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Jafarian Tangrood Z, Spontelli Gisselman A, Sole G, Cury Ribeiro D. Clinical course of pain and function in subacromial shoulder pain: a systematic review with meta-analysis. Physical Therapy Reviews 2023. [DOI: 10.1080/10833196.2023.2192620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
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den Boer PK, Schulte G, Muris DM, Deckers P, Bemelmans YF, Schotanus MG, Winkens B, Ottenheijm RP. Prognosis of shoulder pain in those with and without a psychological disorder: A prospective cohort study with a six-month follow-up. J Back Musculoskelet Rehabil 2022; 35:1191-1201. [PMID: 35754263 PMCID: PMC9697065 DOI: 10.3233/bmr-220018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Because shoulder pain can have an unfavorable prognosis, it is important to have a better understanding of factors that may influence recovery. OBJECTIVE To determine the association between recovery from shoulder pain and the presence of depression, anxiety, and pain catastrophizing. METHODS In a prospective cohort study with a six months follow-up, we included patients visiting an orthopaedic department with shoulder pain. Primary outcome was recovery from shoulder pain measured with the Shoulder Pain and Disability Index at three and six months. Information about depression and anxiety (Hospital Anxiety and Depression Scale), pain catastrophizing (Pain Catastrophizing Scale), and demographic and clinical factors were collected at baseline. A linear mixed model was used to estimate the effects of depression, anxiety, pain catastrophizing, and underlying shoulder disorders on recovery. RESULTS We included 190 patients. There were no statistically significant associations between the presence of depression, anxiety, and pain catastrophizing, and three- and six-month recovery. Also between the underlying shoulder disorders and recovery at three and six months, there were no statistically significant associations. CONCLUSIONS We could not prove that depression, anxiety, and pain catastrophizing, as well as underlying shoulder disorders, were associated with recovery of shoulder pain at six months.
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Affiliation(s)
- Pim K.W. den Boer
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Gil Schulte
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Dennis M.J. Muris
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands,MCC Omnes Centre for Diagnostics and Innovation, Sittard, The Netherlands
| | - Patrick Deckers
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Yoeri F.L. Bemelmans
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Martijn G.M. Schotanus
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands,Department of Orthopaedic Surgery and Traumatology, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Ramon P.G. Ottenheijm
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands,Corresponding author: Ramon P.G. Ottenheijm, Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands. E-mail:
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Walker-bone K, van der Windt DA. Shoulder Pain — Where Are We Now? Curr Treat Options in Rheum 2021; 7:285-306. [DOI: 10.1007/s40674-021-00184-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
Purpose of Review
Shoulder pain is common and costly. For the past century, diagnosis and management has been based upon presumed patho-anatomical abnormalities. With the evolution of imaging techniques and new insight about the causes of musculoskeletal pain, this review evaluates the evidence that a patho-anatomical approach remains justified.
Recent Findings
Imaging modalities have developed considerably but, so far, have only proven value in evaluating full thickness rotator cuff tears prior to surgery. Correlation between imaging findings and symptoms is otherwise poor, with limited evidence of the value and impact of imaging for decision-making. Much of shoulder pain is chronic and few people have single-site musculoskeletal pain. Pain studies suggest that chronic shoulder pain is associated with both central and peripheral pain sensitisation. Moreover, functional MRI points to an effect of cognitive affective pain processing rather than nociception. Few of the established therapies, medical or surgical, that treat the presumed patho-anatomical cause have been shown to have lasting benefit.
Summary
Much of the evidence suggests that shoulder pain is more similar than different from mechanical low back pain. For most people with shoulder pain, the best approach might well be de-medicalisation, support to (self)manage pain, emphasis on retaining movement and identifying adverse beliefs and risk factors for disability and chronicity. Approaches like this are currently being evaluated and more research is desperately required.
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Verdonk DL, Spigt M, Lima Passos V, Klemann-Harings SEJM, Ottenheijm RPG. Phenotyping the shoulder patient based on ultrasound-detected pathologies: a cross-sectional study in general practice. Fam Pract 2021; 38:313-320. [PMID: 33313809 DOI: 10.1093/fampra/cmaa129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Shoulder complaints arise from a single pathology or a combination of different underlying pathologies that are hard to differentiate in general practice. Subgroups of pathologies have been identified on the basis of ultrasound imaging that might affect treatment outcomes. OBJECTIVE Our aim was to validate the existence of different subgroups of patients with shoulder complaints, based on ultrasound-detected pathology, and compare clinical features among them. Profiling shoulder patients into distinct shoulder pathology phenotypes could help designing tailored treatment trials. METHODS This was a cross-sectional study in general practice. Data were extracted from 840 first visit patient records at a single diagnostic centre in the Netherlands. Exclusion criteria were age <18 years and previous shoulder surgery. Latent class analysis was used to uncover cross-combinations of ultrasound detected pathologies, yielding subgroups of shoulder patients. The uncovered subgroups were compared for demographic and clinical characteristics. RESULTS We uncovered four distinct subgroups of patients with shoulder complaints: (i) Frozen shoulder group (11%), (ii) Limited pathology group (44%), (iii) Degenerative pathology group (31%) and (iv) Calcifying tendinopathy group (15%). Group comparisons showed significant differences in demographic and clinical characteristics among subgroups, consistent with the literature. CONCLUSION In a general practice population, we uncovered four different phenotypes of shoulder patients on the basis of ultrasound detected pathology. These phenotypes can be used designing tailored treatment trials in patients with shoulder complaints.
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Affiliation(s)
- Debra L Verdonk
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Mark Spigt
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,General Practice Research Unit, Department of Community Medicine, The Arctic University of Tromsø, Tromsø, Norway
| | - Valéria Lima Passos
- Department of Methodology and Statistics, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht,The Netherlands
| | | | - Ramon P G Ottenheijm
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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van Doorn PF, de Schepper EIT, Schiphof D, Ottenheijm RPG, Thoomes-de Graaf M, Koopmanschap MA, van Ochten JM, van der Windt DA, Bindels PJE, Koes BW, Runhaar J. Clinical and cost effectiveness of a corticosteroid injection versus exercise therapy for shoulder pain in general practice: protocol for a randomised controlled trial (SIX Study). BMJ Open 2021; 11:e050101. [PMID: 33785496 PMCID: PMC8011792 DOI: 10.1136/bmjopen-2021-050101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Shoulder pain is common and the prognosis is often unfavourable. Dutch guidelines on the treatment of shoulder pain in primary care recommend a corticosteroid injection or a referral to exercise therapy, if initial pain management fails and pain persists. However, evidence of the effectiveness of a corticosteroid injection compared with exercise therapy, especially in the long term, is limited. This trial will assess the clinical effectiveness and cost effectiveness of a corticosteroid injection compared with physiotherapist-led exercise therapy over 12 months follow-up in patients with shoulder pain in primary care. METHODS AND ANALYSIS The SIX Study is a multicentre, pragmatic randomised clinical trial in primary care. A total of 213 patients with shoulder pain, aged ≥18 years presenting in general practice will be included. Patients will be randomised (1:1) into two groups: a corticosteroid injection or 12 sessions of physiotherapist-led exercise therapy. The effect of the allocated treatment will be assessed through questionnaires at 6 weeks and after 3, 6, 9 and 12 months. The primary outcome is patient's reported shoulder pain-intensity and function, measured with the Shoulder Pain and Disability Index, over 12 months follow-up. Secondary outcomes include cost effectiveness, pain-intensity, function, health-related quality of life, sleep quality, patient's global perceived effect, work absence, healthcare utilisation and adverse events. Between group differences will be evaluated using a repeated measurements analysis with linear effects models. A cost-utility analysis will be performed to assess the cost effectiveness using quality-adjusted life years from a medical and societal perspective. ETHICS AND DISSEMINATION This study was approved by the Medical Ethics Committee of Erasmus MC University Medical Center Rotterdam (MEC 2020-0300). All participants will give written informed consent prior to data collection. The results from this study will be disseminated in international journals and implemented in the primary care guidelines on shoulder pain. TRIAL REGISTRATION NUMBER Dutch Trial Registry (NL8854).
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Affiliation(s)
| | | | | | | | | | - Marc A Koopmanschap
- Health Economics and HTA, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | | | | | - Bart W Koes
- General Practice, Erasmus MC, Rotterdam, The Netherlands
| | - Jos Runhaar
- General Practice, Erasmus MC, Rotterdam, The Netherlands
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Abstract
Background Physical tests are usually preferred to assess rotator-cuff syndrome but are insufficient to predict the morphology and size of the rotator-cuff. The objective of the study was to rate the ultrasound findings for patients with sudden shoulder pain and to determine potential predictors of the same. Material/Methods A total of 112 patients with sudden shoulder pain with rotator-cuff syndrome, suspected by orthopedic doctors, were subjected to ultrasonography. Real-time ultrasonography was done for the acromioclavicular joint, biceps, infraspinatus, posterior labrum, subscapularis, supraspinatus, teres minor tendon, and the sub-acromial-subdeltoid bursa. Each tendon was assessed via scanning planes in orientation as per longer and shorter axis, and from their myotendinous junction shoulder to bony insertions. Linear and logistic regression analysis were performed to predict the associations of medical history with rotator-cuff injury. Results Ultrasonography identified that 82% of the enrolled patients had at least one particular cause of the rotator-cuff disorder. Among the rotator-cuff disorders, calcific tendonitis (54%) was observed more frequently followed by tendinopathy (32%), subacromial-subdeltoid bursitis (22%), and partial thickness tear (21%). Also, 46 patients (41%) had multiple findings. Older age (older than 40 years) was a strong predicting factor of rotator-cuff disorder (r2=0.36, P=0.0004). Conclusions Ultrasonography is a vital diagnostic procedure used by orthopedic surgeons for diagnosis of the rotator-cuff disorder(s) in patients with sudden shoulder pain.
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Affiliation(s)
- Fang Zheng
- Shanghai General Hospital of Nanjing Medical University, Shanghai, China (mainland).,Department of Ultrasonic, The First Affiliated Hospital of XinXiang Medical University, Weihui, Henan, China (mainland)
| | - Haiyan Wang
- Department of Ultrasonic, The First Affiliated Hospital of XinXiang Medical University, Weihui, Henan, China (mainland)
| | - Hongyan Gong
- Department of Anesthesiology, The First Affiliated Hospital of XinXiang Medical University, Weihui, Henan, China (mainland)
| | - Huijun Fan
- Department of Ultrasonic, The First Affiliated Hospital of XinXiang Medical University, Weihui, Henan, China (mainland)
| | - Kai Zhang
- Department of Ultrasonic, The First Affiliated Hospital of XinXiang Medical University, Weihui, Henan, China (mainland)
| | - Lianfang Du
- Shanghai General Hospital of Nanjing Medical University, Shanghai, China (mainland)
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肩袖损伤程度和肱骨头上移距离间的相关性分析. Beijing Da Xue Xue Bao Yi Xue Ban 2019; 51. [PMID: 30996367 DOI: 10.19723/j.issn.1671-167X.2019.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To evaluate the association between rotator cuff tear and the proximal migration of humeral head. METHODS In this research, we retrospectively selected 30 patients with unilateral rotator cuff tear in Peking University People's Hospital from September 2015 to May 2016, who received magnetic resonance imaging (MRI) and X-ray of the painful shoulder before enrollment in this study, the duration between the two examinations was no longer than 1 week, and also there was no past history of surgery in the selected shoulders. There was no other exclusion criteria. Upward migration index (UMI) was the ratio between the distance of humeral head center to the lower surface of acromion, and the radius of humeral head circle, which could help to minimize the effect of anatomy difference and imaging magnification, compared with the traditional acromiohumeral distance (AHD). Then we introduced this index to stratify the selected 30 patients into 3 groups, and each group contained 10 patients, UMI of group 1 was >1 and ≤1.2, UMI of group 2 was >1.2 and ≤1.4, UMI of group 3 was >1.4. As the supraspinatus was most commonly affected by pathological change among the four rotator cuff tendons, we took it as the research object. Then we used the Spearman correlation analysis to evaluate the relationship between UMI and fatty degeneration, rotator cuff tear size and the thickness of ruptured supraspinatus tendon from X-ray and MRI. RESULTS In the A-P view, the average UMI was 1.33 (1.02-1.51, SD: ±0.22). UMI and the tear size had a significant negative correlation (R=-0.584, P<0.01), and also there was a negative correlation between the fatty degeneration of the supraspinatus (R=-0.312, P=0.033). However, there was no correlation between UMI and the thickness of ruptured supraspinatus (R=0.127, P=0.071). CONCLUSION UMI is related with the fatty degeneration of supraspinatus and the tear size. The reduction of UMI is a predictable and reliable mark of rotator cuff tear and degeneration in clinic. Physicians can use physical examination and X-ray first when facing the patients with shoulder pain, which is convenient and helpful for evaluating rotator cuff tears.
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Tangrood ZJ, Gisselman AS, Sole G, Ribeiro DC. Clinical course of pain and disability in patients with subacromial shoulder pain: a systematic review protocol. BMJ Open 2018; 8:e019393. [PMID: 29743319 PMCID: PMC5942400 DOI: 10.1136/bmjopen-2017-019393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 03/14/2018] [Accepted: 04/03/2018] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Previous systematic reviews have identified the multiple factors impacting on the prognosis of shoulder pain. However, the typical clinical course of subacromial shoulder pain remains unclear. The aim of this systematic review is to assess the clinical course of pain and disability in patients with subacromial shoulder pain. METHOD AND ANALYSIS We will systematically search electronic databases (Medline, Embase and AMED (via Ovid), Web of Science, Cochrane Library and Scopus) from the date of inception to 28 February 2018 for randomised controlled trials (RCTs) and observational studies with patients with subacromial shoulder pain. We will follow patient groups measured with pain and disabilities with no intervention or usual care treatment. Two reviewers will extract the data, and assess the risk of bias within included studies. We will use the Cochrane Risk of Bias tool for RCTs, and a methodological quality assessment tool for observational studies. We will perform meta-analyses for changes in pain and disability scores for each group (usual care and no intervention) at different time categories (up to 6 weeks, 6-12 weeks, 12-26 weeks or more). If there are 10 or more studies, we will perform a meta-regression for each planned analysis. The outcomes of the included studies will be described individually if the above statistical methods are not possible. Findings from this review will be of interest to clinicians and researchers, and will describe the expected clinical course of subacromial shoulder pain. This study may indicate the potential differences between the clinical courses of pain and disability over time. ETHICS AND DISSEMINATION This review will not gather original data, hence ethical approval is not required. The results of this systematic review will be published in a peer-reviewed journal and presented at a scientific conference. PROSPERO REGISTRATION NUMBER CRD42016052518.
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Affiliation(s)
- Zohreh Jafarian Tangrood
- School of Physiotherapy, Centre for Health, Activity, and Rehabilitation Research (CHARR), University of Otago, Dunedin, New Zealand
| | - Angela Spontelli Gisselman
- School of Physiotherapy, Centre for Health, Activity, and Rehabilitation Research (CHARR), University of Otago, Dunedin, New Zealand
- Department of Physical Therapy, High Point University, High Point, North Carolina, USA
| | - Gisela Sole
- School of Physiotherapy, Centre for Health, Activity, and Rehabilitation Research (CHARR), University of Otago, Dunedin, New Zealand
| | - Daniel Cury Ribeiro
- School of Physiotherapy, Centre for Health, Activity, and Rehabilitation Research (CHARR), University of Otago, Dunedin, New Zealand
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Tran G, Hensor EMA, Ray A, Kingsbury SR, O'Connor P, Conaghan PG. Ultrasound-detected pathologies cluster into groups with different clinical outcomes: data from 3000 community referrals for shoulder pain. Arthritis Res Ther 2017; 19:30. [PMID: 28183338 PMCID: PMC5304553 DOI: 10.1186/s13075-017-1235-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/13/2017] [Indexed: 11/10/2022] Open
Abstract
Background Ultrasound is increasingly used to evaluate shoulder pain, but the benefits of this are unclear. In this study, we examined whether ultrasound-defined pathologies have implications for clinical outcomes. Methods We extracted reported pathologies from 3000 ultrasound scans of people with shoulder pain referred from primary care. In latent class analysis (LCA), we identified whether individual pathologies clustered in groups. Optimal group number was determined by the minimum Bayesian information criterion. A questionnaire was sent to all patients scanned over a 12-month period (n = 2322). Data collected included demographics, treatments received, current pain and function. The relationship between pathology-defined groups and clinical outcomes was examined. Results LCA revealed four groups: (1) bursitis with limited inflammation elsewhere (n = 1280), (2) bursitis with extensive inflammation (n = 595), (3) rotator cuff tears (n = 558) and (4) limited pathology (n = 567). A total of 777 subjects (33%) completed questionnaires. The median (IQR) duration post-ultrasound scan was 25 (22–29) months. Subsequent injections were most common in groups 1 and 2 (groups 1–4 76%, 67%, 48% and 61%, respectively); surgery was most common in group 3 (groups 1–4 23%, 21%, 28% and 16%, respectively). Shoulder Pain and Disability Index scores were highest in group 3 (median 48 and 30, respectively) and lowest in group 4 (median 32 and 9, respectively). Patients in group 4 who had surgery reported poor outcomes. Conclusions In a community-based population, we identified clusters of pathologies on the basis of ultrasound. Our retrospective data suggest that these groups have different treatment pathways and outcomes. This requires replication in a prospective study to determine the value of a pathology-based classification in people with shoulder pain. Electronic supplementary material The online version of this article (doi:10.1186/s13075-017-1235-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gui Tran
- Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, 2nd Floor, Chapeltown Road, Leeds, LS7 4SA, UK
| | - Elizabeth M A Hensor
- Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, 2nd Floor, Chapeltown Road, Leeds, LS7 4SA, UK.,NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Leeds, UK
| | - Aaron Ray
- Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, 2nd Floor, Chapeltown Road, Leeds, LS7 4SA, UK
| | - Sarah R Kingsbury
- Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, 2nd Floor, Chapeltown Road, Leeds, LS7 4SA, UK
| | - Philip O'Connor
- Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, 2nd Floor, Chapeltown Road, Leeds, LS7 4SA, UK.,NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Leeds, UK
| | - Philip G Conaghan
- Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, 2nd Floor, Chapeltown Road, Leeds, LS7 4SA, UK. .,NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Leeds, UK. .,Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Nottingham, UK.
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