Journal of Orthopaedic & Sports Physical Therapy最新文献

OBJECTIVE: The purpose of this study was to determine the effect of painful versus nonpainful exercise on pain, disability, and other patient-reported outcomes in adults with chronic musculoskeletal pain. DESIGN: This study is an intervention systematic review with meta-analysis. LITERATURE SEARCH: Electronic databases (CENTRAL, EMBASE, CINAHL, PubMed, and PsycINFO) and trial registers (ClinicalTrials.gov, ANZCTR, World Health Organization International Clinical Trials Registry Platform) were searched from October 2016 to May 2024. STUDY SELECTION CRITERIA: We included randomized controlled trials that compared painful exercise to nonpainful exercise in adults with chronic musculoskeletal pain. DATA SYNTHESIS: Data were analyzed using random-effects meta-analysis and narrative synthesis. We assessed risk of bias using the Cochrane RoB2 tool and certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations framework. RESULTS: We included 16 trials (reported across 18 studies). There was no difference in the effect of painful versus nonpainful exercise on pain intensity or disability in the short, medium, or long term or pain catastrophizing or fear avoidance in the short term. The confidence intervals were wide. Narrative synthesis found similar results for quality of life, self-efficacy, mood, and adverse events. All trials were at high risk of bias, and certainty of evidence was very low to low. CONCLUSION: The effect of painful versus nonpainful exercise on patient-reported outcomes in adults with chronic musculoskeletal pain was unclear. Pain during exercise may not need to be avoided to allow for symptomatic and functional improvement. J Orthop Sports Phys Ther 2025;55(8):1-11. Epub 10 June 2025. https://doi.org/10.2519/jospt.2025.13253.

SYNOPSIS: The JOSPT "Perspectives for Practice" and "Perspectives for Patients" that complement clinical practice guidelines (CPGs) published in JOSPT are popular because they distill key messages from a detailed CPG into 1 easy-to-use resource. The publications serve patients and clinicians. We recognize a need to provide information for health care payers regarding the anticipated duration of care, visit number, and expected outcomes for orthopedic disorders commonly seen by physical therapists and covered in the CPGs. Here, we introduce the "Perspectives for Payers." J Orthop Sports Phys Ther 2025;55(8):1-2. Epub 7 July 2025. doi:10.2519/jospt.2025.13586.

SYNOPSIS: In the absence of diagnostic accuracy (clinical and imaging), specific shoulder structures cannot be implicated as the definitive source of shoulder symptoms. Patients report that the (1) worst pain is unexplained pain, and (2) to engage in a treatment, the treatment must make sense. The diagnostic label, nonspecific shoulder pain does not tick either box: subacromial pain syndrome is confusing, and as nondescript as suprahumeral pain syndrome. The rotator cuff tendons are not the definitive and sole source of shoulder symptoms, which calls into question the validity of terms such as tendinopathy, tendinosis, and tendinitis. The term rotator cuff-related shoulder pain was the overwhelming first choice in a recent global survey of clinicians, and here, we make the case for its clinical use. J Orthop Sports Phys Ther 2025;55(7):1-3. Epub 23 May 2025. doi:10.2519/jospt.2025.13405.

OBJECTIVE: To summarize the effects of neuromuscular electrical stimulation (NMES) interventions for improving strength outcomes after injuries such as tendon ruptures and tendinopathies. DESIGN: Scoping review. LITERATURE SEARCH: A bibliographic database search was performed in PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Physiotherapy Evidence Database (PEDro), and Cochrane Library databases between June and July 2024. STUDY SELECTION CRITERIA: Data on participant demographics, study characteristics, NMES parameters, tendon-related outcomes, and study quality (PEDro scale) were extracted. DATA SYNTHESIS: We performed a scoping review on NMES parameters and dosages used for treating tendon injuries. RESULTS: Of 973 records, 10 studies (5 randomized controlled trials, 3 crossovers, 2 cohorts) involving 166 participants (82.2% male) were included. Most participants were healthy (60%), whereas others had patellar tendinopathy (20%), spinal cord injury (10%), or Achilles tendon rupture (10%). NMES parameters were well detailed; however, only 3 studies reported the dosage. Within-session, NMES alone or superimposed (NMES⁺) altered tendon loading by increasing force, strain, and stress. NMES also changed tendon mechanical properties in both the short and long term. In long-term studies, implementing NMES⁺ reduced tendinopathy symptoms and pain during tendon loading activities. One study compared NMES⁺ to heavy slow resistance training, whereas another compared NMES⁺ to baseline. PEDro scores ranged from 1 to 7. CONCLUSIONS: Studies on NMES for tendon loading were generally well documented. There is room for improvement in detailed reporting of specific dosage and evoked torque to facilitate the clinical implementation of NMES for tendon rehabilitation. J Orthop Sports Phys Ther 2025;55(7):482-494. Epub 16 June 2025. doi:10.2519/jospt.2025.13151.

OBJECTIVE: To evaluate the impact of articular and neural mobilization on pain intensity and disability in patients with cervical radicular pain. DESIGN: Intervention systematic review with network meta-analysis. LITERATURE RESEARCH: The MEDLINE, SciELO, PubMed, PEDro, Scopus, Web of Science, and Cochrane databases were searched up to February 2024. STUDY SELECTION CRITERIA: Randomized controlled trials studying the effects of articular or neural mobilization in adults with cervical radicular pain were included. DATA SYNTHESIS: A frequentist network meta-analysis was used to assess pain intensity and disability. The risk of bias and the certainty of the evidence were evaluated using Version 2 of the Cochrane Risk of Bias (RoB 2) tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, respectively. RESULTS: Out of 777 reports, 50 were analyzed quantitatively. The combination of articular and neural mobilization with usual care was most effective in reducing short-term pain intensity compared to wait and see, sham, or placebo interventions (mean difference [MD], -3.23; 95% confidence interval [CI]: -4.33, -2.12) and to standard care alone (MD, -1.52; 95% CI: -2.31, -0.73). There were significant improvements in pain-related disability with neural mobilization plus usual care, surpassing wait and see, sham, placebo interventions (standardized mean difference [SMD], -1.57; 95% CI: -2.53, -0.61), and usual care alone (SMD, -1.31; 95% CI: -1.88, -0.73). Risk of bias and heterogeneity of included trials downgraded the certainty of evidence. CONCLUSION: Combining mobilization techniques with standard care may be considered in clinical practice, although with care due to the moderate to very low certainty of the evidence. J Orthop Sports Phys Ther 2025;55(7):1-14. Epub 16 May 2025. doi:10.2519/jospt.2025.12757.

OBJECTIVE: To compare the effect of combining proprioceptive exercises with strengthening exercises versus strengthening exercises alone, on shoulder pain and disability in individuals with chronic rotator cuff-related shoulder pain (RCRSP). DESIGN: Parallel group randomized controlled trial. METHODS: Seventy individuals with chronic RCRSP were randomly assigned to either the control group (n = 35; muscle strengthening exercises) or the experimental group (n = 35; muscle strengthening combined with proprioceptive exercises) for a 2-month program of supervised and home-based exercises. The primary outcome, the Shoulder Pain and Disability Index (SPADI), was assessed at baseline, 2 months, and 5 months, while the secondary outcomes (pain intensity, proprioception, isokinetic muscle strength, catastrophizing, kinesiophobia, and self-efficacy), were evaluated at baseline and 2 months. A linear mixed model was used for statistical analysis. RESULTS: There was no significant group-by-time interaction for the SPADI (P = .25). Significant time effects, but no between-group differences, were found for improvements in pain intensity, kinesiophobia, catastrophizing, self-efficacy, kinesthesia, and joint position sense, while a decline in lateral rotator peak torque was noted. CONCLUSION: Combining proprioceptive with shoulder strengthening exercises did not lead to additional improvements across all outcomes in individuals with chronic RCRSP. The lack of a nonintervention group limits the ability to determine whether the improvements in both groups were due to the exercise programs or to natural recovery. J Orthop Sports Phys Ther 2025;55(7):495-511. Epub 16 June 2025. doi:10.2519/jospt.2025.13097.

BACKGROUND: Sensorimotor dysfunction following anterior cruciate ligament (ACL) injury and subsequent ACL reconstruction (ACLR) may lead to errors in motor planning and execution. Dysfunction occurs even after athletes have completed rehabilitation. Therefore, clinicians need to implement strategies to improve how sensorimotor dysfunction is addressed during rehabilitation. CLINICAL QUESTION: How can clinicians improve their rehabilitation of sensorimotor dysfunction following ACLR? The aim of this clinical commentary is to review methods that may improve rehabilitation by targeting sensorimotor dysfunction following ACL injury. KEY RESULTS: Rehabilitation should focus on 2 priorities: (1) improving peripheral and central efferent function, and (2) improving somatosensory function and reducing reliance on the visual-motor system. CLINICAL APPLICATION: Somatosensory function can improve with proprioceptive training but should be implemented within the first 6 weeks of injury/surgery to minimize the chance of increased reliance on the visual-motor system. Methods to increase the complexity of proprioceptive training includes varying the (1) type of task (eg, jumping, decelerating, etc), (2) the visual information used during the task, (3) the cognitive loading during the task, and (4) perturbations. Visual distraction training may be useful for challenging an athlete during sports-specific training and reduce the reliance on the visual-motor system. Improving peripheral and central efferent function involves using regular cryotherapy and transcutaneous electrical nerve stimulation in the early stages to minimize pain and improve muscle recruitment. Throughout rehabilitation, strength training, neuromuscular electrical stimulation, and surface electromyography biofeedback methods improve central and peripheral efferent function when prescribed at a high intensity. J Orthop Sports Phys Ther 2025;55(7):1-9. Epub 16 May 2025. doi:10.2519/jospt.2025.12726.

OBJECTIVE: To investigate the effect of equalizing and nonequalizing resistance training volume on pain intensity, disability, and strength in individuals with patellofemoral pain (PFP). DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: MEDLINE, EMBASE, Cochrane, CINAHL, Physiotherapy Evidence Database, Scopus, SPORTDiscus, and Epistemonikos were searched from inception to December 2024. STUDY SELECTION CRITERIA: Randomized controlled trials that assessed the effects of any resistance exercise in individuals with PFP were included. The studies were categorized into groups with equalized and nonequalized total training volumes. DATA SYNTHESIS: Separate random-effects meta-analyses comparing equalizing (experimental versus control) and nonequalizing (higher versus lower) resistance training volume were conducted. Risk of bias was assessed using the Cochrane Risk of Bias 2, and certainty of evidence was judged according to the GRADE framework. RESULTS: Thirty-seven randomized controlled trials (1853 participants) were included. The higher training volume group had improved pain intensity immediately after the intervention (SMD, -0.88; 95% CI: -1.39, -0.36) and beyond the intervention period (MD, -1.66; 95% CI: -3.02, -0.31), and improved disability immediately after the intervention (SMD, 0.66; 95% CI: 0.19, 1.12) and beyond the intervention period (SMD, 1.03; 95% CI: 0.22, 1.84) compared to the lower training volume group. When the training volume was equalized, there were no differences between the groups. There was no difference in muscle strength between the groups in equalized and nonequalized volumes. CONCLUSION: There was very low-certainty evidence that higher resistance training volume yielded better outcomes for pain intensity and disability compared to a lower volume. Equalized training volumes showed no differences. J Orthop Sports Phys Ther 2025;55(6):1-12. Epub 8 May 2025. doi:10.2519/jospt.2025.13062.

BACKGROUND: The anterior cruciate ligament (ACL) plays an important sensory role within the sensorimotor system. Following ACL injury, sensorimotor dysfunction can have implications for rehabilitation and risk of reinjury. CLINICAL QUESTION: What dysfunction occurs within the sensorimotor system following ACL injury, and how can clinicians assess it? KEY RESULTS: Following ACL injury, dysfunction occurs across the sensorimotor system: afferent pathways, efferent pathways, and central processing. The afferent pathways exhibit dysfunction within the somatosensory system ([1] increased pain and swelling, [2] increased central cortical processing, and [3] reduced proprioception). There is also dysfunction in the visual system (increased visual-motor reliance and central cortical processing). The efferent pathways have reduced excitability of the central cortex, reduced descending motor pathway excitability and altered spinal reflexive excitability (acutely reduced but then chronically increased). CLINICAL APPLICATION: Protocols to assess athletes' sensorimotor function following ACL injury might help clinicians quantify the risk of reinjury. Assessing central processing requires specialized equipment, not typically accessible to clinicians. A practical approach to quantify the extent of sensorimotor dysfunction could focus on assessing the afferent and efferent pathways: tests of proprioception (eg, joint position sense test), pain (eg, visual analog scale and numerical pain rating scale), swelling (eg, sweep test and ballottement test), visual-motor reliance (eg, stepdown test), visual-motor processing ability (eg, sensory stations or neurocognitive tests), muscle strength (eg, repetition maximum testing or isokinetic dynamometry), and voluntary activation (eg, electromyography). J Orthop Sports Phys Ther 2025;55(6):1-17. Epub 25 April 2025. doi:10.2519/jospt.2025.12725.