Journal of Orthopaedic & Sports Physical Therapy最新文献

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.

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.