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Frontiers in Neuroscience 2023In recent years, pain neuroscience education (PNE) has been the focus of extensive research in the scientific literature in the field of physical therapy, but the...
INTRODUCTION
In recent years, pain neuroscience education (PNE) has been the focus of extensive research in the scientific literature in the field of physical therapy, but the results obtained are controversial and its clinical application remains unclear. The main aim of this umbrella review was to assess the effectiveness of PNE in patients with chronic musculoskeletal pain (CMP).
METHODS
We searched systematically in PubMed (Medline), PEDro, EMBASE, CINAHL and PsycINFO. Methodological quality was analyzed using AMSTAR-2 scale and overlapping analysis using GROOVE tool.
RESULTS
16 systematic reviews were included. A qualitative synthesis was performed for the following sets of patients with CMP: overall CMP, chronic spinal pain, patients with fibromyalgia and patients with osteoarthritis. In general terms, it seems that the addition of the PNE-based intervention to other treatments, mostly exercise-based interventions although we might refer to it in terms of a multimodal approach, leads to greater clinical improvements than the multimodal approach alone. We have found this especially in the reduction of the influence of psychosocial variables. However, it seems that studies testing the effectiveness of PNE in isolation, systematic reviews with or without meta-analysis did not show statistically significant improvements overall in terms of pain intensity, disability levels or psychosocial variables.
DISCUSSION
There is a great heterogeneity in the results obtained and the PNE protocols used, a critically low quality in the reviews included and a very high overlap, so there is a need to improve the studies in this field before clinical application.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO (CRD42022355634).
PubMed: 38075271
DOI: 10.3389/fnins.2023.1272068 -
The Surgeon : Journal of the Royal... Jun 2024Surgeons are expected to work long hours in operating theatres. A high prevalence of work-related musculoskeletal (WRMSK) injuries and pain in healthcare professions... (Review)
Review
INTRODUCTION
Surgeons are expected to work long hours in operating theatres. A high prevalence of work-related musculoskeletal (WRMSK) injuries and pain in healthcare professions exists. We aimed to study WRMSK pain and injuries in general surgeons and study their risk in different surgical techniques comprising open, laparoscopic and robotic-assisted surgery.
METHODS
A systematic search was performed in compliance with The PRISMA checklist. Search was performed in PubMed and Cochrane library databases for 6 years to 2024. The search terms used were "disability and surgeon", "occupational injuries and surgeon", and "musculoskeletal pain and surgeons", in addition to MESH terms in PubMed database. Risk of bias was calculated among studies.
RESULTS
The search revealed 3648 citations from which a final list of 24 citations were included after application of inclusion and exclusion criteria. The citations comprised over 1900 surgeons including consultants and surgical trainees from different subspecialities. Incorporated citations consisted of 21 cross-sectional 3 observational studies. Most common pain sites, risks and preventative measure for MSK injuries were revealed.
CONCLUSION
There is high prevalence of WRMSK pain among general surgeons. Surgeons were primarily affected at physical body parts ranging from the neck, shoulders, upper back and lower back to upper extremity. Robotic-assisted surgery led to lower post-operative discomfort and decreased demanding muscle activity in upper extremities but enhanced static neck position resulting in subjective back stiffness compared with laparoscopic surgery.
PubMed: 38862375
DOI: 10.1016/j.surge.2024.05.001 -
Gait & Posture Mar 2024Foot orthoses (FOs) are often prescribed by clinicians to treat foot and ankle conditions, prevent running injuries, and enhance performance. However, the lack of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Foot orthoses (FOs) are often prescribed by clinicians to treat foot and ankle conditions, prevent running injuries, and enhance performance. However, the lack of higher-order synthesis of clinical trials makes it challenging for clinicians to adopt an evidence-based approach to FOs' prescriptions.
RESEARCH QUESTION
Do FOs with different modifications alter lower extremity running kinematics and kinetics?
METHODS
A systematic search of seven databases was conducted from inception to February 2023. The analysis was restricted to healthy adults without foot musculoskeletal impairments and studies that compared the FOs effects with the controls. The methodological quality of the 35 studies that met the eligibility criteria was evaluated using the modified Downs and Black checklist. The random effects model estimated the standardized mean difference (SMD) with 95% confidence intervals and effect sizes. Sub-group analyses based on FOs type were performed to assess the potential effects of the intervention.
RESULTS
Our findings indicated that both custom and off-the-shelf arch-support FOs reduced peak plantar pressure at the medial heel (SMD=-0.35, and SMD=-1.03), lateral heel (SMD=-0.50, and SMD=-0.53), and medial forefoot (SMD=-0.20, and SMD=-0.27), but increased plantar pressure at the mid-foot (SMD=0.30, and SMD=0.56). Compared with the controls, significant increases (SMD=0.36) in perceived comfort were found with custom FOs. A reduction (SMD=-0.58) in initial ankle inversion was found when a raised heel cup was integrated with arch-support FOs. A medial post integrated with arch support exhibited a reduced ankle (SMD=-1.66) and tibial (SMD=-0.63) range of motion. Custom FOs, however, unfavorably affected the running economy (SMD=-0.25) and perceived exertion (SMD=0.20).
SIGNIFICANCE
Although FOs have been reported to have some positive biomechanical effects in healthy populations without musculoskeletal impairments or running-related issues, they need to be optimized and generalized to achieve better running performance and prevent injury.
Topics: Adult; Humans; Foot Orthoses; Biomechanical Phenomena; Lower Extremity; Ankle; Ankle Joint
PubMed: 38367456
DOI: 10.1016/j.gaitpost.2024.02.003 -
Complementary Therapies in Clinical... Aug 2023An increasing number of people suffer from chronic neck pain due to increased telecommuting. Manual therapy is considered a safe and less painful method and has been... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
An increasing number of people suffer from chronic neck pain due to increased telecommuting. Manual therapy is considered a safe and less painful method and has been increasingly used to alleviate chronic neck pain. However, there is controversy about the effectiveness of manipulation therapy on chronic neck pain. Therefore, this systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to determine the effectiveness of manipulative therapy for chronic neck pain.
METHODS
A search of the literature was conducted on seven databases (PubMed, Cochrane Center Register of Controlled Trials, Embase, Medline, CNKI, WanFang, and SinoMed) from the establishment of the databases to May 2022. This study included RCTs on chronic neck pain managed with manipulative therapy compared with sham, exercise, and other physical therapies. The retrieved records were independently reviewed by two researchers. Further, the methodological quality was evaluated using the PEDro scale. All statistical analyses were performed using RevMan V.5.3 software. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessment was used to evaluate the quality of the study results.
RESULTS
Seventeen RCTs, including 1190 participants, were included in this meta-analysis. Manipulative therapy showed better results regarding pain intensity and neck disability than the control group. Manipulative therapy was shown to relieve pain intensity (SMD = -0.83; 95% confidence interval [CI] = [-1.04 to -0.62]; p < 0.0001) and neck disability (MD = -3.65; 95% CI = [-5.67 to - 1.62]; p = 0.004). However, the studies had high heterogeneity, which could be explained by the type and control interventions. In addition, there were no significant differences in adverse events between the intervention and the control groups.
CONCLUSIONS
Manipulative therapy reduces the degree of chronic neck pain and neck disabilities.
Topics: Humans; Neck Pain; Treatment Outcome; Randomized Controlled Trials as Topic; Chronic Pain; Musculoskeletal Manipulations
PubMed: 37084588
DOI: 10.1016/j.ctcp.2023.101751 -
National Journal of Maxillofacial... 2023Temporomandibular disorders (TMD) are a common condition affecting the musculoskeletal group evoking clinical signs such as pain, restricted mouth opening, and... (Review)
Review
Temporomandibular disorders (TMD) are a common condition affecting the musculoskeletal group evoking clinical signs such as pain, restricted mouth opening, and disability in the temporomandibular joint (TMJ), masticatory musculature, and the osseous structures in the surroundings. Saliva is a strong proponent of a diagnostic and prognostic tool for TMDs. Hence, a systematic review was undertaken to answer the research question "What is the role of salivary biomarkers in the identification of TMD?" A thorough literature search was performed in databases of PubMed, Embase, and Google Scholar till February 2022. Every included study was characterized by Study ID, location, sample size, demographic information, biomarker analysis, assessment method, and results. Newcastle-Ottawa scale was used to assess the methodological quality of all qualifying research. A total of eight articles were included for the review after screening the titles, abstracts, and full-text articles. The review included articles of observational design with a control group. TMD disorders were confirmed both clinically and radiographically in the study of Shoukri et al. TMDs are commonly prevalent in maxillofacial conditions. Despite the availability of various diagnostic techniques, certain limitations are remarkable. The researchers are yet to ascertain a gold standard biomarker to identify TMD.
PubMed: 38273906
DOI: 10.4103/njms.njms_136_22 -
Age and Ageing Nov 2023Telerehabilitation can be an appropriate alternative to face-to-face rehabilitation for adults; however, it is uncertain whether it is safe and effective for older... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Telerehabilitation can be an appropriate alternative to face-to-face rehabilitation for adults; however, it is uncertain whether it is safe and effective for older adults.
OBJECTIVE
This review aimed to determine the effect of physiotherapist-led, exercise-based telerehabilitation for older adults on patient outcomes (health-related quality of life, activity limitation, functional impairment) and health service costs.
METHODS
Randomised or non-randomised controlled trials including community-dwelling older adults (mean age ≥ 65 years) who received exercise-based telerehabilitation led by a physiotherapist were eligible. Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, PubMed and Cochrane Library were searched from the earliest available date to August 2022. Methodological quality was assessed using the Physiotherapy Evidence Database scale. Data were synthesised with inverse variance, random-effects meta-analyses to determine standardised mean differences and 95% confidence intervals. Certainty of evidence was determined by applying Grading of Recommendations, Assessment, Development and Evaluation criteria.
RESULTS
Eleven studies (10 randomised) with 1,400 participants (mean age 65-74 years) experiencing musculoskeletal and cardiopulmonary conditions were included. Telerehabilitation was safe, effective and well adhered to. Telerehabilitation was non-inferior to face-to-face physiotherapy in relation to range of movement, strength, 6-min walk distance (6MWD), timed up and go test (TUGT) and quality of life and had lower health-care costs compared with face-to-face physiotherapy. Compared with no intervention, telerehabilitation participants had significantly better range of motion, strength, quality of life, 6MWD and TUGT speed.
CONCLUSION
Physiotherapist-led, exercise-based telerehabilitation is non-inferior to face-to-face rehabilitation and better than no intervention for older adults with musculoskeletal and cardiopulmonary conditions.
Topics: Humans; Aged; Telerehabilitation; Quality of Life; Postural Balance; Physical Therapists; Time and Motion Studies
PubMed: 37979183
DOI: 10.1093/ageing/afad207 -
Sports Health 2023Does lower baseline cognitive function predispose athletes to ACL injury risk, especially when performing unplanned or dual-task movements? (Review)
Review
CONTEXT
Does lower baseline cognitive function predispose athletes to ACL injury risk, especially when performing unplanned or dual-task movements?
OBJECTIVE
To evaluate the association between cognitive function and biomechanics related to ACL injuries during cognitively challenging sports movements.
DATA SOURCES
PubMed (MEDLINE), Web of Science, Scopus, and SciELO databases were searched; additional hand searching was also conducted.
STUDY SELECTION
The following inclusion criteria had to be met: participants completed (1) a neurocognitive test, (2) a cognitively challenging sport-related task involving lower limbs, and (3) a biomechanical analysis. The following criteria determined exclusion from the review: studies involving participants with (1) recent or current musculoskeletal injuries; (2) recent or current concussion; (3) ACL surgical reconstruction, reviews of the literature, commentary or opinion articles, and case studies.
STUDY DESIGN
Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) statement and registered at the International Prospective Register of Systematic Reviews (PROSPERO).
LEVEL OF EVIDENCE
Level 3.
DATA EXTRACTION
Two of authors independently extracted data and assessed the methodological quality of the articles with the Downs and Black and ROBINS-I checklists, to assess methodological quality and risk of bias, respectively.
RESULTS
Six studies with different methodologies and confounding factors were included in this review. Of these 6 studies, 3 were ranked as high-quality, 3 demonstrated a low risk of bias, 2 a moderate risk, and 1 a severe risk. Five studies found a cognitive-motor relationship, with worse cognitive performance associated with increased injury risk, with 1 study reporting the opposite directionality for 1 variable. One study did not identify any interaction between cognitive function and biomechanical outcomes.
CONCLUSION
Worse cognitive performance is associated with an increased injury risk profile during cognitively challenging movements.
Topics: Humans; Anterior Cruciate Ligament Injuries; Athletic Injuries; Biomechanical Phenomena; Cognition
PubMed: 36680310
DOI: 10.1177/19417381221146557 -
Seminars in Arthritis and Rheumatism Aug 2023This study aimed to determine outcome domains of importance to patients living with foot and ankle disorders in rheumatic and musculoskeletal diseases (RMDs), by...
Living with foot and ankle disorders in rheumatic and musculoskeletal diseases: A systematic review of qualitative studies to inform the work of the OMERACT Foot and Ankle Working Group.
OBJECTIVES
This study aimed to determine outcome domains of importance to patients living with foot and ankle disorders in rheumatic and musculoskeletal diseases (RMDs), by exploring the symptoms and impact of these disorders reported in existing qualitative studies.
METHODS
Six databases were searched from inception to March 2022. Studies were included if they used qualitative interview or focus group methods, were published in English, and involved participants living with RMDs (inflammatory arthritis, osteoarthritis, crystal arthropathies, connective tissue diseases, and musculoskeletal conditions in the absence of systemic disease) who had experienced foot and ankle problems. Quality was assessed using the Critical Appraisal Skills Programme qualitative tool and confidence in the findings was assessed using the Grading of Recommendations Assessment, Development and Evaluation Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) approach. All data from the results section of included studies were extracted, coded and synthesised to develop themes.
RESULTS
Of 1,443 records screened, 34 studies were included, with a total of 503 participants. Studies included participants with rheumatoid arthritis (n = 18), osteoarthritis (n = 5), gout (n = 3), psoriatic arthritis (n = 1), lupus (n = 1), posterior tibial tendon dysfunction (n = 1), plantar heel pain (n = 1), Achilles tendonitis (n = 1), and a mixed population (n = 3), who live with foot and ankle disorders. Seven descriptive themes were generated from the thematic synthesis: pain, change in appearance, activity limitations, social isolation, work disruption, financial burden and emotional impact. Descriptive themes were inductively analysed further to construct analytical themes relating to potential outcome domains of importance to patients. Foot or ankle pain was the predominant symptom experienced by patients across all RMDs explored in this review. Based on grading of the evidence, we had moderate confidence that most of the review findings represented the experiences of patients with foot and ankle disorders in RMDs.
CONCLUSIONS
Findings indicate that foot and ankle disorders impact on multiple areas of patients' lives, and patients' experiences are similar regardless of the RMD. This study will inform the development of a core domain set for future foot and ankle research and are also useful for clinicians, helping to focus clinical appointments and measurement of outcomes within clinical practice.
Topics: Humans; Ankle; Musculoskeletal Diseases; Osteoarthritis; Qualitative Research; Pain
PubMed: 37207417
DOI: 10.1016/j.semarthrit.2023.152212 -
Heliyon Oct 2023This study aimed to determine the prevalence of work-related musculoskeletal disorders (WMSDs) in dental students and analyze the potential associated risk factors.
OBJECTIVES
This study aimed to determine the prevalence of work-related musculoskeletal disorders (WMSDs) in dental students and analyze the potential associated risk factors.
METHODS
This review was registered in PROSPERO with the number CRD42022349864. We performed a meta-analysis calculating event rates with relative 95% confidence intervals for each body region. Two investigators systematically searched Cochrane, Pubmed, Scopus, and EBSCO databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).
RESULTS
Sixteen studies, with 3761 dental students, were included. The highest 7-day prevalence was in the lower back (27.2%; 95% CI 20-35), neck (27%; 95% CI 19.1-35.8), and upper back (24.2%; 95% CI 17.2-32). Yearly occurrence was mainly in the neck (51%; 95% CI 41-61), followed by shoulders (45.3%; 95% CI 37.6-53.1) and lower back (42%; 95% CI 34.1-50.2) and a fraction of these reported that symptoms in lower-back (15.2%; 95% CI 12.1-18.5), neck (13.9%; 95% CI 10.6-17.5) and shoulders (12.2%; 95% CI 8.7-16.3) affected work or normal activities. Associated contributing factors include female sex, poor posture habits, inadequate ergonomics knowledge, sedentary lifestyle, high physical activity levels, poor quality of life, and smoking. In contrast, engaging in physical exercise has positively impacted mitigating the risk of musculoskeletal disorders.
CONCLUSIONS
WMSDs have a high prevalence among dental students, particularly in the cervicothoracic, lumbar, and shoulder regions, having a significant impact since training years. Further research with a multidimensional approach with psychosocial and physical assessments is recommended to understand this issue thoroughly.
PubMed: 37780768
DOI: 10.1016/j.heliyon.2023.e19956 -
F1000Research 2022Knee osteoarthritis (OA) is a musculoskeletal disorder that causes pain and increasing loss of function, resulting in reduced proprioceptive accuracy and balance.... (Meta-Analysis)
Meta-Analysis
Knee osteoarthritis (OA) is a musculoskeletal disorder that causes pain and increasing loss of function, resulting in reduced proprioceptive accuracy and balance. Therefore, the goal of this systematic review and meta-analysis is to evaluate the effectiveness of balance training on pain and functional outcomes in knee OA. "PubMed", "Scopus", "Web of Science", "Cochrane", and "Physiotherapy Evidence Database" were searched for studies conducted between January 2000 and December 2021. Randomized controlled trials (RCTs) that investigated the effectiveness of balance training in knee OA, as well as its effects on pain and functional outcome measures, were included. Conference abstracts, case reports, observational studies, and clinical commentaries were not included. Meta-analysis was conducted for the common outcomes, i.e., Visual Analog Scale (VAS), The Timed Up and Go (TUG), Western Ontario and McMaster Universities Arthritis Index (WOMAC). The PEDro scale was used to determine the quality of the included studies. This review includes 22 RCTs of which 17 articles were included for meta-analysis. The included articles had 1456 participants. The meta-analysis showed improvement in the VAS scores in the experimental group compared to the control group [ = 92%; mean difference= -0.79; 95% CI= -1.59 to 0.01; p<0.05] and for the WOMAC scores the heterogeneity ( ) was 81% with a mean difference of -0.02 [95% CI= -0.44 to 0.40; p<0.0001]. The TUG score was analyzed, the was 95% with a mean difference of -1.71 [95% CI= -3.09 to -0.33; p<0.0001] for the intervention against the control group. Balance training significantly reduced knee pain and improved functional outcomes measured with TUG. However, there was no difference observed in WOMAC. Although due to the heterogeneity of the included articles the treatment impact may be overestimated. The current systematic review was registered in PROSPERO on 7th October 2021 (registration number CRD42021276674).
Topics: Humans; Databases, Factual; Ontario; Osteoarthritis, Knee; Pain; Pain Measurement; Postural Balance
PubMed: 38444514
DOI: 10.12688/f1000research.111998.2