Journal of Orthopaedic & Sports Physical Therapy最新文献

OBJECTIVE: To evaluate the efficacy of heel lifts in people with midportion Achilles tendinopathy. DESIGN: This was a parallel-group randomized, sham-controlled, participant- and assessor-blinded trial conducted at a single center (Victoria University, Institute for Health and Sport, Melbourne, Australia). METHODS: One hundred and eight participants (38 females and 70 males; mean age, 48 years; standard deviation, 10 years) with midportion Achilles tendinopathy, diagnosed clinically and confirmed by ultrasound, were randomly allocated to either a heel lift (n = 54) or sham intervention (n = 54) group. The primary outcome was pain intensity (11-point numerical rating scale) at 12 weeks. Differences between groups were analyzed using an intention-to-treat approach with analysis of covariance. RESULTS: There was 100% follow-up of participants at 12 weeks. Pain intensity reduced by a mean of 3.7 points in the heel lifts group and 2.5 points in the sham intervention group. On average, there was a significant between-group difference in favor of heel lifts for reducing pain intensity (adjusted mean difference, -0.9; 95% confidence interval [CI]: -1.7, -0.2; P = .02), which approximated, but did not meet the predetermined minimum important difference of 1.5 points. The primary analysis was not robust to sensitivity analysis when controlling for expectation (adjusted mean difference -0.7; 95% CI: -1.5, 0.0; P = .06). CONCLUSION: In adults with midportion Achilles tendinopathy, heel lifts demonstrated greater efficacy than a sham intervention for reducing pain intensity at 12 weeks, but this benefit was small and may not be clinically meaningful. These results do not support the use of heel lifts for the primary management of Achilles tendinopathy. J Orthop Sports Phys Ther 2025;55(9):1-10. Epub 1 August 2025. doi:10.2519/jospt.2025.13422.

OBJECTIVE: To systematically synthesize and summarize findings from qualitative studies exploring the perceptions and experiences of individuals living with frozen shoulder. DESIGN: Systematic review of qualitative studies. LITERATURE SEARCH: The search strategy was conducted in June and updated in November 2024. We searched the following databases: CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Library, EMBASE, PEDro (Physiotherapy Evidence Database), PsycINFO, MEDLINE (Medical Literature Analysis and Retrieval System Online), Scopus, SPORTDiscus, and Web of Science. STUDY SELECTION CRITERIA: We included qualitative primary studies or mixed-methods studies that (1) clearly identified qualitative data; (2) were published in English or Italian; (3) involved participants aged ≥16 years; and (4) investigated participants' experiences living with frozen shoulder, regardless of phase, intervention type, or publication date. DATA SYNTHESIS: Sandelowski and Barroso's methodology was followed for meta-synthesis and meta-summary. The Confidence in the Evidence from Reviews of Qualitative Research approach evaluated the certainty of the results. RESULTS: Nine studies, comprising 116 participants, were included. One hundred fifty-seven target findings were extracted, analyzed, synthesized, and grouped into 12 categories and 5 main themes: (1) "I cannot recognize my body," (2) "Frozen shoulder is hindering my life," (3) "Frozen shoulder is affecting my psychological well-being," (4) "Navigating recovery," and (5) "Regaining control of my life after frozen shoulder." The critical appraisal indicated moderate methodological quality, and there was a moderate level of confidence that the findings effectively captured the patient experience of frozen shoulder. CONCLUSION: Frozen shoulder affects people's physical function, emotional well-being, and daily life, underscoring the need for a patient-centered approach. Integrating these perspectives into clinical practice can enhance health care strategies and support recovery. J Orthop Sports Phys Ther 2025;55(9):1-16. Epub 30 July 2025. doi:10.2519/jospt.2025.13432.

Synopsis: Identifying pain descriptors provides a way to tailor pain management based on presumed underlying mechanisms. The aim is to use mechanistic pain descriptors (nociceptive, neuropathic, and nociplastic pain) to guide clinical practice into an era of personalized medicine for people with pain. Clinicians should understand the concept of descriptors to improve their understanding of a mechanism-based management of chronic pain. Nonetheless, all treatment of individuals suffering from chronic pain should be holistic (ie, person-centered). Nociplastic pain already serves as an evidence-based explanation that can help make sense of pain without any known pathology, but is not ready to be considered as a target for treatment in itself, based on the current level of evidence. To summarize, treatment outcomes may improve when treatments are matched to patients according to mechanistic descriptors. Current research initiatives are working on bring this closer to the clinic. J Orthop Sports Phys Ther 2025;55(9):1-6. Epub 29 July 2025. doi:10.2519/jospt.2025.13335.

OBJECTIVE: To summarize the perceptions and experiences of patients living with whiplash-associated disorders (WADs). DESIGN: Qualitative evidence synthesis. LITERATURE SEARCH: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Embase, Physiotherapy Evidence Database (PEDro), PsycINFO, MEDLINE, Scopus, SPORTDiscus, and Web of Science databases were searched up to June 2024 and updated in October 2024. STUDY SELECTION CRITERIA: Inclusion criteria were (1) qualitative primary studies or mixed methods studies with clear identification of participants and findings from the qualitative methods, (2) published in English or Italian, (3) included participants aged ≥16 years, and (4) focused on participants' experiences with a diagnosis of WAD. DATA SYNTHESIS: Metasummary and metasynthesis processes were conducted following Sandelowski and Barroso's methodology. The confidence of the findings was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation Confidence in Evidence from Reviews of Qualitative Research (GRADE-CERQual) approach. RESULTS: Eighteen studies were included, comprising a total of 349 participants. Overall, 330 target findings were collected, analyzed, and grouped into 15 categories attributable to 5 main themes: (1) "WAD changed my body," (2) "WAD destabilized my daily life," (3) "WAD has consumed my thoughts," (4) "The recovery journey from WAD," (5) "Life goes on after WAD." The methodological quality of all studies revealed only minor concerns. The GRADE-CERQual assessment indicated moderate confidence in the findings, due to serious concerns regarding their relevance to the patient experience of WAD. CONCLUSION: People with WAD experienced a wide range of interconnected physical, emotional, cognitive, and social challenges. Addressing these multifaceted needs through a biopsychosocial approach can guide more effective management strategies and improve long-term outcomes for patients with WAD. J Orthop Sports Phys Ther 2025;55(9):1-19. Epub 25 July 2025. doi:10.2519/jospt.2025.13156.

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.