Journal of Orthopaedic & Sports Physical Therapy最新文献

OBJECTIVE: To determine whether tailored interventions based on patients' psychological profiles enhanced the outcomes of interventions in people with nonspecific low back pain, compared to usual care. DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: Embase, Cochrane, Medline, Web of Science, CINAHL, and PsycINFO were searched from their inception until November 2, 2023. STUDY SELECTION CRITERIA: We included randomized clinical trials that compared psychological interventions to any alternatives without psychological components in patients with nonspecific low back pain who were stratified based on their psychological risk factors using the cutoff of the questionnaires measuring a psychological construct. DATA SYNTHESIS: The outcomes were pain intensity and disability. The revised Cochrane risk-of-bias tool for randomized trials was used to evaluate the risk of bias. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to judge certainty of evidence. RESULTS: Twenty-nine trials were included, most presenting some concerns for the risk of bias. The certainty of evidence was mostly low, with moderate to substantial heterogeneity. Using psychological stratification, individuals who received a psychological intervention (versus usual care) reported lower pain intensity at the short term (MD, -0.22; 95% confidence interval [CI]: -0.41, -0.02) and midterm (MD, -0.37; 95% CI: -0.57, -0.16). For disability, there was a larger improvement with psychological interventions versus usual care at short-term (SMD, -0.17; 95% CI: -0.32, -0.02), midterm (SMD, -0.16; 95% CI: -0.28, -0.05), and long-term (SMD, -0.17; 95% CI: -0.29, -0.04) follow-ups. CONCLUSIONS: Psychological interventions had a positive impact, although small, on reducing pain intensity and disability in patients with low back pain and psychological risk factors. J Orthop Sports Phys Ther 2025;55(2):1-20. Epub 3 January 2025. doi:10.2519/jospt.2025.12777.

OBJECTIVE: To compare the effectiveness of injury prevention programs (IPPs) for improving high-risk knee motion patterns in the context of reducing the risk of noncontact anterior cruciate ligament injury. DESIGN: Systematic review with Bayesian network meta-analysis. DATA SOURCES: PubMed, Embase, Web of Science, Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature were searched until September 10, 2023. ELIGIBILITY CRITERIA: We included randomized controlled trials involving athletes without prior anterior cruciate ligament injury. The trials had to provide data on peak knee flexion and valgus angles, obtained from 2-leg drop vertical jump, single-leg drop vertical jump, or side-step cutting test. RESULTS: The network meta-analysis synthesized data from 22 randomized controlled trials involving 878 participants, evaluating 12 different IPPs. Results of meta-analyses indicated that, in jumping tests, the external focus instructions (mean difference [MD] = 26; credible interval [CrI] = 7.5, 44; surface under the cumulative ranking curve [SUCRA] = 0.94) and internal focus of attention (MD = 19; CrI = 0.19, 37; SUCRA = 0.81) was effective for increasing peak knee flexion, and core stability training ranked first for reducing knee valgus (MD = -4.40; CrI = -7.7, -1.1; SUCRA = 0.96). None of the IPPs revealed statistically significant effects for the cutting test. CONCLUSION: The external focus instructions and internal focus of attention increased knee flexion, while core stability exercise reduced knee valgus in jumping tests. Intervention effects were inconsistent for cutting tests. J Orthop Sports Phys Ther 2025;55(2):1-14. Epub 20 December 2024. doi:10.2519/jospt.2024.12720.

SYNOPSIS: This editorial draws an analogy between the literary genre of the 'whodunit' and the complexities of patellofemoral pain (PFP). Traditionally, PFP management has centered on biomechanical factors such as hip muscle weakness, foot pronation, and patellar tracking issues. However, long-term outcomes often remain unsatisfactory, highlighting the need for alternative strategies. The editorial underscores the significance of addressing the predominant pain pathway rather than relying solely on biomechanical assessments. It calls for future research to integrate pain characteristics into clinical practice to enhance outcomes.Just as a mystery is difficult to solve by focusing on 1 suspect, PFP is a multifaceted condition arising from a variety of contributing factors, including pain pathways that are often overshadowed by biomechanics. By thoroughly examining the dimensions and characteristics of pain, clinicians and researchers can refine clinical strategies and advance patient care, and ensure a tailored approach to managing this challenging condition. J Orthop Sports Phys Ther 2025;55(2):1-3. Epub 15 January 2025. doi:10.2519/jospt.2025.12883.

OBJECTIVE: To compare injured and uninjured limb knee extensor and flexor peak torque between youth who experienced a sport-related, traumatic knee joint injury and comparable uninjured youth, at baseline (≤4 months of injury) and semiannually for 2 years. Differences by injury type and sex were also explored. DESIGN: Prospective cohort study. METHODS: Bilateral knee extensor and flexor concentric isokinetic peak torque at 90° per second was assessed semiannually in 186 youth (106 injured, 80 controls) for 2 years. Between-group differences in strength over time were estimated with generalized estimating equations (95% confidence interval [CI]). Confounding was controlled using inverse probability weighting. Strength differences between those with anterior cruciate ligament (ACL) tears and those with non-ACL tear injuries as well as between male and female participants were explored. RESULTS: Compared to uninjured controls, injured limb knee extensor strength was lowest at baseline (-37.1 Nm; 95% CI, -45.3 to -28.9) and 6-month follow-up (-13.3 Nm; 95% CI, -20.4 to -6.2), with minimal strength gain beyond the 12-month follow-up (1.7 Nm; 95% CI, -14.3 to 17.6). Knee flexor strength of the injured limb was lowest at baseline (-24.6 Nm; 95% CI, -31.5 to -17.8), and there was minimal strength gain beyond 6 months (2.3 Nm; 95% CI, -7.7 to 12.3). The average residual deficit was similar to the knee extensors (10% to 11%) at 24 months. Exploratory analysis suggested no difference based on injury type or sex. CONCLUSION: Injured limb knee extensor and flexor weakness was present after different youth sport-related knee joint injuries. Strength deficits peaked early after injury, improved over time, and plateaued after 12 months, with lingering deficits at 24 months. Thigh muscle strength trajectory was similar across injury types and sex. J Orthop Sports Phys Ther 2025;55(2):1-11. Epub 20 December 2024. doi:10.2519/jospt.2024.12663.

Author response to the JOSPT Letter to the Editor-in-Chief "Letter to the Editor Regarding "Early Surgery Versus Exercise Therapy and Patient Education for Traumatic and Nontraumatic Meniscal Tears in Young Adults-an Exploratory Analysis From the DREAM Trial"" J Orthop Sports Phys Ther 2025;55(1):71. doi:10.2519/jospt.2025.0201-R.

OBJECTIVE: To explore trajectories of 12-week adherence to a digital education and exercise therapy for knee and hip osteoarthritis (OA), associations with baseline characteristics, and trajectories of patient-reported outcomes measures (PROMs) up to 1-year follow-up. DESIGN: Retrospective cohort (registry) study. METHODS: Weekly data on adherence (ie, the percentage of completed activities [exercises, lessons, and quizzes]) were obtained over 12 weeks (n = 14 097). Longitudinal k-means clustering was used to identify adherence trajectory clusters. Associations of baseline characteristics with adherence trajectory clusters were assessed using multinomial logistic regression. Trajectories of each PROM (pain, function, and general health) from baseline up to 1-year follow-up (measured at 3-month intervals) across adherence trajectory clusters were explored using generalized estimating equations adjusted for baseline characteristics. RESULTS: Four adherence trajectory clusters were identified: "high-persistent" (68.0%), "high-declining" (16.6%), "moderate-increasing" (8.5%), and "moderate-declining" (6.9%). Multinomial logistic regression suggested that female sex, older age, lower body mass index, lower education, living outside metropolitan cities, higher level of physical activity, less anxiety/depression, no fear of movement, having walking difficulties, and higher readiness to do exercise were associated with a higher probability of assignment to "high-persistent" than other clusters. Beliefs/perceptions and sociodemographic factors accounted for most of the explained variation in adherence trajectory clusters. While "high-persistent" cluster generally reported better outcomes than other clusters, these differences were small. CONCLUSION: While there were variations in adherence to the digital treatment, participants reported clinically comparable PROMs regardless of their adherence trajectory cluster. J Orthop Sports Phys Ther 2025;55(1):1-12. Epub 22 November 2024. doi:10.2519/jospt.2024.12864.

Letter to the Editor-in-Chief in response to JOSPT article "Early Surgery Versus Exercise Therapy and Patient Education for Traumatic and Nontraumatic Meniscal Tears in Young Adults-an Exploratory Analysis From the DREAM Trial" by Damsted et al. J Orthop Sports Phys Ther 2025;55(1):70. doi:10.2519/jospt.2025.0201.

OBJECTIVE: To summarize the content and critically appraise the quality and applicability of recent clinical practice guidelines (CPGs) for nonpharmacological, nonsurgical management of spine pain. DESIGN: Systematic review of CPGs. LITERATURE SEARCH: Six databases and seven guideline clearinghouses. STUDY SELECTION CRITERIA: Included de novo CPGs for nonpharmacological, nonsurgical management of spine pain designed for any primary health care providers, published in English, Arabic, French, or traditional Chinese within the past 12 years. DATA SYNTHESIS: Five reviewers independently appraised the guidelines using AGREE II and AGREE-REX. Interrater agreements were calculated for each domain and the total score of these tools using the intraclass correlation coefficient (2, 1) with absolute agreement. RESULTS: We included 30 CPGs, primarily (90%) developed in Western countries, which contained 404 recommendations. High-quality CPGs consistently recommended exercise therapy and multimodal care, encompassing a combination of exercises, mobilization/manipulation, education, alternative medicine, and cognitive-behavioral treatments. Generally, CPGs did not recommend assistive (eg, corsets and orthosis) devices or electro/thermotherapies (eg, therapeutic ultrasound and transcutaneous electrical nerve stimulation). Approximately half of the CPGs demonstrated good methodological quality according to AGREE II, whereas the rest were of poor quality. On the AGREE-REX assessment, one third of the recommendations were of excellent quality. CONCLUSION: Although recent guidelines frequently recommended exercise therapy and multimodal care for the management of spine pain, their recommendations often overlooked demographics and comorbidities. Despite methodological improvements, most CPGs lacked simple clinical applicability and considerations of knowledge users' values. J Orthop Sports Phys Ther 2025;55(1):1-14. Epub 4 November 2024. doi:10.2519/jospt.2024.12729.

Author response to the JOSPT Letter to the Editor-in-Chief "Reinterpreting the Clinical Practice Guidelines for Plantar Heel Pain Through an International Lens" J Orthop Sports Phys Ther 2025;55(1):73-74. doi:10.2519/jospt.2025.0202-R.

OBJECTIVE: We sought to develop recommendations to inform a framework for comprehensively assessing upper and lower limb pain in athletes including the key assessment items sports physiotherapists should consider. DESIGN: Real-time Delphi. METHODS: We recruited sports physiotherapists who were currently working with athletes through the International Federation of Sports Physical Therapists and Irish Society of Chartered Physiotherapists. Participants voted on 86 pain assessment items chosen using best available evidence. The real-time Delphi method facilitated independent anonymous voting, commenting, and immediate review of consensus. Participants indicated level of agreement for inclusion in an upper and lower limb athlete pain assessment framework on a 6-point Likert scale from strongly disagree to strongly agree, and how often they are/will be required in practice on a 5-point scale from never to always. Criteria for consensus agreement and inclusion were (1) >70% sports physiotherapists voting agree/strongly agree AND (2) median vote selected by physiotherapists was agree or strongly agree. RESULTS: Forty-one sports physiotherapists (female, n = 20; male, n = 21), visited the survey an average of 5.3 times (±5), resulting in a completion rate of 98%. Sixty-four assessment items (neurophysiological, n = 20; biomechanical, n = 15; affective, n = 8; cognitive, n = 3; socioenvironmental, n = 10; general assessment aspects of assessment, n = 8) met the criteria for consensus. Frequency of use in practice was always for 28 items often for 32 items and sometimes for 4 items. CONCLUSION: We have presented stakeholder-generated recommendations and priorities for assessing athletes' pain. J Orthop Sports Phys Ther 2025;55(1):1-11. Epub 22 November 2024. https://doi.org/10.2519/jospt.2024.12807.