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Exercise as medicine in hip osteoarthritis: an investigation of exercise type, muscle power and predictive factors (PhD Academy Award) 运动作为治疗髋关节骨关节炎的药物:运动类型、肌肉力量和预测因素调查(学院博士奖)
IF 18.4 1区 医学 Q1 SPORT SCIENCES Pub Date : 2024-10-17 DOI: 10.1136/bjsports-2024-109158
Troels Kjeldsen
The primary aim of my PhD was to compare the effects of progressive resistance training (PRT) and neuromuscular exercise (NEMEX) on physical function, pain and hip-related quality of life in people with hip osteoarthritis (OA). Additionally, I sought to examine the relationship between changes in leg extensor muscle power and improvements in physical function, while also exploring predictive factors for better clinical outcomes following these exercise interventions. Hip OA is a leading cause of disability, and exercise is widely recommended as the first-line treatment to improve pain and physical function.1 However, the optimal type of exercise for hip OA remains unclear.2 Neuromuscular exercise, focusing on improving movement quality through exercises that resemble daily life activities, is widely implemented in clinical practice in Denmark and other countries.3 However, it has never been compared with another type of exercise for hip OA. Interestingly, muscle size, strength and power are markedly hampered …
我攻读博士学位的主要目的是比较渐进阻力训练(PRT)和神经肌肉运动(NEMEX)对髋关节骨性关节炎(OA)患者的身体功能、疼痛和髋关节相关生活质量的影响。此外,我还试图研究腿部伸肌力量的变化与身体功能改善之间的关系,同时探索在这些运动干预后取得更好临床效果的预测因素。髋关节 OA 是导致残疾的主要原因之一,运动被广泛推荐为改善疼痛和身体功能的一线治疗方法。1 然而,治疗髋关节 OA 的最佳运动类型仍不明确。2 神经肌肉运动侧重于通过类似日常生活活动的运动来改善运动质量,在丹麦和其他国家的临床实践中得到广泛实施。有趣的是,肌肉的大小、强度和力量都会受到明显的影响......
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引用次数: 0
Psychosocial predictors of doping intentions and use in sport and exercise: a systematic review and meta-analysis. 在体育运动中使用兴奋剂的意向和使用情况的社会心理预测因素:系统回顾和荟萃分析。
IF 11.6 1区 医学 Q1 SPORT SCIENCES Pub Date : 2024-10-17 DOI: 10.1136/bjsports-2023-107910
Nikos Ntoumanis, Sigurd Dølven, Vassilis Barkoukis, Ian David Boardley, Johan S Hvidemose, Carsten B Juhl, Daniel F Gucciardi

Objective: To conduct a meta-analytic review of psychosocial predictors of doping intention, doping use and inadvertent doping in sport and exercise settings.

Design: Systematic review and meta-analysis.

Data sources: Scopus, Medline, Embase, PsychINFO, CINAHL Plus, ProQuest Dissertations/Theses and Open Grey.

Eligibility criteria: Studies (of any design) that measured the outcome variables of doping intention, doping use and/or inadvertent doping and at least one psychosocial determinant of those three variables.

Results: We included studies from 25 experiments (N=13 586) and 186 observational samples (N=3 09 130). Experimental groups reported lower doping intentions (g=-0.21, 95% CI (-0.31 to -0.12)) and doping use (g=-0.08, 95% CI (-0.14 to -0.03), but not inadvertent doping (g=-0.70, 95% CI (-1.95 to 0.55)), relative to comparators. For observational studies, protective factors were inversely associated with doping intentions (z=-0.28, 95% CI -0.31 to -0.24), doping use (z=-0.09, 95% CI -0.13 to to -0.05) and inadvertent doping (z=-0.19, 95% CI -0.32 to -0.06). Risk factors were positively associated with doping intentions (z=0.29, 95% CI 0.26 to 0.32) and use (z=0.17, 95% CI 0.15 to 0.19), but not inadvertent doping (z=0.08, 95% CI -0.06 to 0.22). Risk factors for both doping intentions and use included prodoping norms and attitudes, supplement use, body dissatisfaction and ill-being. Protective factors for both doping intentions and use included self-efficacy and positive morality.

Conclusion: This study identified several protective and risk factors for doping intention and use that may be viable intervention targets for antidoping programmes. Protective factors were negatively associated with inadvertent doping; however, the empirical volume is limited to draw firm conclusions.

目的对体育运动中兴奋剂使用意向、兴奋剂使用和无意中使用兴奋剂的社会心理预测因素进行荟萃分析综述:设计:系统回顾和荟萃分析:数据来源:Scopus、Medline、Embase、PsychINFO、CINAHL Plus、ProQuest Dissertations/Theses 和 Open Grey:研究(设计不限):测量了兴奋剂使用意向、兴奋剂使用和/或无意中使用兴奋剂的结果变量,以及这三个变量的至少一个社会心理决定因素:我们纳入了 25 项实验研究(样本数=13 586)和 186 项观察样本研究(样本数=3 09 130)。实验组报告的使用兴奋剂的意向(g=-0.21,95% CI (-0.31 to -0.12))和使用兴奋剂的情况(g=-0.08,95% CI (-0.14 to -0.03))低于对照组,但无意中使用兴奋剂的情况(g=-0.70,95% CI (-1.95 to 0.55))低于对照组。在观察性研究中,保护性因素与使用兴奋剂的意向(z=-0.28,95% CI -0.31至-0.24)、使用兴奋剂(z=-0.09,95% CI -0.13至-0.05)和无意中使用兴奋剂(z=-0.19,95% CI -0.32至-0.06)呈反向关系。风险因素与兴奋剂使用意向(z=0.29,95% CI 0.26 至 0.32)和使用(z=0.17,95% CI 0.15 至 0.19)呈正相关,但与无意中使用(z=0.08,95% CI -0.06 至 0.22)无关。使用兴奋剂和有使用兴奋剂意向的风险因素包括使用兴奋剂的规范和态度、补充剂的使用、对身体的不满意度和不良情绪。使用兴奋剂和有使用兴奋剂意向的保护因素包括自我效能感和积极的道德观:本研究发现了一些影响兴奋剂使用意向和使用的保护因素和风险因素,这些因素可能是反兴奋剂计划的可行干预目标。保护性因素与无意中使用兴奋剂呈负相关;然而,由于经验有限,无法得出确切结论。
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引用次数: 0
#WhatWouldYouDo? A cross-sectional study of sports medicine physicians assessing their competency in managing harassment and abuse in sports. #你会怎么做?一项针对运动医学医生的横断面研究,评估他们处理体育运动中的骚扰和虐待行为的能力。
IF 11.6 1区 医学 Q1 SPORT SCIENCES Pub Date : 2024-10-16 DOI: 10.1136/bjsports-2024-108210
Margo Mountjoy, Helena Verhelle, Jonathan T Finnoff, Andrew Murray, Amanda Paynter, Fabio Pigozzi, Camille Tooth, Evert Verhagen, Tine Vertommen

Objectives: To assess the clinical competence of sports medicine physicians to recognise and report harassment and abuse in sports, and to identify barriers to reporting and the need for safeguarding education.

Methods: We implemented a cross-sectional cohort study design recruiting through social media and international sports medicine networks in 2023. The survey captured participant perceptions related to the harmfulness of harassment and abuse. The survey incorporated the reasoned action approach as a theoretical framework to design survey questions to identify attitudes and self-efficacy to detect and report suspicions of harassment and abuse and to identify barriers to reporting.

Results: Sports medicine physicians (n=406) from 115 countries completed the survey. The situations of harassment and abuse presented in the survey were described by sports medicine physicians as having occurred in the 12 months before participating in the survey. Despite recognising the situations as harmful, sports medicine physicians were somewhat uncomfortable being vigilant for the signs and symptoms and reporting suspicions and disclosures of harassment and abuse (M=2.13, SD=0.67). In addition, just over one-quarter (n=101, 26.9%) was unaware of where to report harassment and abuse, and over half did not know (n=114, 28.1%), or were uncertain (n=95, 23.4%) of who the safeguarding officer was in their sports organisation. Participants identified many barriers to reporting harassment and abuse, including concerns regarding confidentiality, misdiagnosis, fear of reprisals, time constraints and lack of knowledge. Over half felt insufficiently trained (n=223, 57.6%), and most respondents (n=324, 84.6%) desired more education in the field.

Conclusions: Educational programmes to better recognise and report harassment and abuse in sports are needed for sports medicine trainees and practising clinicians. An international safeguarding code for sports medicine physicians should be developed.

目的评估运动医学医生识别和报告体育运动中的骚扰和虐待行为的临床能力,并确定报告的障碍和保障教育的必要性:我们在 2023 年通过社交媒体和国际运动医学网络进行了一项横断面队列研究。调查收集了参与者对骚扰和虐待危害性的看法。调查将合理行动方法作为设计调查问题的理论框架,以确定发现和报告骚扰和虐待嫌疑的态度和自我效能,并确定报告的障碍:来自 115 个国家的运动医学医生(n=406)完成了调查。调查中出现的骚扰和虐待情况被运动医学医生描述为在参与调查前的 12 个月内发生的。尽管认识到这些情况是有害的,但运动医学医生在警惕骚扰和虐待的征兆和症状以及报告怀疑和披露骚扰和虐待情况方面有些不自在(M=2.13,SD=0.67)。此外,略超过四分之一(n=101,26.9%)的人不知道到哪里举报骚扰和虐待行为,超过一半的人不知道(n=114,28.1%)或不确定(n=95,23.4%)谁是其所在体育组织的保障官员。参与者指出了报告骚扰和虐待行为的许多障碍,包括对保密性的担忧、误诊、害怕报复、时间限制和缺乏知识。一半以上的受访者认为自己没有接受过充分的培训(人数=223,占 57.6%),大多数受访者(人数=324,占 84.6%)希望在该领域接受更多教育:结论:需要为运动医学受训人员和执业临床医生提供教育计划,以更好地识别和报告体育运动中的骚扰和虐待行为。应为运动医学医生制定国际保障守则。
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引用次数: 0
Mouthguards for the prevention of orofacial trauma in sport: the Faculty of Sport and Exercise Medicine (UK) position statement. 运动中预防口面部创伤的护齿:英国运动与锻炼医学学院立场声明。
IF 11.6 1区 医学 Q1 SPORT SCIENCES Pub Date : 2024-10-15 DOI: 10.1136/bjsports-2024-108663
Irfan Ahmed, Julie Gallagher, Ian Needleman, Rachel Bower, Paul Ashley, Asma Aloui, John Patrick Haughey, Gofrane Abdellaoui, Peter Fine
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引用次数: 0
Safeguarding policies and practices in International Federations: on the right track? 国际单项体育联合会的保障政策和做法:是否正确?
IF 18.4 1区 医学 Q1 SPORT SCIENCES Pub Date : 2024-10-15 DOI: 10.1136/bjsports-2024-108861
Tine Vertommen, Margo Mountjoy, Bram Constandt, Kirsty Burrows
Interpersonal violence in sport—whether physical, sexual, psychological or neglect—remains a pressing public health concern, casting a shadow over the well-being of athletes at all levels. The impact of interpersonal violence, often referred to as ‘harassment and abuse’ in sport policy documents, extends far beyond the individual, touching families, healthcare systems and society.1 In recent years, safeguarding strategies have emerged as a vital strategy to protect athletes in the Olympic Movement, with the International Olympic Committee (IOC) as a key actor. However, the landscape of safeguarding policies and practices within Summer and Winter Olympic International Federations (IFs) still reveals considerable variation, often lacking consistency and comprehensive implementation. Recognising these gaps, an internal quality control project driven by the IOC Safe Sport Unit set out to establish a framework for monitoring and evaluating the safeguarding efforts of IFs. By developing a set of indicators (see table 1), the project aimed to create a baseline framework for measuring safeguarding activities and to provide a tool for tracking changes over time. Through the application of this framework, it becomes possible to identify key challenges and areas in need of attention, resulting in the ability to support IFs in strengthening their safeguarding activities by pinpointing critical gaps. View this table: Table 1 Proposed set of safeguarding indicators for sport organisations All 39 Summer and Winter Olympic IFs participated, reflecting the importance placed on safeguarding by the sports community. As of 2022, 85% of these IFs reported having safeguarding policies, while only just over half had fully implemented them. Safeguarding officers, who are critical to the success of these policies, were predominantly women (54%), but a significant proportion (38%) did not officially hold the title of safeguarding officer or did not receive specialised training (49%), suggesting that many are working without the full recognition, support or training their role requires. …
体育运动中的人际暴力--无论是身体暴力、性暴力、心理暴力还是忽视--仍然是一个紧迫 的公共健康问题,给各级运动员的福祉蒙上了阴影。人际暴力在体育政策文件中通常被称为 "骚扰和虐待",其影响远远超出了个人,触及家庭、医疗保健系统和社会。1 近年来,保障战略已成为奥林匹克运动中保护运动员的一项重要战略,国际奥林匹克委员会(IOC)是其中的主要参与者。然而,夏季奥运会和冬季奥运会国际单项体育联合会(IFs)内部的保障政策和实践仍然存在很大差异,往往缺乏一致性和全面实施。认识到这些差距后,由国际奥委会安全体育部推动的一个内部质量控制项目着手建立一个框架,用于监测和评估国际单项体育联合会的保障工作。通过制定一套指标(见表 1),该项目旨在建立一个衡量保障活动的基准框架,并提供一个跟踪随时间推移发生的变化的工具。通过应用这一框架,可以确定主要挑战和需要关注的领域,从而有能力通过找出关键差距来支持综合框架加强其保障活动。查看此表:所有 39 个夏季和冬季奥运会国际单项体育联合会都参与了调查,这反映了体育界对保障工作的重视。截至 2022 年,85% 的国际单项体育联合会报告已制定了保障政策,但只有略多于一半的国际单项体育联合会全面实施了这些政策。保障官员是这些政策取得成功的关键,她们主要是女性(54%),但很大一部分(38%)没有正式的保障官员头衔或没有接受过专门培训(49%),这表明许多人在工作中没有得到充分的认可、支持或培训。...
{"title":"Safeguarding policies and practices in International Federations: on the right track?","authors":"Tine Vertommen, Margo Mountjoy, Bram Constandt, Kirsty Burrows","doi":"10.1136/bjsports-2024-108861","DOIUrl":"https://doi.org/10.1136/bjsports-2024-108861","url":null,"abstract":"Interpersonal violence in sport—whether physical, sexual, psychological or neglect—remains a pressing public health concern, casting a shadow over the well-being of athletes at all levels. The impact of interpersonal violence, often referred to as ‘harassment and abuse’ in sport policy documents, extends far beyond the individual, touching families, healthcare systems and society.1 In recent years, safeguarding strategies have emerged as a vital strategy to protect athletes in the Olympic Movement, with the International Olympic Committee (IOC) as a key actor. However, the landscape of safeguarding policies and practices within Summer and Winter Olympic International Federations (IFs) still reveals considerable variation, often lacking consistency and comprehensive implementation. Recognising these gaps, an internal quality control project driven by the IOC Safe Sport Unit set out to establish a framework for monitoring and evaluating the safeguarding efforts of IFs. By developing a set of indicators (see table 1), the project aimed to create a baseline framework for measuring safeguarding activities and to provide a tool for tracking changes over time. Through the application of this framework, it becomes possible to identify key challenges and areas in need of attention, resulting in the ability to support IFs in strengthening their safeguarding activities by pinpointing critical gaps. View this table: Table 1 Proposed set of safeguarding indicators for sport organisations All 39 Summer and Winter Olympic IFs participated, reflecting the importance placed on safeguarding by the sports community. As of 2022, 85% of these IFs reported having safeguarding policies, while only just over half had fully implemented them. Safeguarding officers, who are critical to the success of these policies, were predominantly women (54%), but a significant proportion (38%) did not officially hold the title of safeguarding officer or did not receive specialised training (49%), suggesting that many are working without the full recognition, support or training their role requires. …","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":18.4,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142440199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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
Prescribing strength training for stroke recovery: a systematic review and meta-analysis of randomised controlled trials 针对中风康复的力量训练处方:随机对照试验的系统回顾和荟萃分析
IF 18.4 1区 医学 Q1 SPORT SCIENCES Pub Date : 2024-10-15 DOI: 10.1136/bjsports-2024-108476
Kenneth S Noguchi, Kevin Moncion, Elise Wiley, Ashley Morgan, Eric Huynh, Guilherme Moraes Balbim, Brad Elliott, Carlene Harris-Blake, Brent Krysa, Barb Koetsier, Karolyn Pinili, Marla K Beauchamp, Stuart M Phillips, Lehana Thabane, Ada Tang
Objective To examine the effects of strength training on patient-important outcomes of stroke recovery and to quantify the influence of the exercise prescription on treatment effects. Design Systematic review and meta-analysis. Data sources Eight electronic databases (MEDLINE, EMBASE, EMCARE, AMED, PsycINFO, CINAHL, SPORTDiscus, and Web of Science) and two clinical trial registries (ClinicalTrials.gov and WHO International Clinical Trials Registry Platform) were searched from inception to 19 June 2024. Eligibility criteria Randomised controlled trials were eligible if they examined the effects of strength training compared with no exercise or usual care and reported at least one exercise prescription parameter. An advisory group of community members with lived experience of stroke helped inform outcomes most relevant to stroke recovery. Results Forty-two randomised trials (N=2204) were included. Overall risk of bias was high across most outcomes. Strength training improved outcomes rated as ‘critical for decision-making’ by the advisory group, including walking capacity (standardised mean difference (SMD)=0.95 (95% CI 0.34–1.56)), balance (SMD=1.13 (0.51–1.75)), functional ability and mobility (SMD=0.61 (0.09–1.14)), and habitual (mean difference (MD)=0.05 m/s (0.02–0.09)) and fast-paced walking speed (MD=0.09 m/s (0.01–0.17)), with very low to moderate certainty of evidence, mainly due to risk of bias and inconsistency. More frequent strength training, traditional strength training programmes and power-focused intensities (ie, emphasis on movement velocity) were positively associated with walking capacity, health-related quality of life and fast-paced walking speed. Conclusion Strength training alone or combined with usual care improves stroke recovery outcomes that are important for decision-making. More frequent strength training, power-focused intensities and traditional programme designs may best support stroke recovery. PROSPERO registration number CRD42023414077. Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. All individual study data included in this review are available directly from the original manuscripts. Any other data used for this review are available on reasonable request.
目的 研究力量训练对中风患者重要康复结果的影响,并量化运动处方对治疗效果的影响。设计 系统综述和荟萃分析。数据来源 检索了从开始到 2024 年 6 月 19 日的八个电子数据库(MEDLINE、EMBASE、EMCARE、AMED、PsycINFO、CINAHL、SPORTDiscus 和 Web of Science)和两个临床试验登记处(ClinicalTrials.gov 和 WHO 国际临床试验登记平台)。资格标准 如果随机对照试验研究了力量训练与不做运动或常规护理相比的效果,并报告了至少一项运动处方参数,则符合资格。由具有中风生活经验的社区成员组成的顾问小组帮助了解与中风康复最相关的结果。结果 纳入了 42 项随机试验(N=2204)。大多数结果的总体偏倚风险较高。力量训练改善了咨询小组评定为 "对决策至关重要 "的结果,包括行走能力(标准化平均差 (SMD)=0.95 (95% CI 0.34-1.56))、平衡能力(SMD=1.13 (0.51-1.75))、功能能力和活动能力(SMD=0.这些证据的确定性从很低到中等不等,主要原因是存在偏倚和不一致的风险。更频繁的力量训练、传统的力量训练计划和注重力量的训练强度(即强调运动速度)与行走能力、健康相关生活质量和快步行走速度呈正相关。结论 单独进行力量训练或结合常规护理可改善中风恢复效果,这对决策非常重要。更频繁的力量训练、以力量为重点的训练强度和传统的计划设计可能是支持中风康复的最佳方法。PROSPERO 注册号:CRD42023414077。如有合理要求,可提供相关数据。所有与研究相关的数据均包含在文章中或作为补充信息上传。本综述中包含的所有单项研究数据可直接从原稿中获取。本综述使用的任何其他数据均可在合理要求下提供。
{"title":"Prescribing strength training for stroke recovery: a systematic review and meta-analysis of randomised controlled trials","authors":"Kenneth S Noguchi, Kevin Moncion, Elise Wiley, Ashley Morgan, Eric Huynh, Guilherme Moraes Balbim, Brad Elliott, Carlene Harris-Blake, Brent Krysa, Barb Koetsier, Karolyn Pinili, Marla K Beauchamp, Stuart M Phillips, Lehana Thabane, Ada Tang","doi":"10.1136/bjsports-2024-108476","DOIUrl":"https://doi.org/10.1136/bjsports-2024-108476","url":null,"abstract":"Objective To examine the effects of strength training on patient-important outcomes of stroke recovery and to quantify the influence of the exercise prescription on treatment effects. Design Systematic review and meta-analysis. Data sources Eight electronic databases (MEDLINE, EMBASE, EMCARE, AMED, PsycINFO, CINAHL, SPORTDiscus, and Web of Science) and two clinical trial registries (ClinicalTrials.gov and WHO International Clinical Trials Registry Platform) were searched from inception to 19 June 2024. Eligibility criteria Randomised controlled trials were eligible if they examined the effects of strength training compared with no exercise or usual care and reported at least one exercise prescription parameter. An advisory group of community members with lived experience of stroke helped inform outcomes most relevant to stroke recovery. Results Forty-two randomised trials (N=2204) were included. Overall risk of bias was high across most outcomes. Strength training improved outcomes rated as ‘critical for decision-making’ by the advisory group, including walking capacity (standardised mean difference (SMD)=0.95 (95% CI 0.34–1.56)), balance (SMD=1.13 (0.51–1.75)), functional ability and mobility (SMD=0.61 (0.09–1.14)), and habitual (mean difference (MD)=0.05 m/s (0.02–0.09)) and fast-paced walking speed (MD=0.09 m/s (0.01–0.17)), with very low to moderate certainty of evidence, mainly due to risk of bias and inconsistency. More frequent strength training, traditional strength training programmes and power-focused intensities (ie, emphasis on movement velocity) were positively associated with walking capacity, health-related quality of life and fast-paced walking speed. Conclusion Strength training alone or combined with usual care improves stroke recovery outcomes that are important for decision-making. More frequent strength training, power-focused intensities and traditional programme designs may best support stroke recovery. PROSPERO registration number CRD42023414077. Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. All individual study data included in this review are available directly from the original manuscripts. Any other data used for this review are available on reasonable request.","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":18.4,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142440211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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
Refugee Olympic Team: a team like no other. 难民奥林匹克队:独一无二的团队
IF 18.4 1区 医学 Q1 SPORT SCIENCES Pub Date : 2024-10-14 DOI: 10.1136/bjsports-2024-109192
Carlo Bagutti
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引用次数: 0
Best practice guide for patellofemoral pain based on synthesis of a systematic review, the patient voice and expert clinical reasoning. 髌骨股骨痛最佳实践指南,基于系统综述、患者心声和专家临床推理的综合结果。
IF 18.4 1区 医学 Q1 SPORT SCIENCES Pub Date : 2024-10-14 DOI: 10.1136/bjsports-2024-108110
Bradley Stephen Neal,Simon David Lack,Clare Bartholomew,Dylan Morrissey
OBJECTIVEDefine a best practice guide for managing people with patellofemoral pain (PFP).METHODSA mixed-methods convergent segregated synthesis of meta-analysed data with a thematic analysis of semistructured interviews and focus groups. Agreement between subproject results informed the strength of clinical recommendation for interventions eligible for best practice recommendation.DATA SOURCESMedline, Web of Science, Scopus, reference lists and citation tracking; semistructured interviews of people with PFP; and semistructured interviews and focus groups with clinical experts.ELIGIBILITY CRITERIAHigh-quality (PEDro scale >7) randomised controlled trials (RCTs) were retained for efficacy estimation using meta-analysis. People with PFP were required to have experienced an episode of care in the past 6 months and clinical experts were required to have>5 years of clinical experience alongside direct involvement in research.RESULTSData from 65 high-quality RCTs involving 3796 participants informed 11 meta-analyses of interventions. Interviews with 12 people with PFP led to 3 themes and interviews with 19 clinical experts led to 4 themes. These were further explored in three clinical expert focus groups. Best practice for PFP should first involve understanding a patient's background risk factors, their reasons for seeking care, greatest symptoms, and physical impairments, to inform treatment selection. Synthesis led to six distinct interventions being recommended. Knee-targeted±hip-targeted exercise therapy underpinned by education should be delivered, with additional supporting interventions such as prefabricated foot orthoses, manual therapy, movement/running retraining, or taping decided on and tailored to a patient's needs and preferences.CONCLUSIONA best practice guide based on a synthesis of three data streams recommends that exercise therapy and education be delivered as the primary intervention for people with PFP. Prescription of other supporting interventions should be aligned with the individual patient's particular presentation following a thorough assessment.
目的为管理髌骨股骨痛(PFP)患者确定最佳实践指南。方法对元分析数据进行混合方法聚合分离综合,并对半结构式访谈和焦点小组进行专题分析。数据来源Medline、Web of Science、Scopus、参考文献列表和引文追踪;对 PFP 患者进行的半结构化访谈;与临床专家进行的半结构化访谈和焦点小组。要求 PFP 患者在过去 6 个月内接受过一次治疗,临床专家必须有 5 年以上的临床经验,并直接参与研究。对 12 名 PFP 患者的访谈产生了 3 个主题,对 19 名临床专家的访谈产生了 4 个主题。三个临床专家焦点小组对这些主题进行了进一步探讨。治疗 PFP 的最佳实践应首先了解患者的背景风险因素、寻求治疗的原因、最严重的症状和身体损伤,从而为选择治疗方法提供依据。通过综合分析,推荐了六种不同的干预方法。结论 基于三项数据流综合的最佳实践指南建议将运动疗法和教育作为 PFP 患者的主要干预措施。其他辅助干预措施的处方应在全面评估后根据患者的具体表现进行调整。
{"title":"Best practice guide for patellofemoral pain based on synthesis of a systematic review, the patient voice and expert clinical reasoning.","authors":"Bradley Stephen Neal,Simon David Lack,Clare Bartholomew,Dylan Morrissey","doi":"10.1136/bjsports-2024-108110","DOIUrl":"https://doi.org/10.1136/bjsports-2024-108110","url":null,"abstract":"OBJECTIVEDefine a best practice guide for managing people with patellofemoral pain (PFP).METHODSA mixed-methods convergent segregated synthesis of meta-analysed data with a thematic analysis of semistructured interviews and focus groups. Agreement between subproject results informed the strength of clinical recommendation for interventions eligible for best practice recommendation.DATA SOURCESMedline, Web of Science, Scopus, reference lists and citation tracking; semistructured interviews of people with PFP; and semistructured interviews and focus groups with clinical experts.ELIGIBILITY CRITERIAHigh-quality (PEDro scale >7) randomised controlled trials (RCTs) were retained for efficacy estimation using meta-analysis. People with PFP were required to have experienced an episode of care in the past 6 months and clinical experts were required to have>5 years of clinical experience alongside direct involvement in research.RESULTSData from 65 high-quality RCTs involving 3796 participants informed 11 meta-analyses of interventions. Interviews with 12 people with PFP led to 3 themes and interviews with 19 clinical experts led to 4 themes. These were further explored in three clinical expert focus groups. Best practice for PFP should first involve understanding a patient's background risk factors, their reasons for seeking care, greatest symptoms, and physical impairments, to inform treatment selection. Synthesis led to six distinct interventions being recommended. Knee-targeted±hip-targeted exercise therapy underpinned by education should be delivered, with additional supporting interventions such as prefabricated foot orthoses, manual therapy, movement/running retraining, or taping decided on and tailored to a patient's needs and preferences.CONCLUSIONA best practice guide based on a synthesis of three data streams recommends that exercise therapy and education be delivered as the primary intervention for people with PFP. Prescription of other supporting interventions should be aligned with the individual patient's particular presentation following a thorough assessment.","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":18.4,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142439247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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
Quantitative analysis of effectiveness and associated factors of exercise on symptoms in osteoarthritis: a pharmacodynamic model-based meta-analysis. 运动对骨关节炎症状的有效性及相关因素的定量分析:基于药效学模型的荟萃分析。
IF 11.6 1区 医学 Q1 SPORT SCIENCES Pub Date : 2024-10-11 DOI: 10.1136/bjsports-2023-107625
Shun Han, Ting Li, Ying Cao, Zewei Li, Yiying Mai, Tianxiang Fan, Muhui Zeng, Xin Wen, Weiyu Han, Lijun Lin, Lixin Zhu, Siu Ngor Fu, Kim L Bennell, David J Hunter, Changhai Ding, Lujin Li, Zhaohua Zhu

Objective: This study aims to evaluate the time point and magnitude of peak effectiveness of exercise and the effects of various exercise modalities for osteoarthritis (OA) symptoms and to identify factors that significantly affect the effectiveness of exercise.

Design: Pharmacodynamic model-based meta-analysis (MBMA).

Data sources: Embase, PubMed, Cochrane Library, Web of Science and Scopus were searched for randomised controlled trials (RCTs) examining the effect of exercise for OA from inception to 20 November 2023.

Eligibility criteria: RCTs of exercise interventions in patients with knee, hip or hand OA, using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscales or Visual Analogue Scale (VAS) pain scores as outcome measures, were included. The minimum clinically important difference (MCID) for WOMAC total, pain, stiffness, function and VAS pain was 9.0, 1.6, 0.8, 5.4 and 0.9, respectively.

Results: A total of 186 studies comprising 12 735 participants with symptomatic or radiographic knee, hip or hand OA were included. The effectiveness of exercise treatments peaked at 1.6-7.2 weeks after initiation of exercise interventions. Exercise was more effective than the control, but the differences in the effects of exercise compared with control on all outcomes were only marginally different with the MCID (7.5, 1.7, 1.0, 5.4 and 1.2 units for WOMAC total, pain, stiffness, function and VAS pain, respectively). During a 12-month treatment period, local exercise (strengthening muscles and improving mobilisations of certain joints) had the best effectiveness (WOMAC pain decreasing by 42.5% at 12 weeks compared with baseline), followed by whole-body plus local exercise. Adding local water-based exercise (eg, muscle strengthening in warm water) to muscle strengthening exercise and flexibility training resulted in 7.9, 0.5, 0.7 and 8.2 greater improvements in the WOMAC total score, pain, stiffness and function, respectively. The MBMA models revealed that treatment responses were better in participants with more severe baseline symptom scores for all scales, younger participants for the WOMAC total and pain scales, and participants with obesity for the WOMAC function. Subgroup analyses revealed participants with certain characteristics, such as female sex, younger age, knee OA or more severe baseline symptoms on the WOMAC pain scale, benefited more from exercise treatment.

Conclusion: Exercise reaches peak effectiveness within 8 weeks and local exercise has the best effectiveness, especially if local water-based exercise is involved. Patients of female sex, younger age, obesity, knee OA or more severe baseline symptoms appear to benefit more from exercise treatment than their counterparts.

目的:本研究旨在评估锻炼的时间点和峰值效果以及各种锻炼方式对骨关节炎(OA)症状的影响:本研究旨在评估运动疗效峰值的时间点和幅度,以及各种运动方式对骨关节炎(OA)症状的影响,并确定对运动疗效有显著影响的因素:设计:基于药效学模型的荟萃分析(MBMA):数据来源:Embase、PubMed、Cochrane Library、Web of Science和Scopus检索了从开始到2023年11月20日期间研究运动治疗OA效果的随机对照试验(RCT):采用西安大略和麦克马斯特大学骨关节炎指数(WOMAC)分量表或视觉模拟量表(VAS)疼痛评分作为结果测量指标,纳入对膝关节、髋关节或手部 OA 患者进行运动干预的 RCT。WOMAC总分、疼痛、僵硬、功能和VAS疼痛的最小临床重要差异(MCID)分别为9.0、1.6、0.8、5.4和0.9:结果:共纳入了186项研究,包括12 735名膝关节、髋关节或手部有症状或有影像学表现的OA患者。运动治疗的有效性在运动干预开始后1.6-7.2周达到峰值。运动比对照组更有效,但与对照组相比,运动对所有结果的影响在 MCID(WOMAC 总分、疼痛、僵硬、功能和 VAS 疼痛分别为 7.5、1.7、1.0、5.4 和 1.2 个单位)上仅有微小差异。在为期12个月的治疗期间,局部锻炼(增强肌肉力量和改善某些关节的活动度)的效果最好(与基线相比,12周时WOMAC疼痛指数下降了42.5%),其次是全身加局部锻炼。在肌肉强化训练和柔韧性训练的基础上增加局部水上运动(如在温水中进行肌肉强化训练),WOMAC总分、疼痛、僵硬和功能的改善幅度分别为7.9、0.5、0.7和8.2。MBMA模型显示,在所有量表中,基线症状评分更严重的参与者的治疗反应更好;在WOMAC总分和疼痛量表中,更年轻的参与者的治疗反应更好;在WOMAC功能量表中,肥胖的参与者的治疗反应更好。亚组分析显示,具有某些特征的参与者,如女性、年轻、膝关节OA或WOMAC疼痛量表基线症状更严重者,从运动治疗中获益更多:结论:运动治疗在8周内达到最佳效果,局部运动效果最好,尤其是局部水上运动。女性、年轻、肥胖、膝关节 OA 或基线症状更严重的患者似乎从运动治疗中获益更多。
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引用次数: 0
Tale of quadriceps and hamstring muscle strength after ACL reconstruction: a systematic review with longitudinal and multivariate meta-analysis. 前交叉韧带重建后股四头肌和腿筋肌力的变化:纵向和多变量荟萃分析系统综述。
IF 11.6 1区 医学 Q1 SPORT SCIENCES Pub Date : 2024-10-10 DOI: 10.1136/bjsports-2023-107977
Michael Girdwood, Adam G Culvenor, Ebonie K Rio, Brooke E Patterson, Melissa Haberfield, Jamon Couch, Benjamin Mentiplay, Michael Hedger, Kay M Crossley

Objective: This study aimed to investigate how knee extensor and flexor strength change over time after anterior cruciate ligament reconstruction (ACLR).

Design: Systematic review with longitudinal meta-analysis.

Data sources: Medline, Embase, CINAHL, Scopus, Cochrane CENTRAL and SPORTDiscus to 28 February 2023.

Eligibility criteria: Studies of primary ACLR (n≥50), with mean participant age 18-40 years, reporting a quantitative measure of knee extensor or flexor strength were eligible. Muscle strength had to be reported for the ACL limb and compared with: (1) the contralateral limb (within-person); and/or (2) an uninjured control limb (between-person).

Results: We included 232 studies of 34 220 participants. Knee extensor and flexor strength showed sharp initial improvement postoperatively before tailing off at approximately 12-18 months post surgery with minimal change thereafter. Knee extensor strength was reduced by more than 10% compared with the contralateral limb and approximately 20% compared with uninjured controls at 1 year for slow concentric, fast concentric and isometric contractions. Knee flexor strength showed smaller deficits but was still 5%-7% lower than the contralateral limb at 1 year for slow concentric, fast concentric and isometric contractions. Between-person comparisons showed larger deficits than within-person comparisons.

Conclusion: Knee extensor muscle strength is meaningfully reduced (>10%) at 1 year, with limited improvement after this time up to and beyond 5 years post surgery. Many people likely experience persistent and potentially long-term strength deficits after ACLR. Comparison within person (to the contralateral limb) likely underestimates strength deficits in contrast to uninjured controls.

目的本研究旨在探讨膝关节伸肌和屈肌力量在前交叉韧带重建术(ACLR)后随时间的变化情况:设计:系统回顾与纵向荟萃分析:数据来源:Medline、Embase、CINAHL、Scopus、Cochrane CENTRAL 和 SPORTDiscus(截至 2023 年 2 月 28 日):原发性 ACLR 研究(n≥50),参与者平均年龄为 18-40 岁,报告膝关节伸肌或屈肌力量的定量测量结果。必须报告前交叉韧带肢体的肌肉力量,并与以下方面进行比较:(结果:我们共纳入了 232 项研究,34 220 名参与者。膝关节伸肌和屈肌力量在术后初期有明显改善,但在术后约 12-18 个月时逐渐减弱,此后变化极小。与对侧肢体相比,膝关节伸肌力量降低了 10%以上,与未受伤的对照组相比,1 年后在慢速同心、快速同心和等长收缩方面降低了约 20%。膝关节屈肌力量的下降幅度较小,但在1年后的慢速同心收缩、快速同心收缩和等长收缩中,仍比对侧肢体低5%-7%。人与人之间的比较比人与人之间的比较显示出更大的缺陷:结论:膝关节伸肌力量在术后 1 年时明显减弱(>10%),术后 5 年及以后的改善有限。许多人在 ACLR 术后可能会出现持续的、潜在的长期力量不足。与未受伤的对照组相比,个人内部(与对侧肢体)的比较可能会低估力量缺陷。
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期刊
British Journal of Sports Medicine
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