Letter to the Editor-in-Chief in response to the JOSPT article "Proprioceptive Exercises Combined With Strengthening Exercises Are not Superior to Strengthening Exercises Alone for Shoulder Pain and Disability in Individuals With Chronic Rotator Cuff-Related Shoulder Pain: A Randomized Controlled Trial" by Buccioli et al. J Orthop Sports Phys Ther 2025;55(12):1-2. doi:10.2519/jospt.2025.0204.
Author response to the JOSPT Letter to the Editor-in-Chief "Methodological Considerations for Proprioceptive Training in Rotator-Cuff Related Shoulder Pain: Response to "Proprioceptive Exercises Combined With Strengthening Exercises Are not Superior to Strengthening Exercises Alone for Shoulder Pain and Disability in Individuals With Chronic Rotator Cuff-Related Shoulder Pain: A Randomized Controlled Trial"" J Orthop Sports Phys Ther 2025;55(12):1-2. doi:10.2519/jospt.2025.0204-R.
OBJECTIVE: To compare psychological factors between those with tendinopathy and nontendinopathy controls. STUDY DESIGN: Prognosis systematic review with meta-analysis (PROSPERO:CRD42023489445). LITERATURE SEARCH: Seven databases were searched until September 24, 2024. STUDY SELECTION CRITERIA: Studies comparing psychological factors between people with and without tendinopathy were included. We excluded studies that exclusively evaluated participants with tendon tears, tendon ruptures, systemic conditions, fibromyalgia, or psychiatric disorders. DATA SYNTHESIS: Data were pooled across tendinopathy sites for each psychological factor. Meta-analyses were performed for each psychological factor, using a random-effects model to calculate effect sizes and 95% confidence intervals (95% CIs). Upper-limb and lower-limb tendinopathy sites were separated for subgroup analysis. The methodological quality of each study was appraised using Joanna Briggs Institute checklists, and certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation criteria. RESULTS: People with tendinopathy had higher pain catastrophizing (n = 7, mean difference [MD] = 4.01, 95% CI = 0.6, 7.41) than those without tendinopathy. Depression (n = 5, standard mean difference [SMD] = 0.46, 95% CI = 0.11, 0.8) and anxiety (n = 4, SMD = 0.45, 95% CI = 0.01, 0.89) were higher in those with lower-limb tendinopathy compared to nontendinopathy controls. We detected poorer mental health in people with lower-limb tendinopathy (n = 2, MD = 72, 95% CI = -6.68, -0.75) and no differences in kinesiophobia (n = 4), general self-efficacy (n = 2), extraversion (n = 2), or neuroticism (n = 2). CONCLUSION: People with tendinopathy had different psychological profiles than people without tendinopathy. J Orthop Sports Phys Ther 2025;55(12):1-18. Epub 5 November 2025. doi:10.2519/jospt.2025.13307.
OBJECTIVE: To estimate the prevalence of rotator cuff (RC) imaging abnormalities (tendinopathy, partial-thickness tear, full-thickness tear, or calcification) on radiograph, ultrasound, computed tomography, or magnetic resonance imaging (MRI) in asymptomatic adult shoulders. STUDY DESIGN: Systematic review. LITERATURE SEARCH: Ovid MEDLINE, Embase, CINAHL, and Web of Science (searched September 1, 2024), with forward and backward citation searches. STUDY SELECTION CRITERIA: We included studies reporting the prevalence of RC abnormalities on imaging of asymptomatic shoulders. DATA SYNTHESIS: Due to heterogeneity, data were synthesized without meta-analysis. Risk of bias was assessed using a tool for prevalence studies. Certainty of evidence was determined using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: After screening 3801 records and 188 studies in full text, we included 53 studies (29 ultrasound, 24 MRI) across population-based, miscellaneous, and athlete populations. The certainty of evidence was low to very low. For full-thickness tears, prevalence on ultrasound was 11% to 17% in 2 population-based samples (1631 shoulders), 0% to 35% across 14 studies of miscellaneous populations (3390 shoulders), and 0% to 22% across 4 studies of athlete populations (346 shoulders). On MRI, the prevalence was 20% in 1 population-based study (20 shoulders), 0% to 14% across 10 studies of miscellaneous populations (490 shoulders), and 0% to 11% across 12 studies of athlete populations (326 shoulders). For tendinopathy and/or partial-thickness tears, the prevalence on ultrasound was 34% in 1 population-based sample (539 shoulders), 0% to 47% across 11 studies of miscellaneous populations (1971 shoulders), and 7% to 70% across 4 studies of athlete populations (346 shoulders). On MRI, the prevalence was 65% in 1 population-based sample (20 shoulders), 0% to 100% across 10 studies of miscellaneous populations (490 shoulders), and 6% to 96% across 13 studies of athlete populations (426 shoulders). CONCLUSION: Across studies with low- to very low-certainty of evidence, the prevalence of RC imaging abnormalities in asymptomatic shoulders ranged from 0% to 100%. J Orthop Sports Phys Ther 2025;55(12):1-16. Epub 5 November 2025. doi:10.2519/jospt.2025.13611.
OBJECTIVE: To compare the effectiveness of different types of telerehabilitation in managing chronic musculoskeletal pain. DESIGN: A systematic review with network meta-analysis of randomized controlled trials (RCTs). LITERATURE SEARCH: Relevant records were retrieved from the Cochrane Library, Web of Science, EMBASE, MEDLINE, PubMed, Scopus, and CINAHL databases from their inception to August 2024. STUDY SELECTION CRITERIA: Trials that evaluated the effectiveness of telerehabilitation interventions for patients with chronic musculoskeletal pain, focusing on pain and functional disability outcomes. DATA SYNTHESIS: A frequentist random-effects network meta-analysis was conducted to integrate direct and indirect evidence. Sensitivity analyses were performed based on risk-of-bias assessments and study sample sizes to evaluate the robustness of the findings. RESULTS: Thirty-seven RCTs were included. Rehabilitation interventions delivered through self-managed rehabilitation applications (standardized mean difference [SMD] = -0.89; 95% confidence interval [CI]: -1.31, -0.48) and through videoconferencing platforms (SMD = -0.69; 95% CI: -1.19, -0.20) significantly reduced pain intensity compared with usual care or minimal intervention. For functional disability, rehabilitation interventions delivered through videoconferencing rehabilitation (SMD = -0.99; 95% CI: -1.46, -0.53) and self-managed rehabilitation applications (SMD = -0.70; 95% CI: -1.11, -0.29) were most effective. Sensitivity analyses supported these findings, although minor inconsistencies and potential publication bias were noted. CONCLUSION: Self-managed rehabilitation applications and videoconferencing rehabilitation appeared to be the most effective telerehabilitation delivery modes for managing chronic musculoskeletal pain. J Orthop Sports Phys Ther 2025;55(11):1-10. Epub 12 September 2025. doi:10.2519/jospt.2025.13366.
OBJECTIVE: To evaluate the effectiveness of nonsurgical interventions for work-related shoulder pain. DESIGN: Intervention systematic review with meta-analysis of randomized controlled trials. DATA SOURCES: Six databases and 2 clinical trial registries were searched, supplemented by manual searches and citation tracking. Eligible trials compared nonsurgical interventions for work-related shoulder pain. DATA SYNTHESIS: Outcomes of interest were pain intensity, physical functioning, return to work, and productivity loss. Risk of bias was assessed using the Cochrane Risk of Bias tool 2.0; certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. A random-effects meta-analysis and narrative synthesis were performed. RESULTS: Of 8608 records identified, 24 randomized controlled trials met the inclusion criteria. Four trials were included in meta-analysis. No trials were at low risk of bias. The evidence was very uncertain (GRADE) regarding the effect of exercises interventions (eg, strengthening, stretching, and endurance exercises) compared to no intervention on short-term pain intensity (standardized mean difference, -0.60; 95% confidence interval: -1.22, 0.03; 95% prediction interval: -1.83, 0.64; k = 4; n = 172). Reanalyzing using 3 alternative meta-analysis approaches for small-study meta-analyses yielded different results. The narrative synthesis provided no additional insights. CONCLUSION: The evidence was very uncertain about whether exercise interventions (strengthening, stretching, and endurance) provided a moderate short-term (<3 months) benefit for reducing pain compared with no intervention. These results should be interpreted cautiously due to the limited number of trials included in the meta-analysis and the inconsistent terminology for work-related shoulder pain. J Orthop Sports Phys Ther 2025;55(11):1-14. Epub 3 October 2025. doi:10.2519/jospt.2025.13360.
OBJECTIVE: To evaluate the cost-utility of a single session compared with multiple sessions of physical therapy care for adults with spinal disorders. DESIGN: Economic evaluation based on a pragmatic randomized controlled trial. METHODS: Patients with spinal disorders who were referred for a spinal surgery consultation and triaged as nonsurgical cases by an advanced practice physical therapist were randomized to either a single session of education and exercise prescription (n = 52) or multiple sessions (6 sessions) of a multimodal physical therapy intervention (n = 54). Patients answered questionnaires on the health care resources used and related costs, as well as the EuroQol 5-dimension 5-level questionnaire at baseline and at 6, 12, and 26 weeks. Total health care costs and quality-adjusted life years (QALYs) were calculated. A cost-utility analysis comparing both groups was conducted using an intention-to-treat approach with multiple imputation to handle missing data. Nonparametric bootstrapping with 1000 resamples was performed. The incremental cost-effectiveness ratio (ICER) was subsequently calculated. Sensitivity analyses were performed. RESULTS: Compared to the single-session group, the multiple-session group incurred a significantly higher total health care costs of CA$368 (95% confidence interval [CI], $327 to $412) and achieved an additional 0.013 QALY (95% CI, 0.009 to 0.018). The ICER for the multiple-session approach was CA$29 787 per QALY gained compared to the single-session approach. Excluding private costs leads to similar results, while the complete-case analysis suggested that the multiple-session approach was not cost-effective. CONCLUSION: A multiple-session approach may be considered cost-effective compared to a single session of physical therapy for adults with spinal disorders in an advanced practice physical therapy model of care. J Orthop Sports Phys Ther 2025;55(11):1-8. Epub 29 September 2025. doi:10.2519/jospt.2025.13468.
The 2025 Hip Pain and Mobility Deficits - Hip Osteoarthritis Clinical Practice Guideline (CPG) is a revision of the 2017 CPG and represents the second update for this CPG from APTA Orthopedics. In preparation for this update, a review was conducted on the topic of hip osteoarthritis (OA) to identify articles published after March 2016. The topics addressed in this 2025 CPG revision will specifically attempt to answer the question: What is the evidence to support physical therapy interventions directed at patients with hip OA? Prevalence, pathoanatomical features, and clinical course were discussed in detail in both the original 2009 CPG and 2017 CPG revisions and therefore will only be briefly reviewed in this 2025 update. J Orthop Sports Phys Ther 2025;55(11):CPG1-CPG31. Epub 12 September 2025. doi:10.2519/jospt.2025.0301.
OBJECTIVES: To (1) examine the incidence of game- and practice-related knee, ankle, and combined lower extremity injuries in under-13 (ages 11-12 years), under-15 (ages 13-14 years), and under-18 (ages 15-17 years) youth ice hockey players and (2) explore factors associated with game- and practice-related lower extremity injury rates in these players. DESIGN: Prospective cohort study. METHODS: Youth ice hockey players were studied over 5 seasons. Validated injury surveillance methodology was used, which included conducting annual baseline measures, collecting playing exposure, and identifying lower extremity injuries. Crude rates of game- and practice-related knee, ankle, and combined lower extremity injuries were estimated for each age group. Multilevel Poisson regression adjusted for clustering effects by team and multiple imputation of missing covariates were used to estimate incidence rate ratios (IRRs). Models were adjusted for age group, sex, body-checking policy, level of play, weight, previous injury within 12 months, lifetime concussion history, and position. RESULTS: The cohort included 4418 male and female players (representing 6584 player-seasons). The rate of game-related lower extremity injury was highest for under-18 players (1.01/1000 game hours; 95% confidence interval [CI]: 0.75, 1.35), followed by under-15 players (0.64/1000 game hours; 95% CI: 0.49, 0.83) and under-13 players (0.33/1000 game hours; 95% CI: 0.20, 0.55). Rates of practice-related lower extremity injury were lower than the game-related rates for each age group. The factors significantly associated with game-related injury were policy permitting body checking in games (IRR = 1.88; 95% CI: 1.09, 3.24), female sex (IRR = 1.92; 95% CI: 1.02, 3.62), and previous 12-month injury (IRR = 1.43; 95% CI: 1.01, 2.01). CONCLUSION: The rates of knee, ankle, and combined lower extremity injuries were substantially higher in games than in practices. Playing in a body-checking league, female sex, and having a history of injury within the previous 12 months were associated with higher rates of injury. J Orthop Sports Phys Ther 2025;55(10):1-10. Epub 18 August 2025. doi:10.2519/jospt.2025.13106.
OBJECTIVE: To systematically appraise current prognostic factor literature for patellofemoral pain (PFP). DESIGN: Systematic review with evidence- and gap-map. LITERATURE SEARCH: PubMed, CINAHL complete, PEDro, Scopus, SPORTDiscus, Embase, Cochrane Database of Systematic Reviews, and Web of Science (from inception to April 2024). STUDY SELECTION CRITERIA: Included participants were those with symptoms consistent with PFP and an average age ≤45 years. Eligible studies were longitudinal cohort studies and randomized controlled trials with a true "wait-and-see" group that measured at least 1 outcome variable at 2 time points and at least 1 potential prognostic factor at baseline. DATA SYNTHESIS: Prognostic factors were iteratively grouped relative to 7 categories and mapped by population and follow-up. RESULTS: Ten longitudinal cohort studies and 12 randomized controlled trials were included. The most frequently evaluated prognostic factors were sociodemographic (n = 21), anthropometric (n = 21), and symptoms and function (n = 19). Fewer studies evaluated biomechanics (n = 12), behavioral (n = 11), psychological (n = 6), and neurobiological (n = 4) factors. Most studies examined the general population (n = 13), with fewer studies in specific populations (adolescents, n = 4; military, n = 2; runners, n = 2; university athletes, n = 1). Most studies evaluated short-term (≤3 months; n = 9) or long-term (>1 year; n = 11) follow-up, with only 2 studies evaluating medium-term follow-up (3 months to 1 year). CONCLUSION: Sociodemographic, anthropometric, and symptoms and function factors were the most studied prognostic factors for PFP. Neurobiological, psychological, biomechanical, and behavioral factors were understudied. Additional studies are needed to identify prognostic factors in specific populations with high incidence of PFP. A comprehensive understanding of prognostic factors may inform development and implementation of evidence-based interventions. J Orthop Sports Phys Ther 2025;55(10):1-10. Epub 8 September 2025. doi:10.2519/jospt.2025.13491.
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