Journal of Orthopaedic & Sports Physical Therapy最新文献

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.

OBJECTIVE: To evaluate the efficacy of therapeutic patient education delivered by a health care provider, either alone or in combination with other rehabilitation interventions, for reducing pain and disability in adults with subacute and chronic musculoskeletal conditions. DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: Five databases were searched from 2005 to 2025. STUDY SELECTION CRITERIA: Randomized clinical trials (RCTs) evaluating the efficacy of therapeutic patient education in adults with subacute and chronic musculoskeletal conditions, compared to other interventions such as exercise programs. Outcomes included pain, disability, quality of life, kinesiophobia, and catastrophizing. DATA SYNTHESIS: Treatment effects were estimated using random-effects models with standardized mean differences. Risk of bias was assessed using the Cochrane RoB 2.0 tool. Certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. RESULTS: Sixty-nine RCTs were included, and 56 contributed data to meta-analyses (n = 6773 participants; mean age, 43.1 ± 10.3 years; 63% female). Adding therapeutic patient education to other interventions likely reduced pain, disability, and catastrophizing in the short term (moderate-certainty evidence), may reduce pain and disability in the medium term (low-certainty evidence), and likely resulted in a large reduction in kinesiophobia in the short and medium terms (moderate-certainty evidence). The efficacy of therapeutic patient education as a stand-alone intervention was uncertain. CONCLUSION: Evidence supports using therapeutic patient education, in combination with other rehabilitation interventions, to reduce pain, disability, kinesiophobia, and catastrophizing in adults with subacute and chronic musculoskeletal conditions. The magnitude of the effects may vary from small to large. J Orthop Sports Phys Ther 2025;55(10):1-26. Epub 20 August 2025. doi:10.2519/jospt.2025.13247.

SYNOPSIS: Pain near the posteromedial tibia is common in running and jumping athletes. This problem has had many names, with "shin splints" and "medial tibial stress syndrome" (MTSS) the most common. The term shin splints is nonspecific and nondescript, and has never gained clinical traction. Similarly, the clinical use of MTSS with athletes and coaches is often met with confusion as "tibial stress" is frequently misinterpreted as indicating a bone stress injury. With no conclusive evidence regarding the pathophysiology of MTSS, we advocate renaming it "Load Induced Medial-Leg Pain" (LIMP). LIMP avoids the use of "tibial stress," which is problematic due to the unknown pathology of the condition and its confusion with bone stress injury. Using the term LIMP instead of MTSS gives clinicians, researchers, and athletes a clearer, more accurate way to approach managing exercise-related lower leg pain. J Orthop Sports Phys Ther 2025;55(10):1-2. Epub 18 August 2025. doi:10.2519/jospt.2025.13411.

OBJECTIVE: To evaluate the efficacy of high-velocity low-amplitude thrust (HVLAT) manipulations in patients with cervical, thoracic, and lumbar radiculopathy. DESIGN: Intervention systematic review. LITERATURE SEARCH: Five electronic databases were searched from inception to May 2024. STUDY SELECTION CRITERIA: Randomized controlled trials comparing HVLAT to different interventions in patients with cervical, thoracic, or lumbar radiculopathy were eligible, if they reported outcomes related to pain intensity, disability, range of motion, and/or health-related quality of life. DATA SYNTHESIS: Data were pooled using a random-effects model. Heterogeneity was assessed using the I² statistic. The risk of bias (RoB) was assessed with the revised Cochrane RoB tool (RoB 2). The certainty of evidence was rated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. RESULTS: Eleven trials (N = 991) were included. HVLAT was associated with significant pain reduction compared to sham HVLAT (mean difference [MD], -1.20; 95% confidence interval [CI]: -1.90, -0.50) and to nonrecommended interventions (MD, -1.16; 95% CI: -1.54, -0.77) in both cervical and lumbar radiculopathy. HVLAT was associated with reduced pain compared to conventional physical therapy alone (MD, -1.26; 95% CI: -2.20, -0.32) at short- and medium-term follow-up. There were no differences at long-term follow-up. The overall RoB was high; the certainty of evidence ranged from very low to moderate. CONCLUSION: HVLAT could reduce pain and disability in patients with cervical and lumbar radiculopathy in the short term and medium term compared with sham HVLAT interventions, conventional physical therapy alone, and spinal mobilization, but not if compared to spinal mobilization with leg movement. J Orthop Sports Phys Ther 2025;55(10):1-12. Epub 11 September 2025. doi:10.2519/jospt.2025.13103.

An infographic created by the JOSPT Knowledge Mobilization team to disseminate key research messages for clinicians. J Orthop Sports Phys Ther 2025;55(10):623. doi:10.2519/jospt.2025.9001.

OBJECTIVE: To describe the injury type (index/recurrent), location (medial head/lateral head), mechanism, player demographics, and prognosis (recovery/recurrence) in gastrocnemius injuries affecting elite male players. DESIGN: Longitudinal cohort. METHODS: Injury data from 2014 to 2023 were extracted from the Soft Tissue Injury Registry of the Australian Football League. Data items were injury type and circumstances, player demographics, and prognostic outcomes (functional milestones and recurrence). Demographics, injury characteristics, and prognoses were described. Recovery (time to return to play) was compared (survival analysis) for injury type (index vs recurrent), location (medial head vs lateral head), mechanism, intrinsic factors, and training history. RESULTS: Eighty-two magnetic resonance imaging-confirmed gastrocnemius injuries were included (68 index, 14 recurrent). Medial head injuries were most prevalent (78%). The median (interquartile range) time to reach functional milestones was 3 days (3) to walk pain free, 14 days (11) to run at >90% of the maximum speed, 14 days (15.5) to return to full training, and 19 days (16) to return to play. A recent change in loading prior to injury (P = .02), a running-related mechanism (P = .03), and older age (P = .01) resulted in longer recovery. Acceleration was the most common running injury mechanism, occurring in 13 cases. Twenty-nine injuries lacked a specific inciting mechanism. Recurrences occurred <6 months after the index injury in 79% (n = 11) of cases. CONCLUSION: Gastrocnemius injuries predominantly affected the medial head. More than 1 in 6 cases were recurrent. J Orthop Sports Phys Ther 2025;55(10):1-8. Epub 8 September 2025. doi:10.2519/jospt.2025.13526.

OBJECTIVE: To explore factors that influence patient preferences for recommended physical therapies for low back pain. DESIGN: Discrete choice experiment. METHODS: Respondents were randomized to a block of 12 choice tasks and asked to choose between two physical therapies or no treatment. Characteristics of the physical therapies varied between choice tasks and included type (exercise, advice and education, or clinician-directed treatment), effectiveness, time for symptoms to improve, costs, risk of side effects, and treatment duration. Choices were analyzed using a mixed logit model. Latent class analysis examined preference heterogeneity. To measure decision trade-offs, we estimated the smallest worthwhile effect and the "willingness to pay" value. RESULTS: A total of 697 Australians reporting a history of low back in the last year completed all choice tasks. Respondents showed a strong preference for taking any nonpharmacologic care option over no treatment (OR = 17.24; 95% CI [12.89, 22.58]). This preference was present at any level of effectiveness (smallest worthwhile effect = 0%). Respondents preferred physical therapies with higher effectiveness, quicker symptom improvement, lower out-of-pocket expenses, reduced side effects, and shorter duration. Respondents were willing to pay up to A$355 per month for physical therapies over no treatment. Older and less-educated respondents had weaker preferences for physical therapies. CONCLUSION: Respondents had a strong preference for any recommended physical therapies over no treatment for low back pain, even when effects were very small. Clinicians should discuss likely effectiveness, time for improvement, side effects, and treatment duration when supporting patients to choose between recommended physical therapies. J Orthop Sports Phys Ther 2025;55(9):602-610. Epub 30 July 2025. doi:10.2519/jospt.2025.13409.

OBJECTIVE: To explore the effect of the WalkBack intervention on the duration and severity of low back pain in participants who reported a recurrence. DESIGN: Secondary exploratory analysis of the WalkBack randomized controlled trial. METHODS: The WalkBack trial compared an individualized and progressive walking plus education program delivered by physiotherapists, to a no-treatment control group for preventing new recurrences of low back pain. In this study, we analyzed the first recurrence of low back pain (n = 596). The primary outcome for this analysis was the duration of the recurrence (time to recovery in days). The secondary outcomes were the level of interference with daily activity caused by the recurrence, and pain intensity (average and worst). Survival analysis, linear, and ordinal regression were used to compare outcomes between groups. RESULTS: Walking plus education was associated with a shorter duration of pain recurrence compared to control: median time to recovery 3 days (95% confidence interval [CI]: 3, 4) versus 4 days (95% CI: 4, 5); hazard ratio 1.30 (95% CI: 1.10, 1.53; P = .002). There was no between-group difference in interference with daily activity or average pain intensity. The intervention group reported lower worst pain intensity on average than the control group (-0.34 on a numerical pain-rating scale from 0 to 10; 95% CI: -0.65, -0.03; P = .03). CONCLUSION: Participants who received a tailored and progressive walking plus education program reported shorter and milder back pain recurrences than participants in the control group. However, the benefits were small and of uncertain clinical relevance. J Orthop Sports Phys Ther 2025;55(9):1-6. Epub 6 August 2025. doi:10.2519/jospt.2025.13361.