Musculoskeletal Science and Practice最新文献

Background

In response to the COVID-19 pandemic, face-to-face consultations within healthcare settings were suspended. Remote consultations became crucial for managing musculoskeletal conditions alongside Patient Initiated Follow-ups, leading to the development of the DiAL programme at a large National Health Service Community Trust. Previous research has focused on quantitative data, little is known about staff experiences with this programme.

Objectives

To explore the perceptions and opinions of physiotherapy staff using DiAL, in order to highlight the benefits and challenges of this service with identification of areas for future development.

Design

Qualitative focus groups.

Methods

Two virtual focus groups were conducted via Microsoft Teams, involving a purposive sample of physiotherapy staff in the musculoskeletal services known to have used DiAL. Thematic analysis was conducted.

Results

Ten clinicians participated in the study, generating two main themes: Clinician Autonomy and Institutional Needs. These themes encompassed several subthemes.

Conclusions

Clinicians reported higher job satisfaction and improved accessibility for patients, attributing these positive outcomes to the autonomy and flexibility provided by the platform. While the programme met National Health Service targets for Patient Initiated Follow-ups, there was a desire for ongoing improvements and a recognition that previous audits failed to capture all the benefits. DiAL serves as a treatment choice, supporting evidence on the advantages of remote consultations and contributing to the National Health Services’ goal of reducing its carbon footprint. There is a collective desire for the platform to continue with future recommendations including expanding its use and exploring additional audit metrics.

2024 marks the 50th anniversary of the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT). IFOMPT became the first subgroup of World Physiotherapy. IFOMPT aims and works for global promotion of excellence and unity in clinical and academic standards for manual/musculoskeletal physiotherapists. This dissertation reflects on some of IFOMPT's initiatives and achievements as an international organisation in its first 50 years as well as challenges for next 50 years. IFOMPT has achieved in several initiatives. These include the development of an international educational curriculum in manipulative/musculoskeletal physiotherapy which underpins education standards for membership. Educational standards for membership is a relatively unique requirement of a professional organisation.

IFOMPT has achieved in developing several initiatives to disseminate knowledge for best standards of practice for its members and the wider community. The pinnacle is its four yearly international scientific conferences where the latest issues in both research and practice are presented and discussed. IFOMPT has also developed frameworks to guide clinical practice in key areas for safe practice – vascular pathologies of the neck, a clinical reasoning pathway to identify ‘red flags’, and the use of spinal manipulation in paediatrics. Other resources include on-line lectures, podcasts and research reviews.

IFOMPT has challenges for the future. These include increasing the number of member countries and further establishing its profile and position of leadership in manual/musculoskeletal physiotherapy in the international context, particularly with decision makers in world health.

Objective

This study aimed to compare the pain intensity, spine structure, and body composition according to functional disability levels in patients with acute discogenic lumbar radiculopathy (DLR).

Methods

A total of 118 women (n = 83) and men (n = 35) patients with acute DLR (mean age: 51.87 ± 13.38 years) were included in the study. The function ability was measured with the Oswestry Disability Index, pain intensity was measured with the Visual Analogue Scale, spine structure was measured with the Spinal Mouse® device, and body composition was measured with the Bioelectrical Impedance Analysis System.

Results

Patients with mild functional disability levels had significantly lower activity (p˂.001) and night pain intensity (p = 0.001) than patients with moderate, severe, and completely functional disability levels, and patients with completely functional disability levels had significantly higher rest pain intensity (p = 0.005) than patients with mild, moderate, and severe functional disability levels. Patients with mild functional disability levels had significantly better spine check scores (p = 0.001), posture (p = 0.005), and mobility (p = 0.003) than patients with moderate, severe, and completely functional disability levels. Patients with mild functional disability levels had significantly lower fat percentage (p = 0.032), and higher basal metabolic rate (p = 0.024) than patients with moderate, severe, and completely functional disability levels.

Conclusion

Pain intensity, spinal structure, and body composition of acute DLR patients differ greatly according to their functional disability levels. Although it is known that the level of functional disability of patients is a result of the severity or prognosis of the disease, performing different treatment methods aimed at decreasing the functional disability level of patients by health professionals may be important in terms of coping with the disease.

Background and objective

Adoption of low back pain (LBP) guidelines in physiotherapeutic management is a well-documented problem. Thereby, an in-depth understanding of the barriers to implement an active approach for both patients and physiotherapists is needed.

Design

Semi-structured interviews were conducted with physiotherapists and patients with non-specific LBP. Interviews, guided by the Theoretical Domains Framework (TDF), were analyzed using the Qualitative Analysis Guide of Leuven.

Results

A total of 20 participants were interviewed, including ten physiotherapists and ten patients. Our findings reveal that patients and physiotherapists face each 23 barriers spanning 14 TDF domains. The TDF domain “social influences” revealed the most barriers, followed by “beliefs about consequences” and “environmental context” for patients and physiotherapists, respectively. Five barriers did overlap between both groups (lack of guideline awareness, incorrect exercise performance, interdisciplinary communication gaps, time constraints and challenges in patient compliance).

Conclusions

Barriers to LBP guideline recommended physiotherapeutic practices span all 14 TDF domains. Consequently, future implementation interventions need to address multiple TDF domains for effective LBP guideline implementation.

Background

Office-workers who suffer from musculoskeletal pain/disability may experience reduced productivity and absenteeism from work. The Nordic Musculoskeletal Questionnaire (NMQ) is a valid, simple screening tool for the history and presence of self-perceived musculoskeletal symptoms in both general public and occupational settings.

Objective

To translate and culturally adapt the NMQ into Arabic language and examine its psychometric properties.

Methods

The published guidelines were followed to translate and adapt the NMQ into Arabic using a forward-backward process. Construct validity involved comparing NMQ responses with disability-related musculoskeletal questionnaires in different body regions, including the Neck Disability Index (NDI), Oswestry Disability Index (ODI), Quick-Disability of the Arm, Shoulder, and Hand (Quick-DASH), and Reduced Western Ontario and McMaster Universities Osteoarthritis Index (ArWOMAC). The reliability was evaluated using Cronbach's alpha for internal consistency and prevalence-adjusted bias-adjusted kappa (PABAK) for test–retest reliability.

Results

The Arabic NMQ (Ar-NMQ) revealed excellent internal consistency (Cronbach's alpha = 0.85). For the test-retest reliability, the PABAK coefficient ranged between 0.50 and 1. The Ar-NMQ demonstrated strong construct validity. Participants reporting neck pain showed significantly elevated disability scores on the NDI (p < 0.05), while those with back pain exhibited higher ODI scores (p < 0.05). Moreover, individuals reporting shoulder, elbow, and wrist pain and disability displayed elevated Quick-DASH scores (p < 0.05). Similarly, participants reporting hip/thighs, knees, and ankle/feet pain/disability demonstrated significantly higher disability in ArWOMAC (p < 0.05).

Conclusion

The NMQ was successfully translated and adapted into Arabic language, providing a reliable and valid instrument for assessing pain in specific body regions in the Arabic-speaking population.

Objective

To gain insight into the emotions, cognitions, and behaviours experienced by people with chronic low back pain (CLBP) undergoing invasive treatment in a pain unit.

Design

A cross-sectional qualitative study based on individual interviews. This study included patient involvement in its design and development.

Methods

An interpretative phenomenological approach was adopted to understand the multidimensional experience of patients. The interview script was a translated, adapted, and expanded version of the one proposed by Cognitive and Functional Therapy. A mixed coding method was applied to structure the interviews. Three themes were created, with the three most frequently reported emotions, cognitions, and behaviours as subthemes. A patient with CLBP approved the initial protocol and the aim of the study. Subsequently, the patient contributed questions to the interview script, checked the coding process, and approved the final version of the manuscript.

Results

Twenty-two patients undergoing epidural infiltrations in a pain unit were interviewed. (i)“Fears”, (ii)“Frustration”, and (iii)“Worry” were the three most commonly expressed emotions. Cognitions related to (i)“Pain predictability”, (ii)“Pain description and perception”, and (iii)“Pain interference/disability” were also widely reported. The theme “Behaviours” was composed of the following subthemes: (i)“Strategies for managing symptoms”, (ii)“Social behaviours”, and (iii)“Strategies for coping with daily tasks”. Noteworthily, cognitions related to the (i)“Diagnosis”, (ii)“Health system attention”, and (iii)“Medical prescriptions” arose from questions provided by patient involvement.

Conclusion

Patients with CLBP expressed a wide variety of emotions, cognitions, and behaviours that must be considered by health professionals with the goal of providing the best patient-centred care.