The Journal of orthopaedic and sports physical therapy最新文献

{"title":"It's OK to move! Effect of a brief video on community confidence in activity despite back pain: A randomised trial.","authors":"Edel T. O’Hagan, A. Traeger, S. Schabrun, Sean O'Neill, B. Wand, A. Cashin, Christopher M Williams, Ian A Harris, James H. McAuley","doi":"10.2519/jospt.2024.12412","DOIUrl":"https://doi.org/10.2519/jospt.2024.12412","url":null,"abstract":"OBJECTIVE: To estimate the difference in confidence to become active despite low back pain in people who were exposed to one of two video interventions delivered on social media, compared to no intervention. DESIGN: A proof of concept three group randomised controlled trial, in a 1:1:1 ratio. METHODS: Participants aged 18 years and over, with and without low back pain, were recruited via the social media channel Facebook, to view either a humorous video, a neutral video or to no intervention. The videos were delivered online, explained evidence-based management for low back pain, and were designed to \"go viral\". The primary outcome was confidence in becoming active despite pain, measured using the Pain Self Efficacy Questionnaire(Item 10) [range from 0 (not at all confident) to 6 (completely confident)] immediately after watching the video. We aimed to capture the real-time impact and immediate reactions that contributed to the content's reach. RESULTS: Among 1933 randomized participants (mean [SD] age 58.9 [14.0] years, 1285 [75%] women) 1232 [70%] had low back pain and 88.8% completed the primary outcome. 1264 participants were randomised to receive a video intervention, and 633 participants did not receive a video. On a 6-point scale, individuals exposed to either video (n=1088) showed a mean confidence level 0.3 points higher (95% CI 0.1 to 0.6) compared with no video (n=630). CONCLUSION: Participants who viewed a brief video intervention reported a very small difference in confidence to become active despite low back pain, compared with no intervention. The difference may lack clinical relevance.","PeriodicalId":159920,"journal":{"name":"The Journal of orthopaedic and sports physical therapy","volume":" 16","pages":"1-26"},"PeriodicalIF":0.0,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140689694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The smallest worthwhile effect on pain intensity of exercise therapy for people with chronic low back pain: a discrete choice experiment study.","authors":"Harrison J. Hansford, Matthew D Jones, Aidan G. Cashin, R. Ostelo, Alessandro Chiarotto, Sam A. Williams, Saurab Sharma, John M Rose, Jack J. Devonshire, Michael C. Ferraro, M. Wewege, James H McAuley","doi":"10.2519/jospt.2024.12279","DOIUrl":"https://doi.org/10.2519/jospt.2024.12279","url":null,"abstract":"OBJECTIVE: To identify the smallest worthwhile effect (SWE) of exercise therapy for people with non-specific chronic low back pain (CLBP). DESIGN: Discrete choice experiment. METHODS: The SWE was estimated as the lowest reduction in pain that participants would consider exercising worthwhile, compared to not exercising i.e., effects due to natural history and other components (e.g., regression to the mean). We recruited English-speaking adults in Australia with non-specific CLBP to our online survey via email obtained from a registry of previous participants and advertisements on social media. We used discrete choice experiment to estimate the SWE of exercise compared to no exercise for pain intensity. We analysed the discrete choice experiment using a mixed logit model, and mitigated hypothetical bias through certainty calibration, with sensitivity analyses performed with different certainty calibration thresholds. RESULTS: Two-hundred and thirteen participants completed the survey. The mean age (±SD) was 50.7±16.5, median (IQR) pain duration 10 years (5-20), and mean pain intensity (±SD) was 5.8±2.3 on a 0-10 numerical rating scale. For people with CLBP the SWE of exercise was a between-group reduction in pain of 20%, compared to no exercise. In the sensitivity analyses, the SWE varied with different levels of certainty calibration; from 0% without certainty calibration to 60% with more extreme certainty calibration. CONCLUSION: This patient-informed threshold of clinical importance could guide the interpretation of findings from randomised trials and meta-analyses of exercise therapy compared to no exercise.","PeriodicalId":159920,"journal":{"name":"The Journal of orthopaedic and sports physical therapy","volume":" 21","pages":"1-26"},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140692722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Which portion of physiotherapy treatments' effect is attributable to contextual effects in people with musculoskeletal pain?: A meta-analysis of randomised placebo-controlled trials.","authors":"Yasmín Ezzatvar, L. Dueñas, M. Balasch-Bernat, Enrique Lluch-Girbés, Giacomo Rossettini","doi":"10.2519/jospt.2024.12126","DOIUrl":"https://doi.org/10.2519/jospt.2024.12126","url":null,"abstract":"OBJECTIVE: To quantify the proportion attributable to contextual effects of physical therapy interventions for musculoskeletal pain. DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: We searched Ovid, MEDLINE, EMBASE, CINAHL, Scopus, PEDro, Cochrane Controlled Trials Registry, and SPORTDiscus databases from inception to April 2023. STUDY SELECTION CRITERIA: Randomized placebo-controlled trials evaluating the effect of physical therapy interventions on musculoskeletal pain. DATA SYNTHESIS: Risk of bias was evaluated using the Cochrane risk-of-bias tool for randomized trials (ROB 2.0). The proportion of physical therapy interventions effect that is explained by contextual effects was calculated, and a quantitative summary of the data from the studies was conducted using the random-effects inverse-variance model (Hartung-Knapp-Sidik-Jonkman method). RESULTS: Sixty-eight studies were included in the systematic review (participants: n=5,238), and 54 placebo-controlled trials informed our meta-analysis (participants: n=3,793). Physical therapy interventions included soft tissue techniques, mobilization, manipulation, taping, exercise therapy and dry needling. Placebo interventions included manual, non-manual interventions, or both. The proportion attributable to contextual effects of mobilization accounted for 88% of the immediate overall treatment effect for pain intensity (PCE=0.88, 95%CI 0.57-1.20). In exercise therapy, contextual effects accounted for 46% of the overall treatment effect for pain intensity (PCE=0.46, 95%CI 0.41-0.52). Contextual effects in manipulation excelled in short-term pain relief (PCE=0.81, 95%CI 0.62-1.01) and in mobilization in long-term effects (PCE=0.86, 95%CI 0.76-0.96). In taping, contextual effects accounted for 64% of disability improvement (PCE=0.64, 95%CI 0.48-0.80). CONCLUSION: The outcomes of physical therapy interventions for musculoskeletal pain were significantly influenced by contextual effects. Boosting contextual effects consciously to enhance therapeutic outcomes represents an ethical opportunity that could benefit patients.","PeriodicalId":159920,"journal":{"name":"The Journal of orthopaedic and sports physical therapy","volume":"40 5","pages":"1-28"},"PeriodicalIF":0.0,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140716551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How low back pain is managed-a mixed methods study in 32 countries. Part 2 of Low Back Pain in Low- and Middle-Income Countries Series.","authors":"Saurab Sharma, Anupa Pathak, Romy Parker, Leonardo Oliveira Pena Costa, Babita Ghai, C. Igwesi-Chidobe, Prawit Janwantanakul, F. R. de Jesus-Moraleida, M. Chala, Mohammadreza Pourahmadi, Andrew M Briggs, Edward Gorgon, Clare L. Ardern, Karim M Khan, James H McAuley","doi":"10.2519/jospt.2024.12406","DOIUrl":"https://doi.org/10.2519/jospt.2024.12406","url":null,"abstract":"BACKGROUND: The Lancet Series of Low Back Pain (LBP) highlighted the lack of LBP data from low- and middle-income countries (LMICs). The study aimed to describe (1) what LBP care is currently delivered in LMICs, and (2) how that care is delivered. METHODS: An online mixed-methods study. A Consortium for LBP in LMICs (n=65) was developed with an expert panel of leading LBP researchers (>2 publications on LBP) and multidisciplinary clinicians and patient partners with five years of clinical/lived LBP experience in LMICs. Quantitative data were analyzed using descriptive statistics. Two researchers independently analyzed qualitative data using deductive and inductive coding and developed a thematic framework. FINDINGS: Forty-seven (85%) of 55 invited panel members representing 32 LMICs completed the survey (38% women; 62% men). The panel included clinicians (34%), researchers (28%), educators (6%), and patient partners (4%). Pharmacotherapies and electrophysiological agents were the most used LBP treatments. The Thematic Framework comprised of eight themes: (1) Self-management is ubiquitous; (2) Medicines are the cornerstone; (3) Traditional therapies have a place; (4) Society plays an important role; (5) Imaging use is very common; (6) Reliance on passive approaches; (7) Social determinants influence LBP care pathway; and (8) Health systems are ill-prepared to address LBP burden. INTERPRETATION: LBP care in LMICs did not consistently align with the best available evidence. Findings will help research prioritization in LMICs and guide global LBP clinical guidelines. FUNDING: The lead author's Fellowship was supported by the International Association for the Study of Pain.","PeriodicalId":159920,"journal":{"name":"The Journal of orthopaedic and sports physical therapy","volume":"14 2","pages":"1-42"},"PeriodicalIF":0.0,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140714607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Adherence to a Step Count Intervention Following Total Knee Replacement: An Exploratory Cohort Study.","authors":"Vicky Duong,&nbsp;Simone Dennis,&nbsp;Manuela L Ferreira,&nbsp;Gillian Heller,&nbsp;Philippa J A Nicolson,&nbsp;Sarah R Robbins,&nbsp;Xia Wang,&nbsp;David J Hunter","doi":"10.2519/jospt.2022.11133","DOIUrl":"https://doi.org/10.2519/jospt.2022.11133","url":null,"abstract":"<p><strong>Objective: </strong>To explore the person-level predictors of adherence to a step count intervention following total knee replacement (TKR).</p><p><strong>Design: </strong>Prospective cohort study, nested within the PATHway trial.</p><p><strong>Methods: </strong>Participants who had recently undergone TKR were recruited from 3 rehabilitation hospitals in Sydney, Australia, for the main trial. Only data from participants who were randomized to the TKR intervention group were analyzed. Participants in the intervention group (n = 51) received a wearable tracker to monitor the number of steps taken per day. Step count adherence was objectively measured at 3 months as the number of steps completed divided by the number prescribed and multiplied by 100 to express adherence as a percentage. Participants were classified into 4 groups: withdrawal, low adherence (0%-79%), adherent (80%-100%), and >100% adherent. Ordinal logistic regression was used to identify which factors predicted adherence to the prescribed step count.</p><p><strong>Results: </strong>Of the 51 participants enrolled, nine (18% of 51) withdrew from the study before 3 months. Half of participants were classified as >100% adherent (n = 24%, 47%). Ten were classified as low adherence (20%), and 8 participants were classified as adherent (16%). In the univariable model, lower age (OR 0.90; 95% CI 0.83-0.97), higher patient activation (OR 1.03; 95% CI 1.00-1.06), and higher technology self-efficacy (OR 1.03; 95% CI 1.00-1.06) were associated with higher adherence. After adjusting for age in the multivariable model, patient activation and technology self-efficacy were not significant.</p><p><strong>Conclusion: </strong>Younger age, higher patient activation, and higher technology self-efficacy were associated with higher adherence to a step count intervention following TKR in the univariable model. Patient activation and technology self-efficacy were not associated with higher adherence following adjustment for age. <i>J Orthop Sports Phys Ther 2022;52(9):620-629. Epub: 9 July 2022. doi:10.2519/jospt.2022.11133</i>.</p>","PeriodicalId":159920,"journal":{"name":"The Journal of orthopaedic and sports physical therapy","volume":" ","pages":"620-629"},"PeriodicalIF":6.1,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40573112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Myths and Facts\" Education Is Comparable to \"Facts Only\" for Recall of Back Pain Information but May Improve Fear-Avoidance Beliefs: An Embedded Randomized Trial.","authors":"Priscilla Viana da Silva,&nbsp;Steven J Kamper,&nbsp;Emma Robson,&nbsp;Simon R E Davidson,&nbsp;Connor Gleadhill,&nbsp;Bruce Donald,&nbsp;Tiê Parma Yamato,&nbsp;Erin Nolan,&nbsp;Hopin Lee,&nbsp;Christopher Williams","doi":"10.2519/jospt.2022.10989","DOIUrl":"https://doi.org/10.2519/jospt.2022.10989","url":null,"abstract":"<p><strong>Objective: </strong>To assess the effectiveness of patient education with \"myths and facts\" versus \"facts only\" on recall of back pain information and fear-avoidance beliefs in patients with chronic low back pain (LBP).</p><p><strong>Design: </strong>Randomized Study Within A Trial.</p><p><strong>Methods: </strong>One hundred fifty-two participants with chronic LBP were included. Participants allocated to the \"facts only\" group received an information sheet with 6 LBP facts, whereas those allocated to the \"myths and facts\" group received the same information sheet, with each myth refuted by its respective fact. The primary outcome was a correct recall of back pain facts, and the secondary outcome was the physical activity component of the Fear-Avoidance Beliefs Questionnaire (FABQ-PA), 2 weeks after the provision of the information sheet.</p><p><strong>Results: </strong>There was no evidence of a difference in the proportion of participants with a correct recall between the \"myths and facts\" and \"facts only\" groups (odds ratio = 0.98; 95% confidence interval [CI]: 0.48, 1.99) and no significant difference in FABQ-PA mean scores between groups (-1.58; 95% CI: -3.77, 0.61). Sensitivity analyses adjusted for prognostic factors showed no difference in information recall but a larger difference in FABQ-PA scores (-2.3; 95% CI: -4.56, -0.04).</p><p><strong>Conclusion: </strong>We found no overall difference in the recall of back pain information for patients provided with \"myths and facts\" compared with that for patients provided with \"facts only\" and a slight reduction in fear-avoidance beliefs for physical activity using \"myths and facts\" compared with that using \"facts only,\" but the meaningfulness of this result is uncertain. <i>J Orthop Sports Phys Ther 2022;52(9):586-594. Epub: 9 July 2022. doi:10.2519/jospt.2022.10989</i>.</p>","PeriodicalId":159920,"journal":{"name":"The Journal of orthopaedic and sports physical therapy","volume":" ","pages":"586-594"},"PeriodicalIF":6.1,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40573114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of the Most Common Provocation Tests for Diagnosing Carpal Tunnel Syndrome: A Systematic Review With Meta-analysis.","authors":"Sergio Núñez de Arenas-Arroyo, Iván Cavero-Redondo, Ana Torres-Costoso, Sara Reina-Gutiérrez, María José Guzmán-Pavón, Vicente Martínez-Vizcaíno","doi":"10.2519/jospt.2022.10828","DOIUrl":"10.2519/jospt.2022.10828","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the screening performances of the most important provocation tests for diagnosing carpal tunnel syndrome (CTS).</p><p><strong>Design: </strong>Diagnostic test accuracy systematic review with meta-analysis.</p><p><strong>Literature search: </strong>We systematically searched the MEDLINE, Scopus, Web of Science, and Cochrane databases from inception to November 2020.</p><p><strong>Study selection criteria: </strong>Observational studies comparing the accuracies of the Durkan test (DT), the hand elevation test (HET), the Phalen test (PT), the Tinel test (TT), and the upper-limb neurodynamic test specific to the median nerve (ULNT1) with electrodiagnosis for screening for CTS.</p><p><strong>Data synthesis: </strong>Random-effects models for the diagnostic odds ratio (dOR) values computed by Moses' constant for a linear model and 95% confidence intervals (CIs) were used to calculate the accuracy of these tests. Hierarchical summary receiver operating characteristic curve analyses were used to summarize the overall test performance.</p><p><strong>Results: </strong>Thirty-seven studies were included in the meta-analysis, with a total sample of 2662 wrists for DT, 864 wrists for HET, 6361 wrists for PT, 6094 wrists for TT, and 571 wrists for ULNT1. The pooled dORs for screening for CTS were 15.84 (95% CI: 3.78, 66.38) for DT, 128.63 (95% CI: 40.64, 407.12) for HET, 7.23 (95% CI: 4.06, 12.86) for PT, 5.31 (95% CI: 3.49, 8.09) for TT, and 1.78 (95% CI: 0.61, 5.19) for ULNT1.</p><p><strong>Conclusion: </strong>HET has the best clinical performance for detecting CTS and should be considered the first screening test of choice during the physical examination. The most common tests (DT, PT, and TT) have good accuracies for screening for CTS. <i>J Orthop Sports Phys Ther 2022;52(8):522-531. Epub: 19 June 2022. doi:10.2519/jospt.2022.10828</i>.</p>","PeriodicalId":159920,"journal":{"name":"The Journal of orthopaedic and sports physical therapy","volume":"52 8","pages":"522-531"},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40057291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subsequent Musculoskeletal Injury Incidence Are Similar Between General Infection and COVID-19 Among High School Athletes in the Unites States Despite Higher Illness Incidence During Academic Years 2019-2020 and 2020-2021.","authors":"Ellen Shanley,&nbsp;Charles A Thigpen,&nbsp;Albert Prats-Uribe,&nbsp;Tyler Norhen,&nbsp;Trey Staley,&nbsp;Garrett S Bullock","doi":"10.2519/jospt.2022.11200","DOIUrl":"https://doi.org/10.2519/jospt.2022.11200","url":null,"abstract":"<p><strong>Objectives: </strong>To describe overall illness and COVID-19- specific illness in high school athletes in the 2019-2020 and 2020-2021 academic school years, and to describe and assess the risk of musculoskeletal injury following general infection and after COVID-19.</p><p><strong>Design: </strong>Ecological study.</p><p><strong>Methods: </strong>High schools (6 states; 176 high schools) were matched between the 2019-2020 and 2020-2021 academic school years, based on 2020-2021 high school sport participation. Illness and injury data were collected from the high school athletic trainers. Illness was stratified by overall illness, general infection, and COVID-19. Injuries following moderate or severe infections or COVID-19 were recorded. Illness and injury incidence rate per 100 athletes per year, with 95% confidence intervals (95% CIs), were calculated. Negative binomial models comparing injury following general infections and COVID-19 infections were calculated.</p><p><strong>Results: </strong>A total of 98 487 and 72 521 athletes participated in the 2019-2020 and 2020-2021 years. Illness incidence rate was less in the 2019-2020 academic school year [0.30 (95% CI: 0.27, 0.34)] than the 2020-2021 academic school year [1.1 (1.0-1.2)], resulting in a difference of 0.8 (95% CI: 0.7, 0.9). COVID-19 incidence rate was 0.52 (0.47-0.58) in the 2020-2021 year. Injury following general infection incidence rate was 27.9 injuries (21.4-34.5) per 100 athletes in 2019-2020, and 22.5 injuries (19.3-25.7) per 100 athletes in 2020-2021. There was no difference in injury risk following general infection and COVID-19 [rate ratio: 1.2 (95% CI: 0.7, 2.4)].</p><p><strong>Conclusions: </strong>The incidence rate for all illnesses in high school athletes was slightly (0.8) greater in the 2020-2021 academic compared to the 2019-2020 year. Most of the incidence increase was due to infections and COVID-19. Subsequent injury incidence following moderate and severe infections were similar between years and between general infections and COVID-19. <i>J Orthop Sports Phys Ther 2022;52(8):546-553. Epub: 19 June 2022. doi:10.2519/jospt.2022.11200</i>.</p>","PeriodicalId":159920,"journal":{"name":"The Journal of orthopaedic and sports physical therapy","volume":"52 8","pages":"546-553"},"PeriodicalIF":6.1,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40057292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Looking at Both Sides of the Coin: Addressing Rupture of the Therapeutic Relationship in Musculoskeletal Physical Therapy/Physiotherapy.","authors":"Maxi Miciak,&nbsp;Giacomo Rossettini","doi":"10.2519/jospt.2022.11152","DOIUrl":"https://doi.org/10.2519/jospt.2022.11152","url":null,"abstract":"<p><strong>Synopsis: </strong>As physical therapists, we may have all experienced tense moments in our therapeutic relationships with patients. Whether small or large, implicit or explicit, relational breakdowns are a normal part of human interactions. Within the clinical encounter, these tensions are called \"ruptures.\" In psychotherapy, ruptures have been associated with increased dropout rates and poor clinical outcomes. To increase the likelihood that physical therapists establish, maintain, and strengthen therapeutic relationships with their patients, recognizing and repairing ruptures would seem logical. However, we contend that relational tensions, although inevitable, are most often avoided by physical therapists, potentially to the peril of the therapeutic relationship. A responsive approach that involves adjusting our mind-set, being aware, and taking appropriate action could facilitate rupture repair. We provide clinical examples of rupture and repair and discuss the opportunities that \"the other side of the coin\" presents for professional and personal growth. <i>J Orthop Sports Phys Ther 2022;52(8):500-504. Epub: 19 June 2022. doi:10.2519/jospt.2022.11152</i>.</p>","PeriodicalId":159920,"journal":{"name":"The Journal of orthopaedic and sports physical therapy","volume":"52 8","pages":"500-504"},"PeriodicalIF":6.1,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40058652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Best Exercise Options for Reducing Pain and Disability in Adults With Chronic Low Back Pain: Pilates, Strength, Core-Based, and Mind-Body. A Network Meta-analysis.","authors":"Rubén Fernández-Rodríguez, Celia Álvarez-Bueno, Iván Cavero-Redondo, Ana Torres-Costoso, Diana P Pozuelo-Carrascosa, Sara Reina-Gutiérrez, Carlos Pascual-Morena, Vicente Martínez-Vizcaíno","doi":"10.2519/jospt.2022.10671","DOIUrl":"10.2519/jospt.2022.10671","url":null,"abstract":"<p><strong>Objective: </strong>To determine which type of exercise is best for reducing pain and disability in adults with chronic low back pain (LBP).</p><p><strong>Design: </strong>Systematic review with a network meta-analysis (NMA) of randomized controlled trials (RCTs).</p><p><strong>Literature search: </strong>Six electronic databases were systematically searched from inception to July 2021.</p><p><strong>Study selection criteria: </strong>RCTs testing the effects of exercise on reducing self-perceived pain or disability in adults (aged 18-65 years) with chronic LBP.</p><p><strong>Data synthesis: </strong>We followed the PRISMA-NMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses, incorporating NMAs of health care interventions) statement when reporting our NMA. A frequentist NMA was conducted. The probability of each intervention being the most effective was conducted according to surface under the cumulative ranking curve (SUCRA) values.</p><p><strong>Results: </strong>We included 118 trials (9710 participants). There were 28 head-to-head comparisons, 7 indirect comparisons for pain, and 8 indirect comparisons for disability. Compared with control, all types of physical exercises were effective for improving pain and disability, except for stretching exercises (for reducing pain) and the McKenzie method (for reducing disability). The most effective interventions for reducing pain were Pilates, mind-body, and core-based exercises. The most effective interventions for reducing disability were Pilates, strength, and core-based exercises. On SUCRA analysis, Pilates had the highest likelihood for reducing pain (93%) and disability (98%).</p><p><strong>Conclusion: </strong>Although most exercise interventions had benefits for managing pain and disability in chronic LBP, the most beneficial programs were those that included (1) at least 1 to 2 sessions per week of Pilates or strength exercises; (2) sessions of less than 60 minutes of core-based, strength, or mind-body exercises; and (3) training programs from 3 to 9 weeks of Pilates and core-based exercises. <i>J Orthop Sports Phys Ther 2022;52(8):505-521. Epub: 19 June 2022. doi:10.2519/jospt.2022.10671</i>.</p>","PeriodicalId":159920,"journal":{"name":"The Journal of orthopaedic and sports physical therapy","volume":"52 8","pages":"505-521"},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40058650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}