Journal of Orthopaedic & Sports Physical Therapy最新文献

OBJECTIVE: To investigate whether improvements in forward bending were related to reductions in pain catastrophizing (PC) and improvements in pain self-efficacy (PSE) in people with chronic low back pain (CLBP) who were undergoing cognitive functional therapy (CFT). DESIGN: Longitudinal observational study. METHODS: Two hundred sixty-one participants with CLBP received CFT. Forward bending was assessed at each treatment session over 13 weeks (average of 4.3 time points per participant [range, 1-8]). Inertial measurement units placed on T12 and S2 measured spinal range of movement (ROM) and velocity. Participants completed the Pain Catastrophizing Scale and the Pain Self-Efficacy Questionnaire online at 0, 3, 6, and 13 weeks. Multivariate, multilevel models evaluated the associations between individual rates of change over time for 3 spinal movement measures (trunk velocity, trunk ROM, and lumbar ROM) as well as PC/PSE. RESULTS: Strong correlations were observed for increased trunk velocity with reduced PC (r = -0.56; 95% confidence interval [CI]: -0.82, -0.01) and increased PSE (r = 0.63; 95% CI: 0.18, 0.87). There was no evidence of an association between changes in trunk ROM and PC (r = -0.06; 95% CI: 0.38, 0.28) or PSE (r = 0.36; 95% CI: -0.27, 0.65) as well as no evidence of an association between lumbar ROM and PC (r = -0.07; 95% CI: -0.63, 0.55) or PSE (r = 0.16; 95% CI: -0.49, 0.69). CONCLUSION: Improvements in PC and PSE were strongly correlated with increased trunk velocity-but not trunk or lumbar ROM-in people with CLBP who were undergoing CFT. These findings are consistent with CFT that explicitly trains "nonprotective" spinal movement in conjunction with positively reframing pain cognitions. J Orthop Sports Phys Ther 2025;55(4):1-11. Epub 12 March 2025. doi:10.2519/jospt.2025.13114.

This evidence-based clinical practice guideline (CPG) aims to guide clinicians with recommendations covering the assessment, treatment, and prognosis of adults with shoulder pain with suspected rotator cuff (RC) tendinopathy, the nonsurgical medical care and rehabilitation of adults with RC tendinopathy, as well as the return to function and sport for elite and recreational athletes. This CPG includes recommendations for managing RC tendinopathy with or without calcifications and partial-thickness RC tears. J Orthop Sports Phys Ther 2025;55(4):235-274. Epub 30 January 2025. doi:10.2519/jospt.2025.13182.

Letter to the Editor-in-Chief in response to JOSPT article "Neuromuscular Control and Resistance Training for People With Chronic Low Back Pain: a Randomized Controlled Trial" by Farragher JB, Pranata A, Williams GP, et al. J Orthop Sports Phys Ther 2025;55(4):305. doi:10.2519/jospt.2025.0203.

Author response to the JOSPT Letter to the Editor-in-Chief "Neuromuscular Control and Resistance Training for Chronic Low Back Pain: Discussing a Randomized Controlled Trial" J Orthop Sports Phys Ther 2025;55(4):305-306. doi:10.2519/jospt.2025.0203-R.

OBJECTIVE: To estimate the prevalence of imaging findings that may be associated with osteoarthritis (OA), and their relationship with symptoms in dancers. DESIGN: Etiology systematic review with meta-analysis. LITERATURE SEARCH: Four electronic databases were searched (PubMed, Scopus, CINAHL, SPORTDiscus) from inception to September 2023. STUDY SELECTION CRITERIA: Included studies reported joint imaging findings in dancers. We considered all study designs that investigated populations with regular participation in any form of dance, at any stage of career. DATA SYNTHESIS: Data were pooled for meta-analysis if at least 3 studies reported on the same intra-articular imaging findings, at the same joint, in a similar dance genre. RESULTS: Thirty-two studies were included. Meta-analysis was performed for the prevalence of hip, ankle, and first metatarsophalangeal joint OA, and ankle effusion. The first metatarsophalangeal joint had the highest prevalence of radiographic OA (59%). The prevalence of symptomatic OA was low (3%). The ankle (radiographic OA 41%) and then the hip (radiographic OA 19%) joint were the next most common regions to report imaging findings, with a lower prevalence of symptomatic OA seen at the ankle (2%) to pool 2 studies and hip (8%) to pool 4 studies. CONCLUSION: There was very low certainty evidence of the first metatarsophalangeal joint having the highest prevalence of imaging findings in dancers, followed by the ankle and hip joints. A lower prevalence of symptomatic OA was seen at all 3 joints. J Orthop Sports Phys Ther 2024;55(4):1-9. Epub 3 March 2025. doi:10.2519/jospt.2025.12918.

SYNOPSIS: Myofascial pain syndromes (MPSs) affect a significant portion of the population. However, they remain controversial because their etiology, diagnostics, and effect mechanisms rely on theoretical frameworks with limited scientific rigor. This Viewpoint highlights 3 main challenges and proposes solutions: First, diagnosis lacks consistent criteria and is at risk of verification and incorporation biases. Tightened diagnostic criteria and differentiating myofascial pain syndrome from competing conditions will improve accuracy in research and clinical practice. Second, the etiology/pain mechanisms are poorly understood, with symptoms overlapping other conditions. We recommend recording of standardized assessments in national registries including psychological stress and systemic factors to identify distinct phenotypes. Third, the mechanisms behind treatments such as myofascial release and acupuncture are unclear. We advocate for mechanistic clinical trials to uncover how these treatments exert effects. Addressing these challenges will enhance understanding, diagnosis, and treatment of MPS and guide policymakers to fund appropriate research. J Orthop Sports Phys Ther 2025;55(4):1-4. Epub 10 February 2025. doi:10.2519/jospt.2025.13072.

OBJECTIVE: To conduct a cost-utility analysis of a group physiotherapy intervention, compared to usual care, for musculoskeletal disorders in Canadian military personnel. DESIGN: Economic evaluation alongside a pragmatic randomized clinical trial. METHODS: One hundred and twenty military members presenting with shoulder, knee, ankle, or low back pain were randomized to receive either usual one-on-one physiotherapy care or a group intervention. Cumulative health care costs were prospectively collected over 26 weeks from the perspective of the Canadian Armed Forces. The clinical outcome of the cost-utility analysis was the quality-adjusted life-year (QALY) estimated by the ED-5Q-5L (European Quality of Life 5 Dimensions 5 Level Version) at baseline, 6, 12, and 26 weeks. The incremental cost-effectiveness ratio (ICER) was estimated by the cost difference between interventions (in 2023 Canadian dollars [CAD$]) divided by the effect difference. RESULTS: The mean QALY gain was 0.011 in the group intervention, and 0.010 in the usual care. The average cost for a patient was CAD $532 in the group intervention and CAD $599 in the usual care. The ICER (-$67 000/QALY) indicated that the group intervention was cost-effective, as it costs less than usual care while providing comparable effectiveness. CONCLUSION: Group interventions were cost-effective compared to usual care for treating musculoskeletal disorders in military personnel. J Orthop Sports Phys Ther 2025;55(4):1-10. Epub 26 Feb 2025. doi: 10.2519/jospt.2025.12888.

OBJECTIVE: To investigate whether magnetic resonance imaging (MRI) findings modified the outcomes of early surgery compared to exercise and education in young patients with meniscal tears. DESIGN: A secondary effect modifier analysis of a randomized controlled trial. METHODS: The primary outcome was change from baseline to 12 months in the mean score of 4 Knee injury and Osteoarthritis Outcome Score subscales (KOOS₄). Three potential MRI-defined effect modifiers were predefined: (1) the type of meniscal tear (simple vs bucket handle or complex), (2) the meniscus affected (medial vs lateral), and (3) the presence of knee effusion/synovitis (yes/no). We used a linear mixed model to investigate the difference in mean change between the treatment groups, stratified by each of the 3 potential effect modifiers, and estimated the interactions. An adjusted effect difference ≥ 10 points (0-100 scale) was considered clinically relevant. RESULTS: Data from all participants (60 in the surgery group and 61 in the exercise group) were analyzed. The mean (SD) age was 29.7 (6.6) years, and 28% were female. A potential effect modification was observed for knee effusion/synovitis, with its presence implying an increase of the effect of early surgery by 11 points on the KOOS₄ (P = .07). CONCLUSION: Knee effusion/synovitis on MRI potentially modified the treatment effect with a clinically relevant difference in change of the KOOS₄ in patients with effusion/synovitis, favoring early surgery. We found no indication that patients with bucket handle or complex versus simple tears or medial versus lateral tears benefited more from early surgery. J Orthop Sports Phys Ther 2025;55(3):1-11. Epub 30 January 2025. doi:10.2519/jospt.2025.12994.

OBJECTIVE: To compare return-to-sport outcomes between females/women/girls and males/men/boys undergoing hip arthroscopy and explore social and structural determinants of health that may influence return to sport. DESIGN: Systematic review with meta-analysis. LITERATURE SEARCH: CINAHL, Cochrane Central Register of Controlled Trials, Embase, Medline, SPORTDiscus, and Web of Science from inception to February 2024. STUDY SELECTION CRITERIA: Studies were included if they assessed return to sport after hip arthroscopy and analyzed the influence of sex/gender on return-to-sport outcomes, or reported sex- or gender-stratified return-to-sport rates. DATA SYNTHESIS: We used a random effects model to calculate pooled odds ratios and conducted meta-regressions to compare return-to-sport outcomes between females/women/girls and males/men/boys. RESULTS: Forty-five studies were included, with all pooled results deemed as very low-certainty evidence. Compared to males/men/boys, females/women/girls had inferior return to sport at the same or higher level between 1 and 3 years postoperatively (pooled OR = 0.53; 95% CI: 0.34, 0.81; P = .004), and at any level of sport at >3 years postoperatively (pooled OR = 0.46; 95% CI: 0.25, 0.86; P = .014). Sports participation decreased over time, with ~5.5% to 10% lower proportions observed in females/women/girls compared to males/men/boys. The reporting of determinants of returning to sport was minimal, precluding further exploration of their effects. CONCLUSION: Females/women/girls had lower odds of return to sport, especially during longer follow-up periods, than males/men/boys. The lack of reporting of social and structural determinants of health influencing return-to-sport outcomes makes the reasons for this disparity unclear. J Orthop Sports Phys Ther 2025;55(3):1-13. Epub 10 February 2025. doi:10.2519/jospt.2025.12813.

BACKGROUND: On-pitch rehabilitation is key to supporting return to sport in elite soccer (football). The control-chaos continuum (CCC) guides practitioners through the sport-specific components of return to sport. There is a need to update the framework with recent research in injury neurophysiology, soccer performance, and coaching science. CLINICAL QUESTION: How do practitioners integrate the insights from injury neurophysiology, soccer performance, and coaching science discussed in part 1 of this 2-part series into an updated version of the CCC, to enhance the planning and execution of on-pitch rehabilitation for elite soccer players? KEY RESULTS: The revised CCC framework emphasizes the design and delivery of progressive training in increasingly chaotic conditions. The updated framework supports practitioners to incorporate elements of visual-cognitive challenges, attentional challenges, decision making, and progression representation of the game model when players are preparing to return to sport. CLINICAL APPLICATION: The updated CCC outlines training progression from High Control, which involves returning to on-pitch linear running, to High Chaos, which simulates the team environment at game speed. The High Chaos phase can be tailored to support players during their reintegration into team training. The model is adaptable for both short- and long-term injuries, integrating physical-cognitive load monitoring and strength and power diagnostics to enhance decision making throughout return to sport. J Orthop Sports Phys Ther 2025;55(3):1-11. Epub 17 January 2025. doi:10.2519/jospt.2025.13159.