Musculoskeletal Science and Practice最新文献_第9页

Optimizing acute pain relief in severe knee Osteoarthritis: The influence of resistance exercise volume and psychosocial factors 优化重度膝骨关节炎的急性疼痛缓解：阻力运动量和心理社会因素的影响

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-07-29 DOI: 10.1016/j.msksp.2025.103390

Alberto Sánchez-Sabater , Luis Suso-Martí , Rodrigo Núñez-Cortés , Rubén López-Bueno , Carlos Cruz-Montecinos , Joaquín Salazar-Méndez , Vicente Orenga , Lars Louis Andersen , José Casaña , Joaquín Calatayud

Background

While exercise is a key part of knee osteoarthritis (OA) management, the optimal dose for acute pain relief remains unclear. We aimed to determine the optimal resistance exercise volume to induce exercise-induced hypoalgesia (EIH) in older adults with severe knee OA.

Methods

28 participants (11/17 women/men; mean age = 71.6 ± 5.2 years) with severe knee OA awaiting unilateral Total Knee Arthroplasty were recruited. They were randomised to four experimental conditions (cross-over design) conducted with a separation of 4 days. Knee extension exercises with elastic resistance were performed at single exercise sessions at 10 repetition maximum (RM) intensity, while varying the number of sets (control with no exercise, 4 sets, 8 sets, and 12 sets).

Results

Higher exercise volumes (12 and 8 sets) induced greater EIH 10 min post-exercise compared to lower volumes (4 sets) or no exercise, with significant differences favouring the 12-set exercise intervention (η² = 0.472, p < 0.001). Pain intensity increased immediately post-exercise in all exercise interventions but returned to baseline after 10 min in the 4- and 12-set exercise interventions. PPT increased post-10 min in the 8- and 12-set exercise interventions for both the affected and contralateral limbs (p < 0.05). PCS moderated the EIH response, reducing its effect in the 12-set (r = −0.436, p < 0.05) and 8-set (r = −0.418, p < 0.05) exercise intervention.

Conclusions

Greater resistance exercise volume appears to be associated with an initial increase in pain perception followed by a delayed hypoalgesic response in patients with severe knee OA. These exploratory findings suggest that higher-volume resistance exercise may be a valuable strategy for acute pain relief, although clinicians should balance short-term discomfort with long-term benefits, considering both physical and psychosocial factors, to improve pain-related outcomes aimed at reducing acute pain in this population. However, further research is needed to confirm these effects beyond a controlled, single-exercise acute intervention.

虽然运动是膝关节骨关节炎（OA）治疗的关键部分，但缓解急性疼痛的最佳剂量尚不清楚。我们的目的是确定老年严重膝关节OA患者诱导运动诱发痛觉减退（EIH）的最佳阻力运动量。方法28例受试者(男女11/17；平均年龄= 71.6±5.2岁)，伴有严重膝关节炎，等待单侧全膝关节置换术。他们被随机分为四个实验条件（交叉设计），间隔4天。有弹性阻力的膝关节伸展运动在单次运动中以10次最大重复（RM）强度进行，同时改变组数（不运动的对照组，4组，8组和12组）。结果高运动量组（12组和8组）与低运动量组（4组）或不运动量组相比，运动后10分钟EIH发生率更高，且12组运动干预组差异显著(η2 = 0.472, p <；0.001)。在所有运动干预中，疼痛强度在运动后立即增加，但在4组和12组运动干预中，疼痛强度在10分钟后恢复到基线。在8组和12组运动干预中，患肢和对侧肢体的PPT在10分钟后增加(p <；0.05)。PCS调节了EIH的反应，降低了其在12组中的作用(r = - 0.436, p <；0.05)和8组(r = - 0.418, p <；0.05)运动干预。结论：在严重膝关节炎患者中，更大的阻力运动量似乎与最初的疼痛感知增加以及随后的延迟痛觉减退反应有关。这些探索性发现表明，尽管临床医生应考虑身体和心理因素，平衡短期不适和长期利益，以改善旨在减少该人群急性疼痛的疼痛相关结果，但高强度阻力运动可能是缓解急性疼痛的一种有价值的策略。然而，需要进一步的研究来证实这些影响超出了控制，单一运动急性干预。

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引用次数: 0

Effectiveness of an active behavioural physiotherapy intervention (ABPI) for chronic non-specific neck pain: an internal pilot cluster-randomised double-blind clinical trial 主动行为物理治疗干预（ABPI）治疗慢性非特异性颈部疼痛的有效性：一项内部先导集群随机双盲临床试验

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-07-25 DOI: 10.1016/j.msksp.2025.103389

Taweewat Wiangkham , Sureeporn Uthaikhup , Alison Rushton

Background

Chronic non-specific neck pain (CNSNP) causes pain and disability, contributing to a serious public health problem. An active behavioural physiotherapy intervention (ABPI) may be an effective intervention to manage patients with CNSNP based on our previous trial data. To date, a CNSNP population has not been investigated with an ABPI.

Objectives

To preliminarily evaluate the potential effectiveness and feasibility of the ABPI for the management of patients with CNSNP.

Design

An internal pilot cluster-randomised double-blind, parallel 2-arm (ABPI vs standard physiotherapy intervention: SPI) clinical trial across 4 Thai public hospitals.

Methods

Forty participants (20 each arm) were recruited and face-to-face assessed at baseline and 3-month follow-up post baseline using the neck disability index (NDI), numerical pain rating scale (NPRS), cervical range of motion, fear-avoidance beliefs questionnaire, central sensitisation inventory (CSI) and short form-36.

Results

The mean (standard deviation) age of participants was 38.1 (7.8) years. The ABPI demonstrated significant within group improvement in all outcome measures and the NDI, NPRS and CSI illustrated significant improvement for the SPI (p ≤ 0.05). For the comparison between groups, all outcome measures were significantly better in the ABPI arm compared to the SPI (p ≤ 0.05), except the CSI. Finally, the number of fully recovered participants (considering the NDI ≤ 4/50) was greater for the ABPI (15/20 participants, 75 %) than the SPI (7/20 participants, 35 %).

Conclusion

These promising findings from an internal pilot study support continued data collection to conduct the definitive phase III trial (n = 120) to evaluate the effectiveness of the ABPI for the CNSNP management.

慢性非特异性颈部疼痛（CNSNP）引起疼痛和残疾，是一个严重的公共卫生问题。根据我们之前的试验数据，积极的行为物理治疗干预（ABPI）可能是一种有效的干预措施来管理CNSNP患者。迄今为止，CNSNP人群尚未使用ABPI进行调查。目的初步评价ABPI在CNSNP患者治疗中的潜在有效性和可行性。设计一项在4家泰国公立医院进行的内部试点集群随机、双盲、平行双臂（ABPI与标准物理治疗干预：SPI）临床试验。方法采用颈部残疾指数（NDI）、数值疼痛评定量表（NPRS）、颈椎活动度、恐惧回避信念问卷、中枢致敏性量表（CSI）和短表-36对40名参与者（每组20人）进行基线和基线后3个月的面对面评估。结果参与者的平均（标准差）年龄为38.1（7.8）岁。ABPI在所有结果测量中均显示组内显著改善，NDI、NPRS和CSI在SPI中显示显著改善（p≤0.05）。对于组间比较，除CSI外，ABPI组的所有结局指标均显著优于SPI （p≤0.05）。最后，完全康复的参与者（考虑到NDI≤4/50）ABPI（15/20参与者，75%）大于SPI（7/20参与者，35%）。这些来自内部试点研究的有希望的发现支持继续收集数据进行最终的III期试验（n = 120），以评估ABPI对CNSNP管理的有效性。

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引用次数: 0

Physiotherapists’ beliefs of the working mechanisms of manual therapeutic techniques for spinal pain relief: a quantitative content analysis 物理治疗师对脊柱疼痛缓解的手工治疗技术的工作机制的信念：定量内容分析

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-07-17 DOI: 10.1016/j.msksp.2025.103387

J.P. Hendriks , R.R. Reezigt , M.F. Reneman

Background

Manual therapeutic techniques (MTTs), including high velocity thrust manipulation (HVT) and spinal mobilization (MOB), are used to reduce spinal pain. Physiotherapists' beliefs on their working mechanisms to relieve pain are unknown.

Objectives

To explore the prevalence of physiotherapists’ beliefs regarding the working mechanisms of MTTs on pain relief and their associated factors.

Design

Quantitative content analysis.

Method

The results of the verbal and online survey were analyzed based on a theory-driven coding framework (categories and depth). Ordinal, linear, and nominal regression analyses were used to analyze the secondary aim.

Results

A total of 541 physiotherapists were included (survey, n = 383, 70.8 %; verbal surveys, n = 158, 29.2 %), resulting in 759 HVT and 713 MOB responses. Six categories were present: biomechanical (39.3 % HVT, 50.9 % MOB), neurophysiological (39.4 % HVT, 31.4 % MOB), immunological (2.0 % HVT, 1.1 % MOB), non-specific (13.4 % HVT, 14.2 % MOB), unknown (4.3 % HVT, 1.3 % MOB), and not categorizable (1.6 % HVT, 1.1 % MOB). Levels of depth were low (65.1 % HVT, 64.1 % MOB), moderate (17.3 % HVT, 19.0 % MOB), and high (17.4 % HVT, 16.8 % MOB). Having a Master degree, network participation and work experience were associated with the category of working mechanism, level of depth and number of working mechanisms.

Conclusion

The beliefs of physiotherapists in the Netherlands regarding the working mechanisms of MTTs for spinal-related pain reduction are mainly biomechanical and neurophysiological. The working mechanisms were dominantly explained in an unifactorial manner and with a low level of depth. Having a Master of Science degree was strongly associated with more evidence-consistent beliefs and deeper understanding.

手工治疗技术（mtt），包括高速推力操作（HVT）和脊柱活动（MOB），用于减轻脊柱疼痛。物理治疗师对他们减轻疼痛的工作机制的信念是未知的。目的探讨物理治疗师对mtt缓解疼痛的作用机制及其相关因素的看法。定量内容分析。方法基于理论驱动的编码框架（分类和深度）对口头调查和在线调查结果进行分析。使用顺序、线性和名义回归分析来分析次要目标。结果共纳入541名物理治疗师(n = 383，占70.8%；口头调查，n = 158, 29.2%)，结果有759例HVT和713例MOB反应。存在6种类型：生物力学（39.3% HVT, 50.9% MOB）、神经生理学（39.4% HVT, 31.4% MOB）、免疫学（2.0% HVT, 1.1% MOB）、非特异性（13.4% HVT, 14.2% MOB）、未知（4.3% HVT, 1.3% MOB）和不可分类（1.6% HVT, 1.1% MOB）。深度分为低（65.1% HVT, 64.1% MOB）、中（17.3% HVT, 19.0% MOB）和高（17.4% HVT, 16.8% MOB）。硕士学历、网络参与程度、工作经验与工作机制类别、工作机制深度和工作机制数量相关。结论荷兰物理治疗师对mtt治疗脊柱相关疼痛的作用机制的看法主要是生物力学和神经生理学。对其作用机制的解释以单因素为主，深度较低。拥有理学硕士学位与更有证据的信念和更深刻的理解密切相关。

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引用次数: 0

Changes in outcomes following exercise and education in individuals with single-site pain versus multi-site pain; an analysis of 31,276 patients with knee or hip osteoarthritis 单部位疼痛与多部位疼痛患者运动和教育后结果的变化；对31276例膝关节或髋关节骨关节炎患者的分析

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-07-09 DOI: 10.1016/j.msksp.2025.103386

Joice Cunningham , Sania Almousa , Ewa M. Roos , Søren T. Skou , Dorte T. Grønne , Clodagh Toomey , Helen P. French

Objective

Multisite pain (MSP) in osteoarthritis defined as pain in ≥2 sites is associated with poorer health than single-site pain (SSP). We compared changes in health outcomes at 3- and 12 months in those with SSP versus MSP following an 8-week education and exercise programme (GLA:D®).

Methods

Participants with knee/hip OA enrolled in GLA:D® (2014–2021) were categorised into four groups based on number of pain sites: 0–1 sites (SSP), 2 sites (MSP2), 3–4 sites (MSP3-4), ≥5 sites (MSP5+). Changes in pain, Quality of Life (QoL) and physical function were compared across groups at 3- and 12-months using Analysis of Covariance, Generalised Estimating Equations and responder analyses.

Results

Approximately 90 % of 31,276 participants had ≥2 pain sites. At 12 months, pain severity reduced by a mean of −3.79 (95 % CI -4.90 to −2.68) in all MSP groups versus SSP. QoL improved by 1–2 points in MSP2 and MSP3-4 groups compared to SSP, with no difference in change in 40m walk or 30-second chair-stand. The proportion of pain responders was higher in all MSP groups compared to SSP at 3 (43–44 % vs 36 %) and 12 months (44–47 % vs 37 %). There was a greater proportion of responders in QoL in MSP2 versus SSP at 12 months (36 % vs 32 %); and in MSP3-4 versus MSP5+ at 3 months in physical function (56 % vs 52 %).

Conclusions

Whilst improvements in pain and QoL, but not physical function, were greater in those with MSP compared to SSP following an 8-week education and exercise programme, between-group differences were not clinically important.

目的骨关节炎多部位疼痛（MSP）定义为≥2个部位疼痛，与单部位疼痛（SSP）相比，健康状况较差。我们比较了在8周的教育和锻炼计划（GLA:D®）后，SSP和MSP患者在3个月和12个月时健康结果的变化。方法纳入GLA:D®（2014-2021）的膝/髋OA患者根据疼痛部位数量分为4组：0-1个部位（SSP）、2个部位（MSP2）、3-4个部位（MSP3-4）、≥5个部位（MSP5+）。使用协方差分析、广义估计方程和应答者分析比较各组在3个月和12个月时疼痛、生活质量（QoL）和身体功能的变化。结果31276名参与者中约90%有≥2个疼痛部位。在12个月时，与SSP相比，所有MSP组的疼痛严重程度平均降低了- 3.79 （95% CI -4.90至- 2.68）。与SSP相比，MSP2组和MSP3-4组的生活质量提高了1-2分，而40米步行或30秒站立的变化没有差异。与SSP相比，所有MSP组在3个月（43 - 44%比36%）和12个月（44 - 47%比37%）时疼痛应答者的比例更高。在12个月时，MSP2组的生活质量应答者比SSP组的应答者比例更高（36%比32%）；MSP3-4组与MSP5+组在3个月时的身体功能差异（56% vs 52%）。结论：虽然经过8周的教育和锻炼计划后，MSP患者的疼痛和生活质量的改善比SSP患者更大，但身体功能没有改善，但组间差异在临床上并不重要。

{"title":"Changes in outcomes following exercise and education in individuals with single-site pain versus multi-site pain; an analysis of 31,276 patients with knee or hip osteoarthritis","authors":"Joice Cunningham , Sania Almousa , Ewa M. Roos , Søren T. Skou , Dorte T. Grønne , Clodagh Toomey , Helen P. French","doi":"10.1016/j.msksp.2025.103386","DOIUrl":"10.1016/j.msksp.2025.103386","url":null,"abstract":"<div><h3>Objective</h3><div>Multisite pain (MSP) in osteoarthritis defined as pain in ≥2 sites is associated with poorer health than single-site pain (SSP). We compared changes in health outcomes at 3- and 12 months in those with SSP versus MSP following an 8-week education and exercise programme (GLA:D®).</div></div><div><h3>Methods</h3><div>Participants with knee/hip OA enrolled in GLA:D® (2014–2021) were categorised into four groups based on number of pain sites: 0–1 sites (SSP), 2 sites (MSP2), 3–4 sites (MSP3-4), ≥5 sites (MSP5+). Changes in pain, Quality of Life (QoL) and physical function were compared across groups at 3- and 12-months using Analysis of Covariance, Generalised Estimating Equations and responder analyses.</div></div><div><h3>Results</h3><div>Approximately 90 % of 31,276 participants had ≥2 pain sites. At 12 months, pain severity reduced by a mean of −3.79 (95 % CI -4.90 to −2.68) in all MSP groups versus SSP. QoL improved by 1–2 points in MSP2 and MSP3-4 groups compared to SSP, with no difference in change in 40m walk or 30-second chair-stand. The proportion of pain responders was higher in all MSP groups compared to SSP at 3 (43–44 % vs 36 %) and 12 months (44–47 % vs 37 %). There was a greater proportion of responders in QoL in MSP2 versus SSP at 12 months (36 % vs 32 %); and in MSP3-4 versus MSP5+ at 3 months in physical function (56 % vs 52 %).</div></div><div><h3>Conclusions</h3><div>Whilst improvements in pain and QoL, but not physical function, were greater in those with MSP compared to SSP following an 8-week education and exercise programme, between-group differences were not clinically important.</div></div>","PeriodicalId":56036,"journal":{"name":"Musculoskeletal Science and Practice","volume":"79 ","pages":"Article 103386"},"PeriodicalIF":2.2,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679764","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

Commentary on: Machine learning for classifying chronic ankle instability based on ankle strength, range of motion, postural control, and anatomical deformities in delivery service workers with a history of lateral ankle sprains 评论：基于踝关节力量、活动范围、姿势控制和有踝关节外侧扭伤史的送货服务人员解剖畸形，对慢性踝关节不稳定进行分类的机器学习

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-07-07 DOI: 10.1016/j.msksp.2025.103306

Triwiyanto T , I Putu Alit Pawana , Sari Luthfiyah

引用次数: 0

An evaluation of a one-day pain science education event in a 16–18 years school setting targeting pain-related beliefs, knowledge, and behavioural intentions: A mixed-methods, non-randomised controlled trial 在16-18岁的学校环境中，针对疼痛相关信念、知识和行为意图进行为期一天的疼痛科学教育活动的评估：一项混合方法、非随机对照试验

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-07-03 DOI: 10.1016/j.msksp.2025.103385

J. Mankelow , C.G. Ryan , N. Skidmore , J. Potter , D. Ravindran , R. Chattle , S. Browne , S. Suri , A. Graham , J.W. Pate , R. Newport , T. Langford , D. Martin

Background

Public understanding of persistent pain is fraught with misconceptions. Pain education in schools may improve public understanding long-term. This study evaluated the impact of a one-day Pain Science Education (PSE) public health event delivered in a 16–18 year old school setting.

Methods

This was a multi-site, non-randomised controlled, mixed-methods study with three data collection time points: baseline, post intervention, and three-month follow-up. Participants were high school students ≥16 years old. Pain beliefs, knowledge, and behavioural intentions were assessed with the Pain Beliefs Questionnaire (PBQ [organic and psychological subscales]), Concepts of Pain Inventory (COPI-Adult), a case vignette, and reflexive thematic analysis of semi-structured interviews.

Results

Thirty intervention (mean age 16.6 years, 37 % female, 63 % male) and 24 control group participants (16.9 years, 63 % female, 37 % male) were recruited. Attending the pain education event was associated with reductions in Organic Beliefs [mean difference −4.4 (95 % CI, −6.0, −1.9)] and increases in Psychological Beliefs [4.6 (2.7, 6.4)] compared to the control group. This represents a shift away from biomedical beliefs in the intervention group compared to the control group. This shift was partially sustained at 3 months. A similar pattern was seen for the COPI-Adult and case vignette assessments. Semi-structured interviews (n = 13) identified an increased awareness of chronic pain and varying degrees of reconceptualisation of pain towards a biopsychosocial understanding.

Conclusions

Attendance at a one-day PSE-based public health event was associated with improved knowledge, beliefs, and behavioural intentions regarding persistent pain. This exploratory study supports the need for a robust mixed-methods RCT of pain education for school children with long-term follow-up.

公众对持续性疼痛的理解充满了误解。从长远来看，学校的疼痛教育可以提高公众对疼痛的认识。本研究评估了在一所16-18岁的学校进行为期一天的疼痛科学教育（PSE）公共卫生活动的影响。方法：这是一项多地点、非随机对照、混合方法的研究，有三个数据收集时间点：基线、干预后和三个月随访。参与者为年龄≥16岁的高中生。通过疼痛信念问卷（PBQ[有机和心理亚量表]）、疼痛概念量表（COPI-Adult）、案例小品和半结构化访谈的反身性主题分析来评估疼痛信念、知识和行为意图。结果共纳入30例干预组（平均年龄16.6岁，女性占37%，男性占63%）和24例对照组（平均年龄16.9岁，女性占63%，男性占37%）。与对照组相比，参加疼痛教育活动与有机信念的降低[平均差异为- 4.4 (95% CI, - 6.0, - 1.9)]和心理信念的增加[4.6(2.7,6.4)]有关。与对照组相比，这代表了干预组对生物医学信念的转变。这种转变在3个月时部分持续。在copi -成人和病例小短文评估中也发现了类似的模式。半结构化访谈（n = 13）确定了对慢性疼痛的认识增加和对疼痛的不同程度的重新概念化，以实现生物心理社会理解。结论：参加为期一天的基于pse的公共卫生活动与改善关于持续性疼痛的知识、信念和行为意愿相关。本探索性研究支持对学龄儿童疼痛教育进行长期随访的可靠的混合方法随机对照试验的需要。

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引用次数: 0

Prevalence of cervical, vestibulo-ocular and or physiological impairments in symptomatic individuals 4 weeks to 6 months post-concussion 脑震荡后4周至6个月有症状个体的颈椎、前庭-眼和/或生理损伤发生率

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-07-02 DOI: 10.1016/j.msksp.2025.103381

Treleaven J, Carberry K, Cook H, Fulcher D, Syme C, Galea O

Background

Deficits in individual measures relating to cervical, vestibulo-ocular or physiological subsystems have been observed in symptomatic individuals post-concussion. Few studies consider the presence of several impairments within and across each of these three subsystems.

Objective

To evaluate the prevalence of cervical, vestibulo-ocular and or physiological impairment in symptomatic individuals four weeks to six months post-concussion.

Setting

Tertiary hospital and university.

Design

Exploratory observational cohort study.

Methods

Participants were deemed to have: Cervical impairment if positive on at least 3/7 cervical tests, vestibulo-ocular impairment if positive on at least 2/11 tests and physiological impairment if they failed the Buffalo Concussion Treadmill Test.

Results

Impairment across all three subsystems was detected in 29 % of participants, two subsystems in 47 %, one in 23 % and none in 3 %. Eighty-five percent had cervical impairment.

Conclusion

There was a high prevalence of multiple subsystem impairments and the majority had a cervical impairment across a number of cervical tests. Hence, in clinical practice, it is essential to perform a detailed physical examination across all subsystems and consider clinical implications of cervical impairments in the majority of individuals four weeks to six months post-concussion.

背景：在有症状的脑震荡后个体中观察到与颈椎、前庭-眼或生理子系统相关的个体测量缺陷。很少有研究考虑到这三个子系统内部和之间存在几种损伤。目的评价脑震荡后4周至6个月有症状者颈椎、前庭-眼和（或）生理损伤的发生率。三级医院和大学。设计探索性观察队列研究。方法：如果参与者在至少3/7的颈椎测试中呈阳性，则认为他们有颈椎损伤；如果在至少2/11的测试中呈阳性，则认为他们有前庭-眼部损伤；如果他们在布法罗脑震荡跑步机测试中失败，则认为他们有生理损伤。结果29%的参与者在所有三个子系统中检测到损伤，47%的参与者在两个子系统中检测到损伤，23%的参与者在一个子系统中检测到损伤，3%的参与者没有检测到损伤。85%的人有宫颈损伤。结论多子系统损伤发生率高，且多项宫颈检查均以宫颈损伤为主。因此，在临床实践中，有必要对所有子系统进行详细的体格检查，并考虑大多数人在脑震荡后4周到6个月的颈椎损伤的临床意义。

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引用次数: 0

The EMU manipulation study: A randomized trial investigating the efficacy of matched or unmatched cervical/thoracic manipulations on neck pain EMU操作研究：一项随机试验，调查匹配或不匹配的颈/胸操作对颈部疼痛的疗效

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-07-02 DOI: 10.1016/j.msksp.2025.103382

Brian T. Swanson , Mary Cimen , Cara D. DiMercurio , Andrew G. Dunne , Michael Scott Dunne , Chase Hubbard , Brendan Christopher Kirck , Rowan M. Nadeau , Paul Artzer

Introduction

Neck pain is common, and cervical and thoracic thrust joint manipulation are recommended treatments. The Cervical Thoracic Differentiation Test (CTDT) is proposed to differentiate pain of cervical or thoracic origin, but its value in guiding choice of manipulation remains unclear. This study aimed to evaluate the utility of the CTDT in selecting treatment for non-specific mechanical neck pain.

Methods

A quadruple-blinded, two-arm randomized trial enrolled adults aged 18–65 with neck pain ≥3/10. Forty participants completed the Neck Disability Index (NDI), cervical ROM (ROM), VAS for pain (rest and movement), and CTDT. They were equally allocated to a single session of either matched or unmatched manipulation based on CTDT results. Pain and ROM were assessed immediately post-manipulation and 38 participants were assessed at a one-week follow-up.

Results

Forty participants (mean age 24.8 ± 9.9 years, 51.2 % female) were included. Significant differences in the primary outcome of pain with movement were found across all time points (F_{2, 72} = 60.455, p < 0.001). Significant pain reductions were observed from pre-manipulation to immediately post-manipulation and continued at one-week. There were no differences between matched/unmatched manipulations at either time point (p > 0.05). There were no significant differences in pain at rest, NDI scores, or ROM changes between groups.

Conclusions

Both matched and unmatched manipulations significantly reduced pain with movement, with no differences based on CTDT results. In the context of a rigorously blinded trial, cervical and thoracic manipulations appear to be equally efficacious for managing neck pain regardless of CTDT outcomes, although clinical outcomes may differ.

颈部疼痛是常见的，颈椎和胸椎关节按摩是推荐的治疗方法。颈胸椎鉴别试验（CTDT）被提出用于鉴别颈或胸源性疼痛，但其在指导手法选择方面的价值尚不清楚。本研究旨在评估CTDT在选择非特异性机械性颈痛治疗方法中的效用。方法采用四双盲、双臂随机试验，招募年龄在18-65岁、颈部疼痛≥3/10的成年人。40名参与者完成了颈部残疾指数（NDI）、颈椎ROM （ROM）、疼痛VAS（休息和运动）和CTDT。他们被平等地分配到一个基于CTDT结果的匹配或不匹配操作的会话中。操作后立即评估疼痛和关节活动度，38名参与者在一周的随访中进行评估。结果共纳入40例，平均年龄24.8±9.9岁，女性占51.2%。各时间点疼痛伴运动的主要结局存在显著差异(F2, 72 = 60.455, p <；0.001)。从操作前到操作后立即观察到明显的疼痛减轻，并持续一周。在任何时间点，匹配/不匹配操作之间没有差异(p >；0.05)。两组间在静息疼痛、NDI评分或ROM变化方面无显著差异。结论配合和不配合手法均可显著减轻运动疼痛，CTDT结果无差异。在一项严格的盲法试验的背景下，尽管临床结果可能不同，但无论CTDT结果如何，颈椎和胸椎手法似乎对治疗颈部疼痛同样有效。

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引用次数: 0

Comparisons and analysis of cut-off points of patient-reported and performance-based functions in early stages of knee osteoarthritis: A cross-sectional study 比较和分析早期膝关节骨关节炎患者报告的和基于表现的功能的分界点：一项横断面研究

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-07-02 DOI: 10.1016/j.msksp.2025.103384

Sevinc Akdeniz , Derya Ozer Kaya , Kemal Kayaokay , Sevtap Gunay Ucurum

Objective

The primary aim was to compare patient-reported and performance-based functions of early stages of knee osteoarthritis (OA) according to radiographic grades. The secondary purpose was to determine the ability of physical function assessments to discriminate the stages.

Methods

Ninety-five symptomatic knee OA patients (median age = 51 [45–58] years; 65.3 % women) were classified as pre-radiographic (grade 0, n = 19), early (grade 1, n = 38), and mild (grade 2, n = 38) according to the Kellgren-Lawrence. The Knee Injury and Osteoarthritis Outcome Score (KOOS), Visual Analog Scale (VAS), 6-Minute Walk Test (6-MWT), Stair Climb Test (SCT), and Single-Limb Mini Squat Test (SLMS) were used for evaluations. Statistical analyses were performed with One-Way ANOVA, Kruskal Wallis, and ROC analyses.

Results

Pre-radiographic, early, and mild knee OA showed no differences in VAS and KOOS-pain, daily living activities, and quality of life (p > 0.05). The mild group had lower KOOS-sports and recreational activity scores than the pre-radiographic group, had the shortest 6-MWT distance, longest SCT time, and lowest SLMS repetitions. The early group had fewer SLMS repetitions than the pre-radiographic group. The SLMS Test, SCT and 6-MWT values with the best balance of sensitivity and specificity for discriminating early knee OA were 15 repetitions, 11.75 s and 483 m, respectively (area under the curve: 0.816, 0.753 and 0.798 respectively).

Conclusion

No differences were observed for patient-reported functions except KOOS-sport and recreational activities; however, performance-based physical functions differed between radiographic stages. The cut-off results of the performance-based functions may be useful for clinical screening and follow-ups in early knee OA.

主要目的是比较患者报告的早期膝关节骨关节炎（OA）的影像学分级和基于表现的功能。第二个目的是确定身体功能评估区分分期的能力。方法95例有症状的膝关节OA患者（中位年龄51[45-58]岁）；根据Kellgren-Lawrence， 65.3%的女性)分为放射前（0级，n = 19）、早期（1级，n = 38）和轻度（2级，n = 38）。采用膝关节损伤和骨关节炎结局评分（kos）、视觉模拟量表（VAS）、6分钟步行测试（6-MWT）、爬楼梯测试（SCT）和单肢迷你深蹲测试（SLMS）进行评估。统计分析采用单因素方差分析、Kruskal Wallis分析和ROC分析。结果影像学前、早期和轻度膝关节OA患者在VAS和koos疼痛、日常生活活动和生活质量方面均无差异(p >；0.05)。轻度组的koos -运动和娱乐活动评分低于放射前组，6-MWT距离最短，SCT时间最长，SLMS重复次数最少。早期组SLMS重复次数少于放射前组。SLMS Test、SCT和6-MWT值分别为15次重复、11.75 s和483 m（曲线下面积分别为0.816、0.753和0.798），敏感性和特异性平衡最佳。结论除koos -运动和娱乐活动外，患者报告的功能无显著差异；然而，基于表现的身体机能在不同的x线摄影阶段有所不同。基于性能的功能的截止结果可能对早期膝关节OA的临床筛查和随访有用。

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引用次数: 0

Prognostic factors for poor recovery in active-duty military personnel with musculoskeletal disorders: A systematic review with meta-analysis 患有肌肉骨骼疾病的现役军人康复不良的预后因素：一项荟萃分析的系统综述

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice

Pub Date : 2025-07-02 DOI: 10.1016/j.msksp.2025.103383

Simon Olivotto , Kerrie Evans , Kerry Peek , Tania Gardner , Megan Donovan , Debra Shirley , Trudy Rebbeck

Background

Military personnel are twice as likely as civilians to experience chronic musculoskeletal pain. Identifying prognostic factors for poor recovery from musculoskeletal disorders may support the development of tailored care pathways to improve outcomes.

Objectives

Identify prognostic factors for poor recovery in active military personnel with musculoskeletal disorders.

Design

Systematic review of prognostic studies including prospective, retrospective, and secondary analyses of randomised controlled trials.

Methods

MEDLINE, EMBASE, AMED, PsychInfo, Cinahl, Scopus, and SPORTDiscus databases were searched from inception to March 2025. Studies were included if they evaluated prognostic factors for association with recovery outcomes (pain, disability, work status, or perceived recovery) in active military personnel with any musculoskeletal disorder. Two reviewers independently screened eligible studies and assessed methodological quality using the Quality in Prognostic Studies (QUIPS) tool. Descriptive analysis of multivariate data was undertaken with meta-analyses performed where possible.

Results

Twenty-eight studies were included in this review. The factor most strongly associated with poor short-term outcome (disability) was initial pain severity [OR 3.88 (95 %CI 1.50–10.07)] followed by male sex (outcome restricted duty) [OR 2.63 (95 %CI 1.57–4.40)]. The factor most strongly associated with poor long-term outcome (restricted duty) was the presence of comorbid psychiatric diagnosis [RR 6.02 (95 % 4.25–8.51)].

Conclusions

Assessing initial pain severity and psychological stressors may help clinicians identify military personnel with musculoskeletal disorders at risk of poor outcome. Understanding the interaction between occupational psychological stressors and pain symptoms may identify modifiable factors that can be targeted to improve recovery.

军事人员经历慢性肌肉骨骼疼痛的可能性是平民的两倍。识别肌肉骨骼疾病恢复不良的预后因素可能支持量身定制的护理途径的发展，以改善结果。目的探讨现役军人肌肉骨骼疾病患者康复不良的影响因素。设计对预后研究进行系统回顾，包括前瞻性、回顾性和随机对照试验的二次分析。方法检索medline、EMBASE、AMED、PsychInfo、Cinahl、Scopus和SPORTDiscus数据库，检索时间为建库至2025年3月。如果研究评估了患有任何肌肉骨骼疾病的现役军人与恢复结果（疼痛、残疾、工作状态或感知恢复）相关的预后因素，则纳入研究。两名审稿人独立筛选符合条件的研究，并使用预后研究质量（QUIPS）工具评估方法学质量。对多变量数据进行描述性分析，并尽可能进行meta分析。结果本综述共纳入28项研究。与不良短期预后（残疾）最密切相关的因素是初始疼痛严重程度[OR 3.88 (95% CI 1.50-10.07)]，其次是男性（结局受限责任）[OR 2.63 (95% CI 1.57-4.40)]。与不良长期预后（限制责任）最密切相关的因素是精神科共病诊断[RR 6.02(95% 4.25-8.51)]。结论评估初始疼痛严重程度和心理压力源可以帮助临床医生识别有不良预后风险的肌肉骨骼疾病军人。了解职业心理压力源与疼痛症状之间的相互作用，可以确定可调整的因素，从而有针对性地改善康复。

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引用次数: 0