Musculoskeletal Science and Practice最新文献_第7页

Patients’ expectations and experiences of physiotherapy management of migraine 偏头痛患者对物理治疗的期望与体会

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-09-16 DOI: 10.1016/j.msksp.2025.103418

Samantha Kelley, Julia Treleaven, Lucy Thomas, Zhiqi Liang

Background

Migraine is a debilitating condition with diverse presentations, and the role of physiotherapy management remains a contentious topic. There is need for an in-depth understanding of patients' expectations and lived experience of physiotherapy management of migraine. Exploration of patients’ perceptions and preferences for treatment may provide valuable management insights for both clinicians and researchers.

Objective

The aim of this study was to explore participants’ perspectives regarding physiotherapy management of migraine through semi-structured interviews with migraine sufferers.

Methods

Twenty single semi-structured interviews were conducted from March until September 2024 following recruitment at the University of Queensland, as well as via social media dissemination and poster placement at the university and various sites in the community. Reflexive thematic analysis was undertaken, and common themes were identified.

Results

The average age of the participants was 38.15 ± 16.2 years. Three key themes were identified from the interviews, with relevant sub-themes explored: (i) Patients have varied expectations of what physiotherapy can offer; (ii) Patient preferences of physiotherapy treatments and outcomes ranged widely (iii) Physiotherapy as part of overall migraine management.

Conclusion

The findings indicate that patients seeking physiotherapy for management of their migraine prioritise short-term relief in parallel with being provided with long-term strategies. Physiotherapists should be equipped with the skills and knowledge to provide personalised advice and education, appropriate manual therapy and other treatments for short-term relief and self-management strategies that patients are seeking, in conjunction with broader medical care.

背景：偏头痛是一种表现多样的衰弱性疾病，物理治疗管理的作用仍然是一个有争议的话题。有必要深入了解患者对偏头痛物理治疗管理的期望和生活经验。探索患者对治疗的看法和偏好可能为临床医生和研究人员提供有价值的管理见解。目的通过对偏头痛患者的半结构化访谈，探讨参与者对偏头痛物理治疗管理的看法。方法在昆士兰大学招募后，于2024年3月至9月进行了20次单次半结构化访谈，并通过社交媒体传播和在大学和社区各地点张贴海报进行了访谈。进行了反身性主题分析，并确定了共同主题。结果患者平均年龄为38.15±16.2岁。从访谈中确定了三个关键主题，并探讨了相关的子主题：(i)患者对物理治疗所能提供的服务有不同的期望；（ii）患者对物理治疗的偏好和结果差异很大（iii）物理治疗作为偏头痛整体治疗的一部分。结论研究结果表明，寻求物理治疗治疗偏头痛的患者优先考虑短期缓解，同时提供长期策略。物理治疗师应具备技能和知识，以提供个性化的咨询和教育、适当的手工治疗和其他短期缓解治疗，以及患者正在寻求的自我管理策略，同时提供更广泛的医疗服务。

{"title":"Patients’ expectations and experiences of physiotherapy management of migraine","authors":"Samantha Kelley, Julia Treleaven, Lucy Thomas, Zhiqi Liang","doi":"10.1016/j.msksp.2025.103418","DOIUrl":"10.1016/j.msksp.2025.103418","url":null,"abstract":"<div><h3>Background</h3><div>Migraine is a debilitating condition with diverse presentations, and the role of physiotherapy management remains a contentious topic. There is need for an in-depth understanding of patients' expectations and lived experience of physiotherapy management of migraine. Exploration of patients’ perceptions and preferences for treatment may provide valuable management insights for both clinicians and researchers.</div></div><div><h3>Objective</h3><div>The aim of this study was to explore participants’ perspectives regarding physiotherapy management of migraine through semi-structured interviews with migraine sufferers.</div></div><div><h3>Methods</h3><div>Twenty single semi-structured interviews were conducted from March until September 2024 following recruitment at the University of Queensland, as well as via social media dissemination and poster placement at the university and various sites in the community. Reflexive thematic analysis was undertaken, and common themes were identified.</div></div><div><h3>Results</h3><div>The average age of the participants was 38.15 ± 16.2 years. Three key themes were identified from the interviews, with relevant sub-themes explored: (i) Patients have varied expectations of what physiotherapy can offer; (ii) Patient preferences of physiotherapy treatments and outcomes ranged widely (iii) Physiotherapy as part of overall migraine management.</div></div><div><h3>Conclusion</h3><div>The findings indicate that patients seeking physiotherapy for management of their migraine prioritise short-term relief in parallel with being provided with long-term strategies. Physiotherapists should be equipped with the skills and knowledge to provide personalised advice and education, appropriate manual therapy and other treatments for short-term relief and self-management strategies that patients are seeking, in conjunction with broader medical care.</div></div>","PeriodicalId":56036,"journal":{"name":"Musculoskeletal Science and Practice","volume":"80 ","pages":"Article 103418"},"PeriodicalIF":2.2,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096291","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

“Do I need an imaging?” exploring why patients with non-specific chronic low back pain request diagnostic instrumental evaluation: a phenomenological qualitative study “我需要影像学检查吗？”探讨为什么非特异性慢性腰痛患者要求诊断工具评估：一项现象学定性研究

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-09-15 DOI: 10.1016/j.msksp.2025.103416

Graziana Lullo , Gabriele Giannotta , Andrea Tamborrino , Firas Mourad , Massimo Esposto , Giuseppe Giovannico , Morten Hoegh , Matteo Cioeta

Objective

This study aims to investigate patient beliefs surrounding imaging for chronic non-specific low back pain (cLBP) when it is not clinically indicated.

Methods

Semi-structured interviews were conducted with patients diagnosed with cLBP, and thematic analysis was used to identify recurring themes from the interviews.

Results

Eleven patients (6 females, 5 males, mean age 53 ± 15.66 years) participated in the study. Three main themes emerged: (1) cognitive dissonance: need to 'know the cause,' but recognition of multifactorial dimension of pain; (2) imaging as a treatment guide: seen as useful post-conservative treatment failure and (3) imaging has different consequences: reassuring for some; anxiety-inducing and misleading for others.

Conclusion

This study highlights the importance of patient education regarding the limitations of diagnostic imaging for non-specific cLBP and the need for healthcare providers to communicate more effectively about alternative pain management strategies.

目的：本研究旨在探讨慢性非特异性腰痛（cLBP）在无临床指征时对影像学检查的看法。方法对诊断为cLBP的患者进行半结构化访谈，并采用主题分析来确定访谈中反复出现的主题。结果6例患者（女6例，男5例）参与研究，平均年龄（53±15.66岁）。出现了三个主要主题：(1)认知失调：需要“知道原因”，但认识到疼痛的多因素维度；(2)影像学作为治疗指南：在保守治疗失败后被视为有用的；(3)影像学有不同的后果：对一些人来说是令人放心的；引起焦虑，误导他人。结论：本研究强调了对患者进行教育的重要性，即非特异性cLBP诊断成像的局限性，以及医疗保健提供者需要更有效地沟通替代性疼痛管理策略。

{"title":"“Do I need an imaging?” exploring why patients with non-specific chronic low back pain request diagnostic instrumental evaluation: a phenomenological qualitative study","authors":"Graziana Lullo , Gabriele Giannotta , Andrea Tamborrino , Firas Mourad , Massimo Esposto , Giuseppe Giovannico , Morten Hoegh , Matteo Cioeta","doi":"10.1016/j.msksp.2025.103416","DOIUrl":"10.1016/j.msksp.2025.103416","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to investigate patient beliefs surrounding imaging for chronic non-specific low back pain (cLBP) when it is not clinically indicated.</div></div><div><h3>Methods</h3><div>Semi-structured interviews were conducted with patients diagnosed with cLBP, and thematic analysis was used to identify recurring themes from the interviews.</div></div><div><h3>Results</h3><div>Eleven patients (6 females, 5 males, mean age 53 ± 15.66 years) participated in the study. Three main themes emerged: (1) cognitive dissonance: need to 'know the cause,' but recognition of multifactorial dimension of pain; (2) imaging as a treatment guide: seen as useful post-conservative treatment failure and (3) imaging has different consequences: reassuring for some; anxiety-inducing and misleading for others.</div></div><div><h3>Conclusion</h3><div>This study highlights the importance of patient education regarding the limitations of diagnostic imaging for non-specific cLBP and the need for healthcare providers to communicate more effectively about alternative pain management strategies.</div></div>","PeriodicalId":56036,"journal":{"name":"Musculoskeletal Science and Practice","volume":"80 ","pages":"Article 103416"},"PeriodicalIF":2.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145121272","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

Cognitive Muscular Therapy™ for low back pain: a pilot study 认知肌肉疗法™治疗腰痛：一项试点研究。

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-09-13 DOI: 10.1016/j.msksp.2025.103415

Stephen J. Preece , Jason Smith , Nathan Brookes , Sally Gates , Daniela Ghio

Cognitive Muscular Therapy™ for Chronic Low Back Pain.

Background

Chronic low back pain (cLBP) is a major cause of disability. Research shows that people with cLBP over activate the abdominal and superficial paraspinal muscles and this may indicate an underlying pattern of antagonistic flexor-extensor tone. This study was designed test a new intervention for cLBP, Cognitive Muscular Therapy™ (CMT). CMT integrates biomechanical training to improve postural tone with psychological techniques for pain management.

Methods

The CMT intervention included five components: Understanding back pain, General relaxation, Postural deconstruction, Contextual triggers, and Functional integration and incorporated Electromyography (EMG) biofeedback to visualise erector spinae activity. An observational case series was carried out on fifteen participants with cLBP, who each received seven weekly sessions of CMT. Alongside disability and psychological factors, the activation profile of the erector spinae was measured during walking, using EMG. Five participants provided qualitative feedback through interviews.

Results

Significant clinical improvements were observed. The Roland-Morris Disability Questionnaire score reduced by 7 points, the Pain catastrophizing scale reduced by 13.2 points and the Tampa scale of kinesiophobia reduced by 7.8 points. EMG data suggested improved phasic activation of the erector spinae during walking, while interviews showed increased self-efficacy and improved pain management.

Conclusion

This is the first study of CMT for cLBP, showing promising results in reducing pain and disability. By integrating psychological strategies within a biomechanical framework, CMT offers a novel approach to retraining muscle activity. Future work is now required to explore the proposed mechanism of action and fully quantify the clinical effectiveness of this new intervention.

Trial registration

NCT05611476.

认知肌肉疗法™治疗慢性腰痛。背景：慢性腰痛（cLBP）是致残的主要原因。研究表明，患有cLBP的人过度激活腹部和浅表棘旁肌，这可能表明一种潜在的拮抗屈伸肌张力模式。本研究旨在测试一种新的cLBP干预措施，认知肌肉疗法™（CMT）。CMT将生物力学训练与疼痛管理的心理技术相结合，以改善体位张力。方法：CMT干预包括五个组成部分：理解背痛、全身放松、体位解构、情境触发和功能整合，并结合肌电（EMG）生物反馈来可视化竖脊肌活动。对15名cLBP患者进行了观察性病例系列研究，他们每个人每周接受7次CMT治疗。除了残疾和心理因素外，在行走过程中使用肌电图测量竖脊肌的激活谱。五名参与者通过访谈提供了定性反馈。结果：临床效果明显改善。罗兰-莫里斯残疾问卷得分降低7分，疼痛灾难化量表得分降低13.2分，运动恐惧症坦帕量表得分降低7.8分。肌电图数据显示，行走过程中竖脊肌的相位激活有所改善，而访谈显示自我效能增强，疼痛管理得到改善。结论：本研究首次采用CMT治疗cLBP，在减轻疼痛和残疾方面显示出良好的效果。通过在生物力学框架内整合心理策略，CMT提供了一种再训练肌肉活动的新方法。未来的工作现在需要探索所提出的作用机制，并充分量化这种新干预措施的临床有效性。试验注册：NCT05611476。

{"title":"Cognitive Muscular Therapy™ for low back pain: a pilot study","authors":"Stephen J. Preece , Jason Smith , Nathan Brookes , Sally Gates , Daniela Ghio","doi":"10.1016/j.msksp.2025.103415","DOIUrl":"10.1016/j.msksp.2025.103415","url":null,"abstract":"<div><div>Cognitive Muscular Therapy™ for Chronic Low Back Pain.</div></div><div><h3>Background</h3><div>Chronic low back pain (cLBP) is a major cause of disability. Research shows that people with cLBP over activate the abdominal and superficial paraspinal muscles and this may indicate an underlying pattern of antagonistic flexor-extensor tone. This study was designed test a new intervention for cLBP, Cognitive Muscular Therapy™ (CMT). CMT integrates biomechanical training to improve postural tone with psychological techniques for pain management.</div></div><div><h3>Methods</h3><div>The CMT intervention included five components: Understanding back pain, General relaxation, Postural deconstruction, Contextual triggers, and Functional integration and incorporated Electromyography (EMG) biofeedback to visualise erector spinae activity. An observational case series was carried out on fifteen participants with cLBP, who each received seven weekly sessions of CMT. Alongside disability and psychological factors, the activation profile of the erector spinae was measured during walking, using EMG. Five participants provided qualitative feedback through interviews.</div></div><div><h3>Results</h3><div>Significant clinical improvements were observed. The Roland-Morris Disability Questionnaire score reduced by 7 points, the Pain catastrophizing scale reduced by 13.2 points and the Tampa scale of kinesiophobia reduced by 7.8 points. EMG data suggested improved phasic activation of the erector spinae during walking, while interviews showed increased self-efficacy and improved pain management.</div></div><div><h3>Conclusion</h3><div>This is the first study of CMT for cLBP, showing promising results in reducing pain and disability. By integrating psychological strategies within a biomechanical framework, CMT offers a novel approach to retraining muscle activity. Future work is now required to explore the proposed mechanism of action and fully quantify the clinical effectiveness of this new intervention.</div></div><div><h3>Trial registration</h3><div>NCT05611476.</div></div>","PeriodicalId":56036,"journal":{"name":"Musculoskeletal Science and Practice","volume":"80 ","pages":"Article 103415"},"PeriodicalIF":2.2,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093123","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

Morphometric characteristics and variations of the suboccipital muscles: A cadaveric study 枕下肌肉的形态特征和变化：一项尸体研究。

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-09-10 DOI: 10.1016/j.msksp.2025.103414

Menekşe Karahan , Cüneyt Bozer , Selman Çıkmaz , Mehtap Seyaz , Metehan Pehli̇van

Background

The suboccipital muscle complex critically contributes to upper cervical biomechanics and proprioceptive regulation of head posture; however, the comprehensive morphometric characterization and prevalence of its anatomical variants remain poorly defined.

Objectives

This study aimed to evaluate the morphometric characteristics and variations of the suboccipital muscles, assess their symmetry, and determine prevalence of anatomical variations with potential clinical significance.

Design

A cross-sectional cadaveric study.

Method

This study was conducted on 27 cadaveric heads preserved in formalin-alcohol-phenol solution. The suboccipital muscles were dissected to expose the anatomical structures. Morphometric measurements were performed using a digital caliper. Symmetry between the left and right sides was analyzed for each muscle. The presence of anatomical variations such as bifid structures, accessory fibers, and atlantomastoid muscles was recorded.

Results

Bilateral variations in RCPmi were observed in 11.11 % of the cadavers, while a unilateral variation in OCi was identified in 3.7 % of cases. The atlantomastoid muscle was present in 11.11 % of the specimens. No significant differences were observed in the morphometric data of the muscles on the right and left sides; all were symmetrical. No variations were observed in OCs.

Conclusions

This study provides essential anatomical insights into the prevalence of suboccipital muscle variations, particularly in RCPmi and RCPma, which could influence clinical procedures such as dry needling and electromyography (EMG). The findings emphasize the importance of anatomical knowledge in preventing procedural complications. Future studies with larger sample sizes and functional analyses are needed to further explore the clinical impact of these variations.

背景：枕下肌复合体对上颈椎生物力学和本体感觉的头部姿势调节有重要作用；然而，其解剖学变异的全面形态特征和流行程度仍然不明确。目的：本研究旨在评估枕下肌肉的形态特征和变化，评估其对称性，并确定具有潜在临床意义的解剖变异的普遍性。设计：横断面尸体研究。方法：对27具尸体头部进行了福尔马林-乙醇-苯酚溶液保存研究。解剖枕下肌，显露解剖结构。使用数字卡尺进行形态测量。对每一块肌肉的左右两侧对称性进行分析。解剖变异的存在，如双裂结构、副纤维和寰乳突肌被记录下来。结果：11.11%的尸体出现双侧RCPmi变异，3.7%的尸体出现单侧OCi变异。11.11%的标本存在寰乳突肌。左右两侧肌肉形态计量数据无显著差异；都是对称的。在OCs中未观察到变化。结论：这项研究为枕下肌变异的流行提供了重要的解剖学见解，特别是在RCPmi和RCPma中，这可能影响临床手术，如干针和肌电图（EMG）。研究结果强调了解剖学知识在预防手术并发症中的重要性。未来需要更大样本量的研究和功能分析来进一步探索这些变异的临床影响。

{"title":"Morphometric characteristics and variations of the suboccipital muscles: A cadaveric study","authors":"Menekşe Karahan , Cüneyt Bozer , Selman Çıkmaz , Mehtap Seyaz , Metehan Pehli̇van","doi":"10.1016/j.msksp.2025.103414","DOIUrl":"10.1016/j.msksp.2025.103414","url":null,"abstract":"<div><h3>Background</h3><div>The suboccipital muscle complex critically contributes to upper cervical biomechanics and proprioceptive regulation of head posture; however, the comprehensive morphometric characterization and prevalence of its anatomical variants remain poorly defined.</div></div><div><h3>Objectives</h3><div>This study aimed to evaluate the morphometric characteristics and variations of the suboccipital muscles, assess their symmetry, and determine prevalence of anatomical variations with potential clinical significance.</div></div><div><h3>Design</h3><div>A cross-sectional cadaveric study.</div></div><div><h3>Method</h3><div>This study was conducted on 27 cadaveric heads preserved in formalin-alcohol-phenol solution. The suboccipital muscles were dissected to expose the anatomical structures. Morphometric measurements were performed using a digital caliper. Symmetry between the left and right sides was analyzed for each muscle. The presence of anatomical variations such as bifid structures, accessory fibers, and atlantomastoid muscles was recorded.</div></div><div><h3>Results</h3><div>Bilateral variations in RCPmi were observed in 11.11 % of the cadavers, while a unilateral variation in OCi was identified in 3.7 % of cases. The atlantomastoid muscle was present in 11.11 % of the specimens. No significant differences were observed in the morphometric data of the muscles on the right and left sides; all were symmetrical. No variations were observed in OCs.</div></div><div><h3>Conclusions</h3><div>This study provides essential anatomical insights into the prevalence of suboccipital muscle variations, particularly in RCPmi and RCPma, which could influence clinical procedures such as dry needling and electromyography (EMG). The findings emphasize the importance of anatomical knowledge in preventing procedural complications. Future studies with larger sample sizes and functional analyses are needed to further explore the clinical impact of these variations.</div></div>","PeriodicalId":56036,"journal":{"name":"Musculoskeletal Science and Practice","volume":"80 ","pages":"Article 103414"},"PeriodicalIF":2.2,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082498","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

Concurrent validity of the directional preference phenomenon compared to controlled lumbar discography: A supplementary analysis of a diagnostic accuracy study 与控制腰椎椎间盘造影术相比，方向偏好现象的同时有效性：一项诊断准确性研究的补充分析

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-09-10 DOI: 10.1016/j.msksp.2025.103413

Jean-Philippe Deneuville , Mark Laslett , Alexandra Cervantes , Sylvain Peterlongo , Amine Ounajim , Romain Artico

Background

Persistent low back pain (LBP) is a symptom with many potential causes. Centralisation phenomenon (CP) has emerged as promising diagnostic tools for identifying a subset of discogenic pain. CP represents a subgroup of patients demonstrating Directional Preference (DP) and to date the diagnosticaccuracy of DP has never been assessed. To bridge this gap, this study evaluates the diagnostic accuracy of DP for discogenic pain, compares its properties to CP, and explores the development of clinical diagnostic rules (CDRs) for patients with negative testing for DP, or inability to undergo repeated movement testing.

Methods

103 persistent low back pain patients were assessed by a physiotherapist to collect clinical data and determine DP status. Subsequently, a radiologist performed controlled discography to determine the discogenic pain status. Both the physiotherapist and the radiologist were blinded to each other's findings.

Results

DP demonstrated high diagnostic accuracy (specificity: 0.94; Positive Likelihood Ratio (LR⁺): 7.65) but low screening properties (sensitivity: 0.48; Negative Likelihood Ratio (LR⁻): 0.56). CP showed similar diagnostic properties (specificity: 0.94; LR⁺: 5.57). A CDR for untestable DP yielded low predictive power (Area Under the Curve (AUC): 0.57). Due to limited sample size and missing data, no valid CDR could be established to assist diagnostic decision when DP is negative.

Conclusions

DP is a valid diagnostic tool for mechanical discogenic pain but has limited screening utility. Further studies are needed to refine diagnostic approaches and explore subgroups, such as those with Modic changes/inflammation-driven discogenic pain.

背景：持续性腰痛（LBP）是一种有许多潜在原因的症状。集中化现象（CP）已成为识别椎间盘源性疼痛子集的有前途的诊断工具。CP代表了表现出定向偏好（DP）的患者亚组，迄今为止，DP的诊断准确性从未被评估过。为了弥补这一差距，本研究评估了DP对椎间盘源性疼痛的诊断准确性，将其与CP的特性进行了比较，并探讨了DP检测阴性或无法进行重复运动测试的患者的临床诊断规则（cdr）的发展。方法对103例持续性腰痛患者进行物理治疗师评估，收集临床资料并确定DP状态。随后，放射科医生进行对照椎间盘造影术以确定椎间盘源性疼痛的状态。物理治疗师和放射科医生都不知道对方的发现。结果dp诊断准确率高（特异性0.94，阳性似然比（LR+）： 7.65），筛查性低（敏感性0.48，阴性似然比（LR−）：0.56）。CP表现出类似的诊断特性（特异性：0.94;LR+: 5.57）。不可测DP的CDR产生较低的预测能力（曲线下面积（AUC）： 0.57）。由于样本量有限和数据缺失，当DP为阴性时，无法建立有效的CDR来辅助诊断决策。结论sdp是机械性椎间盘源性疼痛的有效诊断工具，但筛查作用有限。需要进一步的研究来完善诊断方法和探索亚组，例如那些有轻微变化/炎症驱动的椎间盘源性疼痛。

{"title":"Concurrent validity of the directional preference phenomenon compared to controlled lumbar discography: A supplementary analysis of a diagnostic accuracy study","authors":"Jean-Philippe Deneuville , Mark Laslett , Alexandra Cervantes , Sylvain Peterlongo , Amine Ounajim , Romain Artico","doi":"10.1016/j.msksp.2025.103413","DOIUrl":"10.1016/j.msksp.2025.103413","url":null,"abstract":"<div><h3>Background</h3><div>Persistent low back pain (LBP) is a symptom with many potential causes. Centralisation phenomenon (CP) has emerged as promising diagnostic tools for identifying a subset of discogenic pain. CP represents a subgroup of patients demonstrating Directional Preference (DP) and to date the diagnosticaccuracy of DP has never been assessed. To bridge this gap, this study evaluates the diagnostic accuracy of DP for discogenic pain, compares its properties to CP, and explores the development of clinical diagnostic rules (CDRs) for patients with negative testing for DP, or inability to undergo repeated movement testing.</div></div><div><h3>Methods</h3><div>103 persistent low back pain patients were assessed by a physiotherapist to collect clinical data and determine DP status. Subsequently, a radiologist performed controlled discography to determine the discogenic pain status. Both the physiotherapist and the radiologist were blinded to each other's findings.</div></div><div><h3>Results</h3><div>DP demonstrated high diagnostic accuracy (specificity: 0.94; Positive Likelihood Ratio (LR<sup>+</sup>): 7.65) but low screening properties (sensitivity: 0.48; Negative Likelihood Ratio (LR<sup>−</sup>): 0.56). CP showed similar diagnostic properties (specificity: 0.94; LR<sup>+</sup>: 5.57). A CDR for untestable DP yielded low predictive power (Area Under the Curve (AUC): 0.57). Due to limited sample size and missing data, no valid CDR could be established to assist diagnostic decision when DP is negative.</div></div><div><h3>Conclusions</h3><div>DP is a valid diagnostic tool for mechanical discogenic pain but has limited screening utility. Further studies are needed to refine diagnostic approaches and explore subgroups, such as those with Modic changes/inflammation-driven discogenic pain.</div></div>","PeriodicalId":56036,"journal":{"name":"Musculoskeletal Science and Practice","volume":"80 ","pages":"Article 103413"},"PeriodicalIF":2.2,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145049162","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

Exploring and comparing bracing protocols for acute isolated posterior cruciate ligament injuries: A scoping review of rationales and approaches 探索和比较急性孤立性后交叉韧带损伤的支具方案：基本原理和方法的范围审查

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-09-10 DOI: 10.1016/j.msksp.2025.103412

W.J. Sura , B.S. Gill , A. Walker

Background

Posterior cruciate ligament (PCL) injuries often result in persistent knee laxity and functional deficits, highlighting the importance of treatment. Dynamic bracing is widely employed in non-operative management, yet standardised protocols remain undefined.

Aim

This scoping review maps existing literature on dynamic bracing for acute isolated PCL injuries and identifies evidence gaps to guide future research.

Methods

A systematic search of PubMed, Embase, CINAHL, and SportDiscus identified relevant studies published up to July 2024. The Population, Concept, and Context framework guided study selection. Eligible studies included articles reporting on non-operative management of acute PCL injuries using dynamic bracing protocols initiated within 12 weeks of injury.

Results

Of 1810 screened studies, 13 met inclusion criteria: seven primary research studies and six reviews. Bracing protocols varied significantly in type, duration, knee flexion angles, weight-bearing status, and activity restrictions. No studies compared different dynamic bracing protocols or directly evaluated their efficacy. Most studies lacked a clear rationale for protocol design, with only four citing prior studies. No recommendation can be made on a bracing protocol.

Conclusion

Evidence on dynamic bracing for acute PCL injuries is limited and inconsistent. Comparative studies are needed to establish standardised protocols and optimize non-operative PCL management.

后交叉韧带（PCL）损伤通常导致持续的膝关节松弛和功能缺陷，强调了治疗的重要性。动态支具在非手术治疗中被广泛应用，但标准化方案尚未明确。目的对急性孤立性PCL损伤动态支具的现有文献进行综述，找出证据缺口，指导未来的研究。方法系统检索PubMed、Embase、CINAHL和SportDiscus截止到2024年7月发表的相关研究。人口、概念和背景框架指导研究选择。符合条件的研究包括报道在损伤12周内使用动态支具方案进行急性PCL损伤非手术治疗的文章。结果在筛选的1810项研究中，13项符合纳入标准：7项主要研究和6项综述。支撑方案在类型、持续时间、膝关节屈曲角度、负重状态和活动限制方面存在显著差异。没有研究比较不同的动力支撑方案或直接评估其疗效。大多数研究缺乏方案设计的明确基本原理，只有四项研究引用了先前的研究。不能就支撑协议提出任何建议。结论动态支具治疗急性PCL损伤的证据有限且不一致。需要进行比较研究，以建立标准化的方案和优化非手术PCL管理。

{"title":"Exploring and comparing bracing protocols for acute isolated posterior cruciate ligament injuries: A scoping review of rationales and approaches","authors":"W.J. Sura , B.S. Gill , A. Walker","doi":"10.1016/j.msksp.2025.103412","DOIUrl":"10.1016/j.msksp.2025.103412","url":null,"abstract":"<div><h3>Background</h3><div>Posterior cruciate ligament (PCL) injuries often result in persistent knee laxity and functional deficits, highlighting the importance of treatment. Dynamic bracing is widely employed in non-operative management, yet standardised protocols remain undefined.</div></div><div><h3>Aim</h3><div>This scoping review maps existing literature on dynamic bracing for acute isolated PCL injuries and identifies evidence gaps to guide future research.</div></div><div><h3>Methods</h3><div>A systematic search of PubMed, Embase, CINAHL, and SportDiscus identified relevant studies published up to July 2024. The Population, Concept, and Context framework guided study selection. Eligible studies included articles reporting on non-operative management of acute PCL injuries using dynamic bracing protocols initiated within 12 weeks of injury.</div></div><div><h3>Results</h3><div>Of 1810 screened studies, 13 met inclusion criteria: seven primary research studies and six reviews. Bracing protocols varied significantly in type, duration, knee flexion angles, weight-bearing status, and activity restrictions. No studies compared different dynamic bracing protocols or directly evaluated their efficacy. Most studies lacked a clear rationale for protocol design, with only four citing prior studies. No recommendation can be made on a bracing protocol.</div></div><div><h3>Conclusion</h3><div>Evidence on dynamic bracing for acute PCL injuries is limited and inconsistent. Comparative studies are needed to establish standardised protocols and optimize non-operative PCL management.</div></div>","PeriodicalId":56036,"journal":{"name":"Musculoskeletal Science and Practice","volume":"80 ","pages":"Article 103412"},"PeriodicalIF":2.2,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145049159","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

A time-in-boundary analysis on postural stability between older adults with and without kinesiophobia 有和无运动恐惧症的老年人体位稳定性的边界时间分析。

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-09-09 DOI: 10.1016/j.msksp.2025.103411

Paul S. Sung , Dongchul Lee

Background

Kinesiophobia in older adults can affect postural stability, though literature on sensitive measurements and functional mobility remains inconsistent.

Objective

To investigate differences in normalized stability times, measured by various Time-in-Boundary (TIB) thresholds, when considering functional mobility based on the Timed Up and Go (TUG) test between older adults with and without kinesiophobia.

Study design

Observational feasibility study of a cross-sectional design.

Methods

Thirty-five older adults with kinesiophobia and 38 control subjects completed the dominant limb standing task on a platform in eyes-open and eyes-closed conditions. The primary outcome was TIB, which is the proportion of time a subject's center of pressure (COP) stays within predefined radial thresholds (10 mm–30 mm) from the average COP position. This was calculated across anteroposterior (AP) and mediolateral (ML) dimensions to assess postural stability.

Results

There were significant differences in visual conditions (F = 64.28, p = 0.001) and thresholds (F = 295.16, p = 0.001) as well as interactions between visual conditions and thresholds (F = 18.05, p = 0.001). The TUG test results, used as a covariate, showed a significant interaction on thresholds (F = 16.35, p = 0.001) and visual conditions x thresholds (F = 4.36, p = 0.04) for the normalized stability times.

Conclusions

Visual input and smaller COP thresholds (<20 mm) are critical in differentiating postural stability between groups, particularly under eyes-open conditions. Older adults with kinesiophobia exhibited reduced stability and slower TUG performance. Clinicians should consider TIB thresholds and visual context when assessing balance and functional mobility.

背景：老年人运动恐惧症可影响体位稳定性，但有关敏感测量和功能活动的文献仍不一致。目的：研究有和无运动恐惧症的老年人在考虑基于Timed Up and Go （TUG）测试的功能活动时，标准化稳定时间（TIB）阈值测量的差异。研究设计：横断面设计的观察性可行性研究。方法：35名老年运动恐惧症患者和38名对照者分别在睁眼和闭眼条件下完成平台上的优势肢体站立任务。主要终点是TIB，即受试者压力中心（COP）保持在预定径向阈值（距离COP平均位置10 mm-30 mm）内的时间比例。通过计算前后位（AP）和中外侧（ML）尺寸来评估姿势稳定性。结果：在视觉条件（F = 64.28, p = 0.001）和阈值（F = 295.16, p = 0.001）以及视觉条件与阈值的交互作用（F = 18.05, p = 0.001）上存在显著差异。作为协变量的TUG检验结果显示，归一化稳定时间的阈值（F = 16.35, p = 0.001）和视觉条件x阈值（F = 4.36, p = 0.04）之间存在显著的相互作用。结论：视觉输入和较小的COP阈值(

{"title":"A time-in-boundary analysis on postural stability between older adults with and without kinesiophobia","authors":"Paul S. Sung , Dongchul Lee","doi":"10.1016/j.msksp.2025.103411","DOIUrl":"10.1016/j.msksp.2025.103411","url":null,"abstract":"<div><h3>Background</h3><div>Kinesiophobia in older adults can affect postural stability, though literature on sensitive measurements and functional mobility remains inconsistent.</div></div><div><h3>Objective</h3><div>To investigate differences in normalized stability times, measured by various Time-in-Boundary (TIB) thresholds, when considering functional mobility based on the Timed Up and Go (TUG) test between older adults with and without kinesiophobia.</div></div><div><h3>Study design</h3><div>Observational feasibility study of a cross-sectional design.</div></div><div><h3>Methods</h3><div>Thirty-five older adults with kinesiophobia and 38 control subjects completed the dominant limb standing task on a platform in eyes-open and eyes-closed conditions. The primary outcome was TIB, which is the proportion of time a subject's center of pressure (COP) stays within predefined radial thresholds (10 mm–30 mm) from the average COP position. This was calculated across anteroposterior (AP) and mediolateral (ML) dimensions to assess postural stability.</div></div><div><h3>Results</h3><div>There were significant differences in visual conditions (F = 64.28, p = 0.001) and thresholds (F = 295.16, p = 0.001) as well as interactions between visual conditions and thresholds (F = 18.05, p = 0.001). The TUG test results, used as a covariate, showed a significant interaction on thresholds (F = 16.35, p = 0.001) and visual conditions x thresholds (F = 4.36, p = 0.04) for the normalized stability times.</div></div><div><h3>Conclusions</h3><div>Visual input and smaller COP thresholds (<20 mm) are critical in differentiating postural stability between groups, particularly under eyes-open conditions. Older adults with kinesiophobia exhibited reduced stability and slower TUG performance. Clinicians should consider TIB thresholds and visual context when assessing balance and functional mobility.</div></div>","PeriodicalId":56036,"journal":{"name":"Musculoskeletal Science and Practice","volume":"80 ","pages":"Article 103411"},"PeriodicalIF":2.2,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082492","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

Brain structural and functional alterations in chronic non-specific low back pain: A case-control study 慢性非特异性腰痛的脑结构和功能改变：一项病例对照研究

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-09-09 DOI: 10.1016/j.msksp.2025.103410

Huibiao Li , Xiaonan Zhan , Xin Zhao , Jianhao Zhou , Mengjiao Wu , Cheng Fan , Hong Liu , Zheng Jiang

Objective

The relationship between clinical symptoms and associated psychosocial factors of chronic non-specific low back pain (CNLBP) and changes in brain structure and function remains unclear. This study aims to identify changes in gray matter volume (GMV) in patients with CNLBP and to examine changes in resting-state functional connectivity (rsFC) in specific brain regions.

Methods

This study included 30 CNLBP patients and 30 healthy controls, who underwent clinical assessments and magnetic resonance imaging scans. Voxel-based morphometry analyzed GMV changes in CNLBP patients' brain regions, which were defined as regions of interest for whole-brain rsFC analysis. Partial correlation and mediation analyses elucidated the central nervous mechanisms of CNLBP.

Results

In CNLBP patients, pain severity is associated with anxiety (P = 0.042), depression (P < 0.001), and pain catastrophizing (P < 0.001), while disability is associated with anxiety (P = 0.002). Reduced GMV was observed in the left precentral gyrus, lingual gyrus, and right cerebellum_Crus1. Altered rsFC was found in the cerebellum-thalamus-precentral network (P < 0.001) and limbic system (P < 0.001). Partial correlation analysis revealed that these changes were associated with clinical symptoms of CNLBP (P < 0.05). Mediation analysis revealed that the severity of BDI-II scores in CNLBP was indirectly mediated by rsFC in the precentral gyrus and cerebellum (P < 0.05).

Conclusions

This study found that the pain intensity and physical dysfunction in CNLBP patients are associated with psychosocial factors, such as anxiety, depression, and pain catastrophizing. In this context, widespread change in brain structure and function may contribute to a better understanding of CNLBP and its associated psychosocial factors.

目的探讨慢性非特异性腰痛（CNLBP）的临床症状及相关心理社会因素与大脑结构和功能改变的关系。本研究旨在确定CNLBP患者的灰质体积（GMV）的变化，并检查特定脑区静息状态功能连接（rsFC）的变化。方法本研究纳入30例CNLBP患者和30例健康对照者，进行临床评估和磁共振成像扫描。基于体素的形态学分析分析了CNLBP患者大脑区域的GMV变化，这些区域被定义为全脑rsFC分析的兴趣区域。偏相关分析和中介分析阐明了CNLBP的中枢神经机制。结果CNLBP患者疼痛严重程度与焦虑（P = 0.042）、抑郁（P < 0.001）、疼痛灾难化（P < 0.001）相关，与焦虑（P = 0.002）相关。左侧中央前回、舌回和右侧小脑区GMV减少。在小脑-丘脑-中央前网络（P < 0.001）和边缘系统（P < 0.001）中发现rsFC改变。偏相关分析显示，这些变化与CNLBP的临床症状相关（P < 0.05）。中介分析显示CNLBP患者BDI-II评分的严重程度可通过中央前回和小脑的rsFC间接介导（P < 0.05）。结论CNLBP患者的疼痛强度和躯体功能障碍与焦虑、抑郁、疼痛灾难化等心理社会因素有关。在这种情况下，大脑结构和功能的广泛变化可能有助于更好地理解CNLBP及其相关的社会心理因素。

{"title":"Brain structural and functional alterations in chronic non-specific low back pain: A case-control study","authors":"Huibiao Li , Xiaonan Zhan , Xin Zhao , Jianhao Zhou , Mengjiao Wu , Cheng Fan , Hong Liu , Zheng Jiang","doi":"10.1016/j.msksp.2025.103410","DOIUrl":"10.1016/j.msksp.2025.103410","url":null,"abstract":"<div><h3>Objective</h3><div>The relationship between clinical symptoms and associated psychosocial factors of chronic non-specific low back pain (CNLBP) and changes in brain structure and function remains unclear. This study aims to identify changes in gray matter volume (GMV) in patients with CNLBP and to examine changes in resting-state functional connectivity (rsFC) in specific brain regions.</div></div><div><h3>Methods</h3><div>This study included 30 CNLBP patients and 30 healthy controls, who underwent clinical assessments and magnetic resonance imaging scans. Voxel-based morphometry analyzed GMV changes in CNLBP patients' brain regions, which were defined as regions of interest for whole-brain rsFC analysis. Partial correlation and mediation analyses elucidated the central nervous mechanisms of CNLBP.</div></div><div><h3>Results</h3><div>In CNLBP patients, pain severity is associated with anxiety (<em>P</em> = 0.042), depression (<em>P</em> < 0.001), and pain catastrophizing (<em>P</em> < 0.001), while disability is associated with anxiety (<em>P</em> = 0.002). Reduced GMV was observed in the left precentral gyrus, lingual gyrus, and right cerebellum_Crus1. Altered rsFC was found in the cerebellum-thalamus-precentral network (<em>P</em> < 0.001) and limbic system (<em>P</em> < 0.001). Partial correlation analysis revealed that these changes were associated with clinical symptoms of CNLBP (<em>P</em> < 0.05). Mediation analysis revealed that the severity of BDI-II scores in CNLBP was indirectly mediated by rsFC in the precentral gyrus and cerebellum (<em>P</em> < 0.05).</div></div><div><h3>Conclusions</h3><div>This study found that the pain intensity and physical dysfunction in CNLBP patients are associated with psychosocial factors, such as anxiety, depression, and pain catastrophizing. In this context, widespread change in brain structure and function may contribute to a better understanding of CNLBP and its associated psychosocial factors.</div></div>","PeriodicalId":56036,"journal":{"name":"Musculoskeletal Science and Practice","volume":"80 ","pages":"Article 103410"},"PeriodicalIF":2.2,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145049161","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

Relative contribution of real/sham spinal manipulation performance, changes in cortisol levels, and patient expectations and fear behaviors in modulating short-term pain relief in people with neck pain: A secondary analysis of a randomized clinical trial 真实/虚假脊柱操作表现、皮质醇水平变化、患者期望和恐惧行为在调节颈部疼痛患者短期疼痛缓解中的相对贡献：一项随机临床试验的二次分析

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-09-08 DOI: 10.1016/j.msksp.2025.103409

Juan Antonio Valera-Calero , Jorge Buffet-García , Magdalena Kocot-Kępska , Dariusz Kosson , Marcin Kołacz , Gustavo Plaza-Manzano

Background

Spinal manipulation (SM) is a widely practiced, hands-on, non-invasive manual therapy aimed at alleviating musculoskeletal pain and improving functional capacity. Although the clinical effects of this intervention are well known, most reviews conclude that the underlying mechanisms needs further investigation. Therefore, the aim of this study was to analyze the individual contribution of SM execution, expectations, fear behaviors and neuroendocrine changes on short-term pain intensity variance following the interventions.

Design

Experimental study.

Methods

A secondary analysis from a previous randomized clinical trial was conducted. Sixty-two patients were randomized for two factors: the intervention assigned (cervical manipulation and sham manipulation) and the induced expectations (positive, neutral and negative) during treatment. A linear regression analysis was conducted to calculate the individual contribution of the SM execution (sham/real), expectations conditioning (positive/negative/neutral), fear behaviors (fear/no fear) and neuroendocrine changes (salivary cortisol) on the variance of immediate pain intensity changes (pre-post intervention difference) following the single intervention.

Results

Changes in salivary cortisol (β = −0.027, p = 0.838) and fear (β = −0.192, p = 0.135) were not significant explanatory variables of pain intensity response (p > 0.05). However, verbally-induced expectations (β = 0.722, p < 0.001) and the manipulation execution (β = 0.207, p = 0.019) showed a significant positive association with pain intensity response, suggesting that positive expectations had a meaningful impact on reducing pain intensity and a real intervention may involve specific hypoalgesic responses.

Conclusion

Clinicians should consider that patients' expectations may influence clinical outcomes. Verbally expressing positive or neutral expectations may improve pain-related outcomes, whereas conveying negative expectations could diminish the treatment's effectiveness.

脊柱操作（SM）是一种广泛实践的，动手的，非侵入性的手工治疗，旨在减轻肌肉骨骼疼痛和提高功能能力。虽然这种干预的临床效果是众所周知的，但大多数综述认为其潜在机制需要进一步研究。因此，本研究的目的是分析SM执行、期望、恐惧行为和神经内分泌变化对干预后短期疼痛强度方差的个体贡献。DesignExperimental研究。方法对先前的随机临床试验进行二次分析。62例患者随机分为两个因素：指定的干预措施（颈椎手法和假手法）和治疗期间诱导的期望（积极、中性和消极）。通过线性回归分析，计算单干预后SM执行（假/真）、期望条件反射（积极/消极/中性）、恐惧行为（害怕/不害怕）和神经内分泌变化（唾液皮质醇）对即时疼痛强度变化方差（干预前后差异）的个体贡献。结果唾液皮质醇（β = - 0.027, p = 0.838）和恐惧（β = - 0.192, p = 0.135）变化不是疼痛强度反应的显著解释变量（p > 0.05）。然而，言语诱导的期望（β = 0.722, p < 0.001）和操作执行（β = 0.207, p = 0.019）与疼痛强度反应显着正相关，这表明积极期望对减轻疼痛强度有显著影响，真正的干预可能涉及特定的镇痛反应。结论临床医生应考虑患者的期望可能会影响临床结果。口头表达积极或中立的期望可能会改善疼痛相关的结果，而传达消极的期望可能会降低治疗的有效性。

{"title":"Relative contribution of real/sham spinal manipulation performance, changes in cortisol levels, and patient expectations and fear behaviors in modulating short-term pain relief in people with neck pain: A secondary analysis of a randomized clinical trial","authors":"Juan Antonio Valera-Calero , Jorge Buffet-García , Magdalena Kocot-Kępska , Dariusz Kosson , Marcin Kołacz , Gustavo Plaza-Manzano","doi":"10.1016/j.msksp.2025.103409","DOIUrl":"10.1016/j.msksp.2025.103409","url":null,"abstract":"<div><h3>Background</h3><div>Spinal manipulation (SM) is a widely practiced, hands-on, non-invasive manual therapy aimed at alleviating musculoskeletal pain and improving functional capacity. Although the clinical effects of this intervention are well known, most reviews conclude that the underlying mechanisms needs further investigation. Therefore, the aim of this study was to analyze the individual contribution of SM execution, expectations, fear behaviors and neuroendocrine changes on short-term pain intensity variance following the interventions.</div></div><div><h3>Design</h3><div>Experimental study.</div></div><div><h3>Methods</h3><div>A secondary analysis from a previous randomized clinical trial was conducted. Sixty-two patients were randomized for two factors: the intervention assigned (cervical manipulation and sham manipulation) and the induced expectations (positive, neutral and negative) during treatment. A linear regression analysis was conducted to calculate the individual contribution of the SM execution (sham/real), expectations conditioning (positive/negative/neutral), fear behaviors (fear/no fear) and neuroendocrine changes (salivary cortisol) on the variance of immediate pain intensity changes (pre-post intervention difference) following the single intervention.</div></div><div><h3>Results</h3><div>Changes in salivary cortisol (β = −0.027, p = 0.838) and fear (β = −0.192, p = 0.135) were not significant explanatory variables of pain intensity response (p > 0.05). However, verbally-induced expectations (β = 0.722, p < 0.001) and the manipulation execution (β = 0.207, p = 0.019) showed a significant positive association with pain intensity response, suggesting that positive expectations had a meaningful impact on reducing pain intensity and a real intervention may involve specific hypoalgesic responses.</div></div><div><h3>Conclusion</h3><div>Clinicians should consider that patients' expectations may influence clinical outcomes. Verbally expressing positive or neutral expectations may improve pain-related outcomes, whereas conveying negative expectations could diminish the treatment's effectiveness.</div></div>","PeriodicalId":56036,"journal":{"name":"Musculoskeletal Science and Practice","volume":"80 ","pages":"Article 103409"},"PeriodicalIF":2.2,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145057385","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

Digital health self-management interventions for musicians with playing-related musculoskeletal disorders: A scoping review 音乐家与演奏相关的肌肉骨骼疾病的数字健康自我管理干预：范围审查

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-09-06 DOI: 10.1016/j.msksp.2025.103408

N. Eleryan , R. Hemming , V. Sparkes , L. Sheeran

Introduction

Playing-related musculoskeletal disorders are common in musicians. Self-management interventions are recommended to improve the management of musculoskeletal disorders and support individuals to safely take responsibility for their own health. Digital health interventions are increasingly used to support self-management of musculoskeletal disorders. However, their use in musicians remains poorly understood.

Aim

The aim of this scoping review is to map the available evidence on digital health interventions for the self-management of playing-related musculoskeletal disorders in musicians. This includes summarising the key characteristics of current interventions including content, mode of delivery and theoretical underpinning, their effect on musicians’ ability to continue to play, and exploring any reported adverse effects, to inform future interventions.

Methods

The review followed the Joanna Briggs Institute scoping review framework and was reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews.

Results

Nine studies were included. None of the interventions were underpinned by a theoretical framework. All interventions targeted student and orchestral musicians, involving exercise, health education, or both, and were delivered via pre-recorded videos (n = 4), websites (n = 3), and video conferencing (n = 2). Six interventions were home-based, one was conducted at a university, and two included a combination of home-based and workplace sessions. Exercise-based digital health interventions (n = 7) reported improvements in pain and physical outcomes.

Conclusion

The evidence on digital health interventions for musicians is limited, with studies targeting student and orchestral musicians and none applying theoretical frameworks. This highlights the need for broader and more rigorous self-management interventions for PRMSDs in musicians.

与演奏相关的肌肉骨骼疾病在音乐家中很常见。建议采取自我管理干预措施，以改善对肌肉骨骼疾病的管理，并支持个人安全地对自己的健康负责。数字健康干预措施越来越多地用于支持肌肉骨骼疾病的自我管理。然而，人们对它们在音乐家身上的作用仍然知之甚少。目的：本综述的目的是绘制音乐家自我管理与演奏相关的肌肉骨骼疾病的数字健康干预措施的现有证据。这包括总结当前干预的关键特征，包括内容、交付模式和理论基础，它们对音乐家继续演奏的能力的影响，并探索任何报告的不利影响，为未来的干预提供信息。方法本综述遵循乔安娜布里格斯研究所的范围综述框架，并按照系统综述的首选报告项目和范围综述的元分析扩展进行报告。结果纳入9项研究。这些干预措施都没有理论框架支撑。所有干预措施都以学生和管弦乐音乐家为目标，包括锻炼、健康教育或两者兼而有之，并通过预先录制的视频（n = 4）、网站（n = 3）和视频会议（n = 2）进行。六项干预以家庭为基础，一项在大学进行，另外两项包括家庭和工作场所的结合。基于运动的数字健康干预（n = 7）报告了疼痛和身体结果的改善。结论音乐家数字健康干预的证据有限，研究对象是学生和管弦乐音乐家，没有一个应用理论框架。这突出表明需要对音乐家的prmsd进行更广泛和更严格的自我管理干预。

{"title":"Digital health self-management interventions for musicians with playing-related musculoskeletal disorders: A scoping review","authors":"N. Eleryan , R. Hemming , V. Sparkes , L. Sheeran","doi":"10.1016/j.msksp.2025.103408","DOIUrl":"10.1016/j.msksp.2025.103408","url":null,"abstract":"<div><h3>Introduction</h3><div>Playing-related musculoskeletal disorders are common in musicians. Self-management interventions are recommended to improve the management of musculoskeletal disorders and support individuals to safely take responsibility for their own health. Digital health interventions are increasingly used to support self-management of musculoskeletal disorders. However, their use in musicians remains poorly understood.</div></div><div><h3>Aim</h3><div>The aim of this scoping review is to map the available evidence on digital health interventions for the self-management of playing-related musculoskeletal disorders in musicians. This includes summarising the key characteristics of current interventions including content, mode of delivery and theoretical underpinning, their effect on musicians’ ability to continue to play, and exploring any reported adverse effects, to inform future interventions.</div></div><div><h3>Methods</h3><div>The review followed the Joanna Briggs Institute scoping review framework and was reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews.</div></div><div><h3>Results</h3><div>Nine studies were included. None of the interventions were underpinned by a theoretical framework. All interventions targeted student and orchestral musicians, involving exercise, health education, or both, and were delivered via pre-recorded videos (n = 4), websites (n = 3), and video conferencing (n = 2). Six interventions were home-based, one was conducted at a university, and two included a combination of home-based and workplace sessions. Exercise-based digital health interventions (n = 7) reported improvements in pain and physical outcomes.</div></div><div><h3>Conclusion</h3><div>The evidence on digital health interventions for musicians is limited, with studies targeting student and orchestral musicians and none applying theoretical frameworks. This highlights the need for broader and more rigorous self-management interventions for PRMSDs in musicians.</div></div>","PeriodicalId":56036,"journal":{"name":"Musculoskeletal Science and Practice","volume":"80 ","pages":"Article 103408"},"PeriodicalIF":2.2,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145020386","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