Prognostic occupational factors for persistent low back pain in primary care.

PURPOSE: To reduce the socio-economic burden of persistent low back pain (LBP), factors influencing the progression of acute/subacute LBP to the persistent state must be identified at an early stage. METHODS: Prospective inception cohort study of patients attending a health practitioner for their first episode of acute/subacute or recurrent LBP. Patients were assessed at baseline addressing occupational, psychological, biomedical and demographic/lifestyle factors and followed up over 6 months. Multivariate logistic regression analysis was performed separately for the variables groups of the four different domains, controlling for age, gender and body mass index. The overall predictive value was calculated for the full regression models of the different domains. Finally, all significant variables from the different domains were combined into a final predictor model. RESULTS: The final four-predictor model predicted 51 % of variance of persistent LBP and included 'resigned attitude towards the job' (OR 1.73; 95 % CI 1.16-2.59), 'social support at work' (OR 0.54; 95 % CI 0.32-0.90), 'functional limitation' (OR 1.05; 95 % CI 1.01-1.10) and 'duration of LBP' (OR 1.04; 95 % CI 1.02-1.06). The accuracy of the model was 83 %, with 92 % of non-persistent and 67 % of persistent LBP patients correctly identified. CONCLUSIONS: In this study of patients with acute/subacute LBP, 'resigned attitude towards the job' increased the likelihood of persistent LBP at 6 month. Addressing this factor with workplace interventions has the potential to modify the outcome. In patients experiencing 'social support at work', the development of persistent LBP was less likely and might therefore be considered as potential resource for prevention of persistent LBP.

Test-retest reliability of movement-evoked pain and sensitivity to movement-evoked pain in patients with rotator cuff-related shoulder pain.

BACKGROUND: The number of researchers and clinicians using movement-evoked pain and sensitivity to movement-evoked pain to assess shoulder pain has increased. However, the intrarater test-retest reliability of movement-evoked pain and sensitivity to movement-evoked pain in people with rotator cuff-related shoulder pain (RCRSP) is still unknown. OBJECTIVE: We examined the intrarater test-retest reliability of movement-evoked pain and sensitivity to movement-evoked pain in participants with RCRSP. METHODS: Seventy-four participants with RCRSP performed five trials of active shoulder abduction to elicit pain under two experimental conditions: active shoulder abduction to the onset of pain and maximum range of motion (ROM). The primary outcome measures were pain intensity and ROM. Test-retest reliability of movement-evoked pain and sensitivity to movement-evoked pain was examined using intraclass correlation coefficient (ICC3,1) and minimal detectable change (MDC90). RESULTS: The reliability of movement-evoked pain under both experimental conditions was good to excellent (ICC: 0.81 to 0.95), while the reliability of sensitivity to movement-evoked pain was poor in both conditions (ICC≤0.45). The MDC90 for pain intensity was 1.6 and 1.8 during shoulder abduction to the onset of pain and maximum ROM, respectively. The MDC90 for ROM was 17.5° and 11.2° during shoulder abduction to the onset of pain and maximum ROM condition, respectively. CONCLUSION: This study confirms movement-evoked pain testing during active shoulder abduction to the onset of pain or maximum ROM condition is reliable to assess pain associated with movement in patients with RCRSP. The minimal detectable change score of movement-evoked pain can guide clinicians and researchers on how to interpret changes in these outcomes.

Initial effect of high-volume mobilisation with movement on shoulder range of motion and pain in patients with rotator cuff-related shoulder pain: protocol for a randomised controlled trial (Evolution Trial).

INTRODUCTION: Mobilisation with movement (MWM) is commonly used for treating patients with rotator cuff-related shoulder pain (RCRSP). However, the evidence supporting MWM efficacy for improving shoulder range of motion (ROM) and pain in patients with RCRSP is limited. It is also unclear whether higher volume MWM leads to better clinical outcomes compared with lower volume MWM in patients with RCRSP. The primary aim of this study is to assess the effect of MWM on the angular onset of pain during shoulder abduction in patients with RCRSP. METHODS AND ANALYSIS: Sixty participants with RCRSP will be randomised to receive either MWM or sham MWM intervention. The primary outcome is the angular onset of pain during shoulder abduction, and secondary outcomes are pain intensity at the angular onset of pain during shoulder abduction, maximum shoulder ROM, pain intensity during maximum shoulder abduction, pressure pain threshold, mechanical temporal summation, global rating of change scale (GROC) and Brief Pain Inventory-Short Form (BPI-SF). The angular onset of pain and the pain intensity at that range will be assessed at baseline, after 1 set and 3 sets of 10 repetitions of MWM or sham MWM. The GROC will be measured immediately after receiving 3 sets of interventions and on day 3 after interventions. The BPI-SF will be measured on days 1, 3, 5 and 7 after interventions. Other secondary outcomes will be assessed at baseline and after 3 sets of interventions. A linear mixed effects model with a random intercept will be used to compare changes in the outcome measures between MWM and sham MWM interventions. ETHICS AND DISSEMINATION: This study has been approved by the University of Otago Ethics Committee (Ref. H21/117). Findings from this study will be disseminated through presentations at international and national conferences and will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: ACTRN 12621001723875.

Exergaming to improve balance and decrease the risk of falling in adults with knee osteoarthritis: a mixed-methods feasibility study.

BACKGROUND: Exergaming (exercise and gaming) is useful in improving balance in various health conditions, yet there is limited research regarding its application in individuals with knee osteoarthritis (OA). OBJECTIVES: The primary aim of this study was to investigate the feasibility and acceptability of exergaming using Nintendo Wii Fit™ to improve balance and reduce the risk of falls in individuals with knee OA. METHODS: A mixed-methods explanatory sequential study design was utilized in this study. Participants with knee OA and history of falling participated in a single-group pre-post experimental study design: eight weeks of usual care followed by eight weeks of an exergaming program. This was followed by semi-structured focus groups to determine the acceptability of the study. RESULTS: The pre-defined feasibility criteria such as recruitment, retention rate (83%), and compliance (78%) were successfully met. The participants found the frequency and duration of the assessment and intervention sessions acceptable. Participants reported enjoying the exergaming, finding it motivating and interactive despite some barriers with technology. No adverse events were reported. There were encouraging results in the clinical outcome measures such as knee muscle strength, balance, fear of falling, and performance of physical function. CONCLUSION: The study found that it is feasible and acceptable to use Nintendo Wii Fit™ as an exergaming tool to improve balance and decrease the risk of falling in adults with knee OA. Findings from this feasibility study are encouraging and support the need to conduct a fully powered randomized controlled trial study.

Dosage of joint mobilisation for the management of rotator cuff-related shoulder pain: protocol for a scoping review.

INTRODUCTION: Rotator cuff-related shoulder pain is the most common diagnosis of shoulder pain, which ranks as the third most common musculoskeletal disorder. The first-line treatment for patients with rotator cuff-related shoulder pain is physiotherapy, and joint mobilisation is widely used in conjunction with other modalities. The type and dosage of joint mobilisations could influence treatment outcomes for patients with rotator cuff-related shoulder pain, although research evidence is inconclusive. OBJECTIVES: To (1) systematically search, identify and map the reported type and dosage of joint mobilisations used in previous studies for the management of patients with rotator cuff-related shoulder pain; and (2) summarise the rationale for adopting a specific joint mobilisation dosage. METHODS AND ANALYSIS: We will follow the methodological framework outlined by Arksey and O'Malley and report the results as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guideline. Two authors will independently screen and extract data from the six databases: PubMed, Scopus, Web of Science, CINAHL, Cochrane Library and SPORTDiscus, with publication date from their inceptions to 25 August 2021. A third author will be consulted if the two authors disagree about the inclusion of any study in the review. We will summarise the results using descriptive statistics and qualitative thematic analysis. ETHICS AND DISSEMINATION: Ethical approval is not required for this protocol. Mapping and summarising the reported type and dosage of joint mobilisations for patients with rotator cuff-related shoulder pain from previous studies will provide a foundation for further optimal selection of type and dosage of joint mobilisations for treating patients with rotator cuff-related shoulder pain. The review is part of an ongoing research that focuses on joint mobilisation for patients with rotator cuff-related shoulder pain. The results will be disseminated through presentations at academic conferences and a peer-reviewed publication.

Impact of Thumb Carpometacarpal Joint Osteoarthritis: A Pragmatic Qualitative Study.

OBJECTIVE: First carpometacarpal (CMC1) joint osteoarthritis (OA) is typically understood as part of the disease entity of hand OA. However, CMC1 joint OA often occurs in isolation or is a primary source of symptoms. The aim of the current study was to explore the experiences of New Zealanders with CMC1 joint OA to better understand the unique impact of this condition, ascertain outcomes of importance, and identify treatment targets. METHODS: In this pragmatic qualitative study, patients who either reported a history suggestive of CMC1 joint OA or had been diagnosed by a physician were recruited from health and community settings in 2 centers on the South Island of New Zealand. Thirty participants (11 men and 19 women, mean ± SD age 65.4 ± 11.36 years) took part in individual face-to-face interviews and kept diaries. The interviews were audio recorded, and along with the diaries, transcribed. Data were analyzed by thematic analysis using a primarily inductive approach. The Health Impact Model was employed to help with interpretation of the results. RESULTS: Five interrelated levels of health impact were identified: symptom status, functional limitations, restrictions in social activities and roles, negative thoughts and feelings, and an altered sense of self. Constant pain and pain at night were key symptoms that were associated with impact at the other levels. CONCLUSION: Constant pain, pain at night, functional capacity, medication burden, emotional impact, and sense of self are important outcomes and treatment targets in people with CMC1 joint OA.

Risk Factors for Falls in Adults with Knee Osteoarthritis: A Systematic Review.

OBJECTIVE: To examine the evidence of risk factors for falls in adults with knee osteoarthritis (OA). TYPE: Systematic Review. METHODOLOGY: A systematic literature search was performed in 9 electronic databases from inception to July 2016. Two reviewers screened articles using set inclusion and exclusion criteria. Observational study designs that included participants with knee OA and history of falls were considered. Results reported as odds ratios, relative risks, prevalence ratios, or hazard ratios were extracted to identify the potential risk factors for falls. Included articles were assessed for methodological quality and level of evidence. SYNTHESIS: The electronic data search yielded 4382 studies related to falls and knee OA. A total of 11 studies were included in the review. The risk factors for falls in individuals with knee OA included impaired balance, muscle weakness, presence of comorbidities, and increasing number of symptomatic joints. The presence of knee pain was also identified as a risk factor for falls; however, the strength of evidence was rated as "conflicting" because of the inconsistency of the findings. Limited evidence was found for knee instability, impaired proprioception, and use of walking aids. CONCLUSION: This review provides evidence of risk factors for falls in individuals with knee OA. Despite the limited to moderate evidence, identification of these risk factors may be valuable for both clinicians and fall prevention program developers. Further studies are warranted to determine which of these risk factors for falls are modifiable in a knee OA population. LEVEL OF EVIDENCE: I.

Effectiveness of a treadmill-based aerobic exercise intervention on pain, daily functioning, and quality of life in women with primary dysmenorrhea: A randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness of a treadmill-based aerobic exercise intervention on pain and associated symptoms of primary dysmenorrhea. METHODS: Seventy women with primary dysmenorrhea were included in the study. The experimental group underwent supervised aerobic training for 4 weeks followed by unsupervised home exercise for the next 6 months. The control group continued usual care. The primary outcome was pain. Secondary outcomes included quality of life (QoL), daily functioning, and sleep. RESULTS: After the 4-week training, compared to the control group exercise significantly improved primary outcomes pain quality (mean difference (MD) -1.9, 95% CI 3.8 to -0.04, p < .05), and intensity (MD -4.7, 95% CI -9.3 to -0.09, p < .05), but not present pain. Significant effects were also reported for pain interference (MD -1.7, 95% CI -3.4 to -0.02, p < .05) at 4 weeks; the other outcomes did not significantly differ between groups at this time. During the follow-up period of 7-months, the effect on pain improved to 22 mm (95% CI 18 to 25). Significant benefits of exercise were maintained up to 7-months for present pain, QoL and daily functioning. CONCLUSION: Exercise has significant effects on primary dysmenorrhea-related pain, QoL and function. TRIAL REGISTRATION: ACTRN12613001195741.

Clinical characteristics and outcomes of treatment of the cervical spine in patients with persistent post-concussion symptoms: A retrospective analysis.

BACKGROUND: Concussion is typically defined as a mild brain injury, and yet the brain is unlikely to be the only source of persistent post-concussion symptoms. Concurrent injury to the cervical spine in particular is acknowledged as a potential source of common persistent symptoms such as headache, dizziness and neck pain. OBJECTIVES: To describe the cervical spine findings and outcomes of treatment in a series of patients with persistent post-concussion symptoms, and describe the clinical characteristics of a cervicogenic component when it is present. DESIGN: Retrospective chart review of a consecutive series of patients with concussion referred to a physiotherapist for cervical spine assessment. METHOD: Patient charts for all patients over a calendar year referred by a concussion service provider to a physiotherapist for cervical spine assessment were de-identified and transferred to the research team. Clinical data were independently extracted by two research assistants and analysed using descriptive statistics. RESULTS/FINDINGS: Data were analysed from 46 patient charts. Those with a cervicogenic component (n = 32) were distinguished from those without a cervicogenic component (n = 14) by physical examination findings, particularly pain on manual segmental examination. Physiotherapy treatment of the cervicogenic component (n = 21) achieved improvements in function (mean increase of 3.8 in the patient-specific functional scale), and pain (mean decrease of 4.6 in the numeric pain-rating scale). CONCLUSIONS: The clinical characteristics described give preliminary support to the idea that the cervical spine may contribute to persistent post-concussion symptoms, and highlight the value of physiotherapy assessment and treatment of the cervical spine following a concussive injury.

A Narrative Synthesis of Nintendo Wii Fit Gaming Protocol in Addressing Balance Among Healthy Older Adults: What System Works?

BACKGROUND: Balance is crucial in performing functional tasks particularly among older adults. Exergaming is gaining attention as a novel approach to enhance balance in a number of clinical populations. OBJECTIVES: The aim of this review was to synthesize and present published evidence for Nintendo Wii Fit™ gaming system protocols. These include game preference, intervention setting, and exercise dosage for improving balance in healthy older adults. Commonly used outcome measures were also identified. METHODS: A literature search was developed using the PICOS strategy using keywords such as "older adult," "Nintendo Wii Fit," "exergaming," and "balance" in the databases: MEDLINE, PubMed, EMBASE, CINAHL, Scopus, Science Direct, and Web of Science. RESULTS: Sixteen articles were included with participants (n = 491) mostly female (69%), and mean age ranged between 71 and 85 years old. Participants were recruited mainly from the community. The most commonly used Wii Fit games were Table tilt, Soccer Heading, Ski Slalom, and Ski jump, performed three times per week, with a duration of 30 minutes per session for 6 weeks. Berg Balance Scale, Timed Up and Go Test, and Centre of Pressure were the most commonly used outcome measures. CONCLUSION: Wii Fit exergames can be a potential alternative to improve balance if safety and technical procedures are provided. With conflicting and mechanism-based evidence on dosage presented, exergaming parameters require further research before firm recommendations can be made. Clinically, effective dosage is an important component in any type of interventions, and exergaming should not be an exception.

Vigorous exercises in the management of primary dysmenorrhea: a feasibility study.

PURPOSE: To examine the feasibility of using an exercise intervention for reducing menstrual pain associated with primary dysmenorrhea (PD) and to obtain preliminary results to estimate the sample size for a future randomized controlled trial (RCT). METHODS: A quasi-experimental design was applied. Ten women 18-45 years with PD were included. The participants underwent vigorous aerobic training at the School of Physiotherapy on a treadmill three times a week for up to 4 weeks followed by aerobic training at home for up to 4 weeks. The feasibility measures were adherence to the intervention programme and intervention prescription, retention and safety. The short form McGill pain questionnaire was used to measure pain at first (T1), second (T2) and third (T3) menstrual cycles following trial entry. RESULTS: Overall adherence was 98%, with 100% adherence to clinic-based intervention and intervention prescription and 96% for home exercise programme. Retention rate was 100%. With respect to pain a large effect size was identified at T2 and T3. No adverse events reported. CONCLUSIONS: Results demonstrated that the intervention is applicable and feasible. In addition, the preliminary results show evidence of positive changes after the intervention. The intervention programme's effectiveness will be studied further, in a future RCT. Implications for Rehabilitation There is a lack of available evidence from randomized controlled trials regarding the use of exercise in alleviating the symptoms associated with primary dysmenorrhea (PD). The preliminary results of this study shows that exercises may be effective in reducing the pain associated with PD indicated by a large effect size. The preliminary findings from this study could also contribute significantly to PD management and introduce new practice opportunities for physiotherapists working in women's health.

Menstrual pain and quality of life in women with primary dysmenorrhea: Rationale, design, and interventions of a randomized controlled trial of effects of a treadmill-based exercise intervention.

Dysmenorrhea in the absence of pelvic abnormality is termed primary dysmenorrhea (PD). The health burden and social and economic costs of PD are high as it is reported to be the leading cause of recurrent absenteeism from school or work in adolescent girls and young adults. The belief that exercise works for relieving symptoms in women with PD is based on anecdotal evidence and non-experimental studies. There is very limited evidence from randomized controlled trials (RCTs) to support the use of exercise to reduce the intensity of menstrual pain. The objective of this study is to evaluate the effectiveness of exercise to reduce intensity of pain and improve quality of life in women with PD. We describe the study design of a single-blind (assessor), prospective, two-arm RCT, and the participant characteristics of the 70 women recruited in the age-group 18 to 43 years. The primary outcome of the study is pain intensity. The secondary outcomes of the study are quality of life, functional limitation, sleep, global improvement with treatment, and protocol adherence. The outcomes assessments are done at first menstrual period (baseline, Week 0), 2nd menstrual period (Week 4) and at two additional time points (Week 16 and Week 28) during the trial. The results of the study will provide physiotherapists, medical practitioners, and researchers as well as the women who have PD with new insights, knowledge, and evidence about the use of exercise to manage pain in women with PD.

Patient characteristics that predict progression of knee osteoarthritis: a systematic review of prognostic studies.

OBJECTIVE: To identify, by systematic review, patient characteristics that can be used by health care practitioners to predict the likelihood of knee osteoarthritis (OA) progression. METHODS: A search was conducted of the electronic databases Medline, EMBase, CINAHL, AMED, and Web of Science in November 2010. Two reviewers screened articles using inclusion/exclusion criteria. Study participants were adults with established knee OA. Outcome measures for disease progression were change in pain or function or deterioration in radiographic features. Included studies identified clinically relevant prognostic factors at baseline and reported a statistical association with outcome. Minimum followup was 1 year. Articles were assessed for bias, and strength of evidence was summarized for potential predictors of progression. RESULTS: Thirty studies were included, of which 26 were of high quality. Age, varus knee alignment, presence of OA in multiple joints, and radiographic features had strong evidence as predictors of knee OA progression. Body mass index was a strong predictor for long-term progression (>3 years). Moderate participation in physical activity was not associated with progression. Numerous variables had limited or conflicting evidence. CONCLUSION: Relatively few predictive variables have strong supporting evidence; numerous variables have limited or conflicting evidence. All variables with strong evidence can be easily evaluated and utilized in clinical practice. Existing knowledge should be developed in future research, particularly in cases where study numbers are low or findings are limited or conflicting. Standardized measurement of potential predictors and outcome measures is recommended.