Musculoskeletal Science and Practice最新文献

Objectives: To investigate the effectiveness of education for people with shoulder pain.

Design: Systematic review LITERATURE SEARCH: We searched several databases (e.g. MEDLINE, EMBASE, CENTRAL, CINAHL) and trial registries from inception to May 25, 2023.

Study selection criteria: Randomised controlled trials investigating any education for people with shoulder pain.

Data synthesis: Pain and disability were primary outcomes. The Physiotherapy Evidence Database (PEDro) scale was used to assess methodological quality. Meta-analysis was not appropriate due to heterogeneity.

Results: We included 14 trials (8 had high methodological quality). The one trial on rotator-cuff related shoulder pain did not assess pain or disability but found best practice education (vs. structure-focused education) increased reassurance and intentions to stay active. The one trial on adhesive capsulitis found daily reminders, encouragement, and education about exercise via text did not improve pain and disability compared to no education. For post-operative shoulder pain, two (of four) trials found education reduced some measure of pain, but none found an effect on disability or any other outcomes. For 'shoulder complaints' (i.e. mixed or unclear diagnosis), no trials found education was more effective than home exercise or no education for improving pain or disability.

Conlusion: Some forms of education appear to improve reassurance, treatment intentions, perceived treatment needs, recovery expectations, and knowledge, but their effect on pain and disability is unclear. High-quality trials are needed to resolve uncertainty surrounding the benefit of education for shoulder pain, particularly rotator-cuff related shoulder pain and adhesive capsulitis.

Background: While technology brings many opportunities for optimizing and improving health services, the lack of professionals trained in telehealth poses an important obstacle. Despite the existance of core competency frameworks for some healthcare professions, there is currently no consensus or guidelines on the core competencies that telehealth professionals should possess within the context of a higher education curriculum. This can hinder the potential benefits of healthcare service delivery.

Objective: To establish a consensus on the core competencies in telehealth that should be integrated into higher education curricula for healthcare professionals.

Methods: A three-round international eDelphi study was conducted. The panel comprised of a diverse group of experts in telehealth, clinicians, lectures and professors, administrators, and teaching coordinators. In the first round, an international steering committee developed a list of competencies that were presented to the panel members and they were asked to rate their level of agreement and suggest additional competencies. The consensus was established based on the competencies that achieved a high level of agreement (>75%) by the end of the third round.

Results: We included 100 panellists from 18 different countries. By the end of the third round, we reached a consensus for 47 core competencies in a telehealth curriculum organized into 12 domains: principles of telehealth; care planning and management; assessment, diagnosis, and treatment; adequacy of the environment; professionalism; legal aspects; patient privacy; patient safety; access and equity; patient preference; technology; applicability of telehealth.

Conclusion: We identified the core competencies in a telehealth curriculum organized into 12 domains to be used as a foundation for training future health professionals.

Objectives: To evaluate the effects of a smartphone game for active neck movement exercise on perceived neck discomfort, new onset neck pain, and active cervical range of motion among high-risk office workers.

Methods: A 6-month prospective cluster-randomized controlled trial was conducted. Workers were randomly assigned at the cluster level into either the intervention group (n = 50), who received a smartphone game to play twice a day, or the control group (n = 50), who received a placebo seat pad to use while sitting. Both groups were followed up for 6 months and outcome measures included the incidence of neck pain, perceived neck discomfort, assessed by the Borg CR-10, and active cervical range of motion. Analyses were performed using Cox proportional hazard models.

Results: The 6-month incidence of neck pain was 20% and 44% in the intervention and control groups, respectively. Hazard ratios, after adjusting for biopsychosocial factors, showed a protective effect of the smartphone game for new onset neck pain (HR_adj = 0.43, 95% CI 0.20 to 0.91). The between group differences in perceived neck discomfort during the follow up did not reach the minimally clinically important difference level. Mean active cervical range of motion in the intervention group were significantly greater than the control group in all directions (p < 0.05).

Conclusion: The smartphone game for active neck movement exercise is an effective intervention to prevent neck pain among high-risk office workers.

Background: Pain is impacted by bio-psycho-social factors and is closely related to disability and poor quality of life. Therefore, a patient-reported outcome measure (PROM) is needed to capture these aspects effectively. The Short Form Brief Pain Inventory (SF-BPI) serves this purpose as a tool for pain assessment. However, the Danish translation (SFBPI-DK) has not undergone validation.

Objective: Assess the validity and reliability of SFBPI-DK.

Methods: In patients with spine-related pain, construct validity was tested using Confirmatory Factor Analysis (CFA) and convergent validity through correlations with EuroQol 5-domain 5-level (EQ-5D-5L), EQ-5D-5L VAS, Work Ability Score (WAS), and Insomnia Severity Index (ISI-7). Internal consistency was assessed with Cronbach's alpha. In individuals with musculoskeletal pain, test-retest reliability and Minimal Detectable Change (MDC) were evaluated. Floor and ceiling effects were reported for both groups.

Results: In patients with spine-related pain (n = 329), construct validity of the SFBPI-DK was confirmed through CFA of a modified 3-factor structure. Convergent validity showed "fair" to "moderate strong" associations with EQ-5D-5L, EQ-5D-5L VAS, WAS, and ISI-7. Internal consistency was satisfactory (Cronbach's alpha 0.89-0.91). In individuals with musculoskeletal pain (n = 119), good temporal stability was demonstrated with ICCs of 0.76-0.88. The MDC for the Severity score, Interference score, and the Physical- and Affective Interference subscores were 3.37, 2.41, 3.57, and 4.01, respectively.

Conclusion: The SFBPI-DK is a valid tool for assessing pain in patients with persistent spine-related pain and a reliable tool for individuals with persistent musculoskeletal pain among Danish-speaking populations.

Question(s): What are the prognostic reasoning practices of physiotherapists towards musculoskeletal disorders?

Design: Exploratory phenomenological study.

Participants: 15 physiotherapists who currently treat musculoskeletal disorders.

Date analysis: Semi-structured interviews were implemented to collect data which was analysed using an inductive coding and thematic analysis approach.

Results: Three themes were identified. First, how physiotherapists considered prognosis within clinical practice. Whilst prognosis is an important consideration, in some circumstances it either may not be considered or is implied. Second, how physiotherapists determine prognosis for musculoskeletal disorders. Several factors shaped the ability of physiotherapists to determine prognosis including how they determine prognosis, and the barriers and facilitators towards determining prognosis. Finally, how physiotherapists discuss prognosis with individuals who have a musculoskeletal disorder. These discussions were shaped by the prognostic information provided, as well as the barriers and facilitators towards discussing prognosis.

Conclusion: The prognostic reasoning of physiotherapists appears to be influenced initially by whether they consider it or not. It is then shaped by both barriers and facilitators towards determining and discussing prognosis. Facilitators for this prognostic reasoning process appear to be aligned with the biomedical model of health, whilst barriers more aligned with psychosocial factors. To improve prognostic reasoning, physiotherapists should continue to strive to conceptualize prognosis within a biopsychosocial framework. Doing so will improve the ability of physiotherapists to prognosticate, which will subsequently improve outcomes associated with musculoskeletal disorders.

Introduction: Fibromyalgia syndrome (FMS) causes significant pain, disability, and costs among patients. It is paramount that healthcare professionals have an updated knowledge of its characteristics and Clinical Practice Guidelines (CPGs).

Objectives: To determine the knowledge, adherence to CPGs, and confidence of Italian physiotherapists in managing patients with FMS, explore barriers to the implementation of CPG' recommendations, compare groups' adherence to CPGs, and determine which variables explained most of the participants' knowledge.

Methods: The survey was administered via social media and newsletter (i.e., Italian Association of Physiotherapists, AIFI) to Italian practicing physiotherapists. The protocol of this work was prospectively registered in the Open Science Framework.

Results: Total replies were 398. Italian physiotherapists showed a good knowledge of FMS and adherence to CPGs. Ninety-one percent reported a medium or lower confidence in managing patients with FMS. Sixty-seven percent judged their knowledge of CPGs as poor or very poor. The remaining 33% mentioned patients' psychosocial aspects, multidisciplinary relationships, and lack of training on communication strategies as the main barriers to the implementation of CPGs. Being an Orthopaedic Manipulative Physical Therapist (OMPT) resulted in a better adherence to CPGs on 11/14 items. Knowledge scores were correlated (r = 0.244) with being an OMPT (Stand β = 0.123) and years of professional activity (Stand β = -0.126).

Conclusions: Although Italian physiotherapists demonstrated a good knowledge of FMS and reported a good adherence to CPGs' recommendations, they may still experience barriers to the implementation of evidence-based management strategies.

Background: The International Federation of Manual and Musculoskeletal Physical Therapists (IFOMPT) membership requires accreditation of countries postgraduate musculoskeletal physiotherapy programmes to meet IFOMPT's Educational Standards through International Monitoring. The Educational Standards and International Monitoring are both being reviewed.

Objectives: To seek insight and feedback from IFOMPT's membership on the Educational Standards and International Monitoring to inform the current review.

Design: Online survey of registered members, external assessors, programme leaders, international delegates.

Method: IFOMPT members were invited to participate in the Educational Standards and International Monitoring survey, between December 2023-January 2024. Content validity was assessed to refine the survey. The survey was offered in 14 languages. Descriptive and inferential analyses were used for closed questions; content analysis was used for open questions.

Results: 869 participants were eligible and completed the survey. IFOMPT's membership clearly valued both the Educational Standards and International Monitoring, and believe they are contemporary and evidence-informed. However, opinion was divided regarding the strengths and weaknesses of the Educational Standards and International Monitoring and whether the Educational Standards represented a minimum or maximum standard. Constructive recommendations were provided for the improvement of the Educational Standards and International Monitoring, including reduction of size and complexity, with increased flexibility to ensure they are fit for purpose into the future and serve towards the growth of IFOMPT.

Conclusions: This was the largest member-wide survey of IFOMPT examining the Educational Standards and International Monitoring. The findings of the survey are extremely valuable to inform the current review of the Educational Standards and International Monitoring, particularly given the divided opinion concerning the useability and content of the Educational Standards.

Background: Neck pain is one of the leading causes of disability in the United States. However, the nature of cervical spine surgery is multi-factorial and often based upon clinical opinions, leaving clinical indications still to be clearly defined.

Objective: To predict which clinical variables most influenced trends toward surgical or conservative management for individuals with neck pain.

Design: Retrospective analysis on prospectively collected data.

Methods: Two-hundred seventy individuals participated in the study. A retrospective chart review was performed to identify qualifying participants. Variables captured during data collection included the following: patient demographic information, physical examination (e.g., neurologic examination), physical performance measures, patient-reported outcome measures (Numeric Pain Rating Scale and Neck Disability Index), and chronicity of symptoms. Group allocation was determined by referring physician's medical diagnosis. A forward step-wise multiple logistic regression analysis was used to develop a final predictor model with p < 0.05 considered significant.

Results: The model showed older age (beta = 0.022; Exp(beta) = 1.022; p = 0.037), longer chronicity of symptoms (beta = 0.000; Exp(beta) = 1.000; p = 0.012), and greater neck disability (beta = 0.027; Exp(beta) = 1.028; p < 0.001) were significant predictors of the operative group. Most notably, patients with a positive neurologic examination were almost four times more likely to be referred to surgery (beta = 1.368; Exp(beta) = 3.927; p < 0.001).

Conclusion: In general neck pain patients, older age, longer chronicity of symptoms, greater disability, and a positive neuro exam are clinical predictors of surgical selection, with positive neuro exam increasing the likelihood of surgery four-fold.