Musculoskeletal Science and Practice最新文献_第10页

The pain education paradox and validation gap 疼痛教育悖论与验证差距

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-12-24 DOI: 10.1016/j.msksp.2025.103476

Asaf Weisman , Monica Noy , Youssef Masharawi

Introduction

Healthcare professionals routinely manage pain, medicine's most common complaint, yet receive critically inadequate pain education, often less than 1 % of curriculum hours, despite pain being present in up to 80 % of clinical consultations. Current pain education programs claim to employ evidence-based approaches. Yet, they operate within a fundamental validation crisis: we cannot validate what constitutes effective practitioner competency because we lack evidence that improved practitioner knowledge translates into better patient outcomes.

Purpose

This paper addresses the validation crisis manifesting across three levels: we don't know which competencies practitioners need, whether our teaching methods develop these competencies, or if practitioner competency matters for patient recovery. We examine how commercial Pain Neuroscience Education programs problematically blur the distinction between practitioner and patient education while masking validation gaps through circular reasoning. The paper presents four foundational competencies that prioritize intellectual honesty over false certainty: understanding pain terminology, integrating contemporary neuroscience, critical appraisal with epistemic humility, and distinguishing between treating pain mechanisms and supporting individuals experiencing pain.

Implications for practice

This framework challenges all healthcare professionals managing pain to abandon unfounded evidence-based claims and embrace radical honesty about uncertainty. For disciplines whose interventions have historically emphasized biomechanical models, including physical therapists, chiropractors, osteopaths, and orthopedic surgeons, this means moving beyond those theories to understand contemporary pain science while clearly communicating scope limitations. The approach enables practitioners to recognize intervention limitations, identify referral needs, set realistic expectations, and avoid nocebo effects from outdated explanations, ultimately serving patients through scientific integrity rather than false promises.

医疗保健专业人员常规处理疼痛，医学上最常见的抱怨，但接受严重不足的疼痛教育，通常不到1%的课程时间，尽管疼痛存在于高达80%的临床咨询。目前的疼痛教育项目声称采用循证方法。然而，他们在一个基本的验证危机中运作：我们无法验证什么构成了有效的从业者能力，因为我们缺乏证据表明，改进的从业者知识可以转化为更好的患者结果。目的：本文解决了三个层面上的验证危机：我们不知道从业者需要哪些能力，我们的教学方法是否培养了这些能力，或者从业者的能力是否对患者的康复很重要。我们研究了商业疼痛神经科学教育项目如何有问题地模糊了医生和患者教育之间的区别，同时通过循环推理掩盖了验证差距。本文提出了四种基本能力，优先考虑智力诚实而不是错误的确定性：理解疼痛术语，整合当代神经科学，批判性评估与认知谦卑，区分治疗疼痛机制和支持个体体验疼痛。这一框架要求所有管理疼痛的医疗保健专业人员放弃毫无根据的基于证据的说法，并接受对不确定性的彻底诚实。对于那些历史上强调生物力学模型的学科，包括物理治疗师、脊椎按摩师、整骨治疗师和整形外科医生，这意味着超越这些理论，了解当代疼痛科学，同时清楚地传达范围限制。该方法使从业者能够认识到干预的局限性，确定转诊需求，设定现实的期望，并避免过时的解释产生反安慰剂效应，最终通过科学诚信而不是虚假承诺为患者服务。

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引用次数: 0

Can baseline features predict a reduction in pain and disability following neck-specific exercise in people with chronic non-specific neck pain?: A systematic review 基线特征能否预测慢性非特异性颈部疼痛患者颈部特异性运动后疼痛和残疾的减少？：系统回顾

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-12-23 DOI: 10.1016/j.msksp.2025.103473

Cho Wai Geoffrey Yu , Ziyan Chen , Edith Elgueta-Cancino , Janet Deane , Valter Devecchi , Deborah Falla

Background

Neck-specific exercises are effective for chronic non-specific neck pain, though responses vary considerably.

Objectives

Identify baseline features that predict a reduction in neck disability, pain and better global change following neck-specific exercise interventions.

Design

Systematic review of prospective cohort studies and secondary analyses of randomised controlled trials.

Methods

Six databases were searched until June 2025. Studies investigating baseline demographic and clinical characteristics, as well as physical and psychological features, with the outcome of pain and disability, or global changes were included. Methodological quality was assessed with the Quality in Prognosis Studies tool, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool was used to assess the certainty of evidence.

Results

Four studies (318 participants) were included. Older age (OR = 5.52) and being male (OR = 5.52) predicted pain reduction. Catastrophising predicted higher levels of disability (OR = 2.91) post exercise. Higher cervical movement velocity (OR = 3.68) and lower accuracy (OR = 5.99) at baseline both predicted less disability and pain. Shorter pain duration (LR+:3.21; LR-:0.36) and lower baseline disability (LR+:2.29; LR-:0.52) predicted a successful global response. The certainty of evidence for these findings is very low.

Conclusions

Baseline characteristics such as older age, male sex, lower movement accuracy, higher movement velocity, shorter pain duration, and lower baseline disability may predict favourable outcomes following neck-specific exercises, while catastrophising may predict poorer disability outcomes. However, given the very low certainty of evidence, these results should be interpreted cautiously.

Trial registration

PROSPERO (Registration number CRD42023408332)

颈部特异性运动对慢性非特异性颈部疼痛是有效的，尽管反应差异很大。目的：确定基线特征，预测颈部特定运动干预后颈部残疾、疼痛的减少和更好的整体变化。设计前瞻性队列研究的系统评价和随机对照试验的二次分析。方法检索6个数据库至2025年6月。研究调查了基线人口统计学和临床特征，以及身体和心理特征，疼痛和残疾的结果，或整体变化。采用预后研究质量（quality in Prognosis Studies）工具评估方法学质量，采用建议评估、发展和评价分级（GRADE）工具评估证据的确定性。结果共纳入4项研究（318名受试者）。年龄较大（OR = 5.52）和男性（OR = 5.52）预测疼痛减轻。灾难预测运动后的残疾水平更高（OR = 2.91）。基线时较高的颈椎运动速度（OR = 3.68）和较低的准确性（OR = 5.99）均预示着更少的残疾和疼痛。较短的疼痛持续时间（LR+:3.21; LR-:0.36）和较低的基线残疾（LR+:2.29; LR-:0.52）预示着成功的整体反应。这些发现的证据的确定性非常低。结论：年龄较大、男性、较低的运动精度、较高的运动速度、较短的疼痛持续时间和较低的基线残疾等特征可能预测颈部特定运动后的有利结果，而灾难化可能预测较差的残疾结果。然而，鉴于证据的确定性非常低，这些结果应谨慎解释。试用注册普洛斯彼罗（注册号CRD42023408332）

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引用次数: 0

Association of central sensitization features with clinical, sonographic, and electrophysiological outcomes in carpal tunnel syndrome 腕管综合征中枢致敏特征与临床、超声和电生理结果的关系。

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-12-18 DOI: 10.1016/j.msksp.2025.103472

Feyza Nur Yücel, Emre Ata

Objective

Carpal tunnel syndrome (CTS), the most common nerve entrapment, is increasingly linked to changes in pain processing, including central sensitization (CS). However, how CS measures relate to tests such as sonography and electrodiagnostic studies (EDX) remains unclear.

Methods

This cross-sectional study included 60 patients with clinically and electrodiagnostically confirmed CTS and 20 healthy controls. Pain sensitization was evaluated using the pressure pain threshold (PPT) at four anatomical sites, and the Central Sensitization Inventory (CSI). Sonographic assessments captured median nerve cross-sectional area (CSA), ΔCSA values, thenar muscle thickness, and nerve echogenicity. Mixed-effects models were used for repeated-site measures (PPT and CSA/Δ), and sex-adjusted ANCOVA was used to analyse single-site outcomes. Pearson correlations were used to assess relationships among sensitization measures, sonographic findings, and EDX parameters.

Results

CTS patients had lower PPT values at all sites and higher CSI scores than controls (p < .05). Mixed-effects modelling confirmed reduced PPT and greater, site-dependent CSA enlargement in CTS. PPT at the carpal tunnel and thenar region correlated negatively with CSAmax and CSAinlet, and positively with motor amplitude. CSI correlated positively with functional disability and neuropathic pain features, but not with pain intensity. Sensitization parameters did not differ across CTS severity grades.

Conclusion

This study shows that objective structural and electrophysiological markers are associated with central pain processes that contribute to the pathophysiology of CTS. These results underline the importance of assessing CTS through multiple dimensions, including structural and functional nerve changes and pain sensitization.

目的：腕管综合征（Carpal tunnel syndrome， CTS）是最常见的神经卡压，越来越多地与疼痛处理的改变，包括中枢致敏（central sensitization， CS）联系在一起。然而，CS测量与超声和电诊断研究（EDX）等测试之间的关系尚不清楚。方法：本横断面研究包括60例临床和电诊断证实的CTS患者和20例健康对照。采用四个解剖部位的压痛阈值（PPT）和中枢致敏量表（CSI）评估疼痛致敏性。超声评估捕获正中神经横截面积（CSA）， ΔCSA值，鱼际肌厚度和神经回声。重复站点测量采用混合效应模型（PPT和CSA/Δ），单站点结果采用经性别调整的ANCOVA。Pearson相关性用于评估致敏措施、超声检查结果和EDX参数之间的关系。结果：与对照组相比，CTS患者在所有部位的PPT值都较低，CSI评分较高(p)。结论：本研究表明，客观结构和电生理标志物与中枢疼痛过程有关，这些过程有助于CTS的病理生理。这些结果强调了通过多个维度评估CTS的重要性，包括结构和功能神经变化以及疼痛敏感。

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引用次数: 0

Measurement properties of six expectation scales for chronic low back pain in Brazilian Portuguese: Not all expectations are the same 巴西葡萄牙人慢性腰痛6种期望量表的测量特性：并非所有期望都相同。

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-12-13 DOI: 10.1016/j.msksp.2025.103471

Beatriz O. Azevedo , Mariana R. de Lira , Helen C. Nogueira Carrer , Roger Berg , M. Gabrielle Pagé , Jarred Younger , Gabriela Z.M. Silva , Thaís C. Chaves

Background

The literature points out that expectations can shape treatment outcomes regarding pain and disability in patients with chronic low back pain (CLBP). There are several instruments available to assess pain-related expectations, and most studies haven't reported the measurement properties of such scales.

Objectives

This study aimed to adapt and examine the measurement properties of the Stanford Expectations of Treatment Scale (SETS), the Treatment Expectations in Chronic Pain Scale (TEC), and four single-item expectations scales in Brazilian Portuguese in CLBP.

Methods

A total of 203 patients participated in the study. The cross-cultural adaptation followed guideline recommendations. Confirmatory factor analysis (CFA) and Cronbach's α were used to assess structural validity and internal consistency, respectively. Intraclass Correlation Coefficient (ICC) was used to test for reliability, and Smallest Detectable Change to analyze measurement error. Spearman's correlation was used to assess hypothesis testing for construct validity.

Results

CFA confirmed a two-factor model for the SETS-Br, and TEC-Br scales showed adequate CFA fit indexes. Internal consistency was acceptable (α ≥ .70) for SETS-Br positive domain, TEC-Br Ideal, and TEC-Br Predicted, but not for SETS-Br negative domain. Reliability was acceptable for the six expectation scales included in the study (ICC>.74). All the expectation scales confirmed at least 75 % of the hypotheses raised a priori for construct validity.

Conclusions

TEC-Br scales met the criteria for good quality for all the measurement properties assessed. Our results suggest that the six scales tested seem to measure different dimensions of the expectations construct, since they showed weak to moderate correlations when compared.

背景：文献指出，期望可以影响慢性腰痛（CLBP）患者的疼痛和残疾治疗结果。有几种可用的工具来评估与疼痛相关的期望，大多数研究都没有报道这些量表的测量特性。目的：本研究旨在调整和检验斯坦福治疗期望量表（SETS）、慢性疼痛治疗期望量表（TEC）和巴西葡萄牙语四个单项期望量表在CLBP中的测量特性。方法：共203例患者参与研究。跨文化适应遵循指南建议。采用验证性因子分析（CFA）和Cronbach's α分别评估结构效度和内部一致性。用类内相关系数（Intraclass Correlation Coefficient， ICC）检验信度，用最小可检测变化（Smallest Detectable Change）分析测量误差。使用Spearman相关来评估结构效度的假设检验。结果：CFA证实了ets - br的双因素模型，TEC-Br量表具有足够的CFA拟合指标。ets - br阳性结构域、TEC-Br理想结构域和TEC-Br预测结构域的内部一致性是可以接受的（α≥0.70），但ets - br阴性结构域的内部一致性是不可接受的。本研究中包含的六个期望量表的信度为可接受的（ICC 0.74）。所有的期望量表都至少证实了75%的先验构造效度假设。结论：TEC-Br量表的所有测量性质均符合质量标准。我们的结果表明，测试的六个量表似乎测量了期望结构的不同维度，因为它们在比较时显示出弱到中等的相关性。

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引用次数: 0

Neuroimmune interactions in musculoskeletal conditions. An introduction for clinicians 肌肉骨骼疾病中的神经免疫相互作用。给临床医生的介绍

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-12-11 DOI: 10.1016/j.msksp.2025.103469

Ivo J. Lutke Schipholt , Michel W. Coppieters , Gwendolyne G.M. Scholten-Peeters , Mark R. Hutchinson , David M. Klyne

Background

The immune system protects against invading pathogens and helps maintain homeostasis. Other pivotal roles include the regulation of tissue health through interactions with the nervous system. Understanding how these neuroimmune interactions may go awry in musculoskeletal conditions and how they can be targeted therapeutically may optimise patient care.

Methods

We conducted a clinically focused narrative review of the role of the immune and nervous systems in musculoskeletal health and conditions such as neck pain, back pain and osteoarthritis and how psychosocial and behavioural factors impact these conditions via interacting with neuroimmune functioning.

Results

The interplay between the immune and nervous system is involved in both the physiology and pathology of musculoskeletal tissues, including bone, joint, nerve, muscle and tendon. We describe this at the local tissue, whole nervous system, and systemic (blood) level and how psychosocial and behavioural factors impact immune activity and influence outcomes. We also highlight recent advances in medical imaging and multi-omics that shed new light on the interplay between the immune and nervous systems in musculoskeletal conditions. Advances in understanding these relationships provide promising new treatment avenues for musculoskeletal conditions and important insights into how psychosocial- and behavioural-based therapies such as exercise and cognitive behavioural therapy work and can be optimised to improve outcomes.

Conclusions

This review provides clinicians with a foundation in the neuroimmunology of musculoskeletal conditions. It also explores how the immune and nervous systems, and their interplay can be modulated to improve prevention and management strategies.

免疫系统保护机体免受病原体入侵，并帮助维持体内平衡。其他关键作用包括通过与神经系统的相互作用来调节组织健康。了解这些神经免疫相互作用如何在肌肉骨骼疾病中出错，以及如何靶向治疗，可能会优化患者护理。方法：我们对免疫和神经系统在肌肉骨骼健康和颈部疼痛、背部疼痛和骨关节炎等疾病中的作用以及社会心理和行为因素如何通过与神经免疫功能的相互作用影响这些疾病进行了临床重点叙述综述。结果免疫系统与神经系统的相互作用涉及骨、关节、神经、肌肉和肌腱等肌肉骨骼组织的生理和病理。我们在局部组织、整个神经系统和全身（血液）水平上描述了这一点，以及社会心理和行为因素如何影响免疫活动和影响结果。我们还强调了医学成像和多组学的最新进展，这些进展为肌肉骨骼疾病中免疫系统和神经系统之间的相互作用提供了新的视角。了解这些关系的进展为肌肉骨骼疾病提供了有希望的新治疗途径，并对基于社会心理和行为的疗法（如运动和认知行为疗法）如何起作用以及如何优化以改善结果提供了重要见解。结论本综述为临床医生在肌肉骨骼疾病的神经免疫学方面提供了基础。它还探讨了如何调节免疫和神经系统及其相互作用，以改善预防和管理策略。

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引用次数: 0

Corrigendum to “Osteoarthritis Hip and Knee Service (OAHKS) in a community health setting compared to the hospital setting: A feasibility study for a new care pathway” [Musculoskel.l Sci.d Pract., 49 (2020) 102167] “骨关节炎髋关节和膝关节服务（OAHKS）在社区卫生环境中与医院环境相比较：一种新的护理途径的可行性研究”的勘误表[musculoskkel]。l科学。d Pract。科学通报，49(2020):102167]。

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-12-10 DOI: 10.1016/j.msksp.2025.103467

Alison J. Gibbs , Nicholas F. Taylor , Raphael Hau , Christian Barton , Chris Fong , Leanne Roddy , Kylie J. Durant , Leanne D. deVos , Jason A. Wallis

引用次数: 0

Neuro-immune contributors to persistent musculoskeletal pain: from mechanisms to clinical assessment and management 神经免疫对持续性肌肉骨骼疼痛的影响：从机制到临床评估和管理。

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-12-10 DOI: 10.1016/j.msksp.2025.103468

Colette Ridehalgh , Joel Fundaun , Scott Farrell

Introduction

Persistent musculoskeletal (MSK) pain conditions are highly prevalent and economically burdensome. Although extensive research has explored various management strategies for these conditions, most interventions yield only modest effects. Recently, there has been increasing recognition of neuro-immune contributions in several persistent MSK pain conditions not traditionally associated with such influences.

Purpose

The aim of this Masterclass is to provide an overview of some key neuro-immune factors that may contribute to persistent MSK pain whilst detailing both simple bedside and advanced novel methods to identify such neuro-immune contributions. It will also examine why an understanding of such contributions may be beneficial for the assessment and management of people with persistent MSK pain conditions.

Implications

Understanding neuro-immune contributions to persistent MSK pain and how to identify them will help clinicians to i). consider the involvement of the nervous and immune systems when managing people with persistent MSK pain conditions, ii). better understand the use of both simple bedside tests and novel methods to identify such mechanisms and iii). consider how neuro-immune contributions may inform management strategies.

持续性肌肉骨骼（MSK）疼痛条件是高度普遍和经济负担。尽管广泛的研究探索了针对这些疾病的各种管理策略，但大多数干预措施仅产生适度的效果。最近，人们越来越多地认识到，在几种与此类影响传统上无关的持续性MSK疼痛条件下，神经免疫的作用。目的：本大师班的目的是提供一些可能导致持续性MSK疼痛的关键神经免疫因素的概述，同时详细介绍简单的床边和先进的新方法来识别此类神经免疫贡献。它也将检查为什么这样的贡献的理解可能是有益的评估和管理的人与持续性MSK疼痛条件。含义：了解神经免疫对持续性MSK疼痛的影响以及如何识别它们将有助于临床医生：1)在管理持续性MSK疼痛患者时考虑神经和免疫系统的参与；2)更好地理解使用简单的床边测试和新方法来识别这些机制；3)考虑神经免疫的影响如何为管理策略提供信息。

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引用次数: 0

The representation of individuals from ethnically minoritised groups in pain science education randomised controlled trials: a scoping review 疼痛科学教育随机对照试验中少数民族个体的代表性：范围审查

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-12-08 DOI: 10.1016/j.msksp.2025.103466

J. Pun , J. Franklin , S. Browne , J. Mankelow , A. Mardon , J. Watson , H.B. Leake , C.G. Ryan

Background

Pain science education seeks to improve an individual's understanding of their pain, and thus improve outcomes. It has been primarily developed and tested within western cultures. The extent and nature of ethnically minoritised group involvement in pain science education trials is unknown.

Objective

This scoping review aimed to investigate the level of representation of people from ethnically minoritised groups in pain science education randomised controlled trials.

Methods

This scoping review follows Joanna Briggs Institute guidelines and is reported in line with PRISMA-SCR guidelines. The following search engines were reviewed: CINAHL, EMBASE, MEDLINE, AMED and APA PSYCArticles. Eligible studies were randomised controlled trials involving people with chronic pain who had received pain science education as a focused intervention. The two stage study selection process and data extraction were completed by independent reviewers. Data is presented to quantify ethnically minoritised representation.

Results

Sixty-two studies were included in the review, totaling 4685 participants. Nineteen studies reported on ethnicity, ten included no participants from minoritised groups, whilst nine included ethnically minoritised participants ranging from 3 to 29 %.

Conclusion

Overall, this review identified that participant ethnicity is not commonly reported in pain science education randomised controlled trials, which highlights an urgent need for better reporting. Where data on ethnicity was reported, ethnically minoritised groups were largely under-represented, raising questions about the generalisability of existing evidence, and underscoring the need for more inclusive and representative research practices in pain science education trials.

疼痛科学教育旨在提高个人对疼痛的理解，从而改善治疗效果。它主要是在西方文化中发展和测试的。少数民族群体参与疼痛科学教育试验的程度和性质尚不清楚。目的本综述旨在调查少数民族在疼痛科学教育随机对照试验中的代表性水平。方法本综述遵循乔安娜布里格斯研究所的指南，并根据PRISMA-SCR指南进行报道。本文综述了以下几个搜索引擎：CINAHL、EMBASE、MEDLINE、AMED和APA PSYCArticles。符合条件的研究是随机对照试验，涉及接受疼痛科学教育作为重点干预的慢性疼痛患者。两个阶段的研究选择过程和数据提取由独立审稿人完成。提供数据是为了量化少数民族的代表性。结果纳入62项研究，共4685名受试者。19项研究报告了种族，10项研究没有少数民族参与者，而9项研究包括少数民族参与者，范围从3%到29% %。结论：总体而言，本综述发现疼痛科学教育随机对照试验中参与者种族的报道并不普遍，这表明迫切需要更好的报道。在种族数据报告中，少数族裔群体的代表性不足，这引发了对现有证据的普遍性的质疑，并强调了在疼痛科学教育试验中需要更具包容性和代表性的研究实践。

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引用次数: 0

Predictors of response to physical exercise for low back pain: a secondary analysis of the ReViEEW trial 腰痛患者对体育锻炼反应的预测因素：review试验的二次分析。

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-12-03 DOI: 10.1016/j.msksp.2025.103465

Ander Espin , Ana Rodriguez-Larrad , Aida Ruiz-Fernández , Andrea Martín-Pérez , Naiara Fernández-Gutiérrez , Lars Louis Andersen , Jon Irazusta

Background

Non-specific low back pain (nsLBP) is a prevalent and disabling condition, especially among eldercare workers. Although physical exercise is strongly recommended for nsLBP, individual responses vary considerably. Understanding the characteristics that distinguish responders from non-responders could lead to more personalized and effective interventions.

Objectives

To identify predictors of response to physical exercise for nsLBP in eldercare workers.

Design

Secondary analysis of the ReViEEW randomized controlled trial.

Methods

Participants (n = 77) with baseline nsLBP intensity of ≥2 on the 0–10 numerical rating scale were included. The intervention consisted of a 12-week, twice-weekly videoconference-supervised exercise program. Responders were defined as those with ≥2-point reduction in pain post-intervention. Thirty-eight variables across eight multidimensional domains were compared between responders and non-responders using independent samples T or Mann–Whitney U tests. Variables showing between-group differences (p < 0.1) were entered into multiple logistic regression analysis.

Results

Thirty-nine participants (51 %) were classified as responders. Of the 38 variables only three differed between groups: responders had significantly higher nsLBP intensity (p = 0.045), lower anxious symptomatology (p = 0.040), and lower hypnotic/anxiolytic medication use (p = 0.092) compared to non-responders. In the regression model, higher baseline pain intensity independently predicted favorable response (OR = 1.37; 95 % CI: 1.03–1.81), while higher anxiety predicted poorer response (OR = 0.79; 95 %CI: 0.64–0.97).

Conclusions

Higher baseline pain intensity and lower anxiety levels were independent predictors of favorable response to physical exercise for nsLBP in eldercare workers. These findings may inform more targeted clinical decision-making and treatment selection in this population.

Trial registration

ClinicalTrials.gov, (NCT05050526). Registered 20 September 2021—Prospectively registered.

背景：非特异性腰痛（nsLBP）是一种常见的致残疾病，尤其是在老年护理人员中。尽管强烈建议进行体育锻炼来治疗非slbp，但个体的反应差异很大。了解反应者和非反应者的区别特征可以导致更个性化和有效的干预措施。目的：确定老年护理人员对非slbp患者体育锻炼反应的预测因素。设计：review随机对照试验的二次分析。方法：纳入0-10数值评定量表中基线nsLBP强度≥2的参与者（n = 77）。干预包括一个为期12周，每周两次的视频会议监督的锻炼计划。应答者定义为干预后疼痛减轻≥2分的患者。使用独立样本T或Mann-Whitney U检验比较响应者和非响应者之间8个多维域的38个变量。显示组间差异的变量(p)结果：39名参与者（51%）被归类为应答者。在38个变量中，组间只有3个不同：与无反应者相比，反应者的nsLBP强度显著较高（p = 0.045），焦虑症状较低（p = 0.040），催眠/抗焦虑药物使用较低（p = 0.092）。在回归模型中，较高的基线疼痛强度独立预测良好的反应（OR = 1.37; 95% CI: 1.03-1.81），而较高的焦虑预测较差的反应（OR = 0.79; 95% CI: 0.64-0.97）。结论：较高的基线疼痛强度和较低的焦虑水平是老年护理人员对非slbp患者体育锻炼反应良好的独立预测因素。这些发现可能为这一人群提供更有针对性的临床决策和治疗选择。试验注册：ClinicalTrials.gov, （NCT05050526）。已注册- 2021年9月20日已注册。

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引用次数: 0

Pain, grip strength, and motor imagery reaction time are associated with pain and disability in individuals with chronic lateral elbow tendinopathy 慢性肘关节外侧病变患者的疼痛、握力和运动意象反应时间与疼痛和残疾有关。

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-12-01 DOI: 10.1016/j.msksp.2025.103463

Hasan Gercek , Emine Cihan , Fatih Celik , Bayram Sonmez Unuvar , Zubeyir Sari

Background

Chronic lateral epicondylitis(LE), is associated with persistent pain and functional impairment in the upper extremity. While peripheral factors such as pain and muscle strength are well recognized, emerging evidence suggests that central mechanisms, including motor imagery ability and body awareness, may also contribute to dysfunction.

Objective

The aim of this study was to investigate the effect of pain intensity, motor imagery performance, grip strength, body awareness and pain duration on pain and disability in individuals with chronic LE.

Design

Cross-sectional.

Methods

This cross-sectional study included 98 individuals diagnosed with chronic LE. Function was assessed using the Patient-Rated Tennis Elbow Evaluation(PRTEE). Pain intensity was measured via the Visual Analog Scale(VAS), grip strength via hand dynamometry, motor imagery through left/right hand judgment using the Recognise™ application, and body awareness using the Body Awareness Questionnaire. Multiple linear regression analysis was performed to determine predictors of functional status.

Results

The regression model was statistically significant(F = 10.984, p < 0.001), explaining 49.6 % of the variance in function(adjusted R² = 0.496). Pain during activity(β = 0.449, p < 0.001), pain at rest(β = 0.196, p = 0.049), pain duration(β = 0.207, p = 0.023), grip strength(β = 0.343, p < 0.001), and motor imagery reaction time(β = 0.228, p = 0.016) were significant predictors. Accuracy in motor imagery and body awareness did not significantly predict function.

Conclusion

Function in chronic LE is influenced by both peripheral and central factors. Rehabilitation approaches should therefore integrate strategies addressing both musculoskeletal impairments and altered neuromotor control to improve functional outcomes.

Trial registiration

Prospectively registered on Clinicaltrials.gov on 07/17/2024 (registration number: NCT06459102) (Link: https://clinicaltrials.gov/study/NCT06459102?term=NCT06459102&rank=1).

背景：慢性外上髁炎（LE）与上肢的持续性疼痛和功能障碍有关。虽然疼痛和肌肉力量等外围因素已得到充分认识，但新出现的证据表明，包括运动想象能力和身体意识在内的中枢机制也可能导致功能障碍。目的：探讨疼痛强度、运动意象表现、握力、身体意识和疼痛持续时间对慢性LE患者疼痛和残疾的影响。设计:横断面。方法：本横断面研究包括98例诊断为慢性LE的个体。使用患者评分网球肘评估（PRTEE）评估功能。通过视觉模拟量表（VAS）测量疼痛强度，通过手部动力测量测量握力，通过使用recognition™应用程序通过左/右手判断来测量运动图像，使用身体意识问卷来测量身体意识。采用多元线性回归分析确定功能状态的预测因子。结果：回归模型具有统计学意义（F = 10.984, p 2 = 0.496）。活动时疼痛（β = 0.449, p）结论：慢性LE的功能受外周和中枢因素的影响。因此，康复方法应整合针对肌肉骨骼损伤和改变的神经运动控制的策略，以改善功能结果。试验注册：于2024年7月17日在Clinicaltrials.gov上前瞻性注册（注册号：NCT06459102）（链接：https://clinicaltrials.gov/study/NCT06459102?term=NCT06459102&rank=1）。

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