BMC Musculoskeletal Disorders

Lumbar magnetic resonance imaging (LMRI) is often performed early in the course of care, which can be discordant with guidelines for non-serious low back pain. Our primary hypothesis was that adults receiving chiropractic spinal manipulative therapy (CSMT) for incident radicular low back pain (rLBP) would have reduced odds of early LMRI over 6-weeks’ follow-up compared to those receiving other care (a range of medical care, excluding CSMT). As a secondary hypothesis, CSMT recipients were also expected to have reduced odds of LMRI over 6-months’ and 1-years’ follow-up. A national 84-million-patient health records database including large academic healthcare organizations (TriNetX) was queried for adults age 20–70 with rLBP newly-diagnosed between January 31, 2012 and January 31, 2022. Receipt or non-receipt of CSMT determined cohort allocation. Patients with prior lumbar imaging and serious pathology within 90 days of diagnosis were excluded. Propensity score matching controlled for variables associated with LMRI utilization (e.g., demographics). Odds ratios (ORs) of LMRI over 6-weeks’, 6-months’, and 1-years’ follow-up after rLBP diagnosis were calculated. After matching, there were 12,353 patients per cohort (mean age 50 years, 56% female), with a small but statistically significant reduction in odds of early LMRI in the CSMT compared to other care cohort over 6-weeks’ follow-up (9%, 10%, OR [95% CI] 0.88 [0.81–0.96] P = 0.0046). There was a small but statistically significant increase in odds of LMRI among patients in the CSMT relative to the other care cohort over 6-months’ (12%, 11%, OR [95% CI] 1.10 [1.02–1.19], P < 0.0174) and 1-years’ follow-up (14%, 12%, OR [95% CI] 1.21 [1.13–1.31], P < 0.0001). These results suggest that patients receiving CSMT for newly-diagnosed rLBP are less likely to receive early LMRI than patients receiving other care. However, CSMT recipients have a small increase in odds of LMRI over the long-term. Both cohorts in this study had a relatively low rate of early LMRI, possibly because the data were derived from academic healthcare organizations. The relationship of these findings to other patient care outcomes and cost should be explored in a future randomized controlled trial. Open Science Framework ( https://osf.io/t9myp ).

The present study aims to determine the time spent in different static trunk postures during a typical working day of workers in a special school for the severe handicaps. Eighteen workers with low back pain (LBP) and fifteen asymptomatic workers were recruited. A cross-sectional design was employed to study the time spent in different static trunk postures which was recorded by a biaxial accelerometer attached to the T12 level of the back of the subjects. The results of ANCOVA revealed that subjects with LBP spent significantly longer percentage of time in static trunk posture when compared to normal (p < 0.05). It was also shown that they spent significantly longer time in trunk flexion for more than 10° (p < 0.0125). An innovative method has been developed for continuous tracking of spinal posture, and this has potential for widespread applications in the workplace. The findings of the present investigation suggest that teachers in special schools are at increased risk of getting LBP. In order to minimise such risk, frequent postural change and awareness of work posture are recommended.

Globally the volume of total knee arthroplasty (TKA) is on the rise, reflecting aging populations, an associated increase in treatment of osteoarthritis, and a desire for improved quality of life. There is evidence that as high as 15 to 20% of patients are not satisfied with their TKA results and efforts need to be made to improve these rates. This study set out to identify what patients consider important when reflecting on TKA satisfaction, to pave the way to identifying service transformation opportunities that will enhance patient-centred care and satisfaction with this procedure. Twenty-seven TKA recipients were recruited in the province of British Columbia, Canada. Semi-structured interviews were conducted about participants’ experience and satisfaction with TKA, three to four years post-surgery. Grounded theory was employed to analyze participants’ stories about what was front of mind when they reflected on satisfaction with their new knee. Participants described their post-TKA knee in terms its adequacy: how it felt and worked, and how it matched their pre-surgical expectations. The central element of their stories was the process of adapting, which gave rise to their perceptions of adequacy. Adapting comprises the patient experience of physically integrating and cognitively accepting their new knee. Patterns of adapting reflect the level of the new knee’s achieved adequacy and the straightforwardness of the adapting process. The conceptualization of adequacy and the process of adapting allow a patient-centred understanding of what patients experience following TKA. For participants who did not readily achieve the adequacy they had anticipated, the challenges they experienced during adapting dominated their stories. Participants’ adapting stories afford key insights into how the health care system could adjust to better support TKA patients, and improve rates of satisfaction with this procedure. The process of adapting lends itself to system intervention in support of enhanced post-TKA outcomes and satisfaction. These interventions could include the development of a care model including long-term clinical support for patients whose knees do not achieve desired results on schedule, and collaborating with patients to set and manage reasonable expectations about how their post-TKA knee will feel and function.

Knee osteoarthritis (OA) is prevalent and often associated with meniscal tear. Physical therapy (PT) and exercise regimens are often used to treat OA or meniscal tear, but, to date, few programs have been designed specifically for conservative treatment of meniscal tear with concomitant knee OA. Clinical care and research would be enhanced by a standardized, evidence–based, conservative treatment program and the ability to study the effects of the contextual factors associated with interventions for patients with painful, degenerative meniscal tears in the setting of OA. This paper describes the process of developing both a PT intervention and a home exercise program for a randomized controlled clinical trial that will compare the effectiveness of these interventions for patients with knee pain, meniscal tear and concomitant OA. This paper describes the process utilized by an interdisciplinary team of physical therapists, physicians, and researchers to develop and refine a standardized in-clinic PT intervention, and a standardized home exercise program to be carried out without PT supervision. The process was guided in part by Medical Research Council guidance on intervention development. The investigators achieved agreement on an in-clinic PT intervention that included manual therapy, stretching, strengthening, and neuromuscular functional training addressing major impairments in range of motion, musculotendinous length, muscle strength and neuromotor control in the major muscle groups associated with improving knee function. The investigators additionally achieved agreement on a progressive, protocol-based home exercise program (HEP) that addressed the same major muscle groups. The HEP was designed to allow patients to perform and progress the exercises without PT supervision, utilizing minimal equipment and a variety of methods for instruction. This multi-faceted in-clinic PT program and standardized HEP provide templates for in-clinic and home-based care for patients with symptomatic degenerative meniscal tear and concomitant OA. These interventions will be tested as part of the Treatment of Meniscal Tear in Osteoarthritis (TeMPO) Trial. The TeMPO Trial was first registered at clinicaltrials.gov with registration No. NCT03059004 on February 14, 2017. TeMPO was also approved by the Institutional Review Board at Partners HealthCare/Brigham and Women’s Hospital.

The 30-item disabilities of the arm, shoulder and hand (DASH) questionnaire is increasingly used in clinical research involving upper extremity musculoskeletal disorders. From the original DASH a shorter version, the 11-item Quick DASH, has been developed. Little is known about the discriminant ability of score changes for the Quick DASH compared to the DASH. The aim of this study was to assess the performance of the Quick DASH and its cross-sectional and longitudinal validity and reliability. The study was based on extracting Quick DASH item responses from the responses to the full-length DASH questionnaire completed by 105 patients with a variety of upper extremity disorders before surgery and at follow-up 6 to 21 months after surgery. The DASH and Quick DASH scores were compared for the whole population and for different diagnostic groups. For longitudinal construct validity the effect size and standardized response mean were calculated. Analyses with ROC curves were performed to compare the ability of the DASH and Quick DASH to discriminate among patients classified according to the magnitude of self-rated improvement. Cross-sectional and test-retest reliability was assessed. The mean DASH score was 34 (SD 22) and the mean Quick DASH score was 39 (SD 24) at baseline. For the different diagnostic groups the mean and median Quick DASH scores were higher than the corresponding DASH scores. For the whole population, the mean difference between the Quick DASH and DASH baseline scores was 4.2 (95% CI 3.2–5.3), follow-up scores was 2.6 (1.7–3.4), and change scores was 1.7 (0.6–2.8). The overall effect size and standardized response mean measured with the DASH and the Quick DASH were similar. In the ROC analysis of change scores among patients who rated their arm status as somewhat or much better and those who rated it as unchanged the difference in the area under the ROC curve for the DASH and Quick DASH was 0.01 (95% CI -0.05–0.07) indicating similar discriminant ability. Cross-sectional and test-retest reliability of the DASH and Quick DASH were similar. The results indicate that the Quick DASH can be used instead of the DASH with similar precision in upper extremity disorders.

To compare the outcomes and characteristics of oblique lumbar interbody fusion stand-alone (OLIF-SA) and OLIF with posterior pedicle screw fixation (OLIF-PPS) in the treatment of Grade I or Grade II degenerative lumbar spondylolisthesis. Between January 2019 and May 2022, 139 patients with degenerative spondylolisthesis were treated with OLIF-SA (n = 85) or OLIF-PPS (n = 54). The clinical and radiographic records were reviewed. The clinical and radiographic outcomes were similar in both groups. The operative time and intraoperative blood loss in the OLIF-SA group were lower than those in the OLIF-PPS group (P < 0.05). However, the OLIF-PPS group had significantly better disc height (DH) and postoperative forward spondylolisthesis distance (FSD) improvement at 6 months (P < 0.05). The OLIF-PPS group had a significantly lower cage subsidence value than the OLIF-SA group (P < 0.05). Improvement of the lumbar lordotic angle (LA) and fusion segmental lordotic angle (FSA) in the OLIF-PPS group was significantly better than that in the OLIF-SA group (P < 0.05). In terms of fusion types, the OLIF-SA group tended to undergo fusion from the edge of the vertebral body. Fusion in the OLIF-PPS group began more often in the bone graft area of the central cage of the vertebral body. The fusion speed of the OLIF-SA group was faster than that of the OLIF-PPS group. OLIF-SA has the advantages of a short operative time, less intraoperative blood loss, and reduced financial burden, while PPS has incomparable advantages in the reduction of spondylolisthesis, restoration of lumbar physiological curvature, and long-term maintenance of intervertebral DH. In addition, the SA group had a unique vertebral edge fusion method and faster fusion speed.

Acute musculoskeletal (MSK) pain is very common and associated with impaired productivity and high economic burden. Access to timely and personalized, evidence-based care is key to improve outcomes while reducing healthcare expenditure. Digital interventions can facilitate access and ensure care scalability. Present the feasibility and results of a fully remote digital care program (DCP) for acute MSK conditions affecting several body areas. Interventional single-arm study of individuals applying for digital care programs for acute MSK pain. Primary outcome was the mean change between baseline and end-of-program in self-reported Numerical Pain Rating Scale (NPRS) score and secondary outcomes were change in analgesic consumption, intention to undergo surgery, anxiety (GAD-7), depression (PHQ-9), fear-avoidance beliefs (FABQ-PA), work productivity (WPAI-GH) and engagement. Three hundred forty-three patients started the program, of which 300 (87.5%) completed the program. Latent growth curve analysis (LGCA) revealed that changes in NPRS between baseline and end-of-program were both statistically (p < 0.001) and clinically significant: 64.3% reduction (mean − 2.9 points). Marked improvements were also noted in all secondary outcomes: 82% reduction in medication intake, 63% reduction in surgery intent, 40% in fear-avoidance beliefs, 54% in anxiety, 58% in depression and 79% recovery in overall productivity. All outcomes had steeper improvements in the first 4 weeks, which paralleled higher engagement in this period (3.6 vs 3.2 overall weekly sessions, p < 0.001). Mean patient satisfaction score was 8.7/10 (SD 1.26). This is the first longitudinal study demonstrating the feasibility of a DCP for patients with acute MSK conditions involving several body areas. Major strengths of this study are the large sample size, the wide range of MSK conditions studied, the breadth of outcomes measured, and the very high retention rate and adherence level. The major limitation regards to the absence of a control group. We observed very high completion and engagement rates, as well as clinically relevant changes in all health-related outcomes and productivity recovery. We believe this DCP holds great potential in the delivery of effective and scalable MSK care. NCT, NCT04092946 . Registered 17/09/2019;

Prevention of chronic pain relies on accurate detection of at-risk patients. Screening tools have been validated mainly in (sub) acute spinal pain and the need of more generic tools is high. We assessed the validity of the French version of the short Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) in patients with a large range of pain duration and localization. First, we re-analyzed data from a 6-month longitudinal study of 73 patients with (sub) acute spinal pain consulting in secondary line settings. Secondly, we performed a new 12-month longitudinal study of 542 primary care patients with (sub) acute and chronic pain in different localizations (spinal, limbs, “non-musculoskeletal”). The area under the receiver operating characteristic curve and cutoff scores were computed and compared for different subpopulations and ÖMPSQ subscores. Data from patients suffering from (sub) acute and chronic spinal pain consulting in both primary and secondary care settings confirmed the validity of the short French ÖMPSQ version and its subsets. In the primary care cohort, the performance of the questionnaire and its psychosocial subscore was variable but at least “fair” in most populations ((sub) acute and chronic, spinal and limb pain). Cutoff scores showed quite large variability depending on the outcome and the subpopulation considered. These results confirm the usefulness of the short French ÖMPSQ for prediction of the evolution of (sub) acute and chronic patients with spinal and limb pain, whatever its duration. However, increasing population heterogeneity results in slightly worse predictive performance and largely variable cutoff scores. Consequently, it might be difficult to choose universal cutoff scores and other criteria, such as patients’ values and the available resources for patient management, should be taken into account.

Shoulder complaints are commonly seen in general practice and physiotherapy practice. The only complaints for which general practitioners (GPs) refer more patients to the physiotherapist are back and neck pain. However, a substantial group have persistent symptoms. The first goal of this study is to document current health care use and the treatment process for patients with shoulder syndromes in both general practice and physiotherapy practice. The second goal is to detect whether there are differences between patients with shoulder syndromes who are treated by their GP, those who are treated by both GP and physiotherapist and those who access physiotherapy directly. Observational study using data from the Netherlands Information Network of General Practice and the National Information Service for Allied Health Care. These registration networks collect healthcare-related information on patient contacts including diagnoses, prescriptions, referrals, treatment and evaluation on an ongoing basis. Many patients develop symptoms gradually and 35% of patients with shoulder syndromes waited more than three months before visiting a physiotherapist. In 64% of all patients, treatment goals are fully reached at the end of physiotherapy treatment. In general practice, around one third of the patients return after the referral for physiotherapy. Patients with shoulder syndromes who are referred for physiotherapy have more consultations with their GP and are prescribed less medication than patients without a referral. Often, this referral is made at the first consultation. In physiotherapy practice, referred patients differ from self-referrals. Self-referrals are younger, they more often have recurrent complaints and their complaints are more often related to sports and leisure activities. There is a fairly large group of patients with persistent symptoms. Early referral by a GP is not advised under current guidelines. However, in many patients, symptoms develop gradually and a wait-and-see policy means more valuable time may pass before physiotherapy intervention takes place. Meanwhile a long duration of complaints is a predictor for poor outcome. Therefore, future research into early referral is required. As physiotherapists, we should develop a way of educating patients to avoid lengthy waiting periods before seeking help. To prevent high costs, physiotherapists could consider a classification of pain and limitations and wait-and-see policy as used by GPs. With early detection, a once-off consultation might be sufficient.