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Kelly M, Fullen BM, Martin D, Bradley C, McVeigh JG. eHealth interventions to support self-management: Perceptions and experiences of people with musculoskeletal disorders and physiotherapists - 'eHealth: It's TIME': A qualitative study. Physiother Theory Pract 2024; 40:1011-1021. [PMID: 36426843 DOI: 10.1080/09593985.2022.2151334] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 10/25/2022] [Accepted: 11/19/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is increasing interest in the potential role of eHealth interventions to support self-management in people with musculoskeletal disorders (MSDs). The COVID-19 pandemic appears to have been a significant catalyst for the implementation of eHealth modalities into routine practice, providing a unique opportunity for real-world evaluation of this underutilized method of delivering physiotherapy. OBJECTIVE To explore the perceptions of eHealth-mediated supported self-management from the perspective of people with MSDs and physiotherapists who work in this clinical area. METHODS A qualitative interpretive descriptive approach was used. Semi-structured telephone interviews with 13 musculoskeletal physiotherapists and 13 people with musculoskeletal disorders were undertaken. Transcripts were analyzed using reflexive thematic analysis. RESULTS Three main themes were identified: 1) Flexibility within a blended care model; 2) eHealth as a facilitator of self-management support; and 3) Technology: Getting it right. Participants expressed concerns about assessment and diagnosis, establishing a therapeutic relationship and felt eHealth should be reserved for follow-up purposes. There was a consistent view expressed that eHealth could facilitate aspects of self-management support. A lack of resources and suboptimal user experience remains a challenge. CONCLUSIONS eHealth-mediated self-management support interventions were broadly acceptably, predominately as a follow-up option.
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Affiliation(s)
- Marie Kelly
- Discipline of Physiotherapy, School of Clinical Therapies, College of Medicine and Health, University College Cork, Cork, Ireland
- Department of Physiotherapy, Mercy University Hospital, Cork, Ireland
| | - Brona M Fullen
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Denis Martin
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Colin Bradley
- Department of General Practice, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Joseph G McVeigh
- Discipline of Physiotherapy, School of Clinical Therapies, College of Medicine and Health, University College Cork, Cork, Ireland
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Mou K, Chan SMH, Vlahos R. Musculoskeletal crosstalk in chronic obstructive pulmonary disease and comorbidities: Emerging roles and therapeutic potentials. Pharmacol Ther 2024; 257:108635. [PMID: 38508342 DOI: 10.1016/j.pharmthera.2024.108635] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/13/2024] [Accepted: 03/11/2024] [Indexed: 03/22/2024]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a multifaceted respiratory disorder characterized by progressive airflow limitation and systemic implications. It has become increasingly apparent that COPD exerts its influence far beyond the respiratory system, extending its impact to various organ systems. Among these, the musculoskeletal system emerges as a central player in both the pathogenesis and management of COPD and its associated comorbidities. Muscle dysfunction and osteoporosis are prevalent musculoskeletal disorders in COPD patients, leading to a substantial decline in exercise capacity and overall health. These manifestations are influenced by systemic inflammation, oxidative stress, and hormonal imbalances, all hallmarks of COPD. Recent research has uncovered an intricate interplay between COPD and musculoskeletal comorbidities, suggesting that muscle and bone tissues may cross-communicate through the release of signalling molecules, known as "myokines" and "osteokines". We explored this dynamic relationship, with a particular focus on the role of the immune system in mediating the cross-communication between muscle and bone in COPD. Moreover, we delved into existing and emerging therapeutic strategies for managing musculoskeletal disorders in COPD. It underscores the development of personalized treatment approaches that target both the respiratory and musculoskeletal aspects of COPD, offering the promise of improved well-being and quality of life for individuals grappling with this complex condition. This comprehensive review underscores the significance of recognizing the profound impact of COPD on the musculoskeletal system and its comorbidities. By unravelling the intricate connections between these systems and exploring innovative treatment avenues, we can aspire to enhance the overall care and outcomes for COPD patients, ultimately offering hope for improved health and well-being.
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Affiliation(s)
- Kevin Mou
- Centre for Respiratory Science and Health, School of Health & Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Stanley M H Chan
- Centre for Respiratory Science and Health, School of Health & Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Ross Vlahos
- Centre for Respiratory Science and Health, School of Health & Biomedical Sciences, RMIT University, Melbourne, VIC, Australia.
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Tang S, Sheng L, Xia J, Xu B, Jin P. The effectiveness of instrument-assisted soft tissue mobilization on range of motion: a meta-analysis. BMC Musculoskelet Disord 2024; 25:319. [PMID: 38654270 PMCID: PMC11036573 DOI: 10.1186/s12891-024-07452-8] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/17/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND To evaluate the effectiveness of instrument-assisted soft tissue mobilization (IASTM) on range of motion (ROM). METHODS We performed a literature search of the PubMed, Embase, Web of Science, and Cochrane Library databases from inception to December 23, 2023. Randomized controlled trials that compared treatment groups receiving IASTM to controls or IASTM plus another treatment(s) to other treatment(s) among healthy individuals with or without ROM deficits, or patients with musculoskeletal disorders were included. The Cochrane risk of bias tool was used to assess the risk of bias. RESULTS Nine trials including 450 participants were included in the quantitative analysis. The IASTM was effective in improving ROM in degree in healthy individuals with ROM deficits and patients with musculoskeletal disorders (n=4) (MD = 4.94, 95% CI: 3.29 to 6.60), and in healthy individuals without ROM deficits (n=4) (MD = 2.32, 95% CI: 1.30 to 3.34), but failed to improve ROM in centimeter in healthy individuals with ROM deficits (n=1) (MD = 0.39, 95% CI: -1.34 to 2.11, p=0.66, I2 = 88%). CONCLUSIONS IASTM can improve ROM in degree in healthy individuals with or without ROM deficits, or in patients with musculoskeletal disorders (with very low to low certainty). TRIAL REGISTRATION The PROSPERO registration ID is CRD42023425200.
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Affiliation(s)
- Sien Tang
- The Fourth Rehabilitation Hospital of Shanghai, No. 995 Kangding Road, Jing'an District, Shanghai, 200000, China.
| | - Li Sheng
- The Fourth Rehabilitation Hospital of Shanghai, No. 995 Kangding Road, Jing'an District, Shanghai, 200000, China
| | - Jinming Xia
- The Fourth Rehabilitation Hospital of Shanghai, No. 995 Kangding Road, Jing'an District, Shanghai, 200000, China
| | - Bing Xu
- The Fourth Rehabilitation Hospital of Shanghai, No. 995 Kangding Road, Jing'an District, Shanghai, 200000, China
| | - Peiyong Jin
- The Fourth Rehabilitation Hospital of Shanghai, No. 995 Kangding Road, Jing'an District, Shanghai, 200000, China
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Barnett R, Shakaib N, Ingram TA, Jones S, Sengupta R, Rouse PC. Rehabilitation interventions delivered via telehealth to support self-management of rheumatic and musculoskeletal diseases: A scoping review protocol. PLoS One 2024; 19:e0301668. [PMID: 38625966 PMCID: PMC11020871 DOI: 10.1371/journal.pone.0301668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 03/20/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Telerehabilitation is a term to describe rehabilitation services delivered via information and communication technology. Such services are an increasingly important component for the management of rheumatic and musculoskeletal diseases (RMDs). Telerehabilitation has the potential to expand the long-term self-management options for individuals with RMDs, improve symptoms, and relieve pressures on health care services. Yet, little is known about the variety of interventions implemented, and how they are being evaluated. Thus, this scoping review aims to identify and describe existing rehabilitation interventions delivered via telehealth for RMDs. Specifically, we aim to identify and summarize the key components of rehabilitation, the technology used, the level of health care professional interaction, and how the effectiveness of interventions is evaluated. METHODS We will conduct this review following the latest JBI scoping review methodology and the PRISMA guidelines for Scoping Reviews (PRISMA-ScR). The 'Population-Concept-Context (PCC)' framework will be used, whereby the 'Population' is RMDs (≥18 years); the 'Concept' is rehabilitation; and the 'Context' is telehealth. Developed in collaboration with a subject Librarian, refined PCC key terms will be utilized to search (from 2011-2021) three electronic databases (i.e., Embase, Scopus, Web of Science) for articles published in English. Search results will be exported to the citation management software (EndNote), duplicates removed, and eligibility criteria applied to title/abstract and full-text review. Relevant information pertaining to the PCC framework will be extracted. Data will be summarized qualitatively, and if appropriate, quantitatively via frequency counts of the components comprising the 'Concept' and 'Context' categories of the PCC framework. DISCUSSION Findings from the proposed scoping review will identify how telehealth is currently used in the delivery of rehabilitation interventions for RMDs. The findings will develop our understanding of such interventions and provide a platform from which to inform future research directions.
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Affiliation(s)
| | - Nuzhat Shakaib
- Department for Health, University of Bath, Bath, United Kingdom
| | | | - Simon Jones
- Department of Computer Science, University of Bath, Bath, United Kingdom
| | - Raj Sengupta
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
- Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom
| | - Peter C. Rouse
- Department for Health, University of Bath, Bath, United Kingdom
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Giovannico G, Pappaccogli M, Cioeta M, Pellicciari L, Youssef S, Angilecchia D, Giannotta G, Brindisino F. The Musculoskeletal 30-question multiple choice questionnaire (MSK-30): a new assessing tool of musculoskeletal competence in a sample of Italian physiotherapists. BMC Musculoskelet Disord 2024; 25:265. [PMID: 38575894 PMCID: PMC10996259 DOI: 10.1186/s12891-024-07400-6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/30/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND The prevalence and cost of musculoskeletal diseases increased dramatically over the past few decades. Therefore, several institutions have begun to re-evaluate the quality of their musculoskeletal educational paths. However, current standardized questionnaires inadequately assess musculoskeletal knowledge, and other musculoskeletal-specific exams have limitations in implementation. The musculoskeletal 30-question multiple choice questionnaire (MSK-30) was proposed as a new tool for assessing basic musculoskeletal knowledge. AIM To analyse basic musculoskeletal knowledge in a sample of Italian physiotherapists by administering the MSK-30 questionnaire. METHODS After a transcultural adaptation process, the MSK-30 was developed and administered to Italian physiotherapists to assess their musculoskeletal knowledge. Participants were invited to participate in the survey via the SurveyMonkey link. Mann-Whitney test and the Kruskal-Wallis test with Bonferroni correction were used to observe the differences between groups in the MSK-30 scores. RESULTS Four hundred-fourteen (n=414) physiotherapists participated in the survey. The median MSK-30 value was higher in physiotherapists who attended the International Federation of Orthopaedic Manipulative Physical Therapists postgraduate certification than in those who attended unstructured postgraduate training in musculoskeletal condition or in those who had not completed any postgraduate training in this field (p<0.001). CONCLUSIONS This work demonstrates significant differences in the management of musculoskeletal disorders between those with specific postgraduate university education and those without. The findings can contribute to the advancement of the physiotherapy profession in Italy. Authors recommend further research with more robust methodologies to deeper understand this topic. Musculoskeletal conditions will continue to represent a significant portion of primary care visits, and future generations of physiotherapists must be prepared to address this challenge.
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Affiliation(s)
- Giuseppe Giovannico
- Department of Medicine and Health Science Vincenzo Tiberio, University of Molise c/o Cardarelli Hospital, C/da Tappino, 86100, Campobasso, Italy
| | - Marco Pappaccogli
- Department of Medicine and Health Science Vincenzo Tiberio, University of Molise c/o Cardarelli Hospital, C/da Tappino, 86100, Campobasso, Italy
| | | | | | - Saad Youssef
- Department of Medicine and Health Science Vincenzo Tiberio, University of Molise c/o Cardarelli Hospital, C/da Tappino, 86100, Campobasso, Italy
| | - Domenico Angilecchia
- Department of Medicine and Health Science Vincenzo Tiberio, University of Molise c/o Cardarelli Hospital, C/da Tappino, 86100, Campobasso, Italy
- Rehabilitation service - ASL Bari, Bari, Italy
| | - Gabriele Giannotta
- Scientific Institute IRCCS "E. Medea" - Unit for Severe disabilities in developmental age and young adults Developmental Neurology and Neurorehabilitation, Brindisi, Italy
| | - Fabrizio Brindisino
- Department of Medicine and Health Science Vincenzo Tiberio, University of Molise c/o Cardarelli Hospital, C/da Tappino, 86100, Campobasso, Italy
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Withers HG, Glinsky JV, Chu J, Jennings MD, Starkey I, Parmeter R, Boulos M, Cruwys JJ, Duong K, Jordan I, Wong D, Trang S, Duong M, Liu H, Hayes AJ, Lambert TE, Zadro JR, Sherrington C, Maher C, Lucas BR, Taylor D, Ferreira ML, Harvey LA. Remotely delivered physiotherapy is as effective as face-to-face physiotherapy for musculoskeletal conditions (REFORM): a randomised trial. J Physiother 2024; 70:124-133. [PMID: 38494405 DOI: 10.1016/j.jphys.2024.02.016] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/09/2024] [Accepted: 02/26/2024] [Indexed: 03/19/2024] Open
Abstract
QUESTION Is remotely delivered physiotherapy as good or better than face-to-face physiotherapy for the management of musculoskeletal conditions? DESIGN Randomised controlled, non-inferiority trial with concealed allocation, blinded assessors and intention-to-treat analysis. PARTICIPANTS A total of 210 adult participants with a musculoskeletal condition who presented for outpatient physiotherapy at five public hospitals in Sydney. INTERVENTION One group received a remotely delivered physiotherapy program for 6 weeks that consisted of one face-to-face physiotherapy session in conjunction with weekly text messages, phone calls at 2 and 4 weeks, and an individualised home exercise program delivered through an app. The other group received usual face-to-face physiotherapy care in an outpatient setting. OUTCOME MEASURES The primary outcome was the Patient Specific Functional Scale at 6 weeks with a pre-specified non-inferiority margin of -15 out of 100 points. Secondary outcomes included: the Patient Specific Functional Scale at 26 weeks; kinesiophobia, pain, function/disability, global impression of change and quality of life at 6 and 26 weeks; and satisfaction with service delivery at 6 weeks. RESULTS The mean between-group difference (95% CI) for the Patient Specific Functional Scale at 6 weeks was 2.7 out of 100 points (-3.5 to 8.8), where a positive score favoured remotely delivered physiotherapy. The lower end of the 95% CI was greater than the non-inferiority margin. Whilst non-inferiority margins were not set for the secondary outcomes, the 95% CI of the mean between-group difference ruled out clinically meaningful differences. CONCLUSION Remotely delivered physiotherapy with support via phone, text and an app is as good as face-to-face physiotherapy for the management of musculoskeletal conditions. TRIAL REGISTRATION ACTRN12619000065190.
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Affiliation(s)
- Hannah G Withers
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Joanne V Glinsky
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Jackie Chu
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | | | - Ian Starkey
- Physiotherapy Department, Blacktown and Mt Druitt Hospitals, Sydney, Australia
| | - Rachel Parmeter
- Physiotherapy Department, Blacktown and Mt Druitt Hospitals, Sydney, Australia
| | - Max Boulos
- Musculoskeletal and Cancer Outpatients, Orthopaedics, ED, Fracture Clinic, Women's Health, Camden and Campbelltown Hospital, Sydney, Australia
| | - Jackson J Cruwys
- Physiotherapy Department, Camden and Campbelltown Hospital, Sydney, Australia
| | - Kitty Duong
- Physiotherapy Department, Camden and Campbelltown Hospital, Sydney, Australia
| | - Ian Jordan
- Physiotherapy Department, Hornsby-Ku-Ring-Gai Hospital, Sydney, Australia
| | - David Wong
- Physiotherapy Department, Liverpool Hospital, Sydney, Australia
| | - San Trang
- Physiotherapy Department, Bankstown-Lidcombe Hospital, Sydney, Australia
| | - Maggie Duong
- Physiotherapy Department, Bankstown-Lidcombe Hospital, Sydney, Australia
| | - Hueiming Liu
- The George Institute for Global Health, Sydney, Australia
| | - Alison J Hayes
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Tara E Lambert
- Physiotherapy Department, Royal North Shore Hospital, Sydney, Australia
| | - Joshua R Zadro
- Institute for Musculoskeletal Health, The University of Sydney, Sydney, Australia
| | | | - Christopher Maher
- Institute for Musculoskeletal Health, The University of Sydney, Sydney, Australia
| | - Barbara R Lucas
- Sydney Musculoskeletal Health, School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Deborah Taylor
- Physiotherapy Department, Royal North Shore Hospital, Sydney, Australia
| | - Manuela L Ferreira
- Sydney Musculoskeletal Health, School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Lisa A Harvey
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
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Lanhers C, Grolier M, Dutheil F, Gay C, Goldstein A, Mourgues C, Levyckyj C, Pereira B, Coudeyre E. Comparison of self-management and spa therapy for upper-extremity musculoskeletal disorders: A randomized controlled trial. Ann Phys Rehabil Med 2024; 67:101813. [PMID: 38479114 DOI: 10.1016/j.rehab.2023.101813] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 11/28/2023] [Accepted: 12/05/2023] [Indexed: 04/13/2024]
Abstract
BACKGROUND Musculoskeletal disorders (MSDs) are common in the workplace and are a public health issue. Persistent pain despite conservative treatment or surgery may lead to poor long-term outcomes. OBJECTIVE To compare the effect of a combined 6-day program of exercise, self-management workshops and spa therapy with self-management on functional capacity in personal and professional daily life at 3 months in people with musculoskeletal disorders. METHODS We conducted a prospective, randomized controlled trial. Participants were employed (any type of work) and aged between 18 and 65 years, with latent or symptomatic upper extremity MSDs, with or without a history of sick leave. They were randomized to participate in 6 days (2 h per day) of spa therapy, exercise, and self-management workshops immediately (intervention) or at 3 months (control). The control group performed self-management until 3 months. The primary outcome was the score on the self-reported Quick Disability of Arm-Shoulder-Hand (QuickDASH) at 3 months. The primary analysis was conducted using analysis of covariance with baseline QuickDASH score as the covariate. RESULTS In total, 150 participants were randomized (85 % women): 78 to the control group and 72 to the intervention group. At 3 months, the QuickDASH total and work scores did not differ between groups (effect-size [ES] = -0.15, 95 %CI, -0.38 to 0.09, p = 0.215, and ES = -0.11, 95 % CI, -0.35 to 0.12, p = 0.343). However, QuickDASH sport/performing arts score was significantly different between randomization groups at 3 months (ES =-0.25, 95 % CI, -0.48 to -0.02, p = 0.035). CONCLUSIONS This study provided no evidence in favor of a short-course, personalized self-management, intensive spa therapy intervention over self-management alone for the management of upper-extremity MSDs. TRIAL REGISTRATION ClinicalTrials.gov (NCT02702466) retrospectively registered.
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Affiliation(s)
- Charlotte Lanhers
- Service de Médecine Physique et de Réadaptation, CHU Clermont-Ferrand, Université Clermont Auvergne, INRAE, UNH, F-63000 Clermont-Ferrand, France.
| | - Maxime Grolier
- Service de Médecine Physique et de Réadaptation, CHU Clermont-Ferrand, Université Clermont Auvergne, INRAE, UNH, F-63000 Clermont-Ferrand, France
| | - Frédéric Dutheil
- Service de santé au travail, CHU Clermont-Ferrand, Université Clermont Auvergne, CNRS, LaPSCo, F-63 000 Clermont-Ferrand, France
| | - Chloé Gay
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, F-63 000, Clermont-Ferrand, France
| | - Anna Goldstein
- Direction de la Recherche Clinique et de l'Innovation, Unité de Biostatistiques CHU Clermont-Ferrand, F-63 000 Clermont-Ferrand, France
| | - Charline Mourgues
- Direction de la Recherche Clinique et de l'Innovation, Unité de Biostatistiques CHU Clermont-Ferrand, F-63 000 Clermont-Ferrand, France
| | | | - Bruno Pereira
- Direction de la Recherche Clinique et de l'Innovation, Unité de Biostatistiques CHU Clermont-Ferrand, F-63 000 Clermont-Ferrand, France
| | - Emmanuel Coudeyre
- Service de Médecine Physique et de Réadaptation, CHU Clermont-Ferrand, Université Clermont Auvergne, INRAE, UNH, F-63000 Clermont-Ferrand, France
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Kelly M. CORR Insights®: Can a Psychological Profile Predict Successful Return to Full Duty After a Musculoskeletal Injury? Clin Orthop Relat Res 2024; 482:630-632. [PMID: 38363558 PMCID: PMC10936998 DOI: 10.1097/corr.0000000000003008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/23/2024] [Indexed: 02/17/2024]
Affiliation(s)
- Michael Kelly
- Professor Of Clinical Orthopaedic Surgery, University of California San Diego, Department of Orthopaedic Surgery, San Diego, CA, USA
- Director of Scoliosis and Spinal Deformities, Division of Orthopedics & Scoliosis at Rady Children's Hospital-San Diego, San Diego, CA, USA
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Saul H, Cassidy S, Swaithes L, Pavlova A. Weights, resistance bands, and rest days are best for tendinopathy. BMJ 2024; 384:q513. [PMID: 38438195 DOI: 10.1136/bmj.q513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
The studyPavlova AV, Shim JSC, Moss R, et al. Effect of resistance exercise dose components for tendinopathy management: a systematic review with meta-analysis. Br J Sports Med 2023;57:1327-34.To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/weights-resistance-bands-rest-days-best-tendinopathy/.
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Klemm P, Schulz N, Boettger P, Lange U. Heat therapy in rheumatic and musculoskeletal diseases - an overview of clinical and molecular effects. Int J Hyperthermia 2024; 41:2322667. [PMID: 38439192 DOI: 10.1080/02656736.2024.2322667] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/20/2024] [Indexed: 03/06/2024] Open
Abstract
Rheumatic and musculoskeletal diseases (RMDs) usually lead to morphological and functional deficits of various extend, increased morbidity and a considerable loss of quality of life. Modern pharmacological treatment has become effective and can stop disease progression. Nonetheless, disease progression is often only slowed down. Moreover, pharmacological treatment does not improve functionality per se. Therefore, multimodal treatment of rheumatic disorders with physical therapy being a key element is of central importance for best outcomes. In recent years, research into physical medicine shifted from a sole investigation of its clinical effects to a combined investigation of clinical effects and potential changes in the molecular level (e.g., inflammatory cytokines and the cellular autoimmune system), thus offering new explanations of clinical effects of physical therapy. In this review we provide an overview of studies investigating different heat applications in RMDs, their effect on disease activity, pain and their influence on the molecular level.
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Affiliation(s)
- Philipp Klemm
- Department of Rheumatology, Clinical Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig-University Gießen, Bad Nauheim, Germany
| | - Nils Schulz
- Department of Rheumatology, Clinical Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig-University Gießen, Bad Nauheim, Germany
| | - Priyanka Boettger
- Department of Rheumatology, Clinical Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig-University Gießen, Bad Nauheim, Germany
| | - Uwe Lange
- Department of Rheumatology, Clinical Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig-University Gießen, Bad Nauheim, Germany
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11
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Barrett DR, Nielsen LM, Rhon DI, Young JL. What are patients' perspectives on the value of physical therapy? A prospective cohort study. Musculoskeletal Care 2024; 22:e1871. [PMID: 38393306 DOI: 10.1002/msc.1871] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE To assess and identify patients' perceptions about the overall value of physical therapy services for musculoskeletal conditions and how these values were associated with their outcomes. METHODS The association between the perceived value of physical therapy (as a score) and Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference and physical function at 6-weeks was assessed in a prospective cohort. Generalised linear models were used to identify relationships between the value of physical therapy score and PROMIS outcomes. Kendall's tau was used to identify correlations between responses and outcomes. RESULTS A total of 133 participants met the final inclusion criteria. The majority of participants were female (63.9%) with a mean age of 55.53 (SD 15.36) years. A majority of participants (63.9%) reported a previous positive personal experience with physical therapy. There was no significant relationship between perceived value of physical therapy and pain interference (β -0.32, p = 0.07, 95% CI-0.67, 0.03) or physical function (β 0.19, p = 0.29, 95% CI-0.16, 0.54). Stronger beliefs in agreement with the value of non-invasive treatment were significant, but weakly correlated with lower pain interference (r = -0.18, p = 0.048) and higher physical function scores (r = 0.22, p = 0.03). CONCLUSIONS Participants had an overall positive perception of the value of physical therapy prior to initiating physical therapy, but this perception was not associated with 6-week pain and function outcomes. A better understanding of the driving factors encouraging patients to seek physical therapy services is needed to provide value-based care.
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Affiliation(s)
- Dustin R Barrett
- Bellin College, Physical Therapy, Green Bay, Wisconsin, USA
- Department of Physical Therapy, Emory and Henry College, Marion, Virginia, USA
| | | | - Daniel I Rhon
- Bellin College, Physical Therapy, Green Bay, Wisconsin, USA
- Department of Physical Medicine & Rehabilitation, F. Edward Hébert School of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Jodi L Young
- Bellin College, Physical Therapy, Green Bay, Wisconsin, USA
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Kawai A. [Musculoskeletal Tumor Basic Research Which May Change the Management of Musculoskeletal Tumors in the Future]. Gan To Kagaku Ryoho 2024; 51:254. [PMID: 38494803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Affiliation(s)
- Akira Kawai
- Dept. of Musculoskeletal Oncology and Rehabilitation Medicine, National Cancer Center Hospital
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13
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Teixeira MJC, Ahmed R, Tehrany R, Jaggi A, Ramanuj P. Collaborative care model versus usual care for the management of musculoskeletal and co-existing mental health conditions: a randomised feasibility mixed-methods study. BMJ Open 2024; 14:e079707. [PMID: 38387980 PMCID: PMC10882312 DOI: 10.1136/bmjopen-2023-079707] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 01/26/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVE This study aimed to assess the feasibility of a future trial comparing the collaborative care model with usual care for patients with musculoskeletal conditions and co-existing symptoms of anxiety and depression. DESIGN A single-centre, parallel-arm, one-to-one, randomised controlled trial design using a mixed-methods approach was used. semistructured interviews and focus groups were conducted post intervention with all participants and staff respectively to explore acceptability towards the model and identify recommendations for improvements. SETTING An orthopaedic rehabilitation outpatient tertiary hospital. PARTICIPANTS Adult patients with musculoskeletal conditions and co-existing moderate or severe symptoms of anxiety and depression attending outpatient therapy appointments. INTERVENTION The collaborative care model consisted of a tailored management programme to facilitate the integration of care provided by physical and mental healthcare professionals. A case manager screened and coordinated targeted mental health support for participants. Participants allocated to usual care had no support from the case manager. MAIN OUTCOMES MEASURE Feasibility indicators (rates of recruitment, randomisation and retention), acceptability of clinical outcome measures, usage of additional resources and cost of intervention implementation. RESULTS Of the 89 patients who provided consent to take part, 40 participants who matched the eligibility criteria were randomised to either the intervention (n=20) or usual care arm (n=20). Overall adherence to the intervention was 58.82%, while the withdrawal rate was 37.5% at 6 months. All of the 27 participants who were retained completed self-reported outcomes. Qualitative data highlighted that integrated mental health support was favourably perceived. In addition to prenegotiating protected psychology time, the need for operationalised communication between the case manager and clinicians was identified as a recommendation for a future trial. CONCLUSIONS The trial and intervention were acceptable to patients and healthcare professionals. While the findings demonstrate the feasibility of trial recruitment, a future trial will require optimised retention strategies to improve adherence and withdrawal rates. TRIAL REGISTRATION NUMBER NCT05018039.
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Affiliation(s)
| | - Refah Ahmed
- East London NHS Foundation Trust, London, UK
| | - Rokhsaneh Tehrany
- Therapies Departament, Royal National Orthopaedic Hospital NHS Trust, London, UK
- University College London, London, UK
| | - Anju Jaggi
- Therapies Departament, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
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14
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Bargeri S, Castellini G, Vitale JA, Guida S, Banfi G, Gianola S, Pennestrì F. Effectiveness of Telemedicine for Musculoskeletal Disorders: Umbrella Review. J Med Internet Res 2024; 26:e50090. [PMID: 38306156 PMCID: PMC10873802 DOI: 10.2196/50090] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/02/2023] [Accepted: 11/29/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Several systematic reviews (SRs) assessing the use of telemedicine for musculoskeletal conditions have been published in recent years. However, the landscape of evidence on multiple clinical outcomes remains unclear. OBJECTIVE We aimed to summarize the available evidence from SRs on telemedicine for musculoskeletal disorders. METHODS We conducted an umbrella review of SRs with and without meta-analysis by searching PubMed and EMBASE up to July 25, 2022, for SRs of randomized controlled trials assessing telemedicine. We collected any kind of patient-reported outcome measures (PROMs), patient-reported experience measures (PREMs), and objective measures, including direct and indirect costs. We assessed the methodological quality with the AMSTAR 2 tool (A Measurement Tool to Assess systematic Reviews 2). Findings were reported qualitatively. RESULTS Overall, 35 SRs published between 2015 and 2022 were included. Most reviews (n=24, 69%) were rated as critically low quality by AMSTAR 2. The majority of reviews assessed "telerehabilitation" (n=29) in patients with osteoarthritis (n=13) using PROMs (n=142 outcomes mapped with n=60 meta-analyses). A substantive body of evidence from meta-analyses found telemedicine to be beneficial or equal in terms of PROMs compared to conventional care (n=57 meta-analyses). Meta-analyses showed no differences between groups in PREMs (n=4), while objectives measures (ie, "physical function") were mainly in favor of telemedicine or showed no difference (9/13). All SRs showed notably lower costs for telemedicine compared to in-person visits. CONCLUSIONS Telemedicine can provide more accessible health care with noninferior results for various clinical outcomes in comparison with conventional care. The assessment of telemedicine is largely represented by PROMs, with some gaps for PREMs, objective measures, and costs. TRIAL REGISTRATION PROSPERO CRD42022347366; https://osf.io/pxedm/.
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Affiliation(s)
- Silvia Bargeri
- Unità di Epidemiologia Clinica, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Greta Castellini
- Unità di Epidemiologia Clinica, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | - Stefania Guida
- Unità di Epidemiologia Clinica, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Giuseppe Banfi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Università Vita-Salute San Raffaele, Milan, Italy
| | - Silvia Gianola
- Unità di Epidemiologia Clinica, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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15
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Hohmann E. Editorial Commentary: Platelet-Rich Plasma for Musculoskeletal Conditions Is Supported by a Large Number of Clinical Studies, Particularly for Knee Osteoarthritis. Arthroscopy 2024; 40:478-480. [PMID: 38296448 DOI: 10.1016/j.arthro.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 02/08/2024]
Abstract
Platelet-rich plasma (PRP) represents a biological treatment for various musculoskeletal conditions. Over the past 20 years, publications regarding the treatment of orthopaedic conditions with PRP have shown a 4-fold increase. Several systematic reviews and meta-analyses have demonstrated that PRP is effective and often superior to other treatment modalities. However, the value of these studies is somehow limited as high risk of bias, study heterogeneity, and low levels of certainty compromise the validity of their conclusions. In this scenario, expert consensus studies can be useful and allow pooling of expert opinion in a scientific manner. Using the modified Delphi technology, it was determined that the definition of PRP, whether leukocyte rich or poor, is still not clear. In addition, it remains unclear whether PRP should be activated, how often it should be injected, what the ideal dose is and how to prepare PRP. Despite these uncertainties, the use PRP for various orthopaedic conditions, in particular for the treatment of knee osteoarthritis, is supported by a large number of clinical studies. However, its use remains an unsolved controversy, and the foundation of a biologics association is a step in the right direction to develop standards and foster research with regards to the safety, clinical efficacy, and clinical applications of orthobiologics. In summary, there is no strong consensus, but many individual statements result in a strong consensus rating.
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16
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Wassell M, Vitiello A, Pollard H. Electronic Health Records Role in Predicting Outcomes to Work-Related Musculoskeletal Disorders: A Study Protocol. Stud Health Technol Inform 2024; 310:1356-1357. [PMID: 38270041 DOI: 10.3233/shti231192] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Work-related musculoskeletal disorders are increasing in cost and time lost from work. Electronic health records have the potential to provide rich data to help inform and predict outcomes to WMSDs. The objective is to compare an EHR dataset from an occupational health service to comparative data, to help determine if the EHR dataset can be used in future studies to predict outcomes to care.
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Affiliation(s)
| | | | - Henry Pollard
- Central Queensland University, Queensland, Australia
- Durban University of Technology, South Africa
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17
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O'Farrell R, Maguire S, Moore L, Murray K, Gorman A, Ball E, Riddell C, O'Neill M, Jordan N, O'Shea F, Veale D, Donnelly S, Murphy G, Fitzgerald G. Delivering Care for Pregnant Women with Rheumatic and Musculoskeletal Diseases. Ir Med J 2024; 117:894. [PMID: 38259237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
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18
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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19
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Romero-Morales C, López-López D, Almazán-Polo J, Mogedano-Cruz S, Sosa-Reina MD, García-Pérez-de-Sevilla G, Martín-Pérez S, González-de-la-Flor Á. Prevalence, diagnosis and management of musculoskeletal disorders in elite athletes: A mini-review. Dis Mon 2024; 70:101629. [PMID: 37716840 DOI: 10.1016/j.disamonth.2023.101629] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Musculoskeletal injuries in elite sports are ones of the most impact issue because their remarkable impact on performance caused by drastic absence of training and competition and a progressive deterioration in physical health, emotional and social athletes' dimensions. Also, the prevalence of epidemiologic research found an incidence of musculoskeletal disorders vary within sports and in elite athletes which is even higher as a consequence of higher demand physical performance. This way, the loss of physical performance due to an sport injury impacts not only the individual economic sphere of the professional but also that ofsports entities, reaching, according to some studies, a loss estimated in the range of 74.7 million pounds. Thus, the purpose of this article is to review and to provide an overview of the most common musculoskeletal injuries in elite sports precipitating factors, clinical presentation, evidence-based diagnostic evaluation, and treatment recommendations with a view to preventing medical conditions or musculoskeletal injuries that may alter performance and general health in the elite athletes.
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Affiliation(s)
- Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Daniel López-López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol , Universidade da Coruña, 15403 Ferrol, Spain.
| | - Jaime Almazán-Polo
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Sara Mogedano-Cruz
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - María Dolores Sosa-Reina
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | | | - Sebastián Martín-Pérez
- Faculty of Health Sciences, Universidad Europea de Canarias, La Orotava, Santa Cruz de Tenerife 38300, Spain
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20
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Katsma M, Liu H, Pan X, Ryan KJ, Roye DP, Chambers HG. Management and treatment of musculoskeletal problems in adults with cerebral palsy: Experience gained from two lifespan clinics. J Pediatr Rehabil Med 2024; 17:19-33. [PMID: 38552124 PMCID: PMC10977450 DOI: 10.3233/prm-240018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/07/2024] [Indexed: 04/02/2024] Open
Affiliation(s)
- Mark Katsma
- Department of Orthopedic Surgery, Balboa Naval Medical Center, San Diego, CA, USA
| | - Haiqing Liu
- Pediatric Orthopedic Department of Shantou University, Guangzhou Huaxin Orthopedic Hospital, Guangzhou, China
| | - Xiaoyu Pan
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, TX, USA
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kyle J. Ryan
- University of California San Diego, San Diego, CA, USA
- Department of Orthopedic Surgery and Rehabilitation, Rady Children’s Hospital, San Diego, CA, USA
| | - David P. Roye
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Henry G. Chambers
- University of California San Diego, Rady Children’s Hospital, San Diego, CA, USA
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21
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Belthur MV, Ranade AS, Monsell F, Herman MJ. Controversies in the Management of Pediatric Musculoskeletal Infections: An International Viewpoint. Instr Course Lect 2024; 73:401-420. [PMID: 38090912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Pediatric musculoskeletal infections (MSIs) are a major contributor to the global burden of musculoskeletal disease in children and young adults. If untreated, or treated inappropriately or inadequately, pediatric bone and joint infections can be fatal or result in morbidity that causes significant functional disabilities to the patient and economic burden to the family and the community at large. The past decade has witnessed many advances in this field with respect to early diagnosis, management, and prevention of complications. It is important to discuss the current controversies in the management of pediatric MSIs with an international perspective. This discussion should include the controversies associated with the early diagnosis and identification of pediatric MSI in diverse settings; the controversies involved in the nonsurgical and surgical management of acute pediatric MSIs; and the controversies associated with the management of sequelae of pediatric MSI.
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22
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Hofstetter L, Mikhail J, Lalji R, Kurmann A, Rabold L, Côté P, Tricco AC, Pagé I, Hincapié CA. Minimal clinical datasets for spine-related musculoskeletal disorders in primary and outpatient care settings: a scoping review. J Clin Epidemiol 2024; 165:111217. [PMID: 37952699 DOI: 10.1016/j.jclinepi.2023.11.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/02/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES Effective measurement and monitoring of health status in patients with spine-related musculoskeletal (MSK) disorders are essential for providing appropriate care and improving outcomes. Minimal clinical datasets are standardized sets of key data elements and patient-centered outcomes that can be measured and recorded during routine clinical care. Our scoping review aimed to identify and map current evidence on minimal clinical datasets for measuring and monitoring health status in patients with spine-related MSK disorders in primary and outpatient healthcare settings. STUDY DESIGN AND SETTING We followed the JBI (formerly Joanna Briggs Institute) methodology for scoping reviews. MEDLINE, CINAHL, Cochrane Library, Index to Chiropractic Literature, MANTIS, ProQuest Dissertations and Theses Global, and medRxiv preprint repository were searched from database inception to August 1, 2021. Two reviewers independently screened titles and abstracts, full-text articles, and charted the evidence. Findings were synthesized and summarized descriptively. RESULTS After screening 5,583 citations and 301 full-text articles, 104 studies about 32 individual minimal clinical datasets were included. Most minimal clinical datasets were developed for patient populations with spine-involving inflammatory arthritis, nonspecific or degenerative spinal pain, and MSK disorders in general. The minimal clinical datasets varied substantially in terms of the author-reported time-to-complete (1-48 minutes) and the number of items (5-100 items). Fifty percent of the datasets involved healthcare professionals in their development process, and only 28% involved patients. Health domain items were most frequently linked to the components of activities and participation (43.9%) and body functions (28.6%), according to the International Classification of Functioning, Disability, and Health. There is no standardized definition of minimal clinical datasets to measure and monitor health status of patients with spine-related MSK disorders in routine clinical practice. Common core elements identified were practicality, feasibility in a busy routine practice, time efficiency, and the capability to be used across different healthcare settings. CONCLUSION Due to the absence of a standard definition for minimal clinical datasets for patients with spine-related MSK disorders, there is a lack of consistency in the selection of key data elements and patient-centered outcomes that should be included. More research on the implementation and feasibility of minimal clinical datasets in routine care settings is warranted and needed. It is essential to involve all relevant partners in the development process of minimal clinical datasets to ensure successful implementation and adoption in routine primary care.
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Affiliation(s)
- Léonie Hofstetter
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland; Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland; University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jérémie Mikhail
- Department of Chiropractic, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Rahim Lalji
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland; Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland; University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Astrid Kurmann
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland
| | - Lorene Rabold
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland
| | - Pierre Côté
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada; Division of Epidemiology and Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Andrea C Tricco
- Division of Epidemiology and Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, School of Nursing, Queen's University, Kingston, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Isabelle Pagé
- Department of Chiropractic, Université du Québec à Trois-Rivières, Trois-Rivières, 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), Quebec City, Canada
| | - Cesar A Hincapié
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland; Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland; University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
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23
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Nelson PA, George T, Bowen E, Sheean AJ, Bedi A. An Update on Orthobiologics: Cautious Optimism. Am J Sports Med 2024; 52:242-257. [PMID: 38164688 DOI: 10.1177/03635465231192473] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Orthobiologics are rapidly growing in use given their potential to augment healing for multiple musculoskeletal conditions. Orthobiologics consist of a variety of treatments including platelet-rich plasma and stem cells that provide conceptual appeal in providing local delivery of growth factors and inflammation modulation. The lack of standardization in nomenclature and applications within the literature has led to a paucity of high-quality evidence to support their frequent use. The purpose of this review was to describe the current landscape of orthobiologics and the most recent evidence regarding their use.
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Affiliation(s)
- Patrick A Nelson
- University of Chicago Department of Orthopedic Surgery, Chicago, Illinois, USA
| | - Tom George
- Northshore University Healthcare System, Evanston, Illinois, USA
| | - Edward Bowen
- Weill Cornell Medicine, New York City, New York, USA
| | - Andrew J Sheean
- San Antonio Military Medical Center, Department of Orthopedic Surgery, San Antonio, Texas, USA
| | - Asheesh Bedi
- Northshore University Healthcare System, Evanston, Illinois, USA
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24
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Chen X, Chen K, Zou J. Editorial: Exercise for age-related musculoskeletal disorders. Front Public Health 2023; 11:1337093. [PMID: 38222089 PMCID: PMC10787645 DOI: 10.3389/fpubh.2023.1337093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 11/27/2023] [Indexed: 01/16/2024] Open
Affiliation(s)
- Xi Chen
- School of Sports Science, Wenzhou Medical University, Wenzhou, China
| | - Kai Chen
- School of Molecular Sciences, University of Western Australia, Perth, WA, Australia
| | - Jun Zou
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
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25
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Campos L, Costa D, Donato H, Nunes B, Cruz EB. Implementation of digital health in rural populations with chronic musculoskeletal conditions: A scoping review protocol. PLoS One 2023; 18:e0291638. [PMID: 38134049 PMCID: PMC10745161 DOI: 10.1371/journal.pone.0291638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
Musculoskeletal conditions are a major source of disability worldwide, and its burden have been rising in the last decades. Rural areas, in particular, are associated with higher prevalence of these conditions as well as higher levels of disability, which is likely related to other determinants that affect these communities. Although digital health has been identified as a potential solution to mitigate the impact of these determinants, it is also known that these populations may face barriers that limit the implementation of these interventions. Therefore, the aim of this scoping review is to comprehensively map the evidence regarding the implementation of digital health interventions in rural populations with chronic musculoskeletal conditions. We will include studies published from the year 2000; that report the use of digital interventions that promote prevention, treatment or monitoring of any chronic musculoskeletal condition or chronic pain from musculoskeletal origin, in patients that live in rural areas. This protocol follows the methodological framework for scoping reviews proposed by Arksey and O'Malley, as well as the Joana Briggs Institute (JBI) approach. We will conduct the search on Medline (PubMed), EMBASE, Web of Science and Scopus, as well as grey literature databases. Two independent reviewers will screen titles and abstracts followed by a full-text review to assess the eligibility of the articles. Data extracted will include the identification of the digital interventions used, barriers and enablers identified by the patients or healthcare providers, the patient-level outcomes measured, and the implementation strategies and outcomes reported. By mapping the evidence on the implementation of digital health interventions in rural communities with musculoskeletal conditions, this scoping review will enhance our understanding of their applicability in real-world settings.
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Affiliation(s)
- Lara Campos
- ESS, Polytechnic Institute of Setúbal, Setúbal, Portugal
- National School of Public Health, NOVA University of Lisbon, Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), Lisboa, Portugal
| | - Daniela Costa
- Comprehensive Health Research Center (CHRC), Lisboa, Portugal
| | - Helena Donato
- Documentation and Scientific Information Service, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Baltazar Nunes
- National School of Public Health, NOVA University of Lisbon, Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), Lisboa, Portugal
- Epidemiology Department, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal
| | - Eduardo B. Cruz
- ESS, Polytechnic Institute of Setúbal, Setúbal, Portugal
- Comprehensive Health Research Center (CHRC), Lisboa, Portugal
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Wang T, Wang J, Chen Y, Ruan Y, Dai S. Efficacy of aquatic exercise in chronic musculoskeletal disorders: a systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res 2023; 18:942. [PMID: 38066577 PMCID: PMC10704680 DOI: 10.1186/s13018-023-04417-w] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Aquatic exercise (AE) is becoming ever more popular as a physical therapy, while it is unclear what precise improvements it will produce and how effective it will be in comparison with other non-surgical therapies. The study aimed to assess whether AE positively impacts chronic musculoskeletal disorder patients in terms of pain, physical function, and quality of life. METHODS PRISMA guidelines were followed, and our study protocol was published online at PROSPERO under registration number CRD42023417411. We searched PubMed, Embase, Web of Science, and Cochrane library databases for English-language articles published before April 11, 2023, including studies from all relevant randomized controlled trials (RCTs). After screening, we ultimately included 32 RCTs with a total of 2,200 participants. We also performed subgroup analyses for all included studies. This meta-analysis calculated standardized mean difference (SMD) with 95% confidence interval (CI), and the variance was estimated using a random-effects model. The quality of the included studies was assessed by using the Cochrane collaborative "risk of bias" assessment tool (version 2.0). Thus ensuring that the literature included is of high quality. RESULTS This meta-analysis included 32 trials with 2,200 participants; these patients were all between the ages of 38-80. The study showed that compared to the no exercise (NE) group, patients in the AE group experienced a remarkable reduction in pain (SMD: -0.64, P < 0.001), a significant increase in physical function (SMD: 0.62, P < 0.001), and a statistically significant improvement in quality of life (SMD: -0.64, P < 0.001). When compared to land-based exercise (LE), AE significantly relieves patients' pain (SMD: -0.35, P = 0.03). CONCLUSIONS This is the first systematic review and meta-analysis to study whether AE could improve chronic musculoskeletal disorders. The evidence suggests that AE benefits pain, physical function, and quality of life in adults with chronic musculoskeletal conditions compared to NE. Furthermore, when compared to LE, AE continues to provide a better improvement in patient pain. More long-term clinical trials are needed to confirm AE's positive effects and improvement mechanisms and the more existential advantages compared to LE.
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Affiliation(s)
- Tianyue Wang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China.
| | - Jiamin Wang
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Yuheng Chen
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Yanmin Ruan
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Senjie Dai
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China
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Mullen N, Ashby S, Haskins R, Osmotherly P. The experiences and preferences of individuals living with a musculoskeletal disorder regarding prognosis: A qualitative study. Musculoskeletal Care 2023; 21:987-996. [PMID: 37139716 DOI: 10.1002/msc.1777] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 05/05/2023]
Abstract
QUESTION(S) What are the experiences and preferences of individuals living with a musculoskeletal disorder regarding prognosis? DESIGN Exploratory phenomenological study. PARTICIPANTS Individuals aged 18-year or older currently experiencing a musculoskeletal disorder and receiving treatment from a physiotherapist. DATA ANALYSIS Data were collected through semi-structured interviews and analysed using inductive coding and thematic analysis. RESULTS Five themes were identified. First, participants described seeking a cause for their pain. This influenced their experience of prognosis as they perceived a diagnosis was required to inform their prognosis. Second, whilst participants wished to receive a prognosis from their physiotherapist, this was often not their experience. Third, participants perceived that physiotherapists have the potential to impact prognosis through exercise prescription, management of conditions, and improving function. Fourth, receiving a prognosis can have both a positive and negative impact on the individual. Positive impacts include planning for the future, motivation, knowledge acquisition, and instilling hope. However, receiving a prognosis can be disheartening if a patient's expectations are unmet. Finally, participants have several preferences regarding receiving a prognosis including when and how often the prognosis is discussed, what prognostic information is provided, how the prognosis is presented, and what prognosis based on. CONCLUSION Individuals wish to receive a prognosis, although this is not always their experience. Individuals perceive that physiotherapists have the ability to provide a prognosis and impact their prognosis. Furthermore, receiving a prognosis has an impact on itself. To ensure patient-centred care, physiotherapists should explicitly discuss the prognosis with patients and consider their preferences when providing a prognosis.
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Affiliation(s)
- Nicholas Mullen
- School of Health Sciences, The University of Newcastle, Newcastle, Australia
| | - Samantha Ashby
- School of Health Sciences, The University of Newcastle, Newcastle, Australia
| | - Robin Haskins
- John Hunter Hospital Outpatient Service, Hunter New England Health, Newcastle, Australia
| | - Peter Osmotherly
- School of Health Sciences, The University of Newcastle, Newcastle, Australia
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O'Sullivan DJ, Bearne LM, Harrington JM, McVeigh JG. Can social prescribing put the 'social' into the biopsychosocial management of people with long-term musculoskeletal disorders? Musculoskeletal Care 2023; 21:1341-1352. [PMID: 37639305 DOI: 10.1002/msc.1810] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/04/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Chronic musculoskeletal disorders (MSD) are a significant burden on individuals' quality of life and society and are made more complex by the presence of multimorbidity. It is recommended that interventions targeting MSD be sustainable, equitable and incorporate the biopsychosocial model of care (BPS). AIMS A criticism of the BPS approach is that the social component of this model is not addressed adequately during the management of people with long-term MSD and that a gap exists between theory and implementation. The use of social prescribing (SP) as an intervention to bridge this gap is discussed. RESULTS AND DISCUSSION Social prescribing is a holistic non-medical person-centered approach to well-being that utilizes link workers (LW) to support individuals with long-term conditions (LTC) in the community. Social prescribing referrals are received from primary healthcare practitioners to LW and range from light touch signposting for employment or financial advice to more intensive support for LTC such as obesity, decreased physical activity and mental health needs. CONCLUSION There is evidence to suggest that SP interventions are effective in the management of LTC; however, due to the paucity of high-quality evidence, it is difficult to be conclusive. Large-scale randomised controlled trials are recommended to support the use of SP interventions in the management of LTC.
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Affiliation(s)
- Declan J O'Sullivan
- Discipline of Physiotherapy, School of Clinical Therapies, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Lindsay M Bearne
- Population Health Research Institute, St George's, University of London, London, UK
| | - Janas M Harrington
- School of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Joseph G McVeigh
- Discipline of Physiotherapy, School of Clinical Therapies, College of Medicine and Health, University College Cork, Cork, Ireland
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29
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Watts AE. Use of Stem Cells for the Treatment of Musculoskeletal Injuries in Horses. Vet Clin North Am Equine Pract 2023; 39:475-487. [PMID: 37625917 DOI: 10.1016/j.cveq.2023.07.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
Mesenchymal stem cells (MSCs) are used as a regenerative therapy in horses for musculoskeletal injury since the late 1990s and in some regions are standard of care for certain injuries. Yet, there is no Food and Drug Administration-approved MSC therapeutic in the United States for horses. In humans, lack of regulatory approval in the United States has been caused by failure of late-phase clinical trials to demonstrate consistent efficacy, perhaps because of nonuniformity of MSC preparation and application techniques. This article discusses clinical evidence for musculoskeletal applications of MSCs in the horse and current challenges to marketing approval.
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Ulysse SN, Chandler MT, Santacroce L, Cai T, Liao KP, Feldman CH. Social Determinants of Health Documentation Among Individuals With Rheumatic and Musculoskeletal Conditions in an Integrated Care Management Program. Arthritis Care Res (Hoboken) 2023; 75:2529-2536. [PMID: 37331999 PMCID: PMC10725994 DOI: 10.1002/acr.25174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/18/2023] [Accepted: 06/13/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVE Social determinants of health (SDoH), such as poverty, are associated with increased burden and severity of rheumatic and musculoskeletal diseases. This study was undertaken to study the prevalence and documentation of SDoH-related needs in electronic health records (EHRs) of individuals with these conditions. METHODS We randomly selected individuals with ≥1 International Classification of Diseases, Ninth/Tenth Revision (ICD-9/10) code for a rheumatic/musculoskeletal condition enrolled in a multihospital integrated care management program that coordinates care for medically and/or psychosocially complex individuals. We assessed SDoH documentation using terms for financial needs, food insecurity, housing instability, transportation, and medication access according to EHR note review and ICD-10 SDoH billing codes (Z codes). We used multivariable logistic regression to examine associations between demographic factors (age, gender, race, ethnicity, insurance) and ≥1 (versus 0) SDoH need as the odds ratio (OR) with 95% confidence interval (95% CI). RESULTS Among 558 individuals with rheumatic/musculoskeletal conditions, 249 (45%) had ≥1 SDoH need documented in EHR notes by social workers, care coordinators, nurses, and physicians. A total of 171 individuals (31%) had financial insecurity, 105 (19%) had transportation needs, 94 (17%) had food insecurity; 5% had ≥1 related Z code. In the multivariable model, the odds of having ≥1 SDoH need was 2.45 times higher (95% CI 1.17-5.11) for Black versus White individuals and significantly higher for Medicaid or Medicare beneficiaries versus commercially insured individuals. CONCLUSION Nearly half of this sample of complex care management patients with rheumatic/musculoskeletal conditions had SDoH documented within EHR notes; financial insecurity was the most prevalent. Only 5% of patients had representative billing codes suggesting that systematic strategies to extract SDoH from notes are needed.
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Affiliation(s)
- Sciaska N. Ulysse
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Mia T. Chandler
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
- Rheumatology Program, Division of Immunology, Boston Children’s Hospital, Boston, MA
| | - Leah Santacroce
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Tianrun Cai
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Katherine P. Liao
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Candace H. Feldman
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
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Berthelsen DB, Simon LS, Ioannidis JPA, Voshaar M, Richards P, Goel N, Strand V, Nielsen SM, Shea BJ, Tugwell P, Bartlett SJ, Hazlewood GS, March L, Singh JA, Suarez-Almazor ME, Boers M, Stevens RM, Furst DE, Woodworth T, Leong A, Brooks PM, Flurey C, Christensen R. Stakeholder endorsement advancing the implementation of a patient-reported domain for harms in rheumatology clinical trials: Outcome of the OMERACT Safety Working Group. Semin Arthritis Rheum 2023; 63:152288. [PMID: 37918049 DOI: 10.1016/j.semarthrit.2023.152288] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/16/2023] [Accepted: 10/24/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVES To develop an understanding of the concept of safety/harms experienced by patients involved in clinical trials for their rheumatic and musculoskeletal diseases (RMDs) and to seek input from the OMERACT community before moving forward to developing or selecting an outcome measurement instrument. METHODS OMERACT 2023 presented and discussed interview results from 34 patients indicating that up to 171 items might be important for patients' harm-reporting. RESULTS Domain was defined in detail and supported by qualitative work. Participants in the Special-Interest-Group endorsed (96 %) that enough qualitative data are available to start Delphi survey(s). CONCLUSION We present a definition of safety/harms that represents the patient voice (i.e., patients' perception of safety) evaluating the symptomatic treatment-related adverse events for people with RMDs enrolled in clinical trials.
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Affiliation(s)
- Dorthe B Berthelsen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark; Department of Rehabilitation, Municipality of Guldborgsund, Nykoebing F, Denmark
| | | | - John P A Ioannidis
- Departments of Medicine, Epidemiology and Population Health, Biomedical Data Science, and Statistics, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University, California, USA
| | - Marieke Voshaar
- Department of Pharmacy, Sint Maartenskliniek, Department of Pharmacy, RadboudUMC, Nijmegen, the Netherlands
| | - Pam Richards
- Department of Rheumatology, University of Bristol, Bristol, United Kingdom
| | - Niti Goel
- Division of Rheumatology, Duke University School of Medicine, Durham, NC, USA
| | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Palo Alto CA, USA
| | - Sabrina M Nielsen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | - Beverly J Shea
- Ottawa Hospital Research Institute, Clinical Epidemiology Program and School of Epidemiology and Public Health, University of Ottawa, Canada
| | - Peter Tugwell
- Department of Medicine, School of Epidemiology, Public Health and Community Medicine, University of Ottawa, Canada
| | | | - Glen S Hazlewood
- Department of Medicine, Cumming School of Medicine, University of Calgary; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; Arthritis Research Canada
| | - Lyn March
- Department of Rheumatology, Royal North Shore Hospital, Kolling Institue and The University of Sydney, Sydney, Australia
| | - Jasvinder A Singh
- Medicine Service, VA Medical Center, Birmingham, AL, USA; Department of Medicine and the School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA; Department of Epidemiology and the UAB School of Public Health, Birmingham, AL, USA
| | - Maria E Suarez-Almazor
- Department of Health Services Research and Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Centre, Houston, TX, USA
| | - Maarten Boers
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | | | - Daniel E Furst
- David Geffen School of Med. Department of Medicine, Division of Rheumatology, UCLA, Los Angeles, California, USA
| | - Thasia Woodworth
- David Geffen School of Med. Department of Medicine, Division of Rheumatology, UCLA, Los Angeles, California, USA
| | - Amye Leong
- Healthy Motivation, Santa Barbara, California USA
| | - Peter M Brooks
- Centre for Health Policy Melbourne School of Population and Global Health University of Melbourne, Australia
| | - Caroline Flurey
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, United Kingdom
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark.
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Vervaeke R, Lafrance S, Demont A. Core competencies for first contact physiotherapists in a direct access model of care for adults with musculoskeletal disorders: A scoping review. Musculoskeletal Care 2023; 21:1353-1363. [PMID: 37641476 DOI: 10.1002/msc.1813] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION To optimise the management of Musculoskeletal disorders (MSKDs), many countries have implemented direct access to physiotherapy; however, the core competencies required for first contact physiotherapists (PTs) have not been precisely defined. The aim of this scoping review is to identify and describe the core competencies required for first contact PTs treating adults with MSKDs. METHODS We conducted a scoping review of the literature by searching eight databases and grey literature up to July 2023. We performed a thematic analysis of the competencies identified based on predefined themes relevant to first contact physiotherapy in direct access models in primary or emergency care settings. RESULTS Sixty-five articles were included. Seventeen core competencies were identified and grouped into 5 themes: (1) Assessment and examination; (2) Management and interventions; (3) Communication; (4) Cooperation and collaboration; and (5) Professionalism and leadership. CONCLUSIONS Our findings provide an international perspective on the core competencies required for first contact PTs.
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Affiliation(s)
| | - Simon Lafrance
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Maisonneuve-Rosemont Hospital Research Center, Université de Montréal Affiliated Research Center, Montreal, Quebec, Canada
| | - Anthony Demont
- INSERM UMR-S 1153, Centre de Recherche Épidémiologique et Statistique Sorbonne Paris Cité, Paris, France
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Vignaud H, Molins C, Legaux C, Slusznis A, Sarhan FR, Demont A. Description of the abilities of physiotherapists in terms of diagnostic hypothesis and management decision for self-referred patients with musculoskeletal disorders in France using clinical vignettes: A cross-sectional survey. Musculoskeletal Care 2023; 21:1592-1600. [PMID: 37902190 DOI: 10.1002/msc.1836] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Direct access to physiotherapy has been introduced in several countries. In France, the healthcare system is evolving towards its introduction; however, no study has described the ability of physiotherapists in this context. OBJECTIVE To describe the ability of physiotherapists practicing in France to formulate correct diagnostic hypotheses and make appropriate management decisions using clinical vignettes. METHODS Pre-existing validated clinical vignettes were used and integrated into a numerical questionnaire. The percentages of correct answers were calculated from the results concerning the choice of diagnostic hypothesis and the management decision, both overall and for the three different patient categories: musculoskeletal, non-critical medical, and critical medical. RESULTS Four hundred eighty-two participants (1.7%) responded to the study. For the formulation of a diagnostic hypothesis, there were 43.0% (415/964), 26.6% (128/482), and 17.8% (86/482) correct answers respectively for the musculoskeletal, non-critical medical, and critical medical categories. For management decisions, there were 60.8% (586/964), 61.6% (297/482), and 85.1% (410/482) correct answers respectively for the same categories. CONCLUSIONS Our results related to the management decision were better than those for the diagnostic hypothesis, especially for the critical medical category. There is still room for improvement. It might be interesting to support this initial study by using more clinical vignettes validated in a French context.
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Affiliation(s)
- Hermine Vignaud
- Institut d'Ingénierie de la Santé-UFR de Médecine, Université de Picardie Jules Verne, Amiens, France
- Union Régional des Professionels de Santé Masseur-Kinésithérapeute d'Ile-de-France, Paris, France
| | - Constance Molins
- Institut d'Ingénierie de la Santé-UFR de Médecine, Université de Picardie Jules Verne, Amiens, France
- Union Régional des Professionels de Santé Masseur-Kinésithérapeute d'Ile-de-France, Paris, France
| | - Clara Legaux
- Institut d'Ingénierie de la Santé-UFR de Médecine, Université de Picardie Jules Verne, Amiens, France
- Union Régional des Professionels de Santé Masseur-Kinésithérapeute d'Ile-de-France, Paris, France
| | - Anouchka Slusznis
- Institut d'Ingénierie de la Santé-UFR de Médecine, Université de Picardie Jules Verne, Amiens, France
- Union Régional des Professionels de Santé Masseur-Kinésithérapeute d'Ile-de-France, Paris, France
| | - François-Régis Sarhan
- Institut d'Ingénierie de la Santé-UFR de Médecine, Université de Picardie Jules Verne, Amiens, France
- UR 7516 CHIMERE, Université de Picardie Jules Verne, Amiens, France
| | - Anthony Demont
- Union Régional des Professionels de Santé Masseur-Kinésithérapeute d'Ile-de-France, Paris, France
- INSERM UMR-S 1153, Centre de Recherche Épidémiologique et Statistique Sorbonne Paris Cité, Paris, France
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Csonka V, Varjú C, Lendvay M. Diabetes mellitus-related musculoskeletal disorders: Unveiling the cluster of diseases. Prim Care Diabetes 2023; 17:548-553. [PMID: 37643934 DOI: 10.1016/j.pcd.2023.08.003] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Abstract
The current study ushers in a comprehensive review in clinical research to demonstrate the prevalence of musculoskeletal (MSK) complications in diabetes mellitus and the most relevant clinical aspects. In particular, revealing the early symptoms of the disorders, the pathology lurking behind the complications and their optimal management. In diabetes mellitus, MSK complications are common and are largely due to similar pathogenetic factors responsible for the internal organ complications associated with diabetes leading to chronic low-intensity inflammatory processes. MSK disorders develop by vasculopathy, neuropathy, arthropathy or combinations of the above, which are not specific to diabetes. However, their prevalence is significantly increased in diabetes and contributes to the disability impairing patients' quality of life. Locomotor disease affects approximately 34.4-83.5 % of patients suffering from type-2 diabetes mellitus. Several musculoskeletal abnormalities (cheiroarthropathy, Dupuytren's contracture, trigger finger, ect.) can be diagnosed upon physical examination, although certain symptoms (frozen shoulder, neurogenic arthropathy, septic arthritis, etc.) require differential diagnostic considerations. Early identification regarding characteristic symptoms in the treatment reducing inflammation and pain, followed with increasingly strenuous exercise therapy, aligned with optimal management of carbohydrate metabolism, proves essential in alleviating MSK complications.
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Affiliation(s)
- Viktória Csonka
- Department of Rheumatology, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
| | - Cecília Varjú
- Department of Rheumatology and Immunology, Medical School, University of Pécs, Pécs, Hungary
| | - Marcell Lendvay
- Department of Rheumatology and Immunology, Medical School, University of Pécs, Pécs, Hungary.
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Møller A, Bond CB, Andersen LN, Hartvigsen J, Stochkendahl MJ. General practitioners' stay-at-work practices in patients with musculoskeletal disorders: using Intervention Mapping to develop a training program. Scand J Prim Health Care 2023; 41:445-456. [PMID: 37837433 PMCID: PMC11001345 DOI: 10.1080/02813432.2023.2268674] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/04/2023] [Indexed: 10/16/2023] Open
Abstract
OBJECTIVES To describe current stay-at-work practices among Danish general practitioners (GPs) in relation to patients with musculoskeletal disorders, to identify potential avenues for improvement, and to suggest a training program for the GPs. DESIGN AND SETTING We followed the principles of Intervention Mapping. Data were collected by means of literature searches, focus group interviews with GPs, and interaction with stakeholder representatives from the Danish labour market. RESULTS GPs' current stay-at-work practices were influenced by systemic, organisational, and legislative factors, and by personal determinants, including knowledge and skills relating to stay-at-work principles and musculoskeletal disorders, recognition of the patient's risk of long-term work disability, their role as a GP, and expectations of interactions with other stay-at-work stakeholders. GPs described themselves as important partners and responsible for the diagnostic and holistic assessments of the patient but placed themselves on the side line relying on the patient or workplace stakeholders to act. Their practices are influenced both by patients, employers, and by other stakeholders. We propose a training course for GPs that incorporate both concrete tools and behaviour change techniques. CONCLUSIONS We have identified varied perspectives on the roles and responsibilities of GPs, as well as legislative and organisational barriers, and proposed a training program. Not all barriers identified can be addressed by a training course, and some questions are left unanswered, among others - who are best suited to help patients staying at work?
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Affiliation(s)
- A. Møller
- Research Unit for General Practice in Copenhagen, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- The Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - C. B. Bond
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - L. N. Andersen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - J. Hartvigsen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | - M. J. Stochkendahl
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
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Cai W, You M, Li J, Li Q, Wang D, Wang H. Application of "immersive contextualization based-learning teaching" mode in the orthopaedic musculoskeletal disorder module of clinical medicine education. BMC Med Educ 2023; 23:906. [PMID: 38031076 PMCID: PMC10687819 DOI: 10.1186/s12909-023-04831-y] [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] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE To evaluate the effect and influence of the "immersive contextualization-based learning" teaching mode (ICBLT) in the orthopaedic musculoskeletal disorder module of clinical medicine education. METHODS Undergraduate students in five consecutive semesters of clinical medicine in West China Hospital, Sichuan University were enrolled in this study. During the teaching process in each semester, a cross-over design was applied, and students were randomly divided into two classes (Class A and Class B) to receive the designated experimental courses with different routes. After they took the final exams, the scores of the selected chapters (sports injury chapter and osteoarthritis chapter) were extracted to conduct Tests of Between-Subjects Effects. Q-Q plot was drawn to test whether the distribution of the scores follows normal distribution. The part of the feedback questionnaires to assess these two teaching modes were also extracted for comparison. RESULTS A total of 441 students were enrolled in this study, among which, Class A teaching route was implemented to 222 students and Class B to the rest 219. The results of Tests of Between-Subjects Effects showed that ICBLT mode could lead to better scores compared to the Lecturing-based learning teaching (LBLT) mode (p < 0.0001). In terms of mastery of practical skills, help to deepen the memory of knowledge and satisfaction with the teaching mode, the ICBLT mode showed better results (p < 0.0001). CONCLUSION ICBLT mode had better potential in helping mastery of practical skills and deepening the memory of knowledge.
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Affiliation(s)
- Wufeng Cai
- Department of Orthopedics, West China Hospital, Orthopedic Research Institute, Sichuan University, Chengdu, China
- Department of Engineering, University of Exeter, Exeter, England
| | - Mingke You
- Department of Orthopedics, West China Hospital, Orthopedic Research Institute, Sichuan University, Chengdu, China
| | - Jian Li
- Department of Orthopedics, West China Hospital, Orthopedic Research Institute, Sichuan University, Chengdu, China.
| | - Qi Li
- Department of Orthopedics, West China Hospital, Orthopedic Research Institute, Sichuan University, Chengdu, China
| | - Duan Wang
- Department of Orthopedics, West China Hospital, Orthopedic Research Institute, Sichuan University, Chengdu, China.
| | - Haoyang Wang
- Department of Orthopedics, West China Hospital, Orthopedic Research Institute, Sichuan University, Chengdu, China.
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Baldwin M, Buckley CD, Guilak F, Hulley P, Cribbs AP, Snelling S. A roadmap for delivering a human musculoskeletal cell atlas. Nat Rev Rheumatol 2023; 19:738-752. [PMID: 37798481 DOI: 10.1038/s41584-023-01031-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 10/07/2023]
Abstract
Advances in single-cell technologies have transformed the ability to identify the individual cell types present within tissues and organs. The musculoskeletal bionetwork, part of the wider Human Cell Atlas project, aims to create a detailed map of the healthy musculoskeletal system at a single-cell resolution throughout tissue development and across the human lifespan, with complementary generation of data from diseased tissues. Given the prevalence of musculoskeletal disorders, this detailed reference dataset will be critical to understanding normal musculoskeletal function in growth, homeostasis and ageing. The endeavour will also help to identify the cellular basis for disease and lay the foundations for novel therapeutic approaches to treating diseases of the joints, soft tissues and bone. Here, we present a Roadmap delineating the critical steps required to construct the first draft of a human musculoskeletal cell atlas. We describe the key challenges involved in mapping the extracellular matrix-rich, but cell-poor, tissues of the musculoskeletal system, outline early milestones that have been achieved and describe the vision and directions for a comprehensive musculoskeletal cell atlas. By embracing cutting-edge technologies, integrating diverse datasets and fostering international collaborations, this endeavour has the potential to drive transformative changes in musculoskeletal medicine.
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Affiliation(s)
- Mathew Baldwin
- The Botnar Institute for Musculoskeletal Sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
| | - Christopher D Buckley
- The Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
| | - Farshid Guilak
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
- Shriners Hospitals for Children, St. Louis, MO, USA
| | - Philippa Hulley
- The Botnar Institute for Musculoskeletal Sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
| | - Adam P Cribbs
- The Botnar Institute for Musculoskeletal Sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
| | - Sarah Snelling
- The Botnar Institute for Musculoskeletal Sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK.
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Surandran S, Ahmed S, Walton T, Nikiphorou E, Dey M. Multimorbidity in rheumatoid arthritis: common mechanistic links and impact and challenges in routine clinical practice. Rheumatology (Oxford) 2023; 62:SI260-SI270. [PMID: 37871920 DOI: 10.1093/rheumatology/kead489] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/13/2023] [Indexed: 10/25/2023] Open
Abstract
Early identification and management of multimorbidity in patients with rheumatic and musculoskeletal diseases (RMDs), such as RA, is an integral, but often neglected, aspect of care. The prevalence and incidence of conditions such as osteoporosis, cardiovascular disease, pulmonary disease and malignancies, often co-existing with RA, continues to have significant implications for the management of this patient group. Multimorbidity in RMDs can be associated with inflammatory disease activity and target organ damage. Lifestyle factors, such as smoking and inactivity, further contribute to the burden of disease. Inflammation is the underlying factor, not just in RA but also many comorbidities. The current framework of a treat-to-target approach focuses on achieving early remission and inflammatory activity suppression. We describe how the comorbidity burden in people with RMDs impacts on disease outcome and treatment response. The importance of addressing comorbidity at an early stage and adopting a patient centred approach is critical in modern practice.
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Affiliation(s)
| | - Saad Ahmed
- Department of Rheumatology, Colchester General Hospital, Colchester, UK
| | - Tom Walton
- Department of Rheumatology, Colchester General Hospital, Colchester, UK
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK
- Rheumatology Department, King's College Hospital, London, UK
| | - Mrinalini Dey
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Department of Rheumatology, Countless of Chester Hospital NHS Foundation Trust, Chester, UK
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Parchment A, Lawrence W, Rahman E, Townsend N, Wainwright E, Wainwright D. 'Making every contact count' with patients with musculoskeletal conditions: a qualitative exploration of acceptability to physiotherapists. BMC Health Serv Res 2023; 23:1125. [PMID: 37858090 PMCID: PMC10588214 DOI: 10.1186/s12913-023-10126-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 10/06/2023] [Indexed: 10/21/2023] Open
Abstract
AIM To qualitatively explore physiotherapists' experiences and acceptability of implementing 'Making Every Contact Count Healthy Conversation Skills' (MECC HCS) in routine practice with patients with musculoskeletal (MSK) conditions. METHODS This article reports the second phase of a mixed method, sequential explanatory study. Physiotherapists trained in and delivering MECC HCS in their practice were invited to take part in semi-structured interviews. We hoped to develop a rich, in-depth understanding of their use and perceptions of the brief intervention and to contextualise findings from the first phase of the study. Qualitative data were analysed using Reflexive Thematic Analysis. RESULTS Physiotherapists valued MECC HCS as being integral to their practice, promoting a person-centred approach to supporting behaviour change and enhancing self-management in patients with MSK conditions and pain. It was believed that this brief intervention could reduce workload pressure for physiotherapists and have significant wider benefits for health services. Time limitations associated with appointments did, however, pose as a challenge to MECC HCS delivery, and it was felt that more organisational-level support was needed to sustain it. CONCLUSIONS These findings support our quantitative data, collected in the first phase of this study. MECC HCS is a highly acceptable brief intervention that can be delivered in physiotherapy care to support behaviour change in patients with MSK conditions. Future roll-out may be optimised within organisations by providing regular refresher training and adopting a MECC champion.
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Affiliation(s)
- Amelia Parchment
- Department for Health, University of Bath, Bath, BA2 7AY, England, UK.
- NIHR Applied Research Collaboration- Greater Manchester, University of Manchester, Manchester, M13 9PL, England.
| | - Wendy Lawrence
- Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, England, UK
| | - Em Rahman
- Public Health Workforce Development, Southern House, Health Education England, Winchester, SO21 2RU, England, UK
| | - Nick Townsend
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, BS8 1TZ, England, UK
| | - Elaine Wainwright
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - David Wainwright
- Department for Health, University of Bath, Bath, BA2 7AY, England, UK
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Kechichian A, Imbert F, Pinsault N. Cooperation between health professionals in primary care for the management of musculoskeletal disorders a narrative review. Sante Publique 2023; 35:271-284. [PMID: 37848374 DOI: 10.3917/spub.233.0271] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Introduction The current medical shortage and increasing healthcare needs lead to the overcrowding of primary care services. In an effort to cope with this, task sharing models of care have been implemented between healthcare professionals. Varied terms are used to describe these models. In France, “cooperation protocol” pathways have been established between general practitioners and physiotherapists. Objective The aim of this narrative review is to define the terms used to describe models of task sharing involving physiotherapists for musculoskeletal care and to describe these models and their impact in order to suggest evolution prospects of French experimentations. Results Delegation, task shifting, substitution, supplementation and advanced practice terms were found in the literature. A clear distinction is suggested between substitution and supplementation. Advanced practice physiotherapy is internationally defined and recognized. Advanced practice physiotherapy models of care seem to improve care access and quality of care without increasing costs. In France, two cooperation protocols have been implemented between general practitioners and physiotherapists for musculoskeletal disorders. Regarding the obstacles to their deployment, these models could evolve considering the international and formally defined framework of advanced practice physiotherapy. Conclusions Task sharing models of care involving physiotherapists could be promising strategies to improve access to care for patients with musculoskeletal disorders. Further studies are needed to better define the models, their objectives and to evaluate their impact in the French context.
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Affiliation(s)
- Amélie Kechichian
- Équipe THEMAS – Laboratoire TIMC – UMR CNRSUGA 5525 – Grenoble – France
- Département de kinésithérapie et physiothérapie – Université Grenoble Alpes – Grenoble – France
| | - Florian Imbert
- Équipe THEMAS – Laboratoire TIMC – UMR CNRSUGA 5525 – Grenoble – France
- Département de kinésithérapie et physiothérapie – Université Grenoble Alpes – Grenoble – France
| | - Nicolas Pinsault
- Équipe THEMAS – Laboratoire TIMC – UMR CNRSUGA 5525 – Grenoble – France
- Département de kinésithérapie et physiothérapie – Université Grenoble Alpes – Grenoble – France
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Koh S, Epelboym Y, Mandell JC, Burch E. Awareness of interventional radiology and image guided musculoskeletal interventions among orthopaedic surgeons, rheumatologists, and physiatrists: A multi-site analysis. Clin Imaging 2023; 102:26-30. [PMID: 37473557 DOI: 10.1016/j.clinimag.2023.06.017] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 06/13/2023] [Accepted: 06/26/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE Evaluate physicians who treat musculoskeletal (MSK) disorders in their knowledge of image-guided MSK interventions, and identify areas that could benefit from education. MATERIALS AND METHODS A 17-question survey was distributed to orthopaedic surgeons, physiatrists, and rheumatologists in the 14-hospital health system. It inquired about demographics, practice environment, awareness of interventional radiology (IR) and MSK radiology (MSKR) training, referral patterns, and knowledge of image-guided MSK interventions. RESULTS In total, 59 of 303 physicians completed the survey (41% orthopaedists, 35% physiatrists, and 24% rheumatologists). Most (93%) were attendings and 41% were female. A minority of survey respondents (17%) recognized the designation of IR as a distinct specialty of medicine per the American Board of Medical Specialties, in contrast to MSKR, which is not designated as a distinct specialty. When queried about IR procedures not under investigation, 24% selected genicular artery embolization and 31% selected embolization for adhesive capsulitis. Barriers to referral were as follows: 21% of specialists performed the procedure, 17% listed electronic medical record challenges, 14% reported scheduling difficulty, 13% reported no barriers, 11% reported difficulty consulting, 11% referred to another specialty, 10% did not have enough knowledge of image guided procedures, and 3% reported the procedure is not performed by IR or MSKR. CONCLUSIONS Survey data reveal a knowledge gap among surveyed physicians regarding IR as a specialty as well as areas of IR research in MSK disorders. Findings suggest areas where referring physicians can be educated and identify barriers to referral.
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Affiliation(s)
- Sukjin Koh
- Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA.
| | - Yan Epelboym
- Division of Angiography and Interventional Radiology, Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA.
| | - Jacob C Mandell
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
| | - Ezra Burch
- Division of Angiography and Interventional Radiology, Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA.
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van der Ven J, van den Bemt BJF, van Dijk L, Opdam M, Haegens LL, Vriezekolk JE, Verhoef LM. Preferences of Patients With Musculoskeletal Disorders Regarding the Timing and Channel of eHealth and Factors Influencing Its Use: Mixed Methods Study. JMIR Hum Factors 2023; 10:e44885. [PMID: 37756049 PMCID: PMC10568401 DOI: 10.2196/44885] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 06/22/2023] [Accepted: 07/22/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Implementation of eHealth is progressing slowly. In-depth insight into patients' preferences and needs regarding eHealth might improve its use. OBJECTIVE This study aimed to describe when patients want to use eHealth, how patients want to communicate and receive information digitally, and what factors influence the use of eHealth in clinical practice. METHODS A multimethod study was conducted. Two meetings of ~5.5 hours with plenary information sessions and focus groups were held with 22 patients from the rheumatology, orthopedics, and rehabilitation departments of a Dutch hospital specialized in musculoskeletal disorders. Assignments were performed during the focus groups in which qualitative (eg, semistructured interview questions) and quantitative (ie, voting and ranking factors) data were collected. RESULTS The way patients want to use eHealth varies between patients and moments of a patient's care pathway. Patients' digital channel preferences depended on the need for interaction with a health care provider (HCP). The interaction need is in turn influenced by the degree to which information or communication is specific to an individual patient and leads to consequences for the patient. The 5 most important factors influencing the use of eHealth were access to medical information (eg, electronic health records), perceived control over disease management, correctness and completeness of information, data security, and access to information or an HCP at any time. The 5 least important factors influencing eHealth use were help with using digital devices, having internet or equipment, digital skills, attitude or emotions toward eHealth, and societal benefits. CONCLUSIONS Patients identified opportunities for using eHealth during all moments of their care pathway. However, preferences for eHealth varied between patients and phases in the care pathway. As a consequence, eHealth should be tailored to fit individual patients' preferences but also the need for interaction regarding different topics by offering a variety of digital channels with a gradient of interaction possibilities. Furthermore, digital skills and access to the internet might become less important to focus on in the future. Improving eHealth use by patients may be achieved by providing patients access to correct and safe (medical) information and more control over their care.
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Affiliation(s)
- Jeffrey van der Ven
- Department of Research, Sint Maartenskliniek, Ubbergen, Netherlands
- Radboud University Medical Centre, Nijmegen, Netherlands
| | - Bart J F van den Bemt
- Department of Research, Sint Maartenskliniek, Ubbergen, Netherlands
- Radboud University Medical Centre, Nijmegen, Netherlands
| | - Liset van Dijk
- Nivel, Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Merel Opdam
- Department of Research, Sint Maartenskliniek, Ubbergen, Netherlands
- Radboud University Medical Centre, Nijmegen, Netherlands
| | - Lex L Haegens
- Department of Research, Sint Maartenskliniek, Ubbergen, Netherlands
- Radboud University Medical Centre, Nijmegen, Netherlands
| | | | - Lise M Verhoef
- Department of Research, Sint Maartenskliniek, Ubbergen, Netherlands
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Thoomes E, Tilborghs G, Heneghan NR, Falla D, de Graaf M. Effectiveness of thoracic spine manipulation for upper quadrant musculoskeletal disorders: protocol for a systematic review. BMJ Open 2023; 13:e076143. [PMID: 37714676 PMCID: PMC10510929 DOI: 10.1136/bmjopen-2023-076143] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/31/2023] [Indexed: 09/17/2023] Open
Abstract
INTRODUCTION Upper quadrant musculoskeletal disorders (UQMD), comprising of cranial, cervical, shoulder and upper extremity disorders, are among the most frequently reported disorders in clinical practice. Thoracic high velocity low amplitude thrust (Tx-HVLAT) manipulation is a form of conservative management recommended in systematic reviews as an effective treatment option for aspects of UQMD disorders such headache, shoulder pain and lateral elbow pain. However, no recent systematic reviews have assessed the effectiveness across UQMD. Therefore, this systematic review aims to update the current evidence on the effectiveness of Tx-HVLAT for patients with UQMD on (1) patient-reported outcomes, (2) performance measures or (3) psychosocial outcomes. METHODS AND ANALYSIS The Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL, PEDro and Index to Chiropractic Literature will be searched from inception using Medical Subject Headings (MeSH), Thesaurus and/or free-text words. Combinations will be made based on localisation, disorder, intervention and design. Following guidelines as advised by the Cochrane Back Review Group, published randomised controlled trials will be included. Two review authors will independently assess the risk of bias (ROB) using the Cochrane Back Review Group's recommended ROB2 tool and will independently extract the data using a standardised data extraction form. Overall quality of the evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method. For continuous data, we will calculate standardised mean differences with 95% CIs. For dichotomous outcomes, relative risks and 95% CIs will be calculated. Where possible we will present a subgroup analysis by disorder. For pooling, a random-effects model will be used. ETHICS AND DISSEMINATION Ethics approval is not required for this systematic review. The study findings will be submitted to a relevant peer-reviewed journal for dissemination and presented at relevant conferences. PROSPERO REGISTRATION NUMBER CRD42023429996.
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Affiliation(s)
- Erik Thoomes
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham College of Life and Environmental Sciences, Birmingham, UK
- Research Department, Fysio-Experts, Hazerswoude, The Netherlands
| | - Gus Tilborghs
- Department of Manual Therapy, Breederode College, Rotterdam, The Netherlands
| | - Nicola R Heneghan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Deborah Falla
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham College of Life and Environmental Sciences, Birmingham, UK
| | - Marloes de Graaf
- Research Department, Fysio-Experts, Hazerswoude, The Netherlands
- Department of Manual Therapy, Breederode College, Rotterdam, The Netherlands
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Gagnon R, Hébert LJ, Guertin JR, Berthelot S, Desmeules F, Perreault K. Integration of primary contact physiotherapists in the emergency department for individuals presenting with minor musculoskeletal disorders: Protocol for an economic evaluation. PLoS One 2023; 18:e0277369. [PMID: 37708179 PMCID: PMC10501643 DOI: 10.1371/journal.pone.0277369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 08/08/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVES 1) To compare the average cost of an emergency department (ED) visit for various minor musculoskeletal disorders between two models of care (physiotherapist and ED physician or ED physician alone); 2) To evaluate the incremental cost-effectiveness ratio (ICER) of these two models of care over a 3-month period post-initial visit; and 3) To estimate the ICER of three ED models of care (physiotherapist and ED physician, ED physician alone, physiotherapist alone) over a two-year period. METHODS Obj.1: The costs incurred by participants in the two groups during their ED visit will be calculated using the Time-Driven Activity-Based Costing (TDABC) method. These costs will be compared using generalized linear models. Obj. 2: The ICER of the two models will be evaluated over three months via a cost-utility analysis that will combine costs and effectiveness data (quality-adjusted life years) using both Health system and Societal perspectives (patient + health system costs). Obj. 3: The 2-year ICER of the three above-mentioned models will be estimated using a mathematical model including a decision tree (0-3 months post-visit) and a Markov model (3-24 months post-visit), also using both Health system and Societal perspectives. Data to answer the three objectives will come from data collected during a randomized clinical trial (n = 78, CHU de Québec)which will be supplemented with data obtained via some of the CHU de Québec administrative databases (nominative data; SIURGE (ED management software), Cristal-Net (patient electronic record), and the ED's pharmacy transactions directory; administrative data: drug costs repository), the literature, and public cost repositories. CONCLUSION This study will help to determine which model of care is most efficient for the management of individuals who come to the ED with minor musculoskeletal disorders. The increased involvement of various health professionals in the management of patients in the ED paves the way for the development of new avenues of practice and more efficient organization of services.
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Affiliation(s)
- Rose Gagnon
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - Luc J. Hébert
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - Jason R. Guertin
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du Centre Hospitalier Universitaire de Québec, Université Laval, Quebec, Quebec, Canada
| | - Simon Berthelot
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du Centre Hospitalier Universitaire de Québec, Université Laval, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
- Centre Hospitalier Universitaire de Québec, Université Laval, Quebec, Quebec, Canada
| | - François Desmeules
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Centre, Centre Intégré Universitaire de Santé et de Services Sociaux de l’Est-de-l’Île-de-Montréal, Montreal, Quebec, Canada
| | - Kadija Perreault
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
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Dias IX, Cordeiro A, Guimarães JAM, Silva KR. Potential and Limitations of Induced Pluripotent Stem Cells-Derived Mesenchymal Stem Cells in Musculoskeletal Disorders Treatment. Biomolecules 2023; 13:1342. [PMID: 37759742 PMCID: PMC10526864 DOI: 10.3390/biom13091342] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/25/2023] [Accepted: 08/03/2023] [Indexed: 09/29/2023] Open
Abstract
The burden of musculoskeletal disorders (MSK) is increasing worldwide. It affects millions of people worldwide, decreases their quality of life, and can cause mortality. The treatment of such conditions is challenging and often requires surgery. Thus, it is necessary to discuss new strategies. The therapeutic potential of mesenchymal stem cells (MSC) in several diseases has been investigated with relative success. However, this potential is hindered by their limited stemness and expansion ability in vitro and their high donor variability. MSC derived from induced pluripotent stem cells (iPSC) have emerged as an alternative treatment for MSK diseases. These cells present distinct features, such as a juvenile phenotype, in addition to higher stemness, proliferation, and differentiation potential than those of MSC. Here, we review the opportunities, challenges, and applications of iPSC as relevant clinical therapeutic cell sources for MSK disorders. We discuss iPSC sources from which to derive iMSC and the advantages and disadvantages of iMSC over MSC as a therapeutic approach. We further summarize the main preclinical and clinical studies exploring the therapeutic potential of iMSC in MSK disorders.
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Affiliation(s)
- Isabelle Xavier Dias
- Teaching and Research Division, National Institute of Traumatology and Orthopaedics, Rio de Janeiro 20940-070, Brazil; (A.C.); (J.A.M.G.)
| | - Aline Cordeiro
- Teaching and Research Division, National Institute of Traumatology and Orthopaedics, Rio de Janeiro 20940-070, Brazil; (A.C.); (J.A.M.G.)
| | - João Antonio Matheus Guimarães
- Teaching and Research Division, National Institute of Traumatology and Orthopaedics, Rio de Janeiro 20940-070, Brazil; (A.C.); (J.A.M.G.)
| | - Karina Ribeiro Silva
- Teaching and Research Division, National Institute of Traumatology and Orthopaedics, Rio de Janeiro 20940-070, Brazil; (A.C.); (J.A.M.G.)
- Laboratory of Stem Cell Research, Histology and Embryology Department, Biology Institute, State University of Rio de Janeiro, Rio de Janeiro 20550-170, Brazil
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Burgess R, Lewis M, Hill JC. Benchmarking quality of care using patient reported outcome measure data for patients presenting with musculoskeletal conditions in primary care GP practices. Musculoskeletal Care 2023; 21:713-722. [PMID: 36864681 DOI: 10.1002/msc.1744] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/05/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Patient Reported Outcome Measures (PROMs) evaluate health status from a patient perspective. They can be used to support care at a patient level but also collectively to review quality of care across care providers. Vast amounts of patients with musculoskeletal (MSK) conditions present to General Practice (GP) primary care practitioners each year. Variation in patient outcomes in this setting however has not been reported. OBJECTIVE To identify variation in patient outcomes measured using the musculoskeletal health questionnaire (MSK-HQ) PROM for adults presenting to 20 GP practices in the UK with MSK conditions. METHODS A secondary analysis of the STarT MSK cluster randomised controlled trial dataset. A standardised case-mix adjustment model, adjusting for condition complexity co-variates, was used to calculate predicted 6-month follow-up MSK-HQ scores, and used to compare adjusted and un-adjusted health gain (n = 868). Patient MSK-HQ change outcomes were aggregated to practice level and boxplots used to display outlier GP practices for un-adjusted and adjusted outcomes. RESULTS Substantial variation in patient outcomes was seen across the 20 practices, even after case-mix adjustment, with mean change in MSK-HQ scores ranging from 6 to 12 points. Boxplots displaying un-adjusted outcomes showed one negative GP practice outlier and two positive outliers. However, the boxplots displaying case-mix adjusted outcomes showed no negative outliers, with two practices remaining as positive outliers, and one practice additionally becoming a positive outlier. CONCLUSION This study showed a two-fold GP practice variation in patient outcomes measured using the MSK-HQ PROM. To our knowledge it is the first study to demonstrate that (a) a standardised case-mix adjustment method can be used to fairly compare patient health outcome variation in GP care, and (b) that case-mix adjustment changes benchmarking findings with regards to provider performance and outlier identification. This has important implications for identifying best practice exemplars and thereby helping to improve the quality of MSK primary care in the future.
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Affiliation(s)
- Roanna Burgess
- Keele University, School of Medicine, Primary Care Centre Versus Arthritis, Staffordshire, UK
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Martyn Lewis
- Keele University, School of Medicine, Primary Care Centre Versus Arthritis, Staffordshire, UK
| | - Jonathan C Hill
- Keele University, School of Medicine, Primary Care Centre Versus Arthritis, Staffordshire, UK
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Mochon R, Rose M, Blanchette V, Fait P, Corbin-Berrigan LA. Exploring workload, satisfaction and sense of safety of health care professionals dealing with musculoskeletal conditions in out-patient clinics during the COVID-19 pandemic. Musculoskeletal Care 2023; 21:926-931. [PMID: 36802269 DOI: 10.1002/msc.1749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 02/23/2023]
Affiliation(s)
- Rose Mochon
- Département des sciences de l'activité physique, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Myriam Rose
- Département des sciences de l'activité physique, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Virginie Blanchette
- Département des sciences de l'activité physique, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
- Research Centre, VITAM - Centre de recherche en santé durable, Québec, Québec, Canada
| | - Philippe Fait
- Département des sciences de l'activité physique, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
- Groupe de recherche sur les affectations neuromusculosquelettiques, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Laurie-Ann Corbin-Berrigan
- Département des sciences de l'activité physique, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
- Groupe de recherche sur les affectations neuromusculosquelettiques, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
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Braithwaite S, Qamhawi Z, Briggs J, Little MW. Transcatheter embolisation in chronic musculoskeletal disorders. Br J Radiol 2023; 96:20220728. [PMID: 37335189 PMCID: PMC10461266 DOI: 10.1259/bjr.20220728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 06/21/2023] Open
Abstract
Chronic musculoskeletal conditions affect millions of patients worldwide resulting in disability, reduced quality of life, and have a profound economic impact on the individual and society. Current treatment strategies fail patients who have not responded to conservative management but are not surgical candidates. Over the last decade, transcatheter embolisation has emerged as a potential treatment for these difficult to treat patients. By exploiting pathological neovascularisation within conditions such as knee osteoarthritis, adhesive capsulitis, and tendinopathy, embolisation has been used to improve patients' pain and function. This review explores the rationale for musculoskeletal transcatheter embolisation, illustrating the technique, and latest evidence for the most common procedures.
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Affiliation(s)
- Simon Braithwaite
- University Department of Radiology, Royal Berkshire Hospital, Reading, United Kingdom
| | - Zahi Qamhawi
- University Department of Radiology, Royal Berkshire Hospital, Reading, United Kingdom
| | - James Briggs
- University Department of Radiology, Royal Berkshire Hospital, Reading, United Kingdom
| | - Mark W Little
- University Department of Radiology, Royal Berkshire Hospital, Reading, United Kingdom
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Iagnocco A, Ciccia F, Conti F, D'Angelo S, Epis OM, Govoni M, Guiducci S, Iannone F, Mosca M, Salaffi F, Sebastiani GD, Sonnati M, Caporali RF. Adherence to therapy in people with rheumatic and musculoskeletal diseases in Italy and the role of the digital health: results of an expert Delphi consensus survey. Clin Exp Rheumatol 2023; 41:1917-1925. [PMID: 37382465 DOI: 10.55563/clinexprheumatol/uip1u1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/29/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVES To present the results of a Delphi consensus survey among Italian rheumatologists on adherence to therapy in people with rheumatic and musculoskeletal diseases (RMDs) in Italy and the role of digital health. METHODS A taskforce of 12 rheumatologists comprehensively discussed the applicability of the 2020 EULAR Points to Consider (PtCs) for Italian rheumatology practice and formulated 44 new country-specific statements. Through an on-line survey, the panellists voted on their level of agreement with the statements using a 10-point Likert scale (0: no agreement; 10: total agreement). A combination of two distinct criteria, a mean agreement level ≥8 and a percentage of at least 75% of responses with a value ≥8, was deemed acceptable. RESULTS The consensus threshold was reached for 43 of the 44 country-specific statements. The following were acknowledged among the barriers to applicability of the recommendations: visit time too short; lack of resources; lack of a clear operational flow-chart; lack of communication skills and poor knowledge of techniques to improve patient adherence by healthcare professionals (HCPs). CONCLUSIONS This consensus initiative helps contribute to more widespread implementation of EULAR PtCs in Italian rheumatology practice. Optimisation of visit time, greater availability of resources, specific training, use of standardised and validated protocols, and active involvement of patients represent the main goals. Digital health can provide valuable support for the application of PtCs and, more generally, in improving adherence. A collaborative effort between HCPs, patients and their associations, scientific societies, and policymakers is strongly advocated to overcome some of the barriers.
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Affiliation(s)
- Annamaria Iagnocco
- Academic Rheumatology Centre, AO Mauriziano Torino, and Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Italy.
| | - Francesco Ciccia
- Department of Precision Medicine, University of Campania L. Vanvitelli, Naples, Italy
| | - Fabrizio Conti
- Division of Rheumatology, Department of Internal Clinical Sciences, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | | | - Oscar Massimiliano Epis
- Division of Rheumatology, Multispecialist Medical Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marcello Govoni
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Italy
| | - Serena Guiducci
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Florence, Italy
| | | | - Marta Mosca
- Department of Rheumatology, University of Pisa, Italy
| | - Fausto Salaffi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | | | | | - Roberto Felice Caporali
- Division of Clinical Rheumatology, ASST Gaetano Pini-CTO Institute, Milan, and Department of Clinical Sciences and Community Health, University of Milan, Italy
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Amundsen O, Moger TA, Holte JH, Haavaag SB, Bragstad LK, Hellesø R, Tjerbo T, Vøllestad NK. Combination of health care service use and the relation to demographic and socioeconomic factors for patients with musculoskeletal disorders: a descriptive cohort study. BMC Health Serv Res 2023; 23:858. [PMID: 37580723 PMCID: PMC10426198 DOI: 10.1186/s12913-023-09852-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/26/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Patients with musculoskeletal disorders (MSDs) access health care in different ways. Despite the high prevalence and significant costs, we know little about the different ways patients use health care. We aim to fill this gap by identifying which combinations of health care services patients use for new MSDs, and its relation to clinical characteristics, demographic and socioeconomic factors, long-term use and costs, and discuss what the implications of this variation are. METHODS The study combines Norwegian registers on health care use, diagnoses, comorbidities, demographic and socioeconomic factors. Patients (≥ 18 years) are included by their first health consultation for MSD in 2013-2015. Latent class analysis (LCA) with count data of first year consultations for General Practitioners (GPs), hospital consultants, physiotherapists and chiropractors are used to identify combinations of health care use. Long-term high-cost patients are defined as total cost year 1-5 above 95th percentile (≥ 3 744€). RESULTS We identified seven latent classes: 1: GP, low use; 2: GP, high use; 3: GP and hospital; 4: GP and physiotherapy, low use; 5: GP, hospital and physiotherapy, high use; 6: Chiropractor, low use; 7: GP and chiropractor, high use. Median first year health care contacts varied between classes from 1-30 and costs from 20€-838€. Eighty-seven percent belonged to class 1, 4 or 6, characterised by few consultations and treatment in primary care. Classes with high first year use were characterised by higher age, lower education and more comorbidities and were overrepresented among the long-term high-cost users. CONCLUSION There was a large variation in first year health care service use, and we identified seven latent classes based on frequency of consultations. A small proportion of patients accounted for a high proportion of total resource use. This can indicate the potential for more efficient resource use. However, the effect of demographic and socioeconomic variables for determining combinations of service use can be interpreted as the health care system transforming unobserved patient needs into variations in use. These findings contribute to the understanding of clinical pathways and can help in the planning of future care, reduction in disparities and improvement in health outcomes for patients with MSDs.
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Affiliation(s)
- Olav Amundsen
- Dept. for Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Tron Anders Moger
- Dept. of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Jon Helgheim Holte
- Dept. of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Silje Bjørnsen Haavaag
- Dept. of Public Health Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Line Kildal Bragstad
- Dept. of Public Health Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Ragnhild Hellesø
- Dept. of Public Health Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Trond Tjerbo
- Dept. of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Nina Køpke Vøllestad
- Dept. for Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
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