Journal of Orthopaedic & Sports Physical Therapy最新文献

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.

OBJECTIVE: To investigate the comparative effectiveness of nonsurgical interventions for adults with acute and subacute sciatica. DESIGN: Intervention systematic review with network meta-analysis LITERATURE SEARCH: Embase, MEDLINE, Cochrane Library, and CINAHL were searched up to June 7, 2024. STUDY SELECTION CRITERIA: Randomized controlled trials of nonsurgical interventions in adults (aged 18 years or older) with acute or subacute sciatica (less than 3 months) were included. DATA SYNTHESIS: The primary outcomes were leg pain intensity and physical function at different follow-up time points. Secondary outcomes were adverse events, mental health, and low back pain intensity. Two reviewers independently conducted screening, data extraction, and risk-of-bias assessment. Random-effects network meta-analysis was conducted, and confidence was evaluated by the Confidence in Network Meta-Analysis (CINeMA) method. RESULTS: Forty randomized controlled trials (5381 participants) were included. At short-term follow-up, compared to sham treatment/placebo, the most efficacious interventions for leg pain intensity were NSAIDs + physical therapy modalities, antibiotics, and antidepressants. Music therapy was effective for improving physical function at short-term follow-up. At long-term follow-up, steroids had a significant effect in reducing leg pain and improving physical function. No intervention showed a significant increase in adverse events compared with sham-treatment/placebo. All the evidence was based on very low confidence, primarily due to within-study bias and imprecision in effect estimates. CONCLUSIONS: Very low-confidence evidence supported some nonsurgical interventions for improving leg pain intensity and physical function in people with acute and subacute sciatica. J Orthop Sports Phys Ther 2025;55(6):1-12. Epub 25 April 2025. doi:10.2519/jospt.2025.13068.

SYNOPSIS: This Viewpoint explores the "professionalization mismatch" in women's football (soccer)-the disparity between rising demands and insufficient resources despite increasing demands on professional athletes. Anterior cruciate ligament (ACL) injury incidence has remained steady over the past 2 decades. ACL injuries are severe injuries for players, often leading to short-term deficits in performance and long-term health issues. Our attempt to conduct a systematic review on ACL injury risk reduction strategies in professional women's football revealed a significant knowledge gap, highlighting the challenges of conducting rigorous research in this context. We propose steps to address these gaps, including evaluating current practices, conducting qualitative research, adopting open science practices, and facilitating interdisciplinary collaboration injury risk reduction programs to the growing demands of professional women football players. Collaborative research can support developing and implementing tailored ACL injury risk reduction strategies to improve players' health and performance in professional women's football. J Orthop Sports Phys Ther 2025;55(6):1-4. Epub 21 April 2025. doi:10.2519/jospt.2025.12926.

OBJECTIVE: This pilot study aimed to evaluate the feasibility of conducting a randomized controlled trial (RCT) comparing direct-access physiotherapy for children and adolescents presenting to the pediatric emergency department (ED) with low acuity musculoskeletal complaints, to current usual care provided by a physician alone. DESIGN: Pragmatic parallel 2-arm, single-blinded, single site, feasibility pilot RCT. METHODS: Sixty-six patients (aged 6-17 years) were randomized into 2 intervention groups: (1) pediatric physiotherapy group (PT) (experimental), an interprofessional model including direct access to a pediatric physiotherapist immediately after triage for assessment and recommendation/intervention + ED physician confirmation of diagnosis and plan; or (2) usual care control group (UC), receiving usual care directly from the ED physician alone. Feasibility outcomes included eligibility, consent, retention, and follow-up completion rates. Clinical outcomes, including pain interference with function, satisfaction and health service use, were evaluated at baseline, post-ED visit, and follow-up visits at 1 and 4 weeks postintervention. RESULTS: Recruitment was completed within 2 months, with 53% of eligible patients enrolled. Retention to the end of study was 92% for randomized children, and similar between groups. The compliance to data collection for each clinical outcome measures ranged from 92% to 98% 4 weeks post-ED visit, and availability of administrative and clinical information from the child's medical record was achieved 100% of the time. CONCLUSION: The pilot RCT demonstrated feasibility in terms of recruitment, retention, and compliance to trial procedures. A larger, fully powered trial is proposed to determine the efficacy of the intervention. J Orthop Sports Phys Ther 2025;55(6):1-11. Epub 29 April 2025. doi:10.2519/jospt.2025.13321.

OBJECTIVE: To investigate the barriers and facilitators to physical activity and exercise among people with chronic low back pain (CLBP). DESIGN: A qualitative evidence synthesis. LITERATURE SEARCH: We searched the MEDLINE, EMBASE, CINAHL, SPORTDiscus, and PsycINFO databases from inception to July 2023. This review was prospectively registered on the Open Science Framework (OSF) (https://archive.org/details/osf-registrations-uwnqh-v1). STUDY SELECTION CRITERIA: Qualitative or mixed-methods studies with a qualitative approach were included. Studies must have recruited adults, of both sexes, aged 18 years or older with CLBP. DATA SYNTHESIS: We used a thematic analysis approach in our review. First, participant quotes in the "Results" section of included studies were analyzed and coded. Second, the codes were used to create our coding framework. Then, the coding framework was applied to included studies. Finally, 2 reviewers independently analyzed the themes constructed in our qualitative evidence synthesis to identify barriers and facilitators for people with CLBP to engage in physical activity. RESULTS: Fifty-seven studies were included. The quality assessment (Critical Appraisal Skills Program) revealed that most studies (77%) had minor concerns. Barriers to physical activity were mainly related to pain intensity, fear of movement, intervention type, lack of information, motivation, and support. Facilitators of physical activity were adequate information, professional and social support, perceived benefits, and favorable conditions to engage in physical activity. Based on the GRADE-CERQual, most themes and subthemes presented moderate quality of evidence. CONCLUSION: The barriers to people with chronic LBP engaging in physical activity included pain intensity and fear of reinjury, type of intervention, lack of information, motivation and support, and occupational and socioenvironmental factors. The main facilitators were receiving information and support from health professionals, motivational activities, knowledge about benefits of the intervention, and external factors. J Orthop Sports Phys Ther 2025;55(5):1-19. Epub 7 April 2025. doi:10.2519/jospt.2025.12905.

OBJECTIVE: To evaluate the effects of prehabilitation on postoperative outcomes following total hip arthroplasty (THA) and total knee arthroplasty (TKA). DESIGN: Overview of systematic reviews and meta-analyses of randomized controlled trials. LITERATURE SEARCH: Guided by the PRIOR (Preferred Reporting Items for Overviews of Reviews) statement, a systematic search of MEDLINE, Embase, Web of Science, and Cochrane CENTRAL (Cochrane Register of Controlled Trials) was conducted using the following overarching topics: hip, knee, arthroplasty, and prehabilitation. STUDY SELECTION CRITERIA: Systematic reviews, meta-analyses, or meta-regressions of randomized controlled trials that investigated how postoperative outcomes differed between patients who underwent primary THA or TKA and engaged in a structured prehabilitation program (exclusively resistance training [RT]-focused or multimodal with RT) or non-RT exercising controls. DATA SYNTHESIS: THA and TKA data were analyzed separately, with results delineated based on RT components (ie, weekly sets, frequency, and load) and the follow-up period (ie, short term: 1-3 years; midterm: 5-7 years; and long term: ≥10 years). RESULTS: Three systematic reviews and 21 meta-analyses (19 THA randomized controlled trials, 1110 THA patients; 46 TKA randomized controlled trials, 3362 TKA patients) ranging from critically low- to moderate-quality evidence were included. Prehabilitation was favorable for reducing the rate of complications, improving strength, objective function, quality of life, and self-reported function in patients undergoing THA and TKA. Effects were attenuated over time and were generally confined to the first 6 months. RT volume did not affect postoperative outcomes in 2 meta-regressions. No analyses evaluated how the manipulation of RT components affected postoperative outcomes. CONCLUSION: Prehabilitation reduced complication rates and improved objective and subjective postoperative outcomes following THA and TKA, with effects generally confined to the first 6 months. J Orthop Sports Phys Ther 2025;55(5):1-22. Epub 3 April 2025. doi:10.2519/jospt.2025.13075.