Journal of Orthopaedic & Sports Physical Therapy最新文献

OBJECTIVE: The aim was to (1) describe structural changes of the anterior cruciate ligament (ACL), evaluated by magnetic resonance imaging (MRI), within 6 weeks until 24 months after ACL injury, and (2) investigate the relationship between ACL structural continuity and patient-reported and clinically assessed outcomes. DESIGN: Longitudinal pragmatic cohort study. METHODS: We included 129 patients, aged 15 to 40 years, with acute ACL injury from the NACOX (natural corollaries and recovery after an acute ACL injury) cohort. Patients were treated according to usual clinical practice, which comprised supervised rehabilitation before considering ACL reconstruction. At baseline and at 3, 6, 12, and 24 months follow-up, 3-Tesla 3-dimensional proton-density fat-saturated MRI scans, and patient-reported and objectively measured outcomes were assessed. The ACL Continuity, Thickness, and Shape (ACTS) scoring system was used for MRI assessment. RESULTS: At 24 months, 60 (47%) participants had received ACL reconstruction. At the last available MRI, 55 (48%) patients had overall ACL structure in continuity and 49 (43%) had ACL fibers in continuity. The overall ACL structure and fiber continuity on ACTS improved by at least 1 step in 31% to 81% of the patients at the different follow-ups. Ligament structure in continuity was associated with fewer giving-way episodes (11% versus 50%, P = .033) and reduced knee laxity at 12 months (side-to-side difference ≥ 3 mm: 53% versus 88%, P = .026) and 24 months (52% versus 100%, P = .013). Results for patient-reported outcomes were inconclusive due to wide confidence intervals. CONCLUSION: The ACL structure improved during the first 24 months after ACL injury when managed without ACL reconstruction. Continuity of ligament structure was associated with fewer giving-way episodes and lower knee laxity. J Orthop Sports Phys Ther 2026;56(3):209-219. Epub 4 February 2026. doi:10.2519/jospt.2026.13397.

OBJECTIVE: To estimate the effectiveness of patient education and self-management interventions for osteoarthritis (OA) in adults aged ≥18 years. DESIGN: Overview of intervention systematic reviews (SRs). LITERATURE SEARCH: Eight databases (MEDLINE [Medical Literature Analysis and Retrieval System Online], Cochrane Library, EMBASE [Excerpta Medica Database], Epistemonikos, Web of Science, Scopus, PEDro [Physiotherapy Evidence Database], and CINAHL [Cumulative Index to Nursing and Allied Health Literature]) were searched from inception to June 26, 2024. STUDY SELECTION CRITERIA: We included intervention SRs, with or without meta-analysis (MA), that evaluated patient education or self-management interventions for adults with OA, reporting pain or functional outcomes. DATA SYNTHESIS: Data were extracted using a standardized template. We extracted intervention effects on pain and function. Methodological quality was evaluated using the AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews) checklist. We assessed the overlap of studies included in the SRs using the corrected covered area (CCA) method. RESULTS: Nineteen SRs (12 with MA) encompassing 171 trials were included. Patient education interventions had modest effects on reducing short-term pain (standardized mean difference [SMD], -0.22 to -0.35). There were no sustained or consistent effects of patient education interventions on function. Self-management interventions yielded small and consistent effects on reducing pain (SMDs ranging approximately from -0.20 to -1.51) and improving function (SMDs up to 1.95), especially over the long term and when combined with patient education. Methodological quality was generally low; 1 SR was rated as high quality. There was a slight overlap among included trials (CCAs of 1.5% for patient education and 4.6% for self-management). CONCLUSION: Self-management interventions, particularly when integrated with patient education or other therapies, may offer more robust and lasting benefits for OA management than patient education alone. J Orthop Sports Phys Ther 2026;56(3):176-192. Epub 4 February 2026. doi:10.2519/jospt.2026.13407.

OBJECTIVE: To compare the effects of supervised physical therapy to home exercise programs on functional outcomes in patients after distal radius fractures. DESIGN: Intervention systematic review with meta-analysis of randomized clinical trials (RCTs). LITERATURE SEARCH: We searched MEDLINE, EMBASE, Web of Science, Scopus, CENTRAL, Epistemonikos, Cumulative Index of Nursing and Allied Health Literature, SPORTDiscus, Physiotherapy Evidence Database, and LILACS databases from inception to April 2025. STUDY SELECTION CRITERIA: We included RCTs comparing supervised physical therapy with a home exercise program on functional outcomes in patients with distal radius fracture. DATA SYNTHESIS: We used a random-effects meta-analysis for clinically homogeneous RCTs. We assessed risk of bias using the Cochrane Risk of Bias 2.0 and applied the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to judge the certainty of evidence. RESULTS: Thirteen RCTs were included. At 6 weeks, there were significant differences for Patient-Rated Wrist Evaluation (mean difference [MD] = -11.64 points, P < .001) with moderate certainty of evidence, for grip strength relative to the unaffected side (MD = 12.85%, P = .03) with low certainty of evidence, and for wrist extension range of motion (MD = 8.99°, P = .03) with moderate certainty of evidence. All results were in favor of the supervised physical therapy group. There were significant differences in favor of supervised physical therapy for wrist function and extension range of motion in patients over 65 years (P < .05). A greater number and frequency of supervised physical therapy sessions were associated with greater pain relief and improved wrist range of motion (P < .05). CONCLUSION: Supervised physical therapy had statistically significant short-term benefits in wrist function, grip strength, and wrist extension range of motion. J Orthop Sports Phys Ther 2026;56(3):158-175. Epub 4 February 2026. doi:10.2519/jospt.2026.13561.

SYNOPSIS: The Moving Forward Together series was developed to inform, guide, and inspire musculoskeletal physical therapists to bring Indigenous health to the forefront of their work in clinical practice, research, and education and to strengthen their roles in allyship and advocacy for Indigenous Communities. In this, the second article of the series, we examine the clinical practice of individual physical therapists and physical therapy services. Our group-comprising Indigenous and non-Indigenous clinicians and/or academics from Aotearoa/New Zealand, Australia, Canada, and Samoa-reflected on current initiatives and explored future directions to offer suggestions on how physical therapists can contribute to positive change within Indigenous musculoskeletal clinical practice in order to improve the musculoskeletal health of Indigenous Peoples. Here, we take a practical, skills-based approach in describing ways to provide respectful and equitable musculoskeletal health care for Indigenous Peoples. J Orthop Sports Phys Ther 2026;56(3):128-134. doi:10.2519/jospt.2026.13739.

OBJECTIVE: To (1) examine Malawian physical therapists' knowledge and beliefs about osteoarthritis (OA), and their perceived capabilities to deliver an OA management program to people with knee and hip OA, and (2) identify barriers and facilitators for an OA management program in Malawi. DESIGN: Two-phased mixed-methods formative evaluation. METHODS: In phase 1, Malawian physical therapists participated in the Good Life with osteoArthritis in Denmark (GLA:D) Australia training course and answered quantitative precourse and postcourse questions that were descriptively summarized, and analysed using McNemar's test, where appropriate. In phase 2, semistructured focus groups generated qualitative data that were thematically analyzed and mapped to the Consolidated Framework for Implementation Research. Mixed-methods data were integrated through triangulation. RESULTS: Eleven Malawian physical therapists (9 [82%] female, 10 [91%] with 5-10 years of clinical experience) participated. From pretraining to posttraining course, participants' knowledge of OA management (percentage change) increased regarding the benefits of therapeutic exercise (91%), importance of weight management (82%), and acceptable symptoms profile (73%). Participants' confidence and beliefs in managing knee and hip OA also increased. Implementation barriers included program costs, current medical management of OA with painkillers, and infrastructure challenges. Implementation facilitators included the content and organization of GLA:D, adaptability of the program, and OA awareness and education among other health professionals. CONCLUSION: Knowledge, confidence, and beliefs in managing knee and hip OA improved post-GLA:D training in Malawian physical therapists. Increasing education of physical therapists, other health professionals, and the public about evidence-based OA management and making contextual adaptions to the GLA:D training and program structure may facilitate implementation of OA management program, such as GLA:D, in low- and-middle-income countries. J Orthop Sports Phys Ther 2026;56(3):193-208. Epub 4 February 2026. doi:10.2519/jospt.2026.13317.

OBJECTIVE: To explore athletes' experiences of "reinjury concerns" in those with lived experience of anterior cruciate ligament (ACL) injury. DESIGN: Systematic review with qualitative evidence synthesis. LITERATURE SEARCH: CINAHL, SPORTDiscus, Scopus, MEDLINE, PsychINFO, and ProQuest Dissertations were searched until January 2025. STUDY SELECTION CRITERIA: Two reviewers independently and in parallel screened studies for inclusion if they were (1) qualitative or mixed-methods; (2) included participants who were athletes with lived experience of an ACL injury; (3) reported the phenomenon of interest, "reinjury concerns," within the findings; and (4) published in English. DATA SYNTHESIS: We applied thematic synthesis based on Thomas and Harden's approach aligned to a constructivist paradigm and followed relevant checklists for performing and reporting a systematic review and qualitative evidence synthesis. Confidence in the findings was evaluated using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual). RESULTS: Forty-five studies were included, comprising 611 participants. Themes described how athletes assessed the threat of reinjury (theme 1), experienced reinjury concerns across a multidimensional spectrum (theme 2), and coped with reinjury concerns (theme 3). Confidence in the findings was mostly rated moderate-high according to the GRADE-CERQual assessment. CONCLUSION: Athletes' experiences of reinjury concerns after ACL injury were multidimensional and shaped by individual beliefs and contexts. Our findings support shifting from the narrow construct fear of reinjury toward a broader conceptualization of reinjury concerns that more accurately reflects athletes' lived experiences and may better inform assessment and clinical approaches after ACL injury. J Orthop Sports Phys Ther 2026;56(3):135-157. Epub 5 February 2026. doi:10.2519/jospt.2026.13852.

OBJECTIVE: To systematically review, map, and appraise the existing prospective evidence on risk factors for, and preventive strategies against, the development of patellofemoral pain (PFP), and to identify key gaps. DESIGN: The study design was a systematic evidence and gap map (EGM). LITERATURE SEARCH: Nine electronic databases (PubMed, CINAHL, PEDro, Scopus, SPORTDiscus, Embase, Cochrane, Web of Science, CENTRAL) were searched from inception to the end of March 2024. STUDY SELECTION CRITERIA: Published prospective observational studies and randomized controlled trials (RCTs) investigating the development of PFP in individuals without baseline PFP were included. Studies of other knee conditions, older adults (mean age > 45), or retrospective designs were excluded. DATA SYNTHESIS: Evidence was mapped across the following domains: sociodemographic, neurobiological, anthropometric, psychological, biomechanical, and behavioral. RESULTS: From 57,897 identified records, 36 studies were included: 24 prospective observational studies and 12 RCTs. Most studies focused on biomechanical risk factors (n=22), with limited exploration of psychological (n=1), behavioral (n=2), and neurobiological (n=1) domains. Preventive interventions involved orthoses (n=4), exercise (n=3), bracing (n=2), gait retraining (n=1), stretching (n=1), or running intensity/volume modification. Nonbiomechanical strategies such as education or graded exposure were rarely tested. Risk of bias was low to moderate for most prospective observational studies and moderate to high for most RCTs. CONCLUSION: This EGM reveals an overreliance on biomechanical perspectives within the context of PFP risk factor research, with limited attention to psychosocial, behavioral, and load-related risk factors. Preventive trials are few, often low in quality, and narrowly focused. Addressing these evidence gaps is essential for developing effective, multifactorial prevention strategies for PFP. J Orthop Sports Phys Ther 2026;56(2):85-97. Epub 15 December 2025. doi:10.2519/jospt.2025.13489.

OBJECTIVES: (1) To compare the prevalence of self-reported hip crepitus between football (soccer and Australian football) players with and without hip/groin pain. In players with hip/groin pain, to (2) explore the association of hip crepitus with early hip osteoarthritis structural features, and (3) explore the association between hip crepitus and the change in these features over 2 years. METHODS: Data from 178 subelite football players with hip/groin pain and 60 pain-free controls were analyzed. The presence and severity of hip crepitus were assessed using a single item of the Copenhagen Hip and Groin Outcome Score and the International Hip Outcome Tool-33, respectively. Participants had radiographs and 3-Tesla magnetic resonance imaging. Bony hip morphology was evaluated using the alpha angle and lateral center-edge angle. The scoring of hip osteoarthritis with magnetic resonance imaging classification was used to evaluate cartilage defects and labral tear presence, location, and severity. Regression models explored the prevalence and associations of self-reported hip crepitus with early hip osteoarthritis features. RESULTS: Football players with hip/groin pain had a higher prevalence (prevalence ratio = 5.0; 95% CI: 2.5, 10.2) of hip crepitus compared to controls. Hip crepitus was only associated with the number of cartilage subregions affected in the hip/groin pain group (odds ratio = 2.08; 95% CI: 1.05, 4.11; P = .03) at baseline, but not with other features. CONCLUSION: Football players with hip/groin pain had a higher prevalence and severity of hip crepitus compared to controls. Hip crepitus was associated with the number of cartilage subregions affected in football players. J Orthop Sports Phys Ther 2026;56(2):119-127. Epub 26 December 2025. doi:10.2519/jospt.2025.13474.

OBJECTIVE: To synthesize the literature and generate evidence and gap maps examining randomized controlled trial (RCT) interventions and outcome measures for patellofemoral pain (PFP). DESIGN: A systematic evidence and gap map. LITERATURE SEARCH: PubMed, CINAHL Complete via EBSCO, PEDro, Scopus, SPORTDiscus (EBSCO), Embase via Ovid, Cochrane Database of Systematic Reviews via Ovid, Web of Science, and CENTRAL. STUDY SELECTION CRITERIA: Peer-reviewed RCTs, pilot RCTs, and pilot feasibility RCTs evaluating interventions for PFP. DATA SYNTHESIS: Interventions were mapped against outcomes. The Cochrane Risk of Bias tool was used to assess risk of bias, and the PFP diagnosis checklist was used to assess the criteria used in each study to confirm a diagnosis of PFP. RESULTS: A total of 307 studies were included. The most frequently included intervention was physical intervention, particularly therapeutic exercises (n = 281, 82%); 59 studies (19%) included nonphysical interventions. Pain outcomes were included in 274 studies (89%), and patient-reported physical function in 216 (70%). Other outcomes, such as activity or movement-related psychological factors, quality of life, and sleep, were infrequently assessed (each <10%). Two hundred seven studies (67%) were at high risk of bias, and 45 studies (15%) met the recommended PFP diagnostic criteria checklist. CONCLUSION: Among 307 RCTs, with approximately three quarters published in the past 10 years, there was an uneven focus on physical interventions and pain and physical function outcomes. J Orthop Sports Phys Ther 2026;56(2):98-108. Epub 5 January 2026. doi:10.2519/jospt.2026.13511.

OBJECTIVE: To estimate the effects of rehabilitation interventions on strength in people with rotator cuff-related shoulder pain (RCRSP). DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: Seven databases were searched from inception to April 2024. STUDY SELECTION CRITERIA: Clinical trials or cohort studies reporting the effects of interventions lasting at least 6 weeks on objective strength outcomes in adults with RCRSP were included. Studies were excluded if they involved adults with other shoulder-related pathologies, focused exclusively on rotator cuff tears, or included participants who had undergone shoulder surgery. DATA SYNTHESIS: We grouped strength testing results from individual studies according to the direction of the strength test. Meta-analyses were conducted using standardized within-group mean difference from baseline to primary follow-up for each study intervention arm. RESULTS: Twenty-eight studies were included in the meta-analysis. Rehabilitation interventions had a moderate effect on shoulder external rotation strength (standardized mean difference [SMD], 0.56; 95% confidence interval [CI]: 0.39, 0.74; I² = 78%; P < .01) and a small effect on shoulder abduction (SMD, 0.47; 95% CI: 0.32, 0.63; I² = 54%; P < .01), internal rotation (SMD, 0.41; 95% CI: 0.30, 0.52; I² = 25%; P < .08), flexion (SMD, 0.25; 95% CI: 0.01, 0.49; I² = 0%; P = .46), and scaption (SMD, 0.48; 95% CI: 0.27, 0.70; I² = 35%; P = .14) strength. Interventions that included strength training or active exercises had small-to-moderate effects on all strength outcomes. Interventions without exercises or strength training had no effects. CONCLUSION: Rehabilitation interventions improved strength in people with RCRSP. Interventions that incorporated active exercises or strength training are recommended to address strength deficits in people with RCRSP. J Orthop Sports Phys Ther 2026;56(2):67-84. Epub 16 December 2025. doi:10.2519/jospt.2025.13445.