Journal of Orthopaedic & Sports Physical Therapy最新文献

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.

OBJECTIVE: To determine the effect on Shoulder Pain and Disability Index (SPADI) scores of adding dry needling to a program of exercise and manual therapy in individuals with subacromial pain syndrome (SAPS). DESIGN: Three-arm randomized trial involving 121 participants with SAPS. METHODS: Participants were randomized to physical therapy (PT) treatment (PT Only), PT and sham dry needling (PT+SDN), or PT and dry needling (PT+DN) groups. The primary outcome was the SPADI at 1 year. Secondary measures included the Physical Function and Pain Interference subscales from the PROMIS-57, the Patient Acceptable Symptom State (PASS), and self-reported shoulder-related health care use. Linear marginal models and generalized estimating equations were used to identify differences between groups at each follow-up. Logistic regression was used to determine differences in health care use between groups at 1 year. RESULTS: Differences (95% confidence interval) in SPADI scores at 1 year between the PT+DN and PT Only (-7.51 [-16.57, 1.54]) and the PT+DN and PT+SDN (-9.85 [-18.98, 0.73]) groups did not reach statistical significance. Differences in the percentage of "yes" responses to the PASS were significant at 6 months between the PT+DN and PT Only groups (34% [14%-55%]) and the PT+DN and PT+SDN groups (24% [4%-45%]) and at 1 year between the PT+DN and PT+SDN groups (28% [7%-49%]). Participants in the PT+DN group were less likely to receive additional care for their shoulder in the year following enrollment (OR = 0.35 [0.13, 0.95]). CONCLUSION: Adding dry needling to a standard PT program did not result in greater improvements in SPADI scores at 1 year. Improvements in secondary outcomes and patient-perceived symptom acceptability may suggest potential clinical value. J Orthop Sports Phys Ther 2026;56(1):50-63. Epub 19 November 2025. doi:10.2519/jospt.2025.13460.

OBJECTIVE: To estimate the comparative effectiveness of tailored exercise therapies in people with chronic, nonspecific low back pain. DESIGN: Systematic review with network meta-analysis. LITERATURE SEARCH: We searched PubMed, Cochrane Library, Web of Science, and Google Scholar from inception to August 27, 2024. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Only randomized controlled trials (RCTs) studying the effects of any type of tailored exercise therapies in persons with chronic, nonspecific low back pain were included. Outcomes of interest were pain intensity and disability. Usual care was the standard comparator; effect sizes were calculated as Hedges's g. DATA SYNTHESIS: We used the R package netmeta to conduct network meta-analyses. Network plotting and P-scores summarized the intervention hierarchy; usual care was the main comparator. Risk of bias was assessed using the Cochrane risk-of-bias tool. The certainty of evidence was evaluated using the CINeMA (Confidence in Network Meta-Analysis) tool. RESULTS: We included 58 randomized trials (n = 10 510 participants) with 29 different treatment or control categories. Risk of bias for pain intensity and disability was high. Cognitive functional therapy alone (SMD_Disability = -0.89 [95% confidence interval = -1.11 to -0.66]; SMD_Pain = -0.71 [-0.97 to -0.45]) or combined with biofeedback (SMD_Disability = -1.00 [-1.36 to -0.64]) were, with moderate-certainty evidence, the most effective treatments for pain intensity (k = 49 RCTs) and disability (k = 45 RCTs) reduction when compared to usual care. CONCLUSION: In comparison to usual care, cognitive functional therapy, alone or with biofeedback, likely results in a large disability reduction. J Orthop Sports Phys Ther 2026;56(1):16-27. Epub 3 December 2025. doi:10.2519/jospt.2025.13281.

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.

SYNOPSIS: Improving Indigenous Peoples' musculoskeletal health is a salient priority and a challenge for the physical therapy profession. Our goal is that Indigenous Peoples' musculoskeletal health is no longer underrecognized or inadequately addressed. In this series, we outline why the physical therapy field must (a) deepen its collective knowledge of Indigenous Peoples' musculoskeletal health; (b) reflect on current initiatives in Indigenous musculoskeletal health across clinical practice, research, education, and allyship/advocacy; (c) explore future directions for each sector to advance the profession; and (d) contribute to positive change for Indigenous Peoples. This article sets the scene for the series, including introducing key concepts. We aspire for this series to support better and fairer musculoskeletal health outcomes for Indigenous Peoples. J Orthop Sports Phys Ther 2025;55(12):1-4. Epub 20 October 2025. doi:10.2519/jospt.2025.13737.