Journal of Orthopaedic & Sports Physical Therapy最新文献

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 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 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.

Categorical outcomes are most often reported in terms of relative risk or odds ratios. Interpreting what these metrics mean can be difficult for clinicians, and researchers often make mistakes in published papers. Key points to understand include the following: odds ratios cannot be interpreted in terms of likelihood of an outcome, in fact they have no intuitive meaning for a patient; relative risks and odds ratios are heavily influenced by how common or rare the outcome is; and an odds ratio will always be larger than a risk ratio from the same data. J Orthop Sports Phys Ther 2025;55(4):1-2. Epub 26 Feb 2025. doi: 10.2519/jospt.2025.0701.

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.