Collating the voice of people with autoimmune diseases: Methodology for the Third Phase of the COVAD Studies.

INTRODUCTION: The growing recognition of holistic patient care highlights the various factors shaping the quality of life of individuals with autoimmune and rheumatic diseases (AIRDs). Beyond the traditional disease measures, there is an emerging acknowledgment of the less-explored aspects, including subjective well-being, social determinants of health, comorbidities, mental health, and medication adherence. Moreover, digital health services have empowered patients to engage actively in decision-making alongside clinicians. To explore these domains within the context of AIRDs, the "Collating the Voice of People with Autoimmune Diseases" COVAD survey was conceived, a successor of the previous two COVAD surveys. In this document, we present the study protocol in comprehensive detail. METHODS: The COVAD-3 survey is a cross-sectional patient self-reported e-survey incorporating multiple widely accepted scales/scores to assess various aspects of patients' lifestyles objectively. To ensure the survey's accuracy and usability across diverse regions, it will be translated into multiple languages and subjected to rigorous vetting and pilot testing. It will be distributed by collaborators via online platforms and data will be collected from patients with AIRDs, and healthy individuals over eight months. Data analysis will focus on outcome measures related to various social, demographic, economic, and psychological factors. CONCLUSION: With the increasing awareness to adopt a holistic treatment approach encompassing all avenues of life, the COVAD-3 survey aims to gain valuable insights into the impact of social, demographic, economic, and psychological determinants of health on the subjective well-being in patients with AIRDs, which will contribute to a better understanding of their overall health and well-being.

Sex and age differences in the patient-reported outcome measures and adherence to an osteoarthritis digital self-management intervention.

Objective: To explore sex and age differences in Patient-Reported Outcomes Measures (PROMs) and adherence to digital osteoarthritis (OA) self-management intervention. Methods: A register-based study with data from an OA digital self-management intervention. PROMs and adherence were collected at baseline and/or 3 â€‹month follow-up: 'pain intensity' in hip/knee (best/worst: 0-10), 'activity impairments' (best/worst: 0-10), 'overall health' perception (worst/best: 0-10), 'physical function' (30-s chair stand test), 'health-related quality of life' (EQ-5D-5L index score; worst/best: 0.243-0.976), the subscales and total scores of the Knee Injury/Hip Disability and Osteoarthritis Outcome Score (KOOS/HOOS-12; worst/best: 0-100), 'fear of movement' (yes/no), 'walking difficulties' (yes/no), 'programme adherence' (0-100 â€‹% and ≥80 â€‹% [yes/no]), 'patient acceptable symptom state' (PASS; yes/no), and 'treatment failure' (those who answered no to PASS question and thought the treatment failed [yes/no]). We used linear/logistic regression to calculate mean/risk differences in the PROMs and adherence levels among sex and age groups at 3-month follow-up. We employed entropy balancing to explore the contributions of baseline characteristics and different covariates to the sex/age differences. Results: We included 14,610 participants (mean (SD) age: 64.1 (9.1), 75.5 â€‹% females). Females generally reported better outcomes than males. Participants aged ≥70 had greater activity impairments, lower KOOS/HOOS-pain/function scores, more walking difficulties, less fear of movement and higher adherence than those <70. However, these differences were small and not likely clinically relevant. Conclusion: No clinically relevant differences in PROMs and adherence were found among sex/age groups in this digital OA programme, suggesting that sex/age seemed not to impact the outcomes of this intervention.

EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis: 2023 update.

INTRODUCTION: Hip and knee osteoarthritis (OA) are increasingly common with a significant impact on individuals and society. Non-pharmacological treatments are considered essential to reduce pain and improve function and quality of life. EULAR recommendations for the non-pharmacological core management of hip and knee OA were published in 2013. Given the large number of subsequent studies, an update is needed. METHODS: The Standardised Operating Procedures for EULAR recommendations were followed. A multidisciplinary Task Force with 25 members representing 14 European countries was established. The Task Force agreed on an updated search strategy of 11 research questions. The systematic literature review encompassed dates from 1 January 2012 to 27 May 2022. Retrieved evidence was discussed, updated recommendations were formulated, and research and educational agendas were developed. RESULTS: The revised recommendations include two overarching principles and eight evidence-based recommendations including (1) an individualised, multicomponent management plan; (2) information, education and self-management; (3) exercise with adequate tailoring of dosage and progression; (4) mode of exercise delivery; (5) maintenance of healthy weight and weight loss; (6) footwear, walking aids and assistive devices; (7) work-related advice and (8) behaviour change techniques to improve lifestyle. The mean level of agreement on the recommendations ranged between 9.2 and 9.8 (0-10 scale, 10=total agreement). The research agenda highlighted areas related to these interventions including adherence, uptake and impact on work. CONCLUSIONS: The 2023 updated recommendations were formulated based on research evidence and expert opinion to guide the optimal management of hip and knee OA.

Italian adaptation and psychometric validation of the Fatigue Impact Scale (FIS) and its modified versions in adults with multiple sclerosis: a Rasch analysis study.

Purpose: Several outcome measures are available to assess the severity of fatigue in people with multiple sclerosis (MS). The aim of this study was to adapt the Italian version of the Fatigue Impact Scale (FIS-40) and its modified versions: a 21-item Modified scale (MFIS-21), its 5-item short version (MFIS-5), and an 8-item version for daily use (DFIS-8) and investigate their measurement properties through classical theory-test (CTT) and Rasch analysis (RA).Methods: 229 Italian-speaking adults with MS were included. Questionnaires were cross-culturally translated and subjected to CTT (i.e. internal consistency through Cronbach's alpha and unidimensionality through confirmatory factor analysis [CFA]) and RA. (i.e. internal construct validity, reliability, and targeting).Results: Internal consistency was high for all scales (>0.850). Final CFAs reported issues in the unidimensionality for all scales except for FIS-40. Baseline RA revealed a misfit for all scales. After adjusting for local dependency, FIS-40, MFIS-21, and MFIS-5 fitted the Rasch model (RM). MFIS-21 and D-FIS-8 required a structural modification, i.e. item deletions to satisfy the RM.Conclusion: The FIS-40, MFIS-21, MFIS-5, and DFIS-8 achieved the fit to the RM after statistical and structural modifications. The fit to the RM allowed for providing ordinal-to-interval measurement conversion tables for all the questionnaires.

The Fatigue Impact Scale (FIS-40), the 21-item Modified scale (MFIS-21), its 5-item short version (MFIS-5) and the 8-item version for daily use (DFIS-8) have been successfully cross-culturally validated in Italian.The FIS-40 and its versions fit the Rasch Model with minimal changes, determining that the studied outcomes represent a unidimensional construct, i.e. fatigue in multiple sclerosis.The final Rasch Model enables the transformation of scores into interval-level measurements, allowing clinicians to gauge the distance between individuals' scores on the scale continuum.Interval-level transformation allows rehabilitation professionals to better interpret clinical changes and researchers to apply parametric statistics.

Wearable Devices to Improve Physical Activity and Reduce Sedentary Behaviour: An Umbrella Review.

BACKGROUND: Several systematic reviews (SRs), with and without meta-analyses, have investigated the use of wearable devices to improve physical activity, and there is a need for frequent and updated syntheses on the topic. OBJECTIVE: We aimed to evaluate whether using wearable devices increased physical activity and reduced sedentary behaviour in adults. METHODS: We conducted an umbrella review searching PubMed, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, MedRxiv, Rxiv and bioRxiv databases up to February 5th, 2023. We included all SRs that evaluated the efficacy of interventions when wearable devices were used to measure physical activity in adults aged over 18 years. The primary outcomes were physical activity and sedentary behaviour measured as the number of steps per day, minutes of moderate to vigorous physical activity (MVPA) per week, and minutes of sedentary behaviour (SB) per day. We assessed the methodological quality of each SR using the Assessment of Multiple Systematic Reviews, version 2 (AMSTAR 2) and the certainty of evidence of each outcome measure using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations). We interpreted the results using a decision-making framework examining the clinical relevance and the concordances or discordances of the SR effect size. RESULTS: Fifty-one SRs were included, of which 38 included meta-analyses (302 unique primary studies). Of the included SRs, 72.5% were rated as 'critically low methodological quality'. Overall, with a slight overlap of primary studies (corrected cover area: 3.87% for steps per day, 3.12% for MVPA, 4.06% for SB) and low-to-moderate certainty of the evidence, the use of WDs may increase PA by a median of 1,312.23 (IQR 627-1854) steps per day and 57.8 (IQR 37.7 to 107.3) minutes per week of MVPA. Uncertainty is present for PA in pathologies and older adults subgroups and for SB in mixed and older adults subgroups (large confidence intervals). CONCLUSIONS: Our findings suggest that the use of WDs may increase physical activity in middle-aged adults. Further studies are needed to investigate the effects of using WDs on specific subgroups (such as pathologies and older adults) in different follow-up lengths, and the role of other intervention components.

Physiotherapists' training in oncology rehabilitation from entry-level to advanced education: A qualitative study.

BACKGROUND AND PURPOSE: Physiotherapy is gaining a central role in oncology. However, the training and competencies needed by physiotherapists in oncology rehabilitation are still unclear. This study aims to articulate the training trajectory of physiotherapists in oncology rehabilitation from entry-level education to advanced education degrees. METHODS: Qualitative focus group study following a 'Reflexive Thematic Analysis' for data analysis. Participants were Italian physiotherapists with expertise in Oncology Rehabilitation (either clinically or academically) and Physiotherapy Bachelor of Science (BSc) course leaders, selected through purposive sampling. RESULTS: Two focus groups were conducted with 14 participants. Six themes were developed: 1. 'Entry-Level Education in Oncology Rehabilitation: Let's Have a Taste', as the BSc introduces oncology rehabilitation. 2. 'Basic Knowledge: Building up the Library' as students acquire basic knowledge on oncology rehabilitation during their BSc; 3. 'Learning by Experience: The Relevance of the Placement' to answer the question "Is this the right road for me?"; 4. 'Clinical Reasoning and Competencies in Oncology Rehabilitation Embedded in Uncertainty' because oncology physiotherapists need to deal with the uncertainty of their patients' status; 5. 'Advanced Education Degree Skills: from Appetiser to the Main Course', as advanced education degree courses allow for becoming an expert in the field; 6. 'A Call to Action for Physiotherapists: Prevention-Diagnosis-Survivorship & End of Life', to realise their critical role in all the phases of the oncology path. CONCLUSIONS: The BSc in Physiotherapy provides a foundation for future physiotherapists to understand oncology rehabilitation, but advanced education is necessary for expertise. The findings of this study have important implications for creating a shared physiotherapy curriculum in oncology rehabilitation. IMPLICATION FOR PHYSIOTHERAPY PRACTICE: This study has significant implications for improving physiotherapy curricula in oncology rehabilitation, positively impacting the skills and competencies of practitioners in this paramount field.

Income-Related Inequality Changes in Osteoarthritis First-Line Interventions: A Cohort Study.

OBJECTIVE: To examine income-related inequality changes in the outcomes of an osteoarthritis (OA) first-line intervention. DESIGN: Retrospective cohort study. SETTING: Swedish health care system. PARTICIPANTS: We included 115,403 people (age: 66.2±9.7 years; females 67.8%; N=115,403) with knee (67.8%) or hip OA (32.4%) recorded in the "Swedish Osteoarthritis Registry" (SOAR). INTERVENTIONS: Exercise and education. MAIN OUTCOME MEASURES: Erreygers' concentration index (E) measured income-related inequalities in "Pain intensity," "Self-efficacy," "Use of NSAIDs," and "Desire for surgery" at baseline, 3-month, and 12-month follow-ups and their differences over time. E-values range from -1 to +1 if the health variables are more concentrated among people with lower or higher income. Zero represents perfect equality. We used entropy balancing to address demographic and outcome imbalances and bootstrap replications to estimate confidence intervals for E differences over time. RESULTS: Comparing baseline to 3 months, "pain" concentrated more among individuals with lower income initially (E=-0.027), intensifying at 3 months (difference with baseline: E=-0.011 [95% CI: -0.014; -0.008]). Similarly, the "Desire for surgery" concentrated more among individuals with lower income initially (E=-0.009), intensifying at 3 months (difference with baseline: E=-0.012 [-0.018; -0.005]). Conversely, "Self-efficacy" concentrated more among individuals with higher income initially (E=0.058), intensifying at 3 months (difference with baseline: E=0.008 [0.004; 0.012]). Lastly, the "Use of NSAIDs" concentrated more among individuals with higher income initially (E=0.068) but narrowed at 3 months (difference with baseline: E=-0.029 [-0.038; -0.021]). Comparing baseline with 12 months, "pain" concentrated more among individuals with lower income initially (E=-0.024), intensifying at 12 months (difference with baseline: E=-0.017 [-0.022; -0.012]). Similarly, the "Desire for surgery" concentrated more among individuals with lower income initially (E=-0.016), intensifying at 12 months (difference with baseline: E=-0.012 [-0.022; -0.002]). Conversely, "Self-efficacy" concentrated more among individuals with higher income initially (E=0.059), intensifying at 12 months (difference with baseline: E=0.016 [0.011; 0.021]). The variable 'Use of NSAIDs' was not recorded in the SOAR at 12-month follow-up. CONCLUSION: Our results highlight the increase of income-related inequalities in the SOAR over time.

Clinical records after asynchronous and synchronous e-learning courses: a multi-method randomised controlled trial on students' performance and experience.

BACKGROUND: Clinical Record (CR) writing is a fundamental skill for healthcare professionals, but the best e-learning methods for teaching it remain unstudied. Therefore, we investigated speech therapy students' differences in the quality production of CR at the placement and their experience after following asynchronous or synchronous e-learning courses. METHODS: A multi-method randomised controlled trial. Fifty speech therapist students were equally and randomly divided into two groups attending asynchronous or synchronous e-learning classes to learn how to write a CR. The quality of the CR was tested through an ad hoc checklist (score 0-32) and the groups' scores were compared. The assessors and the statistician were blinded to students' group assignment. Students' experience was assessed through semi-structured interviews analysed with a reflexive thematic analysis. RESULTS: No score differences between the two groups were found (Cohen's d = 0.1; 95% Confidence Interval [-0.6; 0.7]). Four themes were generated: (1) 'Different Forms of Learning Interaction', as the synchronous group reported a positive experience with being fed back immediately by the lecturer, whereas the asynchronous group reported that pushing back the question time allows for reflecting more on the learning experience; (2) 'Different Ways to Manage the Time', as the synchronous group had to stick to the lecturer's schedule and the asynchronous group felt the possibility to manage its time; (3) 'To Be or Not To Be (Present)?' due to the different experiences of having (or not) the lecturer in front of them; (4) 'Inspiring Relationships With The Peers', where both groups preferred a peer-to-peer discussion instead of contacting the lecturer. DISCUSSION: Asynchronous and synchronous e-learning courses appeared equally effective in teaching CR writing. However, students perceive and experience these methods differently. The choice or blend of these methods should be based on students' needs and preferences, teacher input, as well as organisational requirements rather than solely on students' attended performance.

Use of audience response systems (ARS) in physiotherapists' training: a qualitative study.

OBJECTIVE: To explore the experience of using audience response systems (ARS) in postgraduate physiotherapy training. DESIGN: Qualitative interview study following the 'reflexive thematic analysis' by Braun and Clarke. SETTING: Higher education university. PARTICIPANTS: Ten Italian students (60% men, N=6; 40% women, N=4) agreed to partake in the interviews. RESULTS: We generated four themes. Specifically, the ARS were perceived: (1) as a 'Shared Compass' (theme 1) between the student and the lecturers to monitor and modify the ongoing students' learning journey; (2) useful to 'Come Out of Your Shell' (theme 2) as they help students to overcome shyness and build a team with peers; (3) as 'A Square Peg in a Round Hole' (theme 3) as they should not be used in situations that do not suit them; (4) as 'Not Everyone's Cup of Tea' (theme 4) as mixed opinions among ARS' utilities were found under some circumstances (eg, memorisation process and clinical reasoning). CONCLUSION: Physiotherapy lecturers must use ARS critically, respecting when (eg, not at the end of the lesson) and how to propose them, keeping in mind that some skills (eg, practical ones) might not benefit from their use. Moreover, they need to consider that the ARS are not a tool for everyone, so ARS must be integrated into a multimodal teaching paradigm.

Which lecturers' characteristics facilitate the learning process? A qualitative study on students' perceptions in the rehabilitation sciences.

BACKGROUND: In education, lecturers play a crucial role in facilitating students' learning process. However, only a few studies explored which lecturers' characteristics can facilitate this process in higher education for rehabilitation healthcare professionals. Starting from students' perspectives, our qualitative study investigated the lecturers' characteristics that facilitate students' learning process in the rehabilitation sciences. METHODS: A qualitative interview study. We enrolled students attending the 2nd year of the Master of Science (MSc) degree in 'Rehabilitation Sciences of Healthcare Professions'. Different themes were generated following a 'Reflexive Thematic Analysis'. RESULTS: Thirteen students completed the interviews. From their analysis, we generated five themes. Specifically, a lecturer that facilitates students' learning process should be: 1) 'A Performer who Interacts with the Classroom', 2) A Flexible Planner who Adopts Innovative Teaching Skills', 3) 'A Motivator who Embraces Transformational Leadership', 4) 'A Facilitator Who Encourages a Constructive Learning Context' and 5) 'A Coach who Devises Strategies to Reach Shared Learning Goals'. CONCLUSIONS: The results of this study underscore the importance for lecturers in rehabilitation to cultivate a diverse set of skills drawn from the arts and performance, education, team building and leadership to facilitate students' learning process. By developing these skills, lecturers can design lessons that are worth attending not only for their relevant content but also for their value in human experience.

Management of non-specific thoracic spine pain: a cross-sectional study among physiotherapists.

BACKGROUND: The thoracic area has mainly been neglected in research compared to the lumbar and cervical regions. No clinical practice guidelines (CPGs) for non-specific thoracic spine pain (TSP) have been compiled. Therefore, it can be argued that the absence of specific CPGs raises questions about the management of non-specific TSP. Hence, this study aimed at determining the management of non-specific TSP among physiotherapists in Italy. METHODS: A web cross-sectional survey investigating physiotherapists' management of non-specific TSP was conducted. The survey instrument was divided into three sections. The first section obtained participants' characteristics. The second section determined participants' agreement with 29 statements regarding the clinical management of non-specific TSP utilising a five-point Likert scale. Participants who partially or completely agreed (scores 4-5) were considered to agree with the statements. A ≥ 70% of agreement with a statement was considered as consensus according to previous literature. The third section asked the participants to indicate how often they adopted several treatments to manage non-specific TSP with a 5-point scale (always - often - sometimes - rarely - never). The frequencies of answers were calculated, and a visual representation through a bar chart was reported. The online version of the survey instrument was delivered through the newsletter of the Italian Association of Physiotherapists and the postgraduate master's degree in Rheumatic and Musculoskeletal Rehabilitation of the University of Genova (Genova, Italy). RESULTS: In total, 424 physiotherapists (mean age (SD): 35.1 years (10.5); 50% female) completed the survey. In the second section, physiotherapists achieved consensus for 22/29 statements. Those statements addressed the importance of psychosocial factors, exercise, education, and manual therapy techniques in managing non-specific TSP. In the third section, 79.7% of participants indicated they would always adopt a multimodal treatment (education, therapeutic exercise, manual therapy), followed by education and information (72.9%), therapeutic exercise (62.0%), soft tissue manual therapy (27.1%), and manual therapy (16.5%). CONCLUSIONS: Study participants considered fundamentally using a multimodal programme based on education, exercise and manual therapy to manage non-specific TSP. This approach aligns with the CPGs for other chronic musculoskeletal pain than non-specific TSP.

Living with migraine: A meta-synthesis of qualitative studies.

Introduction: Migraine is one of the top ten causes of disability worldwide. However, migraine is still underrated in society, and the quality of care for this disease is scant. Qualitative research allows for giving voice to people and understanding the impact of their disease through their experience of it. This study aims at synthesising the state of the art of qualitative studies focused on how people with migraine experience their life and pathology. Methods: MEDLINE via PubMed, EMBASE, CINAHL, PsycINFO, and Cochrane Library were consulted up to November 2021 for qualitative studies. Studies to be eligible had to focus on adults (age > 18 years) with a diagnosis of primary episodic or chronic migraine following the International Classification of Headache. The quality of the study was analysed using the CASP (Critical Appraisal Skills Programme) tool. The synthesis was done through a thematic analysis. CERQual (Confidence in Evidence from Reviews of Qualitative research) approach was used to assess the confidence in retrieved evidence. Results: Ten studies were included, counting 262 people with migraine. Our synthesis produced four main themes. (1) "Negative impact of migraine symptoms on overall life" as migraine negatively impacts people's whole life. (2) "Impact of migraine on family, work and social relationship" as migraine reduces the possibility to focus at work and interact with people. (3) "Impact of migraine on emotional health" as people with migraine experience psychological distress. (4) "Coping strategies to deal with migraine" such as keep on living one's own life, no matter the symptoms. Conclusions: Migraine negatively impacts people's whole life, from private to social and work sphere. People with migraine feel stigmatised as others struggle with understanding their condition. Hence, it is necessary to improve awareness among society of this disabling condition, and the quality of care of these people, tackling this disease from a social and health-policy point of view.

Factors Associated With Adherence to a Supervised Exercise Intervention for Osteoarthritis: Data From the Swedish Osteoarthritis Registry.

OBJECTIVE: To explore how lifestyle and demographic, socioeconomic, and disease-related factors are associated with supervised exercise adherence in an osteoarthritis (OA) management program and the ability of these factors to explain exercise adherence. METHODS: A cohort register-based study on participants from the Swedish Osteoarthritis Registry who attended the exercise part of a nationwide Swedish OA management program. We ran a multinomial logistic regression to determine the association of exercise adherence with the abovementioned factors. We calculated their ability to explain exercise adherence with the McFadden R2 . RESULTS: Our sample comprises 19,750 participants (73% female, mean ± SD age 67 ± 8.9 years). Among them, 5,862 (30%) reached a low level of adherence, 3,947 (20%) a medium level, and 9,941 (50%) a high level. After a listwise deletion, the analysis was run on 16,685 participants (85%), with low levels of adherence as the reference category. Some factors were positively associated with high levels of adherence, such as older age (relative risk ratio [RRR] 1.01 [95% confidence interval (95% CI) 1.01-1.02] per year), and the arthritis-specific self-efficacy (RRR 1.04 [95% CI 1.02-1.07] per 10-point increase). Others were negatively associated with high levels of adherence, such as female sex (RRR 0.82 [95% CI 0.75-0.89]), having a medium (RRR 0.89 [95% CI 0.81-0.98] or a high level of education (RRR 0.84 [95% CI 0.76-0.94]). Nevertheless, the investigating factors could explain 1% of the variability in exercise adherence (R2 = 0.012). CONCLUSION: Despite the associations reported above, the poorly explained variability suggests that strategies based on lifestyle and demographic, socioeconomic, and disease-related factors are unlikely to improve exercise adherence significantly.

Flexion-extension strength of the index-thumb system in Italian population. A cross-sectional study to gather normative data.

STUDY DESIGN: Cross-sectional study. INTRODUCTION: Flexion (Palmar Pinch, PP-MVC and Tip Pinch, TP-MVC) and extension (E-MVC) maximal voluntary contraction (MVC) of the index-thumb system offers a quick way to estimate the level of hands' impairment in several musculoskeletal and neurologic conditions. PURPOSE OF THE STUDY: This study established normative data of PP-MVC, TP-MVC, E-MVC in the Italian population and evaluated their correlation with hand dominance, anthropometric factors, dexterity and workload level. METHODS: In our study, 303 healthy people (150F, 153M) were recruited. Participants performed PP-MVC, TP-MVC and E-MVC tests per hand, conducted by using a pinch-gauge. T-test was used to analyze MVC means between sexes and between hands. One-way ANOVA was conducted to compare MVC means in male and female samples stratified by age (18-29, 30-44, 45-59, 60-74, +75). Spearman's correlation analysis was performed to determine anthropometric variables, dexterity and workload level effects on MVCs. RESULTS: Medium-to-large effect sizes of age were shown in the majority of tasks. The 30 to 44 years and then +75 years age groups showed the highest and the lowest values, respectively, for both sex and both hands. Men were meanly 50% stronger, and the dominant hand showed higher values (6-10%). MVC-tests correlated moderately with weight and height weakly with dexterity and workload level. CONCLUSIONS: After 30 to 44 years, hand strength declines in line with the normal process of aging that also entails muscle fibers and the reduction of daily activities in older adults. In relative terms, E-MVC showed the highest strength loss in the over 75 seconds. The difference between sexes was higher in E-MVC than in flexion MVCs. E-MVC seems to depend more on musculoskeletal architecture that differs from women to men, according to the highest correlation between E-MVC and anthropometric variables. Only high workload levels impacted hand strength. In heaviest occupations, no PP-MVCs differences were observed between hands.

Physiotherapists' knowledge of and adherence to evidence-based practice guidelines and recommendations for ankle sprains management: a cross-sectional study.

BACKGROUND: Lateral ankle sprain (LAS) is a common and burdensome injury. However, the quality of its management is scant. Nowadays, physiotherapy management of musculoskeletal diseases seems to be generally not based on research evidence. Studies that investigated the knowledge-to-practice gap in LAS management are yet to be carried out. Therefore, this research investigated physiotherapists' knowledge of and adherence to LAS Clinical Practice Guidelines (CPGs) and recommendations. METHODS: A cross-sectional study based on an online survey structured in three sections. The first section collected demographic data. The second section showed two clinical cases (with positive and negative Ottawa Ankle Rules (OAR), respectively). The participants indicated which treatments they would adopt to manage them. Participants were classified as 'following', 'partially following', 'partially not following' and 'not following' the CPGs and recommendations. In the third section, participants expressed their agreement with different CPG and recommendation statements through a 1-5 Likert scale. RESULTS: In total, 483 physiotherapists (age: 34 ± 10; female 38%, male 61.5%, other 0.5%) answered the survey: 85% completed the first two sections, 76% completed all three sections. In a case of acute LAS with negative OAR, 4% of the participants were considered as 'following' recommended treatments, 68% as 'partially following', 23% as 'partially not following', and 5% as 'not following'. In a case of acute LAS with positive OAR, 37% were considered 'following' recommended treatments, 35% as 'partially following', and 28% as 'not following'. In the third section, the consensus was achieved for 73% of the statements. CONCLUSION: This study showed that although there is a good knowledge about first-line recommended treatments, a better use of CPGs and recommendations should be fostered among physiotherapists. Our results identify an evidence-to-practice gap in LAS management, which may lead to non-evidence-based practice behaviors.

Low Back Pain in People With Lower Limb Amputation: A Cross-Sectional Study.

STUDY DESIGN: A cross-sectional study based on an online questionnaire. OBJECTIVE: The aim was to investigate the prevalence and intensity of low back pain (LBP) in people with lower limb amputation (LLA) and to analyze the association factors that can influence the genesis of LBP. SUMMARY OF BACKGROUND DATA: It is still unclear whether LBP is more prevalent in the amputated population than in its nonamputated counterpart. Given the multifactorial nature of LBP, it is necessary to explore possible factors that can influence its presence and intensity, to build a solid background to define a better rehabilitation pathway for the management of these people. METHODS: The online questionnaire included six sections: informed consent of the study, demographic information, comorbid conditions, history of LLA, history of LBP, and acceptance of the amputation. RESULTS: Between March and June 2021, 239 participants [mean age (SD): 49.2 (11.5); female 11%] completed the survey (response rate: 32%). From the results of this study, LBP in LLA showed a prevalence of 82% postamputation and 70% in the last year. A logistic regression with a backward method showed that participants who had problems in the not affected leg presented 1.58 (95% confidence interval: 0.70; 2.45) times higher odds to have LBP after the amputation. CONCLUSION: This study shows that the prevalence of LBP in lower limb amputees appears to be higher than in the general population, with similar levels of pain intensity and frequency. The highest percentage of people with a sedentary lifestyle not practicing any kind of sports emphasizes the importance of educating this population on the importance of physical activity. New strategies to invest in the education of this population in terms of physical activity are needed. LEVEL OF EVIDENCE: Level 4.

The Temporal Modulation of Nocebo Hyperalgesia in a Model of Sustained Pain.

Background: The direction and the magnitude of verbal suggestions have been shown to be strong modulators of nocebo hyperalgesia, while little attention has been given to the role of their temporal content. Here, we investigate whether temporal suggestions modulate the timing of nocebo hyperalgesia in an experimental model of sustained pain. Methods: Fifty-one healthy participants were allocated to one of three groups. Participants received an inert cream and were instructed that the agent had either hyperalgesic properties setting in after 5 (Nocebo 5, N5) or 30 (Nocebo 30, N30) minutes from cream application, or hydrating properties (No Expectation Group, NE). Pain was induced by the Cold Pressure Test (CPT) which was repeated before cream application (baseline) and after 10 (Test10) and 35 (Test35) minutes. Changes in pain tolerance and in HR at each test point in respect to baseline were compared between the three groups. Results: Tolerance change at Test 10 (Δ10) was greater in N5 (MED = -36.8; IQR = 20.9) compared to NE (MED = -5.3; IQR = 22.4; p < 0.001) and N30 (MED = 0.0; IQR = 23.1; p < 0.001), showing that hyperalgesia was only present in the group that expected the effect of the cream to set in early. Tolerance change at Test 35 (Δ35) was greater in N5 (MED = -36.3; IQR = 35.3; p = 0.002) and in N30 (MED = -33.3; IQR = 34.8; p = 0.009) compared to NE, indicating delayed onset of hyperalgesia in N30, and sustained hyperalgesia in N5. No group differences were found for HR. Conclusions: Our study demonstrated that temporal expectations shift nocebo response onset in a model of sustained pain.

Giving an account of patients' experience: A qualitative study on the care process of hip and knee osteoarthritis.

INTRODUCTION: Despite the publication of clinical practice guidelines, the quality of the care process as experienced by patients with osteoarthritis (OA) appears suboptimal. Hence, this study investigates how patients with OA experience their disease and care process, highlighting potential elements that can enhance or spoil it, to optimise their quality of care. METHODS: A qualitative study based on semi-structured interviews. Patients with hip and knee OA in Italy were interviewed. The interview guide was created by a pool of health professionals and patients. The interviews were analysed through a theme-based analysis following a philosophy of descriptive phenomenological research. RESULTS: Our analysis revealed seven main themes: (1) Experiencing a sense of uncertainty, as interviewees perceived treatment choices not to be based on medical evidence; (2) Establishing challenging relationships with the self and the other, as they did not feel understood and felt ashamed or hopeless about their condition; (3) Being stuck in one's own or the health professionals' beliefs about the disease management, as a common thought was the perception of movement as something dangerous together with a frequent prescription of passive therapies; (4) Dealing with one's own attitudes towards the disease; Understanding (5) the barriers to and (6) the facilitators of the adherence to therapeutic exercise, which revolve around the therapy cost, the time needed and the patients' willingness to change their life habits and (7) Developing an uneasy relationship with food since the diet was considered as something that "you force yourself to follow" and overeating as a way "to eat your feelings". CONCLUSION: The lack of clear explanations and a negative attitude towards first-line nonsurgical treatments (mainly physical exercise), which are considered as a way to fill the time while waiting for surgery, underlines the importance of providing patients with adequate information about OA treatments and to better explain the role of first-line intervention in the care of OA. This will enhance patient-centred and shared decision-making treatments. PATIENT CONTRIBUTION: Patients with hip and knee OA participated in creating the interview and contributed with their experience of their care process.

Automated Motion Analysis of Bony Joint Structures from Dynamic Computer Tomography Images: A Multi-Atlas Approach.

Dynamic computer tomography (CT) is an emerging modality to analyze in-vivo joint kinematics at the bone level, but it requires manual bone segmentation and, in some instances, landmark identification. The objective of this study is to present an automated workflow for the assessment of three-dimensional in vivo joint kinematics from dynamic musculoskeletal CT images. The proposed method relies on a multi-atlas, multi-label segmentation and landmark propagation framework to extract bony structures and detect anatomical landmarks on the CT dataset. The segmented structures serve as regions of interest for the subsequent motion estimation across the dynamic sequence. The landmarks are propagated across the dynamic sequence for the construction of bone embedded reference frames from which kinematic parameters are estimated. We applied our workflow on dynamic CT images obtained from 15 healthy subjects on two different joints: thumb base (n = 5) and knee (n = 10). The proposed method resulted in segmentation accuracies of 0.90 ± 0.01 for the thumb dataset and 0.94 ± 0.02 for the knee as measured by the Dice score coefficient. In terms of motion estimation, mean differences in cardan angles between the automated algorithm and manual segmentation, and landmark identification performed by an expert were below 1°. Intraclass correlation (ICC) between cardan angles from the algorithm and results from expert manual landmarks ranged from 0.72 to 0.99 for all joints across all axes. The proposed automated method resulted in reproducible and reliable measurements, enabling the assessment of joint kinematics using 4DCT in clinical routine.

Experience of the COVID-19 pandemic as lived by patients with hip and knee osteoarthritis: an Italian qualitative study.

OBJECTIVE: To examine the experience of the COVID-19 pandemic as lived by people with hip and knee osteoarthritis (OA), in Italy. DESIGN: A qualitative study based on semi-structured interviews. SETTING: Urban and suburban areas in northern Italy. PARTICIPANTS: A total of 11 people with OA were enrolled through a purposeful sampling and completed the study. PRIMARY OUTCOME MEASURE: The experience of Italian people with OA during the COVID-19 pandemic. RESULTS: Four themes were brought to the forefront from the analysis of the interviews. (1) Being Stressed for the Limited Social Interactions and for the Family Members at High Risk of Infection, as the interviewees were frustrated because they could not see their loved ones or felt a sense of apprehension for their relatives. (2) Recurring Strategies to Cope with the Pandemic such as an active acceptance towards the situation. (3) Being Limited in the Possibility of Undergoing OA Complementary Treatments and Other Routine Medical Visits. (4) Being Unaware of the Importance of Physical Activity as First-Line Interventions which was an attitude already present before the pandemic. CONCLUSION: The COVID-19 pandemic and related restrictions impacted the quality of life and the care of individuals with hip and knee OA. The social sphere seemed to be the most hindered. However, the interviewees developed a good level of acceptance to deal with the pandemic. When it came to their care, they faced a delay of routine medical visits not related to OA and of other complementary treatments (eg, physical therapies) to manage OA. Finally, a controversial result that emerged from these interviews was that first-line interventions for OA (ie, therapeutic exercise) was not sought by the interviewees, regardless of the restrictions dictated by the pandemic. Policy-making strategies are thus necessary to support the awareness of the importance of such interventions.