Journal of Orthopaedic & Sports Physical Therapy最新文献

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.

OBJECTIVE: To evaluate the cost utility of 2 emergency department (ED) care models: management by an emergency physician (EP; usual care), and management by a primary contact physical therapist (PT) and an EP (PT + EP; intervention). DESIGN: Cost-utility analysis based on data collected during a pilot pragmatic randomized clinical trial over a 3-month period (NCT04009369). METHODS: We measured health-related quality of life (HRQoL) and health resource use at baseline, and 1 and 3 months, using the EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L) and a standardized health care resource use questionnaire. Responses to the EQ-5D-5L were transformed into utility scores (Canadian conversion algorithm), and then into quality-adjusted life years (QALYs) using area-under-the-curve analyses. Costs and QALYs were used to derive incremental cost-effectiveness ratios for each perspective. We conducted a complete case analysis (main analysis), and missing data were imputed using multiple imputation (sensitivity analysis). RESULTS: After 3 months, participants managed by the PT + EP had a QALY gain of 0.195 (95% confidence interval [CI]: 0.179, 0.209), compared to 0.182 (95% CI: 0.168, 0.195) for those managed by the EP alone. The average total cost in the PT + EP group for the public payer was $469.23/patient (95% CI: $269.30, $708.85) and $878.37/patient for society (95% CI: $559.72, $1208.23), compared with $804.70/patient (95% CI: $225.58, $1972.78) and $1288.76/patient (95% CI: $551.84, $2452.48), respectively, in the EP group (2019 CAD). PT + EP management was dominant for the public payer and Canadian society perspectives. CONCLUSION: The addition of PTs in EDs may reduce expenses for the public payer and society, while improving HRQoL. J Orthop Sports Phys Ther 2026;56(2):109-118. Epub 27 November 2025. doi:10.2519/jospt.2025.13429.

OBJECTIVES: To (1) assess the efficacy of combining repetitive transcranial magnetic stimulation (rTMS) and motor control exercise on pain intensity compared to each intervention alone or a placebo in patients with nonspecific chronic low back pain (CLBP), and (2) evaluate the effects of motor control exercise versus no-motor control exercise, and active rTMS versus sham rTMS. DESIGN: Factorial randomized controlled trial. METHODS: Adults aged 18 to 65 years with nonspecific CLBP were randomly assigned in a 1:1:1:1 ratio to 1 of 4 groups: active rTMS, sham rTMS, active rTMS + motor control exercise, and sham rTMS + motor control exercise. Participants received 10 sessions of their allocated intervention over 8 weeks. Active and sham rTMS were performed over the primary motor cortex (10 Hz, 2000 pulses/session). The primary outcome was the average pain intensity at 8 weeks. RESULTS: One hundred forty participants (80 females; mean age, 38.4 years) were recruited. Pain intensity significantly reduced over time, with no difference between groups. At 8 weeks, active rTMS + motor control exercise was not better than active rTMS (mean difference [MD], 0.1; 95% confidence interval [CI]: -1.0, 1.1; P = .89), sham rTMS (MD, 0.1; 95% CI:-0.9, 1.1; P = .83), or sham rTMS + motor control exercise (MD, 0.8; 95% CI: -0.3, 1.8; P = .15) to reduce pain. No significant differences in pain intensity were found between active and sham rTMS groups, with or without motor control exercise at 8 weeks. CONCLUSIONS: Combining rTMS and motor control exercise did not significantly reduce pain intensity compared to each intervention used alone or placebo in participants with CLBP. J Orthop Sports Phys Ther 2026;56(1):1-10. Epub 30 October 2025. doi:10.2519/jospt.2025.13681.

OBJECTIVE: To assess how different diagnostic labels affect treatment preferences and beliefs in people with musculoskeletal pain. DESIGN: Systematic review of randomized trials. LITERATURE SEARCH: PubMed, Web of Science, MEDLINE, CINAHL, SPORTDiscus, PsycINFO, ClinicalTrials.gov, and the Australian New Zealand Clinical Trials Registry (ANZCTR) (from inception to September 17, 2025). STUDY SELECTION CRITERIA: Randomized trials evaluating the impact of diagnostic labels for musculoskeletal pain on treatment preferences and beliefs. Studies using hypothetical vignettes were eligible. DATA SYNTHESIS: The primary outcomes were patient treatment preferences and beliefs. Due to heterogeneity of labels and accompanying explanations, a narrative synthesis approach was conducted. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: Five vignette-based randomized trials involving 7575 participants were included. Risk of bias was rated as low to some concerns across all outcomes. Low-certainty evidence suggested that specific diagnostic labels may increase patient preferences for imaging and surgery and may increase the perceived seriousness of the condition. Non-specific labels may lead to more positive recovery beliefs and reduced perceived need for invasive treatments, and to lower patient satisfaction. The information accompanying these labels (eg, explanations, reassurance) may have influenced outcomes. CONCLUSION: Based on low-certainty evidence, specific diagnostic labels may increase demand for invasive care and foster more negative recovery expectations. Non-specific labels may encourage non-invasive management but can contribute to patient dissatisfaction. J Orthop Sports Phys Ther 2026;56(1):4-15. Epub 3 December 2025. doi:10.2519/jospt.2025.13759.

OBJECTIVE: To investigate the effectiveness and cost-effectiveness of an Internet-based self-management program compared with an online booklet for people with chronic musculoskeletal pain. DESIGN: Parallel-group, randomized controlled superiority trial with economic evaluation conducted in Brazil. METHODS: Patients with chronic musculoskeletal pain were randomly allocated to receive an Internet-based self-management program (ReabilitaDOR) or an online booklet. Participants were recruited from university- and community-based physical therapy clinics and through social media. The primary outcome was pain intensity at 8 weeks. The secondary outcomes were function; quality of life; kinesiophobia; global perceived effect; anxiety and depression; pain catastrophizing; pain-related attitudes and beliefs; self-efficacy; and adverse effects at 8 weeks, 6 months, and 12 months after randomization. The economic evaluation from the societal perspective was conducted for pain intensity and quality-adjusted life years (QALYs). RESULTS: We included 162 participants (ReabilitaDOR, n = 83; online booklet, n = 79). There was no statistically significant difference in pain intensity between groups at 8 weeks (mean difference: -0.74; 95% confidence interval: -1.5, 0.04), and no significant differences in the secondary outcomes. From a societal perspective, the intervention had a 0.98 probability of being cost-effective at a willingness-to-pay threshold of $200 per point of improvement in pain intensity and 0.63 at a willingness-to-pay threshold of $50 000 per QALY gained compared to the control group. CONCLUSION: An Internet-based self-management program was not superior to an online booklet for chronic musculoskeletal pain. The Internet-based self-management program seemed to be a cost-effective intervention for pain intensity, but not for QALYs. These findings should be interpreted with caution due to high dropout rates and the trial running during the COVID-19 pandemic. J Orthop Sports Phys Ther 2026;56(1):1-12. Epub 30 October 2025. doi:10.2519/jospt.2025.13418.

Author response to the JOSPT Letters to the Editor-in-Chief "Neuromuscular Control and Resistance Training for Chronic Low Back Pain: Discussing A Randomized Controlled Trial" and "Comment on: Neuromuscular Control and Resistance Training for People with Chronic Low Back Pain: A Randomized Controlled Trial." J Orthop Sports Phys Ther 2026;56(1):65-66. doi:10.2519/jospt.2026.0201.

Infographic illustrating the article "People With Acute Low Back Pain Have Concerns That May Not Be Addressed by Guideline-Recommended Advice: A Mixed-Methods Study", which was published in the September 2024 issue of JOSPT. J Orthop Sports Phys Ther 2026;56(1):64. doi:10.2519/jospt.2026.9001.