Journal of Orthopaedic & Sports Physical Therapy最新文献

SYNOPSIS: This editorial draws an analogy between the literary genre of the 'whodunit' and the complexities of patellofemoral pain (PFP). Traditionally, PFP management has centered on biomechanical factors such as hip muscle weakness, foot pronation, and patellar tracking issues. However, long-term outcomes often remain unsatisfactory, highlighting the need for alternative strategies. The editorial underscores the significance of addressing the predominant pain pathway rather than relying solely on biomechanical assessments. It calls for future research to integrate pain characteristics into clinical practice to enhance outcomes.Just as a mystery is difficult to solve by focusing on 1 suspect, PFP is a multifaceted condition arising from a variety of contributing factors, including pain pathways that are often overshadowed by biomechanics. By thoroughly examining the dimensions and characteristics of pain, clinicians and researchers can refine clinical strategies and advance patient care, and ensure a tailored approach to managing this challenging condition. J Orthop Sports Phys Ther 2025;55(2):1-3. Epub 15 January 2025. doi:10.2519/jospt.2025.12883.

Author response to the JOSPT Letter to the Editor-in-Chief "Letter to the Editor Regarding "Early Surgery Versus Exercise Therapy and Patient Education for Traumatic and Nontraumatic Meniscal Tears in Young Adults-an Exploratory Analysis From the DREAM Trial"" J Orthop Sports Phys Ther 2025;55(1):71. doi:10.2519/jospt.2025.0201-R.

Letter to the Editor-in-Chief in response to JOSPT article "Early Surgery Versus Exercise Therapy and Patient Education for Traumatic and Nontraumatic Meniscal Tears in Young Adults-an Exploratory Analysis From the DREAM Trial" by Damsted et al. J Orthop Sports Phys Ther 2025;55(1):70. doi:10.2519/jospt.2025.0201.

OBJECTIVE: To explore trajectories of 12-week adherence to a digital education and exercise therapy for knee and hip osteoarthritis (OA), associations with baseline characteristics, and trajectories of patient-reported outcomes measures (PROMs) up to 1-year follow-up. DESIGN: Retrospective cohort (registry) study. METHODS: Weekly data on adherence (ie, the percentage of completed activities [exercises, lessons, and quizzes]) were obtained over 12 weeks (n = 14 097). Longitudinal k-means clustering was used to identify adherence trajectory clusters. Associations of baseline characteristics with adherence trajectory clusters were assessed using multinomial logistic regression. Trajectories of each PROM (pain, function, and general health) from baseline up to 1-year follow-up (measured at 3-month intervals) across adherence trajectory clusters were explored using generalized estimating equations adjusted for baseline characteristics. RESULTS: Four adherence trajectory clusters were identified: "high-persistent" (68.0%), "high-declining" (16.6%), "moderate-increasing" (8.5%), and "moderate-declining" (6.9%). Multinomial logistic regression suggested that female sex, older age, lower body mass index, lower education, living outside metropolitan cities, higher level of physical activity, less anxiety/depression, no fear of movement, having walking difficulties, and higher readiness to do exercise were associated with a higher probability of assignment to "high-persistent" than other clusters. Beliefs/perceptions and sociodemographic factors accounted for most of the explained variation in adherence trajectory clusters. While "high-persistent" cluster generally reported better outcomes than other clusters, these differences were small. CONCLUSION: While there were variations in adherence to the digital treatment, participants reported clinically comparable PROMs regardless of their adherence trajectory cluster. J Orthop Sports Phys Ther 2025;55(1):1-12. Epub 22 November 2024. doi:10.2519/jospt.2024.12864.

OBJECTIVE: To summarize the content and critically appraise the quality and applicability of recent clinical practice guidelines (CPGs) for nonpharmacological, nonsurgical management of spine pain. DESIGN: Systematic review of CPGs. LITERATURE SEARCH: Six databases and seven guideline clearinghouses. STUDY SELECTION CRITERIA: Included de novo CPGs for nonpharmacological, nonsurgical management of spine pain designed for any primary health care providers, published in English, Arabic, French, or traditional Chinese within the past 12 years. DATA SYNTHESIS: Five reviewers independently appraised the guidelines using AGREE II and AGREE-REX. Interrater agreements were calculated for each domain and the total score of these tools using the intraclass correlation coefficient (2, 1) with absolute agreement. RESULTS: We included 30 CPGs, primarily (90%) developed in Western countries, which contained 404 recommendations. High-quality CPGs consistently recommended exercise therapy and multimodal care, encompassing a combination of exercises, mobilization/manipulation, education, alternative medicine, and cognitive-behavioral treatments. Generally, CPGs did not recommend assistive (eg, corsets and orthosis) devices or electro/thermotherapies (eg, therapeutic ultrasound and transcutaneous electrical nerve stimulation). Approximately half of the CPGs demonstrated good methodological quality according to AGREE II, whereas the rest were of poor quality. On the AGREE-REX assessment, one third of the recommendations were of excellent quality. CONCLUSION: Although recent guidelines frequently recommended exercise therapy and multimodal care for the management of spine pain, their recommendations often overlooked demographics and comorbidities. Despite methodological improvements, most CPGs lacked simple clinical applicability and considerations of knowledge users' values. J Orthop Sports Phys Ther 2025;55(1):1-14. Epub 4 November 2024. doi:10.2519/jospt.2024.12729.

Author response to the JOSPT Letter to the Editor-in-Chief "Reinterpreting the Clinical Practice Guidelines for Plantar Heel Pain Through an International Lens" J Orthop Sports Phys Ther 2025;55(1):73-74. doi:10.2519/jospt.2025.0202-R.

OBJECTIVE: To evaluate the relative efficacy of various physical therapy interventions for chronic ankle instability (CAI). DESIGN: A network meta-analysis of randomized controlled trials. LITERATURE SEARCH: PubMed, Cochrane Library, Embase, Scopus, and CINAHL bibliographic databases were searched up to December 2023. STUDY SELECTION CRITERIA: Randomized controlled trials examining nonsurgical treatments for CAI. DATA SYNTHESIS: We used frequentist network meta-analysis to assess 8 outcomes across 44 trials, including the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) scale or Sport scale, Cumberland Ankle Instability Tool (CAIT), Star Excursion Balance Test (SEBT) in 3 directions (anterior [A], posteromedial [PM], and posterolateral [PL]), dorsiflexion range of motion, and pain. Surface under the cumulative ranking curve (SUCRA) values identified the most effective interventions. RESULTS: Based on SUCRA rankings, a regimen combining balance and strengthening exercises, augmented with either manual therapy or dry needling, was identified as the most effective in enhancing function (SUCRA: FAAM ADL = 95.2% [manual]/83.9% [dry needling]; FAAM Sport = 87.9% [manual]/80.1% [dry needling]), improving dynamic balance (SUCRA [manual]: SEBT-A = 92.1%; SEBT-PM = 98.0%; SEBT-PL = 90.8%), and significantly relieving pain (SUCRA: 99.9%). A multimodal exercise approach combined with manual therapy showed superior efficacy in increasing dorsiflexion (SUCRA: 61.6%). Tai chi emerged as the most promising intervention for improving stability (SUCRA: 99.9%). CONCLUSION: Interventions that emphasized strengthening and balance exercises were the most effective strategy for achieving best function and pain relief for patients with CAI. Multimodal exercises and tai chi might improve ankle range of motion and instability, respectively. J Orthop Sports Phys Ther 2025;55(1):26-44. Epub 20 December 2024. doi:10.2519/jospt.2024.12601.

OBJECTIVE: We sought to develop recommendations to inform a framework for comprehensively assessing upper and lower limb pain in athletes including the key assessment items sports physiotherapists should consider. DESIGN: Real-time Delphi. METHODS: We recruited sports physiotherapists who were currently working with athletes through the International Federation of Sports Physical Therapists and Irish Society of Chartered Physiotherapists. Participants voted on 86 pain assessment items chosen using best available evidence. The real-time Delphi method facilitated independent anonymous voting, commenting, and immediate review of consensus. Participants indicated level of agreement for inclusion in an upper and lower limb athlete pain assessment framework on a 6-point Likert scale from strongly disagree to strongly agree, and how often they are/will be required in practice on a 5-point scale from never to always. Criteria for consensus agreement and inclusion were (1) >70% sports physiotherapists voting agree/strongly agree AND (2) median vote selected by physiotherapists was agree or strongly agree. RESULTS: Forty-one sports physiotherapists (female, n = 20; male, n = 21), visited the survey an average of 5.3 times (±5), resulting in a completion rate of 98%. Sixty-four assessment items (neurophysiological, n = 20; biomechanical, n = 15; affective, n = 8; cognitive, n = 3; socioenvironmental, n = 10; general assessment aspects of assessment, n = 8) met the criteria for consensus. Frequency of use in practice was always for 28 items often for 32 items and sometimes for 4 items. CONCLUSION: We have presented stakeholder-generated recommendations and priorities for assessing athletes' pain. J Orthop Sports Phys Ther 2025;55(1):1-11. Epub 22 November 2024. https://doi.org/10.2519/jospt.2024.12807.

OBJECTIVES: To explore the extent of functional improvement following primary total knee arthroplasty for knee osteoarthritis and to compare the trajectories of self-reported and performance-based measures of physical function. DESIGN: Longitudinal systematic review with meta-analysis METHODS: We searched 3 electronic databases from January 2005 to February 2023 for longitudinal cohort studies involving adults with knee osteoarthritis undergoing primary total knee arthroplasty. Estimates of self-reported and performance-based physical function were extracted presurgery and up to 5 years postsurgery. Risk of bias was assessed using a 6-item checklist. Self-reported function scores were converted to a 0-100 scale (higher scores indicate worse function). Mixed models provided pooled estimates after excluding low-quality studies. RESULTS: Out of 230 relevant studies, 72 (n = 19 063) of high quality were included in meta-analyses. Self-reported function significantly improved from presurgery (55.6/100; 95% confidence interval [CI], 53.1 to 58.1) to 3-6 months postsurgery (21.1; 95% CI, 17.9 to 24.3; P<.001). A small decline in self-reported function occurred at 6-12 months (31.0; 95% CI, 25.8 to 36.2; P<.001), with no further change at 12-24 months (30.9; 95% CI, 23.2 to 38.6; P = .919). Performance-based measures exhibited variable trajectories, with most estimates indicating no clinically meaningful improvement following total knee arthroplasty. CONCLUSION: Total knee arthroplasty resulted in clinically meaningful improvements in self-reported function at 3-6 months postoperatively. There was some deterioration in function after 6 months, and at no other time point did the estimate reach a clinically important change. There was limited evidence of clinically meaningful improvements in performance-based measures of physical function at any time point. J Orthop Sports Phys Ther 2025;55(1):1-11. Epub 26 November 2024. doi:10.2519/jospt.2024.12570.

Midportion tendinopathy is a common overuse lower extremity injury, with a prevalence of 4% to 7%. Achilles tendinopathy especially affects people who participate in activities that load the Achilles tendon, such as running. The Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire has been the go-to patient-reported outcome measure of the perceived impact of Achilles tendinopathy. Recently, new instruments have been developed to try and overcome concerns about the validity of the VISA-A. The revised CPG summarized current evidence, and updated recommendations to support evidence-based practice, including tailored clinical decision-making, about managing Achilles tendinopathy. The CPG excluded interventions that were outside the typical scope of physical therapy practice (eg, pharmacological interventions and surgery) and extracorporeal shock wave therapy. J Orthop Sports Phys Ther 2025;55(1):68-69. doi:10.2519/jospt.2025.0501.