IMPORTANCE:A biopsychosocial approach serves as an important paradigm underpinning musculoskeletal pain education training. Understanding how educators teach this approach in their training may provide insights on how to improve the clinical translation and adoption of a biopsychosocial model in musculoskeletal pain care. OBJECTIVE:This primary qualitative study explored physiotherapy educators' perspectives on translating the biopsychosocial approach to pain care from knowing ('what') to doing (the 'how' of clinical adoption). METHODS:Semi-structured interviews were conducted with 18 purposively-sampled, experienced physiotherapy pain educators from across Australia. Data were analyzed using reflexive thematic analysis. RESULTS:Eighteen experienced physiotherapy educators participated from nine Australian universities. Five themes (with nine subthemes) were identified, collectively referred to as 'levers to biopsychosocial translation'. These themes were: (1) Considerations for teaching across different physiotherapy health workforce training levels; (2) Theoretical models of pain that underpin and scaffold biopsychosocial training ('what' to teach); (3) Developing biopsychosocial competencies and skills ('how' to teach); (4) Learning enablers, reinforcement strategies, and educational resources; and (5) Supporting clinical adoption. CONCLUSION:This study identified data-driven 'translation levers' (specific tools, structures and processes) perceived by experienced educators as supporting biopsychosocial competence and facilitating clinical adoption in musculoskeletal pain care. These findings offer educators a potential translation framework to support effective biopsychosocial educational and clinical translation and adoption across the learning continuum. The identified resources as educational training supports - to strengthen clinical competence in the biopsychosocial approach to musculoskeletal pain care.
BACKGROUND:Insomnia is common in people with chronic musculoskeletal pain (CMP). However, insomnia is often operationalised in various way, impairing the comparability between studies and limiting clinical integration of findings. OBJECTIVES:This secondary exploratory analysis of data from a pre-registered cross-sectional survey aimed to investigate how varying insomnia classifications affect insomnia prevalence and the outcomes of comparisons of clinical parameters between insomnia and non-insomnia groups in individuals with CMP. METHODS:Data from 1322 individuals with CMP were used for the analyses. Insomnia was classified in six different ways (Strictest classification: modified DSM-5-based classification - most inclusive classification: any nighttime symptoms). Prevalence rates were examined across the different classifications, and statistical comparisons of clinical parameters (e.g., pain-, mood-, and sleep-related measures, each assessed with a single item) between insomnia and non-insomnia groups were conducted, with standardised mean differences estimated to assess how classification choices influence effect sizes. RESULTS:Stricter classifications led to substantially lower prevalence rates compared to more inclusive classifications with differences of up to 25 percentage points (53.33% vs. 78.59% for the strictest and most inclusive definitions). Statistically significant differences between insomnia and non-insomnia groups were found for all variables and classifications. However, for 25 of 27 variables, at least one disagreement in effect size category was observed between classifications, with less stringent classifications consistently yielding larger effect sizes. CONCLUSIONS:The results of this study highlight that clinicians and researchers should carefully consider used classification criteria when interpreting insomnia prevalence rates and related clinical outcomes in the context of CMP.
INTRODUCTION:Patient expectations influence clinical outcomes in musculoskeletal physiotherapy, acting both as prognostic factors and as active contributors to treatment effects. These expectations are shaped by previous healthcare experiences, digital and verbal information, and social context. However, patient expectations may be misaligned with evidence-informed care, creating ethical tensions between optimising contextual effects, supporting person-centred care, and maintaining professional integrity. PURPOSE:This professional practice article discusses the contextual and ethical foundations of patient expectations in musculoskeletal physiotherapy and introduces the Contextually Informed Expectation Alignment framework. This framework provides a structured approach to systematically elicit and classify patient expectations, including concordant, unrealistic but non-harmful, and conflicting expectations, and aligning these with evidence-informed care through shared deliberation and contextual optimisation. IMPLICATIONS:The framework supports clinicians in making patient expectations explicit, differentiating between types of expectations, and responding accordingly within a person-centred and evidence-informed approach. By combining expectation elicitation, classification, and shared deliberation, clinicians can better navigate expectation-evidence tensions, strengthen the therapeutic alliance, and reduce low-value care. This requires attention not only to what patients expect, but also to the needs, values, and capabilities that may be expressed through those expectations. Implementation has implications for physiotherapy education, practice, and research. Clinicians require competencies in communication, ethical reasoning, value clarification, and contextual optimisation. Further research is needed to evaluate the feasibility and acceptability of the framework, determine longer-term effects, and identify which patients, settings, and clinical contexts may benefit most. Addressing patient expectations remains fundamental to high-quality musculoskeletal care.
OBJECTIVE:To examine the association between smartphone addiction and multisite musculoskeletal pain burden among parents, and whether this association is mediated by smartphone-related sleep disturbance and moderated by physical activity. METHODS:A total of 1444 parents (447 fathers and 997 mothers) completed a cross-sectional online survey. Smartphone addiction was assessed using the Smartphone Addiction Scale-Short Version (SAS-SV). Total pain burden was assessed by participants rating their pain in each of four predefined areas over the past week (neck, upper back, lumbar region, and wrist/fingers) on a 0-10 numerical rating scale, with the four regional scores summed. Sleep-related variables were daily sleep duration and smartphone-related sleep disturbance. Physical activity was assessed using the International Physical Activity Questionnaire-Short Form (IPAQ-SF). RESULTS:Smartphone addiction showed a weak but statistically significant positive association with total pain burden (rho = 0.106, p < 0.001) and remained independently associated with pain burden after adjustment for demographic and behavioral factors (B = 0.106, p < 0.001). Smartphone-related sleep disturbance partially mediated this association (indirect effect = 0.016, 95% CI 0.003-0.030). Physical activity moderated the association (B = -0.563, p = 0.015), which was weaker at higher levels of physical activity. Participants with more severe pain profiles had significantly higher smartphone addiction scores. CONCLUSIONS:The findings identify problematic smartphone use as a small-magnitude behavioural correlate of multisite pain burden among parents, independent of the modelled covariates, and best interpreted within a broader behavioural health context encompassing sleep and physical activity rather than through screen time or posture alone.
Objective To evaluate between group and individual data across five behavioural and psychological features (fatigue, poor sleep, perceived stress, anxiety and depression) in individuals with tension-type headache (TTH), idiopathic neck pain (INP) and healthy controls (HC). Methods A secondary analysis of a cross-sectional study in 65 individuals with TTH, 17 with INP and 20 HC. Behavioural and psychological measures, headache, neck pain and disability and sensory measures were collected from the relevant groups. Results The TTH group compared to HC had higher scores and percentages of participants with fatigue, poor sleep and anxiety symptoms (all p < 0.01) but similar levels to the INP group apart from perceived stress where the INP group scored higher (p < 0.01). Clinically relevant scores in at least 2/5 features were seen in 65% and 53% of individuals in the TTH and INP groups respectively, while 70% HC had mostly normal scores. Individuals with TTH and >2/5 clinically relevant scores, had higher headache disability (p = 0.019) but no differences in headache, neck pain and pain sensitivity than those with 0-1/5 feature. Conclusions Individuals with TTH are heterogeneous in terms of behavioural and psychological features. More behavioural and psychological features were not necessarily related to headache and neck pain severity, pain sensitivity, or chronicity. Individuals with idiopathic neck pain exhibit similar features to those with TTH suggesting they may align to a pain state rather than specifically to TTH.
Introduction A complex interplay of biopsychosocial factors influences the management of individuals with persistent musculoskeletal pain. Among these, patient expectations (PEs) are often underappreciated, yet profoundly impactful. Purpose The purpose of this Professional Practice article is to describe the expectations patients bring to the clinical encounter and argue that PEs are not just prognostic; they are modifiable, therapeutic targets that can be leveraged to shape patient outcomes. PEs extend beyond the narrow confines of treatment and recovery to encompass relational, contextual, lifestyle, spiritual, and cultural dimensions that influence therapeutic outcomes. Reconceptualizing PEs as dynamic, multidimensional, and co-created between clinician and patient, physiotherapists can deliver care that is truly person-centered and contextually grounded. Implications Clinically, PEs should be systematically assessed, revisited, and actively aligned with prognosis through person-centered communication and shared decision-making. PEs can inform key aspects of care, including goal setting, intervention selection, and patient engagement. Integrating these PEs into assessment and treatment planning may enhance the therapeutic alliance and support improved engagement and long-term outcomes.
Objectives Does adding the PainSMART-strategy to usual physiotherapy management of musculoskeletal pain (MSKP) improve pain intensity, pain self-efficacy and selected secondary outcomes? Design A multi-centre randomised, control group-blinded, superiority trial. Adults seeking primary care physiotherapy with MSKP were randomly allocated to usual physiotherapy management alone (n=250), or usual physiotherapy management plus the PainSMART-strategy (n=254); a 7-minute pain science education (PSE) film and short physiotherapist-initiated reflection on the film. Data were collected at baseline, follow-ups 1 (24-72hrs pre-physiotherapy consultation), 2 (24hrs post-consultation) and 3 (three months post-baseline). Primary outcomes: Average pain intensity and pain self-efficacy. Secondary outcomes: Best/worst pain intensity, MSKP-perceptions, MSKP-coping strategies, psychological flexibility, physical activity levels, sitting time, global rating of change. Results Average pain intensity: No between-group difference in change from baseline to any follow-up (MD -0.06, 95% CI -0.36 to 0.25, 0-10 scale; 0.05, 95% CI -0.34 to 0.43; -0.08, 95% CI -0.54 to 0.37). Pain self-efficacy: Between-group difference in change from baseline favoured the PainSMART-group at follow-up 1 (MD 1.6, 95% CI 0.10 to 3.0, 0-60 scale; exploratory analysis), but not follow-ups 2 and 3 (MD -0.07, 95% CI -1.8 to 1.6; 1.3, 95% CI -1.0 to 3.6; primary analysis time points). Fewer patients in the PainSMART-group reported worsening. Conclusion Combining the PainSMART-strategy with usual physiotherapy management did not result in additional clinically meaningful benefits once physiotherapy had commenced. During waiting times, the strategy may facilitate earlier improvements in MSKP-perceptions, self-efficacy and physical activity for some. This type of educational intervention is scalable within primary care. Clinical trials registration The study protocol (2023-12-15) and statistical analysis plan (2024-09-25) were prospectively registered at ClinicalTrials.gov (https://clinicaltrials.gov/study/NCT06187428) and the study protocol published (https://doi.org/10.1371/journal.pone.0316806).
BACKGROUND:Autonomic dysregulation has previously been reported in chronic whiplash-associated disorders (WAD). Autonomic function can be evaluated via the pupillary light reflex (PLR). OBJECTIVE:To determine if PLR measures differ between chronic WAD and healthy controls (HCs), and to investigate the relationship between a) PLR and clinical measures associated with central pain processing, and b) psychological measures - posttraumatic stress, anxiety and stress - associated with autonomic nervous system (ANS) function. DESIGN:Observational study with healthy control comparison. PARTICIPANTS:Twenty-six patients with chronic WAD and 26 age/sex-matched HCs (58% female). OUTCOME MEASURES:Independent t-tests compared WAD and HC participants. Correlation analyses investigated the association between PLR and clinical measures of central pain processing (Central Sensitization Inventory, cervical and tibialis anterior pressure pain thresholds, temporal summation and conditioned pain modulation), and psychological measures (Depression, Anxiety, and Stress Scale and the PTSD Checklist for the DSM-5) evaluating posttraumatic stress, anxiety and stress symptoms. RESULTS:For PLR measures, participants with chronic WAD demonstrated significantly reduced pupil constriction amplitude (Mean difference [95%CI]: 0.33 mm [0.08, 0.58]; p = 0.01) and quicker time to return to 75% of resting pupil diameter during re-dilation (Mean difference [95%CI]: 0.39secs [0.08, 0.58]; p = 0.01), indicative of parasympathetic and sympathetic nervous system dysfunction. Pupillometry measures were not related to measures of central pain processing but instead related to stress or anxiety symptoms. CONCLUSIONS:People with chronic WAD demonstrated changes in PLR, indicative of possible autonomic dysregulation. There was no relationship to measures of central pain processing. However, psychological measures were associated with pupillometry, suggesting a potential interaction between autonomic function and psychological manifestations in chronic WAD. The direction of this relationship warrants further investigation.
INTRODUCTION:Osteoarthritis (OA) is a leading cause of pain, disability, and reduced quality of life worldwide. Although OA is commonly interpreted through a structural lens, pain severity is often only weakly related to radiographic severity, suggesting that structure-based models are insufficient to explain many clinical presentations. PURPOSE:This masterclass aims to challenge persistent structural assumptions surrounding OA pain, summarizes the peripheral, central, behavioral, and systemic mechanisms that may shape pain presentation, and provide a mechanism-based clinical reasoning framework to guide assessment and conservative care. In particular, it emphasizes the mismatch between imaging findings and symptoms, the multidimensional nature of pain, and the need to move beyond a purely mechanical interpretation of OA. IMPLICATIONS:Clinicians should move beyond imaging-led reasoning and adopt multidimensional assessment, phenotype-informed interpretation, and individualized multimodal care. OA pain may reflect interacting peripheral nociceptive input, altered pain processing, sleep disturbance, behavioral adaptation, reduced physical reserve, and broader health factors. Exercise and education remain fundamental components of care, but their value depends on how well they are explained, individualized, and matched to the dominant pain presentation. Manual therapy, sleep-related strategies, load modification, pacing, and psychosocially informed interventions may also have a role when selected according to the clinical profile rather than justified by structural findings alone. A mechanism-informed approach may help clinicians improve treatment matching, reduce low-value imaging-based care, and support more coherent, person-centered management of OA pain.
BACKGROUND:Recovery after conservative treatment for cervical radiculopathy (CR) is heterogeneous, but VAS-based pain recovery patterns and their baseline predictors remain unclear. OBJECTIVE:To identify VAS-based pain recovery trajectory phenotypes after conservative treatment for CR, compare clinical outcomes across phenotypes, and explore baseline predictors of unfavorable trajectories. METHODS:In this single-center retrospective cohort study, consecutive CR patients receiving standardized conservative treatment were enrolled. Latent class growth analysis (LCGA) was applied to Visual Analogue Scale (VAS) scores measured at five time points from baseline to 12 months. Neck Disability Index (NDI) trajectories were modeled in parallel to assess robustness. Multinomial logistic regression was used to identify predictors of unfavorable trajectories, with multiple imputation and bootstrap resampling for internal validation. RESULTS:Among 195 patients, LCGA identified four VAS-based pain recovery trajectories: Rapid Recovery (31.8%), Gradual Improvement (37.9%), Slow Incomplete Recovery (19.5%), and Persistent Poor Outcome (10.8%). Composite treatment-failure rates at 12 months were progressively higher across these groups (4.8%, 21.6%, 52.6%, and 85.7%, respectively; P < 0.001), and conversion-to-surgery rates ranged from 1.6% to 42.9%. Longer symptom duration, higher baseline NDI, multi-segment involvement, and severe foraminal stenosis were independently associated with the Persistent Poor Outcome trajectory. The bias-corrected C-statistic was 0.76 (95% CI: 0.70-0.82). CONCLUSION:Four VAS-based pain recovery trajectories were identified after conservative treatment for CR. Baseline functional and imaging features may offer preliminary prognostic information but capture only part of multidimensional recovery. Prospective validation incorporating psychosocial factors is required.
Background Diagnosis plays a central role in musculoskeletal care. However, establishing a clear diagnosis is often challenging, and diagnostic uncertainty is common. Objectives To explore patient experiences of diagnostic uncertainty in musculoskeletal care. Methods Five databases (CINAHL, Embase, MEDLINE, AMED, Web of Science) were searched from inception to October 2025. Qualitative studies involving semi-structured interviews with adults receiving care for MSK conditions were included. Methodological quality was appraised using the Joanna Briggs Institute Qualitative Checklist. Data were synthesised using thematic synthesis, and confidence in findings was assessed using the Grading of Recommendations Assessment, Development, and Evaluation Confidence in the Evidence from Reviews of Qualitative Research approach (GRADE-CERQual). Results Twenty-six studies involving 462 participants were included. Critical appraisal identified 23 studies with varying methodological limitations; all studies were included in the synthesis. Nine descriptive themes were synthesised into three analytical themes: (1) patient expectations and perceived meanings of a diagnosis and interpretations of diagnostic uncertainty; (2) the multi-dimensional experience of diagnostic uncertainty; and (3) the role of contextual factors, particularly communication and the therapeutic relationship, in shaping experiences of diagnostic uncertainty. Using GRADE-CERQual, confidence in these themes was rated as low, moderate and very low, respectively. Conclusion Diagnostic uncertainty is a subjective and multi-dimensional experience shaped in part by patients’ expectations and the meanings attributed to diagnosis. Its impact spans predominantly cognitive and affective domains and may influence clinical presentation. Patient-centred communication and strong therapeutic relationships may support patients in navigating diagnostic uncertainty in musculoskeletal care.
Background Patellofemoral Pain Syndrome (PFPS) is a highly prevalent musculoskeletal condition affecting young adults and athletes. Patients increasingly turn to AI chatbots for medical information, yet the reliability, safety, and readability of these tools for PFPS remain unclear. Objective To evaluate accuracy, clarity, completeness, consistency, readability, and health advice disclaimers in responses from four AI chatbots (ChatGPT, Gemini, Claude, Perplexity). Methods On February 18, 2026, thirty common PFPS questions were submitted to four AI models. Anonymized responses were independently evaluated for: information quality (accuracy, clarity, completeness, consistency) using a 4-point Likert scale; readability via seven indices benchmarked against the sixth-grade level; and safety signaling by dichotomous coding of health advice disclaimers. Results All models achieved median scores of 4.00 for completeness (P = 0.296) and consistency (P = 0.1). Significant differences emerged in accuracy (P = 0.019) and clarity (P < 0.001) overall, though adjusted pairwise accuracy differences were non-significant. Perplexity (median 3.00) was significantly inferior in clarity compared to other models (median 4.00). No model met the sixth-grade readability benchmark (P < 0.001); Gemini and ChatGPT were most readable, while Claude and Perplexity produced the most complex text. Health advice disclaimers appeared in 46.7% of ChatGPT and 40.0% of Claude responses, but only 16.7% for Gemini and Perplexity. Conclusions AI chatbots generate accurate, complete, and consistent PFPS information but uniformly fail readability benchmarks. Disclaimer rates remain low, particularly for Gemini and Perplexity. These findings suggest AI chatbots currently function better as supplementary educational tools, highlighting the need for linguistic simplification and improved safety signaling.
BACKGROUND:E-mentoring has emerged as a novel educational strategy in postgraduate musculoskeletal physiotherapy, with potential to support development of advanced practice capabilities. However, evidence regarding its cross-cultural applicability and effectiveness remains limited. This study aimed to explore the experiences of postgraduate Masters physiotherapy mentees and mentors engaged in e-mentoring in Canada, and to compare findings with the United Kingdom (UK). METHODS:A qualitative study design was employed using interviews and focus groups with postgraduate physiotherapy mentees and mentors participating in e-mentoring across Canada. Thematic analysis was conducted to explore learning processes, perceived outcomes, and challenges. Rigour was enhanced through member checking and team reflexivity. Cross-cultural comparison with UK data enabled identification of shared and context-specific themes. FINDINGS:E-mentoring was perceived as a positive and effective learning approach that supported development of advanced clinical reasoning, critical thinking, communication skills, and professional confidence. A key mechanism was the creation of protected cognitive space, enabling reflective discussion and critical engagement with research evidence. Small-group formats facilitated social learning and fostered communities of practice. Some limitations were identified, including challenges in maintaining engagement, technological barriers, and reduced opportunities for hands-on skill development. Cross-cultural findings demonstrated strong convergence, with similar developmental outcomes across Canada and the UK despite different professional frameworks. CONCLUSION:E-mentoring is perceived as a transferable and scalable educational approach supporting higher-order skill development in postgraduate musculoskeletal physiotherapy. Its effectiveness across cultural contexts suggests strong potential for international implementation when integrated with complementary strategies, including workplace-based learning and practical skills training.
BACKGROUND:Osteoporosis is a major complication in patients with arthritis, yet the long-term protective effect of physical activity (PA) and its underlying mechanisms are not fully understood. METHODS:This study utilized two large aging cohorts, the U.S. Health and Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA). All exposures and outcomes, including PA and physician-diagnosed arthritis and osteoporosis, were based on self-reported data. Cross-sectional analyses assessed the association between PA and arthritis-osteoporosis comorbidity. Longitudinal Cox models examined the effect of baseline PA on new-onset osteoporosis in patients with arthritis. Subgroup, E-value, and mediation analyses were performed to explore effect heterogeneity, robustness, and the mediating role of depression. An exploratory reverse analysis assessed the association of PA with new-onset arthritis in osteoporosis patients. RESULTS:Among 20,175 HRS and 10,525 ELSA participants in the cross-sectional analysis, and 8032 HRS and 2984 patients with arthritis in the prospective analysis, PA was associated with lower comorbidity prevalence (HRS: OR = 0.78; ELSA: OR = 0.69). In longitudinal analyses, active PA was independently associated with reduced osteoporosis risk (HRS: HR = 0.86; ELSA: HR = 0.70) in patients with arthritis. The effect was more pronounced in younger patients and those with heart disease or depression. In HRS, depression significantly mediated 36.55% of the protective effect, whereas this mediation pathway was non-significant in ELSA. No significant association was found between PA and new-onset arthritis in osteoporosis patients. CONCLUSION:Regular physical activity was associated with a lower risk of osteoporosis in patients with arthritis; the association may be partly explained by improvements in depressive symptoms. Promoting PA should be integral to clinical management.
BACKGROUND:Functional recovery following physiotherapy in individuals with chronic low back pain varies considerably and may be influenced by biological, psychological, behavioral, and social characteristics. Few studies have examined the timing of functional recovery using survival analysis in routine physiotherapy practice. METHODS:This prospective observational cohort study included 250 adults with chronic nonspecific low back pain receiving individualized physiotherapy over a median of eight sessions during four weeks. Baseline biopsychosocial characteristics were assessed using the Numeric Pain Rating Scale, Oswestry Disability Index (ODI), Tampa Scale for Kinesiophobia, Pain Catastrophizing Scale, Hospital Anxiety and Depression Scale, Pain Self-Efficacy Questionnaire, and Pittsburgh Sleep Quality Index. Functional recovery was defined as a clinically important improvement of at least 10 points on the ODI. Kaplan-Meier survival analysis and Cox proportional hazards regression were used to examine factors associated with time to recovery. RESULTS:During follow-up, 176 participants (70.4%) achieved functional recovery, with a median recovery time of 14 weeks. In univariable analyses, greater pain intensity, disability, fear of movement, pain catastrophizing, anxiety, depression, poor sleep quality, and lower pain self-efficacy were associated with delayed recovery. After multivariable adjustment, greater baseline disability, fear of movement, pain catastrophizing, poor sleep quality, and lower pain self-efficacy remained independently associated with longer time to functional recovery. CONCLUSIONS:Baseline functional, psychological, and sleep-related characteristics were independently associated with recovery timing in individuals with chronic low back pain receiving physiotherapy. Comprehensive biopsychosocial assessment may improve prognostic evaluation, support individualized monitoring and goal setting, and inform development of externally validated prognostic models.
Background Digital platforms are increasingly used to facilitate continuing professional development for Healthcare Professionals treating persistent musculoskeletal pain. Objective To examine how digital education for Healthcare Professionals managing persistent musculoskeletal pain is delivered. Design Scoping Review Methods Following the Joanna Briggs Institute methodology, six electronic databases were searched using three keyword categories (Healthcare Professionals, Musculoskeletal Pain, digital education). Eligible studies were written in English, included a minimum of 10 participants, used fully digital formats to deliver pain education to qualified healthcare professionals involved in treating adult populations. Studies were charted and evaluated using the e-Health extension of the Template for Intervention Description and Replication (TIDieR) checklist. All outcomes were classified using the New World Kirkpatrick Method: Reaction, Learning, Behaviour, and Results-level outcomes. Results 23 studies were included in the final review. Participants were mostly Physiotherapists (16/23). Digital education varied widely in format, duration and content. TIDieR scores ranged from 6/12 to 12/12, with limited reporting of tailoring and modification (4/23) to healthcare professionals' needs or preferences, and limited actual measures of fidelity or adherence (8/23). The reaction-level outcomes (n = 19/23) were broadly positive on acceptability, satisfaction, and feasibility. Learning-level outcomes (n = 20/23), commonly self-reported, were mixed. Behavioural outcomes were assessed in only 9/23 studies. Only two studies evaluated patient outcomes. Conclusion Digitally delivered education for clinicians managing persistent musculoskeletal pain varied widely in format, duration, and content. Intervention descriptions were often incomplete, and few studies incorporated interactivity or tailoring to learner needs and preferences. Few studies considered clinical outcomes.
BACKGROUND:Despite foot muscle strengthening being a target of exercise interventions for plantar heel pain (PHP) no study has measured foot muscle outcomes, and existing research is limited by a lack of control (no treatment) comparisons. OBJECTIVES:To determine the feasibility of conducting a randomised controlled trial and investigate the acceptability and credibility of comprehensive progressive foot exercise and education compared to brief advice for PHP. DESIGN:Randomised parallel group feasibility trial. METHOD:People with PHP were randomised (1:1 concealed allocation) to receive either foot exercise plus education or brief advice for twelve weeks. Primary outcomes included willingness to enrol, recruitment rate, adherence, logbook completion, dropout rate, early withdrawal reasons, adverse events, additional treatments sought, and credibility/expectancy. RESULTS:Twenty people with PHP (16 women; age 50 ± 9 years; body mass index = 30.7 ± 4.6 kg/m2) were recruited over 15 weeks (1.3 participants per week). Primary outcomes were willingness to enrol (80%), adherence (physiotherapy sessions attended: foot exercise plus education 85%, brief advice 100%; home exercise program: 62% daily sessions completed, 72% thrice weekly sessions completed), logbook completion (foot exercise plus education 75%, brief advice 90%), dropout rate (15%), and additional treatments sought (69%). There were no intervention-related adverse events, and credibility scores were higher for foot exercise plus education. CONCLUSIONS:This study confirms feasibility and acceptability of a protocol comparing foot exercise plus education with brief advice in individuals with PHP, generating key insights to inform future trial design.
