Musculoskeletal Science and Practice最新文献_第10页

Reliability, construct validity, responsiveness and minimum clinically important difference of the numeric pain rating scale and shoulder pain and disability index in patients with subacromial pain syndrome 肩峰下疼痛综合征患者数字疼痛评定量表与肩痛失能指数的信度、结构效度、反应性及最小临床重要差异

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-10-01 Epub Date: 2025-06-28 DOI: 10.1016/j.msksp.2025.103372

Ian Young , James Dunning , James Escaloni , Filippo Maselli , Joshua Prall , Firas Mourad , César Fernández-de-las-Peñas

Background

The numeric pain rating scale (NPRS) and shoulder pain and disability index (SPADI) are commonly used patient-reported outcome measures (PROMs) in patients with rotator cuff tendinopathy. To date, there are gaps in the evidence supporting the clinimetric properties of these PROMs for patients treated with subacromial pain syndrome (SAPS).

Methods

A clinimetric analysis (n = 145) was performed to examine the reliability, construct validity, responsiveness, interpretability, minimal detectable change (MDC₉₅) and minimum clinically important difference (MCID) of the NPRS and SPADI for "improved" (global rating of change from +3 to +7) and "much-improved" (global rating of change from +5 to +7) patients at 3-months follow-up.

Results

The NPRS (ICC: 0.86; 95 %CI, 0.33–0.96) and SPADI (ICC: 0.79; 95 %CI 0.12–0.94) exhibited good reliability and excellent responsiveness (NPRS: area under the curve (AUC) = 0.96, 95 %CI 0.92–0.99; SPADI: AUC = 0.90, 95 %CI 0.84–0.95) in this patient population. Both outcomes demonstrated strong construct validity (Pearson's r; p < 0.001). The MDC₉₅ was a 1.7- and 20.5-point change for the NPRS and SPADI, respectively. For the NPRS, the MCID was a 1.5-point change in the "improved" group and a 2.5-point change in the "much improved" group. For the SPADI, the MCID was an 18-point or 50 % change for the "improved" group, and a 25-point or 70 % change in the "much improved" group.

Conclusions

The NPRS and SPADI demonstrated sound clinimetric properties in patients with SAPS. The MCID exceeded measurement error in the "much improved" group. Diagnosis, type of intervention, level of improvement, and measurement error should be considered when applying the MCID.

背景：数值疼痛评定量表（NPRS）和肩痛与失能指数（SPADI）是肩袖肌腱病变患者常用的患者报告结果测量指标（PROMs）。迄今为止，支持这些PROMs治疗肩峰下疼痛综合征（SAPS）患者的临床特性的证据还存在空白。方法采用临床计量学分析（n = 145），对随访3个月的“改善”（总体评分从+3到+7）和“非常改善”（总体评分从+5到+7）患者的NPRS和SPADI进行信度、结构效度、反应性、可解释性、最小可检测变化（MDC95）和最小临床重要差异（MCID）的检验。结果NPRS (ICC: 0.86；95% CI, 0.33-0.96)和SPADI (ICC: 0.79；95% CI 0.12-0.94)表现出良好的信度和良好的响应性(NPRS：曲线下面积(AUC) = 0.96, 95% CI 0.92-0.99；SPADI: AUC = 0.90, 95% CI 0.84-0.95)。两个结果都显示了很强的构念效度(Pearson’s r；p & lt;0.001)。NPRS和SPADI的MDC95分别变化了1.7和20.5点。对于NPRS，“改善”组的MCID变化为1.5点，“大大改善”组的MCID变化为2.5点。对于SPADI，“改善”组的MCID变化为18点或50%，“大大改善”组的MCID变化为25点或70%。结论NPRS和SPADI在SAPS患者中具有良好的临床性能。在“显著改善”组中，MCID超过了测量误差。应用MCID时应考虑诊断、干预类型、改善水平和测量误差。

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引用次数: 0

Prevalence of cervical, vestibulo-ocular and or physiological impairments in symptomatic individuals 4 weeks to 6 months post-concussion 脑震荡后4周至6个月有症状个体的颈椎、前庭-眼和/或生理损伤发生率

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-10-01 Epub Date: 2025-07-02 DOI: 10.1016/j.msksp.2025.103381

Treleaven J, Carberry K, Cook H, Fulcher D, Syme C, Galea O

Background

Deficits in individual measures relating to cervical, vestibulo-ocular or physiological subsystems have been observed in symptomatic individuals post-concussion. Few studies consider the presence of several impairments within and across each of these three subsystems.

Objective

To evaluate the prevalence of cervical, vestibulo-ocular and or physiological impairment in symptomatic individuals four weeks to six months post-concussion.

Setting

Tertiary hospital and university.

Design

Exploratory observational cohort study.

Methods

Participants were deemed to have: Cervical impairment if positive on at least 3/7 cervical tests, vestibulo-ocular impairment if positive on at least 2/11 tests and physiological impairment if they failed the Buffalo Concussion Treadmill Test.

Results

Impairment across all three subsystems was detected in 29 % of participants, two subsystems in 47 %, one in 23 % and none in 3 %. Eighty-five percent had cervical impairment.

Conclusion

There was a high prevalence of multiple subsystem impairments and the majority had a cervical impairment across a number of cervical tests. Hence, in clinical practice, it is essential to perform a detailed physical examination across all subsystems and consider clinical implications of cervical impairments in the majority of individuals four weeks to six months post-concussion.

背景：在有症状的脑震荡后个体中观察到与颈椎、前庭-眼或生理子系统相关的个体测量缺陷。很少有研究考虑到这三个子系统内部和之间存在几种损伤。目的评价脑震荡后4周至6个月有症状者颈椎、前庭-眼和（或）生理损伤的发生率。三级医院和大学。设计探索性观察队列研究。方法：如果参与者在至少3/7的颈椎测试中呈阳性，则认为他们有颈椎损伤；如果在至少2/11的测试中呈阳性，则认为他们有前庭-眼部损伤；如果他们在布法罗脑震荡跑步机测试中失败，则认为他们有生理损伤。结果29%的参与者在所有三个子系统中检测到损伤，47%的参与者在两个子系统中检测到损伤，23%的参与者在一个子系统中检测到损伤，3%的参与者没有检测到损伤。85%的人有宫颈损伤。结论多子系统损伤发生率高，且多项宫颈检查均以宫颈损伤为主。因此，在临床实践中，有必要对所有子系统进行详细的体格检查，并考虑大多数人在脑震荡后4周到6个月的颈椎损伤的临床意义。

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引用次数: 0

Differences in tactile grid localization accuracy between people with back pain compared to individuals without pain 有背痛的人和没有背痛的人在触觉网格定位准确度上的差异

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-10-01 Epub Date: 2025-08-21 DOI: 10.1016/j.msksp.2025.103394

Kory Zimney , Tyler Turbak , Eric Fjeldheim

Objectives

The study aimed to investigate the grid localization test (GLT) between patients with lower back pain and those without back pain.

Methods

Individuals receiving physical therapy were tested before treatment with a GLT to the low back. Testing was performed in the prone position. Participants were oriented to the 12-box, 50 mm grid squares, arranged in three rows and four columns, with a single touch in the center of each square, and provided with the corresponding number for that square. Twenty random touch points were then applied with a single touch in the center of the square, and the participant's accuracy in reporting the correct number associated with the touched square was recorded.

Results

GLT was done on 26 individuals with lower back pain compared to 26 individuals without back pain. Those with back pain had a mean accuracy score of 52.41 %, compared to those without back pain, who averaged 76.18 % accuracy, adjusted for age as a covariate between groups. This was a significant difference (p < 0.001) that demonstrated a large effect size (partial η² = 0.296). Interestingly, those with acute pain (<3 months) scored (n = 14, mean = 48.9 %, SD = 21.2 %), similarly to those with chronic pain (>3 months) (n = 12, mean = 49.2 %, SD = 20.3 %).

Discussion

When tested with GLT, individuals with low back pain exhibit poorer accuracy scores compared to those without pain. Future studies are needed to determine if treatment to improve accuracy scores has therapeutic benefits.

目的探讨下背部疼痛患者与非下背部疼痛患者的网格定位测试（GLT）。方法对接受物理治疗的个体进行下背部GLT治疗前的检测。试验采用俯卧位。参与者被引导到12个盒子，50毫米的网格正方形，排列成三排四列，在每个正方形的中心有一个触摸，并提供相应的正方形数字。20个随机的触摸点，然后在正方形的中心进行一次触摸，参与者报告与触摸正方形相关的正确数字的准确性被记录下来。结果glt对26名腰痛患者和26名无腰痛患者进行了对比。有背痛的患者平均准确率为52.41%，而没有背痛的患者平均准确率为76.18%，根据年龄作为组间协变量进行了调整。这是一个显著的差异（p < 0.001），证明了一个大的效应量（偏η2 = 0.296）。有趣的是，急性疼痛（3个月）患者得分（n = 14，平均= 48.9%,SD = 21.2%），与慢性疼痛（3个月）患者相似（n = 12，平均= 49.2%,SD = 20.3%）。当进行GLT测试时，与没有疼痛的人相比，有腰痛的人表现出更低的准确性得分。未来的研究需要确定提高准确性评分的治疗是否有治疗效果。

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引用次数: 0

An evaluation of a one-day pain science education event in a 16–18 years school setting targeting pain-related beliefs, knowledge, and behavioural intentions: A mixed-methods, non-randomised controlled trial 在16-18岁的学校环境中，针对疼痛相关信念、知识和行为意图进行为期一天的疼痛科学教育活动的评估：一项混合方法、非随机对照试验

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-10-01 Epub Date: 2025-07-03 DOI: 10.1016/j.msksp.2025.103385

J. Mankelow , C.G. Ryan , N. Skidmore , J. Potter , D. Ravindran , R. Chattle , S. Browne , S. Suri , A. Graham , J.W. Pate , R. Newport , T. Langford , D. Martin

Background

Public understanding of persistent pain is fraught with misconceptions. Pain education in schools may improve public understanding long-term. This study evaluated the impact of a one-day Pain Science Education (PSE) public health event delivered in a 16–18 year old school setting.

Methods

This was a multi-site, non-randomised controlled, mixed-methods study with three data collection time points: baseline, post intervention, and three-month follow-up. Participants were high school students ≥16 years old. Pain beliefs, knowledge, and behavioural intentions were assessed with the Pain Beliefs Questionnaire (PBQ [organic and psychological subscales]), Concepts of Pain Inventory (COPI-Adult), a case vignette, and reflexive thematic analysis of semi-structured interviews.

Results

Thirty intervention (mean age 16.6 years, 37 % female, 63 % male) and 24 control group participants (16.9 years, 63 % female, 37 % male) were recruited. Attending the pain education event was associated with reductions in Organic Beliefs [mean difference −4.4 (95 % CI, −6.0, −1.9)] and increases in Psychological Beliefs [4.6 (2.7, 6.4)] compared to the control group. This represents a shift away from biomedical beliefs in the intervention group compared to the control group. This shift was partially sustained at 3 months. A similar pattern was seen for the COPI-Adult and case vignette assessments. Semi-structured interviews (n = 13) identified an increased awareness of chronic pain and varying degrees of reconceptualisation of pain towards a biopsychosocial understanding.

Conclusions

Attendance at a one-day PSE-based public health event was associated with improved knowledge, beliefs, and behavioural intentions regarding persistent pain. This exploratory study supports the need for a robust mixed-methods RCT of pain education for school children with long-term follow-up.

公众对持续性疼痛的理解充满了误解。从长远来看，学校的疼痛教育可以提高公众对疼痛的认识。本研究评估了在一所16-18岁的学校进行为期一天的疼痛科学教育（PSE）公共卫生活动的影响。方法：这是一项多地点、非随机对照、混合方法的研究，有三个数据收集时间点：基线、干预后和三个月随访。参与者为年龄≥16岁的高中生。通过疼痛信念问卷（PBQ[有机和心理亚量表]）、疼痛概念量表（COPI-Adult）、案例小品和半结构化访谈的反身性主题分析来评估疼痛信念、知识和行为意图。结果共纳入30例干预组（平均年龄16.6岁，女性占37%，男性占63%）和24例对照组（平均年龄16.9岁，女性占63%，男性占37%）。与对照组相比，参加疼痛教育活动与有机信念的降低[平均差异为- 4.4 (95% CI, - 6.0, - 1.9)]和心理信念的增加[4.6(2.7,6.4)]有关。与对照组相比，这代表了干预组对生物医学信念的转变。这种转变在3个月时部分持续。在copi -成人和病例小短文评估中也发现了类似的模式。半结构化访谈（n = 13）确定了对慢性疼痛的认识增加和对疼痛的不同程度的重新概念化，以实现生物心理社会理解。结论：参加为期一天的基于pse的公共卫生活动与改善关于持续性疼痛的知识、信念和行为意愿相关。本探索性研究支持对学龄儿童疼痛教育进行长期随访的可靠的混合方法随机对照试验的需要。

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引用次数: 0

Managing non-traumatic Adolescent knee Pain: feasibility of using the MAP-Knee Tool in secondary care 管理非创伤性青少年膝关节疼痛：在二级护理中使用map -膝关节工具的可行性

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-10-01 Epub Date: 2025-07-01 DOI: 10.1016/j.msksp.2025.103373

Malene K. Bruun , Chris Djurtoft , Ole Rahbek , Michael S. Rathleff , Henrik Riel

Background

A clinical decision-support tool (MAP-Knee Tool) was recently developed to support the consultation process between clinicians and adolescents with non-traumatic knee pain and enhance shared decision-making while reducing diagnostic uncertainty.

Objectives

We aimed to assess the feasibility of using the MAP-Knee Tool in an orthopaedic department for adolescents consulting with non-traumatic knee pain.

Design

Feasibility study.

Method

We combined interviews, a questionnaire, and observations of two orthopaedic surgeons. Feasibility was evaluated based on Acceptability (dichotomised to 'acceptable' (categories 6–7) or 'unacceptable' (categories 1–5) from a 7-point rank scale ranging from 'very acceptable' to 'very unacceptable'), Appropriateness (time consumption), Fidelity (whether the tool was used as intended and the referral pattern), and Sustainability (whether surgeons would continue to use the tool). Consultations with adolescents aged 10–19 years with non-traumatic knee pain were eligible for inclusion.

Results

We included 16 consultations. The duration of each consultation ranged between 8 and 20 min, which fit within the time frame of the surgeons' usual consultations. Both surgeons rated the tool as “very acceptable”. They referred nine adolescents for treatment, four for diagnostic imaging, and three did not receive further treatment or referrals, and the surgeons expressed that the tool did not affect their referral. The surgeons stated that the tool was applicable to practice within their context and that they would especially recommend it to younger doctors.

Conclusions

The MAP-Knee Tool is feasible to use in secondary care based on the experiences of orthopaedic surgeons using the tool during consultations with adolescents.

最近开发了一种临床决策支持工具（MAP-Knee tool），用于支持临床医生和患有非外伤性膝关节疼痛的青少年之间的咨询过程，并在减少诊断不确定性的同时加强共同决策。目的：我们旨在评估在骨科使用MAP-Knee Tool治疗青少年非外伤性膝关节疼痛的可行性。DesignFeasibility研究。方法采用访谈、问卷调查和对两位骨科医生的观察相结合的方法。可行性评估基于可接受性(从“非常可接受”到“非常不可接受”的7分等级量表分为“可接受”（6-7类）或“不可接受”（1-5类），适当性（时间消耗），保真度（工具是否按预期使用和转诊模式）和可持续性（外科医生是否会继续使用该工具）。年龄在10-19岁的非外伤性膝关节疼痛青少年的咨询符合纳入条件。结果纳入16例咨询。每次会诊的时间在8到20分钟之间，符合外科医生通常会诊的时间框架。两位外科医生都认为该工具“非常可接受”。他们推荐了9名青少年进行治疗，4名进行诊断成像，3名没有接受进一步治疗或转诊，外科医生表示该工具不影响他们的转诊。外科医生表示，该工具适用于他们的情况，他们会特别推荐给年轻的医生。结论基于骨科医生在青少年会诊时使用MAP-Knee Tool的经验，MAP-Knee Tool在二级医疗中是可行的。

{"title":"Managing non-traumatic Adolescent knee Pain: feasibility of using the MAP-Knee Tool in secondary care","authors":"Malene K. Bruun , Chris Djurtoft , Ole Rahbek , Michael S. Rathleff , Henrik Riel","doi":"10.1016/j.msksp.2025.103373","DOIUrl":"10.1016/j.msksp.2025.103373","url":null,"abstract":"<div><h3>Background</h3><div>A clinical decision-support tool (MAP-Knee Tool) was recently developed to support the consultation process between clinicians and adolescents with non-traumatic knee pain and enhance shared decision-making while reducing diagnostic uncertainty.</div></div><div><h3>Objectives</h3><div>We aimed to assess the feasibility of using the MAP-Knee Tool in an orthopaedic department for adolescents consulting with non-traumatic knee pain.</div></div><div><h3>Design</h3><div>Feasibility study.</div></div><div><h3>Method</h3><div>We combined interviews, a questionnaire, and observations of two orthopaedic surgeons. Feasibility was evaluated based on Acceptability (dichotomised to 'acceptable' (categories 6–7) or 'unacceptable' (categories 1–5) from a 7-point rank scale ranging from 'very acceptable' to 'very unacceptable'), Appropriateness (time consumption), Fidelity (whether the tool was used as intended and the referral pattern), and Sustainability (whether surgeons would continue to use the tool). Consultations with adolescents aged 10–19 years with non-traumatic knee pain were eligible for inclusion.</div></div><div><h3>Results</h3><div>We included 16 consultations. The duration of each consultation ranged between 8 and 20 min, which fit within the time frame of the surgeons' usual consultations. Both surgeons rated the tool as “very acceptable”. They referred nine adolescents for treatment, four for diagnostic imaging, and three did not receive further treatment or referrals, and the surgeons expressed that the tool did not affect their referral. The surgeons stated that the tool was applicable to practice within their context and that they would especially recommend it to younger doctors.</div></div><div><h3>Conclusions</h3><div>The MAP-Knee Tool is feasible to use in secondary care based on the experiences of orthopaedic surgeons using the tool during consultations with adolescents.</div></div>","PeriodicalId":56036,"journal":{"name":"Musculoskeletal Science and Practice","volume":"79 ","pages":"Article 103373"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Development of a patient decision aid in relation to imaging for rotator cuff tendinopathy: a mixed-methods study. 一种与肩袖肌腱病变影像学相关的患者决策辅助工具的开发：一项混合方法的研究。

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-10-01 Epub Date: 2025-07-19 DOI: 10.1016/j.msksp.2025.103388

P Malliaras, T P Haines, F Burstein, D Connell, P Delir Haghighi, T Hoffmann, J Neil, P Nicklen, H Skouteris, R S Page, R Whale, I Harris, J R Zadro

Background: Unnecessary imaging for rotator cuff related shoulder pain is common and may be related to inadequate shared decision making.

Objective: To develop and evaluate a patient decision aid (PDA) for people with rotator cuff-related shoulder pain to inform decision-making.

Design: Mixed-methods study guided by the International Patient Decision Aids Standards.

Methods: A multidisciplinary steering group guided this research. The PDA was developed iteratively, incorporating feedback from people with shoulder pain and health professionals through semi-structured interviews and acceptability questionnaires (1 = strongly disagree and 5 = strongly agree). Thematic analysis of qualitative data and descriptive analysis of quantitative data was undertaken.

Results: Twenty health professionals and nineteen patients participated in interviews, while a separate cohort of 54 patients and 15 health professionals completed acceptability questionnaires. Most patients (74-98 %) rated the PDA as acceptable, though 37 % perceived it as biased against imaging. Health professionals (median agreement score 4/5) found the PDA useful but highlighted concerns about feasibility in time-constrained settings. Interview feedback emphasized clarity, contextualization of imaging findings, and alignment with clinical guidelines. When using the final version of the PDA in a clinical encounter, all five patients (100 %) reported that the information in the decision aid influenced their decision to have a scan, and four of the five health professionals (80 %) reported that they would use the decision aid in their practice.

Conclusion: This decision aid appears to be an acceptable and useful tool for helping people with rotator cuff-related shoulder pain to make informed decisions about imaging. A randomized controlled trial evaluating whether this decision aid reduces people's intentions to have imaging and facilitate informed treatment choices is now needed.

背景：肩袖相关肩痛的不必要影像学检查很常见，可能与共同决策不足有关。目的：为肩袖相关肩痛患者开发和评估患者决策辅助（PDA），为决策提供依据。设计：国际患者辅助决策标准指导下的混合方法研究。方法：多学科指导小组指导本研究。PDA是迭代开发的，通过半结构化访谈和可接受性问卷（1 =强烈不同意，5 =强烈同意），纳入肩痛患者和健康专业人员的反馈。对定性数据进行专题分析，对定量数据进行描述性分析。结果：20名卫生专业人员和19名患者参与了访谈，另外54名患者和15名卫生专业人员完成了可接受性问卷。大多数患者（74- 98%）认为PDA是可以接受的，尽管37%的人认为它对成像有偏见。卫生专业人员（同意得分中位数为4/5）认为PDA很有用，但强调了在时间有限的情况下可行性的问题。访谈反馈强调清晰度、影像发现的背景化以及与临床指南的一致性。当在临床接触中使用PDA的最终版本时，所有5名患者（100%）报告说决策辅助工具中的信息影响了他们进行扫描的决定，5名卫生专业人员中有4名（80%）报告说他们将在实践中使用决策辅助工具。结论：对于肩袖相关肩痛患者，该辅助决策工具是一种可接受且有用的工具，可帮助患者在影像学检查中做出明智的决定。现在需要进行一项随机对照试验，评估这种决策辅助是否会降低人们进行影像学检查的意愿，并促进知情的治疗选择。

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引用次数: 0

Physiotherapists’ beliefs of the working mechanisms of manual therapeutic techniques for spinal pain relief: a quantitative content analysis 物理治疗师对脊柱疼痛缓解的手工治疗技术的工作机制的信念：定量内容分析

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-10-01 Epub Date: 2025-07-17 DOI: 10.1016/j.msksp.2025.103387

J.P. Hendriks , R.R. Reezigt , M.F. Reneman

Background

Manual therapeutic techniques (MTTs), including high velocity thrust manipulation (HVT) and spinal mobilization (MOB), are used to reduce spinal pain. Physiotherapists' beliefs on their working mechanisms to relieve pain are unknown.

Objectives

To explore the prevalence of physiotherapists’ beliefs regarding the working mechanisms of MTTs on pain relief and their associated factors.

Design

Quantitative content analysis.

Method

The results of the verbal and online survey were analyzed based on a theory-driven coding framework (categories and depth). Ordinal, linear, and nominal regression analyses were used to analyze the secondary aim.

Results

A total of 541 physiotherapists were included (survey, n = 383, 70.8 %; verbal surveys, n = 158, 29.2 %), resulting in 759 HVT and 713 MOB responses. Six categories were present: biomechanical (39.3 % HVT, 50.9 % MOB), neurophysiological (39.4 % HVT, 31.4 % MOB), immunological (2.0 % HVT, 1.1 % MOB), non-specific (13.4 % HVT, 14.2 % MOB), unknown (4.3 % HVT, 1.3 % MOB), and not categorizable (1.6 % HVT, 1.1 % MOB). Levels of depth were low (65.1 % HVT, 64.1 % MOB), moderate (17.3 % HVT, 19.0 % MOB), and high (17.4 % HVT, 16.8 % MOB). Having a Master degree, network participation and work experience were associated with the category of working mechanism, level of depth and number of working mechanisms.

Conclusion

The beliefs of physiotherapists in the Netherlands regarding the working mechanisms of MTTs for spinal-related pain reduction are mainly biomechanical and neurophysiological. The working mechanisms were dominantly explained in an unifactorial manner and with a low level of depth. Having a Master of Science degree was strongly associated with more evidence-consistent beliefs and deeper understanding.

手工治疗技术（mtt），包括高速推力操作（HVT）和脊柱活动（MOB），用于减轻脊柱疼痛。物理治疗师对他们减轻疼痛的工作机制的信念是未知的。目的探讨物理治疗师对mtt缓解疼痛的作用机制及其相关因素的看法。定量内容分析。方法基于理论驱动的编码框架（分类和深度）对口头调查和在线调查结果进行分析。使用顺序、线性和名义回归分析来分析次要目标。结果共纳入541名物理治疗师(n = 383，占70.8%；口头调查，n = 158, 29.2%)，结果有759例HVT和713例MOB反应。存在6种类型：生物力学（39.3% HVT, 50.9% MOB）、神经生理学（39.4% HVT, 31.4% MOB）、免疫学（2.0% HVT, 1.1% MOB）、非特异性（13.4% HVT, 14.2% MOB）、未知（4.3% HVT, 1.3% MOB）和不可分类（1.6% HVT, 1.1% MOB）。深度分为低（65.1% HVT, 64.1% MOB）、中（17.3% HVT, 19.0% MOB）和高（17.4% HVT, 16.8% MOB）。硕士学历、网络参与程度、工作经验与工作机制类别、工作机制深度和工作机制数量相关。结论荷兰物理治疗师对mtt治疗脊柱相关疼痛的作用机制的看法主要是生物力学和神经生理学。对其作用机制的解释以单因素为主，深度较低。拥有理学硕士学位与更有证据的信念和更深刻的理解密切相关。

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引用次数: 0

Exploring individuals’ perspectives on participating in a feasibility trial assessing a combined program of education plus exercise versus general advice for ankle osteoarthritis 探讨个人参与可行性试验的观点，评估教育加运动与踝关节骨关节炎的一般建议相结合的方案

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-10-01 Epub Date: 2025-08-18 DOI: 10.1016/j.msksp.2025.103391

Nathalia Costa , Bill Vicenzino , Viana Vuvan , Natalie J. Collins , Melinda M. Franettovich Smith , Zachary Southern , Tim Duffy , Alexander Downie , David J. Hunter , Michelle D. Smith

Background

The effectiveness of exercise and education in individuals with ankle osteoarthritis (OA) has not been investigated, and their perspectives on these interventions remain underexplored.

Objective

To understand the experiences of individuals with ankle OA on participating in a feasibility trial comparing general advice and education plus exercise and their views on such interventions.

Design

Descriptive qualitative study.

Methods

We invited adults with ankle OA who participated in a feasibility trial for an interview. Data were transcribed, de-identified and analysed using Reflexive Thematic Analysis.

Results

We interviewed twenty-two participants (age range 45–84 years, 14 females) and identified three themes: 1) The trial team made the trial a great experience, with some room for improvement (e.g., online weekly diaries, access to assessment results); 2) Both general advice and education plus exercise interventions can have a meaningful impact on participants' lives. For some who received general advice, the physiotherapy assessment and the advice received were catalysts for change, while exercise was expected and enjoyable for those who received education plus exercise. However, some thought the general advice and education did not add to their existing knowledge; 3) Lack of discipline and ‘life’ aspects (e.g., being a student, getting sick) can hinder participation.

Conclusion

Participants in a feasibility study comparing general advice and education plus exercise had a positive experience with the trial processes, research team, physiotherapists and exercise program. However, perspectives on general advice and education varied, and they had suggestions for improvement that should be considered in future ankle OA trials.

运动和教育对踝关节骨关节炎（OA）患者的有效性尚未被调查，他们对这些干预措施的看法仍未得到充分探讨。目的了解踝关节骨性关节炎患者参加可行性试验的经验，比较一般建议和教育加运动的干预措施，以及他们对这些干预措施的看法。设计描述性定性研究。方法我们邀请参加可行性试验的成年踝关节骨关节炎患者进行访谈。使用反身性主题分析对数据进行转录、去识别和分析。结果我们采访了22名参与者（年龄在45-84岁之间，14名女性），并确定了三个主题：1)试验团队使试验获得了很好的体验，但仍有一些改进的空间（例如，在线每周日记，获取评估结果）；2)一般建议和教育加运动干预都能对参与者的生活产生有意义的影响。对于那些接受一般建议的人来说，物理治疗评估和收到的建议是改变的催化剂，而对于那些接受教育和锻炼的人来说，锻炼是意料之中的，也是令人愉快的。然而，一些人认为一般的建议和教育并没有增加他们现有的知识；3)缺乏纪律和“生活”方面（例如，作为一名学生，生病）会阻碍参与。结论在一项比较普通建议和教育加运动的可行性研究中，参与者对试验过程、研究团队、物理治疗师和运动计划都有积极的体验。然而，对一般建议和教育的看法各不相同，他们提出了在未来踝关节OA试验中应考虑的改进建议。

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引用次数: 0

Optimizing acute pain relief in severe knee Osteoarthritis: The influence of resistance exercise volume and psychosocial factors 优化重度膝骨关节炎的急性疼痛缓解：阻力运动量和心理社会因素的影响

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-10-01 Epub Date: 2025-07-29 DOI: 10.1016/j.msksp.2025.103390

Alberto Sánchez-Sabater , Luis Suso-Martí , Rodrigo Núñez-Cortés , Rubén López-Bueno , Carlos Cruz-Montecinos , Joaquín Salazar-Méndez , Vicente Orenga , Lars Louis Andersen , José Casaña , Joaquín Calatayud

Background

While exercise is a key part of knee osteoarthritis (OA) management, the optimal dose for acute pain relief remains unclear. We aimed to determine the optimal resistance exercise volume to induce exercise-induced hypoalgesia (EIH) in older adults with severe knee OA.

Methods

28 participants (11/17 women/men; mean age = 71.6 ± 5.2 years) with severe knee OA awaiting unilateral Total Knee Arthroplasty were recruited. They were randomised to four experimental conditions (cross-over design) conducted with a separation of 4 days. Knee extension exercises with elastic resistance were performed at single exercise sessions at 10 repetition maximum (RM) intensity, while varying the number of sets (control with no exercise, 4 sets, 8 sets, and 12 sets).

Results

Higher exercise volumes (12 and 8 sets) induced greater EIH 10 min post-exercise compared to lower volumes (4 sets) or no exercise, with significant differences favouring the 12-set exercise intervention (η² = 0.472, p < 0.001). Pain intensity increased immediately post-exercise in all exercise interventions but returned to baseline after 10 min in the 4- and 12-set exercise interventions. PPT increased post-10 min in the 8- and 12-set exercise interventions for both the affected and contralateral limbs (p < 0.05). PCS moderated the EIH response, reducing its effect in the 12-set (r = −0.436, p < 0.05) and 8-set (r = −0.418, p < 0.05) exercise intervention.

Conclusions

Greater resistance exercise volume appears to be associated with an initial increase in pain perception followed by a delayed hypoalgesic response in patients with severe knee OA. These exploratory findings suggest that higher-volume resistance exercise may be a valuable strategy for acute pain relief, although clinicians should balance short-term discomfort with long-term benefits, considering both physical and psychosocial factors, to improve pain-related outcomes aimed at reducing acute pain in this population. However, further research is needed to confirm these effects beyond a controlled, single-exercise acute intervention.

虽然运动是膝关节骨关节炎（OA）治疗的关键部分，但缓解急性疼痛的最佳剂量尚不清楚。我们的目的是确定老年严重膝关节OA患者诱导运动诱发痛觉减退（EIH）的最佳阻力运动量。方法28例受试者(男女11/17；平均年龄= 71.6±5.2岁)，伴有严重膝关节炎，等待单侧全膝关节置换术。他们被随机分为四个实验条件（交叉设计），间隔4天。有弹性阻力的膝关节伸展运动在单次运动中以10次最大重复（RM）强度进行，同时改变组数（不运动的对照组，4组，8组和12组）。结果高运动量组（12组和8组）与低运动量组（4组）或不运动量组相比，运动后10分钟EIH发生率更高，且12组运动干预组差异显著(η2 = 0.472, p <；0.001)。在所有运动干预中，疼痛强度在运动后立即增加，但在4组和12组运动干预中，疼痛强度在10分钟后恢复到基线。在8组和12组运动干预中，患肢和对侧肢体的PPT在10分钟后增加(p <；0.05)。PCS调节了EIH的反应，降低了其在12组中的作用(r = - 0.436, p <；0.05)和8组(r = - 0.418, p <；0.05)运动干预。结论：在严重膝关节炎患者中，更大的阻力运动量似乎与最初的疼痛感知增加以及随后的延迟痛觉减退反应有关。这些探索性发现表明，尽管临床医生应考虑身体和心理因素，平衡短期不适和长期利益，以改善旨在减少该人群急性疼痛的疼痛相关结果，但高强度阻力运动可能是缓解急性疼痛的一种有价值的策略。然而，需要进一步的研究来证实这些影响超出了控制，单一运动急性干预。

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引用次数: 0

The EMU manipulation study: A randomized trial investigating the efficacy of matched or unmatched cervical/thoracic manipulations on neck pain EMU操作研究：一项随机试验，调查匹配或不匹配的颈/胸操作对颈部疼痛的疗效

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-10-01 Epub Date: 2025-07-02 DOI: 10.1016/j.msksp.2025.103382

Brian T. Swanson , Mary Cimen , Cara D. DiMercurio , Andrew G. Dunne , Michael Scott Dunne , Chase Hubbard , Brendan Christopher Kirck , Rowan M. Nadeau , Paul Artzer

Introduction

Neck pain is common, and cervical and thoracic thrust joint manipulation are recommended treatments. The Cervical Thoracic Differentiation Test (CTDT) is proposed to differentiate pain of cervical or thoracic origin, but its value in guiding choice of manipulation remains unclear. This study aimed to evaluate the utility of the CTDT in selecting treatment for non-specific mechanical neck pain.

Methods

A quadruple-blinded, two-arm randomized trial enrolled adults aged 18–65 with neck pain ≥3/10. Forty participants completed the Neck Disability Index (NDI), cervical ROM (ROM), VAS for pain (rest and movement), and CTDT. They were equally allocated to a single session of either matched or unmatched manipulation based on CTDT results. Pain and ROM were assessed immediately post-manipulation and 38 participants were assessed at a one-week follow-up.

Results

Forty participants (mean age 24.8 ± 9.9 years, 51.2 % female) were included. Significant differences in the primary outcome of pain with movement were found across all time points (F_{2, 72} = 60.455, p < 0.001). Significant pain reductions were observed from pre-manipulation to immediately post-manipulation and continued at one-week. There were no differences between matched/unmatched manipulations at either time point (p > 0.05). There were no significant differences in pain at rest, NDI scores, or ROM changes between groups.

Conclusions

Both matched and unmatched manipulations significantly reduced pain with movement, with no differences based on CTDT results. In the context of a rigorously blinded trial, cervical and thoracic manipulations appear to be equally efficacious for managing neck pain regardless of CTDT outcomes, although clinical outcomes may differ.

颈部疼痛是常见的，颈椎和胸椎关节按摩是推荐的治疗方法。颈胸椎鉴别试验（CTDT）被提出用于鉴别颈或胸源性疼痛，但其在指导手法选择方面的价值尚不清楚。本研究旨在评估CTDT在选择非特异性机械性颈痛治疗方法中的效用。方法采用四双盲、双臂随机试验，招募年龄在18-65岁、颈部疼痛≥3/10的成年人。40名参与者完成了颈部残疾指数（NDI）、颈椎ROM （ROM）、疼痛VAS（休息和运动）和CTDT。他们被平等地分配到一个基于CTDT结果的匹配或不匹配操作的会话中。操作后立即评估疼痛和关节活动度，38名参与者在一周的随访中进行评估。结果共纳入40例，平均年龄24.8±9.9岁，女性占51.2%。各时间点疼痛伴运动的主要结局存在显著差异(F2, 72 = 60.455, p <；0.001)。从操作前到操作后立即观察到明显的疼痛减轻，并持续一周。在任何时间点，匹配/不匹配操作之间没有差异(p >；0.05)。两组间在静息疼痛、NDI评分或ROM变化方面无显著差异。结论配合和不配合手法均可显著减轻运动疼痛，CTDT结果无差异。在一项严格的盲法试验的背景下，尽管临床结果可能不同，但无论CTDT结果如何，颈椎和胸椎手法似乎对治疗颈部疼痛同样有效。

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引用次数: 0