Questionnaires assessing knowledge and beliefs about musculoskeletal conditions are potentially suitable for use, but further research is needed: a systematic review.

OBJECTIVES: To evaluate the measurement properties of Patient-reported outcome measures (PROMs) for knowledge and/or beliefs about musculoskeletal conditions. STUDY DESIGN AND SETTING: A systematic review was performed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. This review was prospectively registered on PROSPERO - ID: CRD42022303111. Electronic databases, reference lists, forward citation tracking, and contact with experts were used to identify studies. Eligible studies were reports developing or assessing a measurement property of a PROM measuring musculoskeletal condition specific-knowledge and/or beliefs. We assessed the methodological quality and measurement properties of included studies. A modified Grading of Recommendations Assessment Development and Evaluation approach was used to rate the quality of evidence for each PROM. RESULTS: The literature search was performed from inception to 11th September 2023. Sixty records were included, reporting 290 individual studies, and provided information on 25 PROMs. Five PROMs presented sufficient structural validity, three presented sufficient cross-cultural validity, ten presented sufficient reliability, three presented sufficient criterion validity, six presented sufficient hypothesis-testing, and four presented sufficient responsiveness. No PROM presented sufficient evidence for content validity, internal consistency, and measurement error. Based on the available evidence, no PROM was classified as suitable for use according to the COSMIN recommendations. Twenty-four PROMs are potentially suitable for use, and one PROM is not recommended for use. CONCLUSION: No PROM designed to assess knowledge and/or beliefs about musculoskeletal conditions meets the COSMIN criteria of suitable for use. Most PROMs identified in this systematic review were considered as potentially suitable for use and need further high-quality research to assess their measurement properties.

Cost-Effectiveness of Treatments for Musculoskeletal Conditions Offered by Physiotherapists: A Systematic Review of Trial-Based Evaluations.

BACKGROUND: Musculoskeletal conditions are a leading contributor to disability worldwide. The treatment of these conditions accounts for 7% of health care costs in Germany and is often provided by physiotherapists. Yet, an overview of the cost-effectiveness of treatments for musculoskeletal conditions offered by physiotherapists is missing. This review aims to provide an overview of full economic evaluations of interventions for musculoskeletal conditions offered by physiotherapists. METHODS: We systematically searched for publications in Medline, EconLit, and NHS-EED. Title and abstracts, followed by full texts were screened independently by two authors. We included trial-based full economic evaluations of physiotherapeutic interventions for patients with musculoskeletal conditions and allowed any control group. We extracted participants' information, the setting, the intervention, and details on the economic analyses. We evaluated the quality of the included articles with the Consensus on Health Economic Criteria checklist. RESULTS: We identified 5141 eligible publications and included 83 articles. The articles were based on 78 clinical trials. They addressed conditions of the spine (n = 39), the upper limb (n = 8), the lower limb (n = 30), and some other conditions (n = 6). The most investigated conditions were low back pain (n = 25) and knee and hip osteoarthritis (n = 16). The articles involved 69 comparisons between physiotherapeutic interventions (in which we defined primary interventions) and 81 comparisons in which only one intervention was offered by a physiotherapist. Physiotherapeutic interventions compared to those provided by other health professionals were cheaper and more effective in 43% (18/42) of the comparisons. Ten percent (4/42) of the interventions were dominated. The overall quality of the articles was high. However, the description of delivered interventions varied widely and often lacked details. This limited fair treatment comparisons. CONCLUSIONS: High-quality evidence was found for physiotherapeutic interventions to be cost-effective, but the result depends on the patient group, intervention, and control arm. Treatments of knee and back conditions were primarily investigated, highlighting a need for physiotherapeutic cost-effectiveness analyses of less often investigated joints and conditions. The documentation of provided interventions needs improvement to enable clinicians and stakeholders to fairly compare interventions and ultimately adopt cost-effective treatments.

Time to Service and Its Relationship with Outcomes in Workers with Compensated Musculoskeletal Conditions: A Scoping Review.

PURPOSE: A comprehensive review of the literature on the time between the onset of symptoms and the first episode of care and its effects on important worker outcomes in compensated musculoskeletal conditions is currently lacking. This scoping review aimed to summarize the factors associated with time to service and describe outcomes in workers with workers' compensation accepted claims for musculoskeletal conditions. METHODS: We used the JBI guidelines for scoping reviews and reported following the PRISMA-ScR protocol. We included peer-reviewed articles published in English that measured the timing of health service initiation. We conducted searches in six databases, including Medline (Ovid), Embase (Ovid), PsycINFO, Cinahl Plus (EBSCOhost), Scopus, and the Web of Science. Peer-reviewed articles published up to November 01, 2022 were included. The evidence was summarized using a narrative synthesis. RESULTS: Out of the 3502 studies identified, 31 were included. Eight studies reported the factors associated with time to service. Male workers, availability of return to work programmes, physically demanding occupations, and greater injury severity were associated with a shorter time to service, whereas female workers, a high number of employees in the workplace, and having legal representation were associated with a longer time to service. The relationship between time service and worker outcomes was observed in 25 studies, with early access to physical therapy and biopsychosocial interventions indicating favourable outcomes. Conversely, early opioids, and MRI in the absence of severe underlying conditions were associated with a longer duration of disability, higher claim costs, and increased healthcare utilization. CONCLUSION: Existing evidence suggests that the time to service for individuals with compensated musculoskeletal conditions was found to be associated with several characteristics. The relationship between time to service and worker outcomes was consistently indicated in the majority of the studies. This review highlights the need to consider patient-centred treatments and develop strategies to decrease early services with negative effects and increase access to early services with better outcomes.

Applications of wearable sensors in upper extremity MSK conditions: a scoping review.

PURPOSE: This scoping review uniquely aims to map the current state of the literature on the applications of wearable sensors in people with or at risk of developing upper extremity musculoskeletal (UE-MSK) conditions, considering that MSK conditions or disorders have the highest rate of prevalence among other types of conditions or disorders that contribute to the need for rehabilitation services. MATERIALS AND METHODS: The preferred reporting items for systematic reviews and meta-analysis (PRISMA) extension for scoping reviews guideline was followed in this scoping review. Two independent authors conducted a systematic search of four databases, including PubMed, Embase, Scopus, and IEEEXplore. We included studies that have applied wearable sensors on people with or at risk of developing UE-MSK condition published after 2010. We extracted study designs, aims, number of participants, sensor placement locations, sensor types, and number, and outcome(s) of interest from the included studies. The overall findings of our scoping review are presented in tables and diagrams to map an overview of the existing applications. RESULTS: The final review encompassed 80 studies categorized into clinical population (31 studies), workers' population (31 studies), and general wearable design/performance studies (18 studies). Most were observational, with 2 RCTs in workers' studies. Clinical studies focused on UE-MSK conditions like rotator cuff tear and arthritis. Workers' studies involved industrial workers, surgeons, farmers, and at-risk healthy individuals. Wearable sensors were utilized for objective motion assessment, home-based rehabilitation monitoring, daily activity recording, physical risk characterization, and ergonomic assessments. IMU sensors were prevalent in designs (84%), with a minority including sEMG sensors (16%). Assessment applications dominated (80%), while treatment-focused studies constituted 20%. Home-based applicability was noted in 21% of the studies. CONCLUSION: Wearable sensor technologies have been increasingly applied to the health care field. These applications include clinical assessments, home-based treatments of MSK disorders, and monitoring of workers' population in non-standardized areas such as work environments. Assessment-focused studies predominate over treatment studies. Additionally, wearable sensor designs predominantly use IMU sensors, with a subset of studies incorporating sEMG and other sensor types in wearable platforms to capture muscle activity and inertial data for the assessment or rehabilitation of MSK conditions.

Stakeholder engagement in the development of an upper extremity outcome measure for children with rare musculoskeletal conditions.

BACKGROUND: Upper extremity (UE) involvement is prevalent in 73% of individuals with arthrogryposis multiplex congenita (AMC), yet no AMC-specific outcome measure exists. When developing a measure specific to a population with a rare musculoskeletal condition, clinicians' and patients' perspectives and involvement is a crucial and necessary step. This study sought to determine the most clinically useful items for an outcome measure of UE function for children with AMC as defined by caregivers and clinicians. METHODS: To ensure the perspectives and needs of caregivers of children with AMC and clinicians were considered in the development of the UE measure for AMC, a Nominal Group technique (NGT) with caregivers of children with AMC (phase 1) followed by a three-round survey with clinicians (phase 2) were carried out. RESULTS: Phase 1: Eleven individuals participated in the nominal group technique and identified 32 items. The most important items were Picking up an object (n = 11), Eating (n = 10), Reaching mouth (n = 10), Getting out of bed (n = 10). Phase 2: Invitations to participate to an online survey was sent to 47 experts in the field of AMC, 20 participants completed round 1, 15 completed round 2 and 13 completed round 3. Throughout the survey, participants were asked about movement required to screen the UE, essential domains to be included in the measure, establishing a scoring guide and identifying tasks associated with joint motion and position. CONCLUSION: A preliminary version of an UE AMC-specific outcome measure was developed with the help of caregivers' perspectives and expert opinions.

Arthrogryposis multiplex congenita (AMC) is a rare musculoskeletal condition affects the joints and muscles of the body. In about 70% of the cases, it affects the upper extremities (UE). However, there is no specific outcome measure for UE function in children with AMC. An outcome measure refers to a tool or method used to assess and measure the results or effects of a particular treatment, intervention, or condition. It helps healthcare professionals and researchers understand the impact or outcome of a specific situation, such as the level of improvement or changes in a person's health or function. The goal of this study was to develop such a measure while accounting for the perspectives of youth with AMC, their caregivers and clinicians. To achieve this, a study was conducted in two phases. In the first phase, a Nominal Group technique (NGT) was used to gather input from caregivers of children with AMC. Eleven individuals participated and identified 32 items, with the most important being picking up an object, eating, reaching the mouth, and getting out of bed. In the second phase, a three-round survey was sent to 47 experts in the field of AMC, with 20 participants completing the first round, 15 completing the second round, and 13 completing the third round. The survey asked participants about screening UE movement, essential domains to include in the measure, establishing a scoring guide, and identifying tasks associated with joint motion and position. With the help of caregivers' perspectives and expert opinions, a preliminary version of an UE AMC-specific outcome measure was developed. This measure will be useful in assessing the UE function in children with AMC and will aid clinicians in developing appropriate treatment plans for this rare condition.

The Severity of Pain and Comorbidities Significantly Impact the Dependency on Activities of Daily Living among Musculoskeletal Patients in Jizan, Saudi Arabia.

Limited research has been carried out on the effects of pain, comorbidity, and impaired function in musculoskeletal patients in Jizan, Saudi Arabia. A cross-sectional study was conducted on 115 patients (aged ≥ 55 years) with physician-diagnosed musculoskeletal conditions in Jizan to investigate the association between pain severity, comorbidities, and dependence on activities of daily living (ADLs). Self-reported questionnaires were used to collect data on pain, comorbidities, and physical function measured by ADLs. In ADLs, participants were categorized as dependent (n = 36) or independent (n = 79). Logistic regression analysis was employed to determine the predictors of dependence. The results showed that higher pain severity (adjusted odds ratio (OR): 1.69, 95% confidence interval (CI): 1.21-2.38, p = 0.002) and a greater number of comorbidities (adjusted OR: 1.52, 95% CI: 1.06-2.17, p = 0.021) were independently associated with dependence in ADLs. These associations remained significant even after controlling for covariates. This study concluded that patients with musculoskeletal conditions in Jizan who experience high levels of pain and comorbidities are at risk of dependence on basic daily activities. Therefore, addressing pain and comorbidities is crucial for maintaining independence and improving quality of life. Personalized rehabilitation programs are needed to manage these conditions in this region.

Let's Move with Leon. A randomised controlled trial of a UK digital intervention to improve physical activity in people with a musculoskeletal condition.

OBJECTIVE: This article presents a real-world evaluation of a digital intervention, 'Let's Move with Leon', designed to improve physical activity and health-related quality of life (HRQoL) in people with a musculoskeletal condition. STUDY DESIGN: A pragmatic randomised controlled trial. METHODS: After randomisation and withdrawals were removed, 184 participants were assigned to receive the digital intervention with 185 assigned to a control group. Self-reported physical activity was the primary outcome. Health-related quality of life, the number of days completing strength-based exercises per week, the capability, opportunity, and motivation to be active, and step count were secondary outcomes. Outcomes were assessed over 4, 8 and 13 weeks. RESULTS: Significant improvements were seen for self-reported physical activity at 13 weeks, reported strength days at 8 weeks, perceptions of physical capability and automatic motivation to be active at 4 and 8 weeks. No improvements were seen in step count or HRQoL over the control group. CONCLUSION: Digital interventions such as 'Let's Move with Leon' have the potential to increase physical activity in people with a musculoskeletal condition; however, improvements are likely to be small. Small improvements in physical activity may not be enough to improve HRQoL.

The reach and benefits of a digital intervention to improve physical activity in people with a musculoskeletal condition delivered during the COVID-19 pandemic in the UK.

AIM: To evaluate a digital intervention to improve physical activity in people in the UK with a musculoskeletal condition delivered during movement restrictions brought about because of the COVID-19 pandemic. METHOD: Service evaluation data collected from 26,041 participants over 5 months was assessed against national datasets to understand the reach and representativeness of the digital physical activity intervention. Measures to restrict the movement and interaction of people were in place during these 5 months. Cross-sectional data from 2752 participants across different stages of the 12-week programme assessed levels of physical activity and the components of behaviour as defined by the COM-B model (Capability, Opportunity, Motivation = Behaviour). Regression analysis investigated the relationship between programme stage and physical activity and the components of behaviour. RESULTS: In comparison to the UK population of people with a musculoskeletal condition, the intervention participants were over-represented by females, White, and inactive people. A cross-sectional analysis suggested that the number of participants regularly active increased by programme stage. Scores for the behavioural components of automatic and reflective motivation, physical and psychological capability, and physical opportunity were also improved by programme stage. CONCLUSION: The service evaluation suggests that the digital intervention, designed to improve physical activity in people with a musculoskeletal condition, could be beneficial during measures to restrict movement to slow the spread of infectious disease in those who are already motivated to become or stay active.

Short-Term Effects of Dry Needling with a Standard Exercise Program on Pain and Quality of Life in Patients with Chronic Mechanical Neck Pain.

BACKGROUND: This study aimed to determine the short-term effects of dry needling (DN) combined with a standard exercise program on pain and quality of life in patients with chronic mechanical neck pain (CMNP). METHODS: Thirty-one patients with CMNP were randomly allocated to the experimental and control groups. The experimental group received DN and underwent a standard exercise program (one DN session and six exercise sessions) for two weeks, whereas the control group underwent the same exercise program alone for two weeks. The participants' scores in the Numeric Pain Rating Scale (NPRS), Neck Disability Index (NDI), Short Form-36 Quality of Life Scale (SF-36 QOLS), and Beck Depression Inventory (BDI) before and after the intervention were assessed. RESULTS: The control and experimental groups' post-test NDI, NPRS, SF-36 QOLS, and BDI scores significantly differed from their baseline scores (p ≤ 0.05). The between-group comparison of the post-test scores using Wilcoxon rank-sum test revealed no significant differences between the NDI, NPRS, BDI, and SF-36 QOLS scores of both groups (p ≥ 0.05). CONCLUSIONS: One session of trigger point DN (TrP-DN) with exercise and exercise alone showed the same pain and quality-of-life outcomes after a two-week intervention. We did not recognise TrP-DN as an efficient intervention, not because we obtained evidence that it is ineffective, but because there were inadequate high-quality studies on the subject and unavailable data on the minimum quantity of injections required for better DN outcomes in CMNP patients.

The barriers and facilitators to physical activity in people with a musculoskeletal condition: A rapid review of reviews using the COM-B model to support intervention development.

Objectives: The objective of this review of reviews was to identify the potentially modifiable barriers and facilitators to physical activity in people with a musculoskeletal condition to influence intervention development. Study design: A rapid review of reviews. Methods: The Cochrane library and PubMed Central were searched for reviews using pre-defined search terms and relevant synonyms for "physical activity", "barriers" or "facilitators", and "musculoskeletal condition". The identified reviews were screened for inclusion by the principal investigator in line with recognised streamlining approaches for a rapid review. Only review papers investigating the barriers and facilitators to physical activity in adults with a musculoskeletal condition were included. A team of seven assessed the included reviews for identification of the barriers and facilitators to physical activity coded using the COM-B model of behaviour. Results: 503 reviews were identified with 12 included for analysis across a mix of conditions and designs (n = 2: qualitative; n = 6: quantitative; n = 4 mixed). A multitude of interrelated factors were identified across the COM-B components. The most prevalent factors included disease symptoms and physical function (physical capability), knowledge of the specific benefits of physical activity and knowing what to do (psychological capability), the accessibility of facilities and individualised programming (physical opportunity), tailored advice from healthcare professionals and peer support (social opportunity), beliefs about the benefits or harms of being active (reflective motivation) and having the self-efficacy to be active and experiencing positive emotions (automatic motivation). Conclusions: This review of reviews identified the complex nature of physical activity in people living with a musculoskeletal condition. The identified barriers and facilitators should be considered by intervention designers when developing behaviour change interventions for this population group.

Low back pain presentations to New South Wales emergency departments: Trends over time and geographical variation.

OBJECTIVE: To determine whether rates of ED presentations because of low back pain (LBP) have increased from 2016 to 2019 in New South Wales and map the geographical distribution of ED presentations because of LBP across New South Wales. METHODS: We sourced data from the New South Wales Emergency Department Records for Epidemiology. We included all ED presentations aged 15 years and older with a diagnosis of LBP to the 178 public EDs across New South Wales from 1 January 2016 to 31 December 2019. We calculated the ratio (95% confidence interval) between the 2016 and 2019 age-standardised rates to determine whether an increase in the rate of ED LBP presentations has occurred. To assess geographical variation, we aggregated presentations by their home postcode. We calculated age-standardised rates per 100 000 person year for each of those areas using data from 2016 to 2019. RESULTS: We included 188 275 LBP presentations for patients aged 15 years or older. Their mean (standard deviation) age was 51.3 (20.0) years. From 2016 to 2019, we observed a 5.3% increase in the age-adjusted LBP ED presentation rates (age-standardised ratio 1.05, 95% confidence interval 1.04-1.06). We found a 20-fold variation in LBP ED age-standardised presentation rates across the different local government areas of New South Wales. Higher rates were mostly observed in rural and regional areas. CONCLUSIONS: The demand for ED services because of LBP has increased in New South Wales over time, and we observed a 20-fold variation in presentation rates across different regions.

The effects of behavioural counselling on the determinants of health behaviour change in adults with chronic musculoskeletal conditions making lifestyle changes: A systematic review and meta-analysis.

OBJECTIVE: A systematic review and meta-analysis of controlled trials was carried out to examine the effect of behavioural counselling on determinants of behaviour change in adults with chronic, painful musculoskeletal conditions. METHODS: Seven databases were searched up to January 2019. Two reviewers independently screened title/abstracts and full texts. Eligible trials included those including participants over 18 years of age with a chronic, painful musculoskeletal condition, a measurement of at least one behavioural determinant and lifestyle behaviour, and where behavioural counselling was the distinguishing intervention. Two reviewers independently extracted data and assessed for risk of bias using the Cochrane Risk of Bias Tool. Meta-analyses were conducted, using standardized mean differences and 95% confidence intervals (CIs) when at least two trials examined the same outcome. The quality of the evidence was evaluated using the Grades of Recommendation, Assessment, Development and Evaluation approach. RESULTS: Fourteen unique trials, reported in 16 publications, were included. Low-quality evidence showed that behavioural counselling has a small effect on increasing self-reported physical activity (standardized mean difference 0.26; 95% CI 0.00, 0.53). Very-low-quality evidence showed that behavioural counselling has a moderate effect on self-efficacy related to physical activity (standardized mean difference 0.69; 95% CI 0.19, 1.18). Low-quality evidence suggested that behavioural counselling has no effect on symptoms of depression and anxiety. CONCLUSIONS: Behavioural counselling may help to increase self-reported physical activity levels in adults with chronic painful musculoskeletal conditions. Self-efficacy may be a behavioural determinant in an underlying causal pathway explaining positive lifestyle change.

Joint Hypermobility Syndrome: Recognizing a Commonly Overlooked Cause of Chronic Pain.

Joint hypermobility syndrome, also known as benign hypermobility syndrome, is a connective tissue disease characterized by joint instability, chronic pain, and minor skin changes. It shares many clinical features of Ehlers-Danlos syndrome, Hypermobility Type; enough so that many authorities consider them as one disease process. Approximately 3% of the general population is believed to have joint hypermobility syndrome, but despite this high prevalence, due to lack of awareness, heterogeneity of clinical presentation, and reliance on physical examination for diagnosis, it is largely overlooked by primary care physicians as well as by specialists. This leads to delayed or missed opportunities for diagnosis, and inappropriate interventions that frustrate both providers and patients. We review the literature regarding the pathophysiology, diagnosis, treatment options, and prognosis of joint hypermobility syndrome, and advocate for primary care physicians to consider it in the differential diagnosis of patients with chronic pain.

An Integrated Methodology to Assess Compliance with Delphi Survey Key Components of Yoga Interventions for Musculoskeletal Conditions as Applied in a Systematic Review of Fibromyalgia Studies.

OBJECTIVE: The objective of this article was to present a methodology incorporating existing guidelines and tools for systematic reviews and to evaluate the Delphi survey 33 key component recommendations of yoga interventions for musculoskeletal conditions as a tool for a systematic review in fibromyalgia studies. DATA SOURCES: Databases searched included PubMed, Ovid Medline, PsychINFO, the Cochrane Library, CINAHL, ALT HealthWatch, PEDro, and Web of Science. ARTICLE SELECTION: Selected were articles published between November 14, 2004 and November 13, 2014, written in English, reporting original research of yoga interventions for adults with fibromyalgia. DATA EXTRACTION AND SYNTHESIS: Six articles met the inclusion criteria, revealing that three yoga styles ("Relaxing" yoga, Yoga of Awareness, and Hatha yoga) have been assessed in persons with fibromyalgia. Overall, reporting compliance with the 33 key components ranged from 39.4% to 84.8%, with a mean adherence rate of 62.63% ± 17.74. None of the authors used an accepted reporting guideline; specific components of asana, pranayama, relaxation, and mindfulness practices that would have been incorporated into the interventions tested were identified in only 33.33% of the articles reviewed; and none of the articles included detailed, replicable descriptions of the interventions. CONCLUSIONS: This systematic review supports the need for comprehensive yoga research guidelines. Findings reveal a lack of reporting of intervention details, the need to report a disease-specific rationale for selection of the particular yoga style used for the intervention, and that a limited number of yoga styles have been investigated in persons with fibromyalgia.