Musculoskeletal Science and Practice最新文献

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.

Background: Chronic low back pain is associated with dysfunctions in endogenous analgesia mechanisms, as evaluated through conditioned pain modulation paradigms. Although mobilization with movement has demonstrated enhancements in conditioned pain modulation among patients with conditions such as knee osteoarthritis, its efficacy in chronic low back pain patients has yet to be established.

Objectives: To investigate the effects of mobilization with movement compared to sham mobilization in conditioned pain modulation, mechanical hyperalgesia, and pain intensity in chronic low back pain patients.

Design: Randomized controlled trial following CONSORT and TIDieR guidelines.

Method: Fifty-eight patients with chronic low back pain (mean age 48.77 ± 13.92 years) were randomized into the experimental group, which received real mobilization with movement (n = 29), or the sham mobilization with movement group (n = 29). Only one intervention was performed. Patients were assessed before and after intervention. Conditioned pain modulation, mechanical hyperalgesia and pain intensity were assessed.

Results: Mobilization with movement resulted in no statistically significant differences compared to sham mobilization for conditioned pain modulation (post-treatment difference: 0.023 [-0.299, 0.345], p = 0.158), mechanical hyperalgesia (post-treatment difference: -0.198 [-0.505, 0.109], p = 0.207), or movement-related pain intensity (post-treatment difference: 0.548 [-0.068, 1.236], p = 0.079) improvements post-intervention. Effect sizes were small for conditioned pain modulation (r = 0.126), mechanical hyperalgesia (r = 0.101), and pain intensity (r = 0.208).

Conclusions: Mobilization with movement resulted in no significant differences compared to sham mobilization with movement after one intervention for conditioned pain modulation, mechanical hyperalgesia or pain intensity, with small effect sizes. However, the findings should be interpreted with caution due to absence of screening for appropriately eligible patients.

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: Exergaming is increasingly popular, but its impact on chronic low back pain (CLBP) remain unclear.

Objectives: To evaluate the effectiveness of exergaming versus traditional exercise for managing CLBP using the International Classification of Functioning, Disability and Health (ICF) framework.

Methods: This single-blind, randomized controlled trial included 70 participants with CLBP, who were assigned to either the exergaming or traditional exercise group. Both groups received 2 weeks of treatment with six sessions. Assessments included the Oswestry Disability Index (ODI), range of motion, Hospital Anxiety and Depression Scale (HADS), balance (Biodex Stability System), Fear-Avoidance Beliefs Questionnaire (FABQ), and physical performance tests.

Results: After six sessions over 2 weeks, the exergaming group showed significant improvements over the exercise group in ODI (p < 0.001), chair-rising time (p = 0.001), stair ascent (p = 0.025) and descent times (p < 0.001), flexion (p = 0.005), extension (p = 0.001), balance (p = 0.012), and FABQ subscales (physical activity: p = 0.003; work: p < 0.001) at the 3-month follow-up. Group × time interaction effects favored exergaming for ODI (p = 0.012), chair-rising (p = 0.045), stair ascent (p = 0.010), and descent (p = 0.002) times. While these changes did not meet clinical significance, exergaming was not inferior to traditional exercise in improving spinal motion, physical performance, fear-avoidance beliefs, and disability.

Conclusion: Exergaming appears to be a viable supplementary therapy for patients with CLBP, offering benefits across all ICF domains. Future studies with longer intervention durations are needed to assess its long-term effects.

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.

Objective: The objective of this cross-sectional study was to compare the physical activity level between individuals with and without rotator cuff related shoulder pain (RCRSP), and, in individuals with RCRSP, investigate whether biopsychosocial factors are associated with the physical activity level.

Methods: Seventy-four participants with and 84 participants without RCRSP wore a fitness tracking watch for seven consecutive days to assess physical activity (step count, moderate-to-vigorous physical activity (MVPA)-minutes). Additionally, participants with RCRSP completed questionnaires on their level of pain, disability, and physical activity (short version of the International Physical Activity Questionnaire [IPAQ]), as well as on biopsychosocial factors, including resilience, stress, catastrophizing, anxiety and depressive symptoms, self-efficacy, and social support. Statistical analysis included Mann-Whitney U tests and General Linear Models for group comparisons, as well as multiple regression analyses to explore predictors of physical activity.

Results: No significant between-group difference was found concerning step count and MVPA-minutes. Age and depressive symptoms explained 14% of the variance in step count, while age and resilience explained 15% of MVPA-minutes variance. Additionally, resilience was associated with IPAQ (P < 0.05), indicating that higher resilience correlates with greater reported physical activity (odds ratio: 2.32 [1.27, 4.22]).

Conclusion: While individuals with RCRSP did not show lower physical activity levels compared to their healthy counterparts, greater physical activity was associated with younger age, lower depressive symptoms, and higher resilience in individuals with RCRSP. Future research should explore whether resilience and physical activity interventions can prevent the transition to persistent RCRSP.

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.

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.