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Perruccio AV, Young JJ, Wilfong JM, Denise Power J, Canizares M, Badley EM. Osteoarthritis year in review 2023: Epidemiology & therapy. Osteoarthritis Cartilage 2024; 32:159-165. [PMID: 38035975 DOI: 10.1016/j.joca.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/13/2023] [Accepted: 11/22/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To highlight some important findings from osteoarthritis (OA) epidemiology and therapy research undertaken over the past year. METHODS Search of MEDLINE and EMBASE databases between April 1, 2022 to March 3, 2023 using "exp *Osteoarthritis/" as the preliminary search term. The search was limited to articles published in English and including human subjects. Final inclusions were based on perceived importance and results that may inform improved identification of risk factors or OA treatments, as well as OA subgroups of potential relevance to risk factors or treatment approaches. RESULTS 3182 studies were screened, leaving 208 eligible for inclusion. This narrative review of thirty-three selected studies was arranged into: a) OA predictors - population-based studies, b) Specific predictors of OA and OA outcome; c) Intra-articular injections, and d) OA phenotypes. There was some suggestion of sex differences in predictors of incidence or outcomes. Body mass index changes appear largely to affect knee OA outcomes. Evidence points to a lack of benefit of viscosupplementation in knee OA; findings were variable for other injectables. Studies of OA phenotypes reveal potentially relevant clinical and pathophysiological differences. CONCLUSIONS Identifying risk factors for the incidence/progression of OA represents an ongoing and important area of OA research. Sex may play a role in this understanding and bears consideration and further study. For knee injectables other than viscosupplementation, additional high-quality trials appear warranted. Continued investigation and application of phenotyping across the OA disease, illness and care spectrum may be key to developing disease-modifying agents and their appropriate selection for individuals.
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Affiliation(s)
- Anthony V Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Arthritis Community Research and Epidemiology Unit (ACREU), University Health Network, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - James J Young
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Arthritis Community Research and Epidemiology Unit (ACREU), University Health Network, Toronto, Ontario, Canada; Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - Jessica M Wilfong
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Arthritis Community Research and Epidemiology Unit (ACREU), University Health Network, Toronto, Ontario, Canada.
| | - J Denise Power
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Arthritis Community Research and Epidemiology Unit (ACREU), University Health Network, Toronto, Ontario, Canada.
| | - Mayilee Canizares
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Arthritis Community Research and Epidemiology Unit (ACREU), University Health Network, Toronto, Ontario, Canada.
| | - Elizabeth M Badley
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Arthritis Community Research and Epidemiology Unit (ACREU), University Health Network, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
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Vella SP, Melman A, Coombs D, Maher CG, Swain MS, Monk E, Machado GC. The effectiveness of allied health and nurse practitioner models-of-care in managing musculoskeletal conditions in the emergency department: a systematic review and meta-analysis. BMC Emerg Med 2024; 24:13. [PMID: 38233743 PMCID: PMC10795385 DOI: 10.1186/s12873-023-00925-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/26/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Musculoskeletal conditions are the most common health condition seen in emergency departments. Hence, the most effective approaches to managing these conditions is of interest. This systematic review aimed to evaluate the effectiveness of allied health and nursing models of care for the management of musculoskeletal pain in ED. METHODS MEDLINE, EMBASE, CINAHL and LILACS databases were searched from inception to March 2023 for published randomised trials that compared the effectiveness of allied health and nursing models of care for musculoskeletal conditions in ED to usual ED care. Trials were eligible if they enrolled participants presenting to ED with a musculoskeletal condition including low back pain, neck pain, upper or lower limb pain and any soft tissue injury. Trials that included patients with serious pathology (e.g. malignancy, infection or cauda equina syndrome) were excluded. The primary outcome was patient-flow; other outcomes included pain intensity, disability, hospital admission and re-presentation rates, patient satisfaction, medication prescription and adverse events. Two reviewers performed search screening, data extraction, quality and certainty of evidence assessments. RESULTS We identified 1746 records and included 5 randomised trials (n = 1512 patients). Only one trial (n = 260) reported on patient-flow. The study provides very-low certainty evidence that a greater proportion of patients were seen within 20 min when seen by a physician (98%) than when seen by a nurse (86%) or physiotherapist (77%). There was no difference in pain intensity and disability between patients managed by ED physicians and those managed by physiotherapists. Evidence was limited regarding patient satisfaction, inpatient admission and ED re-presentation rates, medication prescription and adverse events. The certainty of evidence for secondary outcomes ranged from very-low to low, but generally did not suggest a benefit of one model over another. CONCLUSION There is limited research to judge the effectiveness of allied health and nursing models of care for the management of musculoskeletal conditions in ED. Currently, it is unclear as to whether allied health and nurse practitioners are more effective than ED physicians at managing musculoskeletal conditions in ED. Further high-quality trials investigating the impact of models of care on service and health outcomes are needed.
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Affiliation(s)
- Simon P Vella
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
- Sydney Musculoskeletal Health and Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia.
- Royal Prince Alfred Hospital, Level 10N, King George V Building, Missenden Road, Camperdown, NSW, 2050, Australia.
| | - Alla Melman
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sydney Musculoskeletal Health and Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia
| | - Danielle Coombs
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sydney Musculoskeletal Health and Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia
| | - Christopher G Maher
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sydney Musculoskeletal Health and Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia
| | - Michael S Swain
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Elizabeth Monk
- St George Hospital Emergency Department, Sydney, Australia
| | - Gustavo C Machado
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sydney Musculoskeletal Health and Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia
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Coutu MF, Durand MJ, O'Hagan F, Gosselin P, Nastasia I, Berbiche D, Labrecque MÉ, Pettigrew S, Bordeleau M. Workers' Worries, Pain, Psychosocial Factors, and Margin of Manoeuvre, in Relation to Outcomes in a Return-to-Work Program: An Exploratory Study. JOURNAL OF OCCUPATIONAL REHABILITATION 2023:10.1007/s10926-023-10155-x. [PMID: 37996721 DOI: 10.1007/s10926-023-10155-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE To explore the intensity and variation of workers' worries, pain, psychosocial factors, and margin of manoeuvre before and after a return-to-work program, and identified the psychosocial factors associated with non-return to work at the end of the rehabilitation program. METHODS A pre-post study design was used. A convenience sample of 80 workers starting a return-to-work program and having a compensated musculoskeletal injury that caused an absence of more than three months from their regular work was recruited. Data were collected at baseline and at the end of the rehabilitation program on the nature of the worries and maintenance factors defined in Dugas' generalized anxiety and worry model, using validated questionnaires. The margin of manoeuvre was assessed by the treating occupational therapist. A series of descriptive analyses were performed, as well as Generalized Estimating Equations analyses. RESULTS Workers' worries were work-related or disability-related 83% of the time at baseline. These worries were essentially based on the situation then occurring at work 90% of the time. For the Generalized Estimating Equations analyses on work status, the final model was significant, explaining 54% of the variance in non-return to work (Pseudo R2 = 0.54; p = 0.0001). Workers were 8.52 times less likely to return to work when the margin of manoeuvre was insufficient, and twice as likely not to return to work in the presence of intense worry. Worries were significantly associated with insufficient margin of manoeuvre. CONCLUSION A strong association between workers' lack of margin of manoeuvre at work and their worries about their return to work, and poor work outcomes, supports the importance of the worker-environment interaction in rehabilitation programs.
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Affiliation(s)
- Marie-France Coutu
- Centre for Action in Work Disability Prevention and Rehabilitation (CAPRIT), Université de Sherbrooke - Longueuil Campus, 150 Place Charles-Le Moyne, Longueuil, QC, Canada.
- Faculty of Medicine and Health Sciences, Université de Sherbrooke - Longueuil Campus, 150 Place Charles-Le Moyne, Longueuil, QC, Canada.
- Centre de recherche Charles-Le Moyne (CRCLM), Université de Sherbrooke - Longueuil Campus, 150 Place Charles-Le Moyne, Longueuil, QC, Canada.
| | - Marie-José Durand
- Centre for Action in Work Disability Prevention and Rehabilitation (CAPRIT), Université de Sherbrooke - Longueuil Campus, 150 Place Charles-Le Moyne, Longueuil, QC, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke - Longueuil Campus, 150 Place Charles-Le Moyne, Longueuil, QC, Canada
- Centre de recherche Charles-Le Moyne (CRCLM), Université de Sherbrooke - Longueuil Campus, 150 Place Charles-Le Moyne, Longueuil, QC, Canada
| | - Fergal O'Hagan
- Department of Psychology, Trent University, 1600 West Bank Drive, Peterborough, ON, Canada
| | - Patrick Gosselin
- Department of Psychology, Université de Sherbrooke, 2500 Boulevard de l'Université, Sherbrooke, QC, Canada
| | - Iuliana Nastasia
- Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST), 505 Boulevard De Maisonneuve Ouest, Montreal, QC, Canada
| | - Djamal Berbiche
- Faculty of Medicine and Health Sciences, Université de Sherbrooke - Longueuil Campus, 150 Place Charles-Le Moyne, Longueuil, QC, Canada
- Centre de recherche Charles-Le Moyne (CRCLM), Université de Sherbrooke - Longueuil Campus, 150 Place Charles-Le Moyne, Longueuil, QC, Canada
| | - Marie-Élise Labrecque
- Centre for Action in Work Disability Prevention and Rehabilitation (CAPRIT), Université de Sherbrooke - Longueuil Campus, 150 Place Charles-Le Moyne, Longueuil, QC, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke - Longueuil Campus, 150 Place Charles-Le Moyne, Longueuil, QC, Canada
- Centre de recherche Charles-Le Moyne (CRCLM), Université de Sherbrooke - Longueuil Campus, 150 Place Charles-Le Moyne, Longueuil, QC, Canada
| | - Sara Pettigrew
- Centre for Action in Work Disability Prevention and Rehabilitation (CAPRIT), Université de Sherbrooke - Longueuil Campus, 150 Place Charles-Le Moyne, Longueuil, QC, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke - Longueuil Campus, 150 Place Charles-Le Moyne, Longueuil, QC, Canada
- Centre de recherche Charles-Le Moyne (CRCLM), Université de Sherbrooke - Longueuil Campus, 150 Place Charles-Le Moyne, Longueuil, QC, Canada
| | - Martine Bordeleau
- Elderly, Neurostimulation and Pain Research Group, Research Centre on Aging, 1036 Rue Belvédère Sud, Sherbrooke, QC, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 2500 Boulevard de l'Université, Sherbrooke, QC, Canada
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Gorrell MChiroprac LM, Nyirö L, Pasquier M, Pagé I, Heneghan NR, Schweinhardt P, Descarreaux M. Spinal mobilization force-time characteristics: A scoping literature review. PLoS One 2023; 18:e0289462. [PMID: 37963125 PMCID: PMC10645339 DOI: 10.1371/journal.pone.0289462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/24/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Spinal mobilization (SMob) is often included in the conservative management of spinal pain conditions as a recommended and effective treatment. While some studies quantify the biomechanical (kinetic) parameters of SMob, interpretation of findings is difficult due to poor reporting of methodological details. The aim of this study was to synthesise the literature describing force-time characteristics of manually applied SMob. METHODS This study is reported in accordance with the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR) statement. Databases were searched from inception to October 2022: MEDLINE (Ovid), Embase, CINAHL, ICL, PEDro and Cochrane Library. Data were extracted and reported descriptively for the following domains: general study characteristics, number of and characteristics of individuals who delivered/received SMob, region treated, equipment used and force-time characteristics of SMob. RESULTS There were 7,607 records identified and of these, 36 (0.5%) were included in the analysis. SMob was delivered to the cervical spine in 13 (36.1%), the thoracic spine in 3 (8.3%) and the lumbopelvic spine in 18 (50.0%) studies. In 2 (5.6%) studies, spinal region was not specified. For SMob applied to all spinal regions, force-time characteristics were: peak force (0-128N); duration (10-120s); frequency (0.1-4.5Hz); and force amplitude (1-102N). CONCLUSIONS This study reports considerable variability of the force-time characteristics of SMob. In studies reporting force-time characteristics, SMob was most frequently delivered to the lumbar and cervical spine of humans and most commonly peak force was reported. Future studies should focus on the detailed reporting of force-time characteristics to facilitate the investigation of clinical dose-response effects.
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Affiliation(s)
- Lindsay M. Gorrell MChiroprac
- Department of Chiropractic Medicine, Integrative Spinal Research Group, University Hospital Balgrist and University of Zürich, Zürich, Switzerland
| | - Luana Nyirö
- Department of Chiropractic Medicine, Integrative Spinal Research Group, University Hospital Balgrist and University of Zürich, Zürich, Switzerland
| | | | - Isabelle Pagé
- Department of chiropractic, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Québec City, QC, Canada
| | - Nicola R. Heneghan
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Petra Schweinhardt
- Department of Chiropractic Medicine, Integrative Spinal Research Group, University Hospital Balgrist and University of Zürich, Zürich, Switzerland
| | - Martin Descarreaux
- Institut Franco-Européen de Chiropraxie, Toulouse, France
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
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