Musculoskeletal Science and Practice最新文献_第4页

Knee joint pathology and efferent pathway dysfunction: Mapping muscle inhibition from motor cortex to muscle force 膝关节病变和传出通路功能障碍：绘制从运动皮层到肌肉力量的肌肉抑制图谱

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2024-10-11 DOI: 10.1016/j.msksp.2024.103204

David A. Sherman , Justin Rush , Neal R. Glaviano , Grant E. Norte

Background

Dysfunction in efferent pathways after knee pathology is tied to long-term impairments in quadriceps and hamstrings muscle performance, daily function, and health-related quality of life. Understanding the underlying etiology is crucial for effective treatment and prevention of poor outcomes, such as post-traumatic osteoarthritis or joint replacement.

Objectives

To synthesize recent evidence of efferent pathway dysfunction (i.e., motor cortex, motor units) among individuals with knee pathology.

Design

Commentary.

Method

We summarize the current literature investigating the motor cortex, corticospinal tract, and motoneuron pool in individuals with three common knee pathologies: anterior cruciate ligament (ACL) injury, anterior knee pain (AKP), and knee osteoarthritis (OA). To offer a complete perspective, we draw from studies applying a range of neuroimaging and neurophysiologic techniques.

Results

Adaptations within the motor cortices, corticospinal tract, and motoneuron pool are present in those with knee pathology and underline impairments in quadriceps and hamstrings muscle function. Each pathology has evidence of altered motor system excitability and reduced volitional muscle activation and force-generating capacity, but few impairments were common across ACL injury, AKP, and OA studies. These findings underscore the central role of the motor cortex and motor unit behavior in the long-term outcomes of individuals with knee pathology.

Conclusions

Adaptations in the efferent pathways underlie persistent muscle dysfunction across three common knee pathologies. This review provides an overview of these changes and summarizes key findings from neurophysiology and neuroimaging studies, offering direction for future research and clinical application in the rehabilitation of joint injuries.

背景膝关节病变后传出通路的功能障碍与股四头肌和腿肌表现、日常功能和健康相关生活质量的长期损害有关。了解其根本病因对于有效治疗和预防不良后果（如创伤后骨关节炎或关节置换）至关重要、方法我们总结了目前研究三种常见膝关节病变（前交叉韧带 (ACL) 损伤、前膝关节疼痛 (AKP) 和膝关节骨性关节炎 (OA)）患者运动皮层、皮质脊髓束和运动神经元池的文献。为了提供一个完整的视角，我们借鉴了应用一系列神经影像学和神经生理学技术进行的研究。结果膝关节病变患者的运动皮层、皮质脊髓束和运动神经元池均存在适应性改变，并突出显示了股四头肌和腿肌功能的损伤。每种病症都有证据表明运动系统的兴奋性发生了改变，肌肉的自主激活和发力能力下降，但在前交叉韧带损伤、AKP 和 OA 的研究中，很少有共同的损伤。这些发现强调了运动皮层和运动单元行为在膝关节病变患者长期预后中的核心作用。结论传出通路的适应性是三种常见膝关节病变中肌肉功能持续障碍的原因。本综述概述了这些变化，并总结了神经生理学和神经影像学研究的主要发现，为关节损伤康复的未来研究和临床应用提供了方向。

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引用次数: 0

Neck muscle stiffness during craniocervical flexion under functional upper extremity conditions in patients with chronic non-specific neck pain: A shear-wave elastography study 慢性非特异性颈部疼痛患者在上肢功能条件下屈曲颅颈时颈部肌肉僵硬：剪切波弹性成像研究

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2024-10-09 DOI: 10.1016/j.msksp.2024.103203

Ebrahim Ramezani , Meysam Velayati , Mohammad Akbari , Reza Salehi , Holakoo Mohsenifar

Objective

The primary objective of the present study was to examine the differences and patterns of change in the neck extensor (NE) muscle stiffness during the Cranio-cervical flexion (CCF) task under different functional conditions of the upper extremity between CNSNP participants and asymptomatic controls.

Methods

In the current case-control study, 25 participants with CNSNP and 25 asymptomatic controls were recruited. The stiffness of the superficial (i.e., upper trapezius, splenius capitis, and semispinalis capitis) and deep (i.e., semispinalis cervicis and multifidus) NE muscles was measured at prone resting, sitting resting, and during the CCF task in different functional conditions of upper extremity using shear wave elastography.

Results

The findings showed that there was a significant main effect of condition in all NE muscles (P < 0.05), as well as a significant main effect of the group on the stiffness of superficial neck muscles (P < 0.05), indicating higher muscle stiffness in participants with CNSNP compared to the control group. There was no significant group-by-condition interaction effect on the stiffness of NE muscles (P > 0.05), except for the upper trapezius muscle (P = 0.00), indicating a different pattern of stiffness changes compared to the other muscles.

Conclusions

Individuals with CNSNP exhibited significantly greater stiffness in the superficial neck extensor muscles compared to healthy controls. Furthermore, the CCF task performed under functional upper extremity conditions, which includes bilateral shoulder scaption and shoulder abduction-external rotation while seated, resulted in increased stiffness of the NE muscles. Additionally, participants with CNSNP exhibited a higher magnitude of stiffness changes in the upper trapezius muscle across different conditions.

目的本研究的主要目的是探讨在颅颈屈曲（CCF）任务中，在上肢不同功能条件下，CNSNP 患者与无症状对照组之间颈部伸肌（NE）僵硬度的差异和变化规律。方法在本病例对照研究中，招募了 25 名 CNSNP 患者和 25 名无症状对照组。表层（即斜方肌上部、脾岬肌和半脊柱岬肌）和深层（即颈椎半脊柱肌）肌肉的僵硬度分别为 0.5%、0.5% 和 0.5%、结果表明，所有东北东北肌肉的僵硬度均存在显著的主条件效应（P < 0.05），颈部浅层肌肉的僵硬度也存在显著的组间主条件效应（P < 0.05），这表明与对照组相比，中枢神经系统营养不良患者的肌肉僵硬度更高。结论与健康对照组相比，CNSNP 患者颈部浅层伸肌的僵硬度明显更高。此外，在功能性上肢条件下进行的 CCF 任务（包括坐位时的双侧肩胛和肩外展-外旋）会导致东北神经肌肉的僵硬度增加。此外，在不同条件下，CNSNP 患者的斜方肌上部的僵硬度变化幅度更大。

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引用次数: 0

UK physiotherapists’ perceptions on providing face-to-face and virtual rehabilitation for patients with Greater Trochanteric Pain Syndrome (GTPS): A cross-sectional survey 英国物理治疗师对为大转子痛综合征（GTPS）患者提供面对面和虚拟康复治疗的看法：横断面调查。

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2024-10-05 DOI: 10.1016/j.msksp.2024.103199

Ben Foxcroft , Christine Comer , Anthony C. Redmond

Background

Greater Trochanteric Pain Syndrome (GTPS) is a prevalent and debilitating cause of lateral hip pain. Physiotherapists often prescribe exercises and educate patients on self-management strategies. Virtual consultations have increased since COVID-19. Rehabilitating patients with GTPS virtually may offer benefits to patients and healthcare providers.

Objectives

Understand physiotherapists' perceived effectiveness of providing rehabilitation for people with GTPS virtually compared to face-to-face.

Design

Cross-sectional survey.

Methods

An internet-based survey was distributed via Twitter (now X). The survey included participant characteristics and 5-point Likert scales to rate the perceived effectiveness (higher score is more effective) of each consult method to deliver treatments for GTPS. Descriptive and inferential statistics were calculated to compare effectiveness between consultation types.

Results

54 physiotherapists responded. Overall, physiotherapists felt they were more effective at managing patients face-to-face compared to virtually with median scores of 5 (IQR 4–5) to 3 (IQR 2–4) respectively (P < 0.001). Physiotherapists rated themselves more effective at delivering exercise interventions and most educational components face-to-face compared to virtually. Coaching exercises and checking exercise technique received the lowest rating with virtual consults. Higher levels of post-graduate education and confidence in technology were associated with higher perceptions of virtual consults (P < 0.05). There has been a significant increase in virtual practice since COVID-19 (P < 0.001), despite few physiotherapists receiving training.

Conclusion

Physiotherapists rated themselves as more effective in treating patients with GTPS face-to-face compared to virtually in almost all aspects of rehabilitation. However, virtual consultations still scored highly in self-management support and specific aspects of exercise and education.

背景：大转子疼痛综合征（GTPS）是导致髋关节外侧疼痛的一个普遍且令人衰弱的原因。物理治疗师通常会给患者开一些运动处方，并教育他们自我管理的策略。自 COVID-19 以来，虚拟咨询的数量有所增加。通过虚拟方式对 GTPS 患者进行康复治疗可为患者和医疗服务提供者带来益处：了解物理治疗师对通过虚拟方式为 GTPS 患者提供康复治疗的有效性认知：设计：横断面调查：方法：通过 Twitter（现在为 X）发布一项基于互联网的调查。调查内容包括参与者特征和 5 分制李克特量表，用于评定每种咨询方法对 GTPS 治疗的效果（分数越高效果越好）。通过计算描述性和推论性统计来比较不同咨询类型的有效性：54名物理治疗师做出了回应。总体而言，物理治疗师认为，与虚拟咨询相比，面对面咨询更有效，中位数分别为 5（IQR 4-5）和 3（IQR 2-4）（P 结论：物理治疗师对自己的评价是 "更有效"：物理治疗师认为，在康复的几乎所有方面，面对面治疗 GTPS 患者比虚拟治疗更有效。然而，虚拟咨询在自我管理支持以及运动和教育的特定方面仍然得分较高。

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引用次数: 0

Translation and psychometric properties of the Hebrew version of Patient Enablement Instrument for Back Pain (PEI-BP) 希伯来语版背痛患者赋能工具（PEI-BP）的翻译和心理测量特性

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2024-10-05 DOI: 10.1016/j.msksp.2024.103202

Aviya Levin , Ruth Goldstein , Jan Hartvigsen , Henrik Hein Lauridsen , Tamar Pincus , Noa Ben Ami

Background

Low back pain (LBP) is a widespread cause of disability worldwide. Self-management is a significant factor impacting an individual's ability to cope with LBP. The Patient Enablement Instrument for Back Pain (PEI-BP) assesses the ability of people with LBP to self-manage their illness.

Objective

This study aimed to translate and culturally adapt the PEI-BP into Hebrew and evaluate the reliability, validity, and responsiveness.

Design

Cross-sectional study with a nested prospective sub‐sample.

Methods

The PEI-BP was translated and culturally adapted into Hebrew using recommended guidelines. We included 188 LBP patients. The psychometric properties of the PEI-BP were evaluated according to the COSMIN methodology. For construct validity, the Ronald Morris disability questionnaire, the Brief Illness Perception Questionnaire, the Fear-Avoidance Beliefs Questionnaire-physical activity, the 12-item Short‐Form Health Survey mental health, and the Numerical pain rating scale were included. To assess reliability, a sub-sample of participants (n = 50) completed the PEI-BP again after one week and after six weeks (n = 50) to evaluate responsiveness.

Results

The PEI-BP demonstrated good internal consistency (Cronbach's α = 0.821) and test-retest reliability (ICC = 0.77). For construct validity, four out of the five hypothesized correlations were confirmed. Responsiveness showed a Receiver Operating Characteristic curve area of 0.81 (95% CI 0.67–0.93); the minimal detectable change was 14.5. A potential significant ceiling but no floor effects were observed (17.5% and 6.4%, respectively).

Conclusions

The translation and validation of the PEI-BP suggest that it is a feasible, reliable, valid, and responsive instrument for evaluating 'patient enablement' with LBP in the Hebrew-speaking population.

背景腰背痛（LBP）是导致全球残疾的一个普遍原因。自我管理是影响个人应对腰背痛能力的一个重要因素。背痛患者能力评估工具（PEI-BP）可评估腰背痛患者自我管理疾病的能力。本研究旨在将 PEI-BP 翻译成希伯来语并进行文化调整，同时评估其可靠性、有效性和响应性。我们纳入了 188 名枸杞多糖症患者。根据 COSMIN 方法评估了 PEI-BP 的心理测量特性。为了评估结构效度，我们纳入了罗纳德-莫里斯残疾问卷、简明疾病感知问卷、恐惧-逃避信念问卷-体力活动、12 项短式健康调查心理健康和数字疼痛评分量表。结果 PEI-BP 显示出良好的内部一致性（Cronbach's α = 0.821）和测试-再测可靠性（ICC = 0.77）。在建构效度方面，五项假设相关性中有四项得到了证实。反应性的接收者操作特征曲线面积为 0.81（95% CI 0.67-0.93）；可检测到的最小变化为 14.5。结论 PEI-BP 的翻译和验证表明，它是一种可行、可靠、有效且反应灵敏的工具，可用于评估希伯来语人群中 "患者对腰椎间盘突出症的适应能力"。

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引用次数: 0

Assessing the knowledge of low back pain among physiotherapists in Spain: A cohort study with pre- and post-educational course evaluation 评估西班牙物理治疗师对腰背痛的认识：教育课程前后评估的队列研究。

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2024-10-02 DOI: 10.1016/j.msksp.2024.103201

Julia Blasco-Abadía , Pablo Bellosta-López , Thorvaldur Skuli Palsson , Steffan Wittrup McPhee Christensen , Morten Hoegh , Francesco Langella , Pedro Berjano , Priscila De Brito Silva , Palle Schlott Jensen , Víctor Doménech-García

Background

Low back pain (LBP) is the most prevalent musculoskeletal disorder worldwide and physiotherapists are among the primary healthcare professionals assessing and treating the condition. However, scientific knowledge regarding the management of LBP amongst physiotherapists is largely unknown.

Objectives

To evaluate the level of evidence-based knowledge among Spanish physiotherapists in LBP management and assess knowledge enhancement following the completion of an e-learning course.

Design

Single-arm cohort study with pre-post evaluation.

Methods

This single-arm pre-post study involved 1350 physiotherapists practicing in Spain. Initially, participants underwent a 22-question test on evidence-based LBP knowledge, covering socio-economic impact, characteristics of LBP, rehabilitation goals, psychosocial factors, and high- and low-value interventions. After completing the course, participants took a final test with the same 22 questions in randomized order.

Results

Out of the 1350 physiotherapists enrolled, 857 completed the course. The initial responses demonstrated that almost half of the participants considered medical imaging essential before starting physiotherapy treatment, perceived glucocorticoids as recommended for chronic low back pain, and considered ergonomic adjustments crucial for managing the condition. Individuals who completed their education more than 10 years ago showed a minor improvement in evidence-based knowledge compared to those who recently finished their university degree. Following the course, participants displayed improved knowledge, narrowing prior disparities in error percentages across questions.

Conclusion

Due to existing gaps in physiotherapists’ evidence-based knowledge of LBP, particularly among those who have worked longer time as physiotherapists, e-learning initiatives may be a feasible approach to support continuous training of physiotherapists.

背景：腰背痛（LBP）是全球最常见的肌肉骨骼疾病，物理治疗师是评估和治疗该疾病的主要医疗专业人员之一。然而，物理治疗师对腰背痛管理的科学知识却知之甚少：评估西班牙物理治疗师在枸杞多糖症管理方面的循证知识水平，并评估完成电子学习课程后的知识提升情况：设计：单臂队列研究，事后评估：这项单臂事后评估研究涉及西班牙的 1350 名物理治疗师。首先，参与者接受了一项由 22 个问题组成的循证枸杞多糖症知识测试，测试内容包括社会经济影响、枸杞多糖症的特征、康复目标、社会心理因素以及高价值和低价值干预措施。课程结束后，学员们还参加了最后一次测试，测试中的 22 个问题均按随机顺序排列：结果：在报名的 1350 名物理治疗师中，有 857 人完成了课程。初步调查结果显示，近一半的参与者认为在开始物理治疗前必须进行医学影像检查，认为糖皮质激素是治疗慢性腰背痛的推荐药物，并认为人体工程学调整对控制病情至关重要。与刚刚完成大学学业的学员相比，10 多年前完成学业的学员在循证知识方面略有提高。课程结束后，参与者的知识水平有所提高，缩小了之前在不同问题上错误率的差距：由于物理治疗师在腰椎间盘突出症的循证知识方面存在差距，尤其是在工作时间较长的物理治疗师中，电子学习计划可能是支持物理治疗师持续培训的可行方法。

{"title":"Assessing the knowledge of low back pain among physiotherapists in Spain: A cohort study with pre- and post-educational course evaluation","authors":"Julia Blasco-Abadía , Pablo Bellosta-López , Thorvaldur Skuli Palsson , Steffan Wittrup McPhee Christensen , Morten Hoegh , Francesco Langella , Pedro Berjano , Priscila De Brito Silva , Palle Schlott Jensen , Víctor Doménech-García","doi":"10.1016/j.msksp.2024.103201","DOIUrl":"10.1016/j.msksp.2024.103201","url":null,"abstract":"<div><h3>Background</h3><div>Low back pain (LBP) is the most prevalent musculoskeletal disorder worldwide and physiotherapists are among the primary healthcare professionals assessing and treating the condition. However, scientific knowledge regarding the management of LBP amongst physiotherapists is largely unknown.</div></div><div><h3>Objectives</h3><div>To evaluate the level of evidence-based knowledge among Spanish physiotherapists in LBP management and assess knowledge enhancement following the completion of an e-learning course.</div></div><div><h3>Design</h3><div>Single-arm cohort study with pre-post evaluation.</div></div><div><h3>Methods</h3><div>This single-arm pre-post study involved 1350 physiotherapists practicing in Spain. Initially, participants underwent a 22-question test on evidence-based LBP knowledge, covering socio-economic impact, characteristics of LBP, rehabilitation goals, psychosocial factors, and high- and low-value interventions. After completing the course, participants took a final test with the same 22 questions in randomized order.</div></div><div><h3>Results</h3><div>Out of the 1350 physiotherapists enrolled, 857 completed the course. The initial responses demonstrated that almost half of the participants considered medical imaging essential before starting physiotherapy treatment, perceived glucocorticoids as recommended for chronic low back pain, and considered ergonomic adjustments crucial for managing the condition. Individuals who completed their education more than 10 years ago showed a minor improvement in evidence-based knowledge compared to those who recently finished their university degree. Following the course, participants displayed improved knowledge, narrowing prior disparities in error percentages across questions.</div></div><div><h3>Conclusion</h3><div>Due to existing gaps in physiotherapists’ evidence-based knowledge of LBP, particularly among those who have worked longer time as physiotherapists, e-learning initiatives may be a feasible approach to support continuous training of physiotherapists.</div></div>","PeriodicalId":56036,"journal":{"name":"Musculoskeletal Science and Practice","volume":"74 ","pages":"Article 103201"},"PeriodicalIF":2.2,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A 7-item Tampa Scale for Kinesiophobia in people with femoroacetabular impingement syndrome: evaluation of structural validity, hypothesis testing, internal consistency and minimally important change 股骨髋臼撞击综合征患者运动恐惧 7 项坦帕量表：结构有效性、假设检验、内部一致性和最小重要变化评估

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2024-10-01 DOI: 10.1016/j.msksp.2024.103200

Myles C. Murphy , Ebonie K. Rio , Mark J. Scholes , Denise M. Jones , Marcella Pazzinatto , Richie TJ. Johnston , Sally L. Coburn , Joanne L. Kemp

Background

The 17-item Tampa Scale for Kinesiophobia (TSK) is a commonly used patient-reported outcome measure (PROM) to assess kinesiophobia, but the measurement properties of the TSK in people with femoroacetabular impingement syndrome (FAIS) are unknown.

Objectives

1) Revise the existing TSK by removing items, as needed, with inadequate functioning to optimise the TSK for people with FAIS, and 2) evaluate construct validity (both structural validity and hypothesis testing), internal consistency, and minimal important change.

Methods

Cross-sectional cohort study including 153 young adults with FAIS. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to evaluate structural validity and the TSK was revised to remove items with poor function, improving CFA model fit. Hypothesis testing, internal consistency (Cronbach's α) and minimal important change (distribution-based method) were also evaluated.

Results

A 7-item version of the TSK provided the best CFA model fit with 10-items functioning poorly and needing to be removed. The 7-item TSK was uni-dimensional (single factor in EFA) and had adequate structural validity (Standardised Root Measure Square = 0.0771). The 7-item TSK had insufficient hypothesis testing with moderate correlations to 8/14 PROMs measuring different constructs. The 7-item TSK had adequate internal consistency (α = 0.783). The minimal important change of the 7-item TSK was 6.00 points (0–100 point scale).

Conclusion

We found that the ‘7-item TSK for FAIS’, had superior structural validity to the original 17-item scale, suggesting that it may be more appropriate for use in this population. Further studies should evaluate other measurement properties of the 7-item scale.

背景：由17个项目组成的坦帕运动恐惧量表（TSK）是一种常用的患者报告结果测量法（PROM），用于评估运动恐惧，但该量表在股骨肩关节撞击综合征（FAIS）患者中的测量特性尚不清楚：1）修订现有的 TSK，根据需要删除功能不足的项目，以优化 TSK 对股骨外侧撞击综合征患者的适用性；2）评估构造效度（结构效度和假设检验）、内部一致性和最小重要变化：方法：横断面队列研究，包括 153 名患有 FAIS 的年轻人。采用探索性因子分析（EFA）和确证性因子分析（CFA）评估结构效度，并对TSK进行修订，删除功能不佳的项目，改善CFA模型的拟合度。此外，还对假设检验、内部一致性（Cronbach's α）和最小重要变化（基于分布的方法）进行了评估：结果：7 个条目版本的 TSK 提供了最佳 CFA 模型拟合，其中 10 个条目功能不佳，需要删除。7个项目的TSK是单维度的（EFA中的单因子），具有充分的结构效度（标准化测量平方根=0.0771）。7个项目的TSK与8/14个测量不同结构的PROM之间存在中等程度的相关性，假设检验不足。7 个项目的 TSK 具有充分的内部一致性（α = 0.783）。7 项 TSK 的最小重要变化为 6.00 分（0-100 分制）：我们发现，"FAIS 7 项 TSK "的结构效度优于原来的 17 项量表，这表明它可能更适合用于此类人群。进一步的研究应评估 7 个项目量表的其他测量特性。

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引用次数: 0

Sensorimotor control of functional joint stability: Scientific concepts, clinical considerations, and the articuloneuromuscular cascade paradigm in peripheral joint injury 功能性关节稳定性的感觉运动控制：外周关节损伤的科学概念、临床考虑和关节神经肌肉级联范式。

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2024-09-29 DOI: 10.1016/j.msksp.2024.103198

Nicholas C. Clark

Human movement depends on sensorimotor control. Sensorimotor control refers to central nervous system (CNS) control of joint stability, posture, and movement, all of which are effected via the sensorimotor system. Given the nervous, muscular, and skeletal systems function as an integrated “neuromusculoskeletal system” for the purpose of executing movement, musculoskeletal conditions can result in a cascade of impairments that affect negatively all three systems. The purpose of this article is to revisit concepts in joint stability, sensorimotor control of functional joint stability (FJS), joint instability, and sensorimotor impairments contributing to functional joint instability. This article differs from historical work because it updates previous models of joint injury and joint instability by incorporating more recent research on CNS factors, skeletal muscle factors, and tendon factors. The new ‘articuloneuromuscular cascade paradigm’ presented here offers a framework for facilitating further investigation into physiological and biomechanical consequences of joint injury and, in turn, how these follow on to affect physical activity (functional) capability. Here, the term ‘injury’ represents traumatic joint injury with a focus is on peripheral joint injury. Understanding the configuration of the sensorimotor system and the cascade of post-injury sensorimotor impairments is particularly important for clinicians reasoning rational interventions for patients with mechanical instability and functional instability. Concurrently, neurocognitive processing and neurocognitive performance are also addressed relative to feedforward neuromuscular control of FJS. This article offers itself as an educational resource and scientific asset to contribute to the ongoing research and applied practice journey for developing optimal peripheral joint injury rehabilitation strategies.

人体运动依赖于感觉运动控制。感觉运动控制是指中枢神经系统（CNS）对关节稳定性、姿势和运动的控制，所有这些都是通过感觉运动系统实现的。鉴于神经、肌肉和骨骼系统作为一个综合的 "神经-肌肉-骨骼系统 "在执行运动时发挥着作用，因此肌肉骨骼状况会导致一系列损伤，对所有三个系统都产生负面影响。本文旨在重新审视关节稳定性、功能性关节稳定性（FJS）的感觉运动控制、关节不稳定性以及导致功能性关节不稳定性的感觉运动损伤等方面的概念。本文不同于以往的研究，因为它结合了中枢神经系统因素、骨骼肌因素和肌腱因素的最新研究成果，更新了以往的关节损伤和关节不稳定模型。本文提出的新 "关节神经肌肉级联范式 "提供了一个框架，有助于进一步研究关节损伤的生理和生物力学后果，以及这些后果如何反过来影响身体活动（功能）能力。在这里，"损伤 "一词代表创伤性关节损伤，重点是外周关节损伤。了解感知运动系统的构造以及受伤后感知运动障碍的一系列过程，对于临床医生合理干预机械性不稳定和功能性不稳定患者尤为重要。同时，本文还探讨了与 FJS 的前馈神经肌肉控制有关的神经认知处理和神经认知表现。这篇文章作为一种教育资源和科学资产，可为正在进行的研究和应用实践之旅做出贡献，以制定最佳的外周关节损伤康复策略。

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引用次数: 0

Is Achilles tendon structure associated with functional ability and chronic ankle instability in military recruits? 跟腱结构与新兵的功能能力和慢性踝关节不稳定性有关吗？

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2024-09-27 DOI: 10.1016/j.msksp.2024.103197

Gali Dar , Michal Shenhar , Aharon S. Finestone , Jeremy Witchalls , Gordon Waddington , Omer Paulman , Dan Nemet , Nili Steinberg

Objective

To determine the relationship between Achilles tendon (AT) structure, functional ability and chronic ankle instability (CAI) in military recruits.

Methods

Three hundred and sixty newly recruited infantry male soldiers recruited in April 2022 were assessed for AT structure by Ultrasound Tissue Characterization (UTC), for functional abilities (included proprioception ability, heel-raise test, dynamic postural balance, and hopping agility ability) and for CAI (recurrent sprains and a positive perceived instability).

Results

Soldiers that were identified with disorganized tendon had significantly lower heel-raise and agility scores compared to those with organized tendon structures (33.6 ± 18.1(n) vs. 49.9 ± 28.9(n), p < 0.001; and 5.39 ± 2.12(n) vs. 6.16 ± 1.90(n), p = 0.002, respectively). The best discriminator between soldiers with organized vs. disorganized structure, was heel-raise test (AUC = 0.741). Moreover, soldiers with disorganized AT structure had a higher prevalence of CAI compared with those with organized tendon structures (p < 0.05).

Conclusion

Recruits with disorganized tendon structures displayed reduced heel-raise score, agility ability and dynamic postural-balance and greater ankle instability. Inferior tendon quality at the onset of military service is an important physical indicator to consider when seeking to manage future injuries and potential for physical performance. Pre-recruitment screening of the AT structure, CAI, and functional abilities, especially in high-intensity infantry programs, needs to be considered.

目的确定新兵跟腱（AT）结构、功能能力和慢性踝关节不稳定（CAI）之间的关系：方法：对 2022 年 4 月招募的 360 名新步兵男兵进行了跟腱结构超声组织表征（UTC）、功能能力（包括本体感觉能力、抬跟测试、动态姿势平衡和跳跃敏捷能力）和慢性踝关节不稳定（复发性扭伤和积极的不稳定性感知）评估：结果：与肌腱结构有序的士兵相比，肌腱结构紊乱的士兵的提踵测试得分和敏捷性得分明显较低（33.6 ± 18.1（n）对 49.9 ± 28.9（n），P 结论：肌腱结构紊乱的士兵的提踵测试得分和敏捷性得分明显低于肌腱结构有序的士兵：肌腱结构紊乱的新兵在提踵得分、敏捷能力和动态姿势平衡方面都有所下降，踝关节的不稳定性更高。入伍之初肌腱质量较差是一项重要的身体指标，在管理未来损伤和身体表现潜力时应加以考虑。尤其是在高强度的步兵项目中，需要考虑在征兵前对 AT 结构、CAI 和功能能力进行筛查。

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引用次数: 0

Healthcare professionals’ experiences of delivering pain science education to adults from ethnically minoritised groups 医护人员为少数民族成年人提供疼痛科普教育的经验。

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2024-09-27 DOI: 10.1016/j.msksp.2024.103196

J. Pun , J. Franklin , C.G. Ryan

Background

Pain Science Education (PSE) seeks to increase patients understanding of their pain, to improve clinical outcomes. It has been primarily developed and tested within western cultures. There is a lack of research exploring its use with people from ethnically minoritised groups.

Objective

To explore Healthcare Professionals (HCPs) experiences of delivering PSE to people with persistent pain from ethnically minoritised groups.

Methods

In this qualitative study semi-structured interviews were carried out with a convenience sample of 14 HCPs who routinely deliver PSE to patients from ethnically minoritised groups. The interviews were analysed using reflexive thematic analysis.

Results

Three themes were identified: 1) Biomedical model or disengagement, 2) Pain is a taboo topic, and 3) The importance of cultural competence. Participants believed that people from ethnically minoritised groups disengaged with PSE sooner in comparison to non-ethnically minoritised groups and this was rooted in a strong biomedical understanding of pain and preference for biomedical treatments. Addressing patients’ beliefs was deemed difficult as participants felt that pain was considered a taboo amongst some ethnically minoritised groups and HCPs lacked sufficient training in cultural competency to confidently address their pain-related misconceptions.

Conclusions

Overall, HCPs found that many people from ethnically minoritised groups held strongly biomedical views and/or a cultural reluctance to discuss pain. These factors made pain discussions challenging leading to disengagement from PSE and a preference for passive care. Cultural competency training and access to culturally competent PSE resources may facilitate engagement with PSE for people from ethnically minoritised background.

背景：疼痛科学教育（PSE）旨在提高患者对自身疼痛的认识，从而改善临床疗效。它主要是在西方文化中开发和测试的。目前还缺乏针对少数族裔群体的研究：探讨医疗保健专业人员（HCPs）向少数族裔群体中的持续性疼痛患者提供 PSE 的经验：在这项定性研究中，我们对 14 名经常为少数民族患者提供 PSE 的医护人员进行了半结构化访谈。采用反思性主题分析法对访谈进行分析：结果：确定了三个主题：1) 生物医学模式或脱离；2) 疼痛是一个禁忌话题；3) 文化能力的重要性。参与者认为，与非少数族裔群体相比，少数族裔群体更早脱离 PSE，其根源在于对疼痛的强烈生物医学理解和对生物医学治疗的偏好。由于参与者认为疼痛在一些少数族裔群体中被视为禁忌，而保健专业人员缺乏足够的文化能力培训，无法自信地消除患者与疼痛有关的误解，因此解决患者的观念问题被认为是困难的：总体而言，保健医生发现许多少数民族群体的人持有强烈的生物医学观点和/或在文化上不愿意讨论疼痛。这些因素使得疼痛讨论具有挑战性，导致他们不参与 PSE 并倾向于被动护理。文化胜任能力培训和获取具有文化胜任能力的 PSE 资源可促进少数族裔人群参与 PSE。

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引用次数: 0

Do patients’ preferences and expectations match clinical guidelines? A survey of individuals seeking private primary care for a musculoskeletal disorder 患者的偏好和期望是否符合临床指南？一项针对因肌肉骨骼疾病而寻求私人初级保健的个人的调查。

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2024-09-26 DOI: 10.1016/j.msksp.2024.103195

Marc-Olivier Dubé , Pierre Langevin , Hugo Massé-Alarie , Jean-Francois Esculier , Anthony Lachance , Jean-Sébastien Roy

Background

Physiotherapists often inconsistently adhere to clinical practice guidelines (CPGs) when managing musculoskeletal disorders (MSKDs), potentially due to discrepancies between patient-valued interventions and guideline recommendations. Since patients’ expectations are important predictors of outcome, this disparity between CPGs recommendations and patient preferences could be problematic for the effective care of MSKDs.

Objectives

To assess patients’ expectations and preferences for the interventions used in their MSKD management and to establish correspondence rates between patients' preferences and recommendations from CPGs.

Design

Survey.

Method

This cross-sectional descriptive study included a survey on sociodemographics, preferences, and expectations towards interventions for their MSKD, acceptable cost of care, number of treatment sessions required, and their involvement in their MSKD management.

Results

One hundred and fifty participants (94 women and 56 men; mean age: 51 ± 17) responded to the survey. Eighty percent of respondents expected their involvement in their MSKD management to be equal to or superior than that of the physiotherapist. Sixty-nine percent of respondents expected to receive exercises, and 67% expected to receive education. Based on preference ratings, 95% of respondents chose recommended interventions, 57% chose interventions with uncertain levels of recommendation, and 48% chose interventions not recommended by CPGs.

Conclusion

Less than 70% of participants expected to receive education and exercises, the two most frequently recommended interventions by CPGs. On the other hand, the majority of respondents indicated that their involvement should be equal to or superior than that of the physiotherapist. This aligns with CPGs, which advocate for active and self-management strategies.

背景：物理治疗师在处理肌肉骨骼疾病（MSKDs）时，可能由于患者重视的干预措施与指南建议之间的差异，往往不能始终如一地遵守临床实践指南（CPGs）。由于患者的期望是预示治疗效果的重要因素，CPGs 建议与患者偏好之间的这种差异可能会给有效治疗 MSKDs 带来问题：评估患者对 MSKD 治疗中所用干预措施的期望和偏好，并确定患者偏好与 CPGs 建议之间的对应率：方法：横断面描述性研究：这项横断面描述性研究包括一项调查，内容涉及社会人口学、偏好、对 MSKD 干预措施的期望、可接受的护理成本、所需治疗次数以及他们在 MSKD 管理中的参与情况：150 名参与者（94 名女性和 56 名男性；平均年龄：51 ± 17）对调查做出了回应。80%的受访者希望他们参与 MSKD 管理的程度等同于或高于物理治疗师。69%的受访者希望接受锻炼，67%的受访者希望接受教育。根据偏好评级，95% 的受访者选择了推荐的干预措施，57% 的受访者选择了推荐程度不确定的干预措施，48% 的受访者选择了 CPG 未推荐的干预措施：结论：不到 70% 的参与者希望接受教育和锻炼，而这正是 CPG 最常推荐的两种干预措施。另一方面，大多数受访者表示，他们的参与程度应等同于或高于物理治疗师。这与 CPG 所倡导的积极和自我管理策略不谋而合。

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引用次数: 0