Journal of Orthopaedic & Sports Physical Therapy最新文献

OBJECTIVE: To evaluate the relationship between football (soccer) participation and tibiofemoral knee osteoarthritis (OA), considering the influence of competitive level and previous knee injuries. DESIGN: Etiology systematic review with meta-analysis. LITERATURE SEARCH: PubMed, Embase, AMED, and Cochrane were searched for relevant publications. STUDY SELECTION CRITERIA: Studies of football players that included a control group consisting of mainly sedentary nonfootball players, and the relationship of knee OA, were considered. The studies had to report radiographically verified knee OA and specify football activity. DATA SYNTHESIS: Eleven studies, involving 1805 football players and 4022 control individuals were included. Subgroups consisting of data regarding level of play and previous injuries were also synthesized. RESULTS: The overall prevalence of knee OA among football players was increased among professional and recreational players, compared with controls. When knee injuries were excluded, there was no difference in knee OA between football players and controls (OR = 1.25; 95% CI: 0.61, 2.54). Football players with a previous knee injury had a greater risk of knee OA when compared with football players with no history of previous knee injury (OR = 4.16; 95% CI: 1.97, 8.77). CONCLUSION: Football players were at increased risk of knee OA. However, after excluding participants with a history of previous knee injury, there were no differences in knee OA between football players and controls. Previous knee injury was important for developing knee OA. Playing football, in the absence of major knee injuries, did not increase the risk of knee OA. J Orthop Sports Phys Ther 2024;54(5):1-12. Epub 26 February 2024. doi:10.2519/jospt.2024.12029.

OBJECTIVE: To determine if adding lumbar neuromuscular control retraining exercises to a 12-week program of strengthening exercises had greater effect for improving disability than 12 weeks of strengthening exercises alone in people with chronic low back pain (LBP). DESIGN: Single-center, participant- and assessor-blinded, comparative effectiveness randomized controlled trial. METHODS: Sixty-nine participants (31 females; 29 males; mean age: 46.5 years) with nonspecific chronic LBP were recruited for a 12-week program involving lumbar extension neuromuscular retraining in addition to resistance exercises (intervention) or 12 weeks of resistance exercises alone (control). The primary outcome measure was the Oswestry Disability Index. Secondary outcome measures included the Numeric Rating Scale, Tampa Scale for Kinesiophobia, Pain Self-Efficacy Questionnaire, and the International Physical Activity Questionnaire. Outcomes were measured at baseline, 6 weeks, and 12 weeks. RESULTS: Forty-three participants (22 control, 21 intervention) completed all outcome measures at 6 and 12 weeks. Fourteen participants were lost to follow-up, and 12 participants discontinued due to COVID-19 restrictions. Both groups demonstrated clinically important changes in disability, pain intensity, and kinesiophobia. The difference between groups with respect to disability was imprecise and not clinically meaningful (mean difference, -4.4; 95% CI: -10.2, 1.4) at 12 weeks. Differences in secondary outcomes at 6 or 12 weeks were also small with wide confidence intervals. CONCLUSIONS: Adding lumbar neuromuscular control retraining to a series of resistance exercises offered no additional benefit over resistance exercises alone over a 12-week period. J Orthop Sports Phys Ther 2024;54(5):1-10. Epub 18 March 2024. doi:10.2519/jospt.2024.12349.

OBJECTIVE: We aimed to develop a consensus-based rehabilitation guideline specifically designed to reduce apprehension following arthroscopic Bankart repair after traumatic anterior shoulder dislocation. DESIGN: Delphi-based consensus. METHOD: A comprehensive list of interventions for potential inclusion in a postoperative rehabilitation guideline was developed. American and European physiotherapists and orthopedic surgeons were invited to participate in a Delphi panel, engaging in 3 survey rounds. The health professionals were surveyed about their level of agreement on both initially listed and newly suggested interventions. Consensus was established when a "critical-to-include" rating was given in ≥70% of all responses. Ten former patients were consulted to identify the intervention during standard care rehabilitation that had the most impact on reducing postoperative apprehension following ABR. Any interventions not initially listed in the first round were added to the second survey round of the Delphi process. RESULTS: Forty-four health professionals reached consensus on a set of 27 interventions for managing apprehension after arthroscopic Bankart repair. New interventions included gradual exposure to shoulder positions eliciting apprehension, training in anterior stability-provoking positions, and education addressing the impact of psychosocial factors. Former patients identified specific interventions that were effective in reducing postoperative apprehension following ABR. These interventions encompassed medicine ball throws, active-assisted wall slides, and kinetic chain exercises in anterior stability-provoking positions. CONCLUSION: Our Delphi process informed expert recommendations for various interventions aimed at addressing apprehension associated with ABR. The recommendations were the foundation for developing a rehabilitation guideline (REGUIDE). The REGUIDE integrates principles from cognitive-behavioral therapy to improve rehabilitation and mitigate apprehension. J Orthop Sports Phys Ther 2024;54(5):1-13. Epub 20 March 2024. doi:10.2519/jospt.2024.12106.

OBJECTIVE: To provide an updated overview of available prognostic models for people with chronic low back pain (LBP) in primary care. DESIGN: Prognosis systematic review LITERATURE SEARCH: We searched for relevant studies on MEDLINE, Embase, Web of Science, and CINAHL databases (up to July 13, 2022), and performed citation tracking in Web of Science. STUDY SELECTION CRITERIA: We included observational (cohort or nested case-control) studies and randomized controlled trials that developed or validated prognostic models for adults with chronic LBP in primary care. The outcomes of interest were physical functioning, pain intensity, and health-related quality of life at any follow-up time-point. DATA SYNTHESIS: Data were extracted using the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS), and the Prediction model Risk of Bias Assessment Tool (PROBAST) tool was used to evaluate the risk of bias of the models. Due to the number of studies retrieved and the heterogeneity, we reported the results descriptively. RESULTS: Ten studies (out of 5593 hits screened) with 34 models met our inclusion criteria, of which six are development studies and four are external validation studies. Five studies reported the area under the curve of the models (ranging from 0.48 to 0.84), whereas no study reported calibration indices. The most promising model is the Örebro Musculoskeletal Pain Screening Questionnaire Short-Form. CONCLUSIONS: Given the high risk of bias and lack of external validation, we cannot recommend that clinicians use prognostic models for patients with chronic LBP in primary care settings. J Orthop Sports Phys Ther 2024;54(5):1-13. Epub 15 February 2024. doi:10.2519/jospt.2024.12081.

OBJECTIVE: To compare the effect of early meniscal surgery versus exercise and education with the option of later surgery on pain, function, and quality of life in young patients with a meniscal tear, taking symptom onset into account. DESIGN: Randomized controlled trial. METHODS: In a randomized controlled trial (the "Danish RCT on Exercise versus Arthroscopic Meniscal surgery for young adults" [DREAM] trial), 121 patients aged 18-40 years with a magnetic resonance imaging-verified meniscal tear were randomized to surgery or 12 weeks of supervised exercise and patient education. For this exploratory study, the analyses were stratified by symptom onset (traumatic/nontraumatic). The main outcome was the difference in change after 12 months in the mean score of 4 Knee injury and Osteoarthritis Outcome Score subscales (KOOS₄) covering pain, symptoms, function in sport and recreation, and quality of life. RESULTS: Forty-two patients (69%) in the exercise therapy group and 47 (78%) in the surgery group were categorized as having a traumatic tear. We observed no difference in change in the KOOS₄ after 12 months between the 2 treatment groups for either traumatic tears (18.8 versus 16.0 in the surgery versus exercise therapy groups; adjusted mean difference, 4.8 [95% confidence interval, -1.7 to 11.2]) or nontraumatic tears (20.6 versus 17.3 in the surgery versus exercise therapy groups; adjusted mean difference, 7.0 [95% confidence interval, -3.7 to 17.7]). CONCLUSION: In patients with traumatic and nontraumatic meniscus tears, early meniscal surgery did not appear superior to exercise and education in improving pain, function, and quality of life after 12 months. Further research is needed to confirm the clinical applicability of these findings. J Orthop Sports Phys Ther 2024;54(5):1-10. Epub 22 February 2024. doi:10.2519/jospt.2024.12245.

OBJECTIVE: To quantify the dose-response relationship between overall and specific exercise modalities and pain, in patients with nonspecific chronic low back pain (LBP). DESIGN: Systematic review with Bayesian network meta-analysis. LITERATURE SEARCH: We searched the Medline, Embase, Web of Science, Cochrane Library, Scopus, and SPORTDiscus databases from inception to June 2023. STUDY SELECTION CRITERIA: We included randomized controlled trials of exercise interventions in adults with nonspecific chronic LBP and at least 1 pain outcome reported at the main trial end point. DATA SYNTHESIS: A random-effects network meta-analysis was conducted. We assessed risk of bias using the Cochrane Risk of Bias Tool 2.0, and used the GRADE approach to judge the certainty of evidence for each outcome. RESULTS: Eighty-two trials were included (n = 5033 participants). We found a nonlinear dose-response relationship between total exercise and pain in patients with nonspecific chronic LBP. The maximum significant response was observed at 920 MET minutes (standardized mean difference = -1.74; 95% credible intervals: -2.43, -1.04). The minimal clinically important difference for achieving meaningful pain improvement was 520 MET minutes per week. The dose to achieve minimal clinically important difference varied by type of exercise; Pilates was the most effective. The certainty of the evidence was very low to moderate for all outcomes. CONCLUSION: The dose-response relationship of different exercise modalities to improve pain in patients with nonspecific chronic LBP had a U-shaped trajectory and low- to moderate-certainty evidence. The clinical effect was most pronounced with Pilates exercise. J Orthop Sports Phys Ther 2024;54(5):1-13. Epub 8 March 2024. doi:10.2519/jospt.2024.12153.

OBJECTIVE: To describe the changes in quadriceps and hamstrings muscle strength in the uninvolved limb of male professional and recreational athletes during rehabilitation after anterior cruciate ligament reconstruction (ACLR) and compare to preoperative strength values. DESIGN: Prospective longitudinal study. METHODS: During rehabilitation, 665 participants who underwent unilateral ACLR performed a strength test preoperatively and every 6 weeks after surgery for up to 9 months. Isokinetic quadriceps and hamstrings strength of the uninvolved limb were measured at an angular velocity of 60°/s and normalized to body weight (N·m/kg). RESULTS: Quadriceps and hamstrings strength of the uninvolved limb gradually increased during rehabilitation until 6 months post-ACLR, and plateaued thereafter. Postoperative quadriceps' strength significantly exceeded preoperative values by 3 months for professional (2.99 N·m/kg; 95% confidence interval [CI]: 2.93, 3.04; P = .007) and by 6 months for recreational athletes (2.77 N·m/kg; 95% CI: 2.71, 2.83; P<.001), and hamstrings exceeded presurgery levels by 4.5 months (1.71 N·m/kg; 95% CI: 1.67, 1.74; P<.001 and 1.43 N·m/kg; 95% CI: 1.40, 1.46; P = .002, professional and recreational athletes respectively). CONCLUSION: In male professional and recreational athletes, uninvolved limb quadriceps and hamstrings strength gradually improved after ACLR, until 6 months after surgery. The uninvolved limb's strength may present as a "moving target" that requires consistent monitoring during rehabilitation. J Orthop Sports Phys Ther 2024;54(4):1-9. Epub 14 December 2023. doi:10.2519/jospt.2023.11961.

OBJECTIVE: To explore whether preoperative pain intensity, pain cognitions, and quantitative sensory measures influence the established effectiveness of perioperative pain neuroscience education (PPNE) on health-related quality of life at 1 year after surgery for lumbar radiculopathy. DESIGN: Secondary analysis of a triple-blinded randomized controlled trial. METHODS: Participants (n = 90) were Dutch-speaking adults (18-65 years) who were scheduled for surgery for lumbar radiculopathy in 3 Belgian hospitals. They were randomized (1:1) to receive PPNE (n = 41) or perioperative biomedical education (n = 49). Linear mixed models were built for health-related quality of life (ie, SF-6D utility values, Physical and Mental Component of the 36-item Short Form Health Survey) using the following independent variables: therapy, time, and preoperative scores for back and leg pain intensity, pain catastrophizing, kinesiophobia, hypervigilance, and quantitative sensory measures. RESULTS: The impact of PPNE on SF-6D utility values over time was influenced by kinesiophobia (F = 3.30, P = .02) and leg pain intensity (F = 3.48, P = .02). Regardless of the intervention, back pain intensity negatively influenced SF-6D values over time (F = 3.99, P = .009). The Physical Component scores were negatively impacted by back pain intensity (F = 9.08, P = .003) and were influenced over time by leg pain intensity (F = 2.87, P = .04). The Mental Component scores were negatively impacted by back pain intensity (F = 6.64, P = .01) and pain catastrophizing (F = 5.42, P = .02), as well as hypervigilance (F = 3.16, P = .03) and leg pain intensity (F = 3.12, P = .03) over time. CONCLUSION: PPNE may be more effective than perioperative biomedical education in improving postoperative health utility values in patients who reported higher kinesiophobia and leg pain intensity before surgery for lumbar radiculopathy. J Orthop Sports Phys Ther 2024;54(4):1-10. Epub 8 January 2024. doi:10.2519/jospt.2024.12051.

OBJECTIVE: To compare the short- and intermediate-term effects of dry needling to manual therapy on pain, disability, function, and patient-perceived improvement in patients with mechanical neck pain. DESIGN: A single (therapist) blinded randomized controlled trial. METHODS: Seventy-eight patients (mean ± SD age, 50.74 ± 13.81) were randomly assigned to one of the 2 groups: (1) dry needling and therapeutic exercises (DN + Exercises) and (2) manual therapy and therapeutic exercises (MT + Exercises). Both groups received 7 treatment sessions over a maximum of 6 weeks. Outcome measures, collected at baseline, 2 weeks, discharge (7th treatment session), and 3 months after discharge, were as follows: Neck Disability Index (NDI), numeric pain-rating scale (NPRS), Patient-Specific Functional Scale (PSFS), global rating of change (GROC), Fear-Avoidance Belief Questionnaire (FABQ), and Deep Neck Flexor Endurance Test (DNFET). Data were analyzed with mixed-model analysis of covariance (ANCOVA), using pretest scores as covariates, and a Mann-Whitney U test for GROC scores. RESULTS: The ANCOVA revealed significant group-by-time interaction for all variables. Significant between-group differences, favoring MT + Exercises, were observed at all 3 time points on the NDI (2 weeks: F_1,446 = 172.68, P≤.001, [Formula: see text] = .27; discharge: F_1,446 = 254.15, P≤.001, [Formula: see text] = .36; and 3 months: F_1,446 = 339.40, P≤.001, [Formula: see text] = .43). Results for the MT + Exercises group exceeded recommended minimal clinically important difference for all variables, at all follow-up points. CONCLUSION: MT + Exercises was more effective, both in the short term and intermediate term, than DN + Exercises in reducing pain, disability, and improving function in patients with mechanical neck pain. J Orthop Sports Phys Ther 2024;54(4):1-12. Epub 29 January 2024. doi:10.2519/jospt.2024.12091.

OBJECTIVES: To assess the reproducibility of manual therapy interventions used in clinical trials for low back pain (LBP), and summarize knowledge gaps in assessing the reproducibility of manual therapy interventions for LBP. DESIGN: Scoping review. LITERATURE SEARCH: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), and Embase were searched for trials from inception through April 2023. STUDY SELECTION CRITERIA: Randomized controlled trials were included if they described the use of manual therapy to treat LBP in adults 18 to 65 years old and were accessible in English. DATA SYNTHESIS: The Consensus on Exercise Reporting Template (CERT) checklist, used for exercise reporting, was previously modified for manual therapy reporting. This 11-item modified CERT was used to extract details of manual therapy reporting in the included trials. Frequency counts were calculated to identify items most and least commonly reported. RESULTS: Of 128 trials, none reported all 11 items of the modified CERT. The most commonly reported items were the description of how the application of manual therapy was decided (n = 113, 88.3%) and a description of adjunct interventions provided (n = 82, 64.1%). The least reported items were the description of an associated home program (n = 27, 21.1%) and a detailed description of the application of manual therapy (n = 22, 17.2%). CONCLUSION: Reporting of manual therapy interventions in trials investigating LBP was poor overall, limiting the reproducibility of these treatments. Using a checklist designed explicitly for manual therapy intervention reporting may improve reproducibility of these interventions and help align clinical outcomes with experimental findings. J Orthop Sports Phys Ther 2024;54(4):1-10. Epub 29 January 2024. doi:10.2519/jospt.2024.12201.