Musculoskeletal Science and Practice最新文献

Background

Objectives

Methods

Results

Conclusion

Objectives

The purpose of this study was to examine the association between insomnia and the number of pain areas among employees of an automotive company. Secondary aim was to examine the association between depression, anxiety, and stress, and musculoskeletal pain independent of insomnia.

Material and methods

We performed a cross-sectional study conducted in an automobile manufacturing factory. To collect data, we used the Nordic Musculoskeletal Questionnaire, ISI (Insomnia Severity Index), and DASS-21 (Depression, Anxiety, and Stress Scale). The univariate and multiple association analyses were performed using ordinal logistic regression adjusted for gender, age, industrial/non-industrial, sport activity, pack year, educational level, years of employment, anxiety, stress, and depression.

Result

In individuals with insomnia, the lower back was the most common area where pain was reported (59.5%). In all areas, pain symptoms were significantly more prevalent in individuals with insomnia compared to those without insomnia. Insomnia was associated with having pain with an increased odds of number of pain sites (odds ratio [OR] 2.81,95%CI 2.34–3.39). In ordinal logistic regression, there was an association between insomnia and pain, independent of the effects of depression, anxiety, and stress (OR 2.21,95%CI 1.52–3.23).

Discussion

Insomnia was associated with pain in all regions of the body and a higher prevalence of pain in multiple areas. The insomnia-pain association was independent of depression, anxiety, and stress.

Together with visual and vestibular input the cervical spine is vital for sensorimotor control of head and eye movement control, general body postural stability adjustments and co-ordination.

Altered cervical input in persons with neck disorders can lead to signs and symptoms of impaired sensorimotor control across and within several domains. Clinical assessment for differential diagnosis and to direct management of cervical related altered sensorimotor control is clearly required in many patients. This applies not only to patients with neck disorders but also in patients with, for example vestibular disorders or concussion, presenting with signs and symptoms of altered sensorimotor control where the cervical spine may have a role to play.

This paper explores the research and current knowledge in relation to clinical measures of cervical related sensorimotor control. The feasibility, responsiveness, comparison to gold standards and potential of clinical measures of cervical related sensorimotor control to assist in differential diagnosis are considered where relevant. Future research directions should examine the full complement of psychometric properties of tests and consideration of any relationships of these measures to pain, dizziness, trauma and functional implications. Development of other measures as well as use in assessing response post management are also important directions.

These clinical measures, along with a skilled interview and cervical musculoskeletal examination will enable clinicians to recognise and manage impaired cervical sensorimotor control in patients with neck disorders as well as determine the role of the cervical spine in many patients presenting with signs and symptoms of altered sensorimotor control.

Background

The precise manner in which morphological and mechanical properties of cervical muscles in patients with fibromyalgia and migraine are affected remains unclear.

Objectives

The objective of this study was to compare the morphological and mechanical properties of cervical muscles in individuals diagnosed with fibromyalgia who also experience migraine headaches with those who do not.

Methods

The study included two groups of fibromyalgia patients: one with migraine (n = 18, age = 44.7 ± 7.5 years, body mass index = 28.7 ± 6.9 kg/m²) and one without migraine (n = 21, age = 42.6 ± 9.5 years, body mass index = 25.1 ± 4.4 kg/m²). Body pain intensity related to fibromyalgia and migraine attack severity were evaluated with a Visual Analog Scale (VAS). The cervical muscle morphological and mechanical properties, including thickness, cross-sectional area (CSA), and stiffness, were measured using ultrasound imaging.

Results

It was found that there was a greater decrease in longus colli muscle CSA scores (p = 0.004) and a greater increase in upper trapezius muscle stiffness scores (p = 0.013) in the fibromyalgia + migraine group compared to the fibromyalgia group. No statistically significant differences were observed in trapezius muscle thickness (p = 0.261), sternocleidomastoid muscle thickness (p = 0.874), multifidus CSA (p = 0.963), or sternocleidomastoid muscle stiffness (p = 0.642) between the two groups.

Conclusion

Patients with fibromyalgia and migraine exhibited diminished longus colli muscle CSA and heightened upper trapezius muscle stiffness compared to those with fibromyalgia but no migraine. It should be considered that migraine comorbidity in fibromyalgia may negatively affect cervical muscle morphological and mechanical properties.

Background

Pain is prevalent among children and adolescents. The development and implementation of Pain Neuroscience Education (PNE) strategies tailored to this population remains overlooked in contrast to the adult population.

Objective

This study sought to identify the content, delivery methods, and dosage of PNE for children and adolescents available in the literature.

Method

We systematically searched PubMed, EMBASE, Physiotherapy Evidence Database, Scopus, Web of Science, Cochrane Library, PsycINFO, and clinical trial registration databases. Inclusion criteria consisted of studies that involved children submitted to a PNE program in community, school, clinics, hospitals or child development centers. We considered studies that included children with and without pain who received PNE strategies associated or not with self-motivational interventions. Studies focusing on psychological interventions were excluded. We extracted data on authors, publication year, country, sample characteristics, health condition, PNE content, study design, context, outcomes, duration, follow-up, main results, dropout, and adverse effects. Data extracted were qualitatively organized.

Results

A total of 805 studies were initially reviewed. The final sample comprised 17 studies. Common PNE topics included pain neurophysiology, biopsychosocial influences, pain concepts, self-management, and coping strategies. Delivery methods ranged from slideshows and videos to booklets, with sessions lasting 8–60 min. Schools were the most common setting for these interventions.

Conclusion

Our review demonstrates the diversity in PNE content, delivery methods, and intervention dosages among the included studies. Most studies occurred in school settings, potentially limiting its generalizability for clinical contexts.

Background

Machine learning (ML) efficiently processes large datasets, showing promise in enhancing clinical practice within physical therapy.

Objective

The aim of this scoping review is to provide an overview of studies using ML approaches in clinical settings of physical therapy.

Data sources

A scoping review was performed in PubMed, EMBASE, PEDro, Cochrane, Web of Science, and Scopus.

Selection criteria

We included studies utilizing ML methods. ML was defined as the utilization of computational systems to encode patterns and relationships, enabling predictions or classifications with minimal human interference.

Data extraction and data synthesis

Data were extracted regarding methods, data types, performance metrics, and model availability.

Results

Forty-two studies were included. The majority were published after 2020 (n = 25). Fourteen studies (33.3%) were in the musculoskeletal physical therapy field, nine (21.4%) in neurological, and eight (19%) in sports physical therapy. We identified 44 different ML models, with random forest being the most used. Three studies reported on model availability. We identified several clinical applications for ML-based tools, including diagnosis (n = 14), prognosis (n = 7), treatment outcomes prediction (n = 7), clinical decision support (n = 5), movement analysis (n = 4), patient monitoring (n = 3), and personalized care plan (n = 2).

Limitation

Model performance metrics, costs, model interpretability, and explainability were not reported.

Conclusion

This scope review mapped the emerging landscape of machine learning applications in physical therapy. Despite the growing interest, the field still lacks high-quality studies on validation, model availability, and acceptability to advance from research to clinical practice.

Objective

Investigate people's acceptance of specialist musculoskeletal care within a new care pathway for common musculoskeletal conditions (low back pain, neck pain/whiplash, knee osteoarthritis).

Design

Convergent parallel mixed methods design referencing the Theoretical Framework of Acceptability. The study included a subset of participants (n = 29) at-risk of poor outcomes from the intervention arm of the PAthway of CarE for common musculoskeletal conditions (PACE-MSK) trial. In the PACE-MSK arm, participants received specialist physiotherapist care as an adjunct to the care provided by their primary healthcare professional(s). One-to-one semi-structured interviews were conducted around 3-months after commencing in the trial. Quantitative data were collected at baseline and 3-month follow-up (health-related quality of life, pain self-efficacy, global perceived change, satisfaction).

Results

Five themes were identified (Expectations and beliefs shaped patient experience; Clinical expertise and competence influence acceptance; Person-centred care; Mechanisms facilitating beneficial responses to care; Gaps in care pathway implementation). There were positive individual changes in physical quality of life for 17/29 (59%) participants, mental health quality of life for 12/29 (41%), pain self-efficacy for 8/29 (28%) and global perceived change for 19/29 (66%). Management met expectations with the majority reporting high levels of satisfaction. Integrating the qualitative and quantitative data with the Theoretical Framework of Acceptability, there were complementary meta-inferences in the constructs of ‘ethicality’, ‘intervention coherence’, ‘self-efficacy’ and ‘affective attitude’. Divergence was identified in ‘perceived effectiveness’.

Discussion

In general, there was positive acceptance of the care pathway by participants. Specialist physiotherapists’ care was perceived as a positive addition to usual care.

Background

Emerging evidence suggests that individuals with chronic non-specific neck pain may experience altered sensory processing, potentially contributing to the modest response to therapeutic exercise treatments.

Objective

This systematic review aims to explore the effect of therapeutic exercise on pain processing among patients with chronic non-specific neck pain.

Methods

A systematic search was conducted in multiple databases (PubMed, EMBASE, CINAHL, PEDro, SportDiscus, and Cochrane CENTRAL) from inception to June 2023. Inclusion criteria included randomized controlled trials (RCT) comparing therapeutic exercise to non-exercise treatments or no treatment. The screening and data extraction was conducted by two reviewers. The methodological quality was evaluated using the PEDro scale and the certainty of evidence using GRADE. The primary outcomes assessed were pressure pain threshold (PPT), temporal summation, and conditioned pain modulation.

Results

Thirteen trials included a total of 948 participants, with 586 in the exercise therapy group and 362 in the non-exercise group. The therapeutic exercise was not superior to non-exercise treatments for both local and PPT in the immediate (MD = 0.13, 95%CI = −0.18 to 0.43), and short-term follow-up (MD = 0.17, 95%CI = −0.27 to 0.61). In the medium term, therapeutic exercise demonstrated a small effect size in increasing local PPT (Kg/cm2) (MD = 0.64, 95%CI = 0.08 to 1.19) compared to non-exercise interventions. The certainty of evidence for these outcomes was very low.

Conclusions

There is very low certainty of evidence that therapeutic exercise is not superior than non-exercise treatment on pain processing in patients with chronic non-specific neck pain.