) in high and low socio-demographic index countries, respectively, with most countries showing increasing incidence. Disadvantageous incidence trends over time and birth cohorts occurred in all regions except middle-high index countries, which had the lowest increase and declining period effect after 2005.

Conclusion: OA represents an escalating public health burden, predominantly affecting middle-aged and elderly populations, and more women than men. Obesity and ageing are major drivers of rising OA incidence. Swiftly implementing policies to prevent modifiable risks and ensure proper treatment access is imperative to mitigate the impact of OA.

Objectives: This service evaluation examined the impact of offloader knee bracing for unicompartmental osteoarthritis (OA) on pain, quality of life (QoL) and activities of daily living (ADL).

Design: The retrospective service evaluation was completed at two NHS community primary care clinics offering offloader knee bracing services. Between 2015 and 2023 patients prescribed offloader knee braces with unicompartmental osteoarthritis were invited to complete a Knee injury and Osteoarthritis Outcome Score (KOOS) at baseline, one, six and 12 months and at two and three years. KOOS data were analysed to assess the change in ADL, Pain and QoL domains from baseline to one, six and twelve months and up to three years using a paired t-test. Demographic data collected included age, sex, and type of OA.

Results: Two hundred and forty-three patients were issued an offloader knee brace. There were statistically significant differences in pain and ADL for both braces at one and six months (p < 0.05). Participants issued with an ÖSSUR brace demonstrated statistically significant changes in pain and ADL for up to two years (p = 0.0101; p = 0.0153) and QoL up to one year (p = 0.0011). There was no statistically significant difference in either brace at three years. The ÖSSUR brace demonstrated a minimal clinically significant difference at one month for all domains, at one year for pain and ADL and two and three years for pain, ADL and QoL.

Conclusions: Results indicate that offloader knee bracing for unicompartmental knee OA could reduce patients' pain, ADL and QoL in the long term.

Objective: To examine the effect of biological sex on wait-times to first rheumatology appointment in a central triage system before, during and after the COVID-19 pandemic.

Methods: De-identified data of patients referred to one centralised Rheumatology referral centre between November 2019 and December 2023 were extracted from the electronic medical record. Variables collected and analysed included time from referral to first appointment, biological sex, referral period, triage urgency, age, and geographic location.

Results: 19,681 referrals were identified. In the pre-COVID period, there was no significant difference in wait-times by biological sex or age. After adjusting for triage level, age and geographic location, females waited significantly longer in the peri-COVID period versus males (10.2 days, 95% CI 7.1, 13.3), which persisted in the post-COVID period (7.5 days, 95% CI 4.0, 11.1). Similarly, younger patients waited longer than older patients in the peri-COVID period (4.7 fewer days per decade increase in age (95% 3.9, 5.6)). This age discrepancy persisted through the post-COVID period (2.3 days, 95% CI 1.6, 3.5). Geographic location was a significant predictor of wait-times in the post-COVID period, with those outside of Edmonton waiting longer than in Edmonton. Once the change in referral pattern from Northwest Territories was accounted for, this discrepancy ceased.

Conclusions: Female and younger patients have been disproportionately impacted by wait-time increases during the COVID-19 pandemic, with minimal improvements observed during the post-COVID period. These findings should prompt further investigation into the underlying causes of these observed inequities in access to rheumatology care to identify solutions.

Background: Carpal tunnel syndrome (CTS) is a considerable concern, impacting individual health and socio-economic factors. A systematic review and meta-analysis of CTS prevalence would offer valuable insights for healthcare planning, improving outcomes and reducing the burden on affected individuals.

Methods: In line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a meta-analysis was conducted to estimate the prevalence of CTS. Medline, CINAHL, AMED, Scopus, and Web of Science databases were searched for studies published from 1 January 2012 to 10 October 2024. The pooled prevalence rates were determined using a random effects model.

Results: The search yielded 548 initial findings, 103 duplicate records were eliminated, and only 31 of these papers were deemed relevant for inclusion in this review. The prevalence estimates were sourced from 15 different countries, including the United States (n = 8), Saudi Arabia (n = 5), Ethiopia (n = 3), Turkey (n = 2), Iran (n = 2) and Brazil (n = 2), among others. Each of the following countries contributed one study: China, France, Germany, India, Kuwait, the United Kingdom, Korea, the Netherlands, and Sweden. In total, the included studies analysed 5,311,785 individuals, revealing a prevalence of CTS ranging from 0.003 to 0.743. The random-effects meta-analysis yielded an overall prevalence estimate of 0.144, with a 95% confidence interval (CI) of 0.067-0.282, based on 30 studies.

Conclusion: The prevalence estimates for CTS are notably high, highlighting the need for effective surgical management strategies. Developing and implementing these interventions is crucial to enhancing health outcomes for individuals affected by CTS.

Background: Shoulder osteoarthritis is a common cause of pain, disability and difficulty sleeping. Patient information leaflets are produced by NHS Trusts with the aim of informing patients about their diagnosis and available treatment options.

Objectives: The aim of this study was to identify and describe the non-surgical management of people with shoulder osteoarthritis according to publicly available information leaflets produced by NHS Trusts.

Methods: One reviewer undertook an electronic search using Google to identify publicly available patient-facing information leaflets (PIL) produced by NHS Trusts which detailed non-surgical management strategies for people with shoulder osteoarthritis. Relevant data were extracted by one reviewer and verified by two reviewers.

Results: Seventeen PILs from 17 different UK NHS Trusts were identified ranging from December 2016 to February 2024. Information provided in the PIL varied, with topics including general osteoarthritis management, exercise, analgesia, injections, and surgical indications. No PIL covered all areas recommended in the NICE Osteoarthritis Management guidelines.

Conclusion: PILs developed and published by NHS Trusts are variable in content and do not fully reflect current clinical guidelines. High-quality research to inform consistent, clinically, and cost-effective treatment pathways, including information provision, for patients with shoulder osteoarthritis is needed.

Background: Fibromyalgia Syndrome (FMS) is characterised by widespread and persistent pain, intrusive fatigue and cognitive issues, affecting approximately 5.4% of the UK population. Non-pharmacological therapies and education are current management recommendations, but these approaches rely on patients having an active role in their healthcare management. It is therefore important to identify the factors associated with FMS patients being active partners, as this could influence person-centred care provision.

Aim: The aim of this study is to explore the factors associated with patients being an active partner in the management of FMS.

Methods: This is a protocol for mixed methods systematic literature review with convergent integrated approach in accordance with JBI methodology. The databases AMED, MEDLINE, PsychINFO and CINAHL will be searched via EBSCOhost. Screening and selection will be conducted by two reviewers. Primary qualitative, observational and experimental studies from July 2005 to July 2024 will be included. Critical appraisal of eligible studies will be conducted using appropriate JBI tools. Data will be extracted, transformed where necessary and synthesised without meta-analysis.

Discussion: This mixed methods systematic review will provide a comprehensive understanding of the factors associated with patients being active partners, offering not only the 'what' but also the 'why' behind patients taking an active role in their healthcare. This will help guide future research and practice in supporting patients to be active partners in FMS management.

Trial registration: This systematic review has been registered with PROSPERO (registration number: CRD42024575159).

Introduction: Despite growing research, the relationship between social determinants of health (SDoH) and low back pain (LBP) remains inconsistent. This study aimed to investigate the associations between SDoH and self-reported LBP in the Portuguese population in 2019 and explore potential differences between rural and urban areas.

Methods: This is a cross-sectional study that includes 13,230 participants from the 2019 Portuguese National Health Interview Survey. Multivariable logistic regression models were used to assess the associations between SDoH and LBP. Interaction effects were examined to determine whether these relationships are modified by the degree of urbanisation/rurality.

Results: The regression model for demographic and economic determinants showed associations between LBP and sex, age, marital status, education and financial capacity, with older rural residents having a higher likelihood of reporting LBP. The psychosocial model revealed that poor health status, sleep disturbances, fatigue, and dissatisfaction with life course were positively associated with LBP. In the behavioural model, obesity and history of smoking increased the probability of reporting LBP, whereas exercise behaviours reduced it and significantly varied across urban and rural regions. Health-system factors, including hospital visits, medication use, consultations with rehabilitation professionals, delayed healthcare access, and unmet health needs due to financial constraints, were associated with LBP. Rural residents were more likely to seek outpatient care at hospitals.

Discussion: These findings emphasise the importance of integrating the evaluation of SDoH into healthcare settings to develop tailored interventions for LBP management.

Conclusion: LBP was influenced by several SDoH, but differences between rural and urban areas were limited.