Journal of Orthopaedic & Sports Physical Therapy最新文献

OBJECTIVE: To evaluate the relative efficacy of various physical therapy interventions for chronic ankle instability (CAI). DESIGN: A network meta-analysis of randomized controlled trials. LITERATURE SEARCH: PubMed, Cochrane Library, Embase, Scopus, and CINAHL bibliographic databases were searched up to December 2023. STUDY SELECTION CRITERIA: Randomized controlled trials examining nonsurgical treatments for CAI. DATA SYNTHESIS: We used frequentist network meta-analysis to assess 8 outcomes across 44 trials, including the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) scale or Sport scale, Cumberland Ankle Instability Tool (CAIT), Star Excursion Balance Test (SEBT) in 3 directions (anterior [A], posteromedial [PM], and posterolateral [PL]), dorsiflexion range of motion, and pain. Surface under the cumulative ranking curve (SUCRA) values identified the most effective interventions. RESULTS: Based on SUCRA rankings, a regimen combining balance and strengthening exercises, augmented with either manual therapy or dry needling, was identified as the most effective in enhancing function (SUCRA: FAAM ADL = 95.2% [manual]/83.9% [dry needling]; FAAM Sport = 87.9% [manual]/80.1% [dry needling]), improving dynamic balance (SUCRA [manual]: SEBT-A = 92.1%; SEBT-PM = 98.0%; SEBT-PL = 90.8%), and significantly relieving pain (SUCRA: 99.9%). A multimodal exercise approach combined with manual therapy showed superior efficacy in increasing dorsiflexion (SUCRA: 61.6%). Tai chi emerged as the most promising intervention for improving stability (SUCRA: 99.9%). CONCLUSION: Interventions that emphasized strengthening and balance exercises were the most effective strategy for achieving best function and pain relief for patients with CAI. Multimodal exercises and tai chi might improve ankle range of motion and instability, respectively. J Orthop Sports Phys Ther 2025;55(1):26-44. Epub 20 December 2024. doi:10.2519/jospt.2024.12601.

OBJECTIVES: To explore the extent of functional improvement following primary total knee arthroplasty for knee osteoarthritis and to compare the trajectories of self-reported and performance-based measures of physical function. DESIGN: Longitudinal systematic review with meta-analysis METHODS: We searched 3 electronic databases from January 2005 to February 2023 for longitudinal cohort studies involving adults with knee osteoarthritis undergoing primary total knee arthroplasty. Estimates of self-reported and performance-based physical function were extracted presurgery and up to 5 years postsurgery. Risk of bias was assessed using a 6-item checklist. Self-reported function scores were converted to a 0-100 scale (higher scores indicate worse function). Mixed models provided pooled estimates after excluding low-quality studies. RESULTS: Out of 230 relevant studies, 72 (n = 19 063) of high quality were included in meta-analyses. Self-reported function significantly improved from presurgery (55.6/100; 95% confidence interval [CI], 53.1 to 58.1) to 3-6 months postsurgery (21.1; 95% CI, 17.9 to 24.3; P<.001). A small decline in self-reported function occurred at 6-12 months (31.0; 95% CI, 25.8 to 36.2; P<.001), with no further change at 12-24 months (30.9; 95% CI, 23.2 to 38.6; P = .919). Performance-based measures exhibited variable trajectories, with most estimates indicating no clinically meaningful improvement following total knee arthroplasty. CONCLUSION: Total knee arthroplasty resulted in clinically meaningful improvements in self-reported function at 3-6 months postoperatively. There was some deterioration in function after 6 months, and at no other time point did the estimate reach a clinically important change. There was limited evidence of clinically meaningful improvements in performance-based measures of physical function at any time point. J Orthop Sports Phys Ther 2025;55(1):1-11. Epub 26 November 2024. doi:10.2519/jospt.2024.12570.

Midportion tendinopathy is a common overuse lower extremity injury, with a prevalence of 4% to 7%. Achilles tendinopathy especially affects people who participate in activities that load the Achilles tendon, such as running. The Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire has been the go-to patient-reported outcome measure of the perceived impact of Achilles tendinopathy. Recently, new instruments have been developed to try and overcome concerns about the validity of the VISA-A. The revised CPG summarized current evidence, and updated recommendations to support evidence-based practice, including tailored clinical decision-making, about managing Achilles tendinopathy. The CPG excluded interventions that were outside the typical scope of physical therapy practice (eg, pharmacological interventions and surgery) and extracorporeal shock wave therapy. J Orthop Sports Phys Ther 2025;55(1):68-69. doi:10.2519/jospt.2025.0501.

Letter to the Editor-in-Chief in response to JOSPT article "Heel Pain - Plantar Fasciitis: Revision 2023" by Koc et al. J Orthop Sports Phys Ther 2025;55(1):72-73. doi:10.2519/jospt.2025.0202.

SYNOPSIS: To improve the potential for sustained success when implementing injury prevention programs, researchers must focus on patient and public involvement and engagement. Creating lasting equitable relationships between researchers and knowledge users (ie, improving patient and public involvement and engagement) takes time and purposeful investment. Researchers must prioritize, embrace, and integrate patient and public involvement and engagement as a dynamic and continuous social process, unique to each community setting; it is not a one-off checkbox. Recognizing that knowledge users across disciplines and settings are not passive scientific consumers, but active knowledge creators, begins the process of developing equitable partnerships. In this editorial, we highlight the importance of (1) equity in sport and orthopaedic medicine, (2) prioritizing patient and public involvement and engagement at all stages of the research process, and (3) focusing on a knowledge user-centered perspective when designing, analyzing, implementing, and subsequently evaluating musculoskeletal injury prevention programs. J Orthop Sports Phys Ther 2024;54(12):1-5. doi:10.2519/jospt.2024.12668.

Letter to the Editor-in-Chief in response to JOSPT article "Which Portion of Physiotherapy Treatments' Effect Is Not Attributable to the Specific Effects in People With Musculoskeletal Pain? A Meta-analysis of Randomized Placebo-Controlled Trials" by Ezzatvar et al J Orthop Sports Phys Ther 2024;54(12):1-2. doi:10.2519/jospt.2024.0201.

OBJECTIVE: To summarize the effectiveness of eHealth interventions for improving pain, physical disability, psychological factors, and the quality of life for people with spine pain. DESIGN: Overview of systematic reviews. LITERATURE SEARCH: CINAHL, Embase, PubMed, and SPORTDiscus e-databases were searched. STUDY SELECTION CRITERIA: Systematic reviews with meta-analysis of randomized clinical trials evaluating any type of eHealth were included. DATA SYNTHESIS: AMSTAR 2 was used to assess the methodological quality of included reviews. The degree of overlap between reviews was calculated. RESULTS: Sixteen systematic reviews were included. Of them, 13 reviews were exclusively focused on back pain or low back pain. Exercise and psychological interventions were the primary contents of eHealth interventions. In general, eHealth interventions based on physical exercise may improve the quality of life of people with low back pain. eHealth interventions based on cognitive behavioral therapy may reduce pain catastrophizing and fear-avoidance beliefs for physical activity for people with low back pain. eHealth interventions based on multidisciplinary approaches including physical exercise may reduce low back pain. Few systematic reviews used the GRADE system to evaluate the certainty of evidence, and few specified the content of eHealth interventions. CONCLUSION: eHealth interventions may improve the quality of life, pain catastrophizing, and fear-avoidance beliefs for people with low back pain. It is unclear, based on available systematic reviews, how clinicians should deliver eHealth interventions for people with spine pain (eg, neck pain or low back pain). J Orthop Sports Phys Ther 2024;54(12):1-18. Epub 4 November 2024. doi:10.2519/jospt.2024.12844.

Author response to the JOSPT Letter to the Editor-in-Chief "Comment on "Which Portion of Physiotherapy Treatments' Effect Is Not Attributable to the Specific Effects in People With Musculoskeletal Pain? A Meta-Analysis of Randomized Placebo-Controlled Trials" by Ezzatvar et al" J Orthop Sports Phys Ther 2024;54(12):1-2. doi:10.2519/jospt.2024.0201-R.

The Academy of Orthopaedic Physical Therapy (AOPT) has an ongoing effort to create evidence-based clinical practice guidelines (CPG) for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The 2024 Achilles Pain, Stiffness, and Muscle Power Deficit: Midportion Achilles Tendinopathy Clinical Practice Guideline (CPG) is a revision of the 2018 CPG and represents the third CPG from AOPT on this topic. The goals of the revision were to provide a concise summary of the contemporary evidence and to develop new recommendations or revise previously published recommendations to support evidence-based practice. This current CPG covers prevalence, pathoanatomical features, risk factors, clinical course, diagnosis, examination, imaging, and physical therapy interventions for the management of midportion Achilles tendinopathy. J Orthop Sports Phys Ther 2024;54(12):CPG1-CPG32. Epub 27 November 2024. doi:10.2519/jospt.2024.0302.

OBJECTIVES: To (1) estimate the economic cost of disabling musculoskeletal pain in children and adolescents from a health care and societal perspective, (2) identify the characteristics of children and adolescents with higher costs, and (3) estimate the economic cost of children's pain to Brazil. DESIGN: Prospective cohort study. METHODS: We recruited children and adolescents with disabling musculoskeletal pain from public and private schools. The economic cost associated with disabling musculoskeletal pain was reported by parents each month for 1 year. The cost categories were health care, lost productivity, and patient/family costs. The sum of the categories resulted in the societal costs. Costs were reported using means, standard errors, medians, interquartile ranges, confidence intervals, and sum for each cost category. We compared participant characteristics between groups with low and high costs, and estimated the health and social cost of children's pain to the Brazilian federal budget. RESULTS: We included 237 children and adolescents with mean age of 11.8 years (standard deviation, 2.9). Total annual health care costs were $29.58 and $103.13 for health insurance/public health care and out-of-pocket, respectively, per child. Total annual societal costs were $177.62 per child. Individuals in low socioeconomic class E (with a monthly income of up to R$403.00) reported that heavy backpack weight, practice of fewer days of sports, and more negative psychosomatic symptoms were associated with higher health care costs. The annual costs to Brazil from the societal perspective was $1 001 329 553. CONCLUSION: Disabling musculoskeletal pain in children and adolescents in Brazil imposes a serious economic burden of up to $1 billion on the federal budget. J Orthop Sports Phys Ther 2024;54(12):1-10. Epub 4 November 2024. doi:10.2519/jospt.2024.12735.