Journal of Orthopaedic & Sports Physical Therapy最新文献

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.

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.

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: 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 whether a remotely delivered physical therapy exercise and education intervention with daily step goals increased moderate- to vigorous-intensity physical activity (MVPA) compared to a control. DESIGN: Assessor-blinded superiority randomized controlled trial with 2 parallel arms. METHODS: We included adults from the United States who met the National Institute for Health and Care Excellence osteoarthritis (OA) criteria. Participants were randomized to the intervention of five 45- to 60-minute video conferencing consultations with a physical therapist for strengthening exercises, step goals, and education over 12 weeks or a control of OA web-based resources. The primary outcome was change in MVPA over 12 weeks (measured with ActiGraph GT3X). The secondary and exploratory outcomes were changes in light-intensity physical activity, steps/day, treatment beliefs, pain, function in activities of daily living, function in sports and recreation, and quality of life over 12 and 24 weeks. RESULTS: Of 103 participants who were randomized, 88 had monitor data at baseline and 67 (76% of 88) had monitor data at 12 weeks. There were no between-group differences in MVPA change over 12 weeks (between-group difference, -1.8 min/day; 95% confidence interval: -7.0, 3.3), change in light-intensity physical activity, or steps/day. Pain and function improved more with the intervention group compared to the control. A greater number of intervention participants (n= 44) reported nonserious adverse events than the control group (n =10). CONCLUSION: Incorporating daily step goals into a telehealth strength exercise and education program for people with knee OA did not increase MVPA. J Orthop Sports Phys Ther 2025;55(5):1-9. Epub 20 March 2025. doi:10.2519/jospt.2025.13132.

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.

SYNOPSIS: Musculoskeletal (MSK) pain, especially when the reason for the pain is unexplained, is often associated with distress, fear, reduced self-efficacy, and cycles of medicalization. Pathoanatomical diagnoses, based on clinical tests and imaging, have a weak correlation between structural findings and pain, and fail to explain why something hurts. This Viewpoint advocates for nonpathoanatomical functional diagnoses or classifications and practical, relatable explanations for patients with pain without a definitive pathoanatomical cause-what some might call a person-centered model of care. Using an example of low back pain, we explore how functional terminology and empathetic communication can foster better understanding of pain, reduce fear, and support people to engage with treatment. We encourage clinicians to integrate lifestyle factors in a shared decision-making framework. By supporting patients to understand their pain, we suggest an approach that improves both physical and psychological well-being. J Orthop Sports Phys Ther 2025;55(5):1-5. Epub 27 February 2025. doi:10.2519/jospt.2025.13167.

OBJECTIVE: To assess the effectiveness of individual education for patients with chronic low back pain (CLBP), compared to no intervention, placebo, noneducational interventions, or other type of education. DESIGN: Intervention systematic review with meta-analysis of randomized controlled trials (RCTs). LITERATURE SEARCH: PubMed, CINAHL, PEDro, Embase, and Scopus (up to January 14, 2024); citation tracking in Web of Science, grey literature and reference lists of previous systematic reviews. STUDY SELECTION CRITERIA: We included RCTs that evaluated individual patient education interventions for adults with CLBP. DATA SYNTHESIS: Random-effects meta-analysis for clinically homogeneous RCTs. We assessed risk of bias using the Cochrane Risk of Bias 2.0, and applied the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to assess the certainty of evidence. RESULTS: We included 17 RCTs (n = 1893). There was moderate-certainty evidence that individual patient education had a clinically relevant effect compared to noneducational interventions on long-term disability (standardized mean difference, -0.23; 95% confidence interval [CI]: -1.13, 0.66). There was moderate-certainty evidence that individual patient education had no effect on short-term health-related quality of life compared to no intervention (mean difference, -0.003; 95% CI: -0.04, 0.04), and no effect on medium-term disability (SMD, 0.10; 95% CI: -0.37, 0.57) and long-term pain intensity (mean difference, -2.20; 95% CI: -14.43, 10.03) compared to noneducational interventions. CONCLUSION: Individual patient education provided a clinically relevant effect on long-term disability when compared to noneducational interventions. There were no other clinically relevant effects of individual patient education for CLBP. J Orthop Sports Phys Ther 2025;55(5):1-13. Epub 20 March 2025. doi:10.2519/jospt.2025.12794.

OBJECTIVES: To (1) compare analgesic use over 36 weeks between endurance athletes, technical athletes, and team athletes, and (2) explore experiences and sociocultural factors impacting analgesic use. DESIGN: Longitudinal mixed-methods study METHODS: Six hundred eighty-nine youth elite athletes (44% girls/women, 15-20 years) provided weekly reports on number of days with analgesic use, reasons for use, and types of analgesics used for 36 weeks. Prevalence and frequency of analgesic use was compared between athletes from team sports, endurance sports, and technical sports using mixed-effects logistic and Poisson regression models. Reasons and types of analgesics used were compared between groups using Chi-square tests. Nine focus group interviews with 32 participants were conducted and analyzed using thematic analysis. RESULTS: There were no differences in odds of analgesic use between endurance athletes (reference group), technical athletes (odds ratio [OR], 0.94; 95% confidence interval [CI]: 0.65, 1.37), and team athletes (OR, 0.88; 95% CI: 0.62, 1.25). Similarly, there were no differences in rate of analgesic use between endurance athletes (reference group), technical athletes (incidence rate ratio [IRR], 0.97; 95% CI: 0.87, 1.07), or team athletes (IRR, 1.03; 95% CI: 0.94, 1.14). Reasons for use varied between groups, while the types of analgesics used were similar. Sociocultural factors impacting analgesic use included considering the potential consequences of using analgesics for pain and injury, and feeling responsible for team performance. CONCLUSION: Analgesics were commonly used among youth elite athletes in Denmark. Analgesic use generally did not vary between team athletes, endurance athletes, and technical athletes. Several norms, values, and structures in sports environments impacted analgesic use. J Orthop Sports Phys Ther 2025;55(5):1-11. Epub 3 April 2025. doi:10.2519/jospt.2025.13015.