Musculoskeletal Science and Practice最新文献_第2页

Latent classes of trial reporting and publication practices in spinal manipulation research: a meta-epidemiological study 脊柱推拿研究中试验报告和出版实践的潜在分类：一项荟萃流行病学研究。

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-12-27 DOI: 10.1016/j.msksp.2025.103480

Casper Nim , Michelle Frederiksen , Sasha Aspinall , Aron Downie , Martha Funabashi , Steen Harsted , Hazel Jenkins , David McNaughton , Luana Nyirö , Eric J. Roseen , James J. Young , Liz Dennett , Stephen M. Perle , Chad Cook , Carsten Juhl , Jan Hartvigsen

Background

Reliable reporting and publication practices are essential for trustworthy evidence synthesis and clinical decision-making.

Objective

We aimed to identify latent classes of randomized controlled trials (RCTs) evaluating spinal manipulative therapy (SMT) based on trial reporting and publication practices, and to examine whether these classes influenced treatment effects.

Design

Meta-epidemiological study.

Method

Trials were evaluated on whether they met criteria for trial reporting and publication practices across six domains. Latent class analysis was used to identify trial subgroups. Random-effects meta-regression models assessed whether class membership predicted pooled estimates of treatment effects for pain and disability.

Results

We included 239 RCTs and identified four classes: Dated (23 %), older trials (mostly pre-2010) with consistently low proportions of criteria met; Non-contributing (30 %), newer trials that inconsistently met the criteria, had small samples, and short follow-ups; SMT-focused (15 %), which reported SMT details and fidelity more consistently but otherwise resembled the Non-contributing class; and Pragmatic (33 %), consisting of larger trials, meeting most criteria, but often underreported SMT-specific and fidelity details. Reporting practices had larger impact on class membership than publication practices. Despite differences class membership was not associated with treatment effect estimates and explained minimal outcome variability (R² ∼1 %).

Conclusions

Although trial reporting and publication practices varied substantially across SMT trials, these differences were not associated with differences in treatment effects. The widespread failure to meet key criteria raises concerns about the interpretability and credibility of the SMT evidence base. To strengthen transparency and scientific value, future trials should adhere more rigorously to reporting guidelines.

背景：可靠的报告和出版实践对于可信的证据合成和临床决策至关重要。目的：我们旨在根据试验报告和出版实践确定评估脊柱推拿疗法（SMT）的随机对照试验（rct）的潜在类别，并检查这些类别是否影响治疗效果。设计：荟萃流行病学研究。方法：评估试验是否符合六个领域的试验报告和出版实践标准。使用潜在分类分析来确定试验亚组。随机效应元回归模型评估班级成员是否能预测疼痛和残疾治疗效果的汇总估计。结果：我们纳入了239项随机对照试验，并确定了四类：过期（23%），较早的试验（主要是2010年之前），符合标准的比例一直很低；无贡献（30%），不符合标准的新试验，样本小，随访时间短；专注于SMT的（15%），他们更一致地报告SMT细节和保真度，但在其他方面与非贡献类相似；务实（33%），包括更大的试验，符合大多数标准，但往往低估了smt特异性和保真度细节。报告实践比出版实践对班级成员的影响更大。尽管存在差异，但分类成员与治疗效果估计无关，并解释了最小的结果变异性（R2 ~ 1%）。结论：尽管SMT试验的试验报告和出版实践存在很大差异，但这些差异与治疗效果的差异无关。普遍未能满足关键标准引起了对SMT证据基础的可解释性和可信度的关注。为了加强透明度和科学价值，未来的试验应该更严格地遵守报告准则。

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引用次数: 0

Normalisation of impaired neck muscle function after neck-specific exercises identified by speckle-tracking ultrasound analysis: a longitudinal case-control study of individuals with chronic whiplash-associated disorders compared with healthy controls 斑点跟踪超声分析确定的颈部特异性运动后受损颈部肌肉功能的正常化：与健康对照相比，慢性鞭打相关疾病患者的纵向病例对照研究

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-12-27 DOI: 10.1016/j.msksp.2025.103483

Gunnel Peterson , Erika Andersson , Margaretha Jönsson , Anneli Peolsson

Background

Whiplash injury can impair neck muscle function, which is challenging to assess. Diagnostic ultrasound enables evaluation of musculoskeletal function and exercise effectiveness.

Objectives

To evaluate the function of five dorsal neck muscles before and after 12 weeks of neck-specific exercises in individuals with chronic whiplash-associated disorders (WAD), compared with healthy controls.

Method

Twenty-five individuals with WAD grades II and III and 25 age- and sex-matched controls participated in this study. The WAD group completed a 12-week neck-specific exercise programme. Outcome measures, collected at baseline in both groups and post-intervention in the WAD group, included neck muscle deformation (shortening and/or elongation) assessed by ultrasonography with speckle tracking analyses, neck disability (NDI; Neck Disability Index), neck pain (VAS; Visual Analogue Scale), and neck muscle fatigue (Borg CR-10).

Results

There was a significant difference in neck muscle deformation at baseline, with higher deformation in the WAD group compared with controls (F [1,214] = 14.7, P < 0.001). There was no significant difference in deformation between the groups after three months of neck-specific exercises in WAD compared with control baseline data F [1,200] = 0.1, P = 0.965), indicating restoration towards normal muscle function in the WAD group. The WAD group also improved in disability (NDI; mean 9.8, SD 8.4, P < 0.001), neck pain (VAS; mean 12.1, SD 24.7, p = 0.036), and fatigue (Borg CR-10; median 1.0, IQR; 0.5–2.5, P = 0.019).

Conclusions

The study indicates normalisation of dorsal neck muscle function in individuals with WAD after a neck-specific exercise programme.

背景：鞭伤可损害颈部肌肉功能，其评估具有挑战性。诊断超声可以评估肌肉骨骼功能和运动效果。目的：评价慢性鞭扭伤相关疾病（WAD）患者颈部专项运动前后12周颈部背侧肌肉的功能，并与健康对照进行比较。方法：25例WAD II级和III级患者和25例年龄和性别匹配的对照组参加了本研究。WAD组完成了为期12周的颈部运动计划。结果测量，收集在基线两组和干预后WAD组，包括颈部肌肉变形（缩短和/或伸长）评估超声斑点跟踪分析，颈部残疾（NDI；颈部残疾指数），颈部疼痛（VAS；视觉模拟量表），和颈部肌肉疲劳（Borg CR-10）。结果：基线时颈部肌肉变形有显著差异，与对照组相比，WAD组的变形更高（F [1,214] = 14.7， P）。结论：该研究表明，WAD患者在颈部特定运动计划后，颈背肌肉功能正常化。

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引用次数: 0

When the hook is too big: sample size, power, and missed effects in verbal suggestion research 当钩太大时：言语暗示研究中的样本量、威力和错失效应。

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-12-26 DOI: 10.1016/j.msksp.2025.103478

Rodrigo RN. Rizzo

引用次数: 0

Response to Letter to the Editor regarding “Can pre-treatment verbal suggestions influence the short-term effects of spinal manipulation in young adults with chronic non-specific low back pain? A randomized controlled trial” 关于“治疗前口头建议是否会影响患有慢性非特异性腰痛的年轻成人脊柱操作的短期效果？”随机对照试验”。

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-12-26 DOI: 10.1016/j.msksp.2025.103479

Kamil Zaworski , Joanna Baj-Korpak , Małgorzata Tokarska-Rodak , Ewa Plażuk , Andżelika Nazarewicz , Joel Bialosky , Giacomo Rossettini

引用次数: 0

Self-management support for people with non-specific low back pain: a qualitative survey among Italian physiotherapists 非特异性腰痛患者的自我管理支持：意大利物理治疗师的定性调查

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-12-24 DOI: 10.1016/j.msksp.2025.103477

Matteo Cioeta , Gabriele Giannotta , Domenico Carbotti , Davide Cicinelli , Roberta Giovinazzi , Alessandra Dell’Anna , Andrea Germani , Francesco Balestra , Giuseppe Giovannico , Firas Mourad , Nathan Hutting

Background

Non-specific low back pain (NSLBP) is the leading cause of global disability, and self-management is considered a key component of care. However, physiotherapists’ approaches to supporting self-management can be improved.

Objective

To explore how Italian physiotherapists conceptualize and enact self-management support for non-specific low back pain, and to describe perceived barriers and enablers to its implementation in routine practice.

Methods

An online SurveyMonkey questionnaire was administered in February 2024 to assess Italian physiotherapists’ knowledge and experience with self-management strategies for NSLBP. The survey consisted of 15 open-ended questions adapted from a Dutch study. Responses were analysed using inductive thematic analysis.

Results

Thirty physiotherapists (21 female, mean age 30.4 ± 8.7 years) participated. Four themes emerged: (1) Therapeutic interaction style: active, passive, or multimodal?; (2) The patient as the main actor; (3) Self-management as more than a single tool; and (4) The physiotherapist's role in the self-management journey. Most participants viewed self-management support as essential and commonly used education as their primary strategy, while recognising its limitations. Although a variety of treatment approaches was reported, many remained grounded in biomechanical reasoning. A majority expressed the need for further knowledge and skills to better support self-management.

Conclusion

Most participants recognised the importance of self-management in treating NSLBP but did not fully align with its core principles. Although they emphasised patient-focused, person-centred care, it remains unclear whether these principles are truly applied. Over half indicated a need for additional skills, consistent with broader challenges physiotherapists face in integrating self-management strategies.

背景：非特异性腰痛（NSLBP）是全球致残的主要原因，自我管理被认为是护理的关键组成部分。然而，物理治疗师支持自我管理的方法可以得到改进。目的探讨意大利物理治疗师如何概念化和制定非特异性腰痛的自我管理支持，并描述其在日常实践中实施的障碍和促进因素。方法于2024年2月使用在线SurveyMonkey问卷，评估意大利物理治疗师对NSLBP自我管理策略的知识和经验。该调查包括15个开放式问题，改编自荷兰的一项研究。使用归纳主题分析对回应进行分析。结果共有30名物理治疗师参与，其中女性21名，平均年龄30.4±8.7岁。出现了四个主题：(1)治疗互动风格：主动、被动还是多模式？(2)以患者为主要行为者；(3)自我管理不只是一种工具；(4)物理治疗师在自我管理过程中的角色。大多数与会者认为自我管理支持是必不可少的，常用的教育是他们的主要战略，同时认识到其局限性。尽管报道了多种治疗方法，但许多方法仍以生物力学推理为基础。大多数人表示需要更多的知识和技能，以便更好地支持自我管理。结论：大多数参与者认识到自我管理在治疗非slbp中的重要性，但没有完全遵循其核心原则。尽管他们强调以病人为中心、以人为本的护理，但这些原则是否真正得到应用仍不清楚。超过一半的人表示需要额外的技能，这与物理治疗师在整合自我管理策略方面面临的更广泛挑战是一致的。

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引用次数: 0

"A new tool for my toolbox": physiotherapists' perceptions on therapeutic virtual reality for chronic low back pain – a qualitative descriptive study “我工具箱里的新工具”：物理治疗师对慢性下腰痛的治疗性虚拟现实的看法-一项定性描述性研究。

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-12-24 DOI: 10.1016/j.msksp.2025.103475

Syl Slatman , Raymond Ostelo , Harry van Goor , Ton Satink , J. Bart Staal , Jesper Knoop

Objective

Therapeutic virtual reality (VR) is an emerging intervention in physiotherapy for patients with chronic low back pain (CLBP). However, broad adoption of VR by physiotherapists (PTs) is slow. This is possibly due to PT's negative perceptions on and attitudes towards the added value of VR in physiotherapy for patients with CLBP. The aim of this study was to explore these perceptions and attitudes.

Methods

We performed a qualitative descriptive study using semi-structured interviews. The study sample included eleven primary care PTs with a median age of 35 years (range: 28–58). Participating PTs had at least one year of experience using VR for the treatment of patients with CLBP, after which they continued using VR or stopped using it. The interviews were transcribed verbatim and inductively analyzed using reflexive thematic analysis.

Results

Analysis of the interviews identified four overarching themes: (i) therapeutic VR is perceived as non-threatening to the PT's role; (ii) VR has distinctive qualities that complement the PT's toolbox; (iii) contrasting attitudes towards the added value of therapeutic VR for CLBP; and (iv) PTs need specific skills, positive attitudes and knowledge to administer therapeutic VR.

Conclusion

The study results showed that VR was perceived as a valuable and non-threatening innovation for physiotherapy in patients with CLBP, that fits the hands-off and coaching role of PTs. Therapeutic VR seems promising in physiotherapy for patients with CLBP, but further adoption depends on breaking practical and systemic barriers. Also, more education is needed to train PTs to effectively administer VR.

目的：治疗性虚拟现实（VR）是慢性腰痛（CLBP）患者物理治疗的一种新兴干预手段。然而，物理治疗师（PTs）对虚拟现实的广泛采用进展缓慢。这可能是由于PT对VR在CLBP患者物理治疗中的附加价值的负面认知和态度所致。这项研究的目的是探索这些观念和态度。方法：采用半结构化访谈进行定性描述性研究。研究样本包括11名初级保健PTs，中位年龄为35岁（范围：28-58岁）。参与的pt至少有一年使用VR治疗CLBP患者的经验，之后他们继续使用VR或停止使用VR。访谈内容逐字记录，并采用自反性主题分析法进行归纳分析。结果：对访谈的分析确定了四个总体主题：(i)治疗性虚拟现实被认为对PT的角色没有威胁；（ii）虚拟现实具有独特的品质，可以补充PT的工具箱；（iii）对CLBP治疗性VR附加值的不同态度；（iv） PTs需要特定的技能、积极的态度和知识来管理治疗性VR。结论：研究结果表明，VR被认为是CLBP患者物理治疗的一项有价值且无威胁性的创新，符合PTs的不干涉和指导作用。治疗性VR在CLBP患者的物理治疗中似乎很有前景，但进一步采用取决于打破实际和系统障碍。此外，需要更多的教育来培训PTs有效地管理VR。

{"title":"\"A new tool for my toolbox\": physiotherapists' perceptions on therapeutic virtual reality for chronic low back pain – a qualitative descriptive study","authors":"Syl Slatman , Raymond Ostelo , Harry van Goor , Ton Satink , J. Bart Staal , Jesper Knoop","doi":"10.1016/j.msksp.2025.103475","DOIUrl":"10.1016/j.msksp.2025.103475","url":null,"abstract":"<div><h3>Objective</h3><div>Therapeutic virtual reality (VR) is an emerging intervention in physiotherapy for patients with chronic low back pain (CLBP). However, broad adoption of VR by physiotherapists (PTs) is slow. This is possibly due to PT's negative perceptions on and attitudes towards the added value of VR in physiotherapy for patients with CLBP. The aim of this study was to explore these perceptions and attitudes.</div></div><div><h3>Methods</h3><div>We performed a qualitative descriptive study using semi-structured interviews. The study sample included eleven primary care PTs with a median age of 35 years (range: 28–58). Participating PTs had at least one year of experience using VR for the treatment of patients with CLBP, after which they continued using VR or stopped using it. The interviews were transcribed verbatim and inductively analyzed using reflexive thematic analysis.</div></div><div><h3>Results</h3><div>Analysis of the interviews identified four overarching themes: (i) therapeutic VR is perceived as non-threatening to the PT's role; (ii) VR has distinctive qualities that complement the PT's toolbox; (iii) contrasting attitudes towards the added value of therapeutic VR for CLBP; and (iv) PTs need specific skills, positive attitudes and knowledge to administer therapeutic VR.</div></div><div><h3>Conclusion</h3><div>The study results showed that VR was perceived as a valuable and non-threatening innovation for physiotherapy in patients with CLBP, that fits the hands-off and coaching role of PTs. Therapeutic VR seems promising in physiotherapy for patients with CLBP, but further adoption depends on breaking practical and systemic barriers. Also, more education is needed to train PTs to effectively administer VR.</div></div>","PeriodicalId":56036,"journal":{"name":"Musculoskeletal Science and Practice","volume":"81 ","pages":"Article 103475"},"PeriodicalIF":2.2,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145866676","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

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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