Journal of Orthopaedic & Sports Physical Therapy最新文献

{"title":"Group Physical Therapy Programs for Military Members With Musculoskeletal Disorders: A Pragmatic Randomized Controlled Trial.","authors":"Frédérique Dupuis, Kadija Perreault, Luc J Hébert, Marc Perron, Anny Fredette, François Desmeules, Jean-Sébastien Roy","doi":"10.2519/jospt.2024.12342","DOIUrl":"10.2519/jospt.2024.12342","url":null,"abstract":"<p><p><b>OBJECTIVE:</b> To compare the effects of personalized, supervised group-based programs (ie, group physical therapy programs) and usual one-on-one physical therapy care (ie, usual physical therapy care) on disability for military personnel suffering from low back pain, rotator cuff-related shoulder pain, patellofemoral pain syndrome, or lateral ankle sprain. Secondary outcomes were pain severity, pain-related fear, health-related quality of life, and patients' satisfaction with their condition and care. <b>DESIGN:</b> Non-inferiority pragmatic randomized clinical trial. <b>METHODS:</b> One hundred twenty military personnel from the Canadian Armed Forces, experiencing 1 of 4 targeted musculoskeletal disorders, were consecutively recruited and randomly assigned to group physical therapy programs or usual physical therapy care. Disability, pain severity, pain-related fear, and health-related quality-of-life outcomes were measured at 6, 12, and 26 weeks after baseline. Satisfaction with treatment was evaluated at the end of the intervention. Intention-to-treat analyses using linear mixed models with random effects were used to compare the effects of interventions. Chi-square tests were used to compare satisfaction. <b>RESULTS:</b> There were no significant Time × Group interactions for any of the primary and secondary outcomes (Time × Group: <i>P</i>>.67). Satisfaction with treatment also did not differ between groups (<i>P</i>>.05). Statistically significant and clinically important improvements were observed in both groups for all outcomes after 12 weeks (Time effect: <i>P</i><.01), except for health-related quality of life (<i>P</i> = .13). <b>CONCLUSION:</b> Group physical therapy programs were not inferior to usual physical therapy care for managing pain, functional capacity, and patients' satisfaction with care of military personnel presenting with various musculoskeletal disorders. Both interventions led to clinical and statistical improvement in pain and function in the mid and long term. Group physical therapy could be an effective strategy to enhance access to care. <i>J Orthop Sports Phys Ther 2024;54(6):1-10. Epub 26 Mar 2024. doi:10.2519/jospt.2024.12342</i>.</p>","PeriodicalId":50099,"journal":{"name":"Journal of Orthopaedic & Sports Physical Therapy","volume":" ","pages":"417-426"},"PeriodicalIF":6.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140289446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Which Remote Rehabilitation Interventions Work Best for Chronic Musculoskeletal Pain and Depression? A Bayesian Network Meta-Analysis.","authors":"Pavlos Bobos, Tiago V Pereira, Dimitra V Pouliopoulou, Mariana Charakopoulou-Travlou, Goris Nazari, Joy C MacDermid","doi":"10.2519/jospt.2024.12216","DOIUrl":"10.2519/jospt.2024.12216","url":null,"abstract":"<p><p><b>OBJECTIVE:</b> To evaluate the effectiveness of remote rehabilitation interventions for people living with chronic musculoskeletal pain and depression. <b>DESIGN:</b> A systematic review with network meta-analysis (NMA) of randomized controlled trials. <b>LITERATURE SEARCH:</b> We searched the Cochrane Central Register of Controlled Trials, CINAHL, EMBASE, LILACS MEDLINE, PSYNDEX, and PsycINFO databases from inception to May 2023. <b>STUDY SELECTION CRITERIA:</b> Randomized controlled trials that evaluated the effectiveness of remote rehabilitation interventions in people with chronic musculoskeletal pain and depression. <b>DATA SYNTHESIS:</b> We used Bayesian random-effects models for the NMA. Effect estimates were comparisons between rehabilitation interventions and waitlist. We performed a sensitivity analysis based on bias in the randomization process, large trials (>100 patients per arm) and musculoskeletal condition. <b>RESULTS:</b> Fifty-eight randomized controlled trials involving 10 278 participants (median sample size: 137; interquartile range [IQR]: 77-236) were included. Interactive voice response cognitive behavioral therapy (CBT; standardized mean difference [SMD] -0.66, 95% credible interval [CrI] -1.17 to -0.16), CBT in person (SMD -0.50, 95% CrI -0.97 to -0.04), and mobile app CBT plus exercise (SMD -0.37, 95% CrI -0.69 to -0.02) were superior to waitlist at 12-week follow-up for reducing pain (> 98% probability of superiority). For depression outcomes, Internet-delivered CBT and telecare were superior to waitlist at 12-week follow-up (SMD -0.51, 95% CrI -0.87 to -0.13) (> 99% probability of superiority). For pain outcomes, the certainty of evidence ranged from low to moderate. For depression outcomes, the certainty of evidence ranged from very low to moderate. The proportion of dropouts attributed to adverse events was unclear. No intervention was associated with higher odds of dropout. <b>CONCLUSION:</b> Interactive voice response CBT and mobile app CBT plus exercise showed similar treatment effects with in-person CBT on pain reduction among people living with chronic musculoskeletal pain and depression had over 98% probability of superiority than waitlist control at 12-week follow-up. Internet-delivered CBT and telecare had over 99% probability of superiority than waitlist control for improving depression outcomes at 12-week follow-up. <i>J Orthop Sports Phys Ther 2024;54(6):1-16. Epub 26 February 2024. doi:10.2519/jospt.2024.12216</i>.</p>","PeriodicalId":50099,"journal":{"name":"Journal of Orthopaedic & Sports Physical Therapy","volume":" ","pages":"361-376"},"PeriodicalIF":6.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139974336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Double-Leg and Single-Leg Jump Test Reference Values for Athletes With and Without Anterior Cruciate Ligament Reconstruction Who Play Popular Pivoting Sports, Including Soccer and Basketball: A Scoping Review.","authors":"Nicky van Melick, Walter van der Weegen, Nick van der Horst, Rob Bogie","doi":"10.2519/jospt.2024.12374","DOIUrl":"10.2519/jospt.2024.12374","url":null,"abstract":"<p><p><b>OBJECTIVE:</b> To synthesize and present reference values for double-leg and single-leg jump tests in healthy athletes who play pivoting sports, and athletes with anterior cruciate ligament reconstruction (ACLR) who play pivoting sports. <b>DESIGN:</b> Scoping review. <b>LITERATURE SEARCH:</b> We searched PubMed, the Cochrane Library, MEDLINE, Embase, and Web of Science until April 7, 2023. <b>STUDY SELECTION CRITERIA:</b> We included reference values in 2 different categories: (1) double-leg and/or single-leg jump test outcomes in pivoting-sport athletes with ACLR at a specific time point during rehabilitation, and (2) double-leg and/or single-leg jump test outcomes in healthy pivoting-sport athletes. <b>DATA SYNTHESIS:</b> We performed data synthesis for reference values from double-leg jump tests (squat jump and countermovement jump) and single-leg jump tests (vertical hop, single hop for distance, triple hop for distance, crossover hop for distance, medial triple hop for distance, lateral triple hop for distance, 6-m timed hop, side hop, drop jump, and 10-second repeated hop) that were performed according to a standardized test description. We summarized the data for type of sport, sex, sport participation level, and age group. <b>RESULTS:</b> Of the 27 included studies, nine reported reference values from healthy soccer players, six from healthy basketball players, and eleven from other healthy pivoting-sport athletes. LSI dominant/nondominant (LSI-D/ND) ranged between 97% and 106% for healthy soccer players, and between 99% and 120% for healthy basketball players. Four studies reported reference values from pivoting-sport athletes with ACLR from 7 to 10 months postsurgery. <b>CONCLUSION:</b> This scoping review summarizes double-leg and single-leg jump test reference values for athletes who play common pivoting sports, including soccer and basketball. <i>J Orthop Sports Phys Ther 2024;54(6):1-14. Epub 20 March 2024. doi:10.2519/jospt.2024.12374</i>.</p>","PeriodicalId":50099,"journal":{"name":"Journal of Orthopaedic & Sports Physical Therapy","volume":" ","pages":"377-390"},"PeriodicalIF":6.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Preferences and Their Effects on Rehabilitation Outcomes: A Secondary Analysis of a Randomized Controlled Trial.","authors":"Nikolaj Agger, Jim Nørgaard Bøjstrup, David Høyrup Christiansen","doi":"10.2519/jospt.2024.12314","DOIUrl":"10.2519/jospt.2024.12314","url":null,"abstract":"<p><p><b>OBJECTIVE:</b> To assess the effect of aligning patients' preferences with specific rehabilitation delivery modes on rehabilitation outcomes. <b>DESIGN:</b> A secondary analysis of a randomized controlled trial. <b>METHODS:</b> The study cohort comprised 208 patients referred for physiotherapy rehabilitation after nonsurgical or surgical interventions for rotator cuff injury, shoulder impingement, or acromioclavicular osteoarthritis. Participants were randomly assigned to 1 of 3 rehabilitation modalities: (1) group-based exercise, (2) individual exercise, or (3) home exercise. In this study, participants were categorized into 2 groups: \"matched preference\" and \"unmatched preference.\" The primary outcome measure was change in function, measured with the shortened Disabilities of the Arm, Shoulder and Hand (QuickDASH). Secondary outcome measures were change in pain, assessed using the Numeric Rating Scale (NRS), mental well-being measured with the World Health Organization Five Well-Being Index (WHO-5), health-related quality of life assessed using the EuroQol-5 Domain questionnaire (EQ-5D), fear avoidance assessed using the Örebro Musculoskeletal Pain Questionnaire (ÖMPQ), and overall treatment satisfaction. Outcomes were assessed at 3 and 6 months. <b>RESULTS:</b> The primary outcome measure, QuickDASH, showed no significant differences between groups at either 3 months (-3.0 [-8.2 to 2.3]) or 6 months (0.5 [-5.7 to 6.7]). Additionally, no significant differences were observed in the secondary outcome measures. <b>CONCLUSION:</b> Matching patients' preferences for specific rehabilitation delivery modes did not seem to effect rehabilitation outcomes. <i>J Orthop Sports Phys Ther 2024;54(6):1-9. Epub 26 March 2024. doi:10.2519/jospt.2024.12314</i>.</p>","PeriodicalId":50099,"journal":{"name":"Journal of Orthopaedic & Sports Physical Therapy","volume":" ","pages":"408-416"},"PeriodicalIF":6.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140289447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Playing Football (Soccer) Really Increase the Risk of Knee Osteoarthritis? A Systematic Review and Meta-analysis.","authors":"Jonas Olsson Wållgren, Alfred Ferré-Aniorte, Eric Hamrin Senorski, Danny Veznaver, Thorkell Snaebjornsson, Kristian Samuelsson, Eduard Alentorn-Geli","doi":"10.2519/jospt.2024.12029","DOIUrl":"10.2519/jospt.2024.12029","url":null,"abstract":"<p><p><b>OBJECTIVE:</b> To evaluate the relationship between football (soccer) participation and tibiofemoral knee osteoarthritis (OA), considering the influence of competitive level and previous knee injuries. <b>DESIGN:</b> Etiology systematic review with meta-analysis. <b>LITERATURE SEARCH:</b> PubMed, Embase, AMED, and Cochrane were searched for relevant publications. <b>STUDY SELECTION CRITERIA:</b> Studies of football players that included a control group consisting of mainly sedentary nonfootball players, and the relationship of knee OA, were considered. The studies had to report radiographically verified knee OA and specify football activity. <b>DATA SYNTHESIS:</b> Eleven studies, involving 1805 football players and 4022 control individuals were included. Subgroups consisting of data regarding level of play and previous injuries were also synthesized. <b>RESULTS:</b> The overall prevalence of knee OA among football players was increased among professional and recreational players, compared with controls. When knee injuries were excluded, there was no difference in knee OA between football players and controls (OR = 1.25; 95% CI: 0.61, 2.54). Football players with a previous knee injury had a greater risk of knee OA when compared with football players with no history of previous knee injury (OR = 4.16; 95% CI: 1.97, 8.77). <b>CONCLUSION:</b> Football players were at increased risk of knee OA. However, after excluding participants with a history of previous knee injury, there were no differences in knee OA between football players and controls. Previous knee injury was important for developing knee OA. Playing football, in the absence of major knee injuries, did not increase the risk of knee OA. <i>J Orthop Sports Phys Ther 2024;54(5):1-12. Epub 26 February 2024. doi:10.2519/jospt.2024.12029</i>.</p>","PeriodicalId":50099,"journal":{"name":"Journal of Orthopaedic & Sports Physical Therapy","volume":" ","pages":"328-339"},"PeriodicalIF":6.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139974335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuromuscular Control and Resistance Training for People With Chronic Low Back Pain: A Randomized Controlled Trial.","authors":"Joshua B Farragher, Adrian Pranata, Gavin P Williams, Doa El-Ansary, Selina M Parry, Ross A Clark, Benjamin Mentiplay, Jessica Kasza, Samuel Crofts, Adam L Bryant","doi":"10.2519/jospt.2024.12349","DOIUrl":"10.2519/jospt.2024.12349","url":null,"abstract":"<p><p><b>OBJECTIVE:</b> To determine if adding lumbar neuromuscular control retraining exercises to a 12-week program of strengthening exercises had greater effect for improving disability than 12 weeks of strengthening exercises alone in people with chronic low back pain (LBP). <b>DESIGN:</b> Single-center, participant- and assessor-blinded, comparative effectiveness randomized controlled trial. <b>METHODS:</b> Sixty-nine participants (31 females; 29 males; mean age: 46.5 years) with nonspecific chronic LBP were recruited for a 12-week program involving lumbar extension neuromuscular retraining in addition to resistance exercises (intervention) or 12 weeks of resistance exercises alone (control). The primary outcome measure was the Oswestry Disability Index. Secondary outcome measures included the Numeric Rating Scale, Tampa Scale for Kinesiophobia, Pain Self-Efficacy Questionnaire, and the International Physical Activity Questionnaire. Outcomes were measured at baseline, 6 weeks, and 12 weeks. <b>RESULTS:</b> Forty-three participants (22 control, 21 intervention) completed all outcome measures at 6 and 12 weeks. Fourteen participants were lost to follow-up, and 12 participants discontinued due to COVID-19 restrictions. Both groups demonstrated clinically important changes in disability, pain intensity, and kinesiophobia. The difference between groups with respect to disability was imprecise and not clinically meaningful (mean difference, -4.4; 95% CI: -10.2, 1.4) at 12 weeks. Differences in secondary outcomes at 6 or 12 weeks were also small with wide confidence intervals. <b>CONCLUSIONS</b>: Adding lumbar neuromuscular control retraining to a series of resistance exercises offered no additional benefit over resistance exercises alone over a 12-week period. <i>J Orthop Sports Phys Ther 2024;54(5):1-10. Epub 18 March 2024. doi:10.2519/jospt.2024.12349</i>.</p>","PeriodicalId":50099,"journal":{"name":"Journal of Orthopaedic & Sports Physical Therapy","volume":" ","pages":"350-359"},"PeriodicalIF":6.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140144489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a Rehabilitation Guideline (REGUIDE) for Patients Undergoing an Arthroscopic Bankart Repair After Traumatic Anterior Shoulder Dislocation, Focusing on Managing Apprehension: An International Delphi-Based Consensus Study.","authors":"Marianne Larsen van Gastel, Theodore Paul van Iersel, Eric Danjel Tutuhatunewa, Ann M Cools, Michel Pieter Jozef van den Bekerom, Karin Marie Christine Hekman","doi":"10.2519/jospt.2024.12106","DOIUrl":"10.2519/jospt.2024.12106","url":null,"abstract":"<p><p><b>OBJECTIVE:</b> We aimed to develop a consensus-based rehabilitation guideline specifically designed to reduce apprehension following arthroscopic Bankart repair after traumatic anterior shoulder dislocation. <b>DESIGN:</b> Delphi-based consensus. <b>METHOD:</b> A comprehensive list of interventions for potential inclusion in a postoperative rehabilitation guideline was developed. American and European physiotherapists and orthopedic surgeons were invited to participate in a Delphi panel, engaging in 3 survey rounds. The health professionals were surveyed about their level of agreement on both initially listed and newly suggested interventions. Consensus was established when a \"critical-to-include\" rating was given in ≥70% of all responses. Ten former patients were consulted to identify the intervention during standard care rehabilitation that had the most impact on reducing postoperative apprehension following ABR. Any interventions not initially listed in the first round were added to the second survey round of the Delphi process. <b>RESULTS:</b> Forty-four health professionals reached consensus on a set of 27 interventions for managing apprehension after arthroscopic Bankart repair. New interventions included gradual exposure to shoulder positions eliciting apprehension, training in anterior stability-provoking positions, and education addressing the impact of psychosocial factors. Former patients identified specific interventions that were effective in reducing postoperative apprehension following ABR. These interventions encompassed medicine ball throws, active-assisted wall slides, and kinetic chain exercises in anterior stability-provoking positions. <b>CONCLUSION:</b> Our Delphi process informed expert recommendations for various interventions aimed at addressing apprehension associated with ABR. The recommendations were the foundation for developing a rehabilitation guideline (REGUIDE). The REGUIDE integrates principles from cognitive-behavioral therapy to improve rehabilitation and mitigate apprehension. <i>J Orthop Sports Phys Ther 2024;54(5):1-13. Epub 20 March 2024. doi:10.2519/jospt.2024.12106</i>.</p>","PeriodicalId":50099,"journal":{"name":"Journal of Orthopaedic & Sports Physical Therapy","volume":" ","pages":"289-301"},"PeriodicalIF":6.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Models for Chronic Low Back Pain Outcomes in Primary Care Are at High Risk of Bias and Lack Validation-High-Quality Studies Are Needed: A Systematic Review.","authors":"Yanyan Fu, Daniel Feller, Bart Koes, Alessandro Chiarotto","doi":"10.2519/jospt.2024.12081","DOIUrl":"10.2519/jospt.2024.12081","url":null,"abstract":"<p><p><b>OBJECTIVE:</b> To provide an updated overview of available prognostic models for people with chronic low back pain (LBP) in primary care. <b>DESIGN:</b> Prognosis systematic review <b>LITERATURE SEARCH:</b> We searched for relevant studies on MEDLINE, Embase, Web of Science, and CINAHL databases (up to July 13, 2022), and performed citation tracking in Web of Science. <b>STUDY SELECTION CRITERIA:</b> We included observational (cohort or nested case-control) studies and randomized controlled trials that developed or validated prognostic models for adults with chronic LBP in primary care. The outcomes of interest were physical functioning, pain intensity, and health-related quality of life at any follow-up time-point. <b>DATA SYNTHESIS:</b> Data were extracted using the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS), and the Prediction model Risk of Bias Assessment Tool (PROBAST) tool was used to evaluate the risk of bias of the models. Due to the number of studies retrieved and the heterogeneity, we reported the results descriptively. <b>RESULTS:</b> Ten studies (out of 5593 hits screened) with 34 models met our inclusion criteria, of which six are development studies and four are external validation studies. Five studies reported the area under the curve of the models (ranging from 0.48 to 0.84), whereas no study reported calibration indices. The most promising model is the Örebro Musculoskeletal Pain Screening Questionnaire Short-Form. <b>CONCLUSIONS:</b> Given the high risk of bias and lack of external validation, we cannot recommend that clinicians use prognostic models for patients with chronic LBP in primary care settings. <i>J Orthop Sports Phys Ther 2024;54(5):1-13. Epub 15 February 2024. doi:10.2519/jospt.2024.12081</i>.</p>","PeriodicalId":50099,"journal":{"name":"Journal of Orthopaedic & Sports Physical Therapy","volume":" ","pages":"302-314"},"PeriodicalIF":6.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139736530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Surgery Versus Exercise Therapy and Patient Education for Traumatic and Nontraumatic Meniscal Tears in Young Adults-An Exploratory Analysis From the DREAM Trial.","authors":"Camma Damsted, Søren T Skou, Per Hölmich, Martin Lind, Claus Varnum, Hans Peter Jensen, Mogens Strange Hansen, Jonas Bloch Thorlund","doi":"10.2519/jospt.2024.12245","DOIUrl":"10.2519/jospt.2024.12245","url":null,"abstract":"<p><p><b>OBJECTIVE:</b> To compare the effect of early meniscal surgery versus exercise and education with the option of later surgery on pain, function, and quality of life in young patients with a meniscal tear, taking symptom onset into account. <b>DESIGN:</b> Randomized controlled trial. <b>METHODS:</b> In a randomized controlled trial (the \"Danish RCT on Exercise versus Arthroscopic Meniscal surgery for young adults\" [DREAM] trial), 121 patients aged 18-40 years with a magnetic resonance imaging-verified meniscal tear were randomized to surgery or 12 weeks of supervised exercise and patient education. For this exploratory study, the analyses were stratified by symptom onset (traumatic/nontraumatic). The main outcome was the difference in change after 12 months in the mean score of 4 Knee injury and Osteoarthritis Outcome Score subscales (KOOS₄) covering pain, symptoms, function in sport and recreation, and quality of life. <b>RESULTS:</b> Forty-two patients (69%) in the exercise therapy group and 47 (78%) in the surgery group were categorized as having a traumatic tear. We observed no difference in change in the KOOS₄ after 12 months between the 2 treatment groups for either traumatic tears (18.8 versus 16.0 in the surgery versus exercise therapy groups; adjusted mean difference, 4.8 [95% confidence interval, -1.7 to 11.2]) or nontraumatic tears (20.6 versus 17.3 in the surgery versus exercise therapy groups; adjusted mean difference, 7.0 [95% confidence interval, -3.7 to 17.7]). <b>CONCLUSION:</b> In patients with traumatic and nontraumatic meniscus tears, early meniscal surgery did not appear superior to exercise and education in improving pain, function, and quality of life after 12 months. Further research is needed to confirm the clinical applicability of these findings. <i>J Orthop Sports Phys Ther 2024;54(5):1-10. Epub 22 February 2024. doi:10.2519/jospt.2024.12245</i>.</p>","PeriodicalId":50099,"journal":{"name":"Journal of Orthopaedic & Sports Physical Therapy","volume":" ","pages":"340-349"},"PeriodicalIF":6.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139933840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Best Exercise Modality and Dose for Reducing Pain in Adults With Low Back Pain: A Systematic Review With Model-Based Bayesian Network Meta-analysis.","authors":"Zhide Liang, Shudong Tian, Chuanzhi Wang, Meng Zhang, Hengzhi Guo, Yingdanni Yu, Xianliang Wang","doi":"10.2519/jospt.2024.12153","DOIUrl":"10.2519/jospt.2024.12153","url":null,"abstract":"<p><p><b>OBJECTIVE:</b> To quantify the dose-response relationship between overall and specific exercise modalities and pain, in patients with nonspecific chronic low back pain (LBP). <b>DESIGN:</b> Systematic review with Bayesian network meta-analysis. <b>LITERATURE SEARCH:</b> We searched the Medline, Embase, Web of Science, Cochrane Library, Scopus, and SPORTDiscus databases from inception to June 2023. <b>STUDY SELECTION CRITERIA:</b> We included randomized controlled trials of exercise interventions in adults with nonspecific chronic LBP and at least 1 pain outcome reported at the main trial end point. <b>DATA SYNTHESIS:</b> A random-effects network meta-analysis was conducted. We assessed risk of bias using the Cochrane Risk of Bias Tool 2.0, and used the GRADE approach to judge the certainty of evidence for each outcome. <b>RESULTS:</b> Eighty-two trials were included (n = 5033 participants). We found a nonlinear dose-response relationship between total exercise and pain in patients with nonspecific chronic LBP. The maximum significant response was observed at 920 MET minutes (standardized mean difference = -1.74; 95% credible intervals: -2.43, -1.04). The minimal clinically important difference for achieving meaningful pain improvement was 520 MET minutes per week. The dose to achieve minimal clinically important difference varied by type of exercise; Pilates was the most effective. The certainty of the evidence was very low to moderate for all outcomes. <b>CONCLUSION:</b> The dose-response relationship of different exercise modalities to improve pain in patients with nonspecific chronic LBP had a U-shaped trajectory and low- to moderate-certainty evidence. The clinical effect was most pronounced with Pilates exercise. <i>J Orthop Sports Phys Ther 2024;54(5):1-13. Epub 8 March 2024. doi:10.2519/jospt.2024.12153</i>.</p>","PeriodicalId":50099,"journal":{"name":"Journal of Orthopaedic & Sports Physical Therapy","volume":" ","pages":"315-327"},"PeriodicalIF":6.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140061118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}